Volume 135 · Issue 03 · 2022

Chromosomal abnormalities are important causes of ventriculomegaly (VM). In mild and isolated cases of fetal VM, obstetricians rarely give clear indications for pregnancy termination. We aimed to calculate the incidence of chromosomal abnormalities and incremental yield of chromosomal microarray analysis (CMA) in VM, providing more information on genetic counseling and prognostic evaluation for fetuses with VM.

The Chinese language databases Wanfang Data, China National Knowledge Infrastructure, and China Biomedical Literature Database (from January 1, 1991 to April 29, 2020) and English language databases PubMed, Embase, and Cochrane Library (from January 1, 1945 to April 29, 2020) were systematically searched for articles on fetal VM. Diagnostic criteria were based on ultrasonographic or magnetic resonance imaging (MRI) assessment of lateral ventricular atrium width: ≥10 to <15 mm for mild VM, and ≥15 mm for severe VM. Isolated VM was defined by the absence of structural abnormalities other than VM detected by ultrasonography or MRI. R software was used for the meta-analysis to determine the incidence of chromosomal abnormalities and incremental yield of CMA in VM, and the combined rate and 95% confidence interval (CI) were calculated.

Twenty-three articles involving 1635 patients were included. The incidence of chromosomal abnormalities in VM was 9% (95% CI: 5%-12%) and incremental yield of CMA in VM was 11% (95% CI: 7%-16%). The incidences of chromosomal abnormalities in mild, severe, isolated, and non-isolated VM were 9% (95% CI: 4%-16%), 5% (95% CI: 1%-11%), 3% (95% CI: 1%-6%), and 13% (95% CI: 4%-25%), respectively.

Applying CMA in VM improved the detection rate of abnormalities. When VM is confirmed by ultrasound or MRI, obstetricians should recommend fetal karyotype analysis to exclude chromosomal abnormalities. Moreover, CMA should be recommended preferentially in pregnant women with fetal VM who are undergoing invasive prenatal diagnosis. CMA cannot completely replace chromosome karyotype analysis.

It is still unclear if and to what extent antenatal or infant or childhood vitamin D supplementation would affect the development of allergy diseases later in life. This study aimed to review the efficacy of vitamin D supplementation in pregnant women, infants, or children for the prevention of allergies.

MEDLINE (PubMed), EMBASE (OVID), and the Cochrane Central Register of Controlled Trials were searched up to March 1, 2020. We included only randomized controlled trials (RCTs). We performed a systematic review and meta-analysis for vitamin D supplementation in primary allergy prevention. These trials were assessed for risk of bias using the Cochrane Collaboration domains and the consensus was reached via discussion with the full study group. We descriptively summarized and quantitatively synthesized original data to evaluate vitamin D supplementation in primary allergy prevention by using Review Manager software for meta-analysis.

The search yielded 1251 studies. Seven RCTs were included in this analysis. A meta-analysis revealed that vitamin D supplementation for pregnant women or infants may not decrease the risk of developing allergic diseases, such as asthma or wheezing (supplementation for pregnant women, risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.81-1.26, P = 0.90, I² = 47%; supplementation for infants, RR: 1.00, 95% CI: 0.70-1.43, P = 0.99, I² = 0%; supplementation for pregnant women and infants, RR: 0.35, 95% CI: 0.10-1.25, P= 0.11), eczema (supplementation for pregnant women, RR: 0.95, 95% CI: 0.80-1.13, P= 0.77, I²= 0%; supplementation for infants, RR: 0.84, 95% CI: 0.64-1.11, P= 0.19, I²= 42%), allergic rhinitis (supplementation for pregnant women, RR: 0.93, 95% CI: 0.78-1.11, P = 0.15, I² = 47%), lower respiratory tract infection (LRTI) (supplementation for pregnant women, RR: 0.97, 95% CI: 0.85-1.11, P = 0.59, I² = 0%), or food allergy.

Supplementation of vitamin D in pregnant women or infants does not have an effect on the primary prevention of allergic diseases.

PROSPERO (CRD42020167747)

急性胰腺炎（AP）的严重程度差异很大，从临床上的自限性到迅速致命的病程。^[1]坏死性胰腺炎(NP)是最严重的形式，与不良预后相关；死亡率约为15%，或对于感染性坏死性胰腺炎(INP)病例高达30%，其通常进展为脓毒症和多器官衰竭，是死亡和严重并发症的主要原因。^[2]在过去的20年里，INP的管理方法发生了重大变化，并随着经验、新技术和研究数据的积累而继续发展。大手术干预和清创术曾经是有症状坏死灶患者的主要治疗方法，但现在青睐以经皮和/或内镜引流或清创术为重点的微创方法。^[2]涉及微创技术的“逐步”方法代表了治疗INP患者的新范式，开放胰腺清创术现在被认为是治疗NP的最后一步。^[2]

Little was known about the association among time in range (TIR), time above range (TAR), time below range (TBR), and cancer mortality among patients with type 2 diabetes. We aimed to investigate the association among TIR, TAR, TBR, and the risk of cancer mortality among patients with type 2 diabetes.

A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period. Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.

During a mean follow-up of 7.10 years, we confirmed 237 death events related to cancer. The multivariable-adjusted hazard ratio (HR) for cancer mortality was 1.32 (95% confidence interval [CI]: 1.01-1.75) in patients with TIR ≤70% compared with those with TIR >70%. When TIR was considered as a continuous variable, the multivariable-adjusted HR for cancer mortality associated with each 10% decrease in TIR was 1.07 (95% CI: 1.02-1.14). In the site-specific analysis, a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found (HR: 1.24; 95% CI: 1.09-1.41). However, no relationship between hemoglobin A1c and cancer mortality was observed (HR: 1.04; 95% CI: 0.97-1.10).

The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes. New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes.

Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases.

A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines.

Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category).

In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.

Hepatectomy for hepatocellular carcinoma (HCC) beyond the Milan criteria is shown to be beneficial. However, a high rate of post-operative HCC recurrence hinders the long-term survival of the patients. This study aimed to investigate and compare the impacts of tenofovir (TDF) and entecavir (ETV) on the recurrence of hepatitis B viral (HBV)-related HCC beyond the Milan criteria.

Data pertaining to 1532 patients who underwent hepatectomy and received antiviral therapy between January 2014 and January 2019 were collected from five centers. Recurrence-free survival (RFS) analysis was performed using the Kaplan-Meier method. Cox proportional hazards regression analysis was performed to determine prognostic factors for HCC recurrence.

The analysis incorporates 595 HBV-related HCC patients. The overall 5-year RFS was 21.3%. Among them, 533 and 62 patients received ETV and TDF treatment, respectively. The 1-, 3-, and 5-year RFS rates were 46.3%, 27.4%, and 19.6%, respectively, in the ETV group compared with 65.1%, 41.8%, and 37.2%, respectively, in the TDF group (P < 0.001). Multivariate analysis showed that TDF treatment (hazard ratio [HR]: 0.604, P = 0.005), cirrhosis (HR: 1.557, P = 0.004), tumor size (HR: 1.037, P = 0.008), microvascular invasion (MVI) (HR: 1.403, P = 0.002), portal vein tumor thrombus (PVTT) (HR: 1.358, P = 0.012), capsular invasion (HR: 1.228, P= 0.040), and creatinine levels (CREA) (HR: 0.993, P = 0.031) were statistically significant prognostic factors associated with RFS.

Patients with HCC beyond the Milan criteria exhibited a high rate of HCC recurrence after hepatectomy. Compared to the ETV therapy, TDF administration significantly lowered the risk of HCC recurrence.

Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.

We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.

Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.

Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.

Vancomycin treatment failure against vancomycin-susceptible gram-positive cocci is not rare in the intensive care unit (ICU). One of the reasons for this is the substandard drug trough concentration. We aimed to examine the hypothesis that the target serum concentration could be reached earlier with a loading dose of vancomycin.

This retrospective cohort study was conducted at our ICU between June 2018 and June 2020 and involved patients who were suspected of having, or confirmed to have, gram-positive cocci infection and treated with vancomycin. One group of the patients was administered a loading dose of vancomycin (loading group) and compared with the group that did not receive a loading dose (control group). The baseline characteristics, vancomycin serum concentrations, and clinical outcomes were collected and analyzed.

Fifty-five patients were finally included, of which 29 received a loading dose of vancomycin. The serum concentration of vancomycin before the second dose was significantly higher for the loading group than for the control group (10.3 ± 6.1 mg/L vs. 5.7 ± 4.4 mg/L, P = 0.002). The results for both groups were similar before the fifth dose (12.4 ± 7.3 mg/L vs. 10.3 ± 6.3 mg/L in the loading and the control groups, respectively; P = 0.251). The 28-day mortality was lower for the loading group than for the control group (6.7% vs. 34.6% in the loading and control groups, respectively; P = 0.026). No significant differences were observed in serum creatinine (Cr) concentrations of the two groups.

With the loading dose of vancomycin, the target serum concentration of vancomycin may be reached earlier without increasing the risk of acute kidney injury.

https://www.chictr.org.cn; ChiCTR2000035369

Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen. The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen, but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated. This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids (EGOs).

Human eccrine sweat glands were isolated from the skin for tissue culture, and the primary cultured cells were collected and cultured in Matrigel for 14 days in vitro. EGOs at different development days were collected for hematoxylin and eosin (H&E) staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67, cellular motility marker filamentous actin (F-actin), and autophagy marker LC3B. Western blotting was used to detect the expression of Ki67, F-actin, and LC3B. Moreover, apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis assay kit, and the expression of poly (ADP-ribose) polymerase and Caspase-3 was detected by Western blot. In addition, 3-methyladenine (3MA) was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.

The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4. The earliest lumen formation was observed on day 6. From day 8 to day 14, the rate of lumen formation in EGOs increased significantly. The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days, while the F-actin expression level did not change. Notably, the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative. Compared with the control group, the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.

Using our model of eccrine gland 3D-reconstruction in Matrigel, we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.

Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.

This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.

In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121-0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123-0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304-0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.

We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.

ChiCTR.org.cn, ChiCTR1800014968.

原发性恶性心脏肿瘤（PMCTs）罕见但高度致死，其中高达75%是肉瘤，其次是淋巴瘤和间皮瘤。^[1]由于这种疾病的罕见性，迄今为止大多数研究都是小系列或单个病例报告。虽然他们中的少数人调查了PMCT患者的临床特征和生存期，但影响总生存期的因素尚未得到很好的阐明。^[2,3,4]监测、流行病学和最终结果（SEER）计划覆盖了约28%的美国人口，收集了关于患者人口统计学、原发肿瘤部位、肿瘤形态、诊断阶段、生存率和死亡率的数据，包括心脏肿瘤的丰富数据。^[5]在本研究中，我们描述了PMCT患者的临床特征，确定了影响预后的变量，并使用SEER数据库的数据构建了PMCT患者的列线图。

心脏骤停(CA)的年发病率为0.5至1.5/1000，已成为主要的全球公共卫生问题。^[1]尽管美国心脏协会（AHA）-国际复苏联络委员会每5年更新一次心肺复苏（CPR）指南，但CA术后出院后神经系统结局良好的患者的生存率和百分比相对较低。因此，AHA 2010 CPR指南将重症监护室（ICU）心脏骤停后综合征（PCAS）的治疗作为CA生存链的第五个环节提及。PCAS是一种病理生理过程，包括（1）脑损伤，（2）导致血流动力学不稳定的心肌功能障碍，和（3）导致乳酸积累的全身缺血/再灌注反应。^[2]这些关键因素在早期影响CA患者的生存和神经预后。我们评估了PCA期间早期血流动力学、氧代谢和乳酸动力学对28天生存率和神经系统结局的影响。

致编辑：隆突性皮肤纤维肉瘤（DFSP）是一种局部侵袭性皮肤间充质肿瘤，由于相似的组织学特征，可能被误诊为皮肤纤维瘤（DF）。^[1,2,3]在这项研究中，非线性光学（NLO）显微镜用于对未染色的组织学切片成像，以在DFSP和DF之间进行鉴别诊断。本研究旨在证明无标记NLO成像比标准苏木精-伊红（H&E）染色具有显著优势，并允许病理学家通过使用可量化的方法来提高诊断准确性。

致编辑：代谢综合征（MetS）被定义为一组代谢紊乱，包括腹型肥胖、高血糖、高血压和血脂异常。^[1]由于甲状腺激素对于细胞能量稳态和调节至关重要，因此血清甲状腺激素水平被认为与各种代谢参数相关。在过去的十年中，甲状腺激素和代谢综合征之间的关系已在甲状腺功能正常的受试者中进行了广泛的研究，导致了不一致的结果。一些研究表明，高水平的促甲状腺素（TSH）导致代谢综合征或不利代谢参数的发生率增加，而其他研究没有发现这种相关性。此外，一些研究表明，游离甲状腺素（FT4）水平与各种不利的代谢参数或MetS成反比，而其他研究表明，FT4水平在调整后与一些不利的代谢成分没有这种关联，甚至是正相关。这些相互矛盾的结果可能是由不同的设计、设置、种族、排除标准、调整、统计分析以及代谢综合征和人群碘摄入量的定义造成的。基于这些，我们的研究旨在通过标准流行病学和孟德尔随机分析评估甲状腺功能正常人群中甲状腺激素与代谢综合征之间的相关性和因果关系。

致编辑：脂肪肥大（LH）是由多次重叠胰岛素注射引起的最常见的局部并发症。临床上，LH表现为注射或输注部位组织突出和/或增厚，有时导致皮下肿块形成。在组织学上，LH的特征在于胰岛素注射部位皮下组织中血管分布减少、纤维化和脂肪细胞增大和增殖。正因为如此，现有的LH筛查方法主要以临床检查和超声扫描（USS）为主。最近的一项系统综述显示，迄今为止，在用于鉴定LH的不同方法中，只有有限的信息可用于检测灵敏度。到目前为止，黄体生成素诊断的金标准检查仍有争议，对于哪些患者需要这两种检查还没有足够的研究。目前，USS的探测灵敏度vsLH的临床检查尚未在基于大样本的研究中报道。本研究旨在使用大型患者队列比较USS和临床检查之间的检测准确性，并确定两种方法之间LH检测结果不一致的影响因素。

致编辑：相对于没有糖尿病的人，二型糖尿病患者患心血管疾病（CVD）的风险更高。糖尿病患者总是表现出脂质异常。经济的快速发展和城市化进程的加快也导致了生活方式的改变，这可能会对中国糖尿病患者的血脂参数产生影响。鉴于中国社会经济地位的显著差异，在中国普通人群中≥45岁个体中血脂异常的患病率、知晓率、治疗和控制也观察到地理差异。^[1]缺乏关于中国成人2型糖尿病患者血脂浓度和血脂控制的时间趋势和地理变化的大规模研究。因此，我们使用中国国家糖化血红蛋白监测系统（CNHSS）2009年至2013年期间中国成年2型糖尿病门诊患者数据库，对该人群血脂浓度和血脂控制的时间趋势和地理变化进行了研究。中国人民解放军总医院伦理委员会批准了研究方案。在访谈和收集数据之前，获得了所有患者的知情同意。

致编辑：肱骨近端骨折（PHF）主要发生在60岁以上患有严重骨质疏松症的患者中。^[1]虽然大多数PHF可以非手术治疗，但复杂的需要手术固定。^[2]在老年人中，肱骨近端髓腔中的骨小梁结构和距骨区域的丧失使他们容易发生粉碎性骨折和内侧铰链支撑的丧失，导致植入失败和再次手术的高比率。^[3]最近的研究表明，结合到锁定接骨板结构中的骨内支架可能提供更好的髓质支撑和机械稳定性。^[1]然而，PHF固定中使用的骨内膜垫具有不同的形状、模式和位置，这可能导致植入失败和复位损失。^[1,4,5]这可能是因为对不同年龄肱骨近端发生的形态变化缺乏了解。因此，在本研究中，我们分析和比较了老年和年轻患者髓管的解剖学退变模式，以在解剖学上更好地了解肱骨近端的髓质形态和临床上骨内支持的应用。

致编辑：很难捕捉正常儿童青春期开始的确切时间，例如女孩的乳房和男孩的睾丸开始生长的时间，尤其是男孩。因此，对青春期身体发育的详细模式以及青春期开始和发育成熟时激素的临界值和变化的研究很少。通常认为，青春期期间的激素变化是黄体生成素（LH）对青春期开始的刺激作用的直接结果；^[1]因此，LH被广泛接受为评估青春期开始的指标。然而，研究人员尚未就LH的临界值达成一致，尤其是在男孩中。

致编辑：特发性肺纤维化(IPF)是一种慢性、进行性和纤维化性肺部疾病。IPF的临床过程包括呼吸困难、肺功能下降和咳嗽。IPF患者的中位生存期约为3年。5年生存率不到30%。^[1]尽管抗纤维化治疗取得了一些进展，但IPF仍然是一种不治之症。因此，有必要从细胞生物学角度探讨IPF的病理过程，这些探索可为IPF的治疗提供依据。

致编辑：2019年爆发的2019冠状病毒病（COVID-19）已成为全球大流行。与2003年的严重急性呼吸综合征冠状病毒（SARS-CoV）类似，新型冠状病毒可导致急性肺损伤和细胞因子风暴，其特征是白细胞介素（IL）-8、IL-6和肿瘤坏死因子α（TNF-α）升高。^[1]对2003年严重急性呼吸综合征（SARS）流行幸存者的前瞻性研究显示，这些SARS患者表现出不同程度的肺间质纤维化。^[2]类似地，患有严重新冠肺炎的患者也以弥漫性肺泡损伤和肺泡间质纤维化为特征。^[3]

致编辑：冷球蛋白血症是一种以血清中冷球蛋白在体外条件<37℃，复温时再溶解。分为三种类型：I型，其中冷球蛋白由单克隆IgG或IgM组成，很少由IgA或游离免疫球蛋白（Ig）轻链组成；II型，其中冷球蛋白由具有类风湿因子(RF)活性的单克隆IgM和多克隆IgG制成；和III型，其中冷球蛋白由具有RF活性的多克隆IgM和多克隆IgG组成。^[1]II型和III型为混合型冷球蛋白血症（MC）。MC可能与几种传染病有关，如丙型和乙型肝炎。主要表现为冷球蛋白血症性血管炎，^[2]包括乏力、紫癜、关节痛、肌痛、周围神经病变，甚至严重的器官损害，如肾小球肾炎。然而，累及胃肠道和心脏的冷球蛋白血症性血管炎是罕见的。此外，高粘滞综合征的神经、眼和鼻耳症状在MC中也很少见。在此，我们报告一例乙型肝炎病毒（HBV）相关MC病例，并分析文献中的41例病例。我们分析了这42例HBV相关MC病例，以阐明其临床生物学特征和治疗方法。

致编辑：先天性脊柱侧凸（CS）很有可能需要计划外手术，但很少有出版物报道计划外手术的比例、这些计划外手术的原因以及每种原因的患病率。本研究旨在提供有关上述内容的更多信息。我们回顾了2009年至2018年在我院接受计划外手术的CS患者的电子病历。通过检索华西医院数据库，我们找到了317例CS病例。其中，33例接受了计划外手术，其中5例在外医院进行了初次手术。在我们的病例系列中，计划外手术率为9.0%（28/312）。在我们的病例系列中，CS患者计划外手术的最常见原因是进行性畸形（49%，16/33），其次是植入物相关并发症（36%，12/33）、伤口相关并发症（12%，4/33）和手术失误相关并发症（脑脊液[CSF]漏，3%，1/33）。CS计划外手术最常见的原因是进行性脊柱畸形或失衡，占计划外手术的49%（16/33）。