Volume 134 · Issue 04 · 2021

The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.

The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.

Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI:-2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.

This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

长非编码RNA(lncRNA)包含不同类型的RNA聚合酶II转录的分子，表现出大于200个核苷酸的核苷酸长度并且不经历蛋白质翻译。由于其开放阅读框的特征，它们经常被标记为基因组转录的“噪音”。尽管lncRNAs是广泛转录的基因，但它们的表达水平低于蛋白质编码基因的表达水平。根据它们相对于基因组中蛋白质编码基因的位置，lncRNAs被分类为有义、反义、双向、内含子和基因间。最近已经表明，lncRNAs在调节细胞过程（细胞分化和个体发育）和疾病发展（病原感染、免疫破坏）中发挥重要作用。此外，它们已被认为是所有癌症的标志，lncRNA在肿瘤中的特异性表达可用于预测预后，其在循环体液（血浆和尿液）中的稳定性为癌症诊断和治疗的发展提供了新的基础。由于lncRNAs作为信号、诱饵、向导和支架分子在转录和转录后调节基因表达，阐明其功能和潜在的调节机制对生命科学研究的进展具有重要意义[图1A].

心血管疾病仍然是全世界男性和女性死亡的首要原因。^[1]冠状动脉疾病（CAD）代表心血管疾病的主要亚型。最近的证据强调，无论地理区域如何，CAD临床表现的发病率在全球范围内都在增加。^[2]尽管在过去的几十年里，西方国家的CAD死亡率稳步下降，但大约三分之一的CAD患者将死于该疾病。快速准确的诊断决策对CAD患者至关重要，有助于指导有效治疗。^[2]然而，各种因素可能使准确的CAD诊断过程成为一项复杂的任务。

成纤维细胞生长因子23(FGF23）是一种重要的骨细胞衍生激素，调节磷和1，25-二羟基维生素D(1，25[OH]的代谢₂D）。1, 25(OH)₂D和高膳食磷酸盐摄入上调FGF23表达，导致肾脏磷酸盐排泄增加和1，25(OH)减少₂D合成，然后抑制FGF23，从而完成一个负反馈回路。几项针对肾脏疾病患者的临床研究报告称，血清FGF23水平升高与不良预后相关[图1].^[1,2]

他汀类药物是3-羟基-3-甲基戊二酰（HMG）-辅酶A（CoA）还原酶抑制剂，作用于HMG-CoA转化为L-甲羟戊酸的限速酶，以减少胆固醇生物合成。除了通过降低低密度脂蛋白胆固醇浓度来减少心血管事件外，他汀类药物的多效性胆固醇非依赖性功能，包括免疫调节和抗炎作用，也越来越被认识到。当前的冠状病毒病2019（COVID-19）大流行，由严重急性呼吸综合征冠状病毒2（新型冠状病毒）引起，^[1]截至7月2日，已在全球范围内造成超过50万人死亡，并且在没有特定抗病毒疗法的情况下继续传播。他汀类药物作为宿主导向治疗（HDT）具有潜在的抗病毒功能，可能是改善新冠肺炎患者预后的安全手段。^[2,3]

微血管减压术（MVD）已被广泛认为是治疗过度活跃的颅神经根病（如面肌痉挛和三叉神经痛）的最有效方法。^[1,2]随着这种手术在世界范围内的普及，许多神经外科医生提出了他们对手术技巧的看法。例如，一些作者指出，该过程的要点是分离而不是隔离神经血管冲突，在它们之间插入聚四氟乙烯。^[3]人们一直认为“换位”比“插入”更好。^[4]为了实现完全分离，现在经常报道“吊索技术”。^[5]然而，不管技术如何，在进行这种功能性神经外科手术时，我们应该始终把安全放在第一位。可以想象，采用的技术越复杂，侵入手术区域的器械或异物越多，经过的时间越长，最终发生术后并发症的几率就越大。实际上，这个MVD操作可以以更容易和简单的方式完成。在我们中心完成了超过10,000个MVD后，^[6,7]我们已经学会了在更短的时间内用最少的程序完成手术。在本文中，作者提出了安全有效的MVD的“三不”策略。

正在进行的冠状病毒疾病2019（新冠肺炎）疫情在全球范围内导致了相当大的发病率和死亡率。此外，感染人数正在迅速上升。本病由属于β-冠状病毒簇的严重急性呼吸综合征冠状病毒2型（新型冠状病毒）引起；该群集还包括引起严重急性呼吸窘迫综合征(SARS)和中东呼吸综合征的病毒。与SARS冠状病毒（CoV）类似，新型冠状病毒病毒利用血管紧张素转换酶2（ACE2）入侵其靶细胞；然而，新型冠状病毒对ACE2的结合亲和力更高。因此，与SARS-CoV可以被有效遏制不同，新型冠状病毒病毒的传染性更强，也更难控制。

The current deep learning diagnosis of breast masses is mainly reflected by the diagnosis of benign and malignant lesions. In China, breast masses are divided into four categories according to the treatment method: inflammatory masses, adenosis, benign tumors, and malignant tumors. These categorizations are important for guiding clinical treatment. In this study, we aimed to develop a convolutional neural network (CNN) for classification of these four breast mass types using ultrasound (US) images.

Taking breast biopsy or pathological examinations as the reference standard, CNNs were used to establish models for the four-way classification of 3623 breast cancer patients from 13 centers. The patients were randomly divided into training and test groups (n = 1810 vs. n = 1813). Separate models were created for two-dimensional (2D) images only, 2D and color Doppler flow imaging (2D-CDFI), and 2D-CDFI and pulsed wave Doppler (2D-CDFI-PW) images. The performance of these three models was compared using sensitivity, specificity, area under receiver operating characteristic curve (AUC), positive (PPV) and negative predictive values (NPV), positive (LR+) and negative likelihood ratios (LR-), and the performance of the 2D model was further compared between masses of different sizes with above statistical indicators, between images from different hospitals with AUC, and with the performance of 37 radiologists.

The accuracies of the 2D, 2D-CDFI, and 2D-CDFI-PW models on the test set were 87.9%, 89.2%, and 88.7%, respectively. The AUCs for classification of benign tumors, malignant tumors, inflammatory masses, and adenosis were 0.90, 0.91, 0.90, and 0.89, respectively (95% confidence intervals [CIs], 0.87-0.91, 0.89-0.92, 0.87-0.91, and 0.86-0.90). The 2D-CDFI model showed better accuracy (89.2%) on the test set than the 2D (87.9%) and 2D-CDFI-PW (88.7%) models. The 2D model showed accuracy of 81.7% on breast masses ≤1 cm and 82.3% on breast masses >1 cm; there was a significant difference between the two groups (P < 0.001). The accuracy of the CNN classifications for the test set (89.2%) was significantly higher than that of all the radiologists (30%).

The CNN may have high accuracy for classification of US images of breast masses and perform significantly better than human radiologists.

Chictr.org, ChiCTR1900021375; http://www.chictr.org.cn/showproj.aspx?proj=33139.

Previously, we developed a novel Coronary Artery Tree description and Lesion EvaluaTion (CatLet^©) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter-and intra-observer remains to be evaluated.

A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement.

The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59-1.00, Z= 7.23, P < 0.001) and 0.86 (0.54-1.00, Z= 5.20, P < 0.001), respectively, according to the tertile analysis (≤14, 15-22, >22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56-1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28-0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43-0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72-1.00, Z= 6.93, P < 0.001) for tortuosity, 0.54 (0.26-0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48-0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41-0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06-0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range 0.54-1.00).

The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent. The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.

C-arm-based flat-panel detector cone-beam computed tomography (CBCT) venography has never been used in the management of iliac vein compression syndrome (IVCS). This study aimed to determine the technical feasibility and safety of CBCT venography in the diagnosis of IVCS compared with conventional venography (CV).

Twenty patients with clinical manifestations of lower extremity venous insufficiency were prospectively enrolled between May 2018 and December 2018. Each patient underwent both CV and CBCT venography. The feasibility and safety of CBCT venography were assessed by technical success rate and complication rate. The relationships between the clinical indexes and the results of CBCT venography and CV were analyzed with correlation analysis. The consistency of the diagnosis of IVCS using each modality was analyzed by the kappa test.

The technical success rate was 100% for CBCT venography and for CV, without any complications. Compared with CV, CBCT venography was able to show more details of adjacent tissues which might be helpful for making etiological diagnosis. The stenosis rate under CBCT venography had excellent consistency with that under CV (kappa= 0.78, Chi-square test). The stenosis rate under CBCT venography was positively correlated with the presence of collateral veins (odds ratio 1.12, 95% confidence interval: [1.00, 1.26], P= 0.049), while the stenosis rate under CV was not. Unexpectedly, only one patient had a venous pressure gradient of more than 2 mmHg (1 mmHg = 0.133 kPa).

For the diagnosis of IVCS, C-arm-based CBCT venography was technically feasible, with good safety. The presence of collateral veins on CBCT was clinically significant. A C-arm fluoroscopy-based technique that combines CV and CBCT might be a promising protocol for the management of IVCS during a single session.

Texture analysis (TA) can quantify intra-tumor heterogeneity using standard medical images. The present study aimed to assess the application of positron emission tomography (PET) TA in the differential diagnosis of gastric cancer and gastric lymphoma.

The pre-treatment PET images of 79 patients (45 gastric cancer, 34 gastric lymphoma) between January 2013 and February 2018 were retrospectively reviewed. Standard uptake values (SUVs), first-order texture features, and second-order texture features of the grey-level co-occurrence matrix (GLCM) were analyzed. The differences in features among different groups were analyzed by the two-way Mann-Whitney test, and receiver operating characteristic (ROC) analysis was used to estimate the diagnostic efficacy.

Inertia_GLCM was significantly lower in gastric cancer than that in gastric lymphoma (4975.61 vs. 11,425.30, z = -3.238, P = 0.001), and it was found to be the most discriminating texture feature in differentiating gastric lymphoma and gastric cancer. The area under the curve (AUC) of inertia_GLCM was higher than the AUCs of SUVmax and SUVmean (0.714 vs. 0.649 and 0.666, respectively). SUVmax and SUVmean were significantly lower in low-grade gastric lymphoma than those in high grade gastric lymphoma (3.30 vs. 11.80, 2.40 vs. 7.50, z = -2.792 and -3.007, P = 0.005 and 0.003, respectively). SUVs and first-order greylevel intensity features were not significantly different between low-grade gastric lymphoma and gastric cancer. Entropy_GLCM12 was significantly lower in low-grade gastric lymphoma than that in gastric cancer (6.95 vs. 9.14, z = -2.542, P = 0.011) and had an AUC of 0.770 in the ROC analysis of differentiating low-grade gastric lymphoma and gastric cancer.

Inertia_GLCM and entropy_GLCM were the most discriminating features in differentiating gastric lymphoma from gastric cancer and low-grade gastric lymphoma from gastric cancer, respectively. PET TA can improve the differential diagnosis of gastric neoplasms, especially in tumors with similar degrees of fluorodeoxyglucose uptake.

Estrogen is involved in the pathophysiological process of benign prostatic hyperplasia (BPH), in which epithelial-mesenchymal transition (EMT) plays an important role. Upregulation of aquaporin (AQP) 5, which is directly activated by estrogen, has been reported to promote EMT in multiple cells. This study aimed to examine the effects of AQP5 on estrogen-induced EMT in the prostate.

Normal prostate (NP) tissue samples without any histopathological changes and BPH tissue samples with pathologically confirmed hyperplasia were obtained. An EMT cell model was subsequently established by adding estradiol (E2) to RWPE-1 cells, after which AQP5 knockdown was performed. Tissue morphological and immunohistochemical features were examined using hematoxylin-eosin and immunohistochemical staining. Western blot analysis was performed to determine the expression of AQPs, estrogen receptors, and EMT-related proteins. Cell proliferation was assessed and supernatants were collected for enzyme-linked immunosorbent assay to determine transforming growth factor-β1 (TGF-β1) concentrations. Immunofluorescence staining was performed to assess protein expressions in RWPE-1 cells.

BPH tissues exhibited greater EMT (TGF-β1: 1.362 ± 0.196 vs. 0.107 ± 0.067, P = 0.003; vimentin: 1.581 ± 0.508 vs. 0.221 ± 0.047, P < 0.001; E-cadherin: 0.197 ± 0.188 vs. 1.344 ± 0.088, P < 0.001), higher AQP5 (1.268 ± 0.136 vs. 0.227 ± 0.055, P < 0.001) and estrogen receptor (ER) α (1.250 ± 0.117 vs. 0.329 ± 0.134, P < 0.001) expression but lower ERβ (0.271 ± 0.184 vs. 1.564 ± 0.130, P < 0.001) expression than NP tissues. E2-stimulated cells had higher AQP5 expression (1.298 ± 0.058 vs. 1.085 ± 0.104, P = 0.049), increased cell proliferation (1.510 ± 0.089 vs.1.000 ± 0.038, P < 0.001), and EMT (TGF-β1 concentration: 0.352 ± 0.021 ng/mL vs. 0.125 ± 0.014 ng/mL, P < 0.001; vimentin: 1.641 ± 0.120 vs. 0.188 ± 0.020, P = 0.002; E-cadherin: 0.075 ± 0.030 vs. 0.843 ± 0.046, P < 0.001) than controls. E2-stimulated cells with AQP5 knockdown exhibited decreased EMT (TGF-β1 concentration: 0.223 ± 0.041 ng/mL vs. 0.352 ± 0.021 ng/mL, P= 0.016; vimentin: 0.675 ± 0.056 vs. 1.641 ± 0.120, P = 0.001; E-cadherin: 0.159 ± 0.037 vs. 0.075 ± 0.030, P = 0.040) than E2-stimulated cells with non-related small interfering RNA (siRNA).

Our findings suggest that estrogen induces BPH possibly by promoting AQP5 expression. Hence, AQP5 might be a novel target for modulating EMT in prostate epithelial cells.

Hyperthermia in combination with DnaJA4-knockout (KO) obviously affects the anti-viral immunity of HaCaT cells. The mechanisms of this process are not yet fully explored. However, it is known that DnaJA4 interacts with actin cytoskeleton after hyperthermia. Our aim was to investigate the effects of DnaJA4 on F-actin in HaCaT cells following hyperthermia.

Wild-type (WT) and DnaJA4-KO HaCaT cells were isolated at either 37°C (unheated) or 44°C (hyperthermia) for 30 min followed by testing under conditions of 37°C and assessing at 6, 12, and 24 h after hyperthermia. The cytoskeleton was observed with immunofluorescence. Flow cytometry and Western blotting were used to detect the expression of F-actin and relevant pathway protein.

DnaJA4-KO and hyperthermia changed the cytoskeleton morphology of HaCaT cells. F-actin expression levels were elevated in DnaJA4-KO cells compared with WT cells (6364.33 ± 989.10 vs. 4272.67 ± 918.50, P < 0.05). In response to hyperthermia, F-actin expression levels of both WT and DnaJA4-KO cells showed a tendency to decrease followed by an obvious recovery after hyperthermia (WT cells: unheated vs. 6 h after hyperthermia or 24 h after hyperthermia: 0.34 ± 0.02 vs. 0.24 ± 0.01, 0.31 ± 0.01, P < 0.001, P < 0.05; DnaJA4-KO cells: unheated vs. 6 h after hyperthermia or 24 h after hyperthermia: 0.44 ± 0.01 vs. 0.30 ± 0.01, 0.51 ± 0.02, P < 0.001, P < 0.01). WT cells restored to baseline levels observed in the unheated condition, while DnaJA4-KO cells exceeded baseline levels in the recovery. As the upstream factors of F-actin, a similar profile in rho-associated serine/threonine kinase 1 (ROCK 1) and RhoA expressions was observed after hyperthermia. While E-cadherin expression was decreased in response to hyperthermia, it was increased in DnaJA4-KO cells compared with WT cells.

Hyperthermia affects the expression levels of F-actin in HaCaT cells. DnaJA4 knockout increases the expression of F-actin in HaCaT cells after hyperthermia. DnaJA4 regulates the expressions of F-actin and the related pathway proteins in response to hyperthermia in HaCaT cells.

Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment.

Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed.

Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m²vs. 20.7 ± 3.6 kg/m², P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex (r = 0.256, 95% confidence interval [CI]: 0.067-0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704-0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m² yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS.

Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.

碘外渗常见于成功机械取栓后的卒中患者。碘外渗可能与患者预后相关，更多的碘外渗与严重出血性转化（HT）的发展高度相关。因此，有必要确定动脉内治疗后的早期出血和可以预测晚期出血转化的影像学指标。一些研究使用不同的定量和非定量方法来评估碘外渗。然而，他们得出了不同的结果。^[1,2,3]我们研究的目的是提出两种简单实用的半定量方法来评估碘外渗及其与出血转化的关系。

心力衰竭（HF）是一个世界性的问题，因为心血管疾病患者的发病率和死亡率很高。最近，PARADIGM-HF试验（血管紧张素受体-脑啡肽酶抑制剂[ARNI]与血管紧张素转换酶抑制剂[ACEI]确定对心力衰竭总体死亡率和发病率影响的前瞻性比较试验）显示，缺血性心脏病是HF最常见的病因，占射血分数降低HF（HFrEF）的60%。^[1]然而，仍然迫切需要有效的预测因子来预测HF患者的缺血性心肌病（ICM）。

针对严重急性呼吸综合征冠状病毒2型（新型冠状病毒）的抗体检测是逆转录聚合酶链式反应（RT-PCR）检测的补充选项，无论是免疫球蛋白M（IgM）、免疫球蛋白G（IgG）还是联合检测。然而，关于IgM/IgG检测的敏感性和特异性的数据不足，这对于决定是否、何时以及如何使用IgM/IgG抗体检测至关重要。本研究的目的是评估IgM/IgG抗体检测的敏感性、特异性、准确性、阳性预测值(PPV)和阴性预测值(NPV)，特别是与本研究中定义为标准诊断的新型冠状病毒RT-PCR相比的抗干扰能力和κ系数。

颈椎病是指轴下颈椎的退行性改变。颈椎病引起的症状包括中轴性颈痛、神经根型颈椎病和脊髓型颈椎病。最常用的手术治疗方法之一是前路颈椎间盘切除术和融合术（ACDF）；据报道，ACDF导致超过90%的患者发生进行性邻近节段变性（ASD），高达25.6%的患者因症状性ASD而需要再次手术。^[1]最近开发了全椎间盘置换（TDR）假体来恢复病变节段的运动能力，但临床结果和术后再手术率并不优于ACDF。^[2]由于ASD的病因尚不清楚，ASD的一种可能解释是ACDF或TDR后恢复的脊柱运动与体内患者特定颈椎的生理运动。^[1]因为没有体内以前曾报道过有症状患者颈椎运动的数据，我们评估了体内使用动态成像技术测量有C5-6症状的颈椎病患者每个轴下颈椎节段的活动范围（ROM），并将患者的数据与年龄和性别分布匹配的无症状对照组的数据进行比较。我们在手术前专门研究了颈椎病是否以及如何影响颈椎运动。本研究由马萨诸塞州总医院合作伙伴人类研究委员会批准（编号：2012P002508/MGH）。

致编辑：缺血性冠状动脉疾病是心力衰竭（HF）的主要原因，心力衰竭是全世界主要的公共卫生负担。在过去的几十年里，新的药物疗法的开发和早期再灌注策略的实施有助于显著降低与急性心肌梗死（AMI）相关的死亡率。然而，急性心脏缺血事件生存率的提高扩大了易发生心脏重塑和不良心血管（CV）结局的患者群体。

致编辑：慢性冠状动脉完全闭塞（CTO）后血运重建可以缓解心绞痛症状，改善心功能和临床预后。^[1,2]然而，由于并发症发生率高和X射线暴露时间长，用于CTO病变血运重建的经皮冠状动脉介入治疗（PCI）具有挑战性。虽然近年来由于新技术、设备和抗凝策略的出现，CTO的PCI成功率显著提高，^[3,4]这些新装置也导致了冠状动脉穿孔、心脏压塞等并发症，限制了它们的应用。由于CTO的常规PCI手术直观地需要操作安全的设备，我们开发了一种新的设备，称为实时血管内超声（IVUS）双腔微导管（RLS导管）。在此，我们简要描述RLS导管，报告我们使用该设备的经验，并提供其在CTO血运重建中的疗效和安全性数据。

致编辑：一名68岁男性出现失语症2个月。磁共振成像扫描显示左颞叶异常信号，呈不均匀强化[图1A].考虑神经胶质瘤，患者接受了肿瘤全切除术。切除肿瘤的显微镜检查显示为高级别胶质瘤，具有多形性细胞、有丝分裂活性升高、微血管增生和假性坏死[图1B和图1C].部分病灶内有核周晕的圆形细胞。肿瘤细胞也在神经元周围生长，形成二级结构[图1D].免疫组织化学研究显示，肿瘤细胞表达胶质纤维酸性蛋白和少突胶质细胞转录因子2[图1E].p53蛋白仅有局灶性阳性（约占肿瘤细胞的5%），而α-地中海贫血-mia/精神发育迟滞综合征X连锁蛋白表达为阳性。肿瘤细胞对异柠檬酸脱氢酶1(IDH1)R132H、NeuN和H3 K27M呈阴性。Ki-67指数约为20%。对福尔马林固定的石蜡包埋的肿瘤组织进行下一代测序分析（先声诊断公司，中国南京）。结果显示一个杂合IDH1 CGT>AGT G131D突变，表皮生长因子受体（EGFR）扩增，细胞周期蛋白依赖性激酶抑制剂2A/B（CDKN2A/B）10号染色体缺失、缺失以及1p杂合性缺失[图1F和图1G]，而染色体19q是完整的。突变IDH2、H3F3A、HIST1H3B、BRAF、和第三启动子不存在。IDH1sanger测序证实G131D突变[图1H].1p/19q的存在[图1I和图1J]和EGFR扩增[图1K]通过荧光证实原地杂交（广州LBP制药科技有限公司，中国）。肿瘤最终被诊断为胶质母细胞瘤，IDH-突变体（IDH1G131D突变），世界卫生组织IV级。术后患者接受放化疗联合治疗（替莫唑胺，140 mg，qd）。随访2个月未观察到复发或进展。在涉及人类参与者的研究中执行的所有程序均符合机构和/或国家研究委员会的伦理标准（第[2019]004号）和1964年赫尔辛基宣言及其后来的修正案或类似的道德标准。作者已获得适当的患者同意书。

致编辑：在循证医学时代，传统的随机对照试验（RCT）处于证据层次金字塔的顶端。通过控制良好的纳入和排除标准、随机化和严格的干预方案，传统的RCT构建了理想的医疗环境，在这种环境下，结果和干预之间的因果关系可以更好地解释。然而，这也会使传统RCT的外部效度和可推广性受到限制。^[1,2]真实世界研究（RWS）是指分析真实世界数据的研究，包括登记处、数据库、电子健康记录、索赔或保险数据库以及传统对照试验环境之外的其他健康数据。^[3]比较有效性研究（CER）是RWS传统RCT的对应物，是指在现实世界的临床环境中比较干预措施的有效性和安全性的研究。CER由观察性研究和务实的RCT组成，已成为补充传统RCT的有前途的证据来源。^[4]与传统RCT不同，务实RCT试图在真实世界的临床环境中进行试验，以扩展RCT的可推广性。^[5]

致编辑：支气管扩张是一种慢性呼吸系统疾病，其特征是反复咳嗽、咳痰和呼吸道感染。近年来，支气管扩张的治疗越来越受到重视。^[1]支气管扩张患者应接受常规监测，以确定疾病进展并在必要时调整治疗。近年来，已经开发了三种复合疾病特异性系统，其被验证用于评估支气管扩张严重程度和预测预后：支气管扩张严重程度指数(BSI)，FACED(F：1 s%预测的用力呼气量[FEV1%pred]，A：年龄，C：慢性定植的存在铜绿假单胞菌，E：放射学扩展【受影响的肺叶数量】，D：呼吸困难）和FACED加上前一年的恶化（E-FACED）。^[2,3,4]所有三种评分系统分别通过不同的阈值将患者分为低、中、高风险组。研究表明，BSI可以更好地预测支气管扩张的死亡率、恶化、生活质量、呼吸系统症状、6分钟步行距离和肺功能下降。2019年更新的英国胸科学会(BTS)成人支气管扩张指南强调，BSI和FACED评分系统的使用提高了预测支气管扩张患者未来道德的能力，并有助于指导疾病管理。^[4]然而，关于这些系统预测支气管扩张患者再入院的文献仍然有限。本研究评估了BSI、FACED和E-FACED对评估支气管扩张患者再入院风险的预测能力，并对三种系统的预测能力进行了比较。

致编辑：人类基因组计划解码生命的奥秘，探索疾病的发病机制，为疾病的诊断和治疗提供科学依据。传统的测序方法主要提供全基因组序列信息和细胞类型混合的平均值，这没有考虑细胞之间和亚型之间的异质性。基因组测序技术的进步使得单细胞测序（SCS）的发展成为可能。

致编辑：小儿肺移植是一种针对儿童终末期肺病的高度专业化疗法，在世界各地仅有少数移植中心进行。在过去的十年中，全世界每年约有100例小儿肺移植手术。大多数中心每年进行1至4例儿科肺移植，只有5个中心每年进行5例以上。自2007年以来，我们的团队已经为12名儿科患者进行了肺移植，其中11名患者年龄超过10岁。

致编辑：前置胎盘是妊娠晚期和分娩时出血的主要原因之一。根据胎盘下缘与宫颈内侧的关系，前置胎盘可分为不完全性前置胎盘（IPP）和完全性前置胎盘（CPP）。IPP表示胎盘下缘到达但不超过子宫颈内部。CPP是指胎盘的下边缘覆盖并超过子宫颈内部。该通用分类标准适用于子宫肌层完整，仅胎盘前置的病例。然而，当以前通过剖宫产分娩的孕妇在当前妊娠中出现前置胎盘，并且胎盘附着在子宫疤痕上时，产后出血和各种并发症的风险显著增加。这些病例被赋予了一个新的名称，恶性前置胎盘（PPP）。^[1]

致编辑：火棉胶婴儿是一种极其罕见的先天性疾病的描述性术语，其特征是出生时存在覆盖全身的羊皮纸样或玻璃纸样膜。^[1,2]膜通常在几周后脱落，婴儿表现出几种鱼鳞病皮肤类型中的一种。由于皮肤紧绷，火棉胶婴儿经常会出现许多并发症，如睑外翻、睑裂和关节活动受限。^[1,2]偶尔有关于睑外翻的全身和保守治疗管理的病例报道。^[3]然而，很少有关于火棉胶婴儿因睑外翻引起的明显水肿结膜的手术治疗的报道。