Volume 134 · Issue 08 · 2021

胸主动脉腔内修复术（TEVAR）是B型主动脉夹层（TBAD）的首选方法。^[1,2,3]然而，当夹层涉及靠近主动脉上分支的主动脉弓时，对于经典TEVAR来说，情况变得复杂和具有挑战性。近年来，混合血管内开放弓修复（HENDO）理论变得流行，该理论由一些专门针对主动脉弓病变的治疗策略组成。基于HENDO理论的改良血管内技术，同时旨在重建受累的主动脉上分支和覆盖TBAD，是未来发展前景良好的首选。根据具体解剖情况和疾病病理，可选择性行混合或开放手术。

腋窝淋巴结评估是乳腺癌临床病理分期的重要指标之一。研究表明，前哨淋巴结活检（SLNB）较常规腋窝淋巴结清扫（ALND）具有并发症少、创伤小等优点。^[1]SLNB的常见绘图方法包括蓝色染料、放射性同位素、蓝色染料和放射性同位素的组合以及荧光成像。为规范乳腺癌SLNB技术，中国乳腺外科学会（CSBrS）参考建议评估、开发和评价分级（GRADE），根据专家共识和《早期乳腺癌单用蓝色染料引导前哨淋巴结活检技术操作指南》（2018）结合我国乳腺外科临床实践数据，对乳腺癌SLNB临床研究证据质量进行了重新评估，并制定了《早期乳腺癌前哨淋巴结活检临床实践指南：CSBrS实践指南2021》，为我国乳腺外科医生临床实践提供参考。

中国接受乳房切除术的早期乳腺癌患者比例超过70%，^[1]其中Auchincloss手术是腋窝淋巴结阳性乳腺癌的主要手术技术。为规范乳腺癌改良根治术的临床应用，中国乳腺外科学会（CSBrS）组织国内专家对乳腺癌改良根治术的理论基础和技术细节进行了文献检索和专家讨论。参考建议评估、发展和评估系统的分级，对相关证据进行了评估。结合临床可及性，制定CSBrS乳腺癌改良根治实践指南，为乳腺外科医生居家临床实践提供参考。

已有研究表明，自主神经系统在胃癌（GC）的发生发展中起一定作用。^[1,2,3]交感神经和副交感神经纤维在胃壁粘膜下层和肌层构成网络，控制胃蠕动和分泌。这两组神经纤维在中枢神经系统的调节下相互拮抗和协调，完成其神经支配功能。目前，大多数关于自主神经系统和GC的研究集中在单一物种的神经纤维或递质上。本研究旨在阐明交感神经和副交感神经系统如何在GC的发生和发展中拮抗和协调。同时，一些胃肠激素也在GC的发展中被鉴定为交感神经或副交感神经系统的助手或工具。

疫情是一种在世界范围内传播的疾病。当疾病是新的，如冠状病毒疾病2019（新冠肺炎），根据定义，预防、诊断和治疗该疾病的证据基础是有限的。然而，迫切需要临床实践指南来帮助政策和卫生保健工作者做出明智的决定。但是，在高质量证据真空中采取行动，也就是说，将指南建立在低质量研究的基础上，可能会适得其反，并可能有害。^[1,2]因此，在像新冠肺炎这样的疫情期间，指南制定者面临着许多挑战，我们希望在本文中解决这些挑战。

Although endovascular therapy has been widely used for focal aortoiliac occlusive disease (AIOD), its performance for extensive AIOD (EAIOD) is not fully evaluated. We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.

Between January 2008 and June 2018, patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II (TASC II) C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled. Demographic, diagnosis, procedure characteristics, and follow-up information were reviewed. Univariate analysis was used to identify the correlation between the variables and the primary patency. A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency. Five- and 10-year primary and secondary patency, as well as survival rates, were calculated by Kaplan-Meier analysis.

A total of 148 patients underwent endovascular treatment in our center. Of these, 39.2% were classified as having TASC II C lesions and 60.8% as having TASC II D lesions. The technical success rate was 88.5%. The mean follow-up time was 79.2 ± 29.2 months. Primary and secondary patency was 82.1% and 89.4% at 5 years, and 74.8% and 83.1% at 10 years, respectively. The 5-year survival rate was 84.2%. Compared with patients without loss of primary patency, patients with this condition showed significant differences in age, TASC II classification, infrainguinal lesions, critical limb ischemia (CLI), and smoking. Multivariate logistic regression analysis showed age <61 years (adjusted odds ratio [aOR]: 6.47; 95% CI: 1.47-28.36; P = 0.01), CLI (aOR: 7.81; 95% CI: 1.92-31.89; P = 0.04), and smoking (aOR: 10.15; 95% CI: 2.79-36.90; P < 0.01) were independent risk factors for the loss of primary patency.

Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate. Age <61 years, CLI, and smoking were independent risk factors for the loss of primary patency.

Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.

Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.

Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.

Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.

Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.

All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student’s t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.

A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).

Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people’s understanding. Meanwhile, the curing and transferring efficiency should also be improved.

Since 2019, a novel coronavirus named 2019 novel coronavirus (2019-nCoV) has emerged worldwide. Apart from fever and respiratory complications, acute kidney injury has been observed in a few patients with coronavirus disease 2019. Furthermore, according to recent findings, the virus has been detected in urine. Angiotensin-converting enzyme II (ACE2) has been proposed to serve as the receptor for the entry of 2019-nCoV, which is the same as that for the severe acute respiratory syndrome. This study aimed to investigate the possible cause of kidney damage and the potential route of 2019-nCoV infection in the urinary system.

We used both published kidney and bladder cell atlas data and new independent kidney single-cell RNA sequencing data generated in-house to evaluate ACE2 gene expression in all cell types in healthy kidneys and bladders. The Pearson correlation coefficients between ACE2 and all other genes were first generated. Then, genes with r values larger than 0.1 and P values smaller than 0.01 were deemed significant co-expression genes with ACE2.

Our results showed the enriched expression of ACE2 in all subtypes of proximal tubule (PT) cells of the kidney. ACE2 expression was found in 5.12%, 5.80%, and 14.38% of the proximal convoluted tubule cells, PT cells, and proximal straight tubule cells, respectively, in three published kidney cell atlas datasets. In addition, ACE2 expression was also confirmed in 12.05%, 6.80%, and 10.20% of cells of the proximal convoluted tubule, PT, and proximal straight tubule, respectively, in our own two healthy kidney samples. For the analysis of public data from three bladder samples, ACE2 expression was low but detectable in bladder epithelial cells. Only 0.25% and 1.28% of intermediate cells and umbrella cells, respectively, had ACE2 expression.

This study has provided bioinformatics evidence of the potential route of 2019-nCoV infection in the urinary system.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.

A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.

A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ² = 8.183, P = 0.004).

The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

Recently, T-helper 17 (Th17) cells have been proved to play an important role in promoting cervical cancer. But, till now, few study has been carried out to understand the involvement of these cells in efficacy of anti-tumor treatments. This study aimed to investigate the alterations in the percentage of circulating Th17 cells and related cytokines in locally advanced cervical cancer (LACC) patients before and after concurrent chemoradiotherapy (cCRT) and to analyze the correlations between the alterations in Th17 cells and treatment efficacy.

A prospective study with 49 LACC (International federation of gynecology and obstetrics [FIGO] stage IIB-IIIB) patients and 23 controls was conducted. Patients received the same cCRT schedule and were followed up for 3 years. Circulating Th17 cells (CD3+CD8- interleukin [IL]-17+ T cells) and related cytokines IL-17, transforming growth factor-β (TGF-β), IL-10, IL-23, IL-6, and IL-22 were detected before and after cCRT. Correlations between alterations of circulating Th17 cells and treatment efficacy were analyzed. Kaplan-Meier analysis was used for overall survival (OS) and progression-free survival (PFS).

We found that 40 patients finished the entire cCRT schedule and met the endpoint of this study. The percentage of circulating Th17 cells in the LACC patients was higher than that in the controls, and it significantly decreased after cCRT (P < 0.05). After cCRT, patients were divided into two groups based on the average of the Th17 cells declined. The subgroup of patients with a prominent decrease in circulating Th17 cells after cCRT had a higher treatment efficacy and longer PFS and OS times. Compared with the control patients, LACC patients had higher IL-6, IL-10, IL-22, TGF-β levels and a lower IL-23 level (P < 0.05). After cCRT, IL-6, IL-10, IL-17, IL-23 level significantly increased and TGF-β level significantly decreased compared with the levels before cCRT (P < 0.05).

Circulating Th17 cells in the LACC patients (FIGO stage IIB-IIIB) were higher than those in the controls, but they generally decreased after cCRT. A more pronounced decrease in circulating Th17 cells after cCRT was correlated with better therapeutic effect and longer PFS and OS times.

Histone deacetylase 4 (HDAC4) regulates chondrocyte hypertrophy and bone formation. The aim of the present study was to explore the effects of HDAC4 on Interleukin 1 beta (IL-1β)-induced chondrocyte extracellular matrix degradation and whether it is regulated through the WNT family member 3A (WNT3A)/β-catenin signaling pathway.

Primary chondrocytes (CC) and human chondrosarcoma cells (SW1353 cells) were treated with IL-1β and the level of HDAC4 was assayed using Western blotting. Then, HDAC4 expression in the SW1353 cells was silenced using small interfering RNA to detect the effect of HDAC4 knockdown on the levels of matrix metalloproteinase 3 (MMP3) and MMP13 induced by IL-1β. After transfection with HDAC4 plasmids, the overexpression efficiency was examined using Real-time quantitative polymerase chain reaction (qRT-PCR) and the levels of MMP3 and MMP13 were assayed using Western blotting. After incubation with IL-1β, the translocation of β-catenin into the nucleus was observed using immunofluorescence staining in SW1353 cells to investigate the activation of the WNT3A/β-catenin signaling pathway. Finally, treatment with WNT3A and transfection with glycogen synthase kinase 3 beta (GSK3β) plasmids were assessed for their effects on HDAC4 levels using Western blotting.

IL-1β downregulated HDAC4 levels in chondrocytes and SW1353 cells. Furthermore, HDAC4 knockdown increased the levels of MMP3 and MMP13, which contributed to the degradation of the extracellular matrix. Overexpression of HDAC4 inhibited IL-1β-induced increases in MMP3 and MMP13. IL-1β upregulated the levels of WNT3A, and WNT3A reduced HDAC4 levels in SW1353 cells. GSK-3β rescued IL-1β-induced downregulation of HDAC4 in SW1353 cells.

HDAC4 exerted an inhibitory effect on IL-1β-induced extracellular matrix degradation and was regulated partially by the WNT3A/β-catenin signaling pathway.

胸主动脉腔内修复术（TEVAR）已逐渐被认为是B型主动脉夹层（TBAD）的主流疗法，尤其是对复杂的急性TBAD，^[1]由于其微创性和令人满意的临床结果。目前，我们关于主动脉夹层和血管内治疗的知识主要来自西方登记处，包括国际急性主动脉夹层登记处（IRAD）和血管质量倡议（VQI），其中包括少数亚洲TBAD患者，没有任何中国人群。因此，我们报告了一项在中国高容量三级中心接受TEVAR治疗的TBAD患者的长期单中心经验。初步结果将提供有用的见解，并增强我们对中国人群中这种疾病的了解。

漏斗胸（PE）是临床实践中观察到的最常见的先天性胸壁畸形之一，在儿童中估计患病率在500分之一至1000分之一的范围内；其特征是胸骨下部和软骨-肋骨附件向后移位。^[1]由于PE引起的生理症状和损伤各不相同，因为前胸壁的凹陷压迫右心室，引起各种形态和功能心脏改变。随着年龄的增长，一些PE患者的心肺功能会逐渐恶化。^[2]因此，强烈建议进行旨在纠正该疾病的手术修复。^[1,3]几项研究表明，手术修复后PE患者的肺功能和运动能力有所改善。^[3,4,5]然而，由于右心室（RV）的形状不规则，并且使用二维（2D）经胸超声心动图（TTE）难以评估功能，根据先前使用2D TTE评估右心室功能的研究，手术修复PE畸形的心脏益处（尤其是右心室功能改善）的可用性仍然存在争议。^[4,5]相比之下，三维（3D）TTE显示了RV更好的可视化和定位，并且可以更准确地评估RV功能。^[6,7]因此，我们在一组接受手术修复的患者中，采用3D TTE评估了手术前后的RV功能，以证实PE畸形以及手术矫正后RV结构和功能改善的效果。

目前，经导管主动脉瓣植入术（TAVI）已成为被认为不能手术或手术风险高的严重主动脉瓣狭窄患者的可行介入技术。在中国，TAVI技术始于2010年。到目前为止，两种国产设备J Valve（杰成医疗技术，中国苏州）和Venus A-Valve（Venus MedTech，中国杭州）已于2017年获准进入市场，此后大多数中心开始建立TAVI计划。Venus A-Valve是中国唯一的经股动脉经导管瓣膜，在VitaFlow（MicroPort，中国上海）和SAPIEN 3（Edwards Lifesciences，Irvine，CA，美国）几个月前进入中国市场之前，已植入约4000次。

涉及主动脉弓的A型夹层仍然是一种固有的致命疾病。太阳等人^[1]推荐全弓置换联合支架象鼻植入术作为涉及主动脉弓修复的A型夹层的新“标准”疗法。在该手术中，右腋动脉插管用于体外循环（CPB）和选择性脑灌注。^[1]但在某些特殊情况下，如右锁骨下动脉异常、右锁骨下动脉严重受累、右颈总动脉严重受累、急性心包填塞等，本术式可能不适用。分支优先主动脉弓置换技术可以充分解决这些问题。我们分析了该技术的手术数据和中期随访结果。

室间隔破裂（VSR）是急性心肌梗死（AMI）的一种罕见但致命的并发症。^[1]紧急修复手术为VSR患者提供了唯一的生存机会；然而，围手术期死亡率在早期仍然极高。^[2]择期手术广泛应用于现实世界的临床实践中，并与改善预后相关。^[3]然而，择期手术的结果可能是生存偏倚的表现，因为它通常在相对稳定的VSR患者中进行，这些患者有望在早期存活，并且比早期合并血流动力学不稳定的患者预后更好。^[4]在本研究中，我们旨在提出一种新的手术修复技术，该技术可以安全、可行、有效地用于急性期血流动力学不稳定的VSR患者，并报告初步结果。

喉咽反流病（LPRD）目前被定义为与胃十二指肠内容物反流的直接和间接影响相关的上呼吸消化道组织炎症，其可能诱导上呼吸消化道的形态学改变。^[1]胃内容物pH较低，主要引起酸反流，而十二指肠内容物pH高于胃内容物，可引起弱酸反流或碱性反流。因为食管粘膜中的碳酸酐酶可以转化CO₂、细胞代谢产物，转化为碳酸氢盐，起中和胃酸的作用。因此，部分胃酸反流或十二指肠内容物反流在食管远端pH小于4，但到达下咽部时pH大于4，转为弱酸性或碱性反流。因此，采用24小时多通道腔内阻抗-pH（MII-pH）监测，根据下咽部pH的差异，将咽喉返流（LPR）事件分为以下几类^[2]：（1）pH≤4时的酸性LPR；(2)当pH为4至7时，弱酸性LPR；（3）pH高于7时的碱性LPR。弱酸性和碱性LPR均称为非酸性反流。根据食管远端和下咽部的pH值，非酸反流可进一步分为真性非酸反流（食管远端和下咽部均pH>4）和假性非酸反流（食管远端pH≤4，但下咽部pH>4）[图1].然而，对于每个患者，LPR事件的真非酸、假非酸和酸反流的比例有助于制定治疗计划。如果真正的非胃酸反流事件占LPR事件的大多数，那么抑酸治疗就不是主要的。如果假性非酸反流和酸反流占优势，那么抑酸治疗还是很重要的。然而，文献中很少有关于这种比例分类的研究，因此我们旨在分析50例疑似LPRD患者的24 h MII-PH数据，以了解各种LPR的比例，这可能有助于制定LPRD的治疗方案。

致编辑：真菌性角膜炎主要由致病真菌物种引起，如茄病镰刀菌和烟曲霉.的发生率烟曲霉已在全球范围内增加。^[1]虽然真菌性角膜炎已有新的疗法，但目前抗真菌药物的疗效仍不理想。^[2]真菌性角膜炎由于其诊断困难和延迟，以及缺乏有效的药物和治疗方法，仍然是眼科医生面临的挑战。

致编辑：Mirizzi综合征（MS）是一种罕见的胆石症，在所有胆结石病例中发病率为0.1%。^[1]其临床表现和影像学特征有时难以与胆总管结石和胆道肿瘤相鉴别。MS的传统治疗通常是手术，包括胆囊切除术、胆总管探查加T管引流术、胆管空肠吻合术等。^[2]近年来甚至有关于MS的内窥镜治疗的报道，但在结石卡在Hartmann袋中的情况下，这在技术上是困难的并且是不可行的。^[3]在这里，我们报告了一个通过内镜方式降低MS以避免胆管空肠吻合术的病例。

致编辑：孤立性纤维肿瘤（SFT）是间充质肿瘤，最初在胸膜中描述，随后在胸膜外器官中发现，如腹膜、肺、腮腺、鼻窦、眼眶、皮肤和颅内区域。^[1]然而，胸膜外SFT仅限于孤立的病例报告。由于它们的罕见性，相关信息还远远不够，因此，导致这种肿瘤没有得到充分的认识。根据世界卫生组织（WHO）的分类，SFT是多能性肿瘤，可以是良性、中度或恶性的。以上都促使我们进一步了解本病的流行病学、临床特征、药物治疗和预后。

致编辑：对于急性DeBakeyⅠ型主动脉夹层患者，升主动脉或半弓置换术可减少手术时间，危急情况下可挽救生命。然而，残留的远端夹层会增加扩张、破裂和死亡的风险。^[1]相比之下，冷冻象鼻（FET）植入的全主动脉弓置换术（TAR）可以最大限度地减少再次干预的需要，^[2]但可能增加手术死亡率、中风、截瘫和其他并发症的风险。目前，由于长期随访数据的缺乏和不同机构之间的技术差异，急性DeBakey I型主动脉夹层的最佳手术策略问题仍存在争议。因此，在这项研究中，我们比较了有限的早期和长期结果vs.急性DeBakey I型主动脉夹层患者的延长修复治疗。

致编辑：对于不符合或拒绝接受标准化疗的非小细胞肺癌（NSCLC）患者，药物洗脱珠支气管动脉化疗栓塞（DEB-BACE）已被证明是一种可行且耐受性良好的治疗选择。^[1]在这里，我们报告了一例接受DEB-BACE治疗的鳞状细胞肺癌患者的多发性脑栓塞性梗死的罕见并发症，主要发生在脑后循环。据我们所知，这种并发症在接受DEB-BACE的非小细胞肺癌患者中很少报道。我们的机构审查委员会和患者已批准发表本病例报告。

致编辑：颈部半透明性（NT）的测量是非整倍体、胎儿异常和其他病理状况的有效标志物，^[1]这使得在临床治疗中确保NT测量的准确性至关重要。自2012年以来，所有到我院（中国上海交通大学医学院附属国际和平妇幼保健院）就诊的孕妇都需要接受常规的孕早期超声标志物评估。然而，值得注意的是，由于所花费的时间、胎儿的位置、超声医师的技术和其他因素，很难达到每个病例的标准断面并获得准确的测量数据。即使在非标准部分，NT测量在产前诊断中心也是有价值的。因此，本研究的目的是评估不良妊娠结局与NT测量增加之间的关系，这将有助于对我们机构中的妇女进行咨询，从而减少出生缺陷。

致编辑：2019冠状病毒病（COVID-19）全球大流行尚未得到控制，COVID-19已影响全球数千万人。虽然新冠肺炎的主要特征是弥漫性肺泡损伤和急性呼吸衰竭，但对其他器官的损害也值得关注，因为这些患者往往症状更严重，预后更差。在本文中，我们简要综述了新冠肺炎肾脏受累的特点以及肾损伤对疾病预后的影响，以期从肾内科医生的角度更好地了解新冠肺炎疫情。

致编辑：凝血系统是人体内一个复杂的调节系统。在该病例中，年轻患者有各种重要的血栓形成，包括脑静脉窦血栓形成（CVST）、冠状动脉血栓形成和左心室血栓。然而，该患者既没有高凝相关疾病，也没有风险，也没有凝血或纤溶蛋白缺乏。^[1]进一步的基因检测未显示与凝血功能障碍相关的常见基因突变。我们报告了这样一例凝血FVIII活性轻微升高的患者FVIII基因复制。

致编辑：抗黑色素瘤分化相关基因5（MDA-5)阳性间质性肺病(ILD)的特征是快速进展的呼吸衰竭和有限的住院生存期。尚未建立或证明有益的标准疗法。在此，我们报告了一例快速进展的患者，其被诊断为抗MDA-5抗体阳性的ILD，正在接受托珠单抗治疗。