Volume 128 · Issue 18 · 2015

Left ventricular thrombus (LVT) is reported to be a common complication in acute myocardial infarction (AMI) patients. And it has the potential to cause systemic embolism. This retrospective study was to present the current situation of LVT in clinical practice, as well as to evaluate the clinical characteristics and the risk factors of LVT after AMI.

LVT cases (n = 96) were identified from 13,732 AMI (non-ST elevation myocardial infarction was excluded) patients in Fuwai Hospital’s electronic medical records system from January 2003 to January 2013. The controls (n = 192) were gender- and age-matched AMI patients without LVT during this period. A conditional logistic regression (fitted by the Cox model) was performed to identify the independent risk factors.

The incidence of LVT after AMI was 0.7%. Univariate analysis indicated that the anterior myocardial infarction (especially extensive anterior myocardial infarction), lower left ventricular ejection fraction (LVEF), LVEF ≤40%, severe regional wall motion abnormalities (RWMA), pericardial effusion, and left ventricular aneurysm were all related to LVT after AMI. The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF (odds ratio (OR) = 0.891, 95% confidence interval (CI): 0.828–0.960), extensive anterior myocardial infarction (OR = 6.403, 95% CI: 1.769–23.169), severe RWMA (OR = 7.348, 95% CI: 1.323–40.819), and left ventricular aneurysm (OR = 6.955, 95% CI: 1.673–28.921).

This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

Obstetric anal sphincter injuries (OASIS) can cause an adverse impact on women’s physical and mental health. There was lack of published data in Chinese population particularly on studying the risk of OASIS for nonrotational outlet forceps. This study was to determine the incidence and risk factors of OASIS.

This is a retrospective cohort study carried out in a tertiary referral hospital in Hong Kong. The control group was selected randomly. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS. This study reviewed the obstetric records of OASIS women and random control from January 2011 to June 2014. Univariate and multivariate logistic regression analysis was performed to evaluate the influence of potential risk factors on OASIS.

Of 15,446 women delivered, 49 had OASIS. The percentage of OASIS increased from 0.3% (2011) to 0.38% (2014). There was an increasing trend of OASIS in attempted spontaneous vaginal delivery without episiotomy (P < 0.01), but it did not increase the OASIS risk (P = 0.46). Univariate analysis of 49 cases and 438 control subjects showed that forceps delivery (odds ratio [OR] =8.73, P < 0.01), prolong second stage of labor (OR = 1.43, P < 0.01) increased the risk for OASIS. In multivariate regression models, only forceps delivery (OR = 6.28, P < 0.01) proved to be independent risk factor.

The incidence of OASIS in Chinese women was increased after 2012, but still lower than the reported figures in the literature. Outlet forceps delivery could be a possible associated risk factor.

Prevalence of atrial fibrillation (AF) is increasing as the world ages. AF is associated with higher risk of mortality and disease, including stroke, hypertension, heart failure, and dementia. Prevalence of AF differs with each population studied, and research on non-Western populations and the oldest old is scarce.

We used data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey, a community-based study in eight longevity areas in China, to estimate AF prevalence in an elderly Chinese population (n = 1418, mean age = 85.6 years) and to identify risk factors. We determined the presence of AF in our participants using single-lead electrocardiograms. The weighted prevalence of AF was estimated in subjects stratified according to age groups (65–74, 75–84, 85–94, 95 years and above) and gender. We used logistic regressions to determine the potential risk factors of AF.

The overall prevalence of AF was 3.5%; 2.4% of men and 4.5% of women had AF (P < 0.05). AF was associated with weight extremes of being underweight or overweight/obese. Finally, advanced age (85–94 years), history of stroke or heart disease, low high-density lipoprotein levels, low triglyceride levels, and lack of regular physical activity were associated with AF.

In urban elderly, AF prevalence increased with age (P < 0.05), and in rural elderly, women had higher AF prevalence (P < 0.05). Further exploration of population-specific risk factors is needed to address the AF epidemic.

Subthalamic nucleus deep brain stimulation (STN DBS) is effective against advanced Parkinson’s disease (PD), allowing dramatic improvement of Parkinsonism, in addition to a significant reduction in medication. Here we aimed to investigate the long-term effect of STN DBS in Chinese PD patients, which has not been thoroughly studied in China.

Ten PD patients were assessed before DBS and followed up 1, 3, and 5 years later using Unified Parkinson’s Disease Rating Scale Part III (UPDRS III), Parkinson’s Disease Questionnatire-39, Parkinson’s Disease Sleep Scale-Chinese Version, Mini-mental State Examination, Montreal Cognitive Assessment, Hamilton Anxiety Scale and Hamilton Depression Scale. Stimulation parameters and drug dosages were recorded at each follow-up. Data were analyzed using the ANOVA for repeated measures.

In the "off" state (off medication), DBS improved UPDRS III scores by 35.87% in 5 years, compared with preoperative baseline (P < 0.001). In the "on" state (on medication), motor scores at 5 years were similar to the results of preoperative levodopa challenge test. The quality of life is improved by 58.18% (P < 0.001) from baseline to 3 years and gradually declined afterward. Sleep, cognition, and emotion were mostly unchanged. Levodopa equivalent daily dose was reduced from 660.4 ± 210.1 mg at baseline to 310.6 ± 158.4 mg at 5 years (by 52.96%, P < 0.001). The average pulse width, frequency and amplitude at 5 years were 75.0 ± 18.21 μs, 138.5 ± 19.34 Hz, and 2.68 ± 0.43 V, respectively.

STN DBS is an effective intervention for PD, although associated with a slightly diminished efficacy after 5 years. Compared with other studies, patients in our study required lower voltage and medication for satisfactory symptom control.

Delayed puberty can result either from constitutional delay of growth and puberty (CDP) or idiopathic hypogonadotropic hypogonadism (IHH). Gonadotropin-releasing hormone (GnRH) stimulation test has been generally accepted as a current method for diagnosing delayed puberty. The objective of this research was to assess the cut-off values and the efficacy of GnRH stimulation test in the diagnosis of delayed puberty in both males and females.

A study of 91 IHH, 27 CDP patients, 6 prepubertal children, and 20 pubertal adults was undertaken. Blood samples were obtained at 0, 30, 60, and 120 min after GnRH administration and the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. For each parameter, the sensitivities and specificities were estimated, and the receiver operating characteristic (ROC) curves were constructed.

The ROC curves indicated that a serum basal LH <0.6 IU/L or peak LH <9.74 IU/L resulted in moderate sensitivity (73.8% or 80.0%) and specificity (90.9% or 86.4%) in the diagnosis of HH in males. Serum basal LH <0.85 IU/L or basal FSH <2.43 IU/L resulted in moderate sensitivity (80.0% or 100.0%) and specificity (75.0% or 50.0%) in the diagnosis of HH in females.

Our data suggest that isolated use of the gonadorelin stimulation test is almost sufficient to discriminate between HH and CDP in males, but unnecessary in females. The most useful predictor is serum basal or peak LH to differentiate these two disorders in males, but serum basal LH or FSH in females.

Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity. Ocular surface symptoms had a substantial impact on the glaucoma patients’ quality of life and compliance. This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment.

Fifty-eight patients (101 eyes), who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria, were included in the analysis. All patients were maintained the original topical anti-glaucoma treatment. In the SH-treated group (56 eyes), unpreserved 0.3% SH eye drops were administered with 3 times daily for 90 days. In the control group (55 eyes), phosphate-buffered saline were administered with 3 times daily for 90 days. Ocular Surface Disease Index (OSDI) questionnaire, break-up time (BUT) test, corneal fluorescein staining, corneal and conjunctival rose Bengal staining, Schirmer test, and conjunctiva impression cytology were performed sequentially on days 0 and 91.

Compared with the control group, SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test: H = 38.668, P < 0.001), fluorescein and rose Bengal scores (Wilcoxon signed-ranks test: z = -3.843, P < 0.001, and z = -3.508, P < 0.001, respectively), increase in tear film BUT (t-test: t = -10.994, P < 0.001) and aqueous tear production (t-test: t= -10.328, P < 0.001) on day 91. The goblet cell density was increased (t-test: t = -9.981, P < 0.001), and the morphology of the conjunctival epithelium were also improved after SH treatment.

SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment. SH could be proposed as a new attempt to reduce ocular surface toxicity, and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.

The American Heart Association/American Stroke Association proposed a metric called Life’s Simple 7 (LS7) to define cardiovascular health (CVH). The presence of a large number of ideal components of CVH is associated with lower cardiovascular disease and all-cause mortality. We aimed to assess CVH using LS7 in a Chinese population undergoing primary and secondary stroke prevention.

Patients with either ischemic stroke or cardiovascular risk factors were enrolled in the study from October 2010 to July 2013. LS7 components were scored as poor (0 points), intermediate (1 point), or ideal (2 points). The overall LS7 score was categorized as inadequate (0–4), average (5–9), or optimal (10–14) CVH. The Chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used.

In total, 706 patients were enrolled. (1) The distribution of the overall LS7 score (n = 255) indicated that 9.4%, 82.4%, and 8.2% of the patients had inadequate, average, and optimal CVH, respectively. The proportion of patients with optimal CVH undergoing secondary stroke prevention was lower than that for patients undergoing primary stroke prevention (3.8% vs. 12.8%, P = 0.005). The vast majority of participants (76.1%) presented with ≤2 ideal health components. (2) The proportions of patients with poor, intermediate, and ideal status, respectively, for the following LS7 components were assessed: Total cholesterol (n = 275; 5.1%, 73.8%, and 21.1%), blood pressure (n = 351; 32.5%, 59.0%, and 8.5%), blood glucose (n = 280; 9.3%, 39.6%, and 51.1%), physical activity (n = 540; 90.7%, 8.7%, and 0.6%), diet (n = 524; 0.2%, 92.4%, and 7.4%), smoking (n = 619; 20.7%, 2.9%, and 76.4%), and body mass index (n = 259; 6.6%, 35.5%, and 57.9%).

Few Chinese patients undergoing stroke prevention had optimal CVH (determined using LS7). Additionally, fewer patients undergoing secondary prevention had optimal CVH than those undergoing primary prevention. In particular, physical activity and diet status in this population require improvement.

Sinonasal inverted papilloma (IP) is a rare benign tumor of the nasal cavities and paranasal sinuses. It is destructive or bone-remodeling, tends to recur after surgical resection, and has a significant malignant potential. The present study aimed to perform a retrospective analysis of patients with squamous cell carcinoma (SCC) arising from IP, including characteristics, survival outcome, and predictors of associated malignancy.

The medical records of 213 patients diagnosed with IP from January 1970 to January 2014 were retrospectively reviewed. Eighty-seven patients were diagnosed with SCC/IP; their clinical characteristics, treatments, and survival outcomes were analyzed.

Of the 87 patients with SCC/IP, the 5- and 10-year overall survival outcomes were 39.6% and 31.8%, respectively. Twenty-nine of these patients received surgery and 58 received combined surgery and radiation. Of the patients with stages III–IV, the 5-year survival rate was 30.7% for those treated with surgery only and 39.9% for those given the combination treatment (P = 0.849). Factors associated with significantly poor prognosis were advanced-stage, metachronous tumors, or with cranial base and orbit invasion. Age, synchronous or metachronous tumors, and pathological stage were independent risk factors for mortality, shown by multivariate analysis.

Patients with SCC/IP had low overall survival outcomes. Advanced age, stage, and metachronous tumors are the main factors affecting prognosis. Treatment planning should consider high-risk factors to improve survival outcome.

The Composite International Diagnostic Interview-3.0 (CIDI-3.0) is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings.

We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, gold standard) by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen’s K.

Substantial to excellent CIDI to SCID concordance was found for any substance use disorder (area under the receiver operator characteristic curve [AUC] = 0.926), any anxiety disorder (AUC = 0.807) and any mood disorder (AUC = 0.806). The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders (AUC = 0.55) and anorexia nervosa (AUC = 0.50) was insufficient.

Overall, the Chinese version of CIDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.

Many studies have suggested that cigarette smoking and polymorphisms of resistin and glutathione peroxidase-1 (GPx-1) genes are closely correlated with the pathogenesis of nonalcoholic fatty liver disease (NAFLD). However, few reports have investigated these associations with respect to NAFLD susceptibility. We, therefore, examined the distribution of polymorphisms in GPx-1 and resistin genes in NAFLD patients and healthy controls and analyzed the relationship between these polymorphisms and smoking status.

Nine hundred NAFLD patients and 900 healthy controls were selected, and the genetic polymorphisms of resistin gene promoter- 420C/G and GPx-1 gene Pro198Leu were analyzed by polymorphism-polymerase chain reaction (PCR) in DNA extracted from peripheral blood leukocytes. Interactions between the two mutants and the gene–environment interaction with cigarette smoking were also analyzed.

Genotype frequencies of -420C/G (GG) and Pro198Leu (LL) were significantly higher in NAFLD cases (49.56% and 50.11%, respectively) compared with healthy controls (23.67% and 24.22%, respectively) (P = 0.0069; P = 0.0072). Moreover, the risk of NAFLD with -420C/G (GG) was significantly higher than in controls (odds ratio [OR] =3.1685, 95% confidence interval (CI) =1.9366–5.2073). Individuals carrying Pro198Leu (LL) had a high risk of NAFLD (OR = 3.1424, 95% CI = 1.7951–5.2367). Combined analysis of the polymorphisms showed that the -420C/G (GG)/Pro198Leu (LL) genotype was significantly more common in the NAFLD group than in the control group (39.44% vs. 12.78%, respectively, P = 0.0054), while individuals with -420C/G (GG)/Pro198Leu (LL) had a high risk of NAFLD (OR = 5.0357, 95% CI = 3.1852–7.8106). Moreover, the cigarette smoking rate in the NAFLD group was significantly higher than in the control group (OR = 1.8990, P = 0.0083 in the smoking index (SI) ≤400 subgroup; OR = 5.0937, P = 0.0051 in the SI >400 subgroup), and statistical analysis suggested a positive interaction between cigarette smoking and -420C/G (GG) (γ = 5.6018 in the SI ≤400 subgroup; γ = 4.4770 in the SI >400 subgroup) and Pro198Leu (LL) (γ = 5.7715 in the SI ≤400 subgroup; γ = 4.5985 in the SI >400 subgroup) in increasing the risk of NAFLD.

NAFLD risk factors include -420C/G (GG), Pro198Leu (LL) and cigarette smoking, and these three factors have a significant additive effect on NAFLD risk.

The influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis.

PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and VIP database up to July 2014 were searched. High-quality randomized controlled trials were included. Low-quality trials were excluded. Serious adverse events were defined as the primary outcome. The secondary outcomes were hematoma enlargement (HE) at 24 h after onset, mortality, and favorable clinical outcome at 90 days.

Four high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed. Odds ratios (ORs) of primary outcome was 0.96 (95% confidence interval [CI]: 0.82–1.13, P = 0.61). ORs of HE at 24 h after onset, mortality and favorable clinical outcome at 90 days were 0.91 (95% CI: 0.72–1.17, P = 0.47), 0.97 (95% CI: 0.79–1.20, P = 0.81), 1.13 (95% CI: 0.98–1.30, P = 0.09) respectively.

Aggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.

To review the functional mechanism of apolipoprotein J (apoJ) in the process of atherosclerosis and the feasibility of apoJ as a therapeutic endpoint.

Relevant articles published in English from 1983 to present were selected from PubMed. The terms of "atherosclerosis, apolipoprotein J, clusterin (CLU), oxidative stress, and inflammation" were used for searching.

Articles studying the role of apoJ with atherosclerosis and restenosis after injury were reviewed. Articles focusing on the intrinsic determinants of atherosclerosis were selected. The exclusion criteria of articles were that the studies on immunologic vasculitis.

ApoJ, involved in numerous physiological process important for lipid transportation and vascular smooth muscle cell differentiation, including apoptotic cell death, cell-cycle regulation, cell adhesion, tissue remodeling, immune system regulation, and oxidative stress, plays a role in the development of clinical atherosclerosis. In the process of relieving atherosclerosis, apoJ can promote cholesterol and phospholipid export from macrophage-foam cells, and exhibit cytoprotective and anti-inflammatory actions by interacting with lots of known inflammatory proteins which may predict the onset of clinical cardiovascular events and may actually play a causal role in mediating atherosclerotic disease such as C-reactive protein, paraoxonase, and leptin. As known as CLU, apoJ has been identified to play central roles in the process of vascular smooth cells migration, adhesion, and proliferation, which can contribute significantly to restenosis after vascular injury.

Intense effort and substantial progress have been made to identify the apoJ that relieves atherosclerosis and vascular restenosis after percutaneous coronary intervention. More work is needed to elucidate the exact mechanisms of and the interrelationship between the actions of apoJ and to successfully achieve regression of atherosclerosis by regarding it as a therapeutic endpoint.

“恐慌值”（或临界值）的概念最早由美国学者伦德伯格提出^[1]1972年。是指辅助检查结果与正常或预期结果有较大偏差。这些异常结果的出现表明患者可能处于生命可能受到威胁的危险境地。如果临床医生能够及时获得信息，并及时为患者提供有效的干预或治疗，生命就可以挽救。否则，可能会有严重的后果，可能会错过抢救病人的最佳机会。^[2]恐慌值管理是医疗质量管理的重要组成部分，国家卫计委连续几年在《患者安全目标》中明确规定。^[3]在美国、澳大利亚和德国等国家，恐慌值的管理也受到了极大的重视，并被纳入各种医院评估中。例如，在美国国际联合委员会（医疗保健组织认证联合委员会）举行的年度医疗质量评估中，恐慌值的管理是评估的重要部分。

肾源性休息（NRs）是胚胎细胞的异常持续簇，代表发育中肾脏的微观发育不良。尸检时，在大约1%的婴儿肾脏中发现了NRs。肾母细胞瘤病表明存在多发性或弥漫性NRs。NRs和肾母细胞瘤病都被认为是肾母细胞瘤的前驱病变。^[1]肾母细胞瘤病可分为四类：叶周（仅PLNR）；叶内(仅ILNR)；组合（PLNR和ILNR）；和通用。肾母细胞瘤的诊断和治疗不断完善，已达到常识性。然而，关于肾母细胞瘤相关肾母细胞瘤患病率较低的信息很少。本研究旨在探讨肾母细胞瘤相关肾母细胞瘤的预后因素。

卒中后抑郁（PSD）是脑血管病常见的并发症之一。药物治疗和认知行为治疗是目前临床治疗PSD常用的两种方法。但这两种方法都有各自的缺点：前者存在起效慢、副作用多样等问题，患者对后者往往反应不佳。^[1]最近，科学家们开始使用心率变异性（HRV）生物反馈方法来治疗抑郁症患者，并发现了显著的临床疗效。HRV生物反馈要求患者同步心率（HR）振荡，并通过缓慢的腹式呼吸呼吸（约6次/分钟；即，在0.1 Hz的共振频率下），从而最大化HRV。^[2]本研究的目的是检查HRV生物反馈对患者情绪改善的影响，并探索该方法作为全面康复的有效、无副作用补充剂的潜力。

根据一项新的国际血管病变分类，静脉血管畸形已成为先天性血管畸形中最常见的类型。本病的一个特点是终生进行性发展，是危害健康的主要原因，与血管瘤不同。严重血管瘤伴血小板减少症（Kasabach-Merritt综合征）^[1]常见于儿童，尤其是1岁以下的婴儿。Kasabach-Merritt综合征的凝血异常主要由血小板破坏增加引起。然而，严重静脉畸形相关凝血病归因于凝血物质的耗竭和广泛的静脉内凝血，并且发生在成人中。原则上需要手术治疗；然而，没有手术治疗严重静脉畸形的机会，这是与Kasabach-Merritt综合征的主要区别。目前可能无法治愈。在此，我们报告一系列临床罕见的多发性严重全身静脉血管畸形综合征病例。

致编者：右肺动脉-左心房瘘（RPALAF）是一种极其罕见的先天性心血管畸形，临床症状可能难以诊断。高分辨率计算机断层扫描（CT）提供了心血管的清晰视图，可以提供准确的诊断，尽管320层CT扫描提供了这些清晰的视图，但在最近的文献中尚未报道。在一例本病的基础上，我们描述了一例经320层CT证实患有RPALAF的18岁女孩。该病例表明，当临床症状无法显示RPALAF时，320层CT扫描是一种敏感可靠的技术，可用于建立RPALAF的诊断。

致编者：一名44岁男性，无明显既往病史，因发热和淋巴结肿大1个月病史入院。他还出现盗汗、不适、关节痛、尿量减少、腹胀和体重减轻。体格检查发现颈部淋巴结肿大、腋窝和腹股沟沟，可触及肝脏和脾脏，移位性暗沉和水肿。实验室检查显示贫血（血红蛋白89 g/L）和严重血小板减少（血小板9 × 10⁹/L）、尿红细胞和尿蛋白阳性（0.68 g/24h）、肌酐升高（180µmol/L）、红细胞沉降率（ESR）升高（35 mm/h）、丙种球蛋白升高（IgG 19.3 g/L）、白蛋白水平低（27 g/L）。抗核抗体（ANA，斑点图案，1:16 0）、抗dsDNA和抗SSA抗体呈阳性。补体水平降低。超声心动图显示心功能正常，有轻度心包积液。计算机断层扫描显示双侧胸腔积液、纵隔和腹膜后区域淋巴结肿大、肝脾肿大和腹水。穿刺产生黄色透明液体，血清-腹水白蛋白梯度为6 g/L。培养呈阴性。骨髓抽吸显示大而未成熟的巨核细胞增加。淋巴结活检提示透明血管变异型Castleman病（CD）。确诊为多中心CD并发系统性红斑狼疮（SLE）和严重血小板减少症。患者接受了两个疗程的CHOP（环磷酰胺、多柔比星、长春新碱和泼尼松）方案以及静脉免疫球蛋白（Ig）输注、类固醇、达那唑和血小板生成素治疗。然而，他仍然有体温，血小板计数低（[5-7]× 10⁹/L），尽管淋巴结、肝脏和脾脏部分萎缩。然后给予利妥昔单抗(R)（600mg/周，四次给药），患者在治疗后显著改善[图1]：温度恢复正常；外周淋巴结以及肝脏和脾脏变得不可触及；血红蛋白高达125 g/L，血小板110 × 10⁹/L；尿血（-）；尿蛋白(-)(0.18 g/24h)；ESR 20mm/h；肌酐93µmol/L；白蛋白36g/L；IgG 5.58 g/L；ANA、抗dsDNA、抗SSA抗体均为阴性。影像学检查显示胸腔积液和腹水消失，无肿大淋巴结，肝脾正常。给予3个疗程的R-COP作为维持治疗。之后，患者回家，不需要进一步的类固醇或免疫抑制剂治疗。在初次诊断后7年的最后一次随访中，他保持无疾病，并保持良好的功能状态。

致编者：枕神经痛（ON）是继偏头痛和紧张型头痛之后的第三大常见头痛综合征。近年来，当保守药物治疗和阻滞程序无效时，周围神经刺激（PNS）已被用于缓解由某些类型的神经痛引起的剧烈疼痛。PNS是一种使用脊髓刺激装置来缓解神经痛的神经调节。在这里，我们介绍了一例难治性ON患者成功接受PNS治疗的病例。

编者按：肿瘤坏死因子-α（TNF-α）是一种促炎细胞因子，在类风湿性关节炎（RA）的发病机制中起着至关重要的作用，而抗TNF-α药物的出现为RA带来了更好的控制和更低的副作用。最常见的副作用是传染病和药物性狼疮。在此，我们报告了一例有10年RA病史的中国男性患者，在阿达木单抗治疗期间出现新月体免疫球蛋白A（IgA）肾炎和多种自身抗体。