Volume 129 · Issue 02 · 2016

国际医学期刊编辑委员会（ICMJE）认为，有道德义务负责任地分享干预性临床试验产生的数据，因为参与者将自己置于风险之中。越来越多的共识是，世界各地的许多资助者——基金会、政府机构和行业——现在要求数据共享。在这里，我们概述了ICMJE为帮助履行这一义务而提出的要求。我们鼓励对提议的要求进行反馈。任何人都可以在2016年4月18日之前通过www.icmje.org提供反馈。

Fatigue is a common symptom both in diseases status and in healthy subjects. Various supplements and nutraceuticals for relieving of fatigue have been used. However, there are a few studies to evaluate the efficacy and the safety of the drug for fatigue alleviation, we conducted using URSA Complex to evaluate the efficacy on physical fatigue via score changes in the checklist individual strength (CIS).　

The study was designed as a multicenter, randomized, double-blind, placebo-controlled trial, with subjects randomized to one of the two arms, receiving either placebo or URSA Complex administered as identical capsules. The primary efficacy endpoints of this clinical trials are the ratio of improving CIS scores < 76 points in patients at the end (4 weeks). Secondary efficacy variables are as follows one is an improvement of fatigue and the other is an improvement of the liver enzyme.　

The fatigue recovery rate in who had improved CIS scores of < 76 points were 70.0%, 50.9% in the therapy group and placebo group, respectively (P = 0.019). The fatigue recovery rate in CIS score was higher in URSA Complex therapy group than placebo group. The difference between therapy group and placebo group was statistically significant at 4 weeks later, but not 2 weeks.　

Our results provided that the URSA Complex was effective in alleviating physical fatigue. The adverse event frequency in the therapy groups was similar to that in the placebo group.

Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.　

A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.　

Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982–1.021; P = 0.8678).　

These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.

Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is the most common type of lipid storage myopathies in China. Most patients with late-onset MADD are well responsive to riboflavin. Up to now, these patients are often treated with glucocorticoids as the first-line drug because they are misdiagnosed as polymyositis without muscle biopsy or gene analysis. Although glucocorticoids seem to improve the fatty acid metabolism of late-onset MADD, the objective evaluation of their rationalization on this disorder and comparison with riboflavin treatment are unknown.　

We performed a historical cohort study on the efficacy of the two drugs among 45 patients with late-onset MADD, who were divided into glucocorticoids group and riboflavin group. Detailed clinical information of baseline and 1-month follow-up were collected.　

After 1-month treatment, a dramatic improvement of muscle strength was found in riboflavin group (P < 0.05). There was no significant difference in muscle enzymes between the two groups. Significantly, the number of patients with full recovery in glucocorticoids group was less than the number in riboflavin group (P < 0.05). On the other hand, almost half of the patients in riboflavin group still presented high-level muscle enzymes and weak muscle strength after 1-month riboflavin treatment, meaning that 1-month treatment duration maybe insufficient and patients should keep on riboflavin supplement for a longer time.　

Our results provide credible evidences that the overall efficacy of riboflavin is superior to glucocorticoids, and a longer duration of riboflavin treatment is necessary for patients with late-onset MADD.

The supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.　

Between November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.　

The prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ² = 0.578, P = 0.898) and size (Fisher’s exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.　

The hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.

To determine the influence of right ventricular function in patients with constrictive pericarditis (CP) undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically.　

Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded.　

A total of 58 patients with CP (36 received pericardiectomy, 22 managed medically), and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically (P = 0.003), and higher survival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery.　

Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.

Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas.　

Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35–84 years old). Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18–84 months).　

Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7%) exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19–30).　

Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.　

The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.　

The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).　

PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.

Current knowledge about clinical and genetic risk factors for aspirin-induced gastric mucosal injury is not sufficient to prevent these gastric mucosal lesions.　

We recruited aspirin takers as the exposed group and healthy volunteers as the control group. The exposed group was categorized into two subgroups such as subgroup A as gastric mucosal injury diagnosed by gastroscopy, including erosion, ulcer or bleeding of the esophagus, stomach, or duodenum; subgroup B as no injury of the gastric mucosa was detected by gastroscopy. Clinical information was collected, and 53 single nucleotide polymorphisms were evaluated.　

Among 385 participants, 234 were in the aspirin-exposed group. According to gastroscopy, 82 belonged to subgroup A, 91 belonged to subgroup B, and gastroscopic results of 61 participants were not available. Using the Chi-square test and logistic regression, we found that peptic ulcer history (odds ratio [OR] = 5.924, 95% confidence intervals [CI]: 2.115–16.592), dual anti-platelet medication (OR = 3.443, 95% CI: 1.154–10.271), current Helicobacter pylori infection (OR = 2.242, 95% CI: 1.032–4.870), male gender (OR = 2.211, 95% CI: 1.027–4.760), GG genotype of rs2243086 (OR = 4.516, 95% CI: 1.180–17.278), and AA genotype of rs1330344 (OR = 2.178, 95% CI: 1.016–4.669) were more frequent in subgroup A than subgroup B. In aspirin users who suffered from upper gastrointestinal bleeding, the frequency of the TT genotype of rs2238631 and TT genotype of rs2243100 was higher than in those without upper gastrointestinal bleeding.　

Peptic ulcer history, dual anti-platelet medication, H. pylori current infection, and male gender were possible clinical risk factors for aspirin-induced gastric mucosal injury. GG genotype of rs2243086 and AA genotype of rs1330344 were possible genetic risk factors. TT genotype of rs2238631 and TT genotype of rs2243100 may be risk factors for upper gastrointestinal bleeding in aspirin users.

It is important to achieve the definitive pathogen identification in hospital-acquired pneumonia (HAP), but the traditional culture results always delay the target antibiotic therapy. We assessed the method called quantitative loop-mediated isothermal amplification (qLAMP) as a new implement for steering of the antibiotic decision-making in HAP.　

Totally, 76 respiratory tract aspiration samples were prospectively collected from 60 HAP patients. DNA was isolated from these samples. Specific DNA fragments for identifying 11 pneumonia-related bacteria were amplified by qLAMP assay. Culture results of these patients were compared with the qLAMP results. Clinical data and treatment strategies were analyzed to evaluate the effects of qLAMP results on clinical data. McNemar test and Fisher’s exact test were used for statistical analysis.　

The detection of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Stenotrophomonas maltophilia, Streptococcus pneumonia, and Acinetobacter baumannii by qLAMP was consistent with sputum culture (P > 0.05). The qLAMP results of 4 samples for Haemophilus influenzae, Legionella pneumophila, or Mycoplasma pneumonia (MP) were inconsistent with culture results; however, clinical data revealed that the qLAMP results were all reliable except 1 MP positive sample due to the lack of specific species identified in the final diagnosis. The improvement of clinical condition was more significant (P < 0.001) in patients with pathogen target-driven therapy based on qLAMP results than those with empirical therapy.　

qLAMP is a more promising method for detection of pathogens in an early, rapid, sensitive, and specific manner than culture.

Smoking and body mass index (BMI) are the key risk factors for chronic obstructive pulmonary disease (COPD). Adiponectin with both anti-inflammatory and pro-inflammatory properties is a vital modulator of inflammatory processes, which is expressed in epithelial cells in the airway in COPD-emphysema. The aim of this study was to examine the effects of adiponectin on tobacco smoke-induced emphysema in rats, which were fed different diets.　

Seventy-six adult (6–8 weeks old) male Sprague-Dawley rats (average weight 220 ± 20 g) were exposed to smoke or smoke-free room atmosphere and fed different diets (regular, high-fat, or low-fat diets) for 6 months. The rats were randomly divided into six groups. They are nonsmoke-exposed regular diet (n = 10), nonsmoke-exposed high-fat diet (n = 14), nonsmoke-exposed low-fat diet (n = 14), smoke-exposed regular diet (n = 10), smoke-exposed high-fat diet (n = 14), and smoke-exposed low-fat diet groups (n = 14). A full 2³ factorial design was used to evaluate the effect of independent variables on smoke exposure and different rearing methods. Serum adiponectin and inflammatory cytokines were measured by the enzyme-linked immunosorbent assay (ELISA).　

Serum adiponectin levels in rats fed low-fat and regular diets exposed to smoke exposure were remarkably higher than that of rats exposed to room air while serum adiponectin levels of fat-rich diet rats exposed to tobacco smoke were lower than that of rats exposed to room air. Compared with regular diet or low-fat diet group, serum adiponectin levels in high-fat diet rats exposed to tobacco smoke were lower (t = 6.932, 11.026; all P < 0.001). BMI was inversely correlated with serum adiponectin levels (r = −0.751, P = 0.012). Serum interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and 4-hydroxy 2-nonenal (HNE) levels in rats exposed to low-fat or fat-rich diets were remarkably higher than that of rats exposed to normal diets (IL-6, t = 4.196, 3.480; P < 0.01, P = 0.001; TNF-α, t = 4.286, 3.521; P < 0.01, P = 0.001; 4-HNE, t = 4.298, 4.316; all P < 0.001). In nonhigh-fat diet rats exposed to tobacco smoke, serum adiponectin levels correlated positively with serum IL-6, TNF-α, and 4-HNE, bronchoalveolar lavage cell count, and mean linear intercept. In contrast, in high-fat diet rats, serum adiponectin levels correlated inversely with these parameters.　

In smoke-induced emphysema and fat-rich diet rat model, serum adiponectin level was decreased, and the anti-inflammatory effect was attenuated. By contrast, nonhigh-fat diet elevated serum adiponectin and enhanced the role of pro-inflammatory.

This paper aimed to review the current literature on the surface modification of intraocular lenses (IOLs).　

All articles about surface modification of IOLs published up to 2015 were identified through a literature search on both PubMed and ScienceDirect.　

The articles on the surface modification of IOLs were included, but those on design modification and surface coating were excluded.　

Technology of surface modification included plasma, ion beam, layer-by-layer self-assembly, ultraviolet radiation, and ozone. The main molecules introduced into IOLs surface were poly (ethylene glycol), polyhedral oligomeric silsesquioxane, 2-methacryloyloxyethyl phosphorylcholine, TiO₂, heparin, F-heparin, titanium, titanium nitride, vinyl pyrrolidone, and inhibitors of cytokines. The surface modification either resulted in a more hydrophobic lens, a more hydrophilic lens, or a lens with a hydrophilic anterior and hydrophobic posterior surface. Advances in research regarding surface modification of IOLs had led to a better biocompatibility in both in vitro and animal experiments.　

The surface modification is an efficient, convenient, economic and promising method to improve the biocompatibility of IOLs.

心血管疾病（CVD）是全世界死亡的主要原因，并且对发病率有很大贡献。^[1,2,3]根本原因是动脉粥样硬化。^[4]开发新的预防疗法是控制CVD流行的步骤之一。越来越多的人要求在使用心血管（CV）发病率和死亡率（M和M）作为主要结局的试验中评估有前途的疗法。^[5]然而，M和M试验非常昂贵，通常是多中心研究，需要数千名参与者，并且随访期很长。人们对可用作CV M和M的有效替代或替代的替代终点非常感兴趣。替代终点（替代终点）允许在更短的时间内、更少的参与者、更低的成本和更短的试验结果可用时间内评估随机对照试验中的新疗法。这些研究可能显示对动脉粥样硬化进展的直接影响，同时可能用于指导或排除后续的大型M和M试验。动脉粥样硬化的测量直观地是CVD事件的合适替代终点，因为动脉粥样硬化是暴露于风险因素和大多数CV事件之间的疾病。动脉粥样硬化可以使用不同的成像技术从疾病过程的早期到晚期进行无创评估。^[6,7,8,9]

中心静脉导管（CVCs）通常用于获得各种临床适应症的血管通路。这些包括给药、肾脏替代治疗、全胃肠外营养、外周静脉通路不良、心导管插入术和经静脉心脏起搏。^[1]中心静脉通路包括将大口径导管插入颈部的颈内静脉、锁骨下静脉或股静脉以及上胸部或腹股沟（股）区域。^[1]CVCs的首选静脉是右颈内静脉（IJV），因为它直达右心，静脉狭窄和血栓形成的风险最低。^[2,3,4]成功的导管放置不仅需要技术专长，还需要对潜在并发症的认识。^[5]导管错位是相对常见的并发症（5.01%），导致导管功能障碍。^[6,7]上腔静脉（SVC）错位可导致腔或右心房穿孔，并伴有严重的后遗症。^[4,5]多篇文献以孤立的病例报告或小丛书的形式出现，查阅起来繁琐或费时，并不能为问题提供务实的指导或解决方案。本文概述了与CVCs相关的中心静脉的正常和异常解剖，主要针对IJV，类似的优势适用于所有部位。此外，它提出了错位的图解案例，并讨论了实际的管理问题，避免错位和随后的并发症。

肠重复囊肿是一种非常罕见的先天性异常，症状包括腹痛、腹胀、肠出血和便血。便血可由胃粘膜异位引起，尽管婴儿便血还有其他原因；因此，肠重复囊肿可能被误诊为肠套叠或梅克尔憩室。本文报告一例被误诊为梅克尔憩室的肠重复囊肿。

埃博拉病毒病(EVD)是由埃博拉属病毒种引起的急性出血性传染病E.病毒EVD可出现腹痛、呕吐、腹泻等胃肠道症状。该病致死率为30%~90%。^[1,2]据报道，E.病毒通过接触受感染的人或动物的体液或分泌物传播给人类指示病例。2014年3月21日，世卫组织正式通报几内亚爆发EVD疫情。^[3]截至2014年7月2日，几内亚卫生部在5个省和首都科纳克里累计报告了412例EVD临床病例和305例死亡病例。^[4]

冠状动脉计算机断层血管造影（CCTA）作为一种评估冠状动脉解剖结构的无创诊断技术，在临床上得到了广泛的应用。其优点包括对冠状动脉病变的存在和病变特征的诊断具有高敏感性和特异性，扫描时间短，患者辐射暴露低，患者可接受。CCTA诊断冠状动脉病变的敏感性和特异性在患者水平为83%~100%和70%~80%，在血管水平为83%~97%和93%~100%。对于大多数候选人来说，它可以在门诊进行。在患者量大的医院和大多数县医院，甚至更多的多层计算机断层扫描仪用于冠状动脉疾病（CAD）的筛查，但在CCTA之前没有用于CAD功能评估的压力测试设备。与其他成熟的非侵入性应激技术（包括应激运动心电图（ECG）、单光子发射计算机断层扫描（SPECT）和应激心脏超声心动图）相比，CCTA在治疗疑似CAD症状患者方面的规则在不同患者人群中仍未得到很好的研究。对典型、稳定或非典型心绞痛患者的评估通常遵循指南和基于临床研究证据的既定逐步方法。^[1,2,3]冠心病治疗的第一步包括仔细询问病史、基本体格检查、常规心电图和危险因素评估，以确定冠心病的可能性。根据危险因素，将患者分为低、中和高预测试似然概率亚组，并参考进一步的非侵入性和侵入性评估方法。最常用的负荷心电图结果为阳性的患者只有41%的可能患有有创冠状动脉造影定义的阻塞性冠心病。^[4]这就是为什么与CCTA相比，压力测试在初始测试中较少被提及。一些运动心电图结果不可解释。

致编者：伴有下丘脑功能障碍、通气不足和自主神经失调（ROHHAD）综合征的急发性肥胖是一种罕见疾病。它在儿童期（通常在3-4岁）被诊断出来。它影响内分泌、呼吸和自主神经系统。在不同的年龄表现出不同的症状。可见体重快速增加、肥胖、肺泡通气不足、高钠血症、心肺骤停、高催乳素血症、尿崩症、出汗过多、痛觉增加、阻塞性睡眠呼吸暂停、手/脚冰冷和消化运动障碍。肺泡通气不足对诊断至关重要。^[1]行为问题、智力迟钝、性格改变和情绪障碍可能随之而来。没有任何特殊的诊断测试。它的治疗是对症的。^[2]本研究旨在告知临床医生一名患有ROHHAD综合征的女孩的精神症状。

致编辑：伊拉克几个城市白血病发病率的上升与接触贫化铀有关，贫化铀在随后的1990年至2010年伊拉克战争中被使用。^[1,2,3,4]在这里，我们调查了苏莱曼尼亚省（SG）的白血病发病率，该省与伊拉克其他地区一样遭受战争和危机。^[5]据我们所知，这项研究是第一项基于人群的SG白血病研究。

致编者：一名29岁的女性在一次交通事故中作为乘客遭受腹部钝性创伤后1小时因便血被救护车送往急诊科。患者还患有克罗恩病（CD），到达时主诉腹痛和持续便血。体检时，她脸色苍白，心疼，收缩压90 mmHg，心率126次/分钟。血液常规检查显示血红蛋白水平为86克/升。她的收缩压最初对1.0 L静脉晶体激发有反应，但在30分钟内降至70 mmHg，与每个直肠失血进一步大量亮红色一致。便血也增加（可能是新鲜血液），血红蛋白水平降至68 g/L。患者接受了腹部计算机断层扫描（CT）和静脉注射造影剂。CT扫描显示横结肠有可疑的壁缺损，以及游离空气密度和结肠周围脂肪浸润[图1a].此外，横结肠中活动性出血和粘膜强化增加的存在是显著的[图1b].回肠末端弥漫性壁增厚和狭窄，以及整个结肠的轻度壁增厚（CD的典型特征）。因此，患者被转到外科，接受了腹腔镜全结肠切除术和回肠造口术。术后恢复良好，30天后患者出院回家。

致编者：拉斯姆森脑炎（RE）是一种罕见但具有破坏性的单半球脑疾病，通常影响儿童，以顽固性癫痫发作和进行性神经功能缺损为特征。^[1]RE的特征性磁共振成像（MRI）发现是进行性单半球局灶性皮质萎缩。双侧RE非常罕见。在此，我们报告一位面臂肌张力障碍发作和双侧脑萎缩但无癫痫发作的RE患者。

致编者：一名32岁男性因右肾肿瘤在年度体检中被转诊至郑州大学第一附属医院。半年多前发现血压偏高，入院时为138/102mmHg。他没有高血压家族史。他的血清钾水平正常。我们没能检测他的血浆肾素活性。

致编辑：谢等人分析了华法林治疗阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者肺栓塞（PE）的剂量及其不良反应。主要发现是OSAHS患者比非OSAHS患者需要显著更高剂量的华法林（4.73 mg对3.61 mg，P<0.001），停用华法林后OSAHS组PE复发率高于非OSAHS组（21.43%对6.78%，P=0.047).他们得出结论，OSAHS患者在停止6个月华法林治疗后可能出现高凝状态和相对较高的PE复发风险。我们饶有兴趣地阅读了这篇文章。^[1]

感谢您的阅读和对我们最近出版物的宝贵评论。^[1]主要关注的是OSAHS是否是PE的独立危险因素，或者只是其他可能导致血栓性病变的疾病的伴随物，如糖尿病、高血压、吸烟、肥胖等。实际上OSAHS和PE之间的独立关系已经被揭示，^[2,3,4]虽然病理生理机制远未确定。至于重复PE，目前还没有关于其与OSAHS相关性的文献。由于复发性PE的病例有限，目前的研究无法得出OSAHS的独立预后价值（n=10），因此在Cox比例风险模型中调整上述信中提到的作为混杂变量的传统风险因素在统计上是不合理的。鉴于OSAHS的高患病率以及与PE相关的高发病率和死亡率，有必要进行大规模研究。