Volume 129 · Issue 03 · 2016

It is often challenging to distinguish tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE); thoracoscopy is among the techniques with the highest diagnostic ability in this regard. However, such invasive examinations cannot be performed on the elderly, or on those in poor physical condition. The aim of this study was to explore the differential diagnostic value of carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and squamous cell carcinoma (SCC) associated antigen in patients with TPE and MPE.　

Using electrochemiluminescence, we measured the concentration of tumor markers (TMs) in the pleural effusion and serum of patients with TPE (n = 35) and MPE (n = 95). We used receiver operating characteristic (ROC) curve analysis to evaluate the TMs and differentiate between TPE and MPE.　

The cut-off values for each TM in serum were: CA125, 151.55 U/ml; CA199, 9.88 U/ml; CEA, 3.50 ng/ml; NSE, 13.27 ng/ml; and SCC, 0.85 ng/ml. Those in pleural fluid were: CA125, 644.30 U/ml; CA199, 12.08 U/ml; CEA, 3.35 ng/ml; NSE, 9.71 ng/ml; and SCC, 1.35 ng/ml. The cut-off values for the ratio of pleural fluid concentration to serum concentration (P/S ratio) of each TM were: CA125, 5.93; CA199, 0.80; CEA, 1.47; NSE, 0.76; and SCC, 0.90. The P/S ratio showed the highest specificity in the case of CEA (97.14%). ROC curve analysis revealed that, for all TMs, the area under the curve in pleural fluid (0.95) was significantly different from that in serum (0.85; P < 0.001).　

TMs in TPE differ significantly from those in MPE, especially when detected in pleural fluid. The combined detection of TMs can improve diagnostic sensitivity.

Cardiovascular diseases, including dilated cardiomyopathy (DCM) and hypertension, are the leading cause of death worldwide. The role of mitochondrial DNA (mtDNA) in the pathogenesis of these diseases has not been completely clarified. In this study, we evaluate whether A8701G mutation is associated with maternally inherited hypertension and DCM in a Chinese pedigree of a consanguineous marriage.　

Fourteen subjects in a three-generation Han Chinese family with hypertension and DCM, in which consanguineous marriage was present in the parental generation, were interviewed. We divided all the family members into case (7 maternal members) and control group (7 nonmaternal members) for comparison. Clinical evaluations and sequence analysis of mtDNA were obtained from all participants. Frequency differences between maternal and nonmaternal members were tested to locate the disease-associated mutations.　

The majority of the family members presented with a maternal inheritance of hypertension and DCM. Sequence analysis of mtDNA in this pedigree identified eight mtDNA mutations. Among the mutations identified, there was only one significant mutation: A8701G (P = 0.005), which is a homoplasmic mitochondrial missense mutation in all the matrilineal relatives. There was no clear evidence for any synergistic effects between A8701G and other mutations.　

A8701G mutation may act as an inherited risk factor for the matrilineal transmission of hypertension and DCM in conjunction with genetic disorders caused by consanguineous marriage.

Rheumatic diseases involve multiple organs that are affected by immunological mechanisms. Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection. Cytomegalovirus (CMV) is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients. This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.　

Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated. GraphPad Prism version 5.013 (San Diego, CA, USA) was used to conduct statistical analysis. The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test. Significance between qualitative data was analyzed using Pearson’s Chi-squared test. The cut-off thresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic (ROC) curve analysis.　

One hundred and forty-two patients had positive CMV viral load tests. Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic. The symptomatic group received higher doses of prednisolone (PSL) and more frequently immunosuppressants than the asymptomatic group (P < 0.01). The symptomatic group had lower lymphocyte counts, especially CD⁴⁺ T-cells, than the asymptomatic group (P < 0.01). By ROC curve analysis, when CD⁴⁺ T-cell count was <0.39 × 10⁹/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection. The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients (P < 0.01; threshold viral loads: 1.75 × 10⁴ copies/ml). Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts (P < 0.01), including CD4⁺ and CD⁸⁺ T-cells (P < 0.01).　

When CD⁴⁺ T-cell count is <0.39 × 10⁹/L, patients are at high risk for pulmonary CMV infection. Patients are prone to be symptomatic with CMV-DNA load >1.75 × 10⁴ copies/ml. Lymphopenia (especially CD⁴⁺ T-cells), presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.

The efficacy and safety evidence of bortezomib in multiple myeloma (MM) patients with hepatitis B is vacant. This study aimed to investigate the efficacy and safety of bortezomib in MM patients with hepatitis B in China.　

From 2006 to 2011, 739 newly diagnosed MM patients were screened for serum hepatitis B virus (HBV) biomarkers. HBV-infected patients were followed for HBV reactivation by monitoring of serum alanine transaminase (ALT) and HBV DNA load. The pattern of HBV reactivation in relation to bortezomib was evaluated. Seven hundred thirty-nine MM patients were included in this study.　

The prevalence of MM patients infected with HBV was 3.4% (n = 25), of which 17 cases were treated with bortezomib. Bortezomib had no significant influence on liver function (ALT before and after treatment: 36.69 ± 8.90 U/L vs. 11.31 ± 2.74 U/L, P = 0.19) and HBV DNA of MM patients with HBV (detectable HBV DNA percentage: 5.9% vs. 11.8%, P = 0.12).　

Bortezomib can be used safely and effectively in MM patients with hepatitis B. HBV prophylaxis and surveillance are recommended during the MM treatment.

This study aimed to observe the differences in brain gray matter volume in drug-naive female patients after the first episode of major depression with and without stressful life events (SLEs) before the onset of depression.　

Forty-three drug-naive female patients voluntarily participated in the present study after the first major depressive episode. The life event scale was used to evaluate the severity of the impact of SLEs during 6 months before the onset of the major depressive episode. High-field magnetic resonance imaging (MRI) scans were obtained, and the VBM and SPM8 software process were used to process and analyze the MRI.　

Compared to that in patients without SLEs, the volume of brain gray matter was lower in the bilateral temporal lobe, right occipital lobe, and right limbic lobe in the SLE group. However, the gray matter volume did not differ significantly between the two groups after the application of false discovery rate (FDR) correction.　

Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.

Volumetric-modulated arc therapy (VMAT) can only be implemented on the new generation linacs such as the Varian Trilogy^® and Elekta Synergy^®. This prevents most existing linacs from delivering VMAT. The purpose of this study was to investigate the feasibility of using a conventional linear accelerator delivering constant dose rate and constant angular spacing intensity-modulated arc therapy (CDR-CAS-IMAT) for treating cervical cancer.　

Twenty patients with cervical cancer previously treated with intensity-modulated radiation therapy (IMRT) using Varian Clinical 23EX were retreated using CDR-CAS-IMAT. The planning target volume (PTV) was set as 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), target volume conformity index (CI), the dose to organs at risk, radiation delivery time, and monitor units (MUs) were also compared. The paired t-test was used to analyze the two data sets. All statistical analyses were performed using SPSS 19.0 software.　

Compared to the IMRT group, the CDR-CAS-IMAT group showed better PTV CI (0.85 ± 0.03 vs. 0.81 ± 0.03, P = 0.001), clinical target volume CI (0.46 ± 0.05 vs. 0.43 ± 0.05, P = 0.001), HI (0.09±0.02 vs. 0.11 ± 0.02, P = 0.005) and D95 (5196.33 ± 28.24 cGy vs. 5162.63 ± 31.12 cGy, P = 0.000), and cord D2 (3743.8 ± 118.7 cGy vs. 3806.2 ± 98.7 cGy, P = 0.017) and rectum V40 (41.9 ± 6.1% vs. 44.2 ± 4.8%, P = 0.026). Treatment time (422.7 ± 46.7 s vs. 84.6 ± 7.8 s, P = 0.000) and the total plan Mus (927.4 ± 79.1 vs. 787.5 ± 78.5, P = 0.000) decreased by a factor of 0.8 and 0.15, respectively. The IMRT group plans were superior to the CDR-CAS-IMAT group plans considering decreasing bladder V50 (17.4 ± 4.5% vs. 16.6 ± 4.2%, P = 0.049), bowel V30 (39.6 ± 6.5% vs. 36.6 ± 7.5%, P = 0.008), and low-dose irradiation volume; there were no significant differences in other statistical indexes.　

Patients with cervical cancer treated with CDR-CAS-IMAT using Varian Clinical 23EX can get equivalent or superior dose distribution compared to those treated with IMRT. CDR-CAS-IMAT has a less treatment time and MU, which can reduce the uncertainty factor and patient discomfort in treatment.

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) is more complex than the normal hip, with large replacement risks and many complications. Although nonosteotomy THA is convenient to perform, femoral osteotomy shortening can avoid blood vessel and nerve traction injuries. This study aimed to compare osteotomy THA with nonosteotomy to determine reasonable options for operative management of DDH.　

Data on 48 DDH patients who underwent THA were analyzed retrospectively. The patients were divided into two groups: Group A 29 cases (nonosteotomy), and group B 19 cases (osteotomy). Harris and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, limb length discrepancy (LLD), radiological data on the hip, and claudication were evaluated. Data were analyzed by using paired-sample Student’s t-test, independent-sample Student’s t-test, and Pearson’s Chi-square test; the test level was α=0.05.　

Postoperative Harris (90.7 ± 5.1) and WOMAC scores (88.0 ± 10.6) were significantly improved compared with preoperative Harris (44.8 ± 5.7) and WOMAC scores (42.0 ± 5.3) in group A (P < 0.05). Postoperative Harris (90.4 ± 2.8) and WOMAC scores (88.2 ± 5.9) were significantly improved compared with preoperative Harris (44.4 ± 4.2) and WOMAC scores (43.2 ± 4.3) in group B (P < 0.05). One case of dislocation occurred in group A; after closed reduction, dislocation did not recur. In group A, 2 patients developed cutaneous branch injury of the femoral nerve, which spontaneously recovered without treatment. Postoperative LLD >2 cm was seen in one case in group A and five cases in group B. Postoperative claudication showed no significant difference between the two groups (P > 0.05). No patients developed infection; postoperative X-rays showed that the location of the prosthesis was satisfactory, and the surrounding bone was not dissolved.　

THA is effective and safe for DDH. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions, THA without femoral osteotomy may be considered.

Atopic dermatitis (AD) is characterized by defective skin barrier and imbalance in T helper 1/T helper 2 (Th1/Th2) cytokine expression. Filaggrin (FLG) is the key protein to maintaining skin barrier function. Recent studies indicated that Th1/Th2 cytokines influence FLG expression in keratinocytes. However, the role of Th1/Th2 cytokines on FLG processing is not substantially documented. Our aim was to investigate the impact of Th1/Th2 cytokines on FLG processing.　

HaCaT cells and normal human keratinocytes were cultured in low and high calcium media and stimulated by either interleukin (IL)-4, 13 or interferon-γ (IFN-γ). FLG, its major processing proteases and key protease inhibitor lymphoepithelial Kazal-type-related inhibitor (LEKTI) were measured by both real-time quantitative polymerase chain reaction and Western blotting. Their expression was also evaluated in acute and chronic AD lesions by immunohistochemistry.　

IL-4/13 significantly reduced, while IFN-γ significantly up-regulated FLG expression. IL-4/13 significantly increased, whereas IFN-γ significantly decreased the expression of kallikreins 5 and 7, matriptase and channel-activating serine protease 1. On the contrary, IL-4/13 significantly decreased, while IFN-γ increased the expression of LEKTI and caspase-14. Similar trends were observed in AD lesions.　

Our results suggested that Th1/Th2 cytokines differentially regulated the expression of major FLG processing enzymes. The imbalance between Th1 and Th2 polarized immune response seems to extend to FLG homeostasis, through the network of FLG processing enzymes.

The prevalence of hepatitis B virus (HBV) infection is high among individuals infected with human immunodeficiency virus (HIV) in China. Both HIV and HBV can be treated with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC), so we evaluated the safety and efficacy of combination antiretroviral therapy (ART) that included TDF, 3TC, and efavirenz (EFV) among ART-naive individuals who were co-infected with HIV and HBV.　

One hundred HIV/HBV co-infected ARV-naive individuals were started on the regimen of TDF, 3TC, and EFV, and the levels of plasma HBV DNA, HIV RNA, and biochemical evaluation related to the function of liver and kidney were analyzed.　

Concerning efficacy, this study found that by week 48, the vast majority co-infected participants receiving this ART regimen had undetectable HBV DNA levels (71%) and/or HIV RNA levels (90%). Concerning safety, this study found that the median estimated glomerular filtration rate of participants decreased from baseline (109 ml∙min⁻¹∙1.73 m⁻²) to week 12 (104 ml∙min⁻¹∙1.73 m⁻²) but was almost back to baseline at week 48 (111 ml∙min⁻¹∙1.73 m⁻²).　

This combination ART regimen is safe and effective for patients with HIV/HBV co-infection.　

ClinicalTrials.gov, NCT01751555; https://clinicaltrials.gov/ct2/show/NCT01751555.

Lower extremity bursae are very vulnerable to injury during strenuous physical exercises. Understanding the imaging characteristics of normal bursae is essential for early diagnosis of morphological abnormalities. Therefore, we evaluated the normal range of lower extremity bursae in healthy young men using high-resolution ultrasound (HR-US) imaging.　

Bursae in the lower extremities were examined by HR-US in 290 Chinese healthy young men with a median age of 18 years (range, 18–23 years). The bilateral suprapatellar bursa (SPB), deep infrapatellar bursa (DIPB), popliteal bursa (PB), and retrocalcaneal bursa (RCB) were imaged and measured for analysis.　

The HR-US identification rates of the SPB, DIPB, PB, and RCB were 89.0% (517/580), 55.0% (319/580), 29.4% (171/580), and 49.5% (287/580), respectively. With the assumption that the bursae were normal in 95% of the study participants, the length and width values at the maximal cross-section of the SPB, DIPB, PB, and RCB were ≤18.00 and 6.09 mm, 8.10 and 2.11 mm, 7.67 and 3.93 mm, and 7.82 and 2.04 mm, respectively.　

Using HR-US imaging, we were able to analyze lower extremity bursae with high detection rates in healthy young men. The normal ranges of lower extremity bursa dimensions in healthy young men measured by HR-US in this study could be used as reference values for evaluation of bursa abnormalities in the lower extremity.

Thalidomide is an immunomodulatory and anti-angiogenic drug that has shown promise in patients with myeloma. Trials comparing efficacy of standard melphalan and prednisone (MP) therapy with MP plus thalidomide (MPT) in transplant-ineligible or elderly patients with multiple myeloma (MM) have provided conflicting evidence. This meta-analysis aimed to determine the efficacy and toxicity of thalidomide in previously untreated elderly patients with myeloma.　

Medline, the Cochrane Controlled Trials register, conference proceedings of the American Society of Hematology (1995–2014), the American Society of Clinical Oncology (1995–2014), and CBM, VIP, and CNKI databases were searched for randomized control trials with the use of the medical subject headings "MM" and "thalidomide". Trials were assessed by two reviewers for eligibility. Meta-analysis was conducted using a fixed effects model. Sensitivity analysis was performed to test the robustness of the findings.　

Overall, seven trials were identified, covering a total of 1821 subjects. The summary hazard ratio (thalidomide vs. control) was 0.82 (95% confidence interval [CI]: 0.72–0.94) for overall survival (OS), and 0.65 (95% CI: 0.58–0.73) for progression-free survival, in favor of thalidomide treated group. The risk ratio of complete response with induction thalidomide was 3.48 (95% CI: 2.24–5.41). A higher rate of III/IV adverse events were observed in MPT arm compared with the MP arm. However, analysis of sub-groups administering anticoagulation as venous thromboembolism prophylaxis suggested no difference in relative risk of thrombotic events between two arms (RR = 1.47, 95% CI: 0.43–5.07, P = 0.54). Further analysis of trials on the treatment effects of MPT versus MP on adverse events-related mortality showed no statistical difference between two arms (RR = 1.24, 95% CI: [0.95–1.63], P = 0.120).　

Thalidomide appears to improve the OS of elderly and/or transplant-ineligible patients with MM when it is added to standard MP therapy.

It is revealed that circulating fibrocytes are elevated in patients/animals with cardiac fibrosis, and this review aims to provide an introduction to circulating fibrocytes and their role in cardiac fibrosis.　

This review is based on the data from 1994 to present obtained from PubMed. The search terms were "circulating fibrocytes" and "cardiac fibrosis" .　

Articles and critical reviews, which are related to circulating fibrocytes and cardiac fibrosis, were selected.　

Circulating fibrocytes, which are derived from hematopoietic stem cells, represent a subset of peripheral blood mononuclear cells exhibiting mixed morphological and molecular characteristics of hematopoietic and mesenchymal cells (CD34⁺/CD45⁺/collagen I⁺). They can produce extracellular matrix and many cytokines. It is shown that circulating fibrocytes participate in many fibrotic diseases, including cardiac fibrosis. Evidence accumulated in recent years shows that aging individuals and patients with hypertension, heart failure, coronary heart disease, and atrial fibrillation have more circulating fibrocytes in peripheral blood and/or heart tissue, and this elevation of circulating fibrocytes is correlated with the degree of fibrosis in the hearts.　

Circulating fibrocytes are effector cells in cardiac fibrosis.

To guide the optimal selection among first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in clinical practice. This review attempted to provide a thorough comparison among three first-generation EGFR-TKIs, namely icotinib, erlotinib, and gefitinib, with regard to their molecular structure, pharmacokinetic parameters, clinical data, adverse reactions, and contraindications.

An electronic literature search of the PubMed database and Google Scholar for all the available articles regarding gefitinib, icotinib, and erlotinib in the English language from January 2005 to December 2014 was used.

The search terms or keywords included but not limited to "lung cancer", "nonsmall cell lung cancer (NSCLC)", "epidemiology", "EGFR", "TKIs", and "optimal selection".

As suggested by this review, even though the three first-generation EGFR-TKIs share the quinazoline structure, erlotinib had the strongest apoptosis induction activity because of its use of a different side-chain. The pharmacokinetic parameters indicated that both erlotinib and icotinib are affected by food. The therapeutic window of erlotinib is narrow, and the recommended dosage is close to the maximum tolerable dosage. Icotinib enjoys a wider therapeutic window, and its concentration in the blood is within a safe dosage range even if it is administered with food. Based on multiple large-scale clinical trials, erlotinib is universally applied as the first-line treatment. In marked contrast, icotinib is available only in China as the second- or third-line therapeutic approach for treating advanced lung cancer. In addition, it exhibits a similar efficacy but better safety profile than gefitinib.

Although there is a paucity of literature regarding whether icotinib is superior to erlotinib, its superior toxicity profile, noninferior efficacy, and lower cost indicate that it is a better alternative for Chinese patients living with advanced NSCLC.

The purpose of this review is to discuss some critical issues of isoflavones protective against the development of prostate cancer (PCa).　

Data cited in this review were obtained primarily from PubMed and Embase from 1975 to 2015.　

Articles were selected with the search terms "isoflavone", "Phytoestrogen", "soy", "genistin", and "PCa" .　

Isoflavones do not play an important role on prostate-specific antigen levels reduction in PCa patients or healthy men. The effect of isoflavones on sex hormone levels and PCa risk may be determined by equol converting bacteria in the intestine, specific polymorphic variation and concentrations of isoflavones. The intake of various types of phytoestrogens with lower concentrations in the daily diet may produce synergistic effects against PCa. Moreover, prostate tissue may concentrate isoflavones to potentially anti-carcinogenic levels. In addition, it is noteworthy that isoflavones may act as an agonist in PCa.　

Isoflavones play a protective role against the development of PCa. However, careful consideration should be given when isoflavones are used in the prevention and treatment of PCa.

计算机断层扫描（CT）自发明并用于临床或研究以来，目前广泛应用于诊断、分期、评估疾病对治疗的反应，具有更清晰的图像质量和更短的扫描时间。有许多疾病在早期不容易被发现，症状明显，不知不觉地将感染传播给他人，很容易被遗漏。当临床症状出现时，疾病可能已处于晚期，其治疗效果和预后将明显变差。CT可用于无症状人群的筛查和个体健康评估（IHA），提高疾病的检出率，实现疾病的早诊早治，从而提高患者的生存率。尽管防护措施在不断改进，但CT扫描过程中辐射的产生是不可避免的。在受检者接受的辐射剂量中，CT检查作为辐射源的比例越来越大。如何在无症状人群中合理使用CT进行IHA，降低CT的辐射剂量已成为研究热点。2014年，WHO在德国慕尼黑召开了“CT在无症状人群IHA中的合理应用”国际峰会，并达成共识。目前，欧美国家对肺癌、结直肠癌和冠心病无症状人群使用CT进行IHA的研究较多，并建立了相关策略。本文总结和分析了中国无症状人群CT的应用和相关的辐射剂量减少。

哈特曾在《公司治理：一些理论与启示》一书中提出，在委托代理关系中，如果委托人和代理人之间存在利益冲突，没有完全契约的支持，就会出现治理问题。^[1]从治理问题发展而来的治理理论认为，有效的制度安排可以避免或减少这些问题的发生，迫使代理人实现委托人利益最大化。^[2]

肩袖损伤在所有运动中都很常见。在所有肩袖损伤中，冈上肌腱受累最多。严重冈上肌腱损伤可能影响患者的生活质量。然而，冈上肌腱损伤在某些情况下可能相对无症状，可能需要超声检查进行诊断。^[1,2]随着肩关节镜技术的不断进步，冈上肌腱损伤的手术治疗变得更加有效和侵入性更小。^[3]因此，越来越需要对冈上肌腱损伤的严重程度和位置进行准确的形态学和动态表征，以指导治疗。^[4]

虽然子宫腺肌病在很大程度上是一种良性疾病，但在极少数情况下确实会发生恶变，导致子宫肌层中的子宫内膜样腺癌或肉瘤。近年来，子宫内膜异位症的恶变已成为人们关注的焦点。1988年由LaGrenade和Silverberg首次提出非典型子宫内膜异位症（aEM）的概念，^[1]世卫组织认为aEM可能是子宫内膜异位症恶变的前兆。然而，aEM的大多数研究集中在子宫内膜异位症，而子宫腺肌病仍未得到充分研究。本文报告10例子宫腺肌病不典型腺体增生转化，观察其临床及病理特点。

脾动脉瘤，无明显症状，一旦破裂为失血性休克，直接威胁患者生命。影像学检查一直是脾动脉瘤的主要诊断方法，包括超声、计算机断层扫描（CT）、磁共振成像、数字减影血管造影（DSA）等。虽然各种检查方法各有优缺点，但腹部CT检查是临床上应用最全面的方法。本研究提供了来自相对大量患者的脾动脉瘤CT检查的代表性图像。

致编者：哌替啶，也称为哌替啶，是最常用的阿片类镇痛药之一。哌替啶通过产生阿片受体(μ-受体)的长期激活而发挥高度的中枢神经系统抑制作用。我们描述了一例罕见的全身性强直阵挛性癫痫发作病例，患者在静脉（IV）注射哌替啶用于支气管镜术前用药后，患有肺部病变，且既往无癫痫发作史。

致编者：一名46岁男性入院主诉胸闷、气短、呼吸困难4天。4天前，他酒后胸痛，感觉气短、呼吸困难。休息后他感觉好多了，但症状仍然周期性地复发。盗汗、低热，最高体温37.6℃。患者否认有任何其他不适，如心悸、咳嗽、咳痰、咯血或虚弱。胸片示纵隔轻度增宽。非增强计算机断层扫描（CT）显示：倒置位，前上纵隔右侧7.5 cm × 5.3 cm软组织肿块；右肺被压迫。进行了正电子发射断层扫描-CT，结果显示患者有全反位。另见前上纵隔右侧7.4 cm × 5.2 cm × 5.3 cm软组织肿块，边缘光滑，密度不均匀。固体部分的平均CT值为40 Hounsfield单位，氟脱氧葡萄糖摄取增加，最大标准摄取值为2.6[图1].患者除高血压外无阳性既往病史。患者吸烟指数1200（30年× 40/天），家族史阴性。体格检查（PE）显示胸腔和腹腔位置倒置。心电图和常规实验室检查也呈阴性。

致编者：表皮样囊肿，1807年由法国医学院的一位艺术家首次描述，^[1]是一种以复层上皮包膜和复层角蛋白碎片内容物为特征的先天性疾病。它约占所有颅内肿瘤的1%，通常位于桥小脑角、鞍旁区和第四脑室。非增强磁共振成像（MRI）上的脑脊液密度是其典型图像。然而，发生在不常见部位且MRI不典型的表皮样囊肿可能导致诊断困难。虽然不典型表皮样囊肿的放射学和病理学特征仍不清楚，但我们报告了一例位于大脑凸相并呈现非典型图像的表皮样囊肿。

致编辑：弗雷德里克·古德温（Frederick Goodwin）是双相情感障碍领域的一位有影响力的人物，他有一句名言：如果你不能，或者你不会使用锂，那就退出治疗双相情感障碍的行业吧！锂仍然是双相情感障碍的金标准治疗方法。但是，令人痛苦的是，尽管美国食品药品监督管理局批准了12岁及以上的儿童，但它在儿童/青少年精神病学中没有得到充分利用。近日，发现等人。^[1]在7-17岁的青少年双相情感障碍患者中进行了首次锂随机对照试验，其中锂优于安慰剂，耐受性良好，最重要的是，没有大多数非典型抗精神病药物固有的心脏代谢综合征，这些非典型抗精神病药物是目前大多数算法中最先进的治疗方式。在Kowatch的一项开放治疗研究中，锂也显示出1.06的大效应大小等人.^[2]盖勒等人.^[3]在一项为期6周的安慰剂对照双盲研究中，报告了在双相情感障碍和物质使用障碍青少年中抗躁狂疗效的积极作用。刘的荟萃分析等人.,^[4]许多开放标签试验证明平均疗效为40%。在我看来，锂作为青少年双相情感障碍的可行治疗选择已经失宠，原因有几个。众所周知，锂的治疗指数很窄，因此毒性是一个明确的风险，特别是在像这样气候炎热的国家，孩子们很容易脱水。我认为，根据英国国家处方集，每3个月密切监测血清水平，鉴于较高的代谢率和肾脏清除率导致半衰期为<在成人中18小时对24小时，并且锂也在汗液中排泄，所有这些在临床上都将转化为比成人对应物惊人地更高的剂量以实现治疗效果，并且表面上消除了对儿科人群毒性的过度担忧。另一个主要问题是害怕锂对儿童造成的精神迟钝，在这种情况下，反认知效应会对学业需求产生反作用。大量数据涌入神经科学文献，所有这些数据都汇聚在一起，证明了锂对认知的促进作用。这些包括，尤其是增加灰质体积，促进海马神经发生，增加N-乙酰天冬氨酸，神经元活力的推定标志物，增加脑源性嗜中性因子和抗凋亡Bcl-2，抑制促凋亡蛋白P53和β连环蛋白，以及抑制糖原合酶激酶-3 β。由于这些特性，锂已经被尝试用于主要的神经退行性疾病，如肌萎缩侧索硬化症，尽管它是徒劳的。

致编辑：一名4岁女孩有16个月的眉毛肿胀史。儿科医生和普通外科医生诊断她患有皮脂腺囊肿，由于两次手术引流和抗生素治疗均未成功，她被转诊到我们单位。经检查，在左眉毛上发现一个柔软、可自由移动、非压痛的皮下病变[图1].检查的其他发现并不显著，也没有类似病变的家族史。在我们推定诊断为皮样囊肿后，我们将其切除，术中视图显示为柔软的可移动囊性病变，纤维样壁充满油黄色液体，周围无软组织侵犯。组织病理学检查结果与脂肪囊肿一致[图1]，因此她被诊断为单纯性脂肪囊肿。在5年的随访中，没有复发或其他皮肤囊性病变发展的迹象。