Volume 129 · Issue 16 · 2016

2016年6月13日，美国国会根据有关中国器官移植的虚假陈述，通过了H.Res.343号法案，这表明中美在这一问题上存在严重的沟通和误判。在该法案之前和之后，有线新闻网和《纽约时报》进行了一系列歪曲的媒体报道。^[1,2]这是出于政治目的大胆罔顾事实、捏造证据的典型戴着有色眼镜妖魔化中国的行径。

The efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for immunoglobulin A nephropathy (IgAN) are unclear. This study was designed to evaluate the efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for IgAN.

It is a multicenter, prospective, double-dummy randomized controlled trial. Primary IgAN patients were recruited in 13 renal units across Beijing, China, from July 2010 to June 2012. After a 4-week telmisartan (80 mg/d) wash-in, 400 patients continuing on 80 mg/d telmisartan were randomly assigned to additionally receive placebo (Group A), 50 mg/d clopidogrel (Group B), 20 mg/d leflunomide (Group C), or 50 mg/d clopidogrel and 20 mg/d leflunomide (Group D). The 24-week intervention was completed by 360 patients. The primary endpoint was change in 24-h proteinuria at 24 weeks. A linear mixed-effect model was used to analyze the changes at 4, 12, and 24 weeks. Generalized estimating equations were used to evaluate changes in hematuria grade. This trial was registered at the Chinese Clinical Trial Registry.

The effects of telmisartan combined with leflunomide on changes in proteinuria (0.36 [95% confidence interval (CI) 0.18–0.55] g/d, P < 0.001), in serum uric acid (76.96 [95% CI 57.44–96.49] µmol/L, P < 0.001), in serum creatinine (9.49 [95% CI 6.54–12.44] µmol/L, P < 0.001), and in estimated glomerular filtration rate (-6.72 [95% CI -9.46 to -3.98] ml∙min^-1∙1.73 m^-2, P < 0.001) were statistically significant, whereas they were not statistically significant on changes in systolic and diastolic blood pressure and weight (P > 0.05). Telmisartan combined with clopidogrel had no statistical effect on any outcome, and there was no interaction between the interventions. No obvious adverse reactions were observed.

Telmisartan combined with leflunomide, not clopidogrel, is safe and effective for decreasing proteinuria in certain IgAN patients.

chictr.org.cn, ChiCTR-TRC-10000776; http://www.chictr.org.cn/showproj.aspx?proj=8760.

Current risk stratification of idiopathic dilated cardiomyopathy (IDC) lacks sufficient sensitivity and specificity. The objective of this study was to investigate the predictive role of frontal QRS-T angles in IDC.

A prospective study with 509 IDC patients was performed from February 2008 to December 2013 in the Affiliated Drum Tower Hospital, Nanjing University School of Medicine. Baseline values and changes in QRS-T angles were recorded. Follow-up was conducted every 6 months. Analyses by Cox Proportional Hazards model were performed to evaluate the association between QRS-T angle and outcomes. The primary outcome of interest was all-cause mortality.

During a median follow-up of 34 months, 90 of 316 patients with QRS-T angles >90° died compared to 31 of 193 patients with QRS-T angles ≤90° (hazard ratio [HR] =2.4, P < 0.001). Cardiac death was more prevalent in patients with a wide QRS-T angle (HR = 2.4, P < 0.001), similar to heart failure rehospitalization (HR = 2.5, P < 0.001). After adjustment for potential prognostic factors, the QRS-T angle was independently associated with all-cause mortality (HR = 2.5, P < 0.05), cardiac mortality (HR = 1.9, P < 0. 05), and heart failure rehospitalization (HR = 2.3, P < 0.01). Optimized therapy significantly narrowed the frontal QRS-T angle (100.9 ± 53.4° vs. 107.2 ± 54.4°, P < 0.001). The frontal QRS-T angle correlated well with established risk factors, such as left ventricular ejection fraction, brain natriuretic peptide, and New York Heart Association functional class.

The frontal QRS-T angle is a powerful predictor of all-cause mortality, cardiac mortality, and worsening heart failure in IDC patients, independent of well-established prognostic factors. Optimized therapy significantly narrows the QRS-T angle, which might be an indicator of medication compliance, but this requires further investigation.

For a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method.

A retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = L_m/L, where M was the gender- and age-specific multiplier, L_m was the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods.

A total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley’s coefficients, and Anderson’s method, respectively.

Our coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.

Infection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems.

We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients’ data were collected to evaluate the clinical outcome.

All patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session.

Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

The cognitive function of children with either attention deficit hyperactivity disorder (ADHD) or learning disabilities (LDs) is known to be impaired. However, little is known about the cognitive function of children with comorbid ADHD and LD. The present study aimed to explore the cognitive function of children and adolescents with ADHD and learning difficulties in comparison with children with ADHD and healthy controls in different age groups in a large Chinese sample.

Totally, 1043 participants with ADHD and learning difficulties (the ADHD + learning difficulties group), 870 with pure ADHD (the pure ADHD group), and 496 healthy controls were recruited. To investigate the difference in cognitive impairment using a developmental approach, all participants were divided into three age groups (6–8, 9–11, and 12–14 years old). Measurements were the Chinese-Wechsler Intelligence Scale for Children, the Stroop Color-Word Test, the Trail-Making Test, and the Behavior Rating Inventory of Executive Function-Parents (BRIEF). Multivariate analysis of variance was used.

The results showed that after controlling for the effect ofADHD symptoms, theADHD + learning difficulties group was still significantly worse than the pureADHD group, which was, in turn, worse than the control group on full intelligence quotient (98.66 ± 13.87 vs. 105.17 ± 14.36 vs. 112.93 ± 13.87, P < 0.001). The same relationship was also evident for shift function (shifting time of the Trail-Making Test, 122.50 [62.00, 194.25] s vs. 122.00 [73.00, 201.50] s vs. 66.00 [45.00, 108.00] s, P < 0.001) and everyday life executive function (BRIEF total score, 145.71 ± 19.35 vs. 138.96 ± 18.00 vs. 122.71 ± 20.45, P < 0.001) after controlling for the effect of the severity of ADHD symptoms, intelligence quotient, age, and gender. As for the age groups, the differences among groups became nonsignificant in the 12–14 years old group for inhibition (meaning interference of the Stroop Color-Word Test, 18.00 [13.00, 25.00] s vs. 17.00 [15.00, 26.00] s vs. 17.00 [10.50, 20.00] s, P = 0.704) and shift function (shifting time of the Trail-Making Test, 62.00 [43.00, 97.00] s vs. 53.00 [38.00, 81.00] s vs. 101.00 [88.00, 114.00] s, P = 0.778).

Children and adolescents with ADHD and learning difficulties have more severe cognitive impairment than pure ADHD patients even after controlling for the effect of ADHD symptoms. However, the differences in impairment in inhibition and shift function are no longer significant when these individuals were 12–14 years old.

Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication.

Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period.

In Group A, at the 8^th, 16^th, and 24^th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8^th week: χ² = 4.421, P > 0.05; 16^th week: χ² = 2.043, P > 0.05; 24^th week: χ² = 0.00, P > 0.05). In Group B, at the 8^th, 16^th, and 24^th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8^th and 24^th weeks of follow-up were statistically significant (8^th week: χ² = 6.929, P < 0.05; 24^th week: χ² = 13.125, P < 0.05).

For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.

Pediatric dental fear, if left unchecked, can persist for a lifetime and adversely impact the physical and psychological health of a patient. In this study, a feasible nonmedical method for relieving pediatric dental fear was investigated.

A randomized, single-blind, controlled trial model was applied. The juvenile patients experiencing dental fear, whose parents or guardian had signed an informed consent form, were randomly divided into two groups. Group A (n = 50) was the control group, while Group B (n = 50) was the reward group. Participants in Group A accepted routine treatment. Participants in Group B were told that they would obtain a gift as a reward for their good behavior if they were compliant during their dental treatments. The Chinese version of the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) was used to evaluate the level of dental fear of each patient both before and after each treatment. A contrast analysis and a correlation analysis of the results were used to assess the efficacy of the reward mechanism.

All participants in Group B, were obedient during the dental treatment, and they also successfully chose the present they wanted at the end of their dental treatment. Children at different ages showed different reward preferences. Significant difference in the fear scores of the participants in Group B before the treatment and after receiving the reward was found (independent samples t-test, t = 14.72, P < 0.001). In Group A, 86% children’s fear score did not undergo a noticeable change.

A reward system is proved feasible to relieve pediatric dental fear, and the form of reward should meet the demand of patients.

Acute diarrhea remains the serious problem in developing countries, especially among children under 5 years of age. Currently, only two or three common diarrhea pathogens were screened at most hospitals in China. The aim of this study was to provide a wide variety of diarrhea pathogens and their antimicrobial resistance patterns in children under 5 years of age.

Totally 381 stool samples collected from Tongji Hospital between July 1, 2014 and June 30, 2015 were tested by culture and/or polymerase chain reaction for eight kinds of bacteria and five kinds of viruses. An antimicrobial sensitivity test was performed using dilution method recommended by the Clinical and Laboratory Standards Institute.

Viral infections were mainly identified in infants (0–11 months), whereas bacterial infections were more prevalent in the age of 24–59 months. About 69.8% of samples were positive for at least one pathogen, 51.7% of samples were virus positive, followed by bacteria positive cases (19.4%), and 12.6% of cases displayed co-infections with two viruses or a virus and a bacterium. Rotavirus was the most prevalent pathogen, followed closely by norovirus, while Salmonella was the most commonly isolated bacteria, followed by diarrheagenic Escherichia coli (DEC) and Campylobacter. More than 40% of Salmonella spp. and DEC isolates were resistant to first-line antibiotics (ampicillin, trimethoprim-sulfamethoxazole, and tetracycline). Around 10% of Salmonella spp. isolates were resistant to ceftriaxone and ciprofloxacin simultaneously. Campylobacter spp. displayed high resistance to ciprofloxacin but kept low resistance to azithromycin and doxycycline.

The etiology of acute diarrhea varies in children of different age groups. The high frequency of infection with viruses suggests the urgent demand for new viral vaccine development. Proper use of antibiotics in the treatment of acute diarrhea is crucial due to the high level of antibiotic resistance.

Mitochondrial diseases are a group of energy metabolic disorders with multisystem involvements. Variable clinical features present a major challenge in pediatric diagnoses. We summarized the clinical spectrum of m.3243A>G mutation in Chinese pediatric patients, to define the common clinical manifestations and study the correlation between heteroplasmic degree of the mutation and clinical severity of the disease.

Clinical data of one-hundred pediatric patients with symptomatic mitochondrial disease harboring m.3243A>G mutation from 2007 to 2013 were retrospectively reviewed. Detection of m.3243A>G mutation ratio was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism. Correlation between m.3243A>G mutation ratio and age was evaluated. The differences in clinical symptom frequency of patients with low, middle, and high levels of mutation ratio were analyzed by Chi-square test.

Sixty-six patients (66%) had suffered a delayed diagnosis for an average of 2 years. The most frequent symptoms were seizures (76%), short stature (73%), elevated plasma lactate (70%), abnormal magnetic resonance imaging/computed tomography (MRI/CT) changes (68%), vomiting (55%), decreased vision (52%), headache (50%), and muscle weakness (48%). The mutation ratio was correlated negatively with onset age (r = -0.470, P < 0.001). Myopathy was more frequent in patients with a high level of mutation ratio. However, patients with a low or middle level of m.3243A>G mutation ratio were more likely to suffer hearing loss, decreased vision, and gastrointestinal disturbance than patients with a high level of mutation ratio.

Our study showed that half of Chinese pediatric patients with m.3243A>G mutation presented seizures, short stature, abnormal MRI/CT changes, elevated plasma lactate, vomiting, and headache. Pediatric patients with these recurrent symptoms should be considered for screening m.3243A>G mutation. Clinical manifestations and laboratory abnormalities should be carefully monitored in patients with this point mutation.

Angiogenesis is the formation of new blood vessels to supply nutrients to tumors. Vascular endothelial growth factor (VEGF) and cluster of differentiation 34 (CD34) are important signaling proteins involved in angiogenesis. Many studies have demonstrated that VEGF and CD34 are related to tumor progression. This study focused on the relationship between VEGF, CD34, and perioperative hemorrhage in patients with gastric cancer.

To observe the relationship between VEGF and CD34, we tracked 112 patients with advanced gastric cancer for 5 years to assess factors related to hemorrhage, using immunohistochemistry. The results were subjected to statistical analysis using a 2 × 2 contingency table, logistic regression, and receiver operating characteristic (ROC) test.

The concentrations of VEGF and CD34 were critically correlated with perioperative hemorrhage and neural invasion in patients with gastric cancer (P < 0.05). Expression of VEGF and CD34 was related (P < 0.05, χ² = 6.834). VEGF and CD34 co-expression strongly increased the risk of preoperative bleeding (area under the ROC curve >0.7, P < 0.05).

Expression of VEGF and CD34 was critically correlated with perioperative hemorrhage in gastric cancer patients. Co-expression of VEGF and CD34 could be an effective indicator for evaluating the risk of perioperative bleeding in gastric cancer patients.

The previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures.

Prospective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data.

Twenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32).

MIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.

Periprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein (CRP), can provide high value in the diagnosis of PJI remains unanswered and, therefore, was the aim of the study.

First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as "periprosthetic joint infection", "synovial fluid", and "C-reactive protein". Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve, and the area under the SROC (AUSROC) were pooled together and used to evaluate overall diagnostic performance.

Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 (95% confidence interval [CI]: 0.86–0.96), 0.90 (95% CI: 0.87–0.93), and 101.40 (95% CI: 48.07–213.93), respectively. The AUSROC was 0.9663 (standard error, 0.0113).

Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity.

The objective of this study is to review cerebrospinal fluid leakage (CSFL) after thoracic decompression and describe its regular and special features.

Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. "Cerebrospinal fluid", "leakage", "dural tears", and "thoracic decompression" were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data.

All retrieved literature was scrutinized, and four categories were recorded: incidence and risk factors, complications, treatment modalities, and prognosis.

CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only.

CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological factors play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be aware of it.

青光眼是一种慢性进行性神经退行性疾病，表现出异质性、多基因遗传和不完全外显率。^[1]原发性开角型青光眼（POAG）是最常见的青光眼形式。尽管POAG的潜在病因尚不清楚，但有证据表明基因突变与该疾病密切相关。^[2]在myocilin（MYOC）突变，Pro370Leu（P370L）是最严重青光眼表型之一的原因。^[3]然而，MYOC蛋白的功能仍然不太清楚。

脑脊液（CSF）鼻漏是神经外科医生处理的常见疾病。准确识别渗漏部位对于促进手术修复的成功起着关键作用。我们报告了两例经手术证实的脑脊液鼻漏病例，在手术治疗前通过磁共振（MR）脑池造影（西门子，柏林，德国）和颅底冠状薄层计算机断层扫描（CT）（西门子，柏林，德国）进行了检查。患者男，38岁，主诉为“突然头痛、恶心呕吐3小时”。他9年前因车祸头部损伤导致脑脊液鼻漏，经保守治疗后脑脊液漏消退。从那时起，出现了脑脊液鼻漏和脑感染的多次复发。入院后，患者出现脑脊液鼻漏、癫痫大发作、高渗血症、高血糖、吸入性肺炎、脑膜脑炎和昏迷。治疗后除脑脊液鼻漏外，其余症状均消失。颅底冠状薄层CT扫描显示筛骨板左侧骨折，MR脑池造影显示前颅窝底左侧高信号脑脊液柱[图1-案例1]。患者于2012年12月接受“冠状切口左侧额下入路脑脊液鼻漏手术修复”治疗，发现左侧筛骨板骨折或骨缺损1.0 cm × 0.5 cm并进行修复。患者的脑脊液漏在手术后消退。他接受了1周的腰椎引流治疗，在3个月的随访中，脑脊液鼻漏没有复发。

在治疗喉上神经痛（SLN）时，喉上神经阻滞（SLNBs）可以立即缓解持续性疼痛。尽管SLNB是有效的，但由于靠近颈动脉、外静脉和其他血管，该手术可能会增加风险。为了避免并发症，如谨慎的血管内注射、血管内吸收的局部麻醉剂毒性和气管内注射，我们在超声引导下成功地阻断了三名SLN患者的喉上神经。参与本研究的每位患者均获得治疗前的书面知情同意书。

致编者：一名35岁的中国女性入院，主诉双侧颞部慢性间歇性中度头痛1年病史，过去通过布洛芬片或休息缓解，过去1个月强度增加。患者还表现出视力障碍的缓慢发展。2012年1月，患者出现提示中枢性尿崩症的多尿和烦渴。内分泌研究未显示具有临床意义的结果。患者还接受了脑磁共振成像(MRI)，结果显示一个6 mm × 6 mm的卵圆形鞍状病变，高信号，在给予钆-二亚乙基三胺五乙酸(Gd-DTPA)后，T1加权像无明显增强，T2加权像等至低信号[图1a].该患者最初被诊断为Rathke裂囊肿（RCC），并拒绝接受手术。到2013年底，她再次出现多尿和烦渴，在随后的6个月内自行缓解，无需医疗干预。2014年7月进行了一次影像学随访，显示一个9 mm × 11 mm × 14 mm的卵圆形鞍状病变，表明前囊肿增大，呈高信号，给予Gd-DTPA后在T1加权图像上无明显增强，在T2加权图像上为等至高信号[图1b]，显然，MRI的信号特征与最初提示可能出血的信号特征几乎相同。2014年7月至2015年5月，她在中医科求医，并定期服用旨在促进循环和消除瘀滞的草药。2015年5月，她主诉右眼视力轻度模糊。2015年11月，她遭受了严重难以忍受的头痛，右眼视力急剧下降，轻度右侧颞侧偏盲。疼痛呈弥漫性、钝性，持续一周，不能像以前一样通过药片或休息来缓解。她的病史在其他方面并不引人注目。一般体检平安无事。神经系统检查显示患者清醒、警觉且完全定向，无局灶性体征。她四肢的肌肉力量和张力完全正常。各种生理反射可以响应外部刺激而引发。无病理体征。眼科检查结果与她自我报告的症状一致，表明视力（VA）和视野有显著变化。术前右眼VA 0.5+，左眼VA 0.8。观察到部分颞偏盲，无可疑[图1c].血液学和生化检查结果无异常。内分泌评估在正常范围内。MRI研究显示鞍区和鞍上病变呈高信号，给予Gd-DTPA后T1加权像无明显增强，T2加权像为高信号，尺寸为16.8 mm × 16.0 mm × 14.6 mm[图1d].位于肾细胞癌的下后位，有一个不规则形状的病变，在T1加权像上显示低信号，在T2加权像上显示低信号，提示内部卒中。混合信号强度被认为与中风症状一致，表明肾细胞癌囊内陈旧性出血。重复的MRI发现显示肾细胞癌内迅速增大<4年，这是相当罕见的，可能是首次在已发表的病例中描述。患者接受了内镜下鼻内经蝶窦肾细胞癌切除术。在该过程中，囊内内容物被完全排出，囊内内容物是看似黄色的胆固醇晶体而不是预期的陈旧出血，并且以安全的方式尽可能地切除肾细胞壁。手术探查排除肾细胞癌卒中囊内出血。术中和术后均未发生脑脊液漏和颅内感染。组织病理学检查结果证明囊性病变为肾细胞癌。患者从慢性头痛中康复；然而，视觉缺陷未能显著改善。

致编者：阻塞性睡眠呼吸暂停综合征（OSAS）是由睡眠期间上气道完全或部分塌陷的反复发作引起的，可诱发呼吸暂停或呼吸不足。间歇性缺氧和较高二氧化碳水平的反复发作可能导致睡眠频繁中断。^[1]夜间遗尿症（NE）的特征是睡眠期间不自主和反复排尿。NE是儿童OSAS的一种症状，而在成人中很少见。单症状性NE（MNE）定义为无日间症状的NE。我们报告了一名成年女性MNE伴严重OSAS，其症状在经鼻持续气道正压通气（CPAP）治疗后完全消失。

致编辑：寨卡病毒（ZIKV）首次从乌干达寨卡森林的一只恒河猴身上分离出来。^[1]它是一种新兴的虫媒病毒黄病毒科，包括登革热、西尼罗河病毒、黄热病和日本脑炎病毒，并引起由伊蚊属传播的蚊媒疾病。^[2]ZIKV最近在美洲国家，特别是在巴西、委内瑞拉等地被证明是爆炸式的。^[3]我们报告了一例从委内瑞拉输入中国的实验室确诊的ZIKV感染病例。患者于2016年2月6日自委内瑞拉回国后出现发热、皮疹、肌痛、头痛、结膜炎。血清学调查显示ZIKV特异性实时逆转录-聚合酶链反应（RT-PCR）呈阳性。

致编者：小儿腹股沟疝修补术是小儿患者常见的外科手术。腹腔镜疝修补术比传统的开腹疝切开术有几个优点；其中大多数与评估可能的对侧阴道未闭（PPV）和避免输精管和精索血管的创伤有关。

在文章“负载紫杉醇的聚乳酸-共-乙醇酸涂层气管支架的制备和表征”中，该文章发表在第2236-40页，第12期，第127卷中华医学杂志,^[1]文章中的“资金支持和赞助”部分被错误地写成了“首都临床医学应用研究（编号Z121107001012128）”，而不是“北京市医院管理局临床医学发展专项资金支持（编号XMLX201314）”。