Volume 129 · Issue 18 · 2016

Atrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in atrioventricular block (AVB) patients with dual-chamber (DDD) pacemaker implantation.

This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing (VP%) ≥40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olmesartan group (20 mg per day; n = 57) or control group (n = 59). Patients were followed up using pacemaker programming, 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events (AHREs) were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours.

Ten (17.5%) patients in the olmesartan group and 24 patients (40.7%) in the control group occurred new-onset AF, and the difference between two groups was statistically significant (P = 0.04). AF burden was lower in olmesartan group than that in control group (8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04). There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups (P = 0.89 and P = 0.42, respectively). Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion (PD) after 24 months follow-up compared with the control group (109.5 ± 7.4 ms vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ms, P = 0.02, respectively). Left ventricular end-diastolic diameter and left ventricular ejection fraction were not significantly different between two groups (both P > 0.05).

This study suggested that 24-month of olmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.

ChiCTR-TRC-12004443; http://www.chictrdb.org.

Deep vein thrombosis (DVT) may be associated with iliac vein compression. Up to now, the majority of data has come from a retrospective study about the correlation between DVT and iliac vein compression. This prospective study was to determine the incidence of DVT in individuals with iliac vein compression and identify risk factors predictive of DVT.

A total of 500 volunteers without symptoms of venous diseases of lower extremities and overt risk factors of deep venous thrombosis between October 2011 and September 2012 in Shijitan Hospital were enrolled in this cohort study. All the participants underwent contrast-enhanced abdominal computed tomography (CT) to evaluate iliac vein compression. Baseline demographic information and degree of iliac vein compression were collected. They were categorized into ≥50% or <50% iliac vein compression group. Ultrasound examination was performed to screen DVT at the time of CT examination and 3, 6, 9, and 12 months after the examination. Primary event was DVT of ipsilateral lower extremity. Correlation between DVT and iliac vein compression was estimated by multivariate Logistic regression after adjusting for age, gender, malignancy, surgery/immobilization, chemotherapy/hormonal therapy, and pregnancy.

In 500 volunteers, 8.8% (44) had ≥50% iliac vein compression and 91.2% (456) had <50% iliac vein compression. Ipsilateral DVT occurred in six volunteers including two in iliofemoral vein, two in popliteal vein, and two in calf vein within 1 year. Univariate analysis showed that the incidence of DVT was 6.8% in ≥50% compression group, significantly higher than that in <50% compression group (0.7%) (χ² = 12.84, P = 0.01). Patients with malignancy had significantly higher incidence of DVT than those without malignancy (χ² = 69.60, P< 0.01). Multivariate Logistic regression indicated that iliac vein compression and malignancy were independent risk factors of DVT. After adjustment for malignancy, patients with ≥50% iliac vein compression had 10-fold increased risk of developing DVT (adjusted relative risk [RR] = 10.162, 95% confidence interval [CI]: 1.149-89.865, P = 0.037). In subgroup analysis, patients with malignancy and ≥50% iliac vein compression had 12-fold increased the risk of DVT than those without malignance and ≥50% compression (RR = 12.389, 95% CI: 2.327-65.957, P = 0.003).

Iliac vein compression is common, but the incidence of DVT is low. Only individuals with ≥50% iliac vein compression or compression combined with other risk factors might have significantly increased the risk of DVT. Further study is recommended to improve prevention strategies for DVT in significant iliac vein compression.

Right minithoracotomy (RM) has been proven to be a safe and effective approach for mitral valve surgery, but the differences of artificial chordae technique between RM and median sternotomy (MS) were seldom reported. Here, we compared the outcomes of modified artificial chordae technique for mitral regurgitation (MR) through RM or MS approaches.

One hundred and eighteen consecutive adult patients who received mitral valve repair with artificial chordae and annuloplasty for MR through RM (n = 58) or MS (n = 60) from January 2006 to January 2015 were analyzed.

All of the selected patients underwent mitral valve repair successfully without any complication during the surgery. There was no significant difference between RM group and MS group in cardiopulmonary bypass time, aortic cross-clamp time, and early postoperative complications. However, compared with the MS group, the RM group had shorter hospital stay and faster surgical recovery. At a mean follow-up of 44.8 ± 25.0 months, the freedom from more than moderate MR was 93.9% ± 3.5% in RM group and 94.8% ± 2.9% in MS group at 3 years postoperatively. Log-rank test showed that there was no significant difference in the freedom from recurrent significant MR between the two groups (χ² = 0.247, P = 0.619). Multivariate analysis revealed that the presence of mild MR at discharge was the independent risk factor for the recurrent significant MR.

Right minithoracotomy can achieve the similar therapeutic effects with MS for the patients who received modified artificial chordae technique for treating MR.

A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA), compared with conventional open procedure in papillary thyroid microcarcinoma.

One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n = 50 in each group). The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale (VAS), postoperative hospital stay time, complications, and numerical scoring system (NSS, used to assess cosmetic effect) were analyzed.

The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs. 90.7 ± 10.3 min, P < 0.05). The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs. 3.8 ± 1.2, P < 0.05) and NSS (8.9 ± 0.8 vs. 4.8 ± 1.7, P < 0.05). The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant (all P > 0.05). Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group.

Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.

As the clinical value of cytokeratin-19 (CK19) and thymidine kinase-1 (TK1) in advanced gastrointestinal cancer remains controversial, we investigated their expression and clinical significance in this disease.

A total of 171 advanced gastrointestinal cancer patients were prospectively enrolled in this study. The mRNA level of CK19 was detected using quantitative real-time reverse transcription-polymerase chain reaction (PCR) in all patients, along with a control group of fifty healthy individuals. Furthermore, detection of TK1 protein was carried out in 96 patients using a chemiluminescence dot blot assay. The primary endpoint was overall survival (OS) time.

Positive CK19 mRNA expression was detected in 74 (43.3%) of the 171 patients and positive TK1 expression was detected in 66 (68.8%) of the 96 patients. Furthermore, of the 96 patients, 36 (37.5%) were positive for both TK1 protein and CK19 mRNA, 30 (31.3%) were negative for TK1 protein, and 15 (15.6%) were negative for TK1 protein and positive for CK19 mRNA. The results indicated that patients who were positive for CK19 mRNA expression had significantly shorter OS times than those who were negative for it (median OS 7.7 vs. 9.7 months, respectively; P = 0.02). Moreover, patients who were positive for CK19 mRNA and TK1 protein expression had shorter OS times (median OS 6.1 months) than those who were positive for CK19 mRNA and negative for TK1 protein expression (median OS 9.1 months; P = 0.028). Positive CK19 mRNA expression was significantly associated with shorter OS in the univariate analysis (P = 0.027). Based on a multivariate Cox regression analysis, CK19 mRNA together with TK1 protein expression (P = 0.024) was an independent predictor for OS in gastrointestinal cancer patients.

Our results suggest that positive expression of CK19 mRNA and TK1 protein is closely correlated with poor prognosis in advanced gastrointestinal cancer. Furthermore, both CK19 and TK1 are possible gastrointestinal cancer biomarkers.

The brain stem is found to be impaired in multiple system atrophy-cerebellar types (MSA-C). Rapid eye movement (REM) sleep behavior disorder (RBD) is reported as a marker of progressive brain stem dysfunction. Few systematic studies about the sleep disturbances in MSA-C patients combined with or without RBD were reported. This study aimed to explore the polysomnographic (PSG) features of sleep disturbances between MSA-C patients with and without RBD.

Totally, 46 MSA-C patients (23 with RBD, and 23 without RBD) were enrolled in this study. All patients underwent a structured interview for their demographic data, history of sleep pattern, and movement disorders; and then, overnight video-PSG was performed in each patient. All the records were evaluated by specialists at the Sleep Medicine Clinic for RBD and the Movement Disorder Clinic for MSA-C. The Student’s t-test, Mann-Whitney U-test for continuous variables, and the Chi-square test for categorical variables were used in this study.

MSA-C patients with RBD had younger visiting age (52.6 ± 7.4 vs. 56.7 ± 6.0 years, P = 0.046) and shorter duration of the disease (12.0 [12.0, 24.0] vs. 24.0 [14.0, 36.0] months, P = 0.009) than MSA-C patients without RBD. MSA-C with RBD had shorter REM sleep latency (111.7 ± 48.2 vs. 157.0 ± 68.8 min, P = 0.042), higher percentage of REM sleep (14.9% ±4.0% vs. 10.0% ± 3.2%, P = 0.019), and lower Stage I (9.5% ±7.2% vs. 15.9% ±8.0%, P = 0.027) than MSA-C without RBD. Moreover, MSA-C patients with RBD had more decreased sleep efficiency (52.4% ±12.6% vs. 65.8% ±15.9%, P = 0.029) than that without RBD.

In addition to the RBD, MSA-C patients with RBD had other more severe sleep disturbances than those without RBD. The sleep disorders of MSA patients might be associated with the progress of the disease.

Early surgical intervention is required for the primary congenital glaucoma (PCG). There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth.

A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates.

The mean follow-up time was 46.9 ± 34.4 months (range: 12–122 months). The postoperative IOP was significantly lower than the preoperative IOP at all of the follow-up visits (P < 0.001). The complete success rates for all eyes at 1, 2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The IOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly (P = 0.01) although the horizontal corneal diameter did not change significantly (P = 0.11). Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications.

Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.

The effects of near-road pollution on lung function in China have not been well studied. We aimed to investigate the effects of long-term exposure to traffic-related air pollution on lung function, airway inflammation, and respiratory symptoms.

We enrolled 1003 residents aged 57.96 ± 8.99 years living in the Shichahai Community in Beijing. Distances between home addresses and the nearest major roads were measured to calculate home-road distance. We used the distance categories 1, 2, and 3, representing <100 m, 100–200 m, and >200 m, respectively, as the dose indicator for traffic-related air pollution exposure. Lung function, exhaled breath condensate (EBC) pH, and interleukin 6 levels were measured. As a follow-up, 398 participants had a second lung function assessment about 3 years later, and lung function decline was also examined as an outcome. We used regression analysis to assess the impacts of home-road distance on lung function and respiratory symptoms. As the EBC biomarker data were not normally distributed, we performed correlation analysis between home-road distance categories and EBC biomarkers.

Participants living a shorter distance from major roads had lower percentage of predicted value of forced expiratory volume in 1 s (FEV1% -1.54, 95% confidence interval [CI]: -0.20 to -2.89). The odds ratio for chronic cough was 2.54 (95% CI: 1.57–4.10) for category 1 and 1.97 (95% CI: 1.16–3.37) for category 2, compared with category 3. EBC pH was positively correlated with road distance (rank correlation coefficient of Spearman [r_s] = 0.176, P < 0.001).

Long-term exposure to traffic-related air pollution in people who live near major roads in Beijing is associated with lower lung function, airway acidification, and a higher prevalence of chronic cough. EBC pH is a potential useful biomarker for evaluating air pollution exposure.

Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men.

We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG. CAD was defined as any coronary stenosis of ≥50% on conventional invasive CAG, which was used as the reference standard. The patients were divided into typical and atypical groups based on their symptoms of angina pectoris. The diagnostic accuracy of MSCT, including its sensitivity, specificity, negative predictive value, and positive predictive value (PPV), was calculated to determine the usefulness of MSCT in assessing stenoses. The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves.

The PPV (91% vs. 97%, χ² = 5.705, P < 0.05) and diagnostic accuracy (87% vs. 93%, χ² = 5.093, P < 0.05) of MSCT in detecting CAD were lower in women than in men. Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio = 4.94, 95% confidence intervals: 1.16–20.92, Walds = 4.69, P < 0.05). Compared with those in the atypical group, women with typical angina pectoris had higher PPV (98% vs. 74%, χ²= 17.283. P < 0.001), diagnostic accuracy (93% vs. 72%, χ² = 9.571, P < 0.001), and area under the ROC curve (0.91 vs. 0.64, Z = 2.690, P < 0.01) in MSCT diagnosis.

Although MSCT is a reliable diagnostic modality for the exclusion of significant coronary artery stenoses in all patients, gender and atypical symptoms might have some influence on its diagnostic accuracy.

Mitral valve (MV) repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation (MR). However, there has been limited information regarding the echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV.

A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients (79.8%), artificial chordae in 20 (23.8%), and ring annuloplasty in 79 (94.1%). Eighty-one (96.4%) of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up.

At a median echocardiographic follow-up of 36.0 months (interquartile range 14.3–59.4 months), four patients (4.9%) developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 (Z= -8.456, P < 0.001), LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm (t = 15.131, P < 0.001), LVEDD from 51.0 ± 5.0 to 43.3 ± 2.2 mm (t = 14.481, P < 0.001), and LVEF from 67.3 ± 7.0% to 63.9 ± 5.1% (t = 4.585, P < 0.001).

Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.

Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children.

The data analyzed in this review are mainly from articles included in PubMed and EMBASE.

The original articles and critical reviews about POTS were selected for this review.

Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient’s physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted.

The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children.

肺动脉肉瘤（PAS）是一种罕见的起源于肺动脉（PA）的恶性肿瘤，预后不良。^[1]早期诊断和根治性手术切除是生存的唯一机会。^[2,3]由于大多数PA肉瘤累及PA主干，术前组织病理学诊断相当困难。到目前为止，大多数PAS病例都是在尸检或术中冰冻切片诊断的。^[4,5]因此，如果能在术前确诊PAS，将是非常有帮助的。为此，一些作者尝试经导管抽吸活检术前诊断PAS。^[6,7]然而，经导管抽吸活检经常错过肿瘤，因为它不能提供足够的核心组织。在我们的临床实践和其他报道中，成功的很少。^[8]在这项初步研究中，血管内导管引导钳活检（CGFB）的新技术被用于诊断PAS。我们描述了手术过程，并报告了一系列八个病例的结果。

导管消融术是近十年来治疗心房颤动（AF）的重要手段。同时，房性心动过速（AT）已成为房颤消融后最常见的心律失常类型，尤其是在广泛的左心房（LA）基底修饰后。^[1]房颤后AT的发生是由于消融线的传导间隙和消融病灶造成的传导障碍。^[2]这些ATs大多位于LA，在这里，我们描述了房颤消融后AT（MAT）的双房大折返。

肺动静脉畸形（AVM）肺的定义是肺动脉和负责左右分流的静脉之间的异常交通。先天性形式最常见，通常与Rendu-Osler病（ROD）有关。相反，15-45%的ROD患者出现肺AVM。^[1]如今，在大多数情况下，栓塞优于手术切除。除了某些需要手术的情况。本文介绍了手术在动静脉畸形中的作用。

类鼻疽是一种地方性传染病，由类鼻疽伯克霍尔德菌以及热带和亚热带地区流行的两栖动物病.感染的主要途径被认为是通过受损的表面组织和吸入受污染的土壤和水。类鼻疽杆菌可影响所有器官，但肺部感染是最常见的症状，容易导致败血症。^[1]在这里，我们报告了一个罕见的急性心包炎病例，由类鼻疽杆菌感染。

自身免疫性疾病与单克隆恶性肿瘤风险之间的关联已得到充分研究。然而，自身免疫性疾病患者的单克隆B细胞淋巴细胞增多症（MBL）很少报道。最新发布的世界卫生组织（WHO）淋巴肿瘤分类2016年修订版已正式接受MBL为独立疾病实体。^[1]在此，我们提出了一例韦格纳肉芽肿病（WG）伴MBL的病例。通过这个病例，MBL作为风湿病学家鲜为人知的疾病，尤其是在自身免疫性疾病的背景下，的诊断和治疗进行了综述。此外，还讨论了自身免疫性疾病和单克隆恶性肿瘤风险之间的关系。

致编者：异基因造血干细胞移植（allo-HSCT）是急性髓性白血病（AML）患者的一种治愈疗法，由于强化调理放化疗和移植物抗白血病（GVL）的作用。急性白血病（AL）的孤立性髓外（EM）复发是一种罕见的情况，在同种异体HSCT后比单独常规化疗后更常见。^[1]EM复发患者的预后不如骨髓（BM）复发患者好，并且没有标准疗法。

编辑：脑室周围结节性异位（PNHs）代表了由前脑形成过程中不适当的神经元迁移引起的皮质发育畸形。^[1,2]PNH的解剖和临床表现多种多样，从无症状的单侧或双侧小结节到侧脑室内异位的广泛聚集，伴有癫痫和智力残疾。X连锁基因细丝蛋白A的突变（FLNA）基因，在大约100%的家族性PNHs和25%的散发病例中被鉴定。^[2,3]在这里，我们报道了一种新的移码突变FLNA一个中国PNH家系的基因。

编者：快速顺序插管（RSI），定义为同时给予镇静剂和神经肌肉阻滞剂，是急诊科（ED）气管插管的首选方法。虽然血管性水肿和过敏反应不是这些药物常见的副作用，但很少发生。本报告主要针对一名26岁女性，一名已知的脑瘫和癫痫病例，因发烧和呼吸不适入住急诊室。患者发热、咳嗽、咳脓痰3天。用药史包括丙戊酸钠和加巴喷丁。没有药物过敏的报告。入院时生命体征如下：腋窝体温-38.9℃，心率-122次/min，呼吸频率-42次/min，血压-70/50 mmHg（1 mmHg=0.133 kPa）。初始室内空气动脉血氧饱和度₂）为73%，而通过简单面罩供氧后为80%。双肺听诊可听到病程爆裂声，尤其是右侧。血气分析显示代谢性酸中毒和低氧血症。初步评估后，我们决定为患者建立一个安全的气道，以改善氧合，防止能量损失，降低误吸风险。考虑到不稳定的血流动力学状况和ED缺乏依托咪酯，我们决定使用氯胺酮加琥珀胆碱进行诱导。

编辑：腮腺鳞状细胞癌（SCC）通常作为转移或原发性恶性肿瘤发生。它们大多从头颈部皮肤鳞状细胞癌转移。^[1]鼻咽癌（NPC）腮腺转移更为罕见。迄今为止，文献中仅报道了4例病例。^[2,3]在此，我们报告一个罕见的鼻咽癌转移病例，其中腮腺肿块显示为第一表现。

致编辑：我们怀着兴趣阅读了Kwon的文章等人.^[1]关于一例Kearns-Sayre综合征（KSS）患者，该患者成功且无并发症地接受了周围神经阻滞进行多次肌肉活检。我们有以下意见和关切。

在何的文章中等人.,^[1]作者比较了机器人双侧腋窝乳房入路（BABA）与传统开放手术治疗甲状腺乳头状微小癌，结果表明机器人BABA是安全有效的。本研究内容新颖，资料完整可信。内窥镜下头颈部手术机器人手术让读者对这一新生事物有了很好的了解，但对颈部恶性肿瘤手术治疗的实际意义有限，至少不推荐。我愿就几个问题交换意见：