Volume 130 · Issue 01 · 2017

恶性胸膜间皮瘤（MPM）是胸膜最常见的原发性恶性肿瘤。恶性间皮瘤的发生通常与接触矿物纤维如石棉和毛沸石有关。^[1,2,3]报告表明，遗传因素也可能在MPM中发挥作用。^[4]此外，从第一次接触石棉到疾病诊断之间的潜伏期从20年到50年不等。石棉相关疾病（ARD）的死亡负担很重，全球每年有92,250人死于ARD。^[5]为了提高MPM患者的生存率，非常需要有效的早期诊断策略和有效的治疗策略。

Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound (CP-EBUS) has allowed for performing real-time transbronchial needle aspiration (TBNA) of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions.　

We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography (CT) scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush (C-TBLB/b), and final diagnoses were based on pathologic analysis and follow-up.　

In all cases, the mass was able to be identified using EBUS in 97.2% patients (70/72) who were performed with EBUS-TBNA + C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients (56/70) had malignancies, and 14.3% patients (10/70) had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% (32/56) and in EBUS-TBNA was 85.7% (48/56), whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b + EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease.　

The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.

Microwave therapy is a minimal invasive procedure and has been employed in clinical practice for the treatment of various types of cancers. However, its therapeutic application in non-small-cell lung cancer and the underlying mechanism remains to be investigated. This study aimed to investigate its effect on Lewis lung carcinoma (LLC) tumor in vivo.　

Fifty LLC tumor-bearing C57BL/6 mice were adopted to assess the effect of microwave radiation on the growth and apoptosis of LLC tumor in vivo. These mice were randomly assigned to 10 groups with 5 mice in each group. Five groups were treated by single pulse microwave at different doses for different time, and the other five groups were radiated by multiple-pulse treatment of a single dose. Apoptosis of cancer cells was determined by terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. Western blotting was applied to detect the expression of proteins.　

Single pulse of microwave radiation for 5 min had little effect on the mice. Only 15-min microwave radiation at 30 mW/cm² significantly increased the mice body temperature (2.20 ± 0.82)°C as compared with the other groups (0.78 ± 0.29 °C, 1.24 ± 0.52 °C, 0.78 ± 0.42 °C, respectively), but it did not affect the apoptosis of LLC tumor cells significantly. Continous microwave radiation exposure, single dose microwave radiation once per day for up to seven days, inhibited cell division and induced apoptosis of LLC tumor cells in a dose- and duration-dependent manner. It upregulated the protein levels of p53, Caspase 3, Bax and downregulated Bcl-2 protein.　

Multiple exposures of LLC-bearing mice to microwave radiation effectively induced tumor cell apoptosis at least partly by upregulating proapoptotic proteins and downregulating antiapoptotic proteins. Continuous radiation at low microwave intensity for a short time per day is promising in treating non-small-cell lung cancer.

Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment.　

Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann–Whitney U-test was used for analysis.　

Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P= 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P= 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P = 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P = 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS.　

Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic factors except low WSS at stent regions.

Successful antiretroviral therapy (ART) has been demonstrated to be effective in reducing the infectivity of human immunodeficiency virus (HIV). We conducted a study to predict the potential effect of ART on the spread of HIV in Chaoyang District, Beijing, China, using the Asian Epidemic Model (AEM).　

The AEM baseline workbook was used to determine the current infection status and to project the future spread of HIV under current conditions. We changed the input on the ART coverage from 2014 to 2025 and also modified the treatment eligibility in the AEM intervention workbook, in order to allow for analysis of the projected downstream impact of ART.　

By gradually increasing the ART coverage rate from 29.7% (rate of 2013) to 40.0%, 50.0%, 60.0%, 70.0%, 80.0%, and 90.0% (at CD4⁺ ≤350 cells/µl), and by changing the dates of coverage from 2014 to 2020, the number of new infections showed a cumulative decline of 0.60%, 1.59%, 2.94%, 5.33%, 9.32%, and 14.98%, respectively. After 2020, the projected rates of infection rebounded slightly, so with the exception of the years with very high coverage (90.0%), new infections continued to decrease. When we changed the initial threshold of therapy to CD4⁺ cell counts ≤500 cells/µl, new infections decreased 6.00%, 11.64%, 15.92%, 21.11%, 26.92%, 33.05%, and 38.75%, respectively, under varying ART coverages.　

Our study demonstrates that the early initiation of ART for people living with HIV/acquired immune deficiency syndrome (AIDS) has a positive effect in slowing the spread of HIV.

The information-motivation-behavioral skills (IMB) model of health behavior is an effective tool to evaluate the behavior of diabetes self-management. The purpose of this study was to explore behavioral factors affecting the practice of self-monitoring of blood glucose (SMBG) within the frame of IMB model of health behavioral among adult patients with type 1 diabetes in a single diabetes clinic in China.　

A questionnaire with three subscales on SMBG information, motivation, and behavioral skills based on IMB model was developed. Validity and reliability of the measures were examined and guaranteed. Adult patients with type 1 diabetes visiting our diabetes clinic from January to March 2012 (n = 55) were consecutively interviewed. The self-completion questionnaires were administered and finished at face-to-face interviews among these patients. Both descriptive and correlational analyses were made.　

Fifty-five patients finished the questionnaires, with the median duration of diabetes 4.5 years and the median of SMBG frequency 2.00. Specific SMBG information deficits, motivation obstacles, and behavioral skill limitations were identified in a substantial proportion of participants. Scores of SMBG motivation (r = 0.299, P = 0.026) and behavioral skills (r = 0.425, P = 0.001) were significantly correlated with SMBG frequency. The multiple correlation of SMBG information, SMBG motivation, and SMBG behavioral skills with SMBG frequency was R = 0.411 (R² = 0.169, P = 0.023).　

Adult patients with type 1 diabetes in our clinic had substantial SMBG information deficits, motivation obstacles, and skill limitations. This information provided potential-focused education targets for diabetes health-care providers.

Wheezing is common in early childhood and remains an important health concern. The aim of this study was to assess the lung function of wheezing infants and to investigate the relationship between lung function and respiratory outcome.　

Infants <2 years of age with acute lower respiratory tract infection (ALRTI) who had undergone lung function tests were included in the study. They were assigned to wheeze or no wheeze group based on physical examination. Infants without any respiratory diseases were enrolled as controls. Lung function was measured during the acute phase and 3 months after ALRTI. One-year follow-up for infants with ALRTI was achieved.　

A total of 252 infants with ALRTI who had acceptable data regarding tidal breathing were included in the final analysis. Compared with the control and the no wheeze groups, infants in the wheeze group had significantly decreased time to peak tidal expiratory flow as a percentage of total expiratory time (TPTEF/TE) (20.1 ± 6.4% vs. 34.4 ± 6.2% and 26.4 ± 8.3%, respectively, P < 0.0001) and significantly increased peak tidal expiratory flow (PTEF) (90.7 ± 26.3 ml/s vs. 79.3 ± 18.4 ml/s and 86.1 ± 28.0 ml/s, respectively, P < 0.01), sReff and Reff. The infants in the wheeze group still had lower TPTEF/TE and volume to peak tidal expiratory flow as a percentage of total expiratory volume (VPTEF/VE) than the no wheeze infants 3 months after the ALRTI. Moreover, there was a significant inverse relationship between TPTEF/TE, VPTEF/VE, and the recurrence of wheezing and pneumonia.　

Impaired lung function was present in wheezing infants with ALRTI and the deficits persisted. In addition, the lower level of TPTEF/TE and VPTEF/VE was a risk factor for poor respiratory outcome.

Previous studies of contrast-induced acute kidney injury (CI-AKI) were mostly based on selective percutaneous coronary intervention (PCI) cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKI in a Chinese population undergoing emergency PCI.　

A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AKI and non-CI-AKI group. Univariable and multivariable analyses were used to identify the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl (44.2 μmol/L) above baseline within 3 days after exposure to contrast medium.　

The incidence of CI-AKI in patients undergoing emergency PCI was 22.7% (241/1061). Logistic multivariable analysis showed that body surface area (BSA) (odds ratio [OR] 0.213, 95% confidence interval [CI]: 0.075–0.607, P = 0.004), history of myocardial infarction (MI) (OR 1.642, 95% CI: 1.079–2.499, P = 0.021), left ventricular ejection fraction (LVEF) (OR 0.969, 95% CI: 0.944–0.994, P = 0.015), hemoglobin (Hb) (OR 0.988, 95% CI: 0.976–1.000, P = 0.045), estimated glomerular filtration rate (OR 1.027, 95% CI: 1.018–1.037, P < 0.001), left anterior descending (LAD) stented (OR 1.464, 95% CI: 1.000–2.145, P = 0.050), aspirin (OR 0.097, 95%CI: 0.009–0.987, P = 0.049), and diuretics use (OR 1.850, 95% CI: 1.233–2.777, P = 0.003) were independent predictors of CI-AKI in patients undergoing emergency PCI.　

History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AKI in patients undergoing emergency PCI.

Recent studies show that microRNA-145 (miRNA-145) might be an attractive tumor biomarker of considerable prognostic value, but little is known about their relationship with acute myocardial infarction (AMI). This study investigated the correlation between the level of miR-145 and AMI.　

One-hundred patients were divided into three groups: no coronary artery disease (CAD) group, non-ST segment elevation myocardial infarction group, and ST segment elevation myocardial infarction group. The plasma levels of miR-145 were quantified using real-time quantitative polymerase chain reaction. Logarithmic transformation of miRNA-145 levels (Ln_miRNA-145) was used for statistical analysis due to the skewed data distribution.　

Plasma levels of miR-145 were significantly lower in patients with AMI compared to patients in the non-CAD group (−6.38 ± 0.11 vs. −4.47 ± 0.17, P < 0.0001). Compared to those without heart failure, the levels of miR-145 were significantly lower in patients with heart failure (−6.91 ± 0.20 vs. −5.35 ± 0.13, P < 0.0001). We also found that the lower plasma levels of miRNA-145 significantly correlated with increased serum levels of B-type natriuretic peptide (Spearman ρ = −0.60, P < 0.0001), troponin T (Spearman ρ = −0.62, P < 0.0001), and decreased ejection fraction (Spearman ρ = 0.65, P < 0.0001). In a multivariable linear regression analysis, AMI and heart failure were independently associated with lower Ln_miRNA-145 (estimate −0.99, standard error [SE] 0.28; P = 0.001 and estimate −0.62, SE 0.21; P = 0.004).　

Our results suggest that decreased plasma levels of miR-145 are associated with AMI. Circulating miR-145 may be useful in prognosticating cardiac function and the risk of developing heart failure.

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD). However, the association between CKD and CVD risk in patients with type 2 diabetes mellitus (T2DM) in China has not yet been well investigated. This study aimed to determine the association of CKD with the risks of coronary heart disease (CHD) and stroke in a Chinese population with T2DM.　

A total of 1401 inpatients with T2DM at the Second Affiliated Hospital of Zhejiang University School of Medicine between April 2008 and November 2013 were included in this study. The CKD-Epidemiology Collaboration equation for Asians was used to classify CKD. The UK Prospective Diabetes Study risk engine was used to estimate the risks of CHD and stroke.　

CHD risk was significantly increased with CKD stage (20.1%, 24.8%, and 34.3% in T2DM patients with no CKD, CKD Stage 1–2, and Stage 3–5, respectively; P < 0.001 for all). The stroke risk was also increased with CKD stage (8.6%, 12.7%, and 25.4% in T2DM patients with no CKD, CKD Stage 1–2, and Stage 3–5, respectively; P < 0.001 for all). Compared with no-CKD group, the odds ratios (ORs) for high CHD risk were 1.7 (P < 0.001) in the CKD Stage 1–2 group and 3.5 (P < 0.001) in the CKD Stage 3–5 group. The corresponding ORs for high stroke risk were 1.9 (P < 0.001) and 8.2 (P < 0.001), respectively.　

In patients with T2DM, advanced CKD stage was associated with the increased risks of CHD and stroke.

Q fever endocarditis, a chronic illness caused by Coxiella burnetii, can be fatal if misdiagnosed or left untreated. Despite a relatively high positive rate of Q fever serology in healthy individuals in the mainland of China, very few cases of Q fever endocarditis have been reported. This study summarized cases of Q fever endocarditis among blood culture negative endocarditis (BCNE) patients and discussed factors attributing to the low diagnostic rate.　

We identified confirmed cases of Q fever endocarditis among 637 consecutive patients with infective endocarditis (IE) in the Peking Union Medical College Hospital between 2006 and 2016. The clinical findings for each confirmed case were recorded. BCNE patients were also examined and each BCNE patient’s Q fever risk factors were identified. The risk factors and presence of Q fever serologic testing between BCNE patients suspected and unsuspected of Q fever were compared using the Chi-squared or Chi-squared with Yates’ correction for continuity.　

Among the IE patients examined, there were 147 BCNE patients, of whom only 11 patients (7.5%) were suspected of Q fever and undergone serological testing for C. burnetii. Six out of 11 suspected cases were diagnosed as Q fever endocarditis. For the remaining 136 BCNE patients, none of them was suspected of Q fever nor underwent relevant testing. Risk factors for Q fever endocarditis were comparable between suspected and unsuspected patients, with the most common risk factors being valvulopathy in both groups. However, significantly more patients had consulted the Infectious Diseases Division and undergone comprehensive diagnostic tests in the suspected group than the unsuspected group (100% vs. 63%, P = 0.03).　

Q fever endocarditis is a serious yet treatable condition. Lacking awareness of the disease may prevent BCNE patients from being identified, despite having Q fever risk factors. Increasing awareness and guideline adherence are crucial in avoiding misdiagnosing and missed diagnosing of the disease.

髋臼唇是一种三角形纤维软骨结构，与髋臼边缘形成马蹄形附件，将髋臼与下面的髋臼横韧带连接[图1a].^[1]发现高达90%的有症状的发育性髋关节发育不良（DDH）患者合并髋臼唇病变。^[2]髋臼唇病变最常见的表现是肥大、撕裂和/或囊肿形成。^[3,4]然而，最近在几名有症状的DDH患者中观察到一种独特的髋关节状况[图1b].嵌在髋臼中的一层异常的盘状软组织。外层连接到髋臼唇，而内层可以通过手术探针提起并与髋臼软骨分离。

多发性骨骺发育不良（MED；EDM1，OMIM 132400；EDM2，OMIM 600204；EDM3，OMIM 600969；EDM4，OMIM 226900；EDM5，OMIM 607078；EDM6，OMIM 614135）是一种常染色体显性遗传性骨骼系统疾病，以轻度身材矮小和早发性退行性关节疾病为特征，由涉及6个以上基因的异质性基因型引起（补偿,COL9A1,COL9A2,COL9A3,MATN3,DTDST).^[1]然而，在所分析的所有样品中，大约10-20%的上述六个基因中的任何一个都不能鉴定出突变，这表明其他未鉴定的致病基因的存在也参与了MED的发病机制。^[1]

经导管封堵膜周室间隔缺损（pmVSD）已成为一种有前途的治疗方式。然而，经导管闭合多发性PMVSD伴巨大动脉瘤仍然非常具有挑战性。我们介绍我们的初步经验。

自从1988年世界卫生大会批准了彻底根除脊髓灰质炎的计划以来，口服脊髓灰质炎病毒减毒疫苗（OPV）的大规模使用使脊髓灰质炎病例数急剧减少。然而，OPV疫苗带来罕见但严重的不良后果，尤其是在2型疫苗株中。大多数疫苗相关的麻痹性脊髓灰质炎（VAPP）爆发与2型脊髓灰质炎疫苗株有关，大约26-31%的遗传差异疫苗衍生脊髓灰质炎病毒（VDPVs）病例与OPV的2型成分有关。^[1,2]除VAPP病例和VDPV外，2型脊髓灰质炎疫苗株也可引起多种疾病.^[3]据我们所知，没有报告由2型脊髓灰质炎疫苗株引起的肺炎病例。然而，我们在这里报告了一例与2型脊髓灰质炎疫苗株相关的婴儿病例。

致小编：眼肌麻痹会引起复视，病因很多，包括脑血管病。脑干梗死导致的核性眼肌麻痹常伴有脑干功能障碍的其他症状。中脑梗死仅表现为孤立性内直肌核性麻痹是相当罕见的。^[1]在这里，我们提供了这样一个不常见的病例，并讨论了可能的病因。

致编辑：内部恶性肿瘤的皮肤转移是不寻常的。此前的一项研究显示，皮肤转移的发生率仅为1%左右。^[1]肺癌被认为是皮肤转移的最常见来源之一，尤其是在男性中。^[2]在此，我们报告了一例鳞状细胞肺癌皮肤转移的病例。

致编者：我们饶有兴趣地阅读了李和高在蟑螂洛福单胞菌感染。^[1]在其中，作者质疑是否有足够的证据认为这种多鞭毛原生动物在呼吸道中具有重要意义。穆等人.^[2]我还建议所有诊断为肺部的病例L.blattarum中国报告的感染被误诊。

我们感谢Martínez-Girón博士对我们关于支气管肺的文章感兴趣蟑螂洛福单胞菌感染。^[1]然而，所有报告的支气管肺L.blattarum感染只是依赖于光镜发现。文献中的证据都不能通过培养、动物模型或多种分子程序进一步证实。此外，没有证据表明L.blattarum感染是迄今为止的地方病，这使得具有地理局限性的感染难以解释。此外，没有证据表明L.blattarum可通过蟑螂解剖在患者生活环境中发现，^[2]尽管部分病例有接触蟑螂的流行病学史。马丁内斯-吉隆博士提出的关于L.blattarum需要进一步确认，^[3]第一步是找到感染源。此外，之间的区别L.blattarum纤毛上皮细胞在光学显微镜下观察是非常困难的，尽管文献中描述了许多差异点。我们仔细回顾了支气管肺的文献L.blattarum过去二十年的感染。^[4]全部L.blattarum文献中发表的图像与我们通过光学显微镜发现的纤毛上皮细胞极其相似或相同。没有文献证实L.blattarum使用电子显微镜也没有提到的典型描述L.blattarum1969年和1990年。^[5,6]我们认为电镜下的超微结构对于鉴别L.blattarum和纤毛上皮细胞，这在迄今为止已发表的病例中从未被采用。在缺乏有效的分子生物学或培养方法来鉴定L.blattarum目前，感染仍然是一个谜，没有使用科赫的假设进行证实。因此，支气管肺L.blattarum感染仍然是一个悬而未决的问题。此外，我们希望可以进行更多的研究，使辩论早日结束。