Volume 130 · Issue 06 · 2017

Nonanesthetic colonoscopy is popular in clinical practice in China. However, intestinal spasms often result in a prolonged examination time, increased operating difficulties, decreased polyp detection rate, and failure to complete the procedure clinically. Therefore, exploring alternative approaches that can reduce the pain in patients during colonoscopy is of utmost importance, and finding the optimal preoperative administration to improve the quality of nonanesthetic colonoscopy is also necessary. This study aimed to investigate the effects of the prophylactic administration of pinaverium bromide before colonoscopy and the effects of pinaverium bromide alone at different time points or combined with scopolamine butylbromide.

A randomized controlled trial was performed on a cohort of 1000 patients who underwent colonoscopy in outpatient clinic of Wuhan Union Hospital. The patients were randomly assigned to the following groups: Group A, given oral pinaverium bromide (100 mg, three times a day) one day before examination combined with intramuscular injection of scopolamine butylbromide (20 mg) 10 min before colonoscopy; Group B₀, given pinaverium bromide alone on the day of colonoscopy (100 mg, three times a day); Group B₁, given pinaverium bromide alone (100 mg, three times a day) one day before colonoscopy; Group B₂, given pinaverium bromide alone (100 mg, three times a day) two days before colonoscopy; and Group C, given scopolamine butylbromide alone (20 mg) before colonoscopy. The successful rate of colonoscopy, procedure time, degree of abdominal pain, and polyp detection rate were recorded and compared among all groups.

The successful rate of colonoscopy in Group B₁ (82.0%) and Group B₂ (83.0%) was significantly higher than that in Group B₀ (62.0%, all P < 0.01). The time to reach the ileocecal region in Group B₁ and Group B₂ were lower than those in Group B₀ (all P < 0.05). However, no significant differences were observed in polyp detection rate between Group B₁ (24.0%) or Group B₂ (26.0%), and Group B₀ (22.4%, all P > 0.05). Furthermore, there were no significant differences in the various parameters examined between Group B₁ and Group B₂ (P > 0.05). The successful rate of colonoscopy in Group A (92.0%) was significantly higher than that in Group B₁ (82.0%) and Group C (80.0%; both P < 0.05). Moreover, the time for the colonoscope to reach the ileocecal region in Group A were markedly shorter as compared to those in Group B₁ and Group C (P < 0.05). The polyp detection rate in Group A was 32.0%, significantly higher than that in Group B₁ (24.0%, P < 0.05) and Group C (24.2%, P < 0.05).

Administration of pinaverium bromide alone one day before examination was beneficial to relieve symptoms of abdominal pain during nonanesthetic colonoscopy. In addition, therapeutic effects were improved when pinaverium bromide administration was combined with intramuscular injection of scopolamine butylbromide. Therefore, the combined use of pinaverium bromide with scopolamine butylbromide might have great application value to improve the quality of nonanesthetic colonoscopy in the preoperative preparation.

Photoselective vaporization of the prostate is a technique that is widely used for the treatment of benign prostatic hyperplasia (BPH) and has pronounced advantages compared to the traditional transurethral resection of the prostate. Following the recent introduction of end-firing lithium triborate lasers, we have created a new technique called photoselective vaporesection of the prostate (PVRP). This study described our initial experience using the PVRP technique for the treatment of BPH.

This prospective study included a total of 35 patients with BPH who underwent PVRP from August 2013 to July 2014. The chief clinical parameters were obtained and evaluated during the perioperative period and follow-up, including the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate, and prostate volume. All variables were evaluated for statistically significant differences compared to baseline values using the analysis of variance.

The mean subgroup IPSS and QoL scores significantly improved during follow-up; the respective decreases in IPSS storage score, IPSS voiding score, IPSS nocturia score, and QoL score were 75.3%, 83.6%, 51.4%, and 71.7%, respectively (all P < 0.001 compared with baseline). Three patients were diagnosed with prostate cancer based on postoperative pathological examinations. There were no serious perioperative complications.

The PVRP technique demonstrates satisfactory short-term clinical outcomes and perioperative safety in the treatment of BPH.

Numerous studies have investigated the influence of osseous factors on patellofemoral joint instability, but research on the influence of dynamic muscle factors in vivo is still in the exploratory stage. This study aimed to use magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to evaluate vastus medialis oblique (VMO) fiber bundles in patients with recurrent patellar dislocation to explore the changes in muscle morphology and function.

This prospective study involved 30 patients (7 males and 23 females; average age, 21.4 ± 3.8 years) clinically diagnosed with recurrent patellar dislocation in Peking University Third Hospital and 30 healthy volunteers matched for age, sex, and body mass index in our medical school between January 2014 and October 2014. None of the patients had a recent history of traumatic patellar dislocation or transient patellar dislocation. All patients underwent conventional MRI and DTI of the knee. The cross-sectional area of the VMO on MRI and the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and primary (λ1), secondary (λ2), and three-level characteristic (λ3) values on DTI were measured. The independent-samples t-test was used to compare these parameters between the two groups.

Compared with the control group, the patient group showed significantly higher FA values (0.39 ± 0.05 vs. 0.33 ± 0.03) and significantly lower ADC (1.51 ± 0.13 vs. 1.58 ± 0.07), λ2 (4.96 ± 0.13 vs. 5.04 ± 0.07), and λ3 values (4.44 ± 0.14 vs. 4.58 ± 0.07; t = 5.99, t = –2.58, t = –3.02, and t = –4.88, respectively; all P < 0.05). Cross-sectional VMO area and λ1 values did not differ between the two groups (t = –1.82 and t = 0.22, respectively; both P > 0.05).

The functional status of the VMO is closely associated with recurrent patellar dislocation. MRI, especially DTI (FA, ADC, λ2, and λ3), can detect early changes in VMO function and might facilitate the noninvasive monitoring of the functional status of the VMO in patients with recurrent patellar dislocation.

The accuracy of nasopharyngeal aspirate (NPA) specimens in detecting lower respiratory pathogens remains controversial. The objective of this study was to evaluate the diagnostic accuracy of aspirates (NPAs) specimen in lower respiratory tract infections (LRTIs) in children.

The prospective study was designed to collect the data of paired NPAs and bronchoalveolar lavage fluids from children with acute LRTIs from January 2013 to December 2015. All specimens were subjected to pathogen detection: bacterial detection by culture, Mycoplasma pneumoniae (Mp) detection by polymerase chain reaction assay and virus (influenza A and B viruses, parainfluenza virus [PIV] Types 1 and 3, respiratory syncytial virus, and adenovirus) detection by immunofluorescence assay. The diagnostic accuracy analysis of NPAs was stratified by age ≤3 years (n = 194) and >3 years (n = 294).

We collected paired specimens from 488 children. The positive rate of pathogen was 61.6%. For Streptococcus pneumoniae, NPA culture had the specificity of 89.9% and negative predictive value of 100% in age ≤3 years, the specificity of 97.2% and negative predictive value of 98.9% in age >3 years. For Mp, the positive predictive values of NPA was 77.4% in children ≤3 years, and 89.1% in children >3 years. For PIV III, NPA specimen had the specificity of 99.8% and negative predictive value of 96.5% in children ≤3 years. For adenovirus, NPA had the specificity of 97.8% and negative predictive value of 98.4% in age ≤3 years, the specificity of 98.9% and negative predictive value of 99.3% in age >3 years.

NPAs are less invasive diagnostic respiratory specimens, a negative NPA result is helpful in "rule out" lower airway infection; however, a positive result does not reliably "rule in" the presence of pathogens.

Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction.

This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression.

In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = −3.60, P < 0.001), and a history of hypertension (t = −2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = −3.83, P < 0.001; VLF: t = −3.07, P = 0.002; LF: t = −2.79, P = 0.006) and a history of diabetes (SDANN index: t = −3.58, P < 0.001; VLF: t = −2.54, P = 0.012; LF: t = −2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t= −2.38, P = 0.018) was related to the SDANN index.

Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.

Acinetobacter baumannii has emerged as an important pathogen causing a variety of infections. Using data from the China Surveillance of Antimicrobial Resistance Program conducted biennially, we investigated the secular changes in the resistance of 2917 isolates of A. baumannii from 2004 to 2014 to differ antimicrobial agents.

Pathogen samples were collected from 17 to 20 hospitals located in the eastern, central, and western regions of China. Minimum inhibitory concentrations (MICs) were determined by a 2-fold agar dilution method, and antimicrobial susceptibility was established using the 2014 Clinical Laboratory Standards Institute-approved breakpoints. Isolates not susceptible to all the tested aminoglycosides, fluoroquinolones, β-lactams, β-lactam/β-lactam inhibitors and carbapenems were defined as extensively drug resistant.

The rates of nonsusceptibility to common antimicrobial agents remained high (>65%) over the years with some fluctuations to certain agents. The prevalence of imipenem-resistant A. baumannii (IRAB) increased from 13.3% in 2004 to 70.5% in 2014 and that of extensively drug-resistant A. baumannii (XDRAB) increased from 11.1% in 2004 to 60.4% in 2014. The activity of tigecycline was stable with MIC₉₀ ≤4 mg/L against A. baumannii from 2009 to 2014. Susceptibility to colistin remained high (97.0%) from 2009 to 2014. The prevalence of XDRAB increased in all the three surveillance regions over the years and was significantly higher in Intensive Care Unit (ICU) wards than non-ICU wards.

This longitudinal multicenter surveillance program revealed the nationwide emergence of A. baumannii in China and showed a significant increase in prevalence from 2004 to 2014. High levels of bacterial resistance were detected among samples collected from clinical settings in China, with IRAB and XDRAB being especially prevalent. This study will help to guide empirical therapy and identify at-risk groups requiring more intense interventional infection control measures, while also helping to focus surveillance efforts.

During the past decades, the incidence of invasive aspergillosis (IA) caused by Aspergillus fumigatus has increased dramatically. The aims of this study were to investigate the susceptibility of clinical isolates of A. fumigatus to triazole and the underlying cyp51A mutations in triazole-resistant A. fumigatus.

A total of 126 A. fumigatus clinical isolates from 126 patients with proven or probable IA were obtained from four large tertiary hospitals in Nanjing, China, between August 2012 and July 2015. The determination of minimal inhibitory concentrations (MICs) for itraconazole, voriconazole, and posaconazole was performed by broth microdilution according to the European Committee on Antimicrobial Susceptibility Testing reference method.

A total of 4 A. fumigatus isolates (3.17%) were confirmed to be itraconazole resistant, with MICs of ≥8 mg/L, and one isolate (0.8%) was confirmed to be voriconazole resistant and posaconazole resistant, with MICs of 4 mg/L and 0.5 mg/L, respectively. We found that two of the 4 isolates of triazole-resistant A. fumigatus had the L98H amino acid substitution in combination with a 34-base pair tandem repeat in the promoter region, one isolate had an M220I mutation, and another itraconazole-resistant isolate did not have a substitution in the cyp51A gene.

This study shows that triazole-resistant A. fumigatus clinical isolates are present in Nanjing, China, which is a new challenge to the clinical management of IA.

The clinical significance of metabolic syndrome (MS) score, MS, and its individual components with respect to risk prediction of coronary artery disease (CAD) remains unclear. The objective of this study was to investigate whether and to what extent MS score, MS, and its individual components were related to the risk of CAD.

Among 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia, 858 were included in this study according to the inclusion criteria from September 2010 to June 2013. MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria. The severity of coronary atherosclerosis was assessed by Gensini score.

The results showed that the age- and sex-adjusted odds ratios (ORs) for CAD were as follows: MS score, 1.327; MS, 2.013; elevated waist circumference, 1.447; reduced high-density lipoprotein cholesterol, 1.654; and elevated fasting glucose, 1.782; all P < 0.05; whereas for elevated triglycerides, 1.324, and elevated blood pressure, 1.342, both P > 0.05. After multivariate adjustment, results showed that only MS and elevated fasting glucose were significantly associated with CAD (OR, 1.628, 95% confidence interval [CI], 1.151–2.305, P = 0.006 for elevated fasting glucose, and OR, 1.631, 95% CI, 1.208–2.203, P = 0.001 for MS). The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score (standardized coefficient, 0.101, P = 0.031 for elevated fasting glucose and standardized coefficient, 0.103, P = 0.009 for MS score).

The present study demonstrated that MS score, MS, and its individual components might have different contributions to CAD prevalence and severity. MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.

Some patients with pelvic organ prolapse may suffer from lower urinary tract symptoms (LUTS), especially stress urinary incontinence (SUI) named de novo SUI after pelvic floor reconstruction. This study aimed to investigate the incidence and risk factors of de novo SUI.

This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse (POP) at the Department of Gynecology in Peking University People’s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% (101 patients lost to follow-up). There were 75 patients with de novo SUI postoperatively. According to the ratio of 1:3, we ensured the number of control group (n = 225). The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI.

The incidence of de novo SUI was 25% (75/300). Univariate analysis showed that the ratio of lower urinary tract obstruction (LUTO) before surgery in de novo SUI group was significantly higher than the control group (odds ratio [OR] = 2.1, 95% confidence interval [CI] [1.1–4.0], P = 0.022). The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher (OR = 2.1, 95% CI [1.0–3.7], P = 0.045). After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery (OR = 2.3, 95% CI [1.2–4.6], P = 0.013).

Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.

Both Parkinson’s disease (PD) and multiple system atrophy (MSA) have associated sleep disorders related to the underlying neurodegenerative pathology. Clinically, MSA with predominant parkinsonism (MSA-P) resembles PD in the manifestation of prominent parkinsonism. Whether the amount of rapid eye movement (REM) sleep without atonia could be a potential marker for differentiating MSA-P from PD has not been thoroughly investigated. This study aimed to examine whether sleep parameters could provide a method for differentiating MSA-P from PD.

This study comprised 24 MSA-P patients and 30 PD patients, and they were of similar age, gender, and REM sleep behavior disorder (RBD) prevalence. All patients underwent clinical evaluation and one night of video-polysomnography recording. The tonic and phasic chin electromyogram (EMG) activity was manually quantified during REM sleep of each patient. We divided both groups in terms of whether they had RBD to make subgroup analysis.

No significant difference between MSA-P group and PD group had been found in clinical characteristics and sleep architecture. However, MSA-P patients had higher apnea-hypopnea index (AHI; 1.15 [0.00, 8.73]/h vs. 0.00 [0.00, 0.55]/h, P = 0.024) and higher tonic chin EMG density (34.02 [18.48, 57.18]% vs. 8.40 [3.11, 13.06]%, P < 0.001) as compared to PD patients. Subgroup analysis found that tonic EMG density in MSA + RBD subgroup was higher than that in PD + RBD subgroup (55.04 [26.81, 69.62]% vs. 11.40 [8.51, 20.41]%, P < 0.001). Furthermore, no evidence of any difference in tonic EMG density emerged between PD + RBD and MSA - RBD subgroups (P > 0.05). Both disease duration (P = 0.056) and AHI (P = 0.051) showed no significant differences during subgroup analysis although there was a trend toward longer disease duration in PD + RBD subgroup and higher AHI in MSA - RBD subgroup. Stepwise multiple linear regression analysis identified the presence of MSA-P (β = 0.552, P < 0.001) and RBD (β = 0.433, P < 0.001) as predictors of higher tonic EMG density.

Tonic chin EMG density could be a potential marker for differentiating MSA-P from PD.

Atherosclerosis is an inflammatory process that results in complex lesions or plaques that protrude into the arterial lumen. Carotid atherosclerotic plaque rupture, with distal atheromatous debris embolization, causes cerebrovascular events. This review aimed to explore research progress on the risk factors and outcomes of human carotid atherosclerotic plaques, and the molecular and cellular mechanisms of human carotid atherosclerotic plaque vulnerability for therapeutic intervention.

We searched the PubMed database for recently published research articles up to June 2016, with the key words of "risk factors" , "outcomes" , "blood components" , "molecular mechanisms" , "cellular mechanisms" , and "human carotid atherosclerotic plaques" .

The articles, regarding the latest developments related to the risk factors and outcomes, atherosclerotic plaque composition, blood components, and consequences of human carotid atherosclerotic plaques, and the molecular and cellular mechanisms of human carotid atherosclerotic plaque vulnerability for therapeutic intervention, were selected.

This review described the latest researches regarding the interactive effects of both traditional and novel risk factors for human carotid atherosclerotic plaques, novel insights into human carotid atherosclerotic plaque composition and blood components, and consequences of human carotid atherosclerotic plaque.

Carotid plaque biology and serologic biomarkers of vulnerability can be used to predict the risk of cerebrovascular events. Furthermore, plaque composition, rather than lesion burden, seems to most predict rupture and subsequent thrombosis.

Asthma and chronic obstructive pulmonary disease (COPD) are representative chronic inflammatory airway diseases responsible for a considerable burden of disease. In this article, we reviewed the relationship between neutrophil extracellular traps (NETs) and chronic inflammatory airway diseases.

Articles published up to January 1, 2017, were selected from the PubMed, Ovid Medline, Embase databases, with the keywords of "asthma" or "pulmonary disease, chronic obstructive" , "neutrophils" and "extracellular traps."

Articles were obtained and reviewed to analyze the role of NETs in asthma and COPD.

NETs are composed of extracellular DNA, histones, and granular proteins, which are released from activated neutrophils. Multiple studies have indicated that there are a large amount of NETs in the airways of asthmatics and COPD patients. NETs can engulf and kill invading pathogens in the host. However, disordered regulation of NET formation has shown to be involved in the development of asthma and COPD. An overabundance of NETs in the airways or lung tissue could cause varying degrees of damage to lung tissues by inducing the death of human epithelial and endothelial cells, and thus resulting in impairing pulmonary function and accelerating the progress of the disease.

Excessive NETs accumulate in the airways of asthmatics and COPD patients. Although NETs play an essential role in the innate immune system against infection, excessive components of NETs can cause lung tissue damage and accelerate disease progression in asthmatics and COPD patients. These findings suggest that administration of NETs could be a novel approach to treat asthma and COPD. Mechanism studies, clinical practice, and strategies to regulate neutrophil activation or directly interrupt NET function in asthmatics and COPD patients are desperately needed.

胃间质瘤(GST)是一组起源于Cajal间质细胞的胃肠道间质性肿瘤。其早期诊断和治疗对预后至关重要。^[1]商品及服务税的发生仍然不清楚；本研究利用Affymetrix表达谱芯片检测GST的基因表达谱，探索用于GST治疗和预后的新分子靶点。

神经垂体颗粒细胞瘤(GCT)由Boyce和Beadles于1983年首次报道。^[1]在2016年WHO中枢神经系统（CNS）肿瘤分类中，神经垂体GCT被定义为一种独特的诊断。^[2]在此，我们报告两例误诊为垂体腺瘤和颅咽管瘤的神经垂体GCT。其中一例是非常罕见的完全描述的神经垂体GCT，侵犯右侧海绵窦[图1a和1b]，表明良性肿瘤可能具有侵袭性特征。

四体18p（OMIM 614290）是一种非常罕见的染色体异常，患病率为1/140,000-180,000活产。^[1]虽然在一些国家已为人所知，但在我国却鲜有报道。特别是，四体18p的镶嵌甚至是罕见的。由于病例数量非常有限，镶嵌四体18p的表型谱、并发症和预后尚不清楚。在这项研究中，我们通过常规核型分析、高分辨率单核苷酸多态性(SNP)阵列和荧光报道了一名18p镶嵌四体症患者原地杂交（FISH）。

编辑：胃癌是一种常见的胃肠道（GI）恶性肿瘤，而印戒细胞癌（SRCC）是一种众所周知的低分化组织学类型，具有很强的转移倾向。胃癌的播散主要表现为三种模式。最常见的转移途径是通过局部淋巴结。血行播散也很常见，多发生在肝、肺、骨和肾上腺。此外，直接邻近侵犯、腹膜播种和Krukenberg瘤在预后不良的临床中较少见但也非常重要。在本报告中，我们介绍了一例罕见的原发性胃SRCC多发性息肉形式的结肠转移。

致编者：颧骨根脓肿是一种罕见的颅外耳源性并发症。不典型耳源性症状和缺乏认识是误诊的原因。在这里，我们提出了一个由隐匿性乳突炎急性发作导致的颧骨根部脓肿的病例。

致编者：一名56岁中国男性因烦渴（9000 ml/24 h）和多尿（7000 ml/24 h）超过20天，并伴有两侧额颞区间歇性中度头痛约2周，转诊至北京协和医院。患者在当地健康机构接受了带造影剂的脑磁共振成像（MRI），显示存在1.1 cm × 1.4 cm × 2.2 cm的不规则垂体病变。显然，诊断为中枢性尿崩症（DI），但垂体病变仍有待阐明。患者接受醋酸去氨加压素片（1.2 mg，q.n.）以改善烦渴（5000 ml/24 h）和多尿（4000 ml/24 h）。在我院进行了另一次脑MRI增强检查，显示鞍区有一圆形囊性病变，尺寸为1.99 cm × 0.84 cm × 1.08 cm。MRI信号特征在T1加权像(T1WI）上为低至等强度，边缘增强，在T2加权像(T2WI）上为等至高强度[图1].此外，T1WI上未检测到垂体后叶的高信号，与中央DI的典型MRI信号一致。内分泌评估显示无垂体激素紊乱。眼科检查显示无视觉障碍。该患者的既往病史并不显著。总之，手术前仔细考虑和区分垂体脓肿和Rathke裂囊肿（RCC）的入院诊断。患者接受了内窥镜下鼻内经蝶手术。在手术过程中，可见黄白色粘液内容物并排出。此外，白色囊壁被部分切除。意外发生脑脊液漏，随后进行鞍区修复重建。术后发生颅内感染，但通过胃肠外抗生素治疗得到控制。然后将醋酸去氨加压素治疗逐渐减少至每8小时0.05 mg的维持剂量。组织病理学结果证明鞍区病变为肾细胞癌。

致编者：膈肌阵挛作为一种典型的不常见局灶性运动障碍，其特征是膈肌和其他呼吸肌反复不自主同步收缩。^[1]在许多情况下，各种临床表现和确定病因的困难可能导致其诊断晚期和治疗无效。A型肉毒杆菌毒素对肌肉有麻痹作用。然而，据我们所知，很少有将A型肉毒毒素注射到膈肌的报道。在这个病例中，我们报告了在针状肌电图（EMG）引导下通过向膈肌和腹直肌（RA）注射肉毒杆菌毒素A成功治疗膈肌肌阵挛。

编辑：恶性高热（MH）是一种罕见但潜在致命的遗传性骨骼肌疾病，主要由摄入去极化松弛剂（即琥珀胆碱或挥发性麻醉剂）引起。^[1]据报道，其在全身麻醉患者中的发病率为1/5000至1/100,000，儿童似乎比成人更易受影响。^[2]根据美国恶性高热协会（MHAUS）和欧洲恶性高热小组（EMHG）的MH治疗指南，疑似病例应尽快给予丹曲林。^[3,4]不幸的是，丹曲林在世界范围内并不容易获得。在这里，我们报告了一例不使用丹曲林治疗的高度疑似MH病例。我们相信医生，尤其是在丹曲林不容易获得的国家，会对我们的经验感兴趣。