Volume 130 · Issue 13 · 2017

As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample.

The children (aged 6–12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups.

Thirty-eight children withADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P= 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P= 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P< 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P= 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P< 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P= 0.03), working memory (F = 4.48, P= 0.04), ADHD-IV overall score (F = 21.72, P< 0.01), HI subscale score (F = 19.08, P< 0.01), and inattentive subscale score (F = 12.40, P< 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline.

This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD.

http://www.clinicaltrials.gov; NCT02327585.

The WHO recently has recommended the GenoType MTBDRplus version 1.0 and MTBDRsl version 1.0 assays for widespread use in countries endemic with drug-resistant tuberculosis. Despite this, these assays have rarely been evaluated in China, where the burden of drug-resistant tuberculosis is among the highest globally.

Mycobacterium tuberculosis clinical isolates were obtained between January 2008 and December 2008. Isolates were tested for drug resistance against rifampicin (RFP) and isoniazid (INH) using the GenoType MTBDRplus assay and drug resistance against ethambutol (EMB), ofloxacin (OFX), and kanamycin (KM) using the Genotype MTBDRsl assay. These results were compared with conventional drug-susceptibility testing (DST).

Readable results were obtained from 235 strains by GenoType MTBDRplus assay. Compared to DST, the sensitivity of GenoType MTBDRplus assay to detect RFP, INH, and multidrug resistance was 97.7%, 69.9%, and 69.8%, respectively, whereas the specificity for detecting RFP, INH, and multidrug resistance was 66.7%, 69.2%, and 76.8%, respectively. The sensitivity and specificity of the GenoType MTBDRsl assay were 90.9% and 95.2% for OFX, 77.8% and 99.5% for KM, 63.7% and 86.4% for EMB, respectively. Mutations in codon S531L of the rpoB gene and codon S315T1 of KatG gene were dominated in multidrug-resistant tuberculosis (MDR-TB) strains.

In combination with DST, application of the GenoType MTBDRplus and MTBDRsl assays may be a useful supplementary tool to allow a rapid and safe diagnosis of multidrug resistance and extensively drug-resistant tuberculosis.

With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis.

Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations.

The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P < 0.001, by Kruskal-Wallis test), with R² = 0.53 and coefficient of variation (CV) = 0.524.

The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction (AMI). The previous reports were restricted to other countries’ population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China.

This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography (CAG) and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed.

A total of 60 young female AMI (<7 days) patients were enrolled. From their CAG and intracoronary imaging results, the prevalence of SCAD in young female AMI population was 35% (21/60), the prevalence of coronary atherosclerostic heart disease was 65% (39/60). In the SCAD group, 43% (9/21) presented with non-ST-elevation myocardial infarction (NSTEMI) and the remainder presenting as STEMI. SCAD usually occurred in a single vessel (20/21, 95%), especially in left anterior descending artery (14/21, 67%). Eighteen patients (18/21, 86%) underwent conservative treatment, whereas the remaining three patients (3/21, 14%) underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% (20/21), and Type I imaging was observed in 5% (1/21), Type II was observed in 67% (14/21), and Type III was 29% (6/21). The average stenosis in the group was 76.9% ± 20.6%, and the mean lesion length was 36.6 ± 8.6 mm.

SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.

Ebstein’s anomaly (EA) has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography (2D-ITEE) during the EA surgery and to analyze the characteristics of the tricuspid valve (TV) by comparing the data from 2D-ITEE with the results from the surgery.

2D-ITEE data of 164 patients with EA who were operated in the First Hospital of Tsinghua University between July 2004 and April 2014 were retrospectively analyzed in this study. 2D-ITEE was applied in all patients. Downward displacement distances were measured, and the numbers of downward displacement or absent leaflets were compared with that of the surgery and with that of the two-dimensional-transthoracic echocardiogram (2D-TTE). Data comparison was performed using the Chi-square test.

The anterior leaflet partial or total downward displacement was 37.76 ± 17.50 mm in 54 cases, absent in one patient; septal leaflet downward displacement was 29.07 ± 12.34 mm in 134 cases, absent in 17 cases; and posterior leaflet downward displacement was 43.18 ± 19.16 mm in 115 cases, absent in 34 cases. Statistically, there was no significant difference between the results from 2D-ITEE and that of 2D-TTE. The consistency rates of 2D-ITEE with operation for septal and posterior leaflets were 93.2% and 96.1%, respectively, while the rate for anterior was only 40.1%, which was significantly different. Color Doppler flow image showed severe regurgitation in 150 cases and moderate in 14 cases. After surgical correction, moderate regurgitation of TV was found in 58 cases with 2D-ITEE, repair was performed again until the effect was satisfied. No complication occurred relating to the use of 2D-ITEE.

2D-ITEE could help diagnose anterior leaflet, evaluate the effect of TV repair, increase operational success rate, and reduce complication.

Since the 1980s, severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs). Physicians used them for predicting mortality and assessing illness severity in clinical trials. The objective of this study was to assess the performance of Simplified Acute Physiology Score 3 (SAPS 3) and its customized equation for Australasia (Australasia SAPS 3, SAPS 3 [AUS]) in predicting clinical prognosis and hospital mortality in emergency ICU (EICU).

A retrospective analysis of the EICU including 463 patients was conducted between January 2013 and December 2015 in the EICU of Peking University Third Hospital. The worst physiological data of enrolled patients were collected within 24 h after admission to calculate SAPS 3 score and predicted mortality by regression equation. Discrimination between survivals and deaths was assessed by the area under the receiver operator characteristic curve (AUC). Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed-to-expected numbers of deaths which is known as the standardized mortality ratio (SMR).

A total of 463 patients were enrolled in the study, and the observed hospital mortality was 26.1% (121/463). The patients enrolled were divided into survivors and nonsurvivors. Age, SAPS 3 score, Acute Physiology and Chronic Health Evaluation Score II (APACHE II), and predicted mortality were significantly higher in nonsurvivors than survivors (P < 0.05 or P< 0.01). The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.836 (0.796–0.876). The maximum of Youden’s index, cutoff, sensitivity, and specificity of SAPS 3 score were 0.526%, 70.5 points, 66.9%, and 85.7%, respectively. The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 demonstrated a Chi-square test score of 10.25, P= 0.33, SMR (95% CI) = 0.63 (0.52–0.76). The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 (AUS) demonstrated a Chi-square test score of 9.55, P= 0.38, SMR (95% CI) = 0.68 (0.57–0.81). Univariate and multivariate analyses were conducted for biochemical variables that were probably correlated to prognosis. Eventually, blood urea nitrogen (BUN), albumin,lactate and free triiodothyronine (FT3) were selected as independent risk factors for predicting prognosis.

The SAPS 3 score system exhibited satisfactory performance even superior to APACHE II in discrimination. In predicting hospital mortality, SAPS 3 did not exhibit good calibration and overestimated hospital mortality, which demonstrated that SAPS 3 needs improvement in the future.

Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms (LUTS) among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population.

From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasonographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio (OR) and 95% confidence interval (CI).

Compared with the control group, patients with adenomyosis had a greater IPSS total (4 [2–8] vs. 2 [0–3], Z = –8.159, P < 0.001), IPSS storage (2 [1–4] vs. 1[0–2], Z = –7.361 P < 0.001), and IPSS voiding (2 [0–4] vs. 0 [0–1], Z = –7.194, P < 0.001). Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms (IPSS ≥8). The most prevalent LUTS were daytime frequency (40.9%), followed by nocturia (24.8%), weak stream (24.2%), and incomplete emptying (23.5%). In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia (51.1% vs. 30.8%, χ² = 11.162 P= 0.025) and larger uterine volumes (183.3 [109.8–273.8] cm³ vs. 148.5 [96.4–262.7] cm³, Z = –1.441, P= 0.150) compared to patients with an IPSS total score <8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score ≥8 (OR: 2.309, 95% CI: 1.310–4.070, P= 0.004), an IPSS storage subscore ≥4 (OR: 2.422, 95% CI: 1.395–4.206, P= 0.002), and an IPSS voiding subscore ≥5 (OR: 1.971, 95% CI: 1.176–3.302, P= 0.010). However, patients with uterine volume more than 180 cm³ had more than 2-fold risk of bearing IPSS total score ≥8 (OR: 2.437, 95% CI: 1.381–4.300, P= 0.002), IPSS storage subscore ≥4 (OR: 2.486, 95% CI: 1.433–4.314, P= 0.001), and IPSS voiding subscore ≥5 (OR: 2.700, 95% CI: 1.485–4.908, P= 0.001).

Lower urinary tract symptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients’ quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.

Giant cell tumors (GCTs) are benign, locally aggressive tumors. We examined the rate of local recurrence of spinal GCTs and sought to identify recurrence factors in patients who underwent surgery.

Between 1995 and 2014, 94 mobile spine GCT patients were treated at our hospital, comprising 43 male and 51 female patients with an average age of 33.4 years. Piecemeal intralesional spondylectomy and total en bloc spondylectomy (TES) were performed. Radiotherapy was suggested for recurrent or residual GCT cases. Since denosumab was not available before 2014 in our country, only interferon and/or zoledronic acid was suggested.

Of the 94 patients, four underwent conservative treatment and 90 underwent operations. Seventy-five patients (79.8%) were followed up for a minimum of 24 months or until death. The median follow-up duration was 75.3 months. The overall recurrence rate was 37.3%. Ten patients (13.3%) died before the last follow-up (median: 18.5 months). Two patients (2.6%) developed osteogenic sarcoma. The local recurrence rate was 80.0% (24/30) in patients who underwent intralesional curettage, 8.8% (3/34) in patients who underwent extracapsular piecemeal spondylectomy, and 0 (0/9) in patients who underwent TES. The risk factors for local recurrence were lesions located in the cervical spine (P = 0.049), intralesional curettage (P < 0.001), repeated surgeries (P = 0.014), and malignancy (P < 0.001). Malignant transformation was a significant risk factor for death (P < 0.001).

Cervical spinal tumors, curettage, and nonintact tumors were risk factors for local recurrence. Intralesional curettage and malignancy were the most important significant factors for local recurrence and death, respectively.

Metabolic syndrome (MetS) is one of the high cardiovascular (CV) situations. Endothelial dysfunction, which is a common finding in patients with MetS, is related with increased CV risk. In patients with MetS, the effect of the major CV risk factors, not included in the MetS definition, on endothelial dysfunction is not well known. The aim of this study was to determine the effect of major CV risk factors such as gender, smoking, family history, and biochemical parameters on endothelial dysfunction in patients with MetS.

The study was performed between December 2010 and August 2014. A total of 55 patients (15 females and 40 males) with MetS and 81 healthy controls (37 females and 44 males) with a body mass index <25 kg/m² were enrolled in the study. Endothelial dysfunction was measured by flow-mediated dilatation (FMD), oxidative stress parameters; high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), endothelial nitric oxide synthase (e-NOS), nitric oxide, and cell adhesion markers; von Willebrand factor, and e-selectin. Platelet aggregation (endothelial adenosine diphosphate), total platelet count, and mean platelet volume were additionally analyzed and demographic parameters were explored. Student’s t-test, Mann-Whitney U-test, and Chi-square test were used to analyze the results.

The fasting blood glucose (z= 3.52, P= 0.001), hs-CRP (z = 3.23, P= 0.004), ox-LDL (z = 2.62, P= 0.013), and e-NOS (z = 2.22, P= 0.026) levels and cardiac risk score (z = 5.23, P< 0.001) were significantly higher in patients with MetS compared with the control group. Smoking was correlated with decreased FMD (χ² = 9.26, P= 0.002) in MetS patients but not in the control group.

Increased ox-LDL, hs-CRP, and e-NOS are likely to be a result of oxidative stress, a condition in which an imbalance occurs between the production and inactivation of reactive nitrogen and oxygen species. In addition, in patients with MetS, smoking is independently related to endothelial dysfunction.

Chronic intermittent hypoxia is the most remarkable feature of obstructive sleep apnea/hypopnea syndrome and it can induce the change of hypoxia-inducible factor-1α (HIF-1α) expression and contractile properties in the genioglossus. To clarify the role of HIF-1α in contractile properties of the genioglossus, this study generated and compared high-throughput RNA-sequencing data from genioglossus between HIF-1α conditional knockout (KO) mice and littermate wild-type (WT) mice.

KO mice were generated with cre-loxP strategy. Gene expression profile analysis was performed using gene enrichment analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses of differently expressed messenger RNAs were performed to identify the related pathways and biological functions. Six differentially expressed genes (DEGs) were validated by qualitative reverse transcription polymerase chain reaction.

A total of 142 (77 upregulated and 65 downregulated) transcripts were found to exhibit statistically significant difference between the HIF-1α-KO and WT mice. GO and KEGG analyses indicated that DEGs included genes involved in "skeletal muscle cell differentiation," "muscle organ development," "glucose metabolic process," "glycogen biosynthetic and metabolic process," etc.

This study might provide evidence that HIF-1α affects the expression of multiple genes involved in the myogenesis, muscle development, and carbohydrate metabolism through transcriptome analysis in conditional HIF-1α-KO mice.

Catheter-based renal denervation (RDN) is a novel treatment for resistant hypertension (RH). A recent meta-analysis reported that RDN did not significantly reduce blood pressure (BP) based on the pooled effects with mild to severe heterogeneity. The aim of the present study was to identify and reduce clinical sources of heterogeneity and reassess the safety and efficacy of RDN within the identified homogeneous subpopulations.

This was a meta-analysis of 9 randomized clinical trials (RCTs) among patients with RH up to June 2016. Sensitivity analyses and subgroup analyses were extensively conducted by baseline systolic blood pressure (SBP) level, antihypertensive medication change rates, and coronary heart disease (CHD).

In all patients with RH, no statistical differences were found in mortality, severe cardiovascular events rate, and changes in 24-h SBP and office SBP at 6 and 12 months. However, subgroup analyses showed significant differences between the RDN and control groups. In the subpopulations with baseline 24-h SBP ≥155 mmHg (1 mmHg = 0.133 kPa) and the infrequently changed medication, the use of RDN resulted in a significant reduction in 24-h SBP level at 6 months (P = 0.100 and P= 0.009, respectively). Subgrouping RCTs with a higher prevalent CHD in control showed that the control treatment was significantly better than RDN in office SBP reduction at 6 months (P < 0.001).

In all patients with RH, the catheter-based RDN is not more effective in lowering ambulatory or office BP than an optimized antihypertensive drug treatment at 6 and 12 months. However, among RH patients with higher baseline SBP, RDN might be more effective in reducing SBP.

Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.

The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.

Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = −27.97 min, 95% confidence interval [CI]: −49.40–−6.54, P< 0.01); less intraoperative blood loss (WMD = −0.72 ml; 95% CI: −1.30–−0.13, P= 0.02); earlier time to flatus (WMD = −0.83 day; 95% CI: −1.44–−0.22, P< 0.01); earlier time to restart oral intake (WMD = −1.95 days; 95% CI: −3.31–−0.60, P< 0.01); shorter hospital stay (WMD = −3.00 days; 95% CI: −4.87–−1.13, P< 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33–0.97, P= 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.

LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.

Good’s syndrome (GS) is a rare disease characterized by thymoma, hypogammaglobulinemia, low or absent B-cells, decreased T-cells, an inverted CD4+/CD8+ T-cell ratio and reduced T-cell mitogen proliferative responses. GS is difficult to diagnose preoperatively due to its rarity and lack of typical symptoms, the characteristics of Chinese GS patients are still lacking. This study aimed to systematically review all the clinical, laboratory, and immunologic findings of reported cases of Chinese patients with GS.

We searched for case reports and articles up to January 2017 using PubMed, China National Knowledge Infrastructure, Wangfang database and China Science and Technology Journal Database with the following words in combinations as key words: "thymoma," "hypogammaglobulinemia," and "Good’s syndrome." The text words and MeSH terms were entered depending on the databases characteristics. The reference lists from retrieved articles were also screened for additional applicable studies. The authors were restricted to Chinese. There was no language restriction.

Forty-seven patients were reported in 27 studies. We found that GS has a nationwide distribution and that most cases (83%) have been described on the mainland of China. The initial clinical presentation is varied, ranging from symptoms related to the thymoma to infections resulting from immunodeficiency. Type AB (50%) is the most common histologic type of thymomas in Chinese GS patients according to the World Health Organization classification of thymomas. With respect to infection, sinopulmonary infection (74%) is the most common type, followed by skin infection (10%) and intestinal tract infection (10%). Diarrhea was presented in 36% of patients, and autoimmune manifestations were presented in 36% of patients.

GS is a rare association of thymoma and immunodeficiency with a poor prognosis. Astute clinical acumen and increased awareness of the clinical and immunological profile of GS are needed to increase early diagnosis, that would benefit improved therapeutic effects.

危重超声以其无创、方便、快速诊断和治疗过程中动态监测的独特价值，被广泛应用于重症医学，被誉为“可视听诊器”，并应用于医学教育和培训系统。^[1]基于多年应用和推广临界超声的经验，本研究的作者建议，对临界超声的正确理解是最重要的，需要一致的质量控制系统来最大限度地减少误诊、漏诊和对操作者的依赖。为保证危重症超声检查的临床价值，避免误诊漏诊，完善质控体系，本研究确立了危重症超声检查的十项基本原则。

Wolf的带状疱疹后同位素反应(PHIR)描述了在愈合的带状疱疹病变部位出现新的病变。^[1]水痘-带状疱疹病毒（VZV）感染后比单纯疱疹病毒更常见。^[2]这种带状疱疹后病变具有从炎性疾病到恶性肿瘤的广泛范围。我们的文献综述仅报告了11例VZV感染后的粉刺。^[3]在亚洲人群中报告了一例罕见病例。在这里，我们报告了两例中国汉族男性带状疱疹后粉刺，符合Wolf的PHIR。

椎弓根螺钉置入是一种先进的后路固定技术，可以为患者提供巨大的生物力学益处。但椎骨形态复杂，在不穿透皮质的情况下置入螺钉非常困难。因此，需要新的技术来提高椎弓根螺钉放置的准确性和安全性。在此，我们提出了一种基于三维（3D）荧光透视的经皮椎弓根插入手术机器人系统，并介绍了首例机器人辅助胸椎微创固定病例。

根据2010年WHO消化系统肿瘤分类，食管低度上皮内瘤变（LGIEN）与局限于上皮下半部分的超微结构和细胞学异常相关，鳞状细胞癌（SCC）被定义为肿瘤侵犯固有层或渗透到更深的组织层。我们在此报告了一种罕见的食管鳞状病变，具有低度超微结构组织和局限于基底层的细胞学发育不良，以及侵犯固有层。

致编者：自发性腹壁血肿（SAWH）是急性腹痛的不常见原因，总是被误诊。在此，我们报告了一例诊断为SAWH的成功治疗；据我们所知，这是一个极其罕见的来自中国的巨型锯木厂。

编者按：中国政府正在积极倡导医疗改革，旨在降低医疗成本，提高服务质量。至于眼科，从传统的住院手术过渡到以门诊为主的模式可能是一个解决方案。中山眼科中心（ZOC）是中国最大和领先的眼科中心之一，每年进行超过65,000例手术。ZOC现在正致力于向门诊手术模式过渡，提高性能和效率。

致编者：一名20岁男性报告主诉左桥小脑角（CPA）胆脂瘤切除术后复视10天。术前1个半月，患者在无明显诱因的情况下，突然出现左面颊部休克、疼痛难忍。患者无面部感觉减退、听力下降、复视及恶心、呕吐等其他症状。2周后疼痛加重，触摸或洗脸易诱发，口服药物不能控制。计算机断层扫描显示CPA区域病变，磁共振成像显示左侧CPA长T1和T2信号。应用切除手术，术中病理检查确诊为胆脂瘤。术后左眼出现内斜视，不能立即通过中线，右眼运动功能正常[图1].双眼视力均为20/20。电脑复视检查显示左侧外展神经麻痹。

致编者：在此，我们提出一个罕见的病例，其左眼的内直肌和视神经都受到眶内颗粒细胞肿瘤（GCT）的影响。肿块的肉眼大小约为4.3 cm × 2.2 cm × 1.8 cm。

致编者：在徐的一项随机对照试验中等人.,^[1]比较Shikani光学探针和Macintosh喉镜用于颈椎病患者经口气管插管的性能，他们表明，与Macintosh喉镜相比，Shikani光学探针在临床上更有益，尤其是在气道困难的患者中。然而，在我们看来，这项研究中有几个问题使得对他们发现的解释值得怀疑。

致小编：我们感谢王博士，等人.^[1]对于我们文章中的评论。关于第一个评论点，我们同意他们的观点，即使用Macintosh喉镜的Cormack-Lehane 3-4级应被定义为困难喉镜检查。我们论文中对困难气道的定义应该是困难喉镜检查，而不是困难气道。^[1]我们研究中使用的喉分类（Macintosh 3-4刀片）是根据Cormack和Lehane的方法定义的，^[2,3]其中初始视图应在不施加外部喉部压力的情况下进行。我们承认，在使用Macintosh喉镜进行喉镜检查时，喉外压力可能会在临床实践中使用。我们研究的目的是调查Shikani光学探针是否对特定颈椎病患者有益。众所周知，颈部的任何外部压力都可能对宫颈疾病产生潜在的有害影响本身在这一特定患者群体中，是否使用外部压力对于得出客观结论至关重要。此外，当我们比较哪种设备更好时，很难量化外部压力强度对喉镜检查的影响。