Volume 130 · Issue 14 · 2017

Pharmacological therapy for congestive heart failure (CHF) with ventricular arrhythmia is limited. In the study, our aim was to evaluate the effects of Chinese traditional medicine Shensong Yangxin capsules (SSYX) on heart rhythm and function in CHF patients with frequent ventricular premature complexes (VPCs).

This double-blind, placebo-controlled, multicenter study randomized 465 CHF patients with frequent VPCs to the SSYX (n = 232) and placebo groups (n = 233) for 12 weeks of treatment. The primary endpoint was the VPCs monitored by a 24-h ambulatory electrocardiogram. The secondary endpoints included the left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) classification, 6-min walking distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores, and composite cardiac events (CCEs).

The clinical characteristics were similar at baseline. SSYX caused a significantly greater decline in the total number of VPCs than the placebo did (−2145 ± 2848 vs. −841 ± 3411 , P < 0.05). The secondary endpoints of the LVEF, NYHA classification, NT-proBNP, 6MWD, and MLHFQ scores showed a greater improvements in the SSYX group than in the placebo group (ΔLVEF at 12^th week: 4.75 ± 7.13 vs. 3.30 ± 6.53; NYHA improvement rate at the 8^th and 12^th week: 32.6% vs. 21.8%, 40.5% vs. 25.7%; mean level of NT-proBNP in patients with NT-proBNP ≥125 pg/ml at 12^th week: −122 [Q1, Q3: −524, 0] vs. −75 [Q1, Q3: −245, 0]; Δ6MWD at 12^th week: 35.1 ± 38.6 vs. 17.2 ± 45.6; ΔMLHFQ at the 4^th, 8^th, and 12^th week: −4.24 ± 6.15 vs. −2.31 ± 6.96, −8.19 ± 8.41 vs. −3.25 ± 9.40, −10.60 ± 9.41 vs. −4.83 ± 11.23, all P < 0.05). CCEs were not different between the groups during the study period.

In this 12-week pilot study, SSYX was demonstrated to have the benefits of VPCs suppression and cardiac function improvement with good compliance on a background of standard treatment for CHF.

www.chictr.org.cn, ChiCTR-TRC-12002061 (http://www.chictr.org.cn/showproj.aspx?proj=7487) and Clinicaltrials. gov, NCT01612260 (https://clinicaltrials.gov/ct2/show/NCT01612260).

The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.

We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student’s t-test and the Mann-Whitney U-test. For categorical variables, the Pearson’s Chi-square test, the continuity correction test, and Fisher’s exact test were used.

Patients’ demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284–10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005–1.295, P = 0.041).

Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.

Lots of trials demonstrate that second-generation drug-eluting stents (G2-DES), with their improved properties, offer significantly superior efficacy and safety profiles compared to first generation DES (G1-DES) for patients with coronary artery disease (CAD) receiving percutaneous coronary intervention (PCI). This study aimed to verify the advantage of G2-DES over G1-DES in Chinese patients with stable CAD (SCAD).

For this retrospective observational analysis, 2709 SCAD patients with either G1-DES (n = 863) or G2-DES (n = 1846) were enrolled consecutively throughout 2013. Propensity score matching (PSM) was applied to control differing baseline factors. Two-year outcomes, including major adverse coronary events as well as individual events, including target vessel-related myocardial infarction, target lesion revascularization (TLR), target vessel revascularization, and cardiogenic death were evaluated.

The incidence of revascularization between G1- and G2-DES showed a trend of significant difference with a threshold P-value (8.6% vs. 6.7%, χ² = 2.995, P = 0.084). G2-DES significantly improved TLR-free survival compared to G1-DES (96.6% vs. 97.9%, P = 0.049) and revascularization-free survival curve showed a trend of improvement of G2-DES (92.0% vs. 93 .8%, P = 0.082). These differences diminished after PSM. Multivariate Cox proportional hazard regression analysis showed a trend for G1-associated increase in revascularization (hazard ratio: 1.28, 95% confidence interval: 0.95–1.72, P = 0.099) while no significance was found after PSM. Other endpoints showed no significant differences after multivariate adjustment regardless of PSM.

G1-DES showed the same safety as G2-DES in this large Chinese cohort of real-world patients. However, G2-DES improved TLR-free survival of SCAD patients 2 years after PCI. The advantage was influenced by baseline clinical factors. G1-DES was associated with a trend of increase in revascularization risk and was not an independent predictor of worse medium-term prognosis compared with G2-DES.

Seborrheic dermatitis (SD) is a common inflammatory skin condition. The etiology is unclear, although overgrowth of Malassezia on the skin has been suggested to cause SD. This study investigated whether colonization with Staphylococcus plays a role in facial SD, which was not well addressed previously.

The study was conducted from September 1, 2011 to February 20, 2012 in the First Hospital of China Medical University. In the first phase, the study evaluated the level of transepidermal water loss (TEWL) and the number of colony-forming units (CFU) of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus (HIV) seropositive (HIV [+] SD [+] group, n = 13), classical SD (HIV [−] SD [+] group, n = 24) patients, HIV seropositive-non-SD (HIV [+] SD [−] group, n = 16) patients, and healthy volunteers (HIV [−] SD [−] group, n = 16). In the second phase, we enrolled another cohort of HIV (−) SD (+) patients who applied topical fusidic acid (n = 15), tacrolimus (n = 16), or moisturizer (n = 12). Changes in the Seborrheic Dermatitis Area Severity Index (SDASI), TEWL, and Staphylococcus density were evaluated 2 weeks later. Comparisons of each index were performed using analysis of variance (ANOVA) and least significant difference method.

The level of TEWL was greater through lesional sites in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% confidence interval [CI]: 18.873–47.071, P < 0.001 and 95% CI: 28.755–55.936, P < 0.001, respectively). The number of CFU of Staphylococcus was greater in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% CI: 37.487–142.744, P = 0.001 and 95% CI: 54.936–156.400, P < 0.001, respectively). TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers (95% CI: 7.560–38.987, P = 0.004 and 95% CI: 4.659–37.619, P = 0.011, respectively ). Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer (95% CI: 0.03-0.432, P = 0.025 and 95% CI: 0.033–0.44, P = 0.024, respectively).

High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD.

Orthotopic liver transplantation (OLT) improves the prognosis of patients with hepatocellular carcinoma (HCC). Moreover, the complement system is a powerful immune effector that can affect liver function and process of liver cirrhosis. However, studies correlating the complement system with tacrolimus metabolism after OLT are scarce. In this study, the role of single nucleotide polymorphisms (SNPs) associated with the sixth complement component (C6) in tacrolimus metabolism was investigated during the early stages of liver transplantation.

The study enrolled 135 adult patients treated with OLT for HCC between August 2011 and October 2013. Ten SNPs in C6 gene and rs776746 in cytochrome P450 3A5 (CYP3A5) gene were investigated. The tacrolimus levels were monitored daily during 4 weeks after transplantation.

Both donor and recipient CYP3A5 rs776746 allele A were correlated with decreased concentration/dose (C/D) ratios. Recipient C6 rs9200 allele G and donor C6 rs10052999 homozygotes were correlated with lower C/D ratios. Recipient CYP3A5 rs776746 allele A (yielded median tacrolimus C/D ratios of 225.90 at week 1 and 123.61 at week 2), C6 rs9200 allele G (exhibited median tacrolimus C/D ratios of 211.31 at week 1, 110 .23 at week 2, and 99 .88 at week 3 ), and donor CYP3A5 rs776746 allele A (exhibited median C/D ratios of 210.82 at week 1, 111.06 at week 2, 77.49 at week 3, and 85 .60 at week 4 ) and C6 rs10052999 homozygote (exhibited median C/D ratios of 167.59 at week 2, 157.99 at week 3, and 155.36 at week 4) were associated with rapid tacrolimus metabolism. With increasing number of these alleles, patients were found to have lower tacrolimus C/D ratios at various time points during the 4 weeks after transplantation. In multiple linear regression analysis, recipient C6 rs9200 group (AA vs. GG/GA) was found to be related to tacrolimus metabolism at weeks 1, 2, and 3 (P = 0.005, P = 0.045, and P = 0.033, respectively), whereas donor C6 rs10052999 group (CC/TT vs. TC) was demonstrated to be correlated with tacrolimus metabolism only at week 4 (P = 0.001).

Recipient C6 gene rs9200 polymorphism and donor C6 gene rs10052999 polymorphism are new genetic loci that affect tacrolimus metabolism in patients with HCC after OLT.

Idiopathic membranous nephropathy (IMN) is an autoimmune disease and the leading cause of adult nephritic syndrome. HLA-DQA1 had been identified to be associated with IMN in Europeans and the result was replicated in Chinese Han population. In this study, six single nucleotide polymorphisms (SNPs) in the promoter of HLA-DQA1 and other two SNPs with IgA nephropathy were included for the association analysis.

The SNPs were genotyped in 509 patients and 601 controls by the MassArray iPLEX. The quantification of anti-phospholipase A2 receptor (PLA2R) antibodies in sera of IMN patients was performed by anti-PLA2R ELISA (IgG) kit.

After analysis, four SNPs were significantly associated with IMN, with rs2187668 and rs28383345 as the top two signals (P = 8.42×10^-5 and 2.48×10^-5, respectively). Even under dominant model, the two SNPs were still significantly associated with IMN (P = 3.50×10^-3 for rs28383345 and P = 6.55×10^-5 for rs2187668). After conditional study with rs2187668, rs28383345 was the only variant significantly correlated with IMN after Bonferroni correction (P = 0.016). The minor alleles of the two SNPs were also mutually exclusive in our cohort. This indicated that the two SNPs were independently associated with IMN in Chinese Han population. Levels of anti-PLA2R autoantibodies were correlated with the genotypes of the two SNPs, but not significantly (P>0.05).

Our results revealed that a novel independent variant in the promoter of HLA-DQA1 was associated with IMN in Chinese Han population. The locus possessed regulatory role according to the data of RegulomeDB. The exact role of the SNPs on the expression of HLA-DQA1 needs further investigation.

In small fiber neuropathy (SFN), thinly myelinated Aδ and unmyelinated C fibers are primarily affected, resulting in sensory and/or autonomic symptoms. Various etiologies have been shown to be associated with SFN. This study was aimed to analyze a variety of features in peripheral neuropathy (PN) with small fiber involvement, and to compare disease severity among patients with idiopathic PN, PN associated with impaired glucose tolerance (IGT), and metabolic syndrome (MS) PN.

Thirty-eight PN patients with small fiber involvement were enrolled from December 20, 2013 to May 31, 2016. Patients were divided into idiopathic PN, IGT-related PN, and MS-related PN groups. Detailed medical history and small fiber neuropathy were investigated, and symptom inventory questionnaire was conducted, as well as the visual analog scale. Nerve conduction studies and skin biopsies were also performed. The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test.

Eight patients were diagnosed with pure SFN. Intraepidermal nerve fiber density (IENFD) weakly correlated with motor conduction velocity (MCV) (r = 0.372, P = 0.025), and proximal (r = 0.383, P = 0.021) and distal (r = 0.358, P = 0.032) compound muscle action potential (CMAP) of the tibial nerve. IENFD also weakly correlated with MCV of the peroneal nerve (r = 0.399, P = 0.016). IENFD was shown to be significantly different among all groups (χ² = 9.901, P = 0.007). IENFD was significantly decreased (χ² = 23.000, P = 0.003) in the MS-related PN group compared to the idiopathic PN group. The MCV of the tibial nerve was significantly different among all groups (χ² = 8.172, P < 0.017). The proximal (F = 4.336, P = 0.021) and distal (F = 3.262, P = 0.049) CMAP of the tibial nerve was also significantly different among all groups.

IENFD of patients included in the present study weakly correlated with various electrophysiological parameters. Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.

General practitioner (GP) preceptors play an important role in the cultivation of GPs. Many problems exist in the training of GP preceptors. This study aimed to explore the willingness and training needs of GP preceptors and compare the differences between preceptors from general practice and other specialties.

A total of 375 questionnaire forms were sent to 375 GP preceptors from 11 different provinces, and 344 completed forms were returned. The main outcome included general information, teaching motivations, and training needs of GP preceptors.

The study showed that about 89.2% of GP preceptors were willing to be teachers. The majority of respondents strongly agreed that the motivation for becoming a GP supervisor was to learn from teaching. The most important capability they should master was clinical teaching (92.2%), followed by lecture (83.1%) and doctor–patient communication (83.1%). The top three preferred methods of GP preceptors training were case discussion (78.8%), workshop (57.6%), and classroom teaching (56.4%). The domains in which most GP preceptors wanted to acquire knowledge and skill were mental health (59.3%), rehabilitation (47.1%), pediatrics (41.0%), and obstetrics (37.5%). No significant differences were found in the willingness to train GPs (χ² = 3.34, P > 0.05) and whether they would become or continue to become a GP supervisor after the training (χ² = 1.106, P > 0.05).

Although most preceptors were under on-the-job training, they were glad to train GPs. To be qualified, preceptors should be trained according to the actual needs of GP preceptors.

Acute kidney injury (AKI) is a severe disease in critically ill patients. Neutrophil infiltration into kidney was associated with the development of AKI, and P-selectin may be involved in the process of neutrophil recruitment in kidney. This study aimed to explore the potential effect of platelet-derived P-selectin on neutrophil recruitment in a mouse model of sepsis-induced AKI.

A total of 30 C57BL/6 male mice were divided into five groups (n = 6 in each): sham group, sepsis group, anti-Ly6G group, anti-P-selectin group, and platelet depletion group. Sepsis was induced by cecal ligation and puncture. Serum creatinine concentration and platelet activity were measured by biochemical detector and flow cytometry, respectively. Histological and pathological features were analyzed using hematoxylin-eosin (H&E) and immunohistochemistry (IHC) staining, respectively. Myeloperoxidase (MPO) activity was detected with MPO assay. Unpaired t-test was used for data analysis.

Serum creatinine increased significantly in septic group compared to sham group (2.68 ± 0.27 mg/dl vs. 0.82 ± 0.19 mg/dl, t= 12.06, P = 0.0000) but attenuated in antibodies-treated animals compared to septic group (anti-Ly6G: 1.62 ± 0.30 mg/dl vs. 2.68 ± 0.27 mg/dl, t = 5.76, P = 0.0004; anti-P-selectin: 1.76 ± 0.31 mg/dl vs. 2.68 ± 0.27 mg/dl, t = 4.92, P = 0.0012; and platelet depletion: 1.93 ± 0.29 mg/dl vs. 2.68 ± 0.27 mg/dl, t = 4.14, P = 0.0032). Platelet amount significantly decreased compared to sham group (658.20 ± 60.64 × 10⁹/L vs. 822.00 ± 48.60 × 10⁹/L, t = 4.71, P = 0.0015) in septic mice, especially in platelet depletion group (240.80 ± 44.98 × 10⁹/L vs. 822.00 ± 48.60 × 10⁹/L, t = 19.63, P = 0.0000). P-selectin activity was significantly increased in septic group compared to sham group (16.54 ± 1.60% vs. 1.90 ± 0.29%, t = 15.64, P = 0.0000) but decreased significantly in platelet depletion group compared to septic group (3.62 ± 0.68% vs. 16.54 ± 1.60%, t = 12.89, P = 0.0002). IHC analysis shown that neutrophil infiltration increased in septic mice compared to sham group (36.67 ± 3.79% vs. 9.17 ± 1.61%, t= 11.58, P = 0.0003) and function-blocked groups (anti-Ly6G: 36.67 ± 3.79% vs. 15.33 ± 1.53%, t= 9.05, P = 0.0008; anti-P-selectin: 36.67 ± 3.79% vs. 21.33 ± 1.53%, t= 6.51, P = 0.0029; and platelet depletion: 36.67 ± 3.79% vs. 23.33 ± 3.06%, t= 4.75, P = 0.0090). MPO increased significantly in septic group compared to control (49.73 ± 1.83 ng/mg prot vs. 13.04 ± 2.16 ng/mg prot, t = 19.03, P = 0.0000) but decreased in function-blocked groups compared to septic group (anti-Ly6G: 26.52 ± 3.86 ng/mg prot vs. 49.73 ± 1.83 ng/mg prot, t = 9.59, P = 0.0000; anti-P-selectin: 33.06 ± 6.75 ng/mg prot vs. 49.73 ± 1.83 ng/mg prot, t = 4.85, P = 0.0013; and platelet depletion: 33.37 ± 2.25 ng/mg prot vs. 49.73 ± 1.83 ng/mg prot, t = 5.33, P = 0.0007).

Platelets-derived P-selectin may be involved in the development of septic AKI through inducing neutrophil infiltration into kidney.

Mounting evidence has demonstrated that hypoxia-inducible factor-1α (HIF-1α) could attenuate brain injuries after cerebral ischemia and reperfusion (CIR). However, few reports have addressed the therapeutic efficacies of a recombinant adenovirus vector containing HIF-1α (AdHIF-1α) gene after ischemia and reperfusion. The aim of this study was to examine the antiapoptotic and neuroprotective effects of AdHIF-1α gene for cerebral injuries after ischemia and reperfusion in rats.

From February to December 2016, male Sprague-Dawley rats were randomly divided into normal, sham, CIR, AdHIF-1α, and recombinant adenovirus (Ad) groups. Middle cerebral artery occlusion model was established by Longa’s method and reperfusion resumed at 2 h postocclusion. AdHIF-1α solution, Ad solution, and phosphate-buffered saline were injected into the right lateral ventricle of rats in AdHIF-1α, Ad, and CIR groups. Brain tissue sections were observed under fluorescent microscope to confirm the definite expression of recombinant adenovirus in Ad and AdHIF-1α groups. The expressions of HIF-1α protein were analyzed by immunohistochemical staining at 6 h, 24 h, and 72 h postreperfusion. Brain water content and neurological deficit scores were evaluated at 6 h, 24 h, and 72 h postreperfusion. Pathological brain injuries were examined after hematoxylin and eosin stain and nerve cell apoptosis was measured after terminal-deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) stain at 72 h postreperfusion. Comparisons were conducted with one-way analysis of variance by post hoc Scheffe’s test among different experimental groups.

Green fluorescent protein was successfully expressed in brain tissue of Ad and AdHIF-1α groups from 24 h to 21 days postinjection. As detected by immunohistochemical staining, the expressions of HIF-1α protein were obviously enhanced in AdHIF-1α group than those in CIR and Ad groups at 24 h and 72 h postreperfusion, respectively. There were significant reductions of brain water content (78.83% ± 0.34% vs. 83.21% ± 0.50% and 83.35% ± 0.32%; 84.13% ± 0.24% vs. 89.76% ± 0.34% and 89.70% ± 0.18%; respectively; all P < 0.05) and neurological deficit scores (2.90 ± 0.74 vs. 3.50 ± 0.52 and 3.60 ± 0.53 at 24 h; 2.40 ± 0.84 vs. 3.60 ± 0.52 and 3.50 ± 0.53 at 72 h; respectively; all P < 0.05) in AdHIF-1α group versus CIR and Ad groups at 24 h and 72 h postreperfusion, respectively. The pathologic changes of AdHIF-1α group were milder than those in CIR and Ad groups at 72 h postreperfusion. The percentage of TUNEL-positive cells in cerebral subcortex decreased significantly in AdHIF-1α group versus CIR and Ad groups at 72 h postreperfusion (P < 0.05).

AdHIF-1α has an obvious neuroprotective effect on ischemia and reperfusion in rat brains possibly through inhibiting the apoptosis of nerve cells.

One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex.

Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database. The following information was extracted from the paper: arterial oxygen partial pressure (PaO₂), PaO₂/inspired oxygen concentration (PaO₂/FiO₂, oxygenation index [OI]), intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP), heart rate (HR), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA).

Fourteen randomized controlled trials were included containing a total of 625 patients. Compared with placebo group, Dex significantly increased PaO₂/FiO₂ (standard mean difference [SMD] = 0.98, 95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt (SMD= −1.22, 95% CI [−2.20, −0.23], P = 0.020), HR (SMD= −0.69, 95% CI [−1.20, 0.17], P = 0.009), MAP (SMD= −0.44, 95% CI [−0.84, 0.04], P = 0.030), the concentrations of TNF-α (SMD = −1.55, 95% CI [−2.16, −0.95], P <0.001), and IL-6 (SMD= −1.53, 95% CI [−2.37, −0.70], P = 0.0003) were decreased in the treated group, when compared to placebo group. No significant difference was found in MDA (SMD = −1.14, 95% CI [−3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [−0.29, 1.10], P = 0.250) between the Dex group and the placebo group. Funnel plots did not detect any significant publication bias.

Dex may improve OI and reduce intrapulmonary shunt during OLV in adults undergoing thoracic surgery. However, this conclusion might be weakened by the limited number of pooled studies and patients.

Radiation therapy combined with surgical excision was considered as one of the most effective treatment plans for keloid lesions. However, there was no unanimity found over present literatures regarding the issue on optimized treatment strategy for keloids. We here provide a comprehensive review over this issue and emphasize on the influencing factors.

The data analyzed in this review were searched from articles included in PubMed and EMBASE databases.

The original articles and critical reviews discussing the application of radiation therapy in keloids treatment were selected for this review.

The application of radiation therapy has transitioned from simple superficial X-ray irradiation to brachytherapy. Furthermore, several factors including radiation type, dose, fraction, interval, and complications were reviewed, and the results revealed that these factors were significant toward clinical outcome at various levels.

Both past and present evidence support the idea that combination therapy of radiation and surgical therapy is safe and feasible. However, the optimization of treatment strategy was based on different radiation types and should take dose, fractions, interval, and complications into consideration, which will then decrease the rate of recurrence and increase the level of satisfaction.

Contrast-enhanced ultrasound (CEUS) is a well-established imaging modality which has been put into clinical use in recent years with the development of second-generation contrast agent and imaging devices, and its applications in the assessment of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, have provoked abundant discussion and researches among radiologists and rheumatologists. To summarize the achievements of clinical studies on CEUS in the application of arthritis, and to keep up with the latest progresses of the imaging technique, we reviewed the literature in recent years, hoping to establish the role of CEUS in joint diseases.

PubMed and EMBASE.

We searched the database with the conditions "contrast-enhanced ultrasound AND arthritis" with the time limitation of recent 10 years. Clinical studies applying CEUS in inflammatory arthritis and review articles about development of CEUS in joint diseases in English were selected.

As it is proved by most studies in recent years, by delineating microvasculature within the inflamed joints, CEUS can indicate early arthritis with high sensitivity and specificity. Moreover, the imaging of CEUS has been proved to be consistent with histopathological changes of inflammatory arthritis. Quantitative analysis of CEUS permits further evaluation of disease activity. CEUS also plays a significant role in the therapeutic monitoring of the disease, which has been backed up by a number of studies.

CEUS may be a new choice for the rheumatologists to evaluate inflammatory arthritis, because of its low price, ability to provide dynamic pictures, and high sensitivity to angiogenesis. It can also be applied in disease classification and therapeutic monitoring. More studies about CEUS need to be done to set up the diagnostic standards.

工作场所暴力是全球医疗保健中的一个长期问题。受害者通常是急诊科的护士和工作人员。^{[1,2,3,4,5,6,7,8]}随着时间的推移，学术辩论将使我们对这个问题有一个完整的了解。作者在PubMed（www.pubmed.com）上搜索了1990年至2016年的英文相关研究和辩论文章[图1].总共发布了1899个关键词为“工作场所暴力”的条目，600个关键词为“工作场所暴力医疗保健”的条目，786个关键词为“工作场所暴力护理”的条目，279个关键词为“工作场所暴力紧急情况”的条目（这四组之间有一些重叠）。

原发性心脏肿瘤在儿童中很少见，尸检系列患病率为0.0017-0.28%。^[1]良性肿瘤占总数的90%以上。心脏纤维瘤（CFs）是继横纹肌瘤之后儿科人群中第二常见的良性心脏肿瘤。根据肿瘤的大小和位置，患者可以无症状，也可以出现心悸、心脏杂音、心律失常、充血性心力衰竭，甚至猝死。对于有症状的患者，手术切除应被视为最佳选择。^[2,3]本研究报告四例儿童大型左心室纤维瘤的手术病例。

肩胛下囊（SSB）的定义仍有争议。一位研究人员证明了SSB是一个独立的袋子。^[1]然而，其他人认为SSB实际上是肩胛下上隐窝（SSR），它是盂肱关节囊的一个外囊。^[2,3,4]必须确认SSB和SSR是否是两个不同的囊。此外，磁共振（MR）成像中显示的SSR中的液体已被认为是诊断冻结肩的指征。^[3]考虑到SSB和SSR是两种具有密切空间关系的不同结构，识别SSB的MR表现可能具有重要的诊断意义。本研究的目的是使用基于中国可见人（CVH）的三维（3D）可视化技术描述SSB的解剖结构，并探索SSB的MR外观。

糖尿病外展神经麻痹主要症状包括眼球运动障碍和复视。本病主要由严重的血管变性引起。严重影响患者的生活质量和心理健康。目前，对于眼球运动障碍和复视尚无有效的干预手段，患者只能期待神经自我修复。^[1]我们团队发明了眶内电针（IEA）疗法来修复受糖尿病影响的外展神经。同时，我们将其应用于临床，取得了很大的成功。

合成网片常用于肱骨近端骨肿瘤患者人工假体置换后的软组织重建。我们对两个截肢进行了生物力学和组织学测试，以测试关节的稳定性和合成网片的生物相容性。

随着重症医学的发展，机械通气在重症监护病房（ICU）中得到了广泛的应用。接受有创机械通气的患者需要定期或根据需要吸痰，以清除气道分泌物并保持气道通畅。因此，通过使用打开或关闭抽吸模式来确定断开用于抽吸痰的呼吸回路管的要求。目前，开放吸引系统最常用于清除气道分泌物。由于对细菌菌株的耐药性迅速增加，开放式抽吸污染ICU环境的可能性经常受到质疑，本研究对此进行了调查。

汗孔角化病(PK)于1983年首次描述，是一种慢性角化不全皮肤病。临床类型包括米贝利汗孔角化病（PM）、播散性浅表PK、播散性浅表光化性汗孔角化病（DSAP）、面部PK和嗜酸性汗孔角化病（PP）。PK的皮肤镜图像显示明显的环形边缘，带有鳞片和萎缩的中心。^[1]PK的伍德灯图片呈现出钻石项链般的结构。^[2]甲羟戊酸途径酶的基因突变，如甲羟戊酸激酶（MVK)、磷酸甲羟戊酸激酶(PMVK)、甲羟戊酸脱羧酶(MVD）和法呢基二磷酸合酶（FDPS），可能参与PK的发病机制。^[3,4]在本研究中，招募了5例散发性PK患者。研究了皮肤镜特征，并进行了基因检测。

胃食管反流病（GERD）是一种常见的消化系统疾病，以一系列不适症状为特征，由胃或十二指肠内容物反流至食管引起。它现在在世界各地广泛流行。几项流行病学研究表明，GERD的发病率在西方国家为10-20%，近年来在亚洲国家也上升到10.5%。^[1]

异物（FB）去除是外科实践中工作的很大一部分。^[1]然而，由于FB与重要结构的非触诊和密切的解剖关系，或者由于患者具有瘢痕素质，FB移除通常可能是一个外科挑战。^[2]滞留的FBs可能导致感染、慢性疼痛、结构损伤、肉芽肿和心理困扰，尤其是晚期表现（距损伤时间超过1周）。^[1,3]

结核病仍然是发展中国家患病和死亡的主要原因之一。结核性淋巴结炎是肺外结核最常见的形式。即使在这种疾病已经在很大程度上得到控制的发达国家，由于艾滋病毒、移民和免疫抑制治疗，它也再次构成了新的健康挑战。

汗腺癌起源于位于阳光照射区域的小汗腺，约占恶性小汗腺肿瘤的6%<占所有皮肤癌的0.001%。^[1,2]汗腺癌通常表现为1-5 cm的孤立、坚硬、无症状的皮内结节，被完整或偶尔溃疡的紫色、粉色或蓝色病变覆盖。^[1]虽然汗腺癌通常在许多年内缓慢生长，但它可能会突然经历大小的快速增加。汗腺癌的鉴别诊断非常具有挑战性，因为病变的外观是良性的，与其他皮肤肿瘤相似。在本报告中，我们提出了一例汗腺癌患者，他接受了广泛切除和全层植皮治疗。

致编辑：培美曲塞最常报告的不良事件是骨髓抑制。在此，我们报告了一例晚期肺腺癌患者，表现为培美曲塞相关的缺血性结肠炎。

致编者：脂肪肉瘤是最常见的软组织肉瘤，占所有间叶肿瘤的20%。常见于成人四肢深部软组织和腹膜后。^[1]除上述部位外，肉瘤还发生在眼眶、颈部、口腔、睾丸旁和唾液腺区域等部位。在文献中，实际可以追踪到的10岁以下病例的数量尚未超过5例。^[2,3]在此，我们报告了一例极其罕见的硬化性脂肪肉瘤病例，发生在一名7岁患者的深部颞叶。

致编者：52岁女性患者，因“纤维内镜术后心肺骤停4小时”，于2016年11月10日入院。12年前，她因食管癌根治术入院，在我院接受放化疗。患者无呼吸道疾病、咯血或药物过敏史。两年前，患者在我院进行了随访纤维内镜检查。内镜手术前将利多卡因应用于咽喉进行表面麻醉。术中静脉给予异丙酚和氧气吸入用于全身麻醉。胃镜检查顺利进行，但患者突然意识不清。气管插管时血液从气道喷出。她接受了多巴胺/重酒石酸间羟胺和氨茶碱/甲基强的松龙治疗。恢复意识后，患者被送入重症监护室。胸部计算机断层扫描（CT）（2014年2月4日）显示食管癌术后改变和肺部广泛渗出。她的病情好转后出院了。本次于2016年11月10日来我院常规胃镜检查（喉部仅使用利多卡因表面麻醉；未使用丙泊酚）。胃镜检查完成后约10分钟（手术顺利），她出现呼吸困难，失去知觉，并表现出微弱和点头样呼吸。从气道吸出带血痰。血气分析显示pH值为7.073，PaCO₂116.4 mmHg（1 mmHg=0.133 kPa）和PaO₂在82.9 mmHg。她立即接受心肺复苏、气管插管和呼吸机辅助通气。还给予止血、解痉哮喘和血管活性药物治疗。我们发现气道中有大量血性分泌物，双肺呼吸困难。心电图显示窦性心律，偶见室性早搏。胸片显示双侧渗出过程。胸部CT（2016.11.10）示弥漫性肺泡渗出[图1].她在重症监护中接受治疗，并接受机械通气、气道强化管理和营养支持，以及抗感染、解痉、抗哮喘、癫痫控制、低温和止血药物治疗。

编辑：骨性分支瘤是球外分支瘤中最罕见的一种。它是一种良性先天性肿瘤，由von Graefe于1863年首次描述为球外骨瘤。^[1]大多数球外骨分支瘤发现于颞上区。它们通常附着在巩膜外和结膜上，并可能累及肌肉。^[1,2]先前的报告指出，女性占病例的69%，右眼占76%，颞上定位占74%。^[3]根据基于PubMed的研究，截至2016年，报告了76例球外骨分支瘤。在这里，我们报告了一个罕见的病例，局限于左外直肌。