Volume 130 · Issue 16 · 2017

心房颤动（AF）是最常见的心律失常类型，在全世界影响3300万人。^[1]它与许多不良结果相关，包括中风、痴呆、心力衰竭（HF）和死亡率。^[2]基于越来越多的证据说明其有效性和安全性，导管消融（CA）已成为症状性房颤的重要治疗策略。^[3]大多数中心已经逐渐从执行阵发性房颤转移到更复杂的长期持续性房颤或有更多合并症的患者。

The emergency department (ED) has a pivotal influence on the management of acute heart failure (AHF), but data concerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics, ED management, and short- and long-term clinical outcomes of AHF.

This prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median (interquartile range) for the continuous variables, or as number (percentage) for the categorical variables.

The median age of the enrolled patients was 71 (58–79) years, and 46.84% were women. In patients with AHF, coronary heart disease (43.27%) was the most common etiology, and myocardium ischemia (30.22%) was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics (79.28%) and vasodilators (74.90%). Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively.

Substantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.

The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation (AF). We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome (SSS) after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter (LAD) and amino-terminal pro-brain natriuretic peptide (NT-proBNP).

A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data (stroke and death) were collected by pacemaker follow-up visits and telephonic follow-up until December 31, 2015.

During 2151 person-years of follow-up, 46 patients (9.6%) suffered stroke and 52 (10.8%) died. The CHA2DS2-VASc score showed a significant association with the development of stroke (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20–1.75, P < 0.001) and death (HR 1.45, 95% CI 1.22–1.71, P < 0.001). The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke (C-stat 0.69, 95% CI 0.61–0.77 vs. C-stat 0.66, 95% CI 0.57–0.74, P = 0.013), and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death (C-stat 0.70, 95% CI 0.64–0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P = 0.023).

CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

Aspirin is widely used for the prevention of cardiovascular and cerebrovascular diseases for the past few years. However, much attention has been paid to the adverse effects associated with aspirin such as gastrointestinal bleeding. How to weigh the benefits and hazards? The current study aimed to assess the feasibility of a cardiovascular/gastrointestinal risk calculator, AsaRiskCalculator, in predicting gastrointestinal events in Chinese patients with myocardial infarction (MI), determining unique risk factor(s) for gastrointestinal events to be considered in the calculator.

The MI patients who visited Shapingba District People’s Hospital between January 2012 and January 2016 were retrospectively reviewed. Based on gastroscopic data, the patients were divided into two groups: gastrointestinal and nongastrointestinal groups. Demographic and clinical data of the patients were then retrieved for statistical analysis. Univariate and multiple logistic regression analyses were used to identify independent risk factors for gastrointestinal events. The receiver operating characteristic (ROC) curves were used to assess the predictive value of AsaRiskCalculator for gastrointestinal events.

A total of 400 MI patients meeting the eligibility criteria were analyzed, including 94 and 306 in the gastrointestinal and nongastrointestinal groups, respectively. The data showed that age, male gender, predicted gastrointestinal events, and Helicobacter pylori (HP) infection were positively correlated with gastrointestinal events. In multiple logistic regression analysis, predicted gastrointestinal events and HP infection were identified as risk factors for actual gastrointestinal events. HP infection was highly predictive in Chinese patients; the ROC curve indicated an area under the curve of 0.822 (95% confidence interval: 0.774–0.870). The best diagnostic cutoff point of predicted gastrointestinal events was 68.0‰, yielding sensitivity and specificity of 60.6% and 93.1%, respectively, for predicting gastrointestinal events in Chinese patients with MI.

AsaRiskCalculator had a predictive value for gastrointestinal events in Chinese patients with MI. HP infection seemed to be an independent risk factor for gastrointestinal events caused by long-term aspirin treatment in Chinese patients with MI, and it should be included in the risk calculator adapted for Chinese patients.

Coronary intervention therapy is the main treatment for uremic patients with coronary heart disease. The studies on whether dialysis reduces the efficacy of dual antiplatelet drugs are limited. The aim of this study was to examine the effect of dialysis on antiplatelet drugs in uremic patients with coronary heart disease.

This study included 26 uremic patients who had undergone percutaneous coronary intervention in China-Japan Friendship Hospital from November 2015 to May 2017. We examined their thromboelastography results before and after hemodialysis. Self-paired t-tests were employed to analyze changes in the inhibition rate of platelet aggregation.

The mean inhibition rates of arachidonic acid-induced platelet aggregation before and after hemodialysis were 82.56 ± 2.79% and 86.42 ± 3.32%, respectively (t = −1.278, P = 0.213). The mean inhibition rates of adenosine diphosphate-induced platelet aggregation before and after hemodialysis were 67.87 ± 5.10% and 61.94 ± 5.90%, respectively (t = 1.425, P = 0.167). There was no significant difference in the inhibition rates of platelet aggregation before or after hemodialysis. These results also applied to patients with different sensitivity to aspirin and clopidogrel.

Dialysis did not affect the antiplatelet effects of aspirin and clopidogrel in uremic patients with coronary heart disease.

Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center.

Medical records of pediatric patients (<18 years old) who underwent transcatheter closure of CCAF with a giant CAA between April 2007 and September 2016 at Guangdong Cardiovascular Institute (Guangdong, China) were reviewed.

Twelve patients (median age, 6.1 years; range, 1.9–11.0 years) underwent successful transcatheter closure procedures. One patient underwent closure at both the entry and exit points of the CAA, three patients underwent closure at the exit point of the CAA, and eight patients underwent closure at the entry point of the CAA. After a mean follow-up of 7.2 years (range, 0.5–9.8 years), one patient (with closure at the exit point of the CAA) underwent transcatheter re-intervention because of a significant residual shunt. She eventually underwent a surgical procedure due to aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients.

Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications.

The current pain assessment methods are strongly subjective and easily affected by outside influences, and there is an urgent need to develop a reliable objective and quantitative pain-monitoring indicator. The aim of this study was to evaluate the feasibility of using Pain index (Pi) to assess pain symptoms in pain patients.

Subjects were enrolled from patients seeking treatment at Pain Medicine Center of China Medical University Aviation General Hospital from October 2015 to December 2016, such as postherpetic neuralgia, spinal cord injury, femoral head necrosis, lumbar disc herniation, trigeminal neuralgia, complex regional pain syndrome, perineal pain, phantom limb pain, etc., (pain group, n = 111), as well as healthy volunteers without subjective pain (control group, n = 100). The subjective pain symptoms in pain patients were evaluated by Pi and visual analogue scale/numerical rating scales (VAS/NRS), respectively, and the relationship between them was analyzed using single factor correlation analysis and multiple factor regression analysis.

Pi levels in the pain group were significantly higher than those of the control group (t = 6.273, P < 0.001 ), the correlation analysis of Pi and VAS/NRS score in the pain group showed that the Pearson correlation coefficient was 0.797 (P < 0.001); After adjusted for types of pain, pain sites, medication, gender, and age, Pi was found to be independently correlated to VAS/NRS score (P < 0.001).

Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool.

The endometriosis fertility index (EFI) has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer (IVF-ET) is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates (PRs), and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET.

This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score ≥5 were divided into non-IVF-ET group (n = 209) and IVE-ET group (n = 98) to compare the cumulative PRs. Cumulative PRs’ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model.

Significant differences in spontaneous PRs among different EFI scores were identified (χ² = 29.945, P < 0.05). The least function score was proved to be the most important factor for EFI (χ² = 6.931, P < 0.05) staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone (χ² = 4.160, P = 0.041).

The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.

Currently, treatment of symptomatic polycystic liver disease (PLD) is still a challenging problem, especially for these patients who are not feasible for surgery. Minimally invasive options such as laparoscopic fenestration and percutaneous cyst aspiration with sclerotherapy demonstrated disappointing results due to multiple lesions. Because the cysts in PLD are mostly supplied from hepatic arteries but not from portal veins, transcatheter arterial embolization (TAE) of the hepatic artery branches that supply the major hepatic cysts can lead to shrinkage of the cyst and liver size, relieve symptoms, and improve nutritional status. This study aimed to evaluate the effectiveness of TAE with a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil for patients with severe symptomatic PLD during a more than 2-year follow-up.

Institutional review board had approved this study. Written informed consent was obtained from all patients. From February 2007 to December 2014, twenty-three patients (20 women and 3 men; mean age, 49.0 ± 14.5 years) infeasible for surgical treatments underwent TAE. Changes in the abdominal circumferences, volumes of intrahepatic cysts, hepatic parenchyma volume, and whole liver, clinical symptoms, laboratory data, and complications were evaluated after TAE.

Technical success was achieved in all cases. No procedure-related major complications occurred. The median follow-up period after TAE was 48.5 months (interquartile range, 30.0–72.0 months). PLD-related severe symptoms were improved remarkably in 86% of the treated patients; TAE failed to benefit in four patients (four patients did not benefit from TAE). The mean maximum abdominal circumference decreased significantly from 106.0 ± 8.0 cm to 87.0 ± 15.0 cm (P = 0.021). The mean intrahepatic cystic volume reduction rates compared with pre-TAE were 36% at 12 months, 37% at 24 months, and 38% at 36 months after TAE (P < 0.05). The mean liver volume reduction rates were 32% at 12 months, 31% at 24 months, and 33% at 36 months (P < 0.05).

TAE with the mixture of NBCA and iodized oil appears to be a safe and effective treatment method for patients with symptomatic PLD, especially for those who are not good candidates for surgical treatments, to improve both hepatic volume and hepatic cysts volume.

Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outcome information. The American Joint Committee on Cancer (AJCC) expert panel updated the 8^th edition of the staging manual with prognostic stage groups by incorporating biomarkers into the anatomic stage groups. In this study, we retrospectively analyzed the data from our center in China using the anatomic and prognostic staging system based on the AJCC 8^th edition staging manual.

We reviewed the data from January 2008 to December 2014 for cases with Luminal B Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer in our center. All cases were restaged using the AJCC 8^th edition anatomic and prognostic staging system. The Kaplan-Meier method and log-rank test were used to compare the survival differences between different subgroups. SPSS software version 19.0 (IBM Corp., Armonk, NY, USA) was used for the statistical analyses.

This study consisted of 796 patients with Luminal B HER-negative breast cancer. The 5-year disease-free survival (DFS) of 769 Stage I–III patients was 89.7%, and the 5-year overall survival (OS) of all 796 patients was 91.7%. Both 5-year DFS and 5-year OS were significantly different in the different anatomic and prognostic stage groups. There were 372 cases (46.7%) assigned to a different group. The prognostic Stage II and III patients restaged from anatomic Stage III had significant differences in 5-year DFS (χ² = 11.319, P = 0.001) and 5-year OS (χ² = 5.225, P = 0.022). In addition, cases restaged as prognostic Stage I, II, or III from the anatomic Stage II group had statistically significant differences in 5-year DFS (χ² = 6.510, P = 0.039) but no significant differences in 5-year OS (χ² = 5.087, P = 0.079). However, the restaged prognostic Stage I and II cases from anatomic Stage I had no statistically significant differences in either 5-year DFS (χ² = 0.440, P = 0.507) or 5-year OS (χ² = 1.530, P = 0.216).

The prognostic staging system proposed in the AJCC 8^th edition refines the anatomic stage group in Luminal B HER2-negative breast cancer and will lead to a more personalized approach to breast cancer treatment.

Whether cholinergic innervations and/or autophagy have a role in the etiopathology of benign prostatic hyperplasia (BPH) is still unknown. This study aimed to investigate the role of cholinergic innervation and autophagy in the etiopathology of BPH.

Male, 13-week-old spontaneous hypertension rats (spontaneous BPH animal model) were divided into three groups: an experimental group (EG, n = 24), a control group (CG, n = 24), and a normal control group (NC, n = 10). The EG animals were intragastrically injected with tolterodine (3.5 mg/kg, twice a day), CG animals were intragastrically injected with physiological saline, and the NC animals did not receive any treatment. Rats were sacrificed every 4 weeks, and the prostatic gross morphological changes, wet weight/body weight (ww/bw), dry weight/wet weight (dw/ww), histological changes, ultrastructural changes, and LC3 immunohistochemistry were continuously observed and compared.

The gross morphological and ww/bw changes in the three groups were similar at every stage. The dw/ww (mg/mg) values of the EG at week 17, 21, 25, and 29 were 0.1478 ± 0.0034, 0.1653 ± 0.0036, 0.1668 ± 0.0045, and 0.1755 ± 0.0034, respectively, and the CG values were 0.1511 ± 0.0029, 0.1734 ± 0.0020, 0.1837 ± 0.0052, and 0.1968 ± 0.0045, respectively. The difference between EG and CG for dw/ww showed statistical significance after 21 weeks of age (week 21: P = 0.016, week 25: P = 0.008, and week 29: P = 0.001). Both EG and CG, prostatic glandular epithelial cell proliferation, and secretory function improved with age, but in EG, these improvements were slower than those in CG, and all the differences were statistically significant after 21 weeks. An increasing number of autophagosomes in the prostatic glandular cell cytoplasm, attenuation of LC3-I immunohistochemical staining, enhancement of LC3-II staining, and the ratio of LC3-II/LC3-I staining were all progressive in both groups, but the rate of change in EG was faster than that in CG, and these differences gained statistical significance after 25 weeks. Comparisons with regard to the above indexes between CG and NC showed no statistical significance at any stage.

Cholinergic innervations and activation of autophagy appear to have important functions in the etiopathology of BPH. Drug-mediated blockade of cholinergic innervations could delay the physiopathology processes. Moreover, overactivation of autophagy may also play an important role in this delay.

Hypertension is an important risk factor of cardiovascular disease and increases mortality in the elderly. However, the available medical evidences are both inconsistent and insufficient regarding establishing credible and useful blood pressure (BP) targets in the hypertensive elderly. This review summarizes the existing evidences used for establishing optimal BP targets for this patient population and points out some data inconsistencies which have added to the uncertainty.

We conducted a search for the articles published in English in the PubMed database up to March 2017, with the keywords "hypertension," "elderly," "blood pressure," and "antihypertensive."

Articles that related to BP targeting in the hypertensive elderly were selected for this review.

The selected studies indicated that antihypertensive therapy can substantially reduce the risk of cardiovascular events and mortality, for a subset of the elderly (60 years or older) with systolic BP >160 mmHg. Studies regarding more strict targets yielded mixed findings. For the very old and frail patients (80 years or older), there is a lack of evidence that optimal BP targets and intensive antihypertensives are helpful but in fact may be harmful.

There are solid evidences that patients who are 60–80 years old and in good health have benefited from lowering their BP to below 150/90 mmHg. If well tolerated, the BP target can be further lowered to below 140/90 mmHg. However, for the very old and frail, individualized and careful assessment is crucial. Antihypertensive treatment should be cautious and the adverse effect of drugs requires close monitoring as such treatment can be counterproductive.

Primary central nervous system lymphoma (PCNSL) is a specific type of non-Hodgkin lymphoma with poor prognosis. The rare incidence of this disease and difficulty to obtain sufficient tissue material impede deep research into PCNSL. However, application of modern molecular techniques makes it possible to find biological characteristics exclusive to PCNSL. Therefore, we systematically reviewed the latest research progress on biological characteristics and pathogenesis of PCNSL.

The data analyzed in this review were from the articles listed in PubMed database.

Articles focusing on the biology of PCNSL at the cytogenetic or molecular level were reviewed, including clinical, basic research, and review articles.

With respect to histopathology, perivascular growth pattern and reactive perivascular T-cell infiltration are regarded as typical histopathological manifestations of tumor cells in PCNSL. Moreover, tumor cells of PCNSL predominantly express an activated B-cell-like phenotype, including CD10⁻ BCL-6⁺ MUM1⁺, CD10⁻ BCL-6⁻ MUM1⁺, and CD10⁻ BCL-6⁻ MUM1⁻. On the molecular level, some molecular and genetic alterations may contribute to malignant transformation, including mutations of proto-oncogenes and tumor suppressor genes, gains and losses of genetic material, as well as aberrant activation of some important signaling pathways, such as nuclear factor-κB and JAK/STAT pathway.

The integrated molecular mechanisms involved in pathogenesis of PCNSL are not well understood. The important biomarkers indicating prognosis are not identified. Multicenter studies should be carried out to elucidate pathogenesis of PCNSL to find novel and effective therapeutic strategies.

Homocysteine is a sulfur-containing amino acid with potential clinical significance. Abnormal homocysteine levels have been found in patients with psoriasis. This review summarizes the possible correlations among homocysteine, cardiovascular risk, and DNA methylation in psoriasis.

We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including "psoriasis," "homocysteine," "cardiovascular risk," "DNA methylation," "methylenetetrahydrofolate reductase," "MTHFR," and "MTHFR C677T."

Articles about the roles of homocysteine in the cardiovascular risk and DNA methylation in psoriasis were obtained and reviewed.

Observational studies consistently reported that elevated homocysteine is an independent risk factor for cardiovascular diseases. Several studies also consistently reported an association between psoriasis and increased cardiovascular risk. A substantial body of evidence also suggested that an elevated homocysteine level is related to the demethylation of DNA. Data from clinical trials also demonstrated that MTHFR C677T polymorphisms as well as DNA methylation aberrations are associated with psoriasis.

This review highlighted the relationships among homocysteine, cardiovascular risk, and DNA methylation, suggesting that homocysteine may be a biological link between cardiovascular risk and DNA methylation in psoriasis.

显微神经外科在20世纪60年代初首次亮相。它在医学领域变得流行，并成为神经外科的主要手术方法，因为它提高了神经外科的疗效，减少了手术相关的损伤。在过去的五十年里，显微外科经验的积累、显微外科技术的改进、精细的显微器械和先进的术前诊断成像使显微神经外科技术得以发展，并进一步减少了手术相关的创伤。先进的发展使得神经外科医生能够用更小的开颅手术治疗更复杂的病变。锁孔神经外科是现代显微外科技术、术前影像学、神经内镜和现代微创手术理念的结合，是代表医学从显微神经外科向微创神经外科发展的技术之一。

继发性甲状旁腺功能亢进（SHPT）是慢性肾脏病（CKD）的常见并发症，其特征是甲状旁腺激素（PTH）的过度合成和甲状旁腺增生。^[1]CKD的患病率估计为5-10%，CKD相关疾病的负担高得惊人。^[2,3]尽管SHPT的药物治疗取得了进展，但手术甲状旁腺切除术仍然是难治性SHPT的最终治疗方法，可显著降低PTH水平并改善与严重SHPT相关的症状。^[4]甲状旁腺全切除术、甲状旁腺次全切除术或甲状旁腺全切除术联合自体移植是目前治疗SHPT的手术选择。^[5]对于术后需要长期血液透析的患者，甲状旁腺全切除术联合自体移植可能是优选的，对于接受肾移植机会较大的患者，应禁止进行甲状旁腺全切除术而不进行自体移植，因为肾移植后存在医源性甲状旁腺功能减退和低钙血症的风险。^[4]

困难气道是麻醉师经常面临的挑战。对于颈部和胸壁有严重瘢痕挛缩的烧伤恢复期患儿，最佳策略是在麻醉诱导期间保持自主呼吸，尽早插入喉罩气道以确保气道安全。

4-12%的肝硬化患者发生肝性胸水。^[1]一部分持续性胸水患者抵抗保守治疗，称为难治性肝性胸水（RHH）。在约2.1-16.2%的肝硬化患者中观察到门静脉血栓形成(PVT)，^[2]这可能会加重门静脉高压。如果肝硬化患者合并RHH和PVT，经颈静脉肝内门体分流术（TIPS）可能是一种合理的干预措施。^[3]但目前尚无此类成功案例报道。我们在此报告了一例合并RHH和PVT的肝硬化患者，他接受了TIPS并获得了长期生存。

致编者：35岁女性，发热、咽痛6天病史入院。入院时发热，直肠体温40.2℃。她的脉搏正常，为90次/分钟，血压为93/69毫米汞柱。其他发现包括呕吐、腹痛和上躯干黄斑皮疹。她在右上腹和上腹部也有腹部压痛，没有防护。

致编者：运动性ST段抬高是一种不常见的临床情况，患病率为0.15%。^[1]运动期间ST段抬高是短暂和严重缺血的标志。适当的治疗至关重要，因为冠状动脉血管痉挛可导致急性冠状动脉综合征、晕厥、危及生命的心律失常，甚至院外心脏骤停。^[2]在此，我们报告一例因冠状动脉血管痉挛导致运动性心肌缺血和危及生命的心律失常的患者。

致编者：持续性左上腔静脉(PLSVC)伴右上腔静脉(RSVC)缺失是一种非常罕见的先天性异常，可使永久性起搏器导线的植入复杂化。如果心房电极导线在房颤（AF）期间放置在右心耳之外，评估电极导线是否足够固定可能具有挑战性。我们报告了一例无RSVC和病态窦房结综合征伴阵发性房颤的PLSVC病例，其中成功植入了永久性起搏器。

致编者：一名38岁女性因月经过多持续2个月来我院就诊。双手检查未发现症状，阴道超声显示子宫内膜厚度4 mm。诊断性刮宫强烈提示透明细胞腺癌。骨盆磁共振成像显示完整的子宫内膜结合区，无子宫外浸润。其他实验室检查正常；入院时未测定血清甲胎蛋白（AFP）水平。腹腔镜探查术在全身麻醉下进行。根治性手术包括全子宫切除术、双侧输卵管卵巢切除术、盆腔和腹主动脉淋巴结切除术以及大网膜切除术。对所有手术标本进行了仔细分析。子宫后腔左角发现一个2.5 cm × 1.5 cm × 1.5 cm的肿瘤[图1a].网膜内发现数个直径1.0 cm的转移性结节。腹腔未发现其他转移灶。所有盆腔和腹主动脉淋巴结均正常。盆腔冲洗液对肿瘤细胞呈阴性。

编者按：果糖1, 6-二磷酸酶（FBPase）缺乏症是一种常染色体隐性代谢性疾病，其特征是由长期禁食或发热或大量摄入果糖引发的低血糖、酮症和乳酸酸中毒的发作。^[1]众所周知，果糖-1, 6-二磷酸酶1基因的突变（FBP1)可能导致FBPase缺乏，这将相应地导致糖异生最后步骤中的酶阻断。^[1]众所周知，由于缺乏糖原的储存，它在新生儿期和婴儿期通常是致命的，然而，也很少有成人患者患有这种遗传性疾病的报道。在这里，我们描述了一名患有FBPase缺乏症的中国成年女性。

致编者：一名50岁男性在日晒区域反复发作大疱、糜烂和结痂1年。病变愈合，伴有瘢痕和色素沉着过度。日晒后皮损加重。患者有30年的酒精滥用（100-200毫升/天）史。家族遗传史并不显著。体格检查发现面部、颈部和手背多处糜烂，伴有红斑、色素沉着过度、大疱和结痂[图1a].位于太阳穴上方的轻度多毛症。迪安症状呈阳性。血液检查结果如下：谷草转氨酶，91 U/L；丙氨酸氨基转移酶，66U/L；γ-谷氨酰转移酶，447U/L；锌原卟啉水平，3.3µg/gHb；尿卟啉水平升高。病毒和自身免疫筛查均为阴性。尿液颜色浑浊，在伍德灯下呈粉红色荧光。尿卟啉原脱羧酶（乌罗德）基因分析。组织病理学表现为血管周围结痂和嗜酸性粒细胞沉积[图1b].抗酸染色显示血管周围有环状蓝紫色沉积[图1c].确定了散发性迟发性皮肤卟啉症(PCT)的诊断。经复方甘草酸苷护肝、防晒、戒酒治疗3个月后，患者皮损有明显改善。实验室分析也显示有所改善；锌原卟啉降低，1.1µg/gHb，丙氨酸氨基转移酶46 U/L，尿卟啉变为阴性。

致编者：穿孔性弹性增生症(EPS)是不同类型穿孔性疾病的一部分，取决于特发性、反应性或药物诱导性等因素。我们在此报告一例患者，其表现为多个红棕色角质化丘疹在颈部前部和后部合并形成丝状斑块，被发现是典型的D-青霉胺诱导的EPS。

致编者：病毒性肝炎是全球主要的公共卫生问题，据报道，全球有20亿人感染的乙型肝炎病毒（HBV）在恶性肿瘤化疗期间会重新激活。^[1,2]一些文献报道了血液恶性肿瘤中丙型肝炎病毒（HCV）的再激活。^[1,3]乳腺癌是女性最常见的癌症，在全球范围内呈快速上升趋势。因此，肿瘤学家无疑会处理具有无症状HCV携带者且易于HCV再激活的乳腺癌患者。^[3]HCV再激活定义为在无肝转移的患者中丙氨酸转氨酶（ALT）水平至少增加3倍，仔细排除其他原因引起的HCV再激活。^[1]HCV病毒载量增加超过1 × 10³U/L可能是HCV再激活的标志。^[1]