Volume 130 · Issue 22 · 2017

自19世纪中期首次描述溃疡性结肠炎（UC）以来已有100多年的历史，^[1]距离1932年首次报道克罗恩病（CD）已有近90年的历史。^[2]基于对疾病发病机制、流行病学和新出现的治疗靶点的探索，治疗的目标现在已经从症状控制转移到改变自然史以防止肠道损伤和残疾。在亚洲国家，在过去的几十年中，炎症性肠病（IBD）的发病率和患病率不断增加。^[3,4]我们的团队报告了2013年中国北方地区IBD的年龄调整发病率为1.77/100,000人口。^[5]虽然与西方国家相比较低，但发病率和患病率正在迅速增加，并遵循西方国家50年前的步骤。因此，亚洲有越来越多的胃肠病学家致力于IBD亚专科。尽管指南和知识已经到位并定期更新，但亚洲IBD管理仍有未回答的问题和未满足的需求。

For Chinese patients with hepatocellular carcinoma (HCC), surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system (Shanghai Score) for individualized prognosis estimation and adjuvant treatment evaluation.

A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001–2008 at Zhongshan Hospital. Age, hepatitis B surface antigen, hepatitis B e antigen, partial thromboplastin time, total bilirubin, alkaline phosphatase, γ-glutamyltransferase, α-fetoprotein, tumor size, cirrhosis, vascular invasion, differentiation, encapsulation, and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion. The Harrell’s concordance index (C-index) was used to measure model performance. Shanghai Score is calculated by summing the products of the 14 variable values times each variable’s corresponding regression coefficient. Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009–2012, 808 patients from Eastern Hepatobiliary Surgery Hospital during 2008–2010, and 244 patients from Tianjin Medical University Cancer Hospital during 2010–2011 were enrolled as external validation cohorts. Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis.

Shanghai Score showed good calibration and discrimination in postsurgical HCC patients . The bootstrap-corrected C-index (confidence interval [CI]) was 0.74 for overall survival (OS) and 0.68 for recurrence-free survival (RFS) in derivation cohort (4166 patients), and in the three independent validation cohorts, the CIs for OS ranged 0.70–0.72 and that for RFS ranged 0.63–0.68. Furthermore, Shanghai Score provided evaluation for adjuvant treatment choices (transcatheter arterial chemoembolization or interferon-α). The identified subset of patients at low risk could be ideal candidates for curative surgery, and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery. Finally, a web server with individualized outcome prediction and treatment recommendation was constructed.

Based on the largest cohort up to date, we established Shanghai Score – an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery. The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC.

The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.

A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details.

The proportion of postoperative malignancy after morcellation application was 0.18% (62/33,723) for patients who underwent laparoscopic myomectomy. Nearly 62.9% (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 (37.1%) patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 (61.3%) patients had detectable endometrial stromal sarcoma, 13 (21.0%) had detectable uterine leiomyosarcoma, only 3 (3.2%) had detectable carcinosarcoma, and 5 (8.1%) patients with leiomyoma had an undetermined malignant potential.

The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.

Currently, the treatment of large hepatocellular carcinoma (HCC) is still a challenging problem. Transcatheter arterial chemoembolization (TACE) is the main treatment for intermediate end-stage HCC, while it is only a palliative and not a curative treatment due to the existence of residual tumors, and radiofrequency ablation (RFA) has limitations in complete ablation of large HCC. We hypothesized that TACE combined with simultaneous RFA (herein referred to as TACE + RFA) could improve the efficacy and survival of large HCC. This study aimed to investigate the feasibility, efficacy, and safety of TACE + RFA on single large HCC.

A total of 66 patients with single large HCC (≥5 cm in diameter) were recruited between February 2010 and June 2016. TACE was first performed and computed tomography was performed immediately after TACE, and the lesions with poor lipiodol deposition were subjected to simultaneous RFA. The success rate, technique-related complications, liver and kidney functions, serum alpha-fetoprotein (AFP) levels, progression-free survival (PFS), median survival time (MST), focal control rate, and long-term survival rate were evaluated.

TACE + RFA were performed smoothly in all the patients with the success rate of 100%. Intra- and post-operative severe complications were not observed. There were no marked differences in mean alanine transaminase or aspartate transaminase before TACE + RFA compared with 7 days after TACE+ RFA (all P > 0.05). In 57 AFP-positive patients, the levels of serum AFP were reduced by 100.0%, 100.0%, and 94.7% at 1, 3, and 6 months after TACE + RFA, respectively; the tumor control rates (complete remission+ partial remission) were 100.0% (66/66), 92.4% (61/66), 87.9% (58/66), and 70.1% (39/55) at 1, 3, 6, and 12 months after TACE + RFA, respectively. Patients were followed up for 7–82 months after TACE + RFA. The MST was 18.3 months, PFS was 14.2 ± 6.2 months, and the 1-, 3-, and 5-year survival rates were 93.2% (55/59), 42.5% (17/40), and 27.2% (9/33), respectively.

TACE + RFA is safe, feasible, and effective in enhancing the focal control rate and survival rate of patients with large HCC.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that is highly associated with inflammatory bowel disease (IBD). Certain PG patients with no systemic disorders have been diagnosed with idiopathic PG. This study sought to clarify the difference between PG with IBD and idiopathic PG based on clinical features, laboratory tests, and medications.

Twelve patients with PG and IBD and 24 patients with idiopathic PG, who were hospitalized in Peking Union Medical College Hospital from 2000 to 2017, were retrospectively categorized into the IBD group and control group, respectively. Data of clinical features, laboratory tests, and medications were collected and compared between the two groups.

Both groups were similar with respect to their clinical features. However, the IBD group had an increased occurrence of arthralgia or arthritis (58.3% vs. 12.5%, P = 0.007), anemia (83.3% and 29.2%, P = 0.004), and an increased percentage of antineutrophilic cytoplasmic antibody (ANCA)-positive patients (85.7% and 0.0%, P < 0.001), compared to the control group.

PG patients with IBD had increased occurrence rates of arthralgia or arthritis, anemia, and ANCA-positive status compared to idiopathic PG patients.

Whether Helicobacter pylori infection is associated with diabetic gastroparesis (DGP) is unclear. This study aimed to investigate the potential correlation between H. pylori infection and DGP.

In this study, 163 patients with type 2 diabetes mellitus and 175 nondiabetic patients who were treated in our department were divided into DGP, simple diabetes, non-DGP (NDG), and normal groups based on their conditions. The H. pylori infection rate in each group was calculated. H. pylori eradication therapy was performed for patients with H. pylori infection in each group. The eradication rates were compared between the groups, and the improvements in gastroparesis-associated symptoms were compared before and after treatment in patients with DGP.

The H. pylori infection rate was 74.6% in the DGP group, which was significantly higher than that in the simple diabetes (51.1%, P < 0.01), NDG (57.7%, P < 0.05), and normal groups (48.0%, P < 0.01). With increased disease course, the incidence of DGP and the H. pylori infection rate gradually increased (P < 0.05). In the DGP group, the incidences of upper abdominal pain and distention, early satiety, and anorexia were 75.5%, 66.0%, and 67.9%, respectively, before eradication treatment; and 43.4%, 35.8%, and 39.6%, respectively, after eradication treatment, and the difference was statistically significant (P < 0.01). In patients with DGP with successful H. pylori eradication, the number of barium strips discharged after eradication was 5.9 ± 1.0, which was significantly larger than that before treatment (4.1 ± 0.7, P < 0.01). In addition, the number of barium strips discharged was significantly larger in patients with DGP with successful H. pylori eradication than those with failed H. pylori eradication (P < 0.01).

DGP development might be associated with H. pylori infection. H. pylori eradication can effectively improve dyspepsia-associated symptoms and delayed gastric emptying in patients with DGP.

Overexpression and constitutive activation of signal transducer and activator of transcription (STAT) 3 have been suggested in the tumorigenesis of many human cancers, including multiple carcinomas, melanoma, and lymphoma. The diagnosis of hepatocellular carcinoma (HCC) in lobectomy specimens is usually straightforward, but distinguishing cirrhosis from well-differentiated HCC can be challenging in core biopsies. Our aims were to investigate the expression level of STAT3 and phosphorylated STAT3 (pSTAT3) in HCC and cirrhosis, and the application of STAT3 in the differential diagnosis of HCC and cirrhosis.

Sixty cases were divided into three groups: patients with HCC only (Group 1), HCC and cirrhosis (Group 2), and cirrhosis only (Group 3). Formalin-fixed and paraffin-embedded tissue sections were stained immunohistochemically for STAT3, pSTAT3, and CD163. The values obtained from the tissue sections of each group were compared in statistical analysis.

STAT3 showed a high level in HCC and was a significant marker for differentiating HCC from cirrhosis (P < 0.0001). The odds ratio between HCC and cirrhosis increased 34.4 times when the intensity of STAT3 increased by 1 level. Spearman’s correlation and Chi-square tests also demonstrated that expression level of STAT3 did not correlate with age, gender, or the presence of a cirrhotic background.

STAT3 staining differs significantly in HCC and cirrhosis. The findings reinforce the role of STAT3 in the tumorigenesis of HCC and provide a useful marker to differentiate HCC from cirrhosis in challenging liver biopsies.

Major abdominal surgery, including colorectal cancer (CRC) surgery, leads to systemic inflammatory response syndrome that can be detected and monitored with inflammatory markers testing. The aims of the study were to evaluate the usefulness of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in following the inflammatory response in CRC surgery and postoperative period, as well as to determine if duration of the surgery and the time that the colon has been opened during the surgery (open colon time [OCT]) reflect a larger surgical stress through inflammatory markers rise.

The study included 20 patients who underwent CRC surgery and 19 healthy volunteers from June 2011 to September 2012. We determined inflammatory markers 1 day before surgery (T0), 24 h (T1), 48 h (T2), and 7 days after the surgery (T3). All statistical analyses were calculated using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium).

Concentrations of CRP, PCT, and IL-6 in all measurement times were statistically different and sTREM-1 did not yield statistical significance. A weak positive correlation was found between IL-6 in T1 and T2 with the duration of the surgery (T1: r = 0.4060, P < 0.0001; T2: r = 0.3430, P < 0.0001) and OCT (T1: r = 0.3640, P < 0.0001, T2: r = 0.3430, P < 0.0001). A weak positive correlation between CRP in T2 and OCT (r = 0.4210, P < 0.0001) was also found. The interconnectivity of tested parameters showed a weak positive correlation between CRP and IL-6 in T1 (r= 0.3680; P < 0.0001), moderate positive correlation in T2 (r = 0.6770; P < 0.0001), and a strong positive correlation in T3 (r = 0.8651; P < 0.0001).

CRP, IL-6, and PCT were shown to be reliable for postoperative monitoring. Simultaneous determination of CRP and IL-6 might not be useful as they follow similar kinetics. sTREM-1 might not be useful in CRC postoperative monitoring.

www.ClinicalTrials.gov, NCT01244022;https://www.clinicaltrials.gov/ct2/show/NCT01244022?term=01244022&rank=1.

Estimating the grades of liver inflammation is critical in the determination of antiviral therapy in patients chronically infected with hepatitis B virus (HBV). The aim of this study was to investigate the correlation of serum levels of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with the liver inflammation grades in treatment-naïve patients with chronic HBV infection.

We retrospectively enrolled 584 treatment-naïve HBeAg-positive patients who underwent liver biopsy in Ditan Hospital from January 2008 to January 2016. Based on the severity of liver inflammation, the patients were divided into minimal, mild, and moderate groups. SPSS software was used for statistical analysis of all relevant data.

The liver histological examinations showed that 324, 194, and 66 patients had minimal, mild, and moderate liver inflammation, respectively. The median age of the three groups was 30, 33, and 38 years, respectively (χ² = 26.00, P < 0.001). The median HBsAg levels in minimal, mild, and moderate inflammation groups were 4.40, 4.16, and 3.67 log U/ml, respectively, and the median HBeAg levels in the three groups were 3.12, 2.99, and 1.86 log sample/cutoff, respectively; both antigens tended to decrease as the grade of inflammation increased (χ² = 99.68 and χ² = 99.23, respectively; both P < 0.001). The cutoff values of receiver operating characteristic curve in the age, HBsAg and HBeAg levels were 36 years, 4.31 log U/ml, and 2.86 log S/CO, respectively, 1 to distinguish minimal grade and other grades of treatment-naïve HBeAg-positive patients with chronic HBV infection.

Serum HBsAg and HBeAg quantitation might gradually decrease with aggravated liver inflammation and the corresponding cutoff values might help us to distinguish minimal grades and other grades and detect those who do not need antiviral therapy in treatment-naïve HBeAg-positive patients with chronic HBV infection.

Halo nevus (HN) has been shown to be associated with vitiligo, but no standard signs are currently available to identify HN patients at risk of vitiligo, and the relevant data obtained in previous studies are somewhat conflicting. This study aimed to identify factors affecting the presence of vitiligo in HN patients.

We performed a retrospective study on consecutive patients with HN at the First Affiliated Hospital of Sun Yat-sen University between January 2011 and December 2016. Detailed demographic and clinical data were collected to identify the factors associated with the presence of vitiligo in this cohort of patients using uni- and multi-variate logistic regression analyses.

A total of 212 HN patients were included, 101 of whom had vitiligo-associated HN (HNV). Univariate analysis indicated that a personal history of thyroid diseases was positively associated with HNV (odds ratio [OR] = 10.761, P = 0.025), while the onset age of HN was negatively associated with HNV (OR = 0.537, P = 0.026). Multivariate analysis demonstrated that the Koebner phenomenon (KP; OR = 10.632, P < 0.0001), multiple HN (OR = 3.918, P < 0.0001), and a familial history of vitiligo (OR = 3.222, P = 0.014) were independent factors associated with HNV.

HN without vitiligo has clinical features distinct from HN associated with vitiligo. HN patients with KP, multiple lesions, or familial history of vitiligo are more likely to develop vitiligo and therefore should be monitored for clinical signs of such accompanied conditions.

Leber congenital amaurosis (LCA) is a visual disease which is caused by RPE65 mutations and results in retinal degeneration and severe vision loss in early infancy. According to previous researches, mutations of the RPE65 gene account for 16% of all cases of LCA. This study aimed to identify RPE65 gene mutations in Chinese patients with LCA.

We recruited 52 sporadic patients from Peking University Third Hospital in 2016 and applied Sanger sequencing to identify variants among exons responsible for the disease. The genomic DNAs from blood leukocytes of these patients were isolated, and the entire coding region of the RPE65 gene was amplified by polymerase chain reaction. We then determined the sequence of RPE65 using ABI 3100 Genetic Analyzer.

Our study identified that only 1 out of the 52 patients with LCA carried the previously unreported homozygosis missense mutation c1174A>C (T392P) of the RPE65 gene. However, the mutation was associated with the disease phenotype and not detected in 100 normal controls.

Though we identified a novel missense mutation in the RPE65 gene that causes LCA, our result indicates that RPE65 mutations may not play a major role in the LCA patients in China since only 1 out of the 52 patients carried mutation in the RPE65 gene.

Intrauterine adhesion (IUA) is a major health problem that causes infertility, menstrual irregularities, and recurrent pregnancy losses in women. Unfortunately, treatments for IUA are limited, and there are currently no effective strategies for preventing IUA recurrence. In this review, we introduced the role of Hippo signaling in the normal endometrium and IUA and described the mechanisms by which the Hippo pathway integrates with the Wnt and transforming growth factor-β (TGF-β) signaling pathways to form an intricate network governing the development of fibrosis.

Original research articles in English that were published until July 2017 were collected from the PubMed database.

Literature search was conducted using the search terms "endometrial fibrosis OR fibrosis AND or OR intrauterine adhesion OR Asherman syndrome OR IUA," "Hippo AND or OR Hippo/TAZ," "TGF-β," and "Wnt." Related original research articles were included in the comprehensive analysis.

Endometrial fibrosis is recognized as a key pathological event in the development of IUA, which is characterized by epithelial/fibroblast–myofibroblast transition. Myofibroblasts play crucial roles in the pathogenesis of fibrous scarring, and myofibroblast differentiation can be triggered by multiple signaling pathways. Hippo signaling is a critical regulator of the epithelial/fibroblast–myofibroblast transition and α-smooth muscle actin, which exhibits a specific spatiotemporal expression in the endometrium.

Hippo signaling plays a critical role in fibrous diseases and participates in cross talks with Wnt and TGF-β signaling. Our findings not only contributed to knowledge on the pathogenesis of endometrial fibrosis, but can also serve as a useful resource for developing specific molecular inhibitors for IUA treatment and prevention.

The population of elderly patients and the amount of geriatric anesthesia have been growing rapidly in China. Thus, understanding the morbidity and mortality associated with geriatric anesthesia in China is critical to the improvement of anesthesia quality and outcome. The aim of the review was to discuss the geriatric anesthesia-related morbidity and mortality in China, as well as to point out the future trend.

Articles in this review were all searched from Wanfang, China National Knowledge Infrastructure (CNKI), VIP, PubMed, and Web of Science databases, based on the reports originated in China from January 2011 to December 2016.

A total of 57 studies were selected for further study, including 12 retrospective studies, 35 prospective studies, 3 meta-analyses, 4 reviews, 1 viewpoint, and 2 case reports. Of the total studies, 42 studies were in Chinese while 15 were in English.

The mortality and morbidity associated with geriatric anesthesia in China are not yet completely reported. Some factors have been recognized, while some are yet to be identified and confirmed. Several studies addressed postoperative cognitive dysfunction and postoperative delirium, whereas only a few studies can be found on renal complications. Thus, a nationwide registry is essential for geriatric anesthesia-associated adverse outcomes. The mortality associated with geriatric anesthesia in China should be reported promptly. In the future, the perspective of geriatric anesthesia needs to be expanded into perioperative geriatric medicine to improve the perioperative management strategy based on the postoperative outcome-directed concept transformation.

Anesthesiologists should evaluate the physiological and medical status and focus on the prevention of potential complications in the perioperative setting with the goal to enhance elderly patients’ long-term well-being and survival quality.

据估计，全世界有1.3亿-1.5亿人慢性感染丙型肝炎病毒（HCV）。在20世纪80年代末和90年代初，非法商业血浆或献血行为在中国选定的农村地区很常见，这导致了HCV感染的快速传播。横断面研究表明，以前有偿血浆或献血者的HCV感染率从9.6%到72.8%不等。慢性HCV感染可导致肝硬化、肝衰竭和肝细胞癌（HCC），是一个主要的全球健康问题。根除HCV可以预防肝硬化、HCC和死亡的失代偿。^[1]直接作用抗病毒药物（DAAs）的可用性显著提高了持续病毒学应答率，降低了HCV治疗的复杂性和不良反应。目前关于HCV治疗的大部分争论集中在这些药物的高成本上，但即使HCV药物的成本是可以承受的，治疗也只会使已被诊断、可获得护理并希望接受治疗的感染者受益。尽管有有效的HCV治疗方法，但在全球范围内，不超过15%的感染者知道自己的状况，不超过20%的确诊者接受过治疗。

1875年，麦吉尔大学的威廉·奥斯勒组织了第一个有记录的期刊俱乐部，以一种经济有效的方式让员工了解医学科学。^[1]如今，期刊俱乐部已经成为一种常见的互动教育形式，希望让医疗从业者了解最新的文献，了解研究设计和统计，并扩展批判性评估技能。已经出版了大量描述不同形式的期刊俱乐部的文献；大多数是为了提高学生的批判性思维、研究能力和循证临床实践。然而，没有黄金标准来评估它们的有效性。^[2]一些人根据高级顾问的评估对结果进行了评价^[3]而其他人则根据参与者的自我报告调查来评估期刊俱乐部。^[1,4]期刊俱乐部的形式各不相同；并建立了一个广为接受的评估制度。

一名75岁汉族男性，有1天急性呼吸急促病史。病史包括肺腺癌、乙型肝炎病毒（携带者）、高血压、既往深静脉血栓形成（DVT）、吸烟45年、饮酒35年。5年前行右上叶、中叶及纵隔淋巴结清扫术，术后3个月出现胸膜及多发性肺转移。表皮生长因子受体、KRAS和间变性淋巴瘤激酶重排的分子检测均为阴性。他因肺转移接受了33个周期的化疗和2个疗程的放疗。然而，他仍然出现双侧肺转移和多个胸椎和腰椎转移。在当前表现前六周，他接受了纳武单抗（每2周3 mg/kg，3个周期）。

韦尼克脑病（WE）是一种由硫胺素（维生素B1）缺乏引起的急性或亚急性神经系统综合征，在临床实践中通常被低估。仅约6%的非酒精患者和三分之一的酒精患者怀疑WE。^[1]非酒精原因包括胃肠道手术和疾病、营养不良、癌症和化疗治疗以及长期肠外营养。^[2]然而，关于结核病患者WE的报道很少。早期诊断和药物治疗对本病的预后至关重要。

粘膜相关淋巴组织（MALT）淋巴瘤以前只能通过胃标本的组织学检查来诊断，这使得MALT淋巴瘤的诊断非常困难。胃MALT淋巴瘤的内镜表现是可变的，由于其组织形态学相似性，目前常规的白光内镜检查不能区分MALT淋巴瘤的癌组织和炎症。已经开发了一种新的内窥镜方式，称为连锁彩色成像（LCI），可能有助于胃MALT淋巴瘤的诊断。在此，我们报告了一例由LCI诊断的MALT淋巴瘤。男，66岁，在军事医学科学院附属医院行上消化道内镜检查。结果显示，在胃体的大曲率处有一个大小约为15mm的纵向肥大胃皱襞，白光成像正常[WLI；图1a].与WLI相比，病变在LCI上更容易识别，在LCI上表现为鲜红色区域[图1b].此外，在LCI的胃体大曲率处观察到直径约2 cm的扁平病变[图1c].由于病变和正常粘膜之间显著的颜色对比，病变的边界很容易可视化，这突出了平坦和边缘隆起之间的区别。与WLI相比，LCI的病变呈轻微红斑，更清晰易识别[图1d].在LCI期间对红色区域进行的靶活检产生了免疫组织化学CD20(+)阳性而CyclinD1(-)和CD5(-)阴性的标本，导致胃MALT淋巴瘤的病理诊断[图2a-图2d].

脊柱脂肪瘤是良性肿瘤，通常分为硬膜外型和硬膜内型。总之，60%位于硬膜内，40%位于硬膜外。已知最常见的脊柱脂肪瘤与腰骶部的骨不连有关。^[1]我们报告了一例罕见的后纵隔、椎管内、硬膜内、髓内脂肪瘤通过Kovalevsky管合并胸椎T3至T6多节段失败的病例。

致编者：多原发肺癌（MPLC）是指单个患者同时或异时出现一个以上的原发肺癌。MPLC的诊断很复杂，仅根据放射学和组织病理学标准通常很难将MPLC与转移性肺癌区分开来。此外，早期MPLC和转移性肺癌的治疗方案和预后有很大不同。

致编者：抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一种严重的自身免疫性疾病。Dalmau在该患者群体中鉴定出抗海马和前额叶神经细胞膜NMDAR抗体，并首次命名了该综合征。^[1]在这里，我们描述了一例伴有卵巢畸胎瘤的抗NMDAR脑炎患者。

编者按：腓骨肌萎缩症（CMT）是一种临床和遗传异质性遗传性神经病，以1A型最为常见。CMT 1A的特征是从腓骨组开始的肢体远端肌肉进行性无力和萎缩，轻度远端感觉丧失，腱反射减弱，神经传导速度减慢。^[1]脊神经根肥大是CMT 1A的独特体征。^[2]这种体征可以在磁共振图像（MRI）上检测到，但经常被忽视。相反，这种疾病的诊断通常基于活检和基因测试。

致编辑：指甲花纹身已经变得流行，并且越来越多地被报道为皮肤过敏反应的原因。描述了中国3例指甲花纹身引起的接触性皮炎。

致编者：我们报告了一例中国6个月大女婴囊性纤维化（CF）伴假性巴特综合征（PBS）的病例。她在3个月大时“普通感冒”后开始反复咳嗽和喘息，并因“肺炎”多次住院。她接受了口服抗生素和雾化支气管扩张剂，但没有改善。此外，她还出现了低钾血症（2.5 mmol/L）和代谢性碱中毒。她被转移到我们医院接受持续治疗。她的出生史并不复杂。她是血亲父母所生的第四个孩子。她的哥哥在13岁时死于严重的肺炎和支气管扩张。她的姐姐在6岁时被诊断为哮喘，目前控制良好。体格检查显示中度脱水，发育不良（3^研发百分位数），听诊时弥漫性隆奇。计算机断层扫描(CT)显示右肺有散在浸润和轻度实变[图1a].6个月后，重复CT扫描显示轻度双侧支气管扩张[图1b].遗传分析显示她有纯合突变c.532G>A（外显子5）CFTR在她的父母身上也发现了他的突变。没有先天性肺/心脏疾病、结核病、胃食管反流、原发性免疫缺陷疾病、原发性纤毛运动障碍和巴特综合征的证据。最后，她被诊断为CF伴PBS。通过抗生素、液体治疗、呼吸支持治疗和营养补充，她的病情明显好转。CF是高加索人中最常见的单基因疾病，但在亚洲人中很少见。很少有CF患者会出现类似Bartter综合征（称为PBS）的低钠血症、低钾血症和代谢性碱中毒。^[1,2]PBS是一种罕见的CF表型，患病率为16.8%。事实上，它可能是CF的初始表现，尤其是在婴儿中。PBS是公认的，并且已经在高加索起源的专利文献中报道。它经常被误认为是简单的脱水或巴特综合征。据报道，大约30%的患者最初出现在肾病诊所，并被诊断为巴特综合征。^[3]在中国大陆，从1974年至今仅报告了53例CF病例。^[4,5]此外，这些病例的主要表型特征是支气管扩张、鼻窦炎和复发性肺炎。表型特征与白人患者的表型特征不同。^[4,5]在中国，由于缺乏新生儿筛查、表型不典型和人群中的低频率，最终诊断经常被推迟。此外，PBS在中国起源中鲜有报道。因此，具有不典型特征的CF患者在中国很可能被严重低估。该病例扩大了中国人CF患者的表型谱。儿科医生在鉴别诊断出现复发性肺部感染、发育不良和电解质紊乱的婴儿时，应保留CF和PBS，尤其是那些通常怀疑患有Bartter综合征的脱水、低钾血症和代谢性碱中毒的婴儿。随着分子诊断技术的发展，CF在中国人群中并不像以前认为的那样罕见。