Volume 130 · Issue 24 · 2017

Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors (PPIs) combined with clopidogrel therapy, causing much uncertainty in clinical practice. We sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention (PCI) in a long-term follow-up study.

A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy (DAPT) at a single center from January 2013 to December 2013 were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation inhibition was measured by modified thromboelastography (mTEG) in 5042 patients. Propensity score matching (PSM) was applied to control differing baseline factors. Cox proportional hazards regression was used to evaluate the 2-year major adverse cardiovascular and cerebrovascular events (MACCEs), as well as individual events, including all-cause death, myocardial infarction, unplanned target vessel revascularization, stent thrombosis, and stroke.

Among the whole cohort, 27.2% were prescribed PPIs. The ADP-induced platelet aggregation inhibition by mTEG was significantly lower in PPI users than that in non-PPI users (42.0±30.9% vs. 46.4±31.4%, t = 4.435, P< 0.001). Concomitant PPI use was not associated with increased MACCE through 2-year follow-up (12.7% vs. 12.5%, χ² = 0.086, P= 0.769). Other endpoints showed no significant differences after multivariate adjustment, regardless of PSM.

In this large cohort of real-world patients, the combination of PPIs with DAPT was not associated with increased risk of MACCE in patients who underwent PCI at up to 2 years of follow-up.

Debate on treatment for young patients with coronary artery disease still exists. This study aimed to investigate the intermediate- and long-term outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients aged 18–45 years with diabetes mellitus (DM).

Between January 2006 and March 2016, a total of 2018 DM patients aged 18–45 years including 517 cases of CABG and 1501 cases of PCI were enrolled in the study. Using propensity score matching (PSM), 406 patients were matched from each group. The intermediate- and long-term data were collected. The primary end point of this study was long-term death. The secondary end points included long-term major adverse cardiovascular and cerebrovascular events (MACCEs), stroke, angina, myocardial infarction (MI), and repeat revascularization.

Before PSM, the in-hospital mortality was 1.2% in the CABG group and 0.1% in the PCI group, with statistically significant difference (P < 0.0001). The 10-year follow-up outcomes including long-term survival rate and freedom from MACCEs were better in the CABG group than those in the PCI group (97.3% vs. 94.5%, P= 0.0072; 93.2% vs. 86.3%, P< 0.0001), but CABG group was associated with lower freedom from stoke compared to PCI group (94.2% vs. 97.5%, P= 0.0059). After propensity score-matched analysis, these findings at 10-year follow-up were also confirmed. Freedom from MACCEs was higher in CABG group compared to PCI group, but no significant difference was observed (93.1% vs. 89.2%, P= 0.0720). The freedom from recurrent MI was significantly higher in CABG patients compared with PCI patients (95.6% vs. 92.5%, P= 0.0260). Furthermore, CABG was associated with a higher rate of long-term survival rate than PCI (97.5% vs. 94.6%, P= 0.0403). There was no significant difference in the freedom from stroke between CABG and PCI groups (95.3% vs. 97.3%, P= 0.9385). The hospital cost was greater for CABG (13,936±4480 US dollars vs. 10,926±7376 US dollars, P< 0.0001).

In DM patients aged 18–45 years, the cumulative survival rate, and freedom from MI and repeat revascularization for CABG were superior to those of PCI. However, a better trend to avoid stroke was observed with PCI.

For patients with a brain metastasis (BM), systemic therapy is usually administered after the completion of radiotherapy, especially in cases of multiple BMs. However, the role of systemic therapy in patients with a limited number of BMs is not clear. Therefore, we conducted a retrospective study to explore this question.

Consecutive patients with a pathologically confirmed malignancy and 1–3 intracranial lesions that had been documented within the last decade were selected from the databases of three hospitals in China.

A total of 250 patients were enrolled; of them, 135 received radiotherapy alone and 115 received radiotherapy plus systemic therapy. In patients receiving whole-brain radiation therapy (WBRT) as radiotherapy, 28 received WBRT alone and 35 patients received WBRT plus systemic therapy. Of the patients treated with stereotactic radiosurgery (SRS), 107 received SRS alone and 80 received SRS plus systemic therapy. Multivariate analysis revealed that systemic therapy significantly reduced the risk of mortality compared with radiotherapy alone (hazard ratio [HR] = 0.294, 95% confidence interval [CI] = 0.158- 0.548). Further, when the analysis was conducted in subgroups of WBRT (HR = 0.230, 95% CI = 0.081- 0.653) or SRS (HR = 0.305, 95% CI = 0.127–0.731), systemic therapy still showed the ability to reduce the risk of mortality in patients with BMs.

Systemic therapy after either SRS or WBRT radiotherapy may significantly reduce the risk of mortality of patients with 1–3 BMs.

The location of facial port-wine stain (PWS) may be helpful for predicting some associated anomalies; high glaucoma incidence is found in patients with eyes close to PWS-affected areas (V1, ophthalmic branch area of the trigeminal nerve). This study aimed to investigate the characteristics of glaucoma in V1-affected PWS.

A total of 569 patients with V1 area-affected PWS were reviewed in the study. The large series was based on the referral system between the Department of Plastic and Reconstructive Surgery and the Department of Ophthalmology. All patients were screened for glaucoma with assessments of intraocular pressure, cup-to-disc ratio, corneal diameter (only for infants), and axial length.

Of the 569 patients, 110 (19.3%) patients had glaucoma. Among the patients, 18.1% (76/420) had early-onset glaucoma (under 4-year-old group). In the 4 to 18-year-old age group, 29.3% (29/99) of the patients had glaucoma. Compared with right lateral and bilateral PWS, left-sided PWS had a lower risk of glaucoma in this study (odds ratio = 0.432 [95% confidence interval, 0.264- 0.706], P= 0.01). The under 4-year-old group showed a slight predominance of males (61.8%) in glaucoma.

High glaucoma incidence was observed in patients with eyes close to PWS. More attention should be paid to glaucoma screening for right lateral and bilateral PWS patients. The predominance of males in Sturge–Weber syndrome (SWS) early-onset glaucoma patients might be due to the limitation of the case number; however, it might also provide us a new clue of potential relationship between SWS and PCG.

Descemet’s stripping automated endothelial keratoplasty (DSAEK) surgery offers a more standardized approach and reliable method to create corneal grafts with an instrument such as a microkeratome. With the development of Descemet’s membrane endothelial keratoplasty, an excellent clinical outcome is seen in the treatment of corneal endothelial dysfunctions, which indicates that thinner corneal graft results in better clinical outcome. With the recent development of the femtosecond laser, ultrathin corneal graft preparation has become possible. This study aimed to report corneal graft endothelial cell loss (ECL) in a large series of cases undergoing DSAEK with femtosecond laser-assisted corneal graft preparation within a 12-month period.

This study was designed as a prospective, noncomparative, interventional case series. Totally 126 consecutive eyes with endothelial failure of 120 patients, who had corneal endothelial decompensation and underwent femtosecond-assisted DSAEK using the VisuMax femtosecond laser system, were included in the study. Central endothelial cell density (ECD) was recorded postoperatively at 2 weeks (n = 126), 1 month (n = 126), 3 months (n = 110), 6 months (n = 101), and 12 months (n = 71) and then compared with the preoperative eye bank measurements. Pre- and postoperative central ECDs were evaluated using Heidelberg retina tomography-III confocal microscopy. ECL was calculated for each postoperative time point. Graft thickness was examined using anterior segment-optical coherence tomography.

Mean preoperative cell count was 3383±350 cells/mm². Mean postoperative cell counts were 2382±707 cells/mm², 2179 ± 685 cells/mm², 2074 ± 688 cells/mm², 1884 ± 662 cells/mm², and 1723 ± 624 cells/mm² at 2 weeks, 1, 3, 6, and 12 months, respectively; these represented the ECL of 29.7 ± 19.7%, 35.4 ± 19.5%, 38.6 ± 19.8%, 44.3 ± 18.9%, and 48.9 ± 18.4% at the each corresponding time point. The mean corneal graft thickness after surgery was 142 ± 48µm, 118 ± 41 µm, 108 ± 37 µm, 100 ± 32 µm, and 99 ± 32 µm at each corresponding study visit, respectively. There was no correlation between corneal graft thickness and corneal ECL (R = 0.039).

Corneal ECL remained relatively stable up to 12 months after femtosecond laser-assisted ultrathin DSAEK in a large case series. No correlation between cell loss and corneal graft thickness was found, which indicated that corneal graft preparation by the femtosecond laser was safe. ECL was faster within the first 6 months and relatively stable thereafter.

Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions.

Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed.

Gross total tumor removal was achieved in 80/85 cases (94.1%) in this study. All 37 cases with tumors in anterior skull base and all 14 cases with tumors in jugular foramen received total tumor removal. Thirteen and three cases with tumors in clivus received total and subtotal tumor removal, respectively. Total and subtotal tumor removal was performed for 16 cases and 2 cases in lateral skull base, respectively. The complications in this study included: cerebrospinal fluid leakage (n = 3), meningitis (n = 3), and new cranial nerve deficits (n = 3; recovered in 3 months after surgery). In the follow-up period of 40–151 months (median: 77 months), seven patients (8.8%) out of the 80 cases of total tumor removal experienced recurrence.

Complete resection of intra-extracranial growing tumors in various skull base regions can be achieved via the pure ETA in one stage in selected cases. Surgical procedure for radical removal of tumors is feasible and safe.

Amyloid-β deposition and accumulation of autophagic vacuoles are pathologic features of Alzheimer’s disease (AD). Dysregulation of the endosomal–autophagic–lysosomal (EAL) pathway, which impairs amyloid precursor protein processing, is one of the earliest changes in AD. However, the precise role of EAL pathway in neurodegeneration remains unclear. This study aimed to investigate the role of EAL pathway in AD and further study the mechanism of EAL dysfunction.

We used 3-, 7-, and 12-month-old APPswe/PSEN1dE9 (APP/PS1) mice to model different stages of AD with age- and gender-matched wild-type littermates as controls (4–7 mice per group) and detected the changes of EAL markers, endosomal organizers Rab5 and Rab7, autophagosome marker LC3B, and lysosomal proteins Lamp1/2 in cortex and hippocampus by immunohistochemistry and Western blotting analysis. To further explore the mechanism of EAL dysregulation in AD, components of the class III phosphatidylinositol 3-kinase (PI3KC3) complex, activators of Rab7 (Beclin1 and UVRAG), and the negative regulator of Rab7 (Rubicon) were also measured in this two brain regions.

In 7-month-old APP/PS1 brain that amyloid beta initiated to accumulate intracellularly, EAL pathway, and related PI3KC3 members, UVRAG and Beclin1 were upregulated both in cortex and hippocampus (all P< 0.05). By the age of 12 months old, when abundant amyloid plaques formed, EAL markers, UVRAG, and Beclin1 were also upregulated in the cortex (all P< 0.05). However, Rab7 was decreased significantly (P = 0.0447), accompanied by a reduction of its activating PI3KC complex component Beclin1 (P = 0.0215) and enhancement of its inhibiting component Rubicon (P = 0.0055) in the hippocampus.

Our study implies that EAL pathway, represented as Rab7 and its PI3KC3 regulators’ expressions, showed temporal and spatial variation in brains at different stages of AD. It provides new insights into the role of EAL pathway in pathogenesis and indicates potential therapeutic targets in neurodegenerative diseases.

Both Mitofusin 2 (Mfn2) and pelvic organ prolapse (POP) are related to aging. The aim of the present study was to investigate the variations of Mfn2 expression in the uterosacral ligaments of patients with and/or without POP and their correlations with the expression of procollagen.

Fibroblasts were cultured using tissue specimens that were harvested from the uterosacral ligaments of POP and non-POP (NPOP) patients (n = 10 for each group) from September 2016 to December 2016. The Cell Counting Kit-8 (CCK-8) assay was used to compare the differences in cell proliferation between the two groups. Relative quantitative reverse transcription-polymerase chain reaction and Western blotting assays were employed to assess the differences in the mRNA and protein expression levels of Mfn2 and procollagen 1A1/1A2/3A1 between the two groups. The changes in procollagen expression were assessed following the downregulation of Mfn2 in the POP group using RNAi. The data were assessed with independent sample t-test or general linear model univariate analysis using the SPSS 13.0 software.

The results from CCK-8 assay indicated that cell viability in the POP group was significantly lower compared with that of the NPOP group (t_d5,7,9,11= −5.925, −6.851, −9.129, and −9.661, respectively, all P< 0.001, from D5 to D11). The mRNA and protein expression levels of Mfn2 in the cultured fibroblasts of the POP group were significantly higher compared with those of the NPOP group (mRNA: t = 2.425, P= 0.032; protein: t = 2.392, P= 0.037, respectively), whereas only the expression levels of procollagen 1A1/1A2/3A1 were significantly higher in the NPOP group (mRNA: t= −2.165, P_1A1 = 0.041; t= −2.741, P_1A2 = 0.026; t= −2.147, P_3A1 = 0.045, respectively; protein: t= −2.418, P_1A1 = 0.029; t= −2.405, P_1A2 = 0.033; t= −2.470, P_3A1 = 0.012, respectively). The expression levels of procollagen in the POP group increased following the downregulation of Mfn2.

The proliferation rate and cell viability of the fibroblasts in the POP group were significantly lower compared with those in the NPOP group. In the POP fibroblasts, Mfn2 expression was increased, while procollagen expression was decreased.

Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge. The contralateral C7 (CC7) nerve transfer has been used in treating brachial plexus avulsion injury (BPAI) since 1986. However, the effectiveness of the procedure remains a subject of controversy. The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer.

Chinese or English (i.e., "contralateral c-7" , "contralateral c7" , "c7 nerve root" , and "seventh cervical nerve root" ) keywords were used for a literature search for articles related to CC7 nerve transfer in several databases (i.e., PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang Data). Clinical research articles were screened, and animal studies as well as duplicate publications were excluded. Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3, respectively.

The overall ipsilateral recipient nerve recovery rates were as follows: the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 (95% confidence interval [CI]: 0.48- 0.66) and for sensory recovery was 0.52 (95% CI: 0.46–0.58). When the recipient nerve was the median nerve, the efficiency rate for muscle strength recovery was 0.50 (95% CI: 0.39- 0.61) and for sensory was 0.56 (95% CI: 0.50–0.63). When the recipient nerve was the musculocutaneous nerve and the radial nerve, the efficiency rate for muscle strength recovery was 0.74 (95% CI: 0.65- 0.82) and 0.50 (95% CI: 0.31- 0.70), respectively.

Transfer of CC7 nerves to musculocutaneous nerves leads to the best results. CC7 is a reliable donor nerve, which can be safely used for upper limb function reconstruction, especially for entirely BPAI. When modifying procedures, musculocutaneous nerves and median nerve can be combined as recipient nerves.

Antiplatelet therapy (APT) was prevalently being used in the prevention of vascular disease, but the influence of prior APT on the prognosis of patients with intracerebral hemorrhage (ICH) remains controversial. This meta-analysis was to explore the effects of prior APT on the prognosis of patients with primary ICH.

PubMed and Embase were searched to identify the eligible studies. The studies comparing the mortality of ICH patients with or without prior APT were included. The quality of these studies was evaluated by the Newcastle–Ottawa quality assessment scale. The adjusted or unadjusted odds ratio (OR) for mortality between ICH patients with and without prior APT were pooled with 95% confidence interval (95% CI) as the effect of this meta-analysis.

Twenty-two studies fulfilled the inclusion criteria and exhibited high qualities. The pooled OR was 1.37 (95% CI: 1.13–1.66, P= 0.001) for univariate analysis and 1.41 (95% CI: 1.05–1.90, P= 0.024) for multivariate analysis. The meta-regression indicated that for each 1-day increase in the time of assessment, the adjusted OR for the mortality of APT patients decreased by 0.0049 (95% CI: 0.0006–0.0091, P= 0.026) as compared to non-APT patients.

Prior APT was associated with high mortality in patients with ICH that might be attributed primarily to its strong effect on early time.

To review recent research advances on tau, a major player in Alzheimer’s disease (AD) pathogenesis, a biomarker for AD onset, and potential target for AD therapy.

This review was based on a comprehensive search using online literature databases, including PubMed, Web of Science, and Google Scholar.

Literature search was based on the following keywords: Alzheimer’s disease, tau protein, biomarker, cerebrospinal fluid (CSF), therapeutics, plasma, imaging, propagation, spreading, seeding, prion, conformational templating, and posttranslational modification. Relevant articles were carefully reviewed, with no exclusions applied to study design and publication type.

Amyloid plaques enriched with extracellular amyloid beta (Aβ) and intracellular neurofibrillary tangles comprised of hyperphosphorylated tau proteins are the two main pathological hallmarks of AD. Although the Aβ hypothesis has dominated AD research for many years, clinical Aβ-targeting strategies have consistently failed to effectively treat AD or prevent AD onset. The research focus in AD has recently shifted to the role of tau in AD. In addition to phosphorylation, tau is acetylated and proteolytically cleaved, which also contribute to its physiological and pathological functions. Emerging evidence characterizing pathological tau propagation and spreading provides new avenues for research into the molecular and cellular mechanisms underlying AD pathogenesis. Techniques to detect tau at minute levels in CSF and blood have been developed, and improved tracers have facilitated tau imaging in the brain. These advances have potential to accurately determine tau levels at early diagnostic stages in AD. Given that tau is a potential therapeutic target, anti-tau immunotherapy may potentially be a viable treatment strategy in AD intervention.

Detecting changes in tau and targeting tau pathology represent a promising lead in the diagnosis and treatment of AD.

The optimal management strategy for prostate cancer (PCa) remains controversial. We performed a systemic review of current progress and controversies regarding the diagnosis and treatment of PCa.

We searched PubMed for recently published articles up to July 2017 using the following key words: "prostate cancer," "progress," "controversy," "immunotherapy," and "prevention."

Articles were obtained and reviewed to provide a systematic review of the current progress and controversies regarding PCa management.

The value of serum prostate-specific antigen (PSA) screening remains controversial, but PSA screening is recommended to facilitate the early diagnosis of PCa in high-risk groups. Prostate biopsy via the transrectal or perineal approach has both advantages and disadvantages. There was a significant correlation between testosterone levels and PCa prognosis. The current research is focused on the mechanisms responsible for PCa. Active surveillance has been proposed as a management strategy for low-risk, localized PCa, but there is an urgent need for further clinical studies to establish the criteria for recommending this approach. The main complications of radical resection for PCa are urinary incontinence and erectile dysfunction, though three-dimensional laparoscopic and robot-assisted laparoscopic techniques have obvious advantages over radical surgery. Radiotherapy is also a therapeutic option for PCa, while immunotherapies may alter the prostate tumor microenvironment. Ongoing studies aim to provide guidance on effective sequential and combination strategies. Prevention remains an important strategy for reducing PCa morbidity and mortality.

The diagnosis, treatment, and prevention of PCa are complex issues, worthy of intensive study. Further studies are needed to improve the management of PCa.

周围神经损伤是临床上常见的问题，因为远端肢体功能障碍严重影响患者的生活质量，并由此造成巨大的社会和经济负担。^[1]周围神经损伤的修复是一个非常复杂的病理过程。由于神经再生缓慢、神经残端Wallerian变性、组织粘连、肌肉和运动终板萎缩等制约因素，损伤神经的功能康复始终受到限制。周围神经损伤修复的最终目标是使远端靶器官在感觉和运动方面的功能恢复到其原始水平。目前，国内外对周围神经损伤的研究主要集中在神经修复方法、促进轴突生长以及与解剖修复并行的功能重建等方面。

据报道，上颌前磨牙是进行牙髓治疗最复杂的牙齿，^[1]根管治疗因种族、遗传倾向、饮食、地区、性别，^[2]也许还有年龄。迄今为止，很少有详细的研究来评估老年人上颌前磨牙的牙根数量和根管形态。本研究使用锥形束计算机断层扫描（CBCT）分析了老年人上颌前磨牙的根管形态，这在指导牙髓治疗方面具有重要的临床价值。^[3]

轻度促甲状腺激素（TSH）升高非常普遍，而大部分TSH升高的个体没有慢性自身免疫性甲状腺疾病。TSH分泌表现出每日昼夜节律，我们之前报道过睡眠障碍患者的TSH水平明显高于对照组。^[1]在这项研究中，我们评估了夜间睡眠受限个体中孤立性TSH升高的比率，并在夜间睡眠恢复时重新评估了该比率。

由于汞的美白作用，汞通常被添加到美白产品中。美国食品药品监督管理局（FDA）将化妆品中的汞含量限制在1 ppm以下。尽管如此，许多化妆品含有1000 ppm以上的汞，以增加美白效果。在研究中的一组特殊患者中，疼痛、肾损害和神经精神症状是观察到的主要症状。

药物性肝损伤（DILI）是最常见和最严重的药物不良反应之一。特异性DILI比内源性DILI更常见，可分为肝细胞损伤、胆汁淤积性损伤、肝细胞-胆汁淤积性混合性损伤和血管损伤。^[1]梅氏鳞翅目（玛咖）因其多样的药理特性而被深入研究。这些实验研究没有发现任何证据体内或者体外与长期或短期食用相关的毒性。^[2]在此，我们报告了一例可能由玛咖直接诱发的肝损伤，提示玛咖的安全性应通过进一步的研究来评估。

环状染色体形成的主要机制被认为是由于染色体长臂和短臂上的断裂点处的断裂和重聚。该融合事件可以产生末端臂倒位、缺失和重复，其决定所得表型。^[1]环状染色体13相对不常见，估计发病率为1/58,000活产。环13号染色体综合征的临床严重程度是广泛的，并受环的稳定性以及沿13号染色体的缺失和/或重复程度的影响。^[2]13号环状染色体的产前诊断非常罕见。在这里，我们提出了一个产前病例，其分子细胞遗传学特征为镶嵌环13号染色体综合征，胎儿有多种异常超声表现。

原发性色素结节性肾上腺皮质疾病（PPNAD）引起促肾上腺皮质激素（ACTH）非依赖性库欣综合征（CS），这是卡尼复合体（CNC）最常见的内分泌表现。^[1]在PPNAD的疾病过程中，两个肾上腺前腺都受累，并以被萎缩的肾上腺皮质分开的棕黑色小结节为特征。CNC中的内分泌病变包括睾丸肿瘤、PPNAD、产生生长激素（GH）和催乳素的垂体瘤以及甲状腺癌。^[2]是一种遗传异质性的常染色体显性疾病。cAMP依赖性蛋白激酶调节亚基1A型的突变（PRKAR1A）基因存在于近60%的CNC个体中，而染色体2p16上CNC2基因座的未表征基因类似地与疾病发病机制有关。^[2]在这里，我们提出了一个患有PPNAD的中国年轻女孩的病例。

左心耳动脉瘤（LAAA）是一种极为罕见的心脏异常，主要表现为左心耳局限性或弥漫性扩张。^[1]这种情况具有不同的症状，包括心律失常、血栓栓塞事件和心力衰竭，使医生感到困惑，并且很容易被误诊。^[2]我们在此报告一例最初被误诊的巨大LAAA。

腹内妊娠是罕见的，大约每10,000名新生儿中就有1人受到影响。它发生在1.4%的异位妊娠中，死亡率为5.1/1000例，是非腹部异位妊娠的7.7倍。本研究旨在介绍一例使用超声、计算机断层扫描（CT）和磁共振成像（MRI）诊断并使用腹腔镜显微手术治疗的14周原发性肝异位妊娠活体病例。

致编者：氯菊酯是一种伟大的手工化学制剂，拟除虫菊酯I型，以顺式和反式两种主要异构体存在。^[1]它在农业和建筑中的应用是由于良好的可用性和驱除害虫。它可能很容易从胃肠道和皮肤以及吸入灰尘中吸收。^[2,3]它们是大量产生活性氧和坏死途径诱导剂的重要化学物质。使用氯菊酯的信息不足导致对生物系统的许多副作用。精子发生是易受活性氧和氧化应激影响的主要生命系统之一。^[4]由于精子发生发生在睾丸中，任何化学物质如氯菊酯都可能破坏细胞结构和功能，导致不育。^[5]另一方面，针对这些影响的研究大多集中在降低不孕率和提出最佳治疗方法上。大多数研究代表了解决男性不育的各种抗氧化剂。洋葱（洋葱）是一种天然抗氧化剂，用于传统医学。它保护DNA和其他重要分子免受氧化应激，改善精子参数，从而提高生育率。^[6]

致编辑：结节性硬化症(TSC)是一种罕见的常染色体显性和可变外显率，每10万人中约有10人受到影响。^[1]通常，它被描述为腺瘤、精神障碍和癫痫发作的临床三联征。但由于外显不完全，症状可累及孤立器官，可表现为轻度不完全病变或累及多个器官。TSC患者中与肾和肝血管平滑肌脂肪瘤（AML）相关的肺淋巴管肌瘤病（LAM）非常罕见。据我们所知，Ciftci仅报告了一例病例等人.^[2]在这里，我们提出这样一个病例与临床和病理分析。

编辑：滑膜肉瘤（SS）是一种相对罕见的软组织肉瘤，约占所有软组织肉瘤的8%。SS常发生于四肢的关节旁结构，主要见于下肢。其他涉及的侵犯部位是肺、淋巴结和骨。然而，皮肤很少涉及。^[1,2,3]在这里，我们报告了一个极其罕见的双相SS病例，表现为播散性皮肤转移。

致编辑：线粒体丙氨酰-tRNA合成酶2基因突变（AARS2)导致慢性进行性脑白质营养不良或婴儿心肌病。迄今为止，已有15例患者报告患有慢性进行性脑白质营养不良。值得注意的是，所有女性患者（9/15）都出现卵巢衰竭，描述为“卵巢白质营养不良”。^[1,2,3,4]在此，我们报告了一名患有进行性成人脑白质营养不良的女性患者，由于复合杂合突变而无卵巢衰竭AARS2.

致编者：一位65岁的女性，在过去的7年里，左大腿后部出现了一个红棕色的皮肤斑块。最初，病变为轻度隆起、界限分明的斑块，表面光滑，直径约1cm，无任何症状。多年来，它慢慢延伸成表面粗糙的隆起斑块，经常在轻微摩擦后出血。体格检查发现左大腿后部有一明显隆起、界限分明的红棕色斑块（3.0 cm × 2.7 cm），被结痂覆盖[图1a]，略带压痛。活检显示角化过度和角化不全。受累表皮出现棘皮病伴网嵴不规则延长[图1b].有透明细胞（一些含有大的细胞学上不典型的细胞核，染色为深色）[图1c]在棘层，基底膜不受累。免疫组织化学结果显示PAS阴性[图1d]、S100、HMB-45、CEA和GCDFP15[图1e]，Ki-67阳性（<30%), CK34 β E12[图1f]和P63[图1g]，CAM5.2弱阳性[图1h].pagetoid Bowen病(BD)的诊断是明确的。随后，进行了广泛的局部切除（1.0 cm切缘），切除切缘为阴性。在BD的所有组织学变异中，据报道仅发生在4.6%的BD中。与典型的BD不同，pagetoid BD通常出现在上肢和下肢，其次是头/颈部和躯干区域，非常罕见的病例出现在外生殖器位置。^[1]在这种情况下，病变最初表现为痣样，表明它可能继发于先前存在的痣细胞痣。另据报道，少数典型BD病例出现在先前存在的皮肤病变中，如脂溢性角化病。^[2]在组织学上，pagetoid BD的特征是具有圆形细胞核和丰富苍白细胞质的非典型角质形成细胞巢，单独或成群位于表皮内，pagetoid细胞的主要鉴别诊断包括乳腺外pagetoid病(EMPD)和恶性黑色素瘤原地（错误）。与经典BD相似，pagetoid BD总是显示表皮的完全受累、散在的多核肿瘤巨细胞、透明角膜颗粒、单细胞角质化和pagetoid细胞之间可见的细胞间桥，而EMPD病变包含与附近表皮细胞界限清楚的pagetoid细胞、扁平的基底层、累及的角质层、腺泡结构和无细胞间桥。MIS病变中可出现界限分明的页状细胞和累及的角质层；相反，卵泡延伸仅出现在MIS中。免疫组织化学测试总是有帮助的。黑素细胞标志物如S100、melan-A和HMB-45在区分MIS和pagetoid BD方面显示出很大的价值，因为只有MIS病变倾向于染色阳性。CK34 β E12显示细胞可能来源于角质形成细胞。CEA和GCDFP15说明细胞可能来自汗腺。CAM5.2和Ber-EP4通常被认为支持EMPD的诊断；^[3]然而，一些pagetoid BD病例对它们呈阳性。^[4]最近的研究表明，p63可能是一个有用的标记，因为它染色BD的非典型角质形成细胞，但不染色EMPDs。^[5]该患者的组织[补充表1]显示P63、Ki-67（<30%)和CK34 β E12，CAM5.2弱阳性，PAS、S100、HMB-45、CEA和GCDFP15阴性。基于这些发现，可以排除MIS和EMPD；证实了pagetoid BD的诊断。

在题为“上海评分：为中国肝癌根治性切除术后患者构建的预后和辅助治疗评估系统”的文章中，发表在第130卷第22期第2650-2660页中华医学杂志,^[1]网站地址“http://115.28.66.83/pro/theme/admin_4/shanghai.php”在第2页、第5页被错误地写成“http://www.115.28.66.83/pro/theme/admin_4/shanghai.php”^th行，在导言段落下。