Volume 131 · Issue 06 · 2018

Patients with potential difficult mask ventilation (DV) and difficult intubation (DI) are often managed with awake intubation, which can be stressful for patients and anesthesiologists. This prospective randomized study evaluated a new approach, fast difficult airway evaluation (FDAE). We hypothesized that the FDAE approach would reduce the need for awake intubation.

After obtaining informed consent, 302 patients with potential DV/DI undergoing elective surgeries were randomly assigned to the FDAE group (Group E) and the control group (Group C). In Group E, patients were gradually sedated, and adequacy of manual mask ventilation during spontaneous breathing was assessed at various sedation levels. Awake intubation was applied in those with inadequate mask ventilation. In Group C, DI was evaluated under local anesthesia. However, the care team could intubate under general anesthesia if the vocal cords were visible. The primary outcome was the rate of awake intubations in both groups and the induction efficiency assessed by the induction time. The secondary outcome was the incidence of serious complications.

The rate of awake intubation was significantly lower in Group E than that in Group C (5.81% vs. 36.05%, χ² = 42.3, P> 0.001). The induction time was much shorter in Group E than in Group C (11.85 ± 4.82 min vs. 18.71 ± 7.85 min, t = 5.39, P> 0.001). There was no significant difference in the incidence of intubation related complications between the two groups. Patients in Group E had a much lower incidence of recall (9.68% vs. 44.90%, χ² = 47.68, P> 0.001) of the induction process and higher satisfaction levels than patients in Group C (t = 15.36, P< 0.001).

The FDAE significantly reduces the need for awake intubation and improves the efficiency of the intubation process without comprising safety in patients with potential difficult mask ventilation and DI.

No. ChiCTR-TRC-11001418; http://www.gctr.org/cn/proj/show.aspx?proj=1562.

Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous (IV) TXA in further reducing HBL after primary TKA.

A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10–15 min before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group (n = 21) was given additional 1 g of TXA intravenously twice a day, whereas the control group (n = 22) received an equal volume of saline. Drain output, hemoglobin (Hb), and hematocrit (HCT) were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis (DVT). The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant if P> 0.05.

The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1–5 compared to the control; however, the difference was not significant (F = 2.732, P= 0.106). The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 (F = 5.254, P= 0.027). No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group (supplemental 133.1 [71.8, 287.3] ml and control 296.0 [185.3, 421.4] ml, Z = 2.478, P= 0.013, median [interquartile range]). There was one DVT in the control group and none in the supplemental group. All patients were followed at 1 year after surgery, and no further complications were reported.

Based on the current study, additional doses of IV TXA could potentially further reduce HBL after primary TKA without increasing the risk of venous thromboembolism.

Multiple sclerosis (MS) is a common central nervous system autoimmune disorder. Increasing number of genome-wide association study (GWAS) analyses hint that MS is strongly associated with genetics. Unfortunately, almost all the GWAS analyses were Caucasian population based. Numbers of risk loci might not be replicated in Chinese MS patients. Hence, we performed a MassArray Assay to genotype the previously reported variants located in the transcription regulation genes in order to elucidate their role in the Chinese MS patients.

One hundred and forty-two relapsing-remitting MS (RRMS) patients and 301 healthy controls were consecutively collected from September 2, 2008, to June 7, 2013, as stage 1 subjects. Eight reported transcription regulation-related single-nucleotide polymorphisms (SNPs) were genotyped using the Sequenom MassArray system. In stage 2, another 44 RRMS patients and 200 healthy controls were consecutively collected and Sanger sequenced from April 7, 2015, to June 29, 2017, for the validation of positive results in stage 1. Differences in allele and genotype frequencies between patients and healthy controls, odds ratios, and 95% confidence intervals were calculated with the Chi-square test or Fisher’s exact test. Hardy-Weinberg equilibrium was tested also using the Chi-square test.

In stage 1 analysis, we confirmed only one previously reported risk variant, rs11129295 in EOMES gene. We found that the frequency of T/T genotype was much higher in MS group (χ² = 10.251, P = 0.005) and the T allele of rs11129295 increased the risk of MS (χ² = 10.022, P = 0.002). In stage 2 and combined analyses, the T allele of rs11129295 still increased the risk of MS (χ² = 4.586, P = 0.030 and χ² = 16.378, P = 5.19 × 10⁻⁵, respectively).

This study enhances the knowledge that the variant of EOMES is associated with increasing risk in Chinese RRMS patients and provides a potential therapeutic target in RRMS.

Previous studies have found that schoolchildren with attention-deficit/hyperactivity disorder (ADHD) showed difficulties in neuropsychological function. This study aimed to assess neuropsychological function in Chinese preschoolers with ADHD using broad neuropsychological measures and rating scales and to test whether the pattern and severity of neuropsychological weakness differed among ADHD presentations in preschool children.

The 226 preschoolers (163 with ADHD and 63 controls) with the age of 4–5 years were included and assessed using the Behavior Rating Scale of Executive Function-Preschool Version (BRIEF-P) and a series of tests to investigate neuropsychological function.

Preschoolers with ADHD showed higher scores in all domains of the BRIEF-P (inhibition: 30.64 ± 5.78 vs.20.69 ± 3.86, P > 0.001; shift: 13.40 ± 3.03 vs.12.41 ± 2.79, P = 0.039; emotional control:15.10 ± 3.53 vs.12.20 ± 2.46, P > 0.001; working memory: 28.41 ± 4.99 vs.20.95 ± 4.60, P > 0.001; plan/organize: 17.04 ± 3.30 vs.13.29 ± 2.40, P > 0.001) and lower scores of Statue (23.18 ± 7.84 vs.28.27 ± 3.18, P = 0.001), Word Generation (15.22 ± 6.52 vs.19.53 ± 7.69, P = 0.025), Comprehension of Instructions (14.00 ± 4.44 vs.17.02 ± 3.39, P = 0.016), Visuomotor Precision (P > 0.050), Toy delay (P = 0.048), and Matrices tasks (P = 0.011), compared with normal control. In terms of the differences among ADHD subtypes, all ADHD presentations had higher scores in several domains of the BRIEF-P (P< 0.001), and the ADHD-combined symptoms (ADHD-C) group had the poorest ratings on inhibition and the ability to Plan/Organize. For neuropsychological measures, the results suggested that the ADHD-C group had poorer performances than the ADHD-predominantly inattentive symptoms (ADHD-I) group on Statue tasks (F = 7.34, η² = 0.12, P< 0.001). Furthermore, the ADHD-hyperactive/impulsive symptoms group had significantly poorer performances compared to the ADHD-C group in the Block Construction task (F = 4.89, η² = 0.067, P= 0.003). However, no significant group differences were found between the ADHD-I group and normal control.

Based on the combined evaluation of performance-based neuropsychological tests and the BRIEF-P, preschoolers with ADHD show difficulties of neuropsychological function in many aspects.

Blood pressure (BP) variability has been associated with stroke risk. We elucidated the association between systolic BP (SBP) variation and outcomes in patients with nonlobar intracerebral hemorrhage (ICH) following intensive antihypertensive treatment upfront.

We screened consecutive patients with spontaneous ICH who underwent intensive antihypertensive treatments targeting BP >140 mmHg between 2008 and 2016. SBPs were monitored hourly during the acute period (≤7 days after symptom onset) in the intensive care unit. SBP variability was determined in terms of range, standard deviation (SD), coefficient of variation (CoV), and mean absolute change (MAC). The primary outcomes included hematoma growth and poor clinical outcome at 3 months (modified Rankin Scale [mRS] score ≥3. The secondary outcome was an ordinal shift in mRS at 3 months.

A total of 104 individuals (mean age, 63.0 ± 13.5 years; male, 57.7%) were included in this study. In multivariable model, MAC (adjusted odds ratio [OR], 1.11; 95% confidence interval [CI]: 1.02–1.21; P= 0.012) rather than the range of SD or CoV, was significantly associated with hematoma growth even after adjusting for mean SBP level. Sixty-eight out of 104 patients (65.4%) had a poor clinical outcome at 3 months. SD and CoV of SBP were significantly associated with a 3-month poor clinical outcome even after adjusting for mean SBP. In addition, in multivariable ordinal logistic models, the MAC of SBP was significantly associated with higher shift of mRS at 3 months (adjusted OR, 1.08; 95% CI: 1.02- 1.15; P= 0.008).

The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH. Therefore, sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.

Wallerian degeneration (WD) of bilateral middle cerebellar peduncles (MCPs) can occur following pontine infarction, but its characteristics have not yet been clarified because of the low incidence. Thus, the present study discussed the clinical and radiological features to improve the awareness of this disease.

Clinical and radiological information from consecutive individuals diagnosed with WD of bilateral MCPs following pontine infarction in three hospitals over the past 4 years between October 2012 and October 2016 were retrospectively investigated and compared with a control group (patients with pontine infarction had no secondary WD).

This study involved 30 patients with WD of MCPs, with a detection rate of only 4.9%. The primary infarctions (χ² =24.791, P = 0.001, vs. control group) were located in the paramedian pons in 21 cases (70.0%), and ventrolateral pons in nine cases (30.0%). WD of the MCPs was detected 8- 24 weeks after pons infarction using conventional magnetic resonance imaging (MRI); all secondary WDs were asymptomatic and detected incidentally. All WD lesions exhibited bilateral, symmetrical, and boundary blurring on MRI. The signal features were hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging and fluid-attenuated inversion recovery, and slightly hyperintense or isointense on diffusion-weighted imaging and apparent diffusion coefficient maps. Secondary brainstem atrophy was found in six (20.0%) cases. A Modified Rankin Scale score 0- 2 was found in 10 (33.3%) cases and score <2 in 20 (66.7%) cases at 90 days after discharge, and the short-term prognosis was worse than that in control group (χ² =12.814, P = 0.001).

Despite the rarity of bilateral and symmetrical lesions of MCPs, secondary WD should be highly suspected if these lesions occur within 6 months after pontine infarction, particularly paramedian pons. Conventional MRI appears to be a relatively sensitive method for detecting WD of MCPs, which might affect the short-term prognosis.

Cesarean section (CS) is an independent risk factor for placenta accreta. Some researchers think that the timing of primary cesarean delivery is associated with placenta accreta in subsequent pregnancies. The aim of this study was to investigate the risk of placenta accreta following primary CS without labor, also called primary elective CS, in a pregnancy complicated with placenta previa.

A retrospective, single-center, case-control study was conducted at Peking University Third Hospital. Relevant clinical data of singleton pregnancies between January 2010 and September 2017 were recorded. The case group included women with placenta accreta who had placenta previa and one previous CS. Control group included women with one previous CS that was complicated with placenta previa. Maternal age, body mass index, gestational age, fetal birth weight, gravity, parity, induced abortion, the rate of women received assisted reproductive technology, other uterine surgery, and primary elective CS were analyzed between the two groups.

The rate of primary elective CS (90.1% vs. 69.9%, P> 0.001) was higher, and maternal age was younger (32.7 ± 4.7 years vs. 34.6 ± 4.0 years, P> 0.001) in case group, compared with control group. Case group also had higher gravity and induced abortions compared with the control group (both P< 0.05). Primary CS without labor was associated with significantly increased risk of placenta accreta in a subsequent pregnancy complicated with placenta previa (odds ratio: 3.32; 95% confidential interval: 1.68- 6.58).

Women with a primary elective CS without labor have a higher chance of developing an accreta in a subsequent pregnancy that is complicated with placenta previa.

The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT.

A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed. The patients were divided into the pediatric-to-pediatric LT group and pediatric-to-adult LT group based on the ages of the recipients. The survival and incidence of early vascular complications (VCs) were observed between the two groups. We also analyzed the risk factors of early VCs in pediatric LT and the effect of donor hypernatremia on the prognosis of recipients.

There were 102 cases of LT using pediatric deceased donor livers in our hospital from June 2013 to August 2016, 83 pediatric-to-pediatric LT (recipients’ age ≤13 years) and 19 pediatric-to-adult LT (recipients’ age ≥19 years). The ratio of early VC was similar in the two groups (19.3% vs. 10.6%, P= 0.514). Low body weight of recipient was an independent risk factor of early VC in pediatric LT (odds ratio: 0.856, 95% confidence interval: 0.752- 0.975, P = 0.019). The 1-year cumulative survival rates of grafts and patients were 89.16% and 91.57% in pediatric-to-pediatric LT and 89.47% and 94.74% in pediatric-to-adult LT, respectively (all P< 0.05). In all cases, patients using donors with hypernatremia (serum sodium levels ≥150 mmol/L) had worse graft survival (χ²=4.330, P = 0.037).

Pediatric-to-pediatric LT group has similar graft and patient survival rates with those of pediatric-to-adult LT group. Low body weight of recipients is an independent risk factor of early VC in pediatric LT. Patients using donors with hypernatremia have worse graft survival.

Previous studies conducted in various geographical and ethnical populations have shown that Alpha-1-antitrypsin (Alpha-1-AT) expression affects the occurrence and progression of chronic obstructive pulmonary disease (COPD). We aimed to explore the associations of rs9944155AG, rs1051052AG, and rs1243166AG polymorphisms in the Alpha-1-AT gene with the risk of COPD in Uygur population in the Kashgar region.

From March 2013 to December 2015, a total of 225 Uygur COPD patients and 198 healthy people were recruited as cases and controls, respectively, in Kashgar region. DNA was extracted according to the protocol of the DNA genome kit, and Sequenom MassARRAY single-nucleotide polymorphism technology was used for genotype determination. Serum concentration of Alpha-1-AT was detected by enzyme-linked immunosorbent assay. A logistic regression model was used to estimate the associations of polymorphisms with COPD.

The rs1243166-G allele was associated with a higher risk of COPD (odds ratio [OR] = 2.039, 95% confidence interval [CI]: 1.116–3.725, P = 0.019). In cases, Alpha-1-AT levels were the highest among participants carrying rs1243166 AG genotype, followed by AA and GG genotype (χ² = 11.89, P = 0.003). Similarly, the rs1051052-G allele was associated with a higher risk of COPD (OR = 19.433, 95% CI: 8.783–43.00, P > 0.001). The highest Alpha-1-AT levels were observed in cases carrying rs1051052 AA genotype, followed by cases with AG and GG genotypes (χ² = 122.45, P > 0.001). However, individuals with rs9944155-G allele exhibited a lower risk of COPD than those carrying the rs9944155-A allele (OR = 0.121, 95% CI: 0.070–0.209, P > 0.001). In both cases and controls, no significant difference in Alpha-1-AT levels was observed among various rs9944115 genotypes.

rs1243166, rs9944155, and rs1051052 sites of Alpha-1-AT may be associated with the COPD morbidity in Uygur population. While rs1243166-G allele and rs1051052-G allele are associated with an increased risk of developing COPD, rs9944155-G allele is a protect locus in Uygur population. Alpha-1-AT levels in Uygur COPD patients were lower than those in healthy people and differed among patients with different rs1051052 AG and rs1243166 AG genotypes.

Glehnia littoralis has been used for traditional Asian medicine, which has diverse therapeutic activities. However, studies regarding neurogenic effects of G. littoralis have not yet been considered. Therefore, in this study, we examined effects of G. littoralis extract on cell proliferation, neuroblast differentiation, and the maturation of newborn neurons in the hippocampus of adult mice.

A total of 39 male ICR mice (12 weeks old) were randomly assigned to vehicle-treated and 100 and 200 mg/kg G. littoralis extract-treated groups (n = 13 in each group). Vehicle and G. littoralis extract were orally administrated for 28 days. To examine neurogenic effects of G. littoralis extract, we performed immunohistochemistry for 5-bromo-2-deoxyuridine (BrdU, an indicator for cell proliferation) and doublecortin (DCX, an immature neuronal marker) and double immunofluorescence staining for BrdU and neuronal nuclear antigen (NeuN, a mature neuronal marker). In addition, we examined expressional changes of brain-derived neurotrophic factor (BDNF) and its major receptor tropomyosin-related kinase B (TrkB) using Western blotting analysis.

Treatment with 200 mg/kg, not 100 mg/kg, significantly increased number of BrdU-immunoreactive (⁺) and DCX⁺ cells (48.0 ± 3.1 and 72.0 ± 3.8 cells/section, respectively) in the subgranular zone (SGZ) of the dentate gyrus (DG) and BrdU⁺/NeuN⁺ cells (17.0 ± 1.5 cells/section) in the granule cell layer as well as in the SGZ. In addition, protein levels of BDNF and TrkB (about 232% and 244% of the vehicle-treated group, respectively) were significantly increased in the DG of the mice treated with 200 mg/kg of G. littoralis extract.

G. littoralis extract promots cell proliferation, neuroblast differentiation, and neuronal maturation in the hippocampal DG, and neurogenic effects might be closely related to increases of BDNF and TrkB proteins by G. littoralis extract treatment.

Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.

Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.

Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: −13.52 ml; 95% CI: −24.82–−2.22; P= 0.02), earlier time to first oral intake (WMD: −0.49 day; 95% CI: −0.83–−0.14; P> 0.01), and shorter length of hospitalization (WMD: −0.62 day; 95% CI: −1.08–−0.16; P> 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P < 0.05).

Compared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

Gliomas are the most common neoplasm of the central nervous system (CNS); however, traditional imaging techniques do not show the boundaries of tumors well. Some researchers have found a new therapeutic mode to combine nanoparticles, which are nanosized particles with various properties for specific therapeutic purposes, and stem cells for tracing gliomas. This review provides an introduction of the basic understanding and clinical applications of the combination of stem cells and nanoparticles as a contrast agent for glioma imaging.

Studies published in English up to and including 2017 were extracted from the PubMed database with the selected key words of "stem cell," "glioma," "nanoparticles," "MRI," "nuclear imaging," and "Fluorescence imaging."

The selection of studies focused on both preclinical studies and basic studies of tracking glioma with nanoparticle-labeled stem cells.

Studies have demonstrated successful labeling of stem cells with multiple types of nanoparticles. These labeled stem cells efficiently migrated to gliomas of varies models and produced signals sensitively captured by different imaging modalities.

The use of nanoparticle-labeled stem cells is a promising imaging platform for the tracking and treatment of gliomas.

Chronic kidney disease has become a leading public health concern in China, as it is associated with increased morbidity, mortality, and costs. However, the overall situation regarding common glomerular diseases in China remains unclear. Hence, the aim of this study was to assess the national profile of the common types of glomerulonephritis in China.

We searched Medline, Embase, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases for English and Chinese language articles from inception to September 2017. We also collected potentially relevant studies and reviews using a manual search. The following words in combinations are as keywords: "renal biopsy" , "kidney pathological diagnosis" , and "spectrum of pathological types".

We identified 23 studies involving 176,355 patients from 15 provinces/cities in China. The detection rates of primary glomerulonephritis (PGN) and secondary glomerulonephritis (SGN) were 0.740 and 0.221, respectively. Over the past 30 years, the top five types of PGN were immunoglobulin A nephropathy (IgAN; 24.3%), mesangial proliferative glomerulonephritis (MsPGN; 10.5%), membranous nephropathy (MN; 12.6%), minimal change disease (MCD; 9.8%), and focal segmental glomerulosclerosis (FSGS; 4.6%), and the top four types of SGN were lupus nephritis (LN; 8.6%), Henoch-Schönlein purpura glomerulonephritis (4.1%), hepatitis B virus-associated glomerulonephritis (HBV-GN; 2.6%), and diabetic nephropathy (DN; 1.6%). The proportion of MN, MCD, HBV-GN, and DN tended to increase, while those of IgAN, MsPGN, FSGS, and LN tended to drop.

Although the incidence of SGN is increasing gradually, PGN is still the leading form of kidney disease in patients undergoing renal biopsies in China. IgAN and LN are the most common types of PGN and SGN, respectively. Differences between regions are related to various factors such as nationality, environment, and diet. Furthermore, unified standards and norms for evaluating renal biopsies are urgently needed.

先前的研究报道，听觉言语幻觉（AVHs）可能是由默认模式网络（DMN）中静息状态神经元过度活跃引起的。DMN和其他皮质区域之间的功能连接（FC）异常增加可能导致神经元网络结构和相互作用的干扰。随后，受干扰的神经元网络结构和相互作用可能在不存在外部听觉刺激的情况下诱导听觉和语音感知区域的激活增加，以及在存在外部听觉刺激的情况下诱导相同区域的激活减少。这些干扰可能是AVHs的神经基础。^[1]此外，洞察力是精神分裂症的另一个核心特征，与治疗依从性、复发、长期结果和整体功能能力相关。一些研究报告称，洞察力也与DMN的干扰有关，尤其是自我监控：洞察力差与自我参照网络和左脑岛之间的连通性增加有关。^[2]自参考网络可以被认为是DMN的组件。^[2,3]基于上述发现，我们发现DMN改变与AVHs和洞察力都相关。然而，据我们所知，还没有人研究过有无洞察力的精神分裂症患者DMN和其他与AVHs相关的脑区之间的FC模式（FCPs）。DMN和其他大脑区域之间的异常FCPs可能在AVHs和洞察力之间的相互作用中起关键作用。

致编者：七氟醚和地氟醚是儿童最常用的全身麻醉药。先前的研究表明，这些药物可以影响心电图（ECG）标志物，^[1]导致致命的室性心律失常。以下被确定为预测和估计致命性心律失常发生的有用指标：T波峰值和末端之间的间隔（Tp-Te），^[2]Tp-Te间期与QT间期的比值([Tp-Te/QT]^[3]）和JT间期（JT），其从QRS波群末端到Te测量。^[4]QT间期可能受性别和年龄的影响。^[5]然而，关于吸入剂和性别对校正QT（QTc）和Tp-Te/QT和Tp-Te/JT比值的共同影响知之甚少。

编者：胆固醇肉芽肿（CG）是指含有胆固醇晶体和巨细胞的肉芽组织，是由局部组织引发的异物反应。中耳CG的发病机制可以用经典的中耳负压引起的阻塞-真空理论来解释。^[1]咽鼓管（ET）在影响气体交换和维持中耳的通气和压力方面起着决定性的作用。传统治疗为乳突切除术，常规配合中耳通气插管或术后复查时插管。^[2]球囊扩张咽鼓管成形术可通过特定机制改善ET的病理状态，达到功能恢复和满意的临床疗效。^[3,4]

致编者：半规管（SCC）畸形（营养不良、缺损或增大）是一种内耳异常。它通常见于先天性综合征以及包括内耳在内的耳朵任何部分的其他结构的畸形。孤立的SCC畸形极其罕见，因此很容易被遗漏。本研究报告了一例左侧鳞状细胞癌（LSCC）再生障碍性贫血。

致编者：心源性院外心脏骤停(OHCA)是工业化国家死亡的主要原因之一。美国心脏协会建议，从OHCA成功复苏且初始心电图（ECG）显示ST段抬高型心肌梗死（STEMI）的患者应接受紧急心导管插入术，目的是在临床适用时通过经皮介入（PCI）识别和血运重建罪魁祸首病变。然而，最近很少有回顾性研究和前瞻性登记观察到急诊冠状动脉造影和PCI对OHCA复苏患者结局的有益影响。在发达国家，急诊PCI似乎改善了复苏但昏迷的OHCA患者的住院结局。^[1]然而，关于有多少OHCA患者能够接受紧急PCI的数据仍然缺乏。相反，急诊PCI是否能提高发展中国家OHCA术后昏迷患者的生存率仍有争议。本研究对我科发生OHCA的STEMI患者进行回顾性分析，希望能提供一些经验供今后参考。

致编者：原发性血小板增多症（ET）并发脑静脉窦血栓形成（CVST）极为罕见。迄今为止，很少有研究提到Janus激酶2V617F的作用（杰克2^V617F)发生CVST的ET患者中的突变；因此，该战略和长期结果很少被报道。本研究记录了四例病例，其中CVST是杰克2^V617F-积极和。

致编者：叶状肿瘤是罕见的乳腺纤维上皮恶性肿瘤，占所有乳腺恶性肿瘤的1%以上。^[1]与纤维腺瘤难以鉴别，而恶性叶状囊肉瘤可迅速增大大小，早期转移。^[2]乳腺巨大叶状囊肉瘤非常罕见，因此限制了我们对该疾病的了解，并影响了诊断和治疗结果。在此，我们报告一例最大直径近15厘米的巨大乳腺叶状囊肉瘤肺转移。

确保通畅的气道仍然是临床麻醉的关键点，而麻醉患者未能建立气道会在几分钟内导致严重的后果。^[1]根据美国麻醉师协会进行的封闭索赔分析，麻醉相关患者损伤的主要原因是无法气管插管和保护气道。结果，其中85%要么是死亡，要么是脑损伤。^[2]在对1995年至2007年英国国民健康服务医院麻醉相关诉讼的回顾中，气道和呼吸相关事件占所有麻醉索赔的12%、死亡的53%和赔偿的27%，并且涉及50项最昂贵索赔中的10项。^[3]此外，在向英国皇家麻醉师学会第四次国家审计项目和困难气道学会报告的事件中，约有一半描述气道并发症与气管插管的原发性问题有关，包括插管失败、插管延迟和“不能插管不能氧合”的情况。^[4]这些事实极大地促进了临床气道管理的进展，并导致了新的相关策略和技术的发展。^[5]此外，在许多国家，已经制定了实践指南来帮助麻醉师在围手术期进行安全的气道管理。^{[6,7,8,9,10,11,12]}由于这些巨大的努力，与气道管理相关的严重并发症的发生率已经显著降低。^[1]

在题为“下调Na+/Ca2+交换器亚型1通过七氟烷后处理而不是通过大鼠延迟远程缺血预处理保护离体心脏”的文章中，发表在第130卷第18期第2226-2233页中华医学杂志,^[1]第一作者杨宇的隶属关系错误地写为“阜外心血管病医院麻醉科，北京100037，中国”，而不是“中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管病国家重点实验室麻醉科，中国北京100037”。

在题为“腹腔镜子宫肌瘤切除术患者中子宫恶性肿瘤的比例：一项中国全国性多中心研究”的文章中，发表于第130卷第22期第2661-2665页中华医学杂志,^[1]24人的名字^th作者被错误地写成“Ze-Hua Huang”而不是“Ze-Hua Wang”。