Volume 131 · Issue 08 · 2018

帕金森病（PD）是世界上第二常见的神经退行性疾病。在中国，约48-89%的中国PD患者已被证明受到睡眠障碍的影响。近几十年来，我们对睡眠障碍和帕金森病之间关系的理解取得了重大进展，但许多问题仍未得到解答。

神经系统疾病的特征是高频率的残疾和死亡率，其发病机制很大程度上未知。神经系统疾病中遗传性、难治性、罕见病占较大比例；令人同情的是，可治愈的治疗方法有限。全世界有数亿人受到神经疾病的影响。神经系统疾病的诊断和治疗近年来取得了重大进展，尤其是近二十年来随着技术的飞速发展。例如，关于急性缺血性卒中，随着静脉内和动脉内治疗的改善以及近年来世界范围内对二级预防的重视，残疾、死亡率和复发率显著降低。更令人惊讶的是，基因疗法正在成为一种强有力的方法来帮助患有基因缺陷的患者，有可能治疗甚至治愈遗传疾病。几乎与此同时，中国在神经系统疾病的诊断、治疗、预防等方面也发生了显著的变化。更重要的是，中国是一个幅员辽阔、经济发展不平衡、人口众多、文化习俗多样的国家。因此，一些神经系统疾病的危险因素和谱与西方国家不同。在此，我们回顾了近二十年来神经系统疾病的进展，并进一步比较了中国和西方国家的差异。这种比较将有助于医疗从业者和研究人员更好地了解差距，为患者做出更好的医疗决策，并鼓励研究领域的进步。

健康中国倡议的提出，是我国卫生政策和卫生改革的里程碑。尽管将健康中国上升为国家战略，但实现这一战略仍面临艰巨挑战。^[1]这其中，一个是由于过去政策导向的医改实践，缺乏与之相适应的法律机制。

Memory complaint is common in the elderly. Recently, it was shown that self-report memory complaint was predictive of cognitive decline. This study aimed to investigate the predictive value of the source of memory complaints on the risk of cognitive impairment and cognitive decline in a community-based cohort.

Data on memory complaints and cognitive function were collected among 1840 Chinese participants (aged ≥55 years old) in an urban community at baseline interview and 5-year follow-up. Incident cognitive impairment was identified based on education-adjusted Mini-Mental State Examination score. Logistic regression model was used to estimate the association between the source of memory complaints and risk of cognitive impairment conversion and cognitive decline, after adjusting for covariates.

A total of 1840 participants were included into this study including 1713 normal participants and 127 cognitive impairment participants in 2009. Among 1713 normal participants in 2009, 130 participants were converted to cognitive impairment after 5 years of follow-up. In 2014, 606 participants were identified as cognitive decline. Both self- and informant-reported memory complaints were associated with an increased risk of cognitive impairment (odds ratio [OR] = 1.60, 95% confidence interval [CI]: 1.04–2.48) and cognitive decline (OR = 1.30, 95% CI: 1.01–1.68). Furthermore, this association was more significant in males (OR = 2.10, 95% CI: 1.04–4.24 for cognitive impairment and OR = 1.87, 95% CI: 1.20–2.99 for cognitive decline) and in higher education level (OR = 1.79, 95% CI: 1.02–3.15 for cognitive impairment and OR = 1.40, 95% CI: 1.02–1.91 for cognitive decline).

Both self- and informant-reported memory complaints were associated with an increased risk of cognitive impairment conversion and cognitive decline, especially in persons with male gender and high educational background.

Rapid eye movement (REM) sleep behavior disorder (RBD) and obstructive sleep apnea (OSA) are the most common sleep disorders in Parkinson’s disease (PD). The aim of this study was to identify whether RBD could alleviate OSA severity in PD patients and its effect on cognitive impairment.

From February 2014 to May 2017, we recruited 174 PD patients from the Second Affiliated Hospital of Soochow University, all of whom underwent polysomnography (PSG). We collected clinical data, PSG results, and compared information between patients with and without RBD or OSA by analysis of covariance. We also investigated the effect of these sleep disorders on cognitive impairment using linear regression.

We grouped participants as follows: PD only (n = 53), PD + OSA (n = 29), PD + RBD (n = 61), and PD + RBD + OSA (n = 31). Minimum oxygen saturation (SaO₂) during whole sleep and in REM sleep was higher in PD + RBD + OSA patients than that in PD + OSA patients. PD + RBD patients had worse Mini-Mental Status Examination and Montreal Cognitive Assessment (MoCA) scores than those in the PD group (P < 0.001), especially in visuospatial/executive, attention, and memory functions. The PD + OSA group performed worse than the PD group in the delayed recall domain. After adjusting for age, sex, body mass index, education, disease severity, and other sleep disorders, MoCA was negatively associated with OSA (β = −0.736, P = 0.043) and RBD (β = −2.575, P < 0.001). The severity of RBD (tonic/phasic electromyography activity) and OSA (apnea-hypopnea index/oxygen desaturation index/minimum SaO₂) were also associated with MoCA. The adjusted β values of RBD-related parameters were higher than that for OSA.

We found that RBD alleviated OSA severity; however, RBD and OSA together exacerbated PD cognitive impairment. Further studies are needed to evaluate whether OSA treatment can improve cognition in PD.

Sleep disturbance is one of the major non-motor symptoms which cause the disability of Parkinson’s disease (PD) patients. Cystatin C (CysC) is a more sensitive biomarker than serum creatinine or estimated glomerular filtration rate. Previous studies have reported altered CysC levels in neurodegenerative disorders and sleep disorders. This study aimed to explore the correlations of serum CysC levels and objective sleep disturbances in early PD.

We recruited 106 early PD patients and 146 age- and sex-matched controls. All participants underwent clinical investigation and video-polysomnography. Sleep parameters and serum levels of CysC were measured. Then, we investigated the relationships between CysC and clinical variables and objective sleep disturbances in early PD patients.

The mean serum level of CysC was significantly higher in patients with early PD (1.03 ± 0.19 mg/L) compared to controls (0.96 ± 0.15 mg/L, P = 0.009). There were significantly positive correlations between serum CysC levels and age (r = 0.334, P < 0.001), gender (r = 0.264, P = 0.013), and creatinine levels (r = 0.302, P = 0.018) in early PD patients. Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index (AHI) (r = 0.231, P = 0.017), especially hypopnea index (r = 0.333, P < 0.001). In early PD patients, elevated serum CysC levels were positively correlated with oxygen desaturation index (r = 0.223, P = 0.021), percentage of time spent at oxygen saturation (SaO₂) <90% (r = 0.644, P < 0.001), arousal with respiratory event during sleep (r = 0.247, P = 0.013). On the contrary, the elevated serum CysC levels were negatively correlated with mean and minimal SaO₂ (r = −0.323, −0.315, both P = 0.001) in PD patients.

The level of serum CysC was higher in early PD patients. PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation. Therefore, the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.

Patients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.

In total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.

No gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16–2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05–1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.

HPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.

ClinicalTrials.gov: NCT02023567; https://clinicaltrials.gov/ct2/show/NCT02023567?term=NCT02023567&rank=1.

Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.

Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children’s Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.

The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).

Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.

The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.

A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B). According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups (1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52). We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission (CSR) rate as the primary endpoints.

There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B (χ² = 4.631, P = 0.031). The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.

Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of reaching CSR.

In the mainland of China, the trial of labor after cesarean section is still a relatively new technique. In this study, we aimed to investigate the effects of labor onset, oxytocin use, and epidural anesthesia on maternal and neonatal outcomes for vaginal birth after cesarean section (VBAC) in a tertiary hospital in China.

This was a retrospective study carried out on 212 VBAC cases between January 2015 and June 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Relevant data were acquired on a form, including maternal age, gravidity and parity, body mass index before pregnancy, weight gain during pregnancy, type of labor onset, gestational age, the use of oxytocin and epidural anesthesia, birth mode, the duration of labor, and neonatal weight. The factors affecting maternal and neonatal outcomes for cases involving VBAC, especially with regards to postpartum hemorrhage (PPH) and fetal distress, were evaluated by univariate analysis and multivariable logistic regression.

Data showed that 36 women (17.0%) had postpartum hemorrhage (PPH) and 51 cases (24.1%) featured fetal distress. Normal delivery took place for 163 infants (76.9%) while 49 infants (23.1%) underwent operative vaginal deliveries with forceps. There were 178 cases (84.0%) of spontaneous labor and 34 cases (16.0%) required induction. Oxytocin was used in 54 cases (25.5%) to strengthen uterine contraction, and 65 cases (30.7%) received epidural anesthesia. The rate of normal delivery in cases involving PPH was significantly lower than those without PPH (61.1% vs. 80.1%; χ² = 6.07, P = 0.01). Multivariate logistic analysis showed that the intrapartum administration of oxytocin (odds ratio [OR] = 2.47; 95% confidence interval [CI] = 1.07–5.74; P = 0.04) and birth mode (OR = 0.40; 95% CI = 0.18–0.87; P = 0.02) was significantly associated with PPH in VBAC cases. Operative vaginal delivery occurred more frequently in the group with fetal distress than the group without (49.0% vs. 14.9%, χ² = 25.36, P = 0.00). Multivariate logistic analysis also revealed that the duration of total labor (OR = 1.01; 95% CI = 1.00–1.03; P = 0.04) and the gestational week of delivery (OR = 1.08; 95% CI = 1.05–1.11; P = 0.00) were significantly associated with fetal distress in VBAC.

The administration of oxytocin during labor and birth was identified as a protective factor for PPH in VBAC while birth mode was identified as a risk factor. Finally, the duration of total labor and the gestational week of delivery were identified as risk factors for fetal distress in cases of VBAC. This information might help obstetricians provide appropriate interventions during labor and birth for VBAC.

Promoter methylation of MGMT and C13ORF18 has been confirmed as a potential biomarker for early diagnosis of cervical cancer. The aim of this study was to evaluate the performance of MGMT and C13ORF18 promoter methylation for triage of cytology screening samples and explore the potential mechanism.

Methylation-sensitive high-resolution melting was used to detect promoter methylation of MGMT and C13ORF18 in 124 cervical samples. High-risk human papillomavirus (HR-HPV) was detected by the Digene Hybrid Capture 2^®. Gene methylation frequencies in relation to cervical intraepithelial neoplasia (CIN) were analyzed. Frequencies were compared by Chi-square tests. The expression of gene biomarkers and methylation regulators was analyzed by immunohistochemical staining, real-time fluorescence quantitative polymerase chain reaction, and Western blot.

For triage of low-grade squamous intraepithelial lesion (LSIL), gene methylation increased specificity from 4.0% of HR-HPV detection to 30.8% of MGMT (χ² = 9.873, P = 0.002) and to 50.0% of C13ORF18 (χ² = 21.814, P = 0.001). For triage of atypical squamous cells of undetermined significance, HR-HPV detection had higher positive predictive value of 54.8%. Either MGMT or C13ORF18 methylation combined with HR-HPV increased the negative predictive value to 100.0% (χ² = 9.757, P = 0.002). There was no relationship between MGMT and C13ORF18 expression and DNA methylation (χ² = 0.776, P = 0.379 and χ² = 1.411, P = 0.235, respectively). MBD2 protein level in cervical cancer was relatively lower than normal cervical tissue (t = 4.11, P = 0.006).

HR-HPV detection is the cornerstone for triage setting of CIN. Promoter methylation of MGMT and C13ORF18 plays a limited role in triage of LSIL. Promoter methylation of both genes may not be the causes of gene silence.

Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder, and it's diagnosis is difficult. The aim of this study was to investigate the metabolic profiles of PCOS patients by analyzing urine samples and identify useful biomarkers for diagnosis of PCOS.

This study was carried out in the Department of Obstetrics and Gynecology of the Maternal and Child Health Hospital of Hunan Province from December 2014 to July 2016. In this study, the urine samples of 21 women with PCOS and 16 healthy controls were assessed through gas chromatography-mass spectrometry to investigate the urine metabolite characteristics of PCOS and identify useful biomarkers for the diagnosis of this disorder. The Student’s t-test and rank sum test were applied to validate the statistical significance of the between the two groups.

In total, 35 urine metabolites were found to be significantly different between the PCOS patients and the controls. In particular, a significant increase in the levels of lactose (10.01 [0,13.99] mmol/mol creatinine vs. 2.35 [0.16, 3.26] mmol/mol creatinine, P = 0.042), stearic acid (2.35 [1.47, 3.14] mmol/mol creatinine vs. 0.05 [0, 0.14] mmol/mol creatinine, P < 0.001), and palmitic acid (2.13 [1.07, 2.79] mmol/mol creatinine vs. 0 [0, 0] mmol/mol creatinine, P < 0.001) and a decrease in the levels of succinic acid (0 [0, 0] mmol/mol creatinine vs. 38.94 [4.16, 51.30] mmol/mol creatinine, P < 0.001) were found in the PCOS patients compared with the controls. It was possible to cluster the PCOS patients and the healthy controls into two distinct regions based on a principal component analysis model. Of the differentially expressed metabolites, four compounds, including stearic acid, palmitic acid, benzoylglycine, and threonine, were selected as potential biomarkers.

This study offers new insight into the pathogenesis of PCOS, and the discriminating urine metabolites may provide a prospect for the diagnosis of PCOS.

Oxidized low-density lipoprotein (ox-LDL)-induced oxidative stress and endothelial apoptosis are essential for atherosclerosis. Our previous study has shown that ox-LDL-induced apoptosis is mediated by the protein kinase RNA-like endoplasmic reticulum kinase (PERK)/eukaryotic translation initiation factor 2α-subunit (eIF2α)/CCAAT/enhancer-binding protein homologous protein (CHOP) endoplasmic reticulum (ER) stress pathway in endothelial cells. Statins are cholesterol-lowering drugs that exert pleiotropic effects including suppression of oxidative stress. This study aimed to explore the roles of simvastatin on ox-LDL-induced ER stress and apoptosis in endothelial cells.

Human umbilical vein endothelial cells (HUVECs) were treated with simvastatin (0.1, 0.5, or 2.5 µmol/L) or DEVD-CHO (selective inhibitor of caspase-3, 100 µmol/L) for 1 h before the addition of ox-LDL (100 µg/ml) and then incubated for 24 h, and untreated cells were used as a control group. Apoptosis, expression of PERK, phosphorylation of eIF2α, CHOP mRNA level, and caspase-3 activity were measured. Comparisons among multiple groups were performed with one-way analysis of variance (ANOVA) followed by post hoc pairwise comparisons using Tukey’s tests. A value of P < 0.05 was considered statistically significant.

Exposure of HUVECs to ox-LDL resulted in a significant increase in apoptosis (31.9% vs. 4.9%, P < 0.05). Simvastatin (0.1, 0.5, and 2.5 µmol/L) led to a suppression of ox-LDL-induced apoptosis (28.0%, 24.7%, and 13.8%, F = 15.039, all P < 0.05, compared with control group). Ox-LDL significantly increased the expression of PERK (499.5%, P < 0.05) and phosphorylation of eIF2α (451.6%, P < 0.05), if both of which in the control groups were considered as 100%. Simvastatin treatment (0.1, 0.5, and 2.5 µmol/L) blunted ox-LDL-induced expression of PERK (407.8%, 339.1%, and 187.5%, F = 10.121, all P < 0.05, compared with control group) and phosphorylation of eIF2α (407.8%, 339.1%, 187.5%, F = 11.430, all P < 0.05, compared with control group). In contrast, DEVD-CHO treatment had no significant effect on ox-LDL-induced expression of PERK (486.4%) and phosphorylation of eIF2α (418.8%). Exposure of HUVECs to ox-LDL also markedly induced caspase-3 activity together with increased CHOP mRNA level; these effects were inhibited by simvastatin treatment.

This study suggested that simvastatin could inhibit ox-LDL-induced ER stress and apoptosis in vascular endothelial cells.

Remote ischemic postconditioning (RIPostC) appears to protect distant organs from ischemia-reperfusion injury (IRI). However, cerebral protection results have remained inconclusive. In the present study, a meta-analysis was performed to compare stroke patients with and without RIPostC.

CNKI, WanFang, VIP, CBM, PubMed, and Cochrane Library databases were searched up to July 2016. Data were analyzed using both fixed-effects and random-effects models by Review Manager. For each outcome, risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated.

A total of 13 randomized controlled trials that enrolled a total of 794 study participants who suffered from or are at risk for brain IRI were selected. Compared with controls, RIPostC significantly reduced the recurrence of stroke or transient ischemic attacks (RR = 0.37; 95% CI: 0.26–0.55; P < 0.00001). Moreover, it can reduce the levels of the National Institutes of Health Stroke Scale score (MD: 1.96; 95% CI: 2.18–1.75; P < 0.00001), modified Rankin Scale score (MD: 0.73; 95% CI: 1.20–0.25; P = 0.00300), and high-sensitivity C-reactive protein (MD: 4.17; 95% CI: 4.71–3.62; P < 0.00001) between the two groups. There was no side effect of RIPostC using tourniquet cuff around the limb on ischemic stroke treating based on different intervention duration.

The present meta-analysis suggests that RIPostC might offer cerebral protection for stroke patients suffering from or are at risk of brain IRI.

目的：快速眼动睡眠行为障碍（RBD）的特征是在快速眼动睡眠期间梦境的形成和肌肉无力的丧失。RBD与α-突触核蛋白病密切相关，包括帕金森病、路易体痴呆和多系统萎缩。许多研究调查了RBD的影像学和神经生理学、遗传、认知、自主神经功能的标志物及其对神经退行性疾病的预测价值。本报告回顾了这些研究的进展，并讨论了它们的局限性和未来的研究方向。

Excessive daytime sleepiness (EDS) is one of the most common sleep abnormalities in patients with Parkinson’s disease (PD), yet its multifactorial etiology complicates its treatment. This review summarized recent studies on the epidemiology, etiology, clinical implications, associated features, and evaluation of EDS in PD. The efficacy of pharmacologic and non-pharmacologic treatments for EDS in PD was also reviewed.

English language articles indexed in PubMed and Cochrane databases and Chinese-language papers indexed in Wanfang and National Knowledge Infrastructure databases that were published between January 1987 and November 2017 were located using the following search terms: "sleepiness" , "sleep and Parkinson’s disease" , and "Parkinson’s disease and treatment" .

Original research articles and critical reviews related to EDS in PD were selected.

EDS is a major health hazard and is associated with many motor and nonmotor symptoms of PD. Its causes are multifactorial. There are few specific guidelines for the treatment of EDS in PD. It is first necessary to identify and treat any possible factors causing EDS. Recent studies showed that some nonpharmacologic (i.e., cognitive behavioral therapy, light therapy, and repetitive transcranial magnetic stimulation) and pharmacologic (i.e., modafinil, methylphenidate, caffeine, istradefylline, sodium oxybate, and atomoxetine) treatments may be effective in treating EDS in PD.

EDS is common in the PD population and can have an immensely negative impact on quality of life. Its causes are multifactorial, which complicates its treatment. Further investigations are required to determine the safety and efficacy of potential therapies and to develop novel treatment approaches for EDS in PD.

Acute respiratory distress syndrome (ARDS) is an acute and lethal clinical syndrome that is characterized by the injury of alveolar epithelium, which impairs active fluid transport in the lung, and impedes the reabsorption of edema fluid from the alveolar space. This review aimed to discuss the role of pro-resolving mediators on the regulation of alveolar fluid clearance (AFC) in ARDS.

Articles published up to September 2017 were selected from the PubMed, with the keywords of "alveolar fluid clearance" or "lung edema" or "acute lung injury" or "acute respiratory distress syndrome" , and "specialized pro-resolving mediators" or "lipoxin" or "resolvin" or "protectin" or "maresin" or "alveolar epithelial cells" or "aspirin-triggered lipid mediators" or "carbon monoxide and heme oxygenase" or "annexin A1" .

We included all relevant articles published up to September 2017, with no limitation of study design.

Specialized pro-resolving mediators (SPMs), as the proinflammatory mediators, not only upregulated epithelial sodium channel, Na,K-ATPase, cystic fibrosis transmembrane conductance regulator (CFTR), and aquaporins levels, but also improved Na,K-ATPase activity to promote AFC in ARDS. In addition to the direct effects on ion channels and pumps of the alveolar epithelium, the SPMs also inhibited the inflammatory cytokine expression and improved the alveolar epithelial cell repair to enhance the AFC in ARDS.

The present review discusses a novel mechanism for pulmonary edema fluid reabsorption. SPMs might provide new opportunities to design "reabsorption-targeted" therapies with high degrees of precision in controlling ALI/ARDS.

癌症免疫疗法正在导致癌症研究人员治疗该疾病患者的思维方式发生范式转变。^[1]与传统疗法不同，免疫疗法利用免疫系统来对抗癌症，而不是针对肿瘤本身。肺腺癌常被诊断为晚期，预后较差，已成为免疫治疗最常见的肿瘤。

致编者：一名73岁女性因不稳定型心绞痛被转诊至我院进行评估。她有超过10年的高血压病史。2017年3月于另一家医院行冠状动脉造影（CAG），示左前降支（LAD）近端及中段弥漫性钙化性狭窄（约90%），开口部钝缘支狭窄70%，右冠状动脉无明显狭窄。LAD病变无法介入，因为2.0 mm × 15.0 mm Sprinter球囊（Medtronic，USA）无法扩张，2.5 mm × 15.0 mm NC Sprinter球囊（Medtronic，USA）无法通过病变。

致编者：代谢综合征（MetS）是一个重大的公共卫生问题，导致糖尿病、心血管疾病、肾脏疾病甚至癌症的加速发展。^[1]静息心率（RHR）可能是代谢综合征的独立危险因素。在此，我们报告了一项队列研究，以确定RHR与中国北方普通人群代谢综合征风险的相关性。

编辑：表皮生长因子受体（EGFR）在非小细胞肺癌（NSCLC）中过表达，并含有酪氨酸激酶抑制剂（TKI）结构域，作为重要的治疗靶点。先前的研究已经观察到EGFR-TKIs在最常见的靶向外显子突变（19和21）中的功效。本研究旨在探讨不常见的病理特征EGFR突变与EGFR-TKIs治疗的临床疗效。

致编者：一名79岁男性，出现多个无症状、红斑和右前头皮结节，持续约三周。结节的数量逐渐增加。体格检查发现右侧额头皮有多个0.5-1.0 cm的紫红色结节和浸润性斑块，无淋巴结病证据[图1a].血清学检查显示白细胞水平升高。外周嗜酸性粒细胞和血清IgE正常。组织病理学显示真皮血管增生。较大的血管衬有特征性的“平头钉”内皮细胞，其突出到管腔中并具有卵圆形核和胞质内空泡。有明显嗜酸性粒细胞、组织细胞、淋巴细胞和中性粒细胞的混合炎症浸润[图1c].免疫组化发现表皮和真皮树突状细胞增多，CD1a染色阳性，CD1a阳性树突状细胞线密度为70~80/mm（正常范围为42.7±17.9/mm）[图1d].根据病史、临床检查和组织病理学，患者被诊断为血管淋巴样增生伴嗜酸性粒细胞增多（ALHE）。患者未使用任何外用药物。1个月后病变自行消退[图1b].

编者按：帕金森病（PD）是中老年人常见的中枢神经系统（CNS）退行性疾病。PD的特征是静息性震颤、肌强直、运动迟缓、姿势和步态异常。PD的发生率随着年龄的增长而增加。除了运动症状，非运动症状近年来也引起了额外的关注。认知障碍在PD患者中非常常见。据估计，PD轻度认知障碍（PD-MCI）的发生率为20-50%，^[1]其在一些患者的初次就诊时就存在，并且大量PD-MCI患者最终发展为PD伴痴呆(PDD)。PD患者比正常人群更容易患痴呆。研究发现，2/3的PD患者患有不同形式的睡眠障碍，这是PD患者常见的非运动症状之一。PD患者的各种睡眠障碍症状包括夜间失眠、嗜睡增加、睡眠碎片化、睡眠效率降低、快速眼动（REM）睡眠行为障碍，从而对患者的睡眠质量产生严重影响，增加痴呆风险。^[2]因此，认知功能障碍和睡眠障碍是PD的两个重要非运动症状，对生活质量（QOL）有更大的影响。在这里，我们评估了PD患者睡眠质量和认知功能之间的关系。

编者按：自1953年Debakey做了世界上首例颈动脉内膜切除术（CEA）以来，CEA的数量呈广泛增长趋势。特别是20世纪90年代，北美对症颈动脉内膜切除术试验和欧洲颈动脉手术试验证实CEA是治疗颈动脉狭窄的金标准。该手术已成为预防缺血性卒中的一种新方法。

编者按：索拉非尼是一种细胞增殖和血管生成的多激酶抑制剂，有望在肝细胞癌（HCC）中引起瘤内坏死并维持疾病稳定。索拉非尼治疗期间HCC破裂罕见。^[1]我们描述了一名接受索拉非尼治疗的男性患者，在稳定的疾病状态下经历了相对较小的HCC破裂。