Volume 131 · Issue 11 · 2018

Despite recent advances that have improved the pregnancy success rates that can be achieved via in vitro fertilization (IVF) therapy, it is not yet clear which blastocyst morphological parameters best predict the outcomes of single blastocyst transfer. In addition, most of the previous studies did not exclude the effect of embryo aneuploidy on blastocysts transfer. Thus, the present study investigated the predictive value of various parameters on the pregnancy outcomes achieved via the transfer of frozen euploid blastocysts.

The study retrospectively analyzed 914 single euploid blastocyst transfer cycles that were performed at the Peking University Third Hospital Reproductive Medical Center between June 2011 and May 2016. The expansion, trophectoderm (TE), and inner cell mass (ICM) quality of the blastocysts were assessed based on blastocyst parameters, and used to differentiate between "excellent", "good", "average", and "poor" -quality embryos. The relationship between these embryo grades and the achieved pregnancy outcomes was then analyzed via the Chi-square and logistic regression tests.

For embryo grades of excellent, good, average and poor, the clinical pregnancy rates were 65.0%, 59.3%, 50.3% and 33.3%, respectively; and the live-birth rates were 50.0%, 49.7%, 42.3% and 25.0%, respectively. Both the clinical pregnancy rate (χ² = 21.28, P= 0.001) and live-birth rate (χ² = 13.50, P< 0.001) increased with the overall blastocyst grade. Both rates were significantly higher after the transfer of a blastocyst that exhibited either an A-grade or B-grade TE, and similarly, an A-grade ICM, than after the transfer of a blastocyst that exhibited a C-grade TE and/or ICM. The degree of blastocyst expansion had no apparent effect on the clinical pregnancy or live-birth rate. All odds ratio were adjusted for patient age, body mass index, length (years) of infertility history, and infertility type.

A higher overall euploid blastocyst quality is shown to correlate most strongly with optimal pregnancy outcomes. The study thus supports the use of the described TE and ICM morphological grades to augment current embryo selection criteria.

The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer.

Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0.

Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30- 74 months).

With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.

Lupus nephritis (LN) is classified by renal biopsy into proliferative and nonproliferative forms, with distinct prognoses, but renal biopsy is not available for every LN patient. The present study aimed to establish an alternate tool by building a predictive model to evaluate the probability of proliferative LN.

In this retrospective cohort with biopsy-proven LN, 382 patients in development cohort, 193 in internal validation cohort, and 164 newly diagnosed patients in external validation cohort were selected. Logistic regression model was established, and the concordance statistics (C-statistics), Akaike information criterion (AIC), integrated discrimination improvement, Hosmer-Lemeshow test, and net reclassification improvement were calculated to evaluate the performance and validation of models.

The prevalence of proliferative LN was 77.7% in the whole cohort. A model, including age, gender, systolic blood pressure, hemoglobin, proteinuria, hematuria, and serum C3, performed well on good-of-fit and discrimination in the development chohort to predict the risk of proliferative LN (291 for AIC and 0.84 for C-statistics). In the internal and external validation cohorts, this model showed good capability for discrimination and calibration (0.84 and 0.82 for C-statistics, and 0.99 and 0.75 for Pvalues, respectively).

This study developed and validated a model including demographic and clinical indices to evaluate the probability of presenting proliferative LN to guide therapeutic decisions and outcomes.

Serum soluble ST2 (sST2) levels are elevated early after acute myocardial infarction and are related to adverse left ventricular (LV) remodeling and cardiovascular outcomes in ST-segment elevation myocardial infarction (STEMI). Beta-blockers (BB) have been shown to improve LV remodeling and survival. However, the relationship between sST2, final therapeutic BB dose, and cardiovascular outcomes in STEMI patients remains unknown.

A total of 186 STEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sST2 was measured at baseline. Patients were divided into four groups according to their baseline sST2 values (high >56 ng/ml vs. low ≤56 ng/ml) and final therapeutic BB dose (high ≥47.5 mg/d vs. low <47.5 mg/d). Cox regression analyses were performed to determine whether sST2 and BB were independent risk factors for cardiovascular events in STEMI.

Baseline sST2 levels were positively correlated with heart rate (r = 0.327, P= 0.002), Killip class (r = 0.408, P= 0.000), lg N-terminal prohormone B-type natriuretic peptide (r = 0.467, P= 0.000), lg troponin I (r = 0.331, P= 0.000), and lg C-reactive protein (r = 0.307, P= 0.000) and negatively correlated to systolic blood pressure (r= −0.243, P = 0.009) and LV ejection fraction (r= −0.402, P = 0.000). Patients with higher baseline sST2 concentrations who were not titrated to high-dose BB therapy (P < 0.0001) had worse outcomes. Baseline high sST2 (hazard ratio [HR]: 2.653; 95% confidence interval [CI]: 1.201–8.929; P= 0.041) and final low BB dosage (HR: 1.904; 95% CI, 1.084–3.053; P= 0.035) were independent predictors of cardiovascular events in STEMI.

High baseline sST2 levels and final low BB dosage predicted cardiovascular events in STEMI. Hence, sST2 may be a useful biomarker in cardiac pathophysiology.

Development of innovative immunotherapy is imperative to improve the poor survival of the nasopharyngeal carcinoma (NPC ) patients. In this study, we evaluated the T cell response to melanoma-associated antigen (MAGE)-A1, MAGE-A3, or synovial sarcoma X-2 (SSX-2) in the peripheral blood of treatment-naive NPC patients. The relationship of responses among the three proteins and the human leukocyte antigen (HLA)-A types were analyzed to provide evidence of designing novel therapy.

Sixty-one NPC patients admitted into the Tumor Hospital affiliated to the Xinjiang Medical University between March 2015 and July 2016 were enrolled. Mononuclear cells were isolated from the peripheral blood before any treatment. HLA-A alleles were typed with Sanger sequence-based typing technique. The T cell response to the MAGE-A1, MAGE-A3, or SSX-2 was evaluated with the Enzyme-Linked ImmunoSpot assay. Mann-Whitney U-test was used to compare the T cell responses from different groups. Spearman’s rank correlation was used to analyze the relationship of T cell responses.

HLA-A*02:01, A*02:07, and A*24:02 were the three most frequent alleles (18.9%, 12.3%, and 11.5%, respectively) among the 22 detected alleles. 31.1%, 19.7%, and 16.4% of the patients displayed MAGE-A1, MAGE-A3, or SSX-2-specific T cell response, respectively. The magnitudes of response to the three proteins were 32.5, 38.0, and 28.7 SFC/10⁶ peripheral blood mononuclear cells, respectively. The T cell response against the three proteins correlated with each other to different extent. The percentage of A*02:01 and A*24:02 carriers were significantly higher in patients responding to any of the three proteins compared to the nonresponders.

MAGE-A1, MAGE-A3, or SSX-2-specific T cell responses were detectable in a subgroup of NPC patients, the frequency and magnitude of which were correlated.

Patellar dislocation is one of the most common knee injuries in the adolescent population. It is often combined with osteochondral fracture. The purpose of this study was to compare the outcomes between fixation and excision of osteochondral fractures not involving the bearing surface in adolescent patients with patellar dislocations.

Patients who underwent surgery for osteochondral fracture following patellar dislocation in our institution from 2007 to 2014 were retrospectively evaluated. Visual analog scale (VAS) of pain and the International Knee Documentation Committee (IKDC) form were used to assess knee pain and function at follow-up. Patient satisfaction was evaluated. Differences in the values of variables among groups were assessed using t-test if equal variance or Mann–Whitney U-test if not equal variance. The Pearson’s Chi-square test was applied for dichotomous variables if expected frequency was >5 or Fisher’s exact test was applied if not. A value of P < 0.05 was considered statistically significant.

Forty-three patients were included, with the average age of 14.1 ± 2.3 (range, 9.0–17.0) years. Nineteen underwent fixation of osteochondral fractures and 24 did not. The average follow-up time was 28 ± 10 months. There was no significant difference in age, gender, follow-up time, causes of injury, times of dislocation, and location of osteochondral fracture between fixation and excision groups. The fixation group had a significantly longer surgery time (82 ± 14 min) and larger size of osteochondral fracture (2.30 ± 0.70 cm²) than the excision group (43 ± 10 min, 1.88 ± 0.62 cm², respectively, t = 10.77, P < 0.01 and t = 0.84, P < 0.05). At the last follow-up, the average IKDC score in the fixation group (82.52 ± 8.71) was significantly lower than that in the excision group (89.51 ± 7.19, t= 2.65, P < 0.01). There was no significant difference in VAS of pain and patients’ satisfaction. There were 7 (16%) patients with recurrent dislocation.

Excision of osteochondral fractures has equivalent or better outcomes compared to fixation in adolescent patients with patellar dislocations when these fractures do not involve the bearing surface.

Immunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection (BPAR) after expanded criteria donor (ECD) kidney transplantation. The aim of this study was to investigate the relationships between early immunosuppressive exposure and the development of BPAR.

We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolimus (Tac), and prednisone. The levels of mycophenolic acid-area under the curve (MPA-AUC)_0-12h and Tac C₀ were measured at the 1^st week and the 1^st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression.

The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC_0-12hat the 1^st week posttransplant was found in BPAR recipients (38.42 ± 8.37 vs. 50.64 ± 13.22, P < 0.01). In addition, the incidence of BPAR was significantly high (P < 0.05) when the MPA-AUC_0-12h level was <30 mg·h^-1∙L^-1 at the 1^st week (15.0% vs. 44.4%) or the Tac C₀was <4 ng/ml at the 1^st month posttransplant (33.3% vs. 21.6%). Multivariable logistic regression analysis showed that the MPA-AUC_0-12hat the 1^st week (OR: 0.842, 95% CI: 0.784-0.903) and the Tac C₀at the 1^st month (OR: 0.904, 95% CI: 0.822- 0.986) had significant inverse correlation with BPAR (P < 0.05).

Low-level exposure of MPA and Tac C₀ in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC_0-12h <30 mg·h^-1∙L^-1 and Tac C₀ <4 ng/ml should be avoided in the first few weeks after transplantation.

When considering the issue of recurrence, perimenopausal women may have more dilemma during management comparing with young women, for example, whether to retain the uterus and ovary during surgery, whether it is necessary to add adjuvant medicine treatment after operation, and there is no evidence for reference about using of gonadotropin-releasing hormone agonist. This study aimed to study the risk factors for the recurrence of ovarian endometriosis (EM) in patients aged 45 and over.

This is a retrospective nested case-control study. We reviewed the medical records of patients aged over 45 years who underwent surgical treatments for ovarian EM from 1994 to 2014, in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences. By following up to January 2016, 45 patients were found to have relapses and regarded as the recurrence group. The patients with no recurrence during the same follow-up period were randomly selected by the ratio of 1:4 as the nonrecurrence group (180 patients in total). Stratified Cox regression was used to analyze the risk factors of the recurrence.

Univariate analysis showed that there was a significant difference in the postoperative treatment (the percentage of patients who received postoperative treatment in non-recurrence group and recurrence group, 23.9% vs. 40.0%, χ² = 4.729, P = 0.030) and ovarian preservation (the percentage of patients who received surgery of ovarian preservation in non-recurrence group and recurrence group, 25.0 % vs. 44.4%, χ² = 19.462, P < 0.001) between the nonrecurrence group and the recurrence group. There was no correlation between recurrence and the following factors including patient’s age, menarche age, gravidity, parity, CA125 level, ovarian lesions, menopausal status, combined benign gynecological conditions (such as myoma and adenomyoma) and endometrial abnormalities, and surgical approach or surgical staging (all P> 0.05). Multivariate analysis indicated that whether to retain the ovary was the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM (odds ratio: 5.594, 95% confidence interval: 1.919- 16.310, P = 0.002). Conclusion: Ovarian preservation might be the only independent risk factor of recurrence for patients aged 45 years and over with ovarian EM.

Contribution of model for end-stage liver disease incorporating with serum sodium (MELD-Na) score in predicting acute kidney injury (AKI) after orthotopic liver transplantation (OLT) is yet to be identified. This study assessed the prognostic value of MELD-Na score for the development of AKI following OLT.

Preoperative and surgery-related variables of 321 adult end-stage liver disease patients who underwent OLT in Fuzhou General Hospital were collected. Postoperative AKI was defined and staged in accordance with the clinical practice guidelines developed by Kidney Disease: Improving Global Outcomes. Univariate and multivariate analysis was performed to determine the risk factors for AKI following OLT. The discriminating power of MELD/MELD-Na score on AKI outcome was evaluated by receiver operating characteristic (ROC) curve. Spearman’s correlation analysis was used for identifying the correlated relationship between MELD/MELD-Na score and the severity levels of AKI.

The prevalence of AKI following OLT was in 206 out of 321 patients (64.2%). Three risk factors for AKI post-OLT were presented, preoperative calculated MELD score (odds ratio [OR] = 1.048, P= 0.021), intraoperative volume of red cell suspension transfusion (OR = 1.001, P= 0.002), and preoperative liver cirrhosis (OR = 2.015, P= 0.012). Two areas under ROC curve (AUCs) of MELD/MELD-Na score predicting AKI were 0.688 and 0.672, respectively; the difference between two AUCs was not significant (Z = 1.952, P= 0.051). The Spearman’s correlation coefficients between MELD/MELD-Na score and the severity levels of AKI were 0.406 and 0.385 (P = 0.001, 0.001), respectively.

We demonstrated that preoperative MELD score, intraoperative volume of red cell suspension transfusion and preoperative liver cirrhosis were risk factors for AKI following OLT. Furthermore, we preliminarily validated that MELD score seemed to have a stronger power discriminating AKI post-OLT than that of novel MELD-Na score.

The diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.

The history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy’s lesions in the small intestine were treated endoscopically.

A total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy.Among the 18 patients with bleeding from small-bowel Dieulafoy’s lesions, 14 patients were controlled with endoscopic hemostasis.

Double-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Increasing evidence has supported the link of intestinal Fusobacterium nucleatum infection to colorectal cancer (CRC). However, the value of F. nucleatum as a biomarker in CRC detection has not been fully defined. In order to reduce the random error and bias of individual research, this meta-analysis aimed to evaluate the diagnostic performance of intestinal F. nucleatum in CRC patients and provide evidence-based data to clinical practice.

An article search was performed from PubMed, Embase, Cochrane Library, and Web of Science databases up to December 2017, using the following key words: "Fusobacterium nucleatum", "Fusobacterium spp.", "Fn", "colorectal cancer(s)", "colorectal carcinoma(s)", "colorectal neoplasm(s)", and "colorectal tumor(s)". Articles on relationships between F. nucleatum and CRC were selected according to the preestablished inclusion and exclusion criteria. This meta-analysis was performed using STATA 12.0 software, which included mapping of forest plots, heterogeneity tests, meta-regression, subgroup analysis, sensitivity analysis, and publication bias. The sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and their corresponding 95% confidence interval (CI) of each eligible study were summarized.

Finally, data for 1198 participants (629 CRC and 569 healthy controls) in 10 controlled studies from seven articles were included. The summary receiver operator characteristic curve was mapped. The diagnostic performance of intestinal F. nucleatum infection on CRC was as follows: the area under the curve: 0.86 (95% CI: 0.83- 0.89), the pooled sensitivity: 0.81 (95% CI: 0.64- 0.91), specificity: 0.77 (95% CI: 0.59- 0.89), and DOR: 14.00 (95% CI: 9.00–22.00).

Intestinal F. nucleatum is a valuable marker for CRC diagnosis.

Diabetic kidney disease (DKD) has become one of the major causes of end-stage renal disease. Urinary extracellular vesicles (uEVs) contain rich biological information which could be the ideal source for noninvasive biomarkers of DKD. This review discussed the potential early diagnostic and therapeutic values of proteins and microRNAs in uEVs in DKD.

This review was based articles published in PubMed, Embase, Cochrane, and Google Scholar databases up to November 20, 2017, with the following keywords: "Diabetic kidney disease", "Extracellular vesicle", and "Urine" .

Relevant articles were carefully reviewed, with no exclusions applied to the study design and publication type.

There is no "gold standard" technology to separate and/or purify uEVs. The uEVs contain a variety of proteins and RNAs and participate in the physiological and pathological processes of the kidney. UEVs, especially urinary exosomes, may be useful biomarkers for early diagnosis and treatment to DKD. Furthermore, the uEVs has been used as a therapeutic target for DKD.

Proteins and nucleic acids in uEVs represent promising biomarker for the diagnosis and treatment of DKD.

致编辑：Rho GTP酶激活蛋白11A(ArhGAP11A）是Rho GTP酶激活蛋白的成员（Rho间隙）基因家族，位于15号染色体1区3带2亚带（15q13.3）的长臂上。的全长cDNAArhGAP11A是24,806 bp，具有单个开放阅读框。ArhGAP11A由13个外显子编码，编码的蛋白质具有三个结构域：靠近N末端（氨基酸46-246）的RhoGAP结构域和分别位于蛋白质中心（387-516）和C末端（590-997）的两个未表征的结构域。^[1]香川等人。^[2]比较了ArhGAP11A在74例结直肠癌组织标本和5例非癌性粘膜组织标本中进行了基于cDNA微阵列的比较分析。结果显示，ArhGAP11A在结直肠癌组织中的表达显著高于非癌组织，表明ArhGAP11A表达有利于结直肠癌细胞体内迁移和入侵活动。西列洛等人.^[3]分析了1201例浸润性乳腺小叶癌患者的RNA序列数据，但64例中只有少数Rho间隙发现在基底样乳腺癌中高表达。进一步研究^[4]表明ArhGAP11A基底样乳腺癌的发病率通常高于其他类型的乳腺癌，并且体外实验表明ArhGAP11A过表达可刺激正常乳腺癌细胞增殖。ArhGAP11A还发现在胶质母细胞瘤、肝细胞癌和胰腺癌中表达上调。基于这些发现，ArhGAP11A可能与肿瘤的发生发展密切相关。

编辑：胰腺远端切除术是涉及胰腺颈部和身体的肿瘤最常进行的手术之一。左侧胰腺切除术会降低胰腺功能，并与糖尿病发病率增加有关。与以下标准胰十二指肠切除术相比，左侧胰腺切除术后严重外分泌功能不全的报道更多。Beger建议肿瘤摘除和胰腺中段切除术等人.,^[1]尤其是对位于胰颈部和胰体部的胰腺良性肿瘤。然而，胰空肠吻合术胰瘘形成率高（>30%）阻碍了MSPR的广泛使用。^[1,2]到目前为止，还没有描述更好的胰腺重建手术。在这个病例系列中，我们在MSPR后应用了一种新的重建技术，胰空肠桥支架内引流（PJBSID），并研究了术后结果。

编辑：炭疽是一种人畜共患病，大多数哺乳动物，尤其是食草动物，被认为是易感的。^[1]人类几乎总是通过处理受感染的动物、死于该病的动物尸体或这些动物的肉、皮、毛、骨等感染炭疽。^[1,2]贵州省是中国西南部炭疽热的历史中心。^[3]2013年6月，汶干县发生一起由5例人间病例组成的疑似炭疽疫情。临床症状包括手部和前臂皮肤出现红斑、丘疹和水疱，伴有组织肿胀、浸润、中心性皮肤坏死和溃疡性结痂，符合炭疽诊断标准（WS 283-2008）。五株疑似炭疽杆菌从五名患者中的一名以及这次流行病的土壤样本中收集。为患者和流行病的诊断提供病原学依据，提高我们对B.炭疽在贵州省对本次疫情中采集的5株分离株进行了回顾性分子流行病学调查。

致编者：调节带（MB）是隔膜边缘小梁的一部分，它不仅支撑三尖瓣的前乳头肌（APM），还将其连接到游离壁。然而，随着心内超声心动图（ICE）的出现，电生理学家现在意识到MB除了其机械功能之外的致心律失常作用。MB源性室性心动过速或室颤（VT/VF）是一种无结构性心脏病的特发性恶性心律失常，常由同一部位的室性期前收缩（PVC）触发。^[1]由于这种心律失常的机制没有得到很好的说明，先前的研究已经报道了右心室（RV）浦肯野系统的受累，尽管递送到显示浦肯野电位的部位的导管射频（RF）消融显示出有限的疗效。^[2,3]在此，我们报告了一例29岁女性MB起源的VT/VF病例，该病例基于解剖基底（MB的游离壁和隔膜插入）的消融被证明是成功的。

致编者：一名58岁男性，有长达5年的胆囊结石病史，入院前有1天轻度腹痛伴右上腹压痛病史。约5年前主诉类似症状，在同一家医院保守治疗11天后痊愈。体温正常，实验室检查未发现特殊发现。超声检查发现胆囊管腔内有多个小胆结石。出乎意料的是，在腹腔镜胆囊切除术(LC)期间，门静脉在Calot三角和胆囊床处的协作增强[图1a].变形的静脉看起来很脆弱，因此非常小心地用夹子一个接一个地分离和结扎。完成LC。术后获得的腹部计算机断层扫描(CT)[图1b]而5年前[图1c]进行了回顾性审查。前一次CT[图1c]显示门静脉管腔和门静脉系统正常，除急性胆囊炎导致的主要门静脉血栓形成和小型化脓性肝脓肿外，而最近一次CT[图1b]显示门静脉异常。术后病理评估证实标本表面周围有许多扭曲、充血的静脉[胆囊；图1d].

致编者：糖原贮积病（GSD）是一组糖原沉积异常的遗传性疾病。^[1]肺动脉高压（PH）是GSD的一种罕见并发症，病因尚不清楚。自1980年开拓者描述以来，^[2]仅报告了少数GSD相关PH病例。在此，我们报告了一例患者和监护人知情同意的中国病例。

编者：胃肠道（GIT）是非霍奇金淋巴瘤最常见的结外部位，但仅占原发性结肠恶性肿瘤的0.4%。^[1]症状是非特异性的，可能包括腹泻、便秘、腹痛、体重减轻和胃肠道出血。在结肠中，最常见的类型是常规大细胞淋巴瘤、粘膜相关淋巴组织淋巴瘤和T细胞淋巴瘤。^[1,2,3]

致编者：一位70岁的中国男性患有终末期肾病，正在接受间歇性腹膜透析（IPD），于2016年8月入住肾病病房接受常规IPD治疗。入院后，他突然出现腰痛，伴有明显贫血。计算机断层扫描（CT）显示大量心包积液、双侧胸腔积液、腹部和盆腔腹水。后来，他在机械通气支持下插管并接受持续静脉-静脉血液滤过。进行心包穿刺术和胸腔穿刺术。在9号上^th入院当天，因活动性出血安排血管造影。显示出血点来自上腔静脉区域，靠近右心房。然后，患者立即接受了紧急心脏手术。

致编者：结肠癌梗阻的方法包括急诊手术或自膨式金属支架（SEMS）。SEMS插入被证明是一种安全、简单、有效的左侧恶性结肠梗阻治疗方法，可作为姑息治疗或作为切除的桥梁。^[1,2,3,4,5]报告的SEMS插入脾曲近端结肠的病例有<占所有研究的5%。远端肠的长距离和曲折使得难以在目标近端结肠中推进和定位支架，并且右结肠的梗阻传统上通过急性手术来处理。支架植入治疗近端结肠梗阻是一种安全、可行和有效的姑息治疗或作为手术的桥梁，与择期切除相比，急诊右侧结肠切除术的发病率和死亡率显著更高。^[1,2,3,4,5]

致编者：我们怀着极大的兴趣阅读了王先生的《儿童多菌麻风》一文等人.^[1]作者很好地展示了在高度未被怀疑的临床皮肤病病例中的罕见表现。作者还强调了早期活检（包括Fite-Faraco染色）对诊断多菌性麻风病的重要性，这在仅有非典型皮肤表现的患者中很重要。在所讨论的病例中，临床发现表明一例麻风病的临床病例，除持续时间短外，伴有眉毛受累和多发性结节性病变。该儿童被诊断为多细菌性儿童汉森氏病，并接受了多药物治疗，包括每月剂量的利福平450 mg和氯法齐明200 mg，加上每日剂量的氨苯砜50 mg和氯法齐明50 mg。鉴于这一说法，我们强烈认为作者可能试图说，关于多菌性麻风病的标准儿童（10-14岁）治疗方案为利福平450 mg每月一次，氯法齐明150 mg每月一次，每隔一天50 mg，氨苯砜50 mg每日一次，持续12个月^[2]而不是上面可能打错的东西。

感谢您的仔细阅读和对我们最近出版物的宝贵评论。^[1]尽管近几十年来麻风病的发病率和流行率显著下降，但麻风病很可能作为世界上的一个主要健康问题持续存在，特别是在东南亚。我们很高兴看到我们关于儿童多菌性麻风病的论文能被读者注意到。

在第131卷第8期第894-898页发表的题为“记忆抱怨来源与认知障碍和认知衰退风险增加的关联：一项基于社区的研究”的文章中中华医学杂志,^[1]经费支持误写为“国家基础研究自然科学计划（编号81571135）”，而不是“国家基础研究自然科学计划（编号81571103）”。