Volume 131 · Issue 14 · 2018

Whether there is a relationship between glomerular filtration rate (GFR) and hemorrhagic transformation (HT) after acute ischemic stroke (AIS) is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy (TT).

Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University. We divided them into two groups (HT and non-HT group) and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT.

Among 426 consecutive patients, 74 (17.3%) presented HT (mean age: 65 ± 12 years, number of male patients: 47) on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR (odds ratio [OR] = 3.708, confidence interval [CI] = 1.326–10.693, P = 0.013), atrial fibrillation (AF; OR = 2.444, CI = 1.087–5.356, P = 0.027), large cerebral infarction (OR = 2.583, CI = 1.236–5.262, P = 0.010), and hypoalbuminemia (HA; OR = 4.814, CI = 1.054–22.153, P = 0.037) for AIS patients without TT.

The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.

Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.

Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher’s exact test, and regression analysis.

HBeAg seroconversion rate (18.2% vs. 18.2%, t= 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t= 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 log₁₀ U/ml vs. 7.5 log₁₀ U/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 log₁₀ U/ml vs. 4.0 log₁₀ U/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.

The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.

ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.

Although fasting plasma glucose (FPG) has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose (UG).

This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose (2h-PG), and glycated hemoglobin A1c, after adjustment for age. The performance of UG was evaluated using a receiver operating characteristic (ROC) curve analysis.

Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0.90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L (cutoff point ≥130 mg), and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L (cutoff point ≥178.5 mg). The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes ([483/597] 80.9% vs. [335/597] 56.1%, χ² = 85.0, P < 0.001) and glucose abnormalities ([2643/4242] 62.3% vs. [2365/4242] 55.8%, χ² = 37.7, P < 0.001).

The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.

Infectious endophthalmitis is a severe ocular inflammation which can cause devastating visual loss. The aim of the study was to identify the demographic and clinical features of infectious endophthalmitis in Western China for better prophylaxis and treatment of this disease.

A retrospective, cross-sectional study was conducted based on the medical records of inpatients having infectious endophthalmitis in a tertiary referral center in Western China between 2005 and 2016.

The common cause of infectious endophthalmitis was trauma (82.6%), endogenous (7.8%), ophthalmic surgery (6.9%), and corneal ulcer with perforation (2.7%). These four etiological groups differed in age, gender, enucleation rate, visual outcome, etc. The number of cases in the first 6 years accounted for 38.7% of the total collection, which in the second 6 years accounted for 61.3%. The etiology patterns were different between these two periods. Altogether 51.3% of patients received pars plana vitrectomy, 13.9% of patients underwent evisceration, and the remaining 34.8% received other treatments. Of the 670 cases that had culture results, 266 (39.7%) were culture positive and 177 (66.5%) were Gram-positive organisms, 64 (24.1%) were Gram-negative organisms, 11 (4.1%) had fungal infection, and 14 (5.3%) were infected by multiple pathogens.

There was an upward trend of the occurrence of infectious endophthalmitis in Western China for the past decade. The demographic and clinical characteristics of infectious endophthalmitis in Western China had its own characteristics and differed from those of developed countries. Here, open globe trauma was the most common cause of endophthalmitis, most traumatic endophthalmitis patients were male, and most of the injuries were work related, implicate that we should strengthen the education and application of ocular safety regulation specifically targeting the workplace.

One of the main aims of the updated Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) is to diminish variation in the interpretation and reporting of prostate imaging, especially among readers with varied experience levels. This study aimed to retrospectively analyze diagnostic consistency and accuracy for prostate disease among six radiologists with different experience levels from a single center and to evaluate the diagnostic performance of PI-RADS v2 scores in the detection of clinically significant prostate cancer (PCa).

From December 2014 to March 2016, 84 PCa patients and 99 benign prostatic shyperplasia patients who underwent 3.0T multiparametric magnetic resonance imaging before biopsy were included in our study. All patients received evaluation according to the PI-RADS v2 scale (1–5 scores) from six blinded readers (with 6 months and 2, 3, 4, 5, or 17 years of experience, respectively, the last reader was a reviewer/contributor for the PI-RADS v2). The correlation among the readers’ scores and the Gleason score (GS) was determined with the Kendall test. Intra-/inter-observer agreement was evaluated using κ statistics, while receiver operating characteristic curve and area under the curve analyses were performed to evaluate the diagnostic performance of the scores.

Based on the PI-RADS v2, the median κ score and standard error among all possible pairs of readers were 0.506 and 0.043, respectively; the average correlation between the six readers’ scores and the GS was positive, exhibiting weak-to-moderate strength (r = 0.391, P = 0.006). The AUC values of the six radiologists were 0.883, 0.924, 0.927, 0.932, 0.929, and 0.947, respectively.

The inter-reader agreement for the PI-RADS v2 among the six readers with different experience is weak to moderate. Different experience levels affect the interpretation of MRI images.

The latissimus dorsi (LD) flap procedure remains a popular and useful breast reconstruction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment.

A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time (i.e. the size of the seroma did not increase) were observed without treatment. The measured outcomes included the incidence of seromas, the volume and duration of postoperative wound drainage, and other demographic characteristics.

Twenty-four patients (53.3%) developed a seroma at the donor site. Of these, 21 patients (87.5%) did not require treatment, and the seroma resolved over time. The mean duration of a sustained seroma was 6.8 ± 1.4 weeks (range: 4–9 weeks).

This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatment.

Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy.

Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group.

No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group (via ultrasonographic observation), 15 individuals underwent successful antral tube entry, for a success rate of 63%. In the experimental group (via antral progressive water injection), 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups (χ² = 5.834, P = 0.022).

The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.

Excess mucus production is an important pathophysiological feature of chronic inflammatory airway diseases. Effective therapies are currently lacking. The aim of the study was to evaluate the effects of curcumin (CUR) on lipopolysaccharide (LPS)-induced mucus secretion and inflammation, and explored the underlying mechanism in vivo and in vitro.

For the in vitro study, human bronchial epithelial (NCI-H292) cells were pretreated with CUR or vehicle for 30 min, and then exposed to LPS for 24 h. Next, nuclear factor erythroid 2-related factor 2 (Nrf2) was knocked down with Nrf2 small interfering RNA (siRNA) to confirm the specific role of Nrf2 in mucin regulation of CUR in NCI-H292 cells. In vivo, C57BL/6 mice were randomly assigned to three groups (n = 7 for each group): control group, LPS group, and LPS + CUR group. Mice in LPS and LPS + CUR group were injected with saline or CUR (50 mg/kg) intraperitoneally 2 h before intratracheal instillation with LPS (100 μg/ml) for 7 days. Cell lysate and lung tissue were obtained to measured Mucin 5AC (MUC5AC) and Nrf2 mRNA and protein expression by a real-time polymerase chain reaction and Western blotting. Bronchoalveolar lavage fluid (BALF) was collected to enumerate total cells and neutrophils. Histopathological changes of the lung were observed. Data were analyzed by one-way analysis of variance. Student’s t-test was used when two groups were compared.

CUR significantly decreased the expression of MUC5AC mRNA and protein in NCI-H292 cells exposed to LPS. This effect was dose dependent (2.424 ± 0.318 vs. 7.169 ± 1.785, t = 4.534, and 1.060 ± 0.197 vs. 2.340 ± 0.209, t = 7.716; both P < 0.05, respectively) and accompanied by increased mRNA and protein expression of Nrf2 (1.952 ± 0.340 vs. 1.142 ± 0.176, t = −3.661, and 2.010 ± 0.209 vs. 1.089 ± 0.132, t = −6.453; both P < 0.05, respectively). Furthermore, knockdown of Nrf2 with siRNA increased MUC5AC mRNA expression by 47.7%, compared with levels observed in the siRNA-negative group (6.845 ± 1.478 vs. 3.391 ± 0.517, t = −3.821, P < 0.05). Knockdown of Nrf2 with siRNA also markedly increased MUC5AC protein expression in NCI-H292 cells. CUR also significantly decreased LPS-induced mRNA and protein expression of MUC5AC in mouse lung (1.672 ± 0.721 vs. 5.961 ± 2.452, t= 2.906, and 0.480 ± 0.191 vs. 2.290 ± 0.834, t = 3.665, respectively; both P < 0.05). Alcian blue/periodic acid-Schiff staining also showed that CUR suppressed mucin production. Compared with the LPS group, the numbers of inflammatory cells (247 ± 30 vs. 334 ± 24, t = 3.901, P < 0.05) and neutrophils (185 ± 22 vs. 246 ± 20, t = 3.566, P < 0.05) in BALF decreased in the LPS + CUR group, as well as reduced inflammatory cell infiltration in lung tissue.

CUR inhibits LPS-induced airway mucus hypersecretion and inflammation through activation of Nrf2 possibly.

In the current society, infertility related to age has become a social problem. The in vitro fertilization (IVF) success rate in women with poor ovarian response (POR) is very low. Dandelion extract T-1 (DE-T1) is an effective component of the extract from the leaves and stems of Taraxacum officinale, which is one of the medicines used in some patients with POR, but its molecular mechanism remains unclear.

Following IVF, ovarian granulosa cells (GCs) of sixty patients were extracted and divided into normal ovarian response (NOR) and POR groups. GCs were cultured in a dose-dependent and time-dependent manner with DE-T1, proliferation of GCs was determined by Cell Counting Kit-8 assay, and mRNA levels of insulin-like growth factor 1 receptor (IGF-1R), luteotropic hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), LHR, and CYP19A1 (aromatase) were determined by quantitative polymerase chain reaction. Progesterone and estradiol (E2) concentrations were determined by enzyme-linked immunosorbent assay.

The cell viability gradually increased with the progressive increase in the DE-T1 concentration. Compared with the control group (without DE-T1), the mRNA expressions of FSHR, LHR, IGF-1R, and CYP19A1 were upregulated after the addition of DE-T1, especially in the 2.5% DE-T1 group (P < 0.01). The expression of IGF-1R was upregulated approximately 25 times (24.97 ± 4.02 times) in the POR group with 2.5% DE-T1. E2 and progesterone levels increased with the increasing DE-T1 concentration. There were highly significant differences in the E2 and progesterone secretion between the NOR and POR groups (P < 0.01).

DE-T1 may promote steroid hormone synthesis by promoting GC proliferation and upregulating GC receptor expression, thereby improving ovarian endocrine function.

Ischemia preconditioning (IPC) remains the most powerful intervention of protection against myocardial ischemia/reperfusion injury (IRI), but diabetes can weaken or eliminate its cardioprotective effect and detailed mechanisms remain unclear. In this study, we aimed to explore whether changes of autophagy in the diabetic condition are attributable to the decreased cardioprotective effect of IPC.

Sixty diabetic male Sprague-Dawley rats were randomly divided into the control (C), IRI, rapamycin (R), wortmannin (W), rapamycin + IPC (R + IPC), and wortmannin + IPC (W + IPC) groups. The in vivo rat model of myocardial IRI was established by ligaturing and opening the left anterior descending coronary artery via the left thoracotomy. Durations of ischemia and reperfusion are 30 min and 120 min, respectively. Blood samples were taken at 120 min of reperfusion for measuring serum concentrations of troponin I (TnI) and creatine kinase isoenzyme MB (CK-MB) using the enzyme-linked immunosorbent assay. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. The expressions of LC3-II, beclin-1, phosphoinositide 3-kinase (PI3K), mammalian target of rapamycin (mTOR), and P-Akt/Akt ratio in the ischemic myocardium were assessed by Western blotting.

Compared to the IRI group, infarct size (56.1% ± 6.1% vs. 75.4 ± 7.1%, P < 0.05), serum cTnI (0.61 ± 0.21 vs. 0.95 ± 0.26 ng/ml, P < 0.05), and CK-MB levels (6.70 ± 1.25 vs. 11.51 ± 2.35 ng/ml, P < 0.05) obviously decreased in the W + IPC group. Compared with the C group, myocardial expressions of LC3-II (0.46 ± 0.04 and 0.56 ± 0.04 vs. 0.36 ± 0.04, P < 0.05) and beclin-1 (0.34 ± 0.08 and 0.38 ± 0.07 vs. 0.24 ± 0.03, P < 0.05) evidently increased, and myocardial expressions of mTOR (0.26 ± 0.08 and 0.25 ± 0.07 vs. 0.38 ± 0.06, P < 0.05), PI3K (0.29 ± 0.04 and 0.30 ± 0.03 vs. 0.38 ± 0.02, P < 0.05), and P-Akt/Akt ratio (0.49 ± 0.10 and 0.48 ± 0.06 vs. 0.72 ± 0.07, P < 0.05) markedly decreased in the IRI and R groups, indicating an increased autophagy. Compared with the IRI group, myocardial expression of beclin-1 (0.26 ± 0.03 vs. 0.34 ± 0.08, P < 0.05) significantly decreased, and myocardial expressions of mTOR (0.36 ± 0.04 vs. 0.26 ± 0.08, P < 0.05), PI3K (0.37 ± 0.03 vs. 0.29 ± 0.04, P < 0.05), and P-Akt/Akt ratio (0.68 ± 0.05 vs. 0.49 ± 0.10, P < 0.05) increased obviously in the W + IPC group, indicating a decreased autophagy.

Increased autophagy in the diabetic myocardium is attributable to decreased cardioprotection of IPC, and autophagy inhibited by activating the PI3K-Akt-mTOR signaling pathway can result in an improved protection of IPC against diabetic myocardial IRI.

In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis.

We searched the terms "chronic obstructive pulmonary disease," "pulmonary embolism," "exacerbations," and "thromboembolic" in PubMed database and collected the results up to April 2018. The language was limited to English.

We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review.

The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation.

According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.

危重患者总是会遇到影响多个器官的各种危急情况，如低血压、低氧血症、呼吸困难、心脏骤停和急性肾损伤（AKI）。近年来，危重超声检查以其无创、方便、快速诊断和治疗过程中动态监测的独特价值，在重症监护医学中得到了广泛应用，使床边和实时评估变得切实可行。^[1]重症超声心动图（CCE）作为危重超声检查的重要组成部分，可从形态和功能两方面提供有关循环系统的信息，可成为血流动力学不稳定的危重患者挽救生命的有效工具。CCE可以快速识别休克的潜在原因，并为医生选择正确的治疗策略提供明确的信息。^[2,3,4,5]因此，CCE成为危重患者血流动力学监测的里程碑。在本文中，我们总结了CCE的以下十个原则，可能对临床应用有所帮助。

致编者：在文献中，关于单侧孤立性基底静脉血栓形成的报道很少。猫头鹰等人.^[1]2004年报告了首例有影像学证据的病例。

致编者：一名32岁的中国女性，主诉复视、眼球突出和右上眼眶疼痛，于2009年7月入院。计算机断层扫描(CT)显示右上眼眶肿块，测量为25 mm × 14 mm[图1a].2010年1月14日行肿瘤广泛手术切除。组织学证实肿瘤为泪腺腺样囊性癌(LGACC)[图1b];肿瘤细胞浸润到眼眶软组织中，但不含眼眶骨。术后2周实施右上眶区三维适形外照射，总剂量66GY/33F。患者计划在照射后定期随访。

编辑：在过去的二十年里，越来越多的研究使用磁共振成像（MRI）技术来调查精神分裂症的大脑特征。这些研究产生了重要和有用的成就，并从神经角度增强了我们对精神分裂症机制的理解。我们希望在未来，研究人员将在该领域发现更多里程碑式的发现，以缓解当前在准确确定精神分裂症机制和确定这种疾病的精确治疗靶点方面的瓶颈，这种疾病与高残疾和死亡率有关。

致小编：肠镜检查是目前检查和治疗肠道疾病最常用的方法。高质量的肠道准备是结肠镜检查的先决条件，通常导致结肠镜检查在诊断准确性、手术安全性和成本效益方面的成功。目前，9-67%的肠道准备不符合结肠镜检查标准。由于我国大多数医生或护士的工作量很大，因此没有足够的时间向患者充分解释肠道准备的细节，许多患者在预约内窥镜检查时仅被告知如何获得肠道准备药物以及基本肠道准备说明或获得关于标准肠道准备的小册子。^[1]然而，许多患者在没有完全理解肠道准备细节的情况下不能适当地准备，因此，肠道准备的质量通常很低。在过去的几年里，微信（中文版，中国腾讯有限公司）已经成为手机上最受欢迎的消息软件应用程序（app）之一。微信公众号有一个多功能的后台界面，允许服务提供商通过文本进行交流，传递多媒体内容，并与所有订阅者在线聊天。作为现代消息传递软件的代表，微信自然具有将患者与其健康提供者联系起来的潜力。^[2]在此，我们进行了一项前瞻性、随机对照研究，以比较接受标准教育的患者与使用微信公众号进行肠道准备教育的患者进行结肠镜检查的肠道准备质量。我们检验了微信公众号可以通过改善肠道准备的充分性来提高结肠镜检查质量的假设。

致编者：原发性骨非霍奇金淋巴瘤（PNHLB）占<占所有原发性骨肿瘤的5%<占所有非霍奇金淋巴瘤的1%。^[1]文献中仅报道了极少数进展迅速的PNHLB病例，因此仍缺乏影像学证据。在此，我们报告了一例快速进展的PNHLB病例，介绍了患者的临床、放射学和组织学特征。

致编者：急性胰腺炎（AP）是一种常见的消化系统疾病，病因广泛。^[1]除了胆结石和酗酒这两种最常见的AP病因外，所有其他潜在原因都需要考虑。胰腺切除术是切除全部或部分胰腺的手术，包括胰十二指肠切除术（PD）、胰腺远端切除术、胰腺节段切除术和全胰腺切除术。这些程序用于治疗涉及胰腺、壶腹、肝外胆管和十二指肠的几种疾病。基于以往的研究和研究，胰腺切除术与一系列常见并发症如胰瘘、术后出血和胃排空延迟有关已被广泛接受。^[2]作为一种不太常见的即刻手术并发症，术后AP偶尔出现在胰腺手术后。其机制涉及胰腺切除术对胰腺实质的直接创伤。迄今为止，很少有关于AP作为任何胰腺切除术后的长期并发症的研究。

致编者：一名84岁男性因偶发胸腹主动脉瘤（TAAA）从当地诊所转诊，在脊柱磁共振成像中表现为腹腔上主动脉瘤（SCAA），最大直径为6.0 cm。他有高血压和慢性阻塞性肺病的病史，并且是一名30包年的吸烟者。体格检查，生命体征平稳，腹部柔软，无疼痛和压痛。实验室检查结果显示白细胞计数为4840/µL，血清肌酐为9 mg/L，血沉为16 mm/h，c反应蛋白为13.24 mg/L。血液培养中没有任何微生物生长。结核聚合酶链反应和血清抗酸杆菌试验均为阴性。肺功能检查显示中度阻塞性肺病。主动脉计算机断层血管造影(CTA)显示囊状SCAA，最大直径为6.0 cm，起源于主动脉腹腔轴水平的后部，并向后扩大[图1a].SCAA开口与肠系膜上动脉根部的距离为1.5 cm。因此，我们决定在全身麻醉下进行主动脉-腹腔轴旁路联合胸主动脉腔内修复术[图1b-1d].我们在围手术期进行了脑脊液（CSF）引流。此外，我们通过中线皮肤切口进行了主动脉周围夹层和腹腔轴周围夹层。之后，使用假体移植物（直径为0.6 cm的环增强聚四氟乙烯[PTFE]）通过胰腺后和肾后间隙进行主动脉周围隧道。并且，移植物的远端通过端侧法用Prolene#5-0（Ethicon，Cincinnati，OH，USA）与肾下主动脉吻合，移植物的近端通过端侧法用CV#7-0（Gore and Associates，Flagstaff，AZ，USA）与腹腔轴吻合[图1b].之后，我们暴露左股动脉，并通过穿刺插入6-Fr鞘管。我们插入了一根导丝（0.035^®;Terumo Medical Corporation，Somerset，NJ，USA）和血管导管（5-Fr猪尾；Cook Inc.，Bloomington，IN，USA）进入主动脉，并通过主动脉造影确认SCAA、SMA根部和未闭移植物的开放[图1c].之后，我们将支架移植物（直径2.8 cm，长度12.0 cm；Zenith TX2；Cook Inc.，Bloomington，IN，USA）从SMA根部上方通过硬钢丝（Lunderquist^®;库克公司，美国印第安纳州布鲁明顿；图1d).并且，我们通过主动脉造影检查了PTFE和覆膜支架无内漏[图1d].术后1周，CTA显示II型内漏。此外，患者没有任何症状。然而，在术后6周，CTA显示II型内漏持续和轻度增加[图1e].因此，我们通过PTFE移植物在腹腔轴根部进行了弹簧圈栓塞（Interlock，Boston Scientific，Natick，MA，USA）[图1f].此后，内漏得到改善，患者平安无事。

致编者：经皮肾镜取石术（PCNL）是“鹿角形”结石的一线治疗方法。在许多情况下，多通路方法是治疗的主要手段，因为结石负担很高。寻找可行的参数来预测鹿角结石的治疗结果是重要的。影响PCNL的因素是有争议的。几个参数，如漏斗—骨盆角（IPA）、上下萼角（ULCA）、漏斗长度（IL）和漏斗宽度（IW）对影响手术结果很重要。计算机断层扫描（CT）中的客观参数是否可以通过特定方法预测成功尚未得到评估。本研究根据治疗前图像调查了收集系统的解剖结构是否可以改善选定患者的预后。

致小编：梅毒主要是由梅毒螺旋体其可以存在于各种体液如血液、唾液、精子、脑脊液中，也存在于活动性皮肤病变中。^[1]儿童感染的获得性梅毒高度归因于性虐待；然而，感染也可以通过非性接触发生；例如，咀嚼前喂食、亲吻、抚摸或通过受污染的器具，特别是当家庭成员或护理人员患有活动性梅毒时。^[2,3]

编者按：1983年，美国出现了一种名为诊断相关组（DRGs）的新型前瞻性病例报销制度。此后，这种支付系统以运行良好的基于DRG的预期支付系统（PPS）的形式被其他发达国家广泛应用，如澳大利亚、德国、法国、芬兰和日本。^[1,2,3,4]北京市基本医疗保险（BBMI）计划于2001年启动，其主要任务是逐步覆盖所有户籍居民，包括城镇职工、农村居民、老年人、儿童和失业人员。随着参保人群的快速扩面，医疗费用的增长速度已经远远超过保险税收的增长速度，医保基金整体处于失衡状态。但2010年，为了方便患者报销，实行了“持卡”政策，这意味着患者只需支付一点个人费用，其他由医院和医疗保险管理中心（CMIM）结算。从那时起，北京市医疗费用以每年30-40%的速度快速增长，医疗基金严重难以承受。因此，自2011年1月以来，所有二级和三级医院都采用了全球控制办法（这一比率不断提高<分别为25%和18%）根据BBMI文件（2011年第204号）的规定。与此同时，北京6家公立三甲医院相继实施DRG-PPS，象征着中国内地医疗支付改革的凝视。

在题为“染料木黄酮改善暴露于吗啡的雄性小鼠的肝损伤”的文章中，发表于第131卷第13期第1598-1604页中华医学杂志,^[1]所有作者的隶属关系被错误地写成“伊朗克尔曼沙阿Taghbostan 6714686698克尔曼沙阿大学医学院解剖科学系”，而不是“伊朗克尔曼沙阿1568克尔曼沙阿医科大学解剖科学系”。