Volume 131 · Issue 24 · 2018

阿尔茨海默病（AD）以进行性记忆障碍和痴呆导致日常生活严重恶化为特征，一直是目前缺乏有效治疗的公共卫生危机。在≥65岁人群中，AD的报告患病率为3.21%。^[1]如今，中国有700多万人患有AD，而且这个数字还在继续增加。AD给社会带来了沉重的经济负担，而且越来越严重。2015年中国AD患者的社会经济总成本估计为1677.4亿美元，预计到2050年将达到1.89万亿美元。^[2]目前美国批准的药物有五种。美国食品药品监督管理局用于治疗AD。然而，即使在早期阶段应用，药理学治疗也具有有限的功效，并且没有一种可用的治疗可以改变疾病的潜在病程。^[3]鉴于许多临床药物试验的失败，已经研究了替代治疗方法来减缓疾病；一种这样的替代治疗方法是非侵入性脑刺激(NIBS)。

Ongoing efforts have been made to identify new neuroimaging markers to track amyotrophic lateral sclerosis (ALS) progression. This study aimed to explore the monitoring value of multimodal magnetic resonance imaging (MRI) in the disease progression of ALS.

From September 2015 to March 2017, ten patients diagnosed with ALS in Peking Union Medical College Hospital completed head MRI scans at baseline and during follow-up. Multimodal MRI analyses, including gray matter (GM) volume measured by voxel-based morphometry; cerebral blood flow (CBF) evaluated by arterial spin labeling; functional connectivity, including low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), measured by resting-state functional MRI; and integrity of white-matter (WM) fiber tracts evaluated by diffusion tensor imaging, were performed in these patients. Comparisons of imaging metrics were made between baseline and follow-up using paired t-test.

In the longitudinal comparisons, the brain structure (GM volume of the right precentral gyri, left postcentral gyri, and right thalami) and perfusion (CBF of the bilateral temporal poles, left precentral gyri, postcentral gyri, and right middle temporal gyri) in both motor and extramotor areas at follow-up were impaired to different extents when compared with those at baseline (all P < 0.05, false discovery rate adjusted). Functional connectivity was increased in the motor areas (fALFF of the right precentral gyri and superior frontal gyri, and ReHo of right precentral gyri) and decreased in the extramotor areas (fALFF of the bilateral middle frontal gyri and ReHo of the right precuneus and cingulate gyri) (all P < 0.001, unadjusted). No significant changes were detected in terms of brain WM measures.

Multimodal MRI could be used to monitor short-term brain changes in ALS patients.

Brain death is the irreversible cessation of the function of the brain including the brainstem. In 2013, the Brain Injury Evaluation Quality Control Centre (BQCC) of the National Health and Family Planning Commission issued criteria and practical guidelines for the determination of brain death. This study aimed to evaluate whether the institutions have adopted these guidelines and to make suggestions for the improvement of the current criteria and practical guidelines for brain death determination in China.

Consecutive brain death cases from 44 hospitals were evaluated for summary statistics for the following data: the performance of BQCC criteria and practical guidelines, clinical examination, apnea testing, ancillary testing, and the number of examinations as well as the waiting periods between examinations and details of who determined brain death. Data analysis was conducted from January 2013 to December 2017.

A total of 550 cases were obtained. All patients were determined to have deep coma and met the prerequisites for clinical testing. The performance rates of four brainstem reflex examinations (except cough reflex) ranged from 97.5% to 98.0%, and the completion rate as well as the coincidence rate were both 100.0%. The 238 cases (50.7%) completed apnea testing, and 231 cases (42.0%) had to stop apnea testing during the examination because of instability. The performance rates of the three ancillary tests, including electroencephalogram, short-latency somatosensory evoked potential, and transcranial Doppler, were 89.5%, 67.5%, and 79.5%, respectively; furthermore, the coincidence rates were 98.6%, 96.5%, and 99.5%, respectively. The combination of two ancillary tests was more accurate than one single ancillary test. A total of 401 (72.9%) cases successfully underwent two separate examinations to determine brain death with at least a 12-h waiting period. All brain death cases were determined by at least two qualified physicians.

This study might provide suggestions for brain death determination in China.

Few studies have been published on new-onset geriatric epilepsy especially in older Chinese people. This study was to have a comprehensive understanding of new-onset geriatric epilepsy and find a more reasonable diagnosis and management of epilepsy in older people.

One hundred and three patients with onset age 60 years and older were admitted between January 2008 and December 2016. Electronic medical records were reviewed to collect information.

There were 103 older patients with new-onset epilepsy. The mean age of the patients was 68.5 ± 6.4 years (range: 60–89 years), and there were 67 (65%) men and 36 (35%) women. The mean onset age was 67.9 ± 6.2 years (range: 60–89 years). The most common identifiable etiology of symptomatic seizures was autoimmune epilepsy in 43 (41.7%) patients. The second most common etiology was stroke in 15 (14.6%) patients. Seven (6.8%) older patients with acute seizures present with status epilepticus and 26 (25.2%) patients experienced clustered seizures (more than three events in 24 h) at seizure onset. Focal seizures (96.1%) were more common than generalized seizures (3.9%). Fifty-three (51.5%) patients had an abnormal brain magnetic resonance imaging (MRI) scan. Among them, video-electroencephalogram findings in 31 (30.1%) patients correlated with MRI abnormalities. Levetiracetam was the most used drugs before admission, in hospital, and during follow-up.

Autoimmune encephalitis is becoming an increasing risk factor of subsequent epilepsy in older people. Older patients with new epilepsy are more likely to respond to antiepileptic drugs, and drug-resistant epilepsy is uncommon.

Spinal muscular atrophy (SMA) is caused by homozygous deletion or compound heterozygous mutation of survival motor neuron gene 1 (SMN1), which is the key to diagnose SMA. The study was to establish and evaluate a new diagnostic method for SMA.

A total of 1494 children suspected with SMA were enrolled in this study. Traditional strategy, including multiplexed ligation-dependent probe amplification (MLPA) and TA cloning, was used in 1364 suspected SMA children from 2003 to 2014, and the 130 suspected SMA children were tested by a new strategy from 2015 to 2016, who were also verified by MLPA combined with TA cloning. The SMN1 and SMN2 were simultaneously amplified by polymerase chain reaction using the same primers. Mutation Surveyor software was used to detect and quantify the SMN1 variants by calculating allelic proportions in Sanger sequencing. Finally, turnaround time and cost of these two strategies were compared.

Among 1364 suspected SMAchildren, 576 children had SMN1 homozygous deletion and 27 children had SMN1 compound heterozygous mutation. Among the 130 cases, 59 had SMN1 homozygous deletion and 8 had heterozygous deletion: the SMN1-specific peak proportion on exon 7 was 34.6 ± 1.0% and 25.5 ± 0.5%, representing SMN1:SMN2 to be 1:2 and 1:3, respectively. Moreover, five variations, including p.Ser8Lysfs *23 (in two cases), p.Leu228*, p.Pro218Hisfs *26, p.Ser143Phefs*5, and p.Tyr276His, were detected in 6/8 cases with heterozygous deletion, the mutant allele proportion was 31.9%, 23.9%, 37.6%, 32.8%, 24.5%, and 23.6%, which was similar to that of the SMN1-specific site on exon 7, suggesting that those subtle mutations were located in SMN1. All these results were consistent with MLPA and TA cloning. The turnaround times of two strategies were 7.5 h and 266.5 h, respectively. Cost of a new strategy was only 28.5% of the traditional strategy.

Sanger sequencing combined with Mutation Surveyor analysis has potential application in SMA diagnosis.

The incidence of cryptococcal meningitis among immunocompetent patients increases, especially in China and imaging plays an important role. The current study was to find the correlation between magnetic resonance imaging (MRI) manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS).

A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study. All the patients had MRI data and clinical data. The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease. Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test, Chi-square test, Mann-Whitney test and Spearman rank correlation analysis.

In all 65 patients, 41 cases (41/65, 63.1%; Group 1) had normal immunity and 24 cases (24/65, 36.9%; Group 2) had at least one identifiable underlying disease. Fever, higher percentage of neutrophil (NEUT) in white blood cell (WBC), and increased cell number of cerebral spinal fluid (CSF) were much common in patients with underlying disease (Group 1 vs. Group 2: Fever: 21/41 vs. 21/24, χ² = 8.715, P = 0.003; NEUT in WBC: 73.15% vs. 79.60%, Z = −2.370, P= 0.018; cell number of CSF: 19 vs. 200, Z = −4.298, P < 0.001; respectively). Compared to the patients with normal immunity, the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs. Group 2: 20/41 vs. 20/24, χ² = 7.636, P = 0.006). The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r = −0.472, P = 0.031; r = 0.779, P = 0.039; respectively).

With the increased number of the involved brain areas in patients with identifiable underlying disease, the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.

Decision-making concerning the treatment of choroid plexus tumor (CPT) in pediatric patients remains a topic of considerable debate. The aim of this work was to describe clinical features and prognostic risk factors of CPT in the pediatric population and to provide theoretical opinions regarding clinical decisions for CPT.

The data of 96 patients with CPT and younger than 14 years were retrospectively analyzed. Clinical characteristics such as pathological type of CPTs, rate and severity of hydrocephalus, treatment and outcome, and recurrence were investigated. For categorical variables, the Pearson’s Chi-square test was performed. The Mann–Whitney U-test was used for comparisons between nonnormally distributed parameters. Log-rank test was used for progression-free survival (PFS).

The study included 70 choroid plexus papilloma (CPP) cases, 17 atypical choroid plexus papilloma (aCPP) cases, and 9 choroid plexus carcinoma (CPC) cases. Compared with patients with CPP or aCPP, patients with CPC had a shorter disease course (median: CPP, 4 months; aCPP, 2 months; CPC, 1 month; H: 23.5, P < 0.001), higher rate of acute hydrocephalus (CPP, 27.1%; aCPP, 52.9%; CPC, 77.8%; χ² = 10.9, P < 0.05), and lower incidence of cure rate (CPP, 85.7%; aCPP, 70.5%; CPC, 33.3%; χ² = 13.5, P < 0.05). The severity of hydrocephalus with tumor in the lateral or third ventricle was significantly higher than that with tumors in the fourth ventricle (severe hydrocephalus: lateral ventricle, 51.7%; third ventricle, 47.0%; fourth ventricle, 11.1%; χ² = 26.0, P < 0.001). Patients with gross total surgical resection had no better PFS than those with partial resection because of the use of adjuvant therapy in the latter (χ² = 4.0, P > 0.05). Patients with CPC experienced shorter time for recurrence than those with CPP or aCPP (χ² = 40.1, P < 0.0001).

Our results indicated that CPP in the fourth ventricle could trigger serious clinical symptoms at an early stage, requiring early intervention. Adjuvant treatment might be necessary for patients with partially resected CPP, aCPP, and CPC to achieve a favorable outcome.

Plasminogen activator inhibitor 1 (PAI-1) was previously established to impact several phenotypes in many kinds of cancer, including pancreatic cancer. However, its prognostic significance in pancreatic ductal adenocarcinoma (PDAC) needs support of further evidence. This study was designed to address the issue.

PAI-1 expression was detected by tissue microarray-based immunohistochemical staining in formalin-fixed paraffin-embedded specimens from 93 PDAC patients with surgical resection from September 2004 to December 2008. Its relationships with clinicopathologic variables and tumor-specific survival (TSS) were further evaluated using Chi-square, Kaplan-Meier, log-rank, as well as Cox regression analyses.

Expression of PAI-1 was much higher in tumor than that in nontumor tissues, based on comparison of all samples and 74 matched ones (95 [47.5, 180] vs. 80 [45, 95], Z = −2.439, P = 0.015 and 100 [46.9, 182.5] vs. 80 [45, 95], Z = −2.594, P = 0.009, respectively). In addition, tumoral PAI-1 expression was positively associated with N stage (22/35 for N1 vs. 21/51 for N0, χ² = 3.903, P = 0.048). Univariate analyses showed that TSS of patients with high PAI-1 tumors was significantly poorer than that of those with low PAI-1 tumors (log rank value = 19.00, P < 0.0001). In multivariate Cox regression test, PAI-1 expression was identified as an independent predictor for long-term prognosis of resectable PDAC (hazard ratio = 2.559, 95% confidence interval = 1.499–4.367, P = 0.001).

These results suggest that expression of PAI-1 is upregulated in PDAC and might serve as a poor prognostic indicator.

Diabetes mellitus (DM) has become the leading cause of chronic kidney disease (CKD). Nondiabetic renal diseases (NDRDs) have different clinicopathological features and prognosis from those of diabetic nephropathy. Our study sought to analyze the clinical and pathological features of NDRDs, in different age groups through a cross-sectional study.

All patients with type 2 DM at our center who underwent renal biopsy between March 1997 and March 2017 were screened and divided into three groups by age: Group 1 (youth group), 18–44 years old; Group 2 (middle-aged group), 45–59 years old; and Group 3 (elderly group), ≥60 years old. We analyzed the clinicopathological data and risk factors by univariate and multivariate logistic regression for NDRD of the patients to identify the features of NDRD in different age groups.

We included 982 patients in the final analysis. Patients with NDRD accounted for 64.4% of all patients. IgA nephropathy (IgAN) was the most common pathological pattern in young patients with NDRD, accounting for 26.3%. In the middle-aged group, the two most common pathological patterns were IgAN and membranous nephropathy. Membranous nephropathy was the most common pathological pattern in elderly patients with NDRD, accounting for 29.3%. Consistent with pathological features, glomerular hematuria is a risk factor for NDRD in Group 1 (odds ratio [OR], 26.514; 95% confidence interval [CI], 2.503–280.910; P = 0.006). On the other hand, rapidly increasing proteinuria or nephrotic syndrome is a risk factor for NDRD in Group 2 (OR, 5.921; 95% CI, 2.061–17.013; P = 0.001) and Group 3 (OR, 90.409; 95% CI, 6.198–1318.826; P = 0.001).

This single-center study showed that the proportion and composition of NDRD differ among different age groups. Consistent with pathological features, some clinical indices such as hematuria and proteinuria showed different features among different age groups.

Nowadays, the anterior cruciate ligament (ACL) injury has been one of the most common diseases of the knee joint. The relationships between the ACL injury and the anatomical structures are still controversial. This study aimed to identify the anatomical risk factors of ACL injury by magnetic resonance imaging (MRI) of the knee.

This was a retrospective study of 125 patients undergoing primary ACL reconstruction between July 2013 and May 2017. Another 125 patients without any organic knee joint injury were served as controls. The shape of intercondylar notch, the intercondylar notch width index, the intercondylar notch height index, the α angle, the β angle, and the medial and lateral tibial plateau slope were measured with MRI and compared. The data were compared by binary logistic regression to find the risk factors.

The two groups differed in the proportion of male patients (70.4% vs. 52.0%, χ² = 8.911, P = 0.003), but gender was excluded as a risk factor for ACL injury with regression analysis (odds ratio = 1.476, 95% confidence interval [CI]: 0.689–3.160, P = 0.317). The injured group was found to have a smaller notch width index (95% CI = 7.960E-23–2.154E-9, P < 0.001), a larger β angle (95% CI = 1.311–1.785, P < 0.001), and a larger lateral tibial plateau slope (95% CI = 1.201–1.683, P < 0.001). The cutoff values of notch width index, β angle, and the lateral tibial plateau slope were 0.252, 38.5°, and 7.5°, respectively.

In this study, a narrow intercondylar notch (intercondylar notch width index <0.252), a larger lateral tibial slope (>7.5°), and larger β angle (>38.5°) might be the factors associated with ACL injury.

ChiCTR-RRC-17014116; http://www.chictr.org.cn/showproj.aspx?proj=24119.

Macrophage polarization is involved in the development of many diseases such as obesity, diabetes, and cancer. This study aimed to understand the trends and hotspots of macrophage polarization research.

We searched through the Web of Science Core Collection database to obtain original articles in this research domain. CiteSpace, HistCite, and VOSviewer software were used to facilitate the analysis and visualization of scientific productivity and emerging trends.

The survey included 3064 articles, and the annual number of publications exhibited an exponential increase. These articles have received a total of 74,801 citations, and the number of annual citations grew from 68 to 18,074 in a decade. Research on macrophage polarization was performed in 76 countries, and the USA ranked first in terms of research output by contributing 1129 (36.8%) articles. The USA also had the highest H-index, total citations, and highly cited article number. PLOS One, Journal of Immunology, and Scientific Reports were the three journals that published the most articles. Interdisciplinary research areas involving macrophage polarization, such as biomaterials, cancer, and diabetes, were identified by journal citation analysis. The top 20 most productive institutions were located mainly in the USA, France, and China, and top authors originated mainly from the USA and Italy. Tumor biology, obesity, and infection were research hotspots and may be promising in the next few years.

This study provides a comprehensive analysis that delineates the scientific productivity, collaboration, and research hotspots of macrophage polarization research.

睡眠障碍是帕金森病（PD）最常见的非运动症状之一。睡眠障碍影响着世界上40-98%的PD患者。^[1,2,3]在我国，伴有睡眠障碍的PD患者患病率为47.66%~89.10%。^{[4,5,6,7,8,9]}睡眠障碍通常会对PD患者的生活质量产生不利影响。PD伴睡眠障碍的可能发病机制包括丘脑皮质通路变性和神经递质系统的改变。^[3]睡眠障碍的病因是多因素的，涉及调节睡眠的区域退化、药物影响的睡眠结构、药物诱发的睡眠障碍、多因素导致的睡眠碎片化等。^[3]尽管最近发表了三篇关于PD睡眠障碍的综述，但对于伴有睡眠障碍的PD患者的管理建议尚未达成共识。^[1,3,10]

致编辑：Filamin C(民族解放阵线）肌病是一种常染色体显性遗传性肌病，由民族解放阵线.民族解放阵线属于丝蛋白超家族，与肌动蛋白丝交联形成网络，将膜蛋白锚定在细胞骨架上。人蛋白质细丝蛋白包含由人基因组编码的三种同工型：细丝蛋白A、B和C。其中，民族解放阵线是一种Z盘蛋白，由民族解放阵线基因，主要在骨骼肌和心肌中表达。民族解放阵线基因位于染色体7q32-q35上，含有长度约29.5 kb的基因组DNA和49个编码外显子。民族解放阵线是主要在横纹肌中表达的丝氨酸蛋白酶的同种型，含有2725个氨基酸，分子量为291,000。民族解放阵线蛋白质包含两个结构域。氨基末端由两个钙调蛋白同源结构域组成，它们一起构成肌动蛋白结合结构域(ABD)，随后是24个细丝蛋白型免疫球蛋白(Ig-FLMN)重复结构域(杆重叠结构域)，其中最羧基末端负责二聚化、组装和锚定细丝。每个视杆重叠结构域由7条β链组成，其中3-4条β链构成一个β折叠，两个β折叠之间形成蛋白结合界面。

编者按：随着抗生素应用的出现，副鼻窦炎的颅内并发症，包括脑膜炎、颅内脓肿、硬膜下脓胸（SDE）、硬膜外脓肿、海绵窦血栓形成和其他硬膜窦血栓形成已不常见。^[1]然而，SDE仍然是一种威胁生命的疾病实体。它被定义为硬脑膜和蛛网膜之间的化脓性集合。SDE最常见的原因是鼻窦炎。其他原因包括脑膜炎、中耳炎、手术感染、头部创伤和既往硬膜下血肿的菌血症接种。^[1,2]在这里，我们提出了一个鼻窦炎后快速进展的半球间SDE病例。当患者出现头痛和发热，神经影像学表现为硬膜下间隙扩张，尤其是患有鼻窦炎的青少年时，临床医生应意识到SDE。

编辑：神经变性伴脑铁积聚(NBIA)包括一组表现为早发或晚发性帕金森综合征、肌张力障碍、痉挛和认知障碍的疾病。^[1]NBIA的一种亚型，β-螺旋桨蛋白相关神经变性(BPAN)，是由WDR45基因。迄今为止，59部小说WDR45已经报道了突变。文献表明，由于不存在特定的临床或影像学特征，很难在儿童早期检测到该疾病。在本报告中，我们描述了一例9个月大的中国男性婴儿在WDR45基因。

致编者：消除病灶被认为是治愈脑动静脉畸形的关键。在进行介入栓塞时，建议在注射栓塞剂前超选择靠近病灶的微导管。传统的栓塞是通过动脉途径进行的，这需要动脉供血器的可及性。在病变口径狭窄、病程曲折或动脉供应“通道内”的病例中，困难和风险增加。经静脉入路被证明是bAVM栓塞安全有效的途径，不受动脉的限制。^[1]目前的经静脉入路是通过股静脉和颈静脉建立的。他们不得不面对颅内静脉系统在超选择中的基本挑战，如高解剖可变性、弯曲的极端角度和血管壁的脆弱性。一种独特的经静脉入路，在术野对浅表引流静脉（SDV）进行直接穿刺（DP），克服了上述缺点。它首次在脊髓浅表动静脉瘘手术中被报道，并作为危重出血的紧急治疗。^[2]在一期混合手术的平台上，介入和外科手术可以互补结合，避免了每种单一方法的困难和局限性。DP-SDV技术计划在常规动脉和静脉入路无法进入的患者中建立经静脉入路。在我们的研究中，两例bAVM患者通过一期混合手术成功治愈，其中采用DP-SDV技术实施经静脉栓塞。该技术在两个病例中都得到了验证，并诱导了对其病变的有效经静脉栓塞。

编者按：原发性家族性脑钙化（PFBC）是一种罕见的遗传性退行性疾病，一般以基底节、丘脑、齿状核等脑区对称性、双侧钙质沉着为特征，主要表现为神经和精神症状。越来越多的研究报告了这种情况与致病突变之间的联系，例如SLC20A2、PDGFRB、PDGFB、XPR1、和MYORG基因。^[1,2,3,4,5]很少有研究评估家族性临床特征，如基底神经节钙化（VBGC）的体积，以及确定血清钙（Ca）、镁（Mg）、磷（P）、铁（Fe）、铝（Al）、砷（As）、钴（Co）、甲状旁腺激素（PTH）和降钙素（Ct）水平的临床试验结果，或PFBC患者年龄与VBGC之间的关系。为了研究这一主题，我们收集并分析了17个PFBC家族的临床数据。本研究由中南大学临床药理学研究所独立伦理委员会批准（编号：CTXY-140010-3）。该方案在中国临床试验注册中心注册（编号：ChiCTR-COC-15006713）。所有参与者在入组前签署了知情同意书。

致编者：性腺外非癌性绒毛膜癌是非常罕见的肿瘤，大多在中线结构中自发发生，如腹膜后、纵隔和松果体附近，但在其他内脏器官中也有报道，如胃、食管、小肠、前列腺和膀胱。^[1]在过去的七十年中，文献中仅报道了29例男性原发性肺绒毛膜癌（PPC）。发生在肺部的性腺外绒毛膜癌被认为对治疗无反应，并且与不良预后相关。我们报告一例71岁男性患者，其明显起源于肺部的性腺外非癌性绒毛膜癌，并回顾先前报道的病例特征，以探讨原发性肺部绒毛膜癌的诊断和治疗。

致编辑：噬血细胞性淋巴组织细胞增多症(HLH)是一种危及生命的疾病，影响身体的许多部位，包括消化系统、循环系统和呼吸系统。中枢神经系统(CNS)也可能受到影响，特别是在家族性HLH-2(FHL-2)患者中，其约占所有FHL的20%。FHL-2是突变的结果穿孔素1(PRF1)基因，其可以出现在基因上的许多位点。^[1]

致编者：患者是一名16岁的青春期男孩，被诊断为先天性巨结肠。10多年来，他排便困难。他的排便在一周前停止了。因不完全性肠梗阻入院。患者表现出中度营养、精神健康状况不佳和腹部完全隆起的体征，腹围为104 cm。直肠检查为爆破排气排便，肛门压力测量值为89 mmHg。全腹部增强计算机断层扫描和全结肠直肠痰造影显示直肠上、中、降结肠、横结肠、升结肠扩张，肠最大直径23 cm，肠内充满粪便，提示直肠下段和乙状结肠狭窄[图1a和图1b].结肠内窥镜超声检查显示肛门边缘上方4 cm处肠狭窄，超声检查显示12.3 mm肌层增厚[图1c].

致编者：脓毒性肺栓塞（SPE）是一种罕见的非血栓性肺栓塞，其中含栓子的病原体和脓性物质与纤维蛋白血栓混合栓塞至肺动脉，引起肺栓塞伴局灶性肺部感染。来自该复合体的栓塞导致小肺血管狭窄和/或阻塞，这经常导致肺部感染。SPE通常与使用受感染的中心静脉导管以及心内膜炎、脓毒性血栓性静脉炎（包括Lemierre综合征）和口咽部感染有关。^[1]中心静脉通路端口装置（CVAPDs）的使用在世界范围内迅速增加，因为它们对于需要重复采血或长期连续静脉内治疗（如化疗、输注血液制品、液体水合作用或肠外营养）的患者来说是方便和安全的。由于血管内器械和导管的使用越来越多，已报告了更多导管相关和器械相关SPE。在这里，我们报告了一个病例，其中CVAPD感染了表皮葡萄球菌、导致复发性SPE。

编者：单角子宫是由成对苗勒管的吻合失败引起的，其中一个苗勒管同时发育不全或缺失，称为“雏形角”。角通过最小连接的窄纤维组织带或宽而坚固的肌肉附件连接到单角侧；角的肌肉层从厚而强壮到薄而畸形。最罕见和最严重的并发症是初级角妊娠（RHP），通常会导致灾难性的后果。我们参考了北京协和医院（PUMCH）自1980年以来的11例RHP病例。