Volume 132 · Issue 01 · 2019

根据最新版《糖尿病地图集》，糖尿病患病率在全球范围内呈上升趋势，但亚洲和中国的情况尤其令人担忧。^[1,2,3]据估计，对于相同的体重指数（身体质量指数），亚洲人口的糖尿病患病率高于非亚洲人口，^[4]因为亚洲糖尿病人群的BMI较低。基于生理和病理背景，认为与非亚裔2型糖尿病患者相比，亚裔患者可能具有不同的模式，即β细胞功能缺陷多于胰岛素敏感性降低。^[5,6,7]此外，鉴于不同的遗传和药物遗传学种族背景，^[8,9]由此推断，两个种族之间在血糖控制和体重控制方面的治疗反应可能不同。亚裔和非亚裔2型糖尿病患者的治疗反应有什么相似或不同吗？亚洲糖尿病，真的存在吗？有必要更好地理解这个问题。

Owing to the multifactorial nature of the pathogenesis of diabetic peripheral neuropathy (DPN), conventional drug therapies have not been effective. The application of stem cells transplantation may be useful for the treatment of DPN. This study was designed to assess the safety and therapeutic effects of autologous bone marrow mononuclear cells (BMMNCs) transplantation on the treatment of refractory DPN.

One hundred and sixty-eight patients with refractory DPN were recruited and enrolled in the study. They received intramuscular injection of BMMNCs and followed at 1, 3, 6, 12, 18, 24, and 36 months after the transplantation. Clinical data, Toronto Clinical Scoring System (TCSS), and nerve conduction studies (NCSs) were compared before and after the transplantation.

The signs and symptoms of neuropathy were significantly improved after BMMNCs transplantation. The values of the TCSS scores at 1 month (9.68 ± 2.49 vs. 12.55 ± 2.19, P < 0.001) and 3 months (8.47 ± 2.39 vs. 12.55 ± 2.19, P < 0.001) after the treatment reduced significantly compared with the baseline value. This decrement remained persistent until the end of the study. The conduction velocity and action potential and sensory nerves were significantly improved after transplantation (3 and 12 months after the treatment vs. the baseline: motor nerve conduction velocity, 40.24 ± 2.80 and 41.00 ± 2.22 m/s vs. 38.21 ± 2.28 m/s, P < 0.001; sensory nerve conduction velocity, 36.96 ± 2.26 and 39.15 ± 2.61 m/s vs. 40.41 ± 2.22 m/s, P < 0.001; compound muscle action potential, 4.67 ± 1.05 and 5.50 ± 1.20 μV vs. 5.68 ± 1.08 μV, P < 0.001; sensory nerve action potential, 4.29 ± 0.99 and 5.14 ± 1.26 μV vs. 5.41 ± 1.14 μV, P < 0.001). No adverse event associated with the treatment was observed during the follow-up period.

Autologous transplantation of BMMNCs may be an effective and promising therapeutic strategy for the treatment of refractory DPN.

Little is known about the risk factors for sudden cardiac death (SCD) in the overall hospitalized cardiac department population. This study was conducted to investigate the risk factors and develop a predictive model for SCD in a hospitalized cardiac department population.

We conducted a retrospective study of patients admitted to the cardiac department of the First Affiliated Hospital of Xinjiang Medical University from June 2015 to February 2017. We collected the clinical data from medical records. Multiple stepwise logistic regression analysis was carried out to confirm the risk factors for SCD and develop a predictive risk model. The risk score was assessed by the area under receiver operating characteristic (AUROC) curve and the Hosmer-Lemeshow goodness-of-fit test.

A total of 262 patients with SCD and 4485 controls were enrolled in our study. Logistic regression modeling identified eight significant risk factors for in-hospital SCD: age, main admitting diagnosis, diabetes, corrected QT interval, QRS duration, ventricular premature beat burden, left ventricular ejection fraction, and estimated glomerular filtration rate. A predictive risk score including these variables showed an AUROC curve of 0.774 (95% confidence interval: 0.744–0.805). The Hosmer-Lemeshow goodness-of-fit test showed the chi-square value was 2.527 (P = 0.640). The incidence of in-hospital SCD was 1.3%, 4.1%, and 18.6% for scores of 0 to 2, 3 to 5 and ≥6, respectively (P < 0.001).

Age, main admitting diagnosis, diabetes, QTc interval, QRS duration, ventricular premature beat burden, left ventricular ejection fraction, and estimated glomerular filtration rate are factors related to in-hospital SCD in a hospitalized cardiac department population. We developed a predictive risk score including these factors that could identify patients who are predisposed to in-hospital SCD.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with a higher prevalence of osteoporosis. However, the underlying mechanisms linking OSAHS with bone loss are still unclear. The aim of this study was to investigate the changes of receptor activator of nuclear factor-κB ligand (RANKL, an osteoclastogenesis-promoting factor) and osteoprotegerin (OPG, the decoy receptor for RANKL), oxidative stress and bone metabolism markers in OSAHS, in order to understand the potential mechanisms underlying bone loss in OSAHS patients.

Forty-eight male patients with OSAHS, confirmed by polysomnography (PSG) study, were enrolled. Twenty male subjects who were confirmed as not having OSAHS served as the controls. The subjects’ bone mineral density (BMD) was assessed in lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA). Blood samples were collected from all subjects for measurement of RANKL, OPG, the bone formation marker bone-specific alkaline phosphatase (BAP), the bone resorption marker tartrate-resistant acid phosphatase 5b (TRAP-5b), and total antioxidant capacity (TAOC).

The BMD and the T-score of the femoral neck and the lumbar spine were significantly lower in OSAHS patients as compared to the control group (P < 0.05). The serum level of BAP was significantly decreased in the OSAHS group (15.62 ± 5.20 μg/L) as compared to the control group (18.83 ± 5.50 μg/L, t= －2.235, P < 0.05), while the levels of TRAP-5b did not differ between the two groups (t= －1.447, P > 0.05). The serum level of OPG and the OPG/RANKL ratio were lower in the OSAHS group compared to the control group (both P < 0.05). TAOC level was also decreased significantly in the OSAHS group (P < 0.05). Correlation analysis showed that the TAOC level was positively correlated with BAP in the OSAHS group (r= 0.248, P = 0.04), but there were no correlations between TAOC and the BMD or the T-scores. The correlations between the level of OPG (or the OPG/RANKL ratio) and BMD or TAOC did not reach significance.

In OSAHS patients, lower levels of TAOC were associated with decreased bone formation, suggesting a role of oxidative stress in bone loss, while the role of OPG/RANKL imbalance in bone metabolism in OSAHS needs further evaluation .

The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines. But it has inherent defects. The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.

A total of 1093 consecutive STEMI patients were included and followed up 48.2 months. Homocysteine, hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected. The KAMIR score and the GRACE score were calculated. The performance between the KAMIR and the GRACE was compared. The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.

The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death: AUC = 0.802 vs. 0.721, P < 0.001; major adverse cardiovascular events (MACE): AUC = 0.683 vs. 0.656, P < 0.001). It showed that the biomarkers could independently predict death [homocysteine: HR= 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR= 1.052 (1.000–1.104), P= 0.018; NT-pro BNP: HR= 1.142 (1.004–1.280), P= 0.021] and MACE [homocysteine: HR= 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR= 1.012 (1.003–1.021), P= 0.020; NT-pro BNP: HR= 1.136 (1.104–1.168), P= 0.006]. When they were used in combination with the KAMIR, the area under the ROC curve (AUC) significantly increased for death [homocysteine: AUC = 0.802 vs. 0.890, Z = 5.982, P < 0.001; hs-CRP: AUC = 0.802 vs. 0.873, Z= 3.721, P < 0.001; NT-pro BNP: AUC= 0.802 vs. 0.871, Z = 2.187, P= 0.047; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.802 vs. 0.940, Z = 6.177, P < 0.001] and MACE [homocysteine: AUC = 0.683 vs. 0.771, Z= 6.818, P < 0.001; hs-CRP: AUC= 0.683 vs. 0.712, Z= 2.022, P= 0.031; NT-pro BNP: AUC= 0.683 vs. 0.720, Z= 2.974, P= 0.003; homocysteine, hs-CRP and NT-pro BNP: AUC= 0.683 vs. 0.789, Z= 6.900, P < 0.001].

The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients. A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.

The Shanghai growth standards are higher than World Health Organization (WHO) growth standards, which may influence the feeding practices of the caregivers and increase the risk of overweight in these infants. This study aimed to compare the effects of different growth standards on childhood obesity in Shanghai metropolitan area.

This was a cluster-randomized controlled trial conducted in 2 downtown areas with 19 community health service centers in Shanghai from November 2013 to December 2015. Randomization was done at the level of the community. Infants (health newborns) were assessed and monitored by the Shanghai growth standards (S-group) and the 2006 WHO growth standards (W-group), respectively. Measurements were taken at 1.0, 2.0, 4.0, 6.0, 9.0 and 12.0 months of age during follow-up period. Based on the values of length and weight measurements, according to the group’s growth standards, doctors provided the caregivers with corresponding clinical consultation. Changes in weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for length z-score (WLZ) between 2 groups were assessed using mixed regression models. Overweight was compared between 2 group at all follow-up measurements.

A total of 6509 infants (52.1% were boys) were in the W-group, and 8510 infants (51.4% were boys) were in the S-group. The overweight ratios between two groups were distinct at 9 months of age (3.4% in W-group and 4.3% in S-group) and 12 months of age (2.2% in W-group and 3.8% in S-group), and the differences were statistically significant (P= 0.020 and P< 0.001, respectively). Compared to W-group, the increase in WAZ (coefficient= 0.04, P= 0.004) and WLZ (coefficient= 0.09, P < 0.001) were significantly greater, and the LAZ was lower (coefficient = －0.04, P = 0.047) in S-group (W-group values were used as reference in mixed regression models).

Compared to the Shanghai growth standards, the adoption of WHO 2006 growth standards would reduce the risk of infant overweight in Shanghai metropolitan area up to 1 year of age.

ChiCTR1800015371, http://www.chictr.org.cn/Chinese Clinical Trial Registry.

Necroptosis is a new form of cell death that has been identified as a third pathway causing cell death. In this study, necrostatin-1 (Nec-1) was used to determine whether necroptosis exists in a rat ischaemia/reperfusion injury flap model.

In this study, twenty male Sprague-Dawley rats were divided randomly into two groups: a control group (CTL group) and a Nec-1 group. Each abdominal skin flap underwent 3 h of ischaemia and then reperfusion. Fifteen minutes before and after reperfusion, phosphate buffer saline (PBS) was administered intraperitoneally to the CTL group, while Nec-1 was administered intraperitoneally to the Nec-1 group. Twenty-four hours after reperfusion, the whole flap was divided equally into 54 sections. Flap blood perfusion was measured. One sample was taken randomly from each row. Morphological changes, apoptosis, receptor-interacting protein-1 (RIP-1) expression and caspase-3 activity were observed and detected. The measurements between the two groups were compared with the independent t-test, and a P value of <0.05 was considered statistically significant.

Compared to flaps in the CTL group, flaps in the Nec-1 group showed longer survival rates, better blood perfusion and less inflammatory infiltration. The total flap area considered to have survived was 70.88 ± 10.28% in the CTL group, whereas 80.56 ± 5.40% of the area was found to be living in the Nec-1 group (Nec-1 vs. CTL, t= –2.624, P < 0.05). For some rows, there were significant differences in cell apoptosis between the two groups, the apoptosis index (AI) in rows "9 cm", "7 cm", "6 cm" and "5 cm" was significantly lower in the Nec-1 group than that in the CTL group (Nec-1 vs. CTL, P < 0.05). RIP-1 expression was much lower in the Nec-1 group than that in the CTL group in rows "5 cm" to "9 cm" (Nec-1 vs. CTL, P < 0.05). No significant differences in caspase-3 activity were found.

According to the results, necroptosis was present in a rat abdominal ischaemia/reperfusion injury flap model.

Some porous materials have been developed to enhance biologic fusion of the implants to bone in spine fusion surgeries. However, there are several inherent limitations. In this study, a novel biomedical porous tantalum was applied to in vitro and in vivo experiments to test its biocompatibility and osteocompatibility.

Bone marrow-derived mesenchymal stem cells (BMSCs) were cultured on porous tantalum implant. Scanning electron microscope (SEM) and Cell Counting Kit-8 assay were used to evaluate the cell toxicity and biocompatibility. Twenty-four rabbits were performed discectomy only (control group), discectomy with autologous bone implanted (autograft group), and discectomy with porous tantalum implanted (tantalum group) at 3 levels: L3–L4, L4–L5, and L5–L6 in random order. All the 24 rabbits were randomly sacrificed at the different post-operative times (2, 4, 6, and 12 months; n = 6 at each time point). Histologic examination and micro-computed tomography scans were done to evaluate the fusion process. Comparison of fusion index scores between groups was analyzed using one-way analysis of variance. Other comparisons of numerical variables between groups were made by Student t test.

All rabbits survived and recovered without any symptoms of nerve injury. Radiographic fusion index scores at 12 months post-operatively between autograft and tantalum groups showed no significant difference (2.89 ± 0.32 vs. 2.83 ± 0.38, F = 244.60, P = 0.709). Cell Counting Kit-8 assay showed no significant difference of absorbance values between the leaching liquor group and control group (1.25 ± 0.06 vs. 1.23 ± 0.04, t = –0.644, P = 0.545), which indicated the BMSC proliferation without toxicity. SEM images showed that these cells had irregular shapes with long spindles adhered to the surface of tantalum implant. No implant degradation, wear debris, or osteolysis was observed. Histologic results showed solid fusion in the porous tantalum and autologous bone implanted intervertebral spaces.

This novel porous tantalum implant showed a good biocompatibility and osteocompatibility, which could be a valid biomaterial for interbody fusion cages.

Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP). However, few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP. Thus, this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension.

This will be a single-center diagnostic study with a sample size of 440. Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible. Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA). Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared. Moreover, all patients will also undergo radionuclide imaging. The diagnostic value for RAS will be assessed by the receiver operating characteristic curve, including the accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and area under the ROC. Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method.

The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.

Chinese Clinical Trial Registry, ChiCTR1800016252; https://www.chictr.org.cn.

How to increase the long-term retention rate of autologous fat grafting has been widely discussed. This study aimed to evaluate long-term fat graft retention rates for the most widely used fat processing methods in the area of facial esthetic surgery, including centrifugation, filtration, and sedimentation, using three-dimensional (3D) imaging.

PubMed, Embase, Wiley/Cochrane Library, and Web of Science databases were comprehensively searched from inception to July 2018 according to the guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.

Articles were screened using predetermined inclusion and exclusion criteria. Data collected included patient characteristics, follow-up devices, fat grafting techniques, and clinical outcomes. Patient cohorts were pooled, and fat graft retention rates were calculated. Complications were summarized according to different clinical characteristics.

Of 77 articles, 10 clinical studies met the inclusion criteria and reported quantified measurement outcomes with 3D imaging which provide precise volumetric data with approximately 2% standard deviation compared to real volumes. Data of 515 patients were included. Fat grafting retention varied from 21% to 82%. We found filtration and centrifugation techniques could result in better retention outcomes. However, retention varied within each processing technique, with no significant difference among the 3 techniques. Twenty-two complications were reported among 515 patients, including donor-site hematoma (1 case), mild postoperative erythema (2 cases), mild volumetric asymmetries (2 cases), chronic edema (2 cases), overcorrection (2 cases), skin irregularity (6 cases), and headache or dysesthesia (7 cases).

Filtration and centrifugation techniques may result in better fat grafting retention outcomes than gravity sedimentation; however, more accurate statistical evidence is needed. Controversies continue to exist with respect to the performance of the different fat-processing techniques in fat graft retention.

2型糖尿病（T2DM）^[1]是一类由内分泌系统代谢紊乱引起，以高血糖为特征的代谢性疾病。胰岛素分泌不足和胰岛素抵抗是T2DM的基本病理特征。据国际糖尿病联盟（IDF）介绍，^[2]2017年20-79岁成年人的糖尿病患病率为4.25亿总人口的8.8%，到2045年将达到6.29亿。此外，据估计，截至2017年，全球约有一半的成年患者尚未被诊断。2017年，约有400万成年人死于糖尿病，46.1%的患者在60岁之前死亡。这些数据表明，糖尿病患者的数量正在以惊人的速度增加，并已成为对人类健康的挑战。此外，T2DM约占糖尿病总人口的95%，这导致人类和经济健康的重大损失。^[3]T2DM是一种慢性疾病，可引起一系列并发症，从而导致死亡。^[4]因此，预防或延缓并发症的发生是治疗T2DM的主要目的，而对于患有糖尿病的人来说，关键的环节是将血糖水平维持在正常范围内。^[5]目前，T2DM的治疗主要依靠生活方式干预^[6]（如营养治疗和体力活动）、口服药物^[7]（如双胍类、磺脲类和α-葡萄糖苷类抑制剂）、注射药物^[8](如胰岛素和胰高血糖素样肽-1[7-36]酰胺[GLP-1]激动剂)、外科治疗、^[9]以及补充和替代治疗。^[10]

致编辑：药物诱导的免疫性溶血性贫血（DIIHA）是一种罕见但严重的疾病。头孢曲松是抗菌谱广、抗菌作用有效的第三代头孢菌素，是引起DIIHA最常见的药物之一。^[1]头孢曲松诱导的免疫性溶血性贫血（CIIHA）是一种潜在的致命并发症。^[2]大多数患者是儿童。报告的CIIHA病死率高达40%。^[3]急性肾衰竭和心血管失代偿是儿童CIIHA患者最致命的并发症。^[2]早期诊断是困难的，但对结果极其重要。临床治疗包括立即停药和支持性护理，包括适当的输血。

致编辑：结节性硬化症（TSC），出生发病率为1：6000，^[1]是一种常染色体显性遗传的多系统疾病，以细胞增生和组织发育不良为特征，其中肾血管平滑肌脂肪瘤（AML）是一种常见的合并症。然而，肾AML的恶性肿瘤是罕见的。在此，我们分享了一例来自TSC的年轻男性肾AML恶性肿瘤病例。

致编辑：女性的雌激素水平在听觉完整性的维持中起着重要作用。^[1]在实验室研究中，相对于卵巢完整动物的结果，卵巢切除大鼠的听觉功能恶化。^[2]然而，也提出了相互矛盾的发现。^[3]因此，雌激素水平对听觉功能的直接影响尚不确定。同时，卵巢切除大鼠的雌激素治疗已被用于恢复由于雌激素缺乏引起的听觉功能变化。^[2]尽管如此，也报道了关于雌激素替代益处的相互矛盾的发现。^[4]事实上，雌激素缺乏对听觉功能的影响可以通过各种附加因素如抗癌药物顺铂的给药而增加。^[5]这一发现可能表明，雌激素缺乏（如卵巢切除术、绝经、卵巢衰竭）的女性在接受顺铂等耳毒性药物治疗时，听觉功能可能会发生明显变化。由于许多研究已经证明了黄芪（在中医中也称为黄芪）的临床益处，包括减少癌症患者化疗引起的副作用，^[6]我们报告了黄芪对顺铂治疗去卵巢大鼠听觉功能的保护作用。此外，使用与应用于黄芪研究的相同程序也获得了雌激素治疗（单独雌二醇）的性能。因此，可以比较黄芪和雌激素治疗在保护听觉功能方面的益处。

致编辑：系统性红斑狼疮(SLE)是一种自身免疫介导的全身性炎症性疾病，几乎累及身体的所有器官，并与过早动脉粥样硬化、血管炎和凝血病有关。^[1]SLE相关脑动脉瘤导致蛛网膜下腔出血（SAH）的病例报告越来越频繁。然而，仅在2个月内迅速发展的与多发性脑动脉瘤相关的SLE导致的SAH是罕见的，并且脑动脉瘤与SLE之间的因果关系尚不清楚。在此，我们报告了一例由SLE引起的多发性脑动脉动脉瘤，有足够的证据证实脑动脉动脉瘤仅由SLE引起。

致编辑：我们饶有兴趣地阅读了关于“丙戊酸钠治疗相关的急性胰腺炎”的文章。作者：全等人^[1]发表在你尊敬的杂志上。

致编辑：变异性红细胞性角化病（EKV；MIM 133200）的特征是短暂性、形状性、红斑性斑块和局限性角化过度。EKV表现出显著的表型异质性，即使在携带相同致病突变的家族中也是如此。^[1]术语EKV et progressiva（EKVP）是EKV的一种严重变体，已经提出包括多种表型，从有限的过度角化斑块和红斑斑块到严重的进行性对称性红角化病，其特征是更广泛的皮肤受累。^[2]

致编辑：一名63岁男性患者因弥漫性腹痛1天和计算机断层扫描（CT）显示腹主动脉瘤破裂（rAAA）而从当地诊所转诊。他否认有任何高血压、糖尿病、肝炎或肺炎病史。患者血压为100/70 mmHg，脉搏率为105次/分钟，体温为37.1℃。腹部轻度肿胀，伴有弥漫性疼痛和压痛。中腹部可触及5cm × 5cm大小的搏动性肿块。实验室检查结果包括白细胞（WBC）计数为10,600/μ L，血红蛋白（Hb）为92 g/L，血细胞比容为26.7%，血清肌酐（Cr）为0.9 mg/dl，C反应蛋白（CRP）为10.24 mg/L。在初始胸片上，没有病理性肺部病变。腹部CT显示5 cm × 5 cm破裂的肾下腹主动脉假性动脉瘤，呈局灶性强化隆起轮廓[图1A和图1B].决定接受紧急手术。在全身麻醉下，我们通过中线皮肤切口接近腹膜后rAAA和血肿。在夹闭肾下主动脉和双侧髂动脉后，我们在动脉瘤周围区域和动脉瘤壁发现了大量的感染性物质[图1C].我们对动脉瘤周围组织、血栓和动脉瘤壁中的各种微生物进行了培养试验。随后，我们对动脉瘤周围组织和动脉瘤囊进行了仔细的广泛局部清创术和切除，同时进行了大量冲洗[图1D].我们用带网膜瓣的分叉聚四氟乙烯(PTFE)移植物完成了主动脉双髂动脉介入术[图1E].根据我们的rAAA管理方案，我们使用第三代头孢菌素作为术前和术后预防性抗生素，直到确定致病微生物和对抗生素的敏感性。我们在术后前5天加用甲硝唑。动脉瘤周围组织、血栓和动脉瘤壁的培养试验显示肺炎克雷伯菌对除氨苄青霉素外的大多数抗生素均敏感。主动脉壁组织革兰氏染色（Brown-Brenn染色）结果为阴性[图1F].此外，血清学和组织试验沙门氏菌都是阴性的。我们继续每天静脉注射第三代头孢菌素，持续4周。术后3周，我们进行了血清学培养试验，结果为阴性。术后4周，患者出院，无并发症，口服第三代头孢菌素2周。随后的临床过程平安无事。术后6个月CT示PTFE通畅，无感染复发[图1G和图1H].

致编辑：先天性溶血性贫血（CHA）可由红细胞（RBC）中任何成分的缺陷引起，包括血红蛋白病、膜和细胞骨架缺陷、代谢酶病等。其特征是早期出现的正常细胞/大细胞性贫血、网织红细胞增多症和未结合胆红素升高。

致编辑：自主神经功能障碍是不稳定型心绞痛（UAP）发病的重要因素。影响冠状动脉收缩功能，诱发冠状动脉痉挛，加重心肌缺血，降低室颤阈值，增加UAP心源性猝死的发生率。^[1]氧化应激被定义为不能被抗氧化剂的作用抵消的活性氧(ROS)的过量产生，已被认为是导致心血管疾病发生和进展的潜在机制。^[2]尽管自主神经功能障碍和氧化应激之间的因果关系尚未确定，但已经提出氧化应激是通过引起兴奋毒性、神经元损失、轴突损伤而促成神经退行性疾病发作和进展的最关键机制之一。^[3]研究报告称，血清同型半胱氨酸(Hcy)、尿酸、白蛋白和胆红素水平是反映天然氧化抗氧化状态的简单实验室参数。此外，先前的研究表明，氧化应激增加预示着糖尿病的自主神经功能障碍。心率变异性（HRV）在评估自主神经系统波动在健康个体和各种心血管疾病患者中的作用方面具有相当大的潜力。^[4]据报道，在原发性高血压和高血压前期患者中，HRV抑制与氧化应激增加相关。^[5]然而，HRV是否与循环中的内源性氧化-抗氧化物质有关尚未被研究。因此，我们进行了一项横断面研究，以调查HRV与不稳定型心绞痛患者循环天然氧化抗氧化物质之间的相关性。

脓毒症被定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍，这是重症监护病房（ICU）医生经常面临的临床问题。如果没有积极的治疗，脓毒症的发病率和死亡率都很高。^[1]由于医院感染控制在ICU医院感染的治疗中起着至关重要的作用，根据危重患者的临床表现、病原微生物的生物学特性和ICU环境，本文提出了ICU医院感染的策略。