Volume 132 · Issue 02 · 2019

Desminopathy, a hereditary myofibrillar myopathy, mainly results from the desmin gene (DES) mutations. Desminopathy involves various phenotypes, mainly including different cardiomyopathies, skeletal myopathy, and arrhythmia. Combined with genotype, it helps us precisely diagnose and treat for desminopathy.

Sanger sequencing was used to characterize DES variation, and then a minigene assay was used to verify the effect of splice-site mutation on pre-mRNA splicing. Phenotypes were analyzed based on clinical characteristics associated with desminopathy.

A splicing mutation (c.735+1G>T) in DES was detected in the proband. A minigene assay revealed skipping of the whole exon 3 and transcription of abnormal pre-mRNA lacking 32 codons. Another affected family member who carried the identical mutation, was identified with a novel phenotype of desminopathy, non-compaction of ventricular myocardium. There were 2 different phenotypes varied in cardiomyopathy and skeletal myopathy among the 2 patients, but no significant correlation between genotype and phenotype was identified.

We reported a novel phenotype with a splicing mutation in DES, enlarging the spectrum of phenotype in desminopathy. Molecular studies of desminopathy should promote our understanding of its pathogenesis and provide a precise molecular diagnosis of this disorder, facilitating clinical prevention and treatment at an early stage.

Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown. The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls.

Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study. We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n= 5) and controls (n= 5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls. Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls. Comparisons between 2 groups were performed by Student’s t-test or Mann-Whitney U-test.

Twelve differentially expressed proteins were screened out. The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs. 1.310 ± 0.100, t= 2.643, P= 0.017) and caecum (0.765 ± 0.060 vs. 1.212 ± 0.122, t= 2.225, P= 0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs. 1.497 ± 0.392, t= 7.093, P= 0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs. 0.931 ± 0.652, t= 8.363, P= 0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs. 0.631 ± 0.042, t= 8.613,P= 0.007) of the IBS-D group was significantly higher, compared with the controls. The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs. 5.350 [2.230, 7.900], U= 55, P < 0.001).

Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients. The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.

Osteogenesis imperfecta (OI), a heritable bone fragility disorder, is mainly caused by mutations in COL1A1 gene encoding α1 chain of type I collagen. This study aimed to investigate the COL1A1 mutation spectrum and quantitatively assess the genotype-phenotype relationship in a large cohort of Chinese patients with OI.

A total of 161 patients who were diagnosed as OI in Department of Endocrinology of Peking Union Medical College Hospital from January 2010 to December 2017 were included in the study. The COL1A1 mutation spectrum was identified by next generation sequencing and confirmed by Sanger sequencing. A new clinical scoring system was developed to quantitatively assess the clinical severity of OI and the genotype-phenotype relationship was analyzed. The independent sample t-test, analysis of variance, Mann-Whitney U-test, Chi-squared test, Pearson correlation, and multiple linear regression were applied for statistical analyses.

Among 161 patients with OI, 32.9% missense mutations, 16.8% non-sense mutations, 24.2% splice-site mutations, 24.8% frameshift mutations, and 1.2% whole-gene deletions were identified, of which 38 variations were novel. These mutations led to 53 patients carrying qualitative defects and 67 patients carrying quantitative defects in type I collagen. Compared to patients with quantitative mutations, patients with qualitative mutations had lower alkaline phosphatase level (296 [132, 346] U/L vs. 218 [136, 284] U/L, P= 0.009) and higher clinical score (12.2 ± 5.3 vs. 7.4 ± 2.4, P < 0.001), denoting more severe phenotypes including shorter stature, lower bone mineral density, higher fracture frequency, more bone deformity, vertebral compressive fractures, limited movement, and dentinogenesis imperfecta (DI). Patients would not present with DI if the glycine substitutions happened before the 79th amino acid in triple helix of α1 chains .

This presented distinctive COL1A1 mutation spectrum in a large cohort of Chinese patients with OI. This new quantitative analysis of genotype-phenotype correlation would be helpful to predict the prognosis of OI and genetic counseling.

Weight gain during pregnancy reflects the mother’s nutritional status. However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM). This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM.

A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016. Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records. Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression.

In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG. Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50–3.52, P < 0.001), large for gestational age (aOR 2.06, 95% CI 1.44–2.93, P < 0.001), small for gestational age (aOR 0.49, 95% CI 0.25–0.97, P= 0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20–12.00, P= 0.023), preterm birth (aOR 0.45, 95% CI 0.21–0.96, P= 0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13–1.87, P= 0.004). Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96–6.37, P < 0.001).

Both excessive and insufficient weight gain require attention in women with GDM. Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.

DNA methylation is involved in numerous biologic events and associates with transcriptional gene silencing, playing an important role in the pathogenesis of endometrial cancer. ESR1/PGR frequently undergoes de novo methylation and loss expression in a wide variety of tumors, including breast, colon, lung, and brain tumors. However, the mechanisms underlying estrogen and progesterone receptors (ER/PR) loss in endometrial cancer have not been studied extensively. The aims of this study were to determine the expression of DNA (cytosine-5)-methyltransferase 3A/3B (DNMT3A/3B) in endometrial cancer to investigate whether the methylation catalyzed by DNMT3A/3B contributes to low ER/PR expression.

The clinicopathologic information and RNA-Seq expression data of DNMT3A/3B of 544 endometrial cancers were derived from The Cancer Genome Atlas (TCGA) uterine cancer cohort in May 2018. RNA-Seq level of DNMT3A/3B was compared between these clinicopathologic factors with t-test or one-way analysis of variance.

DNMT3A/3B was overexpressed in endometrioid carcinoma (EEC) and was even higher in non-endometrioid carcinoma (NEEC) (DNMT3A, EEC vs. NEEC: 37.6% vs. 69.9%, t=－7.440, P < 0.001; DNMT3B, EEC vs. NEEC: 42.4% vs. 72.8 %, t= －6.897, P < 0.001). In EEC, DNMT3A overexpression was significantly correlated with the hypermethylation and low expression of the ESR1 and PGR (P < 0.05). The same trend was observed in the DNMT3B overexpression subgroup. In the ESR1/PGR low-expression subgroups, as much as 83.1% of ESR1 and 59.5% of PGR were hypermethylated, which was significantly greater than the ESR1/PGR high-expression subgroups (31.3% and 11.9%, respectively). However, the above phenomena were absent in NEEC, while DNMT3A/3B overexpression, ESR1/PGR hypermethylation, and low ER/PR expression occurred much more often. In univariate analysis, DNMT3A/3B overexpressions were significantly correlated with worse prognosis. In multivariate analysis, only DNMT3A was an independent predictor of disease-free survival (P < 0.05).

DNMT3A/3B expression increases progressively from EEC to NEEC and is correlated with poor survival. The mechanisms underlying low ER/PR expression might be distinct in EEC vs. NEEC. In EEC, methylation related to DNMT3A/3B overexpression might play a major role in ER/PR downregulation.

Contributing to the innovative behavior of individuals in the health management process is a desirable condition for increased health institution performance. The relationship between the sense of loneliness and individual innovation behaviors has not been studied and relevant literature is extremely limited. The purpose of this research was to examine the effect of an individual’s sense of loneliness on their innovative behavior.

The research was performed between January and October 2018. The effects of loneliness feelings on the individual innovative behaviors of 451 health science faculty students were measured. The data were collected using the "Individual Information Form," the "individual innovation scale," and the "University of California Los Angeles loneliness scale." The reliability and validity of the scales were tested with Structural Equation Modeling.

It was found that the female participants showed exhibited more innovative behavior than the men. However, there was no significant difference in the loneliness status of participants by gender. A group of 23-year-old individuals showed a significant difference in the risk taking dimension compared to other age groups. First-grade students had more points in the experimental openness and opinion leadership sub-dimension than the other classes. It was observed that the behavior is molded as the education level increases. The regression models showed that loneliness has a negative effect of －0.254 on experiential openness and the leadership of ideas, and has a negative effect of －0.216 on risk taking. There was no effect of the sub-dimensions of loneliness on change resistance. Moreover, on the individualistic behavior of physical loneliness, a －0.267 negative effect was observed. Emotional loneliness has no effect on the sub-dimensions of individual innovation. Finally, the total sense of loneliness was found to have a negative effect on total individual innovation.

The study results clearly show that physical loneliness has a negative effect on individual innovation. It can be said that individuals living in social environments exhibit more innovative behaviors. However, emotional loneliness has no significant effect on innovative behavior. In this context, designing social spaces in health institutions will stimulate individuals’ innovative behaviors.

前庭偏头痛（VM）是一种具有熟悉易感性的常见疾病，其特征是反复发作的头晕或眩晕以及伴随的恶心、呕吐和/或头痛症状。VM患者可能需要神经、急诊或耳鼻喉科服务，并且该疾病经常被误诊为后循环缺血（PCI）或短暂性脑缺血发作（TIA）、周围性前庭眩晕、梅尼埃病（MD）和多发性（腔隙性）脑梗死。基于人群的研究报告显示，VM的患病率高达1%，^[1]是引起头晕/眩晕的常见疾病之一，误诊率高达80%。^[2]因此，为了准确诊断和规范管理，需要关于定义、特征、相关检查和诊断标准的多学科专家共识。

Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades. His bundle pacing (HBP) has been long considered the most physiologic pacing method; however, with the widespread implementation of this method, its disadvantages have become apparent. In this context, left bundle branch pacing (LBBP)—directly engaged in the His-Purkinje system—has been foreseen as the best pacing method to mimic physiologic activation patterns. This review aimed to summarize recent approaches to physiologic cardiac pacing.

This review included fully peer reviewed publications up to July 2018, found in the PubMed database using the keywords "His bundle branch pacing," "right ventricular pacing," and "physiologic pacing."

All selected articles were in English, with no restriction on study design.

The HBP has been studied worldwide, and is currently considered the most physiologic pacing method. However, it has disadvantages, such as high pacing threshold, unsatisfactory sensing and long procedure times, among others. Although LBBP is theoretically superior to HBP, the clinical relevance of this difference remains under debate, as few large randomized clinical trials with LBBP have been published.

Although HBP indeed appears to be the most physiologic pacing method, it has certain shortcomings, such as high pacing threshold, difficult implantation due to specific anatomic features, and others. Further studies are required to clarify the clinical significance of LBBP.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI). In current clinical situation, availability of different oral P2Y₁₂ inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical scenarios. Although optimum time, loading dose and interval of transition between P2Y₁2 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several reasons.

This review was based on data in articles published in PubMed up to June 2018, with the following keywords "antiplatelet therapy" , "ACS" , "PCI" , "ticagrelor" and "clopidogrel" .

Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were selected. References of the retrieved articles were also screened to search for potentially relevant papers.

Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation strategy. Practical considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y₁₂ inhibitors or shortening duration of DAPT (followed by aspirin or P2Y₁₂ receptor inhibitor monotherapy) as potential options are yet to be standardized and validated.

Current review will provide an overview of the pharmacology of common P2Y₁₂ inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation.

To review the literature regarding diagnosis and treatment of labral tear.

A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.

For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.

Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.

Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.

致编辑：患者男，53岁，近日来我院就诊，近半月有心悸、头晕、呼吸困难、胸闷等病史。此外，患者自幼易活动性疲劳，有呼吸道感染易感史。体检后，检测到脉搏不规则和心脏杂音。肺动脉瓣听诊发现胸骨左侧、第一和第二肋骨之间的第二心音加重，3/6级收缩期杂音。基本的实验室检查并不显著。心电图（ECG）显示心房颤动（AF）。胸片显示轻度心脏增大。经胸超声心动图（TTE）提示房间隔缺损（ASD）由左向右分流；左心房、右心房和右心室扩张；中度三尖瓣反流；持续性左上腔静脉（PLSVC）导致轻度肺动脉高压和冠状窦明显扩张。考虑心脏计算机断层扫描（CT）以更好地描绘静脉异常并确定分流的位置。CT在Philips Brilliance 64层多层CT（MDCT）扫描仪上进行，证实了PLSVC的TTE发现[图1A]，并将心脏分流定义为静脉窦型房间隔缺损(SVASD)[图1B].右上腔静脉(SVC)的开口引流到左心房顶部[图1B].左侧持续性SVC引流至冠状窦，然后冠状窦严重扩张，测量为3.0 cm。房间隔缺损2.0 cm。此外，CT有助于排除一些更常见的与PLSVC相关的心脏异常，如室间隔缺损、主动脉缩窄、大血管转位、法洛四联症和肺静脉连接异常。SVASD如果不进行修复，最终可能导致右心容量超负荷和随后的高血压性肺血管疾病。PLSVC通过冠状窦流入右心房，不会导致血流动力学后果。然而，当右SVC直接引流到左心房顶部时，可能会导致右向左分流或左心房血流动力学过载，并有房颤或反常栓塞的风险。因此，建议患者接受手术治疗。心脏手术包括打开右心室，并需要通过单独的静脉插管引流PLSVC。改良Cox-Maze房颤手术与SVASD修复同时进行。手术补片用于修复SVASD，隔离右SVC至右心房的开口。我们没有结扎PLSVC。

致编辑：根据世界卫生组织（WHO）肺肿瘤组织学分类，原发性肺淋巴上皮瘤样癌（LELC）属于其他未分类癌，被认为是肺癌变异的罕见亚型。^[1,2]1987年报道了第一例肺LELC。许多研究表明，EB病毒（EBV）感染与肺LELC之间存在密切关系。^[1,3]然后，已经发现亚洲人群的发病率显著高于西方人群。^[1]全反位（SIT）是一种罕见的常染色体隐性疾病，其中胸部和腹部的器官从其正常位置到身体另一侧呈镜像定位。一些调查表明，SIT的发病率在活产中约为1/5000至1/10,000。^[4,5]在此，我们报告一例罕见的原发性肺LELC合并SIT。

致编辑：多原发性肺腺癌（MPLAs）与转移瘤的鉴别对于正确的临床治疗和预后预测非常重要。自2003年以来，美国胸科医师学会（ACCP）提出的目前修订的MPLAs诊断标准一直被普遍应用。^[1]然而，确定来自同一患者的2个或更多肺腺癌是否同源在技术上仍然具有挑战性。已经描述了解决该问题的各种方法和算法，包括基因突变分析。^[2,3]在这里，我们介绍了一个45例同步多灶性肺腺癌患者的队列。

致编辑：血清碱性磷酸酶（ALP）是慢性肾脏病（CKD）患者的重要骨转换标志物，研究表明较高的血清ALP水平与血液透析（HD）患者的死亡率增加相关。^[1]我们之前的研究还表明，较高的血清ALP水平与腹膜透析（PD）患者的全因死亡率和心血管死亡率独立相关。^[2]最近，来自中国台湾的一份报告显示，ALP浓度与5年期间PD患者的死亡率无关。^[3]因此，在PD患者中使用ALP的结果预测性仍不确定，血清ALP与不同年龄全因死亡率之间的关系仍不清楚。在这里，我们研究了年轻和老年PD患者血清ALP与全因死亡率的关系。

致编辑：脂蛋白肾小球病（LPG）是一种罕见的遗传性肾脏疾病，其特征是受累肾小球毛细血管腔中的脂蛋白血栓明显扩张、血浆载脂蛋白E（apoE）浓度高和蛋白尿。^[1]它主要影响日本和中国血统的人，迄今为止已报告约117例病例。^[2,3]几项遗传学研究表明APOE基因突变可能导致LPG的发展；^[4,5,6]然而，相互矛盾的已发表证据发现，一些患有APOE变异不受影响。^[7]因此，需要进一步的研究来检查APOE液化石油气发病机制中的突变。本研究调查了一种新的点突变APOE一个有一名液化石油气患者及其无症状携带者的家庭的基因APOE变体。

致编辑：自1956年以来，偶尔有原发性甲状旁腺功能亢进（pHPT）和非髓样甲状腺癌（NMTC）共存的报道；^[1,2]同时，pHPT和两种不同的肿瘤（滤泡性和乳头状甲状腺癌）同时发生的报道很少。在此，我们报告了一例66岁的女性患者，她因主诉pHPT和两种不同的癌症而被转移到外科专家那里。患者因血清钙水平升高2.80 mmol/L（参考范围2.08-2.60 mmol/L），于2018-05-21入住我院内分泌代谢科。实验室检查显示甲状旁腺激素（PTH）水平为111.4 ng/L（参考范围15-65 ng/L），提示诊断为pHPT。然而，患者没有提示高钙血症的症状，如全身无力或恶心。随后进行单光子发射计算机断层扫描（SPECT）联合计算机断层扫描（CT）。早期和晚期图像均显示Tc-99m MIBI局灶性滞留增强，位于右甲状腺叶中上部，SPECT/CT融合成像异常信号聚集特异性定位于右甲状腺背侧中上部，提示右侧甲状旁腺腺瘤的存在[图1A].患者未提供与多发性内分泌腺瘤病（男性）相关的显著病史和家族史，其肾上腺区域CT扫描和头颅磁共振成像（MRI）扫描未显示明显异常，因此排除了男性的可能性。还进行了核素骨显像，未发现异常。患者随后接受超声检查，发现右侧甲状旁腺腺瘤和双侧甲状腺实性结节[图1B和1C].超声引导下进行细针穿刺细胞学检查（FNAC），病理结果提示淋巴细胞性甲状腺炎、滤泡性肿瘤和上皮乳头状增生并存。随后，患者转入普外科接受右侧甲状旁腺切除术和双侧甲状腺全切除术的手术治疗。手术标本病理诊断为双侧多结节性甲状腺肿，左侧甲状腺腺瘤，右侧甲状腺滤泡癌（伴有包膜微侵犯，1.2 × 1.0 × 1.0 cm）[图1D]、乳头状微小癌（0.5 × 0.4 × 0.3 cm）[图1E和1F]和甲状旁腺腺瘤。术后血清钙水平降至2.2 mmol/L，术后4天出院。

致编辑：活体供体肝移植（LDLT）扩大了尸体器官捐献率低的国家的供体库。一般来说，左侧同种异体肝移植对于儿童和青少年接受者是足够和安全的。^[1]为了供体的美容需求和早期功能康复，自2002年以来，腹腔镜技术已用于活体肝切除术。^[2]与传统的二维腹腔镜相比，三维可视化提供了更好的深度感知和触觉反馈。^[3]在本报告中，我们提出了一例纯三维腹腔镜全左肝切除术。

致编辑：一名49岁女性，因意外创伤接受脾切除术15年，在常规产科检查中表现为道格拉斯窝无症状小肿块。她随即住进浙江大学医学院附属杭州市第一人民医院接受进一步评估。腹部触诊和实验室检查未发现特殊发现。阴道超声显示，除子宫外，有几个大小不等的未连接肿块，范围从1厘米到4厘米。计算机断层扫描显示多发性软组织阴影，无增强[图1].关于她的脾切除术和影像学发现，考虑异位脾自体移植（ESAT）。脾组织接种是指创伤性脾损伤或脾切除术后的自发性ESAT。^[1,2,3,4,5]一些碎片可以在最终停留位置的所有可能性中存活，更多见于腹腔，如盆腔腹膜。^[1,2,4,5]大多数脾病不会带来任何临床表现。更重要的是，这些接种的脾芯片一旦成形就可以包含正常脾的部分性能(例如，防止脾切除术后严重感染的可能性)；因此，对于无症状患者，干预是不必要的。^[1,3,5]迄今为止，放射性核素脾显像（使用[99m]Tc-硫胶体放射性）、细针活检和腹腔镜探查可能有利于做出结论性诊断。然而，如果这些种子在其生长发育过程中导致明显的并发症如小肠梗阻，或当它们难以与恶性肿瘤鉴别时，则需要腹腔镜手术。在这种情况下，如有必要，将通过culdocentesis进行活检，以进一步确认最初的解释，但密切监测应该是更最佳的选择。因此，她未经治疗就出院了。随访1年时，群众保持先前位置无变化。该病例表明，当缺乏网膜时，盆腔腹膜底部可能是脾脏植入的潜在位置，旨在安全地保留脾脏的部分功能。

致编辑：腺样囊性癌（ACC）是一种罕见的肿瘤，约占所有头颈部恶性肿瘤的1%。^[1]ACC通常发生在主要和次要唾液腺。尽管生长不良，但仍有频繁的局部复发和晚期远处转移的报道。最常受累的器官包括肺、骨、脑和肝，^[2]而甲状腺转移相对罕见。在此，我们报告了一例2年前切除的42岁颌下腺ACC女性双侧甲状腺叶转移病例。当超声检查是诊断甲状腺结节的第一手段时，本病例的主要目的是关注ACC甲状腺转移的超声和弹性成像特征。

致编辑：我们在此报告一例于2018年2月2日通过冰冻切片快速病理检查发现的乳腺病变。该病变在大体观察和组织学特征方面与乳腺癌非常相似。免疫组织化学和磷脂酰肌醇-3-激酶（PIK3CA）进行基因测序。详细报告了病变的临床病理特征。

在题为“气脂胃通颗粒对餐后窘迫综合征-为主的功能性消化不良的随机、双盲、多中心、安慰剂对照试验”的文章中，发表于第131卷第13期第1549-1556页中华医学杂志,^[1]作者的隶属关系和通信地址错误地写为“华中科技大学武汉协和医院消化科，中国湖北武汉430000”，而不是“华中科技大学同济医学院协和医院消化科，中国湖北武汉430022”。