Volume 132 · Issue 08 · 2019

Gestational diabetes mellitus (GDM) is usually diagnosed between 24th and 28th gestational week using the 75-g oral glucose tolerance test (OGTT). It is difficult to predict GDM before 24th gestational week because fast plasma glucose (FPG) decreases as the gestational age increases. It is controversial that if FPG ≥5.1 mmol/L before 24th gestational week should be intervened or not. The aim of this study was to evaluate the value of FPG to screen GDM before 24th gestational week in women with different pre-pregnancy body mass index (BMI).

This was a multi-region retrospective cohort study in China. Women who had a singleton live birth between June 20, 2013 and November 30, 2014, resided in Beijing, Guangzhou and Chengdu, and received prenatal care in 21 selected hospitals, were included in this study. Pre-pregnancy BMI, FPG before the 24th gestational week, and one-step GDM screening with 75 g-OGTT at the 24th to 28th gestational weeks were extracted from medical charts and analyzed. The pregnant women were classified into four groups based on pre-pregnancy BMI: Group A (underweight, BMI < 18.5 kg/m²), Group B (normal, BMI 18.5–23.9 kg/m²), Group C (overweight, BMI 24.0–27.9 kg/m²) and Group D (obesity, BMI ≥28.0 kg/m²). The trend of FPG before 24th week of gestation was described, and the sensitivity and specificity of using FPG before the 24th gestational week to diagnose GDM among different pre-pregnancy BMI groups were reported. Differences in the means between groups were evaluated using independent sample t-test and analysis of variance. Pearson Chi-square test was used for categorical variables.

The prevalence of GDM was 20.0% (6806/34,087) in the study population. FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. FPG was higher in women with higher pre-pregnancy BMI. FPG before the 24th gestational week and pre-pregnancy BMI could be used to predict GDM. The incidence of GDM in women with FPG ≥5.10 mmol/L in the 19th to 24th gestational weeks and pre-pregnancy overweight or obesity was significantly higher than that in women with FPG ≥5.10 mmol/L and pre-pregnancy BMI <24.0 kg/m² (78.5% [62/79] vs. 52.9% [64/121], χ² = 13.425, P < 0.001).

FPG decreased gradually as the gestational age increased in all pre-pregnancy BMI groups until the 19th gestational week. Pre-pregnancy overweight or obesity was associated with an increased FPG value before the 24th gestational week. FPG ≥5.10 mmol/L between 19 and 24 gestational weeks should be treated as GDM in women with pre-pregnancy overweight and obesity.

Irritable bowel syndrome (IBS) is reported associated with the alteration of gut microbial composition termed as dysbiosis. However, the pathogenic mechanism of IBS remains unclear, while the studies of Chinese individuals are scarce. This study aimed to understand the concept of dysbiosis among patients with Chinese diarrhea-predominant IBS (IBS-D), as a degree of variance between the gut microbiomes of IBS-D population and that of a healthy population.

The patients with IBS-D were recruited (assessed according to the Rome III criteria, by IBS symptom severity score) from the Outpatient Department of Gastroenterology of Peking University Third Hospital, and volunteers as healthy controls (HCs) were enrolled, during 2013. The 16S rRNA sequences were extracted from fecal samples. Ribosomal database project resources, basic local alignment search tool, and SparCC software were used to obtain the phylotype composition of samples and the internal interactions of the microbial community. Herein, the non-parametric test, Wilcoxon rank-sum test was carried out to find the statistical significance between HC and IBS-D groups. All the P values were adjusted to q values to decrease the error rate.

The study characterized the gut microbiomes of Chinese patients with IBS-D, and demonstrated that the dysbiosis could be characterized as directed alteration of the microbiome composition leading to greater disparity between relative abundance of two phyla, Bacteroidetes (Z = 4.77, q = 1.59 × 10^-5) and Firmicutes (Z = -3.87, q = 5.83 × 10^-4). Moreover, it indicated that the IBS symptom features were associated with the dysbiosis of whole gut microbiome, instead of one or several certain genera even they were dominating. Two genera, Bacteroides and Lachnospiracea incertae sedis, were identified as the core genera, meanwhile, the non-core genera contribute to a larger pan-microbiome of the gut microbiome. Furthermore, the dysbiosis in patients with IBS-D was associated with a reduction of network complexity of the interacted microbial community (HC vs. IBS-D: 639 vs. 154). The disordered metabolic functions of patients with IBS-D were identified as the potential influence of gut microbiome on the host (significant difference with q < 0.01 between HC and IBS-D).

This study supported the view of the potential influence of gut microbiome on the symptom of Chinese patients with IBS-D, and further characterized dysbiosis in Chinese patients with IBS-D, thus provided more pathological evidences for IBS-D with the further understanding of dysbiosis.

Asymptomatic coronary artery stenosis (ACAS) ≥50% is common in patients with acute ischemic cerebrovascular disease (AICVD), which portends a poor cardiovascular and cerebrovascular prognosis. Identifying ACAS ≥50% early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients. This study aimed to investigate whether aortic arch plaque (AAP), an early atherosclerotic manifestation of brain blood-supplying arteries, could be a predictor for ACAS ≥50% in AICVD.

In this cross-sectional study, atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history. The patients were divided into ACAS ≥50% and non-ACAS ≥50% groups according to whether CTA showed stenosis ≥50% in at least one coronary arterial segment. The AAP characteristics of CTA were depicted from aspects of thickness, extent, and complexity.

Among 118 analyzed patients with AICVD, 29/118 (24.6%) patients had ACAS ≥50%, while AAPs were observed in 86/118 (72.9%) patients. Increased AAP thickness per millimeter (adjusted odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.18–2.05), severe-extent AAP (adjusted OR: 13.66, 95% CI: 2.33–80.15), and presence of complex AAP (adjusted OR: 7.27, 95% CI: 2.30–23.03) were associated with ACAS ≥50% among patients with AICVD, independently of clinical demographics and cervicocephalic atherosclerotic stenosis. The combination of AAP thickness, extent, and complexity predicted ACAS ≥50% with an area under the receiver-operating characteristic curve of 0.78 (95% CI: 0.70–0.85, P < 0.001). All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50% in AICVD (all P < 0.05).

Thicker, severe-extent, and complex AAP were significant markers of the concomitant ACAS ≥50% in AICVD, possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis. As an integral part of atherosclerosis of brain blood-supplying arteries, AAP should not be overlooked in predicting ACAS ≥50% for patients with AICVD.

It is currently unclear if fibrinogen is a risk factor for adverse events in patients receiving percutaneous coronary intervention (PCI) or merely serves as a marker of pre-existing comorbidities and other causal factors. We therefore investigated the association between fibrinogen levels and 2-year all-cause mortality, and compared the additional predictive value of adding fibrinogen to a basic model including traditional risk factors in patients receiving contemporary PCI.

A total of 6293 patients undergoing PCI with measured baseline fibrinogen levels were enrolled from January to December 2013 in Fuwai Hospital. Patients were divided into three groups according to tertiles of baseline fibrinogen levels: low fibrinogen, <2.98 g/L; medium fibrinogen, 2.98 to 3.58 g/L; and high fibrinogen, ≥3.58 g/L. Independent predictors of 2-year clinical outcomes were determined by multivariate Cox proportional hazards regression modeling. The increased discriminative value of fibrinogen for predicting all-cause mortality was assessed using the C-statistic and integrated discrimination improvement (IDI).

The 2-year all-cause mortality rate was 1.2%. It was significantly higher in the high fibrinogen compared with the low and medium fibrinogen groups according to Kaplan-Meier analyses (1.7% vs. 0.9% and 1.7% vs. 1.0%, respectively; log-rank, P= 0.022). Fibrinogen was significantly associated with all-cause mortality according to multivariate Cox regression (hazard ratio 1.339, 95% confidence interval: 1.109–1.763, P= 0.005), together with traditional risk factors including age, sex, diabetes mellitus, left ventricular ejection fraction, creatinine clearance, and low-density lipoprotein cholesterol. The area under the curve for all-cause mortality in the basic model including traditional risk factors was 0.776, and this value increased to 0.787 when fibrinogen was added to the model (IDI= 0.003, Z= 0.140, P= 0.889).

Fibrinogen is associated with 2-year all-cause mortality in patients receiving PCI, but provides no additional information over a model including traditional risk factors.

In the era of precision medicine, chemotherapy is still considered the cornerstone of treatment for lung cancer patients without gene mutations. How to reduce the toxicity and increase the efficiency of chemotherapy is worth exploring. This study aimed to investigate the curative effects and safety of hyperthermia combined with chemotherapy (HCT) for advanced patients with non-small cell lung cancer (NSCLC), especially those with malignant pleural effusion.

We retrospectively evaluated medical records of 93 patients with advanced NSCLC (stage IIIB-IV) from March 2011 to January 2014. The patients were divided into HCT and chemotherapy (CT) groups. The HCT group was treated with gemcitabine and cisplatin (GP) regimen combined with regional radiofrequency deep hyperthermia, while the CT group was treated with GP regimen only. Those with malignant pleural effusion extra underwent thoracentesis and intrapleural injection chemotherapy combined with hyperthermic or not. Clinical treatment results and adverse reactions were compared and analyzed after treatment. SPSS 19.0 software (SPSS Inc., USA) was used for statistical data processing. P values less than 0.05 were accepted to be statistically significant.

Among the 93 patients, HCT group included 48 patients (16 patients with malignant pleural effusion), CT group included 45 patients (10 patients with malignant pleural effusion). There was no significant difference between the two groups in patient characteristics. The overall response rate (ORR) of pleural effusions was much better in HCT group than that in CT group (81.2% vs. 40.0%, P= 0.046). The patients in HCT group had lower incidence rate of weakness (12.5% vs. 46.7%, χ²= 13.16, P < 0.001) and gastrointestinal (25.0% vs. 77.8%, χ² = 25.88, P < 0.001) adverse reactions than that in CT group. The objective tumor response and survival showed no significant differences.

Hyperthermia combined with chemotherapy might lead to the development of better therapeutic strategy for advanced NSCLC with malignant pleural effusion patients. Also, it could greatly reduce the chemotherapy toxic effects in the incidence of weakness and gastrointestinal adverse reactions in advanced NSCLC patients.

Positive surgical margins are independent risk factor for biochemical recurrence, local recurrence, and distant metastasis after radical prostatectomy. However, limited predictive tools are available. This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy (LRP).

From January 2010 to March 2016, a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study. Clinical and pathological results of each patient were collected for further analysis. Univariable and multivariable logistic regression (backward stepwise method) were used for the nomogram development. The concordance index (CI), calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.

Of 418 patients involved in this study, 142 patients (34.0%) had a positive surgical margin on final pathology. Based on the backward selection, four variables were included in the final multivariable regression model, including the percentage of positive cores in preoperative biopsy, clinical stage, free prostate specific antigen (fPSA)/total PSA (tPSA), and age. A nomogram was developed using these four variables. The concordance index (C-index) of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations. The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%. In decision curve analyses, the nomogram showed net benefits in the range from 0.2 to 0.7.

A nomogram to predict positive surgical margins after LRP was developed and validated, which could help urologists plan surgical procedures.

There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of perioperative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP.

A retrospective analysis of 612 patients who received CABG in the General Hospital of People’s Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%–50%) left ventricular dysfunction.

Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and postoperative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively).

Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.

To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery.

The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patients were excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated using Nadler’s formula and Gross’ formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05.

There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler’s formula and Gross’ formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction.

Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.

Cervical cancer has the fourth highest incidence and mortality rate of all cancers in women worldwide; it seriously harms their physical and mental health. The aim of this study was to observe the roles and preliminary mechanism of Taurine (Tau)-induced apoptosis in cervical cancer cells.

Cells from the human cervical cancer cell line SiHa were transfected with the recombinant plasmid pEGFP-N1-MST1 (mammalian sterile 20-like kinase 1); then, the cell proliferation activity was analyzed by the MTT assay, cell apoptosis by flow cytometry, and the related protein levels by Western blotting.

Tau inhibited the proliferation of SiHa cells and induced apoptosis in these cells (the apoptotic rate was 21.95% in the Tau 160 mmol/L group and 30% in the Tau 320 mmol/L group), upregulated the expression of the MST1 (control, 0.53; Tau 40-320 mmol/L groups, 0.84–1.45) and Bax (control, 0.45; Tau 40–320 mmol/L groups, 0.64–1.51) proteins (P < 0.01), and downregulated the expression of Bcl-2 (control, 1.28, Tau 40–320 mmol/L groups, 0.93–0.47) (P < 0.01). The overexpression of MST1 promoted the apoptosis of SiHa cells, enhanced the apoptosis-inductive effects of Tau (P < 0.01), upregulated the expression of the proapoptotic proteins p73, p53, PUMA (p53 upregulated modulator of apoptosis), and caspase-3, and promoted the phosphorylation of YAP (Yes-associated protein).

Tau inhibited the proliferation and induced the apoptosis of cervical cancer SiHa cells. The MST1 protein plays an important role in the Tau-induced apoptosis of cervical cancer cells.

Saphenous vein grafts disease (SVGD) is a common complication after coronary artery bypass graft (CABG) and normally treated by percutaneous coronary intervention (PCI). The most common complication after SVG-PCI is slow or no-reflow. It is known that the no-reflow phenomenon occurs in up to 15% of the SVG-PCI and is associated with high risk of major adverse cardiac events (MACEs) and mortality, therefore, it is important to investigate the factors that could predict the clinical outcome of PCI for risk stratification and guiding interventions. In recent years, the spectral analysis of intravascular ultrasound (IVUS) radiofrequency data (virtual histology-IVUS [VH-IVUS]) has been used to provide quantitative assessment on both plaque compositions and morphologic characteristics.

The PubMed, Embase, and Central databases were searched for possible relevant studies published from 1997 to 2018 using the following index keywords: "Coronary artery bypass grafting," "Saphenous venous graft disease," "Virtual histology-intravascular ultrasound," "Virtual histology-intravascular ultrasound," and "Percutaneous coronary intervention."

The primary references were Chinese and English articles including original studies and literature reviews, were identified and reviewed to summarize the advances in the application of VH-IVUS techniques in situ vascular and venous graft vascular lesions.

With different plaque components exhibiting a defined spectrum, VH-IVUS can classify atherosclerotic plaque into four types: fibrous tissue (FT), fibro fatty (FF), necrotic core (NC), and dense calcium (DC). The radiofrequency signal is mathematically transformed into a color-coded representation, including lipid, fibrous tissue, calcification, and necrotic core. Several studies have demonstrated the independent relationship between VH-IVUS–defined plaque classification or plaque composition and MACEs, but a significant association between plaque components and no-reflow after PCI in acute coronary syndrome. In recent years, VH-IVUS are applied to assess the plaque composition of SVGD, based on the similarity of pathophysiological mechanisms between coronary artery disease (CAD) and SVGD, further studies with the larger sample size, the long-term follow-up, multicenter clinical trials may be warranted to investigate the relationship between plaque composition of saphenous vein graft (SVG) by VH-IVUS and clinical outcomes in patients with SVGD undergoing PCI.

In degenerative SVG lesions, VH-IVUS found that plaque composition was associated with clinical features, future studies need to explore the relationship between VH-IVUS defined atherosclerotic plaque components and clinical outcomes in SVGD patients undergoing PCI, an innovative prediction tool of clinical outcomes can be created.

The endothelial glycocalyx (eGC) is a dynamic and multicomponent layer of macromolecules found at the surface of vascular endothelium, which is largely underappreciated. It has recently been recognized that eGC is a major regulator of endothelial function and may have therapeutic value in organ injuries. This study aimed to explore the role of the eGC in various pathologic and physiologic conditions, by reviewing the basic research findings pertaining to the detection of the eGC and its clinical significance. We also explored different pharmacologic agents used to protect and rebuild the eGC.

An in-depth search was performed in the PubMed database, focusing on research published after 2003 with keywords including eGC, permeability, glycocalyx and injuries, and glycocalyx protection.

Several authoritative reviews and original studies were identified and reviewed to summarize the characteristics of the eGC under physiologic and pathologic conditions as well as the detection and protection of the eGC.

The eGC degradation is closely associated with pathophysiologic changes such as vascular permeability, edema formation, mechanotransduction, and clotting cascade, together with neutrophil and platelet adhesion in diverse injury and disease states including inflammation (sepsis and trauma), ischemia-reperfusion injury, shock, hypervolemia, hypertension, hyperglycemia, and high Na⁺ as well as diabetes and atherosclerosis. Therapeutic strategies for protecting and rebuilding the eGC should be explored through experimental test and clinical verifications.

Disturbance of the eGC usually occurs at early stages of various clinical pathophysiologies which can be partly prevented and reversed by protecting and restoring the eGC. The eGC seems to be a promising diagnostic biomarker and therapeutic target in clinical settings.

盆腔清除术（PE）是指整体切除受累的盆腔器官并重建盆腔，以提高肿瘤患者的生存率。由Brunschwig于1948年首次报道，^[1]此后，PE被用于治疗直肠癌、膀胱癌、前列腺癌和宫颈癌，作为晚期或复发性恶性肿瘤的治愈性或姑息性治疗。对所有受累的肿瘤病变进行手术切除以延长患者的总生存期（OS）是至关重要的；尽管如此，这种医疗操作将诱发各种并发症。对于在初始治疗中接受放射治疗的患者，增加的组织脆性以及炎症已经成为术中的麻烦。^[2]

致编辑：中耳唾液腺分支瘤是位于中耳的正常唾液腺组织。它是一种良性且生长缓慢的肿瘤，通常累及听骨链和面神经，^[1,2]并且大多数患者通常患有传导性听力损失，而没有鼓膜（TM）穿孔。组织学特征包括正常唾液腺组织和被纤毛柱状上皮覆盖的肿块。据我们所知，它是由Buckmiller首先描述的等人.^[3]我们报告了一例罕见的唾液腺分支瘤病例，患者有咽部错构瘤病史，肿块被鳞状上皮覆盖。

致编辑：垂体促性腺瘤是一种无功能垂体腺瘤，其中约35%分泌具有生物活性的黄体生成素（LH）或卵泡刺激素（FSH），这些腺瘤被命名为功能性促性腺瘤（FGA）。我们报告了2014年至2016年间我院收治的三例FSH分泌腺瘤病例。

致编辑：枸杞(鲁氏乳杆菌）默里含有丰富的花青素。本研究的目的是探讨鲁氏乳杆菌在力竭运动前治疗7天的大鼠中，补充提取物对力竭运动损伤的影响。力竭运动诱导血清硝酸盐(NO)和活性氧(ROS)水平升高，但补充鲁氏乳杆菌提取物显著减少了它们（P<0.05).白细胞介素(IL)-1和IL-6也显著降低鲁氏乳杆菌与对照组相比（P<0.05).补充鲁氏乳杆菌提取物还显著减少肌酸激酶同工酶MB（CK-MB）的产生，改善心肌组织病理学。

致编辑：在一项比较丙泊酚、右美托咪定和咪达唑仑对腰硬联合麻醉行髋关节或膝关节置换术的老年患者术后认知功能障碍(POCD)影响的随机对照初步试验中，李等人^[1]表明与右美托咪定相比，异丙酚术中镇静可显著降低POCD的风险。鉴于POCD与主要不良后果相关，例如死亡率增加、生活质量降低和长期恢复延迟，^[2]他们的发现具有潜在的意义。然而，我们注意到，这一发现与最近一项在接受周围神经阻滞髋关节置换术的老年患者中进行的大型随机对照研究的结果完全不同，在该研究中，使用右美托咪定镇静的患者比使用丙泊酚镇静的患者发生POCD的风险更低。^[3]我们想请作者对这些不同的发现发表评论。此外，当随机对照试验用于区分一种干预对主要终点的真实影响时，所有其他风险因素都必须标准化，以避免潜在的偏倚。我们注意到这项研究中的几个重要问题没有得到很好的解决。

致编辑：肺动静脉瘘（PAVF）是绕过肺毛细血管床的异常扩张的血管，提供直接的右向左分流。PAVF的临床表现可以从无症状到劳累呼吸困难、疲劳、发绀和神经系统并发症。先天性PAVF患者常伴有遗传性出血性毛细血管扩张症（HHT）和先天性心脏病。通过经导管技术或手术治疗的主要目的是减少或消除异常分流并预防严重并发症。医疗器械和器械的发展扩大了PAVF介入闭合的适应症。然而，关于经导管闭合PAVFs的疗效和安全性的数据仍然缺乏。

致编辑：2型糖尿病（T2DM）是一种常见的复杂代谢紊乱。先前的研究报告称，T2DM患者存在胰腺癌发生的风险。^[1]碳水化合物抗原199（CA 199）是疾病之间的生物学联系，慢性胰腺炎患者的CA 199水平可能高于健康个体，慢性胰腺炎已被证实是糖尿病的危险因素。^[2]因此，它也是可能由糖尿病引起的胰腺组织受损的象征。到目前为止，已经提出了几种这种关系的机制，如炎症增加、代谢状态异常、胰岛素抵抗、内质网应激、自噬失调等。^[1]血红蛋白A1c（HbA1c）是指示T2DM患者血糖控制的最重要的实验室参数。HbA1c的一般目标是≤7%表示血糖控制良好，而HbA1c值超过7%表示血糖控制不良。^[3]

致编辑：儿童胸部钝性损伤导致的支气管破裂非常罕见，可能超过48小时未被诊断。尽管在三维计算机断层扫描（3D-CT）和支气管镜检查明确诊断后进行了手术修复，但仍可能出现吻合口狭窄的并发症，尤其是在非常年轻的患者中。本研究旨在提出一种改进早期诊断的算法，并报告9名儿童胸部钝性创伤后支气管破裂的治疗经验。

致编辑：酒精性心脏缺损是胎儿酒精谱系障碍（FASD）最重要的临床表现之一，以房室间隔缺损和动脉圆锥畸形为特征。^[1]白藜芦醇，一种传统中草药的多酚成分虎杖主要从其根茎中提取，已知对心血管系统表现出有益作用。例如，白藜芦醇对心脏功能障碍、心肌肥大和压力超负荷具有有益作用。此外，发现白藜芦醇具有抑制血小板聚集、预防动脉粥样硬化和清除自由基的作用。^[2]然而，白藜芦醇在心脏形成过程中对酒精诱导的心脏缺陷的影响仍然未知。斑马鱼胚胎的独特特征，如其透明的身体，体外受精和短生殖周期使它们成为心血管研究的有吸引力的工具。此外，与啮齿动物模型中应用的大多数酒精施用方案不同，斑马鱼胚胎使用的基于浸泡的酒精递送方法是非侵入性的。^[3]

致编辑：一名60岁男子出现持续4年的进行性恶化的肢体无力，这使他自2018年5月以来一直坐在轮椅上。患者还出现肌肉和关节疼痛和麻木。他有二型糖尿病、高血压和痛风病史，无骨病家族史。他接受了糖尿病周围神经病变治疗，但症状持续恶化。入院时，患者发育良好，体形正常。体格检查除全身无力外，无明显异常。实验室评估显示低磷血症，尿磷丢失显著升高。其他实验室异常包括碱性磷酸酶水平升高、轻度维生素D不足和甲状旁腺激素轻度升高。在骨闪烁扫描未能定位骨肿瘤后，全身正电子发射断层扫描(PET)/计算机断层扫描(CT)使用¹⁸F-氟脱氧葡萄糖（¹⁸F-FDG）和放射性标记的生长抑素类似物⁶⁸进行Ga-DOTATATE以明确诊断致癌性低磷血症性骨软化症。两次检查均发现脐周皮下组织有可疑肿块，右侧腋窝淋巴结肿大[图1A和图1B].

致编辑：反-N-甲基-D-天冬氨酸受体(NMDAR)脑炎是一种潜在致命的自身免疫性疾病，其特征是显著的精神症状和癫痫发作。多发生于年轻女性卵巢畸胎瘤患者。^[1]在这里，我们描述了一个严重的抗NMDAR脑炎病例。患者最初被误诊为精神病，在一线免疫治疗的前4周内没有改善。虽然没有继续接受二线免疫治疗，但患者仍恢复良好，随访3年未观察到复发或肿瘤。

在题为“孕前体重指数和妊娠体重增加与分娩阶段的关系”的文章中，发表在第132卷第4期第483-487页中华医学杂志,^[1]作者单位错误地写为“首都医科大学附属北京妇产医院围产医学科。北京100026，中国”而不是“首都医科大学附属北京妇产医院围产医学科。中国北京100026”，资助名称也错误地写为“首都特色项目（北京市科学技术委员会编号151100004015182）”而不是“北京市科学技术委员会（编号Z151100004015182）”。