Volume 132 · Issue 15 · 2019

Allogeneic stem-cell transplantation (SCT) is a well-established immunotherapeutic strategy for multiple myeloma (MM) with a potent and often sustained graft-vs.-myeloma effect. This multicenter investigation aimed to analyze the complications and survival of haploidentical SCT in patients with MM, and compare the main outcomes with matched-related donors (MRDs).

Haploidentical and MRD SCT was identified from a cohort of 97 patients with MM who received a myeloablative transplantation in 13 hospitals from May 2001 to December 2017. A matched-pair analysis was designed. For each haplo recipient, the recipients were randomly selected from the MRD group and were matched according to the following criteria: year of the hematopoietic SCT (±2 years), disease status at transplantation, and the length of follow-up.

Seventy cases received MRD and 27 received haploidentical transplantation. The two groups showed no significant differences regarding age, gender, cytogenetic risk, and diagnostic stage. The cumulative incidences of non-relapse mortality (NRM) at 1 and 3 years based on donor type were 20.5% (95% confidence interval [CI], 10.90–30.10%) and 24.2% (95% CI, 13.81–34.59%) for the MRD group and 16.80% (95% CI, 1.71–31.89%) and 28.70% (95% CI, 8.71–48.69%) for the haplo group, respectively. Cumulative incidence of NRM did not differ significantly between the two groups (χ² = 0.031, P = 0.861). The cumulative incidences of progression-free survival (PFS) and 1 year and 3 years by type of donors were 59.8% (95% CI, 48.24–71.36%) and 45.4% (95% CI, 33.44–57.36%), and 65.6% (95% CI, 47.18–84.02%) and 26.8% (95% CI, 7.59–46. 01%) for MRD and haploidentical donor, respectively. Cumulative incidence of PFS did not differ significantly between the two groups (χ² = 0.182, P = 0.670). In multivariate analyses, no statistically significant differences were observed between haploidentical and MRD for relapse, NRM, PFS, and overall survival. There were no statistically differences on main outcomes after haploidentical and MRD.

Haploidentical SCT could be performed safely and feasibly for patients with MM in need.

Cascade analysis is an effective method to analyze the processing data of an event, such as a provided service or a series of examinations. This study aimed to develop a primary cervical cancer screening cascade in China to promote the quality of the screening process.

We designed a cervical cancer screening cascade in China according to the program flow chart. It had three stages, each with two steps and one result. Data from 117,522 women aged 35 to 64 years in the Rural Cervical Cancer Surveillance Project from January 1, 2014, to December 31, 2014, were collected to analyze the main results of the cascade. The data and proportion are used to describe the follow-up of cervical cancer and pre-cancer detection rate.

In 2014, 117,522 (80.94% of all cases reported by the Rural Cervical Cancer Surveillance Project) women aged 35 to 64 years had not received cervical cytology in the previous 3 years. The pre-cancer and cancer detection rates were 256.12/100,000 and 16.16/100,000, respectively. A total of 3031 cases failed to follow-up through the screening process, and 1189, 1555, and 287 cases were lost at cervical cytology, colposcopy, and histopathological screening stages, respectively. The estimated cases of pre-cancer and cancer cases would have been 544 and 34, respectively, and the estimated detection rates of pre-cancer and cancer would have been 462.89/100,000 and 28.93/100,000, respectively.

In order to increase the detection rate of cervical cancer, cervical cancer screening staff should focus on increasing the rate of follow-up of those who are positive for cervical cancer screening (ie, those with positive cytology results), especially for the 40 to 44 years age range.

Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations. But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear. This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.

The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed. Among these 67 cases, 21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level II–IV), while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0–I). Clinical features, operation details, and pathology data were collected. Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.

Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs. 282.2 ± 101.9 min, t = 4.685, P < 0.001), more surgical bleeding volume (1200 [325, 2900] mL vs. 500 [180, 1000] mL, U = 270.000, P = 0.004), more surgical blood transfusion volume (800 [0, 1400] mL vs. 0 [0, 800] mL, U = 287.500, P = 0.004), more plasma transfusion volume (0 [0, 800] mL vs. 0 [0, 0] mL, U = 319.000, P = 0.004), higher percentage of open operative approach (76.2% vs. 32.6%, χ² = 11.015, P = 0.001), higher percentage of IVC resection (33.3% vs. 0%, χ² = 17.122, P < 0.001), and higher percentage of post-operative complications (52.4% vs. 19.6%, χ² = 7.415, P = 0.010) than patients with large tumors and low-level thrombus. In multivariate analysis, decreased hemoglobin (Hb) (odds ratio [OR]: 0.956, 95% confidence interval [CI]: 0.926–0.986, P = 0.005) and non-sarcomatoid differentiation (OR: 0.050, 95% CI: 0.004–0.664, P = 0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus. The estimated mean cancerspecific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months, without statistical significance (P = 0.955). After univariate and multivariate Cox proportional hazard survival regression analyses, only distant metastasis (hazard ratio [HR]: 3.839, P = 0.002), sarcomatoid differentiation (HR: 7.923, P < 0.001), alkaline phosphatase (HR: 2.661, P = 0.025), and severe post-operative complications (HR: 10.326, P = 0.001) were independent predictors of prognosis.

The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery. In the same T3 stage, neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.

Sleep disorders are one of the earliest non-motor symptoms of Parkinson’s disease (PD). Sleep disorders could, therefore, have value for recognition and diagnosis in PD. However, no unified classification and diagnostic criteria exist to evaluate sleep disorders by polysomnography (PSG). Utilizing PSG to monitor sleep processes of patients with PD and analyze sleep disorder characteristics and their relationship with demographic parameters could aid in bridging this gap. This preliminary study aimed to evaluate the clinical characteristic of sleep disorders in PD using PSG.

PSG was used to evaluate sleep disorders in 27 patients with PD and 20 healthy volunteers between August 2015 and July 2018 in Fujian Medical University Union Hospital. Total sleep time (TST), sleep efficiency (SE), total wake time, and other parameters were compared between the two groups. Finally, the correlation between sleep disorders and age, disease duration, Unified Parkinson’s Disease Rating Scale-III scores, Hoehn-Yahr stage, and levodopa dose were analyzed. The main statistical methods included Chi-square test, two independent samples t test, Fisher exact test, and Pearson correlation.

Sleep fragmentation in the PD group was significantly increased (74.1%) while difficulty falling asleep and early awakening were not, as compared to healthy controls. No significant differences were found in time in bed, sleep latency (SL), non-rapid eye movement (NREM) stage 1 (N1), N1%, N2, N2%, N3%, and NREM% between PD and control groups; but TST (327.96 ± 105.26 min vs. 414.67 ± 78.31 min, P = 0.003), SE (63.26% ± 14.83% vs. 76.8% ± 11.57%, P = 0.001), R N3 (20.00 [39.00] min vs. 61.50 [48.87] min, P = 0.001), NREM (262.59 ± 91.20 min vs. 337.17 ± 63.47 min, P = 0.003), rapid-eyemovement (REM) (32.50 [33.00] min vs. 85.25 [32.12] min, P < 0.001), REM% (9.56 ± 6.01 vs. 15.50 ± 4.81, P = 0.001), REM sleep latency (157.89 ± 99.04 min vs. 103.47 ± 71.70 min, P = 0.034) were significantly reduced in PD group.

This preliminary study supported that sleep fragmentation was an important clinical characteristic of sleep disorders in PD. Whether sleep fragmentation is a potential quantifiable marker in PD needs to be further investigated in the future study.

Recent genome-wide association studies have identified an important role of T-cell receptor α (TRA) gene in the development of narcolepsy type 1. However, the role of TRA haplotype polymorphisms in the symptomatic diversity of narcolepsy remains unclear. This study aimed to investigate whether TRA polymorphisms can influence the symptomatic diversity of narcolepsy.

Totally, 903 patients with narcolepsy type 1 were included in the study. Patients were divided into different groups according to their symptoms. First, 13 genotyped single nucleotide polymorphisms in the TRA were assessed for their association with symptoms of narcolepsy. We used the Chi-square test to determine differences in genotype frequencies in patients with narcolepsy. Further, we identified the haplotypes and variations of the TRA and tested their association with the symptoms of narcolepsy using a logistic regression model.

According to the results of the logistic regression, TRA haplotypes TG and CT were significantly associated with auditory hallucination, with odds ratios of 1.235 (95% confidence interval [CI], 1.012–1.507) and 1.236 (95% CI, 1.012–1.511), respectively (P < 0.05).

The patterns of haplotype in TRA (haplotypes TG and CT) are associated with hypnagogic auditory hallucination in patients with narcolepsy type 1. However, further studies are needed to confirm our results and explore the underlying mechanisms.

Acute ankle fractures can lead to high rate of concomitant intra-articular lesions which may compromise clinical results. The purpose of this study was to evaluate the Prevalence of concomitant intra-articular lesions in acute ankle fractures with arthroscopy. We also sought to analyze the relationship between intra-articular lesions and the fracture type, as well as the severity of the fracture.

It was a retrospective cohort study. From April 2014 to December 2015, we have chosen arthroscopy-assisted open reduction and internal fixation (AORIF) for the treatment of unstable acute ankle fractures. All concomitant intra-articular lesions were assessed and documented carefully and prospectively, such as ligament injuries, osteochondral lesions, and tibiofibular syndesmosis injuries. All fractures were classified according to the Lauge-Hansen classification system. The American Orthopedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale was used to assess post-operative function. Statistical comparisons between the intra-articular lesions, the fracture type, and the severity of the presenting fracture were performed using a Chi-squared analysis.

Data of 36 patients were analyzed in the study, including 23 supination-type fractures and 13 pronation-type fractures. The incidence of tibiofibular syndesmosis injuries, chondral lesions, and loose bodies were 92%, 72%, and 39%, respectively. Avulsion fractures of the anterior tibiofibular syndesmosis were more commonly found in supination-type fractures than pronation-type fracture (45% vs. 15%, χ² = 5.78, P = 0.02), which would cause mechanical blocking in the anterior portion of the ankle. On the contrary, chondral lesions were more commonly found in the more severe fractures than mild fractures (86% vs. 53%, χ² = 4.57, P = 0.03). A mean 41.7 months (range, 33.0–51.0 months) of follow-up was achieved. A mean AOFAS’s ankle-hindfoot scale was 96.9, and 97.2% of the patients were satisfied with the procedure.

Acute ankle fractures have a high incidence of concomitant intra-articular lesions. Avulsion fractures of the anterior tibiofibular syndesmosis are more commonly found in supination-type fractures. Chondral lesions are related to the severity of the fractures, but not with the classification of the fractures. AORIF can be one reliable solution in dealing with the associated injuries seen with acute ankle fractures.

Elderly patients with diffuse large B-cell lymphoma (DLBCL) have a worse prognosis than younger patients, and the optimal treatment strategy for this group remains controversial. We conducted a retrospective analysis to investigate the clinical features and outcomes of elderly patients (>60 years) and to assess the impact of clinical and molecular factors on outcome in this age group.

From April 2006 to December 2012, a total of 349 elderly patients with DLBCL from the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College were included in this analysis. Patients were further divided into two age groups (61–69 years and ≥70 years). We compared clinical characteristics and outcomes between groups.

Of 349 total patients, 204 (58.5%) were aged 61 to 69 years, and 145 (41.5%) patients were aged 70 years or older. Except for the Eastern Cooperative Oncology Group performance status, clinical characteristics were comparable between the two groups. With a median follow-up of 82 (range, 1–129) months, the 5-year overall survival (OS) and progression-free survival (PFS) rates were 51.9% and 45.8%, respectively. The 5-year OS rates for patients aged 61 to 69 years and those over 70 years were 58.3% and 42.8% (P = 0.007), respectively, and the 5-year PFS rates were 51.0% and 38.6% (P = 0.034). Treatment regimens including rituximab provided a higher 5-year OS rate (63.1% vs. 37.1%, P < 0.001) and PFS rate (56.6% vs. 31.8%, P < 0.001) than chemotherapy alone. For patients aged 61 to 69 years, chemotherapy plus rituximab resulted in a higher 5-year OS rate (66.7% vs. 46.4%, P = 0.002) and PFS rate (60.0% vs. 38.1%, P = 0.002) than chemotherapy alone. For patients aged ≥70 years, there was a marked survival advantage in patients who received chemotherapy plus rituximab (5-year OS rate: 57.7% vs. 25.4%, P < 0.001; 5-year PFS rate: 51.3% vs. 23.9%, P < 0.001) compared with that seen in those who received chemotherapy alone. Multivariate analysis established that stage III/IV disease, elevated lactate dehydrogenase (LDH), initial treatment, and chemotherapy with rituximab were independent risk factors for 5-year OS, and stage III/IV disease, elevated LDH, and chemotherapy with rituximab were independent risk factors for 5-year PFS for elderly patients with DLBCL.

In comparison to patients aged 61 to 69 years, those aged ≥70 years have poorer survival. Prolonged survival is obtainable with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-like in elderly Chinese patients in all age groups, indicating that the R-CHOP-like regimen should be considered for this population, even for those aged 70 years or older.

Emerging evidences have indicated that the composition of gut microbiota was significantly influenced by central nervous system diseases. The digestion and metabolism disturbances of patients with amyotrophic lateral sclerosis (ALS) might be strongly associated with ALS; however, this has rarely been evaluated in these populations. This study was to evaluate bacterial and archaeal composition of gut flora and the corresponding metabolism performance of these micro-organisms in fecal samples of patients with ALS.

A comparative study was performed on the intestinal microbiota from eight patients with ALS and eight healthy individuals at Huadong Hospital during November 2017 to April 2018; meanwhile, the metabolite concentrations of human endotoxin, short-chain fatty acids (SCFA), NO₂-N/NO₃-N, and γ-aminobutyric acid were also evaluated by spectrophotometry methods. The correlations between intestinal microbiota and metabolite concentration were compared between the two groups using one-way analysis of variance; the relative abundance of beneficial and harmful micro-organisms in fecal samples was also analyzed.

In general, the richness and evenness of bacterial and archaeal communities of healthy individuals were healthier than that of patients with ALS. The phylum Firmicutes/Bacteroidetes ratio, genus Methanobrevibacter showed an enhancive tendency in patients with ALS, whereas the relative abundance of beneficial micro-organisms (genera Faecalibacterium and Bacteroides) presented a significant decrease tendency in patients with ALS. In addition, the average concentrations of human endotoxin, SCFA, NO₂-N/NO₃-N, and γ-aminobutyric acid in patients with ALS and healthy individuals were 64.2 vs. 65.3 EU/mL, 57.5 vs. 55.3 μg/mL, 5.7 vs. 5.3 ng/mL, and 6.1 vs. 5.4 μmol/L, respectively, indicating that the digestion and metabolism functions of gastrointestinal tract of patients might decline with this disease.

The relative abundance of beneficial and harmful micro-organisms respectively showed decrease and increase tendency in patients with ALS.

Collagen type IV (COL4)-related nephropathy includes a variety of kidney diseases that occur with or without extra-renal manifestations caused by COL4A3-5 mutations. Previous studies revealed several novel mutations, including three COL4A3 missense mutations (G619R, G801R, and C1616Y) and the COL4A3 chr:228172489delA c.4317delA p.Thr1440ProfsX87 frameshift mutation that resulted in a truncated NC1 domain (hereafter named COL4A3 c.4317delA); however, the mutation mechanisms that lead to podocyte injury remain unclear. This study aimed to further explore the mutation mechanisms that lead to podocyte injury.

Wild-type (WT) and four mutant COL4A3 segments were constructed into a lentiviral plasmid, then stably transfected into human podocytes. Real-time polymerase chain reaction and Western blotting were applied to detect endoplasmic reticulum stress (ERS)- and apoptosis-related mRNA and protein levels. Then, human podocytes were treated with MG132 (a proteasome inhibitor) and brefeldin A (a transport protein inhibitor). The human podocyte findings were verified by the establishment of a mus-Col4a3 knockout mouse monoclonal podocyte using clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) technology.

Our data showed that COL4A3 mRNA was significantly overexpressed in the lentivirus stably transfected podocytes. Moreover, the COL4A3 protein level was significantly increased in all groups except the COL4A3 c.4317delA group. Compared to the other test groups, the COL4A3 c.4317delA group showed excessive ERS and apoptosis. Podocytes treated with MG132 showed remarkably increased intra-cellular expression of the COL4A3 c.4317delA mutation. MG132 intervention improved higher ERS and apoptosis levels in the COL4A3 c.4317delA group. Mouse monoclonal podocytes with COL4A3 chr:82717932insA c.4852insA p.Arg1618ThrfsX4 were successfully acquired; this NC1-truncated mutation suggested a higher level of ERS and relatively remarkable level of apoptosis compared to that of the WT group.

We demonstrated that excessive ERS and ERS-induced apoptosis were involved in the podocyte injury caused by the NC1-truncated COL4A3 mutation. Furthermore, proteasome pathway intervention might become a potential treatment for collagen type IV-related nephropathy caused by a severely truncated COL4A3 mutation.

Imbalance of intestinal microbiota was closely related to colitis. Under these circumstances, regulation of enteric flora may be beneficial to the repair of inflammation. We aimed to investigate the effects of probiotics (Bifidobacterium and Lactobacillus), prebiotics and their combination on inflammation, and microflora in mice of acute colitis.

C57BL/6J mice were divided into six groups randomly (blank control group, model control group, probiotics group, synbiotics group, lactitol group and probiotics + lactitol group). Each group was given 2.5% dextran sulfate sodium drinking water for 5 days other than the blank control group. Except for the model control group, the other four groups were intervened with probiotics, synbiotics (probiotics and inulin), lactitol, and probiotics + lactitol. Mice were sacrificed after 1 week of gavage, and pathologic scores were calculated. The feces of different periods and intestinal mucosa samples were collected to analyze the differences of intestinal microbiota by 16S rRNA sequencing. Differences of two groups or multiple groups were statistically examined through unpaired Student t test and analysis of variance (ANOVA), respectively. ANOVA, Tukey, Anosim, and metastats analysis were used to compare differences of microbiota among different groups.

After gavage for 1 week, the pathologic scores of groups with the intervention were significantly lower than those in the model control group, and the difference was statistically significant (P < 0.05). The model control group was higher in the genus of Bacteroides (relative abundance: 0.3679 vs. 0.0099, P = 0.0016) and lower in Lactobacillus (relative abundance: 0.0020 vs. 0.0122, P = 0.0188), Roseburia (relative abundance: 0.0004 vs. 0.0109, P = 0.0157), compared with the blank control group. However, the same phenomenon was not found in groups gavaged with probiotics and lactitol. Compared with model control group, mice with intervention were increased with Bifidobacterium (relative abundance: 0.0172 vs. 0.0039, P = 0.0139), Lachnospiraceae_NK4A136_group (relative abundance: 0.1139 vs. 0.0320, P = 0.0344), Lachnospiraceae_UCG-006 (relative abundance: 0.0432 vs. 0.0054, P = 0.0454), and decreased with Alistipes (relative abundance: 0.0036 vs. 0.0105, P = 0.0207) in varying degrees. The mucosal flora was more abundant than the fecal flora, and genus of Mucispirillum (relative abundance: 0.0207 vs. 0.0001, P = 0.0034) was more common in the mucosa. Lactitol group showed higher level of Akkermansia than model control group (relative abundance: 0.0138 vs. 0.0055, P = 0.0415), probiotics group (relative abundance: 0.0138 vs. 0.0022, P = 0.0041), and synbiotics group (relative abundance: 0.0138 vs. 0.0011, P = 0.0034), while probiotics + lactitol group had more abundant Akkermansia than synbiotics group (relative abundance: 0.0215 vs. 0.0013, P = 0.0315).

Probiotics and prebiotics reduce the degree of inflammation in acute colitis mice obviously. Mice with acute colitis show reduced beneficial genera and increased harmful genera. Supplementation of probiotics and prebiotics display the advantage of increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota. Lactitol might promote the proliferation of Akkermansia.

The purpose of this review is to stress the complicated interactions between the microbiota and the development of heart failure. Moreover, the feasibility of modulating intestinal microbes and metabolites as novel therapeutic strategies is discussed.

This study was based on data obtained from PubMed up to March 31, 2019. Articles were selected using the following search terms: "gut microbiota," "heart failure," "trimethylamine N-oxide (TMAO)," "short-chain fatty acid (SCFA)," "bile acid," "uremic toxin," "treatment," "diet," "probiotic," "prebiotic," "antibiotic," and "fecal microbiota transplantation."

Accumulated evidence has revealed that the composition of the gut microbiota varies obviously in people with heart failure compared to those with healthy status. Altered gut microbial communities contribute to heart failure through bacterial translocation or affecting multiple metabolic pathways, including the trimethylamine/TMAO, SCFA, bile acid, and uremic toxin pathways. Meanwhile, modulation of the gut microbiota through diet, pre/probiotics, fecal transplantation, and microbial enzyme inhibitors has become a potential therapeutic approach for many metabolic disorders. Specifically, a few studies have focused on the cardioprotective effects of probiotics on heart failure.

The composition of the gut microbiota in people with heart failure is different from those with healthy status. A reduction in SCFA-producing bacteria in patients with heart failure might be a notable characteristic for patients with heart failure. Moreover, an increase in the microbial potential to produce TMAO and lipopolysaccharides is prominent. More researches focused on the mechanisms of microbial metabolites and the clinical application of multiple therapeutic interventions is necessarily required.

随着内镜技术和设备的发展，内镜手术已被广泛用于治疗许多疾病，如早期胃肠道癌症、粘膜下肿瘤和贲门失弛缓症。内镜手术可分为消化内镜隧道技术（DETT）和非隧道技术。非隧道技术包括内镜粘膜切除术、内镜分段粘膜切除术、内镜粘膜下剥离术（ESD）、多带粘膜切除术、内镜粘膜下挖掘术和内镜全层切除术。^[1]内镜粘膜下隧道剥离术（ESTD）、经口内镜肌切开术（POEM）和粘膜下隧道内镜切除术（STER）被认为是DETT的类型。内镜切除比开放手术和电视辅助手术更安全、更微创。^[2,3]切除并发症发生率被视为评价内镜手术安全性的主要标准，而出血和“穿孔”被报道为最常见的术中并发症。^[4,5]

围手术期神经认知障碍（PND）是一个国际多学科小组推荐的新术语，该小组名为命名共识工作组，包括来自麻醉学、神经病学、老年病学、精神病学、神经心理学、外科和心理学等多个学科的专家。它是围手术期发现的认知障碍的综合术语。这一新命名法的建议已于2018年11月同时发表在多家有影响力的期刊上。^{[1,2,3,4,5,6]}这是围手术期认知障碍领域的巨大变化。因此，有必要了解这一新命名法的原因和目的，新旧命名法之间的差异，以及新命名法对未来围手术期认知障碍临床和基础研究可能产生的影响。

急诊科经常会遇到很多重症。^[1,2,3]脓毒症是急诊室死亡的主要原因，是一种由危及生命的感染诱发的涉及生理、病理和生化异常的综合征。^[4]脓毒症直接或间接损害几乎所有类型的免疫细胞的功能，^[5,6]并启动随时间变化的复杂免疫应答，导致严重的免疫抑制，包括代谢衰竭、表观遗传重编程和髓源性抑制细胞。^[7,8]

中共中央于2018年5月30日会同国务院发布了首个与学术道德相关的政策。^[1]它详细介绍了一系列旨在提高整个研究领域的学术诚信的改革，包括资金、工作申请、同行评审和出版物。新政策明确，建立职责明确、协同高效的科研诚信高水平管理体系，要求科技部、中国社会科学院负责自然科学、哲学社会科学领域科研诚信工作的统筹协调和指导。MOST和CASS还被授权对学术不端行为案件进行调查和裁决，这一职责以前由个别机构履行。此外，该政策规定，教育部（MOE）、卫生和计划生育委员会、国家新闻出版局（NNPB）、中国科学技术协会、国家自然科学基金委员会、国家社会科学基金委员会、中国科学院、中国工程院以及各级地方政府及其相关科技规划管理部门、教育、卫生、新闻和出版部门应各自履行监督职能，监督学术诚信和政策具体条款的执行。作为一项非常引人注目的政策，它引入了与国家“社会信用体系”相联系的综合惩罚制度，引起了国际社会的极大关注，该体系自2014年建立以来对中国的生活产生了巨大影响，^[2]在这个系统中，不遵守一个政府机构的规则可能意味着面临其他政府机构的限制或处罚。^[3]它解释说，学术不端行为可以受到全面的处罚清单的惩罚，从而产生一种在世界各地从未见过的问责制度。^[4]以建设世界一流科技期刊为目标，我国学术期刊在进入机遇与挑战并存的新发展时期的同时，也有可能进行严峻的改革和革新。所谓“联合”或“社会”处罚的出台，被媒体热议。公众舆论一致认为，如果违法者真的受到惩罚，如在现有的惩罚（如失去赠款和奖励）之外，限制在学术界以外的工作或发放信用卡、保险，甚至购买火车票，那么关于不当行为或“失去信任”的新政策将会有效。

近年来，越来越多的证据表明，体外冲击波疗法（ESWT）可以提供一种有效和非侵入性的方法来治疗肌肉骨骼疾病，如肩部肌腱病、肘外侧上髁病、大转子疼痛综合征、髌腱病、跟腱病、足底筋膜炎和骨骼疾病。^[1,2]ESWT作为一种安全、廉价、无创的治疗方法，在骨科医学中发挥了有前途的作用。^[3,4,5]受此启发，一些研究人员试图研究其用于治疗股骨头坏死。ESWT值得推荐为股骨头坏死（ONFH）的最佳选择。

致编辑：来自桥小脑角（CPA）的一组极其异质性的肿瘤仅占所有颅内肿瘤的约5%。因此，在这里，我们报告了一系列四个相对罕见的CPA病例，以提供对该区域术前分化的额外见解。

致编辑：男，48岁（80kg，182cm），拟于2017年9月19日行盆腔肿瘤切除术。本病例报告符合基于共识的临床病例报告(CARE)指南，该指南可通过提高健康研究(EQUATOR)网络指南获得。他的病史仅包括5年前接受的胆囊切除术。术前实验室数据无显著性（静脉钾水平，4.0 mmol/L）。心电图（ECG）显示完全性右束传导阻滞，心率73次/分钟。到达手术室后，引入动脉管路以连续测量有创动脉压。术前动脉血气®Premier 3000；Instrumentation Laboratory Co.，Bedford，MA，USA）分析显示pH为7.41，二氧化碳分压（PCO₂）水平为39 mmHg，HCO₃^-水平25.1 mmol/L，钾水平3.6 mmol/L。随后，通过静脉给予麻醉剂诱导全身麻醉，并通过吸入和静脉麻醉剂的组合维持麻醉。输注乳酸林格氏液（湖南科伦药业有限公司，中国湖南）和羟乙基淀粉（北京费森尤斯卡比制药有限公司，中国北京）以维持血容量。手术通过经腹膜入路进行，在下腹壁放置了五个端口。将患者置于30°Trendelenburg体位。在手术中，发现一个大的囊性肿瘤（直径约7厘米）在膀胱后壁和直肠之间凸出。盆腔肿瘤与前列腺和直肠前壁致密粘连。在肿瘤切除过程中损伤了膀胱后壁和直肠壁。目前，ABG分析显示pH值为7.26，PCO₂水平为50 mmHg，HCO₃^-水平21.1 mmol/L，钾水平3.7 mmol/L。此后，由主治结直肠外科医生修复直肠浆膜层病变1.5 h。完成该程序后，ABG分析显示pH值为7.26，PCO₂水平为53 mmHg，HCO₃^-水平22.1 mmol/L，钾水平5.8 mmol/L。虽然循环系统稳定，心电图未见明显变化，但动脉钾水平急剧升高。为了验证这一观察结果的准确性，我们再次抽取动脉血，用两台相同型号的血气分析仪进行测试。钾水平的结果与前一项相似。然后，注射12IU胰岛素、40mL 50%葡萄糖和5mg呋塞米。动脉钾水平分别在40分钟和2小时后降至4.6和4.1 mmol/L。为了整体肿瘤切除，前列腺和精囊完全切除。最后，由泌尿科医生在腹腔镜下进行膀胱尿道吻合术。患者拔管后安全返回病房。术中出血量约为600 mL。围手术期未输注任何血液制品。实验室数据显示术后第1、2和6天静脉钾水平分别为4.02、3.91和3.90 mmol/L。10天后安全出院。

致编辑：肺嗜酸细胞类癌（OCTL）是一种罕见的神经内分泌癌。在此，我们报告一例OCTL并发肺结核（TB）。

致编辑：多重酰基辅酶A脱氢缺乏症是一种常染色体隐性脂质贮积肌病（LSM）。^[1]临床特征是异质性的，分为三类：伴有先天性异常的新生儿发病型（I型）、无先天性异常的新生儿发病型（II型）和迟发型（III型）。^[2]在过去的20年里，越来越多的LSM病例被报道。^[3,4]在本报告中，我们描述了一名携带复合杂合突变的LSM患者ETFDH基因，包括外显子6的一个新剪接突变（c.684+1G>T）和外显子10的一个新点突变（c.1204A>T）。

致编辑：脑白质营养不良是一组遗传性神经障碍，其特征在于损害白质的髓鞘。基于脑白质营养不良的原始定义，Timmons等人^[1]描述了4例髓鞘形成不足、促性腺激素性性腺功能减退和牙齿缺失的患者，并建议将本病命名为4H综合征。几年后，人们发现POLR3A或者POLR3B编码RNA聚合酶III的两个最大亚基的基因被证明会导致4H脑白质营养不良。^[2]我们在此报告了一名患有4H脑白质营养不良的妇女在POLR3A中以纯合状态携带c.1911+18 C>T突变，这是国内首次报道该突变位点。

致编辑：吉罗维氏肺孢子虫肺炎（PCP）是一种危及生命的机会性感染，常见于人类免疫缺陷病毒（HIV）感染患者。五氯苯酚可发生在没有HIV的患者中，包括那些接受过器官移植、化疗和/或高剂量皮质类固醇治疗的患者。^[1]侵袭性曲霉病（IA）也是免疫功能低下患者的机会性感染，包括接受化疗、类固醇治疗、移植的患者和晚期HIV感染的个体。^[2]

致编辑：重度抑郁症（MDD）是青少年自杀的主要原因之一。剖腹产不仅影响母亲，也影响孩子，包括婴儿的认知和大脑发育以及其他身体疾病。^[1]许多影响儿童的疾病已被发现与剖腹产分娩有关，主要是由于缺乏阴道微生物和婴儿在正常阴道分娩时所经历的挤压压力。^[1]然而，很少有关于年轻MDD患者抑郁严重程度和剖腹产之间关系的报道。因此，我们旨在分析年轻抑郁症患者抑郁症状与剖腹产之间的主要关系。

致编辑：孤立性浆细胞瘤是一种不常见的浆细胞肿瘤，占所有浆细胞肿瘤的5%~10%。根据部位分为两类：发生于骨的孤立性骨浆细胞瘤（SBP）和发生于软组织的孤立性髓外浆细胞瘤（EMP）。SBP比EMP高40%。虽然EMP可以在全身出现，但90%出现在头颈部，尤其是鼻腔、鼻旁窦和咽部。^[1]然而，喉部EMP是一种罕见的情况，占所有喉部恶性病变的0.04%至0.19%。而喉EMP的变异表现使得在没有最终病理结果的情况下，准确诊断相当困难。在此，我们报告一例被误诊为声带息肉的EMP病例。

致编辑：Marchiafava-Bignami病（MBD）是一种罕见的神经系统疾病，常与酒精中毒有关，其特征是胼胝体（CC）中层脱髓鞘和坏死。^[1]文献中描述了MBD的广泛临床表现，包括精神状态改变、行走受损、构音障碍、缄默症、断开综合征体征、尿失禁、癫痫发作和痴呆。常规磁共振成像（MRI）序列可用于诊断MBD，其证明CC对称受累，在T2加权和流体衰减反转恢复（FLAIR）图像上具有高信号。然而，MBD患者的病变不仅限于CC。本研究的目的是证明MBD的临床和放射学特征。

致编辑：2017年4月8日，北京市政府在北京全市3600多家公立和民营医院启动医药分开综合改革。^[1]目前的改革范围很广，因为它包括取消药品加成，引入医疗服务费（MSF），以及435个基本医疗服务项目的价格调整。改革有多个目标，包括提高医疗服务质量和促进更有效地利用有限的资源。然而，这项改革的主要目标之一是通过提高反映医务人员价值的物品的价格和降低反映设备和药品价值的物品的价格，在全球预算的限制范围内重塑医院的收入结构。MSF是向前迈出的关键一步：