Volume 132 · Issue 18 · 2019

Thyroid autoimmunity (TAI) is prevalent among women of reproductive age and associated with adverse pregnancy outcomes. This study aimed to investigate the association between iron nutritional status and the prevalence of TAI in women during the first trimester of pregnancy and in non-pregnant women of childbearing age.

Cross-sectional analysis of 7463 pregnant women during the first trimester of pregnancy and 2185 non-pregnant women of childbearing age nested within the sub-clinical hypothyroid in early pregnancy study, a prospective collection of pregnant and non-pregnant women’s data, was conducted in Liaoning province of China between 2012 and 2015. Serum thyrotropin, free thyroxine, thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), serum ferritin, and urinary iodine were measured. Iron deficiency (ID) was defined as serum ferritin <15 μg/L and iron overload (IO) was defined as ferritin >150 μg/L. TPOAb-positive was defined as >34 U/mL and TgAb-positive was defined as >115 U/mL. Multilevel logistic regression was conducted to examine the association between TAI and different iron nutritional status after adjusting for potential confounders.

The prevalence of isolated TPOAb-positive was markedly higher in women with ID than those without ID, in both pregnant and non-pregnant women (6.28% vs. 3.23%, χ² = 10.264, P = 0.002; 6.25% vs. 3.70%, χ² = 3,791, P = 0.044; respectively). After adjusting for confounders and the cluster effect of hospitals, ID remained associated with TPOAb-positive in pregnant and non-pregnant women (odds ratio [OR]: 2.111, 95% confidence interval [CI]: 1.241–3.591, P = 0.006; and OR: 1.822, 95% CI: 1.011–3.282, P = 0.046, respectively).

ID was associated with a higher prevalence of isolated TPOAbs-positive, but not with isolated TgAb-positive, in both pregnant women during the first trimester of pregnancy and non-pregnant women of childbearing age, while IO was not associated with either isolated TPOAb-positive or isolated TgAb-positive.

ChiCTR-TRC-13003805, http://www.chictr.org.cn/index.aspx.

The association between peripheral leukocyte count and bleeding events in nonvalvular atrial fibrillation (NVAF) patients treated with dabigatran remains unclear. This study aimed to explore the association between leukocyte count and bleeding events after excluding other confounders in NVAF patients taking dabigatran.

A total of 851 NVAF patients treated with dabigatran (110 mg bid) were recruited from 12 centers in China from February 2015 to December 2017. Follow-up was completed by May 2018. The exposure and outcome variables were leukocyte count measured at baseline and the number of bleeding events within the subsequent 6 months. Multivariate Cox proportional hazards models were constructed to analyze independent associations, and a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (penalized spline method) was used to address nonlinearity between leukocyte count and bleeding. The inflection point was calculated using a recursive algorithm, and then a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed.

During 6-month follow-up, 87 participants occurred bleeding events. For every 1 × 10⁹/L increase in leukocyte count, the risk of bleeding increased by 11% (hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 0.99–1.25). The smooth curve showed nonlinear relationship between leukocyte count and bleeding events. The inflection point of the leukocyte count was 6.75 × 10⁹/L. For leukocyte counts < 6.75 × 10⁹/L, the HR (95% CI) was 0.88 (0.69–1.13), and for leukocyte counts ≥ 6.75 × 10⁹/L, the HR (95% CI) was 1.28 (1.09–1.51).

This study found a J-shaped association between baseline leukocyte count and risk of bleeding in NVAF patients treated with dabigatran.

NCT02414035, https://clinicaltrials.gov.

Handan Eye Study (HES), a large population-based cohort study in rural area of northern China, was one of the few studies focusing on the major eye diseases of rural Chinese population. The aim of this study was to introduce the design, methodology and to assess the data quality of the follow-up phase of HES.

All participants were recruited in Yongnian county of Handan city between 2012 and 2013. Main outcomes were measured by visual quality scales and ocular examinations. We performed the Chi-square test to make comparison of categorical data among groups, One-way analysis of variance and Kruskal-Wallis test was applied to make comparison of continuous data among groups, a post-hoc test was done to make further pairwise comparison. Inter-class correlation coefficients (ICCs) and Kappa coefficients were used to evaluate the consistency between different operators. Logistic regression was used to explore the influence factors of death, odds ratio (OR) and 95% confidence interval (CI) were used to estimate the effect size of each influence factor.

The follow-up rate was 85.3%. Subjects were classified into three groups: the follow-up group (n = 5394), the loss to follow-up group (n = 929), and the dead group (n = 507), comparison of their baseline information was done. Compared with the other two groups, age of the dead group (66.52 ± 10.31 years) was the oldest (Z = 651.293, P < 0.001), male proportion was the highest (59.0%) (χ² = 42.351, P < 0.001), only 65.9% of the dead finished middle school education (Z = 205.354, P < 0.001). The marriage percentage, body mass index (BMI), best-corrected visual acuity (BCVA), and intra-ocular pressure of the dead group was the lowest either. Spherical equivalent error (SER) of the dead group was the highest. Besides, history of smoking, hypertension, diabetes, and heart disease were more common in the dead group. Multivariate analysis showed that age (OR = 1.901, 95% CI: 1.074–1.108), gender (OR = 0.317, 95% CI: 0.224–0.448), and BCVA (OR = 0.282, 95% CI: 0.158–0.503) were associated with death. While between the follow-up group and the loss to follow-up group, there was only difference on age, gender, BMI, systolic blood pressure and SER. The Cronbach coefficients of all scales used in the follow-up were ≥0.63 and the cumulative variances were ≥0.61, indicating good reliability and validity. The ICCs and Kappa coefficients between different operators were ≥0.69.

HES has a high follow-up rate and a low risk of loss to follow-up bias. Age, gender, and BCVA are influence factors of death. Specifically, male subjects are at a higher risk of death than female, age is a risk factor of death while BCVA is a protective factor for death.

Anastomotic leakage is a serious surgical complication in rectal cancer; however, effective evaluation methods for predicting anastomotic leakage individual risk in patients are not currently available. This study aimed to develop a method to evaluate the risk of leakage during surgery.

The 163 patients with rectal cancer, who had undergone anterior resection and low-ligation procedures for Doppler sonographic hemodynamic measurement from April 2011 to January 2015 in Peking University Cancer Hospital, were prospectively recruited. A predictive model was constructed based on the associations between anastomotic leakage and alterations in the anastomotic blood supply in the patients, using both univariate and multivariate statistical analyses, as well as diagnostic methodology evaluation, including Chi-square test, logistic regression model, and receiver operating characteristic curve.

The overall anastomotic leakage incidence was 9.2% (15/163). Doppler hemodynamic parameters whose reduction was significantly associated with anastomotic leakage were peak systolic velocity, pulsatility index, and resistance index. The areas under the receiver operating characteristic curve of residual rates of peak systolic velocity, pulsatility index, and resistance index in predicting anastomotic leakage were 0.703 (95% confidence interval [CI]: 0.552–0.854), 0.729 (95% CI: 0.579–0.879), and 0.689 (95% CI: 0.522–0.856), respectively. The predictive model revealed that the patients with severely reduced blood-flow signal exhibited a significantly higher incidence rate of anastomotic leakage than those with sufficient blood supply (19.6% vs. 3.7%, P = 0.003), particularly the patients with low rectal cancer (25.9% vs. 3.9%, P = 0.007) and those receiving neoadjuvant chemoradiotherapy (32.1% vs. 3.7%, P = 0.001), independent of prophylactic ileostoma. Multivariate analysis revealed that insufficient blood supply of the anastomotic bowel was an independent risk factor for anastomotic leakage (odds ratio: 10.37, 95% CI: 2.703–42.735, P = 0.001).

Based on this explorative study, Doppler sonographic hemodynamic measurement of the anastomotic bowel presented potential value in predicting anastomotic leakage.

The prognosis of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is very poor with a high mortality. The aim of this study was to describe the clinical features and survival of patients with AE-IPF with usual pulmonary fibrosis (UIP) and possible UIP (P-UIP) pattern on chest high resolution computed tomography (HRCT).

This retrospective study included 107 patients with AE-IPF admitted to Nanjing Drum Tower Hospital from January 2010 to December 2016. The subjects were divided into UIP (n = 86) and P-UIP group (n = 21) based on chest HRCT. Continuous variables were analyzed using Student’s t test or Mann-Whitney U test. Categorical variables were analyzed using χ² test. Log-rank test was used for the survival analysis. Cox proportional models evaluated the risk factors for AE occurrence and survival.

The male, older patients, previous N-acetylcysteine use, elevated white blood cell (WBC) counts, and microbiology infection were more common in the UIP group than the P-UIP group (χ²= 13.567, P < 0.001; z = -2.936, P = 0.003; χ² = 5.901, P = 0.015; t = 2.048, P = 0.043; χ² = 10.297, P = 0.036, respectively). The percentage of AE with UIP pattern in idiopathic interstitial pneumonia (IIP) was significantly higher than P-UIP pattern (χ² = 40.011, P < 0.001). Smoking was the risk factor for AE within 6 months after IPF diagnosis in the UIP group. The cumulative proportion survival of 30-days was significantly higher in the UIP group compared with the P-UIP group (χ² = 5.489, P = 0.019) despite of the similar overall survival in the two groups. Multivariate Cox regression analysis indicated WBC count, partial pressure of oxygen in artery (PaO₂)/fractional concentration of inspired oxygen (FiO₂), and computed tomography (CT) score were the independent predictors for survival in the UIP group (hazard ratio [HR]: 1.070, 95% confidential interval [CI]: 1.027-1.114, P = 0.001; HR: 0.992, 95% CI: 0.986–0.997, P = 0.002; and HR: 1.649, 95% CI: 1.253–2.171, P < 0.001, respectively).

AE occurrence of UIP patients in IIP was significantly more than P-UIP cases. The short-term survival was better in the UIP group despite of the similar overall survival in the two groups. WBC count, PaO₂/FiO₂, and CT score were the independent predictors for survival in UIP subjects.

Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction. This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction.

Thirty morbidly obese patients with a body mass index 40 to 73 kg/m² undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study. After adequate pre-oxygenation, 5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min. After motor responses to jaw thrust disappeared, a SAD was inserted and insertion conditions were graded. The anatomic position of SAD was assessed using a fiberoptic bronchoscope.

The SAD was successfully inserted at the first attempt in all patients. Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%), respectively. The fiberoptic views of SAD position were adequate in 28 patients (93%).

Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients.

ChiCTR1800016868; http://www.chictr.org.cn/showproj.aspx?proj=28646.

Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.

We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.

Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001–1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264–8.609; P = 0.034).

This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Few studies have reported brain function differences in drug-naïve first-episode schizophrenia patients who had auditory verbal hallucinations (AVH) with insight vs. those without insight. This study aimed to investigate brain function differences between drug-naïve first-episode AVH-schizophrenia patients with and without insight.

Forty first-episode drug-naïve AVH-schizophrenia patients with or without insight and 40 healthy controls between December 2016 and December 2018 were recruited in this study. The auditory hallucinations rating scale (AHRS) was used to assess AVH severity, while the insight and treatment attitudes questionnaire was used to distinguish insight. The global functional connectivity density (gFCD) between different groups was compared using a voxel-wise one-way analysis of covariance. The relationship between gFCD and AHRS total scores were analyzed using voxel-wise multiple regression.

Finally, 13 first-episode drug-naïve AVH-schizophrenia patients with insight, 15 AVH-schizophrenia patients without insight, and 20 healthy controls were included for analysis. Except for global assessment of functioning scores, there were no significant differences in sociodemographic information between the AVH-schizophrenia and healthy groups (P > 0.05). Compared to the healthy controls, AVH-schizophrenia patients with insight demonstrated a decreased gFCD in the supramarginal gyrus within the primary auditory cortex, while those without insight demonstrated an increased gFCD in the inferior frontal gyrus and superior temporal gyrus and decreased gFCD in the supplemental motor area. Compared to the AVH-schizophrenia patients with insight, those without insight demonstrated an increased gFCD in the supra-marginal gyrus and posterior superior temporal lobule and a decreased gFCD in the frontal lobe. No significant correlation between gFCD and AVH severity (AHRS total score: r = 0.23, P = 0.590; and frequency: r = 0.42, P = 0.820) was found in both AVH-schizophrenia groups.

The gFCD-aberrant brain regions in the AVH-schizophrenia patients without insight were wider compared to those with insight, although the AHRS scores were not significantly different. The AVH-schizophrenia patients without insight had wide functional impairment in the frontal lobule, which may underlie the lack of insight and the abnormal hyperactivity in the inferior frontal gurus and temporal lobe related to the AVH symptoms.

Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.

We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.

Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29–0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23–0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.

Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.

MicroRNAs (miRNAs) have played important roles in the regulation of gene expression in many cancers, but their roles in esophageal squamous cell carcinoma (ESCC) are still unclear. The aim of this study was to determine the potential ESCC-specific key miRNAs from a large sample dataset in The Cancer Genome Atlas (TCGA).

Integrative bioinformatics analysis was used to identify key ESCC-specific miRNAs related to the ESCC patients’ tumor histological grade and lymphatic metastasis from TCGA. Next, these key miRNA potential gene regulatory functions and relationships with ESCC patients’ clinical characteristics and overall survival were analyzed. Finally, three key miRNAs were selected randomly and quantificational real-time polymerase chain reaction (qRT-PCR) was used to validate in 51 newly diagnosed ESCC patients’ tissues samples (collected from Nov. 2017 to Feb. 2019, in Wuwei, China) whether the bioinformatics analyses results were reliable and valid. Two-tailed Student’s t test, Pearson Chi-squared test and Kaplan-Meier survival analysis were used in this study.

Thirty-five ESCC-specific miRNAs from TCGA database were investigated (fold-change > 2.0, P < 0.05), and 28 participated in the miRNAs-mRNAs co-expression network construction, while 17 were related with ESCC patients’ tumor histological grade, TNM stage, and lymphatic metastasis (P < 0.05). Meanwhile, six miRNAs (including miR-200b-3p, miR-31-5p, miR-15b-5p, miR-141-3p, miR-135b-5p, and miR-195-5p) were correlated with overall survival of ESCC patients (log-rank, P < 0.05). MiR-135b-5p, miR-15b-5p, and miR-195-5p were selected for verification of the expression levels in 51 ESCC patients’ tissue samples by using qRT-PCR. We found that the fold-changes between qRT-PCR and TCGA were completely consistent. The results also suggested that miR-135b-5p, miR-15b-5p, and miR-195-5p were significantly correlated with tumor differentiation degrees (P < 0.05), miR-195-5p was significantly correlated with tumor TNM stage (P < 0.05), and miR-135b-5p was significantly correlated with lymph-node metastasis (P < 0.05). MiR-135b-5p, miR-15b-5p, and miR-195-5p expression levels, ESCC patient clinical features association analysis results and the aforementioned TCGA bioinformatics analyses were similar.

This study identified key ESCC-related miRNAs. The key miRNAs are worthy of further investigation as potential novel biomarkers for diagnosis, classification, and prognosis of ESCC.

Autologous fat grafting has gained popularity in breast augmentation. Various methods can be used to estimate the volume retention rate. This systematic review aimed to establish whether the type of method used for measuring breast volume is a factor that influences the reported volume retention rate.

Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception of the database up to February 2019. Articles describing autologous fat grafting for breast augmentation were selected based on pre-determined inclusion and exclusion criteria. The characteristics of the included studies were summarized, and the reported volume retention rate from the studies was compared. A quality assessment of all included articles was performed using the methodological index for non-randomized studies criteria.

A total of 618 articles were identified, of which 12 studies, with a total of 1337 cases, were eligible. The retention rate of injected adipose tissue varied when the method of fat grafting and volume analysis used were both the same, as well as when the method of fat grafting was the same but the method of volumetric evaluation used was different.

Currently, the tools available for estimating the volume retention rate come with limitations. In order to objectively evaluate the percentage of graft retention, a standard protocol that applies to the different methods should be established in the future.

Anabolic-androgenic steroids (AAS) represents a group of synthetic testosterone derivatives that play an important role in clinical treatment. These drugs are widely abused among the general public to increase lean weight and improve athletic performance. It has been reported that AAS use can produce many adverse effects, especially the occurrence of cardiovascular risk. Although there are many related studies, there has been no consensus on AAS use and cardiovascular risk. The present study was to review the effect of AAS on the cardiovascular system.

The data in this review were obtained from articles included in PubMed and the National Center for Biotechnology Information database.

Original articles, case reports, and systematic reviews about AAS were selected for the article.

The use/abuse of AAS is correlated with higher cardiovascular risks, and many AAS users/abusers had cardiovascular diseases. However, there are many confounding factors in the studies that explored the causality between AAS intake and disease development, and additional studies are required to determine AAS toxicity.

AAS produces toxic effects on the cardiovascular system, and it is necessary to ensure that more people know this about AAS, including medical personnel.

Chronic rhinosinusitis (CRS) involves inflammation of the nasal and para-nasal mucosa. Due to its heterogeneous nature, unknown pathogenesis, and high recurrence rate, effective treatment is difficult. Nasal cytology is presently not a part of the routine diagnosis or treatment decision for CRS.

A literature search was performed for published papers in English between January 1990 and June 2019 using MEDLINE.

Terms used were chronic rhinosinusitis, eosinophils, etiology, immunopathology, inflammation, mast cells, nasal cytology, polyps, and treatment. Both reviews and original articles were collected and studied.

There is no standard nasal fluid, mucus sampling, or staining techniques for identifying inflammatory cell types. Results were divergent from different countries. Moreover, the main focus of these papers on the cells in nasal washings was eosinophils, with infrequent mentioning of other cell types that may imply different etiology and pathology. The heterogeneous cell profile of CRS and the role of mast cells have been unappreciated due to the lack of specific immunohistochemical technique or study of its unique mediators.

Nasal cytology could help distinguish the type and the activation state of inflammatory cells. Thus it can help in providing a clearer picture of CRS pathogenesis, identifying different patient groups, and developing effective treatments.

由于技术的复杂性，主动脉弓病变的外科治疗对心脏外科医生来说是一个挑战。对于不适合接受传统开放弓置换术的高危患者，去分支胸主动脉腔内修复术（d-TEVAR）往往是一个不错的选择。逆行A型主动脉夹层（RTAD）是d-TEVAR术后常见且致命的并发症，^[1]因此d-TEVAR在低风险患者中是禁忌的。在此，我们描述了使用人造血管对升主动脉进行主动脉成形术的d-TEVAR的改进，并随后用作锚定区以最大限度地减少RTAD的发生。

肝脏未分化胚胎肉瘤(UESL)在临床上很少出现。在所有儿童实体瘤中，大约1%~4%是恶性肝肿瘤，UESL占肝肿瘤的9%~15%。UESL通常发生在6至10岁，没有明显的性别差异。^[1]UESL的首发症状是腹胀和腹痛，没有黄疸，而体检通常显示除了可触及的肝脏肿瘤外没有阳性生命体征。^[1]血清甲胎蛋白（AFP）检测对UESL不敏感。^[2]UESL的术前诊断非常困难。明确的诊断取决于组织病理学检查，包括免疫组织化学分析。UESL患者通常波形蛋白、抗胰蛋白酶（AAT）、结蛋白和平滑肌肌动蛋白呈阳性，细胞角蛋白（CK8/18）呈阳性，但AFP和S-100蛋白呈阴性。^[3]肿瘤完全切除仍是影响UESL预后的关键因素。^[2]UESL是一种预后不良的侵袭性肝肿瘤。此前报道的UESL的长期无病生存率低于37%。^[1]近年来，随着治疗转变为使用手术联合化疗，UESL的预后有所改善。最近的一篇文章报道，总的5年生存率高达92%~100%。^[2,4]但UESL复发率较高，总体预后仍不容乐观。由于其发病率低，其复发特点及影响预后的高危因素报道较少。因此，在本报告中，我们总结了UESL的复发特征和影响预后的危险因素。

致编辑：心源性猝死是世界范围内的主要公共卫生问题。^[1]及时的心肺复苏（CPR）和除颤有助于改善预后，避免室颤的神经系统后遗症。^[2]然而，除颤器在中国的可用性和利用率很低。^[3]因此，我们调查了苏州市（中国江苏省）所有基层（公立和私立）医院连续两年（行政干预前后）除颤器的可用性和利用率，以评估行政干预的效果。

致编辑：脑膜瘤是最常见的中枢神经系统肿瘤。^[1]世界卫生组织（WHO）2016分类系统将脑膜瘤分为三级：I级（良性）、II级（非典型）和III级（间变性/恶性）脑膜瘤。^[1]良性脑膜瘤通常与良好的预后相关；然而，更高等级（WHO II级和III级）的脑膜瘤更具侵袭性，导致不太有利的结果。^[1]

致编辑：POU结构域3类转录因子4或BRN-4(POU3F4）是非综合征性X连锁听力损失（HL）的致病基因，其特征是内耳异常。迄今为止，已经将六个X连锁非综合征HL基因座（DFNX1-6）定位于X染色体，并且已经鉴定了这些基因中的五个：磷酸核糖焦磷酸合成酶1（PRPS1）（DFNX1，OMIM：304500），POU3F4(DFNX2，OMIM：304400)，^[1]小肌肉蛋白，X-连接（SMPX）（DFNX4，OMIM：300066），凋亡诱导因子，线粒体相关，1（AIFM1）（DFNX5，OMIM：300614）和胶原蛋白，IV型α-6（COL4A6）（DFNX6，OMIM；300914）。POU3F4突变占所有DFNX病例的近50%。^[2,3]人类POU3F4基因位于Xq21.1区，只有一个外显子，编码361个氨基酸。POU3F4属于POU结构域转录因子超家族，由POU特异性结构域（75个氨基酸）和POU同源结构域（63个氨基酸）组成，两者都影响DNA结合和特异性。POU3F4蛋白参与中耳和内耳的发育，以及出生前大脑某些区域的发育。^[4]然而，HL是在DFNX2患者中观察到的唯一临床表型。到目前为止，在编码区（57个突变）和推定的调节元件区（15个突变）中有72个不同的突变POU3F4据报道，在DFNX2家族中，基因与非综合征性HL相关。在这项研究中，一种新的无义突变POU3F4分析发现与一个中国汉族家庭的非综合征X连锁遗传HL有关。

致编辑：粘多糖贮积症(MPS)障碍是一组罕见的遗传性溶酶体贮积障碍，其中由溶酶体酶缺乏引起的糖胺聚糖(GAG)的进行性细胞积累导致多器官功能障碍。每种MPS病症(I-IX)都是由特定溶酶体酶的缺乏和随后降解的GAGs片段在尿液、血液和脑脊液中增加引起的。MPS II，也称为亨特综合征（OMIM 309900），是一种由艾杜糖醛酸-2-硫酸酯酶缺乏引起的隐性X连锁溶酶体贮积症（IDS).TheIDS基因位于Xq28上，包含9个外显子，编码550个氨基酸的前体蛋白。^[1]超过500IDS已经在人类基因突变数据库中鉴定出导致MPS II的突变。这种缺乏导致GAG(包括硫酸皮肤素和硫酸乙酰肝素)在肝、脾、结缔组织和脑的溶酶体中积累，并在尿液中排泄。^[2]MPS II传统上根据临床严重程度分为两种亚型。轻度形式的个体可能具有减轻的躯体并发症，身材矮小，存活到成年，并且通常没有表现出精神发育迟滞。相反，严重受影响的个体以早期躯体异常为特征，包括进行性神经损伤、肝脾肿大、进行性心肺恶化、骨骼畸形，并且通常在15岁之前死于阻塞性气道疾病或心力衰竭。^[3]在这里，我们描述了一名携带乙酰肝素-N-硫酸酯酶新变异的MPS II藏族男孩的临床和遗传学发现（SGSH、磺酰胺酶）。我们的报告还解释了IDS酶活性突变。

致编辑：Rosai-Dorfman病（RDD），也称为窦组织细胞增生症伴巨大淋巴结病（SHML），由Rosai和Dorfman于1969年首次报道。^[1]结节性RDD通常以大量淋巴结病为特征；然而，结外RDD并不常见，其更严重的纤维化和病变中更少的组织细胞使其比结RDD更难诊断。^[2]我们在此描述了一名在下咽、喉和颈部淋巴结同时患有结外RDD的患者，并且有半身刺痛的长期病史，手术切除后消失。

致编辑：减肥手术作为病态肥胖及其相关代谢性疾病患者的有效治疗方法，正日益受到欢迎。非酒精性脂肪性肝病（NAFLD）是与病态肥胖相关的常见合并症。越来越多的证据表明，非酒精性脂肪性肝炎患者具有肝硬化和肝脏相关死亡率等不良结局的高风险。预计到2025年，NAFLD引起的肝功能衰竭将成为美国肝移植（LT）的最常见原因。^[1]在美国，LT接受者的肥胖患病率估计为20%至30%。^[2]LT是终末期肝病的唯一根治性治疗方法。如果终末期肝病和病态肥胖患者在LT后不能有效控制体重，供肝将再次处于NAFLD的高危状态。可以同时进行LT和袖状胃切除术（SG），以有效控制这些患者的术后体重和代谢紊乱。我们报告了一例终末期肝病和病态肥胖患者同时出现LT和SG的病例。

致编辑：一名27岁男性，无精神病史，有2个月的冷漠、反应性下降和不适病史。这些新的行为变化发生之前是疲劳和失眠。体检时，患者四肢肌张力、肌力正常，未检出病理性反射。四年前，患者接受了脊髓脑膜瘤切除术。手术前，出现了一些类似的症状，如冷漠和反应性降低；症状持续一个月，术后缓解。四天后，患者出现缄默症和反应迟钝。他被诊断为器质性精神病，住进了精神病院。患者开始常规抗精神病治疗，包括奥氮平、艾司西酞普兰、舍曲林和奥沙西泮，但其缄默症和反应迟钝无改善。

致编辑：一名57岁男性被诊断为膀胱癌，并接受了膀胱肿瘤经尿道切除术以治疗高级别T1尿路上皮癌。膀胱内卡介苗（BCG）（治疗用BCG，CDIBP，中国）免疫治疗每周进行一次，持续6周，浓度为120 mg，在50 mL盐水中。患者无结核病史。治疗6周后，患者主诉会阴不适。直肠指检（DRE）显示压痛，因此怀疑前列腺左叶感染。显微镜尿分析显示红细胞很少。总前列腺特异性抗原(PSA)水平为2.61 ng/mL，游离PSA为0.23 ng/mL。进行磁共振(MR)扫描以评估前列腺感染，并在左前列腺外周区显示约2.1 × 1.2 cm的T2加权成像(T2WI）低强度病变和扩散加权成像显示高强度病变[图1A和图1B].为了鉴别诊断T2WI上的前列腺低信号病变，进行了前列腺活检。随后的组织学显示肉芽肿性前列腺炎[图1C]根据聚合酶链反应，结核病呈阳性。其他地方没有结核病的证据。根据这些发现，证实了结核性前列腺脓肿。患者接受了为期9个月的异烟肼（300 mg/天）、利福平（450 mg/天）和乙胺丁醇（750 mg/天）抗结核方案治疗。抗结核治疗1个月后症状缓解。在完成9个月的抗结核治疗方案后，进行了随访MR扫描，显示前列腺脓肿消失。最近的膀胱镜检查显示没有肿瘤复发的证据，也没有前列腺炎症。

致编辑：后部可逆性脑病综合征（PRES）是一种罕见的中枢神经系统（CNS）疾病。临床上可表现为头痛、视物模糊、癫痫发作或昏迷。PRES的诊断基于皮质下白质的枕叶和顶叶的经典放射学成像研究，有时在皮质中。高血压脑病、子痫、免疫抑制剂和细胞毒性药物可引起PRES。PRES患者在去除致病因素后可以康复而无后遗症。值得注意的是，诊断的不确定性和治疗的延迟可能会加重中枢神经系统损伤或死亡。然而，该疾病的潜在机制仍然不清楚和有争议。

中华医学会（CMA）是中国最大的国家级医学和学术组织。CMA成立于1915年，作为中国科技医学专业人士自愿组成的非营利性、学术性组织，是中国医学科技和保健课程发展的重要社会力量。经过100年的发展，CMA现已拥有88个专业学会、677,000名会员和478个专业子学会团体。CMA加入了42个国际或地区医学组织，并与各省、自治区、直辖市和副省级城市的医学协会保持密切合作。CMA出版186种纸质和电子医学期刊，每年主办近200次国际和国家级高水平医学学术会议。

在题为“A红色毛癣菌基于重建人表皮-Episkin的感染模型^®》，发表于中华医学杂志,^[1]“资金支持和赞助”部分应更正为“本研究得到广东省自然科学基金资助（编号：2015A030313137）。