Volume 132 · Issue 20 · 2019

Determining the Helicobacter pylori (H. pylori) infection state during the gastroscopic process is important but still challenging. The linked color imaging (LCI) technique might emphasize the mucosal color change after H. pylori infection, which might help the diagnosis. In the present study, we aimed to compare the LCI technique with traditional white light imaging (WLI) endoscopy for diagnosing active H. pylori infection.

We collected and analyzed gastroscopic images from 103 patients in our hospital from November 2017 to March 2018, including both LCI and WLI modes. All images were randomly disordered and independently evaluated by four endoscopists who were blinded to the H. pylori status of patients. In addition, the H. pylori state was determined by both rapid urease test and pathology staining. The sensitivity, specificity, positive prediction value (PPV), and negative prediction value (NPV) were calculated for the detection of H. pylori infection. Moreover, the kappa value and interclass correlation coefficient (ICC) were used to evaluate the inter-observer variety by SPSS 24.0 software.

Of the 103 enrolled patients, 27 of them were positive for H. pylori infection, while the 76 patients were negative. In total, 388 endoscopic images were selected, including 197 WLI and 191 LCI. The accuracy rate for H. pylori evaluation in the corpus LCI group was significantly higher than other groups (81.2% vs. 64.3%-76.5%, χ² = 34.852, P < 0.001). Moreover, the corpus LCI group had the optimal diagnostic power with the sensitivity of 85.41% (95% confidence interval [CI]: 76.40%-91.51%), the specificity of 79.71% (95% CI: 74.38%-84.19%), the PPV of 59.42% (95% CI: 50.72%-67.59%), and the NPV of 94.02% (95% CI: 89.95%-96.56%), respectively. The kappa values between different endoscopists were higher with LCI than with WLI (0.433-0.554 vs. 0.331-0.554). Consistently, the ICC value was also higher with LCI than with WLI (0.501 [95% CI: 0.429-0.574] vs. 0.397 [95% CI: 0.323-0.474]). We further analyzed the factors that might lead to misjudgment, revealing that active inflammation might disturb WLI judgment (accuracy rate: 58.70% vs. 76.16%, χ² = 21.373, P < 0.001). Atrophy and intestinal metaplasia might affect the accuracy of the LCI results (accuracy rate: 66.96% vs. 73.47%, χ² = 2.027; 68.42% vs. 73.53 %, χ² = 1.594, respectively); however, without statistical significance (P = 0.154 and 0.207, respectively).

The application of LCI at the corpus to identify H. pylori infection is reliable and superior to WLI. The inter-observer variability is lower with LCI than with WLI.

Chinese Clinical Trial Registry: ChiCTR1800016730; http://www.chictr.org.cn/showproj.aspx?proj=28400

Primary spontaneous pneumothorax (PSP) is a common manifestation of Birt-Hogg-Dubé (BHD) syndrome, which is an autosomal dominant disorder caused by mutation of the folliculin (FLCN) gene. This study was established to investigate the mutation of the FLCN gene and the phenotype in a family with PSP.

We investigated the clinical and genetic characteristics of a large Chinese family with recurrent spontaneous pneumothorax. Genetic testing was performed by Sanger sequencing of the coding exons (4-14 exons) of the FLCN gene.

Among ten affected members in a multi-generational PSP kindred, with a total of 18 episodes of spontaneous pneumothorax, the median age for the initial onset of pneumothorax was 42.5 years (interquartile range: 28.8-57.2 years). Chest computed tomography scan of the proband showed pulmonary cysts and pneumothorax. A novel nonsense mutation (c.1273C>T) in exon 11 of FLCN gene that leads to a pre-mature stop codon (p.Gln425*) was identified in the family. The genetic analysis confirmed the diagnosis of BHD syndrome in this family in the absence of skin lesions or renal tumors.

A novel nonsense mutation of FLCN gene was found in a large family with PSP in China. Our results expand the mutational spectrum of FLCN gene in patients with BHD syndrome.

With the development of assisted reproductive technology (ART) and its increasing success rate in the mainland of China, more attention has been paid to the safety of ART. In this study, we explored the associations between conception by ART and pregnancy/perinatal complications, and neonatal outcomes compared with similar outcomes following spontaneous conception.

This retrospective cohort study of pregnancies over a 3-year period (2013-2015) was performed at Beijing Obstetrics and Gynecology Hospital, Beijing, China. Subjects were divided into two groups: conception by ART (n = 2256) or spontaneous conception (n = 6768). According to different fertilization modes, the ART group was divided into in vitro fertilization (IVF, n = 1873) and intracytoplasmic sperm injection (ICSI, n = 383) subgroups. The ART group was also divided into two different embryo transfer methods; fresh embryo transfer (ET, n = 1583) and frozen embryo transfer (FET, n = 673) subgroups. Pregnancy complications, perinatal complications, and neonatal outcomes of the enrolled subjects were investigated and analyzed by univariate analysis and multivariate logistic regression.

After adjustment for maternal age, gravidity, parity, maternal education, smoking, alcohol consumption, and body mass index (BMI), pregnancies conceived by ART were associated with a significantly increased incidence of gestational diabetes mellitus (GDM; OR 1.88, 95% CI 1.56-2.27), gestational hypertension (OR 2.18, 95% CI 1.83-2.60), and intrahepatic cholestasis of pregnancy (ICP) (OR 2.79, 95% CI 2.15-3.64), compared with spontaneous conception. These associations were similar for the singleton group. In the twin group, only the incidence of ICP was significantly higher than in controls. We found that pregnancies conceived by ART were associated with perinatal complications, including placental abruption (OR 2.14, 95% CI 1.33-3.45), premature rupture of membranes (PROM; OR 1.24, 95% CI 1.06-1.45), postpartum hemorrhage (OR 2.89, 95% CI 2.33-3.59) and polyhydramnios (OR 2.01, 95% CI 1.29-3.16). The singleton group had a similar result with placental abruption, but not with fetal membranes ruptures before labor and polyhydramnios. There were no significant differences in the incidence of these perinatal complications in the twin group. Some neonatal outcomes, including preterm labor (OR 4.29, 95% CI 3.84-4.80) and low birth weight (OR 1.72, 95% CI 1.42-2.08), were more likely to occur with singleton births after ART. However, there were no significant differences for these outcomes from twin pregnancies. Perinatal complications and neonatal outcomes were consistent between the IVF and ICSI subgroups. The FET and ET subgroups showed a similar increase in complications, except for the incidence of placental abruption. After taking into account the effects of parity, birth plurality and maternal age, the ART group still exhibited increased maternal and neonatal complications, although some differences narrowed or disappeared.

This retrospective cohort study demonstrated that patients who underwent ART were at increased risk of several adverse pregnancy outcomes compared with women who conceived spontaneously. These complications may be attributed in part to the relatively high multiple pregnancy rate after ART. Elective single embryo transfer should be promoted in China to reduce the obstetrical risks of ART pregnancy. Singletons of ART pregnancy exhibited increased maternal and neonatal complications as well, suggesting that underlying infertility or other maternal or parental factors may contribute to the adverse outcomes.

Spider nevi (SN) are quite common in children. SN are treated via different techniques, and complete removal often requires multiple treatments. However, few studies have evaluated the treatment of SN. The present study aimed to evaluate the therapeutic effect and safety of a 595-nm pulsed-dye laser (PDL) for treating facial SN in children.

A total of 110 children aged 0.2 to 12 years with facial SN were treated with a 595-nm PDL in a single institution from January 2016 to February 2018. In accordance with the treatment method, the patients were retrospectively divided into the small-spot-combined-with-large-spot group (SL-group) and the large-spot group (L-group). Patients with poor therapeutic results were retreated every 6 weeks until the lesions disappeared. The minimum follow-up period was 1 year. The groups were compared using independent-samples t tests, Mann-Whitney U test, Chi-square test, and Fisher exact probability test.

The therapeutic efficacy was significantly higher in the SL-group than in the L-group, with clearance rates of 90.9% and 53.0% after the primary treatment, respectively (χ²= 17.937, P < 0.001). For skin lesions with a central spider body diameter ≥1 mm, the once-treatment cure rates were 100% in the SL-group and 34.8% in the L-group (χ² = 20.780, P < 0.001). For skin lesions with a central spider body diameter <1 mm, the once-treatment cure rates were 82.6% in the SL-group and 62.8% in the L-group (χ² = 3.961, P = 0.138). The rates of adverse reactions and recurrence did not differ between the two groups (P = 0.141 and P = 1.000, respectively).

The 595-nm PDL might be a safe and effective treatment option for facial SN in children. The small-spot-combined-with-large-spot method is especially suitable for SN with a central spider body diameter ≥1 mm.

Crohn disease is a chronic bowel disease that causes serious complications. Prevalence of Crohn disease is increasing. Studies have shown that the behavior of the disease is not stable and severe complications secondary to behavior change over time have been shown. In this study, we aimed to evaluate the prognostic risk factors associated with phenotypic change in Crohn disease in a Turkish patient cohort.

Patients followed up from March 1986 to August 2011 were evaluated for demographic and clinical characteristics to determine possible risk factors and initial clinical phenotype of the disease based on the Montreal classification. The cumulative probabilities of developing stricturing or penetrating intestinal complications were estimated using the Kaplan-Meier analysis. Univariate and multivariate Cox-proportional hazard models were used to assess associations between baseline clinical characteristics and intestinal complications.

Three hundred and thirty patients (mean age, 30.6 ± 11.1 years; 148 female) were included in the study. Mean follow-up duration was 7.4 ± 5.3 years (range: 1.0-25.0 years). At baseline 273 patients had inflammatory-type disease, 57 patients experienced stricturing/penetrating intestinal complications before or at the time of diagnosis. The cumulative probability of developing complicated disease was 37.4% at 5 years, 54.3% at 10 years, 78.8% at 25 years. Independent predictors associated with progression to intestinal complications were current smoking, perianal disease, extra-intestinal manifestations, and location of disease.

Location of disease is the most powerful indicator for the development of stenosis and penetrating complications in inflammatory-type disease. Patients with ileal involvement should be considered for more aggressive immunosuppressive therapy.

Glioma is the most common primary malignant tumor in the central nervous system. Because of the resistance of glioma to chemoradiotherapy and its aggressive growth, the survival rate of patients with glioma has not improved. This study aimed to disclose the effect of retinol dehydrogenase 10 (RDH10) on the migration and invasion of glioma cells, and to explore the potential mechanism.

Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine the expression levels of RDH10 in healthy glial cells and glioma cells. Human glioma cell strains, U87 and U251, were infected with negative control or RDH10-interfering lentiviruses. RT-PCR and Western blotting were performed to determine the knockdown efficiency. Scratch and transwell assays were used to assess cell migration and invasion after RDH10 knockdown. Finally, changes in transforming growth factor-β (TGF-β)/SMAD signaling pathway-related expression were examined by Western blotting. Differences between groups were analyzed by one-way analysis of variance.

RDH10 was highly expressed in glioma cells. Compared with the control group, RDH10 knockdown significantly reduced RDH10 messenger RNA and protein expression levels in U87 and U251 glioma cells (U87: 1.00 ± 0.08 vs. 0.22 ± 0.02, t= 16.55, P < 0.001; U251: 1.00 ± 0.17 vs. 0.39 ± 0.01, t= 6.30, P < 0.001). The scratch assay indicated that compared with the control group, RDH10 knockdown significantly inhibited the migration of glioma cells (U87: 1.00% ± 0.04% vs. 2.00% ± 0.25%, t= 6.08, P < 0.01; U251: 1.00% ± 0.11% vs. 2.48% ± 0.31%, t= 5.79, P < 0.01). Furthermore, RDH10 knockdown significantly inhibited the invasive capacity of glioma cells (U87: 97.30 ± 7.01 vs. 13.70 ± 0.58, t = 20.36, P < 0.001; U251: 96.20 ± 7.10 vs. 18.30 ± 2.08, t = 18.51, P < 0.001). Finally, Western blotting demonstrated that compared with the control group, downregulation of RDH10 significantly inhibited TGF-β expression, phosphorylated SMAD2, and phosphorylated SMAD3 (TGF-β: 1.00 ± 0.10 vs. 0.53 ± 0.06, t= 7.05, P < 0.01; phosphorylated SMAD2: 1.00 ± 0.20 vs. 0.42 ± 0.17, t= 4.01, P < 0.01; phosphorylated SMAD3: 1.00 ± 0.18 vs. 0.41 ± 0.12, t= 4.12, P < 0.01).

RDH10 knockdown might inhibit metastasis of glioma cells via the TGF-β/SMAD signaling pathway.

Adiponectin is the most abundant adipokines that plays critical roles in the maintenance of energy homeostasis as well as inflammation regulation. The half-life of adiponectin is very short and the small-molecule adiponectin receptor agonist has been synthesized recently. In the present study, the potential roles of AdipoRon, an adiponectin receptor agonist, in a mouse model of lipopolysaccharide (LPS)/D-galactosamine (D-Gal)-induced acute hepatitis was explored.

BALB/c mice (n = 144, male) were divided into three sets. In set 1, 32 mice were randomized into four groups: the control group, the AdipoRon group, the LPS/D-Gal group, and the AdipoRon + LPS/D-Gal group. The mice in set 1 were sacrificed after LPS/D-Gal treatment, and the plasma samples were collected for detection of tumor necrosis factor-alpha (TNF-α). In set 2, the 32 mice were also divided into four groups similar to that of set 1. The mice were sacrificed 6 h after LPS/D-Gal injection and plasma samples and liver were collected. In set 3, 80 mice (divided into four groups, n = 20) were used for survival observation. The survival rate, plasma aminotransferases, histopathological damage were measured and compared between these four groups.

AdipoRon suppressed the elevation of plasma aminotransferases (from 2106.3 ± 781.9 to 286.8 ± 133.1 U/L for alanine aminotransferase, P < 0.01; from 566.5 ± 243.4 to 180.1 ± 153.3 U/L for aspartate aminotransferase, P < 0.01), attenuated histopathological damage and improved the survival rate (from 10% to 60%) in mice with LPS/D-Gal-induced acute hepatitis. Additionally, AdipoRon down-regulated the production of TNF-α (from 328.6 ± 121.2 to 213.4 ± 52.2 pg/mL, P < 0.01), inhibited the activation of caspase-3 (from 2.04-fold to 1.34-fold of the control), caspase-8 (from 2.03-fold to 1.31-fold of the control), and caspase-9 (from 2.14-fold to 1.43-fold of the control), and decreased the level of cleaved caspase-3 (0.28-fold to that of the LPS/D-Gal group). The number of terminal deoxynucleotidyl transferase-mediated nucleotide nick-end labeling-positive apoptotic hepatocytes in LPS/D-Gal-exposed mice also reduced.

These data indicated that LPS/D-Gal-induced acute hepatitis was effectively attenuated by the adiponectin receptor agonist AdipoRon, implying that AdipoRon might become a new reagent for treatment of acute hepatitis.

Extralevator abdominoperineal excision (ELAPE) has become a popular procedure for low rectal cancer as compared with abdominoperineal excision (APE). No definitive answer has been achieved whether one is superior to the other. This study aimed to evaluate the safety and efficacy of ELAPE for low rectal cancer with meta-analysis.

The Web of Science, Cochrane Library, Embase, and PubMed databases before September 2019 were comprehensively searched to retrieve comparative trials of ELAPE and APE for low rectal cancer. Pooled analyses of the perioperative variables, surgical complications, and oncological variables were performed. Odds ratio (OR) and mean differences (MD) from each trial were pooled using random or fixed effects model depending on the heterogeneity of the included studies. A subgroup analysis or a sensitivity analysis was conducted to explore the potential source of heterogeneity when necessary.

This meta-analysis included 17 studies with 4049 patients, of whom 2248 (55.5%) underwent ELAPE and 1801 (44.5%) underwent APE. There were no statistical differences regarding the circumferential resection margin positivity (13.0% vs. 16.2%, OR = 0.69, 95% CI = 0.42-1.14, P = 0.15) and post-operative perineal wound complication rate (28.9% vs. 24.1%, OR = 1.21, 95% CI = 0.75-1.94, P= 0.43). The ELAPE was associated with lower rate of intraoperative perforation (6.6% vs. 11.3%, OR = 0.50, 95% CI = 0.39-0.64, P < 0.001) and local recurrence (8.8% vs. 20.5%, OR = 0.29, 95% CI = 0.21-0.41, P < 0.001) when compared with APE.

The ELAPE was associated with a reduction in the rate of intra-operative perforation and local recurrence, without any increase in the circumferential resection margin positivity and post-operative perineal wound complication rate when compared with APE in the surgical treatment of low rectal cancer.

Evidence suggests that various diseases may contribute to the circular RNAs (circRNAs) expression disorder. This review was aimed at looking for appropriate biomarkers for the treatment of diseases.

The comprehensive search used online literature databases including PubMed of National Center for Biotechnology Information and Web of Science.

The study selection was based on the following keywords: circRNAs, biogenesis, biologic function, and disease. The time limit for literature retrieval was from the year 1976 to 2019, with language restriction in English. Relevant articles were carefully reviewed, with no exclusions applied to study design and publication type.

CircRNAs are one of the critical non-coding RNAs (ncRNAs), which are covalently closed continuous loops that do not possess 5^＇ and 3^＇ ends. This makes them resistant to exoribonuclease activity and potentially more stable than their cognate linear transcripts, thus making them ideal candidates for biomarker development. Due to the stable and extensive tissue-specific expression of circRNAs, they can function as microRNA sponges and bind to RNA-binding proteins, regulate transcription and splicing, and translate into proteins to participate in the regulation of physiologic and pathologic processes. Moreover, the expression disorders of circRNAs in diseases, such as neurodegenerative disease, cardiovascular disease, and cancer, make them have potential applications for the diagnosis and treatment of diseases.

Changes in circRNA expression profiles related to various diseases, and circRNAs often exhibit low expression in cancer tissues. In addition, circRNAs can be detected in patient’s body fluids to indicate that circRNAs are effective biomarkers for disease diagnosis. These characteristics make circRNAs have potential applications as novel therapeutic targets for diseases.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease of human beings characterized by not fully reversible airflow limitation. Emphysema is the main pathological feature of COPD which causes high mortality worldwide every year and consumes a large amount of medical expenses. This paper was to review the establishment and evaluation methods of animal models of emphysema or COPD, and put forward some new ideas on animal selection, method of modeling, and model evaluation.

The author retrieved information from the PubMed database up to July 2019, using various combinations of search terms, including emphysema, model, and animal.

Original articles, reviews, and other articles were searched and reviewed for animal models of emphysema.

This review summarized animal models of emphysema from the perspectives of animal selection, emphysema mechanism, modeling method and model evaluation, and found that passive smoking is the classic method for developing animal model of emphysema, mice are more suitable for experimental study on emphysema. Compared with pulmonary function indicators, airway inflammation indicators and oxidative stress indicators, pathomorphological indicators of lung tissue are the most important parameters for evaluating the establishment of the animal model of emphysema.

Mice model induced by passive smoking is the classic animal model of emphysema. Pathomorphological indicators are the most important parameters for evaluating the establishment of the animal model of emphysema.

Secreted modular calcium-binding proteins (SMOCs) are extracellular glycoproteins of the secreted protein, acidic, and rich in cysteine-related modular calcium-binding protein family and include two isoforms, SMOC1 and SMOC2, in humans. Functionally, SMOCs bind to calcium for various cell functions. In this review, we provided a summary of the most recent advancements and findings of SMOC1 and SMOC2 in development, homeostasis, and disease states.

All publications in the PubMed database were searched and retrieved (up to July 24, 2019) using various combinations of keywords searching, including SMOC1, SMOC2, and diseases.

All original studies and review articles of SMOCs in human diseases and embryo development written in English were retrieved and included.

SMOC1 and SMOC2 regulate embryonic development, cell homeostasis, and disease pathophysiology. They play an important role in the regulation of cell cycle progression, cell attachment to the extracellular matrix, tissue fibrosis, calcification, angiogenesis, birth defects, and cancer development.

SMOC1 and SMOC2 are critical regulators of many cell biological processes and potential therapeutic targets for the control of human cancers and birth defects.

与单纯手术相比，局部结直肠癌（CRC）术后辅助化疗（ACT）可显著提高生存率。^[1,2]以氟尿嘧啶（5-FU）为基础的辅助化疗在III期结直肠癌中的益处在国家外科辅助乳腺和肠道项目(NSABP)方案C-01试验中得到证实^[3]并在随后的研究中得到巩固。^[1,4]因此，从那时起，5-FU已被广泛用作CRC的基本ACT。更令人鼓舞的是，根据三项大型III期随机临床试验（RCT），加入奥沙利铂可以进一步赋予接受基于5-FU的ACT的患者生存优势：2004年奥沙利铂/5-FU/亚叶酸钙辅助治疗结肠癌的多中心国际研究（MOSAIC）试验、NSABP C-07试验和NO16968试验。^[5,6,7,8,9]MOSAIC试验显示，在3年无病生存期（DFS）和5年DFS方面，在5-FU加亚叶酸（FL）的基础上加用奥沙利铂优于单独FL。^[5,6]在NSABP C-07试验中也观察到了类似的结果，其中加入奥沙利铂使3年DFS增加了6.6%。^[7]NO16968试验^[9]报告卡培他滨联合奥沙利铂（CAPOX）的7年DFS为63.0%vs对于推注5-FU/亚叶酸，56.0%(风险比[HR]=0.80，95%置信区间[CI]0.69-0.93；P=0.0045).因此，以奥沙利铂为基础的6个月方案已成为条件良好且能耐受更具侵袭性的细胞毒性化疗药物的III期CRC患者术后ACT的金标准。^[10]因此，在过去十年中，肿瘤学家受到启发，将奥沙利铂的添加扩展到新辅助化疗甚至新辅助放化疗中。然而，超期使用的“极限”在哪里？值得注意的是，奥沙利铂联合ACT 6个月的生存获益伴随着严重的毒性，包括骨髓抑制、胃肠道毒性和神经毒性。特别地，累积剂量依赖性神经毒性甚至可能是不可逆的，并且不利地影响总体生活质量。此外，由于治疗毒性，过量的ACT可对患者的免疫状态产生影响。^[11,12]换句话说，过度ACT不一定有好处，反而会适得其反。

促排卵是指针对无排卵妇女的卵巢刺激类型，旨在通过产生正常排卵周期和诱导单显性卵泡选择和排卵来恢复正常生育能力。在中国，大量患有排卵障碍的妇女由不是不孕症专业的妇产科医生（ob-gyns）治疗。本研究的目的是调查自我报告的妇产科医生诱导排卵的熟练程度以及该手术最常用的药物。

致编辑：膀胱癌在发病率、诊断、治疗和生存率方面表现出显著的性别差异。^[1]男性膀胱癌的发病率大约是女性的三倍。虽然女性通常比男性更不容易患膀胱癌，但一旦女性患上这种疾病，预后就不太好。然而，膀胱癌中这些性别差异的分子基础仍然知之甚少。研究表明，膀胱癌比几乎任何其他癌症类型都有更多的体细胞DNA改变，但男性和女性之间的具体差异仍然未知。^[2]为了确定膀胱癌性别差异的基因组突变，我们通过分析从癌症基因组图谱（TCGA）获得的高通量数据，研究了性别特异性体细胞DNA改变，包括304例肌肉浸润性膀胱癌的高加索样本（224例男性和80例女性）。

致编辑：Dandy-Walker畸形（DWM）是一种罕见的累及后颅窝的先天性畸形。DWM的诊断基于一系列特征性神经影像学发现，包括小脑蚓部完全或部分发育不全、第四脑室囊性扩张和后颅窝扩大。^[1]几种畸形综合征和细胞遗传学异常与DWM有关。然而，DWM和肿瘤的共存是罕见的。^[2]关于DWM和神经节胶质瘤共存的报道很少。

致编辑：FIP-1样-1-血小板衍生生长因子受体-α的存在（FIP1L1-PDGFRA,F/P）融合基因约占所有嗜酸性粒细胞增多症的23%（3%-56%）。^[1]从2008年起，世界卫生组织（WHO）分类将本病重新定义为“伴有嗜酸性粒细胞增多和PDGFRA重排”，现在构成了一种独特类型的造血障碍。F/P融合蛋白是酪氨酸激酶，因此对酪氨酸激酶抑制剂(TKI)敏感。TKI被推荐作为治疗伴有嗜酸性粒细胞增多的髓系/淋巴系肿瘤的一线治疗PDGFRA根据世卫组织指南重新安排。^[2]

致编辑：我们感谢这篇细心而有趣的文章”体重校正骨矿含量在中国女性骨质疏松症诊断中的作用”刘著等人^[1]作者很好地表明骨骼是三维组织，只有体积骨矿物质密度（vBMD）可以被认为是完全标准化的，因为面积骨矿物质密度（aBMD）是二维的，可能导致大骨受试者的漏诊和小骨受试者的误诊。此外，尽管vBMD具有不可否认的优点，但最复杂的双能X射线吸收法(DXA)仪器不能测量骨体积体内因此，他们试图用体重标准化骨矿物质含量（wBMC）代替vBMD进行骨质疏松症的诊断，可以避免这种漏诊或误诊。

致编辑：患者安全问题不断成为头条新闻。中国也面临着同样的患者安全问题。根据2014年至2015年医疗纠纷统计报告，在中国许多大城市，例如北京和上海，患者死亡主要是由于医疗救治和操作程序缺乏标准造成的。^[1]实施基于模拟的医疗保健培训可能是标准化医疗程序的潜在解决方案。然而，中国的医疗保健模拟目前仍面临着巨大的挑战。

致编辑：慢性阻塞性肺疾病急性加重（AECOPD）患者通常需要机械通气支持。但呼吸机相关的副作用仍然不可避免，导致治疗失败。体外二氧化碳去除（ECCO₂R)技术将血液引流到人工膜肺，在没有机械通气的情况下进行氧合和去除二氧化碳。这里₂R在中国以外已经被广泛使用，但在中国还没有官方的使用报道。最近，我们使用ECCO治疗了两例AECOPD患者₂R.

致编辑：Wolfram综合征（WS，MIM 222300）是一种罕见的常染色体隐性遗传疾病，由WFS1或者CISD2（WFS2）其患病率估计为十六万至七十七万分之一。^[1]患者通常在6岁左右出现胰岛素依赖型糖尿病(DM)，然后在11岁左右出现视神经萎缩(OA)。其他症状，如尿崩症、感音神经性耳聋、尿路异常和神经精神障碍，发生在老年并影响一小部分个体。预计死亡年龄约为30至40岁，大多由呼吸衰竭引起。WS以常染色体隐性方式遗传，而一些致病突变WFS1基因是显性的，与听力障碍、OA、DM和精神问题有关，并导致Wolfram样综合征。^[2]在本报告中，我们描述了一个案例WFS1-1例中国患者的非胰岛素依赖型DM和OA相关谱系障碍发作。该患者在WFS1基因，并发现了一个新的无义突变c.2217C>A。

致编辑：黑素细胞痣是皮肤科常见的良性肿瘤疾病，可发生于各个年龄段和皮肤表面的部位。色素痣皮肤病变有不同的临床表现。如果医学诊断仅根据病变的颜色、形状或临床经验，很难与其他具有类似色素痣临床表现的疾病区分。痣主要分为三类：交界痣（仅局限于表皮的黑素细胞）、真皮内痣（仅局限于真皮）和复合痣（既有表皮成分又有真皮成分）。这三种不同类型痣之间的关系以及哪些因素有助于一种类型的形成vs另一个还不清楚。^[1]

致编辑：毛霉菌病和曲霉病是机会性真菌感染，可导致危及生命的并发症。^[1,2]肺放线菌病是一种罕见的感染，常与其他肺部疾病混淆。^[3]在同一宿主中与这三种病原体共感染是罕见的。在这里，我们报告了一个独特的空洞性病变伴曲霉病、毛霉菌病和放线菌病合并感染的病例。

致编辑：神经外科手术后的手术部位感染（SSI）虽然不常见，但却是一种严重的并发症。据报道，SSI的患病率在0.5%至8.0%之间，^[1,2]SSI的风险与手术次数（>1次）、脑脊液（CSF）引流、手术持续时间超过4小时、CSF渗漏、静脉窦进入、美国麻醉师协会评分超过2分、性别、手术目的（非创伤性）和其他感染独立相关。^[3]脑脊液漏、腰椎和脑室外引流是与创伤性脑损伤相关的SSI的独立危险因素。^[4]就泰国南部的持续冲突而言，已有爆炸诱发的创伤性脑损伤（bTBI）患者的报告。^[4,5,6]爆炸效应会造成伤害，包括头皮开放性伤口、颅骨骨折、硬脑膜撕裂和脑脊液渗漏。^[6,7]这种被污染的伤口会导致SSI。^[7]从文献综述来看，似乎缺乏关于BTBI SSI相关因素的研究。本研究的目的是探讨bTBI患者与SSI相关的临床和神经影像学参数。