Volume 132 · Issue 22 · 2019

Few data are available regarding the progression of liver disease and therapeutic efficacy in chronic hepatitis B virus (HBV) carriers infected by mother-to-child transmission (MTCT). This study aimed to investigate these two aspects by comparing the adult chronic HBV carriers in MTCT group with those in horizontal transmission group.

The 683 adult chronic HBV patients qualified for liver biopsy including 191 with MTCT and 492 with horizontal transmission entered the multi-center prospective study from October 2013 to May 2016. Biopsy results from 217 patients at baseline and 78 weeks post antiviral therapy were collected.

Patients infected by MTCT were more likely to have e antigen positive (68.6% vs. 58.2%, χ² = -2.491, P = 0.012) than those with horizontal transmission. However, in patients with MTCT, levels of alkaline phosphatase (ALP) (P = 0.031), Fibroscan (P = 0.013), N-terminal propeptide of Type III procollagen (PIIINP) (P = 0.014), and Laminin (LN) (P = 0.006) were high, in contrast to the patients with horizontal transmission for whom the levels of albumin (ALB) (P = 0.041), matrix metalloproteinase-3 (MMP-3) (P = 0.001) were high. The 47.2% of patients with MTCT and 36.8% of those with horizontal transmission had significant liver fibrosis (P = 0.013). Following antiviral therapy for 78 weeks, 21.2% and 38.0% patients with MTCT and horizontal transmission acquired hepatitis B e antigen (HBeAg) clearance, respectively (P = 0.043), and the virological response rates were 54.7% and 74.1% in the MTCT and horizontal groups, respectively (P = 0.005). MTCT was a risk factor for HBeAg clearance and virological response.

Adult patients with MTCT were more prone to severe liver diseases, and the therapeutic efficacy was relatively poor, which underlined the importance of earlier, long-term treatment and interrupting perinatal transmission.

NCT01962155; https://clinicaltrials.gov.

Coronary artery disease (CAD) in octogenarians (age of ≥80 years) has a high risk of mortality and high medical expenses. Research shows that the prevalence of CAD is higher among octogenarians than that among younger people, but few such patients undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study aimed to evaluate different treatments with respect to their clinical effects and impacts on quality of life of octogenarians with CAD.

Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital, Capital Medical University (Beijing, China) from January 2010 to January 2016 were collected in this study. The patients were categorized into three groups based on the treatments they received: the PCI group (n = 292), CABG group (n = 110), and medical treatment group (n = 117). The followings were recorded during follow-up: clinical data, death (all-cause and cardiovascular-related), re-hospitalization time, Seattle Angina Questionnaire (SAQ) score, and occurrence of hemorrhagic events (cerebral bleeding, gastrointestinal bleeding, and dermal ecchymosis).

The median follow-up duration was 25.0 (25th, 75th percentile: 17.0, 55.5) months among 417 patients. The all-cause death rates (28.2% vs. 12.0% and 14.6%, respectively) and cardiovascular-related death rates (15.4% vs. 3.8% and 6.4%, respectively) were significantly higher in the medical treatment group than those in the PCI group and CABG group (all P < 0.05). The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group (3.8% vs. 12.8% and 14.9%, respectively) (χ² = 8.238, P = 0.018). The SAQ scores of physical limitation, angina frequency, treatment satisfaction, and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group (all P < 0.05). No significant difference in the angina stability score was observed among the three groups (F = 3.179, P = 0.204).

PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.

Colorectal cancer (CRC) has become one of the major life-threatening complications in patients with inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD). This study aimed to explore the clinicalpathologic similarities and differences in the IBD-associated CRC (IBD-CRC) between patients in China and Canada.

Data of 78 patients with IBD-CRC retrospectively retrieved from two representative medical institutions in Beijing (China) and Calgary (Canada) over the same past 13 years, including 25 (22 UC-associated and three CD-associated) from Beijing group and 53 (32 UC-associated and 21 CD-associated) from Calgary group, were compared with regards to their clinical and pathologic characteristics.

Several known features of IBD-CRC were seen in both groups, including long duration and large extent of colitis, active inflammation background, multifocal lesions, and advanced tumor-node-metastasis stage. Beijing group showed a significantly higher percentage of UC (88.0% vs. 60.4%, P = 0.018), younger age at diagnosis of CRC (48.6 ± 12.8 years vs. 61.6 ± 14.7 years, P < 0.001), lower ratio of mucinous adenocarcinoma (7.1% vs. 42.4%, P = 0.001) compared with Calgary group. None of the Beijing group had concurrent primary sclerosing cholangitis, while 5.7% of Calgary group did. Surveillance colonoscopy favored the detection rate of precancerous lesions (41.4% vs.17.0%, P = 0.002).

As compared with patients from the Calgary group, the IBD-CRC patients in Beijing group were younger, less CD-associated and had less mucinous features, otherwise they were similar in many common features.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a contributing factor for non-alcoholic fatty liver disease (NAFLD). Non-invasive algorithms including fatty liver index (FLI) and hepatic steatosis index (HSI) have been used as a screening test for NAFLD in epidemiologic studies. The aim of this study is to compare the diagnostic accuracy of FLI and HSI for NAFLD detection in adults with OSAHS.

We enrolled consecutive adult subjects who were newly diagnosed with OSAHS from March 2016 to January 2018. NAFLD was diagnosed by ultrasonography. The accuracy and cut-off point of the FLI and HSI to detect NAFLD were assessed by analyzing the area under the receiver operating characteristic (AUROC) curve and the maximum Youden index analysis, respectively.

The 326 subjects were diagnosed as NAFLD according to ultrasound findings, while 105 subjects who had normal abdominal ultrasonography were grouped as controls. Both FLI and HSI values were significantly higher in patients with NAFLD compared with controls. The AUROC of FLI and HSI for predicting NAFLD was 0.802 (95% confidence interval [CI] 0.762-0.839) and 0.753 (95% CI 0.710-0.793), respectively. The AUROC of FLI was significantly higher than that of HSI (P = 0.0383). The optimal cut-off value of FLI and HSI was 60 (sensitivity 66% and specificity 80%) and 35 (sensitivity 81% and specificity 60%), respectively.

Both FLI and HSI can serve as screening tools for NAFLD in OSAHS adults. The FLI shows better performance in diagnosing NAFLD than HSI.

Chinese Clinical Trial Registry (No. ChiCTR-OOB-15007253), http://www.chictr.org.cn/showproj.aspx?proj=11606.

Trocar-site hernia (TSH) is a serious complication after laparoscopic procedures. Although it is a rare entity, it can have life-threatening consequences. This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.

We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital (PUMCH) from August 1998 to July 2018 and further sifted through the results for cases involving TSH. All included patients were divided into different groups according to patient characteristics, and the rate of TSH was compared among groups. Moreover, the detailed information of all patients with TSH was recorded and analyzed. Statistical analyses were performed with GraphPad Prism 6.

The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016% (9/55,244). The rate of TSH was significant higher in elder patients (≥60 years old; 3/2686, 0.112%) than in younger patients (<60 years old, 6/52,558; 0.011%, P = 0.008). Moreover, the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery (SILS, 2/534, 0.357%) than conventional laparoscopic surgery (7/54,710, 0.013%, P = 0.003). The average age of patients with TSH was 53.4 years (range, 35.0-79.0 years). Two of the nine patients had late-onset TSH following SILS; the other seven had early-onset TSH following conventional laparoscopy. Five TSH cases occurred at right lateral port sites, and the remaining three occurred at the umbilical port site. All patients underwent repair surgery, and one required small bowel resection.

Older age and SILS are potential associated factors for TSH development, while reducing excessive manipulation and improving suturing skills, especially at the umbilical trocar site following SILS and the right lateral trocar site, can avoid herniation.

Due to the different treatments for low-volume metastatic prostate cancer (PCa) as well as high-volume ones, evaluation of bone metastatic status is clinically significant. In this study, we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients.

A single-center retrospective analysis, focusing on prostate biopsies of newly diagnosed PCa patients, was performed. A total of 261 patients were enrolled in this study in a 4-year period. All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and, if present, the number of metastatic lesions would then be calculated. Clinical information such as age, prostate-specific antigen (PSA), fibrinogen, clinical T stage, and Gleason score were collected. Patients were divided into three groups: (i) a non-metastatic group, (ii) a high volume disease (HVD) group (>3 metastases with at least one lesion outside the spine), and (iii) a low volume disease (LVD) group (metastatic patients excluding HVD ones). The main statistical methods included non-parametric Mann-Whitney test, Spearman correlation, receiver operating characteristic (ROC) curves, and logistic regression.

Fibrinogen positively correlated with Gleason score (r = 0.180, P = 0.003), PSA levels (r = 0.216, P < 0.001), and number of metastatic lesions (r = 0.296, P < 0.001). Compared with the non-metastatic and LVD groups, the HVD group showed the highest PSA (104.98 ng/mL, median) and fibrinogen levels (3.39 g/L, median), as well as the largest proportion of Gleason score >7 (86.8%). Both univariate (odds ratio [OR] = 2.16, 95% confidential interval [CI]: 1.536-3.038, P < 0.001) and multivariate (OR = 1.726, 95% CI: 1.206-2.472, P = 0.003) logistic regressions showed that fibrinogen was independently associated with HVD. The ROC curve suggested that fibrinogen acts as a predictor of HVD patients, yielding a cut-off of 3.08 g/L, with a sensitivity of 0.684 and a specificity of 0.760 (area under the curve = 0.739, 95% CI: 0.644-0.833, P < 0.001).

Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients. Our results indicate that fibrinogen might be a potential predictor of HVD.

Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique.

Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment.

The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with -0.5 ± 1.7 mm in the conventional group (t = -7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ² = 4.95, P = 0.035).

The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.

Organ preservation has long been a consideration in the treatment of supraglottic and hypopharyngeal carcinoma to improve the quality of life (QOL). Definitive radiotherapy (DRT) with or without systematic treatment, such as chemotherapy, is always the first choice to achieve improved QOL. This retrospective study focused on the survival differences between DRT and surgery followed by adjuvant radiotherapy (S + RT) in supraglottic and hypopharyngeal carcinoma.

This study included adult patients with supraglottic or hypopharyngeal carcinoma undergoing single-modality treatment with either DRT or S + RT between January 2012 and August 2016. A total of 59 patients were identified, of whom 31 were treated with DRT, and 28 were treated with S + RT. In the 31 cases of DRT, 23 cases were treated with concurrent chemoradiotherapy (CRT), one case was treated with DRT plus cetuximab, and seven cases were treated with DRT alone. Of the other 28 cases of S + RT, 15 cases were treated with adjuvant concurrent CRT. Survival analysis was used to compare the overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) between DRT and S + RT groups.

The median follow-up was 20 months (range, 4-67 months). The patients of the two groups were similar with respect to mean age, original sites, and tumor stages. The 1-, 2-, and 5-year OS rates were 80.6%, 53.4%, and 24.7% for the DRT group and 85.7%, 67.1%, and 24.7% for the S + RT group, respectively. There was no significant difference between the two groups (χ² = 3.183, P = 0.074). The 1-, 2-, and 5-year LRFS and DMFS were 90.4%, 61.7%, and 18.0% and 87.4%, 49.2%, and 9.9%, respectively, and no statistical difference was observed between the two groups (LRFS: χ² = 0.028, P = 0.868; DMFS: χ² = 3.347, P = 0.067). No significant difference was found between the two groups in acute radiotoxicity.

Without loss of laryngeal function, the survival of DRT is comparable to that of S + RT in supraglottic and hypopharyngeal carcinoma.

Malignant pleural effusion (MPE) is a complicated condition of patients with advanced tumors. Further dissecting the microenvironment of infiltrated immune cells and malignant cells are warranted to understand the immune-evasion mechanisms of tumor development and progression.

The possible involvement of microRNAs (miRNAs) in malignant pleural fluid was investigated using small RNA sequencing. Regulatory T cell (Treg) markers (CD4, CD25, forkhead box P3), and Helios (also known as IKAROS Family Zinc Finger 2 [IKZF2]) were detected using flow cytometry. The expression levels of IKZF2 and miR-4772-3p were measured using quantitative real-time reverse transcription polymerase chain reaction. The interaction between miR-4772-3p and Helios was determined using dual-luciferase reporter assays. The effects of miR-4772-3p on Helios expression were evaluated using an in vitro system. Correlation assays between miR-4772-3p and functional molecules of Tregs were performed.

Compared with non-malignant controls, patients with non-small cell lung cancer had an increased Tregs frequency with Helios expression in the MPE and peripheral blood mononuclear cells. The verified downregulation of miR-4772-3p was inversely related to the Helios⁺ Tregs frequency and Helios expression in the MPE. Overexpression of miR-4772-3p could inhibit Helios expression in in vitro experiments. However, ectopic expression of Helios in induced Tregs reversed the effects induced by miR-4772-3p overexpression. Additionally, miR-4772-3p could regulate Helios expression by directly targeting IKZF2 mRNA.

Downregulation of miR-4772-3p, by targeting Helios, contributes to enhanced Tregs activities in the MPE microenvironment.

Endostatin, a biologically active fragment of collagen XVIII, has been observed in patients with ischemic heart disease. The aim of the present study was to investigate whether endostatin overexpression could attenuate cardiac hypertrophy by inhibiting the cyclic adenosine monophosphate-protein kinase A (cAMP-PKA) signaling pathway.

This study was examined in vivo in rats and in vitro in primary neonatal rat cardiomyocytes treated with angiotensin (Ang) II to model cardiac hypertrophy. Twenty-four male Sprague-Dawley rats were randomized into adenovirus (Ad)-green fluorescent protein, Ang II, Ad-endostatin, and Ang II + Ad-endostatin groups (n = 6 in each group). Four weeks later, all the rats were weighed and sacrificed after transthoracic echocardiography. Cardiac function was evaluated by transthoracic echocardiography, cardiomyocyte size was evaluated by hematoxylin-eosin staining. Levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were evaluated by quantitative reverse-transcription polymerase chain reaction or Western blotting, PKA level was evaluated by Western blotting, and cAMP level was evaluated by enzyme-linked immunosorbent assay. Statistical significance among multiple groups was evaluated by one-way analysis of variance.

Endostatin overexpression reduced the increases in left ventricle (LV) mass (P = 0.0063), LV mass/body weight (BW) (P = 0.0013), interventricular septal thickness (IVS) in diastole (P = 0.0013), IVS in systole (P = 0.0056), left ventricular posterior wall thickness (LVPW) in diastole (P = 0.0291), LVPW in systole (P = 0.0080), heart weight (HW) (P = 0.0138), HW/BW (P = 0.0001), and HW/tibial length (P = 0.0372) in Ang II-treated rats. In addition, endostatin overexpression reduced cardiomyocyte cross-sectional area expansion, and reduced the levels of ANP and BNP in Ang II-treated rats (P = 0.0251 and 0.0477 for messenger RNA [mRNA]), and primary neonatal rat cardiomyocytes (P = 0.0188 and P = 0.0024 for mRNA; P = 0.0023 and 0.0013 for protein, respectively). Additionally, endostatin overexpression reduced the increase of cAMP (P = 0.0054) and PKA (P = 0.0328) levels in cardiomyocytes treated with Ang II. Treatment with cAMP reversed the effects of endostatin overexpression on ANP (P = 0.0263) and BNP (P = 0.0322) levels in cardiomyocytes induced by Ang II.

Endostatin overexpression could alleviate cardiac hypertrophy by inhibiting the cAMP-PKA signaling pathway.

This article aims to present a brief profile of the advances in prevention and treatment of myocardial injury in cancer therapy based on relevant literature or reports.

The data cited in this review were obtained from articles indexed in PubMed and China National Knowledge Internet (CNKI) up to June 2019.

Articles were selected with the following keywords "Anti-cancer therapy," "Myocardial injury," "Breast cancer," "Echocardiography," and "Chemotherapy."

Due to the rapid development of novel cancer therapeutic approaches, the life expectancy of tumor patients has been prolonged continuously. Meanwhile, a large number of studies have found that among patients benefiting from precise management, some medications have exerted direct or indirect side effects on the cardiovascular system, leading to the occurrence of myocardial injury. Because there are many common risk factors between breast cancer and cardiovascular disease, and there is a special anatomical position between breast and heart, the cardiology related to breast cancer patients is relatively unique in onco-cardiology.

Heart function monitoring is critical during anti-cancer therapy so that we can early identify cardiac abnormalities and actively adopt measures to prevent myocardial injury.

Pancreatic ductal adenocarcinoma cancer (PDAC) is one of the leading causes of cancer-related death worldwide. Hence, the development of effective anti-PDAC therapies is urgently required. Patient-derived xenograft (PDX) models are useful models for developing anti-cancer therapies and screening drugs for precision medicine. This review aimed to provide an updated summary of using PDX models in PDAC.

The author retrieved information from the PubMed database up to June 2019 using various combinations of search terms, including PDAC, pancreatic carcinoma, pancreatic cancer, patient-derived xenografts or PDX, and patient-derived tumor xenografts or PDTX.

Original articles and review articles relevant to the review’s theme were selected.

PDX models are better than cell line-derived xenograft and other models. PDX models consistently demonstrate retained tumor morphology and genetic stability, are beneficial in cancer research, could enhance drug discovery and oncologic mechanism development of PDAC, allow an improved understanding of human cancer cell biology, and help guide personalized treatment.

In this review, we outline the status and application of PDX models in both basic and pre-clinical pancreatic cancer researches. PDX model is one of the most appropriate pre-clinical tools that can improve the prognosis of patients with pancreatic cancer in the future.

To review the diagnosis of chronic wound biofilms and discuss current treatment approaches.

Articles included in this review were obtained from the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before August 2019 with keywords including chronic wound, biofilm, bacterial biofilms, and chronic wound infection.

Relevant articles were selected by carefully reading the titles and abstracts. Further, different diagnosis and clinical treatment methods for chronic wound biofilm were compared and summarized from the selected published articles.

Recent guidelines on medical biofilms stated that approaches such as the use of scanning electron microscopy and confocal laser scanning microscopy are the most reliable types of diagnostic techniques. Further, therapeutic strategies include debridement, negative pressure wound therapy, ultrasound, antibiotic, silver-containing dressing, hyperbaric oxygen therapy, and others.

This review provides the identification and management of biofilms, and it can be used as a tool by clinicians for a better understanding of biofilms and translating research to develop best clinical practices.

骨关节炎（OA）是一种以关节痛为主要临床表现的关节软骨退行性疾病。来自中国健康与退休纵向研究的数据库显示，中国症状性OA（膝关节Kellgren和Lawrence评分≥2分，伴有膝关节疼痛）的发病率为8.1%。随着我国老龄化的发展，OA的发病率呈上升趋势。由于关节软骨内没有血管、神经、淋巴，其自愈能力较差。有许多类型的非手术治疗，例如包括非甾体抗炎药、糖皮质激素或阿片类药物的药物，^[1,2]以及包括注射透明质酸(HA)或富血小板血浆(PRP)的理疗治疗，^[3,4]预防疼痛，改善关节功能。所有这些方法都可以暂时防止疼痛，但不能中断关节软骨的退化。在使用吸脂装置从人体中提取脂肪后，可以通过分离和洗涤装置获得微片段化脂肪组织(MAT)，而无需消化酶。^[5]它支持三维支架、生长因子和细胞集落，如间充质干细胞（MSCs）。MAT注射可减轻OA患者疼痛，改善关节功能，且不引起不良事件。

原发性免疫性血小板减少症（ITP）是一种常见的出血性疾病，给社会经济带来巨大负担，其特征是粘膜、皮肤、脑和/或其他重要器官出血。^[1]严重出血甚至会导致死亡。尽管ITP很严重，但缺乏诊断和治疗的黄金标准。因此，很大程度上取决于医生的经验以及病人及其家属的意愿。事实上，诊断和治疗ITP患者的标准是在1996年美国血液学会发表一份具有里程碑意义的指南时才出现的。了解血液科医生管理ITP的常规策略以及他们遵守或偏离ITP指南的程度非常重要。然而，这样的研究很少。我们在2009年发表了这样一项研究。^[2]此后，中国血液学家诊断和治疗ITP的环境发生了根本性的变化，包括2011年中国血液学会（CSH）指南的发布及其2016年的更新。^[3]

透明细胞肾细胞癌（ccRCC）似乎倾向于转移到胰腺。^[1]近年来，来自欧洲和美国的越来越多的临床系列证明了胰腺转移瘤切除术令人鼓舞的生存结果，^[2]但东亚人群临床资料较少或仅有部分病例报道，^[3]并且没有关于适当管理的具体指导方针。本研究的目的是通过报告围手术期和生存结果来介绍我们对ccRCC胰腺转移瘤切除术的经验。

获得性免疫缺陷综合征（AIDS）患者由于免疫缺陷，容易发生机会性感染。由于艾滋病病毒是神经性的，10%的艾滋病患者首先表现为中枢神经系统（CNS）症状。^[1]超过40%未经治疗的艾滋病患者会发展为中枢神经系统疾病。^[2]艾滋病合并颅内病变的诊断和治疗主要依据临床经验和实验室检查。如有必要，考虑脑活检以帮助诊断和选择合适的治疗方法。在临床实践中，要得到明确的诊断是非常困难的。为进一步分析此类患者的临床特点，为临床诊治提供参考，我们回顾性分析了北京协和医院收治的3例艾滋病合并中枢神经系统感染病例。

致编辑：槌状骨折是一种非常常见的手部损伤。尽管一些无远端指间关节（DIPJ）半脱位的小碎片病例的非手术治疗是可以接受的，但许多作者认为通过精确复位恢复关节表面对于预防继发性骨关节炎、运动丧失和不良美容结果非常重要。^[1]为了获得准确的复位，已经开发了几种复位和固定技术（如延长块钉扎、钩板固定、类似克氏针的伞柄固定等）。^[2,3,4]但是当骨折碎片很小或粉碎时，基于当前的技术很难实现稳定的固定。为了开发一种更通用的方法来处理不同类型的锤状骨折，并发症更少，使用了横向双孔微型钢板。

致编辑：类风湿性关节炎（RA）是一种以滑膜增生和关节破坏为特征的慢性炎症性疾病。膝关节是RA患者中最常见的受累关节，大约25%的RA患者将在22年内接受关节置换术。^[1]全膝关节置换术（TKA）是一种成功治疗骨关节炎或RA引起的严重关节痛患者的方法。对松动率增加和可能需要多次翻修手术的担忧传统上不鼓励在60岁以下患者中使用TKA。^[2]尽管年轻患者的结果令人鼓舞，^[3]几乎没有中期随访数据。其他研究人员专注于TKA中有争议的表面置换。对表面置换和非表面置换关节成形术结果的比较发现两组之间没有显著差异，而其他人认为髌骨表面置换应常规进行。因此，我们报告了60岁以下RA患者成功的膝关节置换术设计的中期生存率，并比较了表面置换组和非表面置换组之间的差异。

致编辑：患者女，66岁，主诉左肩、手臂肌肉无力、麻木、疼痛16个月，后逐渐出现肌肉萎缩、前臂肿胀。入院前，她被诊断为臂丛神经炎，接受了静脉注射甲基强的松龙500 mg，持续3天，随后逐渐减少口服强的松龙。然而，她并没有从治疗中获益多少。她的个人病史和家族史并不显著。之前对她的大脑、颈脊髓和臂丛进行的胸部计算机断层扫描(CT)和磁共振成像(MRI)扫描[图1A]并不显著。针肌电图检查发现运动单位募集减弱，自发活动异常，包括左臂丛神经支配的肌肉部分出现阳性尖波和纤维性颤动。神经传导研究表明，在左臂丛神经分支支配的肌肉中，复合肌动作电位和感觉神经动作电位振幅随远端潜伏期延长而显著降低。这种表现在下躯干神经支配的区域更容易看到，如尺神经支配的肌肉。否则，神经传导速度的降低可以忽略不计。

致编辑：一名44岁女性在当地医院就诊，原因是在过去2个月内反复发作心悸，伴有冷汗、黑蒙、呕吐和四肢无力。当她感觉不舒服时，心电图显示“室性心动过速”。注射“胺碘酮”（剂量不详）后症状显著缓解，患者出院。当地医生建议消融，因此患者被转移到我院。患者总体健康，曾居住在有牧场的地区。据患者自述，30年前她曾被诊断为肝包虫病，但在当地医院手术治疗后已痊愈。此外，患者声称没有其他病史。入院后未发现血液学异常，但24小时动态心电图监测显示频发室性期前收缩。彩色多普勒超声心动图提示室间隔心尖部收缩明显减弱，伴有心尖部血栓。

致编辑：隆突性皮肤纤维肉瘤是一种低至中分化肿瘤，占所有恶性肿瘤的0.1%。^[1]这种肿瘤类型主要发生在躯干的浅表皮肤和皮下组织，在乳腺癌患者中很少见。^[2]在此，我们报告一位乳房隆突性皮肤纤维肉瘤患者，其肿瘤形状不规则。

致编辑：通过对1124例急性心肌梗死(AMI)住院患者的回顾性研究，王等人^[1]显示急性肾损伤（AKI）的独立危险因素为年龄>60岁、高血压、慢性肾脏病（CKD）、Killip分级≥3级、广泛前壁心肌梗死、使用呋塞米、未使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB），这些因素可为AKI的发生发展提供具有良好判别能力的预测模型。鉴于AKI与AMI患者的发病率和死亡率显著相关，^[2]他们的发现具有潜在的临床意义。除了作者在讨论中描述的局限性；然而，我们注意到他们研究中的一些方法问题需要进一步澄清。

高等人^[1]最近发表了一篇论文在中华医学杂志题为“巨噬细胞极化的研究动态：文献计量分析.”在这篇文章中，高等人在方法部分提到，“数据于2017年10月25日从‘科学网核心收藏’的科学引文索引扩展（SCI-E）数据库中获得。使用的搜索查询是‘TS=（巨噬细胞和极化）。’时间跨度设置为2007年至2016年，语言设置为‘英语’，文档类型设置为‘文章’。搜索结果为3064篇符合纳入标准的文章。”