MedNexus
2022年 · 第135卷第11期
出版日期 2022-06-05电子版 ￥0.00元
MedNexus
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- Review Article
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Editorial
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我国新生儿先天性心脏病筛查临床研究对公共卫生政策的影响Miao Yang, Youping Tian, Pin Jia, Xiaojing Ma, Xiaoling Ge, Xiaojing Hu, Quming Zhao, Fang Liu, Bing Jia, Weili Yan 等
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002031
摘要
先天性心脏病（CHD）是最常见的先天性畸形之一，在活产婴儿中的患病率约为1%。[
Consensus
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中国原发性手掌多汗症外科治疗专家共识（2021版）Yanguo Liu, Wenhan Weng, Yuanrong Tu, Jun Wang
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002198
摘要
Primary palmar hyperhidrosis (PPH) is a pathologic condition of excessive sweating on hands that has adverse impacts on patients' social activity, professional life, and psychological state. Endoscopic thoracic sympathicotomy (ETS) is by far the treatment choice for PPH with the most stable and durable curative effects, but special attention should be given to the side effects of the surgery, especially compensatory hyperhidrosis (CH). This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis (CECPH), which was published 10 years ago. This consensus emphasizes the need for special attention and careful assessment of the patients’ feelings, as well as their emotional and mental state, and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for diagnosis. It also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side effect. New evidence of the epidemiology, pathogenesis of PPH, and indications for surgery were also assessed or recommended.
Review Article
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靶向PI3K信号通路治疗非小细胞肺癌Lin Jiang, Jingbo Zhang, Yan Xu, Heng Xu, Mengzhao Wang
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002195
摘要
The phosphosphatidylinositol-3-kinase (PI3K) signaling pathway is one of the most important intracellular signal transduction pathways affecting cell functions, such as apoptosis, translation, metabolism, and angiogenesis. Lung cancer is a malignant tumor with the highest morbidity and mortality rates in the world. It can be divided into two groups, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC accounts for >85% of all lung cancers. There are currently many clinical treatment options for NSCLC; however, traditional methods such as surgery, chemotherapy, and radiotherapy have not been able to provide patients with good survival benefits. The emergence of molecular target therapy has improved the survival and prognosis of patients with NSCLC. In recent years, there have been an increasing number of studies on NSCLC and PI3K signaling pathways. Inhibitors of various parts of the PI3K pathway have appeared in various phases of clinical trials with NSCLC as an indication. This article focuses on the role of the PI3K signaling pathway in the occurrence and development of NSCLC and summarizes the current clinical research progress and possible development strategies.
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精准癌症免疫治疗中的新抗原：从鉴定到临床应用Qiao Zhang, Qingzhu Jia, Jing Zhang, Bo Zhu
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002181
摘要
Immunotherapies targeting cancer neoantigens are safe, effective, and precise. Neoantigens can be identified mainly by genomic techniques such as next-generation sequencing and high-throughput single-cell sequencing; proteomic techniques such as mass spectrometry; and bioinformatics tools based on high-throughput sequencing data, mass spectrometry data, and biological databases. Neoantigen-related therapies are widely used in clinical practice and include neoantigen vaccines, neoantigen-specific CD8+ and CD4+ T cells, and neoantigen-pulsed dendritic cells. In addition, neoantigens can be used as biomarkers to assess immunotherapy response, resistance, and prognosis. Therapies based on neoantigens are an important and promising branch of cancer immunotherapy. Unremitting efforts are needed to unravel the comprehensive role of neoantigens in anti-tumor immunity and to extend their clinical application. This review aimed to summarize the progress in neoantigen research and to discuss its opportunities and challenges in precision cancer immunotherapy.
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胃癌靶向治疗和免疫治疗研究进展Xuewei Li, Jun Xu, Jun Xie, Wenhui Yang
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002185
摘要
Gastric cancer (GC) is one of the most common malignant tumors worldwide. Its incidence ranks the 5th among all malignant tumors globally, and it is the 3rd leading cause of death among patients with cancer. Surgical treatment is the first choice in clinical practice. However, targeted therapy, immunotherapy, and other treatment methods have also become research hotspots at home and abroad with the development of individualized precision therapy in recent years, besides traditional radiotherapy and chemotherapy. At present, targeted therapy and immunotherapy are methods used for treating GC, and they have important clinical application value and prospects. This study aimed to review the research progress of targeted therapy and immunotherapy for GC, focusing on its mechanism of action and related important clinical trials, hoping to provide references for the clinical treatment of GC.
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儿童COVID-19：流行病问题和候选疫苗Peng Zhang, Mingwei Wei, Pengfei Jin, Zhuopei Li, Jingxin Li, Fengcai Zhu
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002169
摘要
A large-scale vaccination of coronavirus disease-19 (COVID-19) in adults has been conducted for nearly a year, and there is a growing recognition that immunization for children is also essential. It has been months since emergency use of pediatric COVID-19 vaccine was approved, we reviewed the prevalence and transmission of COVID-19 in children. The prevalence of COVID-19 in children is reduced due to vaccination even in a Delta prevalent period, so an increase in the vaccination rate is needed in children. Although the precise role of children in the transmission requires more research to uncover, they likely played a significant role, according to the available literature. We also described four candidate COVID-19 vaccines for children on their safety and immunogenicity and the impact of severe acute respiratory syndrome coronavirus 2 variants on childhood vaccination. Safety issues on pediatric vaccines post-approval, like adverse events following immunization and adverse events of special interest require studies on long-term and effective regulatory mechanisms.
Medical Progress
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基于成像的深度学习在肝病中的应用Enyu Yuan, Zheng Ye, Bin Song
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002199
摘要
肝病是由异质性病因引起的肝损害的统称，在世界范围内造成沉重的健康负担。现代医学成像，如计算机断层扫描（CT）、磁共振成像（MRI）和超声检查，在肝病的诊断和治疗中起着重要作用。基于成像的深度学习（DL）是近十年来研究最活跃的技术之一。它通过分层结构实现高维特征提取，可用于各种临床场景，特别是计算机视觉中的卷积神经网络。
Viewpoint
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中国肥胖大流行：流行病学、负担、挑战和机遇Jing Li, Qingyang Shi, Qingyang Gao, Xiong-Fei Pan, Li Zhao, Yazhou He, Haoming Tian, Zhiming Zhu, Sheyu Li
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002189
摘要
中国面临着沉重的肥胖大流行。中国疾病预防控制中心最近的数据表明，2018年估计有超过8.1%的中国成年人（8500万中国成年人）患有肥胖症，是2004年水平的三倍。[
Original Article
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不吸烟者肺癌风险的性别差异：一项基于中国国家肺癌筛查计划的多中心人群前瞻性研究Zheng Wu, Fengwei Tan, Zhuoyu Yang, Fei Wang, Wei Cao, Chao Qin, Xuesi Dong, Yadi Zheng, Zilin Luo, Liang Zhao 等
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002161
摘要
Background:
Non-smokers account for a large proportion of lung cancer patients, especially in Asia, but the attention paid to them is limited compared with smokers. In non-smokers, males display a risk for lung cancer incidence distinct from the females—even after excluding the influence of smoking; but the knowledge regarding the factors causing the difference is sparse. Based on a large multicenter prospective cancer screening cohort in China, we aimed to elucidate the interpretable sex differences caused by known factors and provide clues for primary and secondary prevention.
Methods:
Risk factors including demographic characteristics, lifestyle factors, family history of cancer, and baseline comorbidity were obtained from 796,283 Chinese non-smoking participants by the baseline risk assessment completed in 2013 to 2018. Cox regression analysis was performed to assess the sex difference in the risk of lung cancer, and the hazard ratios (HRs) that were adjusted for different known factors were calculated and compared to determine the proportion of excess risk and to explain the existing risk factors.
Results:
With a median follow-up of 4.80 years, 3351 subjects who were diagnosed with lung cancer were selected in the analysis. The lung cancer risk of males was significantly higher than that of females; the HRs in all male non-smokers were 1.29 (95% confidence interval [CI]: 1.20-1.38) after adjusting for the age and 1.38 (95% CI: 1.28-1.50) after adjusting for all factors, which suggested that known factors could not explain the sex difference in the risk of lung cancer in non-smokers. Known factors were 7% (|1.29-1.38|/1.29) more harmful in women than in men. For adenocarcinoma, women showed excess risk higher than men, contrary to squamous cell carcinoma; after adjusting for all factors, 47% ([1.30-1.16]/[1.30-1]) and 4% ([7.02-6.75]/[7.02-1])) of the excess risk was explainable in adenocarcinoma and squamous cell carcinoma. The main causes of gender differences in lung cancer risk were lifestyle factors, baseline comorbidity, and family history.
Conclusions:
Significant gender differences in the risk of lung cancer were discovered in China non-smokers. Existing risk factors did not explain the excess lung cancer risk of all non-smoking men, and the internal causes for the excess risk still need to be explored; most known risk factors were more harmful to non-smoking women; further exploring the causes of the sex difference would help to improve the prevention and screening programs and protect the non-smoking males from lung cancers.
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1990-2019年中国胰腺炎负担及相关危险因素：2019年全球疾病负担研究的系统分析Ke Han, Shimin Chen, Yang Song, Chen Du, Fei Gao, Shaohua Liu, Yao He, Ningli Chai, Enqiang Linghu, Miao Liu
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002164
摘要
Background:
Pancreatitis is a common disease of the digestive system. Acute pancreatitis is one of the most common reasons for gastrointestinal hospital admission, and chronic pancreatitis significantly reduces quality of life. However, national epidemiological data on pancreatitis in China are lacking. This study aimed to quantify the disease burden of pancreatitis in China from 1990 to 2019.
Methods:
This study was based on the Global Burden of Disease Study 2019 dataset. Age-standardized rates of incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) were used to describe the disease burden of pancreatitis, and estimated annual percentage change (EAPC) was used to indicate the average change in age-standardized rates. We also described the trend of pancreatitis-related mortality and DALYs, which are attributable to alcohol use by age and sex.
Results:
From 1990 to 2019, the ASIR, ASPR, ASMR, and age-standardized DALYs of pancreatitis in China decreased by 10.90, 1.50, 0.49, and 15.54 per 100,000, respectively, with EAPCs of -1.35 (95% uncertainty interval [UI]: -1.67, -1.02) and -0.37 (95% UI: -0.43, -0.31), -2.01 (95% UI: -2.07, -1.94) and -2.32 (95% UI: -2.37, -2.28), respectively. Recently, the numbers of incident and prevalent cases have risen, with estimates of 380,018 (95% UI: 308,669-462,767) and 493,765 (95% UI: 416,705-578,675), respectively, in 2019. Among men, the disease burden of pancreatitis was more severe than among women, and with variances in the distribution among different age groups. Age-standardized DALYs caused by alcohol-related pancreatitis have gradually worsened in the past decade, accounting for 34.09% of the total in 2019.
Conclusions:
The disease burden of pancreatitis in China has declined in the past 30 years, but the exacerbation of population aging poses a challenge to prevention and control of pancreatitis. Alcohol use has gradually become an important factor in the disease burden of pancreatitis in recent years.
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表达数量性状基因座的系统分析鉴定了与胰腺癌预后相关的无名指和WD重复结构域3的新调控变异Ying Zhu, Xiating Peng, Xiaoyang Wang, Pingting Ying, Haoxue Wang, Bin Li, Yue Li, Ming Zhang, Yimin Cai, Zequn Lu 等
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002180
摘要
Background:
Pancreatic adenocarcinoma (PAAD) is an extremely lethal malignancy. Identification of the functional genes and genetic variants related to PAAD prognosis is important and challenging. Previously identified prognostic genes from several expression profile analyses were inconsistent. The regulatory genetic variants that affect PAAD prognosis were largely unknown.
Methods:
Firstly, a meta-analysis was performed with seven published datasets to systematically explore the candidate prognostic genes for PAAD. Next, to identify the regulatory variants for those candidate genes, expression quantitative trait loci analysis was implemented with PAAD data resources from The Cancer Genome Atlas. Then, a two-stage association study in a total of 893 PAAD patients was conducted to interrogate the regulatory variants and find the prognostic locus. Finally, a series of biochemical experiments and phenotype assays were carried out to demonstrate the biological function of variation and genes in PAAD progression process.
Results:
A total of 128 genes were identified associated with the PAAD prognosis in the meta-analysis. Fourteen regulatory loci in 12 of the 128 genes were discovered, among which, only rs4887783, the functional variant in the promoter of Ring Finger and WD Repeat Domain 3 (RFWD3), presented significant association with PAAD prognosis in both stages of the population study. Dual-luciferase reporter and electrophoretic mobility shift assays demonstrated that rs4887783-G allele, which predicts the worse prognosis, enhanced the binding of transcript factor REST, thus elevating RFWD3 expression. Further phenotypic assays revealed that excess expression of RFWD3 promoted tumor cell migration without affecting their proliferation rate. RFWD3 was highly expressed in PAAD and might orchestrate the genes in the DNA repair process.
Conclusions:
RFWD3 and its regulatory variant are novel genetic factors for PAAD prognosis.
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中国肌肉质量、力量和质量与全因死亡率的关系：一项基于人群的队列研究Man Wu, Yuxia Wei, Jun Lv, Yu Guo, Pei Pei, Jiachen Li, Huaidong Du, Ling Yang, Yiping Chen, Xiaohui Sun 等
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002193
摘要
Background
It remains unclear about the association of muscle mass, strength, and quality with death in the general Chinese population of diverse economical and geographical backgrounds. The present study aimed to comprehensively examine such associations across different regions in China.
Methods
Based on the China Kadoorie Biobank study, the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer. Muscle mass and grip strength were measured using calibrated instruments. Arm muscle quality was defined as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength, and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index, grip strength, and arm muscle quality, respectively. Cox proportional hazards models yielded hazard ratios (HRs) and 95% confidence intervals (CIs) for risks of all-cause mortality in relation to muscle mass, strength, and quality.
Results
During a median follow-up of 3.98 years, 739 participants died. The HR (95% CI) of all-cause mortality risk was 1.28 (1.08-1.51) for low appendicular muscle mass index, 1.38 (1.16-1.62) for low total muscle mass index, 1.68 (1.41-2.00) for low grip strength, and 1.41 (1.20-1.66) for low arm muscle quality in models adjusted for sociodemographic characteristics, lifestyle factors, and medical histories.
Conclusion
Low muscle mass, grip strength, and arm muscle quality are all associated with short-term increased risks of mortality, indicating the importance of maintaining normal muscle mass, strength, and quality for general Chinese adults.
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中国荨麻疹流行病学：一项基于人群的研究Jiaqing Li, Dandan Mao, Shuoshuo Liu, Ping Liu, Jing Tian, Chenhong Xue, Xiaojing Liu, Ruiqun Qi, Bingxue Bai, Jianjun Nie 等
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002172
摘要
Background:
Urticaria is a common skin disease characterized by episodes of wheals, and it has a negative effect on patients’ quality of life. Large-scale population-based epidemiological studies of urticaria are scarce in China. The aim of this survey was to determine the prevalence, clinical forms, and risk factors of urticaria in the Chinese population.
Methods:
This survey was conducted in 35 cities from 31 provinces, autonomous regions, and municipalities of China. Two to three communities in each city were selected in this investigation. Participants completed questionnaires and received dermatological examinations. We analyzed the prevalence, clinical forms, and risk factors of urticaria.
Results:
In total, 44,875 questionnaires were distributed and 41,041 valid questionnaires were collected (17,563 male and 23,478 female participants). The lifetime prevalence of urticaria was 7.30%, with 8.26% in female and 6.34% in male individuals (P < 0.05). The point prevalence of urticaria was 0.75%, with 0.79% in female and 0.71% in male individuals (P < 0.05). Concomitant angioedema was found in 6.16% of patients. Adults had a higher prevalence of urticaria than adolescents and children. Living in urban areas, exposure to pollutants, an anxious or depressed psychological status, a personal and family history of allergy, thyroid diseases, and Helicobacter pylori infection were associated with a higher prevalence of urticaria. Smoking was correlated with a reduced risk of urticaria.
Conclusion:
This study demonstrated that the lifetime prevalence of urticaria was 7.30% and the point prevalence was 0.75% in the Chinese population; women had a higher prevalence of urticaria than men. Various factors were correlated with urticaria.
Correspondence
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与人类免疫缺陷病毒感染相关的细菌和真菌肠道生态失调Xueqi Wu, Yuanhong Xu, Qingfeng Li, Fengjiao Yang, Shenghua He, Yingjie Li, Shujuan Yang, Peibin Zeng
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002194
摘要
致编辑：人们越来越关注与HIV感染相关的肠道细菌生态失调，解决了肠道细菌在人类免疫缺陷病毒(HIV)感染人群中持续慢性炎症和严重肠道功能障碍中的关键作用。然而，对HIV感染引起的肠道真菌生态失调知之甚少。因此，我们开展了一项病例对照研究，旨在探索HIV感染中细菌和真菌的肠道生态失调，这可能会揭示HIV感染相关的细菌和真菌肠道生态失调的更全面特征，这些细菌和真菌可能在HIV感染中观察到的慢性全身免疫激活中发挥作用。
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盐裂皮肤间接免疫荧光法、直接免疫荧光法和BP180 NC16A ELISA法对大疱性类天疱疮的诊断价值Suo Li, Ruiyu Xiang, Ke Jing, Zhiliang Li, Yuan Wang, Hanmei Zhang, Xiaoguang Li, Suying Feng
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002196
摘要
致编辑：大疱性类天疱疮（BP）的实验室诊断方法包括直接免疫荧光（DIF）显微镜检查、BP180 NC16A酶联免疫吸附试验（ELISA）和使用盐裂皮肤的间接免疫荧光（ssIIF）。免疫荧光（IF）研究是BP实验室检查的重要组成部分。DIF被视为BP诊断的金标准；但无特异性，也可见于其他获得性自身免疫性表皮下水疱性皮肤病。发现ssIIF对BP诊断具有100%的特异性，在一些指南中，建议对每个临床疑似BP的患者进行ssIIF。[
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含辛基水杨酸、水杨酸、亚油酸、烟酰胺和吡罗克酮乙醇胺乳膏联合5%过氧化苯甲酰治疗寻常痤疮的疗效和安全性：一项随机对照研究Wei Li, Qian Yu, Zhong Shen, Lanxin Zhang, Wei Zhang, Caixia Li
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002191
摘要
致编辑：寻常痤疮是一种累及皮脂腺的慢性炎症性皮肤病。其发病率约为9.4%，常发生于青少年。[
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基于三磷酸腺苷的肿瘤化疗敏感性试验可预测接受紫杉烷类药物术后辅助化疗的胃癌患者的临床结局Yicong Bian, Minzhou Huang, Sheng Ma, Linsheng Liu, Fan Xia, Zhiyao Chen, Di Yu, Chenrong Huang, Liyan Miao
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000002210
摘要
致编辑：胃癌是世界上最常诊断的癌症之一。对于病理肿瘤淋巴结转移分期为II期或III期的患者，通常需要术后辅助化疗，通过控制根治性切除后的残留肿瘤细胞来降低复发风险。[
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糖皮质激素治疗新冠肺炎的进一步探讨Yun’ai Feng, Haichao Li
中华医学杂志英文版2022年 135卷 11期
DOI: 10.1097/CM9.0000000000001872
摘要
致编辑：冠状病毒2019（COVID-19）治疗（恢复期）的随机评估[
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