MedNexus
2022年 · 第135卷第18期
出版日期 2022-09-20电子版 ￥0.00元
MedNexus
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- Original Article
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Review Article
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可切除食管癌的治疗：从传统全身治疗到免疫治疗Yan Yan, Xijia Feng, Chengqiang Li, Toni Lerut, Hecheng Li
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002371
摘要
Esophageal cancer (EC) has a high incidence and poor prognosis. The two major histological types, squamous cell carcinoma and adenocarcinoma, differ in their epidemiology and treatment options. Patients with locally advanced EC benefit from multimodal therapy concepts including neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy, and perioperative chemotherapy. Currently, immunotherapy for the solid tumor is a hot spot. Treatment with adjuvant immune checkpoint inhibitors (ICIs) is the first immunotherapy for resectable EC listed in the latest National Comprehensive Cancer Network Guidelines for the Esophageal and Esophagogastric Junction Cancers. Recent clinical trials have established ICIs for three treatment models of resectable EC. Their short-term results demonstrated ideal efficacy and tolerable toxicity, though some concerns remain. This review summarizes the novel data on the ICIs for resectable EC and lists the registered related clinical trials. Hopefully, this review can provide a reference for ongoing research on the treatment options for resectable EC.
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铁下垂及其在肝细胞癌中作用的新观点Tianhao Cong, Yingen Luo, Yan Fu, Yu Liu, Yujie Li, Xiao Li
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002327
摘要
For a long time, the morbidity and mortality rates of hepatocellular carcinoma (HCC) have remained high. Since the concept of ferroptosis was introduced in 2012, researchers’ perspectives have shifted toward finding novel ferroptosis-related treatment strategies, especially for tumors that are resistant to apoptosis. In recent years, there have been an increasing number of studies on ferroptosis, and these studies have found that ferroptosis has great potential and promise for cancer treatment. Ferroptosis is a kind of regulated cell death (RCD); unlike apoptosis, ferroptosis is an iron-dependent type of RCD driven by lipid peroxidation. The whole process of ferroptosis mainly revolves around three pathways (system xc-/ glutathione peroxidase 4 [GPX4]), lipid peroxidation, and iron metabolism), which are also regulated by various metabolic factors. This review will attempt to analyze the relationship between the system xc-/GPX4 pathway, lipid peroxidation, iron metabolism, and ferroptosis from three aspects (triggering, execution, and regulation), and the regulatory factors for ferroptosis will be summarized. In this review, we will also illustrate the relationship between ferroptosis and tumors as well as its application in tumors from the perspective of HCC. Finally, we will summarize the current limitations and needs and provide perspectives related to the focus of development in the future.
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自身免疫性疾病中的Tc17细胞Yong Peng, Xiang Deng, Qiuming Zeng, Yandan Tang
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002083
摘要
Multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE), a pathologically similar disease used to model MS in rodents, are typical CD4+ T cell-dominated autoimmune diseases. CD4+ interleukin (IL)17+ T cells (Th17 cells) have been well studied and have shown that they play a critical role in the pathogenesis of MS/EAE. However, studies have suggested that CD8+IL17+ T cells (Tc17 cells) have a similar phenotype and cytokine and transcription factor profiles to those of Th17 cells and have been found to be crucial in the pathogenesis of autoimmune diseases, including MS/EAE, psoriasis, type I diabetes, rheumatoid arthritis, and systemic lupus erythematosus. However, the evidence for this is indirect and insufficient. Therefore, we searched for related publications and attempted to summarize the current knowledge on the role of Tc17 cells in the pathogenesis of MS/EAE, as well as in the pathogenesis of other autoimmune diseases, and to find out whether Tc17 cells or Th17 cells play a more critical role in autoimmune disease, especially in MS and EAE pathogenesis, or whether the interaction between these two cell types plays a critical role in the development of the disease.
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合成生物学在膀胱癌中的应用Mengting Ding, Jiaxing Lin, Caipeng Qin, Ping Wei, Jiahe Tian, Tianxin Lin, Tao Xu
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002344
摘要
Bladder cancer (BC) is the most common malignant tumor of the genitourinary system. The age of individuals diagnosed with BC tends to decrease in recent years. A variety of standard therapeutic options are available for the clinical management of BC, but limitations exist. It is difficult to surgically eliminate small lesions, while radiation and chemotherapy damage normal tissues, leading to severe side effects. Therefore, new approaches are required to improve the efficacy and specificity of BC treatment. Synthetic biology is a field emerging in the last decade that refers to biological elements, devices, and materials that are artificially synthesized according to users’ needs. In this review, we discuss how to utilize genetic elements to regulate BC-related gene expression periodically and quantitatively to inhibit the initiation and progression of BC. In addition, the design and construction of gene circuits to distinguish cancer cells from normal cells to kill the former but spare the latter are elaborated. Then, we introduce the development of genetically modified T cells for targeted attacks on BC. Finally, synthetic nanomaterials specializing in detecting and killing BC cells are detailed. This review aims to describe the innovative details of the clinical diagnosis and treatment of BC from the perspective of synthetic biology.
Perspective
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抗黑色素瘤分化相关基因-5的发病机制(MDA5)皮肌炎Chenghua Weng, Zhichun Liu
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002049
摘要
皮肌炎（DM）是一种特发性炎性肌病，有典型的皮肤表现和肌肉病变，通常累及多个器官。抗黑色素瘤分化相关基因-5（MDA5）DM通常表现为临床无肌病性DM（CADM），其特征是一系列独特的皮肤和全身表现，包括皮肤溃疡和间质性肺病（ILD）。其中，ILD是抗MDA5 DM最常见的并发症，在某些情况下可发展为快速进行性ILD（RP-ILD）。[
Original Article
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系统性红斑狼疮(SLE)的性别差异：中国SLE治疗和研究组(CSTAR)注册中心XVII的初始队列Yinli Gui, Wei Bai, Jian Xu, Xinwang Duan, Feng Zhan, Chen Zhao, Zhenyu Jiang, Zhijun Li, Lijun Wu, Shengyun Liu 等
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002360
摘要
Background:
The onset and clinical presentation of systemic lupus erythematosus (SLE) are sex-related. Few studies have investigated the distinctions in clinical characteristics and treatment preferences in male and female SLE patients in the initial cohort. This study aimed to improve the understanding of Chinese SLE patients by characterizing the different sexes of SLE patients in the inception cohort.
Methods:
Based on the initial patient cohort established by the Chinese SLE Treatment and Research Group, a total of 8713 patients (795 men and 7918 women) with newly diagnosed SLE were enrolled between April 2009 and March 2021. Of these, 2900 patients (347 men and 2553 women) were eligible for lupus nephritis (LN). A cross-sectional analysis of the baseline demographic characteristics, clinical manifestations, laboratory parameters, organ damage, initial treatment regimens, and renal pathology classification was performed according to sex.
Results:
In the SLE group, as compared to female patients, male patients had a later age of onset (male vs. female: 37.0 ± 15.8 years vs. 35.1 ± 13.7 years, P = 0.006) and a higher SLE International Collaborative Clinic/American College of Rheumatology damage index score (male vs. female: 0.47 ± 1.13 vs. 0.34 ± 0.81, P = 0.015), LN (male vs. female: 43.6% vs. 32.2%, P < 0.001), fever (male vs. female: 18.0% vs. 14.6%, P = 0.010), thrombocytopenia (male vs. female: 21.4% vs. 18.5%, P = 0.050), serositis (male vs. female: 14.7% vs. 11.7%, P= 0.013), renal damage (male vs. female: 11.1% vs. 7.4%, P < 0.001), and treatment with cyclophosphamide (CYC) (P < 0.001). The frequency of leukopenia (male vs. female: 20.5% vs. 25.4%, P = 0.002) and arthritis (male vs. female: 22.0% vs. 29.9%, P < 0.001) was less in male patients with SLE. In LN, no differences were observed in disease duration, SLE Disease Activity Index score, renal biopsy pathological typing, or 24-h urine protein quantification among the sexes. In comparisons with female patients with LN, male patients had later onset ages (P = 0.026), high serum creatinine (P < 0.001), higher end-stage renal failure rates (P = 0.002), musculoskeletal damage (P = 0.023), cardiovascular impairment (P = 0.009), and CYC use (P = 0.001); while leukopenia (P = 0.017), arthritis (P = 0.014), and mycophenolate usage (P = 0.013) rates were lower.
Conclusions:
Male SLE patients had more severe organ damage and a higher LN incidence compared with female SLE patients; therefore, they may require more aggressive initial treatment compared to female patients.
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三联疗法预防类风湿性关节炎复发的疗效、安全性和成本效益：一项随机对照试验（ESCoRT研究）Juan Zhao, Wei Zhou, Yangfeng Wu, Xiaoyan Yan, Li Yang, Zhuoli Zhang
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002336
摘要
Background:
Biological agents, such as tumor necrosis factor inhibitors (TNFi), have been widely used in rheumatoid arthritis (RA) patients and greatly improved goal achievement. The aim of this study was to investigate whether conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) combination was better in reducing relapse than methotrexate (MTX) monotherapy, and more cost-effective than continuing TNFi plus MTX in RA patients who achieved low disease activity (LDA) with TNFi and MTX therapy.
Methods:
RA patients who failed to csDMARDs received an induction therapy of MTX plus TNFi for maximally 12 weeks. Those achieving LDA in 12 weeks were randomly assigned at a 1:1:1 ratio into three groups: (A) adding hydroxychloroquine and sulfasalazine for the first 12 weeks and then discontinuing TNFi for the following 48 weeks; (B) maintaining TNFi and MTX for 60 weeks; and (C) maintaining TNFi and MTX for the first 12 weeks and then discontinuing TNFi for the following 48 weeks. The primary outcome was relapse.
Results:
A total of 117 patients were enrolled for induction therapy and 67 patients who achieved LDA within 12 weeks were randomized, with 24, 21, and 22 patients in groups A, B, and C, respectively. The relapse rates of groups A and B during the entire 60 weeks were comparable [10/22 (45.5%) vs. 7/20 (35.0%), χ2 = 0.475, P = 0.491], however, significantly lower than that of group C [10/22 (45.5%) vs. 17/20 (85.0%), χ2 = 5.517, P = 0.019; 7/20 (35.0%) vs. 17/20 (85.0%), χ2 = 11.035, P = 0.004, respectively]. Taking RMB 100,000 Yuan as the threshold of willingness to pay, compared to MTX monotherapy (group C), both TNFi maintenance and triple csDMARDs therapies were cost-effective, but triple csDMARDs therapy was better.
Conclusion:
For RA patients who have achieved LDA with TNFi and MTX, csDMARDs triple therapy was a cost-effective option in favor of reducing relapse.
Trial registration:
ClinicalTrials.gov, NCT02320630.
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中国类风湿性关节炎登记处（CREDIT）V：性别对中国患者类风湿性关节炎的影响Nan Jiang, Qin Li, Hongbin Li, Yongfei Fang, Lijun Wu, Xinwang Duan, Jian Xu, Cheng Zhao, Zhenyu Jiang, Yanhong Wang 等
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002110
摘要
Background:
The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients.
Methods:
Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits.
Results:
A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0 vs. 6.7 mg/L), pain visual analogue scale (4.8 vs. 4.5), patient’s and physician’s global assessment (4.9 vs. 4.5 and 4.9 vs. 4.5), 28-joint disease activity score using DAS28-CRP (4.3 vs. 4.0) simplified disease activity index (21.9 vs. 19.9), and clinical disease activity index (19.3 vs. 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4% vs. 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women.
Conclusions:
In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.
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综合分析确定为乳腺癌的关键预后预测基因Ting Hu, Xu Wang, Yun Xia, Lu Wu, Yuxi Ma, Rui Zhou, Yanxia Zhao
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002025
摘要
Background:
Aurora kinases (AURKs) family plays a vital role not only in cell division but also in tumorigenesis. However, there are still rare systematic analyses of the diverse expression patterns and prognostic value of the AURKs family in breast cancer (BC). Systematic bioinformatics analysis was conducted to explore the biological role, prognostic value, and immunologic function of AURKs family in BC.
Methods:
The expression, prognostic value, and clinical functions of AURKs family in BC were evaluated with several bioinformatics web portals: ONCOMINE Gene Expression Profiling Interactive Analysis, Kaplan-Meier plotter, cBioPortal, Metascape, GeneMANIA, and LinkedOmics; and the result was verified using human tissues.
Results:
The expression of AURKA and AURKB were upregulated in BC in subgroup analyses based on tumor stage (all P < 0.05). BC patients with high AURKA and AURKB expression had a worse overall survival, relapse-free survival, and distant metastasis-free survival (all P < 0.05). Verification experiment revealed that AURKA and AURKB were upregulated in BC (P < 0.05). AURKA and AURKB were specifically associated with several tumor-associated kinases (polo-like kinase 1 and cyclin-dependent kinase 1), miRNAs (miR-507 and miR-381), and E2F transcription factor 1. Moreover, AURKA and AURKB were correlated with immune cell infiltration. Functional enrichment analysis revealed that AURKA and AURKB were involved in the cell cycle signaling pathway, platinum drug resistance signaling pathway, ErbB signaling pathway, Hippo signaling pathway, and nucleotide-binding and oligomerization domain-like receptor signaling pathway.
Conclusions:
Aurora kinases AURKA and AURKB could be employed as novel prognostic biomarkers or promising therapeutic targets for BC.
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脂多糖诱导的肠上皮损伤：一种新的基于类器官的脓毒症模型体外Sisi Huang, Sheng Zhang, Limin Chen, Xiaojun Pan, Zhenliang Wen, Yizhu Chen, Lidi Zhang, Jiao Liu, Dechang Chen
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002348
摘要
Background:
Advances in organoid culture technology have provided a greater understanding of disease pathogenesis, which has been rarely studied in sepsis before. We aim to establish a suitable organoids-based intestinal injury model for sepsis.
Methods:
Stable passaged organoids were constructed and pre-treated with lipopolysaccharide (LPS) to mimic sepsis-induced intestinal injury. The LPS-induced sepsis model was used as a reference. We used quantitative real-time polymerase chain reaction to evaluate the RNA levels of inflammatory factors and antimicrobial peptides. Enzyme-linked immunosorbent assay was used to evaluate the protein levels, hematoxylin and eosin staining was used to evaluate the pathology of the small intestine of mice, and immunohistochemistry and immunofluorescence were used to evaluate the intestinal epithelial barrier function. Perkin Elmer OperettaTM was used to obtain high-resolution images of three-dimensional organoids.
Results:
An LPS concentration >150 μg/mL after 24 h was identified to cause organoid growth restriction. The fluorescence intensity of zonula occludens-1 and occludins at LPS concentrations >100 μg/mL decreased significantly after 24 h. After LPS stimulation for 8 h, the RNA expression levels of interleukin (IL)-1α, tumor necrosis factor alpha, granulocyte-macrophage colony-stimulating factor, IL-6, and regenerating islet-derived protein 3 alpha, beta, and gamma increased. These results resembled those of intestinal epithelial layer alterations in a mouse sepsis model. For IL-10, the RNA expression level increased only when the LPS level >200 μg/mL for 24 h.
Conclusions:
This study provides the primary intestinal in vitro model to study the effects of LPS-induced intestinal injury resembling sepsis. This model provides a platform for immune associated mechanism exploration and effective drug screening.
Technical Notes
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袖状胃切除术加未切开空肠空肠旁路术治疗肥胖症和2型糖尿病Zhiwei Zhai, Ganbin Li, Yu Tao, Zhenjun Wang, Jiagang Han
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002087
摘要
减肥代谢手术已被证实是实现体重减轻、治疗肥胖相关疾病、提高生活质量的有效、安全、可行的方法。由于其简单性，袖状胃切除术（SG）在过去十年中比Roux-en-Y胃旁路术（RYGB）更常用。[
Clinical Observation
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经皮椎体成形术联合化疗治疗多发性骨髓瘤合并椎体压缩性骨折Yang Zhang, Huayong Zheng, Fei Wang, Lizhi Zhang, Yuan Zhang, Xiumei Liu, Zhicheng Zhang, Fang Li
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002017
摘要
多发性骨髓瘤（MM）是一种血液系统恶性肿瘤，其中浆细胞在骨髓中增殖，导致溶骨性骨破坏。高达90%的MM患者存在骨受累，并与疼痛和骨骼相关并发症相关，如病理性椎体压缩性骨折（VCFs）。[
Correspondence
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他克莫司治疗不同表现系统性红斑狼疮的临床疗效：一项真实世界研究Wei Bai, Mengtao Li, Shuang Zhou, Liying Peng, Jiuliang Zhao, Xinping Tian, Qian Wang, Xiaomei Leng, Shangzhu Zhang, Yanhong Wang 等
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002302
摘要
致编辑：系统性红斑狼疮（SLE）是一种累及多系统的自身免疫性疾病。近年来，治疗性靶向治疗（T2T）策略被推荐用于SLE。[
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阿达木单抗和司库奇尤单抗对斑块型银屑病患者代谢相关合并症的影响Si Zhang, Lin Cai, Heng Zhang, Zheng Zhao, Xiaoyang Liu, Yan Zhao, Jianzhong Zhang
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002143
摘要
致编辑：银屑病通常与心血管疾病、肥胖和代谢综合征（MS）等合并症相关。然而，上述疾病在中国斑块型银屑病患者中的患病率仍然未知。最近，肿瘤坏死α抑制剂、白细胞介素-17A抑制剂等生物制剂已成功用于斑块型银屑病的治疗。然而，生物治疗对代谢相关合并症的影响仍有争议。有必要研究代谢相关合并症和斑块型银屑病与生物制剂作用之间的关系。
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抗磷脂抗体的标准外临床表现不容忽视Can Huang, Chaojun Hu, Jiuliang Zhao, Qian Wang, Xinping Tian, Mengtao Li, Xiaofeng Zeng
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002128
摘要
致编辑：抗磷脂综合征（APS）是一种以持续阳性抗磷脂抗体（aPL）（包括狼疮抗凝剂（LA）、抗心磷脂抗体（aCL）和抗β 2糖蛋白-I抗体（抗β 2GPI））患者发生血栓和产科事件为特征的疾病。APS的临床症状包括许多非血栓性表现，也称为标准外表现，包括血小板减少症、aPL肾病、网状青斑、瓣膜性心脏病和神经系统表现。[
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川崎病患者冠状动脉血栓形成风险分层：形态学和血流动力学研究Haoyao Cao, Tinghui Zheng, Da Li, Jing Liu, Zhan Liu, Liqing Peng
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000001931
摘要
到编辑：冠状动脉瘤（CAAs）是川崎病（KD）的并发症之一，可引起心肌缺血、梗死，甚至猝死。[
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中国人群强直性脊柱炎延迟诊断的改善Yuhan Sun, Zhuoran Hu, Xuecheng Zhang, Jun Qi, Zhiming Lin
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000001950
摘要
致编辑：强直性脊柱炎（AS）是中轴性脊柱关节炎（ax-SpA）的代表性表型，延迟诊断是一个挑战。这种延迟可能正在改善，[
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Bakri球囊填塞治疗产后出血Hui Yang, Guoqiang Sun, Yao Cheng, Dongmei Cao, Yun Zhao
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002387
摘要
致编辑：产后出血（PPH）是分娩的严重并发症，也是全世界孕产妇发病率和死亡率的主要原因。因此，正确和积极的PPH治疗是降低孕产妇死亡率的关键。Bakri球囊是PPH的一种治疗方法。在这里，我们研究了Bakri球囊的治疗效果、优点和缺点，为寻求合适的病理场合和放置Bakri球囊（美国印第安纳州斯潘塞库克公司）的最佳时机提供理论基础，并开发一种更合理有效的治疗PPH的方法。
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S-1和奥沙利铂联合纳米粒白蛋白结合紫杉醇辅助化疗治疗晚期胃腺癌Yu Xia, Chenglou Zhu, Lei Xu, Jibin Yao, Mingxu Da
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002003
摘要
致编辑：胃癌（GC）是全球第五大常见恶性肿瘤和第三大癌症相关死亡原因，超过70%的病例发生在亚洲人群中。[
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中国二孩政策实施各阶段初产妇剖宫产率及其指征变化的回顾性研究Yumei Cheng, Shaofei Su, Shaowen Wu
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000002422
摘要
致编辑：剖宫产（CS）是产科最重要和最安全的手术之一。当有医学指征时，CS可以是一种挽救生命的干预措施。在中国独生子女政策期间，出于各种原因，夫妇倾向于选择CS。2010年，中国的CS率上升至世界最高水平。[
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Re：保留十二指肠头部切除术与胰十二指肠切除术的对比分析Sergio Pedrazzoli
中华医学杂志英文版2022年 135卷 18期
DOI: 10.1097/CM9.0000000000001995
摘要
致编辑：我们饶有兴趣地读了孙的文章等人[
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