MedNexus
2023年 · 第136卷第08期
出版日期 2023-04-20电子版 ￥0.00元
MedNexus
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Editorial
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多基因评分：掌握整个生命过程的锚Guangfu Jin, Hongxia Ma, Hongbing Shen, Zhibin Hu
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002648
摘要
2001年，第一个人类基因组的草图序列被报道，随后在2004年发表了一个接近完整的序列。基因组宝库的一个希望是让科学家发现人类疾病的遗传基础，从而促进合理的诊断和治疗方法的设计。二十年后，通过全基因组关联研究(GWAS)，超过420,000个基因座与数百种表型相关联，[
Review Article
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急性白血病铁下垂Tianxin Lyu, Xudong Li, Yongping Song
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002642
摘要
Ferroptosis is an iron-dependent cell death pathway that is different from apoptosis, pyroptosis, and necrosis. The main characteristics of ferroptosis are the Fenton reaction mediated by intracellular free divalent iron ions, lipid peroxidation of cell membrane lipids, and inhibition of the anti-lipid peroxidation activity of intracellular glutathione peroxidase 4 (GPX4). Recent studies have shown that ferroptosis can be involved in the pathological processes of many disorders, such as ischemia– reperfusion injury, nervous system diseases, and blood diseases. However, the specific mechanisms by which ferroptosis participates in the occurrence and development of acute leukemia still need to be more fully and deeply studied. This article reviews the characteristics of ferroptosis and the regulatory mechanisms promoting or inhibiting ferroptosis. More importantly, it further discusses the role of ferroptosis in acute leukemia and predicts a change in treatment strategy brought about by increased knowledge of the role of ferroptosis in acute leukemia.
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嗜酸性胃肠炎：发病机制、诊断和治疗Kaiwen Li, Gechong Ruan, Shuang Liu, Tianming Xu, Kai Guan, Ji Li, Jingnan Li
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002511
摘要
Eosinophilic gastroenteritis (EGE) is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine, and consists of mucosal, muscular, and serosal subtypes. Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2 (Th2)-dependent cytokines and induced by food allergy. Due to the lack of a diagnostic gold standard, EGE has a high rate of delayed diagnosis or misdiagnosis. However, several new diagnostic strategies have been developed, such as novel genetic biomarkers and imaging tests. Although dietary therapy and corticosteroids remain the common choices for EGE treatment, recent decades have seen the emergence of novel treatment alternatives, such as biologics that target particular molecules involved in the pathogenic process. Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.
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肥胖症的蛋白质组和基因组整合分析Qigang Zhao, Baixue Han, Qian Xu, Tao Wang, Chen Fang, Rui Li, Lei Zhang, Yufang Pei
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002644
摘要
The prevalence of obesity has increased worldwide in recent decades. Genetic factors are now known to play a substantial role in the predisposition to obesity and may contribute up to 70% of the risk for obesity. Technological advancements during the last decades have allowed the identification of many hundreds of genetic markers associated with obesity. However, the transformation of current genetic variant-obesity associations into biological knowledge has been proven challenging. Genomics and proteomics are complementary fields, as proteomics extends functional analyses. Integrating genomic and proteomic data can help to bridge a gap in knowledge regarding genetic variant–obesity associations and to identify new drug targets for the treatment of obesity. We provide an overview of the published papers on the integrated analysis of proteomic and genomic data in obesity and summarize four mainstream strategies: overlap, colocalization, Mendelian randomization, and proteome-wide association studies. The integrated analyses identified many obesity-associated proteins, such as leptin, follistatin, and adenylate cyclase 3. Despite great progress, integrative studies focusing on obesity are still limited. There is an increased demand for large prospective cohort studies to identify and validate findings, and further apply these findings to the prevention, intervention, and treatment of obesity. In addition, we also discuss several other potential integration methods.
Original Article
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核因子-Y通过抑制代谢应激下活性氧诱导的胰腺β细胞凋亡介导胰腺β细胞代偿Siyuan He, Xiaoqian Yu, Daxin Cui, Yin Liu, Shanshan Yang, Hongmei Zhang, Wanxin Hu, Zhiguang Su
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002645
摘要
Background:
Pancreatic β-cells elevate insulin production and secretion through a compensatory mechanism to override insulin resistance under metabolic stress conditions. Deficits in β-cell compensatory capacity result in hyperglycemia and type 2 diabetes (T2D). However, the mechanism in the regulation of β-cell compensative capacity remains elusive. Nuclear factor-Y (NF-Y) is critical for pancreatic islets’ homeostasis under physiological conditions, but its role in β-cell compensatory response to insulin resistance in obesity is unclear.
Methods:
In this study, using obese (ob/ob) mice with an absence of NF-Y subunit A (NF-YA) in β-cells (ob, Nf-ya βKO) as well as rat insulinoma cell line (INS1)-based models, we determined whether NF-Y-mediated apoptosis makes an essential contribution to β-cell compensation upon metabolic stress.
Results:
Obese animals had markedly augmented NF-Y expression in pancreatic islets. Deletion of β-cell Nf-ya in obese mice worsened glucose intolerance and resulted in β-cell dysfunction, which was attributable to augmented β-cell apoptosis and reactive oxygen species (ROS). Furthermore, primary pancreatic islets from Nf-ya βKO mice were sensitive to palmitate-induced β-cell apoptosis due to mitochondrial impairment and the attenuated antioxidant response, which resulted in the aggravation of phosphorylated c-Jun N-terminal kinase (JNK) and cleaved caspase-3. These detrimental effects were completely relieved by ROS scavenger. Ultimately, forced overexpression of NF-Y in INS1 β-cell line could rescue palmitate-induced β-cell apoptosis, dysfunction, and mitochondrial impairment.
Conclusion:
Pancreatic NF-Y might be an essential regulator of β-cell compensation under metabolic stress.
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铋、埃索美拉唑、甲硝唑和米诺环素或四环素作为一线治疗方案幽门螺杆菌根除：一项随机对照试验Baojun Suo, Xueli Tian, Hua Zhang, Haoping Lu, Cailing Li, Yuxin Zhang, Xinlu Ren, Xingyu Yao, Liya Zhou, Zhiqiang Song
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002629
摘要
Background:
Given the general unavailability, common adverse effects, and complicated administration of tetracycline, the clinical application of classic bismuth quadruple therapy (BQT) is greatly limited. Whether minocycline can replace tetracycline for Helicobacter pylori (H. pylori) eradication is unknown. We aimed to compare the eradication rate, safety, and compliance between minocycline- and tetracycline-containing BQT as first-line regimens.
Methods:
This randomized controlled trial was conducted on 434 naïve patients with H. pylori infection. The participants were randomly assigned to 14-day minocycline-containing BQT group (bismuth potassium citrate 110 mg q.i.d., esomeprazole 20 mg b.i.d., metronidazole 400 mg q.i.d., and minocycline 100 mg b.i.d.) and tetracycline-containing BQT group (bismuth potassium citrate/esomeprazole/metronidazole with doses same as above and tetracycline 500 mg q.i.d.). Safety and compliance were assessed within 3 days after eradication. Urea breath test was performed at 4–8 weeks after eradication to evaluate outcome. We used a noninferiority test to compare the eradication rates of the two groups. The intergroup differences were evaluated using Pearson chi-squared or Fisher’s exact test for categorical variables and Student’s t-test for continuous variables.
Results:
As for the eradication rates of minocycline- and tetracycline-containing BQT, the results of both intention-to-treat (ITT) and per-protocol (PP) analyses showed that the difference rate of lower limit of 95% confidence interval (CI) was >−10.0% (ITT analysis: 181/217 [83.4%] vs. 180/217 [82.9%], with a rate difference of 0.5% [−6.9% to 7.9%]; PP analysis: 177/193 [91.7%] vs. 176/191 [92.1%], with a rate difference of −0.4% [−5.6% to 6.4%]). Except for dizziness more common (35/215 [16.3%] vs. 13/214 [6.1%], P = 0.001) in minocycline-containing therapy groups, the incidences of adverse events (75/215 [34.9%] vs. 88/214 [41.1%]) and compliance (195/215 [90.7%] vs. 192/214 [89.7%]) were similar between the two groups.
Conclusion:
The eradication efficacy of minocycline-containing BQT was noninferior to tetracycline-containing BQT as first-line regimen for H. pylori eradication with similar safety and compliance.
Trial registration:
ClinicalTrials.gov, ChiCTR 1900023646.
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慢性阻塞性肺疾病急性加重住院患者舒张压低与不良结局：一项多中心队列研究Chen Zhou, Qun Yi, Yuanming Luo, Hailong Wei, Huiqing Ge, Huiguo Liu, Xianhua Li, Jianchu Zhang, Pinhua Pan, Mengqiu Yi 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002666
摘要
Background:
Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients.
Methods:
Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes.
Results:
Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53–3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32–2.05, Z = 19.67, P < 0.01), and ICU admission (HR = 1.45, 95% CI: 1.24–1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality.
Conclusion:
Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients.
Clinical Trial Registration:
Chinese Clinical Trail Registry, No. ChiCTR2100044625.
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银屑病关节炎患者的附着点炎：来自中国银屑病关节炎登记处（CREPAR）的全国性数据Fan Yang, Chaofan Lu, Huilan Liu, Lei Dou, Yanhong Wang, Hongbin Li, Xinwang Duan, Lijun Wu, Yongfu Wang, Xiuying Zhang 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002646
摘要
Background:
The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.
Methods:
Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.
Results:
In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0–18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59–3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01–1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01–1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs’ (csDMARDs) use.
Conclusions:
Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
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完全经皮血运重建术对改善慢性完全闭塞和多血管疾病患者长期预后的影响Zeya Li, Ziru Zhou, Lei Guo, Lei Zhong, Jingnan Xiao, Shaoke Meng, Yingdong Wang, Huaiyu Ding, Bo Zhang, Hao Zhu 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002653
摘要
Background:
Limited data are available on the comparison of clinical outcomes of complete vs. incomplete percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) and multi-vessel disease (MVD). The study aimed to compare their clinical outcomes.
Methods:
A total of 558 patients with CTO and MVD were divided into the optimal medical treatment (OMT) group (n = 86), incomplete PCI group (n = 327), and complete PCI group (n = 145). Propensity score matching (PSM) was performed between the complete and incomplete PCI groups as sensitivity analysis. The primary outcome was defined as the occurrence of major adverse cardiovascular events (MACEs), and unstable angina was defined as the secondary outcome.
Results:
At a median follow-up of 21 months, there were statistical differences among the OMT, incomplete PCI, and complete PCI groups in the rates of MACEs (43.0% [37/86] vs. 30.6% [100/327] vs. 20.0% [29/145], respectively, P = 0.016) and unstable angina (24.4% [21/86] vs. 19.3% [63/327] vs. 10.3% [15/145], respectively, P = 0.010). Complete PCI was associated with lower MACE compared with OMT (adjusted hazard ratio [HR] = 2.00; 95% confidence interval [CI] = 1.23 – 3.27; P = 0.005) or incomplete PCI (adjusted HR = 1.58; 95% CI = 1.04–2.39; P = 0.031). Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups (20.5% [25/122] vs. 32.6% [62/190], respectively; adjusted HR = 0.55; 95% CI = 0.32–0.96; P = 0.035) and unstable angina (10.7% [13/122] vs. 20.5% [39/190], respectively; adjusted HR = 0.48; 95% CI = 0.24–0.99; P = 0.046).
Conclusions:
For treatment of CTO and MVD, complete PCI reduced the long-term risk of MACEs and unstable angina, as compared with incomplete PCI and OMT. Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
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基于机器和深度学习的临床特征和实验室标志物预测肌肉减少症He Zhang, Mengting Yin, Qianhui Liu, Fei Ding, Lisha Hou, Yiping Deng, Tao Cui, Yixian Han, Weiguang Pang, Wenbin Ye 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002633
摘要
Background:
Sarcopenia is an age-related progressive skeletal muscle disorder involving the loss of muscle mass or strength and physiological function. Efficient and precise AI algorithms may play a significant role in the diagnosis of sarcopenia. In this study, we aimed to develop a machine learning model for sarcopenia diagnosis using clinical characteristics and laboratory indicators of aging cohorts.
Methods:
We developed models of sarcopenia using the baseline data from the West China Health and Aging Trend (WCHAT) study. For external validation, we used the Xiamen Aging Trend (XMAT) cohort. We compared the support vector machine (SVM), random forest (RF), eXtreme Gradient Boosting (XGB), and Wide and Deep (W&D) models. The area under the receiver operating curve (AUC) and accuracy (ACC) were used to evaluate the diagnostic efficiency of the models.
Results:
The WCHAT cohort, which included a total of 4057 participants for the training and testing datasets, and the XMAT cohort, which consisted of 553 participants for the external validation dataset, were enrolled in this study. Among the four models, W&D had the best performance (AUC = 0.916 ± 0.006, ACC = 0.882 ± 0.006), followed by SVM (AUC = 0.907 ± 0.004, ACC = 0.877 ± 0.006), XGB (AUC = 0.877 ± 0.005, ACC = 0.868 ± 0.005), and RF (AUC = 0.843 ± 0.031, ACC = 0.836 ± 0.024) in the training dataset. Meanwhile, in the testing dataset, the diagnostic efficiency of the models from large to small was W&D (AUC = 0.881, ACC = 0.862), XGB (AUC = 0.858, ACC = 0.861), RF (AUC = 0.843, ACC = 0.836), and SVM (AUC = 0.829, ACC = 0.857). In the external validation dataset, the performance of W&D (AUC = 0.970, ACC = 0.911) was the best among the four models, followed by RF (AUC = 0.830, ACC = 0.769), SVM (AUC = 0.766, ACC = 0.738), and XGB (AUC = 0.722, ACC = 0.749).
Conclusions:
The W&D model not only had excellent diagnostic performance for sarcopenia but also showed good economic efficiency and timeliness. It could be widely used in primary health care institutions or developing areas with an aging population.
Trial Registration:
Chictr.org, ChiCTR 1800018895.
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IGFBP-3通过抑制胰岛素样生长因子/胰岛素信号传导促进恶病质相关脂质流失Xiaohui Wang, Jia Li, Wei Zhang, Feng Wang, Yunzi Wu, Yulin Guo, Dong Wang, Xinfeng Yu, Ang Li, Fei Li 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002628
摘要
Background:
Progressive lipid loss of adipose tissue is a major feature of cancer-associated cachexia. In addition to systemic immune/inflammatory effects in response to tumor progression, tumor-secreted cachectic ligands also play essential roles in tumor-induced lipid loss. However, the mechanisms of tumor-adipose tissue interaction in lipid homeostasis are not fully understood.
Methods:
The yki-gut tumors were induced in fruit flies. Lipid metabolic assays were performed to investigate the lipolysis level of different types of insulin-like growth factor binding protein-3 (IGFBP-3) treated cells. Immunoblotting was used to display phenotypes of tumor cells and adipocytes. Quantitative polymerase chain reaction (qPCR) analysis was carried out to examine the gene expression levels such as Acc1, Acly, and Fasn et al.
Results:
In this study, it was revealed that tumor-derived IGFBP-3 was an important ligand directly causing lipid loss in matured adipocytes. IGFBP-3, which is highly expressed in cachectic tumor cells, antagonized insulin/IGF-like signaling (IIS) and impaired the balance between lipolysis and lipogenesis in 3T3-L1 adipocytes. Conditioned medium from cachectic tumor cells, such as Capan-1 and C26 cells, contained excessive IGFBP-3 that potently induced lipolysis in adipocytes. Notably, neutralization of IGFBP-3 by neutralizing antibody in the conditioned medium of cachectic tumor cells significantly alleviated the lipolytic effect and restored lipid storage in adipocytes. Furthermore, cachectic tumor cells were resistant to IGFBP-3 inhibition of IIS, ensuring their escape from IGFBP-3-associated growth suppression. Finally, cachectic tumor-derived ImpL2, the IGFBP-3 homolog, also impaired lipid homeostasis of host cells in an established cancer-cachexia model in Drosophila. Most importantly, IGFBP-3 was highly expressed in cancer tissues in pancreatic and colorectal cancer patients, especially higher in the sera of cachectic cancer patients than non-cachexia cancer patients.
Conclusion:
Our study demonstrates that tumor-derived IGFBP-3 plays a critical role in cachexia-associated lipid loss and could be a biomarker for diagnosis of cachexia in cancer patients.
Correspondence
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食管鳞癌及癌前病变早期发现的微生物和流行病学因素Minjuan Li, Dantong Shao, Jiachen Zhou, Jianhua Gu, Zhiyuan Fan, Junjie Qin, Xinqing Li, Changqing Hao, Wenqiang Wei
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002275
摘要
致编辑：食管癌（EC）在全球癌症相关发病率和死亡率的主要原因中分别排名第九和第五。[
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钠-葡萄糖协同转运蛋白2抑制剂在亚洲心力衰竭患者中的应用Shingo Kato, Nobuyuki Horita, Daisuke Utsunomiya
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002652
摘要
致编辑：钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂是公认的治疗心力衰竭（HF）的必备药物之一。最近的随机对照试验（RCT）表明，SGLT-2抑制剂显著降低了HF患者的HF住院率或心血管死亡率。[
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磁压缩吻合术治疗肾移植术后输尿管狭窄的临床疗效Jiangwei Zhang, Wujun Xue, Puxun Tian, Hang Yan, Jin Zheng, Xiao Li, Ying Wang, Xiaoming Ding, Yi Lyu
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002325
摘要
致编辑：输尿管狭窄是肾移植术后最常见的并发症之一，据相关报道其发生率为1.0-8.3%。[
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基于决策树Markov模型的抗逆转录病毒治疗快速启动成本—效果评价Yuan Guan, Qi Tang, Han Zhu, Danping Liu, Tangkai Qi, Renfang Zhang, Jun Chen, Li Liu, Yinzhong Shen, Hongzhou Lu
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002659
摘要
致编辑：人类免疫缺陷病毒（HIV）1型感染仍然是全球范围内严重且棘手的公共卫生问题。2020年，联合国艾滋病毒/获得性免疫缺陷综合征（艾滋病）联合规划署（艾滋病规划署）报告，全球有3770万艾滋病毒感染者存活，68万人与艾滋病毒相关的死亡。[
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福建省住院成人社区获得性肺炎病原体谱的变化：2012-2018年多中心、回顾性研究Fan Wu, Jian Wu, Nengluan Xu, Qunying Lin, Dongfa Qiu, Xuhua Lyu, Ming Lin, Wenxiang Yue, Yan Xiao, Lili Ren 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002250
摘要
致编辑：成人社区获得性肺炎（CAP）是指累及肺泡壁的肺实质炎症。发生于社区环境（院外），包括入院后潜伏期明确的病原体引起的肺炎。CAP仍是医疗卫生资源的主要负担。随着广谱抗菌药物的使用、人口老龄化以及新病原体的出现，CAP的病原体谱发生了变化。除了传统的微生物培养和免疫学检测方法外，核酸检测在病原体检测中发挥着越来越重要的作用，极大地扩大了病原体的检测范围。目前福建省尚无病原学调查。因此，我们在福建不同地区的4个中心开展了CAP病原菌回顾性流行病学研究，分析年龄和季节对病原菌分布的影响，以期为区域性CAP诊治提供理论依据。本研究纳入了2012年至2018年的数据，但2019-2022年的数据除外，因为冠状病毒疾病2019（新冠肺炎）疫情可能对CAP的病原体分布造成一定影响。
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中国III期抗癌药物试验的结局指标Lanwei Guo, Huiyao Huang, Yue Yu, Jun Wang, Le Wang, Shuhang Wang, Dawei Wu, Yuan Fang, Ning Jiang, Shaokai Zhang 等
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002264
摘要
致编辑：III期临床试验已被用于提供证据支持大多数治疗癌症的新药的批准。[
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与植入性胎盘谱系障碍相关的母体循环生物标志物Zhirong Guo, Huixia Yang, Jingmei Ma
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002241
摘要
致编辑：植入性胎盘谱系（PAS）疾病是指一系列异常胎盘形成。PAS亚型包括胎盘植入（creta或adherenta，PA）、胎盘植入（PI）和胎盘植入（PP）。在过去的四十年里，PAS的发病率急剧增加。一项使用美国全国代表性样本的研究显示，在接受剖宫产活产的妇女中，PAS的患病率为0.29%。[
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基于电子门静脉成像设备(EPID)的体内剂量学放射治疗输送错误检测Xueying Yang, Lisheng Geng, David Huang, Kaiwen Li, Hongqing Zhuang, Jing Cai, Ruijie Yang
中华医学杂志英文版2023年 136卷 08期
DOI: 10.1097/CM9.0000000000002665
摘要
致编辑：由于调强放疗（IMRT）计划和交付的高度复杂性，应实施患者特定质量保证（PSQA），以确保治疗交付的可靠性并提高治疗效果。治疗前PSQA程序是IMRT中的常规程序，在某种程度上可以避免剂量递送中的严重错误。然而，由于患者的解剖结构变化、设置不确定性和治疗期间的器官运动，不能保证递送给患者的剂量与计划的相同。因此，体内剂量测定（IVD）已被推荐作为常规IMRT的一部分，以监测输送给患者的实际剂量，检测误差来源，并协助适应性治疗。
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勘误表：粪便移植可以通过调节肠道菌群和促进血清素分泌来减轻抽动秽语综合征小鼠模型的抽动严重程度中华医学杂志英文版2023年 136卷 08期
DOI: 10.3760/cma.j.issn.0366-6999.2023.08.101
摘要
作者声明，在文章“粪便移植可以通过调节肠道菌群和促进血清素分泌来减轻抽动秽语综合征小鼠模型中的抽动严重程度”中，该文章发表在第135卷第6期第707-713页中华医学杂志,[
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