2023年 · 第136卷第09期

出版日期 2023-05-05电子版￥0.00元

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Consensus Statement

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关于人类卵裂期胚胎和囊胚形态学评估的专家共识

Da Li, Lodovico Parmegiani, Dalei Yang, Gábor Vajta, Rong Li, Chinese Association of Reproductive Medicine

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002609

摘要

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中国临界发育性髋关节发育不良诊治专家共识（2022年版）

Jia Zhang, Chunbao Li, Mingyang An, Yidong Wu, Kangkang Yu, Yujie Liu, The Youth Group of the Sports Medicine Branch of the Chinese Medical Association, The Hip Sports Injury Working Committee of the Sports Medicine Branch of the Chinese Medical Association, The Hip Preservation Group of the Rehabilitation, Reconstruction Surgery Committee of the Chinese Association of Rehabilitation Medicine 等

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002483

摘要

Review Article

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心血管医疗保健的可穿戴传感、大数据技术：现状与未来展望

Fen Miao, Dan Wu, Zengding Liu, Ruojun Zhang, Min Tang, Ye Li

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002117

摘要

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肾移植候选人和受者的虚弱：发病机制和干预策略

Huawei Cao, Jiandong Zhang, Zejia Sun, Jiyue Wu, Changzhen Hao, Wei Wang

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002312

摘要

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老年患者胆道手术的热点与难点

Zongming Zhang, Jiahong Dong, Fangcai Lin, Qiusheng Wang, Zhi Xu, Xiaodong He, Shizhong Yang, Youwei Li, Limin Liu, Chong Zhang 等

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002589

摘要

Meta Analysis

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基线低剂量计算机断层扫描肺癌筛查的准确性：一项系统综述和荟萃分析

Lanwei Guo, Yue Yu, Funa Yang, Wendong Gao, Yu Wang, Yao Xiao, Jia Du, Jinhui Tian, Haiyan Yang

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002353

摘要

Background: Screening using low-dose computed tomography (LDCT) is a more effective approach and has the potential to detect lung cancer more accurately. We aimed to conduct a meta-analysis to estimate the accuracy of population-based screening studies primarily assessing baseline LDCT screening for lung cancer. Methods: MEDLINE, Excerpta Medica Database, and Web of Science were searched for articles published up to April 10, 2022. According to the inclusion and exclusion criteria, the data of true positives, false-positives, false negatives, and true negatives in the screening test were extracted. Quality Assessment of Diagnostic Accuracy Studies-2 was used to evaluate the quality of the literature. A bivariate random effects model was used to estimate pooled sensitivity and specificity. The area under the curve (AUC) was calculated by using hierarchical summary receiver-operating characteristics analysis. Heterogeneity between studies was measured using the Higgins I2 statistic, and publication bias was evaluated using a Deeks’ funnel plot and linear regression test. Results: A total of 49 studies with 157,762 individuals were identified for the final qualitative synthesis; most of them were from Europe and America (38 studies), ten were from Asia, and one was from Oceania. The recruitment period was 1992 to 2018, and most of the subjects were 40 to 75 years old. The analysis showed that the AUC of lung cancer screening by LDCT was 0.98 (95% CI: 0.96-0.99), and the overall sensitivity and specificity were 0.97 (95% CI: 0.94-0.98) and 0.87 (95% CI: 0.82-0.91), respectively. The funnel plot and test results showed that there was no significant publication bias among the included studies. Conclusions: Baseline LDCT has high sensitivity and specificity as a screening technique for lung cancer. However, long-term follow-up of the whole study population (including those with a negative baseline screening result) should be performed to enhance the accuracy of LDCT screening.

Original Article

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中国国民健康调查(CNHS)汉族和裕固族人群高血压诊断预测模型

Chengdong Yu, Xiaolan Ren, Ze Cui, Li Pan, Hongjun Zhao, Jixin Sun, Ye Wang, Lijun Chang, Yajing Cao, Huijing He 等

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000001989

摘要

Background: The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies. Methods: The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model. Results: The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website (https://chris-yu.shinyapps.io/hypertension_risk_prediction/) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval [CI]: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population. Conclusion: This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.

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原发性和继发性肌层浸润性膀胱癌生存结局的比较：一项倾向评分匹配研究

Waichan Lok, Jiapeng Zhang, Xiaonan Zheng, Tianhai Lin, Hang Xu, Ping Tan, Qiang Wei

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002512

摘要

Background: Studies have classified muscle-invasive bladder cancer (MIBC) into primary (initially muscle-invasive, PMIBC) and secondary subtypes (initially non-muscle-invasive but progresses, SMIBC), for which controversial survival outcomes were demonstrated. This study aimed to compare the survival outcomes between PMIBC and SMIBC patients in China. Methods: Patients diagnosed with PMIBC or SMIBC at West China Hospital from January 2009 to June 2019 were retrospectively included. Kruskal-Wallis and Fisher tests were employed to compare clinicopathological characteristics. Kaplan-Meier curves and Cox competing proportional risk model were used to compare survival outcomes. Propensity score matching (PSM) was employed to reduce the bias and subgroup analysis was used to confirm the outcomes. Results: A total of 405 MIBC patients were enrolled, including 286 PMIBC and 119 SMIBC, with a mean follow-up of 27.54 and 53.30 months, respectively. The SMIBC group had a higher proportion of older patients (17.65% [21/119] vs. 9.09% [26/286]), chronic disease (32.77% [39/119] vs. 22.38% [64/286]), and neoadjuvant chemotherapy (19.33% [23/119] vs. 8.04% [23/286]). Before matching, SMIBC had a lower risk of overall mortality (OM) (hazard ratios [HR] 0.60, 95% confidence interval [CI] 0.41-0.85, P = 0.005) and cancer-specific mortality (CSM) (HR 0.64, 95% CI 0.44-0.94, P= 0.022) after the initial diagnosis. However, higher risks of OM (HR 1.47, 95% CI 1.02-2.10, P = 0.038) and CSM (HR 1.58, 95% CI 1.09-2.29, P = 0.016) were observed for SMIBC once it became muscle-invasive. After PSM, the baseline characteristics of 146 patients (73 for each group) were well matched, and SMIBC was confirmed to have an increased CSM risk (HR 1.83, 95% CI 1.09-3.06, P = 0.021) than PMIBC after muscle invasion. Conclusions: Compared with PMIBC, SMIBC had worse survival outcomes once it became muscle-invasive. Specific attention should be paid to non-muscle-invasive bladder cancer with a high progression risk.

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胃癌远端胃切除术后Billroth-I与Roux-en-Y吻合术长期生活质量的比较：一项随机对照试验

Kun Yang, Weihan Zhang, Zehua Chen, Xiaolong Chen, Kai Liu, Linyong Zhao, Jiankun Hu

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002602

摘要

Background: The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. Methods: A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group (N = 70) and R-Y group (N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. Results: The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs. 88.8 ± 16.1, P= 0.033; postoperative 3 year: 87.3 ± 15.2 vs. 92.8 ± 11.3, P= 0.028; postoperative 5 year: 90.9 ± 13.7 vs. 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs. 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs. 1.8 ± 4.7, P= 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P= 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs. 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. Conclusions: Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. Trial Registration: ChiCTR.org.cn, ChiCTR-TRC-10001434.

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未配对结直肠癌组织样本的稳健微卫星不稳定性检测模型

Zili Zhang, Hua Wan, Bing Xu, Hongyang He, Guangyu Shan, Jingbo Zhang, Qixi Wu, Tong Li

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002216

摘要

Background: Microsatellite instability (MSI) is a key biomarker for cancer immunotherapy and prognosis. Integration of MSI testing into a next-generation-sequencing (NGS) panel could save tissue sample, reduce turn-around time and cost, and provide MSI status and comprehensive genomic profiling in single test. We aimed to develop an MSI calling model to detect MSI status along with the NGS panel-based profiling test using tumor-only samples. Methods: From January 2019 to December 2020, a total of 174 colorectal cancer (CRC) patients were enrolled, including 31 MSI-high (MSI-H) and 143 microsatellite stability (MSS) cases. Among them, 56 paired tumor and normal samples (10 MSI-H and 46 MSS) were used for modeling, and another 118 tumor-only samples were used for validation. MSI polymerase chain reaction (MSI-PCR) was performed as the gold standard. A baseline was built for the selected microsatellite loci using the NGS data of 56 normal blood samples. An MSI detection model was constructed by analyzing the NGS data of tissue samples. The performance of the model was compared with the results of MSI-PCR. Results: We first intersected the target genomic regions of the NGS panels used in this study to select common microsatellite loci. A total of 42 loci including 23 mononucleotide repeat sites and 19 longer repeat sites were candidates for modeling. As mononucleotide repeat sites are more sensitive and specific for detecting MSI status than sites with longer length motif and the mononucleotide repeat sites performed even better than the total sites, a model containing 23 mononucleotide repeat sites was constructed and named Colorectal Cancer Microsatellite Instability test (CRC-MSI). The model achieved 100% sensitivity and 100% specificity when compared with MSI-PCR in both training and validation sets. Furthermore, the CRC-MSI model was robust with the tumor content as low as 6%. In addition, 8 out of 10 MSI-H samples showed alternations in the four mismatch repair genes (MLH1, MSH2, MSH6, and PMS2). Conclusion: MSI status can be accurately determined along the targeted NGS panels using only tumor samples. The performance of mononucleotide repeat sites surpasses loci with longer repeat motif in MSI calling.

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人毛囊来源的间充质干细胞促进兔跟腱病模型肌腱修复

Yingyu Ma, Zhiwei Lin, Xiaoyi Chen, Xin Zhao, Yi Sun, Ji Wang, Xiaozhou Mou, Hai Zou, Jinyang Chen

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002542

摘要

Background: Hair follicles are easily accessible and contain stem cells with different developmental origins, including mesenchymal stem cells (MSCs), that consequently reveal the potential of human hair follicle (hHF)-derived MSCs in repair and regeneration. However, the role of hHF-MSCs in Achilles tendinopathy (AT) remains unclear. The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits. Methods: First, we extracted and characterized hHF-MSCs. Then, a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo. Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT, and quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT. Furthermore, statistical analyses were performed using independent sample t test, one-way analysis of variance (ANOVA), and one-way repeated measures multivariate ANOVA as appropriate. Results: Flow cytometry, a trilineage-induced differentiation test, confirmed that hHF-derived stem cells were derived from MSCs. The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy, as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased. Moreover, collagen I and III were upregulated in rabbit AT treated with hHF-MSCs (compared with AT group; P < 0.05). Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration, possibly through Tenascin-C (TNC) upregulation and matrix metalloproteinase (MMP)-9 downregulation. Conclusions: hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III. Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber, possibly because of upregulation of TNC and downregulation of MMP-9, thus suggesting that hHF-MSCs are more promising for AT.

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lncRNA AC005224.4/miR-140-3p/SNAI2调节轴通过上皮-间质转化促进卵巢癌的侵袭和转移

Tingchuan Xiong, Yinghong Wang, Yuan Zhang, Jianlin Yuan, Changjun Zhu, Wei Jiang

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002201

摘要

Background: Ovarian cancer is one of the most widespread malignant diseases of the female reproductive system worldwide. The plurality of ovarian cancer is diagnosed with metastasis in the abdominal cavity. Epithelial-mesenchymal transition (EMT) exerts a vital role in tumor cell metastasis. However, it remains unclear whether long non-coding RNA (lncRNA) are implicated in EMT and influence ovarian cancer cell invasion and metastasis. This study was designed to investigate the impacts of lncRNA AC005224.4 on ovarian cancer. Methods: LncRNA AC005224.4, miR-140-3p, and snail family transcriptional repressor 2 (SNAI2) expression levels in ovarian cancer and normal ovarian tissues were determined using real-time quantitative polymerase chain reaction (qRT-PCR). Cell Counting Kit-8 (CCK-8) and Transwell (migration and invasion) assays were conducted to measure SKOV3 and CAOV-3 cell proliferation and metastasis. E-cadherin, N-cadherin, Snail, and Vimentin contents were detected using Western blot. Nude mouse xenograft assay was utilized to validate AC005224.4 effects in vivo. Dual-luciferase reporter gene assay confirmed the targeted relationship between miR-140-3p and AC005224.4 or SNAI2. Results: AC005224.4 and SNAI2 upregulation and miR-140-3p downregulation were observed in ovarian cancer tissues and cells. Silencing of AC005224.4 observably moderated SKOV3 and CAOV-3 cell proliferation, migration, invasion, and EMT process in vitro and impaired the tumorigenesis in vivo. miR-140-3p was a target of AC005224.4 and its reduced expression level was mediated by AC005224.4. miR-140-3p mimics decreased the proliferation, migration, and invasion of ovarian cancer cells. SNAI2 was identified as a novel target of miR-140-3p and its expression level was promoted by either AC005224.4 overexpression or miR-140-3p knockdown. Overexpression of SNAI2 also facilitated ovarian cancer cell viability and metastasis. Conclusion: AC005224.4 was confirmed as an oncogene via sponging miR-140-3p and promoted SNAI2 expression, contributing to better understanding of ovarian cancer pathogenesis and shedding light on exploiting the novel lncRNA-directed therapy against ovarian cancer.

Correspondence

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静脉血栓栓塞症住院患者的预防和治疗方法

Yuanhua Yang, Xiaoying Li, Zhenguo Zhai, Dan Shen, Lina Han, Peifu Tang

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002237

摘要

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血清尿酸浓度与影像学中轴性脊柱关节炎的关系：202例患者的横断面研究

Yupeng Lai, Yanpeng Zhang, Zhihao Lei, Yihong Huang, Tongxin Ni, Pin He, Xiaoling Li, Chiduo Xu, Jun Xia, Meiying Wang

中华医学杂志英文版2023年 136卷 09期

DOI: 10.1097/CM9.0000000000002148