MedNexus
2023年 · 第136卷第12期
出版日期 2023-06-20电子版 ￥0.00元
MedNexus
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- Review Article
- Meta Analysis
- Medical Progress
- Original Article
- Correspondence
- Corrigendum
Editorial
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骨科手术机器人解决方案Mingxing Fan, Qi Zhang, Yanming Fang, Wei Tian
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002702
摘要
在骨科手术中，内固定的准确性关系到手术的成功与否。过去，骨科医生通常根据解剖标志或透视图像徒手放置螺钉。虽然徒手置入螺钉的手术技术很多，但徒手置入螺钉的准确性不够高，结果可能不稳定。文献中报道的徒手螺钉放置的准确性差异很大。特别是在脊柱中，由于其独特的解剖结构和重要的邻近组织，不准确的螺钉放置可能导致严重的并发症，如神经或血管损伤、脑脊液漏、胸或腹部器官损伤和节段不稳定。外科医生必须经过广泛的专业培训，积累深入的手术经验，以减少螺钉置入不准确的发生率。
Review Article
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非酒精性脂肪性肝病粘液层与肠道微生物群的相互作用：土壤和种子Binbin Zhang, Jie Li, Jinlong Fu, Li Shao, Luping Yang, Junping Shi
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002711
摘要
The intestinal mucus layer is a barrier that separates intestinal contents and epithelial cells, as well as acts as the "mucus layer-soil" for intestinal flora adhesion and colonization. Its structural and functional integrity is crucial to human health. Intestinal mucus is regulated by factors such as diet, living habits, hormones, neurotransmitters, cytokines, and intestinal flora. The mucus layer’s thickness, viscosity, porosity, growth rate, and glycosylation status affect the structure of the gut flora colonized on it. The interaction between "mucus layer-soil" and "gut bacteria-seed" is an important factor leading to the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Probiotics, prebiotics, fecal microbiota transplantation (FMT), and wash microbial transplantation are efficient methods for managing NAFLD, but their long-term efficacy is poor. FMT is focused on achieving the goal of treating diseases by enhancing the "gut bacteria-seed". However, a lack of effective repair and management of the "mucus layer-soil" may be a reason why "seeds" cannot be well colonized and grow in the host gut, as the thinning and destruction of the "mucus layer-soil" is an early symptom of NAFLD. This review summarizes the existing correlation between intestinal mucus and gut microbiota, as well as the pathogenesis of NAFLD, and proposes a new perspective that "mucus layer-soil" restoration combined with "gut bacteria-seed" FMT may be one of the most effective future strategies for enhancing the long-term efficacy of NAFLD treatment.
Meta Analysis
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颈动脉内膜切除术后糖尿病与不良结局：一项系统综述和荟萃分析Fengshi Li, Rui Zhang, Xiao Di, Shuai Niu, Zhihua Rong, Changwei Liu, Leng Ni
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002730
摘要
Background:
There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.
Methods:
Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.
Results:
A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.
Conclusions:
In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.
Medical Progress
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溃疡性结肠炎粪便微生物群移植供体选择和粪便处理的“最佳配方”是什么？Haiyue Li, Yue Li, Jiaming Qian
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002704
摘要
粪便微生物群移植(FMT)描述了一种治疗方法，其中来自健康供体的粪便通过上胃肠道或下胃肠道递送到受体患者的肠道中。FMT现在是复发患者的标准治疗选择艰难梭菌感染（rCDI），但FMT也已应用于其他几种肠道疾病，尤其是炎症性肠病（IBD），尤其是溃疡性结肠炎（UC）。多项临床试验现已表明，FMT不仅对轻中度活动性UC患者而且对临床缓解期患者都是有效且安全的治疗方法。
Original Article
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1990年至2019年全球肝癌负担轨迹及至2035年预测Fan Yang, Dianqin Sun, Changfa Xia, He Li, Maomao Cao, Xinxin Yan, Siyi He, Shaoli Zhang, Wanqing Chen
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002703
摘要
Background:
Large disparities exist in liver cancer burden trends across countries but are poorly understood. We aimed to investigate the global trajectories of liver cancer burden, explore the driving forces, and predict future trends.
Methods:
Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trajectories were defined using growth mixture models. Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories. A Bayesian age-period-cohort model was used to predict future trends through 2035.
Results:
Three trajectories of liver cancer burden were identified: increasing, stable, and decreasing groups. Almost half of the American countries were classified in the decreasing group (48.6% for ASIR and ASMR), and the increasing group was the most common in the European region (ASIR, 49.1%; ASMR, 37.7%). In the decreasing group, the decrease of liver cancer due to hepatitis B contributed 63.4% and 60.4% of the total decreases in ASIR and ASMR, respectively. The increase of liver cancer due to alcohol use, hepatitis C, and hepatitis B contributed the most to the increase in the increasing group (30.8%, 31.1%, and 24.2% for ASIR; 33.7%, 30.2%, and 22.2% for ASMR, respectively). The increasing group was associated with a higher sociodemographic index, gross domestic product per capita, health expenditure per capita, and universal health coverage (all P <0.05). Significant variations in disease burden are predicted to continue through 2035, with a disproportionate burden in the decreasing group.
Conclusion:
Global disparities were observed in liver cancer burden trajectories. Hepatitis B, alcohol use, and hepatitis C were identified as driving forces in different regions.
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一线免疫检查点抑制剂联合化疗治疗晚期非小细胞肺癌的颅内活性Zhe Huang, Fang Wu, Qinqin Xu, Lianxi Song, Xiangyu Zhang, Zhan Wang, Li Deng, Yongchang Zhang, Liang Zeng, Nong Yang
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002720
摘要
Background:
Immune checkpoint inhibitors (ICIs) are increasingly used as first-line therapy for patients with advanced non-small cell lung cancer (NSCLC) harboring no actionable mutations; however, data on their efficacy among patients presenting with intracranial lesions are limited. This study aimed to explore the efficacy and safety of ICIs combined with chemotherapy in advanced NSCLC patients with measurable brain metastasis at initial diagnosis.
Methods:
Our study retrospectively analyzed clinical data of a total of 211 patients diagnosed with driver gene mutation-negative advanced NSCLC with measurable, asymptomatic brain metastasis at baseline from Hunan Cancer Hospital between January 1, 2019 and September 30, 2021. The patients were stratified into two groups according to the first-line treatment regimen received: ICI combined with chemotherapy (n = 102) or chemotherapy (n = 109). Systemic and intracranial objective response rates (ORRs) and progression-free survival (PFS) were analyzed. Adverse events were also compared between the groups.
Results:
Compared with the chemotherapy-based regimen, the ICI-containing regimen was associated with a significantly higher intracranial (44.1% [45/102] vs. 28.4% [31/109], χ2 = 5.620, P = 0.013) and systemic (49.0% [50/102] vs. 33.9% [37/109], χ2 = 4.942, P = 0.019) ORRs and longer intracranial (11.0 months vs. 7.0 months, P <0.001) and systemic (9.0 months vs. 5.0 months, P <0.001) PFS. Multivariable analysis consistently revealed an independent association between receiving ICI plus platinum-based chemotherapy as a first-line regimen and prolonged intracranial PFS (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.37-0.73, P <0.001) and systemic PFS (HR = 0.48, 95% CI: 0.35-0.66, P <0.001). No unexpected serious adverse effects were observed.
Conclusion:
Our study provides real-world clinical evidence that ICI combined with chemotherapy is a promising first-line treatment option for driver gene mutation-negative advanced NSCLC patients who present with brain metastasis at initial diagnosis.
Clinical trial registration:
https://www.clinicaltrials.gov/, OMESIA, NCT05129202.
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为临床实践指南开发科学、透明和适用的排名(STAR)工具Nan Yang, Hui Liu, Wei Zhao, Yang Pan, Xiangzheng Lyu, Xiuyuan Hao, Xiaoqing Liu, Wen’an Qi, Tong Chen, Xiaoqin Wang 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002713
摘要
Background:
This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.
Methods:
This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument’s intrinsic and interrater reliability, content and criterion validity, and usability.
Results:
STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach’s α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen’s kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson’s r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.
Conclusion:
The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
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中国银屑病人群中银屑病关节炎的患病率：一项由经验丰富的风湿病学家进行的多中心研究Hua Zhang, Miao Chen, Ran Cui, Xia Li, Kexiang Yan, Lihong Chen, Zhenghua Zhang, Ning Yu, Xinling Bi, Hui Deng 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002683
摘要
Background:
Reports on the prevalence of psoriatic arthritis (PsA) among Chinese patients with psoriasis are very limited. This study, conducted by rheumatologists, estimated the prevalence of PsA in a large number of Chinese patients with psoriasis.
Methods:
Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited. All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA. All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists.
Results:
A total of 2434 psoriasis patients, including 1561 males and 873 females, were enrolled. Both the questionnaire and rheumatologists’ examinations were completed in the dermatology clinics. The results identified 252 patients with PsA, comprising 168 males and 84 females. The overall prevalence of PsA among psoriasis patients was 10.4% (95% confidence interval [95% CI], 9.1%-11.7%). By sex, the prevalence was 10.8% (95% CI, 9.2%-12.5%) for males and 9.6% (95% CI, 7.7%-11.9%) for females and there was no significant sex difference in the prevalence of PsA (P = 0.38). Of the 252 PsA patients, 125 (49.6%, 95% CI, 41.3%-59.1%) were newly diagnosed by rheumatologists. Consequently, the prevalence of undiagnosed PsA among psoriasis patients was 5.2% (95% CI, 4.4%-6.2%).
Conclusion:
The prevalence of PsA in the Chinese population with psoriasis is about 10.4%, which is almost double that of previous reports in the Chinese population, but lower than that in Caucasians.
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Semaphorin-3F通过Hippo途径逆转弥漫性大B细胞淋巴瘤利妥昔单抗耐药Qiong Li, Naya Ma, Xinlei Li, Chao Yang, Wei Zhang, Jingkang Xiong, Lidan Zhu, Jiali Li, Qin Wen, Lei Gao 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002686
摘要
Background:
Exploring the underlying mechanism of rituximab resistance is critical to improve the outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Here, we tried to identify the effects of the axon guidance factor semaphorin-3F (SEMA3F) on rituximab resistance as well as its therapeutic value in DLBCL.
Methods:
The effects of SEMA3F on the treatment response to rituximab were investigated by gain- or loss-of-function experiments. The role of the Hippo pathway in SEMA3F-mediated activity was explored. A xenograft mouse model generated by SEMA3F knockdown in cells was used to evaluate rituximab sensitivity and combined therapeutic effects. The prognostic value of SEMA3F and TAZ (WW domain-containing transcription regulator protein 1) was examined in the Gene Expression Omnibus (GEO) database and human DLBCL specimens.
Results:
We found that loss of SEMA3F was related to a poor prognosis in patients who received rituximab-based immunochemotherapy instead of chemotherapy regimen. Knockdown of SEMA3F significantly repressed the expression of CD20 and reduced the proapoptotic activity and complement-dependent cytotoxicity (CDC) activity induced by rituximab. We further demonstrated that the Hippo pathway was involved in the SEMA3F-mediated regulation of CD20. Knockdown of SEMA3F expression induced the nuclear accumulation of TAZ and inhibited CD20 transcriptional levels via direct binding of the transcription factor TEAD2 and the CD20 promoter. Moreover, in patients with DLBCL, SEMA3F expression was negatively correlated with TAZ, and patients with SEMA3FlowTAZhigh had a limited benefit from a rituximab-based strategy. Specifically, treatment of DLBCL cells with rituximab and a YAP/TAZ inhibitor showed promising therapeutic effects in vitro and in vivo.
Conclusion:
Our study thus defined a previously unknown mechanism of SEMA3F-mediated rituximab resistance through TAZ activation in DLBCL and identified potential therapeutic targets in patients.
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化疗和内分泌治疗作为激素受体阳性HER2阴性转移性乳腺癌患者一线治疗的疗效和临床结局Yang Yuan, Shaohua Zhang, Tao Wang, Li Bian, Min Yan, Yongmei Yin, Yuhua Song, Yi Wen, Jianbin Li, Zefei Jiang
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002676
摘要
Background:
Endocrine therapy (ET) and ET-based regimens are the preferred first-line treatment options for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (HR+/HER2- MBC), while chemotherapy (CT) is commonly used in clinical practice. The aim of this study was to investigate the efficacy and clinical outcome of ET and CT as first-line treatment in Chinese patients with HR+/HER2- MBC.
Methods:
Patients diagnosed with HR+/HER2-MBC between January 1st, 1996 and September 30th, 2018 were screened from the Chinese Society of Clinical Oncology Breast Cancer database. The initial and maintenance first-line treatment, progression-free survival (PFS), and overall survival (OS) were analyzed.
Results:
Among the 1877 included patients, 1215 (64.7%) received CT and 662 (35.3%) received ET as initial first-line treatment. There were no statistically significant differences in PFS and OS between patients receiving ET and CT as initial first-line treatment in the total population (PFS: 12.0 vs. 11.0 months, P = 0.22; OS: 54.0 vs. 49.0 months, P = 0.09) and propensity score matched population. For patients without disease progression after at least 3 months of initial therapy, maintenance ET following initial CT (CT-ET cohort, n = 449) and continuous schedule of ET (ET cohort, n = 527) had longer PFS than continuous schedule of CT (CT cohort, n = 406) in the total population (CT-ET cohort vs. CT cohort: 17.0 vs. 8.5 months; P <0.01; ET cohort vs. CT cohort: 14.0 vs. 8.5 months; P <0.01) and propensity score matched population. OS in the three cohorts yielded the same results as PFS.
Conclusions:
ET was associated with similar clinical outcome to CT as initial first-line treatment. For patients without disease progression after initial CT, switching to maintenance ET showed superiority in clinical outcome over continuous schedule of CT.
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FGF23通过FGFr3/TNAP/OPN通路对先天性脊柱侧凸骨质减少的促进作用Hongqi Zhang, Gang Xiang, Jiong Li, Sihan He, Yunjia Wang, Ang Deng, Yuxiang Wang, Chaofeng Guo
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002690
摘要
Background:
Congenital scoliosis (CS) is a complex spinal malformation of unknown etiology with abnormal bone metabolism. Fibroblast growth factor 23 (FGF23), secreted by osteoblasts and osteocytes, can inhibit bone formation and mineralization. This research aims to investigate the relationship between CS and FGF23.
Methods:
We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region. FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured. Receiver operator characteristic (ROC) curve analyses were conducted to evaluate the specificity and sensitivity of FGF23. The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3 (FGFr3)/tissue non-specific alkaline phosphatase (TNAP)/osteopontin (OPN) in primary osteoblasts from CS patients (CS-Ob) and controls (CT-Ob) were detected. In addition, the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.
Results:
DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins, accompanied by increased mRNA levels. CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography (CT) values compared with controls. The FGF23 mRNA levels were negatively correlated with the CT value of the spine, and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS. Additionally, significantly increased levels of FGF23, FGFr3, OPN, impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob. Moreover, FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels, while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob. Mineralization of CS-Ob was rescued after FGF23 knockdown.
Conclusions:
Our results suggested increased peripheral blood FGF23 levels, decreased bone mineral density in CS patients, and a good predictive ability of CS by peripheral blood FGF23 levels. FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP/OPN pathway.
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血友病关节病患者全膝关节置换术后的长期临床结果：10-17年随访后的单外科医生队列Bin Feng, Yingjie Wang, Xiying Dong, Zeng Li, Jin Lin, Xisheng Weng
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002677
摘要
Background:
Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.
Methods:
We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients’ overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.
Results:
Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients’ patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.
Conclusions:
TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.
Correspondence
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985个中国骨骼发育不良家系的临床和遗传特征Shanshan Li, Shanshan Lyu, Wenzhen Fu, Yunqiu Hu, Hua Yue, Lin Chen, Zhenlin Zhang
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002654
摘要
致编辑：骨骼发育不良是一组原发性累及肌肉骨骼系统的临床和遗传性异质性疾病，包括骨、软骨、肌腱、韧带和肌肉，通常以身材矮小、运动受限或脆性骨折为特征，有时并发骨外表型。[
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中国非常年轻（≤35岁）乳腺癌患者的临床病理特征和预后：一项基于人群的回顾性研究Xin Ye, Xiaoyun Zhou, Qi He, Zhiwei Wang, Jie Wang, Min Ji
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002635
摘要
致编辑：在中国，非常年轻的乳腺癌患者（≤35岁）约占所有乳腺癌病例的10%，而西方国家为2%。这提示不同的发病率可能是由不同的地理区域和种族引起的，甚至导致不同的临床病理特征和预后。唐等人[
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西达本胺-BEAC联合自体干细胞移植治疗高危非霍奇金淋巴瘤的II期临床试验Yi Xia, Li Wang, Kaiyang Ding, Jiazhu Wu, Hua Yin, Maogui Hu, Haorui Shen, Jinhua Liang, Ruize Chen, Yue Li 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002636
摘要
致编辑：非霍奇金淋巴瘤（NHL）是一种常见的恶性血液病。尽管靶向疗法的发展提高了侵袭性NHL患者的生存率，但自体造血干细胞移植（HSCT）仍然不可或缺。自体干细胞移植（ASCT）没有标准的调理方案。三种常见的方案是卡莫司汀、依托泊苷、阿糖胞苷和美法仑(BEAM)；卡莫司汀、依托泊苷、阿糖胞苷和环磷酰胺(BEAC)；和全身照射。与这些方案相关的3年无进展生存期（PFS）率从40%到50%不等。西达本胺是一种新型亚型选择性组蛋白去乙酰化酶抑制剂（HDACi），通过使染色质松动和脱氧核糖核酸（DNA）暴露，可直接抑制肿瘤细胞周期进程，诱导肿瘤细胞凋亡，恢复耐药肿瘤细胞对药物的敏感性。临床试验表明，HDACi、克拉屈滨、吉西他滨和白消安的组合作为复发/难治性NHL患者的移植前预处理方案具有良好的安全性和疗效。[
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体力活动与非酒精性脂肪性肝病的剂量反应关系：一项前瞻性队列研究Pei Li, Qingqing Yang, Xinping Wang, Shengzhi Sun, Wangnan Cao, Siwang Yu, Siyan Zhan, Feng Sun
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002532
摘要
致编辑：非酒精性脂肪性肝病（NAFLD）是全球最常见的慢性肝病之一，这种全身性疾病带来了巨大的经济负担，并将在未来导致更大的疾病负担。[
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2019冠状病毒病灭活疫苗接种后的免疫应答Ya Sun, Haonan Kang, Yilan Zhao, Kai Cui, Xuan Wu, Shaohui Huang, Chaofan Liang, Wenqiang Wang, Huixia Cao, Xiaoju Zhang 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002707
摘要
致编辑：疫苗相关的适应性免疫系统，包括B细胞反应诱导的体液免疫和T细胞诱导的细胞免疫，对于控制严重急性呼吸综合征冠状病毒-2（新型冠状病毒）感染至关重要。[
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第二原发癌的好发部位和危险因素：基于SEER数据库的泛癌分析Shan Xiong, Hengrui Liang, Peng Liang, Xiuyu Cai, Caichen Li, Ran Zhong, Jianfu Li, Bo Cheng, Feng Zhu, Limin Ou 等
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002681
摘要
致编辑：在过去几年中，癌症幸存者的数量持续增加，这主要是由于人口的增长和老龄化以及癌症检测和治疗的改进。截至2019年1月1日，超过1690万患有癌症的美国人还活着，预计到2030年1月1日，癌症幸存者的数量将达到2210万以上。[
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金黄色葡萄球菌中国三级医院血流感染的单中心回顾性研究Cheng Zheng, Qingqing Chen, Sijun Pan, Yuanyuan Li, Li Zhong, Xijiang Zhang, Wei Cui, Ronghai Lin, Gensheng Zhang, Shufang Zhang
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002699
摘要
致编辑：尽管医疗保健取得了重大进展，但血流感染（BSI）的发病率和死亡率仍然很高，这仍然是一个全球公共卫生挑战。BSI可由多种微生物引起，最常见的微生物有大肠杆菌,肺炎克雷伯菌，和金黄色葡萄球菌(金黄色葡萄球菌），根据中国抗菌药物监测网（CHINET）。[
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抑制ATP/P2X7R信号通过灭活巨噬细胞NF-κ B通路保护硫酸葡聚糖钠诱导的结肠炎和克罗恩病的肠屏障Yajun Liu, Junbo Xiao, Xu Zhao, Jun Yi, Yani Yin, Xiaowei Liu
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002708
摘要
致编辑：免疫细胞的增强激活是炎症性肠病（IBD）病理进展的决定性因素，其可以释放大量的炎性细胞因子和生物活性分子，表明它们作为IBD的潜在治疗靶点的作用。嘌呤能受体是广泛存在于许多哺乳动物组织和器官中的膜蛋白家族。P2X7受体（P2X7R）作为嘌呤能受体的一个亚型，在上皮细胞和大多数免疫细胞中均有丰富的表达。在炎症过程中，三磷酸腺苷(ATP)通过各种刺激在细胞外释放。通常，通过P2X7R的激活，细胞外ATP（eATP）可以刺激炎症，而ATP降解为腺苷通常发挥抗炎作用。因此，ATP/P2X7R信号传导可以刺激免疫细胞产生各种生物活性。目前，结肠炎的小鼠模型已经阐明了P2X7R在炎症中的作用，这得到了炎症过程中细胞外嘌呤增加以及嘌呤受体基因和蛋白表达失调的支持。[
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麻醉对胃肠内镜检查的影响：对全国50家公立医院的大规模调查Haijun Hou, Ming Tian, Fukun Liu, Fushan Xue, Shutian Zhang
中华医学杂志英文版2023年 136卷 12期
DOI: 10.1097/CM9.0000000000002664
摘要
致编辑：近年来，胃肠内窥镜检查（GIE）的麻醉被广泛用于早期胃肠道癌症筛查。在德国，大约82%的胃镜检查是在镇静/麻醉下进行的，在美国，98%的结肠镜检查是在镇静/麻醉下进行的。[
Corrigendum
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勘误表：电针激活GABA能系统通过抑制TLR4/MyD88/NF-κ B信号通路减轻哮喘模型气道炎症中华医学杂志英文版2023年 136卷 12期
DOI: 10.3760/cma.j.issn.0366-6999.2023.12.101
摘要
《电针诱导激活GABA能系统通过抑制TLR4/MyD88/NF-κ B信号通路减轻哮喘模型气道炎症》一文存在一些错误。136，第4期，第451-460页中华医学杂志.[
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