MedNexus
2023年 · 第136卷第14期
出版日期 2023-07-20电子版 ￥0.00元
MedNexus
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- Review Article
- Original Article
- Consensus Statement
- Meta Analysis
- Correspondence
Review Article
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类风湿性关节炎的骨免疫学研究：来自单细胞组学方法Nan Hu, Jing Wang, Bomiao Ju, Yuanyuan Li, Ping Fan, Xinxin Jin, Xiaomin Kang, Shufang Wu
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002678
摘要
Cellular immune responses as well as generalized and periarticular bone loss are the key pathogenic features of rheumatoid arthritis (RA). Under the pathological conditions of RA, dysregulated inflammation and immune processes tightly interact with skeletal system, resulting in pathological bone damage via inhibition of bone formation or induction of bone resorption. Single-cell omics technologies are revolutionary tools in the field of modern biological research. They enable the display of the state and function of cells in various environments from a single-cell resolution, thus making it conducive to identify the dysregulated molecular mechanisms of bone destruction in RA as well as the discovery of potential therapeutic targets and biomarkers. Here, we summarize the latest findings of single-cell omics technologies in osteoimmunology research in RA. These results suggest that single-cell omics have made significant contributions to transcriptomics and dynamics of specific cells involved in bone remodeling, providing a new direction for our understanding of cellular heterogeneity in the study of osteoimmunology in RA.
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铜稳态失调促进细胞损伤及其与肝病的关系Tao Liu, Yali Liu, Feiyu Zhang, Yanhang Gao
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002697
摘要
Copper plays an important role in many metabolic activities in the human body. Copper level in the human body is in a state of dynamic equilibrium. Recent research on copper metabolism has revealed that copper dyshomeostasis can cause cell damage and induce or aggravate some diseases by affecting oxidative stress, proteasome, cuprotosis, and angiogenesis. The liver plays a central role in copper metabolism in the human body. Research conducted in recent years has unraveled the relationship between copper homeostasis and liver diseases. In this paper, we review the available evidence of the mechanism by which copper dyshomeostasis promotes cell damage and the development of liver diseases, and identify the future research priorities.
Original Article
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欧洲人群前瞻性队列胃癌功能性多基因风险评分的构建和评估Yuanliang Gu, Caiwang Yan, Tianpei Wang, Beiping Hu, Meng Zhu, Guangfu Jin
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002716
摘要
Background:
A polygenic risk score (PRS) derived from 112 single-nucleotide polymorphisms (SNPs) for gastric cancer has been reported in Chinese populations (PRS-112). However, its performance in other populations is unknown. A functional PRS (fPRS) using functional SNPs (fSNPs) may improve the generalizability of the PRS across populations with distinct ethnicities.
Methods:
We performed functional annotations on SNPs in strong linkage disequilibrium (LD) with the 112 previously reported SNPs to identify fSNPs that affect protein-coding or transcriptional regulation. Subsequently, we constructed an fPRS based on the fSNPs by using the LDpred2-infinitesimal model and then analyzed the performance of the PRS-112 and fPRS in the risk prediction of gastric cancer in 457,521 European participants of the UK Biobank cohort. Finally, the performance of the fPRS in combination with lifestyle factors were evaluated in predicting the risk of gastric cancer.
Results:
During 4,582,045 person-years of follow-up with a total of 623 incident gastric cancer cases, we found no significant association between the PRS-112 and gastric cancer risk in the European population (hazard ratio [HR] = 1.00 [95% confidence interval (CI) 0.93–1.09], P = 0.846). We identified 125 fSNPs, including seven deleterious protein-coding SNPs and 118 regulatory non-coding SNPs, and used them to construct the fPRS-125. Our result showed that the fPRS-125 was significantly associated with gastric cancer risk (HR = 1.11 [95% CI, 1.03–1.20], P = 0.009). Compared to participants with a low fPRS-125 (bottom quintile), those with a high fPRS-125 (top quintile) had a higher risk of incident gastric cancer (HR = 1.43 [95% CI, 1.12–1.84], P = 0.005). Moreover, we observed that participants with both an unfavorable lifestyle and a high genetic risk had the highest risk of incident gastric cancer (HR = 4.99 [95% CI, 1.55-16.10], P = 0.007) compared to those with both a favorable lifestyle and a low genetic risk.
Conclusion:
These results indicate that the fPRS-125 derived from fSNPs may act as an indicator to measure the genetic risk of gastric cancer in the European population.
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胆囊癌根治性切除术后的教科书结局：一项10年回顾性单中心研究Qi Li, Hengchao Liu, Qi Gao, Feng Xue, Jialu Fu, Mengke Li, Jiawei Yuan, Chen Chen, Dong Zhang, Zhimin Geng
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002695
摘要
Background:
Textbook outcome (TO) can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement. We explored the factors associated with achieving a TO for gallbladder carcinoma (GBC) after curative-intent resection and analyzed the effect of adjuvant chemotherapy (ACT) on TO and non-TO patients.
Methods:
A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed. Multivariable logistic regression was used to investigate the factors associated with TO.
Results:
Among 540 patients with GBC who underwent curative-intent resection, 223 patients (41.3%) achieved a TO. The incidence of TO ranged from 19.0% to 51.0% across the study period, with a slightly increasing trend over the study period. The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection (P = 0.003). Age ≤60 years (P = 0.016), total bilirubin (TBIL) level ≤34.1 μmol/L (P <0.001), well-differentiated tumor (P = 0.008), no liver involvement (P <0.001), and T1-2 stage disease (P = 0.006) were independently associated with achieving a TO for GBC after resection. Before and after propensity score matching (PSM), the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant; ACT improved the prognosis of patients in the non-TO group (P <0.05).
Conclusion:
Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection, and ACT can improve the prognosis of those with non-TO.
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黄连素、阿莫西林和沃诺拉赞三联疗法的疗效和安全性幽门螺杆菌初始治疗：一项随机对照试验Shasha Chen, Weina Shen, Yuhuan Liu, Qiang Dong, Yongquan Shi
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002696
摘要
Background:
With the development of traditional Chinese medicine research, berberine has shown good efficacy and safety in the eradication of Helicobacter pylori (H. pylori). The present study aimed to evaluate the efficacy and safety of triple therapy containing berberine, amoxicillin, and vonoprazan for the initial treatment of H. pylori.
Methods:
This study was a single-center, open-label, parallel, randomized controlled clinical trial. Patients with H. pylori infection were randomly (1: 1: 1) assigned to receive berberine triple therapy (berberine 500 mg, amoxicillin 1000 mg, vonoprazan 20 mg, A group), vonoprazan quadruple therapy (vonoprazan 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, B group), or rabeprazole quadruple therapy (rabeprazole 10 mg, amoxicillin 1000 mg, clarithromycin 500 mg, colloidal bismuth tartrate 220 mg, C group). The drugs were taken twice daily for 14 days. The main outcome was the H. pylori eradication rate. The secondary outcomes were symptom improvement rate, patient compliance, and incidence of adverse events. Furthermore, factors affecting the eradication rate of H. pylori were further analyzed.
Results:
A total of 300 H. pylori-infected patients were included in this study, and 263 patients completed the study. An intention-to-treat (ITT) analysis showed that the eradication rates of H. pylori in berberine triple therapy, vonoprazan quadruple therapy, and rabeprazole quadruple therapy were 70.0% (70/100), 77.0% (77/100), and 69.0% (69/100), respectively. The per-protocol (PP) analysis showed that the eradication rates of H. pylori in these three groups were 81.4% (70/86), 86.5% (77/89), and 78.4% (69/88), respectively. Both ITT analysis and PP analysis showed that the H. pylori eradication rate did not significantly differ among the three groups (P >0.05). In addition, the symptom improvement rate, overall adverse reaction rate, and patient compliance were similar among the three groups (P >0.05).
Conclusions:
The efficacy of berberine triple therapy for H. pylori initial treatment was comparable to that of vonoprazan quadruple therapy and rabeprazole quadruple therapy, and it was well tolerated. It could be used as one choice of H. pylori initial treatment.
Trial Registration:
ClinicalTrials.gov, No. NCT05014334
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预测乳腺癌术后脑转移的生存率和预后：一项基于人群的回顾性分析Yan Nie, Bicheng Ying, Zinan Lu, Tonghui Sun, Gang Sun
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002674
摘要
Background:
Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness.
Methods:
From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Data of another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan-Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts.
Results:
LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically significantly correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients (P < 0.001).
Conclusion:
The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.
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2022年中国新冠肺炎疫情浪潮期间在单中心观察到的早期术后结果和并发症的变化：一项单中心双视角队列研究Lini Wang, Ziyu Zheng, Shouqiang Zhu, Gang Luo, Baobao Gao, Yumei Ma, Shuai Xu, Hailong Dong, Chong Lei
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002724
摘要
Background:
Currently, the effect of the 2022 nationwide coronavirus disease 2019 (COVID-19) wave on the perioperative prognosis of surgical patients in China is unclear. Thus, we aimed to explore its influence on postoperative morbidity and mortality in surgical patients.
Methods:
An ambispective cohort study was conducted at Xijing Hospital, China. We collected 10-day time-series data from December 29 until January 7 for the 2018–2022 period. The primary outcome was major postoperative complications (Clavien–Dindo class III–V). The association between COVID-19 exposure and postoperative prognosis was explored by comparing consecutive 5-year data at the population level and by comparing patients with and without COVID-19 exposure at the patient level.
Results:
The entire cohort consisted of 3350 patients (age: 48.5 ± 19.2 years), including 1759 females (52.5%). Overall, 961 (28.7%) underwent emergency surgery, and 553 (16.5%) had COVID-19 exposure (from the 2022 cohort). At the population level, major postoperative complications occurred in 5.9% (42/707), 5.7% (53/935), 5.1% (46/901), 9.4% (11/117), and 22.0% (152/690) patients in the 2018–2022 cohorts, respectively. After adjusting for potential confounding factors, the 2022 cohort (80% patients with COVID-19 history) had a significantly higher postoperative major complication risk than did the 2018 cohort (adjusted risk difference [aRD], 14.9% (95% confidence interval [CI], 11.5–18.4%); adjusted odds ratio [aOR], 8.19 (95% CI, 5.24–12.81)). At the patient level, the incidence of major postoperative complications was significantly greater in patients with (24.6%, 136/553) than that in patients without COVID-19 history (6.0% [168/2797]; aRD, 17.8% [95% CI, 13.6–22.1%]; aOR, 7.89 [95% CI, 5.76–10.83]). Secondary outcomes of postoperative pulmonary complications were consistent with primary findings. These findings were verified through sensitivity analyses using time-series data projections and propensity score matching.
Conclusion:
Based on a single-center observation, patients with recent COVID-19 exposure were likely to have a high incidence of major postoperative complications.
Registration:
NCT05677815 at https://clinicaltrials.gov/.
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H19招募N6-甲基腺苷（m6a)在胃癌中促进SCARB1翻译和促进血管生成的阅读器YTHDF1Rumeng Bai, Miaomiao Sun, Yuanyuan Chen, Shuaishuai Zhuo, Guoxin Song, Tianjun Wang, Zhihong Zhang
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002722
摘要
Background:
Angiogenesis is described as a complex process in which new microvessels sprout from endothelial cells of existing vasculature. This study aimed to determine whether long non-coding RNA (lncRNA) H19 induced the angiogenesis of gastric cancer (GC) and its possible mechanism.
Methods:
Gene expression level was determined by quantitative real-time polymerase chain reaction and western blotting. Cell counting kit-8, transwell, 5-Ethynyl-2′-deoxyuridine (EdU), colony formation assay, and human umbilical vein endothelial cells (HUVECs) angiogenesis assay as well as Matrigel plug assay were conducted to study the proliferation, migration, and angiogenesis of GC in vitro and in vivo. The binding protein of H19 was found by RNA pull-down and RNA Immunoprecipitation (RIP). High-throughput sequencing was performed and next Gene Ontology (GO) as well as Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis was conducted to analyze the genes that are under H19 regulation. Methylated RIP (me-RIP) assay was used to investigate the sites and abundance among target mRNA. The transcription factor acted as upstream of H19 was determined through chromatin immunoprecipitation (ChIP) and luciferase assay.
Results:
In this study, we found that hypoxia-induced factor (HIF)-1α could bind to the promoter region of H19, leading to H19 overexpression. High expression of H19 was correlated with angiogenesis in GC, and H19 knocking down could inhibit cell proliferation, migration and angiogenesis. Mechanistically, the oncogenic role of H19 was achieved by binding with the N6-methyladenosine (m6A) reader YTH domain-containing family protein 1 (YTHDF1), which could recognize the m6A site on the 3′-untransated regions (3′-UTR) of scavenger receptor class B member 1 (SCARB1) mRNA, resulting in over-translation of SCARB1 and thus promoting the proliferation, migration, and angiogenesis of GC cells.
Conclusion:
HIF-1α induced overexpression of H19 via binding with the promoter of H19, and H19 promoted GC cells proliferation, migration and angiogenesis through YTHDF1/SCARB1, which might be a beneficial target for antiangiogenic therapy for GC.
Consensus Statement
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中国肺癌筛查标准及规范化管理Qi Wang, Xiaoju Zhang, Dawei Yang, Li Bai, Chunxue Bai
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002733
摘要
根据最新中国癌症流行病学报告,[
Meta Analysis
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联合化疗和PD-1/PD-L1抑制剂治疗乳腺癌的安全性和有效性评估：一项荟萃分析Da Qian, Yuhao Xu, Yihao Wu, Jie Qiu, Weimin Hong, Xuli Meng
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002631
摘要
Background:
As the efficacy of programmed cell death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors combined with chemotherapy in curing breast cancer is still controversial, this meta-analysis compares the efficacy and safety of PD-1/PD-L1 inhibitors combined with chemotherapy and chemotherapy alone in the treatment of breast cancer, which provides guidance for the clinical treatment.
Methods:
Relevant studies published as of April 2022 in the various databases including EMBASE, PubMed, and Cochrane Library were selected. Randomized controlled trials (RCTs) in which control patients underwent chemotherapy alone and experimental group patients underwent combination chemotherapy and PD-1/PD-L1 inhibitor treatment were included in this investigation. Investigations without complete information, researches from which information could not be extracted, duplicate articles, animal studies, review articles, and systematic reviews were excluded. STATA 15.1 was employed for all statistical analyses.
Results:
In total, eight eligible studies were identified, revealing that combination chemotherapy and PD-1/PD-L1 inhibitor treatment was linked to significant increases in progression-free survival (PFS) relative to chemotherapy alone (hazard ratio [HR] = 0.83, 95% confidence interval [CI]: 0.70–0.99, P = 0.032) but not overall survival (HR = 0.92, 95% CI: 0.80–1.06, P = 0.273). Pooled adverse event rates were also increased within the group of combination treatment relative to the chemotherapy group (risk ratio [RR] = 1.08, 95% CI: 1.03–1.14, P = 0.002). Specifically, nausea rates were lesser within the group of combination treatment relative to the group of chemotherapy (RR = 0.48, 95% CI: 0.25–0.92, P = 0.026). Subgroup analyses indicated that the PFS of patients who underwent combination atezolizumab or pembrolizumab and chemotherapy treatment were substantially longer than those of patients who underwent chemotherapy alone (HR = 0.79, 95% CI: 0.69-0.89, P ≤0.001; HR = 0.79, 95% CI: 0.67–0.92, P = 0.002).
Conclusions:
The pooled results suggest that combination chemotherapy and PD-1/PD-L1 inhibitor treatment approaches help prolong PFS in breast cancer patients, but have no statistically significant effect on overall survival (OS). Additionally, combination therapy can significantly improve complete response rate (CRR) compared with chemotherapy alone. However, combination therapy was associated with greater rates of adverse events.
Correspondence
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共病小细胞肺癌患者放疗后肺泡蛋白沉积症的缓解Yongbo Xiang, Wei Li, Zhijie Wang, Jianyang Wang, Xin Xu, Luhua Wang, Nan Bi
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002734
摘要
致编辑：肺泡蛋白沉积症（PAP）是一种以肺泡腔内肺表面活性物质异常和过度积聚为特征的罕见疾病。PAP病例通常分为三种病因形式：先天性、继发性和特发性PAP。全肺灌洗（WLL）已被广泛用于治疗PAP。[
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2017年至2022年间发布的综合高血压指南的方法学和报告质量Zijun Wang, Ying Lou, Yunlan Liu, Junxian Zhao, Renfeng Su, Yajia Sun, Hui Liu, Qianling Shi, Jun Cai, Yaolong Chen
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002738
摘要
高血压，也称为高血压，是一种严重的疾病，可能导致严重的健康问题，如心脏病发作和中风。据世界卫生组织（WHO）称，[
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经皮冠状动脉介入治疗后患者炎症、体重指数和长期预后之间的关系：一项大型队列研究Guyu Zeng, Deshan Yuan, Sida Jia, Peizhi Wang, Liu Ru, Tianyu Li, Ce Zhang, Xueyan Zhao, Song Lei, Lijian Gao 等
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002706
摘要
致编辑：尽管进行了最佳的二级预防治疗，但经皮冠状动脉介入治疗（PCI）后仍有很大比例的冠状动脉疾病（CAD）患者处于心血管事件复发的高风险中。炎症是残余心血管风险的众所周知的组成部分，并有助于动脉粥样硬化的进展，导致动脉粥样硬化斑块的不稳定和破裂。[
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原发性胆汁反流相关危险因素分析：一项多中心横断面研究Qiang Dong, Songbo Li, Shasha Chen, Xiaodong Qu, Xingyu Zhao, Yani Li, Shasha Wang, Yongquan Shi
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002725
摘要
致编辑：胆汁反流（BR）又称十二指肠胃反流，是指胆汁、胰液、十二指肠液等十二指肠内容物反流至胃内。未经胃手术而发生的BR称为原发性胆汁反流（PBR）。[
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国际分期系统（R2-ISS）第二次修订版在新诊断多发性骨髓瘤患者真实队列中的预后价值Wenqiang Yan, Huishou Fan, Jingyu Xu, Jiahui Liu, Lingna Li, Chenxing Du, Shuhui Deng, Weiwei Sui, Yan Xu, Dehui Zou 等
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002735
摘要
致编辑：多发性骨髓瘤(MM)是一种以异质性特征为特征的浆细胞疾病。[
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全膝关节置换术后手术部位感染的发生、危险因素和微生物学：一项回顾性研究的初步结果Yiming Xu, Yingjie Wang, Wei Zhu, Bin Feng, Zehui Lyu, Yixin Bian, Xisheng Weng
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002740
摘要
致编辑：全膝关节置换术（TKA）已经成为终末期关节疾病的既定治疗方法。在中国，2011年至2019年间，TKA病例数量增加了5.9倍。各种感染都是TKA的灾难性并发症。最近的报告强调了手术部位感染（SSIs）的低估患病率，并预计2020年至2030年间髋关节和膝关节置换术后复杂SSIs将增加14%。[
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梅特尔1基因多态性与中国儿童肾母细胞瘤易感性：一项五中心病例对照研究Linqing Deng, Ruixi Hua, Zhengtao Zhang, Jinhong Zhu, Jiao Zhang, Jiwen Cheng, Suhong Li, Haixia Zhou, Guochang Liu, Jing He 等
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002739
摘要
致编辑：肾母细胞瘤，或称肾母细胞瘤，是最常诊断的儿童肾癌，占1-7岁儿童所有肾肿瘤的>90%，该病可能与遗传因素有关。[
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成人1型糖尿病结构化营养和高级碳水化合物计数问卷Fansu Huang, Xiaolin Ji, Yuting Xie, Juan Li, Xia Li, Zhiguang Zhou
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002721
摘要
致编辑：高级碳水化合物计数（CC）是1型糖尿病（T1DM）患者推荐的饮食策略和必要的营养知识。[
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之间的相互作用OCT1和LPIN1多囊卵巢综合征患者对吡格列酮—二甲双胍片的多态性及反应Haixia Zeng, Yanting Huang, Dengke Liu, Tianqin Xie, Zheng Chen, Qiulan Huang, Xiaojun Zhou, Xiaoyang Lai, Jianping Liu
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002322
摘要
致编辑：多囊卵巢综合征（PCOS）是育龄妇女常见的内分泌疾病。PCOS的特征是排卵不频繁或不排卵、高雄激素水平和高胰岛素血症。雄激素过多是本病的主要病理生理机制。二甲双胍可降低胰岛素和雄激素水平，升高雌二醇水平，诱导排卵。[
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人工子宫：拯救极早产儿的范式转变Zhelan Huang, Tiantian Xiao, Wenhao Zhou
中华医学杂志英文版2023年 136卷 14期
DOI: 10.1097/CM9.0000000000002745
摘要
致编辑：大约1500万早产儿，即在<全球每年都有37周胎龄(GA)出生，其中0.4%是极早产儿(EPI)，即在<28周GA。[
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