2023年 · 第136卷第16期

出版日期 2023-08-20电子版￥0.00元

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Editorial

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新型冠状病毒感染与妊娠：临床更新与展望

Chen Wang, Huixia Yang

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002762

摘要

Consensus Statement

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炎性乳腺癌诊治临床实践指南：中国乳腺外科学会（CSBrS）实践指南2022

Li Ma, Yanshou Zhang, Tiantian Tang, Xiangmei Zhang, Yunjiang Liu, Chinese Society of Breast Surgery

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002780

摘要

Review Article

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从免疫微环境角度认识子宫内膜异位症

Dian Fan, Xu Wang, Zhixian Shi, Yuting Jiang, Bohao Zheng, Lian Xu, Shengtao Zhou

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002649

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食管癌靶向治疗和免疫治疗进展

Haiou Yang, Xuewei Li, Wenhui Yang

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002768

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结核后肺病与慢性阻塞性肺病

Xiaoyan Gai, Brian Allwood, Yongchang Sun

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002771

摘要

Original Article

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遗传和健康生活方式因素与中国人群重型肝病发病率和预后的关系

Yuanjie Pang, Jun Lv, Christiana Kartsonaki, Canqing Yu, Yu Guo, Yiping Chen, Ling Yang, Iona Y. Millwood, Robin G. Walters, Silu Lv 等

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002754

摘要

Background: Severe liver disease (SLD), including cirrhosis and liver cancer, constitutes a major disease burden in China. We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD. Methods: The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30–79 years. The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HRs) for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors (smoking, alcohol, physical activity, and central adiposity). Additionally, the contribution of genetic risk for hepatitis B virus (HBV, assessed by genetic variants in major histocompatibility complex, class II, DP/DQ [HLA-DP/DQ] genes) was also estimated. Results: Compared with those with 0–1 healthy lifestyle factor, participants with 2, 3, and 4 factors had 12% (HR 0.88 [95% confidence interval [CI] 0.85, 0.92]), 26% (HR 0.74 [95%CI: 0.69, 0.79]), and 44% (HR 0.56 [95%CI: 0.48, 0.65]) lower risks of SLD, respectively. Inverse associations were observed among participants with both low and high genetic risks (HR per 1-point increase 0.83 [95% CI: 0.74, 0.94] and 0.91 [95% CI: 0.82, 1.02], respectively; Pinteraction = 0.51), although with a non-significant trend among those with a high genetic risk. Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk. Despite the limited power, healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk (HR 0.59 [95%CI: 0.37, 0.96]). Conclusions: Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk. Moreover, it is also important for improving the prognosis of SLD in individuals with a low genetic risk. Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis, particularly among individuals with a high genetic risk.

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基于26,226例大规模真实样本的I期肺癌生存率持续增加和改善

Chengdi Wang, Jun Shao, Lujia Song, Pengwei Ren, Dan Liu, Weimin Li

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002729

摘要

Background: Lung cancer prevails and induces high mortality around the world. This study provided real-world information on the evolution of clinicopathological profiles and survival outcomes of lung cancer, and provided survival information within stage I subtypes. Methods: Patients pathologically confirmed with lung cancer between January 2009 and December 2018 were identified with complete clinicopathological information, molecular testing results, and follow-up data. Shifts in clinical characteristics were evaluated using χ2 tests. Overall survival (OS) was calculated through the Kaplan–Meier method. Results: A total of 26,226 eligible lung cancer patients were included, among whom 62.55% were male and 52.89% were smokers. Non-smokers and elderly patients took increasingly larger proportions in the whole patient population. The proportion of adenocarcinoma increased from 51.63% to 71.80%, while that of squamous carcinoma decreased from 28.43% to 17.60%. Gene mutations including EGFR (52.14%), KRAS (12.14%), and ALK (8.12%) were observed. Female, younger, non-smoking, adenocarcinoma patients and those with mutated EGFR had better survival prognoses. Importantly, this study validated that early detection of early-stage lung cancer patients had contributed to pronounced survival benefits during the decade. Patients with stage I lung cancer, accounted for an increasingly considerable proportion, increasing from 15.28% to 40.25%, coinciding with the surgery rate increasing from 38.14% to 54.25%. Overall, period survival analyses found that 42.69% of patients survived 5 years, and stage I patients had a 5-year OS of 84.20%. Compared with that in 2009–2013, the prognosis of stage I patients in 2014–2018 was dramatically better, with 5-year OS increasing from 73.26% to 87.68%. Regarding the specific survival benefits among stage I patients, the 5-year survival rates were 95.28%, 93.25%, 82.08%, and 74.50% for stage IA1, IA2, IA3, and IB, respectively, far more promising than previous reports. Conclusions: Crucial clinical and pathological changes have been observed in the past decade. Notably, the increased incidence of stage I lung cancer coincided with an improved prognosis, indicating actual benefits of early detection and management of lung cancer.

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杂合子CARD9突变有利于过敏性支气管肺曲霉病的发展

Xia Xu, Haiwen Lu, Jianxiong Li, Jielin Duan, Zhongwei Wang, Jiawei Yang, Shuyi Gu, Rongguang Luo, Shuo Liang, Wei Tang 等

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002786

摘要

Background: Previous research demonstrated that a homozygous mutation of g.136372044G>A (S12N) in caspase recruitment domain family member 9 (CARD9) is critical for producing Aspergillus fumigatus-induced (Af-induced) T helper 2 (TH2) - mediated responses in allergic bronchopulmonary aspergillosis (ABPA). However, it remains unclear whether the CARD9S12N mutation, especially the heterozygous occurrence, predisposes the host to ABPA. Methods: A total of 61 ABPA patients and 264 controls (including 156 healthy controls and 108 asthma patients) were recruited for sequencing the CARD9 locus to clarify whether patients with this heterozygous single-nucleotide polymorphisms are predisposed to the development of ABPA. A series of in vivo and in vitro experiments, such as quantitative real-time polymerase chain reaction, flow cytometry, and RNA isolation and quantification, were used to illuminate the involved mechanism of the disease. Results: The presence of the p.S12N mutation was associated with a significant risk of ABPA in ABPA patients when compared with healthy controls and asthma patients, regardless of Aspergillus sensitivity. Relative to healthy controls without relevant allergies, the mutation of p.S12N was associated with a significant risk of ABPA (OR: 2.69 and 4.17 for GA and AA genotypes, P = 0.003 and 0.029, respectively). Compared with patients with asthma, ABPA patients had a significantly higher heterozygous mutation (GA genotype), indicating that p.S12N might be a significant ABPA-susceptibility locus (aspergillus sensitized asthma: OR: 3.02, P = 0.009; aspergillus unsensitized asthma: OR: 2.94, P = 0.005). The mutant allele was preferentially expressed in ABPA patients with heterozygous CARD9S12N, which contributes to its functional alterations to facilitate Af-induced TH2-mediated ABPA development. In terms of mechanism, Card9 wild-type (Card9WT) expression levels decreased significantly due to Af-induced decay of its messenger RNA compared to the heterozygous Card9S12N. In addition, ABPA patients with heterozygous CARD9S12N had increased Af-induced interleukin-5 production. Conclusion: Our study provides the genetic evidence showing that the heterozygous mutation of CARD9S12N, followed by allele expression imbalance of CARD9S12N, facilitates the development of ABPA.

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PAI-1基因多态性通过调节中性粒细胞活性影响脓毒症患者的预后

Shaowei Jiang, Yang Wang, Liang Chen, Honghua Mu, Connor Meaney, Yiwen Fan, Janesh Pillay, Hairong Wang, Jincheng Zhang, Shuming Pan 等

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002316

摘要

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袖状胃切除术后胃漏的管理和结果：来自2010-2020年国家登记的结果

Mengyi Li, Na Zeng, Yang Liu, Xitai Sun, Wah Yang, Yanjun Liu, Zhongqi Mao, Qiyuan Yao, Xiangwen Zhao, Hui Liang 等

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002499

摘要

Background: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. Methods: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan–Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. Results: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population (P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment (P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. Conclusions: Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

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B7-H3通过AKT/pAKT/Nrf2途径促进谷胱甘肽代谢赋予胃癌细胞干细胞特性

Lu Xia, Yuqi Chen, Juntao Li, Jiayu Wang, Kanger Shen, Anjing Zhao, Haiyan Jin, Guangbo Zhang, Qinhua Xi, Suhua Xia 等

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002772

摘要

Background: Cancer stem-like cells (CSCs) are a small subset of cells in tumors that exhibit self-renewal and differentiation properties. CSCs play a vital role in tumor formation, progression, relapse, and therapeutic resistance. B7-H3, an immunoregulatory protein, has many protumor functions. However, little is known about the mechanism underlying the role of B7-H3 in regulating gastric cancer (GC) stemness. Our study aimed to explore the impacts of B7-H3 on GC stemness and its underlying mechanism. Methods: GC stemness influenced by B7-H3 was detected both in vitro and in vivo. The expression of stemness-related markers was examined by reverse transcription quantitative polymerase chain reaction, Western blotting, and flow cytometry. Sphere formation assay was used to detect the sphere-forming ability. The underlying regulatory mechanism of B7-H3 on the stemness of GC was investigated by mass spectrometry and subsequent validation experiments. The signaling pathway (Protein kinase B [Akt]/Nuclear factor erythroid 2-related factor 2 [Nrf2] pathway) of B7-H3 on the regulation of glutathione (GSH) metabolism was examined by Western blotting assay. Multi-color immunohistochemistry (mIHC) was used to detect the expression of B7-H3, cluster of differentiation 44 (CD44), and Nrf2 on human GC tissues. Student’s t-test was used to compare the difference between two groups. Pearson correlation analysis was used to analyze the relationship between two molecules. The Kaplan–Meier method was used for survival analysis. Results: B7-H3 knockdown suppressed the stemness of GC cells both in vitro and in vivo. Mass spectrometric analysis showed the downregulation of GSH metabolism in short hairpin B7-H3 GC cells, which was further confirmed by the experimental results. Meanwhile, stemness characteristics in B7-H3 overexpressing cells were suppressed after the inhibition of GSH metabolism. Furthermore, Western blotting suggested that B7-H3-induced activation of GSH metabolism occurred through the AKT/Nrf2 pathway, and inhibition of AKT signaling pathway could suppress not only GSH metabolism but also GC stemness. mIHC showed that B7-H3 was highly expressed in GC tissues and was positively correlated with the expression of CD44 and Nrf2. Importantly, GC patients with high expression of B7-H3, CD44, and Nrf2 had worse prognosis (P = 0.02). Conclusions: B7-H3 has a regulatory effect on GC stemness and the regulatory effect is achieved through the AKT/Nrf2/GSH pathway. Inhibiting B7-H3 expression may be a new therapeutic strategy against GC.

Correspondence

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基于每搏输出量变化和δ每搏输出量的目标导向液体治疗对脑膜瘤切除术患者术后复合并发症发生率的影响

Shuai Feng, Wei Xiao, Ying Zhang, Yanhui Ma, Shuyi Yang, Tongchen He, Tianlong Wang

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002249

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男性和绝经后女性的性激素结合球蛋白、遗传易感性和2型糖尿病风险

Wen Zhang, Haojie Zhang, Bin Wang, Yuying Wang, Ningjian Wang, Yingli Lu

中华医学杂志英文版2023年 136卷 16期

DOI: 10.1097/CM9.0000000000002791