MedNexus
2023年 · 第136卷第23期
出版日期 2023-12-05电子版 ￥0.00元
MedNexus
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- Consensus Statement
- Review Article
- Meta Analysis
- Original Article
- Correspondence
Consensus Statement
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关于人卵母细胞和胚胎玻璃化的专家共识Da Li, Yingzhuo Gao, Rong Li, Chinese Association of Reproductive Medicine
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002895
摘要
人类卵母细胞和胚胎的冷冻保存是辅助生殖技术（ART）中的一个关键因素。基于最新的指导方针和共识[
Review Article
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表皮生长因子受体化合物和伴随突变：精确治疗策略的进展Wenqian Li, Rilan Bai, Hanfei Guo, Jiuwei Cui
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002548
摘要
Epidermal growth factor receptor (EGFR) mutations are common oncogenic driver mutations in patients with non-small cell lung cancer (NSCLC). The application of EGFR-tyrosine kinase inhibitors (TKIs) is beneficial for patients with advanced and early-stage NSCLC. With the development of next-generation sequencing technology, numerous patients have been found to have more than one genetic mutation in addition to a single EGFR mutation; however, the efficacy of conventional EGFR-TKIs and the optimal treatments for such patients remain largely unknown. Thus, we review the incidence, prognosis, and current treatment regimens of EGFR compound mutations and EGFR concomitant mutations to provide treatment recommendations and guidance for patients with these mutations.
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肿瘤免疫微环境调节纳米策略治疗肺癌转移Lingling Zhu, Juan Wu, Honglin Gao, Ting Wang, Guixiu Xiao, Chenggong Hu, Qing Lin, Qinghua Zhou
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002525
摘要
As one of the most malignant tumors worldwide, lung cancer, fueled by metastasis, has shown rising mortality rates. However, effective clinical strategies aimed at preventing metastasis are lacking owing to its dynamic multi-step, complicated, and progressive nature. Immunotherapy has shown promise in treating cancer metastasis by reversing the immunosuppressive network of the tumor microenvironment. However, drug resistance inevitably develops due to inadequate delivery of immunostimulants and an uncontrolled immune response. Consequently, adverse effects occur, such as autoimmunity, from the non-specific immune activation and non-specific inflammation in off-target organs. Nanocarriers that improve drug solubility, permeability, stability, bioavailability, as well as sustained, controlled, and targeted delivery can effectively overcome drug resistance and enhance the therapeutic effect while reducing adverse effects. In particular, nanomedicine-based immunotherapy can be utilized to target tumor metastasis, presenting a promising therapeutic strategy for lung cancer. Nanotechnology strategies that boost the immunotherapy effect are classified based on the metastatic cascade related to the tumor immune microenvironment; the breaking away of primary tumors, circulating tumor cell dissemination, and premetastatic niche formation cause distant secondary site colonization. In this review, we focus on the opportunities and challenges of integrating immunotherapy with nanoparticle formulation to establish nanotechnology-based immunotherapy by modulating the tumor microenvironment for preclinical and clinical applications in the management of patients with metastatic lung cancer. We also discuss prospects for the emerging field and the clinical translation potential of these techniques.
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放射治疗对肿瘤微环境影响的研究进展Zewen Zhang, Yuanhao Peng, Xin Peng, Desheng Xiao, Ying Shi, Yongguang Tao
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002535
摘要
Cancer is a major threat to human health and causes death worldwide. Research on the role of radiotherapy (RT) in the treatment of cancer is progressing; however, RT not only causes fatal DNA damage to tumor cells, but also affects the interactions between tumor cells and different components of the tumor microenvironment (TME), including immune cells, fibroblasts, macrophages, extracellular matrix, and some soluble products. Some cancer cells can survive radiation and have shown strong resistance to radiation through interaction with the TME. Currently, the complex relationships between the tumor cells and cellular components that play major roles in various TMEs are poorly understood. This review explores the relationship between RT and cell-cell communication in the TME from the perspective of immunity and hypoxia and aims to identify new RT biomarkers and treatment methods in lung cancer to improve the current status of unstable RT effect and provide a theoretical basis for further lung cancer RT sensitization research in the future.
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调节性T细胞与心血管疾病Wangling Hu, Jingyong Li, Xiang Cheng
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002875
摘要
Inflammation is a major underlying mechanism in the progression of numerous cardiovascular diseases (CVDs). Regulatory T cells (Tregs) are typical immune regulatory cells with recognized immunosuppressive properties. Despite the immunosuppressive properties, researchers have acknowledged the significance of Tregs in maintaining tissue homeostasis and facilitating repair/regeneration. Previous studies unveiled the heterogeneity of Tregs in the heart and aorta, which expanded in CVDs with unique transcriptional phenotypes and reparative/regenerative function. This review briefly summarizes the functional principles of Tregs, also including the synergistic effect of Tregs and other immune cells in CVDs. We discriminate the roles and therapeutic potential of Tregs in CVDs such as atherosclerosis, hypertension, abdominal arterial aneurysm, pulmonary arterial hypertension, Kawasaki disease, myocarditis, myocardial infarction, and heart failure. Tregs not only exert anti-inflammatory effects but also actively promote myocardial regeneration and vascular repair, maintaining the stability of the local microenvironment. Given that the specific mechanism of Tregs functioning in CVDs remains unclear, we reviewed previous clinical and basic studies and the latest findings on the function and mechanism of Tregs in CVDs.
Meta Analysis
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精神分裂症和重性抑郁障碍患者脑磁化转移比的共同和不同异常：一项基于体素的比较荟萃分析Huan Lan, Xueling Suo, Chao Zuo, Weishi Ni, Song Wang, Graham J. Kemp, Qiyong Gong
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002538
摘要
Background:
Patients with schizophrenia (SCZ) and major depressive disorder (MDD) share significant clinical overlap, although it remains unknown to what extent this overlap reflects shared neural profiles. To identify the shared and specific abnormalities in SCZ and MDD, we performed a whole-brain voxel-based meta-analysis using magnetization transfer imaging, a technique that characterizes the macromolecular structural integrity of brain tissue in terms of the magnetization transfer ratio (MTR).
Methods:
A systematic search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in PubMed, EMBASE, International Scientific Index (ISI) Web of Science, and MEDLINE for relevant studies up to March 2022. Two researchers independently screened the articles. Rigorous scrutiny and data extraction were performed for the studies that met the inclusion criteria. Voxel-wise meta-analyses were conducted using anisotropic effect size-signed differential mapping with a unified template. Meta-regression was used to explore the potential effects of demographic and clinical characteristics.
Results:
A total of 15 studies with 17 datasets describing 365 SCZ patients, 224 MDD patients, and 550 healthy controls (HCs) were identified. The conjunction analysis showed that both disorders shared higher MTR than HC in the left cerebellum (P=0.0006) and left fusiform gyrus (P=0.0004). Additionally, SCZ patients showed disorder-specific lower MTR in the anterior cingulate/paracingulate gyrus, right superior temporal gyrus, and right superior frontal gyrus, and higher MTR in the left thalamus, precuneus/cuneus, posterior cingulate gyrus, and paracentral lobule; and MDD patients showed higher MTR in the left middle occipital region. Meta-regression showed no statistical significance in either group.
Conclusions:
The results revealed a structural neural basis shared between SCZ and MDD patients, emphasizing the importance of shared neural substrates across psychopathology. Meanwhile, distinct disease-specific characteristics could have implications for future differential diagnosis and targeted treatment.
Original Article
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中国多发性骨髓瘤的负担：2019年全球疾病负担、伤害和危险因素研究分析Jiangmei Liu, Weiping Liu, Lan Mi, Cai Cai, Tiejun Gong, Jun Ma, Lijun Wang
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002600
摘要
Background:
There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma (MM) in China; therefore, this study determined the characteristics of the disease burden of MM at national and provincial levels in China.
Methods:
The burden of MM, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs), with a 95% uncertainty interval (UI), was determined in China following the general analytical strategy used in the Global Burden of Disease, Injuries, and Risk Factors Study 2019. The trends in the burden of MM from 1990 to 2019 were also evaluated.
Results:
There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05 (95% UI, 12.31-20.77) per 100,000 in 2019. The estimated number of incident case and deaths of MM were 18,793 and 13,421, with age-standardized incidence and mortality rates of 0.93 (95% UI, 0.67-1.15) and 0.67 (95% UI, 0.50-0.82) per 100,000, respectively. The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak (93.82) in the 70 to 74 years age group. Males had a higher burden than females, with approximately 1.5- to 2.0-fold sex difference in age-specific DALY rates in all age groups. From 1990 to 2019, the DALYs of MM increased 134%, from 148,479 in 1990 to 347,453 in 2019.
Conclusion:
The burden of MM has doubled over the last three decades, which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.
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超敏反应性肺炎的临床特征：非纤维化和纤维化亚型Xueying Chen, Xiaoyan Yang, Yanhong Ren, Bingbing Xie, Sheng Xie, Ling Zhao, Shiyao Wang, Jing Geng, Dingyuan Jiang, Sa Luo 等
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002613
摘要
Background:
The presence of fibrosis is a criterion for subtype classification in the newly updated hypersensitivity pneumonitis (HP) guidelines. The present study aimed to summarize differences in clinical characteristics and prognosis of non-fibrotic hypersensitivity pneumonitis (NFHP) and fibrotic hypersensitivity pneumonitis (FHP) and explore factors associated with the presence of fibrosis.
Methods:
In this prospective cohort study, patients diagnosed with HP through a multidisciplinary discussion were enrolled. Collected data included demographic and clinical characteristics, laboratory findings, and radiologic and histopathological features. Logistic regression analyses were performed to explore factors related to the presence of fibrosis.
Results:
A total of 202 patients with HP were enrolled, including 87 (43.1%) NFHP patients and 115 (56.9%) FHP patients. Patients with FHP were older and more frequently presented with dyspnea, crackles, and digital clubbing than patients with NFHP. Serum levels of carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 153, gastrin-releasing peptide precursor, squamous cell carcinoma antigen, and antigen cytokeratin 21-1, and count of bronchoalveolar lavage (BAL) eosinophils were higher in the FHP group than in the NFHP group. BAL lymphocytosis was present in both groups, but less pronounced in the FHP group. Multivariable regression analyses revealed that older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors for the development of FHP. Twelve patients developed adverse outcomes, with a median survival time of 12.5 months, all of whom had FHP.
Conclusions:
Older age, <20% of lymphocyte in BAL, and ≥1.75% of eosinophil in BAL were risk factors associated with the development of FHP. Prognosis of patients with NFHP was better than that of patients with FHP. These results may provide insights into the mechanisms of fibrosis in HP.
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宏基因组和靶向代谢组学分析揭示结直肠癌和2型糖尿病患者肠道微生物群的不同表型Yong Yang, Zihan Han, Zhaoya Gao, Jiajia Chen, Can Song, Jingxuan Xu, Hanyang Wang, An Huang, Jingyi Shi, Jin Gu
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002421
摘要
Background:
Type 2 diabetes mellitus (T2DM) is an independent risk factor for colorectal cancer (CRC), and the patients with CRC and T2DM have worse survival. The human gut microbiota (GM) is linked to the development of CRC and T2DM, respectively. However, the GM characteristics in patients with CRC and T2DM remain unclear.
Methods:
We performed fecal metagenomic and targeted metabolomics studies on 36 samples from CRC patients with T2DM (DCRC group, n = 12), CRC patients without diabetes (CRC group, n = 12), and healthy controls (Health group, n = 12). We analyzed the fecal microbiomes, characterized the composition and function based on the metagenomics of DCRC patients, and detected the short-chain fatty acids (SCFAs) and bile acids (BAs) levels in all fecal samples. Finally, we performed a correlation analysis of the differential bacteria and metabolites between different groups.
Results:
Compared with the CRC group, LefSe analysis showed that there is a specific GM community in DCRC group, including an increased abundance of Eggerthella, Hungatella, Peptostreptococcus, and Parvimonas, and decreased Butyricicoccus, Lactobacillus, and Paraprevotella. The metabolomics analysis results revealed that the butyric acid level was lower but the deoxycholic acid and 12-keto-lithocholic acid levels were higher in the DCRC group than other groups (P < 0.05). The correlation analysis showed that the dominant bacterial abundance in the DCRC group (Parvimonas, Desulfurispora, Sebaldella, and Veillonellales, among others) was negatively correlated with butyric acid, hyodeoxycholic acid, ursodeoxycholic acid, glycochenodeoxycholic acid, chenodeoxycholic acid, cholic acid and glycocholate. However, the abundance of mostly inferior bacteria was positively correlated with these metabolic acid levels, including Faecalibacterium, Thermococci, and Cellulophaga.
Conclusions:
Unique fecal microbiome signatures exist in CRC patients with T2DM compared to those with non-diabetic CRC. Alterations in GM composition and SCFAs and secondary BAs levels may promote CRC development.
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成人非心脏手术的个体化红细胞输注策略：一项随机对照试验Ren Liao, Jin Liu, Wei Zhang, Hong Zheng, Zhaoqiong Zhu, Haorui Sun, Zhangsheng Yu, Huiqun Jia, Yanyuan Sun, Li Qin 等
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002584
摘要
Background:
Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient’s medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu’s Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.
Methods:
Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China’s guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).
Results:
We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P<0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P<0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.
Conclusion:
The individualized red-cell transfusion strategy using the West-China-Liu’s Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.
Trial registration:
ClinicalTrials.gov, NCT01597232.
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成人斯蒂尔病患者中性粒细胞脂质运载蛋白升高及其临床意义Ji Li, Yingni Li, Ru Li, Xiangbo Ma, Lianjie Shi, Shengguang Li, Qian Guo, Yuan Jia, Zhanguo Li
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002580
摘要
Background:
Human neutrophil lipocalin (HNL) has been used extensively to differentiate acute bacterial infection from febrile diseases as a biomarker to reflect the activation of the neutrophil. The serum HNL levels in the adult-onset Still’s disease (AOSD) patients with and without infection, as well as the healthy controls (HCs), were analyzed statistically in this study to evaluate the value of HNL for the diagnosis of AOSD.
Methods:
A total of 129 AOSD patients were enrolled, from whom blood samples were drawn and the AOSD diagnosis was confirmed through the review of the medical records, where the systemic score, demographic characteristics, clinical manifestations, and laboratory parameters were also collected for the patients; in addition, a total of 40 HCs were recruited among the blood donors from the healthcare center with the relevant information collected. The HNL test was done for the blood samples with the enzyme-linked immunosorbent assay and the analyses were done for the correlations of HNL with clinical manifestations and diagnostic effectiveness.
Results:
The serum HNL increased significantly in the patients with only AOSD as compared with that in the HCs (139.76 ± 8.99 ng/mL vs. 55.92 ± 6.12 ng/mL; P < 0.001). The serum HNL level was correlated with the white blood cell (WBC) count (r = 0.335, P < 0.001), neutrophil count (r = 0.334, P < 0.001), erythrocyte sedimentation rate (r = 0.241, P = 0.022), C-reactive protein (r = 0.442, P < 0.0001), and systemic score (r = 0.343, P < 0.0001) in the AOSD patients significantly. Patients with fever, leukocytosis ≥15,000/mm3, and myalgia in the HNL-positive group were observed relatively more than those in the HNL-negative group (P = 0.009, P = 0.023, and P = 0.007, respectively). HNL was a more sensitive indicator than ferritin and C-reactive protein (CRP) to differentiate the AOSD patients with bacterial infection from AOSD-only patients, and the Youden index was 0.6 for HNL and 0.29 for CRP.
Conclusion:
Serum HNL can be used as a biomarker for the diagnosis of the AOSD, and HNL is also observed to be associated with the disease activity.
Correspondence
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中国银屑病诊断和治疗现状的更新：来自国家银屑病中心登记处的结果Zhihui Yang, Xinyu Yao, Mingyue Wang, Hang Li, Ruoyu Li
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002563
摘要
致编辑：银屑病是一种常见的慢性免疫介导的全身性炎症性疾病[
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类风湿性关节炎患者全髋关节、全膝关节置换术后发作的临床特点Liang Zhang, Cong Ma, Hongchao Li, Tao Bian, Siliang Man, Yixin Zhou
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002564
摘要
致编辑：常规合成疾病缓解抗风湿药物（csDMARDs）的引入在减轻类风湿性关节炎（RA）的体征和症状以及延迟或预防结构性关节损伤方面非常有效。此外，生物DMARDs(bDMARDs)和靶向合成DMARDs(tsDMARDs)的开发和临床使用极大地改变了RA患者的预后，特别是当它们与靶向治疗方案(T2T)组合时。[
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择期开颅术后新发颈源性头痛的临床特点及危险因素分析Lan Meng, Zheng Chen, Fang Luo
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002583
摘要
致编辑：开颅术后一周内新发头痛通常被认为是急性开颅后头痛（PCH）。这种头痛主要发生在术后的最初几天内，并且与年龄较小、女性和乙状结肠后入路显著相关。[
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系统性红斑狼疮伴弥漫性肺泡出血Rongxiu Huo, Xinxiang Huang, Jinying Lin
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002571
摘要
致编辑：系统性红斑狼疮(SLE)是一种以产生各种自身抗体为特征的自身免疫性疾病。成人患病率为每10万人20至70人，儿童患病率为每10万人1.89至25.7人。[
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中国育龄系统性红斑狼疮患者的月经不调、妊娠结局和分娩结局：一项多中心横断面研究Yuke Hou, Jiayang Jin, Liang Luo, Yuchao Zhong, Zhe Peng, Ziyi Song, Chun Li, Xuewu Zhang
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002559
摘要
致编辑：系统性红斑狼疮(SLE)是一种自身免疫性疾病，倾向于影响育龄女性。中国目前有近400万人患有SLE，其早期可引起多器官损害，严重影响患者的生活质量。[
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体外循环与冠状动脉旁路移植术患者急性肾损伤的关系：一项回顾性队列研究Hairong Gong, Taoyuan Zhang, Hailong Dong, Chong Lei
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002465
摘要
致编辑：急性肾损伤（AKI）是心脏和大型非心脏手术的常见并发症。体外循环（CPB）辅助心脏手术与其他无CPB的手术相比，AKI发生率更高，表明CPB可能是心脏手术相关AKI（CSA-AKI）的危险因素。[
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与灭活冠状病毒病2019疫苗的同源加强剂对奥密克戎变种有效吗？来自中国吉林的真实证据Jun Guo, Lei Zha, Kai Zeng, Mingyu Shao, Dan Chen, Bing Wang, Yun Zhou, Gang Yang, Xue Zhang, Xia Zou 等
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002575
摘要
致编辑：最新的令人担忧的变种奥密克戎在2021年11月首次报告后立即成为占主导地位的全球变种。[
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数字孪生技术在医疗保健领域的机遇与挑战Mingbang Wang, Huijuan Hu, Song Wu
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002896
摘要
致编辑：被认为是数字孪生方法主要应用的经典案例是1970年的阿波罗13号任务。2003年，密歇根大学的迈克尔·格里夫斯教授提出了数字孪生的概念。然而，数字孪生概念的广泛传播要归功于美国国家航空航天局在2011年将数字孪生应用于航空航天器健康维护和保证。[
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Jak抑制剂治疗白癜风的meta分析Xinlyu Huang, Xiaolan Ding
中华医学杂志英文版2023年 136卷 23期
DOI: 10.1097/CM9.0000000000002581
摘要
致编辑：白癜风是一种以皮肤色素脱失斑块为特征的自身免疫性疾病，在有限的治疗选择下难以控制。干扰素(IFN)-γ-趋化因子轴似乎是白癜风的关键驱动因素。当面对黑素细胞抗原时，黑素细胞特异性CD8+T细胞产生IFN-γ，然后激活局部角质形成细胞中的Janus激酶(JAK)/信号转导子和转录激活子(STAT)途径，随后角质形成细胞产生下游趋化因子C-X-C基序趋化因子配体9和10，导致额外募集T细胞以攻击黑素细胞。
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