2024年 · 第137卷第05期

出版日期 2024-03-05电子版￥0.00元

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Consensus Statement

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先天性巨结肠诊治中国专家共识声明

Tianqi Zhu, Weibing Tang, Jiexiong Feng, Chinese Research Group of Hirschsprung Disease

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000003010

摘要

Review Article

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用于导航神经调节的个体化脑图谱

Chaohong Gao, Xia Wu, Xinle Cheng, Kristoffer Hougaard Madsen, Congying Chu, Zhengyi Yang, Lingzhong Fan

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002979

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胆道癌免疫治疗研究进展

Yuhao Zhao, Mao Yang, Jiayi Feng, Xu’an Wang, Yingbin Liu

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002759

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肺癌治疗的最新进展和剩余挑战

Tasha Barr, Shoubao Ma, Zhixin Li, Jianhua Yu

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002991

摘要

Meta Analysis

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妊娠与先前接受过分化型甲状腺癌治疗的患者的疾病复发：一项系统综述和荟萃分析

Rui Shan, Xin Li, Ming Tao, Wucai Xiao, Jing Chen, Fang Mei, Shibing Song, Bangkai Sun, Chunhui Yuan, Zheng Liu

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000003008

摘要

Background: Differentiated thyroid cancer (DTC) is commonly diagnosed in women of child-bearing age, but whether pregnancy influences the prognosis of DTC remains controversial. This study aimed to summarize existing evidence regarding the association of pregnancy with recurrence risk in patients previously treated for DTC. Methods: We searched PubMed, Embase, Web of Science, Cochrane, and Scopus based on the prespecified protocol registered at PROSPERO (CRD42022367896). After study selection, two researchers independently extracted data from the included studies. For quantitative data synthesis, we used random-effects meta-analysis models to pool the proportion of recurrence (for pregnant women only) and odds ratio (OR; comparing the risk of recurrence between the pregnancy group and the nonpregnancy group), respectively. Then we conducted subgroup analyses to explore whether risk of recurrence differed by response to therapy status or duration of follow-up time. We also assessed quality of the included studies. Results: A total of ten studies were included. The sample size ranged from 8 to 235, with participants’ age at pregnancy or delivery ranging from 28 to 35 years. The follow-up time varied from 0.1 to 36.0 years. The pooled proportion of recurrence in all pregnant patients was 0.13 (95% confidence intervals [CI]: 0.06-0.25; I2: 0.58). Among six included studies reporting response to therapy status before pregnancy, we observed a trend for increasingly higher risk of recurrence from excellent, indeterminate, and biochemically incomplete to structurally incomplete response to therapy (Ptrend <0.05). The pooled risk of recurrence in the pregnancy group showed no evidence of a significant difference from that in the nonpregnancy group (OR: 0.75; 95% CI: 0.45-1.23; I2: 0). The difference in follow-up time (below/above five years) was not associated with either the proportion of recurrence in all pregnant patients (P >0.05) or the OR of recurrence in studies with a comparison group (P >0.05). Two included studies that focused on patients with distant metastasis also did not show a significant difference in disease recurrence between pregnancy and nonpregnancy groups (OR: 0.51 [95% CI: 0.14-1.87; I2: 59%]). Conclusion: In general, pregnancy appears to have a minimal association with the disease recurrence of DTC with initial treatment. Clinicians should pay more attention to progression of DTC among pregnant women with biochemical and/or structural persistence. Registration: PROSPERO, https://www.crd.york.ac.uk/PROSPERO/; No. CRD42022367896.

Medical Progress

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小分子药物治疗炎症性肠病的新进展

Dongying Yao, Zhihua Ran

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000003026

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人工智能在肺结核诊断中的应用

Jingli Du, Yue Su, Juan Qiao, Shang Gao, Enjun Dong, Ruilan Wang, Yanhui Nie, Jing Ji, Zhendong Wang, Jianqin Liang 等

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000003018

摘要

Perspective

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肠道病毒组：坏死性小肠结肠炎治疗的下一个前沿

Shuqin Zeng, Li Zeng, Panyu Yang, Qu Zheng, Shaopu Wang

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002921

摘要

Original Article

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整合素β 5亚单位通过FoxO1介导的巨自噬调节高血糖诱导的血管内皮细胞凋亡

Xuze Lin, Sizhuang Huang, Side Gao, Jinxing Liu, Jiong Tang, Mengyue Yu

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002769

摘要

Background: Hyperglycemia frequently induces apoptosis in endothelial cells and ultimately contributes to microvascular dysfunction in patients with diabetes mellitus (DM). Previous research reported that the expression of integrins as well as their ligands was elevated in the diseased vessels of DM patients. However, the association between integrins and hyperglycemia-induced cell death is still unclear. This research was designed to investigate the role played by integrin subunit β5 (ITGB5) in hyperglycemia-induced endothelial cell apoptosis. Methods: We used leptin receptor knockout (Lepr-KO) (db/db) mice as spontaneous diabetes animal model. Selective deletion of ITGB5 in endothelial cell was achieved by injecting vascular targeted adeno-associated virus via tail vein. Besides, we also applied small interfering RNA in vitro to study the mechanism of ITGB5 in regulating high glucose-induced cell apoptosis. Results: ITGB5 and its ligand, fibronectin, were both upregulated after exposure to high glucose in vivo and in vitro. ITGB5 knockdown alleviated hyperglycemia-induced vascular endothelial cell apoptosis and microvascular rarefaction in vivo. In vitro analysis revealed that knockdown of either ITGB5 or fibronectin ameliorated high glucose-induced apoptosis in human umbilical vascular endothelial cells (HUVECs). In addition, knockdown of ITGB5 inhibited fibronectin-induced HUVEC apoptosis, which indicated that the fibronectin-ITGB5 interaction participated in high glucose-induced endothelial cell apoptosis. By using RNA-sequencing technology and bioinformatic analysis, we identified Forkhead Box Protein O1 (FoxO1) as an important downstream target regulated by ITGB5. Moreover, we demonstrated that the excessive macroautophagy induced by high glucose can contribute to HUVEC apoptosis, which was regulated by the ITGB5-FoxO1 axis. Conclusion: The study revealed that high glucose-induced endothelial cell apoptosis was positively regulated by ITGB5, which suggested that ITGB5 could potentially be used to predict and treat DM-related vascular complications.

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2型糖尿病与冠心病的双向关系：前瞻性队列研究和遗传学分析

Wenqiang Zhang, Li Zhang, Chenghan Xiao, Xueyao Wu, Huijie Cui, Chao Yang, Peijing Yan, Mingshuang Tang, Yutong Wang, Lin Chen 等

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002894

摘要

Background: While type 2 diabetes mellitus (T2DM) is considered a putative causal risk factor for coronary artery disease (CAD), the intrinsic link underlying T2DM and CAD is not fully understood. We aimed to highlight the importance of integrated care targeting both diseases by investigating the phenotypic and genetic relationships between T2DM and CAD. Methods: We evaluated phenotypic associations using data from the United Kingdom Biobank (N = 472,050). We investigated genetic relationships by leveraging genomic data conducted in European ancestry for T2DM, with and without adjustment for body mass index (BMI) (T2DM: Ncase/Ncontrol = 74,124/824,006; T2DM adjusted for BMI [T2DMadjBMI]: Ncase/Ncontrol = 50,409/523,897) and for CAD (Ncase/Ncontrol = 181,522/984,168). We performed additional analyses using genomic data conducted in multiancestry individuals for T2DM (Ncase/Ncontrol = 180,834/1,159,055). Results: Observational analysis suggested a bidirectional relationship between T2DM and CAD (T2DM→CAD: hazard ratio [HR] = 2.12, 95% confidence interval [CI]: 2.01–2.24; CAD→T2DM: HR = 1.72, 95% CI: 1.63–1.81). A positive overall genetic correlation between T2DM and CAD was observed (rg = 0.39, P = 1.43 × 10-75), which was largely independent of BMI (T2DMadjBMI–CAD: rg = 0.31, P = 1.20 × 10–36). This was corroborated by six local signals, among which 9p21.3 showed the strongest genetic correlation. Cross-trait meta-analysis replicated 101 previously reported loci and discovered six novel pleiotropic loci. Mendelian randomization analysis supported a bidirectional causal relationship (T2DM→CAD: odds ratio [OR] = 1.13, 95% CI: 1.11-1.16; CAD→T2DM: OR = 1.12, 95% CI: 1.07-1.18), which was confirmed in multiancestry individuals (T2DM→CAD: OR = 1.13, 95% CI: 1.10-1.16; CAD→T2DM: OR = 1.08, 95% CI: 1.04-1.13). This bidirectional relationship was significantly mediated by systolic blood pressure and intake of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, with mediation proportions of 54.1% (95% CI: 24.9-83.4%) and 90.4% (95% CI: 29.3-151.5%), respectively. Conclusion: Our observational and genetic analyses demonstrated an intrinsic bidirectional relationship between T2DM and CAD and clarified the biological mechanisms underlying this relationship.

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中国脑血管病死亡率：近期及未来趋势探讨

Bin Lv, Ge Song, Feng Jing, Mingyu Li, Hua Zhou, Wanjun Li, Jiacai Lin, Shengyuan Yu, Jun Wang, Xiangyu Cao 等

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002760

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膳食摄入和血清铜锌水平与肝细胞癌风险的配对病例对照研究

Xiaozhan Liu, Yaojun Zhang, Dinuerguli Yishake, Yan Luo, Zhaoyan Liu, Yuming Chen, Huilian Zhu, Aiping Fang

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002761

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聚类分析揭示了与不良生殖结局相关的代谢紊乱PCOS妇女的同质亚组

Hanxiao Chen, Rujun Zeng, Xun Zeng, Lang Qin

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002787

摘要

Background: Polycystic ovarian syndrome (PCOS) is a heterogeneous and complex reproductive endocrinological disease that could lead to infertility. There were many attempts to classify PCOS but it remains unclear whether there is a specific subgroup of PCOS that is associated with the best or worst reproductive outcomes of assisted reproductive techniques (ART). Methods: Infertile PCOS patients who underwent their first cycle of in vitro fertilization (IVF) in West China Second University Hospital, Sichuan University from January 2019 to December 2021 were included. Basic clinical and laboratory information of each individual were extracted. Unsupervised cluster analysis was performed. Controlled ovarian stimulation parameters and reproductive outcomes were collected and compared between the different clusters of PCOS. Results: Our analysis clustered women with PCOS into "reproductive", "metabolic", and "balanced" clusters based on nine traits. Reproductive group was characterized by high levels of testosterone (T), sex hormone-binding globulin (SHBG), follicular stimulation hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH). Metabolic group was characterized by high levels of body mass index (BMI), fasting insulin, and fasting glucose. Balanced group was characterized by low levels of the aforementioned reproductive and metabolic parameters, except for SHBG. Compared with PCOS patients in reproductive and balanced clusters, those in metabolic cluster had lower rates of good quality day 3 embryo and blastocyst formation. Moreover, PCOS patients in the reproductive cluster had greater fresh embryo transfer (ET) cancelation rate and clinical pregnancy rate after fresh ET than metabolic cluster (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.77-6.44, and OR = 6.19, 95% CI: 1.58-24.24, respectively). And compared with PCOS of metabolic cluster, PCOS of balanced cluster also had higher chance for fresh ET cancelation (OR = 2.83, 95% CI: 1.26-6.35). Conclusion: Our study suggested that PCOS patients in metabolic cluster may be associated with adverse reproductive outcomes and might need individualized treatment and careful monitoring before and during ART.

Correspondence

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老年心脏病三尖瓣反流患者钙磷状况的预后价值

Qingrong Liu, Kai Cao, Ziang Li, Yunqing Ye, Qian Zhang, Hongliang Zhang, Haiyan Xu, Zhe Li, Yongjian Wu, CHINA-DVD Collaborators

中华医学杂志英文版2024年 137卷 05期

DOI: 10.1097/CM9.0000000000002916

摘要