2024年 · 第137卷第06期

出版日期 2024-03-20电子版￥0.00元

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Editorial

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连续病房监护和术后强化管理

Kai Li, Jiayi Wang, Daniel I. Sessler

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002997

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结肠内镜肠内插管的概念、突破和未来

Faming Zhang, Gaochen Lu, Xin Wang, Lihao Wu, Rui Li, Yongzhan Nie

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003020

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疾病中的血管生成：从最初的治疗概念到当前临床益处的半个世纪偏移

Yihai Cao

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003002

摘要

Review Article

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癌症相关成纤维细胞的最新进展：生物标志物、信号通路和治疗机会

Donger Zhou, Lei Zheng

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003031

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螺旋神经节神经元的损伤与保护

Beilei Duan, Kevin A. Peng, Line Wang

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002765

摘要

Original Article

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Hippo(YAP)-自噬轴通过JNK信号保护肝脏缺血再灌注损伤

Shuguang Zhu, Xiaowen Wang, Haoqi Chen, Wenfeng Zhu, Xuejiao Li, Ruiwen Cui, Xiaomeng Yi, Xiaolong Chen, Hua Li, Genshu Wang

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002727

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肺动脉高压患者2019冠状病毒病疫苗接种：一项全国性前瞻性队列研究

Xiaohan Wu, Jingyi Li, Jieling Ma, Qianqian Liu, Lan Wang, Yongjian Zhu, Yue Cui, Anyi Wang, Cenjin Wen, Luhong Qiu 等

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002767

摘要

Background: Coronavirus disease 2019 (COVID-19) has potential risks for both clinically worsening pulmonary hypertension (PH) and increasing mortality. However, the data regarding the protective role of vaccination in this population are still lacking. This study aimed to assess the safety of approved vaccination for patients with PH. Methods: In this national prospective cohort study, patients diagnosed with PH (World Health Organization [WHO] groups 1 and 4) were enrolled from October 2021 to April 2022. The primary outcome was the composite of PH-related major adverse events. We used an inverse probability weighting (IPW) approach to control for possible confounding factors in the baseline characteristics of patients. Results: In total, 706 patients with PH participated in this study (mean age, 40.3 years; mean duration after diagnosis of PH, 8.2 years). All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China. Among them, 278 patients did not receive vaccination, whereas 428 patients completed the vaccination series. None of the participants were infected with COVID-19 during our study period. Overall, 398 patients received inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, whereas 30 received recombinant protein subunit vaccine. After adjusting for baseline covariates using the IPW approach, the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase (27/428 [6.3%] vs. 24/278 [8.6%], odds ratio = 0.72, P = 0.302). Approximately half of the vaccinated patients reported at least one post-vaccination side effects, most of which were mild, including pain at the injection site (159/428, 37.1%), fever (11/428, 2.6%), and fatigue (26/428, 6.1%). Conclusions: COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH, although there were some tolerable side effects. A large-scale randomized controlled trial is warranted to confirm this finding. The final approval of the COVID-19 vaccination for patients with PH as a public health strategy is promising.

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诊断急性肺栓塞的机器学习模型及其与Wells评分、修正Geneva评分和Years算法的比较

Linfeng Xi, Han Kang, Mei Deng, Wenqing Xu, Feiya Xu, Qian Gao, Wanmu Xie, Rongguo Zhang, Min Liu, Zhenguo Zhai 等

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002837

摘要

Background: Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models. Methods: This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Naïve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis. Results: The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score (P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions: Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

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父母坚持健康生活方式与后代认知能力的关系：中国的一项前瞻性队列研究

Rongxia Lv, Yuhui Huang, Siyi Huang, Shiyi Wu, Siwen Wang, Guangyu Hu, Yanan Ma, Peige Song, Jorge E. Chavarro, S.V. Subramanian 等

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002861

摘要

Background: Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring’s cognitive development during early childhood. This study aimed to investigate the prospective associations between overall parental lifestyle and offspring’s cognitive performance during adolescence and young adulthood in China. Methods: We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies. A healthy parental lifestyle score (ranged 0-5) was constructed based on the following five modifiable lifestyle factors: Smoking, drinking, exercise, sleep, and diet. Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring’s fluid and crystallized intelligence in subsequent years (2012, 2014, 2016, and 2018). Results: Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence (multivariable-adjusted β = 0.53, 95% confidence interval [CI]: 0.29-0.77) and overall crystallized intelligence (multivariable-adjusted β = 0.35, 95% CI: 0.16-0.54) than those in the bottom tertile of parental healthy lifestyle scores. The results were similar after further adjustment for the offspring’s healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status. Additionally, maternal and paternal healthy lifestyle scores were independently associated with better offspring’s cognitive performance, with significant contribution observed for paternal never-smoking, weekly exercise, and diversified diet. When both parents and offspring adhered to a healthier lifestyle, we observed the highest level of the offspring’s overall crystallized intelligence. Conclusions: Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring’s cognitive performance during adolescence and early adulthood, regardless of socioeconomic status. These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.

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染色体重排夫妇整倍体胚胎鉴定的知识嵌入时空分析

Fangying Chen, Xiang Xie, Du Cai, Pengxiang Yan, Chenhui Ding, Yangxing Wen, Yanwen Xu, Feng Gao, Canquan Zhou, Guanbin Li 等

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000002803

摘要

Background: The goal of the assisted reproductive treatment is to transfer one euploid blastocyst and to help infertile women giving birth one healthy neonate. Some algorithms have been used to assess the ploidy status of embryos derived from couples with normal chromosome, who subjected to preimplantation genetic testing for aneuploidy (PGT-A) treatment. However, it is currently unknown whether artificial intelligence model can be used to assess the euploidy status of blastocyst derived from populations with chromosomal rearrangement. Methods: From February 2020 to May 2021, we collected the whole raw time-lapse videos at multiple focal planes from in vitro cultured embryos, the clinical information of couples, and the comprehensive chromosome screening results of those blastocysts that had received PGT treatment. Initially, we developed a novel deep learning model called the Attentive Multi-Focus Selection Network (AMSNet) to analyze time-lapse videos in real time and predict blastocyst formation. Building upon AMSNet, we integrated additional clinically predictive variables and created a second deep learning model, the Attentive Multi-Focus Video and Clinical Information Fusion Network (AMCFNet), to assess the euploidy status of embryos. The efficacy of the AMCFNet was further tested in embryos with parental chromosomal rearrangements. The receiver operating characteristic curve (ROC) was used to evaluate the superiority of the model. Results: A total of 4112 embryos with complete time-lapse videos were enrolled for the blastocyst formation prediction task, and 1422 qualified blastocysts received PGT-A (n = 589) or PGT for chromosomal structural rearrangement (PGT-SR, n = 833) were enrolled for the euploidy assessment task in this study. The AMSNet model using seven focal raw time-lapse videos has the best real-time accuracy. The real-time accuracy for AMSNet to predict blastocyst formation reached above 70% on the day 2 of embryo culture, and then increased to 80% on the day 4 of embryo culture. Combing with 4 clinical features of couples, the AUC of AMCFNet with 7 focal points increased to 0.729 in blastocysts derived from couples with chromosomal rearrangement. Conclusion: Integrating seven focal raw time-lapse images of embryos and parental clinical information, AMCFNet model have the capability of assessing euploidy status in blastocysts derived from couples with chromosomal rearrangement.

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1990-2019年中国脊柱损伤的发病率、患病率和原因：2019年全球疾病负担研究的结果

Chenjun Liu, Tingling Xu, Weiwei Xia, Shuai Xu, Zhenqi Zhu, Maigeng Zhou, Haiying Liu

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003045

摘要

Background: Spinal injuries are an urgent public health priority; nevertheless, no China-wide studies of these injuries exist. This study measured the incidence, prevalence, causes, regional distribution, and annual trends of spinal injuries in China from 1990 to 2019. Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 to estimate the incidence and prevalence of spinal injuries in China. The data of 33 provincial-level administrative regions (excluding Taiwan, China) provided by the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (CDC) were use to systematically analyze the provincial etiology, geographical distribution, and annual trends of spinal injuries. The Bayesian meta-regression tool DisMod-MR 2.1 was used to ensure the consistency among incidence, prevalence, and mortality rates in each case. Results: From 1990 to 2019, the number of living patients with spinal injuries in China increased by 138.32%, from 2.14 million to 5.10 million, while the corresponding age-standardized prevalence increased from 0.20% (95% uncertainty interval [UI]: 0.18-0.21%) to 0.27% (95% UI: 0.26-0.29%). The incidence of spinal injuries in China increased by 89.91% (95% UI: 72.39-107.66%), and the prevalence increased by 98.20% (95% UI: 89.56-106.82%), both the most significant increases among the G20 countries; 71.00% of the increase could be explained by age-specific prevalence. In 2019, the incidence was 16.47 (95% UI: 12.08-22.00, per 100,000 population), and the prevalence was 358.30 (95% UI: 333.96-386.62, per 100,000 population). Based on the data of 33 provincial-level administrative regions provided by CDC, age-standardized incidence and prevalence were both highest in developed provinces in Eastern China. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces. Conclusions: In China, the overall disease burden of spinal injuries increased significantly during the past three decades but varied considerably according to geographical location. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces.

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电针通过调节SIRT-1/PGC-1 α/线粒体通路改善轻度创伤性脑损伤大鼠模型的认知功能

Bo Jin, Yemei Gao, Yixian Fu, Suxin Zhang, Ke Zhang, Yibing Su

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003032

摘要

Background: Mild traumatic brain injury (mTBI) is a common neurological trauma that can lead to cognitive impairment. The sirtuin-1 (SIRT-1)/peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) pathway has been reported to have neuroprotective effects in rats with craniocerebral injury. We evaluated potential mechanisms underlying electroacupuncture-mediated recovery of cognitive function after mTBI, focusing on the SIRT-1/PGC-1α/mitochondrial pathway. Methods: We included forty 6-week-old male Sprague-Dawley rats in this study. Rats were randomly divided into four groups: controlled cortical impactor (CCI, n = 10), sham operation (sham, n = 10), electroacupuncture-treated CCI (CCI+EA, n = 10), and electroacupuncture-treated sham (sham+EA, n = 10) group. Randomization was performed by assigning a random number to each rat and using a random number table. The mTBI rat model was established using a controllable cortical impactor. Electroacupuncture therapy was performed on the back of rats, by inserting acupuncture needles to the specific acupoints and setting appropriate parameters for treatment. We evaluated spatial learning and memory functions with the Morris water maze test. We performed quantitative real-time polymerase chain reaction (qRT-PCR), western blotting, adenosine triphosphate (ATP) determination, and mitochondrial respiratory chain complex I (MRCC I) determination on rat hippocampal tissue. We analyzed SIRT-1/PGC-1α expression levels and the results of mitochondrial function assays, and compared differences between groups using bilateral Student’s t-tests. Results: Compared with the sham group, SIRT-1/PGC-1α expression was downregulated in the hippocampus of CCI group (P <0.01). Although this expression was upregulated following electroacupuncture, it did not reach the levels observed in the sham group (P <0.05). Compared with the sham group, MRCC I and ATP levels in the CCI group were significantly reduced, and increased after electroacupuncture (P <0.01). In the Morris water maze, electroacupuncture reduced the incubation period of rats and increased average speed and number of crossing platforms (P <0.05). Conclusion: Electroacupuncture may improve cognitive function in the mTBI rat model by regulating the SIRT-1/PGC-1α/mitochondrial pathway.

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基于临床病理分类分级的高分化胃神经内分泌肿瘤个体化治疗：一项多中心回顾性研究

Ju Huang, Huimin Liu, Dekun Yang, Tianming Xu, Jing Wang, Jingnan Li

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003029

摘要

Background: The incidence of well-differentiated gastric neuroendocrine tumors (G-NET) is increasing annually, and while they have a good prognosis and low mortality rate, their high recurrence rate makes treatment options controversial. This study aims to determine the relationship between individualized treatment plans and the recurrence of G-NET. Methods: We performed a multicenter, retrospective study of 94 patients with highly differentiated G-NET and treated at Peking Union Medical College Hospital, Yantai Yuhuangding Hospital, and Beijing Zhong-Neng-Jian Hospital from November 2015 to September 2023. Risk factors for recurrence of G-NETs were investigated using chi-squared test and multifactorial logistic regression analysis. Results: After a median follow-up of 49 months, the overall recurrence rate among the 94 G-NET patients was 14% (13/94). The recurrence rates of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), somatostatin analog (SSA) therapy, and surgery were 43% (6/14), 10% (5/49), 5% (1/22), and 11% (1/9), respectively. Post-treatment recurrence rates were significantly different (P = 0.014) among four treatments (EMR, ESD, SSA, and surgery), and further subgroup comparisons revealed lower recurrence rates in the ESD and SSA groups than in the EMR group. From the second month onward, SSA therapy considerably reduced the gastrin levels from 1081.0 (571.5, 2472.8) pg/mL to 461.5 (255.3, 795.0) pg/mL (Z = -3.521, P <0.001). Both chi-squared test and multifactorial logistic regression analysis suggested that among the clinicopathological parameters studied, only the pre-treatment gastrin level (P = 0.018 and 0.005) and the type of treatment (P = 0.014 and 0.017) were significantly associated with G-NET recurrence. Conclusions: Individualized treatment strategies may reduce the risk of relapse after G-NET treatment. Long-term SSA therapy may be a secure and efficacious treatment option for type 1 G-NET with more than six lesions, and it substantially decreases the incidence of post-treatment recurrence.

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用于灵敏检测HIV-1总DNA和整合DNA的液滴数字聚合酶链反应分析的开发

Lin Yuan, Zhiying Liu, Xin Zhang, Feili Wei, Shan Guo, Na Guo, Lifeng Liu, Zhenglai Ma, Yunxia Ji, Rui Wang 等

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003081

摘要

Technical Note

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微型股骨头假体在负重圆顶塌陷性股骨头坏死中的应用（ARCO III）：一个短期随访病例系列

Zhongzheng Wang, Yuchuan Wang, Tianyu Wang, Yining Lu, Xiaodong Lian, Yanbin Zhu, Wei Chen, Zhiyong Hou, Yingze Zhang

中华医学杂志英文版2024年 137卷 06期

DOI: 10.1097/CM9.0000000000003012