MedNexus
2024年 · 第137卷第18期
出版日期 2024-09-20电子版 ￥0.00元
MedNexus
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- Review Article
- Original Article
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Concensus Statement
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免疫检查点抑制剂在肝癌肝移植中应用的中国专家共识Zhengxin Wang, Jiayin Yang, Guangming Li
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003237
摘要
原发性肝癌（PLC）是中国第四大常见恶性肿瘤和第二大肿瘤相关死亡原因。肝细胞癌（HCC）占PLC的75-85%。[
Review Article
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早发性胃癌的新趋势Xinlin Wang, Xianchun Gao, Jun Yu, Xiaotian Zhang, Yongzhan Nie
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003259
摘要
The incidence of early-onset gastric cancer (EOGC) is consistently increasing, and its etiology is notably complex. This increase may be attributed to distinctive factors that differ from those associated with late-onset gastric cancer (LOGC), including genetic predispositions, dietary factors, gastric microbiota dysbiosis, and screening of high-risk cases. These factors collectively contribute to the onset of cancer. EOGC significantly differs from LOGC in terms of clinicopathological and molecular characteristics. Moreover, multiple differences in prognosis and clinical management also exist. This study aimed to systematically review the latest research advancements in the epidemiological characteristics, etiological factors, clinicopathological and molecular features, prognosis, and treatment modalities of EOGC.
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类器官技术在乳腺癌研究中的进展与展望Changsheng Huang, Hongyan Jin
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000002889
摘要
Breast cancer, a malignant tumor with a high incidence in women, lacks in vitro research models that can represent the biological functions of breast tumors in vivo. As a new biological tool, the organoid model has unique advantages over traditional methods, such as cell culture and patient-derived xenografts. Combining organoids with other emerging technologies, such as gene engineering and microfluidic chip technology, provides an effective method to compensate for the deficiencies in organoid models of breast cancer in vivo. The emergence of breast cancer organoids has provided new tools and research directions in precision medicine, and drug research. In this review, we summarized the merits and demerits of organoids compared to traditional biological models, explored the latest developments in the combination of new technologies and organoid models, and discussed the construction methods and application prospects of different breast cancer organoid models.
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细菌外膜囊泡在抗癌中的作用Yiming Meng, Cuicui Kong, Yushu Ma, Jing Sun, Guirong Zhang
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003234
摘要
Bacterial outer membrane vesicles (OMVs) are diminutive vesicles naturally released by Gram-negative bacteria. These vesicles possess distinctive characteristics that attract attention for their potential use in drug administration and immunotherapy in cancer treatment. Therapeutic medicines may be delivered via OMVs directly to the tumor sites, thereby minimizing exposure to healthy cells and lowering the risk of systemic toxicity. Furthermore, the activation of the immune system by OMVs has been demonstrated to facilitate the recognition and elimination of cancer cells, which makes them a desirable tool for immunotherapy. They can also be genetically modified to carry specific antigens, immunomodulatory compounds, and small interfering RNAs, enhancing the immune response to cancerous cells and silencing genes associated with disease progression. Combining OMVs with other cancer treatments like chemotherapy and radiation has shown promising synergistic effects. This review highlights the crucial role of bacterial OMVs in cancer, emphasizing their potential as vectors for novel cancer targeted therapies. As researchers delve deeper into the complexities of these vesicles and their interactions with tumors, there is a growing sense of optimism that this avenue of study will bring positive outcomes and renewed hope to cancer patients in the foreseeable future.
Original Article
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1990-2019年中国及其省份消化系统疾病负担：2019年全球疾病负担研究结果Zhiyuan Cheng, Tinglu Wang, Yunfei Jiao, Jinlei Qi, Xun Zhang, Siwei Zhou, Lei Xin, Rong Wan, Maigeng Zhou, Zhaoshen Li 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003277
摘要
Background:
Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces.
Methods:
This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI).
Results:
In 2019, there were 499.2 million cases of digestive system diseases in China, resulting in 1,557,310 deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend.
Conclusion:
Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI.
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中国和世界女性乳腺癌和五种妇科癌症的负担Nuopei Tan, You Wu, Bin Li, Wanqing Chen
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003293
摘要
Background:
Female breast and five gynecological cancers remain substantial burden in China and worldwide. GLOBOCAN 2022 has recently updated the estimates of cancer burden. This study aims to depict the profiles of disease burden and to compare the age-specific rates of female breast and five gynecological cancers in China with those in other countries.
Methods:
The latest estimates of incidence and mortality of female breast and five gynecological cancers from various regions and countries were extracted from the GLOBOCAN 2022 database. We compared the proportion of total cases or deaths for cancers affecting female breast and five gynecological cancers and other tumor types in China and globally. Correlation analysis was conducted to evaluate the relationship between age-standardized incidence rate (ASIR) or age-standardized mortality rate (ASMR) and the Human Development Index (HDI). Additionally, age-specific rate curves were plotted for ten exemplary countries with different income levels.
Results:
Female breast and five gynecological cancers in China accounted for 30.2% of all newly diagnosed cancer cases. Breast cancer and cervical cancer are the most commonly diagnosed, with nearly 507,000 new cases, representing 23.48% of the new cases. The incidence rates of breast, uterine corpus, ovarian, and vulvar cancers were positively associated with HDI tiers. Chinese women aged 50-54 years are experiencing high incidence rates of breast, cervix uteri, corpus uteri, and ovarian cancers.
Conclusions:
Female breast and five gynecological cancers continue to be a significant health concern for women in China and worldwide. It is crucial to implement comprehensive prevention strategies tailored to address the increasing trend among younger individuals and reduce regional disparities.
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与阿尔茨海默病行为和心理症状相关的营养相关遗传-临床-放射学列线图的开发和验证Jiwei Jiang, Yaou Liu, Anxin Wang, Zhizheng Zhuo, Hanping Shi, Xiaoli Zhang, Wenyi Li, Mengfan Sun, Shirui Jiang, Yanli Wang 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000002914
摘要
Background:
Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.
Methods:
This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.
Results:
Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations.
Conclusion:
A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.
Registration:
Chictr.org.cn, ChiCTR2100049131.
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晚期非小细胞肺癌患者一线PD-1阻断加化疗反应的基因组相关因素Tao Jiang, Jian Chen, Haowei Wang, Fengying Wu, Xiaoxia Chen, Chunxia Su, Haiping Zhang, Fei Zhou, Ying Yang, Jiao Zhang 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003094
摘要
Background:
Programmed death 1 (PD-1) blockade plus chemotherapy has become the new first-line standard of care for patients with advanced non-small-cell lung cancer (NSCLC). Yet not all NSCLC patients benefit from this regimen. This study aimed to investigate the predictors of PD-1 blockade plus chemotherapy in untreated advanced NSCLC.
Methods:
We integrated clinical, genomic, and survival data from 287 patients with untreated advanced NSCLC who were enrolled in one of five registered phase 3 trials and received PD-1 blockade plus chemotherapy or chemotherapy alone. We randomly assigned these patients into a discovery cohort (n = 125), a validation cohort (n = 82), and a control cohort (n = 80). The candidate genes that could predict the response to PD-1 blockade plus chemotherapy were identified using data from the discovery cohort and their predictive values were then evaluated in the three cohorts. Immune deconvolution was conducted using transcriptome data of 1014 NSCLC patients from The Cancer Genome Atlas dataset.
Results:
A genomic variation signature, in which one or more of the 15 candidate genes were altered, was correlated with significantly inferior response rates and survival outcomes in patients treated with first-line PD-1 blockade plus chemotherapy in both discovery and validation cohorts. Its predictive value held in multivariate analyses when adjusted for baseline parameters, programmed cell death ligand 1 (PD-L1) expression level, and tumor mutation burden. Moreover, applying both the 15-gene panel and PD-L1 expression level produced better performance than either alone in predicting benefit from this treatment combination. Immune landscape analyses revealed that tumors with one or more variation in the 15-gene panel were associated with few immune infiltrates, indicating an immune-desert tumor microenvironment.
Conclusion:
These findings indicate that a 15-gene panel can serve as a negative prediction biomarker for first-line PD-1 blockade plus chemotherapy in patients with advanced NSCLC.
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人类免疫缺陷病毒感染者的心理健康差异：一项关于医患一致性和治疗方案的横断面研究Jinchuan Shi, Zhongdong Zhang, Junyan Zhang, Yishu Zhang, Jiating Qiu, Fang Liu, Daoyuan Song, Yanfang Ma, Lianmei Zhong, Hongxing Wang 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003202
摘要
Background:
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown.
Methods:
A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen’s kappa test was used to assess the agreement between physicians and PLWH.
Results:
The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P <0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P <0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR] = 0.71, 95% CI: 0.59-0.87, P = 0.003) and a lower prevalence of anxiety issues (OR = 0.63, 95% CI: 0.52-0.76, P <0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR = 0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR = 0.81, 95% CI: 0.67-0.99).
Conclusion:
Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.
Rapid Report
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一种评价人群认知健康的综合指数Yuanyuan Lu, Fan Mao, Peng Yin, Jie Chang, Zhenping Zhao, Kun Yang, Qi Qin, Maigeng Zhou, Yi Tang
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003241
摘要
认知健康是人类生存和生活质量的主要决定因素。随着越来越多的全球人口进入老年（定义为60岁及以上），痴呆症已成为公共卫生和社会护理的优先事项。[
Correspondence
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主干管优先入路：良性和低度恶性病变胰腺摘除适应症的潜在扩展Xing Wang, Xiang Fu, Yonghua Chen, Hao Zhang, Zhenjiang Zheng, Xiaofei Zhong, Rui Wang, Xubao Liu, Chunlu Tan
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003285
摘要
致编辑：胰十二指肠切除术(PD)、远端胰腺切除术(DP)和中央胰腺切除术(CP)通常导致功能性胰腺实质的不良损失、消化道连续性的破坏和并发症的高发生率。近年来，传统的胰腺剜除术（TPE）越来越多地用于距离主管道（MD）>2 mm的小型良性和低度恶性胰腺病变，因为它可以最大限度地保留功能性胰腺实质并保持消化道的连续性。距离太短（≤2 mm）的病例不是很好的候选病例，因为在进行TPE时，距离太短可能会损坏MD。[
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成人新冠肺炎患者胸部数字断层合成的初步临床评价Zhanxia Li, Xiuhua Wu, Guobin Zhang, Dianliang Wu, Yunjiao Zhang, Chengji Wang, Lumin Zou, Xiaohua Gu, Tao Ren
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003297
摘要
致编辑：2019冠状病毒病（COVID-19）大流行造成了重大的全球健康危机，导致了惊人的死亡率，并带来了巨大的经济负担。[
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2010-2019年特大城市流感时间序列预测模型：基于季节性自回归集成移动平均和深度学习混合预测模型Jin Yang, Liuyang Yang, Gang Li, Jing Du, Libing Ma, Ting Zhang, Xingxing Zhang, Jiao Yang, Luzhao Feng, Weizhong Yang 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003238
摘要
致编辑：流感病毒不断进化，具有感染广泛宿主的能力，导致反复感染和持续发病。[
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屋尘螨过敏性特应性皮炎患者的过敏原免疫治疗：一项系统综述和荟萃分析Siyi You, Ruixi Zhou, Junjie Ying, Shiping Li, Xiaojuan Su, Dezhi Mu
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003017
摘要
致编辑：特应性皮炎（AD）是世界范围内最常见的慢性过敏性皮肤病。屋尘螨（HDM）是最普遍的空气过敏原和致病原因，可引发皮肤屏障破坏和多敏化。过敏原免疫疗法（AIT）可能是通过应用一定剂量的特定过敏原刺激体内适应性免疫来改善AD自然病史的唯一病因治疗。[
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改良活检钳对恶性胆道狭窄诊断的影响：一项随机对照试验Guochen Shang, Yu Jin, Zhen Ding, Rong Lin
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003240
摘要
致编辑：恶性胆道狭窄通常与高度侵袭性和诊断上具有挑战性的疾病相关，包括胆管癌、胰腺癌、胆囊癌、肝癌和转移性癌症。[
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中国1990-2019年非酒精性脂肪性肝病相关肝硬化等慢性肝病负担及至2030年疾病负担趋势预测Jieyu Peng, Shu Huang, Ping Wang, Rui Luo, Wei Zhang, Xiaomin Shi, Lei Shi, Xiaolin Zhong, Muhan Lv, Yan Peng 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003211
摘要
致编辑：非酒精性脂肪性肝病（NAFLD）是一种进行性肝病，与肝脏中的脂肪蓄积密切相关。NAFLD的发病机制从肝脏脂肪变性到更严重的脂肪性肝炎，然后发展为纤维化和终末期肝硬化。该病已成为全球范围内肝脏相关和全因死亡率的独立危险因素。随着生活水平的提高，NAFLD是中国主要的慢性肝病。中国NAFLD负担的增加已成为公共健康的重要威胁，特别是与之相关的肝硬化和其他慢性肝病。先前的一项研究通过系统综述和荟萃分析评估了中国NAFLD的流行病学、危险因素、并发症和管理。[
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成人原位肝移植患者静脉血栓栓塞预测诺模图的开发和验证Younan Li, Rongrong Zhu, Junlai Zhao, Zhanjiang Cao, Jiyong Song, Rui Tang, Ang Li, Xuan Tong, Yucheng Hou, Qian Lu 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003272
摘要
致编辑静脉血栓栓塞（VTE）是原位肝移植（OLT）后常见的并发症，发生率为2.8-8.6%，[
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协会INSR北京地区儿童肥胖预防生活方式干预的长期反应基因变异Jing Chen, Rui Shan, Jieyun Song, Hui Wang, Wucai Xiao, Shuang Zhou, Aiyu Gao, Fang Zhang, Zheng Liu
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003209
摘要
致编辑：儿童肥胖是一个严重的公共卫生问题，会对身体和心理健康产生长期影响。生活方式干预已被广泛用于治疗儿童肥胖。值得注意的是，个体对同一干预的反应因遗传背景而异。先前的研究人员已经探索了几种糖代谢相关基因对儿童肥胖干预的调节作用，包括TCF7L2[
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慢性肺病继发肺动脉高压中的肥胖悖论Changwei Wu, Wenhui Wu, Cijun Luo, Hongling Qiu, Lan Wang, Qinhua Zhao, Sugang Gong, Huiting Li, Jian Xu, Jing He 等
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003263
摘要
致编辑：肥胖目前已成为一个重要的公共卫生问题，已被认为是多种慢性疾病患者的积极预后因素，包括肺动脉高压，这种现象被称为“肥胖悖论”。[
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TGF-β信号通路在诱导多能干细胞重编程中的作用Weiwen Fan, Heling Yuan, Le Chang, Qiang Li, Jing Gao, Lihua Ma, Lvzhe Chen, Ying Dai, Xinghua Pan, Xiangqing Zhu
中华医学杂志英文版2024年 137卷 18期
DOI: 10.1097/CM9.0000000000003229
摘要
致编辑：2006年Takahashi和Yamanaka发现的诱导多能干细胞（iPSCs）被誉为干细胞研究的重大突破。并且大量实验研究证明，转化生长因子-β（TGF-β）信号通路是iPSC重编程中的关键信号通路。TGF-β信号通路在不同条件下可促进或抑制iPSC重编程[
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