2025年 · 第138卷第03期

深部脑刺激（DBS）是一种神经外科手术，允许基于靶向回路的神经调节；它也是帕金森病（PD）的标准护理。^[1]术后DBS编程是一个至关重要的步骤，可以指定最佳刺激参数和释放症状，以促进患者的生活质量。2016年发布的《帕金森病患者程序化脑深部电刺激中国专家共识》规范了PD患者术后程序化的应用。^[2]然而，多个方面限制了患者参加面对面编程的能力，包括他们的流动性以及他们的住所和DBS中心之间的地质距离，这导致患者使用远程编程的比例越来越高，频率越来越高，使其成为一种迫切的需求。^[3,4]因此，创建一个标准协议来指导这种远程治疗的应用是很重要的。

过敏性支气管肺曲霉病（ABPA）于1952年首次被系统描述。它被定义为一种复杂的过敏性疾病，由免疫系统对烟曲霉(烟曲霉).^[1]随后，又提出了由其他真菌引起的过敏性支气管肺真菌病（ABPM）的概念。ABPA/ABPM的诊断标准经历了1977年的Rosenberg模式标准、2013年的国际人类和动物真菌学会（ISHAM）标准和2021年的日本新诊断标准。^[2,3,4]然而，随着对该疾病的深入了解，以及最新随机对照试验的表现，发现现有标准存在差异。因此，迫切需要一套新的准则。有鉴于此，ISHAM工作组最近修订了ABPA(M)诊断、分类和治疗的临床实践指南，该指南发表在欧洲呼吸杂志.^[5]我们旨在强调2024年修订的ISHAM指南的重大变化，并结合我们的研究提出进一步的观点。

心血管外科的起源和发展与心脏病学和整个医学专业的发展密不可分。从20世纪初至今，心血管外科已经展现出显著的成就，从一个“禁区”演变为大多数类型心脏病都可以手术治疗的领域。许多病人因此恢复了健康，重获新生。在本文中，我们回顾了中国心血管外科发展的历史，总结了历史经验，纪念了前辈们的成就，讲述了他们探索、奋进、奉献的精神。心血管外科发展的历史故事意义重大——向患者传递希望的信息。

With the increasing utilization of cancer therapy, the incidence of lung injury associated with these treatments continues to rise. The recognition of pulmonary toxicity related to cancer therapy has become increasingly critical, for which interstitial lung disease (ILD) is a common cause of mortality. Cancer therapy-related ILD (CT-ILD) can result from a variety of treatments including chemotherapy, targeted therapy, immune checkpoint inhibitors, antibody-drug conjugates, and radiotherapy. CT-ILD may progress rapidly and even be life-threatening; therefore, prompt diagnosis and timely treatment are crucial for effective management. This review aims to provide valuable information on the risk factors associated with CT-ILD; elucidate its underlying mechanisms; discuss its clinical features, imaging, and histological manifestations; and emphasize the clinical-related views of its diagnosis. In addition, this review provides an overview of grading, typing, and staging treatment strategies used for the management of CT-ILD.

Silent mutations within the RAS gene have garnered increasing attention for their potential roles in tumorigenesis and therapeutic strategies. Kirsten-RAS (KRAS) mutations, predominantly oncogenic, are pivotal drivers in various cancers. While extensive research has elucidated the molecular mechanisms and biological consequences of active KRAS mutations, the functional significance of silent mutations remains relatively understudied. This review synthesizes current knowledge on KRAS silent mutations, highlighting their impact on cancer development. Silent mutations, which do not alter protein sequences but can affect RNA stability and translational efficiency, pose intriguing questions regarding their contribution to tumor biology. Understanding these mutations is crucial for comprehensively unraveling KRAS-driven oncogenesis and exploring novel therapeutic avenues. Moreover, investigations into the clinical implications of silent mutations in KRAS-mutant tumors suggest potential diagnostic and therapeutic strategies. Despite being in early stages, research on KRAS silent mutations holds promise for uncovering novel insights that could inform personalized cancer treatments. In conclusion, this review underscores the evolving landscape of KRAS silent mutations, advocating for further exploration to bridge fundamental biology with clinical applications in oncology.

Emerging evidence suggests that dysbiosis of the gut microbiota is associated with the pathogenesis of Parkinson’s disease (PD), a prevalent neurodegenerative disorder. The microbiota-gut-brain axis plays a crucial role in the development and progression of PD, and numerous studies have demonstrated the potential therapeutic benefits of modulations in the intestinal microbiota. This review provides insights into the characterization of the gut microbiota in patients with PD and highlights associations with clinical symptoms and underlying mechanisms. The discussion underscores the increased influence of the gut microbiota in the pathogenesis of PD. While the relationship is not fully elucidated, existing research demonstrates a strong correlation between changes in the composition of gut microbiota and disease development, and further investigation is warranted to explain the specific underlying mechanisms.

在这里，我们首先讨论我们对麻醉诱导机制的理解的进展。这包括由三个有影响力的理论形成的麻醉基础：非特异性脂质理论、特异性蛋白质靶点理论和神经回路理论。然后，我们讨论了由于麻醉剂从身体和大脑中消除而导致的纯被动麻醉恢复的传统识别。紧随其后的是最近的一项研究，该研究揭示了一种基于大脑从麻醉中主动重启意识的内在能力的共同机制。最后，提出了一个关于大脑如何从麻醉中恢复意识的新理论。

The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.

This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.

Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278] vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses.

This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

The urban-rural disparities in overweight and obesity among children and adolescents are narrowing, and there is a need for long-term and updated data to explain this inequality, understand the underlying mechanisms, and identify priority groups for interventions.

We analyzed data from seven rounds of the Chinese National Survey on Students Constitution and Health (CNSSCH) conducted from 1985 to 2019, focusing on school-age children and adolescents aged 7-18 years. Joinpoint regression was used to identify inflection points (indicating a change in the trend) in the prevalence of overweight and obesity during the study period, stratified by urban/rural areas and sex. Annual percent change (APC), average annual percent change (AAPC), and 95% confidence interval (CI) were used to describe changes in the prevalence of overweight and obesity. Polynomial regression models were used to predict the prevalence of overweight and obesity among children and adolescents in 2025 and 2030, considering urban/rural areas, sex, and age groups.

The prevalence of overweight and obesity in urban boys and girls showed an inflection point of 2000, with AAPC values of 10.09% (95% CI: 7.33-12.92%, t = 7.414, P <0.001) and 8.67% (95% CI: 6.10-11.30%, t = 6.809, P <0.001), respectively. The APC for urban boys decreased from 18.31% (95% CI: 4.72-33.67%, t = 5.926, P = 0.027) to 4.01% (95% CI: 1.33-6.75%, t = 6.486, P = 0.023), while the APC for urban girls decreased from 13.88% (95% CI: 1.82-27.38%, t = 4.994, P = 0.038) to 4.72% (95% CI: 1.43-8.12%, t = 6.215, P = 0.025). However, no inflection points were observed in the best-fit models for rural boys and girls during the period 1985-2019. The prevalence of overweight and obesity for both urban and rural boys is expected to converge at 35.76% by approximately 2027. A similar pattern is observed for urban and rural girls, with a prevalence of overweight and obesity reaching 20.86% in 2025.

The prevalence of overweight and obesity among Chinese children and adolescents has been steadily increasing from 1985 to 2019. A complete reversal in urban-rural prevalence is expected by 2027, with a higher prevalence of overweight and obesity in rural areas. Urgent action is needed to address health inequities and increase investments, particularly policies targeting rural children and adolescents.

Research has indicated that the disease burden of alopecia areata (AA) in China exceeds the global average. Therefore, accurate and updated epidemiological information is crucial for policymakers. In this study, we aimed to comprehensively assess the disease burden of AA in China.

The following four key indicators were utilized: the prevalence of cases; disability-adjusted life-years (DALYs); the age-standardized prevalence rate (ASPR); and the age-standardized DALY rate (ASDR) of AA according to the Global Burden of Disease (GBD) study 2021. We analyzed the epidemiological burden of AA in China during 2021, examined changes between 1990 and 2021, and performed a Bayesian age-period-cohort analysis to predict trends over the course of the next decade (2022-2030). Additionally, a Gaussian process regression model was applied to estimate the relationship between the gross domestic product (GDP) and the ASPR and ASDR of AA at the provincial level between 1992 and 2021.

In 2021, the estimated number of patients with AA in China was approximately 3.49 million (95% uncertainty interval [UI], 3.37-3.62 million); of these patients, 1.20 million (95% UI, 1.16-1.25 million) were male and 2.29 million (95% UI, 2.20-2.37 million) were female. This large number of patients with AA resulted in a total of 114,431.25 DALYs (95% UI, 74,780.27-160,318.96 DALYs). Additionally, the ASPR and ASDR were 224.61 per 100,000 population (95% UI, 216.73-232.65 per 100,000 population) and 7.41 per 100,000 population (95% UI, 4.85-10.44 per 100,000 population), respectively; both of these rates were higher than the global averages. The most affected demographic groups were young and female individuals 25-39 years of age. Slight regional disparities were observed, with the northern and central regions of China bearing comparatively higher burdens. Between 1990 and 2021, the health loss and disease burden caused by AA in China remained relatively stable. The ASPR and ASDR of AA increased with the GDP when the annual GDP was less than 2 trillion Chinese yuan; however, a downward trend was observed as the GDP surpassed 2 trillion Chinese yuan. A slight upward trend in the disease burden of AA in China is predicted to occur over the next decade.

AA continues to be a public health concern in China that shows no signs of declining. Targeted efforts for young individuals and females are necessary because they experience a disproportionately high burden of AA.

Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood.

A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons.

All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions.

This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.

P16 inactivation is frequently accompanied by telomerase reverse transcriptase (TERT) amplification in human cancer genomes. P16 inactivation by DNA methylation often occurs automatically during immortalization of normal cells by TERT. However, direct evidence remains to be obtained to support the causal effect of epigenetic changes, such as P16 methylation, on cancer development. This study aimed to provide experimental evidence that P16 methylation directly drives cancer development.

A zinc finger protein-based P16-specific DNA methyltransferase (P16-Dnmt) vector containing a "Tet-On" switch was used to induce extensive methylation of P16 CpG islands in normal human fibroblast CCD-18Co cells. Battery assays were used to evaluate cell immortalization and transformation throughout their lifespan. Cell subcloning and DNA barcoding were used to track the diversity of cell evolution.

Leaking P16-Dnmt expression (without doxycycline-induction) could specifically inactivate P16 expression by DNA methylation. P16 methylation only promoted proliferation and prolonged lifespan but did not induce immortalization of CCD-18Co cells. Notably, cell immortalization, loss of contact inhibition, and anchorage-independent growth were always prevalent in P16-Dnmt&TERT cells, indicating cell transformation. In contrast, almost all TERT cells died in the replicative crisis. Only a few TERT cells recovered from the crisis, in which spontaneous P16 inactivation by DNA methylation occurred. Furthermore, the subclone formation capacity of P16-Dnmt&TERT cells was two-fold that of TERT cells. DNA barcoding analysis showed that the diversity of the P16-Dnmt&TERT cell population was much greater than that of the TERT cell population.

P16 methylation drives TERT-mediated immortalization and transformation of normal human cells that may contribute to cancer development.

对于困难的气道管理，建议通过声门上气道装置（SAD）进行气管插管。然而，用于SAD引导插管的特定气管导管在紧急情况下并不总是可用的，因此需要使用非特定导管，如聚氯乙烯（PVC）和增强气管导管。尽管已经报道了用这些管成功插管，但临床医生经常面临将它们穿过SAD的困难，即使正确放置SAD也会增加气道损伤的风险。已经尝试了各种策略来解决这个问题，包括使用不同的管类型、PVC管的预处理、SAD位置调整、反向加载和光纤引导。重要的是，迄今为止很少有研究评估各种气管导管对通过SAD进行光纤插管期间声门下气道损伤的影响。本随机对照试验旨在比较PVC、强化和百视达引起的声门下气道损伤^TM通过SAD BlockBuster进行光纤监测插管期间的气管导管（拓仁医疗器械，中国天津）^TM（拓仁医疗器械），第二代SAD，旨在方便盲插或光纤引导插管。

致编辑：肺癌，特别是肺腺癌(LUAD)，是全球癌症相关死亡率的主要原因之一。^[1,2]然而，只有一小部分LUAD患者在一线或后续治疗环境中从化学免疫治疗中获得了临床益处。程序性死亡配体1（PD-L1）表达和肿瘤突变负荷（TMB）都被证明不足以准确预测这些情况下的治疗结果。^[3]因此，迫切需要鉴定可靠的生物标志物来为治疗决策提供信息。

致编辑：放射治疗（RT）在治疗胸部肿瘤中很重要。然而，RT不可避免地会对正常肺造成损害，导致放射性肺损伤（RILI）。物理和生物因素共同决定了RILI。了解物理技术发展在降低RILI中的作用，更有利于发展和应用放疗物理技术。这里所说的物理技术主要是基于物理学（工程）的原理和方法应用于RT。

致编辑：肺癌仍然是全球癌症相关死亡的主要原因。^[1]其组织学分类包括非小细胞肺癌(NSCLC)，其包括腺癌、鳞状细胞癌和大细胞癌。其中，肺腺癌（LUAD）是最常见的亚型。内脏胸膜侵犯（VPI）是影响肿瘤分级的重要因素，也是肺癌患者预后的独立危险因素。但由于大多数情况下缺乏可测量的标志物，只能通过影像学技术和病理学检查来检测。^[2]目前，临床筛查中常用的生物标志物，如癌胚抗原（CEA），在诊断早期肺癌方面仍表现出较高的假阳性率。因此，鉴定新的标志物或方法以更准确地评估轻微病变肺结节的特征具有相当重要的意义，特别是在肺癌诊断的早期阶段。

致编辑：O-连接的β-N-乙酰葡糖胺化（O-GlcNAcylation）是由两种酶O-GlcNAc转移酶（OGT）和O-GlcNAcase（OGA）调节的关键翻译后修饰。O-GlcNAcylation的失调与许多疾病过程，特别是肿瘤发生有关。肺癌是全世界癌症相关死亡率的主要原因。大多数肺癌患者被诊断为晚期，这对他们的生命构成了严重的风险。O-GlcNAcylation促进癌细胞适应不利环境，在肺癌的发生和进展中起关键作用。本文简要概述了O-GlcNAcylation的性质及其在各种疾病中的研究进展，特别关注肺癌。

致编辑：新辅助化疗（NAC）显著改善了乳腺内淋巴结（IMN）受累乳腺癌患者的预后，^[1]但是IMN的局部治疗包括IMN解剖（IMND）和IMN增强照射（IMNB）长期以来一直存在争议，^[2]由于手术入路困难和高剂量辐射引起的心肺副作用。^[3]迄今为止，IMNs的手术解剖很少进行；因此，关于IMND生存结果的数据非常有限。就放射治疗（RT）而言，NAC后转移性IMN患者的IMN放射剂量存在显著差异。^[4]在这项研究中，我们报告了我们在转移性IMN局部治疗方面的机构经验及其对接受NAC的患者预后的影响。

致编辑：宫颈癌（CC）是女性癌症死亡的第二大原因，是一项重大的全球健康挑战。^[1]宫颈鳞状细胞癌（CSCC）占CC病例的70%，盆腔淋巴结转移是CC相关死亡的关键原因。^[2]因此，了解肿瘤通过淋巴管扩散的潜在机制变得势在必行。^[3]RNA解旋酶涉及RNA代谢的几乎所有方面。^[4]死盒解旋酶24（DDX24）是研究最少的死盒RNA解旋酶之一，在几种癌症类型中上调。^[5]然而，DDX24在CSCC进展和转移中的作用仍然难以捉摸。在这里，我们研究了DDX24在CSCC背景下介导癌细胞EMT和淋巴管生成中的重要作用。我们的研究为CSCC淋巴转移提供了一个潜在的治疗靶点。

致编辑：免疫检查点抑制剂（ICIs）已显示出显著的临床反应；然而，它们的疗效仍然局限于一小部分患者。外周血单核细胞（PBMCs）提供了一种有效、可及和微创的方法来评估肿瘤免疫状态和识别ICI应答者。在这项研究中，我们旨在阐明PBMC基因表达在ICI治疗反应和预后中的作用。

致编辑：随着人口老龄化加速，骨关节炎（OA）已成为老年人致残的主要原因，显著增加了社会负担。^[1]OA被认为是由关节软骨的磨损引起的慢性、进行性关节疾病。这种退变可导致关节的组织学和结构变化，最终导致关节功能的全面损害。^[2]

致编辑：痴呆是一种常见的退行性疾病，其特征是认知功能和进行日常生活活动的能力进行性下降。2010年，全球有超过3500万人患有痴呆症，预计到2050年，这一数字将增加到超过1.15亿。^[1]轻度认知障碍（MCI）是介于正常衰老和痴呆之间的中间状态，有较高的向痴呆过渡的风险。^[2]在过去的几十年里，中国已经进行了100多项流行病学研究来调查痴呆和MCI的患病率及其影响因素。虽然这些研究有助于理解认知障碍的发病机制，但其患病率估计高度不一致，导致结果不可靠。这些差异可能与年龄跨度不同、痴呆和MCI诊断标准不一致以及评估工具不同有关。为了克服这些限制，我们进行了一系列亚组分析。我们的目的是确定中国社区老年人中痴呆和MCI的患病率，并调查痴呆/MCI与人口统计学特征、生活方式和临床因素的横断面相关性。

致编辑：根据中国国家癌症中心公布的最新统计数据，2022年中国新诊断癌症病例约482.47万例，癌症死亡患者约257.42万例。^[1]不受控制的细胞增殖和生理性死亡抵抗是最具代表性的癌症特征，在临床实践中使恢复健康的过程复杂化并限制治疗有效性。^[2]调节多种细胞死亡途径以重新编程癌症自杀已成为实现有价值药物发现的有前途的方法。鉴于使用益母草作为一种历史悠久的民间药物，相对低毒性和抑制恶性肿瘤的特性使科学家的注意力转移到挖掘其多样的活性成分和确定其药理活性上，从而为其在临床癌症治疗中的给药铺平道路。