2026年 · 第139卷第02期

造血系统是生物体生理学的基石，维持终身血细胞生成，同时在免疫防御和组织稳态中发挥关键作用。随着年龄的增长，这种精确调节的系统经历进行性功能衰退，这是由造血干细胞（HSC）、其骨髓（BM）生态位和全身因素的相互关联的变化驱动的，所有这些都导致衰老相关的造血障碍。在这篇社论中，我们综合了这些进展，并探讨了对造血衰老机制的新兴见解如何为开发针对年龄相关造血衰退及其临床后果的靶向治疗干预提供了机会。

肥胖孕妇的能量摄入和体重增加有什么建议？

Interorgan crosstalk refers to the bidirectional communication and interaction between different organs in the body. It plays a crucial role in maintaining metabolic homeostasis and is essential for proper physiological function. Dysregulation of organ crosstalk has been associated with the development of various metabolic disorders, including metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is a growing health issue worldwide, affecting approximately 30% of the global population. There has been a growth in literature to address the dysregulated crosstalk between multiple extrahepatic organs and the liver; thus, many striking findings have been published. However, the underlying mechanisms remain largely obscure. In this study, we focused on the perspective of circulating proteins, metabolites, neuroendocrine signals, and extracellular vesicles, summarizing systematically how they affect extrahepatic organs and the liver in the pathogenesis of MASLD. Furthermore, particular attention is placed on the potential novel therapeutic strategies.

Obesity, a global public health crisis driven by complex interactions of genetic, environmental, and behavioral factors, necessitates innovative therapeutic strategies. This review explores the pathogenesis of obesity, emphasizing genetic determinants, metabolic dysregulation, gut microbiota alterations, and energy imbalance. The evolution of anti-obesity pharmacotherapy has progressed from the use of high-risk agents such as amphetamines and thyroid extracts to modern gut hormone-based therapies, notably glucagon-like peptide-1 receptor agonists (GLP-1RAs), which effectively suppress appetite and improve glycemic control. Current pharmacologic agents target central appetite regulation or peripheral mechanisms. However, there are still risks such as muscle loss and long-term safety issues. Emerging therapeutic strategies are focusing on novel targets such as growth differentiation factor 15 (GDF15) and its specific receptor glial cell-line derived neurotrophic factor family receptor α-like (GFRAL), inhibin βE (INHBE), as well as bile acid receptors including the farnesoid X receptor (FXR) and Takeda G protein-coupled receptor 5 (TGR5). Concurrently, the field is advancing multi-targeted drugs and drug combinations to enhance weight loss efficacy and reduce side effects. Furthermore, the development of oral formulations such as oral Semaglutide is expected to provide convenience for patients and enhance their willingness to receive treatment. In the future, with the development of multi-omics technologies and the widespread application of artificial intelligence, it is expected to support personalized therapies, thereby improving treatment efficacy and accuracy.

Long non-coding RNA (lncRNA) nuclear paraspeckle assembly transcript 1 (NEAT1) is a critical component of nuclear paraspeckles, influencing gene expression through epigenetic, transcriptional, and post-transcriptional mechanisms. The dysregulated expression and function of NEAT1 are associated with diverse human disorders ranging from inflammatory diseases to cancers. However, the emerging pathophysiological roles and therapeutic strategies of NEAT1 in skin disorders have not yet been thoroughly reviewed and discussed. This review offers a comprehensive perspective and discusses the recent therapy progress on NEAT1 in skin disorders, mainly, including skin cancers and immune-related conditions. NEAT1 is always upregulated in various skin disorders, such as systemic lupus erythematosus (SLE), atopic dermatitis (AD), and melanoma, which primarily functions as a competitive endogenous RNA (ceRNA) via targeting microRNA and regulates multiple immune cells to exert pathogenic effects. Notably, the expression levels of NEAT1 in psoriasis studies present contrary results, with some studies showing increased expression and others indicating downregulation, making its role in the pathophysiology of psoriasis appear complex, and its specific regulation of different cells requires further research. Moreover, technologies focusing on NEAT1 inhibition with upstream element regulation and direct silencing, and NEAT1 overexpression based on drug induction and exogenous introduction, are growing vigorously. In conclusion, this review provides significant insights into potential diagnostic biomarkers and therapeutic targets of NEAT1 for these disorders.

Prostate cancer (PCa) presents a significant global health challenge, and cachexia in end-stage PCa further reduces survival time and deteriorates patient quality of life. This necessitates nuanced approaches to prevention, diagnosis, and treatment. This review analyzes the complex role of growth differentiation factor 15 (GDF15) in various aspects of PCa, including metabolism, chemoresistance, metastasis, and clinical implications. Mechanically, the interactions of GDF15 with PCa lipid metabolism and stromal activation are hypothesized to drive PCa progression and promote cachexia. GDF15’s role in PCa bone metastasis is mediated through interactions with osteoblasts and osteoclasts. Furthermore, GDF15’s role in chemoresistance emphasizes its impact on drug responses and suggests a potential therapeutic target. Clinically, GDF15 has shown potential as a biomarker, offering diagnostic precision and prognostic value, particularly when combined with established markers such as prostate-specific antigen. The review concludes with a discussion on several monoclonal antibodies targeting GDF15 in clinical trials, such as AV-380, NGM120, Visugromab, and AZD8853, highlighting promising strategies for novel therapies and precision medicine.

Peptide-drug conjugates (PDCs) have emerged as a promising strategy in cancer therapy, offering improved therapeutic efficacy and reduced toxicity. Compared to antibody-drug conjugates (ADCs) and small molecule-drug conjugates (SMDCs), PDCs possess distinct advantages, such as lower immunogenicity, improved tumor penetration, and simpler synthesis. This review discusses the latest advancements in PDC design, including novel peptide targeting mechanisms, linker selection, and formulation improvements for increased stability. Additionally, it explores the expanding clinical applications of PDCs and examines their limitations. The aim of this review is to provide a comprehensive overview of current PDC progress and outline future directions for their role in cancer treatment.

Although guidelines stress the importance of early screening for individuals at high risk of lung cancer in China, there is a lack of data on risk-adapted starting ages for screening. This study aims to determine the appropriate starting age for lung cancer screening in China, considering various risk factors associated with the disease.

The data used were from the Cancer Screening Program in Urban China. A total of 413,725 eligible participants aged 40-74 years from eight cities in China were enrolled between 2013 and 2021. The outcomes of the study included lung cancer diagnosis and age at diagnosis. The risk-adapted starting age for screening was defined as the age at which individuals with varying levels of lung cancer risk reached a 10-year cumulative risk level similar to that of those aged 50 years in the general population.

Among the 413,725 individuals who participated in the study, 1607 were diagnosed with lung cancer with a median follow-up of 4.90 (3.01, 6.84) years. The participants were categorized into different risk groups based on their lung cancer risk scores, which were determined by various risk factors, such as gender, education level, body mass index, vegetable intake, smoking pack-years, and tea consumption. In the study, the optimal starting age for lung cancer screening was determined on the basis of an individual’s risk level. Using the 10-year cumulative risk of lung cancer at age 50 years in the general population as a benchmark (0.59% [95% confidence interval, 0.52-0.63%]), the study revealed that individuals with high, medium, or low risk of lung cancer should start screening at ages 46, 48, or 54 years and older, respectively.

This study establishes the age at which lung cancer screening should begin on the basis of the principle of equal management and risk management. These findings have the potential to contribute to updates in the current screening guidelines.

Neurological dysfunction is a common complication of traumatic brain injury (TBI), and early treatments are critical for the long-term prognosis. This study aimed to investigate whether hypidone hydrochloride (YL-0919) improves neurological function impairment in mice with TBI.

TBI was induced in adult male C57BL/6J mice using the controlled cortical impact (CCI) method. First, the modified neurological severity score (mNSS), rotarod test, and Morris water maze (MWM) test were conducted to assess the impact of YL-0919 on neurological function in mice with TBI. Next, immunofluorescence and laser speckle contrast imaging were utilized to measure the number and activation of microglia and cerebral blood flow (CBF) after TBI. Enzyme-linked immunosorbent assay (ELISA) was employed to assess the inflammatory factors. Finally, Western blotting was performed to measure the expression of proteins. Golgi-Cox staining was utilized to investigate the structure of pyramidal neurons.

YL-0919 significantly alleviated neurological dysfunction in TBI+YL-0919 mice compared with TBI+Vehicle mice, increased the time spent on the rotarod (F = 1.297, P <0.05), and partially relieved cognitive dysfunction in TBI mice (for mNSS, F = 5.540, P <0.01; for MWM test, F = 30.78, P <0.05). Additionally, YL-0919 effectively inhibited the proliferation and activation of microglia (both P <0.01), promoted the recovery of CBF around the brain injury site and inhibited the expression of tumor necrosis factor-α (F = 9.142, P <0.05) and IL-1β (F = 4.662, P <0.05), and increased the concentration of IL-4 (F = 5.172, P <0.05). Furthermore, continuous gavage of YL-0919 (2.5 mg/kg) for seven days effectively increased the protein expression of brain-derived neurotrophic factor (BDNF), promoted the phosphorylation of mammalian target of rapamycin (mTOR), increased postsynaptic density protein 95 (PSD95) and synapsin1 levels, and increased the neuronal dendritic complexity and the dendritic spine density around the brain injury site (all P <0.05).

Our findings indicated that YL-0919 can ameliorate neurological dysfunction in mice after TBI through the suppression of inflammation and the stimulation of the BDNF-mTOR signaling pathway. These findings provide an insightful perspective on the potential pharmacological mechanism involved in the neuroprotective effect of YL-0919.

Chronic kidney disease (CKD) is a global health issue, with renal fibrosis being a common pathway in CKD development. Histone modification plays crucial roles in transcriptional regulation, but their pathological functions and mechanisms in CKD are not well understood.

We utilized chromatin immunoprecipitation with next-generation DNA sequencing (ChIP-seq) and RNA-seq to evaluate the states and functions of H3 lysine 27 acetylation (H3K27ac) and H3 lysine 4 trimethylation (H3K4me3) in kidney of CKD mice. We identified epigenetic factors regulating H3K27ac through motif analysis. Expression of activating transcription factor 3 (ATF3) in CKD mouse models and patients’ kidneys was validated via immunofluorescence staining or Western blot. We further generated the Atf3 deficient (Atf3^-/-) mice to explore its effect in kidney function and fibrosis. ChIP-seq of H3K27ac from Atf3^-/- CKD mice was employed to validate ATF3’s regulatory effects. We explored how ATF3 maintains the state of H3K27ac by integrating the data sources from multiple databases.

The states of H3K27ac and H3K4me3 were changed during CKD, and positively correlated with differential gene expression. ATF3 was highly expressed in kidney of both patients and mice with CKD, and co-localized with H3K27ac in genome, epigenetically regulating H3K27ac state. Atf3 deficient in CKD mice significantly ameliorated kidney dysfunction and fibrotic phenotype, and reduced H3K27ac levels at the ATF3 binding sites. Mechanically, ATF3 may facilitate H3K27ac maintenance by corrodinating histone acetyltransferase (HATs)-associated regulatory machinery during CKD.

ATF3 promotes kidney injury and fibrosis in CKD by maintaining the state of H3k27ac via coordinating HATs regulatory machinery.

Interleukin-1 receptor-associated kinase 1 (IRAK1), an active serine/threonine kinase, is an indispensable mediator of inflammatory responses and innate immunity. Emerging evidence has highlighted the oncogenic role of IRAK1 in tumors. However, the role of IRAK1 in gastric cancer (GC) progression remains unclear.

IRAK1 expression levels in patients with GC at Peking Union Medical College Hospital were assessed by Western blotting, quantitative real-time polymerase chain reaction, and immunohistochemistry. To elucidate the role of IRAK1 in GC pathogenesis, we established GC cells with clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein 9 (Cas9) mediated IRAK1 knockout and lentiviral vector-mediated IRAK1 overexpression and subsequently conducted in vitro and in vivo experiments. Additionally, we assessed the effect of IRAK1 expression levels in GC cells on the M2 polarization of tumor-associated macrophages (TAMs) via a Transwell coculture system. Functional assays were subsequently carried out to determine whether IRAK1 regulates the proliferation, invasion, and epithelial-mesenchymal transition (EMT) of GC cells through the induction of TAM M2 polarization and to clarify the associated regulatory mechanisms.

IRAK1 expression was progressively increased during GC progression. Clinicopathological feature analysis revealed that high IRAK1 expression predicted poor survival outcomes. In vitro and in vivo experiments revealed that IRAK1 was highly expressed in GC cells and facilitated the proliferation, migration, invasion, and EMT of GC cells via the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway. More interestingly, IRAK1 affected the malignant biological behavior of GC cells by inducing M2-like polarization of macrophages. Mechanistically, coculturing M0 macrophages with IRAK1-knockout GC cells suppressed interleukin (IL)-8 secretion, thereby inhibiting Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway activation in TAMs. Inactivation of the JAK2/STAT3 pathway suppressed the M2 polarization of TAMs, ultimately inhibiting GC progression.

IRAK1 influences the malignant biological behavior of GC cells by activating the PI3K/AKT/mTOR pathway and inducing the M2-like polarization of macrophages via the IL-8/JAK2/STAT3 pathway in TAMs. Our findings provide a novel diagnostic biomarker and a promising therapeutic strategy for GC.

Sevoflurane impairs neurogenesis and cognitive function in the developing brain; however, the underlying mechanisms remain unclear. This study aimed to investigate the role of fatty acid β-oxidation (FAO) in neural stem/progenitor cells (NSPCs) as a potential factor in sevoflurane-induced neurogenesis inhibition and cognitive deficits.

NSPCs, NE-4C cells, and postnatal day 7 (PND 7) rats were exposed to sevoflurane. Cell viability was measured using the methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. Neurogenesis was assessed by immunohistochemistry. Apoptosis was detected via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL). Cognitive function was tested with the Morris water maze. Lipid metabolism profiles were analyzed through lipidomics. Messenger RNA (mRNA) expression levels of key FAO enzymes and the major carnitine transporter were quantified by real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR). Protein expression of carnitine palmitoyltransferase 1a (CPT1a) and nuclear peroxisome proliferator-activated receptor α (PPARα) was examined by Western blotting. CPT1a enzymatic activity was determined using a biochemical assay. FAO activity was measured with the FAOBlue assay.

Sevoflurane exposure impaired neurogenesis and cognitive function. In NSPCs, sevoflurane exposure induced extensive alterations in lipid metabolism intermediates, inhibited the mRNA expression of acyl-coenzyme A (CoA) oxidase 1 (ACOX1), acyl-CoA oxidase 3 (ACOX3), hydroxyacyl-CoA dehydrogenase beta subunit (HADHB), CPT1a, carnitine palmitoyltransferase 2 (CPT2), acyl-CoA dehydrogenase short-chain (ACADS), and solute carrier family 22 member 5 (SLC22A5), suppressed FAO activity, reduced CPT1a expression and activity, and decreased PPARα levels in the nucleus. Enhancing FAO activity in NSPCs ameliorated the negative effects of sevoflurane on neurogenesis. Overexpression of CPT1a rescued the sevoflurane-induced inhibition of FAO activity and neurogenesis in NE-4C cells. Pretreatment with palmitoylethanolamide (PEA), a PPAPα agonist, increased both the nuclear content of PPARα protein and the expression of CPT1a in NSPCs and rat hippocampus after sevoflurane exposure. Furthermore, pretreatment with PEA or the CPT1a substrate carnitine rescued sevoflurane-induced damage to FAO activity in NSPCs, neurogenesis, and cognitive function.

Sevoflurane impairs neurogenesis and cognitive function by suppressing FAO in NSPCs of the developing brain. Boosting FAO activity in NSPCs could be a potential strategy to prevent sevoflurane-induced cognitive deficits.

致编辑：心房颤动(AF)是最常见的持续性心律失常，^[1]特别是在老年人中，由于其与缺血性中风的联系，带来了巨大的社会医学负担。^[2]尽管全身性口服抗凝剂（OAC）药物非常有效，但许多患者仍在与副作用、依从性问题和对生活质量的担忧作斗争。^[3]经皮左心耳封堵术（LAAO）是房颤和长期抗凝治疗禁忌症患者抗凝的替代方法，已在美国心脏病学会（ACC）和欧洲心脏病学会（ESC）指南中得到认可。^[2]值得注意的是，调查LAAO并为这些指南提供证据基础的关键随机对照试验（RCT）和注册中心主要在美国或欧洲进行，92-94%的参与者是白种人，而其他种族群体的代表性明显不足。

致编辑：欧洲老年人肌肉减少症工作组（EWGSOP）将肌肉减少症定义为同时存在低肌肉质量和低肌肉力量或表现，已成为老龄化人群中关键的公共健康问题。^[1]此外，肌肉减少性肥胖（SO）是另一种高危老年综合征，最初由Baumgartner描述为肌肉减少和肥胖的共存。^[2]肥胖和肌肉减少症通常在老龄化人群中共存，并表现出很强的双向关联。最近一项涵盖106项临床研究的荟萃分析（N=167,151名老年人）报告了两性中SO的合并患病率为9%。^[3]重要的是，它显示全因死亡率的风险增加了51%（合并风险比[HR]=1.51，95%置信区间[CI]1.14-2.02，P<0.001）。^[3]鉴于其对健康的不利影响，新兴研究强调需要将SO作为一种独特的多因素表型来处理。因此，确定SO的稳健预测因子对于有针对性的干预至关重要。

致编辑：年轻人成熟型糖尿病（MODY）是一组异质性单基因疾病，其特征在于早发（通常在青春期或儿童期）、常染色体显性遗传和胰岛素分泌受损。迄今为止，已经鉴定了总共14种不同的MODY亚型，每种亚型都是由不同基因的突变引起的[补充表1，http://links.lww.com/CM9/C683]。然而，现有的MODY分类难以应用于临床。MODY基因突变类型越多，现有的MODY分类就越失去合理性和临床实用性。在本文中，我们为MODY提出了一种新的分类。根据其致病机制，我们将MODY分为四种类型：胰岛素分泌障碍（A型）、内质网应激（B型）、转录调节障碍（C型）和信号转导异常（D型）。这种新的分类可以揭示MODY亚型之间的异同，便于根据各亚型的病理生理学和临床表现选择合适的治疗策略。

致编辑：尿失禁（UI）是女性的主要全球健康问题，影响近50%的人口并产生巨大的成本。^[1]包括分娩和老龄化在内的关键风险因素导致UI发病率在15.9%至34%之间。2021年美国国家健康与护理卓越研究所(NICE)指南建议将监督盆底肌肉(PFM)训练作为压力和混合UI的主要保守治疗，旨在增强PFM力量。然而，超过30%的患者在初次咨询时难以自愿感染他们的PFM，这限制了日常锻炼的有效性，即使在数字治疗设备的指导下也是如此。改良牛津量表（MOS），^[2]由于缺乏标准化的诊断工具以及对医疗保健提供者和公众的教育有限，通过触诊评估PFM强度的黄金标准在促进依从性方面面临挑战。一个持续的问题是缺乏与训练有素的专业人员的评估精度相匹配的数字设备，特别是对于PFM强度评估。在远程医疗中，一个重要的问题是如何准确诊断PFM功能并远程制定个性化的康复计划。肌电图（EMG）通过测量来自肌纤维的电信号（指示肌肉募集和力量）显示出在康复环境中进行家庭监测的潜力；更高的肌电信号表明更大的肌肉力量。根据MOS评分验证的阴道内EMG与PFM强度密切相关。虽然EMG设备已经帮助了全国2160个健康中心的600多万妇女，但由于PFM力量评估的诊断效果不明确，她们在UI的家庭康复中面临障碍。

致编辑：慢性胰腺炎（CP）的特征是胰腺的复发性炎症，常并发胰腺组织的不可逆损伤。脑瘫的病因很多；常见的因素包括遗传倾向和环境因素，如吸烟和饮酒。^[1]基因突变和遗传易感性在发病机制中的作用最近引起了极大的关注，在基础科学领域产生了大量高质量的研究成果。本文主要综述了近年来与CP相关的遗传多态性、遗传易感性和胰腺纤维化发病机制的研究进展，旨在为基础和临床研究提供参考。

致编辑：在中国，脑出血（ICH）与显著较高的死亡率相关^[1]相对于缺血性中风。中国ICH发病率高于欧美；^[2]然而，很少有研究详细介绍中国ICH的疾病负担，尤其是关于住院期间临床特征的数据。因此，本研究旨在调查和分析住院期间ICH患者的临床特征以及2015年至2022年间的时间趋势变化。

致编辑：银屑病是一种慢性炎症性疾病，发病率高，生活质量差，尤其在中国。^[1,2]然而，中国银屑病疾病负担的空间变异性和时间趋势的全貌仍不清楚。这种缺乏不利于疾病的防控和医疗公平，构成了公共卫生挑战。