MedNexus
2026年 · 第139卷第10期
出版日期 2026-05-20电子版 ￥0.00元￥100.00元
MedNexus
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Consensus Statement
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断肢保存与修复临床实践指南Jianzheng Zhang, Rongji Zhang, Wei Chai, Licheng Zhang, Jianwen Zhao, Hongying He, Weidong Shi, Shaoguang Li, Lin Yang, Li Han 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003820
摘要
肢体移植分为再植和同种异体移植。再植是指断肢的直接或间接再植，而同种异体移植是指同一物种不同基因型个体之间的肢体移植。静态冷藏(SCS)仍然是黄金标准体外肢体保护。这种使用冰袋的低温（0-4°C）储存方法简单、经济且易于实施。然而，它受到4-6小时的短保存窗口的限制，之后组织活力和功能完整性下降。[
Review Article
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医用仿生材料Yuchen Zhang, Junfeng Guo, Qiang Luo, Xingyue Zhang, Chaoqiang Fan, Shuang Feng, Jie Luo, Yuqing Fan, Qinglin Wei, Jiana Li 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004036
摘要
Recent advances in biomedical research have facilitated the exploration of biomimetic materials and their potential for diagnosing and treating diseases. This review synthesizes reports of recent research into biomimetic materials and provides a focused analysis of their therapeutic and diagnostic efficacy across multiple physiological systems, including the locomotor, digestive, respiratory, urinary, endocrine, nervous, integumentary, hematopoietic, and circulatory systems. These findings highlight the transformative potential of these materials in the management of systemic diseases. They also reveal the challenges associated with material optimization, clinical translation, and future research. These challenges highlight the unresolved hurdles and largely untapped opportunities.
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与免疫效应细胞相关的噬血细胞性淋巴组织细胞增生样综合征相关的嵌合抗原受体T细胞疗法：诊断、高危因素和治疗Yixuan Zhang, Jilong Yang, Huiqi Xin, Kexin Ai, Mengsu Yang, Yuhua Li, Yanjie He
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004066
摘要
Immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS) is a life-threatening complication of chimeric antigen receptor T cell (CAR-T) therapy. Despite its high mortality rate, IEC-HS remains underrecognized due to overlapping clinical and laboratory features with severe cytokine release syndrome (CRS), leading to delayed diagnosis and suboptimal management. This review systematically analyzes key strategies to distinguish IEC-HS from severe CRS in the literature. The analysis focuses on temporal patterns, such as the delayed onset of IEC-HS after CAR-T infusion. It also examines dynamic laboratory trends, including persistently elevated ferritin and lactate dehydrogenase levels and a slower decline in C-reactive protein (CRP). In addition, distinct cytokine profiles are discussed, such as prolonged interferon-gamma (IFN-γ) elevation and surges in chemokines and growth factors. We further identify high-risk factors for IEC-HS, including patient-specific factors (baseline inflammation, low natural killer [NK] cell counts), disease-related factors (high B-cell acute lymphoblastic leukemia [B-ALL] burden and prior high-grade CRS), and CAR-T-related factors (CD22 target, CD28 costimulation, T-cell selection, high CAR-T cell dose, excessive CAR-T cell expansion, and TET2 gene mutation). For management, we evaluate conventional therapies (corticosteroids, etoposide) and emerging immunomodulatory agents (anakinra, ruxolitinib, emapalumab), emphasizing the 2023 treatment regimen by the American Society of Transplantation and Cellular Therapy (ASTCT). By integrating risk stratification, early diagnostic criteria, and tailored therapeutic approaches, this review aims to improve clinical outcomes for IEC-HS patients.
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免疫系统相关疾病中的大麻素：从实验室到临床Wenyu Zhang, Buzhuo Chen, Yanting Cao, Wangrui Lei, Huadong Zhao, Yang Yang, Jiayou Tang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003818
摘要
As a psychoactive drug, marijuana is used for recreational purposes. Given its addictive nature and the serious damage it causes to both individual health and social stability, marijuana has been banned in most countries worldwide. In recent years, with the continuous improvement of basic research, researchers have discovered the role of cannabinoids, the primary active ingredient in marijuana, in multiple human systems. Research found that cannabinoids can regulate immune system function and have therapeutic potential in immune system-related diseases. However, the use of cannabinoids still poses certain hazards. For instance, cannabinoids can exert certain impacts on fetal nervous system development; cannabinoids use can lead to adverse reactions such as dizziness, nausea, and dry mouth. Moreover, there are still numerous contradictions in current research on the effects of cannabinoids, and the mechanisms by which cannabinoids exert protective effects in certain diseases remain unelucidated. In this review, we systematically discuss the endocannabinoid system and summarize the molecular and cellular bases of cannabinoid function in the immune system, and elucidate the effects of cannabinoids on immune system-related diseases.
Original Article
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中国和美国肝癌患者的管理和预后Mengyuan Xu, Qiushuo Geng, Tianhao Shan, Manqi Liu, Jianguo Chen, Meicen Liu, Bingfeng Han, Changfa Xia, Xianhui Ran, Kexin Sun 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004096
摘要
Background:
The management and outcomes of liver cancer in China have not been well studied. This study aimed to evaluate the management and prognosis of patients with liver cancer in China through a comprehensive multicenter analysis and to compare these findings with data from the United States (US).
Methods:
We conducted a retrospective cohort study using data from 13 hospitals across 10 provinces in China, covering patients diagnosed with primary liver cancer between January 2016 and December 2017. We collected data on sociodemographic characteristics, lifestyle factors, stage at diagnosis, and first-line treatment. Patients’ survival outcomes were tracked using active and passive follow-up methods until December 2023. Multivariable Cox regression was used to identify prognostic factors. We further compared treatment patterns and prognoses of liver cancer patients between 13 hospitals in China and the Surveillance, Epidemiology, and End Results (SEER) cohort in the US.
Results:
A total of 4951 patients with liver cancer from China and 18,365 from the Surveillance, Epidemiology, and End Results cohort were analyzed. In the Chinese cohort, commonly used treatments, ranked from highest to lowest, were surgery (37.3%, 1821/4879), interventional therapy (32.1%, 1570/4898), chemotherapy (17.4%, 850/4877), radiofrequency ablation (6.9%, 337/4872), radiotherapy (3.7%, 182/4890), and targeted therapy (2.6%, 127/4875). Surgery rates for patients with liver cancer in stages I to IV were 59.2% (309/522), 58.8% (443/753), 39.0% (328/841), and 18.6% (141/760), respectively. According to the stage at diagnosis, 5-year survival rates for patients in stages I to IV were 48.1% (95% confidence interval [CI]: 44.0–52.6%), 37.8% (95% CI: 34.5–41.4%), 24.0% (95% CI: 21.3–27.0%), and 8.0% (95% CI: 6.2–10.1%), respectively. Compared with the US, China had higher surgery rates and stage-specific survival for patients with liver cancer across all stages. Data from both countries indicated a poor prognosis for liver cancer, with the stage at diagnosis and surgical intervention being key prognostic factors in both China and the US.
Conclusion:
The present findings underscore the urgent need for early diagnosis and curative treatment interventions such as surgery to enhance survival outcomes for patients with liver cancer.
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老年胃肠癌和肺癌患者免疫相关不良事件的真实世界研究Infong Chan, Lingdong Kong, Bo Jia, Fengxiao Dong, Yuling He, Xumeng Ji, Guomei Ren, Lili Wang, Zhihao Lu, Lin Shen 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004069
摘要
Background:
Immune checkpoint inhibitors (ICIs) are known for their durable efficacy and favorable tolerance profiles. However, elderly patients are often underrepresented in clinical trials. The manifestation of immune-related adverse events (irAEs) in elderly patients with different tumor types remains unclear. This study aimed to compare irAEs in elderly patients with gastrointestinal and lung cancers receiving ICIs and to provide real-world safety data.
Methods:
This retrospective study included elderly patients (≥70 years) with gastrointestinal (GI) tumors or lung cancer who received ≥2 cycles of ICIs across multiple departments within a single academic medical center between January 2016 and February 2022. A 2:1 propensity score matching was used to balance baseline characteristics between the cohorts. The primary endpoint was the incidence of any-grade irAEs between GI tumors and lung cancer, whereas secondary analyses focused on organ-specific toxicities. Statistical comparisons were performed using the chi-squared test.
Results:
The overall incidence of any-grade irAEs was higher in elderly patients with lung cancer than in those with GI tumors (61.0% vs. 47.9%; P = 0.013). After matching for baseline characteristics, the lung cancer group still showed a trend toward a higher incidence of irAEs (61.7% vs. 50.8%; P = 0.056). Notably, patients with GI tumors had a higher incidence of skin toxicity (28.7% vs. 15.1%; P = 0.002), whereas patients with lung cancer had a higher incidence of thyroid dysfunction (28.1% vs. 11.9%, P <0.001).
Conclusions:
Elderly patients with lung cancer were more likely to experience irAEs during immunotherapy than those with GI tumors. However, dermatological toxicities were more common in elderly patients with GI tumors, whereas thyroid dysfunction was more frequently observed in those with lung cancer.
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既往癌症患者肾移植与透析生存结局的比较Guohua He, Yunfeng Xi, Xiaoyun Jiang, Liying Qiao, Yunjing Zhang, Weiwei Kang, Lu Xu, Yingzi Yang, Huziwei Zhou, Guozhen Liu 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003700
摘要
Background:
The number of cancer survivors that develop kidney failure is increasing. However, there is a lack of evidence supporting clinicians offering kidney transplant or dialysis when facing a kidney failure patient with a previous cancer history.
Methods:
This retrospective observational cohort study was conducted using the Inner Mongolia Regional Health Information Platform. Patients who underwent kidney transplantation or dialysis with a preexisting cancer diagnosis between January 1, 2012 and December 31, 2021 were included. We used overall mortality as the primary outcome, and cancer-specific mortality as the secondary outcome.
Results:
A total of 170,414 patients diagnosed with cancer were identified, out of which 1762 patients started kidney replacement therapy (KRT) after the cancer diagnosis, 5.45% (n = 96) accepted kidney transplants and 94.55% (n = 1666) underwent dialysis. Females tended to be less likely to commence kidney transplantation (odds ratio [OR] = 0.381, 95% confidence interval [CI]: 0.237–0.602). During a median follow-up of 3.19 (interquantile range [IQR] = 1.37–5.13) years, 566 (32.12%) deaths were recorded. The overall mortality rate (18.75% vs. 32.89%, P = 0.006) was lower in the kidney transplant group than in the dialysis group. After adjusting for sex, age, ethnicity, KRT start year, residency economic level, insurance type, cancer type, and cancer stage, kidney transplantation was associated with decreased overall mortality (hazard ratio [HR] = 0.542, 95% CI: 0.338–0.871, P = 0.011) compared with dialysis. These results were consistent after propensity score matching. The difference in cancer-specific mortality (10.42% vs. 17.59%, P = 0.095) and annual medical costs ($10,016.37 vs. $10,977.18, P = 0.982) between transplant and dialysis were statistically insignificant.
Conclusions:
In patients with prior cancer diagnoses, kidney transplantation showed better overall survival, similar cancer-specific survival outcomes, and cost-effectiveness than dialysis. Our findings add survival and cost data for KRT and provide evidence for stakeholders to consider the KRT mode in patients with a history of cancer.
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MPGK：孟德尔随机化、多基因风险评分、基因本体论和京都基因和基因组分析百科全书的用户友好工具Jungang Yang, Xuejiao Song, Jingkai Xu, Yue Yang, Xianbo Zuo, Yong Cui
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003980
摘要
Background:
Mendelian randomization (MR), polygenic risk score (PRS), Geno Ontology (GO), and the Kyoto Encyclopedia of Genes and Genomes (KEGG) are powerful bioinformatic analysis tools. However, the analysis of MR, PRS, GO, and KEGG may pose a challenge for novices. This article intends to introduce a program that adeptly guides beginners in implementing these analysis functions, ensuring that even those new to the field can confidently use them.
Methods:
The MPGK program was developed to run on the command line. It conveniently implements the MR, PRS, GO, and KEGG analysis functions by calling well-written R programs. The results of our analyses were validated using genome-wide association study (GWAS) summary data for diabetes and psoriasis, as well as gene sequencing data for diabetes.
Results:
Three demo analyses using the MPGK program demonstrate the comprehensive capabilities of the MPGK program in conducting advanced bioinformatics analysis. First, the MPGK program revealed a causal relationship between diabetes and psoriasis. Additionally, the PRS analysis generated polygenic risk scores for diabetes, demonstrating the implementation of PRS analysis within the MPGK framework. Furthermore, the GO and KEGG analyses indicated that psoriasis is associated with infection and T helper 17 cells. These findings are consistent with the previous literature.
Conclusion:
MPGK can be easily used to perform comprehensive analysis, including MR, PRS, GO, and KEGG analyses, by both beginners and researchers.
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评估随机对照试验中患者报告结局指标的最小、中度和显著临床重要差异Jiani Wu, Liang Yao, Kuan Liao, Janelle Yorke, Yongpei Yu, Zhishun Liu, Xiaomei Yao, Zongshi Qin
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004084
摘要
Background:
Patient-reported outcome measures (PROMs) are increasingly used in clinical trials, yet thresholds that define clinically important difference (CID) within patients and treatment effects beyond placebo remain inconsistently reported, limiting its utility in clinical research and practice. Using chronic pelvic pain and its core PROM as a worked example, the study aims to present a structured framework for CID thresholds that separates within-group change from between-group difference in treatment effect, each further stratified as minimal, moderate, and marked.
Methods:
We used data from a multicenter randomized controlled trial of acupuncture vs. sham acupuncture in 440 men with chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) conducted from October 2017 to April 2019. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) served as the PROM and the Patient Global Impression of Change (PGI-C) as the anchor. CIDs were estimated using a linear mixed-effects model to assess changes in NIH-CPSI scores across PGI-C categories.
Results:
At the end of treatment, 12.3% (51/414) participants reported no change, 34.1% (141/414) slight improvement, 32.1% (133/414) moderate improvement, and 19.6% (81/414) marked improvement; and 1.9% (8/414) reported worsening. The estimated Clinically important within-group difference (CIDswithin-group) in NIH-CPSI total score was 4.6 points for minimal, 6.0 points for moderate, and 7.3 points for marked improvement. The corresponding Clinically important between-group difference (CIDsbetween-group) were 1.4, 2.7, and 4.1 points, respectively.
Conclusions:
In this methodological study, we proposed a pragmatic and scalable operational framework to derive thresholds for minimal, moderate, and marked CIDs. By explicitly distinguishing CIDswithin-group and CIDsbetween-group, the approach clarifies two frequently conflated terms that serve distinct purposes in interpretation and decision-making. This framework offers benchmarks to strengthen inference on treatment response, trial design, and guideline decision thresholds.
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表观遗传升高RAD51AP1调节RAD51-UAF1复合物对替莫唑胺耐药性的影响EGFRvIII胶质母细胞瘤Yuanhao Chang, Jingchen Yang, Zhuo Li, Xiaoxue Zhu, Tao Jiang, Qixue Wang, Mingchen Yu, Bo Han, Xing Liu
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003567
摘要
Background:
Epidermal growth factor receptor variant III (EGFRvIII) mutation is the most prevalent genetic change in glioblastoma. Abnormal DNA damage repair caused by EGFRvIII, which leads to temozolomide (TMZ) resistance, is a major cause of reduced postoperative survival in glioblastoma patients. This study aims to uncover the molecular mechanism of TMZ resistance in EGFRvIII-mutant glioblastoma.
Methods:
We constructed a Clustered regularly interspaced shortpalindromic repeats (CRISPR)/CRISPR-associated (Cas) system 9 library to identify synthetic lethal genes for EGFRvIII-bearing cells. Abnormal epigenetic regulation of the RAD51-associated protein 1 (RAD51AP1) promoter was assessed via chromatin immunoprecipitation sequencing (ChIP-seq) and chromatin immunoprecipitation polymerase chain reaction (ChIP-PCR) analyses. In vitro and in vivo experiments were carried out to investigate the role of the RAD51AP1 gene in TMZ resistance in EGFRvIII-bearing glioblastoma.
Results:
The CRISPR/Cas9 library identified RAD51AP1, a synthetic lethal gene for EGFRvIII-bearing cells exposed to TMZ. ChIP-seq and ChIP-PCR analyses revealed that acetylated histone H3 lysine 27 (H3K27ac) and SRY-box transcription factor 9 (SOX9) together induced RAD51AP1 transcription in EGFRvIII cells. High expression levels of RAD51AP1, promoted formation of the RAD51–UAF1 complex to activate homologous recombination and inhibit TMZ-induced DNA damage.
Conclusion:
The results of this study suggest that aberrant RAD51AP1 expression is a crucial mechanism by which EGFRvIII-mutant glioblastoma resists TMZ chemotherapy, laying the groundwork for future personalized medicine.
Correspondence
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国产新型定向脑深部电刺激系统治疗帕金森病的疗效和安全性Hutao Xie, Xi Wu, Hualin Yu, Guihuai Wang, Zengguang Wang, Jie Zhang, Xiaodong Cai, Fangang Meng, Quan Zhang, Anchao Yang 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003696
摘要
致编辑：深部脑刺激（DBS）是治疗晚期帕金森病（PD）的既定疗法，通常靶向丘脑底核（STN）或苍白球内层（GPi）。传统的全向电极虽然能有效缓解症状，但会无意中刺激邻近结构，导致构音障碍和感觉异常等副作用，可能阻碍最佳临床结果。使用分段技术的定向电极通过实现用于靶向刺激的精确“电流转向”来解决这一限制，从而减少副作用。[
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膝关节骨关节炎腓骨近端截骨术向后续手术的转换：事件发生时间分析和预测因素Chengsi Li, Tianyu Wang, Dongwei Wu, Haichuan Guo, Zhenbang Yang, Xinqun Cheng, Yanbin Zhu, Yingze Zhang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004047
摘要
致编辑：腓骨近端截骨术（PFO）已成为一种微创、保膝手术，用于治疗轻度至中度内侧骨关节炎（KOA），比胫骨高位截骨术（HTO）恢复更快，并发症更少；[
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隐性负担：膀胱癌患者偶发前列腺癌的临床影响Junyong Ou, Kunming Ni, Haodong Song, Gengwu Li, Yi Huang, Guoliang Wang, Lulin Ma, Jianfei Ye, Shudong Zhang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004031
摘要
致编辑：膀胱癌(Bca)是世界范围内最常见的尿路恶性肿瘤。[
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肺腺癌的免疫逃逸机制Xiangtao Mao, Yong Yang, Rong Fu, Guoping Zheng, Hailong Wang, Min Pang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003539
摘要
致编辑：肺癌多年来一直是全球癌症相关死亡的主要原因，估计2020年发生了220万例新肺癌病例和180万例肺癌相关死亡。[
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心房颤动新亚组的预后和预期寿命Yuefeng Yu, Jiang Li, Ying Sun, Bowei Yu, Xiao Tan, Bin Wang, Yingli Lu, Ningjian Wang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000004044
摘要
致编辑：心房颤动（AF）是最常见的持续性心律失常，全球约有5970万人受到影响，患者数量还在上升。[
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经颅交流电刺激调节睡眠的疗效及参数选择Ruike Sun, Yuqing Xie, Xin Tian, Yuexia Hu, Huixian Li, Yun Li, Yuhan Chen, Zhiwei Guo, Sheyu Li, Yanyan Wang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003997
摘要
致编辑：经颅交流电刺激（tACS）是一种非侵入性脑刺激（NIBS）技术，通过放置在头皮上的电极将特定频率（赫兹）的低强度正弦交流电输送到目标脑区域来改变人类的神经活动和行为。[
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使用第五代无线蜂窝技术和专用互联网线路进行跨洲手术的远程手术可行性：一项试点研究Qingbo Huang, Ye Wang, Zhi Li, Alberto Breda, Richard Pierre Gaston, Vito Pansadoro, Giuseppe Simone, Yibo Chen, Songliang Du, Yu Gao 等
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003945
摘要
致编辑：远程手术代表了医疗技术的一个有前途的进步，允许熟练的外科医生远程执行复杂的程序。通过利用第五代移动通信技术（5G）等高速互联网基础设施，远程手术有可能克服地理限制，扩大获得专家手术护理的机会。然而，其成功实施取决于几个关键因素，包括稳定、低延迟的数据传输、可靠的网络性能以及长距离保持手术精度的能力。帕特尔等人[
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代谢组学分析揭示COPD前期不同的代谢模式和潜在的循环生物标志物Xiaoxia Ren, Junling Pang, Ruoxi He, Junchao Jiang, Zaiyong Wang, Yanyan Xu, Sheng Xie, Ting Yang, Jing Wang, Chen Wang
中华医学杂志英文版2026年 139卷 10期
DOI: 10.1097/CM9.0000000000003532
摘要
致编辑慢性阻塞性肺病(COPD)是一种常见的、可预防的和可治疗的肺部病症，其特征在于气道和/或肺泡的慢性炎症后气道的进行性阻塞。肺活量测定法定义的COPD的患病率，其特征是支气管扩张剂后一秒用力呼气量/用力肺活量1/FVC）比率<0.7在≥40岁的成人中，在中国肺部健康（CPH）研究中估计为13.7%。[
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