2021年 · 第134卷第05期

Cardioembolic stroke (CES), also known as cardiogenic stroke, refers to a clinical syndrome caused by a cardiogenic embolus from the heart, leading to cerebral artery embolism through circulation, and it consequently results in corresponding brain dysfunction. CES is associated with greater severity, poor outcomes, and a relatively high recurrence rate, compared with other subtypes of ischemic stroke.^[1]

Psoriasis is a chronic inflammatory disease that involves complex pathogenic interactions between the innate and adaptive immune systems, affecting approximately 2% of the population. In patients with psoriasis, the incidence of several important diseases is reportedly higher than that observed in the general population. Among them, cardiovascular diseases (CVDs) are the most common cause of morbidity and mortality in patients with psoriasis. Hence, effective and safe treatments are critical in lowering cardiovascular risk in this patient group.

With the acceleration of the aging and change of work and living habits across the world, cervical spondylopathy has become more prevalent, bringing enormous economic burden and medical cost pressure to both societies and governments.^[1]At present, conservative treatment is usually used in the early stages of the condition whilst surgical intervention is employed to treat patients with severe radicular symptoms and spinal cord compression. These surgical therapies include anterior cervical spine surgery (ACSS) including both anterior cervical corpectomy and fusion, anterior cervical discectomy and fusion, and artificial cervical disc replacement, which is the most widely used technique since it was proposed in 1955.^[2]The popularity of ACSS is advantageous due to minimal trauma and low bleeding observed in patients and can directly remove the compression caused by herniated discs and osteophytes. Nevertheless, since the deep gap front cervical vertebral body is small and adjoins the trachea, the postoperative hematoma is one of the most important complications in ACSS, resulting in dyspnea and can even threaten the lives of patients.^[3]Thus, it is conventional to place a drainage tube when performing ACSS, which is conducive to emptying the bleeding from within the wound cavities and reducing the incidence of postoperative hematoma.

Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.

We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.

The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.

Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.

Models to predict mortality in trauma play an important role in outcome prediction and severity adjustment, which informs trauma quality assessment and research. Hospitals in China typically use the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to describe injury. However, there is no suitable prediction model for China. This study attempts to develop a new mortality prediction model based on the ICD-10-CM lexicon and a Chinese database.

This retrospective study extracted the data of all trauma patients admitted to the Beijing Red Cross Emergency Center, from January 2012 to July 2018 (n = 40,205). We used relevant predictive variables to establish a prediction model following logistic regression analysis. The performance of the model was assessed based on discrimination and calibration. The bootstrapping method was used for internal validation and adjustment of model performance.

Sex, age, new region-severity codes, comorbidities, traumatic shock, and coma were finally included in the new model as key predictors of mortality. Among them, coma and traumatic shock had the highest scores in the model. The discrimination and calibration of this model were significant, and the internal validation performance was good. The values of the area under the curve and Brier score for the new model were 0.9640 and 0.0177, respectively; after adjustment of the bootstrapping method, they were 0.9630 and 0.0178, respectively.

The new model (China Mortality Prediction Model in Trauma based on the ICD-10-CM lexicon) showed great discrimination and calibration, and performed well in internal validation; it should be further verified externally.

The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels. The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion, possibly due to the circadian rhythm in urinary excretion. This study aimed to explore the circadian rhythm, characteristics, and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches.

Eighty-five participants (mean age 32.4 years) completed the 24-h urine collection by successively collecting each of the single-voided specimens within 24 h. The concentrations of the urinary sodium, potassium, and creatinine for each voided specimen were measured. Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium, potassium, and creatinine excretion. The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model.

The metabolism of urinary sodium, potassium, and creatinine showed different patterns of circadian rhythm, although the urinary sodium excretion showed non-significant parameters in the cosinor model. A significant circadian rhythm of urinary creatinine excretion was observed, while the circadian rhythm of sodium was less significant than that of potassium. The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent, which had a nocturnal peak and fell to the lowest around noon to afternoon. In contrast, the peak of potassium was observed in the morning and dropped to the lowest point in the evening. The hourly urinary excretion followed a similar circadian rhythm.

It is necessary to consider the circadian rhythm of urinary sodium, potassium, and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.

Breast cancer (BC) is a common malignancy with highly female incidence. So far the function of notoginsenoside R1 (NGR1), the extract from Panax notoginseng, has not been clearly elucidated in BC.

Optimal culture concentration and time of NGR1 were investigated by cell counting kit-8 assay. Cell proliferation ability was measured by colony formation assays. Transwell assay was used to detect the effect of NGR1 on cell migration and invasion. The apoptosis rate of cells between each group was measured by TUNEL assay.

NGR1 treatment has an inhibitory effect on proliferation, migration, invasion, and angiogenesis and a stimulating effect on cell cycle arrest and apoptosis of Michigan Cancer Foundation-7 (MCF-7) cells. The 50% growth inhibitory concentration for MCF-7 cells at 24 h was 148.9 mmol/L. The proportions of MCF-7 cells arrested in the G0/G1 phase were 36.94±6.78%, 45.06 ± 5.60%, and 59.46±5.60% in the control group, 75, and 150 mmol/L groups, respectively. Furthermore, we revealed that NGR1 treatment attenuates BC progression by targeted downregulating CCND2 and YBX3 genes. Additionally, YBX3 activates phosphatidylinositol 3-phosphate kinase (PI3K)/protein kinase B (Akt) signaling pathway by activating kirsten rat sarcoma viral oncogene, which is an activator of the PI3K/Akt signaling pathway.

These results suggest that NGR1 can act as an efficacious drug candidate that targets the YBX3/PI3K/Akt axis in patients with BC.

The incidence of chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA) has increased in the last two decades. The mechanism underpinning susceptibility to and high mortality of COPD complicated with IPA is unclear, and the role of T helper cells 17 (Th17 cells) in the compound disease remains unknown. Therefore, this study aimed to assess the function of Th17 cells in COPD combined with IPA.

COPD, IPA, and COPD+IPA mouse models were established in male wild type C57/BL6 mice. The amounts of Th17 cells and retinoic acid-related orphan receptors γt (RORγt) were tested by flow cytometry. Then, serum interleukin (IL)-17 and IL-23 levels were detected by enzyme-linked immunosorbent assay (ELISA) in the control, COPD, IPA and COPD+IPA groups. In addition, COPD+IPA was induced in IL-17 knockout (KO) mice, for determining the role of Th17 cells in COPD+IPA.

Compared with the COPD group, the COPD+IPA group showed higher amounts of blood RORγt ([35.09 ± 16.12]% vs. [17.92 ± 4.91]%, P = 0.02) and serum IL-17 (17.96 ± 9.59 pg/mL vs. 8.05 ± 4.44 pg/mL, P = 0.02), but blood ([5.18 ± 1.09]% vs. [4.15 ± 0.87]%, P= 0.28) and lung levels of Th17 cells ([1.98 ± 0.83]% vs. [2.03 ± 0.98]%, P= 0.91), lung levels of RORγt ([9.58 ± 6.93]% vs. [9.63 ± 5.98]%, P = 0.49) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 68.70 ± 15.20 pg/mL, P = 0.15) showed no significant differences. Compared with the IPA group, the COPD+IPA group displayed lower amounts of blood ([5.18 ± 1.09]% vs. [9.21 ± 3.56]%, P = 0.01) and lung Th17 cells ([1.98 ± 0.83]% vs. [6.29 ± 1.11]%, P = 0.01) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 154.90 ± 64.60 pg/mL, P = 0.01) and IL-17 (17.96 ± 9.59 pg/mL vs. 39.81 ± 22.37 pg/mL, P = 0.02), while comparable blood ([35.09 ± 16.12]% vs. [29.86 ± 15.42]%, P = 0.25) and lung levels of RORγt ([9.58 ± 6.93]% vs. [15.10 ± 2.95]%, P = 0.18) were found in these two groups. Finally, Aspergillus load in IL-17 KO COPD+IPA mice was almost 2 times that of COPD+IPA mice (1,851,687.69 ± 944,480.43 vs. 892,958.10 ± 686,808.80, t= 2.32, P = 0.02).

These findings indicate that Th17 cells might be involved in the pathogenesis of COPD combined with IPA, with IL-17 likely playing an antifungal role.

The pathogenesis of osteosarcoma (OS) is still unclear, and it is still necessary to find new targets and drugs for anti-OS. This study aimed to investigate the role and mechanism of the anti-OS effects of miR-296-5p.

We measured the expression of miR-296-5p in human OS cell lines and tissues. The effect of miR-296-5p and its target gene staphylococcal nuclease and tudor domain containing 1 on proliferation, migration, and invasion of human OS lines was examined. The Student’s t test was used for statistical analysis.

We found that microRNA (miR)-296-5p was significantly downregulated in OS cell lines and tissues (control vs. OS, 1.802 ± 0.313 vs. 0.618 ± 0.235, t= 6.402, P < 0.01). Overexpression of miR-296-5p suppressed proliferation, migration, and invasion of OA cells. SND1 was identified as a target of miR-296-5p by bioinformatic analysis and dual-luciferase reporter assay. Overexpression of SND1 abrogated the effects induced by miR-296-5p upregulation (miRNA-296-5p vs. miRNA-296-5p + SND1, 0.294 ± 0.159 vs. 2.300 ± 0.277, t= 12.68, P = 0.003).

Our study indicates that miR-296-5p may function as a tumor suppressor by targeting SND1 in OS.

Cerebral venous sinus thrombosis (CVST) is a rare disease involving thrombosis of the cerebral veins and sinuses. Severe consequences may occur if CVST is not treated promptly and appropriately, including intracranial hypertension and cerebral venous infarcts due to venous block that can cause epilepsy, severe neurological morbidity, or even death.^[1]

This study investigated the effect of liraglutide (an analog of human glucagon-like peptide-1 [GLP-1]) on the proliferation of Ishikawa (IK) and human endometrial carcinoma (HEC)-1B endometrial cancer (EC) cell lines, identified whether liraglutide enhances the anti-tumor effect of progesterone, and explored the role of liraglutide in progesterone receptor (PGR) expression in EC cell lines and potential pathways.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive form of peripheral T-cell lymphoma (PIT) associated with poor prognosis. It is characterized by lymph node enlargement, B symptoms (unexplained recurrent fevers (often above 38°C), night sweats, and unexplained weight loss of more than 10% within 6 months), polyclonal hypergammaglobulinemia, and autoimmune hemolysis.^[1]C-reactive protein (CRP) synthesized by hepatocytes is an acute-phase protein and an important marker of systemic inflammation. Serum CRP level is not only an independent prognostic factor in Hodgkin lymphoma but also an important independent predictor of AITL. Meanwhile, albumin (ALB) is used for nutrition assessment and acts as an anti-acute phase protein. The plasma concentration of ALB decreases during inflammation and bacterial infection. The Glasgow prognostic score (GPS), consisting of ALB and CRP levels, has been studied in several common solid tumors, including hepatocellular carcinoma, colorectal cancer, and renal cell carcinoma.^[2]However, the value of GPS in the realm of AITL is unclear. On the other hand, the prognosis index for PIT has been widely used to evaluate the prognosis of various types of T-cell non-Hodgkin lymphoma. Therefore, we conducted a retrospective cohort study to explore the prognostic value of GPS and to compare the prognostic significance of GPS and PIT models in patients with AITL.

To the Editor:Stroke is a sudden attack of disturbance of cerebral blood circulation; its incidence is getting higher and higher, and it has become the second most common cause of death, the fourth leading cause of loss of productivity, and the main cause of disability of people all over the world,^[1,2]which has caused very serious pressure and burden on the social economy and public health. Although intravenous thrombolysis (IVT) with alteplase has been recognized as the first scheme for acute ischemic stroke within 4.5 h of onset,^[3,4]there are still many patients who do not benefit from it and it lead to serious complications. Nowadays, endovascular thrombectomy (EVT) for acute ischemic stroke has also become a part of the standard treatment for patients with acute ischemic stroke complicated with large-vessel occlusion. However, it is still controversial whether to use alteplase intravenous thrombolysis before EVT in patients with acute ischemic stroke within 4.5 h of onset. Many epidemiological studies have shown that patients have no significant benefit from bridging endovascular thrombectomy compared with direct EVT (dEVT),^[4]while other studies have shown the opposite results.^[3]

To the Editor: Idiopathic pulmonary fibrosis (IPF) is a kind of lung disease characterized by chronic and progressive pulmonary fibrosis with unknown etiology, whose pathological manifestation is usual interstitial pneumonia.^[1]However, the prognosis of IPF was still poor, and the median survival time after diagnosis was about 2 to 3 years.^[2]Therefore, it seems important to seek and develop an effective therapeutic modality for IPF. Through base pairs of intramolecular complementary sequences of messenger RNA (mRNA), microRNA (miRNA) plays a key role in RNA silencing and post-transcriptional gene expression regulation.^[3]Each miRNA can have multiple target genes and several miRNAs can co-regulate one gene. They also play an important role in organ fibrosis, especially in IPF, and the role may be related to the pathogenesis of the disease.^[4,5]Construction of potential miRNA-mRNA regulatory network of IPF will help to reveal more comprehensive molecular mechanism of miRNAs in IPF.

To the Editor: Since the outbreak of coronavirus disease 2019 (COVID-19), a large number of healthcare workers (HCWs) volunteered to leave their familiar working and living environments to travel to Hubei province to undertake emergency response work. For most medical workers who traveled to Hubei province, this was their first time participating in such a crisis situation. Previous studies have reported that HCWs face a double blow of high-intensity work and high psychological pressure, making them particularly prone to mental health difficulties.^[1]Moreover, there were no psychological emergency prevention plans for the medical personnel in areas affected by the epidemic, potentially having a significant impact on the physical and mental health of medical staff. In the current study, we investigated the mental health of HCWs sent to Hubei province from Shanxi during the COVID-19 outbreak. In addition, we analyzed the stress factors affecting HCWs, and the methods they utilized for emotional adjustment and coping.

To the Editor:Since December 2019, the epidemic of coronavirus disease 2019 (COVID-19) has become the focus of attention in China and worldwide. Despite the effective control of the outbreak in China, the global situation of COVID-19 was not optimistic which has gradually become a global threat of the year 2020. COVID-19 may cause high mortality in the elderly and patients with cardiovascular diseases, malignant tumors, and other underlying diseases.^[1]Breast cancer is the main cause of death from cancer in women.^[2]Patients who are diagnosed with breast cancer often have low immunity and need to undergo long-term anti-tumor treatment. Therefore, this population may have a high risk of COVID-19 infection and death. In addition, during the COVID-19 epidemic, tumor patients cannot go to the hospital in time for the diagnosis and treatment as a result of traffic control and the high risk of hospital infection, which might lead to adverse effects on prognosis.

To the Editor:Diabetic retinopathy (DR) is a condition characterized by retinal microvascular damages of diabetes mellitus. As the primary cause of blindness in adults, DR has already become a public health problem worldwide and threatens the outcomes of diabetic patients and even healthy population. The correlation between DR and common anthropometric measurements represented by body mass index (BMI) was still controversial.^[1]Another basic anthropometric index also calculated by height and weight, body surface area (BSA) could more accurately reflect the size of body, and distinguish adipose or muscle tissues.^[2]In addition, previous research considered that adipokines secreted from adipose tissue might play an important role in the mechanism of obesity and type 2 diabetes. The level of adiponectin decreased in obese people and lower adiponectin might cause insulin resistance and diabetes.^[3]We firstly investigated the relationship between BSA and DR in Chinese type 2 diabetic patients, and compared it with BMI. The study was approved by the Institutional Review Board of the First Affiliated Hospital of China Medical University (AF-SOP-07-1.1-01/2019-13). Written informed consent was obtained for the entire study population included in this study.

To the Editor: Compared with the majority of reduced-size liver transplantations (RSLTs) performed in pediatric recipients,^[1,2,3]the experience of RSLTs in adult recipients and surgical strategies for the reduction of grafts are relatively unfamiliar. Herein, we report a successful case of adult-to-adult RSLT, in which a unique method for removing the right posterior sector while preserving the right hepatic vein (RHV) was performed. This study was approved by the West China Hospital Ethics Committee (No. 2019-718) and was conducted in accordance with the ethical guidelines of theDeclaration of Helsinki.

To the Editor:Biliary atresia (BA) is a biliary obstruction disease that affects the lives of infants and young children. Kasai procedure (KP) improves the outcomes of BA, but it has not successfully solved various problems of BA with postoperative inflammation of bile duct and liver fibrosis, intrahepatic bile duct cystic expansion (intrahepatic biliary cysts, IBC), portal hypertension, liver function failure,etc. As a result, most of the children still need liver transplantation (LT).^[1]In recent years, cystic dilatation of the intrahepatic bile duct, which may be an important factor of prognosis, has been paid more attention by surgeons with the development of imaging technique. This study aimed to analyze the relationship among the formation characteristics and pathological manifestations of IBC, the bilirubin level, and the time to the end-stage liver function after KP.

To the Editor: As one of the most severe vascular complications after liver transplantation (LT), early hepatic arterial thrombosis (eHAT) may lead to ischemic liver necrosis and ischemic biliary tract complications such as biliary leakage and eventually graft or patient loss.^[1]The outcome, however, can be significantly improved by early diagnosis and intervention.^[2]Satisfying intervention is achieved by revascularization, when it fails, life-saving retransplantation must be considered. Given that retransplantation is not always available because of the poor graft pool especially in eastern countries,^[1]every LT center should devote to reduce the incidence of eHAT.

To the Editor: Fecal immunochemical tests (FITs) are immunoassays that are designed to detect human hemoglobin to indicate the occurrence of colonic neoplasia, which have been widely used in global colorectal cancer (CRC) screening programs. Previous diagnostic studies demonstrated that strong gradient in site-specific sensitivity existed with typically higher rate for advanced adenoma located in distal colon/rectum than that in the proximal parts, which may be explained by the colonic transition time affecting the degradation of hemoglobin, and the shape of adenoma (pedunculated, flat, and sessile) in different anatomic regions.^[1]In addition, questionnaire-based risk assessment (QRA) using the established CRC-related risk factors has been proposed to identify high-risk populations for CRC screening.^[2]However, previous studies demonstrated that site-specific differences existed for several risk factors.^[3,4]In a CRC screening setting, whether and to what extent the FIT and QRA would affect the site-specific detection rate of colorectal neoplasia have not been evaluated. Therefore, we aimed to empirically evaluate the site-specific variations of the detection rates of adenomas for the FIT- and QRA-based screening based on a population-based CRC screening trial (TARGET-C).

To the Editor: Anemia is a very common clinical scenario, which could be caused by various kinds of diseases. Though common, sometimes it could be exceedingly difficult to find out the underlying causes of anemia, especially for complicated cases. Herein, we reported a case of an old patient with a seemingly evident cause of anemia (hematuria), who was afterward diagnosed with a rare disease of cold agglutinin (CA) disease (CAD), which was confirmed to be the main etiology of his severe anemia.