2021年 · 第134卷第19期

The role of multigene assays in chemotherapy decision-making in patients with early invasive breast cancer has been widely recognized. In 2017, the American Society of Clinical Oncology (ASCO) clinical guidelines for multigene profiling assays focused on increasing the intensity of recommendations for the clinical use of MammaPrint^®.^[1]The 8th edition of the American Joint Committee on Cancer (AJCC) staging system, officially launched in 2018, established the concept of prognostic staging for the first time, adding the use of non-anatomical information to evaluate the prognosis. Initially, Oncotype Dx^®was recommended for suitable patients based on Level I evidence. Subsequently, five testing techniques, Oncotype Dx^®, MammaPrint^®, EndoPredict^®, PAM50^®, and BCI, were formally incorporated into the system.^[2]To assist breast disease specialists in China in their selection of appropriate multigene profiling assays and detection methods for patients, and also to instill caution on decision-making with reference to multigene assays, the Chinese Society of Breast Surgery (CSBrS) has, through literature investigation and expert discussion, provided information on the key clinical problems and guidelines for the use of multigene assays, evaluating the evidence with reference to the Grades of Recommendations Assessment Development and Evaluation (GRADE) system. Combined with the availability of these assays in China, the clinical practice guidelines for multigene assays were formulated and published. The purpose of this guideline is to provide a reference for clinicians specializing in breast diseases in China.

To promote the standardization of post-mastectomy breast reconstruction in China, the Chinese Society of Breast Surgery (CSBrS) determined the key issues in post-mastectomy breast reconstruction in clinical practice through a literature review and expert discussions, and then developed the CSBrS Clinical Practice Guidelines for Post-mastectomy Breast Reconstruction (2021 version) by systematically assessing relevant published evidence according to the Grading of Recommendations Assessment, Development, and Evaluation recommendations and based on the accessibility of clinical practice in China. This guideline provides a reference for Chinese breast surgeons.

Spontaneous intracerebral hemorrhage (ICH) is a serious life-threatening event with the highest morbidity and mortality. ICH is a global burden affecting approximately 2 million people annually. It is estimated that more than one-third of ICH patients die within the first month of onset, and 40% of survivors remain disabled. However, there is an absence of evidence-proved therapies for ICH.^[1]

Risk stratification for ischemic stroke is essential for patients with atrial fibrillation (AF) before the consideration of anticoagulation therapy. According to current AF management guidelines, about 90% of AF patients should receive anticoagulation therapy, and risk of stroke death in AF patients was around 68%. It is thus of importance to precisely define the patients who are in urgent need of anticoagulation therapy. In this context, study results from Maet al^[1]published in this issue could be helpful to precisely define the AF patients who are at real risk of stroke. The study aims to develop an accurate and easy-to-use predictive model for the 1-year risk of thromboembolic events (TEs), including ischemic stroke and systemic embolic events, in Chinese patients with AF.

Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients.

From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA₂DS₂-VA score (excluding female sex from the CHA₂DS₂-VASc score).

Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval [CI]: 0.41%-1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65-0.73), higher than that of CHA₂DS₂-VA score (0.66, 95% CI: 0.62-0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA₂DS₂-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%-15.7%).

In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA₂DS₂- VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making.

www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729).

Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.

We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e’) ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e’ were assessed by combination, grouping, and trend analyses.

Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e’ elevation. A multivariate analysis revealed FMR and E/e’ as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ² = 7.672, P = 0.006) and between the E/e’ ≥ 14 and E/e’ < 14 groups (χ² = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ² = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e’ ≥ 14 with FMR) compared with groups 1 (E/e’ < 14 without FMR) and 2 (E/e’ < 14 with FMR) (P = 0.001 and 0.046, respectively).

Patients with shock can be identified by the presence of FMR. FMR and E/e’ are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e’ ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e’.

ClinicalTrials.gov, NCT03082326.

Existing clinical prediction models for in vitro fertilization are based on the fresh oocyte cycle, and there is no prediction model to evaluate the probability of successful thawing of cryopreserved mature oocytes. This research aims to identify and study the characteristics of pre-oocyte-retrieval patients that can affect the pregnancy outcomes of emergency oocyte freeze-thaw cycles.

Data were collected from the Reproductive Center, Peking University Third Hospital of China. Multivariable logistic regression model was used to derive the nomogram. Nomogram model performance was assessed by examining the discrimination and calibration in the development and validation cohorts. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration plots.

The predictors in the model of "no transferable embryo cycles" are female age (odds ratio [OR] = 1.099, 95% confidence interval [CI] = 1.003-1.205, P = 0.0440), duration of infertility (OR = 1.140, 95% CI = 1.018-1.276, P = 0.0240), basal follicle-stimulating hormone (FSH) level (OR = 1.205, 95% CI = 1.051-1.382, P = 0.0084), basal estradiol (E2) level (OR = 1.006, 95% CI = 1.001-1.010, P = 0.0120), and sperm from microdissection testicular sperm extraction (MESA) (OR = 7.741, 95% CI = 2.905-20.632, P < 0.0010). Upon assessing predictive ability, the AUC for the "no transferable embryo cycles" model was 0.799 (95% CI: 0.722-0.875, P < 0.0010). The Hosmer-Lemeshow test (P = 0.7210) and calibration curve showed good calibration for the prediction of no transferable embryo cycles. The predictors in the cumulative live birth were the number of follicles on the day of human chorionic gonadotropin (hCG) administration (OR = 1.088, 95% CI = 1.030-1.149, P = 0.0020) and endometriosis (OR = 0.172, 95% CI = 0.035-0.853, P = 0.0310). The AUC for the "cumulative live birth" model was 0.724 (95% CI: 0.647-0.801, P < 0.0010). The Hosmer-Lemeshow test (P = 0.5620) and calibration curve showed good calibration for the prediction of cumulative live birth.

The predictors in the final multivariate logistic regression models found to be significantly associated with poor pregnancy outcomes were increasing female age, duration of infertility, high basal FSH and E2 level, endometriosis, sperm from MESA, and low number of follicles with a diameter >10 mm on the day of hCG administration.

Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.

Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.

After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).

In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.

Age-related macular degeneration (AMD) is the leading cause of vision loss worldwide. However, the mechanisms involved in the development and progression of AMD are poorly delineated. We aimed to explore the critical genes involved in the progression of AMD.

The differentially expressed genes (DEGs) in AMD retinal pigment epithelial (RPE)/choroid tissues were identified using the microarray datasets GSE99248 and GSE125564, which were downloaded from the gene expression omnibus database. The overlapping DEGs from the two datasets were screened to identify DEG-related biological pathways using gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. The hub genes were identified from these DEGs through protein-protein interaction network analyses. The expression levels of hub genes were evaluated by quantitative real-time polymerase chain reaction following the induction of senescence in ARPE-19 with FK866. Following the identification of AMD-related key genes, the potential small molecule compounds targeting the key genes were predicted by PharmacoDB. Finally, a microRNA-gene interaction network was constructed.

Microarray analyses identified 174 DEGs in the AMD RPE compared to the healthy RPE samples. These DEGs were primarily enriched in the pathways involved in the regulation of DNA replication, cell cycle, and proteasome-mediated protein polyubiquitination. Among the top ten hub genes, HSP90AA1, CHEK1, PSMA4, PSMD4, and PSMD8 were upregulated in the senescent ARPE-19 cells. Additionally, the drugs targeting HSP90AA1, CHEK1, and PSMA4 were identified. We hypothesize that Hsa-miR-16-5p might target four out of the five key DEGs in the AMD RPE.

Based on our findings, HSP90AA1 is likely to be a central gene controlling the DNA replication and proteasome-mediated polyubiquitination during the RPE senescence observed in the progression of AMD. Targeting HSP90AA1, CHEK1, PSMA4, PSMD4, and/or PSMD8 genes through specific miRNAs or small molecules might potentially alleviate the progression of AMD through attenuating RPE senescence.

A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.

We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V₁-₆) to detect patients with serum potassium concentrations <3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University. The blood draw was completed within 10 min before and after the ECG examination, and there was no new or ongoing infusion during this period.

We used 6904 ECGs and 1726 ECGs as development and internal validation data sets, respectively. In addition, 1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets. Using 12 ECG leads (leads I, II, III, aVR, aVL, aVF, and V₁-₆), the area under the receiver operating characteristic curve (AUC) of the DLM was 0.80 (95% confidence interval [CI]: 0.77-0.82) for the internal validation data set. Using an optimal operating point yielded a sensitivity of 71.4% and a specificity of 77.1%. Using the same 12 ECG leads, the external validation data set resulted in an AUC for the DLM of 0.77 (95% CI: 0.75-0.79). Using an optimal operating point yielded a sensitivity of 70.0% and a specificity of 69.1%.

In this study, using 12 ECG leads, a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80. Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.

Emerging evidence indicates that the sineoculis homeobox homolog 1-eyes absent homolog 1 (SIX1-EYA1) transcriptional complex significantly contributes to the pathogenesis of multiple cancers by mediating the expression of genes involved in different biological processes, such as cell-cycle progression and metastasis. However, the roles of the SIX1-EYA1 transcriptional complex and its targets in colorectal cancer (CRC) are still being investigated. This study aimed to investigate the roles of SIX1-EYA1 in the pathogenesis of CRC, to screen inhibitors disrupting the SIX1-EYA1 interaction and to evaluate the efficiency of small molecules in the inhibition of CRC cell growth.

Real-time quantitative polymerase chain reaction and western blotting were performed to examine gene and protein levels in CRC cells and clinical tissues (collected from CRC patients who underwent surgery in the Department of Integrated Traditional and Western Medicine, West China Hospital of Sichuan University, between 2016 and 2018, n = 24). In vivo immunoprecipitation and in vitro pulldown assays were carried out to determine SIX1-EYA1 interaction. Cell proliferation, cell survival, and cell invasion were determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, clonogenic assay, and Boyden chamber assay, respectively. The Amplified Luminescent Proximity Homogeneous Assay Screen (AlphaScreen) method was used to obtain small molecules that specifically disrupted SIX1-EYA1 interaction. CRC cells harboring different levels of SIX1/EYA1 were injected into nude mice to establish tumor xenografts, and small molecules were also injected into mice to evaluate their efficiency to inhibit tumor growth.

Both SIX1 and EYA1 were overexpressed in CRC cancerous tissues (for SIX1, 7.47 ± 3.54 vs.1.88 ± 0.35, t = 4.92, P = 0.008; for EYA1, 7.61 ± 2.03 vs. 2.22 ± 0.45, t = 6.73, P = 0.005). The SIX1/EYA1 complex could mediate the expression of two important genes including cyclin A1 (CCNA1) and transforming growth factor beta 1 (TGFB1) by binding to the myocyte enhancer factor 3 consensus. Knockdown of both SIX1 and EYA1 could decrease cell proliferation, cell invasion, tumor growth, and in vivo tumor growth (all P < 0.01). Two small molecules, NSC0191 and NSC0933, were obtained using AlphaScreen and they could significantly inhibit the SIX1-EYA1 interaction with a half-maximal inhibitory concentration (IC₅₀) of 12.60 ± 1.15 μmol/L and 83.43 ± 7.24 μmol/L, respectively. Administration of these two compounds could significantly repress the expression of CCNA1 and TGFB1 and inhibit the growth of CRC cells in vitro and in vivo.

Overexpression of the SIX1/EYA1 complex transactivated the expression of CCNA1 and TGFB1, causing the pathogenesis of CRC. Pharmacological inhibition of the SIX1-EYA1 interaction with NSC0191 and NSC0933 significantly inhibited CRC cell growth by affecting cell-cycle progression and metastasis.

Since the discovery of neuraxial blockade, spinal anesthesia has been frequently used for cesarean section. According to an international consensus statement on hypotension management, Kinsellaet al^[1]reported the incidence of post-spinal anesthesia hypotension in parturient women to be as high as 70% to 80%. Post-spinal anesthesia hypotension is mainly caused by sympathetic vasomotor block, which results in reduced systemic vascular resistance, venous pooling in capacitance vessels, and decreased cardiac output. Severe hypotension may lead to maternal and fetal adverse events. Undesirable maternal hypotension may contribute to reduced uterus blood flow resulting in decreased placental perfusion and fetal hypoxia leading to acute fetal acidosis. Pregnant women having a positive preoperative stress test were associated with an increased risk of post-spinal anesthesia hypotension during cesarean delivery.^[2]However, the sensitivity of the stress test for predicting post-spinal anesthesia hypotension was only 69%.^[2]In clinical practice, non-invasive, reliable, and readily available techniques are still much in need to predict the incidence of hypotension after spinal anesthesia as well as to improve the management of spinal anesthesia-induced hypotension for cesarean delivery.

Aplastic anemia (AA) is a bone marrow failure syndrome that can be classified as either congenital or acquired AA. Most cases of acquired AA are idiopathic, in which the abnormal immune system attacks bone marrow hematopoietic stem cells and their microenvironment.^[1]Some AA is secondary to radiotherapy and/or chemotherapy. However, most of the cytopenia can recover within 1 to 2 months after stopping the chemoradiotherapy, because bone marrow suppression therapies are devised to be reversible. Even though, some patients fail to recover from the hematopoiesis after more than 3 therapy-free months. These patients, who were diagnosed as AA after careful workup, were unable to continue with their planned chemoradiotherapy, and sometimes suffered from or died of infections or bleeding caused by severe cytopenia, or relapse from the primary tumors. The extensive use of bone marrow suppression therapy in patients with malignant tumors has been associated with an increase in therapy-related AA. Unfortunately, there are currently no guidelines or consensus on the management of these patients. In this study, we explored the efficacy and safety of cyclosporine A (CsA) in these patients.

Ventricular puncture is a common neurosurgical procedure, which is usually performed freehand using body surface anatomic landmarks as targeting references.^[1,2]However, it is reported that the failure rate of freehand lateral ventricle puncture could be as high as 43% in traumatic brain injury cases if body surface anatomic landmarks are used as targeting references,^[3]and the occurrence of hemorrhages associated with ventricular puncture could reach 16.2%.^[4]Classic puncture sites, such as Kocher point, are helpful in improving the success rate of ventricular puncture. However, it is still risky to perform freehand puncture with classic puncture sites. Several causes could lead to this issue, including the following: (1) Individual patients have different conditions; a puncture approach suitable for all patients might not be possible. (2) Selection of puncture approach is largely dependent on the judgment of the surgeon, because the puncture approach does not usually fall on the coronal, sagittal, or axial images of the regular computed tomography (CT) scan; surgeons need to use spatial imagination based on CT images to design the ventricular puncture trajectory (VPT), which could lead to errors. (3) In freehand puncture, directional deviations could occur easily without the guidance of a frame as a fixed space reference to the puncture path.

Surgical robots have been widely used in surgery. Currently, the da Vinci Surgical System (Intuitive Surgery, Inc., Sunnyvale, CA, USA) is the most common robotic system used in the clinical setting. This system has proven useful for lesions in occult positions, such as tumors at the base of the tongue, ranulas, and submandibular lithiases. It is less traumatic compared to traditional open surgical procedures; however, its suitability for punctures remains debatable. Remebot (Beijing Baihui Weikang Technology Co., Ltd.; Beijing, China) is a surgical robot that is currently being used for neurosurgical procedures. Based on the intra-operational navigation, it can aid the surgeon with both the direction and depth of puncture, simultaneously. Although it can reportedly achieve an accuracy of 1.330 ± 0.566 mm^[1]in biopsy operations, the same has not been reported in the field of oral and maxillofacial surgery. Therefore, in order to verify the feasibility of using a robot in oral and maxillofacial surgery, we chose to puncture the foramen ovale (FO) and foramina stylomastoideum (FS) in the present study.

To the Editor:Since 1027, when the Tian Sheng Bronze Statue showing acupoints and meridians was first introduced for medical practitioners, it has evolved to the currently used acupoints and meridians atlas in traditional Chinese medicine (TCM).^[1]To date, the acupoints represent defined areas on the body surface relative to certain landmarks. The acupoints in the extremity endings would connect anatomically with diverse associated visceral organs or tissues, forming a Meridian and Collateral network. Illustrated on the atlas, each main meridian is usually a virtual line connecting a group of adjacent acupoints that correlate with certain visceral organ. In modern medical science, the anatomical structures of main meridians remain largely unclarified.

To the Editor: Lipomatous neoplasms with spindle cell components and atypical features are rare soft tissue tumors. Atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLPS) is one of the most common liposarcomas withMDM2(12q13-15) gene amplification. However, recently, some studies have suggested that unique lipomatous tumors named "atypical spindle cell lipomatous tumor" (ASLT) and atypical pleomorphic lipomatous tumor (APLT) should be distinguished from WDLPS because they have a better prognosis.^[1,2]ASLT and APLT are tumors withRB1gene deletions and the same chromosomal alterations as classical spindle cell lipoma (SCL)/pleomorphic lipoma.^[2]The latest edition of the "World Health Organization Classification of Tumors of Soft Tissue and Bone, fifth edition" formally introduced the names of ASLT/APLT^[3]; these tumors are rare among Chinese patients, and only a few small series of cases have been reported in Asia.

To the Editor: Sertoli-Leydig cell tumors (SLCTs) are a rare type of sex cord-stromal tumor of the ovary, accounting for <0.5% of all ovarian tumors.^[1]An accurate diagnosis and the knowledge of prognosis based on clinical and pathological features have important therapeutic implications; however, the rarity of SLCT renders collecting reliable data difficult. We aimed to analyze the features of SLCTs to clarify their relationship with the behavior of the tumor and explore reasonable modes of therapy.

To the Editor: Aging is associated with kidney dysfunction and an increased risk of cardiovascular disease. The connection between the cardiovascular system and kidney function is apparent, even in the early stage of renal insufficiency. Cystatin C (CYSC), one of the cystatin superfamily that is expressed in all the nucleated cells, was considered to be one of the best indicators for evaluating renal function.^[1]CYSC is a potent inhibitor of cathepsin B (CTSB), which is strictly regulated by CYSC in extracellular matrix remodeling. Imbalances between CYSC and CTSB are connected with atherosclerosis (AS), coronary heart disease, and chronic kidney disease with aging-related phenotypes. Our previous study confirmed that serum CTSB levels were associated with age and decreased cardiovascular-renal functions in healthy adults,^[2]suggesting that CTSB exhibits heightened sensitivity to changes in cardiovascular and glomerular function. The present investigation, underlining the role of synthetic and degradative pathways in the aging process, emphasizes that cardio-renal interaction with aging could depend partly on differential expression of some genes leading to an imbalance of functional proteins. In this study, we analyzed the association between renal function, measured by CYSC and estimated glomerular filtration rate (eGFR), and vascular parameters in a healthy Chinese population.

To the Editor: Bone marrow mesenchymal stem cells (BMSCs) are the most studied adult stem cells. However, the deficiencies of BMSCs still remain, such as their low purification rate, limited number, and trauma to the human body. In recent years, some studies have demonstrated that some cells in the adipose tissue extracts bear a similar function to BMSCs, the potential to differentiate into various tissues, known as adipose-derived stem cells (ADSCs).^[1]Compared with BMSCs, ADSCs possess the advantages of a wider range of sources, easier collection, less pain for patients, rapid proliferation, no immune rejection, and no moral and ethical issues involved. At present, the studies on ADSCs are mostly limited to lower mammals, such as rabbits and mice, and the experimental research reports on primates are less. Primates have similar anatomical and physiological features to humans, which has become a popular option for many animal experiments.^[2]The purpose of this study was to explore the isolation method and potential multipotent differentiation of ADSCs derived from macaquesin vitro, providing the experimental data and new insights for primate ADSCs in regenerative medicine.

To the Editor: According to the data from the National Health and Nutrition Examination Survey (2007-2010), the prevalence of kidney stones in the United States (US) population is 8.8%.^[1]A prior US population study has found that the prevalence of kidney stones increases with obesity, diabetes, and metabolic syndrome; for individuals with type 2 diabetes, the severity of disease is associated with a greater risk of kidney stones.^[1,2]Choiet al^[3]reported that a diagnosis of diabetes was a significant predictive risk factor for failure of spontaneous stone passage (SSP) possibly secondary to ureteral edema and those diabetic patients should be considered for candidates for more invasive treatment. However, this study included only 26 diabetic patients, and only 31 of 366 patients failed to spontaneously pass their stones both of which may limit the power to predict SSP of diabetes.^[3]This is an important question to answer given the volume of stones in the US and the consequences of changes in SSP rates between patient groups. Therefore, through a retrospective analysis of the database of emergency renal colic visits in Cleveland Clinic Foundation, we evaluate the association of diabetes on SSP and investigated the predictive factors of SSP in diabetic patients.

To the Editor: As the prevalence of stroke in the general population is two to three times less than among patients with type 2 diabetes mellitus (T2DM), among whom stroke accounts for 11.0% of all deaths, stroke is clearly a major macrovascular complication that increases the mortality and morbidity of patients with T2DM.^[1]The pathophysiology of stroke consists of complicated processes involving oxidative stress, endothelial dysfunction, and pro-inflammatory response. CD36 is a B scavenger receptor that is involved in inflammation, innate immunity, and lipid metabolism and has been implicated in the pathophysiology of atherosclerosis.^[2]However, there is no study evaluating the effect of CD36 polymorphism in patients with T2DM according to disease duration. Therefore, the present study evaluates the association between the rs1761667 CD36 single nucleotide polymorphism (SNP) and stroke in Korean patients with T2DM according to disease duration.

To the Editor: Hepatitis B virus (HBV) infection is a major global health problem associated with liver-related morbidity and mortality. Chronic HBV infection, defined as hepatitis B surface antigen (HBsAg) positivity, affecting approximately 257 million people worldwide. Chronic infection with HBV may result in the development of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Liver transplantation (LT) remains the only curative treatment for HBV-related end-stage liver diseases.^[1]

To the Editor: The global trend of an aging population and an epidemic of coronary heart diseases (CHDs) have led to an increasing volume of non-cardiac surgeries in patients with CHDs.^[1,2]Drastic fluctuation of hemodynamic parameters can be life-threatening for CHD patients with little tolerance to the increased cardiac load and decreased oxygen delivery.^[3]Residual paralysis of muscle relaxation after general anesthesia may lead to hypoxemia with respiratory muscle weakness and aggravate the patient’s tension. The cholinesterase inhibitor neostigmine is routinely used to reverse the neuromuscular blockade (NMB) after surgeries under general anesthesia. However, the combined use of neostigmine and atropine in patients with CHD may be potentially problematic because of side effects, such as myocardial ischemia, cardiac arrhythmia, or atrioventricular block.^[4]Sugammadex is a new NMB reversal that is selective for steroidal muscle relaxants, particularly rocuronium. However, the effect of sugammadex on the recovery profiles of CHD patients has not been fully elucidated.

To the Editor: Gut microbiota, the trillions of microbes living in the human and rodent gut, play a pivotal role in cardiovascular diseases, including hypertension and atherosclerosis. One of the crucial mechanisms underlying gut microbiota functions in cardiovascular diseases is the microbiota-derived metabolites such as short-chain fatty acids (SCFAs). And emerging evidence demonstrated gut microbiota-derived metabolites -- SCFAs maintained stable blood pressure.^[1]However, there is no large cohort study on the correlation of SCFAs with hypertension.