2021年 · 第134卷第21期

The two major goals of common disease genetics research have been dissection of the aetiopathogenesis of common diseases, and the development of genetic predictors or diagnostic tools of disease. The former goal has clearly been successfully achieved, with successes in genomics driven repositioning of therapeutic agents (e.g. of interleukin [IL]-17/23 inhibition into psoriasis and ankylosing spondylitis based on genome-wide association study [GWAS] findings, particularly of association of IL-23 receptor variants with those diseases^[1,2]), and in ongoing drug development programs informed by GWAS associations.^[3]Early hopes that GWAS-associations would prove useful as diagnostic tests were not realised, because GWAS demonstrated that common disease heritability is truly polygenic, with very large numbers (likely thousands to tens of thousands) of genetic variants involved, each contributing a small fraction of the total genetic effect on the disease.^[4]The recent development of approaches that combine findings across the genome has revolutionised this field though,^[5]and will in turn have major effects on the practice of medicine. In this paper we review what polygenic risk scores (PRS) are, how they are developed, and their potential applications in rheumatology.

Tumor necrosis factor (TNF) becomes a well-known name largely owing to the success of its antagonists in therapy of inflammatory diseases.^[1,2]In 1975, in searching for cancer therapeutic agent, Lloyd Old and colleagues^[3]found a substance in the serum of mice received endotoxin and bacillus Calmette-Guérin infection, which can cause tumor necrosis in experimental tumor models. The substance was named TNF. The gene of TNF was later cloned and proved to be identical to a molecule called cachectin^[4]which was responsible for the cachectic status of patients with malignancy. Soon after its protein was purified, TNF was recognized to be a potent inflammatory cytokine^[5,6]mediating a wide range of inflammatory activities in the body, but may have a little effect on direct tumor cell killing. The tumor necrosis effect of TNF is actually an indirect action, that is, TNF induces inflammation leading to hemorrhagic necrosis of tumor tissue. Attempts for tumor therapy with TNF has been disappointing, but blocking TNF activity can reduce the toxicity and may enhance the therapeutic effect of immune check point inhibitors. Thereby, combination of TNF and immune checkpoint blockade may be a viable strategy for cancer immunotherapy.^[7]

Dementia with Lewy bodies (DLB) is the second most common type of neurodegenerative dementia, and prone to misdiagnosis and missed diagnosis in the clinic. Based on the evidence about DLB, we proposed the following recommendations on the diagnosis and management of DLB.

Minimally invasive surgical techniques, represented by endoscopic surgery, are one of the major advances in surgery during the 20th century. Based on the experience in other disciplines, breast surgeons have overcome the difficulties and developmental bottlenecks of endoscopic surgery in non-cavity organs, and operative techniques are maturing. The Chinese Society of Breast Surgery (CSBrS) identified the key issues in the clinical practice guidelines for endoscopic breast surgery in China through literature review and expert discussion, evaluated the quality of clinical research evidence according to the grading of recommendations assessment, development, and evaluation (GRADE) system, and developed the CSBrS practice guidelines (2021 edition) with the aim of accessibility in the clinical practice of breast surgery in China.

It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies. This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for distinguishing glioma recurrence and pseudoprogression.

According to particular criteria of inclusion and exclusion, related studies up to May 1, 2019, were thoroughly searched from several databases including PubMed, Embase, Cochrane Library, and Chinese biomedical databases. The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies. By using the "mada" package in R, the heterogeneity, overall sensitivity, specificity, and diagnostic odds ratio were calculated. Moreover, funnel plots were used to visualize and estimate the publication bias in this study. The area under the summary receiver operating characteristic (SROC) curve was computed to display the diagnostic efficiency of DCE-MRI.

In the present meta-analysis, a total of 11 studies covering 616 patients were included. The results showed that the pooled sensitivity, specificity, and diagnostic odds ratio were 0.792 (95% confidence interval [CI] 0.707-0.857), 0.779 (95% CI 0.715-0.832), and 16.219 (97.5% CI 9.123-28.833), respectively. The value of the area under the SROC curve was 0.846. In addition, the SROC curve showed high sensitivities (>0.6) and low false positive rates (<0.5) from most of the included studies, which suggest that the results of our study were reliable. Furthermore, the funnel plot suggested the existence of publication bias.

While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression, it was capable of improving diagnostic accuracy. Hence, further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.

Hepatocellular carcinoma (HCC) ranks sixth in population age-standardized incidence (ASI) and fourth in population age-standardized mortality (ASM) globally and is the fourth ASI and the second ASM, respectively, of the cancer spectrum in China.^[1]HCC usually develops as a result of chronic hepatitis B, the major underlying etiology of HCC in China. Concerning the tumor microenvironment, a growing body of research has focused on the intercellular and molecular crosstalk between tumor cells and the surrounding hepatic stromal cells, including hepatic stellate cells (HSCs), liver stromal endothelial cells (LSECs), and immune cells. Among stromal cells, HSCs play a central role in the crosstalk between tumor and stroma, which contributes significantly to HCC progression.

Severe acute pancreatitis (SAP) is a potentially lethal disease with considerable morbidity and mortality. It is often accompanied by systemic inflammatory response syndrome, sepsis, and organ dysfunction.^[1]It is generally believed that intestinal barrier dysfunction and bacterial translocation (BT) are the primary causes of systemic inflammation and sepsis complications in patients with SAP.^[2]Recently, increasing evidence has shown that autophagy plays an important role in intestinal homeostasis. Autophagy can protect the intestinal mucosal barrier during SAP by degrading and recovering the cytoplasmic content of intestinal epithelial cells and damaged organelles, removing invading microorganisms, and participating in antigen presentation and lymphocyte development.^[2,3]Therefore, regulating autophagy as a form of treatment for SAP may bring beneficial results.

While spinal involvement in patients with axial spondyloarthritis (axSpA) gets all the attention, extra-spinal joint involvement can pose a major physical and functional burden for these patients. Along with the shoulder, hip joints are considered "root joints" in ankylosing spondylitis (AS).^[1]Involvement of these joints has a major social and economic impact, restricting activities of daily life. The hip is the most frequently affected non-spinal joint in AS, and in juvenile spondyloarthritis (SpA), severely affecting mobility and carrying a high risk for major incapacity, particularly in the young patients.^[2,3]Hip involvement can occur independently from spine damage^[4]and it was shown that hip rather than spine involvement contributed more for a worsening in Bath AS Functional Index in older patients.^[5]Despite this, large randomized controlled trials have evaluated spinal and sacroiliac joint damage as a prognostic surrogate for incapacitation.^[6]To put it simply, what is the clinical consequence and/or relevance of fused sacroiliac joints? The answer: None.

The emergency department (ED) should reliably provide the required medical treatment to patients who are in an emergency or are critically ill. However, the ED faced two challenges in China. There were no limitations to the medical resources that could be accessed by ED patients, and health care providers could not deny patients. Thus, the ED was overcrowded, making it difficult to distinguish critically ill patients from those requiring non-emergency treatment.

Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.

From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.

There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.

The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.

Although there are few studies mentioned there may be some relationship between psoriatic arthritis (PsA) and osteoporosis, clinical data in real world still need to be clarified in China. The aim of this study was to assess the areal and volumetric bone mineral density (BMD), frequency of fracture, and risk factors in patients with PsA.

A total of one hundred PsA patients who visited Peking University First Hospital and one hundred age- and sex-matched healthy controls with DXA data were enrolled in the study. Patients with clinical fractures confirmed by X-ray during follow-up were also recorded. Clinical characteristics of the patients were recorded and compared between the abnormal BMD group and the normal BMD group, as well as between the fracture and non-fracture groups. Risk factors for fracture and low BMD were analyzed.

Mean BMD at the total hip and femoral neck was significantly lower in PsA patients than that in healthy controls (0.809 ± 0.193 vs. 0.901 ± 0.152 g/cm², P = 0.041; 0.780 ± 0.146 vs. 0.865 ± 0.166 g/cm², P = 0.037, respectively). Moreover, lumbar spine BMD was negatively correlated with psoriasis duration, swollen joint count and DAS28-CRP (r = -0.503, -0.580, -0.438; P < 0.05). Total hip BMD and femoral neck BMD were negatively correlated with HAQ (r = -0.521, -0.335; P < 0.05). Fractures occurred in 29 patients during the follow-up period. Logistic regression analysis showed that older age (OR 1.132 [95% CI: 1.026-1.248), P < 0.05], higher HAQ score (OR 1.493, 95%CI: 1.214-1.836, P < 0.01), higher disease activity index for psoriatic arthritis (OR 1.033, 95% CI: 1.002-1.679, P < 0.05) and hip joint involvement (OR 6.401, 95% CI: 4.012-44.180, P < 0.05) were risk factors for fracture in the multivariate model.

Increased risks of osteoporosis and fracture were found in PsA patients compared to healthy controls. Besides age, high disease activity and hip joint involvement were risk factors for decreased BMD and fracture.

Circular RNA (circRNA) is a type of closed circular noncoding RNA (ncRNA), mostly formed by back-splicing or alternative splicing of pre-messenger RNA (mRNA). The aim of this study was to explore the expression profile of circRNA in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS) and discover potential molecular markers of AS.

The circRNA microarray technology was used to detect the expression of circRNAs in the peripheral blood of 6 patients with AS and 6 healthy controls (HC). To screen the differentially expressed circRNAs by fold change (FC) and P value, these differentially expressed circRNAs were analyzed by bioinformatics. In 60 cases of AS and 30 cases of HC, 4 circRNAs were subjected to real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and their correlation with various clinical indicators was analyzed. Finally, the receiver operating characteristic (ROC) curve was used to analyze their potential as AS diagnostic markers.

The microarray results showed that there were 1369 significantly differently expressed (P < 0.05, FC > 1.5) circRNAs between the AS and HC groups (675 upregulated and 694 downregulated). The results of bioinformatics analysis suggested that they were mainly involved in "enzyme binding," "adenosine ribonucleotide binding," "MAPK signaling pathway" , etc. The RT-qPCR results showed that the expressions of hsa_circRNA_001544 (U = 486.5, P < 0.05) and hsa_circRNA_102532 (U = 645, P < 0.05) were significantly different between the AS group and the HC group. The AS group was further divided into two subgroups: active AS (ASA) and stable AS (ASS). After analysis, it was found that compared with the HC group, hsa_circRNA_001544 was significantly increased in both ASA (U = 214, P < 0.05) and ASS groups (U = 273, P < 0.05), while hsa_circRNA_008961 (U = 250, P < 0.05) and hsa_circRNA_102532 (U = 295, P < 0.05) were only significantly increased in the ASA group. Furthermore, hsa_circRNA_012732 was significantly different between the ASA and ASS groups (U = 194, P < 0.05), and there was no statistical significance among the remaining groups. Correlation analysis results showed that hsa_circRNA_012732 was negatively correlated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), high-sensitivity C-reactive protein (hsCRP), and globulin (GLOB) and positively correlated with lymphocyte count (LY), mean corpusular volume, and albumin (ALB), and hsa_circRNA_008961 was negatively correlated with platelet (PLT) count. ROC curve analysis showed that hsa_circRNA_001544 (95% CI = 0.610-0.831, P < 0.05) and hsa_circRNA_102532 (95% CI = 0.521-0.762, P < 0.05) were statistically significant, and their area under curve (AUC) values were 0.720 and 0.642, respectively.

There are differentially expressed circRNAs in PBMCs of AS patients, and they may be involved in the occurrence and development of AS. Among these differentially expressed circRNAs, hsa_circRNA_012732 has the potential to become an indicator of disease activity, and hsa_circRNA_001544 has the potential to become a molecular marker for AS diagnosis.

Psoriatic arthritis (PsA) is an inflammatory arthropathy characterized by psoriasis and bone erosion on radiology. Dickkopf-1 (Dkk-1) is considered to be the main inhibitor of the Wnt signaling pathway and results in reduced osteoblast proliferation. The aim of this study was to investigate the serum level of Dkk-1 and its association with bone erosion in PsA patients.

Serum Dkk-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 69 patients with PsA and 60 controls, including 39 rheumatoid arthritis (RA) patients, and 21 healthy controls (HCs). Rheumatoid factor and anti-cyclic citrullinated peptide levels were also determined by ELISA. The association of Dkk-1 level with clinical and laboratory features of PsA was analyzed. Logistic regression analysis was used to analyze the risk factors for bone erosion in PsA.

Dkk-1 was elevated in 68.1% (47/69) of the patients with PsA, 46.2% (18/39) of RA patients, and 9.5% (2/21) of HCs. Serum Dkk-1 concentration was significantly higher in PsA patients compared with that in HCs. The level of serum Dkk-1 was correlated with a swollen joint count, and levels of complement components 3 and 4. Elevated Dkk-1 level (odds ratio = 4.440, 95% confidence interval: 1.246-15.817, P = 0.021) was identified as the risk factor for bone erosion in PsA.

The serum level of Dkk-1 is abnormally elevated in PsA patients. The elevation of Dkk-1 might be involved in the mechanism of bone erosion in patients with PsA.

Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3-5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20°-40°).

From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation.

In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = -3.918, P = 0.001), and 3.7 ± 0.4 (t = -6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = -2.825, P = 0.088) and mental health domain (t = -3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = -1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group.

For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.

Computed tomography (CT) and magnetic resonance imaging (MRI) data can be fused to identify the tumor boundaries. This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely. This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.

Between September 2008 and December 2015, 24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation. The cohort comprised 16 males and eight females with a median age of 19.5 years (range: 12-48 years). The tumor location was the femoral diaphysis in three patients, distal femur in 19, and proximal tibia in two. The tumors were osteosarcoma (n = 15), chondrosarcoma (n = 3), Ewing sarcoma (n = 3), and other sarcomas (n = 3). We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.

Pathological examination verified that all resected specimens had appropriate surgical margins. The median distance from the tumor resection margin to the joint was 30 mm (range: 13-80 mm). The median follow-up duration was 62.5 months (range: 24-134 months). Of the 24 patients, 21 remain disease free, one is alive with disease, and two died of the disease. One patient developed local recurrence. Complications requiring additional surgical procedures occurred in six patients, including one with wound hematoma, one with delayed wound healing, one with superficial infection, one with deep infection, and two with mechanical failure of the prosthesis. The mean Musculoskeletal Tumor Society score at the final follow-up was 91% (range: 80%-100%). The 5- and 10-year implant survival rates were 91.3% and 79.9%, respectively.

Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.

With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.

A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.

A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0-9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).

The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.

Nucleolar protein 6 (NOL6) is a nucleolar RNA-associated protein that is highly conserved between species. It has been proved to be associated with the prognosis of liver cancer. However, the underlying mechanism has not been fully established. This study aimed to assess the relationship between NOL6 and liver cancer prognosis.

We constructed an NOL6-short hairpin RNA (shRNA)-expressing lentivirus. Through viral transfection, cell growth assay and fluorescence-activated cell sorting, we evaluated the effect of shRNA-mediated NOL6 knockdown on the proliferation, colony formation, and apoptosis of hepatocellular carcinoma (HCC) cells. The relationship between NOL6 expression and HCC patient survival has been established through bioinformatics analysis. We also explored the downstream molecular regulatory network of NOL6 in HCC by performing an Ingenuity Pathway Analysis in the database.

Increased NOL6 expression was detected in HCC cells compared to normal controls; HCC patients with high NOL6 expression had poorer prognoses than those with low expression. NOL6 knockdown inhibited HCC cell proliferation, apoptosis, and colony formation. Also, MAPK8, CEBPA, and FOSL1 were selected as potential downstream genes of NOL6.

NOL6 up-regulates HCC cell proliferation and affects downstream expression of related genes. Moreover, NOL6 is considered to be associated with poor prognosis in HCC patients.

Microribose nucleic acids (miRNAs) are implicated in the progression of lung adenocarcinoma. MicroRNA-345-5p (miR-345-5p) is a recently identified anti-oncogene in some human cancers, but its functional role and possible molecular mechanism in lung adenocarcinoma remain unknown. This study aimed to identify the biological function and underlying mechanism of miR-345-5p in lung adenocarcinoma cells.

In this study, lung adenocarcinoma tissues and adjacent tissues were collected in the First Affiliated Hospital of Anhui Medical University between April 2016 and February 2017. The expression of miR-345-5p and ras homolog family member A (RhoA) in lung adenocarcinoma tissues and human lung adenocarcinoma cell lines (A549, H1650, PC-9, and H441) was detected by reverse transcription quantitative polymerase chain reaction analysis. Functional assays including colony formation, flow cytometry analysis, wound healing, and transwell assays were performed to assess the proliferation, apoptosis, migration, and invasion of lung adenocarcinoma cells. In addition, RNA pulldown and luciferase reporter assays were conducted to evaluate the relationship between miR-345-5p and RhoA. Difference between the two groups was analyzed with Student’s t test, while that among multiple groups was analyzed with one-way analysis of variance.

MiR-345-5p expression displayed lower level in lung adenocarcinoma tissues (0.241 ± 0.095 vs.1.000 ± 0.233, t = 19.247, P < 0.001) and cell lines (F = 56.992, P < 0.001) than control tissues and cells. Functional experiments demonstrated that upregulation of miR-345-5p inhibited the malignant phenotypes of lung adenocarcinoma cells via suppressing cell proliferation, migration, invasion, and facilitating cell apoptosis. Additionally, RhoA was verified to be the downstream target of miR-345-5p. Expression of RhoA was downregulated by overexpression of miR-345-5p in PC-9 (0.321 ± 0.047 vs. 1.000 ± 0.127, t = 8.536, P < 0.001) and H1650 (0.398 ± 0.054 vs. 1.000 ± 0.156, t = 4.429, P = 0.011) cells. Rescue assays revealed that overexpression of RhoA rescued the suppressive effects of miR-345-5p upregulation on proliferation, migration, and invasion of lung adenocarcinoma cells. Further, miR-345-5p was found to regulate the Rho/Rho-associated protein kinase (ROCK) signaling pathway by downregulation of RhoA in lung adenocarcinoma cells.

MiR-345-5p plays a tumor suppressor role in lung adenocarcinoma cells by downregulating RhoA to inactivate the Rho/ROCK pathway.

Psoriasis is a chronic, systemic inflammatory disease characterized by demarcated, scaly, erythematous skin plaques. Psoriatic arthritis (PsA) is the most common comorbidity, with roughly 25% to 30% of psoriasis patients developing PsA during their lifetime.^[1]Although the prevalence of psoriasis is relatively low in China (0.6%) there is evidence of substantial disease severity among Chinese patients.^[2,3]In a recently published Phase 3 clinical trial with a predominantly Chinese population, patients had higher disease severity at baseline, compared to patients in trials with predominantly Western populations.^[3]A systematic review of observational and clinical studies showed that 14% of Asian psoriasis patients had concomitant PsA compared to 23% of European patients.^[4]Currently, there is still a significant unmet need in Chinese psoriasis and PsA patients.

Orbital floor fractures affect eye movement, but the underlying mechanism remains unclear. Therefore, the present retrospective study aimed to clinically characterize fractures in different inferior orbital wall locations, and to determine the relationship between fracture type and ocular motility disorder.

Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma, accounting for approximately 80% of cases. Although most patients in the early stages of ccRCC can be cured by surgery, ccRCC is often in the advanced stage when patients are diagnosed, with >30% of the patients presenting with distant metastases at the time of diagnosis. For ccRCC patients with distant metastases, the 5-year survival is only 12%. Immunotherapy selectively corrects tumor microenvironment (TME) immunity, which is of great significance for patients with advanced ccRCC.

To the Editor: Enthesitis is an inflammation of the iliac attachment of ligaments or tendons, which may be among the first symptoms of spondyloarthritis (SpA) and is a unique characteristic of SpA which can differentiate it from rheumatoid arthritis. In spondyloarthropathies, peripheral enthesitis precedes joint symptoms and is associated with a higher degree of erosive disease. Four methods are available for evaluation of enthesitis, including tenderness, conventional radiography, ultrasonography, and magnetic resonance imaging (MRI). However, over 100 entheses are found in the human body. The aforementioned four methods can detect only local enthesitis. Whole-body MRI (WB-MRI) is a novel approach that allows visualization of the entire body in one examination, but has lower image resolution than conventional MRI.^[1]Recent studies have explored the application of WB-MRI. However, real-world data are lacking, and most of them are limited to psoriatic arthritis (PsA). In the present study, the distribution pattern of enthesitis was explored in patients with SpA using WB-MRI in real world set. The result was compared with that of other clinical instruments used to evaluate enthesitis.

To the Editor: Ankylosing spondylitis (AS) has always been viewed as a male-dominated disease with previous studies showing a male-female ratio of approximately 3:1. However, more recent surveys have shown increasing homogeneity in gender prevalence.^[1]Female patients with AS tend to have a longer diagnosis delay compared with male patients. AS patients with delayed diagnosis displayed worse outcomes in disease activity, function, spinal mobility, and radiographic damage.^[2,3]

To the Editor:While being one of the common causes of low back pain (LBP), the pathogenesis, as well as definitive diagnostic criteria and expert treatment recommendations for endplate inflammation remain largely unclear. Clinically, vertebroplasty and local injection of corticosteroids are often used for relieving the pain instead of targeting the cause.