2022年 · 第135卷第01期

The application of video-assisted thoracoscopy, laparoscopy, and Da Vinci robotic surgery allows surgical treatment to enter the stage of minimally invasive surgery (MIS).^[1,2,3]Compared with traditional open surgery, MIS is less invasive with a shorter hospital stay.^[4,5]However, both MIS and traditional open surgery fail to maintain the integrity of organs while resecting the lesions. To date, MIS does not change the treatment mode used in traditional open surgery, namely, "resect not only lesions but also partial or complete selected organ," leading to loss of some organs and anatomical reconstruction of remaining organs. Every organ in the human body has its own function and plays an important role in the normal metabolism of our body; thus, no organ is redundant. Moreover, we know much less about the interaction between organs than the function of special organs. If one organ was partially or completely resected, the remaining organ might not function as well as it did before the resection. The functions of other organs might be affected by the loss or partial removal of this organ. Patients often suffer from complications related to the loss of organs. For example, patients who underwent proximal gastrectomy often suffered from reflux post-operation, resulting in a decline in their sleep quality. Patients often lived with dyspepsia, innutrition, diarrhea, and anemia after total gastrectomy.

Psoriasis is a common, chronic, immune-mediated inflammatory skin disease with increased epidermal proliferation. The objective of this review was to systematically identify the evidence and perform a network meta-analysis (NMA) to estimate the relative efficacy of secukinumab (SEC) against adalimumab (ADA) and infliximab (INF) for the treatment of moderate-to-severe plaque psoriasis.

A systematic literature review (SLR) was conducted according to a pre-specified protocol to identify relevant studies. Initially, the databases were searched from database inception till June 2013, and the SLR was updated in April 2020. The eligibility criteria included adult patients (≥18 years old) with moderate-to-severe plaque psoriasis, and the SLR included randomized controlled trials (RCTs). The comparators of interest were SEC, ADA, INF, and placebo (PLA), while outcomes of interest were Psoriasis Area and Severity Index (PASI) (50, 75, and 90) at weeks 12, 16, and 24. A Bayesian NMA for PASI was utilized with a framework that evaluated the probability of PASI responses in different categories of PASI thresholds within a single model.

A total of 23 RCTs that assessed the efficacy of SEC, ADA, and INF in patients with moderate-to-severe plaque psoriasis were identified. At 12 weeks, SEC was associated with a significantly better response compared with PLA and ADA for PASI 75 and 90, while response results were comparable against INF. At 12 weeks, risk ratio (95% confidence interval) derived from NMA for SEC vs. ADA and INF for PASI 75 was 1.35 (1.19, 1.57) and 1.01 (0.90, 1.18), respectively. At the 16-week and 24-week time interval, SEC was significantly better than PLA, ADA, and INF for PASI 75 and 90.

Efficacy of SEC in the treatment of patient populations with moderate-to-severe plaque psoriasis is well demonstrated through NMA.

Cold snare polypectomy (CSP) is one of the endoscopic resection technologies and has been recommended for the removal of diminutive polyps (<5 mm) or noncancerous polyps up to 10 mm in size to reduce the incidence and mortality rate of colorectal cancer.^[1]Recently, CSP has made some progress. In this paper, the indications, efficacy, safety, and development of CSP are reviewed.

The coronavirus disease 2019 (COVID-19) has been declared as a pandemic by the World Health Organization.^[1]Most COVID-19 patients exhibit mild to moderate symptoms, while approximately 15% progress rapidly to severe pneumonia, and about 5% eventually develop acute respiratory distress syndrome (ARDS),^[2]which requires mechanical ventilation (MV) and even extracorporeal membrane oxygenation. The mortality of COVID-19 patients who received MV was reported to be as high as 66%.^[3]Therefore, the treatments aiming to improve mortality should focus on two aspects: first, prevention of the aggravation of the disease in mild and moderate COVID-19 patients; second, the rescue therapy for patients in serious conditions.

Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression.

The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression.

Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression.

Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.

Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.

We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical information were collected. Multivariable logistic regression analyses were performed to identify risk factors for ICH and mortality.

Of 77 patients, 11 (14.3%) suffered from ICH, and 36 (46.8%) survived. The survival rate was significantly lower (18.2% [2/11] vs. 51.5% [34/66], P = 0.040) in patients with ICH than in those without ICH. Multivariable analysis revealed that factors independently associated with ICH were diabetes mellitus (adjusted odds ratio [aOR]: 12.848, 95% confidence interval [CI]: 1.129-146.188, P = 0.040) and minimum fibrinogen during ECMO (aOR: 2.557, 95% CI: 1.244-5.252, P = 0.011). Multivariable analysis showed that factors independently associated with mortality were acute hepatic failure during ECMO (aOR: 9.205, 95% CI: 1.375-61.604, P = 0.022), CO₂ retention before ECMO (aOR: 7.602, 95% CI: 1.514-38.188, P = 0.014), and minimum platelet concentration during ECMO (aOR: 0.130, 95% CI: 0.029-0.577, P = 0.007).

Diabetes mellitus and minimum fibrinogen concentration during ECMO are risk factors for ICH in patients with severe respiratory failure managed using VV-ECMO. This indicated that anticoagulants use and nervous system monitoring should be performed more carefully in patients with diabetes when treated with VV-ECMO due to severe respiratory failure.

Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC.

FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of incidence and mortality in 60 countries from 2000 through 2019 were evaluated by joinpoint regression analysis using data of Global Burden of Disease 2019. The association between potential behavioral, metabolic, and socioeconomic risk factor exposure at the nation level retrieved from the World Bank and Global Health Observatory and the incidence and mortality of FBC were evaluated by multivariate linear regression.

FBC incidence and mortality varied greatly in the 60 included countries. Higher incidence and mortality rates were typically observed in countries with higher HDIs and vice versa. During 2000 to 2019, significantly increasing trends in incidence and mortality were observed in 26 (average annual percent changes [AAPCs], 0.35-2.96) and nine countries (AAPC, 0.30-1.65), respectively, while significantly decreasing trends in both incidence and mortality were observed in 22 countries, most of which were high-HDI countries. Among the population aged ≥40 years, there were 26 and 11 countries showing significantly increased trends in incidence and mortality, respectively. Ecological analysis showed that countries with higher prevalence rates of high cholesterol and higher health expenditures were more likely to have higher FBC incidence, and countries with higher rates of obesity and poorer universal health coverage were more likely to have higher FBC mortality.

Despite decreased or stabilized FBC incidence and mortality rates were observed in some countries with high HDI over the past decades, disease burden became even severer in developing countries, especially for the population aged ≥40 years. Effective targeted preventive programs are strongly encouraged to reduce the FBC disease burden worldwide.

The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.

In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.

Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.

Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.

Clinicaltrials.gov; NCT02878811.

Differential diagnosis of active tuberculosis (ATB) and latent tuberculosis infection (LTBI) has been a challenge for clinicians in high TB burden countries. The purpose of this study was to improve the accuracy of differential diagnosis of ATB and LTBI by using fluorescent immunospot (FluoroSpot) assay to detect specific Th1 cell immune responses. The novel mycobacterium tuberculosis (MTB) latency-associated antigens Rv1733c and synthetic long peptides derived from Rv1733c (Rv1733c SLP) were used based on virulence factors early secreting antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10).

Fifty-seven ATB cases, including 20 pathogen-confirmed ATB and 37 clinically diagnosed ATB, and 36 LTBI cases, were enrolled between January and December 2017. FluoroSpot assay was used to detect the interferon γ (IFN-γ) and interleukin 2 (IL-2) secreted by the specific T cells after being stimulated with MTB virulence factors ESAT-6 and CFP-10, MTB latency-associated antigens Rv1733c and Rv1733c SLP. The receiver operating characteristic (ROC) curve was used to define the best cutoff value of latency-associated antigens in the use of differentiating ATB and LTBI. The sensitivity, specificity, predictive value, and likelihood ratio of ESAT-6 and CFP-10-FluoroSpot combined with latency-associated antigen in the differential diagnosis of ATB and LTBI were also calculated.

Following the stimulation with Rv1733c and Rv1733c SLP, the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP had the largest area under the ROC curve, which was 0.766. With a cutoff value of 1 (spot-forming cells [SFCs]/2.5 × 10⁵ peripheral blood mononuclear cells) for frequency, the sensitivity and specificity of distinguishing ATB from LTBI were 72.2% and 73.7%, respectively. ESAT-6 and CFP-10-FluoroSpot detected the frequency and proportion of single IFN-γ-secreting T cells; the sensitivity and specificity of distinguishing ATB from LTBI were 82.5% and 66.7%, respectively. Combined with the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP on the basis of ESAT-6 and CFP-10-FluoroSpot, the sensitivity and specificity increased to 84.2% and 83.3%, respectively.

Rv1733c SLP, combined with ESAT-6 and CFP-10, might be used as a candidate antigen for T cell-based tuberculosis diagnostic tests to differentiate ATB from LTBI.

Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).

A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan-Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.

In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer-Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.

A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.

As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches.

In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months’ management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months.

A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96.

The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management.

ClinicalTrials.gov, NCT03264638.

A global trend towards greater health awareness with a resulting reduction in smoking has contributed to the improved control and early detection of lung cancer.^[1]Furthermore, developments in diagnostic technologies have enhanced the detection of multifocal lung cancer, characterized by multiple cancerous lesions. Multifocal lung cancer can be divided into multiple primary lung cancer (MPLC) and pulmonary metastasis-associated lung cancer intrapulmonary metastases (IM) according to the types of lesions.

Lung cancer is a leading cause of cancer-associated death worldwide, and the morbidity and mortality of lung cancer have increased over the past few decades. Imaging techniques are limited in providing a definitive diagnosis, which requires a tissue sample for pathologic evaluation. Adenocarcinomas account for 40% of all lung cancers and tend to occur peripherally in the lung,^[1]making them amenable to ultrasound-guided percutaneous biopsy for pathologic diagnosis. Peripheral lung cancers are usually close to the pleura, enabling ultrasound to clearly show the internal structure of the lesion, its blood supply, and its relationship with surrounding tissues.

Osteoarthritis (OA) is a debilitating disease with limited treatment options.^[1]Autophagy serves as an important protective mechanism against the deterioration of cartilage and is negatively regulated by the mammalian target of rapamycin (mTOR).^[2]In previous studies, celastrol could promote autophagy in various cell types and had the promising therapeutic potential for OA.^[3]However, the effect and underlying mechanisms of celastrol on autophagy in OA remain unclear.

To the Editor: The clinical spectrum of coronavirus disease 2019 (COVID-19) appears to be wide, ranging from asymptomatic to severe progressive pneumonia with respiratory failure, multiorgan failure, and even death. Here, we investigated the clinical and pathological characteristics of a patient who died from severe COVID-19. Our findings will facilitate a deeper understanding of the pathogenesis and progression of COVID-19 and improve clinical strategies to combat the disease.

To the Editor: Type 2 diabetes (T2D) showed increasing prevalence worldwide and put a huge burden on healthcare systems.^[1]Branched-chain amino acids (BCAAs, including Leucine, Isoleucine, and Valine), a prominent group of essential amino acids, are important nutrition signals that have important effects on protein synthesis, glucose homeostasis, and nutrient-sensitive signaling pathways. Plasma BCAA can predict the development of T2D, whereas the studies of dietary BCAA on T2D risk showed conflicting results.^[2]Most of the researches about dietary BCAAs used a single or limited number of measurements, ignoring the dynamic changes of dietary BCAA levels throughout life and their relevance to the development of diabetes. A life-course approach using multiple dietary BCAA measurements over time may shed new light on dietary BCAA trajectories and their relation to T2D risk. Therefore, in the current study, we first use latent class mixed model (LCMM) to characterize BCAA intake trajectories over 18 years in longitudinal data from China and investigate the association of BCAA intake trajectories with the risk of T2D and its biomarkers after adjusting for potential confounding factors.

To the Editor: Female infertility due to reproductive aging has become a prominent concern in the population. Evidence indicates that oxidative stress is one of the dominant mechanisms underlying reproductive aging.^[1,2]Although female reproductive aging involves gradual changes to the hypothalamic-pituitary-ovarian (HPO) axis, previous studies support a key involvement of the hypothalamus.^[3,4]In our recent dataset, it was shown that estrogen-induced oxidative stress led to the senescence of hypothalamic astrocytes that predated reproductive dysfunction.^[3]Growing evidence has demonstrated that antioxidants might delay reproductive aging by reducing oxidative damage to ovaries.^[1,2]However, the effect of antioxidants on the hypothalamus has not been reported. Astaxanthin (AST), 3,3^＇-dihydroxy-β-carotene-4,4^＇-dione, is a xanthophyll carotenoid found predominantly in marine animals such as salmon, trout, lobster, and shrimp. Ginseng is a tonic drug in traditional Chinese medicine. Ginsenoside Rg1, a class of steroidal glycosides, is a prominent active anti-aging ingredient within ginseng responsible for these effects. Notably, the two antioxidants freely cross the blood-brain barrier. In this study, we evaluated the effects of these two natural compounds on the hypothalamus and ovaries in protecting female mice from reproductive aging.

To the Editor: Diabetic foot ulcers (DFUs) are an important cause of morbidity in patients with diabetes mellitus (DM). The prevalence of foot ulcers in patients with diabetes is 4% to 10%, with the lifetime incidence estimated to be between 19% and 34%.^[1]DFUs have become a considerable burden on patients and the healthcare service system. However, the mechanism is not fully understood, and DFUs are still difficult to heal.

To the Editor:Portal vein tumor thrombus (PVTT) is present in 10% to 40% of patients with hepatocellular carcinoma (HCC) at diagnosis and has a profound adverse effect on progno-sis.^[1]Sorafenib is recommended as the first-line treatment for patients with advanced HCC, including those who have PVTT. However, its efficacy is modest.^[1,2]A combination of transarterial chemoembolization (TACE) and sorafenib (TACE-S) has been reported to be associated with improved outcomes.^[1,3]But unfortunately, its efficacy in controlling PVTT remained limited, with an objective response rate (ORR) of only 9.7%.^[3]Previous studies have demonstrated that iodine-125 (¹²⁵I) seed brachytherapy targeting PVTT can lead to a significant reduction in tumor thrombus with few complications.^[4,5]We hypothesized that TACE-S combined with¹²⁵I seed brachytherapy (TACE-S-I) could improve the control of PVTT and confer a greater survival benefit. Therefore, we conducted this study to evaluate the efficacy and safety of TACE-S-I compared with TACE-S in HCC patients with PVTT.

To the Editor:Antithrombotic therapy is essential to prevent adverse ischemic events during and after percutaneous coronary intervention (PCI). Anticoagulation during PCI is most commonly achieved with heparin or bivalirudin. Bivalirudin does not activate platelets, does not bind to plasma proteins and has linear pharmaco-kinetics with a short half-life of 25 min.^[1,2,3]These characteristics indicate that bivalirudin may be an ideal anticoagulation drug for PCI. Prior trials which were about patients with acute myocardial infarction (AMI) undergoing primary PCI showed that a bivalirudin-based anticoagulation strategy decreased the risk of major bleeding, but it was associated with an increased risk of acute stent thrombosis (ST) compared with a heparin-based strategy.^[4]It was considered that short half-life of bivalirudin and delayed onset of platelet P2Y₁₂receptor inhibitor in AMI patients led to a blank period of antithrombotic therapy after primary PCI.^[5]Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary interventionin acute myocardial infarction: the BRIGHT randomized clinical trial,^[5]using a high-dose infusion of bivalirudin for 3 to 4 h after PCI, the results showed that compared with the heparin or heparin combined with platelet glycoprotein IIb/IIIa receptor antagonist (GPI), bivalirudin did not increase acute ST and reduced the occurrence of net adverse clinical events (NACE). However, for patients with coronary heart disease (CHD) who choose elective PCI, there is still no clear evidence of the benefit of post-procedure infusion of bivalirudin for 3 to 4 h. Therefore, our study validates the efficacy and safety of bivalirudin without post-procedure infusion contrasting to heparin during elective PCI.

To the Editor:Segmentectomy is an effective surgical method to cure early lung cancer. Segmentectomy which is designed precisely can preserve the pulmonary function to the maximal level with comparable post-operative survival rate. However, there are still some factors such as surgical experience, anatomy familiarity, and intersegmental plane identification, influencing the application of segmentectomy.

To the Editor:Fever detection is critical for the screening and control of highly contagious febrile diseases. Axilla or rectal temperatures, although considered to be the gold standard for fever detection in clinical practice,^[1]are impractical for mass screening. Rapid, cost-effective, and non-contact temperature measurement tools with high sensitivity and accuracy are needed. Non-contact infrared thermometer (NCIT) is one of the most commonly used tools for screening of corona virus disease 2019 in public settings in China, as fever is a typical and early manifestation. The distance between the sensor of NCIT and the skin surface might have a significant impact on the readings.^[2]In addition, the fact of outdoor temperature being significantly lower than room temperature might lead to lower readings and therefore false-negative results. Previously, it was shown in a pediatric population that misleading temperature readings could happen if measurements were taken before the skin had adjusted to indoor temperature.^[3]In this study, we aimed to assess the impact of distance of thermometer placement and exposure to cold outdoor environment on temperature measurement using a NCIT.

To the Editor: Cardiac arrest (CA) is the leading cause of morbidity and mortality among hospitalized patients globally and has low rates of overall survival. After the return of spontaneous circulation (ROSC), patients with CA and systemic ischemia/reperfusion injury can manifest as sepsis-like syndromes and immune disorders that increase the risk of infections. CD4⁺T lymphocytes play an important role in organ ischemia-reperfusion injury. T-helper (Th) types 1 and 2 cells are classical subsets of CD4⁺T cells. Extensive research on their functions in infectious and immune-related inflammatory diseases indicates that both subsets participate in host defense and direct immune responses. Data from CA/cardiopulmonary resuscitation porcine models and patients have revealed imbalances in Th1/Th2 cell ratio.^[1]Therefore, Th1 and Th2 cells are important for understanding post-ROSC immune dysfunction in patients with CA.

To the Editor: Umbilical cord blood transplant (UCBT) serves as an alternative option for treating patients with B cell acute lymphoblastic leukemia (ALL), in the absence of a compatible donor. However, disease recurrence presents a difficult challenge. Chimeric antigen receptor (CAR)-T cell therapy is a promising approach for treating patients with relapsed/refractory ALL. Among the intensive investigations of infusion of CAR-T cells after transplant, few focus on patients who were administered CAR-T therapy after they relapsed subsequently to UCBT. Here, we report the response rate, toxicity, and survival of CD19 CAR-T cells administered to 10 children and young adults with relapsed acute B lymphoblastic leukemia (B-ALL) after UCBT.