2023年 · 第136卷第10期

Albumin, which is a 65-kDa liver-synthesized protein, accounts for nearly 50% of total plasma protein and contributes to approximately 80% of intravascular oncotic pressure. Albumin helps maintain microvascular integrity, functions as an antioxidant, and transports hormones, fatty acid, bile salts, bilirubin, electrolytes (e.g., calcium, magnesium, copper, zinc,et al.), and drugs.^[1,2,3]Human serum albumin (HSA) is a sterile, liquid albumin product derived from large pools of human plasma by fractionation and pasteurization. The medical use of HAS could date back to approximately the time of World War II.^[4]

Tumor chemoprevention and treatment are two approaches aimed at improving the survival of patients with cancers. An ideal anti-tumor drug is that which not only kills tumor cells but also alleviates tumor-causing risk factors, such as precancerous lesions, and prevents tumor recurrence. Chinese herbal monomers are considered to be ideal treatment agents due to their multi-target effects. Astragaloside has been shown to possess tumor chemoprevention, direct anti-tumor, and chemotherapeutic drug sensitization effects. In this paper, we review the effects of astragaloside on tumor prevention and treatment and provide directions for further research.

Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.

Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy," "fluid resuscitation," and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.

A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission (P = 0.02) and the length of hospital stay (P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.

For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD 42022363945.

Melanoma accounts for one-third of all malignant skin tumors (approximately 6.8-20.0%). Globally, the incidence and mortality rates of melanoma are increasing.^[1]For early-stage (I-II) melanoma, extended resection shows a better survival advantage. Once melanoma metastasizes, it can lead to poor prognosis.^[2]Melanoma with strong immunogenicity is an excellent immunotherapy research object.^[3]Immunotherapy drugs for melanoma have developed rapidly in the last 20 years. The clinical benefits of these drugs are apparent,^[4,5]which provides better treatment options for most patients with melanoma. Here, we reviewed the current progress in immunotherapy for melanoma.

Ischemic acute kidney injury (AKI) is a common syndrome associated with considerable mortality and healthcare costs. Up to now, the underlying pathogenesis of ischemic AKI remains incompletely understood, and specific strategies for early diagnosis and treatment of ischemic AKI are still lacking. Here, this study aimed to define the transcriptomic landscape of AKI patients through single-cell RNA sequencing (scRNA-seq) analysis in kidneys.

In this study, scRNA-seq technology was applied to kidneys from two ischemic AKI patients, and three human public scRNA-seq datasets were collected as controls. Differentially expressed genes (DEGs) and cell clusters of kidneys were determined. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, as well as the ligand-receptor interaction between cells, were performed. We also validated several DEGs expression in kidneys from human ischemic AKI and ischemia/reperfusion (I/R) injury induced AKI mice through immunohistochemistry staining.

15 distinct cell clusters were determined in kidney from subjects of ischemic AKI and control. The injured proximal tubules (PT) displayed a proapoptotic and proinflammatory phenotype. PT cells of ischemic AKI had up-regulation of novel pro-apoptotic genes including USP47, RASSF4, EBAG9, IER3, SASH1, SEPTIN7, and NUB1, which have not been reported in ischemic AKI previously. Several hub genes were validated in kidneys from human AKI and renal I/R injury mice, respectively. Furthermore, PT highly expressed DEGs enriched in endoplasmic reticulum stress, autophagy, and retinoic acid-inducible gene I (RIG-I) signaling. DEGs overexpressed in other tubular cells were primarily enriched in nucleotide-binding and oligomerization domain (NOD)-like receptor signaling, estrogen signaling, interleukin (IL) -12 signaling, and IL-17 signaling. Overexpressed genes in kidney-resident immune cells including macrophages, natural killer T (NKT) cells, monocytes, and dendritic cells were associated with leukocyte activation, chemotaxis, cell adhesion, and complement activation. In addition, the ligand-receptor interactions analysis revealed prominent communications between macrophages and monocytes with other cells in the process of ischemic AKI.

Together, this study reveals distinct cell-specific transcriptomic atlas of kidney in ischemic AKI patients, altered signaling pathways, and potential cell-cell crosstalk in the development of AKI. These data reveal new insights into the pathogenesis and potential therapeutic strategies in ischemic AKI.

Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.

In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared.

A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers’ interpretation and clinical factor model (P <0.05).

The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.

Right ventricular (RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction (HFpEF). Coronary artery disease (CAD) can contribute to the pathophysiological characteristics of HFpEF. This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.

This prospective study included 250 consecutive acute HFpEF patients with CAD. Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value, based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). The primary endpoint was a composite of all-cause death, recurrent ischemic events, and HF hospitalizations.

TAPSE/PASP ≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling (area under the curve, 0.731; sensitivity, 61.4%; and specificity, 76.6%). Of the 250 patients, 150 and 100 patients could be grouped into the RV-arterial coupling (TAPSE/PASP >0.43) and uncoupling (TAPSE/PASP ≤0.43) groups, respectively. Revascularization strategies were slightly different between groups; the RV-arterial uncoupling group had a lower rate of complete revascularization (37.0% [37/100] vs. 52.7% [79/150], P <0.001) and a higher rate of no revascularization (18.0% [18/100] vs. 4.7% [7/150], P <0.001) compared to the RV-arterial coupling group. The cohort with TAPSE/PASP ≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP >0.43. Multivariate Cox analysis showed TAPSE/PASP ≤0.43 as an independent associated factor for the primary endpoint, all-cause death, and recurrent HF hospitalization (hazard ratios [HR]: 2.21, 95% confidence interval [CI]: 1.44-3.39, P <0.001; HR: 3.32, 95% CI: 1.30-8.47, P = 0.012; and HR: 1.93, 95% CI: 1.10-3.37, P = 0.021, respectively), but not for recurrent ischemic events (HR: 1.48, 95% CI: 0.75-2.90, P = 0.257).

RV-arterial uncoupling, based on TAPSE/PASP, is independently associated with adverse outcomes in acute HFpEF patients with CAD.

LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer.

We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels.

On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs. 1.4% [2/145]).

LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile.

ClinicalTrials.gov, NCT04563936.

Neuroendocrine neoplasms (NENs) are rare tumors characterized by variable biology and delayed diagnosis. However, the nationwide epidemiology of NENs has never been reported in China. We aimed to estimate the incidence and survival statistics of NENs in China, in comparison to those in the United States during the same period.

Based on the data from 246 population-based cancer registries covering 272.5 million people of China, we calculated age-specific incidence on NENs in 2017 and multiplied by corresponding national population to estimate the nationwide incidence in China. The data of 22 population-based cancer registries were used to estimate the trends of NENs incidence from 2000 to 2017 through the Joinpoint regression model. We used the cohort approach to analyze the 5-year age-standardized relative survival by sex, age group, and urban-rural area between 2008 and 2013, based on data from 176 high-quality cancer registries. We used data from the Surveillance, Epidemiology, and End Results (SEER) 18 program to estimate the comparable incidence and survival of NENs in the United States.

The overall age-standardized rate (ASR) of NENs incidence was lower in China (1.14 per 100,000) than in the United States (6.26 per 100,000). The most common primary sites were lungs, pancreas, stomach, and rectum in China. The ASRs of NENs incidence increased by 9.8% and 3.6% per year in China and the United States, respectively. The overall 5-year relative survival in China (36.2%) was lower than in the United States (63.9%). The 5-year relative survival was higher for female patients than male patients, and was higher in urban areas than in rural areas.

The disparities in burden of NENs persist across sex, area, age group, and site in China and the United States. These findings may provide a scientific basis on prevention and control of NENs in the two countries.

Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.

All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young’s modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.

Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.

Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.

It is known that the Proximal Extension To Induce Complete Attachment (PETTICOAT) technique improves the distal aortic remodeling compared with standard thoracic endovascular aortic repair (TEVAR).^[1,2]However, the only available Zenith Dissection Endovascular System (Cook Medical Inc., Bloomington, Ind, USA) has several limitations, including only two sizes (36 mm and 46 mm) and an one-taper design, which may not be suitable for the complex morphology of dissection at distal aorta, particular for the east Asian population. Thus, our center designed the new "Fabulous" stent system and acheieved better early curative effect.

To the Editor: Natural orifice specimen extraction surgery (NOSES) is an actively developing approach for extracting specimens and performing non-incisional colorectal cancer surgery. Previous studies have shown that its effectiveness and safety in the surgical treatment of rectal cancer are similar to those of conventional laparoscopic surgery. NOSES was demonstrated to be a possible alternative approach to conventional laparoscopy, for which a mini-laparotomy is used to extract the specimen, as there were no differences in surgical characteristics and short-term outcomes.^[1]Recently, new promising approaches have been demonstrated for rectal tumors extraction with bowel eversion and extra-abdominal resection.^[2]

To the Editor: Colorectal cancer (CRC) remains a leading cause of cancer-related death worldwide.^[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis, the serrated neoplastic pathway accounts for 20%-30% of CRCs. Sessile serrated lesions (SSLs), the most common premalignant serrated polyp subtype, share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions. However, SSLs can be easily missed due to their flat shape and subtle endoscopic features. Sometimes they can also be difficult to distinguish from other types of polyps, especially hyperplastic polyps (HPs), which are believed to have no malignant potential.^[2]Approximately 10% of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination, reflecting diagnostic difficulties in colonoscopy.^[3,4]Current guidelines recommend "diagnose-and-leave" and "resect-and-discard" strategies for diminutive polyps, which might lead to SSLs being leftin situor diagnoses being missed,^[5]raising the risk of recurrence and post-colonoscopy cancers. Furthermore, it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk. Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.

To the Editor:As a rare indolent B cell non-Hodgkin lymphoma, lymphoplasmacytic lymphoma/Waldenström’s macroglobulinemia (LPL/WM) has unique clinical and biological characteristics.^[1]However, due to the difficulties in obtaining tumor metaphase for karyotyping and slow cell proliferation, only very few studies have detected the cytogenetic aberration of LPL/WM.^[2,3]In addition, 6q deletion is the most common cytogenetic aberration in WM, with an incidence rate of about 50%.^[2]Nevertheless, other cytogenetic aberrations remain largely unclear, and the prognostic role of cytogenetic aberrations needs to be further explored. In the present study, we systematically analyzed 305 LPL/WM cases in China, focusing on the characteristics and cytogenetic aberrations in Chinese patients.

To the Editor:Diabetic kidney disease (DKD) has become the leading cause of end-stage kidney disease (ESKD). According to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, rapid kidney function decline in DKD is defined as an estimated glomerular filtration rate (eGFR) slope ≤-5 mL·min^-1·1.73 m^-2·year^-1. The prognoses of patients who experience rapid eGFR decline are usually poor. In a multicenter retrospective study, 230 of 377 (61%) biopsy-proven DKD patients were rapid decliners.^[1]It was reported that 32% and 42% of 195 type 2 diabetes (T2D) Pima Indians with normoalbuminuria and microalbuminuria, respectively, had a rapid eGFR decline, indicating that proteinuria alone has difficulty in fully predicting rapid kidney function decline in DKD patients with T2D.^[2]Therefore, it is of interest to identify more useful clinicopathological predictors of a rapid kidney function decline in T2D patients.

To the Editor:Although reports of neonatal upper airway obstruction in patients in neonatal intensive care units (NICUs) are common, neonatal tracheotomy is rare, possibly due to the small number of patients and the even smaller number of well-equipped hospitals to do a successful operation in neonates. However, despite the extensive efforts of qualified, skilled neonatologists and pediatric otorhinolaryngologists in performing a neonatal tracheotomy, some neonates did not undergo this surgery. When a neonate meets the indications of tracheotomy but his/her parent refuses to do the operation, he/she is facing a higher risk to be discharged against medical advice (DAMA) as per their parents' wish. To explore the preliminary evidence of neonatal tracheotomy in China, as well as to find out the outcome difference between neonates who underwent tracheotomy and those who did not undergo tracheotomy when they met the surgical indications, we conducted a retrospective study. Patients were treated in Beijing Children’s Hospital. Patients were categorized into the tracheotomy group or non-tracheotomy group according to whether their parents signed the tracheotomy consent and finally completed the tracheotomy. This study was approved by the Ethics Committee of Beijing Children’s Hospital, Capital Medical University (No. [2021]-E-139-R) and was registered in the Chinese Clinical Trial Registry (No. ChiCTR2100050720). All parents/guardians of participants provided written informed consent.

To the Editor: Colorectal cancer is one of the most common cancers worldwide, and chronic inflammation caused by colitis, especially ulcerative colitis, increases the risk of colorectal cancer. Compared with sporadic colorectal cancer whose hallmark is constitutive activation of Wingless/β-catenin signaling and the adenomacarcinoma sequence,P53andK-Rasmutations, which occur earlier, adenomatous polyposis coli occurs later during the progression of colitis-associated colorectal cancer (CAC). Surgery and chemotherapy are the preferred treatments of CAC, but long-term use of first-line chemotherapy agents such as 5-fluorouracil or irinotecan is limited by drug resistance or adverse reactions. Therefore, it is necessary for us to identify "green" drugs. Traditional Chinese medicines (TCMs) are complex and diverse and are found in nature. The anti-inflammatory, antibacterial, antiviral, antioxidant, antitumor, antiradiation, and immunomodulatory activity of TCMs have been extensively studied. TCMs are more able than synthesized drugs to prevent inflammation from progressing to cancer. This review summarizes the advantages of TCMs for treating CAC.

To the Editor:For patients with critical tracheal stenosis in surgery, extracorporeal membrane oxygenation (ECMO) is probably the last, yet safest, choice to ensure definitive airway security. Systemic anticoagulation in the form of heparin is a typical choice. However, heparin is fraught with its own complications that include both bleeding in the patient and clotting within the circuitry.^[1]In recent years, with progressive technological advancements, the application of heparin-free ECMO in trauma patients has been gradually reported but rarely reported in non-trauma patients.^[2]We would like to report three successful cases of heparin-free veno-venous extracorporeal membrane oxygenation (VV-ECMO) in non-trauma patients with difficult airways for surgery, two of which are patients with malignant tumors. This study was approved by the Ethics Committee of the Beijing Tongren Hospital (No. TREC2022-KY012). Written informed consent was obtained from the patients. All the three patients with severe tracheal stenosis caused by cervical tumors were admitted for tumor resection or segmental tracheal resection. The narrowest segment of the trachea measured 0.20-0.39 cm in contrast-enhanced CT scan. Awake endotracheal intubation can be extremely risky because of the imminent possibility of total airway obstruction and severe hypoxemia. In addition, tracheostomy was not prepared due to the enlarged tumor and location of the lesion. We established VV-ECMO before anesthesia induction to support adequate ventilation and oxygenation. The parameters for VV-ECMO settings are shown inTable 1. No systemic heparin was given. With oxygenation secured by ECMO, induction of general anesthesia and mechanical ventilation was managed by an endotracheal tube or laryngeal mask. All three patients were provided with lung protective ventilation strategies. It is important to know that not all venous blood is drained from the right atrium, and the residual deoxygenated blood that continues to the pulmonary system will rely on the lungs for gas exchange. Therefore, lung-protective ventilation should be performed if possible for supplemental oxygen and lung protection. The oxygenation for the three patients was maintained by VV-ECMO together with mechanical ventilation intraoperatively.

To the Editor: Acute myeloid leukemia (AML) is a heterogeneous disease characterized by proliferation of abnormal myeloblasts in the bone marrow. Traditional treatment, such as chemotherapy with or without hematopoietic stem cell transplantation (HSCT), has been used as the first-line therapy in AML. However, the clinical outcome of patients with AML varies greatly due to several factors, such as the tumor immune microenvironment (TME).^[1]Immune checkpoint inhibitors (ICIs) have recently gained popularity as therapeutic options for relapsed AML or measurable residual disease (MRD)-positive AML patients.^[2]Based on previous studies, immune dysregulation plays an important role in AML relapse, and immune-related genes may provide prognostic information for AML patients. Thus, exploring the immune-related genetic prognostic index (IRGPI) to predict prognosis and therefore provide personalized guidance for ICI therapy is urgently needed. In this study, we developed an immune-related genetic prognostic index for AML that was able to predict overall survival (OS) and ICI immunotherapy benefit. We focused on all immune-related genes in AML transcriptome data and screened immune-related genes associated with prognosis by weighted gene coexpression network analysis (WGCNA) to construct an immune-related gene prognostic index (IRGPI). We then characterized the immune and molecular features of the IRGPI, examined its prognostic ability for AML patients, and compared it with tumor immune dysfunction and exclusion (TIDE) as well as the tumor inflammation signature (TIS).^[3,4]The results showed that the IRGPI is a promising prognostic biomarker for AML patients to predict the survival and benefits of ICI immunotherapy.

To the Editor:Currently known syndromes of acute post-infectious or inflammatory demyelination include acute disseminated encephalomyelitis, encephalitis, transverse myelitis (TM), and Guillain-Barré syndrome (GBS). Demyelination is frequently limited to the central or peripheral nervous systems. The coexistence of myelitis and demyelinating peripheral neuropathy has only been reported in a few children^[1,2]and young adults.^[3]Also, concomitant TM and GBS in elderly immunocompetent patients has been rarely described.

To the Editor: Breast cancer is one of the malignant diseases that cause death in women and is a severe threat to women’s health. With the progress of medical treatment, there are many methods to treat breast cancer, such as drug therapy and hormone therapy. Among them, molecular targeted therapy has dramatically improved the treatment effect of breast cancer. Therefore, it is vital to find important molecular markers.^[1]Breast cancer can be divided into four subtypes: triple-negative (TN), lumA, lumB, and HER2+.^[2]HER2+ breast cancer accounts for 15-20% of breast cancers, with a higher grade, a more aggressive phenotype, and a worse prognosis.^[3]

Following the original article’s publication,^[1]the authors declared that the affiliation of the first author Xiaoping Li was submitted incorrectly, while correct author affiliations should be as follows. The authors apologize for any inconvenience caused.