2023年 · 第136卷第12期

In orthopedic surgery, the accuracy of internal fixation is related to the success of the procedure. In the past, orthopedic surgeons usually placed screws freehand according to anatomical landmarks or fluoroscopy images. Although there are many surgical techniques for inserting screws freehand, the accuracy of freehand screw placement is not high enough, and the results can be unstable. The accuracy of freehand screw placement reported in the literature varies greatly. Particularly in the spine, with its unique anatomy and important adjacent tissues, inaccurate screw placement may lead to serious complications, such as nerve or vessel injury, cerebrospinal fluid leakage, thoracic or abdominal organ injury, and segment instability. Surgeons must undergo extensive professional training and accumulate in-depth surgical experience to reduce the incidence of inaccurate screw placement.

The intestinal mucus layer is a barrier that separates intestinal contents and epithelial cells, as well as acts as the "mucus layer-soil" for intestinal flora adhesion and colonization. Its structural and functional integrity is crucial to human health. Intestinal mucus is regulated by factors such as diet, living habits, hormones, neurotransmitters, cytokines, and intestinal flora. The mucus layer’s thickness, viscosity, porosity, growth rate, and glycosylation status affect the structure of the gut flora colonized on it. The interaction between "mucus layer-soil" and "gut bacteria-seed" is an important factor leading to the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Probiotics, prebiotics, fecal microbiota transplantation (FMT), and wash microbial transplantation are efficient methods for managing NAFLD, but their long-term efficacy is poor. FMT is focused on achieving the goal of treating diseases by enhancing the "gut bacteria-seed". However, a lack of effective repair and management of the "mucus layer-soil" may be a reason why "seeds" cannot be well colonized and grow in the host gut, as the thinning and destruction of the "mucus layer-soil" is an early symptom of NAFLD. This review summarizes the existing correlation between intestinal mucus and gut microbiota, as well as the pathogenesis of NAFLD, and proposes a new perspective that "mucus layer-soil" restoration combined with "gut bacteria-seed" FMT may be one of the most effective future strategies for enhancing the long-term efficacy of NAFLD treatment.

There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.

Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.

A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.

In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.

Fecal microbiota transplantation (FMT) describes a therapeutic approach in which feces from healthy donors are delivered into the guts of recipient patients through either the upper or lower gastrointestinal tract. FMT is now a standard therapeutic option for patients with recurrentClostridium difficileinfection (rCDI), but FMT has also been applied to several other gut diseases, not least inflammatory bowel disease (IBD), especially ulcerative colitis (UC). Several clinical trials have now shown that FMT is an efficacious and safe treatment not only for patients with mild-to-moderate active UC but also those in clinical remission.

Large disparities exist in liver cancer burden trends across countries but are poorly understood. We aimed to investigate the global trajectories of liver cancer burden, explore the driving forces, and predict future trends.

Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trajectories were defined using growth mixture models. Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories. A Bayesian age-period-cohort model was used to predict future trends through 2035.

Three trajectories of liver cancer burden were identified: increasing, stable, and decreasing groups. Almost half of the American countries were classified in the decreasing group (48.6% for ASIR and ASMR), and the increasing group was the most common in the European region (ASIR, 49.1%; ASMR, 37.7%). In the decreasing group, the decrease of liver cancer due to hepatitis B contributed 63.4% and 60.4% of the total decreases in ASIR and ASMR, respectively. The increase of liver cancer due to alcohol use, hepatitis C, and hepatitis B contributed the most to the increase in the increasing group (30.8%, 31.1%, and 24.2% for ASIR; 33.7%, 30.2%, and 22.2% for ASMR, respectively). The increasing group was associated with a higher sociodemographic index, gross domestic product per capita, health expenditure per capita, and universal health coverage (all P <0.05). Significant variations in disease burden are predicted to continue through 2035, with a disproportionate burden in the decreasing group.

Global disparities were observed in liver cancer burden trajectories. Hepatitis B, alcohol use, and hepatitis C were identified as driving forces in different regions.

Immune checkpoint inhibitors (ICIs) are increasingly used as first-line therapy for patients with advanced non-small cell lung cancer (NSCLC) harboring no actionable mutations; however, data on their efficacy among patients presenting with intracranial lesions are limited. This study aimed to explore the efficacy and safety of ICIs combined with chemotherapy in advanced NSCLC patients with measurable brain metastasis at initial diagnosis.

Our study retrospectively analyzed clinical data of a total of 211 patients diagnosed with driver gene mutation-negative advanced NSCLC with measurable, asymptomatic brain metastasis at baseline from Hunan Cancer Hospital between January 1, 2019 and September 30, 2021. The patients were stratified into two groups according to the first-line treatment regimen received: ICI combined with chemotherapy (n = 102) or chemotherapy (n = 109). Systemic and intracranial objective response rates (ORRs) and progression-free survival (PFS) were analyzed. Adverse events were also compared between the groups.

Compared with the chemotherapy-based regimen, the ICI-containing regimen was associated with a significantly higher intracranial (44.1% [45/102] vs. 28.4% [31/109], χ² = 5.620, P = 0.013) and systemic (49.0% [50/102] vs. 33.9% [37/109], χ² = 4.942, P = 0.019) ORRs and longer intracranial (11.0 months vs. 7.0 months, P <0.001) and systemic (9.0 months vs. 5.0 months, P <0.001) PFS. Multivariable analysis consistently revealed an independent association between receiving ICI plus platinum-based chemotherapy as a first-line regimen and prolonged intracranial PFS (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.37-0.73, P <0.001) and systemic PFS (HR = 0.48, 95% CI: 0.35-0.66, P <0.001). No unexpected serious adverse effects were observed.

Our study provides real-world clinical evidence that ICI combined with chemotherapy is a promising first-line treatment option for driver gene mutation-negative advanced NSCLC patients who present with brain metastasis at initial diagnosis.

https://www.clinicaltrials.gov/, OMESIA, NCT05129202.

This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.

This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument’s intrinsic and interrater reliability, content and criterion validity, and usability.

STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach’s α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen’s kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson’s r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.

The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.

Reports on the prevalence of psoriatic arthritis (PsA) among Chinese patients with psoriasis are very limited. This study, conducted by rheumatologists, estimated the prevalence of PsA in a large number of Chinese patients with psoriasis.

Consecutive patients with a confirmed diagnosis of psoriasis attending nine dermatology clinics in five hospitals were recruited. All psoriasis patients were asked to complete a questionnaire comprising 16 questions to identify possible cases of PsA. All patients with one or more positive answers to the questionnaire were evaluated by two experienced rheumatologists.

A total of 2434 psoriasis patients, including 1561 males and 873 females, were enrolled. Both the questionnaire and rheumatologists’ examinations were completed in the dermatology clinics. The results identified 252 patients with PsA, comprising 168 males and 84 females. The overall prevalence of PsA among psoriasis patients was 10.4% (95% confidence interval [95% CI], 9.1%-11.7%). By sex, the prevalence was 10.8% (95% CI, 9.2%-12.5%) for males and 9.6% (95% CI, 7.7%-11.9%) for females and there was no significant sex difference in the prevalence of PsA (P = 0.38). Of the 252 PsA patients, 125 (49.6%, 95% CI, 41.3%-59.1%) were newly diagnosed by rheumatologists. Consequently, the prevalence of undiagnosed PsA among psoriasis patients was 5.2% (95% CI, 4.4%-6.2%).

The prevalence of PsA in the Chinese population with psoriasis is about 10.4%, which is almost double that of previous reports in the Chinese population, but lower than that in Caucasians.

Exploring the underlying mechanism of rituximab resistance is critical to improve the outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Here, we tried to identify the effects of the axon guidance factor semaphorin-3F (SEMA3F) on rituximab resistance as well as its therapeutic value in DLBCL.

The effects of SEMA3F on the treatment response to rituximab were investigated by gain- or loss-of-function experiments. The role of the Hippo pathway in SEMA3F-mediated activity was explored. A xenograft mouse model generated by SEMA3F knockdown in cells was used to evaluate rituximab sensitivity and combined therapeutic effects. The prognostic value of SEMA3F and TAZ (WW domain-containing transcription regulator protein 1) was examined in the Gene Expression Omnibus (GEO) database and human DLBCL specimens.

We found that loss of SEMA3F was related to a poor prognosis in patients who received rituximab-based immunochemotherapy instead of chemotherapy regimen. Knockdown of SEMA3F significantly repressed the expression of CD20 and reduced the proapoptotic activity and complement-dependent cytotoxicity (CDC) activity induced by rituximab. We further demonstrated that the Hippo pathway was involved in the SEMA3F-mediated regulation of CD20. Knockdown of SEMA3F expression induced the nuclear accumulation of TAZ and inhibited CD20 transcriptional levels via direct binding of the transcription factor TEAD2 and the CD20 promoter. Moreover, in patients with DLBCL, SEMA3F expression was negatively correlated with TAZ, and patients with SEMA3F^lowTAZ^high had a limited benefit from a rituximab-based strategy. Specifically, treatment of DLBCL cells with rituximab and a YAP/TAZ inhibitor showed promising therapeutic effects in vitro and in vivo.

Our study thus defined a previously unknown mechanism of SEMA3F-mediated rituximab resistance through TAZ activation in DLBCL and identified potential therapeutic targets in patients.

Endocrine therapy (ET) and ET-based regimens are the preferred first-line treatment options for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (HR+/HER2- MBC), while chemotherapy (CT) is commonly used in clinical practice. The aim of this study was to investigate the efficacy and clinical outcome of ET and CT as first-line treatment in Chinese patients with HR+/HER2- MBC.

Patients diagnosed with HR+/HER2-MBC between January 1st, 1996 and September 30th, 2018 were screened from the Chinese Society of Clinical Oncology Breast Cancer database. The initial and maintenance first-line treatment, progression-free survival (PFS), and overall survival (OS) were analyzed.

Among the 1877 included patients, 1215 (64.7%) received CT and 662 (35.3%) received ET as initial first-line treatment. There were no statistically significant differences in PFS and OS between patients receiving ET and CT as initial first-line treatment in the total population (PFS: 12.0 vs. 11.0 months, P = 0.22; OS: 54.0 vs. 49.0 months, P = 0.09) and propensity score matched population. For patients without disease progression after at least 3 months of initial therapy, maintenance ET following initial CT (CT-ET cohort, n = 449) and continuous schedule of ET (ET cohort, n = 527) had longer PFS than continuous schedule of CT (CT cohort, n = 406) in the total population (CT-ET cohort vs. CT cohort: 17.0 vs. 8.5 months; P <0.01; ET cohort vs. CT cohort: 14.0 vs. 8.5 months; P <0.01) and propensity score matched population. OS in the three cohorts yielded the same results as PFS.

ET was associated with similar clinical outcome to CT as initial first-line treatment. For patients without disease progression after initial CT, switching to maintenance ET showed superiority in clinical outcome over continuous schedule of CT.

Congenital scoliosis (CS) is a complex spinal malformation of unknown etiology with abnormal bone metabolism. Fibroblast growth factor 23 (FGF23), secreted by osteoblasts and osteocytes, can inhibit bone formation and mineralization. This research aims to investigate the relationship between CS and FGF23.

We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region. FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured. Receiver operator characteristic (ROC) curve analyses were conducted to evaluate the specificity and sensitivity of FGF23. The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3 (FGFr3)/tissue non-specific alkaline phosphatase (TNAP)/osteopontin (OPN) in primary osteoblasts from CS patients (CS-Ob) and controls (CT-Ob) were detected. In addition, the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.

DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins, accompanied by increased mRNA levels. CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography (CT) values compared with controls. The FGF23 mRNA levels were negatively correlated with the CT value of the spine, and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS. Additionally, significantly increased levels of FGF23, FGFr3, OPN, impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob. Moreover, FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels, while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob. Mineralization of CS-Ob was rescued after FGF23 knockdown.

Our results suggested increased peripheral blood FGF23 levels, decreased bone mineral density in CS patients, and a good predictive ability of CS by peripheral blood FGF23 levels. FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP/OPN pathway.

Total knee arthroplasty (TKA) can reduce severe joint pain and improve functional disability in hemophilia. However, the long-term outcomes have rarely been reported in China. Therefore, this study aimed to evaluate the long-term outcomes and complications of TKA in Chinese patients with hemophilic arthropathy.

We retrospectively reviewed patients with hemophilia who underwent TKA between 2003 and 2020, with at least 10 years of follow-up. The clinical results, patellar scores, patients’ overall satisfaction ratings, and radiological findings were evaluated. Revision surgery for implants during the follow-up period was recorded.

Twenty-six patients with 36 TKAs were successfully followed up for an average of 12.4 years. Their Hospital for Special Surgery Knee Score improved from an average of 45.8 to 85.9. The average flexion contracture statistically significantly decreased from 18.1° to 4.2°. The range of motion (ROM) improved from 60.6° to 84.8°. All the patients accepted patelloplasty, and the patients’ patellar score improved from 7.8 preoperatively to 24.9 at the last follow-up. There was no statistically significant difference in clinical outcomes between the unilateral and bilateral procedures, except for a better ROM at follow-up in the unilateral group. Mild and enduring anterior knee pain was reported in seven knees (19%). The annual bleeding event was 2.7 times/year at the last follow-up. A total of 25 patients with 35 TKAs were satisfied with the procedure (97%). Revision surgery was performed in seven knees, with 10- and 15-year prosthesis survival rates of 85.8% and 75.7%, respectively.

TKA is an effective procedure for patients with end-stage hemophilic arthropathy, which relieves pain, improves knee functions, decreases flexion contracture, and provides a high rate of satisfaction after more than ten years of follow-up.

To the Editor: Skeletal dysplasia is a group of clinical and genetic heterogeneous disorders with primary involvement of the musculoskeletal system, including bone, cartilage, tendons, ligaments, and muscles, and is usually characterized by short stature, motion limitation, or fragility fractures, sometimes complicated with extra-skeletal phenotypes.^[1]Due to the usually heterogeneous and nonspecific clinical manifestations of the disorder, identification of the pathogenic genes is crucial for patients to obtain an accurate molecular diagnosis, which not only provides explanations for patient phenotypes and ends lengthy diagnostic odysseys but also offers information concerning natural courses, specific therapies, genetic counseling for family members and prenatal diagnoses for at-risk fetuses. Genetic services have emerged in developing countries in the last decade of the twentieth century, and advances in studies concerning genetic disorders are changing the health care setting in China and the way clinicians think about the causes, diagnosis, and treatment of skeletal dysplasia.^[2]However, a lack of comprehensive understanding of the clinical and genetic architecture of skeletal dysplasia in Chinese patients constrains further implementation of relevant genetic services into the health care system to a better position.^[3]Additionally, there is currently no medical insurance coverage for genetic testing in China, and the tests are generally paid for by the patients themselves or through scientific research funds. These factors place new demands on clinicians for medical genetic expertise and urge the establishment of a molecular diagnostic strategy for skeletal dysplasia so that genetic testing can be applied effectively in clinical practice.

To the Editor: In China, very young breast cancer patients (≤35-year-old) make up approximately 10% of all breast cancer cases, compared to 2% in Western countries. This suggests that different morbidity may be caused by different geographic regions and ethnicities, even leading to different clinicopathological characteristics and prognoses. Tanget al^[1]reported that very young breast cancer patients had poor disease-free survival (DFS), and the risk of disease progression was 1.557-fold higher than that for the elderly patients, but no difference was observed in overall survival (OS). However, few studies have focused on very young patients with breast cancer in China. Therefore, we conducted a retrospective population-based study to investigate the oncological outcomes of very young breast cancer patients. The studies involving human participants were reviewed and approved by the Ethics Committee of the International Peace Maternity and Child Health Hospital ([No. GKLW] 2021-37).

To the Editor:Non-Hodgkin lymphoma (NHL) is a common type of hematological malignancy. Although the development of targeted therapies has improved the survival of patients with aggressive NHL, autologous hematopoietic stem cell transplantation (HSCT) remains indispensable. There is no standard conditioning regimen for autologous stem cell transplantation (ASCT). Three common regimens are carmustine, etoposide, cytarabine, and melphalan (BEAM); carmustine, etoposide, cytarabine, and cyclophosphamide (BEAC); and total body irradiation. The 3-year progression-free-survival (PFS) rate associated with these regimens varies from 40% to 50%. Chidamide, a novel subtype-selective histone deacetylase inhibitor (HDACi), can directly inhibit tumor cell cycle progression, induce tumor cell apoptosis, and restore the sensitivity of drug-resistant tumor cells to drugs by loosening chromatin and exposing deoxyribonucleic acid (DNA). Clinical trials have shown that a combination of HDACi, cladribine, gemcitabine, and busulfan had a promising safety profile and efficacy as a pretransplant conditioning regimen in patients with relapsed/refractory NHL.^[1]This phase II clinical trial aimed to evaluate the efficacy and safety of the chidamide-BEAC (Chi-BEAC) conditioning regimen with ASCT for treating high-risk or relapsed/refractory aggressive NHLs.

To the Editor: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases globally, and this systemic disease carries a substantial economic burden and will result in a greater disease burden in the future.^[1]

To the Editor: The vaccine-related adaptive immune systems, including humoral immunity induced by B cell reaction and cellular immunity induced by T cells, are crucial for controlling severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.^[1]Therefore, it is vital to clarify the immune changes caused by inactivated vaccines, which are most commonly used in China, for evaluating the protective effect of vaccines and formulating vaccination plans.

To the Editor:Over the past few years, the number of cancer survivors has continued to increase, primarily driven by the growing and aging population and the improvements in cancer detection and treatment. More than 16.9 million Americans with prior cancers were alive on January 1, 2019, and the number of cancer survivors was estimated to reach >22.1 million by January 1, 2030.^[1]The lifetime risk of individual second primary cancer (SPC) has been confirmed when confronted with such a large amount of cancer survivors.^[2]Definition of specific site is shown in supplementary material, http://links.lww.com/CM9/B616.

To the Editor: Despite major advances in medical care, the incidence and mortality of bloodstream infection (BSI) remain high, which is still a global public health challenge. BSI can be caused by various microorganisms, and the most common organisms areEscherichia coli,Klebsiella pneumoniae, andStaphylococcus aureus(S. aureus), according to the China Antimicrobial Surveillance Network (CHINET).^[1]S. aureusis the third most common cause of BSI, which is associated with short-term mortality rates of 15-30%, long-term excess mortality, and increased healthcare costs. At present, there are many studies on Gram-negative bacteremia but relatively few onS. aureusbloodstream infection (SA-BSI), especially in China. With the occurrence of new treatments and clinical conditions, such as aging and extensive antibiotic resistance, it is necessary to reanalyze the clinical characteristics and prognosis of SA-BSI.

To the Editor:The enhanced activation of immune cells is a decisive factor for the pathological progress of inflammatory bowel disease (IBD), which can release generous inflammatory cytokines and bioactive molecules suggesting their roles as potential therapeutic targets for IBD. Purinergic receptors are a family of membranous proteins found extensively in many mammalian tissues and organs. As a subtype of purinergic receptors, the expressions of P2X7 receptor (P2X7R) can be detected abundantly in epithelial cells and most immune cells. During inflammation, adenosine triphosphate (ATP) is released extracellularly by various stimuli. In general, through the activation of P2X7R, extracellular ATP (eATP) can stimulate inflammation, while the degradation of ATP to adenosine usually exerts anti-inflammation roles. Consequently, ATP/P2X7R signaling can stimulate immune cells to produce various biological activities. Currently, mouse models of colitis have clarified the role of P2X7R in inflammation, which was supported by the increase in extracellular purines in the process of inflammation and the deregulated expression of purine receptor genes and proteins.^[1,2]In addition, nuclear factor kappa B (NF-κB) is a pleiotropic transcription factor, which can drive the expression of pro-survival genes in intestinal epithelial cells and coordinate the expression of pro-inflammatory genes in innate and adaptive immune system cells. NF-κB has been proven to be a key regulator in the progression of IBD.^[3]

To the Editor: In recent years, anesthesia for gastrointestinal endoscopy (GIE) has been widely used for early gastrointestinal cancer screening. Approximately 82% of gastroscopies are performed under sedation/anesthesia in Germany, and 98% of colonoscopies are performed under sedation/anesthesia in the United States.^[1,2]Increasingly, more studies are proving the beneficial effects of anesthesia on GIE. Nevertheless, patients and even endoscopists still have concerns about performing GIE under anesthesia. We performed a multicenter prospective observational cohort study to identify the effect of anesthesia on compliance, satisfaction, and safety in Chinese patients undergoing GIE.

There are some errors in the article "Electroacupuncture-induced activation of GABAergic system alleviates airway inflammation in asthma model by suppressing TLR4/MyD88/NF-κB signaling pathway" which appeared in vol. 136, issue 4, page 451-460 ofChinese Medical Journal.^[1]First, the sentence in theStudy designshould be modified to "The level of GABA, the expressions of GABAAR, and TLR4/MyD88/NF-κB signaling pathway were assessed using Western blot and histological staining". Second, the drug concentration in theEstablishment of the experimental animal model of asthmais wrong, the correct one is "OVA (Sigma Aldrich, Louis, MO, USA) and aluminum hydroxide (Al(OH)3; Sigma Aldrich) were prepared in concentrations of 250 μg/mL and 10 mg/mL, respectively". Third, there are four icon mistakes inResults, and the correct sentences should be submitted as following: "Inflammatory infiltration was significantly reduced in OVA + EA group compared with the OVA group (inflammation score 3.00 [3.00-3.25]vs.5.00 [4.00-5.00],P= 0.010) [Figure 3A, C]", "In contrast to the OVA group, goblet cells were significantly reduced in the OVA + EA group (PAS score 4.00 [3.00-4.00]vs.1.50 [1.00-2.00],P= 0.002) [Figure 3B, D]", "After inhibition of GABAAR, the OVA + EA + antagonist group showed more severe infiltration of inflammatory cells in alveoli, congestion of blood capillaries, and thickening of alveolar septa than in the OVA + EA group (inflammation score 4.50 [4.00-5.00]vs.3.00 [3.00-3.25],P= 0.038) [Figures 3A, C]", "The PAS scores in the OVA + EA + antagonist group were significantly greater than those in the OVA + EA group (PAS score 3.00 [2.75-3.25]vs.1.50 [1.00-2.00],P= 0.047) [Figures 3B, D]". The errors do not affect the results and conclusions of the article.