2023年 · 第136卷第13期

Asthma is characterized by chronic airway inflammation and airway hyper-responsiveness. However, the differences in pathophysiology and phenotypic symptomology make a diagnosis of "asthma" too broad hindering individualized treatment. Four asthmatic inflammatory phenotypes have been identified based on inflammatory cell profiles in sputum: eosinophilic, neutrophilic, paucigranulocytic, and mixed-granulocytic. Paucigranulocytic asthma may be one of the most common phenotypes in stable asthmatic patients, yet it remains much less studied than the other inflammatory phenotypes. Understanding of paucigranulocytic asthma in terms of phenotypic discrimination, distribution, stability, surrogate biomarkers, underlying pathophysiology, clinical characteristics, and current therapies is fragmented, which impedes clinical management of patients. This review brings together existing knowledge and ongoing research about asthma phenotypes, with a focus on paucigranulocytic asthma, in order to present a comprehensive picture that may clarify specific inflammatory phenotypes and thus improve clinical diagnoses and disease management.

Lung cancer has the highest risk of brain metastasis (BM) among all solid carcinomas. The emergence of BM has a significant impact on the selection of oncologic treatment for patients. Immune checkpoint inhibitors (ICIs) are the most promising treatment option for patients without druggable mutations and have been shown to improve survival in patients with non-small cell lung cancer (NSCLC) BM in clinical trials with good safety. Moreover, ICI has shown certain effects in NSCLC BM, and the overall intracranial efficacy is comparable to extracranial efficacy. However, a proportion of patients showed discordant responses in primary and metastatic lesions, suggesting that multiple mechanisms may exist underlying ICI activity in BM. According to studies pertaining to tumor immune microenvironments, ICIs may be capable of provoking immunity in situ. Meanwhile, systematic immune cells activated by ICIs can migrate into the central nervous system and exert antitumor effects. This review summarizes the present evidence for ICI treatment efficacy in NSCLC BM and proposes the possible mechanisms of ICI treatment for NSCLC BMs based on existing evidence.

Previous studies have revealed that the number of cancer survivors developing a second primary malignancy is increasing, especially among thyroid cancer patients, and lung cancer is still the main cause of cancer death. Therefore, we aimed to investigate the risk of second primary lung cancer (SPLC) in patients with thyroid cancer.

We searched the PubMed, Web of Science, Embase, and Scopus databases up to November 24, 2021, for relevant research and merged the standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) to evaluate the risk of developing SPLC in patients with thyroid cancer.

Fourteen studies involving 1,480,816 cases were included in our meta-analysis. The pooled result demonstrated that thyroid cancer patients may have a higher risk of SPLC than the general population (SIR = 1.21, 95% CI: 1.07-1.36, P < 0.01, I² = 81%, P < 0.01). Subgroup analysis stratified by sex indicated that female patients may have a markedly higher risk of SPLC than male patients (SIR = 1.65, 95% CI: 1.40-1.94, P < 0.01, I² = 75%, P < 0.01).

Thyroid cancer patients are more likely to develop SPLC than the general population, especially women. However, other risk factors must be investigated, and more prospective studies are needed to confirm our results.

International Prospective Register of Systematic Reviews: No. CRD42021285399.

Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.

Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.

A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified). Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P < 0.01) and KSS (MD = -2.61, P < 0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P < 0.01) and KSS (MD = -2.44, P < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.

For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).

Postoperative pulmonary complications often lead to increased mortality and financial burden. Residual paralysis plays a critical role in postoperative pulmonary complications. This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications.

PubMed, Embase, Web of Science, Medline through Ovid, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature Databases were searched from their inception to 24 June, 2021. Random effects models were used for all analyses. Cochrane risk of bias tool was used to assess the quality of RCTs, while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies.

Seventeen studies were included in the meta-analysis. Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications (relative risk [RR]: 0.73; 95% confidence interval [CI]: 0.60-0.89; P = 0.002; I² = 81%), pneumonia (RR: 0.64; 95% CI: 0.48-0.86; I² = 42%) and respiratory failure (RR: 0.48; 95% CI: 0.41-0.56; I² = 0%). However, pooled data from RCTs did not show any difference between the two groups in pneumonia (RR: 0.58; 95% CI: 0.24-1.40; I² = 0%) and no respiratory failure was reported in the included RCTs. The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs (RR: 0.85; 95% CI: 0.69-1.05; I² = 0%) or cohort studies (RR: 1.01; 95% CI: 0.87-1.18; I² = 0%).

The evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs. Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown. Well-designed RCTs with large scale are needed.

PROSPERO (https://www.crd.york.ac.uk/PROSPERO/); CRD 42020191575

Dapsone hypersensitivity syndrome (DHS) was first reported by Lowe and Smith^[1]in 1949 in Nigeria and was termed "dapsone syndrome" by Allday and Barnes^[2]in 1951. DHS is a drug-induced hypersensitivity syndrome (DIHS) caused by dapsone 4′4’-diaminodiphenylsulfone (DDS). DHS is characterized by fever, rash, lymphadenopathy, and hepatitis, which usually develop after patients receive DDS for 5 to 6 weeks. Epidemiological studies have estimated DHS prevalence and fatality rates of 1.4% and 9.9%, respectively.^[3]Until recently, the "wait and see" approach was used for patients with suspected DHS. Herein, we review recent developments in DHS research, focusing on its etiology, pathogenesis, diagnosis, and prevention, to make DDS a safer medication for most of the population through the prospective exclusion of susceptible patients before DDS administration.

Melasma (chloasma) is a highly prevalent and cosmetically disfiguring pigmented skin disease that mainly manifests as bilateral irregular brown macules on sun-exposed areas of the face.^[1]Although melasma causes no physical discomfort, it poses a significant psychological burden on patients due to distressing cosmetic concerns. The sustained epidermal hypermelanization is a prominent pathological feature of melasma, which is usually considered to result from melanin overproduction by hyperactive melanocytes.^[2]However, existing therapeutic interventions that suppress melanocytes and tyrosinase, the rate-limiting enzyme in the synthetic pathway of melanin pigments, fail to achieve satisfactory outcomes, especially for recalcitrant melasma patients whose lesions tend to rebound.^[2]

After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).

This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.

Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D-lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.

Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.

ChiCTR-INR-17013093.

Few studies have explored the impact of perchlorate, nitrate, and thiocyanate (PNT) on kidney function. This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease (CKD) among the general population in the United States.

This analysis included data from 13,373 adults (≥20 years) from the National Health and Nutrition Examination Survey 2005 to 2016. We used multivariable linear and logistic regression, to explore the associations of urinary PNT with kidney function. Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes.

After traditional creatinine adjustment, perchlorate (P-traditional) was positively associated with estimated glomerular filtration rate (eGFR) (adjusted β: 2.75; 95% confidence interval [CI]: 2.25 to 3.26; P < 0.001), and negatively associated with urinary albumin-to-creatinine ratio (ACR) (adjusted β: -0.05; 95% CI: -0.07 to -0.02; P = 0.001) in adjusted models. After both traditional and covariate-adjusted creatinine adjustment, urinary nitrate and thiocyanate were positively associated with eGFR (all P values <0.05), and negatively associated with ACR (all P values <0.05); higher nitrate or thiocyanate was associated with a lower risk of CKD (all P values <0.001). Moreover, there were L-shaped non-linear associations between nitrate, thiocyanate, and outcomes. In the adjusted models, for quartiles of PNT, statistically significant dose-response associations were observed in most relationships. Most results were consistent in the stratified and sensitivity analyses.

Exposures to PNT might be associated with kidney function, indicating a potential beneficial effect of environmental PNT exposure (especially nitrate and thiocyanate) on the human kidney.

Lung cancer has been the leading cause of cancer-related deaths worldwide for many years. This study aimed to investigate the global patterns and trends of lung cancer.

Lung cancer incidence and mortality were derived from the GLOBOCAN 2020 database. Continuous data from Cancer Incidence in Five Continents Time Trends were used to analyze the temporal trends from 2000 to 2012 using Joinpoint regression, and average annual percent changes were calculated. The association between the Human Development Index and lung cancer incidence and mortality was assessed by linear regression.

An estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020. The age-standardized incidence rate (ASIR) ranged from 36.8 per 100,000 in Demark to 5.9 per 100,000 in Mexico. The age-standardized mortality rate (ASMR) varied from 32.8 per 100,000 in Poland to 4.9 per 100,000 in Mexico. Both ASIR and ASMR were approximately twice higher in men than in women. The ASIR of lung cancer showed a downward trend in the United States of America (USA) between 2000 and 2012, and was more prominent in men. The age-specific incidence rates of lung cancer for ages of 50 to 59 years showed an upward trend in China for both men and women.

The burden of lung cancer is still unsatisfactory, especially in developing countries like China. Considering the effectiveness of tobacco control and screening in developed countries, such as the USA, there is a need to strengthen health education, accelerate the establishment of tobacco control policies and regulations, and improve early cancer screening awareness to reduce the future burden of lung cancer.

There is little published evidence about the role of non-alcoholic fatty liver disease (NAFLD) in the progression from prehypertension to hypertension. This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension.

The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline; those with excessive alcohol consumption and other liver diseases were excluded. NAFLD was diagnosed by ultrasonography and stratified as mild, moderate, or severe. Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension according to the presence and 3 categories of severity of NAFLD.

During a median of 12.6 years of follow-up, 10,638 participants progressed to hypertension from prehypertension. After adjusting for multiple risk factors, patients with prehypertension and NAFLD had a 15% higher risk of incident hypertension than those without NAFLD (HR = 1.15, 95% CI 1.10-1.21). Moreover, the severity of NAFLD was associated with the incidence of hypertension, which was higher in patients with more severe NAFLD (HR = 1.15 [95% CI 1.10-1.21] in the mild NAFLD group; HR = 1.15 [95% CI 1.07-1.24] in the moderate NAFLD group; and HR = 1.20 [95% CI 1.03-1.41] in the severe NAFLD group). Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association.

NAFLD is an independent risk factor for hypertension in patients with prehypertension. The risk of incident hypertension increases with the severity of NAFLD.

Stroke is the leading cause of death in China, and predicting the stroke burden could provide essential information guiding the setting of medium- and long-term health policies and priorities. The study aimed to project trends associated with stroke burden in China through 2050, not only in terms of incidence and mortality but also for prevalence and disability-adjusted life years (DALYs).

Data on stroke rates in incidence, prevalence, deaths, and DALYs in China between 1990 and 2019 were obtained from a recent Global Burden of Disease study. Demographic-specific trends in rates over time were estimated using three models: the loglinear model, the Lee-Carter model, and a functional time series model. The mean absolute percentage error and the root mean squared error were used for model selection. Projections up to 2050 were estimated using the best fitting model. United Nations population data were used to project the absolute numbers through 2050.

From 2019 to 2050, the crude rates for all measures of the stroke burden are projected to increase continuously among both men and women. We project that compared with those in 2019, the incidence, prevalence, deaths, and DALYs because of stroke in China in 2050 will increase by 55.58%, 119.16%, 72.15%, and 20.04%, respectively; the corresponding increases in number were 2.19, 34.27, 1.58, and 9.21 million. The age-standardized rate is projected to substantially decline for incidence (8.94%), death (40.37%), and DALYs (43.47%), but the age-standardized prevalence rate is predicted to increase by 10.82%. By 2050, the burden of stroke among the population aged ≥65 years will increase significantly: by 104.70% for incidence, by 218.48% for prevalence, by 100.00% for death, and by 58.93% for DALYs.

With the aging population in China increasing over the next three decades, the burden of stroke will be markedly increased. Continuous efforts are needed to improve stroke health care and secondary prevention, especially for older adults.

To the Editor:Asthma is an abnormal chronic inflammatory disease characterized by the involvement of a complex network of cells. Barrier epithelial cells (ECs) represent the first line of defense and express pattern recognition receptors to recognize type-2 cell-mediated immune insults. An exaggerated abnormal barrier function or inadequate immune response may contribute to the pathophysiology of asthma.^[1,2]

To the Editor: The overall survival rate among patients undergoing cardiac surgery has significantly increased, and reducing mortality and post-operative complications remain vital. Malnutrition is a common condition in hospitalized patients. There are several methods to evaluate nutritional status; however, some elements of malnutrition are difficult to measure. The controlling nutritional status (CONUT) score is an objective nutritional indicator and easy-to-perform practical screening tool that uses the serum albumin, peripheral lymphocyte count, and total cholesterol. Specifically, the combination of these three components can evaluate protein reserves, immune defenses, and calorie depletion.^[1]Recently, the predictive value of the CONUT score has been validated in surgical patients with peripheral arterial disease, malignant tumors, and heart disease.^[2]Several studies found high CONUT score was associated with high mortality in patients undergoing transcatheter aortic valve implantation (TAVI), percutaneous coronary intervention, or coronary artery bypass grafting.^[2,3]However, the prognostic impact of the CONUT score has not been fully investigated in Chinese patients undergoing cardiac surgery. Therefore, this study aimed to determine the prognostic impact of malnutrition, as assessed by the CONUT score, in patients undergoing cardiac surgery.

To the Editor:Chronic obstructive pulmonary disease (COPD), a clinical syndrome encompassing a spectrum of chronic, progressive, and debilitating respiratory disorders, is increasingly recognized as a multisystemic heterogeneous disease.^[1]Because the characteristics of East Asian COPD patients differ from those of Westerners, it would be practical to investigate whether variations in COPD genetic performance exist between East Asian and Western populations.^[2]

To the Editor:Transthoracic needle aspiration (TTNA) and bronchoscopy have been the preferred methods for the sampling of pulmonary nodules suspected of lung cancer. However, despite having a higher diagnostic accuracy, TTNA has been associated with a high rate of pneumothorax. Moreover, conventional bronchoscopy with a low rate of pneumothorax has exhibited a low diagnostic yield for peripheral pulmonary nodules, particularly for nodules <2 cm in size or those without a bronchus leading directly to them. Thus, Herthet al^[1]developed a novel bronchoscopy technique called bronchoscopic transparenchymal nodule access (BTPNA) under the guidance of Archimedes Virtual Bronchoscopic Navigation (VBN) System for the purpose of accessing pulmonary nodules using a transparenchymal approach without relying on the airway to approach the lesion. Here, we systematically reviewed evidence regarding BTPNA to provide general guidance on the safe implementation and development of this novel approach.

To the Editor: With the extensive uptake of pertussis vaccine, morbidity and mortality related to pertussis have decreased significantly. The application of acellular vaccines (ACVs) occurred later in China than in developed countries; correspondingly, the pertussis resurgence in China also began later. The latest global genotype dynamic prediction model cannot explain theB. pertussisgenotype change trend in China.^[1]ChineseB.pertussisstrains gradually formed their own unique developmental branches.^[2]Here, a phylogenetic tree of prevailingB.pertussisstrains from three different regions of China was visualized by EvolView (http://www. evolgenius.info/evolview.html). A total of 199 isolatedB.pertussisstrains were used for the phylogenetic analysis. TheB.para-pertussisstrain isolated from Tianjin was used as the out-group, and Chinese strain (CS), which is widely used as a vaccine strain for ACV production in China, was used as the reference strain. In particular, we analyzed the multilocus sequence typing (MLST) and macrolide-resistance-conferring gene mutations.

To the Editor: As the novel coronavirus disease 2019 (COVID-19) pandemic rapidly spreads around the world, it has resulted in unprecedented economic loss, social turmoil, and detrimental effects on public mental health. In particular, the implementation of disease control measures such as nationwide lockdowns, social distancing, school closures, and home quarantine has given rise to a wide range of social anxiety (SA) around the world, from nonclinical manifestations to clinical social anxiety disorder (SAD).^[1]Given the potentially severe impairments from SA and the limited mental health care resources, it is vital to identify whether there are vulnerability/risk neuropsychological factors contributing to the progression of SA during the pandemic. In addition, obsessive-compulsive symptoms/disorder (OCS/OCD), another important mental health issue during the pandemic, is conceptually and empirically related to SA and shares some neuroanatomical substrates with SA;^[2]however, this potential link in the context of the COVID-19 pandemic has been less investigated. The current study therefore aims to explore the differences of neuroanatomical structures for discrepant changes of SA in normal young people, and the potential mediating roles of pandemic-specific OCS in the linking of brain structure with SA alterations during the COVID-19 pandemic.

To the Editor:Obesity characterized with excess accumulation of white adipose tissue increases the prevalence of gestational diabetes mellitus (GDM). Exposure to intrauterine hyperglycemia increases the long-term sequelae including cardiovascular abnormalities and metabolic syndrome in adult offspring.^[1]As early as two decades ago, Dr. David Barker provided evidence that nutritional exposuresin uterohas a lasting impact on offspring’s health status in adulthood.^[2]This emphasizes the critical role of early intrauterine environmental exposures and highlights the potential origins of adult metabolic diseases.

To the Editor:To control the coronavirus disease 2019 (COVID-19) pandemic and reduce the complications and deaths resulting from the transmission of the disease, a variety of COVID-19 vaccines, such as mRNA vaccines, adenovirus-vector vaccines, inactivated viral vaccines, and others, have been licensed for emergency use. Most of these vaccines were rolled out in different countries following the successful completion of phase 3 clinical trials. Scale-up of vaccine production and vaccination have provided notable protection to large populations, although some vaccines may cause side effects. Furthermore, as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has mutated and spread further over time, some notable novel variants have emerged, but whether these variants are vulnerable to currently available vaccines is yet to be determined.

To the Editor:Tumors are one of the main causes of death worldwide. Pyroptosis is a newly discovered form of cell death, causing cell swelling and rapid lysis, which releases pro-inflammatory mediators and enhances the inflammatory response.^[1]Inflammation increases the immune response to tumors and inhibits their progression. The ultimate goal of cancer therapeutics is to maximize the destruction of tumor cells while minimizing the damage to normal tissues.^[2]Targeting pyroptosis of tumor cells could overcome the apoptotic resistance and trigger antitumor immunity, thus being a good treatment for tumors.

To the Editor:China has the largest number of intracerebral hemorrhage (ICH) patients of any single country,^[1]and efforts to mine, utilize, and share the relevant data are warranted. As a structured diagnosis and treatment pipeline for ICH has been demonstrated to improve patient outcomes, there is an urgent need to construct a large medical database to store relevant data and facilitate data mining, analysis, and sharing. However, traditional stroke databases are dominated by text data without comprehensive imaging data, and few studies have focused on the construction of databases on ICH.^[2,3]To integrate multimodal data on ICH and standardize data processing and feedback, the Chinese Intracranial Hemorrhage Imaging Database (CICHID) was established by Peking Union Medical College Hospital in 2019 and is under continuous refinement. Differing from traditional text-based databases, CICHID is a large multimodal data warehouse implementing comprehensive clinical data storage and multidimensional imaging data analysis.