2023年 · 第136卷第17期

In the field of plastic and reconstructive surgery, the loss of organs or tissues caused by diseases or injuries has resulted in challenges, such as donor shortage and immunosuppression. In recent years, with the development of regenerative medicine, the decellularization-recellularization strategy seems to be a promising and attractive method to resolve these difficulties. The decellularized extracellular matrix contains no cells and genetic materials, while retaining the complex ultrastructure, and it can be used as a scaffold for cell seeding and subsequent transplantation, thereby promoting the regeneration of diseased or damaged tissues and organs. This review provided an overview of decellularization-recellularization technique, and mainly concentrated on the application of decellularization-recellularization technique in the field of plastic and reconstructive surgery, including the remodeling of skin, nose, ears, face, and limbs. Finally, we proposed the challenges in and the direction of future development of decellularization-recellularization technique in plastic surgery.

Patients with mass-forming pancreatitis (MFP) or pancreatic ductal adenocarcinoma (PDAC) presented similar clinical symptoms, but required different treatment approaches and had different survival outcomes. This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) in differentiating MFP from PDAC.

A literature search was performed in the PubMed, EMBASE (Ovid), Cochrane Library (CENTRAL), China National Knowledge Infrastructure (CNKI), Weipu (VIP), and WanFang databases to identify original studies published from inception to August 20, 2021. Studies reporting the diagnostic performances of CEUS and CECT for differentiating MFP from PDAC were included. The meta-analysis was performed with Stata 15.0 software. The outcomes included the pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves of CEUS and CECT. Meta-regression was conducted to investigate heterogeneity. Bayesian network meta-analysis was conducted to indirectly compare the overall diagnostic performance.

Twenty-six studies with 2115 pancreatic masses were included. The pooled sensitivity and specificity of CEUS for MFP were 82% (95% confidence interval [CI], 73%-88%; I² = 0.00%) and 95% (95% CI, 90%-97%; I² = 63.44%), respectively; the overall +LR, -LR, and DOR values were 15.12 (95% CI, 7.61-30.01), 0.19 (95% CI, 0.13-0.29), and 78.91 (95% CI, 30.94-201.27), respectively; and the area under the SROC curve (AUC) was 0.90 (95% CI, 0.87-92). However, the overall sensitivity and specificity of CECT were 81% (95% CI, 75-85%; I² = 66.37%) and 94% (95% CI, 90-96%; I² = 74.87%); the overall +LR, -LR, and DOR values were 12.91 (95% CI, 7.86-21.20), 0.21 (95% CI, 0.16-0.27), and 62.53 (95% CI, 34.45-113.51), respectively; and, the SROC AUC was 0.92 (95% CI, 0.90-0.94). The overall diagnostic accuracy of CEUS was comparable to that of CECT for the differential diagnosis of MFP and PDAC (relative DOR 1.26, 95% CI [0.42-3.83], P > 0.05).

CEUS and CECT have comparable diagnostic performance for differentiating MFP from PDAC, and should be considered as mutually complementary diagnostic tools for suspected focal pancreatic lesions.

Primary malignant bone tumors are uncommon, and their epidemiological features are rarely reported. We aimed to study the incidence and death characteristics of bone tumors from 2000 to 2015.

Population-based cancer registries submitted registry data to National Central Cancer Registry of China (NCCRC). The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of primary bone tumor were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population. The annual percentage change (APC) in rate was calculated using the Joinpoint Regression Program.

Data from 368 registries met quality control criteria, of which 134 and 234 were from urban and rural areas, respectively. The data covered 309,553,499 persons. The crude incidence, age-standardized incidence, and crude mortality rates were 1.77, 1.35, and 1.31 per 100,000, respectively. Incidence and mortality rates were higher in males than those in females; they showed downward trends, with declines of 2.2% and 4.8% per year, respectively, and the rates in urban areas were lower than those in rural areas. Significant declining trends were observed in urban areas. Stable trends were seen in rural areas during 2000 to 2007, followed by downward trends. Age-specific incidence and mortality rates showed stable trends in the age group of 0 to 19 years, and downward trends in the age group elder than 19 years.

The incidence and mortality rates of primary malignant bone tumors in rural areas were higher compared to those in urban areas. Targeted prevention measures are required to monitor and control bone tumor incidence and improve the quality of life of affected patients. This research can provide a scientific basis for the prevention and control of bone tumors, as well as basic information for follow-up research.

More than 75 million procedures with intravascular iodine-based contrast media (ICM) are performed worldwide every year, and some patients undergoing these procedures do not have normal thyroid function. The long-term effects of ICM in patients with mild thyroid dysfunction (TD) are unclear.

This prospective cohort study was conducted in China. Patients with stable angina pectoris with total triiodothyronine (TT3) reduction, normal thyroid-stimulating hormone, and reverse triiodothyronine (rT3) were enrolled and divided into high-dose (≥100 mL ICM) and low-dose groups (<100 mL ICM). We dynamically investigated the trends in thyroid function, rT3, and thyroid antibodies one year after ICM exposure.

A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up. Thyroglobulin antibody (TGAB) levels were elevated in 41 (26.6%) patients before ICM exposure, 11 (7.1%) of whom also had elevated thyroid peroxidase antibody levels. Transient subclinical TD occurred 6 months after ICM exposure; 75.5% (34/45) of post-operative TD occurred in the high-dose group. One patient developed severe hypothyroidism with myxedema, requiring drug intervention 1 year after ICM exposure. The level of rT3 showed no statistically significant changes during post-operative follow-up (P = 0.848). The TGAB level decreased at 6th month (P < 0.001), but increased at 1 year after ICM exposure (P = 0.002).

Patients with T3 reduction are at a risk of transient subclinical TD and hypothyroidism after a single large dose of ICM. Follow-up of this population at 9-12 months after ICM exposure is warranted.

There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants.

We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression.

A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions.

The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.

Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.

The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations.

Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level (P for interaction = 0.80) and non-HDL-C level (P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P-value of 0.47.

High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.

ClinicalTrials.gov, NCT03015311.

Glutamine synthetase (GS) and arginase 1 (Arg1) are widely used pathological markers that discriminate hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma; however, their clinical significance in HCC remains unclear.

We retrospectively analyzed 431 HCC patients: 251 received hepatectomy alone, and the other 180 received sorafenib as adjuvant treatment after hepatectomy. Expression of GS and Arg1 in tumor specimens was evaluated using immunostaining. mRNA sequencing and immunostaining to detect progenitor markers (cytokeratin 19 [CK19] and epithelial cell adhesion molecule [EpCAM]) and mutant TP53 were also conducted.

Up to 72.4% (312/431) of HCC tumors were GS positive (GS+). Of the patients receiving hepatectomy alone, GS negative (GS-) patients had significantly better overall survival (OS) and recurrence-free survival (RFS) than GS+ patients; negative expression of Arg1, which is exclusively expressed in GS- hepatocytes in the healthy liver, had a negative effect on prognosis. Of the patients with a high risk of recurrence who received additional sorafenib treatment, GS- patients tended to have better RFS than GS+ patients, regardless of the expression status of Arg1. GS+ HCC tumors exhibit many features of the established proliferation molecular stratification subtype, including poor differentiation, high alpha-fetoprotein levels, increased progenitor tumor cells, TP53 mutation, and upregulation of multiple tumor-related signaling pathways.

GS- HCC patients have a better prognosis and are more likely to benefit from sorafenib treatment after hepatectomy. Immunostaining of GS may provide a simple and applicable approach for HCC molecular stratification to predict prognosis and guide targeted therapy.

Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS). Bone marrow stem cells (BMSCs) are a crucial regulator of bone homeostasis. Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia, but the underlying mechanism of this phenomenon remains unclear.

A total of 22 AIS patients and 18 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Bone marrow blood was collected for BMSC isolation and culture. Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group. Furthermore, a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.

A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed. Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified, including differences in the expression of LRRC17, DCLK1, PCDH7, TSPAN5, NHSL2, and CPT1B. Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy. The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.

Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity, which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.

Metastasis is the main cause of tumor-associated death and mainly responsible for treatment failure of breast cancer. Autophagy accelerates tumor metastasis. In our work, we aimed to investigate the possibility of microRNAs (miRNAs) which participate in the regulation of autophagy to inhibit tumor metastasis.

MiRNA array and comprehensive analysis were performed to identify miRNAs which participated in the regulation of autophagy to inhibit tumor metastasis. The expression levels of miR-3653 in breast cancer tissues and cells were detected by quantitative real-time polymerase chain reaction. In vivo and in vitro assays were conducted to determine the function of miR-3653. The target genes of miR-3653 were detected by a dual luciferase reporter activity assay and Western blot. The relationship between miR-3653 and epithelial-mesenchymal transition (EMT) was assessed by Western blot. Student’s t-test was used to analyze the difference between any two groups, and the difference among multiple groups was analyzed with one-way analysis of variance and a Bonferroni post hoc test.

miR-3653 was downregulated in breast cancer cells with high metastatic ability, and high expression of miR-3653 blocked autophagic flux in breast cancer cells. Clinically, low expression of miR-3653 in breast cancer tissues (0.054 ± 0.013 vs. 0.131 ± 0.028, t = 2.475, P = 0.014) was positively correlated with lymph node metastasis (0.015 ± 0.004 vs. 0.078 ± 0.020, t = 2.319, P = 0.023) and poor prognosis (P < 0.001). miR-3653 ameliorated the malignant phenotypes of breast cancer cells, including proliferation, migration (MDA-MB-231: 0.353 ± 0.013 vs. 1.000 ± 0.038, t= 16.290, P < 0.001; MDA-MB-468: 0.200 ± 0.014 vs. 1.000 ± 0.043, t = 17.530, P < 0.001), invasion (MDA-MB-231: 0.723 ± 0.056 vs. 1.000 ± 0.035, t = 4.223, P= 0.013; MDA-MB-468: 0.222 ± 0.016 vs. 1.000 ± 0.019, t= 31.050, P < 0.001), and colony formation (MDA-MB-231: 0.472 ± 0.022 vs. 1.000 ± 0.022, t= 16.620, P < 0.001; MDA-MB-468: 0.650 ± 0.040 vs. 1.000 ± 0.098, t= 3.297, P = 0.030). The autophagy-associated genes autophagy-related gene 12 (ATG12) and activating molecule in beclin 1-regulated autophagy protein 1 (AMBRA1) are target genes of miR-3653. Further studies showed that miR-3653 inhibited EMT by targeting ATG12 and AMBRA1.

Our findings suggested that miR-3653 inhibits the autophagy process by targeting ATG12 and AMBRA1, thereby inhibiting EMT, and provided a new idea and target for the metastasis of breast cancer.

Intracytoplasmic sperm injection (ICSI) is an effective method for human-assisted reproductive technology, especially for male-factor infertility. However, the average fertilization rate of ICSI is 70%, and total fertilization failure occurs in 3% of cycles.^[1]Oocyte activation deficiency is the primary cause of fertilization failure.

The treatment of Manske type IIIB and IV thumb hypoplasia remains controversial, and parents increasingly expect to maintain the hypoplastic thumb in preference to a five-digit hand.^[1,2]There has been a recent increased number of reports regarding the reconstruction of severe thumb hypoplasia with the use of free metatarsal transfers (MTs). Tsujinoet al^[3]reconstructed a thumb with a non-vascularized 4th metatarsal, and filled the bone defect with an iliac graft. Chowet al^[4]reported on thumb reconstruction with hemi-width MT, which reduced not only the sacrifice of the donor foot but also the strength of the reconstructed metacarpal.

To the Editor:Autosomal recessive mental retardation-52 (MRT52, OMIM: 616887) was first reported in 2016 and is characterized by global developmental delay,^[1]severe intellectual disability (ID), speech disorder, and seizures, but no dysmorphic features.^[1,2]MRT52 is caused by a homozygous mutation in the vesicular integral membrane protein 36 kDa (VIP36)-like protein, which is also named lectin mannose-binding 2-like (LMAN2L) gene (OMIM: 609552).^[3]Nuferet al^[4]mapped theLMAN2Lgene to chromosome 2q11.2. Although the exactLMAN2Lfunction is not clear, evidence suggests that theLMAN2Lgene encodes a transmembrane protein (TM) located in the endoplasmic reticulum (ER), where it functions as a cargo receptor in glycoprotein transportation.^[4,5]

To the Editor:Cockayne syndrome (CS; Mendelian Inheritance in Man # 133540, 216400) is a rare autosomal recessive neurodegenerative disorder described by Edward Cockayne in 1936.^[1]The prevalence of CS is 2.7 per million live births,^[2]and the disease is probably underdiagnosed. The major clinical features are progressive growth failure and microcephaly as well as other characteristics such as a "cachectic dwarfism" appearance with sunken eyes, cutaneous photosensitivity, mental retardation, demyelinating peripheral neuropathy, pigmentary retinopathy, cataracts, deafness, dental anomalies, and premature death.^[1,3]There is considerable variation in the severity of the disorder, leading to classification into three main types.

To the Editor: Liposarcoma is a common subtype of retroperitoneal sarcoma. Due to the complicated anatomical heterogeneity of retroperitoneal liposarcoma (RPLS), it compresses and invades adjacent important organs, and massive bleeding frequently occurs during surgery. Therefore, a combined visceral resection is required, which means that RPLS surgery has greater difficulty and a lower complete resection rate compared to surgeries for other solid tumors. Although in our previous studies we found that intraperitoneal thermoperfusion chemotherapy including cisplatin may improve the prognosis of patients with RPLS,^[1]surgery is the most effective treatment for RPLS, and adjuvant therapies have shown almost ineffective. There is a paucity of research focusing specifically on molecular mechanisms underlying RPLS pathogenesis. Consequently, no diagnostic biomarkers, druggable targets, or prognostic factors are available for RPLS.

To the Editor:Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscles that presents as an acute hypermetabolic state triggered by depolarizing muscle relaxants and volatile anesthetics in susceptible individuals.^[1]The reported incidence of MH reaction ranged from 1:250,000 to 1:10,000.^[1]However, the exact incidence in the Asian population remains unknown. A recent report suggested that the incidence of MH in Japan was 1 to 2 per 100,000 anesthetics,^[2]which was similar to that in Western countries. In China, there are only a few reported cases, which may be attributed to incomplete records, and the actual incidence might be higher.^[3,4]In China, between January 1978 and March 2004, only 34 cases of MH were recorded.^[5]Due to the lack of the effective drug dantrolene, the mortality rate at that time was 73.5%.^[5]Here, we reported the onset and treatment of a patient with suspected MH.

To the Editor:Acute large vessel occlusion (LVO) is responsible for most acute ischemic stroke (AIS), a common cause of disability and death worldwide. Randomized controlled clinical trials (RCTs) provided evidence endorsing intravenous thrombolysis (IVT, also termed bridging therapy [IVT]) and endovascular thrombectomy over IVT alone as the current standard treatment for people with LVO in the anterior circulation.^[1]The current American and European guidelines recommend using IVT for all eligible individuals with LVO before direct mechanical thrombectomy (d-MT) (class of recommendation-I). Recent RCTs suggest that MT was non-inferior to BT in terms of efficacy and safety,^[2,3]which contradict the results from multiple meta-analyses favoring BT over d-MT.^[4]The benefit of routine IVT for eligible individuals before thrombectomy has become controversial. BT is associated with complications, including the risk of vasospasm, distal emboli, or symptomatic intracranial hemorrhage.

To the Editor: Newborn screening (NBS) plays a valuable and important role in the early identification of treatable and preventable inborn errors of metabolism (IEMs) to avoid severe outcomes and improve quality of life. Qiaoet al^[1]reported that China has made remarkable achievements in women’s reproductive, maternal, newborn, child, and adolescent health (RMNCAH) and succeeded in reducing the mortality of newborns over the past 70 years. As the third floor of a whole RMNCAH building, the NBS system has played a key role in early treatment to reduce neonatal morbidity and mortality and improve quality of life. To ensure the quality, dignity, equity, and universal coverage of the NBS, China has been devoted to establish a rationally distributed NBS system over the past 40 years [Supplementary Figure 1, http://links.lww.com/CM9/B175].^[2]In China, the NBS network is consisted of hierarchical administrations and service agencies, and NBS health care services are provided under the joint administration of national-, provincial-, prefecture-, and county-level governments. To standardize the NBS healthcare service and increase the demand for high-quality NBS health care, China has formulated and launched numerous policies, legislations, regulations, diagnosis and treatment guidelines, and technical standards. Based on such a solid foundation supported by national consensus on women’s and children’s rights, health policies, financial support, scientific research, clinical guidelines and standards, and information technologies, the quality management of the NBS network (QMIP-NBS) in China has been carefully planned and implemented.

To the Editor: Airway fibrosis is one of the pathological manifestations of tracheobronchial stenosis, which is a rare but potentially high-impact event with significant morbidity and mortality. The epithelium is important as the first line of protection against the external environment. Injured epithelial cells generally undergo epithelial-mesenchymal transition (EMT) to lose cell-cell junctions and apical-basal polarity and reorganize the cytoskeleton, resulting in increased motility and deformability of individual cells to promote cell migration, which facilitates epithelial repair.^[1]The development of tissue fibrosis is associated with inappropriate reactivation of EMT, which is characterized by the loss of epithelial cell marker E-cadherin and the overexpression of mesenchymal markers N-cadherin, vimentin, and alpha-smooth muscle actin. Transforming growth factor-beta 1 (TGF-β1) causes tissue scarring primarily by activating its downstream small mother against decapentaplegic (Smad) signaling. It was found that upregulating Smad3 can promote cell migration and the EMT process.^[2]

To the Editor:Asthma is a complex chronic inflammatory lung disease, and its pathogenesis is not fully understood. It is believed that airway epithelium primarily acts as a defensive barrier to protect the lung from allergens, avoiding the asthma. The integrity of the airway epithelial barrier is dependent on tight junctions comprised of zona occludens (ZO) 1 to 3, occludin, and claudin 1 to 5, and adherens junctions mainly formed by E-cadherin, β-catenin, and junctional adhesion molecule, which maintain apicobasal polarity of bronchial epithelial cells. Our team has previously confirmed that house dust mite (HDM) disrupts the airway epithelial barrierin vivoandin vitroand that thymic stromal lymphopoietin (TSLP) plays an essential role in this process.^[1]Autophagy, associated with various human diseases, is a highly conserved and lysosome-dependent process that selectively degrades and recycles the targeted organelles within lysosomes. The role of autophagy in allergic asthma is still under debate. In this study, we hypothesized that the autophagy process plays a critical role in HDM-induced asthma, and HDM induces autophagy-related genes (ATGs), which are associated with epithelial barrier disruption; and we utilized HDM to stimulate human bronchial epithelial cells (HBECs) to evaluate the role of autophagy in HDM-induced asthma.

To the Editor: Major depressive disorder (MDD) is a common mood disorder that contributes considerably to disability worldwide. Abnormalities in either structural connectivity or functional connectivity in the brains of patients with MDD have been widely reported, which greatly extends our knowledge of the pathophysiology of MDD.

To the Editor:Peri-operative hyperglycemia in patients with or without diabetes is associated with a higher incidence of post-operative complications.^[1]In China, more than 130 million people have been diagnosed with diabetes, and more than one-third of the total population has prediabetes. Hyperglycemia in hospitalized patients is common, and the peri-operative hyperglycemia rate varies from 30% to 40% in different studies.^[2]Controlling peri-operative blood glucose is conducive to a better outcome of surgery and this has become a broad consensus; the awareness of a need for blood glucose control is continuously increasing among surgeons. It has been reported that the immune cell composition following hyperglycemia differs in both diabetic and non-diabetic patients, as compared to other patients.^[3]To study the impact of intra-operative blood glucose management, an observational study was performed on intra-operative hyperglycemia patients to compare the outcomes of patients who received insulin treatment and those who did not.