2024年 · 第137卷第23期

Split liver transplantation (SLT) is a procedure where an intact donor liver is splitted into two anatomically and functionally independent grafts, which are transplanted to two recipients. SLT can effectively expand the source of donor liver, and has become the predominant surgical solution to the shortage of donor livers after years of exploration and refinement.

Human infection with highly pathogenic avian influenza (HPAI) caused by certain strains of avian influenza A viruses, such as H5N1 and H7N9, results in severe acute respiratory disease with a high mortality rate, among which the former is pathogenic to birds.^[1]In recent years, HPAI H5 has spread globally, causing human infections. The first reported case of bovine H5N1 infection, which was subsequently transmitted to humans, garnered significant international attention. Drawing on the historical influenza pandemic experience and biological characteristics of the virus, under specific conditions, such as reassortment with human and swine influenza viruses, avian influenza viruses (AIV) may achieve efficient human-to-human transmission, potentially leading to a global pandemic. Here, we aimed to review the historical trends of H5N1 avian influenza infections in humans and the recent developments in epidemiological situations, evaluate the transmission risk of H5N1 avian influenza, and propose avian influenza control recommendations for public health decision-making.

Sepsis-related organ dysfunction is associated with increased morbidity and mortality. Previous studies have found that the endothelium plays crucial roles in maintaining the vascular permeability during sepsis, as well as in regulating inflammation and thrombosis. During sepsis, endothelial cells may release cytokines, chemokines, and pro-coagulant factors, as well as express adhesion molecules. In general, endothelial responses during sepsis typically inhibit bacterial transmission and coordinate leukocyte recruitment to promote bacterial clearance. However, excessive or prolonged endothelial activation can lead to impaired microcirculation, tissue hypoperfusion, and organ dysfunction. Given the structural and functional heterogeneity of endothelial cells in different organs, there are potential differences in endothelial responses by organ type, and the risk of organ damage may vary accordingly. This article reviews the endothelial response observed in sepsis and its effects on organ function, summarizes current progress in the development of therapeutic interventions targeting the endothelial response, and discusses future research directions to serve as a reference for researchers in the field.

Vascular cognitive impairment (VCI) encompasses a wide spectrum of cognitive disorders, ranging from mild cognitive impairment to vascular dementia. Its diagnosis relies on thorough clinical evaluations and neuroimaging. VCI predominately arises from vascular risk factors (VRFs) and cerebrovascular disease, either independently or in conjunction with neurodegeneration. Growing evidence underscores the prevalence of VRFs, highlighting their potential for early prediction of cognitive impairment and dementia in later life. The precise mechanisms linking vascular pathologies to cognitive deficits remain elusive. Chronic cerebrovascular pathology is the most common neuropathological feature of VCI, often interacting synergistically with neurodegenerative processes. Current research efforts are focused on developing and validating reliable biomarkers to unravel the etiology of vascular brain changes in VCI. The collaborative integration of these biomarkers into clinical practice, alongside routine incorporation into neuropathological assessments, presents a promising strategy for predicting and stratifying VCI. The cornerstone of VCI prevention remains the control of VRFs, which includes multi-domain lifestyle modifications. Identifying appropriate pharmacological approaches is also of paramount importance. In this review, we synthesize recent advancements in the field of VCI, including its definition, determinants of vascular risk, pathophysiology, neuroimaging and fluid-correlated biomarkers, predictive methodologies, and current intervention strategies. Increasingly evident is the notion that more rigorous research for VCI, which arises from a complex interplay of physiological events, is still needed to pave the way for better clinical outcomes and enhanced quality of life for affected individuals.

Liver disease involves a complex interplay of pathological processes, including inflammation, hepatocyte necrosis, and fibrosis. End-stage liver disease (ESLD), such as liver failure and decompensated cirrhosis, has a high mortality rate, and liver transplantation is the only effective treatment. However, to overcome problems such as the shortage of donor livers and complications related to immunosuppression, there is an urgent need for new treatment strategies that need to be developed for patients with ESLD. For instance, hepatocytes derived from donor livers or stem cells can be engrafted and multiplied in the liver, substituting the host hepatocytes and rebuilding the liver parenchyma. Stem cell therapy, especially mesenchymal stem cell therapy, has been widely proved to restore liver function and alleviate liver injury in patients with severe liver disease, which has contributed to the clinical application of cell therapy. In this review, we discussed the types of cells used to treat ESLD and their therapeutic mechanisms. We also summarized the progress of clinical trials around the world and provided a perspective on cell therapy.

Chronic hepatitis B virus (HBV) infection is a global public health concern. Existing antiviral drugs, including nucleos(t)ide analogs and interferon-α, can suppress HBV replication and improve the prognosis. However, the persistence of covalently closed circular DNA (cccDNA), the integration of HBV-DNA into the host genome, and compromised immune responses impede the successful treatment of hepatitis B. While achieving a functional cure of HBV remains elusive with the current treatment methods, this is the goal of new therapeutic approaches. Therefore, developing novel antiviral drugs is necessary for achieving a functional or complete cure for chronic hepatitis B. In recent years, substantial progress has been made in drug discovery and development for HBV infection. Direct-acting antiviral agents such as entry inhibitors, capsid assembly modulators, subviral particle release inhibitors, cccDNA silencers, and RNA interference molecules have entered clinical trials. In addition, several immunomodulatory agents, including toll-like receptor agonists, therapeutic vaccines, checkpoint inhibitors, and monoclonal antibodies, are also making their way toward clinical use. In this review, we summarize the recent progress and limitations of chronic hepatitis B treatment and discuss perspectives on approaches to achieving functional cure. Although it will take some time for these new antiviral drugs to be widely used in clinical practice, combination therapy may become a preferable treatment option in the future.

Helicobacter pylori (H. pylori) infects approximately half of the population worldwide and causes chronic gastritis, peptic ulcers, and gastric cancer. Test-and-treat strategies have been recommended for the prevention of H. pylori-associated diseases. Advancements in high-throughput sequencing technologies have broadened our understanding of the complex gastrointestinal (GI) microbiota and its role in maintaining host homeostasis. Recently, an increasing number of studies have indicated that the colonization of H. pylori induces dramatic alterations in the gastric microbiota, with a predominance of H. pylori and a reduction in microbial diversity. Dysbiosis of the gut microbiome has also been observed after H. pylori infection, which may play a role in the development of colorectal cancer. However, there is concern regarding the impact of antibiotics on the gut microbiota during H. pylori eradication. In this review, we summarize the current literature concerning how H. pylori infection reshapes the GI microbiota and the underlying mechanisms, including changes in the gastric environment, immune responses, and persistent inflammation. Additionally, the impacts of H. pylori eradication on GI microbial homeostasis and the use of probiotics as adjuvant therapy are also discussed. The shifts in the GI microbiota and their crosstalk with H. pylori may provide potential targets for H. pylori-related gastric diseases and extragastric manifestations.

Efferocytosis refers to the process that phagocytes recognize and remove the apoptotic cells, which is essential for maintaining tissue homeostasis both in physiological and pathological conditions. Numerous studies have demonstrated that efferocytosis can prevent secondary necrosis and proinflammatory factor release, leading to the resolution of inflammation and tissue immunological tolerance in numerous diseases such as stroke. Stroke is a leading cause of death and morbidity for adults worldwide. Persistent inflammation triggered by the dead cells or cell debris is a major contributor to post-stroke brain damage. Effective efferocytosis might be an efficient strategy to minimize inflammation and restore brain homeostasis for neuronal regeneration and function recovery. In this review, we will discuss the phagocytes in the brain, the molecular mechanisms underlying efferocytosis, the role of efferocytosis in inflammation resolution, and the potential therapeutic applications targeting efferocytosis in stroke.

Inflammatory bowel disease (IBD) imposes a significant economic and social burden in China. We aim to assess the epidemiological trends of IBD in China, and to predict the burden in the near future.

The incidence, mortality, prevalence, and disability-adjusted life year (DALYs) of IBD from 1990 to 2021 were obtained from Global Burden of Disease Study 2021. Estimated annual percentage change (EAPC), average annual percent change, total percent change, and age-period-cohort model were used to access trends. Bayesian age-period-cohort model was utilized to predict the risk of incidence and mortality.

In 2021, IBD affected 168,077 people in China, with 24,941 new cases and 5640 deaths. The age-standardized rate (ASR) of incidence and death was 1.4 and 0.3, respectively. The incidence and prevalence in China were lower than the global and high socio-demographic index (SDI) regions, but the ASR of incidence and prevalence (EAPC: 2.93 and 2.54, respectively) had rapidly increased from 1990 to 2021. The ASR of death and DALYs had significantly decreased (EAPC: -3.05 and -2.93, respectively). Middle-aged and elderly populations faced a severe burden of incidence and prevalence, while the elderly population faced a severe mortality burden. It is projected that by 2035, the ASR of incidence will continue to rise, whereas the death rate will continue to decline.

The burden of IBD in China is serious and increasingly severe. Establishing a comprehensive disease management system in China will help better control the medical burden of IBD.

Tracheal, bronchus, and lung cancer (TBL) is a major cause of mortality and top contributor to productivity loss in large emerging economies such as the BRICS (Brazil, Russia, India, China, and South Africa). We examined the time trends of TBL mortality across the BRICS to better understand the disease burden in these countries and inform public health and healthcare resource allocation.

TBL mortality-related data between 1990 and 2019 were obtained from the Global Burden of Disease Study 2019 and analyzed using age-period-cohort models. Net drift (local drift) was used to describe the expected age-adjusted TBL mortality rate over time overall (each age group); the longitudinal age curve was used to reflect the age effect; the period rate ratios (RRs) were used to reflect the period effect; and the cohort RR was used to reflect the cohort effect.

In 2019, there were 958.3 thousand TBL deaths across the BRICS, representing 46.9% of the global TBL deaths. From 1990 to 2019, the age-standardized mortality rate (ASMR) of TBL decreased in Russia, Brazil, and South Africa while increased in China and India, with the largest reduction reported in Russia (-29.6%) and the largest increase in China (+22.4%). India showed an overall increase (+15.7%) in TBL mortality but the mortality risk decreased among individuals born after 1990 (men) and 1995 (women). Although South Africa and Brazil experienced an overall decline in TBL mortality, their recent birth cohorts, such as Brazilian individuals born after 1985 (men) and 1980 (women), and South African men born after 1995, had an increasing TBL mortality risk. China has experienced an overall increase in TBL mortality, with the mortality risk rising among individuals born after 1995 for both men and women. Russia, which had the highest TBL mortality among the BRICS countries in 1990, has demonstrated significant improvement over the past three decades.

Over the past 30 years, the BRICS accounted for an increasing proportion of global TBL mortality. TBL mortality increased in older women in all the BRICS countries except Russia. Among the recent birth cohort, the risk of TBL mortality increased in Brazil, China, and South Africa. More effective efforts are needed in the BRICS to reduce the burden of TBL and help achieve the United Nation’s Sustainable Development Goals.

The crucial role of the epidermal function in the regulation of cutaneous and extracutaneous functions has been well demonstrated over the past decades. Epidermal permeability barrier dysfunction enhances epidermal DNA and lipid synthesis, and cutaneous and systemic inflammation.^[1,2]Conversely, improvement in epidermal permeability barrier function inhibits epidermal lipid synthesis, cytokine production, and epidermal proliferation in barrier-disrupted skin.^[1,2]Similarly, reduced stratum corneum hydration (SCH) levels can negatively impact epidermal function and increase cytokine levels in the circulation.^[3,4]Correspondingly, improvement in epidermal function lowers the circulating levels of proinflammatory cytokines in addition to alleviation and prevention of the relapse of inflammatory skin disorders such as psoriasis.^[2,5,6]Interestingly, improvement in epidermal function also mitigates the progression of cognitive impairment in the elderly.^[7]Taken together, the evidence indicates the regulatory role of epidermal function in cutaneous and extracutaneous functions. Thus, improvement in epidermal function can benefit the overall human health.

Liver cirrhosis is associated with high morbidity, mortality, and medical costs worldwide. Although transjugular intrahepatic portosystemic shunt (TIPS) has been shown to improve the survival of patients with cirrhosis, systemic inflammation is critical in the initiation and progression of decompensated cirrhosis. Our previous study showed that celecoxib, a selective cyclooxygenase-2 inhibitor (COX-2-I) with anti-inflammatory efficacy, effectively ameliorated liver fibrosis.^[1]However, few studies have clinically explored the treatment of liver cirrhosis with COX-2-I.

Dyslipidemia is a metabolic disorder with a higher prevalence among people living with human immunodeficiency virus (HIV) than that among the general population, and it significantly increases the risk of cardiovascular disease (CVD).^[1]HIV infection can lead to dyslipidemia through persistent inflammation, immune activation, and direct effects on lipid metabolism.^[1]The initiation of antiretroviral therapy (ART) can exacerbate dyslipidemia, often characterized by increased concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), along with a decrease in the concentration of high-density lipoprotein cholesterol (HDL-C).^[2]Additionally, traditional risk factors contribute to the development of dyslipidemia in this population.^[3]

To the Editor: Tapinarof is an aryl hydrocarbon receptor (AhR) ligand derived from metabolites ofPhotorhabdus luminescens.^[1]It has been shown that 1% tapinarof cream had high efficacy on psoriasis,^[2]and has been approved for the treatment of psoriasis in China and in the United States. The "interleukin (IL)-23/IL-17-producing T helper (Th17) inflammation axis" plays a predominant role in the pathogenesis of psoriasis. Tapinarof also suppresses the expression of IL-17 and inhibits oxidative stress.^[3]Here, we studied the role of tapinarof on dendritic cells (DCs) activation and on differentiation of Th17 and Treg in human and mouse. We also studied the effect of tapinarof in imiquimod (IMQ)-induced mice psoriasis model.

To the Editor: Transcatheter aortic valve replacement (TAVR) has witnessed a rapid global surge and emerged as a viable alternative for treating aortic stenosis patients. Obesity, a well-established risk factor for the development of cardiovascular diseases, significantly contributes to disease burden. Research on TAVR patients, predominantly from Western nations, has highlighted a decreased risk associated with overweight or obesity,^[1,2,3]which is known as the "obesity paradox" phenomenon. However, the body mass index (BMI) of East Asian patients undergoing TAVR is notably lower than that of Western countries.^[4]Consequently, the BMI-mortality relationship seen in Western countries may not be directly applicable to Asia. We aimed to examine both categorical and dose-response associations between BMI and prognostic outcomes in patients undergoing TAVR within a Chinese national cohort.

To the Editor:The acupoint catgut embedding (ACE) is a traditional external therapy originating from acupuncture therapy in China and has been widely used to treat acute and chronic diseases.^[1]This single-center, randomized, single-blind prospective study aims to investigate the efficacy and safety of ACE for postoperative analgesia in the patients undergoing open orthopedic surgery. The study protocol received approvals from the Ethics Committee of the Shanghai Fourth People’s Hospital (No. 2019112-001) and were registered at the Chinese Clinical Trial Registry (ChiCTR2000034008, https://www.chictr.org.cn/). The written informed consent were obtained from all the patients before study enrollment. The study included the patients aged 18-80 years, with an American Society of Anesthesiologists score of I or II, body mass index (BMI) between 18 kg/m²and 30 kg/m², and those who underwent open orthopedic surgery under general anesthesia at Shanghai Fourth People’s Hospital, School of Medicine, Tongji University from June 2020 to December 2021. The surgery procedure time was more than one hour, but less than six hours. The informed consent was obtained by a researcher in the pain assessments and questionnaire surveys. The patients with central nervous system disease or mental illness, uncontrollable hypertension, diabetes mellitus, coronary heart disease or cardiac insufficiency, severe liver or kidney dysfunction, preoperative blood hemoglobin <90 g/L were excluded from the trial. The ACE contradiction treatments (such as local cutaneous injury or infection), the history of fainting during acupuncture and the history of drug or alcohol abuse, or study enrollment in other clinical trials were recorded.

To the Editor: My name is Ahmed Elgendi, a hepato-pancreato-biliary surgeon, Alexandria University, Egypt. I am writing to share my experience in attending the minimally invasive liver surgery training program as part of the Belt and Road initiative in West China Hospital (Chengdu, China), and the impact it made on changing our concepts and practices.

To the Editor: The treatment principle for pediatric spinal deformity is not only to control the spinal deformity but also to maintain the development of the spine and the chest and the mobility of the spine. To achieve this goal, various kinds of growth-friendly implants have been introduced over the last two decades, which can be divided into three categories, including distraction-based, compression-based, and guided growth systems. The aim of this article is to comprehensively review the currently available growth-friendly implants for pediatric spinal deformity, especially the advancements made in recent decades, to provide reference for clinical treatment and implant design.

To the Editor: Lung cancer is the leading cause of cancer-related mortalities worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases.^[1]Photodynamic therapy (PDT) has been used in lung cancer for nearly four decades. Its relatively low risk and ablative abilities render it a favorable adjuvant treatment alternative for NSCLC. It has been integrated into the modern multidisciplinary treatment of lung cancer due to its promising clinical outcomes in combination with other therapies. Herein, we comprehensively review the available evidence regarding PDT, focusing on clinical efficacy and possible future development in lung cancer.

To the Editor: Obstructive sleep apnea (OSA) and hypertension are two strongly linked disorders that frequently coexist in clinics.^[1]OSA is an important cause of secondary hypertension and leads to hypertension in up to half of patients with OSA.^[1]However, the underlying biological mechanism by which OSA increases the risk of developing hypertension remains uncertain.

To the Editor: The concept of enhanced recovery after surgery (ERAS) has garnered attention worldwide, and received robust recognition and support from numerous governments, owing to its impressive outcomes and expanding application areas.^[1,2]The development of a surgical system for accelerated recovery under the less pain, early move, early eat, and reassuring (LEER) model represents a goal-oriented, integrated methodology designed to address the lack of a systematic and standardized workflow in current accelerated recovery surgical practices, aiming to standardize and systematize ERAS procedures comprehensively. Utilizing the successes of the LEER model, our team has established a multidisciplinary, integrated ward for accelerated rehabilitation, which has not only innovated the ERAS multidisciplinary team (MDT) in form and content, but also sparked new approaches for broadening its application across all clinical settings.^[3]This letter discusses the establishment of the LEER model application system and the concept of its clinical expansion.