2025年 · 第138卷第03期

Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation; it is also a standard of care for Parkinson’s disease (PD).^[1]Postoperative DBS programming is a crucial step that can specify the best stimulation parameters and release symptoms to promote patients’ quality of life. The "Chinese Expert Consensus on Programming Deep Brain Stimulation for Patients with Parkinson’s Disease", which was published in 2016, regulated the application of postoperative programming for PD patients.^[2]However, multiple aspects limited patients’ ability to attend face-to-face programming, including their mobility and the geological distance between their residences and the DBS center, which led to a higher rate of patients using remote programming with increasing frequency, making it an urgent demand.^[3,4]Therefore, it is important to create a standard protocol to guide the application of this remote treatment.

Allergic bronchopulmonary aspergillosis (ABPA) was first systematically described in 1952. It was defined as a complex allergic disease caused by the immune system’s response toAspergillus fumigatus(A. fumigatus).^[1]Subsequently, the concept of allergic bronchopulmonary mycosis (ABPM) caused by other fungi has been proposed. The diagnostic standards for ABPA/ABPM have gone through the Rosenberg Pattern criteria in 1977, the International Society for Human and Animal Mycology (ISHAM) criteria in 2013, and the Japanese new diagnostic criteria in 2021.^[2,3,4]However, with an advanced comprehension of the disease, as well as the performance of up-to-date randomized controlled trials, the existing criteria were found to have discrepancies. Consequently, a new set of guidelines is urgently needed. In light of this, the ISHAM working group has recently revised the clinical practice guidelines for the diagnosis, classification, and the treatment of ABPA (M), which were published in theEuropean Respiratory Journal.^[5]We aimed to emphasize major changes in the 2024 Revised ISHAM guideline and to combine our research to present a further perspective.

The inception and development of cardiovascular surgery are inseparably linked to the development of cardiology specifically and the overall medical profession in general. From the early 20th century to the present, cardiovascular surgery has demonstrated notable achievements, evolving from a "forbidden zone" into a field in which most types of heart disease can be treated surgically. Many patients have thus regained health and a new lease of life. In this article, we reviewed the history of the development of cardiovascular surgery in China, summarizing historical experiences, commemorating the achievements of our predecessors, and recounting their spirit of exploration, endeavor, and dedication. The historic story of the development of cardiovascular surgery is of huge significance—delivering a message of hope to patients.

With the increasing utilization of cancer therapy, the incidence of lung injury associated with these treatments continues to rise. The recognition of pulmonary toxicity related to cancer therapy has become increasingly critical, for which interstitial lung disease (ILD) is a common cause of mortality. Cancer therapy-related ILD (CT-ILD) can result from a variety of treatments including chemotherapy, targeted therapy, immune checkpoint inhibitors, antibody-drug conjugates, and radiotherapy. CT-ILD may progress rapidly and even be life-threatening; therefore, prompt diagnosis and timely treatment are crucial for effective management. This review aims to provide valuable information on the risk factors associated with CT-ILD; elucidate its underlying mechanisms; discuss its clinical features, imaging, and histological manifestations; and emphasize the clinical-related views of its diagnosis. In addition, this review provides an overview of grading, typing, and staging treatment strategies used for the management of CT-ILD.

Silent mutations within the RAS gene have garnered increasing attention for their potential roles in tumorigenesis and therapeutic strategies. Kirsten-RAS (KRAS) mutations, predominantly oncogenic, are pivotal drivers in various cancers. While extensive research has elucidated the molecular mechanisms and biological consequences of active KRAS mutations, the functional significance of silent mutations remains relatively understudied. This review synthesizes current knowledge on KRAS silent mutations, highlighting their impact on cancer development. Silent mutations, which do not alter protein sequences but can affect RNA stability and translational efficiency, pose intriguing questions regarding their contribution to tumor biology. Understanding these mutations is crucial for comprehensively unraveling KRAS-driven oncogenesis and exploring novel therapeutic avenues. Moreover, investigations into the clinical implications of silent mutations in KRAS-mutant tumors suggest potential diagnostic and therapeutic strategies. Despite being in early stages, research on KRAS silent mutations holds promise for uncovering novel insights that could inform personalized cancer treatments. In conclusion, this review underscores the evolving landscape of KRAS silent mutations, advocating for further exploration to bridge fundamental biology with clinical applications in oncology.

Emerging evidence suggests that dysbiosis of the gut microbiota is associated with the pathogenesis of Parkinson’s disease (PD), a prevalent neurodegenerative disorder. The microbiota-gut-brain axis plays a crucial role in the development and progression of PD, and numerous studies have demonstrated the potential therapeutic benefits of modulations in the intestinal microbiota. This review provides insights into the characterization of the gut microbiota in patients with PD and highlights associations with clinical symptoms and underlying mechanisms. The discussion underscores the increased influence of the gut microbiota in the pathogenesis of PD. While the relationship is not fully elucidated, existing research demonstrates a strong correlation between changes in the composition of gut microbiota and disease development, and further investigation is warranted to explain the specific underlying mechanisms.

Herein, we first discuss advancements in our understanding of the mechanisms involved in the induction of anesthesia. This includes the fundamentals of anesthesia as shaped by three influential theories: The non-specific lipid theory, the specific protein target theory, and the neural circuit theory. We then discuss the traditional identification of purely passive recovery from anesthesia due to the elimination of anesthetics from the body and brain. This is followed by a recent study that has revealed a common mechanism based on the brain’s intrinsic ability to actively reboot consciousness from anesthesia. Finally, a novel theory of how the brain emerges from anesthesia and regains consciousness is presented.

The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.

This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.

Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278] vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses.

This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

The urban-rural disparities in overweight and obesity among children and adolescents are narrowing, and there is a need for long-term and updated data to explain this inequality, understand the underlying mechanisms, and identify priority groups for interventions.

We analyzed data from seven rounds of the Chinese National Survey on Students Constitution and Health (CNSSCH) conducted from 1985 to 2019, focusing on school-age children and adolescents aged 7-18 years. Joinpoint regression was used to identify inflection points (indicating a change in the trend) in the prevalence of overweight and obesity during the study period, stratified by urban/rural areas and sex. Annual percent change (APC), average annual percent change (AAPC), and 95% confidence interval (CI) were used to describe changes in the prevalence of overweight and obesity. Polynomial regression models were used to predict the prevalence of overweight and obesity among children and adolescents in 2025 and 2030, considering urban/rural areas, sex, and age groups.

The prevalence of overweight and obesity in urban boys and girls showed an inflection point of 2000, with AAPC values of 10.09% (95% CI: 7.33-12.92%, t = 7.414, P <0.001) and 8.67% (95% CI: 6.10-11.30%, t = 6.809, P <0.001), respectively. The APC for urban boys decreased from 18.31% (95% CI: 4.72-33.67%, t = 5.926, P = 0.027) to 4.01% (95% CI: 1.33-6.75%, t = 6.486, P = 0.023), while the APC for urban girls decreased from 13.88% (95% CI: 1.82-27.38%, t = 4.994, P = 0.038) to 4.72% (95% CI: 1.43-8.12%, t = 6.215, P = 0.025). However, no inflection points were observed in the best-fit models for rural boys and girls during the period 1985-2019. The prevalence of overweight and obesity for both urban and rural boys is expected to converge at 35.76% by approximately 2027. A similar pattern is observed for urban and rural girls, with a prevalence of overweight and obesity reaching 20.86% in 2025.

The prevalence of overweight and obesity among Chinese children and adolescents has been steadily increasing from 1985 to 2019. A complete reversal in urban-rural prevalence is expected by 2027, with a higher prevalence of overweight and obesity in rural areas. Urgent action is needed to address health inequities and increase investments, particularly policies targeting rural children and adolescents.

Research has indicated that the disease burden of alopecia areata (AA) in China exceeds the global average. Therefore, accurate and updated epidemiological information is crucial for policymakers. In this study, we aimed to comprehensively assess the disease burden of AA in China.

The following four key indicators were utilized: the prevalence of cases; disability-adjusted life-years (DALYs); the age-standardized prevalence rate (ASPR); and the age-standardized DALY rate (ASDR) of AA according to the Global Burden of Disease (GBD) study 2021. We analyzed the epidemiological burden of AA in China during 2021, examined changes between 1990 and 2021, and performed a Bayesian age-period-cohort analysis to predict trends over the course of the next decade (2022-2030). Additionally, a Gaussian process regression model was applied to estimate the relationship between the gross domestic product (GDP) and the ASPR and ASDR of AA at the provincial level between 1992 and 2021.

In 2021, the estimated number of patients with AA in China was approximately 3.49 million (95% uncertainty interval [UI], 3.37-3.62 million); of these patients, 1.20 million (95% UI, 1.16-1.25 million) were male and 2.29 million (95% UI, 2.20-2.37 million) were female. This large number of patients with AA resulted in a total of 114,431.25 DALYs (95% UI, 74,780.27-160,318.96 DALYs). Additionally, the ASPR and ASDR were 224.61 per 100,000 population (95% UI, 216.73-232.65 per 100,000 population) and 7.41 per 100,000 population (95% UI, 4.85-10.44 per 100,000 population), respectively; both of these rates were higher than the global averages. The most affected demographic groups were young and female individuals 25-39 years of age. Slight regional disparities were observed, with the northern and central regions of China bearing comparatively higher burdens. Between 1990 and 2021, the health loss and disease burden caused by AA in China remained relatively stable. The ASPR and ASDR of AA increased with the GDP when the annual GDP was less than 2 trillion Chinese yuan; however, a downward trend was observed as the GDP surpassed 2 trillion Chinese yuan. A slight upward trend in the disease burden of AA in China is predicted to occur over the next decade.

AA continues to be a public health concern in China that shows no signs of declining. Targeted efforts for young individuals and females are necessary because they experience a disproportionately high burden of AA.

Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood.

A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons.

All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions.

This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.

P16 inactivation is frequently accompanied by telomerase reverse transcriptase (TERT) amplification in human cancer genomes. P16 inactivation by DNA methylation often occurs automatically during immortalization of normal cells by TERT. However, direct evidence remains to be obtained to support the causal effect of epigenetic changes, such as P16 methylation, on cancer development. This study aimed to provide experimental evidence that P16 methylation directly drives cancer development.

A zinc finger protein-based P16-specific DNA methyltransferase (P16-Dnmt) vector containing a "Tet-On" switch was used to induce extensive methylation of P16 CpG islands in normal human fibroblast CCD-18Co cells. Battery assays were used to evaluate cell immortalization and transformation throughout their lifespan. Cell subcloning and DNA barcoding were used to track the diversity of cell evolution.

Leaking P16-Dnmt expression (without doxycycline-induction) could specifically inactivate P16 expression by DNA methylation. P16 methylation only promoted proliferation and prolonged lifespan but did not induce immortalization of CCD-18Co cells. Notably, cell immortalization, loss of contact inhibition, and anchorage-independent growth were always prevalent in P16-Dnmt&TERT cells, indicating cell transformation. In contrast, almost all TERT cells died in the replicative crisis. Only a few TERT cells recovered from the crisis, in which spontaneous P16 inactivation by DNA methylation occurred. Furthermore, the subclone formation capacity of P16-Dnmt&TERT cells was two-fold that of TERT cells. DNA barcoding analysis showed that the diversity of the P16-Dnmt&TERT cell population was much greater than that of the TERT cell population.

P16 methylation drives TERT-mediated immortalization and transformation of normal human cells that may contribute to cancer development.

Tracheal intubation through a supraglottic airway device (SAD) is recommended for difficult airway management. However, specific tracheal tubes for SAD-guided intubation are not always available in emergencies, necessitating the use of non-specific tubes such as polyvinyl chloride (PVC) and reinforced tracheal tubes. Although successful intubation with these tubes has been reported, clinicians often face difficulties passing them through the SAD, increasing the risk of airway injury even with correct SAD placement. Various strategies, including using different tube types, pretreatment of PVC tubes, SAD position adjustments, reverse loading, and fiberoptic guidance, have been attempted to address this issue. Importantly, few studies to date has assessed the impact of various tracheal tubes on subglottic airway injury during fiberoptic intubation via a SAD. This randomized controlled trial was designed to compare the subglottic airway injury caused by PVC, reinforced, and BlockBuster^TMtracheal tubes (Tuo Ren Medical Instrument, Tianjin, China) during fiberoptic-monitored intubation through the SAD BlockBuster^TM(Tuo Ren Medical Instrument), a second-generation SAD designed to facilitate blind or fiberoptic-guided intubation.

To the Editor: Lung cancer, specifically lung adenocarcinoma (LUAD), is one of the primary cause of cancer-related mortality globally.^[1,2]Nevertheless, only a small subset of individuals with LUAD have derived clinical benefits from chemoimmunotherapy in either first-line or subsequent treatment settings. Both programmed death-ligand 1 (PD-L1) expression and tumor mutational burden (TMB) have proven inadequate in accurately predicting treatment outcomes in these scenarios.^[3]Consequently, there exists a pressing necessity to identify a reliable biomarker to inform treatment decisions.

To the Editor: Radiation therapy (RT) is important in treating thoracic tumors. However, RT inevitably causes damage to normal lungs, leading to radiation-induced lung injury (RILI). Physical and biological factors conjointly determine RILI. Understanding the role of physical technology development in reducing RILI is more conducive to developing and applying radiotherapy physical technology. The physical technology mentioned here is mainly based on the principles and methods of physics (engineering) applied in RT.

To the Editor:Lung cancer remains the leading cause of cancer-related deaths worldwide.^[1]Its histological classification includes non-small cell lung cancer (NSCLC), which encompasses adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Among these, lung adenocarcinoma (LUAD) is the most common subtype. Visceral pleural invasion (VPI) is a significant factor influencing tumor grade and serves as an independent risk factor for the prognosis of patients with lung cancer. However, due to the lack of measurable markers in most cases, it can only be detected through imaging techniques and pathological examinations.^[2]Currently, commonly used biomarkers in clinical screening, such as carcinoembryonic antigen (CEA), still exhibit a high false-positive rate in diagnosing early-stage lung cancer. Therefore, identifying new markers or methods to more accurately evaluate the characteristics of minimally diseased pulmonary nodules holds considerable importance, especially in the early stages of lung cancer diagnosis.

To the Editor:O-linked β-N-acetylglucosaminylation (O-GlcNAcylation) is a crucial post-translational modification regulated by two enzymes, O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Dysregulation of O-GlcNAcylation has been implicated in numerous disease processes, particularly in tumorigenesis. Lung cancer is the leading cause of cancer-related mortality worldwide. Most patients with lung cancer are diagnosed at an advanced stage, which poses grave risks to their lives. O-GlcNAcylation facilitates cancer cell adaption to adverse environments, playing a critical role in the onset and progression of lung cancer. This article provides a brief overview of O-GlcNAcylation properties and recent advancements in its study across various diseases, with a particular focus on lung cancer.

To the Editor:Neoadjuvant chemotherapy (NAC) significantly improves the prognosis for patients with breast cancer with internal mammary lymph node (IMN) involvement,^[1]but the locoregional treatment of IMNs including IMN dissection (IMND) and IMN boost irradiation (IMNB) has long been debated,^[2]owing to the difficulty in surgical approaches and cardiopulmonary side effects caused by high-dose radiation.^[3]To date, the surgical dissection of IMNs is rarely performed; thus, the data regarding survival outcome of IMND is quite limited. In terms of radiotherapy (RT), there is marked discrepancy in radiation dose to IMNs in patients with metastatic IMN following NAC.^[4]In this study, we report our institutional experience in the locoregional treatment of metastatic IMN and its impact on prognosis in patients who have undergone NAC.

To the Editor: Cervical cancer (CC) is the second leading cause of cancer death in women, representing a major global health challenge.^[1]Cervical squamous cell carcinoma (CSCC) accounts for 70% of CC cases, and pelvic lymph node metastasis is a critical cause of CC-related death.^[2]Thus, understanding the underlying mechanisms of the tumor spread through lymphatic vessels becomes imperative.^[3]RNA helicases are involved in almost all aspects of RNA metabolism.^[4]DEAD-box helicase 24 (DDX24), one of the least explored DEAD-box RNA helicases, was upregulated in several cancer types.^[5]However, the role of DDX24 in CSCC progression and metastasis remains elusive. Here, we investigated the essential role of DDX24 in mediating cancer cell EMT and lymphangiogenesis in the context of CSCC. Our study provides a potential therapeutic target for CSCC lymphatic metastasis.

To the Editor:Immune checkpoint inhibitors (ICIs) have shown remarkable clinical responses; however, their efficacy remains limited to a small subset of patients. Peripheral blood mononuclear cells (PBMCs) offer an effective, accessible, and minimally invasive approach to assess tumor immune status and identify ICI responders. In this study, we aimed to elucidate the role of PBMC gene expression in ICI treatment response and prognosis.

To the Editor: As population aging accelerates, osteoarthritis (OA) has emerged as a major cause of disability among the elderly, significantly increasing the social burden.^[1]OA is recognized as a chronic, progressive joint disease resulting from the wear and tear of articular cartilage. This degeneration can lead to histological and structural changes in the joints, ultimately causing comprehensive impairment of joint function.^[2]

To the Editor:Dementia is a common degenerative disease characterized by a progressive decline in cognitive function and the ability to perform activities of daily living. In 2010, >35 million people worldwide were living with dementia, and this number is expected to increase to >115 million by 2050.^[1]Mild cognitive impairment (MCI) is an intermediate state between normal aging and dementia, and it has a higher risk of transition to dementia.^[2]Over the past few decades, >100 epidemiological studies have been conducted in China to investigate the prevalence of dementia and MCI and their influencing factors. Although these studies are helpful in understanding the pathogenesis of cognitive impairment, their prevalence estimates are highly inconsistent, resulting in unreliable results. These differences may be related to different age spans, inconsistent diagnostic criteria for dementia and MCI, and different assessment tools. To overcome these limitations, we performed a series of subgroup analyses. Our aims were to determine the prevalence of dementia and MCI among the elderly in the Chinese community and investigate the cross-sectional association of dementia/MCI with demographic characteristics, lifestyle, and clinical factors.

To the Editor: According to the latest statistics published by National Cancer Center of China, approximately 4,824,700 cancer cases were newly diagnosed and 2,574,200 patients died from cancer in China in 2022.^[1]Uncontrolled cell proliferation and physiological death resistance, which are the most representative cancer characteristics, complicate the process of restoring health and restrict treatment effectiveness in clinical practice.^[2]Regulating multiple cell-death pathways to reprogram cancerous suicide has emerged as a promising approach to achieve valuable drugs discovery. Given the use ofLeonurus japonicusas a historical folk medicine, relative hypotoxicity, and malignancy-inhibiting properties, it has shifted scientists’ attention to mining its diverse active components and determining its pharmacological activities, thereby paving the way for its administration in clinical cancer treatment.