2025年 · 第138卷第23期

The incidence of cardiovascular diseases (CVD) together with their associated risk factors increasingly impact public health. According to the data provided in the 2024 Annual Report on Cardiovascular Health and Diseases in China, the crude incidence of cardiovascular and cerebrovascular diseases among Chinese residents aged ≥18 years, including acute myocardial infarction (AMI), angina pectoris treated by percutaneous transluminal coronary angioplasty/stent implantation and/or coronary artery bypass grafting, stroke, and sudden cardiac death was 620.33 per 100,000 population, with 87.6 for AMI. Stroke had an incidence of 491.0 per 100,000 population. The prevalence of adult coronary heart disease (CHD, aged ≥18 years) was 758 per 100,000 population. The CVD mortality in 2021 remained the highest, exceeding that of cancer and other causes. The crude mortality rate of CVD in 2021 was 364.16 per 100,000 population in rural areas and 305.39 per 100,000 population in urban areas. The crude mortality rates of cerebrovascular diseases and CHD among urban and rural residents in 2021 were 140.02 and 175.58, 135.08 and 148.19 per 100,000 population, respectively. In addition to interpreting the key findings of CVD incidence and mortality in China, we also update the data of associated risk factors, including tobacco use, physical activity, diet and nutrition, overweight and obesity, hypertension, dyslipidemia, diabetes, chronic kidney disease, sleep and psychological factors, environmental factors, and the diagnostic conditions of CVD diseases, aiming to provide a scientific foundation for advancing CVD prevention and control, and to inform relevant public health policy development.

The cyclic guanosine monophosphate-adenosine monophosphate synthase–stimulator of interferon genes (cGAS–STING) pathway is a cornerstone of host innate immunity, playing a central role in detecting cytosolic double-stranded DNA of both endogenous and exogenous origins. Upon activation, cGAS synthesizes the second messenger 2′3′-cyclic GMP-AMP (cGAMP), which binds and activates STING to trigger downstream immune responses, including the production of type I interferons and proinflammatory cytokines. Emerging studies highlight the cGAS–STING pathway as a promising therapeutic target for preventing and treating diverse pathologies, with particularly transformative potential in anticancer therapies. In this review, we dissect the key findings, functions, and associated components of the cGAS–STING pathway. In addition, we emphasize the factors that upregulate or downregulate the pathway, as well as the role of the cGAS–STING pathway in health and disease. By integrating mechanistic insights with clinical perspectives, this review aims to bridge fundamental discoveries with therapeutic applications of cGAS–STING biology.

Mitochondria serve as multifunctional powerhouses within cells, coordinating essential biological activities that are critical for cell viability, including material metabolism, signal transduction, and the maintenance of homeostasis. They support cells in adapting to complex and fluctuating environments. Oocytes, being the largest cells in multicellular organisms, contain a high number of mitochondria with unique structural characteristics. Mitochondria play active roles in the development and maturation of oocytes. A decline in mitochondrial function negatively affects both the quality and quantity of oocytes, thereby contributing to ovarian aging. However, the specific mechanisms through which mitochondrial dysfunction influences the progression of ovarian aging and impacts reproductive longevity remain unclear. Furthermore, medical strategies aimed at rejuvenating mitochondria to restore ovarian reserve and improve female reproductive potential may open new avenues for clinical treatment. In this review, we summarize the current understanding and key evidence regarding the role of mitochondrial dysfunction in ovarian aging and present emerging medical approaches targeting mitochondria to alleviate premature ovarian aging and enhance reproductive performance.

Gastric cancer (GC) is a globally prevalent malignancy with a particularly heavy burden in China. Helicobacter pylori (H. pylori) is a Group I carcinogen for GC, with a higher seroprevalence rate indicating a higher GC incidence. However, only approximately 3% of the individuals with H. pylori infection eventually develop GC, and about 2.6% still progress to GC even 10–20 years after the eradication of H. pylori. Thus, the pathogenic mechanism of H. pylori for GC must be elucidated, and high-risk individuals precisely identified. Furthermore, GC can occur even in individuals who have never been infected with H. pylori. As H. pylori infection rates decline, the proportion of H. pylori-negative GC cases is increasing annually, gaining significant research attention. In this review, potential pathogenic mechanisms of H. pylori infection are explored from the aspects of H. pylori virulence factors and host factors (genetic susceptibility and immune microenvironment). Possible risk factors for H. pylori-negative GC include infections by other microorganisms (e.g., bacteria, fungi, and viruses), autoimmune gastritis, bile reflux, genetic mutations, and environmental factors. We aim to review the potential mechanisms for GC with varying H. pylori infection statuses, identify the high-risk individuals, and pose questions that need to be addressed. In the future, as the prevalence of H. pylori infection gradually decreases, GC prevention and management must evolve to address host-specific factors and the growing challenge of H. pylori-negative GC by integrating multidisciplinary perspectives.

Asthma is a diverse disease that can be categorized into various phenotypes and endotypes, including obesity-related asthma and allergic asthma. "Treatable traits (TTs)" represent a new approach to managing asthma. Asthma accompanied by dyslipidemia would be a distinct asthma phenotype that is becoming increasingly common. Therefore, dyslipidemia can potentially serve as a target for the management of asthma. Nevertheless, it remains highly under-researched compared to other observable traits. Gaining knowledge about the clinical and inflammatory characteristics, underlying mechanisms, and potential therapeutic medications for asthma with dyslipidemia is crucial for its effective management. This review aimed to provide a comprehensive overview of asthma with dyslipidemia, consolidating existing knowledge and ongoing research.

Infertility is a burdensome, often overlooked condition. This study aimed to investigate the global distribution and trends in the burden of infertility from 1990 to 2021.

We obtained data on the prevalence and years lived with disability (YLDs) related to infertility from the Global Burden of Disease 2021 study and evaluated them by calculating the estimated annual percentage change in age-standardized rates. We investigated the relationship between sociodemographic index (SDI) and the burden of infertility on the global, regional, and national levels.

In 2021, there were 143,261,562 female and 55,481,380 male infertility cases worldwide, respectively. In China, female and male infertility cases accounted for 23.59% and 21.47% of the global totals, reaching 33,795,944 and 11,909,889, respectively. Compared with 2019, the global number of female and male infertility cases increased by 5,286,227 in females and 2,017,271 in males. In contrast, China saw a decline in both female and male infertility cases, with reductions of 698,735 and 154,591, respectively. From 1990 to 2021, the age-standardized prevalence rate (ASPR) and age-standardized YLDs rate (ASYR) for female infertility both increased by 0.59% annually, whereas these two corresponding indicators for male infertility increased by 0.50% annually worldwide. The burden of female infertility was consistently higher than that of male infertility and demonstrated a faster rate of increase. East Asia had the highest ASPR and ASYR for female infertility, whereas Eastern Europe had the highest metrics for male infertility. A horizontal S-shaped association was observed between the SDI and ASPR and ASYR of infertility, with a rapid decline in the infertility burden when the SDI exceeded 0.7.

The global burden of infertility has increased over the years, with a higher burden on women and underdeveloped regions. These findings emphasize the need to prioritize healthcare for patients with infertility to address the rising burden.

Asthma, one of the most widespread chronic respiratory diseases, has placed a considerable economic and social stress on China. This study examines the burden of asthma in China from 1990 to 2021 and forecasts future trends, providing guidance for establishing focused preventive and regulatory strategies.

Utilizing data from the Global Burden of Disease Database 2021, the analysis of trends in asthma burden was conducted for China from 1990 to 2021. Key indicators such as incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analysed. The investigation applied the estimated annual percentage change (EAPC), average annual percentage change (AAPC), and age–period–cohort model (APCM) to evaluate these trends. Furthermore, predictions for incidence and mortality in 2035 were generated using the Bayesian APCM and the Nordpred model.

In 2021, there were 25,015,668 prevalent asthma cases in China, alongside 3,934,875 new cases and 26,233 deaths. The age-standardized incidence rate and age-standardized death rate for 2021 were 364.17 (95% uncertainty interval [95% UI]: 283.22–494.1) per 100,000 population and 1.47 (95% UI: 1.15–1.79) per 100,000 population, respectively. The age-standardized rates (ASRs) for incidence were detected to be elevated in the 0–4 years age group, and the prevalence was significantly higher in the 5–9 years age group compared to other cohorts. ASR for incidence and prevalence of asthma in China were lower than that in the global average. Between 1990 and 2021, the ASR of incidence, prevalence, mortality, and DALYs demonstrated a downward trajectory, with EAPC values of −1.17, −1.57, −4.69, and −2.98, respectively. People aged 0–9 years and over 60 years experienced a disproportionately higher disease burden. Projections indicate that the ASRs for incidence will continue to rise, whereas the death will continue to decline by 2035.

Between 1990 and 2021, a general reduction in the asthma burden in China was observed. However, the burden remains particularly high among people aged 0–9 years and over 60 years, underscoring the need for targeted interventions and policies to address the ongoing challenges of asthma.

Concurrent chemo-radiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer (LACC), but there are still many patients who suffer tumor recurrence. However, valuable predictors of treatment outcomes remain limited. This study aimed to assess the value of the serum immune biomarkers to predict the prognosis.

We reviewed cervical cancer patients treated with CCRT between January 2014 and May 2018 at Peking Union Medical College Hospital. The systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and lactate dehydrogenase (LDH) were calculated using blood samples. The relationship between immune markers and the treatment outcome was analyzed. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficiency. The Cox proportional hazards model and log-rank were used to predict overall survival (OS) and disease-free survival (DFS).

This study included 667 patients. Among them, 195 (29.2%) patients were defined as treatment failure, including 127 (19.0%) patients with pelvic failure, 94 (14.1%) distant failure, and 25 (3.7%) concurrent pelvic and distant failure. It revealed that the tumor stage, size, metastatic lymph nodes (MLNs), and serum immune biomarkers, such as SII, SIRI, and LDH, were significantly related to treatment outcomes. We demonstrated that the optimal cut-off of the SII, SIRI, and LDH were 970.4 × 10⁹/L, 1.3×10⁹/L, and 207.52 U/L, respectively. Importantly, this study presented that LDH level had the highest OR (OR =4.2; 95% CI [2.3-10.8]). Furthermore, the OS and DFS for patients with pre-SII ≥970.5 ×10⁹/L. were significantly worse than those with pre-SII <970.5 × 10⁹/L. Similarly, pre-SIRI ≥1.25×10⁹/L and pre-LDH ≥207.5 U/L were related to poor survival outcomes.

This study demonstrated that the baseline SII, SIRI, and LDH levels can be used to accurately and effectively predict the treatment outcomes after CCRT and long-term prognosis. Our results may offer additional prognostic information in clinical, which helps to detect the potential recurrent metastasis in time.

Cluster of differentiation 8 positive (CD8⁺) T cells play a crucial role in the response against tumors, including hepatocellular carcinoma (HCC), where their dysfunction is commonly observed. While the association between elevated peroxisome proliferator-activated receptor alpha (PPARα) expression in HCC cells and exosomes and unfavorable prognosis in HCC patients is well-established, the underlying biological mechanisms by which PPARα induces CD8⁺ T cell exhaustion mediated by HCC exosomes remain poorly understood.

Bioinformatics analyses and dual-luciferase reporter assays were used to investigate the regulation of microRNA-27b-3p (miR-27b-3p) and thymocyte selection-associated high mobility group box (Tox) by Pparα. In vitro and in vivo experiments were conducted to validate the effects of HCC-derived exosomes, miR-27b-3p overexpression, and Pparα on T cell function. Exosome characterization was confirmed using transmission electron microscopy, Western blotting, and particle size analysis. Exosome tracing was performed using small animal in vivo imaging and confocal microscopy. The expression levels of miR-27b-3p, Pparα, and T cell exhaustion-related molecules (Tox, Havcr2, and Pdcd1) were detected using quantitative reverse transcription polymerase chain reaction analysis, Western blotting analysis, immunofluorescence staining, and flow cytometry analysis.

Pparα expression was significantly increased in HCC and negatively correlated with prognosis. It showed a positive correlation with Tox and a negative correlation with miR-27b-3p. The overexpressed Pparα from HCC cells was delivered to CD8⁺ T cells via exosomes, which absorbed miR-27b-3p both in vitro and in vivo, acting as "miRNA sponges". Further experiments demonstrated that Pparα can inhibit the negative regulation of Tox mediated by miR-27b-3p through binding to its 3′untranslated regions.

HCC-derived exosomes deliver Pparα to T cells and promote CD8⁺ T cell exhaustion and malignant progression of HCC via the miR-27b-3p/TOX regulatory axis. The mechanisms underlying T-cell exhaustion in HCC can be utilized for the advancement of anticancer therapies.

Gout is a chronic disease primarily caused by elevated urate levels, severely affecting joint health. Its global distribution varies, and updated data for China are lacking. This study aimed to analyze the current burden and trends of gout globally and in China, examining the burden by gender, age, and risk factors while providing future predictions.

This descriptive epidemiological secondary analysis utilized data from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2021 study. Age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life years (DALYs) rates (ASDR) were used to assess the gout burden. Trends from 1990 to 2021 were analyzed across global regions, genders, and sociodemographic index (SDI) levels. The burden in China was further examined by gender, age, and associated risk factors. The Bayesian age–period–cohort (BAPC) model was used to predict future trends. Gout burden in China and the United States was compared.

In 2021, gout affected 57 million people globally, with 9.4 million new cases and 1.75 million DALYs. From 1990 to 2021, the ASIR, ASPR, and ASDR increased by 17.2%, 21.9%, and 21.3%, respectively. Males experienced a significantly higher burden, with greater ASIR, ASPR, and ASDR increasing with higher SDI levels. In China, male ASIR, ASPR, and ASDR were over 2.8 times those of females, and the burden increased with age. In 2021, 31.4% of gout-related DALYs in China were attributed to high body mass index and 7.6% to kidney dysfunction. Between 1990 and 2021, the high body mass index-related burden of gout rose annually for both genders, while the kidney dysfunction-related gout burden remained stable. By 2050, the burden of gout in China is expected to continue increasing, with a slower rise in females and a decline in males after an initial increase. However, the overall burden will remain substantial. In comparison, the gout burden will be higher in the United States than in China.

Gout is becoming a significant health burden globally and in China, particularly among Chinese males and older individuals. With the aging population and lifestyle changes exacerbating the issue, effective strategies and measures are essential to prevent or reduce gout-related health issues.

The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China.

A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables.

In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75–84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196–3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292–927.436 Yuan).

The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.

Parental myopia is an important risk factor for myopia in Chinese children and adolescents. This study aimed to assess the influence of parental myopia and the severity of myopia on offspring and to evaluate whether adopting healthy lifestyles can mitigate the effects of parental myopia on offspring.

This cross-sectional study analyzed data from children and adolescents aged 6–17 years with complete vision assessments and parental history of myopia from six provinces in China during 2013–2014. Parental demographic information, children’s outdoor activity time, sleep time, and sedentary time were collected via questionnaire. Parental myopia was classified as no myopia, paternal myopia, maternal myopia, and both. The offspring were categorized into 10 groups based on parental myopia prescription. Associations of the above factors with myopia in children and adolescents were evaluated by logistic regression analysis.

Among 40,864 children and adolescents (50.3% boys and 49.7% girls), 22,537 (55.2%) were diagnosed with myopia. In comparison to offspring devoid of parental myopia, children with one parent affected by myopia exhibited odds ratio (OR) of 1.75 (95% confidence interval [CI]: 1.62–1.88) for myopia, while those with both parents affected showed OR of 2.27 (95% CI: 2.02–2.55) after adjusted for lifestyle factors. The likelihood of myopia in offspring increased with increasing severity of parental myopia, with a 3.08-fold increase in risk observed when both parents presented high myopia. Nonetheless, children adhering to two or more healthy lifestyle factors demonstrated a diminished risk of myopia compared with those with fewer than two lifestyle factors, especially among offspring of non-myopic or mildly myopic parents.

Parental myopia has a dose-dependent association with their offspring. Healthy lifestyles may reduce the impact of parental factors on myopia in offspring. The observed associations suggest that although the genetic burden of parental myopia cannot be ignored, healthy lifestyles and nurturing are also very important.

Parkinson’s disease (PD) is a leading cause of death and disability worldwide, and is associated with a significant Global Burden of Disease (GBD). We analyzed the trends in PD incidence, mortality, and disability-adjusted life year (DALY) burden in China, and compared them with global data.

Estimates and 95% uncertainty intervals (UIs) for incidence, mortality, DALYs, years lived with disability (YLDs), and years of life lost (YLLs) for PD were extracted from the GBD, Injuries, and Risk Factors Study 2021. We describe the epidemiology of PD at global and Chinese levels, analyze trends in incidence and mortality from 1990 to 2021 by joinpoint regression models, and decompose PD burden according to population size, age structure, and epidemiological changes.

GBD 2021 estimated 508,378 (95% UI: 430,499–592,748) incident cases of PD, 92,035 (95% UI: 75,908–108,133) deaths, and 2,159,514 (95% UI: 1,826,196–2,521,344) DALYs in China, with the higher age-standardized rate (ASR) in incidence, mortality and DALYs than the global levels. The DALY burden of PD in China increased slightly from 1990 to 2021, consistent with the global upward trend. Joinpoint regression analysis indicated that the ASR of incidence in China increased faster than the global average, while the ASR of mortality decreased, with the fastest decline in 2004–2014. Decomposition analysis revealed that men and the middle sociodemographic index (SDI) quintile (32.82%) were responsible for the most significant DALYs, whose changes were primarily driven by population growth and aging.

The burden of PD showed an overall increasing trend from 1990 to 2021, which was primarily driven by population growth and aging. This study highlights the significant challenges in controlling and managing PD, including the increase in cases and gender differences, which may provide guidance for comprehensive strategies to address the changing profiles of PD in China.

Enzalutamide, a second-generation androgen receptor (AR) pathway inhibitor, is widely used in the treatment of castration-resistant prostate cancer. However, after a period of enzalutamide treatment, patients inevitably develop drug resistance. In this study, we characterized leucine-rich repeated G-protein-coupled receptor 5 (LGR5) and explored its potential therapeutic value in prostate cancer.

A total of 142 pairs of tumor and adjacent formalin-fixed paraffin-embedded tissue samples from patients with prostate cancer were collected from the Pathology Department at Sun Yat-sen Memorial Hospital. LGR5 was screened by sequencing data of enzalutamide-resistant cell lines combined with sequencing data of lesions with different Gleason scores from the same patients. The biological function of LGR5 and its effect on enzalutamide resistance were investigated in vitro and in vivo. Glutathione-S-transferase (GST) pull-down, coimmunoprecipitation, Western blotting, and immunofluorescence assays were used to explore the specific binding mechanism of LGR5 and related pathway changes.

LGR5 was significantly upregulated in prostate cancer and negatively correlated with poor patient prognosis. Overexpression of LGR5 promoted the malignant progression of prostate cancer and reduced sensitivity to enzalutamide in vitro and in vivo. LGR5 promoted the phosphorylation of glycogen synthase kinase-3β (GSK-3β) by binding heat shock protein 90,000 alpha B1 (HSP90AB1) and mediated the activation of the Wingless/integrated (WNT)/β-catenin signaling pathway. The increased β-catenin in the cytoplasm entered the nucleus and bound to the nuclear AR, promoting the transcription level of AR, which led to the enhanced tolerance of prostate cancer to enzalutamide. Reducing HSP90AB1 binding to LGR5 significantly enhanced sensitivity to enzalutamide.

LGR5 directly binds to HSP90AB1 and mediates GSK-3β phosphorylation, promoting AR expression by regulating the WNT/β-catenin signaling pathway, thereby conferring resistance to enzalutamide treatment in prostate cancer.

To the Editor: Atherosclerosis (AS), the pathological basis of most cardiovascular diseases (CVDs) and the leading cause of death and disability worldwide, is a complex disease involving multiple mechanisms. Previous studies have indicated that phenotypic switching of vascular smooth muscle cells (VSMCs) leads to a lack of VSMC marker cell forms, such as macrophage-like cells, which directly facilitate AS.^[1]Macrophage-like cells derived from VSMCs accelerate AS by inhibiting lipid clearance, promoting cell death, and exacerbating inflammation.^[2]Therefore, preventing the formation of VSMC-derived foam cells may represent a novel treatment strategy for AS and associated CVDs.

To the Editor: Psoriasis, a chronic immune-mediated disorder affecting 0.09–11.4% of population globally, imposes profound physical, psychological, and socioeconomic burdens on patients. Conventional therapies, including phototherapy and systemic agents, often yield poor long-term efficacy due to inadequate targeting of disease pathophysiology and tolerability concerns.^[1]Recent advances in understanding interleukin-17A (IL-17A) as the central cytokine driving psoriatic inflammation have revolutionized treatment, positioning IL-17 inhibitors as cornerstone therapies for moderate-to-severe disease.

To the Editor: A healthy synovium undergoes transformation into proliferative infiltrating tissue during pathological remodeling to rheumatoid arthritis (RA).^[1]These changes lead to the development of heterogeneous populations that drive joint tissue inflammation and damage.^[2,3,4]This study aimed to evaluate the impact of intermittent fasting (IF) on synovial fibroblasts (SFs) in an RA mouse model. The animal experiments were approved by the Institutional Animal Care and Use Committee of Soochow University (ECSU-2020000228). The detailed information on animal model construction, IF experimental design, cell lines selection and culture, mouse synovial tissue digestion, flow cytometry and cell sorting, immunohistochemical staining, mouse serum biochemical measurements,in vitroosteoclastogenesis assay, RNA extraction and quantitative real-time polymerase chain reaction (qRT-PCR), RNA-sequencing analysis, measurement of the migration and invasion of SF, western blot analysis, as well as histological analysis and micro-computed tomography (Micro-CT), is presented in Supplementary Materials, http://links.lww.com/CM9/C435.

To the Editor: The efficacy of current psoriasis treatments is assessed using multiple indicators, with the physician’s global assessment of the Psoriasis Area and Severity Index (PASI) frequently used as the endpoint. Recent years have witnessed the widespread use of microscopic evaluation tools such as dermatoscopy and reflectance confocal microscopy (RCM) as additional assessment tools.^[1]However, the correlation between outcomes obtained using PASI and microscopic tools in psoriasis receiving biological therapy is not well understood. In the study, we enrolled 122 patients with moderate to severe psoriasis, with 35 patients treated with adalimumab, 43 with guselkumab, and 44 with secukinumab. PASI scores and dermatoscopy-based Vascular Psoriasis Area and Severity Index (VPASI) scores^[2]were evaluated at weeks 0 and 24, respectively. Furthermore, dermal papillae (DP) and capillary loops (CL) areas were measured using Image J (version 1.43, National Institutes of Health, Bethesda, USA) under RCM pre- and post-treatment. The two served as indicators of treatment efficacy. For each patient, five distinct lesions at the dermal-epidermal junction were selected for precise measurement. Briefly, the lesions were scanned and measured to further determine the average value of the data. In addition, photos were taken for each five lesions for follow-up measurements in the same areas. The primary endpoint was the attainment of a PASI90 response, defined as a 90% or greater reduction in psoriasis severity.^[2]Correlation analyses were conducted for the association between PASI and VPASI scores as well as between DP and CL areas. Pearson correlation analysis was conducted for data exhibiting a bivariate normal distribution, whereas Spearman correlation analysis was performed for data that did not follow a normal distribution. AP-value of <0.05 was considered statistically significant. This study has been approved by the Ethics Committee of Chengdu Second People’s Hospital (No. [KY]PJ2021063).

To the Editor: Primary aldosteronism (PA) is a common cause of secondary hypertension, accounting for 5% to 20% of hypertensive patients.^[1]The two main subtypes are aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Differentiating these subtypes is crucial for selecting appropriate treatment.^[2]However, the current gold standard for subtype diagnosis, adrenal venous sampling (AVS), is invasive, costly, and not universally available.^[3]This study aimed to develop a noninvasive prediction score using clinical and imaging parameters to distinguish APA from IHA.

To the Editor: The role of the peroxisome proliferator-activated receptor (PPAR) δ in colorectal cancer (CRC) is controversial. Indeed,PPARβ/δcan inhibit cancer by inhibiting metastasis and promote cancer by promoting metastasis and angiogenesis.^[1,2]ThePPARδ-87T/C (also referred to as +294 T/C [rs2016520]) single-nucleotide polymorphism (SNP) is associated with the binding ability of the transcription factor specificity protein-1 (Sp-1).^[3,4]Sp-1 is an important transcription factor in CRC tumorigenesis and progression.^[5]Therefore, Sp-1 is a potential molecular marker of CRC progression and a promising therapeutic target in this malignancy. The purpose of this study was to investigate the impact ofPPARδ-87T/C on transcription factor binding. This study assessed the relationship between thePPARδ-87T/C polymorphism, CRC risk, and key clinicopathological parameters in a Western Chinese Han population.

To the Editor: Estrogen (E₂) supplementation is an effective treatment for endometrial preparation for frozen embryo transfer (FET) cycles. It has been estimated that embryo cryopreservation was used in more than 75% of assisted reproductive technology (ART) cycles in 2018.^[1]Because of its favorable pregnancy outcomes, FET is the most recommended strategy for women undergoing ART. However, it is associated with high risks of large for gestational age, high birth weight, and hypertensive disorders of pregnancy. Among endometrial preparation protocols, programmed FET is most suitable for women with natural ovulation difficulties and insufficient endometrial thickness on ovulation days. However, whether the duration of estrogen use in programmed cycles affects pregnancy and neonatal outcomes is still controversial. Bourdonet al^[2]concluded that exceeding estradiol administration could decrease live birth rate (LBR). Liet al^[3]and Jianget al^[4]found no association between duration of E₂and LBR in women undergoingin vitrofertilization (IVF). Thus, it is of high sociological importance to pay attention to neonatal and obstetric outcomes in early pregnancy and develop a method for the first-line prevention of adverse outcomes of ART.

The editors ofChinese Medical Journal(the CMJ) are retracting the article, "Effect of adenovirus-mediated overexpression ofPTENon brain oxidative damage and neuroinflammation in a rat kindling model of epilepsy", published in 2019.^[1]A reader sent an email reporting that the five subfigures in Figure 2(A) of the above article are suspected of plagiarism and image misappropriation. The corresponding author responded that due to job transfer and laboratory relocation, he is unable to provide the original experimental images and records to address the concerns. After discussion, the editors of the CMJ decided to retract this article.