2026年 · 第139卷第11期

Target patient population for the guidelines: Individuals with compensated advanced chronic liver disease

Systemic lupus erythematosus (SLE) is an autoimmune disease with an incidence rate of 47.61 per 100,000 individuals in China.^[1]More than half of SLE patients experience cutaneous and musculoskeletal manifestations during the course of the disease. The standard treatment for active skin disease includes topical agents, antimalarials, and/or systemic glucocorticoids (GCs).^[2]In clinical practice, for many patients who do not respond to topical agents and antimalarials, increasing the GC dosage on the basis of standard treatment is widely recognized as the most accepted therapeutic approach. However, the use of GCs poses risks, such as metabolic impairment, reduced bone density, and increased susceptibility to infections, highlighting the need for novel therapeutics.^[3]Tofacitinib is a Janus kinase (JAK) inhibitor that can block the effects of several cytokines. We have previously conducted a meta-analysis of JAK inhibitors in SLE, suggesting that they have the potential to serve as viable treatment options for both systemic and cutaneous lupus erythematosus.^[4]To further investigate this, we conducted a retrospective real-world cohort study to compare the efficacy of tofacitinib and GCs escalation in patients with mild-to-moderate SLE and poor responses to topical agents and antimalarials treatment, especially mucocutaneous and musculoskeletal involvement.

To the Editor: Generalized pustular psoriasis (GPP) is a rare, chronic, and life-threatening condition characterized by widespread eruption of sterile pustules.^[1,2]The mortality rate of GPP is 39.2 per 1000 person-years, with over half of the patients requiring hospitalization.^[3]Another non-follicular pustular disease, acute generalized exanthematous pustulosis (AGEP), is currently defined as a rare, acute, and severe cutaneous adverse reaction.^[4]The confusion between GPP and AGEP remains a clinical challenge, highlighting the urgency for additional diagnostic markers to distinguish between these two conditions. Therefore, we aim to provide analytical insights that facilitate the diagnosis of these two distinct dermatological entities.

To the Editor: Acute myocarditis is an inflammatory myocardial disease with diverse presentations and outcomes. However, the prognostic indicators for myocarditis remain limited. According to the updated 2025 European Society of Cardiology (ESC) guidelines on myocarditis and pericarditis, cardiac magnetic resonance (CMR) is a noninvasive imaging modality for the definitive diagnosis of myocarditis.^[1]Moreover, the CMR has significant prognostic value for myocarditis. Previous studies have identified several independent predictors of adverse cardiovascular events, including the presence of late gadolinium enhancement (LGE), septal or midwall LGE, reduced left ventricular ejection fraction (LVEF), and impaired left ventricular global longitudinal strain.^[2]These parameters reflect the extent of myocardial inflammation, fibrosis, and functional impairment. A recent study suggested that right ventricular (RV) involvement and systolic dysfunction are significant predictors of adverse outcomes.^[3]However, the role of right ventricular LGE in prognostic stratification remains unclear. Furthermore, data from Asian cohorts with myocarditis are limited.

To the Editor: Inflammatory bowel disease (IBD) encompasses a spectrum of chronic, non-specific inflammatory disorders primarily affecting the gastrointestinal tract, with Crohn’s disease (CD) and ulcerative colitis (UC) as its two major subtypes.^[1]Increasing research has illuminated the complex interplay between gut microbiota and IBD pathogenesis. Patients with IBD exhibit profound dysbiosis characterized by reduced microbial diversity, depletion of beneficial commensal bacteria, and an overgrowth of pathogenic species. Notably, bacterial outer membrane vesicles (OMVs) have emerged as critical mediators in the communication between gut microbiota, immune cells, and intestinal epithelial cells, either supporting or undermining intestinal homeostasis. These insights highlight the gut microbiota’s dual role as both a driver of disease and a promising therapeutic target for IBD. Advances in microbial engineering have further revolutionized this field, enabling the genetic customization of microbial strains to enhance mucosal healing with exceptional specificity and adaptability. In this review, we provided a comprehensive overview of the emerging applications of gut microbiota in IBD treatment, with a focus on recent breakthroughs in microbial engineering and their therapeutic implications.

To the Editor: Type 1 diabetes (T1D) is an autoimmune disease resulting from the interplay between genomic predisposition and environmental influences, including gut microbiome dysbiosis.^[1]Chronic complications of T1D have been linked to abnormal glycemic fluctuations. However, the conventional glycemic control metric, glycosylated hemoglobin, reflects only average glucose levels over several months and does not capture short-term variability. In contrast, time in range (TIR), a metric derived from continuous glucose monitoring (CGM), measures the proportion of time that glucose concentrations remain within the target range (typically 3.9-10.0 mmol/L).^[2]TIR thus provides a dynamic assessment of glycemic control, incorporating both the frequency and duration of hypoglycemia and hyperglycemia. Recent studies have suggested that TIR is a predictor of future diabetic complications,^[3]yet the underlying mechanisms remain largely unclear. The gut microbiota plays a key role in metabolic diseases,^[4]but its response to TIR status and its contribution to the link between TIR and diabetic complications in T1D remain unexplored. Fecal metaproteomics, a technique that enables the comprehensive profiling of microbial and host proteins, offers a powerful approach to investigate these interactions.

To the Editor: Vascular calcification (VC) is a prevalent pathological feature of cardiovascular and cerebrovascular diseases, with its underlying mechanism still unclear. This knowledge gap poses challenges for developing effective treatment strategies to prevent or reverse VC. Iron, an important element for maintaining cellular and systemic functions, has been found to be closely associated with calcium levels. This study aims to illustrate the impact and potential mechanism of iron metabolism in VC and provide novel perspectives for diagnosing and treating this condition.

To the Editor: As idiopathic generalized epilepsies (IGEs), juvenile myoclonic and absence epilepsies (JME and JAE) typically manifest during adolescence. These disorders share key clinical features like adolescent-onset seizures and high relapse rates after the withdrawal of antiepileptic drug therapy.^[1]It has been believed that the thalamocortical system participates in the imbalance of cortical excitation and inhibition of IGEs.^[2]However, less is known about whether these abnormalities in thalamocortical circuits are specific to subsyndromes. Moreover, no research has explored whole-brain functional connectivity (FC) by a graph theory approach in IGEs focused on patients with JME and JAE.

To the Editor: Infertility is a widespread health issue affecting millions globally, with male factors contributing to about half of cases, many of which remain idiopathic and are thought to have an underlying genetic basis.^[1]Although many genes associated with male infertility are known in mice, the translation of this information to humans has been slow.^[2]Without a genetic diagnosis, it is difficult for a clinician to evaluate the potential success of assisted reproductive technology and the reproductive health of their offspring.

To the Editor: Isolated cryptococcal antigenemia (ICA) is defined as the presence of cryptococcal antigen (CrAg) in the blood in the absence of clinical or radiological evidence of cryptococcal infection in target organs.^[1,2,3]ICA is an established predictor of cryptococcal meningitis (CM) and mortality among patients infected with human immunodeficiency virus (HIV), underscoring the importance of timely preemptive antifungal treatment.^[1,2,3]However, real-world data on the prevalence of ICA and the use of preemptive fluconazole treatment in China remain limited.