2026年 · 第139卷第15期

Alopecia areata (AA) is a nonscarring autoimmune disorder characterized by patchy, asymptomatic hair loss affecting the scalp and other hair-bearing areas, prevalent across demographics. According to the Global Burden of Disease (GBD) study, AA is among the top 15 dermatological conditions globally, with China exhibiting a higher disease burden than the global average.^[1]Besides cosmetic concerns, AA is often associated with other autoimmune conditions and significantly impacts psychological health, leading to depression, anxiety, and reduced quality of life.^[2]

Psoriasis arthropathica, also known as psoriatic arthritis (PsA), is a chronic, progressive inflammatory disease characterized by substantial clinical heterogeneity. Epidemiological data indicate that the global prevalence of PsA among patients with psoriasis is approximately 17.58%, whereas the prevalence among Chinese patients with psoriasis is approximately 10.4%.^[1,2]The etiology and pathogenesis of PsA have not yet been fully elucidated; however, chronic progressive inflammation is thought to be driven by a complex interplay of genetic predisposition, environmental triggers, and immune dysregulation.

To the Editor: Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second most common cause of cancer-related death in China.^[1]However, traditional surgical treatment options, such as resection and ablation, cannot achieve long-term survival benefits.^[2]Between 2015 and 2023, the number of global clinical trials of chimeric antigen receptor T (CAR-T) therapy for the treatment of liver cancer increased approximately tenfold. These clinical trials involved diverse CAR targets. Although most of these CAR targets in clinical trials were previously reported to have relatively high expression levels in HCC, CAR-T cells, unlike T cell receptor T (TCR-T) cells, which respond to very low antigen density, require higher antigen densities to fully activate their effector functions.^[3]However, previous studies have focused primarily on the expression of CAR targets or biomarkers in total tumors, largely overlooking tumor heterogeneity. Moreover, CAR targets expressed in normal tissue (heart, liver, brain, lung, kidney, etc.) may lead to "on-target, off-tumor" (OTOT) toxicity.^[4]Analyzing CAR targets in relation to gene expression and protein levels in normal human and tumor tissues can help improve CAR design and the safety and efficacy of CAR-T cell therapy. Although some studies have reported the expression of CAR targets on acute myeloid leukemia and some solid tumors, analyses including CAR targets in HCC are lacking. In this study, we conducted an analysis of CAR targets in clinical trials of CAR-T cell therapy for HCC, incorporating data from The Cancer Genome Atlas (TCGA), Genotype-Tissue Expression (GTEx), the Human Protein Atlas (HPA), and tumor tissues from multiple clinical centers.

To the Editor: Cluster of differentiation 39 (CD39) is an extracellular ATPase that cleaves adenosine triphosphate (ATP) to adenosine diphosphate and adenosine monophosphate. By doing so, it depletes extracellular ATP that has been generated by the activated T cells or released by other cells in the stressed environment, such as human immunodeficiency virus (HIV) invasion. CD39-generated adenosine monophosphate is further cleaved to adenosine by CD73, the other main ectoenzyme in purinergic signaling. CD39 and CD73 function as metabolic enzymes to produce adenosine, thereby exerting inhibitory effects in tumors^[1,2]; by contrast, CD26 facilitates adenosine conversion to inosine and plays complex biological roles in diseases.^[3,4]However, the nonenzymatic immunological roles of CD4 lymphocytes coexpressing these three molecules after the onset of HIV-1 infection remain unclear. Here, 42 individuals with acute HIV-1 infection (AHI), 44 chronic HIV-1 infection (CHI) individuals, and 25 HIV-1-negative healthy controls (HCs) were enrolled to investigate the roles of CD4 lymphocytes expressing CD26, CD39, and CD73 at different HIV-1 infection stages.

To the Editor: In 2021, there were 4.1 million incident stroke cases, 2.6 million stroke-related deaths, and 53.2 million stroke related disability-adjusted life-years in China.^[1]Therefore, a better understanding of the pathogenesis of ischemic stroke and identification of novel biomarkers associated with its prognosis can provide new ideas for the treatment and management of ischemic stroke. Adenosine deaminase (ADA) is essential for energy metabolism and nervous system function. In a prospective cohort study, increased ADA levels were predictive of a large infarct volume, and high National Institutes of Health Stroke Scale (NIHSS) scores and increased modified Rankin Scale (mRS) scores were predictive among patients with large vessel occlusion stroke. However, the significance of serum ADA levels on clinical outcomes among patients with ischemic stroke remains unclear. Therefore, well-designed prospective studies on the association between serum ADA levels and clinical outcomes after ischemic stroke are required. We conducted a large-scale study based on the Minhang Stroke Cohort to prospectively investigate the relationships between serum ADA levels and adverse outcomes at three months among patients with ischemic stroke.

To the Editor: Laparoscopic hepatectomy techniques have been applied in living-donor hepatectomy, primarily due to their minimally invasive nature.^[1]However, whether laparoscopic techniques can be used effectively for the procedure of liver transplant recipient remains to be explored. In July 2021, Suhet al^[2]reported the first case of a purely laparoscopic procedure for liver transplant recipients, with an operative time of 960 min. In April 2022, they reported an improved case of laparoscopic explant hepatectomy followed by robot-assisted graft implantation, with a decreased operative time of 740 min. Both recipients were discharged with no major complications.^[3]These reports have attracted widespread attention; however, the excessively long operative durations have raised concerns. Nevertheless, they represent pioneering steps toward purely laparoscopic liver transplantation (PLLT). However, the long operative times reported in clinical cases suggest that PLLT is not yet applicable clinically. Presently, there are considerable challenges in performing PLLT, including a lack of adequate operative field exposure, vessel and bile duct anastomoses, acceptable operative duration, streamlined surgical procedures, and the availability of appropriate instruments. Addressing these challenges requires further experimental studies in animal models, particularly pigs, whose visceral anatomy, size, and abdominal cavity closely resemble those of humans. Therefore, this study aimed to establish a porcine model of PLLT to explore suitable procedures, train liver transplant surgeons, facilitate the development of specialized surgical instruments, and pave the way for clinical PLLT.

To the Editor: Maternal anthropometrics are well-established determinants of fetal size. However, the joint effect of maternal and paternal anthropometrics on fetal growth trajectories remains unexplored. To address this, our study enrolled 9075 low-risk singleton pregnant women from 24 hospitals across 18 provinces in China and identified four distinct fetal growth trajectory profiles with K-means clustering, enabling an analysis of the parental anthropometrics composite effect.

The authors declare that in the article "Chinese expert consensus on the application of immune checkpoint inhibitors in liver transplantation for hepatocellular carcinoma"^[1]published in vol.137, issue 18 of theChinese Medical Journal, the funding statement "This concensus was funded by the National Key Research and Development Program of China (Nos. 2021YFA1100500 and 2023YFC2505900), National Natural Science Foundation of China (Nos. 81873874, 82071797, and 82241225), and Beijing Natural Science Foundation (No. 7222096)" on Page 2145 should be corrected to "This concensus was funded by the National Key Research and Development Program of China (Nos. 2023YFC2505900 and 2021YFA1100500), National Natural Science Foundation of China (Nos. 81873874, 82071797, and 82241225), and Beijing Natural Science Foundation (No. 7222096)". The authors deeply apologize for any inconvenience caused.