2026年 · 第139卷第16期

Randomized controlled trials (RCTs) remain the gold standard for evaluating the causal effect of interventions. However, many clinical and policy questions cannot be fully addressed by RCTs due to ethical, logistical, or resource constraints. Observational studies using real-world data, including electronic health records, disease registries, and administrative claims, are also frequently used to complement trial evidence.^[1]Yet, many such studies suffer from suboptimal design or analytical strategies, leading to avoidable confounding and bias.^[2]

Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor (NNRTI), has been commonly used as a first-line therapy for human immunodeficiency virus (HIV) infection in China and worldwide.^[1]However, its use has been associated with several side effects, including central nerous system disturbances, which can affect a patient’s quality of life and treatment adherence.^[2]The potential benefits of reducing the standard dose of EFV from 600 mg daily to 400 mg have garnered attention in recent years, particularly regarding the decrease of adverse effects, maintaining therapeutic efficacy, and improving cost-effectiveness.^[3,4]

Pediatric sepsis is a systemic inflammatory response syndrome triggered by infection (such as pulmonary or intra-abdominal infections) and represents a common critical illness in clinical settings.^[1]Sepsis-associated encephalopathy (SAE) is a severe complication of sepsis that can lead to death in serious cases, while survivors may suffer sequelae such as cognitive dysfunction and neurodevelopmental delays.^[2]

To the Editor: Recently, several studies have shown that polycyclic aromatic hydrocarbons (PAHs) induce airway inflammation in patients with asthma. However, the mechanisms underlying the involvement of PAHs in the onset and progression of asthma are complex.^[1]PAHs are a group of organic compounds made up of several fused aromatic rings, and their toxicity generally increases with the number of aromatic rings. Given their notable toxicity, multiple international conventions and regulatory frameworks have been launced aiming to reduce the emission of PAHs, decreasing their detrimental effects on human health. However, owing to the diversity of PAHs, the specific mechanisms by which they are involved in asthma onset and progression remain unclear.

To the Editor: Neoadjuvant chemoimmunotherapy (NCIT) followed by surgery has been widely used for stage III patients with resectable tumors and limited mediastinal node (N2) involvement.^[1,2,3]In clinical practice, patients typically undergo two to four cycles of induction chemoimmunotherapy (ICIT), after which they are re-evaluated through multidisciplinary team (MDT) discussions to assess the feasibility of surgical intervention.^[4,5]Individuals who meet the surgical criteria could be scheduled for surgery. However, little is known about the impact of ICIT followed by radical surgery on stage IIIA-IIIB (N2) patients. Thus, we conducted a retrospective analysis of patients receiving ICIT followed by radical resection from two large-volume centers in China to explore the impact of ICIT on mid-/long-term survival in IIIA-IIIB (N2) NSCLC patients in the real world.

To the Editor: Stroke remains the second leading cause of death and disability worldwide and is associated with high rates of disability, mortality, and recurrence.^[1]Symptomatic intracranial atherosclerotic stenosis (sICAS), characterized by clinical symptoms caused by cerebral hypoperfusion due to the narrowing of intracranial arteries, is a major contributor to ischemic stroke. The primary treatment strategies for sICAS include conventional medical therapy (CMT) and endovascular treatment (ET). The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial demonstrated that ET was associated with a higher risk of stroke or death within 30 days compared to CMT (14.7%vs. 5.8%).^[2]However, beyond the 30-day window, the rate of ischemic events was significantly higher in the CMT group (6.2%) than in the ET group (2.2%).^[2]These findings suggest that treatment outcomes vary across specific timeframes. Common ET approaches for sICAS include stenting and balloon angioplasty. Both techniques aim to reduce the degree of stenosis; however, stent placement requires dual antiplatelet therapy (DAPT), which is linked to an increased risk of serious bleeding complications.

To the Editor: Spinal muscular atrophy (SMA) is a neuromuscular disorder caused by mutations in theSMN1(survival of motor neuron 1) gene, with an estimated global birth prevalence of approximately 1 in 10,000 live births. SMA leads to progressive motor function deterioration and reduced lifespan due to its degenerative nature and the historical absence of curative treatment. Disease-modifying therapies (DMTs) targeting the underlying molecular mechanisms have transformed SMA management. Among these, nusinersen—an intrathecally administered antisense oligonucleotide—has demonstrated significant improvements in motor function and survival in the clinical trials. In China, however, evidence regarding the real-world effectiveness and safety of nusinersen in children with SMA remains limited, primarily due to small sample sizes and short follow-up durations in previous studies. To address this, a multicenter, SMA-specific longitudinal registry with a planned 5-year follow-up was established in 2021.^[1]Preliminary results from this registry indicated improvements or stabilization in motor function among children receiving nusinersen. This follow-up analysis utilizes data from the registry to further evaluate the effectiveness and safety of nusinersen in individuals with type II/III SMA followed for up to 22 months.

To the Editor: Sepsis, the leading cause of intensive care unit (ICU) admissions, has a mortality rate ranging from 10% to 50%.^[1]Despite significant advances in understanding sepsis, it continues to be associated with acute organ failure and poses a global health challenge. Its heterogeneous nature complicates the standardization of diagnosis, treatment, and prognosis, highlighting the importance of predicting patient outcomes. Systemic inflammation frequently results in electrolyte imbalances in ICU patients. Potassium (K⁺), essential for cellular metabolism and membrane potential, plays a crucial role in the proper functioning of the cardiovascular, visceral, and nervous systems. Both hypokalemia and hyperkalemia can lead to severe complications. Additional research is required to elucidate the relationship between serum K⁺levels and sepsis prognosis. Therefore, this study retrospectively analyzed clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database to investigate the correlation between serum potassium levels and 28-day and in-hospital mortality in sepsis, aiming to provide insights and evidence to inform future clinical practice. This study adhered to the regulations outlined in theDeclaration of Helsinki. Access to the MIMIC-IV database was approved by the review committees of Beth Israel Deaconess Medical Centre and Massachusetts Institute of Technology. As a result, the Ethical Committee of the Affiliated Kunshan Hospital of Jiangsu University waived the requirement for informed consent and ethical approval. Participants were categorized into three groups based on potassium tertiles (T1-T3). Continuous variables were compared usingt-tests or Kruskal-Wallis tests, while categorical variables were compared using Fisher’s exact test. Mortality rates were calculated for each tertile. Multivariate Cox regression analysis, adjusted for confounding factors, were used to construct models and evaluate the predictive value of K⁺levels. Nonlinear relationships were examined with restricted cubic splines and two-piecewise Cox models. Stratified analyses were performed to evaluate consistency across subgroups. Statistical significance was set atP<0.05, using IBM SPSS 24.0 (IBM SPSS Inc., Chicago, USA) and Empowerstats 6.0 (Empower Statistics, X Medical Technology Co., Ltd, China).

To the Editor: Hemophilia A (HA) is a congenital bleeding disorder associated with spontaneous or traumatic bleeds, primarily affecting males.^[1]HA is characterized by a deficiency or lack of coagulation factor VIII (FVIII), causing recurrent bleeding, predominantly into joints, muscles, and soft tissues.^[1]In children with HA, especially infants, early bleed control is crucial to prevent potentially life-threatening bleeding and the development of joint arthropathy over time.^[2]

To the Editor: To enhance the responsibility of clinicians in the prevention and control of infectious diseases, China has released a document on infectious disease prevention and control responsibilities of medical institutions.^[1]Although the document released emphasizes the role of clinicians in providing vaccination advice, factors such as busy schedules and lack of incentives reduce the clinical implementation of vaccine-related activities.^[2]Hence, exploring relevant measures to enhance clinicians' engagement in vaccine-related initiatives is imperative to enable them to fulfill their public health roles and promote population well-being.

To the Editor: Achalasia of cardia (AC) is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and irregular peristalsis of the esophageal body, with clinical symptoms including dysphagia, regurgitation, chest pain, and weight loss.^[1]It has been shown that inhibitory myenteric neurons in LES specimens from patients with AC are reduced or even absent, suggesting that AC may be a neurodegenerative disease of the esophageal myenteric plexus.^[1]Despite extensive research, the exact etiology of AC remains unclear. Commonly accepted potential etiopathogenesis models include genetic predisposition, viral infection, and autoimmune-related mechanisms.^[1]The relationship between AC and eosinophilic esophagitis (EoE), a immune-mediated esophageal motility abnormality characterized by endoscopic biopsies with ≥15 eosinophils per high-powered field after excluding other causes of esophageal eosinophilia, is an old but still inconclusive topic.^[2]Recent studies have revealed potential associations between AC and other allergic diseases.^[3,4]However, there is a lack of large-scale prospective studies and causal inference analyses to establish definitive evidence.

To the Editor: Celiac disease (CD) is an immune-mediated disorder triggered by the ingestion of dietary gluten, resulting in inflammation and villous atrophy of the small intestine in genetically predisposed individuals. It frequently manifests with gastrointestinal symptoms in children and is strongly associated with the human leukocyte antigen (HLA)-DQ2andHLA-DQ8genetic markers. Historically perceived as predominantly affecting Caucasian populations, CD is now acknowledged as a global disorder with increasing incidence rates, a trend attributed in part to heightened public awareness and advanced diagnostic methodologies. Recent research in China suggests a higher prevalence of CD than previously estimated, however, comprehensive nationwide studies are lacking, and findings remain inconsistent across different regions. The aim of this study is to evaluate the prevalence and characteristics of CD in Chinese children who present with unexplained gastrointestinal symptoms across multiple provinces.

To the Editor: Long-term follow-up (LTFU) care is crucial for survivors of childhood cancers, as their risks for morbidity and mortality increase as they age.^[1]Risk-based survivorship care, which includes a personalized surveillance plan for potential long-term side effects and interventions to remediate and prevent late effects, is recommended for all childhood cancer survivors at least annually and more frequently as clinically indicated. Health problems related to cancer treatment that persist or develop five or more years after completion of therapy are known as late effects. Key components of LTFU include regular monitoring of organ function (cardiac, pulmonary, renal, hepatic, endocrine, neurocognitive, hearing and vision), screening for subsequent malignancies, psychosocial assessment, and health-promotion counseling. This approach is facilitated by evidence-based clinical practice guidelines. Based on data from the literature linking specific cancer treatments to adverse outcomes, the Children’s Oncology Group^[2]and the International Late Effects of Childhood Cancer Guideline Harmonization Group^[3]provide exposure-based recommendations for screening of long-term side effects in survivors of childhood cancer to support risk-based survivorship care.

In the article "Expression of Yes-associated protein in non-small cell lung cancer and its relationship with clinical pathological factors" published in Vol. 125, Issue 22 ofChinese Medical Journal,^[1]we acknowledge thatFigure 3contained errors in the bar chart and its corresponding labels due to mistakes made during figure preparation. The labels for the adenocarcinoma and squamous cell carcinoma groups in the third Western blotting panel inFigure 3Awere reversed. The errors do not affect the results and conclusions of the article. The correctedFigure 3and its legend is shown below. The authors sincerely apologize for any inconvenience caused.