Volume 133 · Issue 08 · 2020

骨关节炎(OA)目前被认为不仅仅是承重关节的退行性疾病，而是由于衰老、损伤、炎症、代谢紊乱，etc其患病率很高：60岁以上男性为9.6%，女性为18.0%。大多数健康专家表示，OA是无法治愈的，并且只关注姑息治疗，因为我们缺乏有效的疾病缓解骨关节炎药物（DMOADs）。^[1]但我们是否应该希望通过密集的研究和药物开发，在中国精准治疗OA是可能的？

Rheumatoid arthritis (RA), a systemic autoimmune disease characterized by synovial inflammation, can cause cartilage and bone damage as well as disability. The aim of this study was to explore whether serum glucose-6-phosphate isomerase (GPI) is correlated with disease activity and the value of GPI in the evaluation of infliximab treatment in patients with RA.

Sixty-two patients with RA who had an inadequate response to methotrexate (MTX) were enrolled in Peking University People’s Hospital from July 1, 2016 to July 31, 2018. Infliximab (3 mg/kg, intravenous at weeks 0, 2, and 6 and then every 8 weeks) was administered to patients with stable background MTX therapy. Serum samples were obtained at baseline and week 18. Serum GPI levels were determined using enzyme-linked immunosorbent assay. The associations between serum GPI levels and clinical features were analyzed.

Serum GPI was positively correlated with Disease Activity Score in 28 joints (DAS28), swollen joint count, tender joint count and C-reactive protein level (P < 0.001, P < 0.001, P < 0.001, and P = 0.033, respectively). The change of DAS28 in GPI-positive patients was greater than that in GPI-negative patients (P < 0.001). Compared with those for patients receiving MTX monotherapy at baseline, the GPI levels were significantly declined when MTX was combined with infliximab (P < 0.001).

Serum GPI is related to disease activity and clinical response to infliximab treatment.

Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patientassessed) and proportions of treatment cost to household income.

This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (<10%, 10-30%, 31-50%, and >50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients’ treatment satisfaction.

When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P < 0.001). Effectiveness, side effects, and convenience scores were higher in the <10% subgroup compared to those in the >50% subgroup (all P < 0.05). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 13.183, P = 0.004). For biological diseasemodifying anti-rheumatic drugs, effectiveness and convenience scores were lower in the severe RA subgroup than those in the extremely mild RA subgroup (both P < 0.05). Convenience score was higher in the <10% subgroup compared to that in the 31% to 50% and >50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032).

Higher disease severity and higher financial burden were associated with lower patient satisfaction.

Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions.

Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses.

At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was -11.3% (95% confidence interval: -16.3% to -6.3%, P_superiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (-0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group.

In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis.

ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov

Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range.

We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied.

There was no significant kyphosis in cervical curvature (>-5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level.

Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Gastric cancer (GC) is one of the most globally prevalent cancers in the world. The pathogenesis of GC has not been fully elucidated, and there still lacks effective targeted therapeutics. The influence of altered kinesin superfamily protein 22 (KIF22) expression in GC progression is still unclearly. The aim of this study was to investigate the KIF22 effects on GC and related mechanisms.

Gastric carcinoma tissues and matching non-cancerous tissues were collected from patients with GC who have accepted a radical gastrectomy in Lanzhou University Second Hospital from May 2013 to December 2014. The expression of KIF22 was examined in GC of 67 patients and 20 para-carcinoma tissues by immunochemical staining. The relationship between the expression of KIF22 and clinicopathologic characteristics was next investigated in the remaining 52 patients except for 15 patients who did not complete follow-up for 5 years. Cell viability was performed via 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) test and colony formation assay in the MGC-803 and BGC-823 GC cells. Cell scratch and trans-well invasion assay was performed to assess migration ability in the MGC-803 and BGC-823 GC cells. Gene set enrichment analysis (GSEA) pathway enrichment analysis was performed to explore the potential functions. Cell cycle was detected by flow cytometry. In addition, the two GC cell lines were used to elucidate the underlying mechanism of KIF22 in GC in vitro via assessing the effects on mitogenactivated protein kinase and extracellular regulated protein kinases (MAPK/ERK) signal transduction pathway-related expressions by Western blotting assays. The differences were compared by t tests, one-way analysis of variance, and Chi-squared tests.

The study showed that KIF22 was up-regulated in GC, and KIF22 high expression was significantly related to differentiation degree (χ² = 12.842, P = 0.002) and poorly overall survivals. GSEA pathway enrichment analysis showed that KIF22 was correlated with the cell cycle. Silence of KIF22 decreased the ability of the proliferation and migration in gastric cells, induced G1/S phase cell cycle arrest via regulating the MAPK-ERK pathways.

KIF22 protein level was negatively correlated with prognosis. KIF22 knockdown might inhibit proliferation and metastasis of GC cells via the MAPK-ERK signaling pathway.

Takayasu arteritis-induced renal arteritis (TARA), commonly seen in Takayasu arteritis (TA), has become one of the main causes of poor prognosis and early mortality in patients with TA. TARA progressing into Takayasu arteritis-induced renal artery stenosis (TARAS), could lead to severe complications including malignant hypertension, cardiac-cerebral vascular disease, and ischemic nephropathy. Since there existed no guidelines on treatments, this study aimed to review the comprehensive treatments for TARA.

We searched systematically in databases including PubMed, Ovid-Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from inception to May 2018. Literature selection, data extraction, and statistical analysis were performed.

Eighty-two literatures were recruited focusing on medical treatments (n = 34) and surgical treatments (n = 48). We found that combined medical treatments of glucocorticoids and conventional synthetic disease-modifying anti-rheumatic drugs could reach high rates of remission in patients with TARA, and biological disease-modifying anti-rheumatic drugs were preferred for refractory patients. After remission induction, surgical treatment could help reconstruct renal artery and recover renal function partly. Percutaneous transluminal angioplasty was the first choice for patients with TARAS, while open surgery showed a good longterm survival.

Patients with TARA should benefit both from medical treatments and from surgical treatments comprehensively and sequentially. Multidisciplinary team coordination is recommended especially in patients with severe complications.

Hyperuricemia and gout have become public health concerns; many important guidelines have recommended xanthine oxidase inhibitors (XOIs) as the first-line urate-lowering therapies (ULTs) to treat chronic gout with hyperuricemia. However, whether treating hyperuricemia and gout with ULTs modifies cardiovascular risks remains controversial. The aim of this study was to assess the incident risk of cardiovascular (CV) events (CVE) in hyperuricemia population, assess the cardiovascular benefit-risk of ULTs in hyperuricemia patients with or without gout in diverse cardiovascular risk sub-groups, and specify the safety of different ULTs.

We searched PubMed, Embase, the Cochrane Library, Wanfang, Chongqing VIP (CQVIP, en.cqvip.com), and China National Knowledge Infrastructure Database for prospective cohort studies and randomized controlled trials (RCTs) in English and Chinese. Potential medications included XOIs, and uricosurics. RCTs were divided into sub-groups analysis based on blinding status and patients’ history of CV diseases. Risk ratios (RRs) were calculated and were reported with corresponding 95% confidence intervals (CIs) by fixed-effects or random-effects model.

Seven prospective cohort studies and 17 RCT studies were included. The risks of both major adverse cardiovascular events (MACE) (RR = 1.72, 95% CI 1.28-2.33) and CVE (RR = 1.35, 95% CI 1.12-1.62) were higher in the hyperuricemia population than non-hyperuricemia one. In seven RCT studies where XOIs were compared with no-treatment or placebo, the results of five low CV risk studies showed that XOIs lowered the risks of both MACE (RR = 0.35, 95% CI 0.20-0.62) and CVE (RR = 0.61, 95% CI 0.44-0.85); whereas two high CV risk studies showed that XOIs lowered the risk of CVE (RR = 0.69, 95% CI 0.54-0.88) rather than MACE (RR = 0.62, 95% CI 0.29-1.35). In nine RCT studies where the cardiovascular safety between febuxostat and allopurinol were compared, no statistical difference was found in the risk of MACE or CVE.

The hyperuricemia population does have a higher incidence of CVE, and the results suggested that XOIs might reduce the incidence of MACE and total CVE. In addition, from the perspective of cardiovascular safety, febuxostat equaled allopurinol in our meta-analysis.

2019年，北京大学第一医院收治一名50岁中国女性，间歇性发热伴口干和眼干24年，阵发性意识丧失11年，加重1年。首次风湿病评估前24年开始每2~3个月间歇性发热（38~39℃），无需干预体温可恢复正常。23年前癫痫发作并腹痛后，她出现严重的体重减轻、疲劳、虚弱、皮肤色素沉着和低血压（80/45 mmHg）。实验室检查显示钾正常，低钠血症133 mmol/L（正常范围135-145 mmol/L），清晨血清皮质醇浓度低0.56 μ g/mL（正常范围4.40-9.20 μ g/dL），24h尿皮质醇低259.6 μ g/d（正常范围370.0-639.0 μ g/d），促肾上腺皮质激素（ACTH）高128.37 pg/mL（正常范围7.20-63.30 pg/mL）。她还患有贫血，血红蛋白77 g/L，血小板减少症，血小板70 × 10⁹/L至90 × 10⁹/L，活化部分凝血活酶时间（APTT）显著延长105.1 s（正常范围22.7-31.8 s）。血清肌酐从110升高至135 μ mol/L（正常范围44-133 μ mol/L）。血培养和纯化蛋白衍生物试验均为阴性。泼尼松龙每日30 mg联合支持治疗，患者血压恢复正常，不再发热，血清肌酐降至120 μ mol/L。同时，患者的疲劳和皮肤色素沉着也得到了缓解，但腋毛和阴毛脱落。进一步的自身免疫测试显示阳性抗核抗体（ANA）1:10 00和抗SSA抗体；然而，正常的血清补体水平。自从她被诊断为自身免疫性肾上腺功能不全（AI）以来，泼尼松替代治疗（每天上午8点5 mg，下午4点5 mg）已经维持了20多年。

自2010年开创该技术以来，证实使用经口内镜肌切开术（POEM）治疗贲门失弛缓症的安全性和有效性的报告大幅增加。^[1]然而，这些报告侧重于短期至中期随访，关于POEM治疗贲门失弛缓症的长期结果的数据非常有限。令人满意的短期结果是否会持久仍不得而知。此外，一些接受POEM的贲门失弛缓症患者指出，他们可以从有助于症状缓解的术后饮食建议中受益。因此，本研究旨在确定使用POEM治疗贲门失弛缓症的长期治疗结果，并评估在此期间的术后Eckardt评分。我们还根据接受该治疗的贲门失弛缓症患者的反馈精心制作了一套POEM后饮食建议，以实现POEM后患者更好的症状缓解。

周围神经系统损伤可导致神经的部分或完全横断，从而导致瘫痪、感觉差或异常以及疼痛性神经病变。富血小板纤维蛋白（PRF）被定义为具有高再生潜力的第二代血小板浓缩物。^[1]此外，PRF易于制备，无需化学预处理，因为诱导更快的神经修复在神经导管用于周围神经修复的临床使用中是至关重要的。然而，PRF膜神经导管（PRF-NGC）尚未得到很好的研究。在本研究中，将PRF-NGC与自体神经移植物（ANG）和聚氨酯（PUR）神经导管进行比较，以研究PRF-NGC对周围神经修复的潜在作用。通过免疫荧光染色和透射电子显微镜分析再生神经。收集腓肠肌的湿重测量值和Masson三色染色切片，用于确定量化坐骨神经功能恢复。

致编辑：风湿性疾病是以关节炎症为特征的疾病，但其他器官也受到影响。^[1]风湿性疾病在我国较为常见，嘌呤类似物免疫抑制剂硫唑嘌呤（AZA）针对这些疾病的临床应用日益受到关注。尽管AZA广泛用于治疗风湿性疾病，但由于不良反应，尤其是白细胞减少，其临床应用受到限制。

一名29岁的中国女性主诉反复头晕5个月，步态障碍2个月。入院时（2016年4月），发现她有宽基础步态、水平眼球震颤和阳性跟膝试验。最初的血液学、生化、微生物学、激素检查和肿瘤血清标志物无显著性。脑脊液（CSF）中观察到寡克隆条带，无其他病理改变，而颈椎和脑的磁共振成像（MRI）正常。计算机断层扫描(CT)发现前纵隔肿块[图1A].尽管在CSF或血清中缺乏副肿瘤抗体，如抗神经元核自身抗体1型（ANNA-1，也称为“抗Hu”）、ANNA-2（也称为“抗Ri”）、浦肯野细胞抗体1型（PCA-1，也称为“抗Yo”）、抗CV2（也称为“collapsin应答介质蛋白5[CRMP5]”）、抗Ma、抗两性蛋白、抗Tr（也称为“δ/notch样表皮生长因子相关受体[DNER]”）和抗谷氨酸脱羧酶（GAD），但她的神经学表现仍然指向副肿瘤神经综合征（PNSs）之一。

在《中华医学杂志》第133卷第2期第174-182页发表的题为“长非编码RNA HOTAIRM1通过调控miR-873-5p/ZEB2轴促进胶质瘤细胞增殖和抑制凋亡”的文章中，^[1]作者和隶属关系部分应更正如下：

在题为“经颅交流电刺激治疗重度抑郁症的方案：一项随机对照试验”的文章中，发表在第133卷第1期第61-67页中华医学杂志,^[1]摘要、研究设计、随机化和盲法的“九十二”图1应该是“一百”和“46”图1应为“50”；样本量计算和图1都被纠正了。