Volume 134 · Issue 05 · 2021

心源性卒中（CES）又称心源性卒中，是指由来自心脏的心源性栓子通过循环导致脑动脉栓塞，并因此导致相应的脑功能障碍而引起的临床综合征。与其他亚型缺血性卒中相比，CES与更大的严重程度、较差的结局和相对较高的复发率相关。^[1]

银屑病是一种慢性炎症性疾病，涉及先天免疫系统和适应性免疫系统之间复杂的致病相互作用，影响约2%的人群。据报道，在银屑病患者中，几种重要疾病的发病率高于在普通人群中观察到的发病率。其中，心血管疾病（CVDs）是银屑病患者发病和死亡的最常见原因。因此，有效和安全的治疗对于降低该患者群体的心血管风险至关重要。

随着世界各国老龄化进程的加快以及工作和生活习惯的改变，颈椎病日益流行，给社会和政府都带来了巨大的经济负担和医疗费用压力。^[1]目前，保守治疗通常用于病情的早期阶段，而手术干预用于治疗具有严重神经根症状和脊髓压迫的患者。这些手术疗法包括颈椎前路手术（ACSS），包括颈椎前路椎体切除术和融合术、颈椎前路椎间盘切除术和融合术以及人工颈椎间盘置换术，这是自1955年提出以来使用最广泛的技术。^[2]ACSS的普及是有利的，因为在患者中观察到最小的创伤和低出血，并且可以直接去除由椎间盘突出和骨赘引起的压迫。然而，由于深间隙前颈椎椎体较小且毗邻气管，术后血肿是ACSS最重要的并发症之一，导致呼吸困难，甚至可能威胁患者的生命。^[3]因此，在进行ACSS时，通常放置引流管，这有利于排空伤口腔内的出血并减少术后血肿的发生率。

Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.

We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.

The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.

Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.

Models to predict mortality in trauma play an important role in outcome prediction and severity adjustment, which informs trauma quality assessment and research. Hospitals in China typically use the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to describe injury. However, there is no suitable prediction model for China. This study attempts to develop a new mortality prediction model based on the ICD-10-CM lexicon and a Chinese database.

This retrospective study extracted the data of all trauma patients admitted to the Beijing Red Cross Emergency Center, from January 2012 to July 2018 (n = 40,205). We used relevant predictive variables to establish a prediction model following logistic regression analysis. The performance of the model was assessed based on discrimination and calibration. The bootstrapping method was used for internal validation and adjustment of model performance.

Sex, age, new region-severity codes, comorbidities, traumatic shock, and coma were finally included in the new model as key predictors of mortality. Among them, coma and traumatic shock had the highest scores in the model. The discrimination and calibration of this model were significant, and the internal validation performance was good. The values of the area under the curve and Brier score for the new model were 0.9640 and 0.0177, respectively; after adjustment of the bootstrapping method, they were 0.9630 and 0.0178, respectively.

The new model (China Mortality Prediction Model in Trauma based on the ICD-10-CM lexicon) showed great discrimination and calibration, and performed well in internal validation; it should be further verified externally.

The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels. The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion, possibly due to the circadian rhythm in urinary excretion. This study aimed to explore the circadian rhythm, characteristics, and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches.

Eighty-five participants (mean age 32.4 years) completed the 24-h urine collection by successively collecting each of the single-voided specimens within 24 h. The concentrations of the urinary sodium, potassium, and creatinine for each voided specimen were measured. Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium, potassium, and creatinine excretion. The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model.

The metabolism of urinary sodium, potassium, and creatinine showed different patterns of circadian rhythm, although the urinary sodium excretion showed non-significant parameters in the cosinor model. A significant circadian rhythm of urinary creatinine excretion was observed, while the circadian rhythm of sodium was less significant than that of potassium. The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent, which had a nocturnal peak and fell to the lowest around noon to afternoon. In contrast, the peak of potassium was observed in the morning and dropped to the lowest point in the evening. The hourly urinary excretion followed a similar circadian rhythm.

It is necessary to consider the circadian rhythm of urinary sodium, potassium, and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.

Breast cancer (BC) is a common malignancy with highly female incidence. So far the function of notoginsenoside R1 (NGR1), the extract from Panax notoginseng, has not been clearly elucidated in BC.

Optimal culture concentration and time of NGR1 were investigated by cell counting kit-8 assay. Cell proliferation ability was measured by colony formation assays. Transwell assay was used to detect the effect of NGR1 on cell migration and invasion. The apoptosis rate of cells between each group was measured by TUNEL assay.

NGR1 treatment has an inhibitory effect on proliferation, migration, invasion, and angiogenesis and a stimulating effect on cell cycle arrest and apoptosis of Michigan Cancer Foundation-7 (MCF-7) cells. The 50% growth inhibitory concentration for MCF-7 cells at 24 h was 148.9 mmol/L. The proportions of MCF-7 cells arrested in the G0/G1 phase were 36.94±6.78%, 45.06 ± 5.60%, and 59.46±5.60% in the control group, 75, and 150 mmol/L groups, respectively. Furthermore, we revealed that NGR1 treatment attenuates BC progression by targeted downregulating CCND2 and YBX3 genes. Additionally, YBX3 activates phosphatidylinositol 3-phosphate kinase (PI3K)/protein kinase B (Akt) signaling pathway by activating kirsten rat sarcoma viral oncogene, which is an activator of the PI3K/Akt signaling pathway.

These results suggest that NGR1 can act as an efficacious drug candidate that targets the YBX3/PI3K/Akt axis in patients with BC.

The incidence of chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA) has increased in the last two decades. The mechanism underpinning susceptibility to and high mortality of COPD complicated with IPA is unclear, and the role of T helper cells 17 (Th17 cells) in the compound disease remains unknown. Therefore, this study aimed to assess the function of Th17 cells in COPD combined with IPA.

COPD, IPA, and COPD+IPA mouse models were established in male wild type C57/BL6 mice. The amounts of Th17 cells and retinoic acid-related orphan receptors γt (RORγt) were tested by flow cytometry. Then, serum interleukin (IL)-17 and IL-23 levels were detected by enzyme-linked immunosorbent assay (ELISA) in the control, COPD, IPA and COPD+IPA groups. In addition, COPD+IPA was induced in IL-17 knockout (KO) mice, for determining the role of Th17 cells in COPD+IPA.

Compared with the COPD group, the COPD+IPA group showed higher amounts of blood RORγt ([35.09 ± 16.12]% vs. [17.92 ± 4.91]%, P = 0.02) and serum IL-17 (17.96 ± 9.59 pg/mL vs. 8.05 ± 4.44 pg/mL, P = 0.02), but blood ([5.18 ± 1.09]% vs. [4.15 ± 0.87]%, P= 0.28) and lung levels of Th17 cells ([1.98 ± 0.83]% vs. [2.03 ± 0.98]%, P= 0.91), lung levels of RORγt ([9.58 ± 6.93]% vs. [9.63 ± 5.98]%, P = 0.49) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 68.70 ± 15.20 pg/mL, P = 0.15) showed no significant differences. Compared with the IPA group, the COPD+IPA group displayed lower amounts of blood ([5.18 ± 1.09]% vs. [9.21 ± 3.56]%, P = 0.01) and lung Th17 cells ([1.98 ± 0.83]% vs. [6.29 ± 1.11]%, P = 0.01) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 154.90 ± 64.60 pg/mL, P = 0.01) and IL-17 (17.96 ± 9.59 pg/mL vs. 39.81 ± 22.37 pg/mL, P = 0.02), while comparable blood ([35.09 ± 16.12]% vs. [29.86 ± 15.42]%, P = 0.25) and lung levels of RORγt ([9.58 ± 6.93]% vs. [15.10 ± 2.95]%, P = 0.18) were found in these two groups. Finally, Aspergillus load in IL-17 KO COPD+IPA mice was almost 2 times that of COPD+IPA mice (1,851,687.69 ± 944,480.43 vs. 892,958.10 ± 686,808.80, t= 2.32, P = 0.02).

These findings indicate that Th17 cells might be involved in the pathogenesis of COPD combined with IPA, with IL-17 likely playing an antifungal role.

The pathogenesis of osteosarcoma (OS) is still unclear, and it is still necessary to find new targets and drugs for anti-OS. This study aimed to investigate the role and mechanism of the anti-OS effects of miR-296-5p.

We measured the expression of miR-296-5p in human OS cell lines and tissues. The effect of miR-296-5p and its target gene staphylococcal nuclease and tudor domain containing 1 on proliferation, migration, and invasion of human OS lines was examined. The Student’s t test was used for statistical analysis.

We found that microRNA (miR)-296-5p was significantly downregulated in OS cell lines and tissues (control vs. OS, 1.802 ± 0.313 vs. 0.618 ± 0.235, t= 6.402, P < 0.01). Overexpression of miR-296-5p suppressed proliferation, migration, and invasion of OA cells. SND1 was identified as a target of miR-296-5p by bioinformatic analysis and dual-luciferase reporter assay. Overexpression of SND1 abrogated the effects induced by miR-296-5p upregulation (miRNA-296-5p vs. miRNA-296-5p + SND1, 0.294 ± 0.159 vs. 2.300 ± 0.277, t= 12.68, P = 0.003).

Our study indicates that miR-296-5p may function as a tumor suppressor by targeting SND1 in OS.

脑静脉窦血栓形成（CVST）是一种涉及脑静脉和窦血栓形成的罕见疾病。如果CVST没有得到及时和适当的治疗，可能会发生严重的后果，包括由于静脉阻塞导致的颅内高压和脑静脉梗塞，可导致癫痫、严重的神经系统疾病，甚至死亡。^[1]

本研究研究了利拉鲁肽（人胰高血糖素样肽-1[GLP-1]的类似物）对Ishikawa（IK）和人子宫内膜癌（HEC）-1B子宫内膜癌（EC）细胞系增殖的影响，鉴定了利拉鲁肽是否增强孕酮的抗肿瘤作用，并探索了利拉鲁肽在EC细胞系孕酮受体（PGR）表达中的作用和潜在途径。

血管免疫母细胞性T细胞淋巴瘤（AITL）是一种侵袭性外周T细胞淋巴瘤（PIT），预后不良。以淋巴结肿大、B症状（不明原因反复发热（常在38℃以上）、盗汗、6个月内不明原因体重减轻10%以上）、多克隆高丙种球蛋白血症、自身免疫性溶血为特征。^[1]肝细胞合成的C反应蛋白（CRP）是一种急性期蛋白，也是全身炎症的重要标志物。血清CRP水平不仅是霍奇金淋巴瘤的独立预后因素，也是AITL的重要独立预测因素。同时，白蛋白（ALB）用于营养评估，并作为抗急性期蛋白。ALB的血浆浓度在炎症和细菌感染期间降低。由ALB和CRP水平组成的格拉斯哥预后评分（GPS）已经在几种常见的实体瘤中进行了研究，包括肝细胞癌、结直肠癌和肾细胞癌。^[2]然而，GPS在AITL领域的价值尚不清楚。另一方面，PIT预后指标已被广泛用于评估各种类型的T细胞非霍奇金淋巴瘤的预后。因此，我们进行了一项回顾性队列研究，以探讨GPS的预后价值，并比较GPS和PIT模型在AITL患者中的预后意义。

致编辑：中风是脑血液循环障碍的突然发作；其发病率越来越高，已成为全球第二大常见死因、第四大生产力丧失原因和主要致残原因，^[1,2]给社会经济和公众健康造成了非常严重的压力和负担。尽管阿替普酶静脉溶栓（IVT）已被公认为发病4.5 h内急性缺血性卒中的首选方案，^[3,4]仍有许多患者没有从中受益，并导致严重的并发症。如今，急性缺血性卒中血管内血栓切除术（EVT）也已成为急性缺血性卒中合并大血管闭塞患者标准治疗的一部分。但对于发病4.5 h以内的急性缺血性脑卒中患者，EVT前是否使用阿替普酶静脉溶栓仍存在争议。许多流行病学研究表明，与直接EVT（dEVT）相比，患者从桥接血管内取栓术中没有明显获益，^[4]而其他研究显示了相反的结果。^[3]

致编辑：特发性肺纤维化（IPF）是一种病因不明、以慢性、进行性肺纤维化为特征的肺部疾病，其病理表现为通常的间质性肺炎。^[1]然而，IPF的预后仍然较差，诊断后的中位生存期约为2~3年。^[2]因此，寻找和开发有效的IPF治疗方式似乎很重要。通过信使RNA（mRNA）分子内互补序列的碱基对，微小RNA（miRNA）在RNA沉默和转录后基因表达调控中发挥关键作用。^[3]每个miRNA可以具有多个靶基因，并且几个miRNA可以共同调节一个基因。它们在器官纤维化中也发挥着重要作用，尤其是在IPF中，作用可能与疾病的发病机制有关。^[4,5]IPF潜在的miRNA-mRNA调控网络的构建将有助于揭示IPF中miRNAs更全面的分子机制。

致编辑：自2019冠状病毒病（COVID-19）爆发以来，大量医护人员自愿离开熟悉的工作和生活环境，前往湖北省承担应急响应工作。对于大多数前往湖北省的医务工作者来说，这是他们第一次参与这样的危机情况。此前有研究报道，医护人员面临高强度工作和高心理压力的双重打击，特别容易出现心理健康困难。^[1]此外，没有针对受疫情影响地区的医务人员的心理应急预防计划，可能对医务人员的身心健康产生重大影响。在目前的研究中，我们调查了新冠肺炎疫情期间从山西派往湖北省的医务人员的心理健康状况。此外，我们分析了影响医务人员的压力因素，以及他们用于情绪调节和应对的方法。

致编辑：2019年12月以来，2019冠状病毒病（COVID-19）疫情成为中国乃至全球关注的焦点。尽管中国疫情得到有效控制，但全球COVID-19疫情形势不容乐观，已逐渐成为2020年的全球威胁。新冠肺炎可能导致老年人和心血管疾病、恶性肿瘤和其他基础疾病患者的高死亡率。^[1]乳腺癌是女性癌症死亡的主要原因。^[2]确诊为乳腺癌的患者往往免疫力低下，需要长期接受抗肿瘤治疗。因此，这一人群感染新冠病毒和死亡的风险可能很高。此外，在新冠肺炎疫情期间，由于交通管制和医院感染风险较高，肿瘤患者无法及时前往医院接受诊疗，可能对预后产生不利影响。

致编辑：糖尿病视网膜病变（DR）是一种以糖尿病视网膜微血管损伤为特征的疾病。作为成人失明的主要原因，DR已经成为世界范围内的公共卫生问题，并威胁着糖尿病患者甚至健康人群的预后。DR与以体重指数（BMI）为代表的常见人体测量值之间的相关性仍有争议。^[1]体表面积（BSA）也是由身高和体重计算的另一项人体测量基本指标，可以更准确地反映身体的大小，并区分脂肪或肌肉组织。^[2]此外，先前的研究认为，脂肪组织分泌的脂肪因子可能在肥胖和2型糖尿病的发生机制中发挥重要作用。肥胖人群脂联素水平降低，脂联素水平降低可能导致胰岛素抵抗和糖尿病。^[3]我们首先调查了中国2型糖尿病患者BSA与DR的关系，并与BMI进行了比较。该研究由中国医科大学附属第一医院机构审查委员会批准（AF-SOP-07-1.1-01/2019-13）。本研究中纳入的所有研究人群均获得了书面知情同意书。

致编辑：与大多数在儿科接受者中进行的缩小尺寸肝移植（RSLT）相比，^[1,2,3]成人受体RSLT的经验和移植物复位的手术策略相对陌生。在此，我们报告了一例成功的成人对成人RSLT病例，其中采用了一种独特的方法，在保留右肝静脉（RHV）的同时切除右后段。本研究经华西医院伦理委员会批准（编号：2019-718），并按照中国华西医院伦理指南进行赫尔辛基宣言.

致编辑：胆道闭锁（BA）是一种影响婴幼儿生活的胆道梗阻性疾病。Kasai手术（KP）改善了BA的预后，但尚未成功解决BA术后胆管炎症和肝纤维化、肝内胆管囊性扩张（肝内胆管囊肿，IBC）、门静脉高压症、肝功能衰竭，etc因此，大多数儿童仍然需要肝移植（LT）。^[1]近年来，随着影像学技术的发展，肝内胆管囊性扩张可能是影响预后的重要因素，越来越受到外科医生的重视。本研究旨在分析KP后IBC的形成特点、病理表现与胆红素水平、达到终末期肝功能时间的关系。

致编辑：作为肝移植（LT）后最严重的血管并发症之一，早期肝动脉血栓形成（eHAT）可能导致缺血性肝坏死和缺血性胆道并发症如胆漏并最终导致移植物或患者丢失。^[1]然而，早期诊断和干预可以显著改善结果。^[2]满意的干预是通过血运重建实现的，当失败时，必须考虑挽救生命的再次移植。由于移植物池较少，特别是在东方国家并不总是可以进行再移植，^[1]每个LT中心都应该致力于降低eHAT的发生率。

致编辑：粪便免疫化学试验(FIT)是设计用于检测人血红蛋白以指示结肠瘤形成发生的免疫测定，其已广泛用于全球结肠直肠癌(CRC)筛查项目。先前的诊断研究表明，位点特异性敏感性存在很强的梯度，位于远端结肠/直肠的晚期腺瘤的发生率通常高于近端部分，这可以通过影响血红蛋白降解的结肠转变时间以及不同解剖区域腺瘤的形状（有蒂、扁平和无蒂）来解释。^[1]此外，已经提出使用已确定的CRC相关风险因素的基于问卷的风险评估（QRA）来识别CRC筛查的高风险人群。^[2]然而，先前的研究表明，几个风险因素存在位点特异性差异。^[3,4]在结直肠癌筛查环境中，尚未评估FIT和QRA是否以及在多大程度上影响结直肠肿瘤的部位特异性检出率。因此，我们旨在基于人群的结直肠癌筛查试验（TARGET-C），经验性地评估基于FIT和QRA的筛查腺瘤检出率的位点特异性变化。

致编辑贫血是一种非常常见的临床情况，可由多种疾病引起。虽然很常见，但有时很难找出贫血的潜在原因，尤其是对于复杂的病例。在此，我们报告了一例看似明显的贫血（血尿）原因的老年患者，后来被诊断为罕见的冷凝集素（CA）病（CAD），这被证实是其严重贫血的主要病因。