Volume 135 · Issue 01 · 2022

电视胸腔镜、腹腔镜、达芬奇机器人手术的应用，使外科治疗进入微创手术（MIS）阶段。^[1,2,3]与传统开放手术相比，MIS侵入性更小，住院时间更短。^[4,5]然而，MIS和传统的开放手术都不能在切除病变的同时保持器官的完整性。迄今为止，MIS并没有改变传统开放手术中使用的治疗模式，即“不仅切除病变，而且部分或完全切除选定的器官”，导致一些器官的丢失和剩余器官的解剖重建。人体内的每个器官都有自己的功能，对我们身体的正常代谢起着重要的作用；因此，没有器官是多余的。而且，我们对器官之间相互作用的了解比对特殊器官功能的了解要少得多。如果一个器官被部分或完全切除，其余器官的功能可能不如切除前。其他器官的功能可能会因该器官的丧失或部分切除而受到影响。患者经常遭受与器官丧失相关的并发症。例如，接受近端胃切除术的患者术后经常出现反流，导致他们的睡眠质量下降。全胃切除术后患者常伴有消化不良、营养不良、腹泻和贫血。

Psoriasis is a common, chronic, immune-mediated inflammatory skin disease with increased epidermal proliferation. The objective of this review was to systematically identify the evidence and perform a network meta-analysis (NMA) to estimate the relative efficacy of secukinumab (SEC) against adalimumab (ADA) and infliximab (INF) for the treatment of moderate-to-severe plaque psoriasis.

A systematic literature review (SLR) was conducted according to a pre-specified protocol to identify relevant studies. Initially, the databases were searched from database inception till June 2013, and the SLR was updated in April 2020. The eligibility criteria included adult patients (≥18 years old) with moderate-to-severe plaque psoriasis, and the SLR included randomized controlled trials (RCTs). The comparators of interest were SEC, ADA, INF, and placebo (PLA), while outcomes of interest were Psoriasis Area and Severity Index (PASI) (50, 75, and 90) at weeks 12, 16, and 24. A Bayesian NMA for PASI was utilized with a framework that evaluated the probability of PASI responses in different categories of PASI thresholds within a single model.

A total of 23 RCTs that assessed the efficacy of SEC, ADA, and INF in patients with moderate-to-severe plaque psoriasis were identified. At 12 weeks, SEC was associated with a significantly better response compared with PLA and ADA for PASI 75 and 90, while response results were comparable against INF. At 12 weeks, risk ratio (95% confidence interval) derived from NMA for SEC vs. ADA and INF for PASI 75 was 1.35 (1.19, 1.57) and 1.01 (0.90, 1.18), respectively. At the 16-week and 24-week time interval, SEC was significantly better than PLA, ADA, and INF for PASI 75 and 90.

Efficacy of SEC in the treatment of patient populations with moderate-to-severe plaque psoriasis is well demonstrated through NMA.

冷圈套器息肉切除术（CSP）是内镜切除技术之一，已被推荐用于切除小型息肉（<5 mm)或大小达10 mm的非癌性息肉，以降低结直肠癌的发病率和死亡率。^[1]最近，光热发电取得了一些进展。本文就CSP的适应症、疗效、安全性及发展进行综述。

冠状病毒疾病2019（新冠肺炎）已被世界卫生组织宣布为疫情。^[1]大多数新冠肺炎患者表现出轻度至中度症状，而约15%迅速进展为重度肺炎，约5%最终发展为急性呼吸窘迫综合征（ARDS），^[2]这需要机械通气(MV)甚至体外膜肺氧合。据报道，接受MV的新冠肺炎患者死亡率高达66%。^[3]因此，旨在改善死亡率的治疗应集中在两个方面：一是预防轻中度新冠肺炎患者病情加重；二是病情严重患者的抢救疗法。

Endoscopic biopsy can underestimate gastric malignancies as low-grade intraepithelial neoplasia (LGIN). Definitively diagnosed LGIN would progress. This study aimed to evaluate predictive factors to identify malignancies misdiagnosed as LGIN by biopsy and LGIN at high risk of progression.

The clinical records of patients diagnosed with gastric LGIN by endoscopic biopsy who underwent at least two endoscopies during the first year of follow-up between 2007 and 2017 were retrospectively collected. Three endoscopists reviewed photographs of the initial endoscopy, described lesion characteristics, and made endoscopic diagnoses. Logistic regression was used to analyze predictors to identify malignancies underestimated as LGIN. A receiver operating characteristic curve was used to evaluate the diagnostic accuracy of these predictors. Patient clinical outcomes of follow-up >1 year were collected. Kaplan-Meier estimates with log-rank tests and Cox proportional hazards regression were used to analyze predictors of progression.

Overall, 48 of 182 (26.4%) patients were proven to have malignancies. A single lesion, a large lesion size, and marked intestinal metaplasia (IM) were independent predictors of initially misdiagnosed malignancies. The area under the curve of these predictors was 0.871, with a sensitivity of 68.7% and specificity of 92.5%. Twelve of 98 patients (12.2%) progressed during the 33-month median follow-up period. A whitish appearance, irregular margins, marked IM, and histological diagnosis of LGIN more than twice within the first year were predictors for progression.

Lesions diagnosed as LGIN by biopsy with marked IM and other predictors above should be prudently treated for high potential to be malignancies or progress. Endoscopic follow-up with repeated biopsies within the first year is recommended.

Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.

We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical information were collected. Multivariable logistic regression analyses were performed to identify risk factors for ICH and mortality.

Of 77 patients, 11 (14.3%) suffered from ICH, and 36 (46.8%) survived. The survival rate was significantly lower (18.2% [2/11] vs. 51.5% [34/66], P = 0.040) in patients with ICH than in those without ICH. Multivariable analysis revealed that factors independently associated with ICH were diabetes mellitus (adjusted odds ratio [aOR]: 12.848, 95% confidence interval [CI]: 1.129-146.188, P = 0.040) and minimum fibrinogen during ECMO (aOR: 2.557, 95% CI: 1.244-5.252, P = 0.011). Multivariable analysis showed that factors independently associated with mortality were acute hepatic failure during ECMO (aOR: 9.205, 95% CI: 1.375-61.604, P = 0.022), CO₂ retention before ECMO (aOR: 7.602, 95% CI: 1.514-38.188, P = 0.014), and minimum platelet concentration during ECMO (aOR: 0.130, 95% CI: 0.029-0.577, P = 0.007).

Diabetes mellitus and minimum fibrinogen concentration during ECMO are risk factors for ICH in patients with severe respiratory failure managed using VV-ECMO. This indicated that anticoagulants use and nervous system monitoring should be performed more carefully in patients with diabetes when treated with VV-ECMO due to severe respiratory failure.

Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC.

FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of incidence and mortality in 60 countries from 2000 through 2019 were evaluated by joinpoint regression analysis using data of Global Burden of Disease 2019. The association between potential behavioral, metabolic, and socioeconomic risk factor exposure at the nation level retrieved from the World Bank and Global Health Observatory and the incidence and mortality of FBC were evaluated by multivariate linear regression.

FBC incidence and mortality varied greatly in the 60 included countries. Higher incidence and mortality rates were typically observed in countries with higher HDIs and vice versa. During 2000 to 2019, significantly increasing trends in incidence and mortality were observed in 26 (average annual percent changes [AAPCs], 0.35-2.96) and nine countries (AAPC, 0.30-1.65), respectively, while significantly decreasing trends in both incidence and mortality were observed in 22 countries, most of which were high-HDI countries. Among the population aged ≥40 years, there were 26 and 11 countries showing significantly increased trends in incidence and mortality, respectively. Ecological analysis showed that countries with higher prevalence rates of high cholesterol and higher health expenditures were more likely to have higher FBC incidence, and countries with higher rates of obesity and poorer universal health coverage were more likely to have higher FBC mortality.

Despite decreased or stabilized FBC incidence and mortality rates were observed in some countries with high HDI over the past decades, disease burden became even severer in developing countries, especially for the population aged ≥40 years. Effective targeted preventive programs are strongly encouraged to reduce the FBC disease burden worldwide.

The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.

In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.

Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.

Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.

Clinicaltrials.gov; NCT02878811.

Differential diagnosis of active tuberculosis (ATB) and latent tuberculosis infection (LTBI) has been a challenge for clinicians in high TB burden countries. The purpose of this study was to improve the accuracy of differential diagnosis of ATB and LTBI by using fluorescent immunospot (FluoroSpot) assay to detect specific Th1 cell immune responses. The novel mycobacterium tuberculosis (MTB) latency-associated antigens Rv1733c and synthetic long peptides derived from Rv1733c (Rv1733c SLP) were used based on virulence factors early secreting antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10).

Fifty-seven ATB cases, including 20 pathogen-confirmed ATB and 37 clinically diagnosed ATB, and 36 LTBI cases, were enrolled between January and December 2017. FluoroSpot assay was used to detect the interferon γ (IFN-γ) and interleukin 2 (IL-2) secreted by the specific T cells after being stimulated with MTB virulence factors ESAT-6 and CFP-10, MTB latency-associated antigens Rv1733c and Rv1733c SLP. The receiver operating characteristic (ROC) curve was used to define the best cutoff value of latency-associated antigens in the use of differentiating ATB and LTBI. The sensitivity, specificity, predictive value, and likelihood ratio of ESAT-6 and CFP-10-FluoroSpot combined with latency-associated antigen in the differential diagnosis of ATB and LTBI were also calculated.

Following the stimulation with Rv1733c and Rv1733c SLP, the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP had the largest area under the ROC curve, which was 0.766. With a cutoff value of 1 (spot-forming cells [SFCs]/2.5 × 10⁵ peripheral blood mononuclear cells) for frequency, the sensitivity and specificity of distinguishing ATB from LTBI were 72.2% and 73.7%, respectively. ESAT-6 and CFP-10-FluoroSpot detected the frequency and proportion of single IFN-γ-secreting T cells; the sensitivity and specificity of distinguishing ATB from LTBI were 82.5% and 66.7%, respectively. Combined with the frequency of single IL-2-secreting T cells stimulated by Rv1733c SLP on the basis of ESAT-6 and CFP-10-FluoroSpot, the sensitivity and specificity increased to 84.2% and 83.3%, respectively.

Rv1733c SLP, combined with ESAT-6 and CFP-10, might be used as a candidate antigen for T cell-based tuberculosis diagnostic tests to differentiate ATB from LTBI.

Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).

A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan-Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.

In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer-Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.

A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.

As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches.

In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months’ management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months.

A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96.

The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management.

ClinicalTrials.gov, NCT03264638.

全球健康意识提高的趋势导致吸烟减少，这有助于改善肺癌的控制和早期发现。^[1]此外，诊断技术的发展增强了对以多个癌性病变为特征的多灶性肺癌的检测。多灶性肺癌根据病变类型可分为多原发肺癌（MPLC）和肺转移相关肺癌肺内转移（IM）。

肺癌是世界范围内癌症相关死亡的主要原因，并且肺癌的发病率和死亡率在过去几十年中增加。成像技术在提供明确诊断方面受到限制，这需要组织样本用于病理学评估。腺癌占所有肺癌的40%，往往发生在肺的外周，^[1]使它们适合于超声引导下的经皮活检进行病理诊断。周围型肺癌通常靠近胸膜，使超声能够清楚地显示病变的内部结构、血供以及与周围组织的关系。

骨关节炎（OA）是一种使人衰弱的疾病，治疗选择有限。^[1]自噬是对抗软骨退化的重要保护机制，并受哺乳动物雷帕霉素靶标（mTOR）的负调节。^[2]在先前的研究中，雷公藤红素可以促进各种细胞类型的自噬，并具有治疗OA的前景。^[3]然而，雷公藤红素对OA自噬的作用和潜在机制仍不清楚。

致编辑：2019冠状病毒病（COVID-19）的临床谱似乎很广，从无症状到伴有呼吸衰竭、多器官衰竭甚至死亡的严重进行性肺炎。在这里，我们调查了一名死于重症新冠肺炎的患者的临床和病理特征。我们的发现将有助于更深入地了解新冠肺炎的发病机制和进展，并改善对抗该疾病的临床策略。

致编辑：2型糖尿病（T2D）在全球范围内的患病率不断上升，给医疗保健系统带来了巨大的负担。^[1]支链氨基酸（BCAAs，包括亮氨酸、异亮氨酸和缬氨酸）是一组重要的必需氨基酸，是重要的营养信号，对蛋白质合成、葡萄糖稳态和营养敏感信号通路具有重要影响。血浆BCAA可以预测T2D的发展，而膳食BCAA对T2D风险的研究显示了相互矛盾的结果。^[2]大多数关于膳食支链氨基酸的研究使用了单一或有限数量的测量，忽略了膳食支链氨基酸水平在一生中的动态变化及其与糖尿病发展的相关性。随着时间的推移，使用多种膳食BCAA测量的生命过程方法可能会为膳食BCAA轨迹及其与T2D风险的关系提供新的线索。因此，在当前的研究中，我们首先使用潜在类别混合模型（LCMM）来表征中国纵向数据中18年来的BCAA摄入轨迹，并在调整潜在混杂因素后调查BCAA摄入轨迹与T2D风险及其生物标志物的相关性。

致编辑：由于生殖老龄化导致的女性不孕已成为人口中的一个突出问题。有证据表明，氧化应激是生殖衰老的主要机制之一。^[1,2]尽管女性生殖衰老涉及下丘脑-垂体-卵巢（HPO）轴的逐渐变化，但先前的研究支持下丘脑的关键参与。^[3,4]在我们最近的数据集中，表明雌激素诱导的氧化应激导致下丘脑星形胶质细胞的衰老，这早于生殖功能障碍。^[3]越来越多的证据表明，抗氧化剂可能通过减少对卵巢的氧化损伤来延缓生殖衰老。^[1,2]然而，抗氧化剂对下丘脑的影响尚未见报道。虾青素（AST），3，3^＇-二羟基-β-胡萝卜素-4, 4^＇-二酮是一种叶黄素类胡萝卜素，主要存在于海洋动物如鲑鱼、鳟鱼、龙虾和虾中。人参是中药中的补药。人参皂苷Rg1是一类甾体糖苷，是人参中产生这些作用的主要活性抗衰老成分。值得注意的是，这两种抗氧化剂可以自由穿过血脑屏障。在这项研究中，我们评估了这两种天然化合物在保护雌性小鼠免受生殖衰老方面对下丘脑和卵巢的影响。

致编辑糖尿病足溃疡(DFU)是糖尿病(DM)患者发病的重要原因。糖尿病患者足部溃疡的患病率为4%至10%，终生发病率估计在19%至34%之间。^[1]DFU已经成为患者和医疗保健服务系统的巨大负担。然而，其机制尚未完全了解，DFU仍然难以愈合。

致编辑：门静脉癌栓（PVTT）在诊断时存在于10%至40%的肝细胞癌（HCC）患者中，对预后有深远的不利影响。^[1]索拉非尼被推荐作为晚期HCC患者（包括PVTT患者）的一线治疗。然而，其功效适中。^[1,2]据报道，经动脉化疗栓塞（TACE）和索拉非尼（TACE-S）联合治疗可改善预后。^[1,3]但遗憾的是，其控制PVTT的疗效仍然有限，客观缓解率（ORR）仅为9.7%。^[3]先前的研究表明，碘-125（¹²⁵I)靶向PVTT的seed近距离放射治疗可以导致肿瘤血栓的显著减少，并发症很少。^[4,5]我们假设TACE-S联合¹²⁵I种子近距离放射治疗（TACE-S-I）可改善PVTT的控制并带来更大的生存获益。因此，我们进行了这项研究，以评估TACE-S-I与TACE-S相比在伴有PVTT的HCC患者中的疗效和安全性。

致编辑：抗血栓治疗对于预防经皮冠状动脉介入治疗（PCI）期间和之后的不良缺血事件至关重要。PCI期间的抗凝最常见的是肝素或比伐卢定。比伐卢定不激活血小板，不与血浆蛋白结合，具有线性药代动力学，半衰期较短，为25分钟。^[1,2,3]这些特点表明，比伐卢定可能是PCI的理想抗凝药物。先前关于接受初次PCI的急性心肌梗死（AMI）患者的试验表明，基于比伐卢定的抗凝策略降低了大出血的风险，但与基于肝素的策略相比，它与急性支架内血栓形成（ST）的风险增加相关。^[4]认为比伐卢定半衰期短，血小板P2Y起效延迟₁₂AMI患者的受体抑制剂导致了初次PCI后抗血栓治疗的空白期。^[5]急性心肌梗死初次经皮冠状动脉介入治疗中比伐卢定与肝素联合或不联合替罗非班的比较：BRIGHT随机临床试验，^[5]PCI后使用大剂量输注比伐卢定3~4 h，结果显示，与肝素或肝素联合血小板糖蛋白IIb/IIIa受体拮抗剂（GPI）相比，比伐卢定不增加急性ST，减少净不良临床事件（NACE）的发生。然而，对于选择择期PCI的冠心病（CHD）患者，仍无明确证据表明术后输注比伐卢定3~4 h的益处。因此，我们的研究验证了在择期PCI期间，与肝素相比，术后不输注比伐卢定的疗效和安全性。

致编辑：肺段切除术是治愈早期肺癌的有效手术方法。精确设计的肺段切除术能最大限度地保留肺功能，术后生存率相当。但仍存在手术经验、解剖熟悉程度、节段间平面识别等因素，影响节段切除术的应用。

致编辑：发热检测对于高传染性发热性疾病的筛查和控制至关重要。腋窝或直肠温度虽然被认为是临床上发热检测的金标准，^[1]对于大规模筛查是不切实际的。需要具有高灵敏度和准确性的快速、经济、非接触式温度测量工具。非接触式红外测温仪（NCIT）是我国公共场所2019冠状病毒病筛查最常用的工具之一，因为发热是一种典型的早期表现。NCIT传感器和皮肤表面之间的距离可能对读数有显著影响。^[2]此外，室外温度显著低于室温的事实可能导致较低的读数，从而导致假阴性结果。以前，在儿科人群中显示，如果在皮肤适应室内温度之前进行测量，可能会发生误导性的温度读数。^[3]在这项研究中，我们旨在评估温度计放置距离和暴露于寒冷的室外环境对使用NCIT测量温度的影响。

致编辑：心脏骤停（CA）是全球住院患者发病率和死亡率的主要原因，总生存率较低。在恢复自主循环（ROSC）后，CA和全身缺血/再灌注损伤患者可表现为脓毒症样综合征和增加感染风险的免疫紊乱。CD4⁺T淋巴细胞在器官缺血再灌注损伤中起重要作用。辅助性T（Th）1型和2型细胞是CD4的经典亚群⁺T细胞。对它们在感染性和免疫相关炎症性疾病中的功能的广泛研究表明，这两个亚群都参与宿主防御和直接免疫反应。来自CA/心肺复苏猪模型和患者的数据揭示了Th1/Th2细胞比率的失衡。^[1]因此，Th1和Th2细胞对于理解CA患者ROSC后免疫功能障碍是重要的。

致编辑：在没有相容供体的情况下，脐带血移植（UCBT）可作为治疗B细胞急性淋巴细胞白血病（ALL）患者的替代选择。然而，疾病复发提出了一个困难的挑战。嵌合抗原受体（CAR）-T细胞疗法是治疗复发/难治性ALL患者的一种有前途的方法。在移植后输注CAR-T细胞的深入研究中，很少有人关注在UCBT后复发后接受CAR-T治疗的患者。在这里，我们报告了10例复发性急性B淋巴细胞白血病（B-ALL）儿童和年轻人在UCBT后给予CD19 CAR-T细胞的应答率、毒性和生存率。