Volume 136 · Issue 01 · 2023

严重急性呼吸系统综合症冠状病毒2（新型冠状病毒）是一种新病毒，仍然充满惊喜。截至2022年9月，已有超过6.05亿例冠状病毒疾病2019（新冠肺炎）确诊病例，包括向世界卫生组织（世卫组织）报告的650万例死亡。^[1]新型冠状病毒病毒是一种不好的病毒，它经常产生新的变种，逃避自然免疫，有时也逃避疫苗[图1].^[2]

Data on the immunogenicity and safety of heterologous immunization schedules are inconsistent. This study aimed to evaluate the immunogenicity and safety of homologous and heterologous immunization schedules.

Multiple databases with relevant studies were searched with an end date of October 31, 2021, and a website including a series of Coronavirus disease 2019 studies was examined for studies before March 31, 2022. Randomized controlled trials (RCTs) that compared different heterologous and homologous regimens among adults that reported immunogenicity and safety outcomes were reviewed. Primary outcomes included neutralizing antibodies against the original strain and serious adverse events (SAEs). A network meta-analysis (NMA) was conducted using a random-effects model.

In all, 11 RCTs were included in the systematic review, and nine were ultimately included in the NMA. Among participants who received two doses of CoronaVac, another dose of mRNA or a non-replicating viral vector vaccine resulted in a significantly higher level of neutralizing antibody than a third CoronaVac 600 sino unit (SU); a dose of BNT162b2 induced the highest geometric mean ratio (GMR) of 15.24, 95% confidence interval [CI]: 9.53-24.39. Following one dose of BNT162b2 vaccination, a dose of mRNA-1273 generated a significantly higher level of neutralizing antibody than BNT162b2 alone (GMR = 1.32; 95% CI: 1.06-1.64), NVX-CoV2373 (GMR = 1.60; 95% CI: 1.16-2.21), or ChAdOx1 (GMR = 1.80; 95% CI: 1.25-2.59). Following one dose of ChAdOx1, a dose of mRNA-1273 was also more effective for improving antibody levels than ChAdOx1 (GMR = 11.09; 95% CI: 8.36-14.71) or NVX-CoV2373 (GMR= 2.87; 95% CI: 1.08-3.91). No significant difference in the risk for SAEs was found in any comparisons.

Relative to vaccination with two doses of CoronaVac, a dose of BNT162b2 as a booster substantially enhances immunogenicity reactions and has a relatively acceptable risk for SAEs relative to other vaccines. For primary vaccination, schedules including mRNA vaccines induce a greater immune response. However, the comparatively higher risk for local and systemic adverse events introduced by mRNA vaccines should be noted.

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; No. CRD42021278149.

Whether high cut-off (HCO) membranes are more effective than high-flux (HF) membranes in patients requiring renal replacement therapy (RRT) remains controversial. The aim of this systematic review was to investigate the efficacy of HCO membranes regarding the clearance of inflammation-related mediators, β2-microglobulin and urea; albumin loss; and all-cause mortality in patients requiring RRT.

We searched all relevant studies on PubMed, Embase, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure, with no language or publication year restrictions. Two reviewers independently selected studies and extracted data using a prespecified extraction instrument. Only randomized controlled trials (RCTs) were included. Summary estimates of standardized mean differences (SMDs) or weighted mean differences (WMDs) and risk ratios (RRs) were obtained by fixed-effects or random-effects models. Sensitivity analyses and subgroup analyses were performed to determine the source of heterogeneity.

Nineteen RCTs involving 710 participants were included in this systematic review. Compared with HF membranes, HCO membranes were more effective in reducing the plasma level of interleukin-6 (IL-6) (SMD -0.25, 95% confidence interval (CI)-0.48 to -0.01, P = 0.04, I² = 63.8%); however, no difference was observed in the clearance of tumor necrosis factor-α (TNF-α) (SMD 0.03, 95% CI -0.27 to 0.33, P = 0.84, I² = 4.3%), IL-10 (SMD 0.22, 95% CI -0.12 to 0.55, P = 0.21, I² = 0.0%), or urea (WMD -0.27, 95% CI -2.77 to 2.23, P = 0.83, I² = 19.6%). In addition, a more significant reduction ratio of β₂-microglobulin (WMD 14.8, 95% CI 3.78 to 25.82, P = 0.01, I² = 88.3%) and a more obvious loss of albumin (WMD -0.25, 95% CI -0.35 to-0.16, P < 0.01, I² = 40.8%) could be observed with the treatment of HCO membranes. For all-cause mortality, there was no difference between the two groups (risk ratio [RR] 1.10, 95% CI 0.87 to 1.40, P = 0.43, I² = 0.0%).

Compared with HF membranes, HCO membranes might have additional benefits on the clearance of IL-6 and β2-microglobulin but not on TNF-α, IL-10, and urea. Albumin loss is more serious with the treatment of HCO membranes. There was no difference in all-cause mortality between HCO and HF membranes. Further larger high-quality RCTs are needed to strengthen the effects of HCO membranes.

Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.

We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients’ satisfaction and side effects.

Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I² = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I² = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I² = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I²= 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I² = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P= 0.21; I²= 93%).

Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

胃肠道(GI)是一个独特的器官，它有自己的神经系统，称为肠神经系统(ENS)，也称为“小大脑”。ENS有2亿到6亿个神经元，可以在没有大脑输入的情况下独立运作。它通过由交感神经和副交感神经系统组成的自主神经系统与大脑交流。副交感神经系统由迷走神经和骶神经组成。

Maturity-onset diabetes of the young (MODY) is the most common monogenic diabetes. The aim of this study was to assess the prevalence of MODY in phenotypic type 2 diabetes (T2DM) among Chinese young adults.

From April 2015 to October 2017, this cross-sectional study involved 2429 consecutive patients from 46 hospitals in China, newly diagnosed between 15 years and 45 years, with T2DM phenotype and negative for standardized glutamic acid decarboxylase antibody at the core laboratory. Sequencing using a custom monogenic diabetes gene panel was performed, and variants of 14 MODY genes were interpreted as per current guidelines.

The survey determined 18 patients having genetic variants causing MODY (6 HNF1A, 5 GCK, 3 HNF4A, 2 INS, 1 PDX1, and 1 PAX4). The prevalence of MODY was 0.74% (95% confidence interval [CI]: 0.40-1.08%). The clinical characteristics of MODY patients were not specific, 72.2% (13/18) of them were diagnosed after 35 years, 47.1% (8/17) had metabolic syndrome, and only 38.9% (7/18) had a family history of diabetes. No significant difference in manifestations except for hemoglobin A1c levels was found between MODY and non-MODY patients.

The prevalence of MODY in young adults with phenotypic T2DM was 0.74%, among which HNF1A-, GCK-, and HNF4A-MODY were the most common subtypes. Clinical features played a limited role in the recognition of MODY.

Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.

This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO₂) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO₂ was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO₂ of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression.The secondary outcome was the correlation between SmtO₂ in the forearm and that in the thigh.

We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO₂ < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.

Muscular tissue desaturation, defined as a baseline SmtO₂ < 80% in the forearm, may be associated with an increased risk of POP.

No. ChiCTR-ROC-17012627.

Synovectomy has been introduced into total knee arthroplasty (TKA) with the aim of relieving pain and inflammation of the synovium. However, there are no long-term, comparative data to evaluate the effect of synovectomy in TKA. This study was aimed at assessing pain, function, and complications in patients undergoing synovectomy during TKA for osteoarthritis (OA) at long-term follow-up.

This was a prospective randomized controlled trial of 42 consecutive patients who underwent staged bilateral TKA. Patients undergoing the first-side TKA were allocated to receive TKA with or without synovectomy followed by a 3-month washout period and crossover to the other strategy for the opposite-side TKA. The overall efficacy of both strategies was evaluated by determination of blood loss, the Knee Society score (KSS), and knee inflammation conditions during a 3-month postoperative period. The postoperative pain, range of motion (ROM), and complications were sequentially evaluated to compare the two groups until 10 years after surgery.

At the 10-year follow-up, both groups had a similarly significantly improved ROM (114.88 ± 9.84° vs. 114.02 ± 9.43°, t = 0.221, P = 0.815) and pain relief with no differences between the two groups (1.0 [1.0] vs. 1.0 [1.5], U = 789.500, P = 0.613). Similar changes in total blood loss, KSS, and knee inflammation were found in both groups during 3 months postoperatively (P > 0.05). Additionally, there was no significant difference regarding complications and satisfaction between the two groups (P > 0.05).

Synovectomy in conjunction with TKA for primary OA does not seem to provide any benefit regarding postoperative pain, ROM, and satisfaction during a 10-year follow-up. In addition, it may not result in more blood loss and increased incidence of long-term complications. Based on our long-term findings, it should not be performed routinely.

Chinese Clinical Trial Registry, ChiCTR-INR-16008245; https://www.chictr.org.cn/showproj.aspx?proj= 13334.

Preliminary studies have indicated that Shexiang Baoxin Pill (MUSKARDIA) has a coronary artery dilation effect and increases the coronary blood flow, relieving the symptoms of angina. This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease (CAD) and diabetes mellitus (DM).

This was a subgroup analysis of a multicenter, randomized, placebo-controlled phase IV trial. CAD patients with a medical history of DM or baseline fasting blood glucose (FBG) ≥7.0 mmol/L were grouped according to the treatment (standard therapy plus MUSKARDIA or placebo). The primary outcome was major adverse cardiovascular events (MACEs), which was the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary outcome was the composite outcome of all-cause death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina or heart failure, and coronary angioplasty.

MACEs occurred in 2.6% (9/340) and 4.8% (18/376) of patients in the MUSKARDIA and placebo groups, respectively (P = 0.192). Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo (15.3% [52/340] vs. 22.6% [85/376], P = 0.017). Risk of MACEs (hazard ratio [HR] = 0.69, 95% confidence interval [CI]: 0.31-1.57) was comparable between two groups. In patients with uncontrolled DM (≥4 measurements of FBG ≥7 mmol/L in five times of follow-up), the risk of secondary outcome was significantly lower with MUSKARDIA (5/83, 6.0%) than with placebo (15/91, 16.5%) (HR= 0.35, 95%CI: 0.13-0.95).

As an add-on to standard therapy, MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM. Furthermore, MUSKARDIA may reduce the frequency of all-cause death, hospitalization, and coronary angioplasty in this population, especially in those with uncontrolled DM.

ChiCTR.org.cn, ChiCTR-TRC-12003513

No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects.

Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported.

A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001).

The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.

细胞遗传学畸变（CAs）是多发性骨髓瘤（MM）风险分层的重要标志物。近年来，MM中异常t（11；14）（q13；q32）的预后意义仍存在争议。此外，关于t（11；14）MM和额外CAs的影响的研究很少。^[1]因此，我们对我们中心收集的相关数据进行了回顾性研究，以进一步分析中国t（11；14）MM患者的特征，并详细阐述其遗传谱的异质性。

致编辑：用于2型糖尿病(T2DM)的基于肠降血糖素的疗法包括胰高血糖素样肽-1受体激动剂(GLP-1 RAs)的肠降血糖素模拟物和二肽基肽酶-4(DPP-4)抑制剂的肠降血糖素增强剂。^[1]由于肠促胰岛素类药物具有良好的降糖效果，且无体重增加或低血糖风险，这些药物越来越多地用于T2DM患者。GLP-1 RAs被认为在控制糖化血红蛋白、空腹血糖和体重方面优于DPP-4抑制剂。^[2]然而，不良事件的发生率，如GLP-1 RAs引起的胃肠道不良反应和头晕，高于DPP-4抑制剂。^[3]与其他抗糖尿病药物不同，已经提出了与基于肠促胰岛素的治疗相关的胃肠癌风险的安全性问题。更好地了解它们作为二线降糖治疗的作用，并全面评估它们的益处和危害，可以为临床实践中的治疗选择提供信息。

致编辑：胸腺恶性肿瘤是指起源于胸腺的一组恶性肿瘤，包括胸腺瘤、胸腺癌、胸腺类癌和其他不常见组织学起源的恶性肿瘤。

致编辑：鉴于前期疾病的高发生率和各种起始原因，危重疾病已成为临床实践中最异质性的群体，这增加了治疗挑战。尽管有不同类型的伤害性“打击”，但这种对各种急性危重状况的反应是相对同质的，最终可能进展为危重疾病。

致编辑：髂静脉压迫综合征（IVCS）是一种有充分记录的解剖异常，其特征是邻近动脉和椎骨压迫髂静脉。根据是否同时存在深静脉血栓形成，IVCS可分为血栓性和非血栓性病变。血管内手术已成为非血栓性IVC的主流治疗方法。^[1]在大多数情况下，球囊扩张不足以治疗非血栓性IVC，因为静脉壁容易反冲。因此，髂静脉病变的支架植入术对于保持静脉腔的扩大是必要的。然而，支架植入术可能会带来支架内血栓形成和再狭窄等副作用。由内膜增生引起的支架内再狭窄（ISR）仍然是动脉疾病支架植入术的主要缺点。然而，关于非血栓性IVC中ISR的发生和预测因素的证据有限。因此，我们进行了这项研究，以确定非血栓性IVC患者ISR的发生率，并探索ISR的潜在预测因素。

致编辑：自2010年以来，癌症一直是全球和中国的主要死亡原因。^[1]随着癌症治疗的进步，癌症的存活率提高；同时，许多癌症患者和癌症幸存者由于强烈的抗癌治疗而患有心血管疾病(CVD)。^[2,3,4]为了预防和治疗由癌症治疗介导的心血管问题，建立了一门名为心脏肿瘤学的新医学学科。尽管心脏肿瘤学领域已经存在了20年，^[5]其在中国的发展仍处于早期阶段。

致编辑：纤维化是由有助于组织或器官重建的复杂细胞和分子反应触发的长期伤口愈合过程。^[1]膀胱纤维化由病理压力如静水压力、拉伸力和流体剪切应力引发。压力增加导致膀胱炎性微环境、平滑肌肥大和纤维化。迄今为止，膀胱纤维化的两个常见病因是机械性梗阻(部分膀胱出口梗阻[pBOO])和慢性膀胱炎。^[2]

致编辑：骨肉瘤（OS）是一种严重危害青少年健康的疾病，是影响儿童和青少年的第八大常见原发性恶性骨肿瘤。OS通常发生在长管状骨的干骺端，由间充质细胞发展而来，占原发性骨肿瘤的20%。约70%~80%的患者为8~9岁，每年发病病例在100~300万人左右。^[1]

致编辑：慢性血栓栓塞性肺动脉高压（CTEPH）是一种慢性进行性疾病，肺动脉压（PAP）升高，最终导致右心衰竭和死亡。球囊肺动脉成形术（BPA）是一种新的有效治疗方法，适用于不适合手术或肺动脉内膜切除术（PEA）后出现复发性或持续性肺动脉高压的CTEPH患者。近年来，国内外各大医学中心都在逐步开发和完善BPA，但总体上缺乏统一的治疗流程和并发症控制策略。

在“丹酚酸B减少白细胞介素-1 β诱导的小鼠结肠炎复发”一文中，发表于第133卷第12期第1436-1444页中华医学杂志,^[1]图3的第三个苏木精和曙红(HE)图像包含与图7的第四个HE图像不正确地相同的图像。作者承认，他们在整理图时把图片放错了地方。错误不影响文章的结果和结论。更新和正确的图3如下所示。作者对由此造成的任何不便深表歉意。