Volume 136 · Issue 02 · 2023

Adoptive therapeutic immune cells, such as chimeric antigen receptor (CAR)-T cells and natural killer cells, have established a new generation of precision medicine based on which dramatic breakthroughs have been achieved in intractable lymphoma treatments. Currently, well-explored approaches focus on autologous cells due to their low immunogenicity, but they are highly restricted by the high costs, time consumption of processing, and the insufficiency of primary cells in some patients. Induced pluripotent stem cells (iPSCs) are cell sources that can theoretically produce indefinite well-differentiated immune cells. Based on the above facts, it may be reasonable to combine the iPSC technology and the CAR design to produce a series of highly controllable and economical "live" drugs. Manufacturing hypoimmunogenic iPSCs by inactivation or over-expression at the genetic level and then arming the derived cells with CAR have emerged as a form of "off-the-shelf" strategy to eliminate tumor cells efficiently and safely in a broader range of patients. This review describes the reasonability, feasibility, superiority, and drawbacks of such approaches, summarizes the current practices and relevant research progress, and provides insights into the possible new paths for personalized cell-based therapies.

三尖瓣反流（TR）是一种经常遇到但治疗不足的心脏瓣膜病变。与左侧瓣膜疾病不同，据估计只有5%的显著TR患者接受了手术治疗，其中86%的患者与其他主要手术联合治疗。^[1]这种未满足的需求部分是由于缺乏关于受益于手术的严重TR死亡率降低的前瞻性证据，以及历史观点，即一旦左心问题得到纠正，功能性TR（是绝大多数TR的病因）将得到改善。然而，未经治疗的严重TR表现出各种症状和不良预后，包括早期和晚期死亡率增加和生活质量受损。^[2]随着基于导管的瓣膜治疗的快速发展，已经为曾经被遗忘的三尖瓣提供了侵入性较小的治疗选择，进一步扩大了TR干预决策的复杂性。

Evidence on the relations of the American Heart Association’s ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps.

A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis.

During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed.

ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

Long-term remote ischemic conditioning (RIC) has been proven to be beneficial in multiple diseases, such as cerebral and cardiovascular diseases. However, the hyperacute and acute effects of a single RIC stimulus are still not clear. Quantitative proteomic analyses of plasma proteins following RIC application have been conducted in preclinical and clinical studies but exhibit high heterogeneity in results due to wide variations in experimental setups and sampling procedures. Hence, this study aimed to explore the immediate effects of RIC on plasma proteome in healthy young adults to exclude confounding factors of disease entity, such as medications and gender.

Young healthy male participants were enrolled after a systematic physical examination and 6-month lifestyle observation. Individual RIC sessions included five cycles of alternative ischemia and reperfusion, each lasting for 5 min in bilateral forearms. Blood samples were collected at baseline, 5 min after RIC, and 2 h after RIC, and then samples were processed for proteomic analysis using liquid chromatography-tandem mass spectrometry method.

Proteins related to lipid metabolism (e.g., Apolipoprotein F), coagulation factors (hepatocyte growth factor activator preproprotein), members of complement cascades (mannan-binding lectin serine protease 1 isoform 2 precursor), and inflammatory responses (carboxypeptidase N catalytic chain precursor) were differentially altered at their serum levels following the RIC intervention. The most enriched pathways were protein glycosylation and complement/coagulation cascades.

One-time RIC stimulus may induce instant cellular responses like anti-inflammation, coagulation, and fibrinolysis balancing, and lipid metabolism regulation which are protective in different perspectives. Protective effects of single RIC in hyperacute and acute phases may be exploited in clinical emergency settings due to apparently beneficial alterations in plasma proteome profile. Furthermore, the beneficial effects of long-term (repeated) RIC interventions in preventing chronic cardiovascular diseases among general populations can also be expected based on our study findings.

Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders.

This was a retrospective study performed at the Institute of Health Management, Chinese People’s Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test.

The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs. 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs. 9.44% [1692/17,926], 95% CI 8.94-9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs. 1.85% [332], 95% CI 1.61-2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs. 0.59% [105], 95% CI 0.47-0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]).

The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.

To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer’s ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution.

This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS).

During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups.

Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.

Juvenile amyotrophic lateral sclerosis (JALS) is an uncommon form of amyotrophic lateral sclerosis whose age at onset (AAO) is defined as prior to 25 years. FUS mutations are the most common cause of JALS. SPTLC1 was recently identified as a disease-causative gene for JALS, which has rarely been reported in Asian populations. Little is known regarding the difference in clinical features between JALS patients carrying FUS and SPTLC1 mutations. This study aimed to screen mutations in JALS patients and to compare the clinical features between JALS patients with FUS and SPTLC1 mutations.

Sixteen JALS patients were enrolled, including three newly recruited patients between July 2015 and August 2018 from the Second Affiliated Hospital, Zhejiang University School of Medicine. Mutations were screened by whole-exome sequencing. In addition, clinical features such as AAO, onset site and disease duration were extracted and compared between JALS patients carrying FUS and SPTLC1 mutations through a literature review.

A novel and de novo SPTLC1 mutation (c.58G>A, p.A20T) was identified in a sporadic patient. Among 16 JALS patients, 7/16 carried FUS mutations and 5/16 carried respective SPTLC1, SETX, NEFH, DCTN1, and TARDBP mutations. Compared with FUS mutation patients, those with SPTLC1 mutations had an earlier AAO (7.9 ± 4.6 years vs. 18.1 ± 3.9 years, P < 0.01), much longer disease duration (512.0 [416.7-607.3] months vs. 33.4 [21.6-45.1] months, P < 0.01), and no onset of bulbar.

Our findings expand the genetic and phenotypic spectrum of JALS and help to better understand the genotype-phenotype correlation of JALS.

Breast cancer patients who are positive for hormone receptor typically exhibit a favorable prognosis. It is controversial whether chemotherapy is necessary for them after surgery. Our study aimed to establish a multigene model to predict the relapse of hormone receptor-positive early-stage Chinese breast cancer after surgery and direct individualized application of chemotherapy in breast cancer patients after surgery.

In this study, differentially expressed genes (DEGs) were identified between relapse and nonrelapse breast cancer groups based on RNA sequencing. Gene set enrichment analysis (GSEA) was performed to identify potential relapse-relevant pathways. CIBERSORT and Microenvironment Cell Populations-counter algorithms were used to analyze immune infiltration. The least absolute shrinkage and selection operator (LASSO) regression, log-rank tests, and multiple Cox regression were performed to identify prognostic signatures. A predictive model was developed and validated based on Kaplan-Meier analysis, receiver operating characteristic curve (ROC).

A total of 234 out of 487 patients were enrolled in this study, and 1588 DEGs were identified between the relapse and nonrelapse groups. GSEA results showed that immune-related pathways were enriched in the nonrelapse group, whereas cell cycle- and metabolism-relevant pathways were enriched in the relapse group. A predictive model was developed using three genes (CKMT1B, SMR3B, and OR11M1P) generated from the LASSO regression. The model stratified breast cancer patients into high- and low-risk subgroups with significantly different prognostic statuses, and our model was independent of other clinical factors. Time-dependent ROC showed high predictive performance of the model.

A multigene model was established from RNA-sequencing data to direct risk classification and predict relapse of hormone receptor-positive breast cancer in Chinese patients. Utilization of the model could provide individualized evaluation of chemotherapy after surgery for breast cancer patients.

Imatinib mesylate (IM) resistance is an emerging problem for chronic myeloid leukemia (CML). Previous studies found that connexin 43 (Cx43) deficiency in the hematopoietic microenvironment (HM) protects minimal residual disease (MRD), but the mechanism remains unknown.

Immunohistochemistry assays were employed to compare the expression of Cx43 and hypoxia-inducible factor 1α (HIF-1α) in bone marrow (BM) biopsies of CML patients and healthy donors. A coculture system of K562 cells and several Cx43-modified bone marrow stromal cells (BMSCs) was established under IM treatment. Proliferation, cell cycle, apoptosis, and other indicators of K562 cells in different groups were detected to investigate the function and possible mechanism of Cx43. We assessed the Ca²⁺-related pathway by Western blotting. Tumor-bearing models were also established to validate the causal role of Cx43 in reversing IM resistance.

Low levels of Cx43 in BMs were observed in CML patients, and Cx43 expression was negatively correlated with HIF-1α. We also observed that K562 cells cocultured with BMSCs transfected with adenovirus-short hairpin RNA of Cx43 (BMSCs-shCx43) had a lower apoptosis rate and that their cell cycle was blocked in G0/G1 phase, while the result was the opposite in the Cx43-overexpression setting. Cx43 mediates gap junction intercellular communication (GJIC) through direct contact, and Ca²⁺ is the key factor mediating the downstream apoptotic pathway. In animal experiments, mice bearing K562, and BMSCs-Cx43 had the smallest tumor volume and spleen, which was consistent with the in vitro experiments.

Cx43 deficiency exists in CML patients, promoting the generation of MRD and inducing drug resistance. Enhancing Cx43 expression and GJIC function in the HM may be a novel strategy to reverse drug resistance and promote IM efficacy.

Vaccination against coronavirus disease 2019 (COVID-19) has become the primary approach in the fight against the spread of COVID-19. Studies have shown that vaccination against COVID-19 has adverse effects, particularly on human reproductive health, despite the fact that vaccination rates are still on the rise. However, few studies have reported whether vaccination affects the outcome of in vitro fertilization-embryo transfer (IVF-ET) or not. In this study, we compared the outcome of IVF-ET and the development of follicles and embryos between vaccinated and unvaccinated groups.

A single-center retrospective cohort study of 10,541 in vitro fertilization (IVF) cycles was conducted from June 2020 to August 2021. 835 IVF cycles with a history of vaccination against COVID-19 and 1670 IVF cycles that served as negative controls were selected and analyzed utilizing the Matchlt package of R software (http://www.R-project.org/) and the nearest neighbor matching algorithm for propensity-matched analysis at a 1:2 ratio.

The number of oocytes collected in the vaccinated group and the unvaccinated group were 8.00 (0, 40.00) and 9.00 (0, 77.00) (P = 0.073) and the good-quality embryo rates of the two groups were 0.56±0.32 and 0.56±0.31 averagely (P = 0.964). Clinical pregnancy rates for the vaccinated group and unvaccinated group were 42.4% (155/366) and 40.2% (328/816) (P= 0.486) and biochemical pregnancy rates were 7.1% (26/366) and 8.7% (71/816) (P= 0.355). Two other factors were analyzed in this study; vaccination among different genders and different types (inactivated vaccine or recombinant adenovirus vaccine) showed no statistically significant effect on the above outcomes.

In our findings, vaccination against COVID-19 showed no statistically significant effect on the outcomes of IVF-ET and the development of follicles and embryos, nor did the gender of the vaccinated person or the formulation of vaccines show significant effects.

The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration.

This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities.

A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found (P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation.

Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.

致编辑：结肠直肠癌（CRC）是全球第三大常见恶性肿瘤和第二大癌症死亡原因。^[1]结直肠腺瘤（CRA）是结直肠结肠癌的前驱病变。CRA的及时诊断和治疗对于预防CRC的发生和改善预后具有重要意义。考虑到与侵入性手术相关的风险和结肠镜检查的高成本，迫切需要鉴定结肠直肠肿瘤（CRNs）的可靠非侵入性标志物。

致编辑：心脏骤停（CA）是全球成人死亡的主要原因之一。根据美国心脏协会的最新报告，^[1]急诊医疗服务评估的成人院外心脏骤停（OHCA）和院内心脏骤停（IHCA）的发生率分别为140.7/100,000和10.2/1000。

致编辑：重症监护病房（ICU）早期肺康复（PR）的目的是降低ICU后综合征的发生率，增加无呼吸机天数，重建和改善功能能力，改善健康相关的生活质量，促进心理健康，并增强对日常生活的参与。ICU中的PR非常有效，在运动耐力、功能能力和健康相关生活质量下降的患者的康复中发挥着重要作用。中国以外的几项调查评估了ICU早期康复的实施情况，^[1]但来自中国的数据很少。本研究旨在调查具有肺部和重症医学（PCCM）标准化认证的二级和三级医院对早期PR的认识和实施情况。PCCM的工作人员被招募来填写一份自行设计的问卷。我们将早期PR定义为入住ICU后5天内的PR。

致编辑：患有严重持续性哮喘的患者经历更高的发病率和更多的生活质量损害，尽管卫生保健资源的使用更高，并且使用现有的哮喘治疗方法，如吸入性皮质类固醇和β-激动剂，有时口服皮质类固醇(OCS)治疗。2型(T2)高哮喘已被鉴定为对靶向T2生物疗法如抗IgE、抗白细胞介素(IL)5或抗IL5R α和抗IL4R α单克隆抗体有反应的表型，其目前在欧洲和北美可获得，并且目前正在世界其他地区引入。^[1]虽然中国4.2%的成人哮喘患病率没有西方国家高，但根据欧洲呼吸学会和美国胸科学会（ERS/ATS）定义定义的重度哮喘正在得到认可。^[2]452名重度哮喘患者的中国呼吸系统疾病结局预测生物标志物（C-BIOPRED）队列描述了这些患者的特征，这些患者与中国以外队列中报道的患者具有相似的特征。^[3]为了了解T2靶向生物治疗在中国的潜在影响，我们根据血液嗜酸性粒细胞计数(BEC)≥150/μ L或≥300/μ L和/或FeNO≥20 ppb的标准确定了T2高哮喘的患病率（https://ginasthma.org/wp-content/uploads/2021/08/SA-Pocket-guide-v3.0-SCREEN-WMS.pdf）。数据以平均值（标准偏差）或受试者例数（占总数的%）表示。P值代表使用Kruskal-Wallis检验对连续变量或Fisher精确检验对分类变量进行的四组之间的比较。P<0.05被认为具有统计学意义。在55.8%（BEC≥300 μ L）至75.7%（FeNO≥20 ppb）的重度哮喘患者中，T2高水平存在，而BEC≥150/μ L和FeNO≥20 ppb或BEC≥300/μ L和FeNO≥20 ppb的组合分别为55.9%和38.7%【补充图1，http：//links.lww.com/CM9/B402】。在246例在一年时重新评估的重度哮喘患者中，相似百分比的患者保持T2高，但T2高或T2低中有10%至15%改变为交替类别。痰嗜酸性粒细胞计数（SEC）是T2高哮喘的较好标志物，^[4]并且使用≥2%的SEC，^[5]75%的患者被归类为T2高。

致编辑：非酒精性脂肪性肝病(NAFLD)成为全球流行病，目前估计患病率为24%。NAFLD的范围包括单纯性脂肪变性和非酒精性脂肪性肝炎。叶酸，也叫维生素B₉是化合物家族的总称，包括未取代的四氢叶酸(THF)、5-甲基四氢叶酸(5-MTHF)、5-甲酰基四氢叶酸(5-FTHF)、5，10-亚甲基-THF(5，10-CH)₂-THF)和未代谢的叶酸(UMFA)。叶酸通常作为膳食补充剂添加到产品中。叶酸在单碳代谢中起关键作用，单碳代谢涉及生物合成过程的一个碳单元的活化和转移，包括嘌呤和胸苷合成以及同型半胱氨酸再甲基化为甲硫氨酸。NAFLD与代谢紊乱密切相关，而叶酸和NAFLD之间的关联尚未很好地确定。我们使用了参加2011-2016年美国国家健康和营养检查调查（NHANES）的具有全国代表性的美国成年人样本的数据，根据血清和饮食方面探索叶酸和NAFLD之间的关系。

致编辑：尿动力学是用于描述评估下尿路(LUT)功能和功能障碍的测量的通用术语。^[1]对于大多数LUT障碍，仅使用影像学辅助检查并不能提供特定障碍的有效临床证据。因此，需要一些特定的方法来评估膀胱和尿道的功能。压力-流量研究是定量分析LUT储存和排泄功能的最有效方法。^[2]

致编辑：精索静脉曲张（VCs）是指pampiniform丛的静脉扩张。对于有明确手术指征的VCs，主要治疗方法是手术治疗。随着微创技术的发展，近年来显微腹股沟下精索静脉曲张切除术（MSV）的应用逐渐增多，已成为VCs的标准治疗方法。^[1]在我科长期的临床实践中，曾有部分年轻人因特殊行业体检（如军队体检）而需要手术治疗VCs。他们希望切口美观、无缝且隐蔽。带着对美容的期待，我们在手术切口的选择上做了一些改进。使用疤痕美容评估和评级（SCAR）量表，^[2]我们在这项研究中全面评估了接受改良MSV（IMSV）和MSV患者的美容效果。

致编辑：矿物质补充剂通常被认为是对促进整体健康状况和长寿至关重要的化合物。在许多观察性研究中，全身矿物质状况已被证明与预期寿命相关，而矿物质状况对预期寿命的因果影响尚未得到系统阐明。在这项研究中，我们使用双样本孟德尔随机化（MR）分析，通过大规模全基因组关联研究（GWAS）总结数据调查了六种矿物质（钙、镁、铁、铜、锌和硒）对预期寿命的因果影响。

致编辑：骨关节炎（OA）是最常见的年龄相关性疾病之一，以滑膜炎症和软骨进行性退化为特征。据报道，2017年全球有三分之一的65岁老人和3.03亿人受到OA的影响。^[1,2]尽管发表了大量关于OA的研究，但其发病机制仍不清楚且有争议。软骨退变被认为是导致疾病进展的关键病理因素。然而，越来越多的研究表明，滑膜炎症可能是OA发展的主要驱动力。王等人^[3]提示滑膜炎症可通过激活toll样受体/髓样分化因子88/核因子-κ B（TLRs/MyD88/NF-κ B）信号通路加速软骨退变。成纤维细胞样滑膜细胞（FLSs）可以获得侵袭性增殖表型，驱动软骨和骨破坏。无论哪种驱动因素在OA中起主导作用，FLSs和软骨细胞之间的通讯都起着至关重要的作用。外泌体(EX)是直径约为50-150nm和脂质双层膜结构的囊泡。^[4]EXs含有许多生物活性物质，如非编码RNA（ncRNA）、蛋白质和信使RNA（mRNA），它们在OA细胞和关节内微环境的串扰中起着重要作用。微小RNA(miRNA)是一组长度约为22个核苷酸的小ncRNA，其通过在转录后水平调节基因表达在人类疾病的表观遗传学中发挥关键作用。然而，很少有研究检测滑液（SF）衍生的EXs中差异表达的miRNAs（DEM）。

致编辑最近，我们回顾了自1988年以来几乎所有报道含有六个序列无关管家基因Surfeit 1至Surfeit 6和其中一个家族成员surfeit 4的Surfeit基因座的文章（冲浪4）基因让我们感兴趣。在本文中，我们将总结冲浪4基因，以及其在多种疾病和癌症中可能的生理功能和发病机制，期望探讨其临床应用价值。