Volume 136 · Issue 10 · 2023

白蛋白是一种65kDa的肝脏合成蛋白，占总血浆蛋白的近50%，并贡献约80%的血管内溶胀压力。白蛋白有助于维持微血管完整性，起抗氧化剂的作用，并转运激素、脂肪酸、胆汁盐、胆红素、电解质(例如钙、镁、铜、锌，等人.)和药物。^[1,2,3]人血清白蛋白（HSA）是一种无菌液体白蛋白产品，通过分级和巴氏杀菌从大量人血浆中获得。HAS的医疗用途可以追溯到大约第二次世界大战时期。^[4]

Tumor chemoprevention and treatment are two approaches aimed at improving the survival of patients with cancers. An ideal anti-tumor drug is that which not only kills tumor cells but also alleviates tumor-causing risk factors, such as precancerous lesions, and prevents tumor recurrence. Chinese herbal monomers are considered to be ideal treatment agents due to their multi-target effects. Astragaloside has been shown to possess tumor chemoprevention, direct anti-tumor, and chemotherapeutic drug sensitization effects. In this paper, we review the effects of astragaloside on tumor prevention and treatment and provide directions for further research.

Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.

Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy," "fluid resuscitation," and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.

A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission (P = 0.02) and the length of hospital stay (P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.

For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD 42022363945.

黑色素瘤占所有恶性皮肤肿瘤的三分之一（约6.8-20.0%）。在全球范围内，黑色素瘤的发病率和死亡率都在增加。^[1]对于早期（I-II）黑色素瘤，扩大切除显示出更好的生存优势。黑色素瘤一旦发生转移，可导致预后不良。^[2]具有较强免疫原性的黑色素瘤是极好的免疫治疗研究对象。^[3]针对黑色素瘤的免疫治疗药物在最近20年发展迅速。这些药物的临床获益是显而易见的，^[4,5]这为大多数黑色素瘤患者提供了更好的治疗选择。在此，我们回顾了目前黑色素瘤免疫治疗的进展。

Ischemic acute kidney injury (AKI) is a common syndrome associated with considerable mortality and healthcare costs. Up to now, the underlying pathogenesis of ischemic AKI remains incompletely understood, and specific strategies for early diagnosis and treatment of ischemic AKI are still lacking. Here, this study aimed to define the transcriptomic landscape of AKI patients through single-cell RNA sequencing (scRNA-seq) analysis in kidneys.

In this study, scRNA-seq technology was applied to kidneys from two ischemic AKI patients, and three human public scRNA-seq datasets were collected as controls. Differentially expressed genes (DEGs) and cell clusters of kidneys were determined. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, as well as the ligand-receptor interaction between cells, were performed. We also validated several DEGs expression in kidneys from human ischemic AKI and ischemia/reperfusion (I/R) injury induced AKI mice through immunohistochemistry staining.

15 distinct cell clusters were determined in kidney from subjects of ischemic AKI and control. The injured proximal tubules (PT) displayed a proapoptotic and proinflammatory phenotype. PT cells of ischemic AKI had up-regulation of novel pro-apoptotic genes including USP47, RASSF4, EBAG9, IER3, SASH1, SEPTIN7, and NUB1, which have not been reported in ischemic AKI previously. Several hub genes were validated in kidneys from human AKI and renal I/R injury mice, respectively. Furthermore, PT highly expressed DEGs enriched in endoplasmic reticulum stress, autophagy, and retinoic acid-inducible gene I (RIG-I) signaling. DEGs overexpressed in other tubular cells were primarily enriched in nucleotide-binding and oligomerization domain (NOD)-like receptor signaling, estrogen signaling, interleukin (IL) -12 signaling, and IL-17 signaling. Overexpressed genes in kidney-resident immune cells including macrophages, natural killer T (NKT) cells, monocytes, and dendritic cells were associated with leukocyte activation, chemotaxis, cell adhesion, and complement activation. In addition, the ligand-receptor interactions analysis revealed prominent communications between macrophages and monocytes with other cells in the process of ischemic AKI.

Together, this study reveals distinct cell-specific transcriptomic atlas of kidney in ischemic AKI patients, altered signaling pathways, and potential cell-cell crosstalk in the development of AKI. These data reveal new insights into the pathogenesis and potential therapeutic strategies in ischemic AKI.

Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.

In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared.

A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers’ interpretation and clinical factor model (P <0.05).

The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.

Right ventricular (RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction (HFpEF). Coronary artery disease (CAD) can contribute to the pathophysiological characteristics of HFpEF. This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.

This prospective study included 250 consecutive acute HFpEF patients with CAD. Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value, based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). The primary endpoint was a composite of all-cause death, recurrent ischemic events, and HF hospitalizations.

TAPSE/PASP ≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling (area under the curve, 0.731; sensitivity, 61.4%; and specificity, 76.6%). Of the 250 patients, 150 and 100 patients could be grouped into the RV-arterial coupling (TAPSE/PASP >0.43) and uncoupling (TAPSE/PASP ≤0.43) groups, respectively. Revascularization strategies were slightly different between groups; the RV-arterial uncoupling group had a lower rate of complete revascularization (37.0% [37/100] vs. 52.7% [79/150], P <0.001) and a higher rate of no revascularization (18.0% [18/100] vs. 4.7% [7/150], P <0.001) compared to the RV-arterial coupling group. The cohort with TAPSE/PASP ≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP >0.43. Multivariate Cox analysis showed TAPSE/PASP ≤0.43 as an independent associated factor for the primary endpoint, all-cause death, and recurrent HF hospitalization (hazard ratios [HR]: 2.21, 95% confidence interval [CI]: 1.44-3.39, P <0.001; HR: 3.32, 95% CI: 1.30-8.47, P = 0.012; and HR: 1.93, 95% CI: 1.10-3.37, P = 0.021, respectively), but not for recurrent ischemic events (HR: 1.48, 95% CI: 0.75-2.90, P = 0.257).

RV-arterial uncoupling, based on TAPSE/PASP, is independently associated with adverse outcomes in acute HFpEF patients with CAD.

LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer.

We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels.

On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs. 1.4% [2/145]).

LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile.

ClinicalTrials.gov, NCT04563936.

Neuroendocrine neoplasms (NENs) are rare tumors characterized by variable biology and delayed diagnosis. However, the nationwide epidemiology of NENs has never been reported in China. We aimed to estimate the incidence and survival statistics of NENs in China, in comparison to those in the United States during the same period.

Based on the data from 246 population-based cancer registries covering 272.5 million people of China, we calculated age-specific incidence on NENs in 2017 and multiplied by corresponding national population to estimate the nationwide incidence in China. The data of 22 population-based cancer registries were used to estimate the trends of NENs incidence from 2000 to 2017 through the Joinpoint regression model. We used the cohort approach to analyze the 5-year age-standardized relative survival by sex, age group, and urban-rural area between 2008 and 2013, based on data from 176 high-quality cancer registries. We used data from the Surveillance, Epidemiology, and End Results (SEER) 18 program to estimate the comparable incidence and survival of NENs in the United States.

The overall age-standardized rate (ASR) of NENs incidence was lower in China (1.14 per 100,000) than in the United States (6.26 per 100,000). The most common primary sites were lungs, pancreas, stomach, and rectum in China. The ASRs of NENs incidence increased by 9.8% and 3.6% per year in China and the United States, respectively. The overall 5-year relative survival in China (36.2%) was lower than in the United States (63.9%). The 5-year relative survival was higher for female patients than male patients, and was higher in urban areas than in rural areas.

The disparities in burden of NENs persist across sex, area, age group, and site in China and the United States. These findings may provide a scientific basis on prevention and control of NENs in the two countries.

Three-dimensional shear wave elastography (3D-SWE) is a promising method in distinguishing benign and malignant thyroid nodules. By combining with conventional method, it may further improve the diagnostic value. The study aimed to assess the diagnostic value of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) combined with 3D-SWE in ACR TI-RADS 4 and 5 thyroid nodules.

All nodules were examined by conventional ultrasonography, ACR TI-RADS classification, and 3D-SWE examination. Conventional ultrasonography was used to observe the location, size, shape, margin, echogenicity, taller-than-wide sign, microcalcification, and blood flow of thyroid nodules, and then ACR TI-RADS classification was performed. The Young’s modulus values (3D-C-Emax, 3D-C-Emean, and elastography standard deviation [3D-C-Esd]) were measured on the reconstructed coronal plane images. According to the receiver operating characteristic (ROC) curve, the best diagnostic efficiency among 3D-C-Emax, 3D-C-Emean, and 3D-C-Esd was selected and the cut-off threshold was calculated. According to the surgical pathology, they were divided into benign group and malignant group. And appropriate statistical methods such as t-test and Mann-Whitney U test were used to compare the difference between the two groups. On this basis, 3D-SWE combined with conventional ACR TI-RADS was reclassified as combined ACR TI-RADS to determine benign or malignant thyroid nodules.

Of the 112 thyroid nodules, 62 were malignant and 50 were benign. The optimal cut-off value of three-dimensional maximum Young’s modulus in coronal plane (3D-C-Emax) was 51.5 kPa and the area under the curve (AUC) was 0.798. The AUC, sensitivity, specificity, and accuracy of conventional ACR TI-RADS were 0.828, 83.9%, 66.0%, and 75.9%, respectively. The AUC, sensitivity, specificity, and accuracy of combined ACR TI-RADS were 0.845, 90.3%, 66.0%, and 79.5%, respectively. The difference between the two AUC values was statistically significant.

Combined ACR TI-RADS has higher diagnostic efficiency than conventional ACR TI-RADS. The sensitivity and accuracy of combined ACR TI-RADS showed significant improvements. It can be used as an effective method in the diagnosis of thyroid nodules.

已知与标准胸主动脉腔内修复术（TEVAR）相比，近端延伸诱导完全附着（衬裙）技术改善了远端主动脉重塑。^[1,2]然而，唯一可用的Zenith夹层血管内系统（Cook Medical Inc.，Bloomington，Ind，USA）有几个限制，包括只有两种尺寸（36mm和46mm）和一个锥形设计，这可能不适合远端主动脉夹层的复杂形态，特别是东亚人群。因此，我中心设计了新型“神话”支架系统，取得了较好的早期疗效。

致编辑：自然口标本提取手术（NOSES）是一种积极发展的提取标本和进行非切口结直肠癌手术的方法。既往研究表明，其在直肠癌手术治疗中的有效性和安全性与常规腹腔镜手术相似。NOSES被证明是传统腹腔镜检查的一种可能的替代方法，传统腹腔镜检查使用小型剖腹手术提取标本，因为在手术特征和短期结果方面没有差异。^[1]最近，已经证明了用肠外翻和腹外切除术切除直肠肿瘤的新的有前途的方法。^[2]

致编辑：结肠直肠癌（CRC）仍然是全球癌症相关死亡的主要原因。^[1]除了结肠直肠癌发生的经典腺瘤到癌模型外，锯齿状肿瘤途径占CRC的20%-30%。无柄锯齿状病变（SSL）是最常见的癌前锯齿状息肉亚型，具有结肠镜检查后CRC的许多基因组特征，因此被认为是其前驱病变。然而，由于SSL的扁平形状和微妙的内窥镜特征，SSL很容易被遗漏。有时它们也很难与其他类型的息肉区分开来，尤其是增生性息肉（HPs），后者被认为没有恶性潜能。^[2]大约10%最初内镜诊断为HPs的息肉在组织病理学检查后被重新分类为SSL，反映了结肠镜检查的诊断困难。^[3,4]目前的指南建议对小息肉采取“诊断并离开”和“切除并丢弃”策略，这可能导致SSL被留下原地或者漏诊，^[5]增加复发和结肠镜检查后癌症的风险。此外，在胃肠界，切除SSL的风险是否超过癌症风险的降低仍有争议。任何提高SSL诊断准确性的策略都可能产生有意义的临床影响。

致编辑：作为一种罕见的惰性B细胞非霍奇金淋巴瘤，淋巴浆细胞淋巴瘤/Waldenström巨球蛋白血症（LPL/WM）具有独特的临床和生物学特征。^[1]然而，由于难以获得用于核型分析的肿瘤中期和细胞增殖缓慢，只有极少数研究检测到LPL/WM的细胞遗传学畸变。^[2,3]此外，6q缺失是WM中最常见的细胞遗传学畸变，发生率约为50%。^[2]然而，其他细胞遗传学畸变在很大程度上仍不清楚，细胞遗传学畸变的预后作用需要进一步探索。在本研究中，我们系统分析了中国305例LPL/WM病例，重点是中国患者的特征和细胞遗传学异常。

致编辑：糖尿病肾病（DKD）已成为终末期肾病（ESKD）的主要原因。根据肾脏疾病改善总体结局（KDIGO）指南，DKD的快速肾功能下降定义为估计肾小球滤过率（eGFR）斜率≤-5mL·min^-1·1.73米^-2·年份^-1eGFR快速下降的患者预后通常较差。在一项多中心回顾性研究中，377例（61%）活检证实的DKD患者中有230例是快速衰退者。^[1]据报道，在195名伴有正常白蛋白尿和微量白蛋白尿的2型糖尿病（T2D）皮马印第安人中，分别有32%和42%的人eGFR快速下降，表明单独蛋白尿难以完全预测伴有T2D的DKD患者肾功能快速下降。^[2]因此，确定T2D患者肾功能快速下降的更有用的临床病理学预测因素是令人感兴趣的。

致编辑：尽管新生儿重症监护室（NICU）患者发生新生儿上气道阻塞的报道很常见，但新生儿气管切开术很少见，这可能是由于患者数量少，设备齐全的医院在新生儿中成功进行手术的数量更少。然而，尽管合格的、熟练的新生儿科医生和儿科耳鼻喉科医生在进行新生儿气管切开术方面做出了广泛的努力，一些新生儿没有接受这种手术。当新生儿符合气管切开术的指征，但他/她的父母拒绝做手术时，他/她面临着按照父母意愿违背医疗建议出院的更高风险(DAMA)。为探讨中国新生儿气管切开术的初步证据，以及了解新生儿在符合手术指征时行气管切开术与未行气管切开术的结局差异，我们进行了一项回顾性研究。患者在北京儿童医院接受治疗。根据父母是否签署气管切开同意书并最终完成气管切开，将患者分为气管切开组或非气管切开组。本研究经首都医科大学附属北京儿童医院伦理委员会批准（编号：[2021]-E-139-R），并在中国临床试验注册中心注册（编号：ChiCTR2100050720）。所有参与者的父母/监护人都提供了书面知情同意书。

致编辑：结直肠癌是全球范围内最常见的癌症之一，结肠炎尤其是溃疡性结肠炎引起的慢性炎症会增加患结直肠癌的风险。与以无翼/β-catenin信号和腺癌序列组成型激活为标志的散发性结直肠癌相比，P53和K-Ras在结肠炎相关结直肠癌（CAC）的进展过程中，较早发生的突变导致结肠腺瘤性息肉病较晚发生。手术和化疗是CAC的首选治疗方法，但长期使用5-氟尿嘧啶或伊立替康等一线化疗药物受到耐药性或不良反应的限制。因此，我们有必要对“绿色”药品进行鉴别。中药是复杂多样的，存在于自然界中。中药的抗炎、抗菌、抗病毒、抗氧化、抗肿瘤、抗辐射和免疫调节活性已被广泛研究。中药比合成药物更能防止炎症发展为癌症。现就中医药治疗CAC的优势进行综述。

致编辑：对于手术中严重气管狭窄的患者，体外膜肺氧合（ECMO）可能是确保最终气道安全的最后也是最安全的选择。肝素形式的全身抗凝是典型的选择。然而，肝素本身充满了并发症，包括患者出血和回路内凝血。^[1]近年来，随着技术的不断进步，无肝素ECMO在创伤患者中的应用逐渐有报道，但在非创伤患者中鲜有报道。^[2]我们想报告三例无肝素静脉-静脉体外膜肺氧合（VV-ECMO）成功应用于手术气道困难的非创伤患者，其中两例为恶性肿瘤患者。本研究由北京同仁医院伦理委员会批准（编号：TREC2022-KY012）。从患者处获得书面知情同意书。3例颈部肿瘤致严重气管狭窄患者均入院行肿瘤切除术或气管节段切除术。在增强CT扫描中，气管最窄段为0.20-0.39 cm。清醒气管插管可能是极其危险的，因为完全气道阻塞和严重低氧血症的可能性迫在眉睫。此外，由于肿瘤增大和病变位置，未准备气管造口术。我们在麻醉诱导前建立了VV-ECMO，以支持充分的通气和氧合。VV-ECMO设置的参数如所示表1未给予全身肝素。在ECMO确保氧合的情况下，通过气管内导管或喉罩进行全身麻醉和机械通气的诱导。所有3例患者均接受了肺保护性通气策略。重要的是要知道，并非所有的静脉血都是从右心房排出的，残留的持续到肺部系统的缺氧血液将依靠肺部进行气体交换。因此，如果可能，应进行肺保护性通气，以补充氧气和肺保护。3例患者术中采用VV-ECMO联合机械通气维持氧合。

致编辑：急性髓性白血病（AML）是一种以骨髓中异常成髓细胞增殖为特征的异质性疾病。传统治疗，如化疗联合或不联合造血干细胞移植（HSCT）已被用作AML的一线治疗。然而，由于多种因素，如肿瘤免疫微环境(TME)，AML患者的临床结局差异很大。^[1]免疫检查点抑制剂（ICIs）最近作为复发性AML或可测量残留疾病（MRD）阳性AML患者的治疗选择而广受欢迎。^[2]基于既往研究，免疫失调在AML复发中起重要作用，免疫相关基因可能为AML患者提供预后信息。因此，迫切需要探索免疫相关遗传预后指数（IRGPI）来预测预后，从而为ICI治疗提供个性化指导。在这项研究中，我们开发了一种免疫相关的AML遗传预后指数，该指数能够预测总生存期（OS）和ICI免疫治疗益处。我们聚焦AML转录组数据中的所有免疫相关基因，通过加权基因共表达网络分析（WGCNA）筛选与预后相关的免疫相关基因，构建免疫相关基因预后指数（IRGPI）。然后，我们表征了IRGPI的免疫和分子特征，检查了其对AML患者的预后能力，并将其与肿瘤免疫功能障碍和排斥（TIDE）以及肿瘤炎症特征（TIS）进行了比较。^[3,4]结果表明，IRGPI是AML患者预测ICI免疫治疗生存率和获益的有前途的预后生物标志物。

致编辑：目前已知的急性感染后或炎性脱髓鞘综合征包括急性播散性脑脊髓炎、脑炎、横贯性脊髓炎(TM)和格林-巴利综合征(GBS)。脱髓鞘通常局限于中枢或外周神经系统。脊髓炎和脱髓鞘周围神经病变并存的报道仅见于少数儿童^[1,2]和年轻人。^[3]此外，在老年免疫功能正常患者中合并TM和GBS的报道很少。

致编辑：乳腺癌是导致女性死亡的恶性疾病之一，严重威胁女性健康。随着医学治疗的进步，治疗乳腺癌的方法有很多，如药物治疗、激素治疗等。其中，分子靶向治疗极大地提高了乳腺癌的治疗效果。因此，寻找重要的分子标记至关重要。^[1]乳腺癌可分为四种亚型：三阴性（TN）、lumA、lumB和HER2+。^[2]HER2+乳腺癌占乳腺癌的15-20%，分级更高，表型更具侵袭性，预后更差。^[3]

在最初的文章发表之后，^[1]作者声明，第一作者李小平的从属关系提交不正确，而正确的作者从属关系应如下。作者对由此造成的任何不便表示歉意。