Volume 136 · Issue 09 · 2023

迄今为止，胚胎的常规形态学指标仍被用作主要的评级参数或标准。然而，仍然缺乏标准化且易于使用的人类卵裂期胚胎和囊胚的形态学评估标准。根据伊斯坦布尔共识,^[1]卵裂期胚胎、滋养外胚层（TE）细胞和内细胞团（ICM）的形态学评分系统包括三个等级，即良好、一般和差。然而，标准简单且不太详细，这增加了胚胎评估程序的主观性。在这个共识中，我们提供了一个卵裂期胚胎和囊胚的评分系统，其中使用说明性图像解释了评估指标。此外，该共识量化了多种评价指标，如卵裂期胚胎中的细胞数、囊胚中TE和ICM细胞数，从而提高了实践中的可操作性。同时细化胚胎评估等级，界定优质可用胚胎，展示胚胎异常形态特征，便于选择移植胚胎。该共识由中国生殖医学会发起，欧洲和大洋洲胚胎学家共同编制，旨在进一步优化辅助生殖实验室的质量管理体系，提升辅助生殖技术的绩效。

髋关节发育不良（DDH）是引起成人髋关节疼痛的最常见疾病之一，也是骨关节炎（OA）的重要原因。髋关节临界发育不良（BDDH）是一种介于正常髋关节和成人DDH之间的疾病。在BDDH中，髋臼的外侧中心边缘角（LCEA）通常定义在18°至25°或20°至25°之间；然而，这一定义仍有争议。^[1]

Wearable technology, which can continuously and remotely monitor physiological and behavioral parameters by incorporated into clothing or worn as an accessory, introduces a new era for ubiquitous health care. With big data technology, wearable data can be analyzed to help long-term cardiovascular care. This review summarizes the recent developments of wearable technology related to cardiovascular care, highlighting the most common wearable devices and their accuracy. We also examined the application of these devices in cardiovascular healthcare, such as the early detection of arrhythmias, measuring blood pressure, and detecting prevalent diabetes. We provide an overview of the challenges that hinder the widespread application of wearable devices, such as inadequate device accuracy, data redundancy, concerns associated with data security, and lack of meaningful criteria, and offer potential solutions. Finally, the future research direction for cardiovascular care using wearable devices is discussed.

With the rapid aging of the global population posing a serious problem, frailty, a non-specific state that reflects physiological senescence rather than aging in time, has become more widely addressed by researchers in various medical fields. A high prevalence of frailty is found among kidney transplant (KT) candidates and recipients. Therefore, their frailty has become a research hotspot in the field of transplantation. However, current studies mainly focus on the cross-sectional survey of the incidence of frailty among KT candidates and recipients and the relationship between frailty and transplantation. Research on the pathogenesis and intervention is scattered, and relevant review literature is scarce. Exploring the pathogenesis of frailty in KT candidates and recipients and determining effective intervention measures may reduce waiting list mortality and improve the long-term quality of life of KT recipients. Therefore, this review explains the pathogenesis and intervention measures for frailty in KT candidates and recipients to provide a reference for the formulation of effective intervention strategies.

With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.

Screening using low-dose computed tomography (LDCT) is a more effective approach and has the potential to detect lung cancer more accurately. We aimed to conduct a meta-analysis to estimate the accuracy of population-based screening studies primarily assessing baseline LDCT screening for lung cancer.

MEDLINE, Excerpta Medica Database, and Web of Science were searched for articles published up to April 10, 2022. According to the inclusion and exclusion criteria, the data of true positives, false-positives, false negatives, and true negatives in the screening test were extracted. Quality Assessment of Diagnostic Accuracy Studies-2 was used to evaluate the quality of the literature. A bivariate random effects model was used to estimate pooled sensitivity and specificity. The area under the curve (AUC) was calculated by using hierarchical summary receiver-operating characteristics analysis. Heterogeneity between studies was measured using the Higgins I² statistic, and publication bias was evaluated using a Deeks’ funnel plot and linear regression test.

A total of 49 studies with 157,762 individuals were identified for the final qualitative synthesis; most of them were from Europe and America (38 studies), ten were from Asia, and one was from Oceania. The recruitment period was 1992 to 2018, and most of the subjects were 40 to 75 years old. The analysis showed that the AUC of lung cancer screening by LDCT was 0.98 (95% CI: 0.96-0.99), and the overall sensitivity and specificity were 0.97 (95% CI: 0.94-0.98) and 0.87 (95% CI: 0.82-0.91), respectively. The funnel plot and test results showed that there was no significant publication bias among the included studies.

Baseline LDCT has high sensitivity and specificity as a screening technique for lung cancer. However, long-term follow-up of the whole study population (including those with a negative baseline screening result) should be performed to enhance the accuracy of LDCT screening.

The prevalence of hypertension is high among Chinese adults, thus, identifying non-hypertensive individuals at high risk for intervention will help to improve the efficiency of primary prevention strategies.

The cross-sectional data on 9699 participants aged 20 to 80 years were collected from the China National Health Survey in Gansu and Hebei provinces in 2016 to 2017, and they were nonrandomly split into the training set and validation set based on location. Multivariable logistic regression analysis was performed to develop the diagnostic prediction model, which was presented as a nomogram and a website with risk classification. Predictive performances of the model were evaluated using discrimination and calibration, and were further compared with a previously published model. Decision curve analysis was used to calculate the standardized net benefit for assessing the clinical usefulness of the model.

The Lasso regression analysis identified the significant predictors of hypertension in the training set, and a diagnostic model was developed using logistic regression. A nomogram with risk classification was constructed to visualize the model, and a website (https://chris-yu.shinyapps.io/hypertension_risk_prediction/) was developed to calculate the exact probabilities of hypertension. The model showed good discrimination and calibration, with the C-index of 0.789 (95% confidence interval [CI]: 0.768, 0.810) through internal validation and 0.829 (95% CI: 0.816, 0.842) through external validation. Decision curve analysis demonstrated that the model was clinically useful. The model had a higher area under receiver operating characteristic curves in training and validation sets compared with a previously published diagnostic model based on Northern China population.

This study developed and validated a diagnostic model for hypertension prediction in Gansu Province. A nomogram and a website were developed to make the model conveniently used to facilitate the individualized prediction of hypertension in the general population of Han and Yugur.

Studies have classified muscle-invasive bladder cancer (MIBC) into primary (initially muscle-invasive, PMIBC) and secondary subtypes (initially non-muscle-invasive but progresses, SMIBC), for which controversial survival outcomes were demonstrated. This study aimed to compare the survival outcomes between PMIBC and SMIBC patients in China.

Patients diagnosed with PMIBC or SMIBC at West China Hospital from January 2009 to June 2019 were retrospectively included. Kruskal-Wallis and Fisher tests were employed to compare clinicopathological characteristics. Kaplan-Meier curves and Cox competing proportional risk model were used to compare survival outcomes. Propensity score matching (PSM) was employed to reduce the bias and subgroup analysis was used to confirm the outcomes.

A total of 405 MIBC patients were enrolled, including 286 PMIBC and 119 SMIBC, with a mean follow-up of 27.54 and 53.30 months, respectively. The SMIBC group had a higher proportion of older patients (17.65% [21/119] vs. 9.09% [26/286]), chronic disease (32.77% [39/119] vs. 22.38% [64/286]), and neoadjuvant chemotherapy (19.33% [23/119] vs. 8.04% [23/286]). Before matching, SMIBC had a lower risk of overall mortality (OM) (hazard ratios [HR] 0.60, 95% confidence interval [CI] 0.41-0.85, P = 0.005) and cancer-specific mortality (CSM) (HR 0.64, 95% CI 0.44-0.94, P= 0.022) after the initial diagnosis. However, higher risks of OM (HR 1.47, 95% CI 1.02-2.10, P = 0.038) and CSM (HR 1.58, 95% CI 1.09-2.29, P = 0.016) were observed for SMIBC once it became muscle-invasive. After PSM, the baseline characteristics of 146 patients (73 for each group) were well matched, and SMIBC was confirmed to have an increased CSM risk (HR 1.83, 95% CI 1.09-3.06, P = 0.021) than PMIBC after muscle invasion.

Compared with PMIBC, SMIBC had worse survival outcomes once it became muscle-invasive. Specific attention should be paid to non-muscle-invasive bladder cancer with a high progression risk.

The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.

A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group (N = 70) and R-Y group (N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied.

The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs. 88.8 ± 16.1, P= 0.033; postoperative 3 year: 87.3 ± 15.2 vs. 92.8 ± 11.3, P= 0.028; postoperative 5 year: 90.9 ± 13.7 vs. 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs. 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs. 1.8 ± 4.7, P= 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P= 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs. 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points.

Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes.

ChiCTR.org.cn, ChiCTR-TRC-10001434.

Microsatellite instability (MSI) is a key biomarker for cancer immunotherapy and prognosis. Integration of MSI testing into a next-generation-sequencing (NGS) panel could save tissue sample, reduce turn-around time and cost, and provide MSI status and comprehensive genomic profiling in single test. We aimed to develop an MSI calling model to detect MSI status along with the NGS panel-based profiling test using tumor-only samples.

From January 2019 to December 2020, a total of 174 colorectal cancer (CRC) patients were enrolled, including 31 MSI-high (MSI-H) and 143 microsatellite stability (MSS) cases. Among them, 56 paired tumor and normal samples (10 MSI-H and 46 MSS) were used for modeling, and another 118 tumor-only samples were used for validation. MSI polymerase chain reaction (MSI-PCR) was performed as the gold standard. A baseline was built for the selected microsatellite loci using the NGS data of 56 normal blood samples. An MSI detection model was constructed by analyzing the NGS data of tissue samples. The performance of the model was compared with the results of MSI-PCR.

We first intersected the target genomic regions of the NGS panels used in this study to select common microsatellite loci. A total of 42 loci including 23 mononucleotide repeat sites and 19 longer repeat sites were candidates for modeling. As mononucleotide repeat sites are more sensitive and specific for detecting MSI status than sites with longer length motif and the mononucleotide repeat sites performed even better than the total sites, a model containing 23 mononucleotide repeat sites was constructed and named Colorectal Cancer Microsatellite Instability test (CRC-MSI). The model achieved 100% sensitivity and 100% specificity when compared with MSI-PCR in both training and validation sets. Furthermore, the CRC-MSI model was robust with the tumor content as low as 6%. In addition, 8 out of 10 MSI-H samples showed alternations in the four mismatch repair genes (MLH1, MSH2, MSH6, and PMS2).

MSI status can be accurately determined along the targeted NGS panels using only tumor samples. The performance of mononucleotide repeat sites surpasses loci with longer repeat motif in MSI calling.

Hair follicles are easily accessible and contain stem cells with different developmental origins, including mesenchymal stem cells (MSCs), that consequently reveal the potential of human hair follicle (hHF)-derived MSCs in repair and regeneration. However, the role of hHF-MSCs in Achilles tendinopathy (AT) remains unclear. The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits.

First, we extracted and characterized hHF-MSCs. Then, a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo. Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT, and quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT. Furthermore, statistical analyses were performed using independent sample t test, one-way analysis of variance (ANOVA), and one-way repeated measures multivariate ANOVA as appropriate.

Flow cytometry, a trilineage-induced differentiation test, confirmed that hHF-derived stem cells were derived from MSCs. The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy, as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased. Moreover, collagen I and III were upregulated in rabbit AT treated with hHF-MSCs (compared with AT group; P < 0.05). Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration, possibly through Tenascin-C (TNC) upregulation and matrix metalloproteinase (MMP)-9 downregulation.

hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III. Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber, possibly because of upregulation of TNC and downregulation of MMP-9, thus suggesting that hHF-MSCs are more promising for AT.

Ovarian cancer is one of the most widespread malignant diseases of the female reproductive system worldwide. The plurality of ovarian cancer is diagnosed with metastasis in the abdominal cavity. Epithelial-mesenchymal transition (EMT) exerts a vital role in tumor cell metastasis. However, it remains unclear whether long non-coding RNA (lncRNA) are implicated in EMT and influence ovarian cancer cell invasion and metastasis. This study was designed to investigate the impacts of lncRNA AC005224.4 on ovarian cancer.

LncRNA AC005224.4, miR-140-3p, and snail family transcriptional repressor 2 (SNAI2) expression levels in ovarian cancer and normal ovarian tissues were determined using real-time quantitative polymerase chain reaction (qRT-PCR). Cell Counting Kit-8 (CCK-8) and Transwell (migration and invasion) assays were conducted to measure SKOV3 and CAOV-3 cell proliferation and metastasis. E-cadherin, N-cadherin, Snail, and Vimentin contents were detected using Western blot. Nude mouse xenograft assay was utilized to validate AC005224.4 effects in vivo. Dual-luciferase reporter gene assay confirmed the targeted relationship between miR-140-3p and AC005224.4 or SNAI2.

AC005224.4 and SNAI2 upregulation and miR-140-3p downregulation were observed in ovarian cancer tissues and cells. Silencing of AC005224.4 observably moderated SKOV3 and CAOV-3 cell proliferation, migration, invasion, and EMT process in vitro and impaired the tumorigenesis in vivo. miR-140-3p was a target of AC005224.4 and its reduced expression level was mediated by AC005224.4. miR-140-3p mimics decreased the proliferation, migration, and invasion of ovarian cancer cells. SNAI2 was identified as a novel target of miR-140-3p and its expression level was promoted by either AC005224.4 overexpression or miR-140-3p knockdown. Overexpression of SNAI2 also facilitated ovarian cancer cell viability and metastasis.

AC005224.4 was confirmed as an oncogene via sponging miR-140-3p and promoted SNAI2 expression, contributing to better understanding of ovarian cancer pathogenesis and shedding light on exploiting the novel lncRNA-directed therapy against ovarian cancer.

致编辑：静脉血栓栓塞症（VTE）是由深静脉血栓形成（DVT）和肺栓塞（PE）组成的统称。它是一个主要的全球健康问题，因为它影响5%至15%的住院患者。VTE发生的各种诱发因素包括癌症、手术、长期固定、骨折、瘫痪、口服避孕药的使用和遗传性凝血病。由于这些危险因素和住院患者VTE的发生取决于住院原因，美国胸科医师学会（ACCP）指南（第9版）推荐了不同的VTE评估评分标准。尽管对VTE预防的认识越来越强，但VTE的负担很高，这表明预防不足和不合格的普遍存在。ACCP治疗指南推荐适当的以抗凝剂为基础的治疗方案，持续至少3个月，以降低早期复发和死亡的风险。此外，近年来，VTE的发病率在中国一直在增加，这表明尽管ACCP指南提出了建议，但在中国并没有积极遵循预防措施。因此，我们设计了当前的研究，以确定接受适当VTE预防措施（完全符合ACCP指南，第9版）的患者比例，确定既往住院诊断为VTE的患者的风险因素，并分析中国VTE患者的治疗模式及其临床结局。

致编辑：影像学中轴性脊柱关节炎（SpA）发展的危险因素仍不确定。既往研究发现，高浓度的血清尿酸（SUA）导致除痛风外的其他风湿性关节炎疾病的不同关节中尿酸单钠（MSU）沉积。此外，据报道痛风可以模拟SpA。因此，我们的研究探讨了放射学轴向SpA的发展是否与高SUA浓度有关。

致编辑：肺癌导致世界上癌症相关死亡人数最多。淋巴结转移是肺癌扩散的主要途径，其治疗策略与患者预后密切相关。^[1]根据国家综合癌症网络的指南，一旦纵隔淋巴结已经受累，患者就被认为已经到了肺癌晚期，治疗策略应该有所不同。^[2]计算机断层扫描（CT）是肺癌患者术前预测淋巴结转移的常用方法。然而，并不是所有的异常淋巴结都能在术前通过CT识别出来。因此，更准确地预测淋巴结转移对于肺癌治疗是重要的。

致编辑：骨髓抑制是化疗最常见的副作用之一。由于骨髓的持续破坏，一些患者即使在停止化疗超过三个月后也会发展为长期再生障碍性贫血（AA）。艾曲泊帕（EPAG）作为一种血小板生成素受体激动剂，已广泛用于各种来源的血小板减少症患者，^[1]包括继发于化疗的AA患者。然而，据报道，EPAG和环孢素A（CsA）都可能诱导异常克隆的扩增或有争议地增加肿瘤的风险。^[2]因此，挑战是在预防癌症复发的同时治疗严重的血细胞减少症。我们的研究报告了EPAG联合或不联合CsA治疗继发于化疗的AA患者的疗效和安全性，试图找到解决这些困难的方法。

致编辑：睾酮是由睾丸间质细胞产生的一种基本男性性激素。睾酮水平受年龄影响，在20多岁和30多岁达到峰值，此后逐渐下降。^[1]低睾酮水平可能使男性，尤其是老年男性，在冠状病毒疾病2019（新冠肺炎）中预后不良或死亡。^[2]因此，睾酮水平对老年男性的健康状况有显著影响。确定影响老年男性睾酮水平的可改变的非药物因素对于改善他们的健康非常重要。

致编辑：精神分裂症是一种进行性的、使人衰弱的疾病。^[1]在急性期进行安全有效的治疗是改善预后的第一步，非常重要。阿立哌唑是已知的多巴胺系统稳定剂，它对多巴胺D具有高亲和力的部分激动作用₂和血清素-1A(5-HT1A)受体以及对血清素-2A(5-HT2A)受体的拮抗作用。^[2]它已被证明在改善急性精神分裂症的阳性和阴性症状方面是有效的，并且它显示出比大多数抗精神病药物更好的耐受性。^[3]我们进行了一项真实世界研究，以进一步证实阿立哌唑在中国精神分裂症急性发作患者中的疗效和安全性，并试图探索可能与阿立哌唑疗效相关的临床变量，包括各种药物方案，为急性精神分裂症患者阿立哌唑治疗的优化提供依据。

致编辑：在全球范围内，急性肾损伤（AKI）是一种常见的危及生命的疾病。AKI在老年患者中更为普遍，死亡率不断上升。与年轻患者相比，老年AKI患者持续损伤的风险更高，预后更差。^[1]老年人通常有合并症，增加了他们对AKI的易感性。肾脏疾病：改善总体结果（KDIGO）标准根据由血清肌酐（SCr）水平或尿量（UO）定义的AKI的较高阶段来定义和分期AKI。^[2]然而，UO的记录在临床上很难获得，关于UO联合SCr对老年患者AKI诊断或预后的价值的数据缺乏。因此，本研究的目的是探讨UO是否会影响AKI的分类，并提高预测老年患者临床预后的准确性。

致编辑：杜氏肌营养不良症（DMD）是一种罕见的X连锁遗传性疾病，由肌营养不良蛋白缺乏引起，导致骨骼肌和心肌细胞的肌膜脆性和变性。^[1]心脏受累表现为DMD心肌病，是DMD患者中疾病相关发病率和死亡率的主要原因。^[2]然而，心肌病的体征和症状通常是微妙的，并且在走动和早期非走动阶段经常被忽视。因此，在更新的诊断和管理声明中推荐非侵入性成像方法用于DMD患者心肌受累的评估，超声心动图（Echo）和心脏磁共振（CMR）是最常用的两种成像方法。^[3]但常规回声不能评价心肌组织特征，在早期诊断中作用有限。具有多个序列和参数的CMR允许详细的特征评估，特别是晚期钆增强（LGE）对心肌纤维化的评估与病理学高度一致。既往研究报道了LGE对DMD患者心肌纤维化的评估，^[4,5]但是调查DMD患者在生命的第一个十年中心肌纤维化患病率的研究仍然缺乏。此外，DMD是一种多系统疾病，骨骼肌和心肌细胞可能发生营养不良蛋白功能的丧失。在实践中，患有DMD的个体很早就开始骨骼肌管理，但直到疾病晚期才被转介给心脏专家。因此，在疾病早期明确骨骼肌受累和心肌受累之间的关联非常重要，这可能有助于临床医生更早地开始多学科管理，进一步改善患者的生活质量。在目前的研究中，描述了DMD患者生命的前十年LGE存在的患病率。逻辑回归分析用于确定LGE存在的关联因素。