Volume 136 · Issue 17 · 2023

In the field of plastic and reconstructive surgery, the loss of organs or tissues caused by diseases or injuries has resulted in challenges, such as donor shortage and immunosuppression. In recent years, with the development of regenerative medicine, the decellularization-recellularization strategy seems to be a promising and attractive method to resolve these difficulties. The decellularized extracellular matrix contains no cells and genetic materials, while retaining the complex ultrastructure, and it can be used as a scaffold for cell seeding and subsequent transplantation, thereby promoting the regeneration of diseased or damaged tissues and organs. This review provided an overview of decellularization-recellularization technique, and mainly concentrated on the application of decellularization-recellularization technique in the field of plastic and reconstructive surgery, including the remodeling of skin, nose, ears, face, and limbs. Finally, we proposed the challenges in and the direction of future development of decellularization-recellularization technique in plastic surgery.

Patients with mass-forming pancreatitis (MFP) or pancreatic ductal adenocarcinoma (PDAC) presented similar clinical symptoms, but required different treatment approaches and had different survival outcomes. This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) in differentiating MFP from PDAC.

A literature search was performed in the PubMed, EMBASE (Ovid), Cochrane Library (CENTRAL), China National Knowledge Infrastructure (CNKI), Weipu (VIP), and WanFang databases to identify original studies published from inception to August 20, 2021. Studies reporting the diagnostic performances of CEUS and CECT for differentiating MFP from PDAC were included. The meta-analysis was performed with Stata 15.0 software. The outcomes included the pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves of CEUS and CECT. Meta-regression was conducted to investigate heterogeneity. Bayesian network meta-analysis was conducted to indirectly compare the overall diagnostic performance.

Twenty-six studies with 2115 pancreatic masses were included. The pooled sensitivity and specificity of CEUS for MFP were 82% (95% confidence interval [CI], 73%-88%; I² = 0.00%) and 95% (95% CI, 90%-97%; I² = 63.44%), respectively; the overall +LR, -LR, and DOR values were 15.12 (95% CI, 7.61-30.01), 0.19 (95% CI, 0.13-0.29), and 78.91 (95% CI, 30.94-201.27), respectively; and the area under the SROC curve (AUC) was 0.90 (95% CI, 0.87-92). However, the overall sensitivity and specificity of CECT were 81% (95% CI, 75-85%; I² = 66.37%) and 94% (95% CI, 90-96%; I² = 74.87%); the overall +LR, -LR, and DOR values were 12.91 (95% CI, 7.86-21.20), 0.21 (95% CI, 0.16-0.27), and 62.53 (95% CI, 34.45-113.51), respectively; and, the SROC AUC was 0.92 (95% CI, 0.90-0.94). The overall diagnostic accuracy of CEUS was comparable to that of CECT for the differential diagnosis of MFP and PDAC (relative DOR 1.26, 95% CI [0.42-3.83], P > 0.05).

CEUS and CECT have comparable diagnostic performance for differentiating MFP from PDAC, and should be considered as mutually complementary diagnostic tools for suspected focal pancreatic lesions.

Primary malignant bone tumors are uncommon, and their epidemiological features are rarely reported. We aimed to study the incidence and death characteristics of bone tumors from 2000 to 2015.

Population-based cancer registries submitted registry data to National Central Cancer Registry of China (NCCRC). The data collected from 501 local cancer registries in China were assessed using NCCRC screening methods and criteria. Incidence and mortality rates of primary bone tumor were stratified by age group, gender, and area. Age-standardized incidence and mortality rates were adjusted using the Chinese standard population in 2000 and Segi’s world population. The annual percentage change (APC) in rate was calculated using the Joinpoint Regression Program.

Data from 368 registries met quality control criteria, of which 134 and 234 were from urban and rural areas, respectively. The data covered 309,553,499 persons. The crude incidence, age-standardized incidence, and crude mortality rates were 1.77, 1.35, and 1.31 per 100,000, respectively. Incidence and mortality rates were higher in males than those in females; they showed downward trends, with declines of 2.2% and 4.8% per year, respectively, and the rates in urban areas were lower than those in rural areas. Significant declining trends were observed in urban areas. Stable trends were seen in rural areas during 2000 to 2007, followed by downward trends. Age-specific incidence and mortality rates showed stable trends in the age group of 0 to 19 years, and downward trends in the age group elder than 19 years.

The incidence and mortality rates of primary malignant bone tumors in rural areas were higher compared to those in urban areas. Targeted prevention measures are required to monitor and control bone tumor incidence and improve the quality of life of affected patients. This research can provide a scientific basis for the prevention and control of bone tumors, as well as basic information for follow-up research.

More than 75 million procedures with intravascular iodine-based contrast media (ICM) are performed worldwide every year, and some patients undergoing these procedures do not have normal thyroid function. The long-term effects of ICM in patients with mild thyroid dysfunction (TD) are unclear.

This prospective cohort study was conducted in China. Patients with stable angina pectoris with total triiodothyronine (TT3) reduction, normal thyroid-stimulating hormone, and reverse triiodothyronine (rT3) were enrolled and divided into high-dose (≥100 mL ICM) and low-dose groups (<100 mL ICM). We dynamically investigated the trends in thyroid function, rT3, and thyroid antibodies one year after ICM exposure.

A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up. Thyroglobulin antibody (TGAB) levels were elevated in 41 (26.6%) patients before ICM exposure, 11 (7.1%) of whom also had elevated thyroid peroxidase antibody levels. Transient subclinical TD occurred 6 months after ICM exposure; 75.5% (34/45) of post-operative TD occurred in the high-dose group. One patient developed severe hypothyroidism with myxedema, requiring drug intervention 1 year after ICM exposure. The level of rT3 showed no statistically significant changes during post-operative follow-up (P = 0.848). The TGAB level decreased at 6th month (P < 0.001), but increased at 1 year after ICM exposure (P = 0.002).

Patients with T3 reduction are at a risk of transient subclinical TD and hypothyroidism after a single large dose of ICM. Follow-up of this population at 9-12 months after ICM exposure is warranted.

There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants.

We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression.

A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions.

The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.

Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.

The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations.

Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level (P for interaction = 0.80) and non-HDL-C level (P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P-value of 0.47.

High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.

ClinicalTrials.gov, NCT03015311.

Glutamine synthetase (GS) and arginase 1 (Arg1) are widely used pathological markers that discriminate hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma; however, their clinical significance in HCC remains unclear.

We retrospectively analyzed 431 HCC patients: 251 received hepatectomy alone, and the other 180 received sorafenib as adjuvant treatment after hepatectomy. Expression of GS and Arg1 in tumor specimens was evaluated using immunostaining. mRNA sequencing and immunostaining to detect progenitor markers (cytokeratin 19 [CK19] and epithelial cell adhesion molecule [EpCAM]) and mutant TP53 were also conducted.

Up to 72.4% (312/431) of HCC tumors were GS positive (GS+). Of the patients receiving hepatectomy alone, GS negative (GS-) patients had significantly better overall survival (OS) and recurrence-free survival (RFS) than GS+ patients; negative expression of Arg1, which is exclusively expressed in GS- hepatocytes in the healthy liver, had a negative effect on prognosis. Of the patients with a high risk of recurrence who received additional sorafenib treatment, GS- patients tended to have better RFS than GS+ patients, regardless of the expression status of Arg1. GS+ HCC tumors exhibit many features of the established proliferation molecular stratification subtype, including poor differentiation, high alpha-fetoprotein levels, increased progenitor tumor cells, TP53 mutation, and upregulation of multiple tumor-related signaling pathways.

GS- HCC patients have a better prognosis and are more likely to benefit from sorafenib treatment after hepatectomy. Immunostaining of GS may provide a simple and applicable approach for HCC molecular stratification to predict prognosis and guide targeted therapy.

Osteopenia has been well documented in adolescent idiopathic scoliosis (AIS). Bone marrow stem cells (BMSCs) are a crucial regulator of bone homeostasis. Our previous study revealed a decreased osteogenic ability of BMSCs in AIS-related osteopenia, but the underlying mechanism of this phenomenon remains unclear.

A total of 22 AIS patients and 18 age-matched controls were recruited for this study. Anthropometry and bone mass were measured in all participants. Bone marrow blood was collected for BMSC isolation and culture. Osteogenic and adipogenic induction were performed to observe the differences in the differentiation of BMSCs between the AIS-related osteopenia group and the control group. Furthermore, a total RNA was extracted from isolated BMSCs to perform RNA sequencing and subsequent analysis.

A lower osteogenic capacity and increased adipogenic capacity of BMSCs in AIS-related osteopenia were revealed. Differences in mRNA expression levels between the AIS-related osteopenia group and the control group were identified, including differences in the expression of LRRC17, DCLK1, PCDH7, TSPAN5, NHSL2, and CPT1B. Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed several biological processes involved in the regulation of autophagy and mitophagy. The Western blotting results of autophagy markers in BMSCs suggested impaired autophagic activity in BMSCs in the AIS-related osteopenia group.

Our study revealed that BMSCs from AIS-related osteopenia patients have lower autophagic activity, which may be related to the lower osteogenic capacity and higher adipogenic capacity of BMSCs and consequently lead to the lower bone mass in AIS patients.

Metastasis is the main cause of tumor-associated death and mainly responsible for treatment failure of breast cancer. Autophagy accelerates tumor metastasis. In our work, we aimed to investigate the possibility of microRNAs (miRNAs) which participate in the regulation of autophagy to inhibit tumor metastasis.

MiRNA array and comprehensive analysis were performed to identify miRNAs which participated in the regulation of autophagy to inhibit tumor metastasis. The expression levels of miR-3653 in breast cancer tissues and cells were detected by quantitative real-time polymerase chain reaction. In vivo and in vitro assays were conducted to determine the function of miR-3653. The target genes of miR-3653 were detected by a dual luciferase reporter activity assay and Western blot. The relationship between miR-3653 and epithelial-mesenchymal transition (EMT) was assessed by Western blot. Student’s t-test was used to analyze the difference between any two groups, and the difference among multiple groups was analyzed with one-way analysis of variance and a Bonferroni post hoc test.

miR-3653 was downregulated in breast cancer cells with high metastatic ability, and high expression of miR-3653 blocked autophagic flux in breast cancer cells. Clinically, low expression of miR-3653 in breast cancer tissues (0.054 ± 0.013 vs. 0.131 ± 0.028, t = 2.475, P = 0.014) was positively correlated with lymph node metastasis (0.015 ± 0.004 vs. 0.078 ± 0.020, t = 2.319, P = 0.023) and poor prognosis (P < 0.001). miR-3653 ameliorated the malignant phenotypes of breast cancer cells, including proliferation, migration (MDA-MB-231: 0.353 ± 0.013 vs. 1.000 ± 0.038, t= 16.290, P < 0.001; MDA-MB-468: 0.200 ± 0.014 vs. 1.000 ± 0.043, t = 17.530, P < 0.001), invasion (MDA-MB-231: 0.723 ± 0.056 vs. 1.000 ± 0.035, t = 4.223, P= 0.013; MDA-MB-468: 0.222 ± 0.016 vs. 1.000 ± 0.019, t= 31.050, P < 0.001), and colony formation (MDA-MB-231: 0.472 ± 0.022 vs. 1.000 ± 0.022, t= 16.620, P < 0.001; MDA-MB-468: 0.650 ± 0.040 vs. 1.000 ± 0.098, t= 3.297, P = 0.030). The autophagy-associated genes autophagy-related gene 12 (ATG12) and activating molecule in beclin 1-regulated autophagy protein 1 (AMBRA1) are target genes of miR-3653. Further studies showed that miR-3653 inhibited EMT by targeting ATG12 and AMBRA1.

Our findings suggested that miR-3653 inhibits the autophagy process by targeting ATG12 and AMBRA1, thereby inhibiting EMT, and provided a new idea and target for the metastasis of breast cancer.

卵胞浆内单精子注射（ICSI）是人类辅助生殖技术的有效方法，尤其是对男性因素不育。然而，ICSI的平均受精率为70%，3%的周期发生完全受精失败。^[1]卵母细胞活化缺乏是受精失败的主要原因。

Manske IIIb型和IV型拇指发育不全的治疗仍有争议，父母越来越希望保留发育不全的拇指，而不是五指手。^[1,2]最近有越来越多的关于使用游离跖骨转移（MTs）重建严重拇指发育不全的报道。津野等人^[3]用非血管化的第4跖骨重建拇指，并用髂骨移植物填充骨缺损。食物等人^[4]报道了用半宽MT重建拇指，它不仅减少了供体足的牺牲，而且减少了重建掌骨的强度。

致编辑：常染色体隐性遗传智力低下-52（MRT52，OMIM：616887）于2016年首次报道，其特征是整体发育迟缓，^[1]严重智力残疾（ID）、言语障碍和癫痫发作，但无畸形特征。^[1,2]MRT52是由囊泡整合膜蛋白36 kDa（VIP36）样蛋白的纯合突变引起的，该蛋白也称为凝集素甘露糖结合2样（LMAN2L）基因（OMIM：609552）。^[3]努费尔等人^[4]映射了LMAN2L染色体2q11.2的基因。虽然确切的LMAN2L功能尚不清楚，有证据表明LMAN2L基因编码位于内质网（ER）中的跨膜蛋白（TM），在那里它在糖蛋白运输中充当货物受体。^[4,5]

致编辑：Cockayne综合征（CS；人类孟德尔遗传#133540，216400）是一种罕见的常染色体隐性神经退行性疾病，由Edward Cockayne在1936年描述。^[1]CS患病率为2.7/百万活产，^[2]这种疾病可能诊断不足。主要临床特征是进行性生长衰竭和小头畸形以及其他特征，如眼睛凹陷的“恶病质侏儒症”外观、皮肤光敏性、智力迟钝、脱髓鞘性周围神经病变、色素性视网膜病变、白内障、耳聋、牙齿异常和过早死亡。^[1,3]该疾病的严重程度有相当大的差异，导致分为三种主要类型。

致编辑：脂肪肉瘤是腹膜后肉瘤的常见亚型。由于腹膜后脂肪肉瘤（RPLS）复杂的解剖异质性，压迫和侵犯邻近重要器官，术中常发生大出血。因此，需要进行联合内脏切除，这意味着与其他实体瘤的手术相比，RPLS手术难度更大，完全切除率更低。尽管在我们之前的研究中我们发现包括顺铂在内的腹腔热灌注化疗可以改善RPLS患者的预后，^[1]手术是RPLS最有效的治疗方法，辅助治疗几乎无效。很少有研究专门关注RPLS发病机制的潜在分子机制。因此，没有可用于RPLS的诊断生物标志物、可药物靶标或预后因素。

致编辑：恶性高热（MH）是一种骨骼肌的药物遗传学疾病，在易感个体中表现为由去极化肌肉松弛剂和挥发性麻醉剂触发的急性高代谢状态。^[1]报告的MH反应发生率范围为1:25 0,000至1:10, 000。^[1]然而，亚洲人群的确切发病率仍然未知。最近的一份报告表明，日本MH的发病率为每100,000名麻醉剂中有1至2名，^[2]这与西方国家的情况相似。在中国，只有少数报告病例，这可能归因于记录不完整，实际发病率可能更高。^[3,4]在中国，1978年1月至2004年3月期间，仅记录了34例MH病例。^[5]由于缺乏有效药物丹曲林，当时的死亡率为73.5%。^[5]在这里，我们报告了一名疑似MH患者的发病和治疗。

致编辑：急性大血管闭塞（LVO）是大多数急性缺血性中风（AIS）的原因，这是世界范围内残疾和死亡的常见原因。随机对照临床试验（RCT）提供的证据支持静脉溶栓（IVT，也称为桥接治疗【IVT】）和血管内血栓切除术优于单独IVT作为前循环LVO患者的当前标准治疗。^[1]目前的美国和欧洲指南建议所有符合条件的LVO患者在直接机械血栓切除术（d-MT）前使用IVT（推荐等级-I）。最近的随机对照试验表明，MT在疗效和安全性方面不劣于BT，^[2,3]这与多项荟萃分析的结果相矛盾，多项荟萃分析支持BT而不是d-MT。^[4]血栓切除术前常规IVT对符合条件的个体的益处一直存在争议。BT与并发症相关，包括血管痉挛、远端栓塞或症状性颅内出血的风险。

致编辑：新生儿筛查（NBS）在早期识别可治疗和可预防的先天性代谢错误（IEMs）以避免严重后果和提高生活质量方面发挥着有价值和重要的作用。乔等人^[1]报告称，过去70年来，中国在妇女生殖、孕产妇、新生儿、儿童和青少年健康方面取得了显著成就，并成功降低了新生儿死亡率。作为整个RMNCAH大楼的第三层，NBS系统在早期治疗以降低新生儿发病率和死亡率以及提高生活质量方面发挥了关键作用。为了确保国家统计局的质量、尊严、公平和全民覆盖，中国在过去40年里一直致力于建立合理分布的国家统计局体系【补充图1，http://links.lww.com/CM9/B175】。^[2]在中国，国家统计局网络由分级管理和服务机构组成，国家统计局的医疗保健服务由国家、省、地、县级政府共同管理。为规范NBS医疗保健服务，增加对高质量NBS医疗保健的需求，中国制定并推出了众多政策、立法、法规、诊疗指南和技术标准。基于这样一个由全国妇女儿童权利共识、卫生政策、资金支持、科学研究、临床指南和标准以及信息技术支撑的坚实基础，中国NBS网络（QMIP-NBS）的质量管理得到了精心规划和实施。

致编辑：气道纤维化是气管支气管狭窄的病理表现之一，是一种罕见但潜在的高影响事件，具有显著的发病率和死亡率。上皮作为抵御外部环境的第一道防线是重要的。损伤的上皮细胞通常经历上皮-间充质转化（EMT）以失去细胞-细胞连接和顶端-基底极性并重组细胞骨架，导致单个细胞的运动性和变形性增加以促进细胞迁移，这有利于上皮修复。^[1]组织纤维化的发展与EMT的不适当再激活有关，其特征在于上皮细胞标志物E-钙粘蛋白的丢失和间充质标志物N-钙粘蛋白、波形蛋白和α-平滑肌肌动蛋白的过表达。转化生长因子-β 1（TGF-β 1）主要通过激活其下游小母体对抗十五麻痹（Smad）信号传导而导致组织瘢痕形成。发现上调Smad3可以促进细胞迁移和EMT过程。^[2]

致编辑：哮喘是一种复杂的慢性炎症性肺部疾病，其发病机制尚不完全清楚。据信，气道上皮主要充当防御屏障以保护肺免受过敏原的侵害，从而避免哮喘。气道上皮屏障的完整性依赖于由闭塞带(ZO)1至3、闭塞蛋白和紧密蛋白1至5组成的紧密连接，以及主要由E-钙粘蛋白、β-连环蛋白和连接粘附分子形成的粘附连接，其维持支气管上皮细胞的顶基底极性。我们的团队先前已经证实屋尘螨（HDM）破坏气道上皮屏障体内和体外胸腺基质淋巴细胞生成素（TSLP）在这一过程中起着重要作用。^[1]与各种人类疾病相关的自噬是一种高度保守和溶酶体依赖性的过程，其选择性地降解和再循环溶酶体内的靶向细胞器。自噬在过敏性哮喘中的作用仍有争议。在这项研究中，我们假设自噬过程在HDM诱导的哮喘中起关键作用，HDM诱导自噬相关基因（ATGs），这些基因与上皮屏障破坏有关；我们利用HDM刺激人支气管上皮细胞（HBECs）来评估自噬在HDM诱导的哮喘中的作用。

致编辑：重度抑郁障碍（MDD）是一种常见的情绪障碍，在世界范围内导致残疾。MDD患者大脑中结构连接或功能连接的异常已被广泛报道，这极大地扩展了我们对MDD病理生理学的了解。

致编辑：有或无糖尿病患者的围手术期高血糖与较高的术后并发症发生率相关。^[1]在中国，已有超过1.3亿人被诊断为糖尿病，总人口的三分之一以上患有糖尿病前期。住院患者高血糖很常见，围手术期高血糖率在不同研究中从30%到40%不等。^[2]控制围手术期血糖有利于手术获得更好的结果，这已成为广泛的共识；外科医生对血糖控制需求的认识不断提高。据报道，与其他患者相比，糖尿病患者和非糖尿病患者高血糖后的免疫细胞组成不同。^[3]为了研究术中血糖管理的影响，对术中高血糖患者进行了一项观察性研究，以比较接受胰岛素治疗和未接受胰岛素治疗的患者的结局。