Volume 139  ·   Issue 13  ·  2026

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common X-linked enzymopathy, affects over 500 million people worldwide, with the highest frequencies observed in Africa, Asia, Latin America, and the Mediterranean region.^[1]Although G6PD deficiency is classically known for causing hemolytic anemia under oxidative stress, emerging evidence suggests its implication extends to diabetes, cardiovascular diseases, and stroke.^[2]Ischemic stroke is among the leading causes of disability and mortality worldwide, influenced by complex genetic and environmental factors.^[3]Given that ischemic stroke is closely associated with oxidative stress and vascular integrity, G6PD deficiency may represent a critical genetic factor influencing stroke risk and outcomes. However, its specific role and underlying mechanisms in ischemic stroke remain incompletely elucidated.

The stress response is a physiological process involving hormonal and metabolic changes in response to stressors; its primary objective is to maintain hemostasis when it is balanced. During the perioperative period, stressors, such as pain, accumulate and result in an excessive stress response. Most recent studies have regarded the perioperative stress response as a risk factor that has a negative effect on postoperative recovery; thus, many researchers have focused on proposing more strategies to suppress the stress response that results from surgery. Pain functions to initiate the stress response; meanwhile, the perioperative stress response potentiates the intensity of pain. The interaction between them is worth investigating.

To the Editor: Systemic sclerosis (SSc) is a complex autoimmune disease characterized by immune dysfunction and excessive collagen deposition, leading to fibrosis across multiple organs and tissues.^[1]Key features include skin thickening, Raynaud’s phenomenon (RP), and internal organ involvement with interstitial lung disease (ILD), pulmonary arterial hypertension, renal crisis, and myocardial involvement. Early diagnosis of SSc complications is crucial for effective management and improved patient outcomes, emphasizing the necessity of research to identify robust diagnostic indicators.

To the Editor: Information processing speed (IPS), typically assessed using the Symbol Digit Modalities Test (SDMT), is a highly sensitive yet fragile cognitive domain that often mediates age-related decline in other cognitive abilities.^[1,2]White matter hyperintensities (WMHs) are a prominent feature of cerebral small vessel disease and have been reported to mediate the association between blood–brain barrier dysfunction and IPS decline in older adults.^[3]Given that IPS performance relies heavily on attentional control and executive processing, disruptions within attention- and executive-related brain networks may play a critical role in WMH-related decline in IPS.

To the Editor: Recurrent spontaneous abortion (RSA), defined as two or more consecutive pregnancy losses before 20 weeks of gestation with the same partner, affects 2–5% of women of reproductive age worldwide. It not only disrupts the current pregnancy but also elevates the risk of subsequent complications, including intrauterine adhesions, endometriosis, and cervical insufficiency. The etiology of RSA is multifactorial, involving chromosomal abnormalities, uterine anomalies, autoimmune disorders, and endometrial dysfunction. Accumulating evidence points to immune tolerance imbalance as a key contributing factor.^[1]Immune homeostasis during pregnancy relies on finely tuned interactions among maternal immune cells, cytokines, and their associated signaling pathways. Inflammatory proteins are critical mediators in this process, influencing trophoblast invasion, placental development, and maternal–fetal tolerance. A balanced ratio of T-helper 1 (Th1) and Th2 cytokines ensures regulated inflammatory responses, whereas the equilibrium between Th17 and regulatory T (Treg) cells is essential for maintaining tolerance at the maternal–fetal interface. Dysregulation of these pathways, along with aberrant signaling of key interface molecules such as interleukin-23 receptor (IL-23R) and T cell immunoglobulin and mucin domain-containing protein 3 (Tim-3)/galectin-9 (Gal-9), has been observed in RSA patients, underscoring the pivotal role of inflammatory mediators in sustaining successful gestation.

To the Editor: Coronary heart disease (CHD) remains a critical public health issue, significantly impacting populations worldwide. The etiology of CHD is often complex and involves a diverse set of risk factors. Although individuals with CHD share a common endophenotype, they generally exhibit distinct molecular or signaling pathways.^[1]Clustering, a commonly employed exploratory and hypothesis-generating technique, is vital for examining heterogeneous subtypes that may aid in accurate cardiovascular phenotyping and disease prevention. However, prior studies have predominantly focused on phenotype-only or genetic-only clustering, with limited integration of genetic and non-genetic factors in exploring heterogeneity. In this study, we performed a clustering analysis by integrating genetic and phenotypic data, further examining stratified CHD risk and the heterogeneity within the clusters.

To the Editor: Inflammatory bowel disease (IBD) is increasing worldwide. Since the first reported patient in China in 1956, the rate has increased and has been an overwhelming challenge for public health. Nutrition and IBD are confusing because the individual patients’ lifestyles, environments, and microbiomes differ. Here, we emphasize the microbiome, the genetic landscape, and the nutritional factors associated with IBD. Dietary factors, microbiomes, and genetic susceptibilities may play a role in determining how this disease represents a puzzle in medicine.^[1]Although overlaps are well known, Crohn’s disease (CD) and ulcerative colitis (UC) are the two primary diagnoses identifiable in IBD. As observed by Yang and Qian^[2]recently, there is a geographic gradient in China, with UC more prevalent in the northern region and CD more commonplace in the southern region, and temporal trends up to 2030 are pretty alarming.

To the Editor: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the first-line approach for the diagnosis of mediastinal and hilar lymphadenopathy and peribronchial/peritracheal masses, and for invasive mediastinal staging.^[1]However, the narrow-bore needle often limits tissue acquisition for pathology. The "macroscopic on-site evaluation" (MOSE) technique—referring to the immediate macroscopic assessment of the visible tissue core (VTC) by endoscopic ultrasound (EUS) operators—was first proposed by Iwashitaet al^[2]in their investigation of its diagnostic utility during EUS-guided fine-needle aspiration (EUSFNA). Unlike EUS-FNA, which primarily targets a single lesion, EBUS-TBNA routinely samples multiple targets, such as peribronchial/peritracheal masses and multi-station mediastinal/hilar lymph nodes, to simultaneously achieve diagnosis and nodal staging. Thus, per-lesion specimen adequacy is essential to ensure accurate staging and procedural efficiency. Although studies have demonstrated that MOSE can be successfully adapted for EUS biopsy needles and can enhance specimen quality, evidence regarding its clinical applicability to EBUS-TBNA remains limited. Therefore, this study evaluated MOSE for assessing specimen adequacy during EBUS-TBNA using 22-gauge needles.

To the Editor: Psoriasis is a chronic, immune-mediated skin disease with systemic inflammation. Biological therapies have emerged as a superior option compared with traditional systemic treatments. Given the high recurrence rate of psoriasis, maintenance therapy is crucial. Although long-term management may involve switching biologics, data on switching patterns among Chinese psoriasis patients remain limited. This study investigates the switching patterns of secukinumab in Chinese psoriasis patients. The study was approved by the Medical Science Research Ethics Committee of Peking University Third Hospital (No. IRB00006761-M2024895) and Peking University First Hospital (No. 2020-255). Prior to enrollment, all patients signed an electronic informed consent form.

To the Editor: Generalized pustular psoriasis (GPP) is a rare and highly heterogeneous autoinflammatory skin disease characterized by neutrophil infiltration of the epidermis. Recent advances have highlighted neutrophils as central drivers of GPP pathogenesis through multifaceted mechanisms.

To the Editor: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and an important cause of cancer-related death.^[1]Approximately 40.0–66.2% of patients with HCC develop portal vein tumor thrombus (PVTT), and their median survival is only 2–5 months.^[2]Transcatheter arterial chemoembolization (TACE), a minimally invasive, nonsurgical intervention widely used in the treatment of liver cancer, is currently considered a standard therapeutic option for patients with intermediate-stage HCC.^[3]In the present study, a retrospective cohort study, we used the double spring coil TACE (DSC-TACE) approach, which was developed to test the therapeutic potential of this novel strategy namely, to increase iodized oil deposition within PVTT, improve portal vein blood flow, and ultimately reduce the risk of mortality. A total of 94 patients with unresectable HCC and PVTT treated at Shandong Cancer Hospital and Institute between May 1, 2015, and December 31, 2021, were retrospectively enrolled in this study. This retrospective study using anonymized clinical data has been approved by the review board of Cancer Hospital of Shandong First Medical University (No. 2021012046). All procedures were performed in accordance with theDeclaration of Helsinki. The study was also registered at Chictr.org. cn (Registration No: ChiCTR2200055193). To assess the therapeutic effect of DSC-TACE in the treatment of HCC, patients with HCC were divided into four groups, including the conventional TACE (c-TACE) group (26 patients), the sorafenib group (18 patients), the c-TACE plus sorafenib group (26 patients), and the DSC-TACE plus sorafenib group (24 patients). The major clinicopathological features of the enrolled patients are shown in Supplementary Table 1, http://links.lww.com/CM9/C894.

In the article "A novel intracoronary hypothermia device reduces myocardial reperfusion injury in pigs" published in Vol. 137, Issue 20, of theChinese Medical Journal,^[1]the authors admit that they misplaced the pictures in the procedure of organizing the figure. The error does not affect the results and conclusions of the article. The updated and corrected Figure 2 is shown below. The authors deeply apologize for any inconvenience caused.