Volume 137 · Issue 24 · 2024

自发性脑出血（ICH）占全球所有中风的10-30%，在亚洲人、西班牙裔和非裔美国人中更为普遍。^[1,2,3]未控制的高血压和抗凝剂的使用是自发性脑出血的常见原因。^[4,5,6]非对比头部计算机断层扫描（CT）对脑出血的诊断非常敏感。CT血管造影（CTA）、磁共振血管造影（MRA）或导管血管造影可排除血管异常和其他潜在病因，尤其是在年轻患者中。^[3]意识水平低下、脑出血体积大、脑室内延伸和血肿扩张是脑出血后不良预后的预测因素。^{[7,8,9,10,11]}尽管早期开创性的外科治疗研究显示出有希望的结果，^[12,13]随后的里程碑式随机对照试验（RCT），包括脑出血手术试验（STICH）、STICH II和微创手术加阿替普酶用于脑出血清除III期（MISTIE III），未能显示手术清除的明确结局获益。^{[14,15,16,17]}针对血肿扩张的药物治疗，如将收缩压（SBP）强化降低至140 mmHg以下，用Andexanet alfa、重组活化因子VII（rFVIIa）或氨甲环酸逆转抗凝或止血治疗，显示血肿扩张减少，但无显著结局获益。^{[18,19,20,21,22,23]}

In China, hypertension is the most common chronic non-communicable disease and the most significant risk factor for cardiovascular mortality among urban and rural residents. To standardize the clinical diagnosis and treatment of hypertension and to improve the prevention and control level of hypertension in China, Chinese Society of Cardiology, Chinese Medical Association; Hypertension Committee of Cross-Straits Medicine Exchange Association; Cardiovascular Disease Prevention and Rehabilitation Committee, Chinese Association of Rehabilitation Medicine, jointly collaborated to formulate the Clinical Practice Guideline for Hypertension Management in China. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and strength of recommendations, and the reporting items for practice guidelines in healthcare (RIGHT) were followed to establish the guideline. Detailed evidence-based recommendations for the diagnosis, evaluation, and treatment of 44 clinical questions in the field of hypertension, including essential and secondary hypertension, have been provided to guide clinical practice.

International Practice Guidelines Registry Platform, http://www.guidelines-registry.cn/, No. IPGRP-2021CN346.

Respiratory syncytial virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus of the Orthopneumovirus genus of the Pneumoviridae family in the order Mononegavirales. RSV can cause acute upper and lower respiratory tract infections, sometimes with extrapulmonary complications. The disease burden of RSV infection is enormous, mainly affecting infants and older adults aged 75 years or above. Currently, treatment options for RSV are largely supportive. Prevention strategies remain a critical focus, with efforts centered on vaccine development and the use of prophylactic monoclonal antibodies. To date, three RSV vaccines have been approved for active immunization among individuals aged 60 years and above. For children who are not eligible for these vaccines, passive immunization is recommended. A newly approved prophylactic monoclonal antibody, Nirsevimab, which offers enhanced neutralizing activity and an extended half-life, provides exceptional protection for high-risk infants and young children. This review provides a comprehensive and detailed exploration of RSV’s virology, immunology, pathogenesis, epidemiology, clinical manifestations, treatment options, and prevention strategies.

Cancer remains a major global health challenge, with conventional treatments like chemotherapy and radiotherapy often hindered by significant side effects, lack of specificity, and limited efficacy in advanced cases. Among emerging therapeutic strategies, mRNA vaccines have shown remarkable potential due to their adaptability, rapid production, and capability for personalized cancer treatment. This review provides an in-depth analysis of messenger RNA (mRNA) vaccines as a therapeutic approach for cancer immunotherapy, focusing on their molecular biology, classification, mechanisms, and clinical studies. Derived from reported literature and data on clinicaltrials.gov, it examines studies on mRNA vaccines encoding tumor-specific antigens (TSAs), tumor-associated antigens (TAAs), immunomodulators, and chimeric antigen receptors (CARs) across various cancer types. The review highlights the ability of mRNA vaccines to encode TSAs and TAAs, enabling personalized cancer treatments, and classifies these vaccines into non-replicating and self-amplifying types. It further explores their mechanisms of action, including antigen presentation and immune activation, while emphasizing findings from clinical studies that demonstrate the potential of mRNA vaccines in cancer therapy. Despite their promise, challenges remain in enhancing delivery systems, improving immunogenicity, and addressing tumor heterogeneity. Overcoming these obstacles will require further investigation to fully harness the potential of mRNA vaccines in personalized cancer treatment.

Regulatory T cell (Tregs) predominantly maintain the immune balance and prevent autoimmunity via their immunosuppressive functions. However, tumor-infiltrating Tregs (TI-Tregs) may mediate tumor immune tolerance in complex tumor microenvironments, resulting in poor prognosis. Distinguishing specific TI-Treg subpopulations from peripheral Tregs and intratumoral conventional T cells (Tconvs) has recently emerged as an important topic in antitumor therapy. In this review, we summarize novel therapeutic approaches targeting both the metabolic pathways and hallmarks of TI-Tregs in preclinical and clinical studies. Although the phenotypic and functional diversity of TI-Tregs remains unclear, our review provides new insights into TI-Treg-based therapies and facilitates precision medicine for tumor treatment.

The rise in global life expectancy has led to an increase in the older population, presenting significant challenges in managing infectious diseases. Aging affects the innate and adaptive immune systems, resulting in chronic low-grade inflammation (inflammaging) and immune function decline (immunosenescence). These changes would impair defense mechanisms, increase susceptibility to infections and reduce vaccine efficacy in older adults. Cellular senescence exacerbates these issues by releasing pro-inflammatory factors, further perpetuating chronic inflammation. Moreover, comorbidities, such as cardiovascular disease and diabetes, which are common in older adults, amplify immune dysfunction, while immunosuppressive medications further complicate responses to infections. This review explores the molecular and cellular mechanisms driving inflammaging and immunosenescence, focusing on genomic instability, telomere attrition, and mitochondrial dysfunction. Additionally, we discussed how aging-associated immune alterations influence responses to bacterial, viral, and parasitic infections and evaluated emerging antiaging strategies, aimed at mitigating these effects to improve health outcomes in the aging population.

In multiple areas such as science, technology, and economic activities, it is necessary to unify the management of repetitive tasks or concepts by standardization to obtain the best order and high efficiency. Organoids, as living tissue models, have rapidly developed in the past decade. Organoids can be used repetitively for in vitro culture, cryopreservation, and recovery for further utilization. Because organoids can recapitulate the parental tissues’ morphological phenotypes, cell functions, biological behaviors, and genomic profiles, they are known as renewable "living biobanks". Organoids cover two mainstream fields: Adult stem cell-derived organoids (also known as patient-derived organoids) and induced pluripotent stem cell-derived and/or embryonic stem cell-derived organoids. Given the increasing importance of organoids in the development of new drugs, standardized operation, and management in all steps of organoid construction is an important guarantee to ensure the high quality of products. In this review, we systematically introduce the standardization of organoid construction operation procedures, the standardization of laboratory construction, and available standardization documents related to organoid culture that have been published so far. We also proposed the challenges and prospects in this field.

Cellular senescence, an irreversible state of cell cycle arrest characterized by phenotypic changes and a specific secretory profile, plays a dual role in liver health and disease. Under physiological conditions, senescence aids organ repair and regeneration, but its accumulation due to aging or pathological stress significantly contributes to chronic liver diseases, including alcoholic liver disease, metabolic dysfunction-associated steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Senescence is identified by a range of cellular and molecular changes, such as morphological alterations, expression of cell cycle inhibitors, senescence-associated β-galactosidase activity, and nuclear membrane changes. The onset of senescence in organ cells can affect the entire organism, primarily through the senescence-associated secretory phenotype, which has autocrine, paracrine, and endocrine effects on tissue microenvironments. The objective of this review is to offer a contemporary overview of the pathophysiological events involving hepatic senescent cells and to elucidate their role in the onset and progression of liver diseases, particularly through mechanisms like telomere shortening, genomic and mitochondrial DNA damage, and inflammation. Additionally, this review discusses the emerging senolytic therapies aimed at targeting senescent cells to delay or mitigate liver disease progression. The therapeutic potential of these interventions, alongside their safety and effectiveness, highlights the need for further research to refine these approaches and address unresolved problems in the field of hepatic cellular senescence.

Nanomedicine is an interdisciplinary area that utilizes nanoscience and technology in the realm of medicine. Rapid advances in science and technology have propelled the medical sector into a new era. The most commonly used nanotechnology in the field of medicine is nanoparticles. Due to their unique physicochemical properties, nanoparticles offer significant benefits of precision medicine for diseases such as inflammatory bowel disease that cannot be effectively treated by existing approaches. Nanomedicine has emerged as a highly active research field, with extensive scientific and technological studies being carried out, as well as growing international competition in the commercialization of this field. The accumulation of expertise in the key technologies relating to nanomedicine would provide strategic advantages in the development of cutting-edge medical techniques. This review presented a comprehensive analysis of the primary uses of nanoparticles in medicine, including recent advances in their application for the diagnosis and treatment of inflammatory bowel disease. Furthermore, we discussed the challenges and possibilities associated with the application of nanoparticles in clinical settings.

With the rapid development of artificial intelligence technology, its applications in medical imaging have become increasingly extensive. This review aimed to analyze the current development status and future direction of intelligent imaging technology by investigating its application in various medical departments. To achieve this, we conducted a comprehensive search of various data sources up to 2024, including PubMed, Web of Science, and Google Scholar, based on the principle of comprehensive search. A total of 332 articles were screened, and after applying the inclusion and exclusion criteria, 56 articles were selected for this study. According to the findings, intelligent imaging technology exhibits robust image recognition capabilities, making it applicable across diverse medical imaging modalities within hospital departments. This technology offers an efficient solution for the analysis of various medical images by extracting and accurately identifying complex features. Consequently, it significantly aids in the detection and diagnosis of clinical diseases. Its high accuracy, sensitivity, and specificity render it an indispensable tool in clinical diagnostics and related tasks, thereby enhancing the overall quality of healthcare services. The application of intelligent imaging technology in healthcare significantly enhances the efficiency of clinical diagnostics, resulting in more accurate and timely patient assessments. This advanced technology offers a faster and more precise diagnostic approach, ultimately improving patient care and outcomes. This review analyzed the socioeconomic changes brought about by intelligent imaging technology to provide a more comprehensive evaluation. Also, we systematically analyzed the current shortcomings of intelligent imaging technology and its future development directions, to enable future research.

Cancer patterns in China are becoming similar to those in the United States (US). Comparing the recent cancer profiles, trends, and determinants in China and the US can provide useful reference data.

This study used open-source data. We used GLOBOCAN 2022 cancer estimates and United Nations population estimates to calculate cancer cases and deaths in both countries during 2024. Data on cancer incidence and mortality trends were obtained from the Surveillance, Epidemiology, and End Results (SEER) program and National Centre for Health Statistics in the US and cancer registry reports of the National Cancer Center (NCC) of China. Data from the Global Burden of Disease study (GBD) and a decomposition approach were used to estimate the contributions of four determinants to the change in cancer deaths.

In 2024, there are an estimated 3,246,625 and 2,510,597 new cancer cases and 1,699,066 and 640,038 cancer deaths in China and the US, respectively. The highest estimated cancer cases are lung cancer in China and breast cancer in the US. The age-standardized incidence rates of lung and colorectal cancer in the US, and stomach, liver, and esophageal cancer in China have decreased, but the incidence rates of liver cancer in the US and colorectal cancer, prostate cancer in men, and cervical cancer in women in China have increased. Increases in the adult population size and population aging are main reasons for the increase in cancer deaths; case fatality rates are a main reason for the decrease in cancer deaths in both countries.

China has made progress in cancer control but lags the US. Considering the transformation in China’s pattern of cancers epidemiology, it is imperative to develop stronger policies by adopting the cancer prevention and control strategies used in the US to address population aging and curb growing cancer trends.

Lifetime cancer risk is an index that indicates the cumulative probability of cancer at some age during a person’s lifetime. Nevertheless, comparative evaluations regarding the probability of developing lung cancer and dying from the disease among diverse populations at the global, regional, and national levels are scarce.

Lung cancer data from 185 countries were obtained from GLOBOCAN 2022, and data on any other cause of death were acquired from the United Nations. The lifetime risks of lung cancer development and death were estimated using adjustment for multiple primary cancers (AMP) method. The lung cancer risks in countries or regions worldwide were compared by region and the Human Development Index (HDI).

The global lifetime risk of developing and dying from lung cancer in 2022 was 3.49% and 2.69%, respectively. The lifetime probabilities of developing lung cancer in countries/areas with low, medium, high, and very high HDIs were 0.33%, 0.95%, 4.72%, and 5.29%, and dying from lung cancer in low, medium, high and very high HDI countries were 0.30%, 0.86%, 3.69% and 3.92%, respectively. After the age of 40 years, the remaining probability of lung cancer development and death decreased with age, leaving a residual risk of 2.00% and 1.71%, respectively, starting at 70 years.

The probability of developing lung cancer during one’s lifetime is equivalent to 1 in 28 and 1 in 37 people suffering and dying from lung cancer. The age-related risk of developing and dying of lung cancer varies among geographic locations with different HDIs.

The burden of esophageal cancer varies across different regions of the world. The aim of this study is to analyze the current burden of esophageal cancer in 185 countries in 2022 and to project the trends up to the year 2050.

We extracted data on primary esophageal cancer cases and deaths from the GLOBOCAN 2022 database, which includes data from 185 countries. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 person-years were calculated by stratifying by Human Development Index (HDI) levels and regions. Considering changes in population size and age structure, we assumed that the risks of incidence and mortality remain constant at the levels of 2022 to forecast the number of new cases and deaths from esophageal cancer globally by 2050.

In 2022, an estimated 511,054 people were diagnosed with esophageal cancer globally, and 445,391 died from the disease. The global ASIR and ASMR for esophageal cancer were 5.00 and 4.30 per 100,000, respectively. The highest rates were observed in East Africa (7.60 for incidence, 7.20 for mortality per 100,000), East Asia (7.60 for incidence, 5.90 for mortality per 100,000), Southern Africa (6.30 for incidence, 5.90 for mortality per 100,000), and South Central Asia (5.80 for incidence, 5.50 for mortality per 100,000). Among the 185 countries worldwide, esophageal cancer was among the top five causes of cancer incidence in 18 countries and among the top five causes of cancer mortality in 25 countries. In 2022, China had 224,012 new cases and 187,467 deaths from esophageal cancer, accounting for approximately 43.8% and 42.1% of the global total, respectively, which is higher than the proportion of China’s population to the global population (17.9%). ASIR was 8.30 per 100,000, and ASMR was 6.70 per 100,000. The highest burden of esophageal cancer was in high HDI countries, with new cases and deaths accounting for 51.3% and 50.0% of the global total, respectively. The ASIR and ASMR were highest in the high HDI group (6.10 and 5.10 per 100,000, respectively), also exceeding the global averages. There was a trend of decreasing mortality to incidence ratio with increasing HDI, but no correlation was observed between HDI and ASIR or ASMR. In all regions worldwide, the incidence and mortality rates were higher in males than in females (with a male-to-female ASR ratio ranging from 1.10 to 28.7). Compared to 2022, it is projected that by 2050, the number of new esophageal cancer cases will increase by approximately 80.5%, and deaths will increase by 85.4% due to population growth and aging.

The burden of esophageal cancer remains heavy. Adopting a healthy lifestyle, including reducing tobacco and alcohol intake, avoiding moldy foods, and increasing intake of fresh fruits and vegetables, can help reduce the risk of stomach and esophageal cancer. In addition, the development and implementation of evidence-based and effective public health policies are critical to reducing the global disease burden of esophageal cancer.

Biliary tract carcinomas (BTCs) are relatively rare but lethal primary malignant tumors derived from the biliary tract system. The burden of BTCs varies according to sex, age, region, and country, but limited attention has been paid to the burden of BTCs. We sought to explore the up-to-date data from the Global Burden of Disease Study (GBD) and expand findings by accessing the demographic features of BTC disease burden.

Using the latest data from the GBD 2021, we evaluated and analyzed the distributions and patterns of BTC disease burden in various age groups, sexes, regions, and countries.

The number of incident cases, deaths, and disability-adjusted life-years (DALYs) tended to increase and peaked at 216,770 (95% uncertainty interval [UI]: 181,890-245,240), 171,960 (95% UI: 142,350-194,240), and 3,732,100 (95% UI: 3,102,900-4,317,000) person-years, respectively, in 2021. However, the average global age-standardized rates (ASRs) of incident cases, deaths, and DALYs shrunk by -11.46% (95% UI: -21.91 to 3.35%), -24.09% (95% UI: -33.19 to 16.88%), and -26.25% (95% UI:-35.53 to 18.36%), respectively, from 1990 to 2021. Meanwhile, the male/female ratio (male per 100 female) of incidence, deaths, and DALYs changed from 76.40, 75.41, and 74.72 to 86.89, 79.11, and 82.29, respectively. In 2021, the highest number of incident cases, deaths, and DALYs occurred in East Asia. The top three highest incidences, deaths, and DALYs were observed in China, India, and Japan, and the highest ASRs were observed in Chile in 2021. Analysis of the Human Development Index along with disease burden estimates of BTCs also suggests that the burden of the disease is related to the level of comprehensive development of the society.

This study provided a comprehensive comparison of differences in the burden of disease across populations and over time, and further presented evidence concerning the formulation of prevention and control policies and etiologic studies for BTCs and proposed logical hypotheses to investigate.

Epidemiological studies have demonstrated a causal relationship between ambient ozone (O₃) and mortality from chronic obstructive pulmonary disease (COPD), which is the only outcome considered in the Global Burden of Disease Study 2021 for O₃. This study aims to evaluate the temporal trend and spatial distribution of the COPD burden attributable to O₃ across China from 1990 to 2021.

The ambient O₃ concentrations in China were estimated. Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we estimated the annual number, age-standardized rate, and percentage of deaths and disability-adjusted life-years (DALYs) from COPD attributable to O₃ pollution during 1990-2021 at the national and provincial levels in China.

In 2021, a total of 125.7 (95% uncertainty interval [UI], 26.4-228.3) thousand deaths and 1917.5 (95% UI, 398.7-3504.6) thousand DALYs from COPD were attributable to ambient O₃ pollution in China, accounting for 9.8% (95% UI, 2.1-17.0%) and 8.1% (95% UI, 1.8-14.1%) of the total COPD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in regions with worse health conditions. The age-standardized rates of COPD deaths and DALYs per 100,000 populations ranged from 0.5 (95% UI, 0-1.4) and 8.1 (95% UI, 0.7-20.9) in Hong Kong to 22.8 (95% UI, 3.9-43.5) and 396.6 (95% UI, 68.9-763.7) in Xizang. From 1990 to 2021, there was a notable decrease in the age-standardized rates of COPD-related deaths (68.2%, 95% UI, 60.1-74.9%) and DALYs (71.5%, 95% UI, 63.7-77.6%), especially in regions with poor health conditions. However, the attributable numbers and percentages changed relatively marginally.

Ambient O₃ pollution is a major contributor to the COPD burden in China. Our findings highlight the significant spatial heterogeneity across different provinces and underscore the implementation of geographically tailored policies to effectively reduce O₃ pollution and alleviate the associated disease burden.

致编辑：目前的联合抗逆转录病毒疗法（cART）可以有效抑制大多数人类免疫缺陷病毒-1（HIV，PLWH）感染者的血浆病毒载量。然而，大约20-30%接受cART的PLWH可能具有非常低但可检测的血浆病毒载量（<20拷贝/mL，市售测定中的定量限)，称为残留HIV-1低水平病毒血症(LLV)。^[1]残留HIV-1 LLV检测可以反映PLWH中HIV-1储库的来源和动态，从而在HIV-1管理和基础研究中发挥重要作用。^[2]

致编辑：在2019冠状病毒病（COVID-19）大流行期间，严重呼吸衰竭的患者需要呼吸机甚至更高水平的生命支持，使体外膜肺氧合（ECMO）成为人们关注的焦点。^[1]ECMO常用于重症心肺衰竭患者的抢救和治疗；其核心部件是膜肺（氧合器）和血泵，具有两种基本支持模式：静脉静脉（V-V）和静脉动脉（V-A）ECMO。新冠肺炎患者可能需要V-V ECMO治疗急性呼吸窘迫综合征，并且当需要联合心循环支持时；支持模式可以是V-A ECMO。

致编辑：根据最近一项调查1990年至2019年中国及其省份消化系统疾病负担的研究，食管癌在肿瘤性消化系统疾病中排名第三，而肝硬化在非肿瘤性消化系统疾病中发病率最高。^[1]内窥镜技术的最新进展显著提高了诊断和治疗早期食管癌（EEC）的能力。然而，由于与肝硬化导致的门静脉高压和肝功能异常相关的独特病理生理变化，在肝硬化患者中管理EEC提出了复杂的挑战。内窥镜治疗因需要避免或控制损伤性静脉曲张引起的大出血以及克服先前预防方式引起的粘膜下纤维化而变得复杂。本研究回顾了肝硬化患者EEC内镜治疗的最新临床研究结果，为内镜医师提供了有价值的见解。此外，已发表的报告集中于肝硬化患者早期食管病变的内镜治疗病例，总结在补充表1中，http：//links。lww.com/CM9/C187.

致编辑：光动力疗法（PDT）是鲜红斑痣（PWSs）的替代治疗选择，与脉冲染料激光（PDL）相比具有几个优点。^[1]然而，一些患者仍然经历治疗耐药性和显著的副作用。^[1]光学清除剂（OCA）已被证明可增强小鼠模型中的光穿透。^[2]因此，我们旨在评估联合OCA预处理是否可以改善临床PDT治疗结果，并研究不同类型的OCA，尤其是透明质酸微针（HA-MNs）在增强PDT方面的有效性。

致编辑：放射疗法是现代癌症治疗方式的重要组成部分，被诊断患有癌症的所有个体中近70%使用。然而，常规放射治疗（CONV-RT）会损害周围的健康组织，限制最大安全剂量，并可能降低治疗效果。最近的研究表明，超高剂量率放射治疗（FLASH-RT）在保持相同肿瘤控制的同时保留了健康组织。^[1]

致编辑：由于微创手术的发展，越来越多地进行单端口（SP）机器人手术。^[1]与传统的机器人和腹腔镜手术相比，SP机器人手术的优点是由于机器人的灵活性，提高了手术的精度；此外，切口更少更短，创伤最小，疤痕几乎看不见，没有“筷子效应”，恢复更快。2009年，考克等人^[2]率先使用SP机器人手术系统成功实施根治性前列腺切除术和根治性肾切除术，证明了SP机器人系统的安全性。由于淋巴结的解剖和手术范围的限制，SP机器人手术的实施在一定程度上受到限制。三脚架等人^[3]报道了SP机器人胃部分切除术治疗胃肠道间质瘤（GISTs）。崔等人^[4]报道了SP机器人全胃切除术治疗晚期胃癌，通过7 cm长的上腹部切口进行体外Roux-en-Y吻合术。公园等人^[5]报道了使用达芬奇SP机器人系统进行胃癌减少端口机器人远端胃切除术的安全性和可行性。然而，SP机器人系统在晚期胃癌患者根治术中的纯粹应用迄今为止尚未见报道。中国山东省立医院胃肠外科李乐平教授和尚良教授于2023年7月使用术锐SR-ENS-600 SP机器人系统成功实施了全球首例纯SP机器人晚期胃癌根治全胃切除术（SPRTG）[图1].