MedNexus
2025年 · 第138卷第22期
出版日期 2025-11-20电子版 ￥0.00元
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Consensus Statement
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结节性痒疹诊疗指南Li Zhang, Qingchun Diao, Xia Dou, Hong Fang, Songmei Geng, Hao Guo, Yaolong Chen, Chao Ji, Chengxin Li, Linfeng Li 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003732
摘要
结节性痒疹(Prurigo nodularis，PN)是一种慢性瘙痒性炎症性皮肤病，以对称分布于四肢背部和伸肌表面的过度角化丘疹和结节为特征，伴有严重瘙痒。PN对生活质量有严重影响。[
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风湿性疾病患者结核病诊断、治疗和预防实践指南Collaborative Group for Tuberculosis Prevention and Control in Patients with Rheumatic disease in China, Chinese Society of Clinical Epidemiology and Evidence-Based Medicine, Chinese Medical Association, Chinese Society of Rheumatology, Chinese Medical Association, Chinese Society of Tuberculosis, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003613
摘要
大约90%的个体感染结核分枝杆菌（MTB）不进展为活动性结核病（ATB），但仍处于无症状潜伏性结核病感染（LTBI）状态。风湿性疾病（RDs）的特征是免疫功能障碍，通常用糖皮质激素、免疫抑制剂和生物制剂治疗。疾病本身及其治疗使RD患者成为结核病（TB）感染和疾病进展的高危人群。保守估计表明，ATB的患病率比在普通人群中观察到的患病率高约2-5倍。RD和ATB均可导致多器官和多系统损害。RD和并发ATB的患者通常表现出复杂的临床表现，使诊断和治疗具有挑战性，并导致高死亡率。
Sino Recommendation
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驱动基因阳性非小细胞肺癌患者的术后辅助治疗Lung Cancer Treatment Collaboration Group, Chinese Medical Association
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003817
摘要
驱动基因突变的非小细胞肺癌（NSCLC）患者如何选择辅助治疗的药物？
Review Article
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精确肿瘤学中的计算病理学：从任务特定模型到基础模型的演变Yuhao Wang, Yunjie Gu, Xueyuan Zhang, Baizhi Wang, Rundong Wang, Xiaolong Li, Yudong Liu, Fengmei Qu, Fei Ren, Rui Yan 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003790
摘要
With the rapid development of artificial intelligence, computational pathology has been seamlessly integrated into the entire clinical workflow, which encompasses diagnosis, treatment, prognosis, and biomarker discovery. This integration has significantly enhanced clinical accuracy and efficiency while reducing the workload for clinicians. Traditionally, research in this field has depended on the collection and labeling of large datasets for specific tasks, followed by the development of task-specific computational pathology models. However, this approach is labor intensive and does not scale efficiently for open-set identification or rare diseases. Given the diversity of clinical tasks, training individual models from scratch to address the whole spectrum of clinical tasks in the pathology workflow is impractical, which highlights the urgent need to transition from task-specific models to foundation models (FMs). In recent years, pathological FMs have proliferated. These FMs can be classified into three categories, namely, pathology image FMs, pathology image-text FMs, and pathology image-gene FMs, each of which results in distinct functionalities and application scenarios. This review provides an overview of the latest research advancements in pathological FMs, with a particular emphasis on their applications in oncology. The key challenges and opportunities presented by pathological FMs in precision oncology are also explored.
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人工智能在医学影像分析中的作用Lu Wang, Shimin Zhang, Nan Xu, Qianqian He, Yuming Zhu, Zhihui Chang, Yanan Wu, Huihan Wang, Shouliang Qi, Lina Zhang 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003824
摘要
With the emergence of deep learning techniques based on convolutional neural networks, artificial intelligence (AI) has driven transformative developments in the field of medical image analysis. Recently, large language models (LLMs) such as ChatGPT have also started to achieve distinction in this domain. Increasing research shows the undeniable role of AI in reshaping various aspects of medical image analysis, including processes such as image enhancement, segmentation, detection in image preprocessing, and postprocessing related to medical diagnosis and prognosis in clinical settings. However, despite the significant progress in AI research, studies investigating the recent advances in AI technology in the aforementioned aspects, the changes in research hotspot trajectories, and the performance of studies in addressing key clinical challenges in this field are limited. This article provides an overview of recent advances in AI for medical image analysis and discusses the methodological profiles, advantages, disadvantages, and future trends of AI technologies.
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特异性RNA转录物：从概念到临床Qili Shi, Haochen Li, Zhiao Chen, Xianghuo He
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003805
摘要
Over the past decade, high-throughput RNA sequencing (RNA-seq) has vastly expanded our understanding of transcriptome dynamics in human physiology and disease. As a powerful tool for investigating systematic changes in RNA biology, RNA-seq has facilitated the discovery of novel functional RNA species. Mature RNA transcripts, which transmit genetic information from DNA to proteins, undergo intricate transcriptional and post-transcriptional regulation. This process allows a single gene to produce multiple RNA transcripts, each performing specific functions depending on the physiological or pathological context. Specific RNA transcripts (SRTs) are uniquely expressed in particular tissues or tumors and are closely associated with tissue-specific functions or disease states, particularly cancer. This review explores the generation of SRTs through key mechanisms, such as alternative splicing (AS), transcriptional regulation, polyadenylation (polyA), and the influence of transposable elements (TEs). We also examine their critical roles in normal tissue development and diseases, with an emphasis on their relevance to cancer. Furthermore, the potential applications of SRTs in diagnosing and treating diseases, especially malignancies, are discussed. By serving as diagnostic markers and therapeutic targets, SRTs hold significant promise in the development of personalized medicine and precision therapies. This review aims to provide new insights into the importance of SRTs in advancing the understanding and treatment of human diseases.
Original Article
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lecanemab在中国早期阿尔茨海默病患者中的安全性和有效性：来自多维真实世界研究的证据Wenyan Kang, Chao Gao, Xiaoyan Li, Xiaoxue Wang, Huizhu Zhong, Qiao Wei, Yonghua Tang, Peijian Huang, Ruinan Shen, Lingyun Chen 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003888
摘要
Introduction:
Lecanemab has shown promise in treating early Alzheimer’s disease (AD), but its safety and efficacy in Chinese populations remain unexplored. This study aimed to evaluate the safety and 6-month clinical outcomes of lecanemab in Chinese patients with mild cognitive impairment (MCI) or mild AD.
Methods:
In this single-arm, real-world study, participants with MCI due to AD or mild AD received biweekly intravenous lecanemab (10 mg/kg). The study was conducted at Hainan Branch, Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Patient enrollment and baseline assessments commenced in November 2023. Safety assessments included monitoring for amyloid-related imaging abnormalities (ARIA) and other adverse events. Clinical and biomarker changes from baseline to 6 months were evaluated using cognitive scales (mini-mental state examination [MMSE], montreal cognitive assessment [MoCA], clinical dementia rating-sum of boxes [CDR-SB]), plasma biomarker analysis, and advanced neuroimaging.
Results:
A total of 64 patients were enrolled in this ongoing real-world study. Safety analysis revealed predominantly mild adverse events, with infusion-related reactions (20.3%, 13/64) being the most common. Of these, 69.2% (9/13) occurred during the initial infusion and 84.6% (11/13) did not recur. ARIA-H (microhemorrhages/superficial siderosis) and ARIA-E (edema/effusion) were observed in 9.4% (6/64) and 3.1% (2/64) of participants, respectively, with only two symptomatic cases (one ARIA-E presenting with headache and one ARIA-H with visual disturbances). After 6 months of treatment, cognitive scores remained stable compared to baseline (MMSE: 22.33 ± 5.58 vs. 21.27 ± 4.30, P = 0.733; MoCA: 16.38 ± 6.67 vs. 15.90 ± 4.78, P = 0.785; CDR-SB: 2.30 ± 1.65 vs. 3.16 ± 1.72, P = 0.357), while significantly increasing plasma amyloid-β 42 (Aβ42) (+21.42%) and Aβ40 (+23.53%) levels compared to baseline.
Conclusions:
Lecanemab demonstrated a favorable safety profile in Chinese patients with early AD. Cognitive stability and biomarker changes over 6 months suggest potential efficacy, though high dropout rates and absence of a control group warrant cautious interpretation. These findings provide preliminary real-world evidence for lecanemab’s use in China, supporting further investigation in larger controlled studies.
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老年妇女乳腺癌的全球、地区、国家发病率和死亡率：一项基于人群的癌症登记数据分析Chao Li, Shaoyuan Lei, Yan Xu, Yongqiang Zhang, Lin Li, Rongshou Zheng, Li Ding
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003667
摘要
Background:
The burden of breast cancer for older adults has been rising with the increasing population aging. This study aims to describe the burden of breast cancer in older adults worldwide, analyze the temporal trends for older breast cancer incidence, and assess the socioeconomic inequalities of breast cancer incidence and mortality with human development index (HDI) levels, which will provide valuable information in preventing and controlling the increasing breast cancer burden in older women.
Methods:
The incidence and mortality rates of specific cancer types in older individuals in 2022 were sourced from the Global Cancer Today database. Trends in breast cancer incidence acquired from the Cancer Incidence in Five Continents (CI5) database. HDI and other risk factors were obtained from the United Nations. We used a generalized linear model to estimate the rate ratio and 95% confidence interval (CI) between HDI levels and breast cancer burden in older people.
Results:
It was estimated approximately 1,058,466 newly diagnosed breast cancer cases and 383,774 breast cancer deaths in women ≥60 years, accounting for 18.9% and 12.7% of global cancer cases and deaths. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were 172.9 and 57.7 per 100,000, ranking first and second among all cancer incidence and mortality in older women. The highest ASIR and ASMR were four-fold higher than the lowest, with ASIR ranging from a peak of 399.1 per 100,000 in Australia-New Zealand to a low of 90.6 per 100,000 in South Central Asia, and ASMR varying from a high of 118.6 per 100,000 in Melanesia to a low of 28.8 per 100,000 in East Asia. The largest increases in ASIR from 1998-2002 to 2013-2017 were observed in South Korea, China, and Estonia. The corresponding estimated 5-year average percentage changes (EAPC) were 6.01%, 2.89%, and 1.93%, respectively.
Conclusions:
The global burden of breast cancer in older women is increasing fast and varies greatly across countries. Effective prevention strategies are essential to address the increasing breast cancer burden for older women.
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50万中国男性和女性与后代数量相关的全现象发病率和死亡率风险谱：一项前瞻性队列研究Meng Xiao, Aolin Li, Canqing Yu, Yuanjie Pang, Pei Pei, Ling Yang, Yiping Chen, Huaidong Du, Yujie Hua, Junshi Chen 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003815
摘要
Background:
Prospective evidence on how offspring number influences morbidity and mortality remains limited. This study investigated the associations between number of offspring and morbidity and mortality risks among 0.5 million Chinese adults.
Methods:
By using data from the China Kadoorie Biobank (CKB; n = 512,723, an approximately 12-year follow-up), sex-stratified phenome-wide association study (PheWAS) analyses were conducted to investigate associations between offspring number (without vs. with offspring; more than one vs. one offspring) and risks of ICD10-coded morbidity and mortality. Sex-specific adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated by Cox proportional-hazards models.
Results:
Among 210,129 men and 302,284 women aged 30-79 years, 1,338,837 incident events were recorded. PheWAS results revealed that offspring number was associated with disease risks across multiple systems. Cox models showed that childless men (vs. one offspring) had higher risks for nine of 36 diseases, while childless women for five of 37. Each additional offspring was associated with reduced risks of mental and behavioral disorders in men (aHR [95% CI] = 0.93 [0.87-0.98]) and both mental and behavioral disorders (aHR [95% CI] = 0.93 [0.89-0.97]) and breast cancer (aHR [95% CI] = 0.82 [0.78-0.86]) in women. However, each additional offspring was associated with a 4% increase in the risk of cholelithiasis and cholecystitis in women (aHR [95% CI] = 1.04 [1.02-1.07]). Among 282,630 patients, 44,533 deaths were documented. Childless patients had higher mortality risk in both men (aHR [95% CI] = 1.37 [1.28-1.47]) and women (aHR [95% CI] = 1.27 [1.15-1.41]). For men, each additional offspring reduced mortality by 4% (aHR [95% CI] = 0.96 [0.95-0.98]), while for women, the lowest risk was observed among those with three to four offspring (Pnonlinear <0.0001).
Conclusions:
Offspring number is closely linked to morbidity and mortality risks. Further research is warranted to verify our findings and clarify the underlying mechanisms involved.
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基于沃诺拉赞的四联疗法在以下方面不劣于基于埃索美拉唑的四联疗法幽门螺杆菌根除：一项多中心、双盲、随机、3期研究Zhiqiang Song, Qin Du, Guoxin Zhang, Zhenyu Zhang, Fei Liu, Nonghua Lu, Liqun Gu, Shingo Kuroda, Liya Zhou
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003437
摘要
Background:
Owing to the high prevalence of antibiotic resistance in Helicobacter pylori (H. pylori) in China, bismuth-containing quadruple therapies have been recommended for H. pylori eradication. This study compared the efficacy and safety of quadruple regimens containing vonoprazan vs. esomeprazole for H. pylori eradication in a patient population in China.
Methods:
This was a phase 3, multicenter, randomized, double-blind study. Patients with confirmed H. pylori infection were randomized 1:1 to receive quadruple therapy for 14 days: amoxicillin 1000 mg and clarithromycin 500 mg after meals, bismuth potassium citrate 600 mg before meals, plus either vonoprazan 20 mg or esomeprazole 20 mg before meals, all twice daily. The primary outcome was the eradication rate of H. pylori, evaluated using a 13C urea breath test at 4 weeks after treatment. The non-inferiority margin was at 10%.
Results:
The study included 510 patients, 506 of whom completed the follow-up assessment. The primary analysis revealed eradication rates of 86.8% (210/242) and 86.7% (208/240) for vonoprazan and esomeprazole therapy, respectively (treatment difference: 0.1%; 95% confidence interval [CI]: -5.95, 6.17; non-inferiority P = 0.0009). Per-protocol analysis showed eradication rates of 87.4% for vonoprazan and 86.3% for esomeprazole (treatment difference: 1.2%; 95% CI: -5.03, 7.36; non-inferiority P = 0.0004). Vonoprazan and esomeprazole were well tolerated, with similar safety profiles.
Conclusion:
Vonoprazan was found to be well-tolerated and non-inferior to esomeprazole for eradicating H. pylori in patients from China.
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代谢相关脂肪性肝病的全球负担：2021年全球疾病负担研究的系统分析Yichen Wang, Xiaoquan Huang, Sitao Ye, Tian Li, Yuting Huang, Mahesh Cheryala, Shiyao Chen
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003517
摘要
Background:
Metabolic-associated fatty liver disease (MAFLD) is a common liver disease and may become the leading cause of severe liver disease in the future. The Global Burden of Disease (GBD) study assesses MAFLD’s impact in countries and regions worldwide, providing insights into its prevalence.
Methods:
Prevalence data for MAFLD from 1990 to 2021 by country and region in all sex and age groups were collected from the Global Health Data Exchange. The categorization of countries and geographic areas by development was performed using the Sociodemographic Index (SDI).
Results:
Between 1990 and 2021, the global crude prevalence rate of MAFLD increased from 10.6% to 16.1% (beta-coefficient: 0.2%, 95% confidence interval [CI]: 0.2-0.2%, P <0.001), and the age-standardized prevalence rate was increased from 12.1% to 15.0% (beta-coefficient: 0.1%, 95% CI: 0.1-0.1%, P <0.001). In 2021, MAFLD was estimated to have affected 1.3 billion people worldwide. Significant uptrends were observed in all regions, super regions, and SDI categories. The fastest increase from 1990 to 2021 and the highest prevalence rate in 2021 were experienced by countries and territories with high-middle and middle SDI. An increase in the prevalence of MAFLD from 1990 to 2021 was demonstrated in all but six countries.
Conclusions:
In 2021, the number of patients affected by MAFLD was doubled compared to 1990, and the prevalence rate increased by over 50%. The burden of MAFLD, as measured by prevalence, was more prominent in countries and territories with middle SDI and in those located in North African and Middle Eastern, possibly due to changes in lifestyle in these areas over the past 30 years.
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患者报告的健康状况vs急性心力衰竭患者N-末端B型利钠肽前体水平Jingkuo Li, Lubi Lei, Wei Wang, Yan Li, Yanwu Yu, Boxuan Pu, Yue Peng, Xiqian Huo, Lihua Zhang
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003555
摘要
Background:
Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels may not fully translate into patient-reported health status in patients with heart failure (HF). We aimed to evaluate the correlation between NT-proBNP levels and patient-reported health status changes at one month after discharge of patients, and their associations with risk of death and rehospitalization in patients with acute HF.
Methods:
We used data from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (PEACE 5p-HF Study). Patient-reported health status was measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Patients who were hospitalized for HF and completed the KCCQ-12 and NT-proBNP tests before and one month after discharge were eligible in our study. We stratified patients into different groups based on NT-proBNP levels (i.e., improved, stable, and deteriorated) and KCCQ-12 scores (i.e., not deteriorated and deteriorated). We also examined the associations of the joint NT-proBNP and KCCQ-12 change with the risk of one-year and four-year clinical outcomes.
Results:
A total of 2461 patients were included in the analysis. The mean age was 64.06 ± 13.51 years, and 36.37% (895/2461) of the study population were female. Among patients with improved NT-proBNP levels, 115 (10.95%) patients had deteriorated KCCQ-12 scores. The correlation between the change in the KCCQ-12 score and NT-proBNP level was weak (r2 = 0.002, P = 0.013). Stratification by changes in the KCCQ-12 score revealed subgroups with distinctive risks, such that patients with deteriorated KCCQ-12 scores in any of the NT-proBNP change groups exhibited an increased risk of one-year all-cause death than participants with not deteriorated KCCQ-12 scores in any of the NT-proBNP change groups. Patients with improved NT-proBNP levels and deteriorated KCCQ-12 scores presented greater risks of one-year all-cause death (hazard ratio [HR]: 2.45, 95% confidence interval [CI]: 1.34-4.48) than patients with stable NT-proBNP levels and not deteriorated KCCQ-12 scores (HR [95% CI], 1.77 [1.25-2.53]).
Conclusions:
A discrepancy between changes in NT-proBNP levels and KCCQ-12 scores was common. The change in NT-proBNP levels was not sufficient to characterize critical aspects related to HF during one month after discharge of patients. Changes in the KCCQ-12 score exhibit complementary information to NT-proBNP levels for the prediction of clinical outcomes in patients with acute HF.
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接受或不接受免疫检查点抑制剂新辅助治疗的非小细胞肺癌患者的真实世界长期结局Bolun Zhou, Lin Li, Fan Zhang, Qilin Huai, Liang Zhao, Fengwei Tan, Qi Xue, Wei Guo, Shugeng Gao
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003551
摘要
Background:
Immune checkpoint inhibitors (ICIs) have been included in various neoadjuvant therapy (NAT) regimens for non-small cell lung cancer (NSCLC). However, due to the relatively short period for the use of ICIs in NAT, patients’ clinical outcomes with different regimens are uncertain. Our study aims to examine the efficacy of neoadjuvant immunotherapy (NAIT) for NSCLC patients and compare the overall survival (OS) and event-free survival (EFS) of patients receiving different NAT regimens.
Methods:
This study retrospectively included 308 NSCLC patients treated with different NAT regimens and subsequent surgery in National Cancer Center between August 1, 2016 and July 31, 2022. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were conducted to evaluate the prognosis of patients.
Results:
With a median follow-up of 27.5 months, the 1-year OS rates were 98.8% and 96.2%, and the 2-year OS rates were 96.6% and 85.8% in patients of the NAIT and neoadjuvant chemotherapy (NACT) group, respectively (hazard ratio [HR], 0.339; 95% confidence interval [CI], 0.160-0.720; P = 0.003). The 1-year EFS rates were 96.0% and 88.0%, and the 2-year EFS rates were 92.0% and 77.7% for patients in the NAIT and NACT groups, respectively (HR, 0.438; 95% CI, 0.276-0.846; P = 0.010). For patients who did not achieve pathological complete response (pCR), significantly longer OS (P = 0.012) and EFS (P = 0.019) were observed in patients receiving NAIT than those receiving NACT. Different NAT regimens had little effect on surgery and the postoperative length of stay (6 [4, 7] days vs. 6 [4, 7] days, Z = -0.227, P = 0.820).
Conclusions:
NAIT exhibited superior efficacy to NACT for NSCLC, resulting in longer OS and EFS. The OS and EFS benefits were also observed among patients in the NAIT group who did not achieve pCR.
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情绪困扰的早期发现和管理对非精神病住院患者住院时间的影响：一项基于医院的回顾性队列研究Wanjun Guo, Huiyao Wang, Wei Deng, Zaiquan Dong, Yang Liu, Shanxia Luo, Jianying Yu, Xia Huang, Yuezhu Chen, Jialu Ye 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003599
摘要
Background:
While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients.
Methods:
This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS (n = 178,883) and non-BS-GPS (n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively.
Results:
The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.
Conclusion:
Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
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人脐带间充质干细胞在新冠肺炎患者中的安全性和有效性：一项真实世界观察Siyu Wang, Tao Yang, Tiantian Li, Lei Shi, Ruonan Xu, Chao Zhang, Zerui Wang, Ziying Zhang, Ming Shi, Zhe Xu 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003459
摘要
Background:
The effects of human umbilical cord-derived mesenchymal stem cell (UC-MSC) treatment on coronavirus disease 2019 (COVID-19) patients have been preliminarily characterized. However, real-world data on the safety and efficacy of intravenous transfusions of MSCs in hospitalized COVID-19 patients at the convalescent stage remain to be reported.
Methods:
This was a single-arm, multicenter, real-word study in which a contemporaneous external control was included as the control group. Besides, severe and critical COVID-19 patients were considered together as the severe group, given the small number of critical patients. For a total of 110 patients, 21 moderate patients and 31 severe patients were enrolled in the MSC treatment group, while 26 moderate patients and 32 severe patients were enrolled in the control group. All patients received standard treatment. The MSC treatment patients additionally received intravenous infusions of MSCs at a dose of 4 × 107 cells on days 0, 3, and 6, respectively. The clinical outcomes, including adverse events (AEs), lung lesion proportion on chest computed tomography, pulmonary function, 6-min walking distance (6-MWD), clinical symptoms, and laboratory parameters, were measured on days 28, 90, 180, 270, and 360 during the follow-up visits.
Results:
In patients with moderate COVID-19, MSC treatment improved pulmonary function parameters, including forced expiratory volume in the first second (FEV1) and maximum forced vital capacity (VCmax) on days 28 (FEV1, 2.75 [2.35, 3.23] vs. 2.11 [1.96, 2.35], P = 0.008; VCmax, 2.92 [2.55, 3.60] vs. 2.47 [2.18, 2.68], P = 0.041), 90 (FEV1, 2.93 [2.63, 3.27] vs. 2.38 [2.24, 2.63], P = 0.017; VCmax, 3.52 [3.02, 3.80] vs. 2.59 [2.45, 3.15], P = 0.017), and 360 (FEV1, 2.91 [2.75, 3.18] vs. 2.30 [2.16, 2.70], P = 0.019; VCmax,3.61 [3.35, 3.97] vs. 2.69 [2.56, 3.23], P = 0.036) compared with the controls. In addition, in severe patients, MSC treatment notably reduced the proportion of ground-glass lesions in the whole lung volume on day 90 (P = 0.045) compared with the controls. No difference in the incidence of AEs was observed between the two groups. Similarly, no significant differences were found in the 6-MWD, D-dimer levels, or interleukin-6 concentrations between the MSC and control groups.
Conclusions:
Our results demonstrate the safety and potential of MSC treatment for improved lung lesions and pulmonary function in convalescent COVID-19 patients. However, comprehensive and long-term studies are required to confirm the efficacy of MSC treatment.
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三氧化二砷预处理减轻小鼠肝缺血再灌注损伤：ERK/AKT和自噬的作用Chaoqun Wang, Hongjun Yu, Shounan Lu, Shanjia Ke, Yanan Xu, Zhigang Feng, Baolin Qian, Miaoyu Bai, Bing Yin, Xinglong Li 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003411
摘要
Background:
Arsenic trioxide (ATO) is indicated as a broad-spectrum medicine for a variety of diseases, including cancer and cardiac disease. While the role of ATO in hepatic ischemia/reperfusion injury (HIRI) has not been reported. Thus, the purpose of this study was to identify the effects of ATO on HIRI.
Methods:
In the present study, we established a 70% hepatic warm I/R injury and partial hepatectomy (30% resection) animal models in vivo and hepatocytes anoxia/reoxygenation (A/R) models in vitro with ATO pretreatment and further assessed liver function by histopathologic changes, enzyme-linked immunosorbent assay, cell counting kit-8, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Small interfering RNA (siRNA) for extracellular signal-regulated kinase (ERK) 1/2 was transfected to evaluate the role of ERK1/2 pathway during HIRI, followed by ATO pretreatment. The dynamic process of autophagic flux and numbers of autophagosomes were detected by green fluorescent protein-monomeric red fluorescent protein-LC3 (GFP-mRFP-LC3) staining and transmission electron microscopy.
Results:
A low dose of ATO (0.75 µmol/L in vitro and 1 mg/kg in vivo) significantly reduced tissue necrosis, inflammatory infiltration, and hepatocyte apoptosis during the process of hepatic I/R. Meanwhile, ATO obviously promoted the ability of cell proliferation and liver regeneration. Mechanistically, in vitro studies have shown that nontoxic concentrations of ATO can activate both ERK and phosphoinositide 3-kinase-serine/threonine kinase (PI3K-AKT) pathways and further induce autophagy. The hepatoprotective mechanism of ATO, at least in part, relies on the effects of ATO on the activation of autophagy, which is ERK-dependent.
Conclusion:
Low, non-toxic doses of ATO can activate ERK/PI3K-AKT pathways and induce ERK-dependent autophagy in hepatocytes, protecting liver against I/R injury and accelerating hepatocyte regeneration after partial hepatectomy.
Viewpoint
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中国专家对“糖尿病足”到“糖尿病相关足病”定义变化的看法Jun Xu, Wuquan Deng, Zhangrong Xu, Xingwu Ran
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003819
摘要
2023年5月13日在荷兰海牙举行的第九届糖尿病足国际研讨会期间发布了2023年版糖尿病足国际工作组(IWGDF)糖尿病相关足病预防和管理指南。这些指南包括对相关术语和定义的更改，特别是将“糖尿病足”替换为“糖尿病相关足病”，将“糖尿病足溃疡”替换为“糖尿病相关足溃疡”。前一种变化不仅包括术语的修改，还包括定义的变更，而后一种变化仅构成文本调整，没有改变基本定义。[
Correspondence
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gemox、乐伐替尼和PD-1阻断剂的组合vs.gemox单药治疗肝内胆管癌伴转移的一线治疗Wenjing Zhang, Wei Liang, Hongji You, Yali Li, Qinqiu He, Wang Wei, Qunfang Zhou, Fei Tuo
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003765
摘要
致编辑：肝内胆管癌（ICC）在肝脏恶性肿瘤中排名第二，全身化疗是目前晚期ICC患者控制肿瘤的选择。[
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R-DA-EPOCH方案治疗HIV相关伯基特淋巴瘤患者的预后：中国上海的单中心经验Yueming Shao, Zhenyan Wang, Wei Song, Yang Tang, Tangkai Qi, Li Liu, Jun Chen, Yinzhong Shen, Renfang Zhang
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003666
摘要
致编辑：HIV相关淋巴瘤，特别是弥漫性大B细胞淋巴瘤（DLBCL）和伯基特淋巴瘤（BL），是HIV感染者（PWH）中最常见的恶性肿瘤，显著增加了发病率和死亡率。[
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通过共同注意深度学习整合放射学和组织学预测转移性前列腺癌患者的无进展生存期Yuanshen Zhao, Feng Liu, Chaofan Zhu, Chongzhe Yan, Bangkang Fu, Junjie He, Xin Xie, Rongpin Wang, Zhicheng Li
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003697
摘要
致编辑：在前列腺癌治疗，特别是转移性前列腺癌（mPCa）的发展前景中，向去势抵抗性前列腺癌（CRPC）的转变代表了一个关键挑战。[
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动态步态参数揭示前交叉韧带重建后膝关节功能恢复的长期代偿特征：一项回顾性队列研究Qitai Lin, Zehao Li, Meiming Li, Yongsheng Ma, Wenming Yang, Yugang Xing, Yang Liu, Ruifeng Liang, Yixuan Zhang, Ruipeng Zhao 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003719
摘要
致编辑：前交叉韧带（ACL）断裂是一种常见的膝关节损伤，它改变了膝关节运动学，包括关节内运动和力，导致膝关节复发性功能不稳定。在美国，估计每年有200,000例ACL破裂，ACL破裂很普遍，尤其是在年轻的身体活跃的个体中。[
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开始乳腺癌筛查的家族史调整年龄建议：一项前瞻性队列研究的7年随访Juan Zhu, Le Wang, Weiwei Gong, Xue Li, Youqing Wang, Chen Zhu, Huizhang Li, Lei Shi, Chen Yang, Lingbin Du
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003797
摘要
致编辑：乳腺癌仍然是全球女性癌症发病率和死亡率的主要原因。[
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的关键作用KRT6A间质性膀胱炎：机器学习识别膀胱疼痛、免疫和纤维化的特征基因Li Tao, Xuejian Zhou, Ying Xiao, Xingwei Jin, Qizhang Wang, Boke Liu, Tianxiang Zheng, Liming Song, Yuan Shao
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003728
摘要
致编辑：间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种慢性炎症性疾病，其特征是持续性骨盆疼痛、尿急、尿频和膀胱纤维化，显著降低患者的生活质量。[
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在中国北方无脂肪肝病的甲状腺功能正常人群中，低正常FT3和FT3/FT4比值与血清脂蛋白(a)水平升高相关Honglin Sun, Jiaxuan Wang, Xiaoyu Ding, Ying Wang, Guang Wang, Jia Liu
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003821
摘要
致编辑脂蛋白(a)(Lp[a])是仅在肝脏中产生的富含胆固醇酯的脂蛋白，包含两种主要成分：含有载脂蛋白B(apoB)的低密度脂蛋白(LDL)样颗粒和通过二硫桥连接至apoB的糖蛋白载脂蛋白(a)(apo[a])。[
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放射性碘治疗对侵袭性甲状腺乳头状癌癌症特异性生存率的预后意义Ziyang Ye, Genpeng Li, Tao Wei, Jingqiang Zhu, Zhihui Li, Jianyong Lei
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003825
摘要
致编辑：甲状腺乳头状癌（PTC）是最常见的内分泌恶性肿瘤，大多数患者获得良好的长期预后。[
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中国重症监护病房的疼痛、激越和谵妄实践：一项全国性多中心调查研究Xiaofeng Ou, Lijie Wang, Jie Yang, Pan Tao, Cunzhen Wang, Minying Chen, Xuan Song, Zhiyong Liu, Zhenguo Zeng, Man Huang 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003814
摘要
致编辑：疼痛—激越—谵妄（PAD）的标准化管理是重症监护室（ICU）临床实践的基本组成部分。[
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抢先免疫治疗KMT2A异基因干细胞移植后重排急性白血病Jing Liu, Shuang Fan, Xiaohui Zhang, Lanping Xu, Yu Wang, Yifei Cheng, Chenhua Yan, Yuhong Chen, Yuanyuan Zhang, Meng Lv 等
中华医学杂志英文版2025年 138卷 22期
DOI: 10.1097/CM9.0000000000003720
摘要
致编辑：涉及赖氨酸甲基转移酶2A的重排（KMT2A）代表急性白血病（AL）中的复发性遗传异常，通常与不良临床结局相关。[
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