Chinese Medical Journal最新文献

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for severe aplastic anemia (SAA). In China, the number of SAA patients undergoing allo-HSCT has risen considerably. However, owing to variations in clinical practices between China and other countries, certain aspects of transplantation demonstrate unique and distinct characteristics. To address these unique challenges and standardize clinical practice, we developed evidence-based guidelines tailored to the management of Chinese SAA patients undergoing allo-HSCT.

Methods: This clinical practice guideline was developed using the Evidence to Decision framework and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to formulate evidence-based recommendations. In instances where high-quality evidence was lacking, the Delphi method was used to integrate expert opinions. The guidelines adhere to the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework and the Reporting Items for Practice Guidelines in Health Care (RIGHT) statement to ensure methodological rigor and transparency.

Results: The guidelines present 32 recommendations encompassing key aspects of allo-HSCT for SAA, including patient eligibility criteria, donor and graft selection, pretransplant assessment, conditioning strategies, graft-versus-host disease prophylaxis, early management of posttransplant complications, and long-term follow-up. These recommendations are based on the latest clinical evidence and expert consensus, offering a structured approach to optimize transplantation outcomes.

Conclusions: These guidelines establish standardized protocols to enhance allo-HSCT management for SAA in China by integrating current evidence and expert consensus. Its widespread adoption is expected to improve donor selection strategies, conditioning regimen applications, posttransplant care, and long-term patient outcomes. Ultimately, these recommendations aim to increase the quality of patient care, improve survival rates, and contribute to the advancement of national health care standards.

Background: Visual input supports locomotion through sensorimotor integration. However, the neural mechanisms underlying how the brain adapts to degraded vision are not well understood. This study investigated the effects of visual occlusion on interactions between regions within the sensorimotor network.

Methods: Twelve healthy young adults (8 males, 4 females; mean age 24.0 ±2.1 years) were recruited from the Department of Ophthalmology at Peking University Third Hospital between December 2024 and September 2025. Pattern-reversal visual evoked potentials were recorded under both normal vision and visual occlusion condition (Snellen 20/60 acuity). We acquired resting-state functional magnetic resonance imaging (rs-fMRI) data to calculate the amplitude of low-frequency fluctuations (ALFF) and seed-based functional connectivity (FC) focused on visuomotor integration regions. A one-way repeated-measures analysis of variance was conducted with three within-subject conditions: seated rest, level walking with normal vision, and level walking with visual occlusion.

Results: Stimuli consisted of checkerboard patterns with large (1°) and small (15') checks. Under 1° visual stimulation, visual occlusion prolonged binocular P100 latency (117.00 ± 8.55 ms vs. 111.81 ± 5.12 ms; 116.78 ± 9.79 ms vs. 110.96 ± 4.28 ms; all P <0.05) and reduced N75-P100 amplitude (5.798 ± 2.372 μV vs. 8.613 ± 3.949 μV; 6.230 ± 2.459 μV vs. 7.453 ± 2.692 μV, all P <0.05). For 15' stimulation, occlusion decreased both binocular N75-P100 (5.935 ± 3.500 μV vs. 10.794 ± 5.249 μV; 3.991 ± 1.585 μV vs. 10.361 ± 3.143 μV, all P <0.001) and P100-N135 amplitudes (6.218 ± 3.516 μV vs. 12.499 ± 4.236 μV; 4.427 ± 2.218 μV vs. 10.767 ± 4.904 μV, all P <0.001). Rs-fMRI analysis showed reduced ALFF in the right paracentral lobule after walking (peak Montreal Neurological Institute (MNI) coordinates: 3, -39, 66; P <0.001, F = 14.009). Walking activated multiple visuomotor pathways (all P <0.001), including the bilateral calcarine and middle temporal gyri, the right calcarine and middle frontal gyri, the bilateral supplementary motor area and right cuneus, and the bilateral precentral gyrus and right cerebellar lobule VI. The visual occlusion strengthened FC between the right precentral and the right middle frontal gyri (peak MNI: 27, 57, 27; F = 16.456, P <0.001).

Conclusions: Basic visuomotor pathways demonstrate consistent activation to maintain locomotion. Increased functional connectivity between the right precentral and middle frontal gyri serves as a compensatory mechanism for reduced visual input.

Abstract: This comprehensive review explores the atypical metabolic roles of metabolites, extending beyond their conventional functions in energy production and biosynthesis. It systematically discusses how metabolites serve as substrates for post-translational protein modifications (PTMs), including lactylation, acetylation, and palmitoylation, detailing their metabolic origins, enzymatic regulation, and impacts on development, homeostasis, and diseases. Additionally, the review highlights how metabolites and metabolic enzymes act as signaling molecules to modulate intracellular and intercellular signal transduction, influencing processes like cell differentiation, survival, and proliferation. Unlike previous reviews, this work integrates PTM mechanisms with metabolic signaling networks, aiming to inspire research on metabolic regulation in health and disease, and to identify novel therapeutic targets.

Background: The landscape of metastatic castration-resistant prostate cancer (mCRPC) treatment has evolved greatly; however, limited data are available regarding its relative efficacy and safety. We conducted a systematic review and network meta-analysis to analyze and compare the effectiveness and safety of first-line therapies for mCRPC, particularly doublet therapy and monotherapy.

Methods: The PubMed, Embase, and Cochrane Library databases were searched from their inception until June 6, 2023. ClinicalTrials.gov and congress abstracts were also searched. We selected randomized controlled trials (RCTs) in English that reported the first-line treatment outcomes of mCRPC. The primary efficacy outcomes included radiographic progression-free survival (rPFS), overall survival (OS), and safety outcomes included any adverse events (AEs) and grade 3 or higher AEs (grade ≥3 AEs). Considering only trials that used therapies without docetaxel (Doc) assess rPFS and no common arm between therapies with or without Doc in terms of OS and safety outcomes, two separate pairwise meta-analyses were conducted. We performed subgroup, metaregression, and sensitivity analyses to identify moderators and account for heterogeneity. The Cochrane risk-of-bias assessment tool was used to evaluate the quality of each study.

Results: Thirty-five RCTs with 24,400 patients comparing 30 treatments were analyzed. In the non-Doc group, poly (adenosine diphosphate-ribose) polymerase inhibitor (PARPi) doublet with androgen receptor signaling inhibitor (ARSI) conferred rPFS and OS improvements in patients with mCRPC, especially with alterations in homologous recombination repair (HRR) genes. In the Doc group, combination therapies showed no significant difference in OS compared to Doc. Regarding safety outcomes, ra-223 plus abiraterone and estramustine plus docetaxel showed the lowest risks of AEs in the non-Doc and Doc groups, respectively. The PARPi doublet with the ARSI had a relatively low ranking.

Conclusion: While raising concerns about safety profiles, our findings highlight that the PARPi doublet with ARSI probably has the greatest benefit in mCRPC patients with HRR gene alterations.

Registration: PROSPERO, No. CRD42023400452.