To the Editor: Li and Izpisua Belmonte (Feb. 7 issue)(1) systematically used organoids to establish various kinds of preclinical models of human diseases. However, they do not fully discuss possible modeling of the tumor immune microenvironment. We do not entirely agree with the authors that three-dimensional organoids are more limited than animal models because of their lack of vascularization and an immune system. Increasing numbers of studies have supported the use of three-dimensional organoid models for holistic study of the tumor immune microenvironment.(2-5) Three-dimensional organoids represent the in vivo interaction of tumor and immune cells in the tumor microenvironment, and . . .
To the Editor: In the ODYSSEY OUTCOMES trial, Schwartz et al. (Nov. 29 issue)(1) report that the proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor alirocumab could reduce the risk of recurrent ischemic cardiovascular events in patients who have had an acute coronary syndrome and are receiving intensive statin therapy. However, because less than 3% of these patients were receiving ezetimibe in addition to statin therapy, the trial might not support the use of alirocumab in similar patients in clinical practice. According to the latest guideline on the management of cholesterol,(2) ezetimibe should be added to statin therapy (given at the . . .
Asthma is one of the most common chronic respiratory diseases in the world. Despite advances in the understanding of the biologic characteristics of asthma and its treatment, many surveys continue to document suboptimal control in large proportions of patients around the world.(1,2) Both U.S. and international guidelines recommend the use of short-acting beta(2)-agonists (SABAs) as needed for the treatment of mild intermittent asthma.(3,4) When symptoms become persistent, the recommended treatment is an inhaled glucocorticoid taken on a regular basis, so-called maintenance therapy, which should lead to reduced use of a SABA. In reality, patients tend to rely on as-needed SABAs . . .
BackgroundIn 2017, surveillance for tickborne diseases in China led to the identification of a patient who presented to a hospital in Inner Mongolia with a febrile illness that had an unknown cause. The clinical manifestation of the illness was similar to that of tickborne encephalitis virus (TBEV) infection, but neither TBEV RNA nor antibodies against the virus were detected. MethodsWe obtained a blood specimen from the index patient and attempted to isolate and identify a causative pathogen, using genome sequence analysis and electron microscopy. We also initiated a heightened surveillance program in the same hospital to screen for other patients who presented with fever, headache, and a history of tick bites. We used reverse-transcriptase-polymerase-chain-reaction (RT-PCR) and cell-culture assays to detect the pathogen and immunofluorescence and neutralization assays to determine the levels of virus-specific antibodies in serum specimens from the patients. ResultsWe found that the index patient was infected with a previously unknown segmented RNA virus, which we designated Alongshan virus (ALSV) and which belongs to the jingmenvirus group of the family Flaviviridae. ALSV infection was confirmed by RT-PCR assay in 86 patients from Inner Mongolia and Heilongjiang who presented with fever, headache, and a history of tick bites. Serologic assays showed that seroconversion had occurred in all 19 patients for whom specimens were available from the acute phase and the convalescent phase of the illness. ConclusionsA newly discovered segmented virus was found to be associated with a febrile illness in northeastern China. (Funded by the National Key Research and Development Program of China and the National Natural Science Foundation of China.) A group of patients with a febrile illness and a history of tick bites was identified in northeastern China. A previously unknown virus was determined to be a possible etiologic agent. This virus was also found in ticks in the area.