Prevalence and associated risk factors of Helicobacter pylori infection in community households in Lanzhou city

BACKGROUND Helicobacter pylori(H.pylori)infection exhibits a familial clustering phenomenon.AIM To investigate the prevalence of H.pylori infection,identify associated factors,and analyze patterns of transmission within families residing in the community.METHODS From July 2021 to September 2021,a total of 191 families(519 people)in two randomly chosen community health service centers in the Chengguan District of Lanzhou in Gansu Province,were recruited to fill out questionnaires and tested for H.pylori infection.Individuals were followed up again from April 2023 and June 2023 to test for H.pylori infection.The relationship between variables and H.pylori infection was analyzed using logistic regression and generalized linear mixed models.RESULTS In 2021,the individual-based H.pylori infection rate was found to be 47.0%(244/519),which decreased to 38.1%(177/464)in 2023.Additionally,the rate of individual-based H.pylori new infection was 22.8%(55/241).The family-based H.pylori infection rate in 2021 was 76.9%(147/191),which decreased to 67.1%(116/173)in 2023,and the rate of family-based H.pylori new infection was 38.6%(17/44).Individual H.pylori infection was positively correlated with age,body mass index(BMI),eating food that was excessively hot,frequent acid reflux,bloating,and halitosis symptoms,and negatively correlated with family size and nut consumption.New individual H.pylori infection was positively correlated with BMI,other types of family structures,drinking purified water,and frequent heartburn symptoms,while negatively correlated with the use of refrigerators and following a regular eating schedule.A larger living area was an independent protective factor for H.pylori infection in households.Frequently consuming excessively hot food and symptoms of halitosis were independent risk factors for H.pylori infection in individuals;frequent consumption of nuts was an independent protective factor for H.pylori infection.Other types of family structure,drinking purified water,and frequent heartburn symptoms were independent risk factors for new individual H.pylori infection;the use of a refrigerator was an independent protective factor for new H.pylori infections.CONCLUSION The household H.pylori infection rate in Lanzhou is relatively high and linked to socio-demographic factors and lifestyles.Eradication efforts and control of related risk factors are recommended in the general population.

玻璃体黄斑粘连对抗VEGF药物治疗视网膜分支静脉阻塞疗效的影响

目的:探讨玻璃体黄斑粘连(VMA)对视网膜分支静脉阻塞(BRVO)患者抗VEGF治疗的影响。方法:回顾性病例研究。选取2017-01/2019-05在我院眼科接受玻璃体腔注射康柏西普治疗的BRVO伴黄斑水肿患者110例110眼,根据初诊时OCT特征,将纳入患者分为存在VMA组(VMA+组,34眼)和无VMA组(VMA-组,76眼)。首次注药后至少定期随访6mo,记录注射次数,检测两组患者最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT),根据OCT扫描结果评估玻璃体黄斑粘附状态及黄斑部玻璃体后脱离(PVD)发生情况。结果:随访至首次注药后6mo,VMA+组和VMA-组患者平均玻璃体腔注射次数无差异(2.91±1.05次vs 3.08±1.22次,P=0.915)。首次注药后第6mo时,两组患者BCVA和CMT均显著改善,且VMA+组患者BCVA较VMA-组患者增益更明显[-0.20(-0.33,-0.10)LogMAR vs-0.20(-0.30,-0.10)LogMAR,P=0.041],但两组患者CMT变化值无差异(P=0.914)。随访期间,VMA+组患者中3眼基线时为局灶性VMA的患眼均发生黄斑部PVD(100.0%),基线时为广泛性VMA的患者31眼中5眼发生了黄斑部PVD(16.1%),局灶性粘连较广泛性粘连的患者更易发生黄斑部PVD(P=0.009)。结论:BRVO患者合并VMA时抗VEGF治疗后视力改善的潜力更大,故VMA的存在不妨碍抗VEGF治疗BRVO的疗效。

Role of succinate dehydrogenase deficiency and oncometabolites in gastrointestinal stromal tumors

Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract.At the molecular level,GISTs can be categorized into two groups based on the causative oncogenic mutations.Approximately 85%of GISTs are caused by gain-of-function mutations in the tyrosine kinase receptor KIT or platelet-derived growth factor receptor alpha(PDGFRA).The remaining GISTs,referred to as wild-type(WT)GISTs,are often deficient in succinate dehydrogenase complex(SDH),a key metabolic enzyme complex in the tricarboxylic acid(TCA)cycle and electron transport chain.SDH deficiency leads to the accumulation of succinate,a metabolite produced by the TCA cycle.Succinate inhibitsα-ketoglutarate-dependent dioxygenase family enzymes,which comprise approximately 60 members and regulate key aspects of tumorigenesis such as DNA and histone demethylation,hypoxia responses,and m6A mRNA modification.For this reason,succinate and metabolites with similar structures,such as D-2-hydroxyglutarate and fumarate,are considered oncometabolites.In this article,we review recent advances in the understanding of how metabolic enzyme mutations and oncometabolites drive human cancer with an emphasis on SDH mutations and succinate in WT GISTs.

Predictors of difficult endoscopic resection of submucosal tumors originating from the muscularis propria layer at the esophagogastric junction

BACKGROUND Endoscopic resection approaches,including endoscopic submucosal dissection(ESD),submucosal tunneling endoscopic resection(STER)and endoscopic fullthickness resection(EFTR),have been widely used for the treatment of submucosal tumors(SMTs)located in the upper gastrointestinal tract.However,compared to SMTs located in the esophagus or stomach,endoscopic resection of SMTs from the esophagogastric junction(EGJ)is much more difficult because of the sharp angle and narrow lumen of the EGJ.SMTs originating from the muscularis propria(MP)in the EGJ,especially those that grow extraluminally and adhere closely to the serosa,make endoscopic resection even more difficult.AIM To investigate the predictors of difficult endoscopic resection for SMTs from the MP layer at the EGJ.METHODS A total of 90 patients with SMTs from the MP layer at the EGJ were included in the present study.The difficulty of endoscopic resection was defined as a long procedure time,failure of en bloc resection and intraoperative bleeding.Clinicopathological,endoscopic and follow-up data were collected and analyzed.Statistical analysis of independent risks for piecemeal resection,long operative time,and intraoperative bleeding were assessed using univariate and multivariate analyses.RESULTS According to the location and growth pattern of the tumor,44 patients underwent STER,14 patients underwent EFTR,and the remaining 32 patients received a standard ESD procedure.The tumor size was 20.0 mm(range 5.0–100.0 mm).Fourty-seven out of 90 lesions(52.2%)were regularly shaped.The overall en bloc resection rate was 84.4%.The operation time was 43 min(range 16–126 min).The intraoperative bleeding rate was 18.9%.There were no adverse events that required therapeutic intervention during or after the procedures.The surgical approach had no significant correlation with en bloc resection,long operative time or intraoperative bleeding.Large tumor size(≥30 mm)and irregular tumor shape were independent predictors for piecemeal resection(OR:7.346,P=0.032 and OR:18.004,P=0.029,respectively),long operative time(≥60 min)(OR:47.330,P=0.000 and OR:6.863,P=0.034,respectively)and intraoperative bleeding(OR:20.631,P=0.002 and OR:19.020,P=0.021,respectively).CONCLUSION Endoscopic resection is an effective treatment for SMTs in the MP layer at the EGJ.Tumors with large size and irregular shape were independent predictors for difficult endoscopic resection.

Changes of HPA axis function in rats with attention deficit hyperactivity disorder

Objective:To observe the Levels of serum CORT, ACTH and CRH in SHR rats, the expression of GR, MR and CRH mRNA in hypothalamus and GR, MR mRNA in hippocampus of the ADHD model animal SHR rat, and to explore the HPA axis function and related factors in SHR rats.Methods: Junior SHR rats were used as ADHD model group and WKY rats as control group. The levels of CORT, ACTH and CRH in serum were detected by ELISA, and the mRNA expressions of GR, MR, CRH in hypothalamus and GR, MR in hippocampus were detected by RT-PCR.Results:The levels of serum CORT and ACTH in SHR rats were significantly lower than those in WKY rats (P < 0.01), and the levels of serum CRH were significantly higher than those in WKY rats (P < 0.01). GR and MR mRNA expression levels in hypothalamus and hippocampus were significantly higher than those in WKY rats (P < 0.01), while CRH mRNA expression in hypothalamus was significantly lower than that in WKY rats (P < 0.01).Conclusion:The HPA axis of SHR rats showed hyporesponsiveness, which may be related to CRH priming disorder and high expression of GR and MR mRNA in hypothalamus and hippocampus.

Small intestinal angiosarcoma on clinical presentation, diagnosis, management and prognosis: A case report and review of the literature

BACKGROUND Angiosarcoma is a highly malignant soft-tissue sarcoma derived from vascular endothelial cells that mainly occurs in the skin and subcutaneous tissues.Smallintestinal angiosarcomas are rare,and the prognosis is poor.CASE SUMMARY We reported a case of primary multifocal ileal angiosarcoma and analyze previously reported cases to improve our understanding of small intestinal angiosarcoma.Small intestinal angiosarcoma is more common in elderly and male patients.Gastrointestinal bleeding,anemia,abdominal pain,weakness,and weight loss were the common symptoms.CD31,CD34,factor VIII-related antigen,ETS-related gene,friend leukemia integration 1,and von Willebrand factor are valuable immunohistochemical markers for the diagnosis of small-intestinal angiosarcoma.Small-intestinal angiosarcoma most commonly occurs in the jejunum,followed by the ileum and duodenum.Radiation and toxicant exposure are risk factors for angiosarcoma.After a definite diagnosis,the mean and median survival time was 8 mo and 3 mo,respectively.Kaplan-Meier survival analysis showed that age,infiltration depth,chemotherapy,and the number of small intestinal segments invaded by tumor lesions were prognostic factors for small intestinal angiosarcoma.Multivariate Cox regression analysis showed that chemotherapy and surgery significantly improved patient prognosis.CONCLUSION Angiosarcoma should be considered for unexplained melena and abdominal pain,especially in older men and patients with a history of radiation exposure.Prompt treatment,including surgery and adjuvant chemotherapy,is essential to prolonging patient survival.

OsNLP3 enhances grain weight and reduces grain chalkiness in rice

Grain weight,a key determinant of yield in rice(Oryza sativa L.),is governed primarily by genetic factors,whereas grain chalkiness,a detriment to grain quality,is intertwined with environmental factors such as mineral nutrients.Nitrogen(N)is recognized for its effect on grain chalkiness,but the underlying molecular mechanisms remain to be clarified.This study revealed the pivotal role of rice NODULE INCEPTION-LIKE PROTEIN 3(OsNLP3)in simultaneously regulating grain weight and grain chalkiness.Our investigation showed that loss of OsNLP3 leads to a reduction in both grain weight and dimension,in contrast to the enhancement observed with OsNLP3 overexpression.OsNLP3 directly suppresses the expression of OsCEP6.1 and OsNF-YA8,which were identified as negative regulators associated with grain weight.Consequently,two novel regulatory modules,OsNLP3-OsCEP6.1 and OsNLP3-OsNF-YA8,were identified as key players in grain weight regulation.Notably,the OsNLP3-OsNF-YA8 module not only increases grain weight but also mitigates grain chalkiness in response to N.This research clarifies the molecular mechanisms that orchestrate grain weight through the OsNLP3-OsCEP6.1 and OsNLP3-OsNF-YA8 modules,highlighting the pivotal role of the OsNLP3-OsNF-YA8 module in alleviating grain chalkiness.These findings reveal potential targets for simultaneous enhancement of rice yield and quality.

Contrasting strategies of optimizing carrier concentration in bulk InSe for enhanced thermoelectric performance

Indium selenide(InSe),as a wide-bandgap semiconductor,has received extensive attention in the flexible electronics field in recent years due to its exceptional plasticity and promising thermoelectric performance.However,the low carrier concentration severely limits its thermoelectric performance improvement.In this work,we conducted contrasting strategies that can be employed to increase the carrier concentration of InSe,including bandgap narrowing and heterovalent doping.Specifically,the carrier concentration initially increases as a result of the reduced bandgap upon Te alloying and then slightly decreases due to the weak electronegativity of Te.Whereas Br doping realizes high carrier concentration by pushing the Fermi level into the conduction bands and activating the multiple bands.On the other hand,both Te and Br obviously suppress the thermal conductivity due to the point defect scattering.By contrast,Br doping realizes a higher thermoelectric performance with a maximum ZT of~0.13 at 773 K benefiting from the better optimization of carrier concentration.This work elucidates the strategies for enhancing carrier concentration at anion sites and demonstrates the high efficiency of halogen doping in InSe.Moreover,the carrier concentration of InSe is promising to be further optimized,and future work should focus on employing approaches such as cation doping or secondphase compositing.

Management Recommendations on Sleep Disturbance o Patients with Parkinson's Disease

INTRODUCTION Sleep disturbance is one of the most common nonmotor symptoms in Parkinson's disease (PD).Sleep disturbance affects 40-98% of PD patients in the world. In China, the prevalence of PD patients with sleep disturbance ranges from 47.66% to 89.10%. Sleep disturbance usually has adverse impact on the quality of life of PD patients. Apossible pathogenesis of PD with sleep disturbance include thalamocortical pathway degeneration and changes of neurotransmitter systems. The etiology of sleep disturbance is multifactorial,involving degeneration of areas regulating sleep,sleep structure affected by drugs,sleep disturbance induced by drug,and sleep fragmentation by multiple factors.

Gut Microbiota-brain Axis

Objective：To systematically review the updated information about the gut microbiota-brain axis.Data Sources：All articles about gut microbiota-brain axis published up to July 18,2016,were identified through a literature search on PubMed,ScienceDirect,and Web of Science,with the keywords of＂gut microbiota＂,＂gut-brain axis＂,and ＂neuroscience＂.Study Selection：All relevant articles on gut microbiota and gut-brain axis were included and carefully reviewed,with no limitation of study design.Results：It is well-recognized that gut microbiota affects the brain＆#39;s physiological,behavioral,and cognitive functions although its precise mechanism has not yet been fully understood.Gut microbiota-brain axis may include gut microbiota and their metabolic products,enteric nervous system,sympathetic and parasympathetic branches within the autonomic nervous system,neural-immune system,neuroendocrine system,and central nervous system.Moreover,there may be five communication routes between gut microbiota and brain,including the gut-brain＆#39;s neural network,neuroendocrine-hypothalamic-pituitary-adrenal axis,gut immune system,some neurotransmitters and neural regulators synthesized by gut bacteria,and barrier paths including intestinal mucosal barrier and blood-brain barrier.The microbiome is used to define the composition and functional characteristics of gut microbiota,and metagenomics is an appropriate technique to characterize gut microbiota.Conclusions：Gut microbiota-brain axis refers to a bidirectional information network between the gut microbiota and the brain,which may provide a new way to protect the brain in the near future.

Up-Regulation of Trem2 Inhibits Hippocampal Neuronal Apoptosis and Alleviates Oxidative Stress in Epilepsy via the PI3K/Akt Pathway in Mice

Epilepsy is a chronic and severe neurological disorder that has negative effects on the autonomous activities of patients. Functionally, Trem2(triggering receptor expressed on myeloid cells-2) is an immunoglobulin receptor that affects neurological and psychiatric genetic diseases. Based on this rationale, we aimed to assess the potential role of Trem2 integration with the PI3 K/Akt pathway in epilepsy. We used microarray-based gene expression profiling to identify epilepsy-related differentially-expressed genes. In a mouse hippocampal neuron model of epilepsy, neurons were treated with lowMg^2+ extracellular fluid, and the protein and mRNA expression of Trem2 were determined. Using a gain-offunction approach with Trem2, neuronal apoptosis and its related factors were assessed by flow cytometry, RT-qPCR,and Western blot analysis. In a pilocarpine-induced epileptic mouse model, the malondialdehyde(MDA) and8-hydroxy-20-deoxyguanosine(8-OHdG) content and superoxide dismutase(SOD) and glutathione-peroxidase(GSH-Px) activity in the hippocampus were determined,and the protein expression of Trem2 was measured. In addition, the regulatory effect of Trem2 on the PI3 K/Akt pathway was analyzed by inhibiting this pathway in both the cell and mouse models of epilepsy. Trem2 was found to occupy a core position and was correlated with epilepsy.Trem2 was decreased in the hippocampus of epileptic miceand epileptic hippocampal neurons. Of crucial importance,overexpression of Trem2 activated the PI3 K/Akt pathway to inhibit neuronal apoptosis. Moreover, activation of the PI3 K/Akt pathway through over-expression of Trem2 alleviated oxidative stress, as shown by the increased expression of SOD and GSH-Px and the decreased expression of MDA and 8-OHdG. The current study defines the potential role of Trem2 in inhibiting the development of epilepsy, indicating that Trem2 up-regulation alleviates hippocampal neuronal injury and oxidative stress, and inhibits neuronal apoptosis in epilepsy by activating the PI3 K/Akt pathway.

Realizing high thermoelectric properties in p-type polycrystalline SnSe by inducing DOS distortion

SnSe crystals have been discovered as one of the most efficient thermoelectric materials due to their remarkable thermal and electrical transports. But the polycrystalline SnSe possesses much lower performance especially for the low carrier mobility and electrical conductivity. We firstly attempted to explain and verify the difference in the electrical conductivity as a function of temperature between p-type crystalline and polycrystalline SnSe by considering the grain boundary effects in the polycrystalline samples. On the basis of 2% Na doping to optimize the carrier concentration, the carrier mobility is improved by further introducing In, leading to enhanced carrier mobility from 3 to 9 cm2·V^(-1)·s^(-1) in polycrystalline SnSe. Moreover, In doping introduces extra resonant levels in SnSe, which increases the density of states near Fermi level and leads to an enhanced band effective mass. Large Seebeck coefficient of ~205 l V·K^(-1) at 300 K and maximum power factor of ~7.5 l W·cm^(-1)·K^(-2) at 773 K can be obtained in the Sn_(0.975)Na_(0.02)In_(0.005) Se sample,leading to a competitively high dimensionless figure of merit(ZT) value exceeding 1.1 at 773 K.

Status of Noninvasive Brain Stimulation in the Therapy of Alzheimer's Disease

Alzheimer's disease (AD),characterized by progressive memory impairment and dementia leading to severe deterioration of daily living,has been a public health crisis that currently lacks effective treatments.The reported prevalence of AD was 3.21% in people aged ≥65 years,More than 7 million people live with AD in China today and the number continues to increase.AD imposes a heavy financial burden on the society and it is becoming worse.The total socioeconomic costs of Chinese patients with AD was estimated to be US $167.74 billion in 2015 and is predicted to reach US $1.89 trillion by 2050.

A Marked Increase in Obstetric Hysterectomy for Placenta Accreta

Background：Obstetric hysterectomy （OH） as a lifesaving measure to manage uncontrolled uterine hemorrhage appears to be increasing recently.The objective of this study was to determine the etiology and changing trends of OH and to identify those at particular risk of OH to enhance the early involvement of multidisciplinary intensive care.Methods：A retrospective study was carried out in patients who had OH in China-Japan Friendship Hospital from 2004 to 2014.Maternal characteristics,preoperative evaluation,operative reports,and prenatal outcomes were studied in detail.Results：There were 19 cases of OH among a total of 18,838 deliveries.Comparing the study periods between 2004-2010 and 2011-2014,OH increased from 0.8/1000 （10/12,890） to 1.5/1000 （9/5948）.Indications for OH have changed significantly during this study period with uterine atony decreasing from 50.0% （5/10） to 11.1% （1/9） （P 〈 0.05）,and placenta accreta as the indication for OH has increased significantly from 20.0% （2/10） to 77.8% （7/9） （P 〈 0.05）.Ultrasonography and magnetic resonance imaging （MRI） have been used to make an exact antepartum diagnosis of placenta accreta.A multidisciplinary management led to improved outcomes for patients with placenta accreta.Conclusion：As the multiple cesarean delivery rates have risen,there has been a dramatic increase in OH for placenta accreta.An advance antenatal diagnosis of ultrasonography,and MRI,and a multidisciplinary teamwork can maximize patients＇ safety and outcome.

A study of medial and lateral temporal lobe epilepsy based on stereoelectroencephalography

Background:Patients with temporal lobe epilepsy(TLE)originating from different seizure onset zones had distinct electrophysiological characteristics and surgical outcomes.In this study,we aimed to investigate the relationship between the origin and prognosis of TLE,and the stereoelectroencephalography(SEEG)features.Methods:Thirty patients with TLE,who underwent surgical treatment in our functional neurosurgery department from January 2016 to December 2017,were enrolled in this study.All patients underwent anterior temporal lobectomy after an invasive preoperative evaluation with SEEG.Depending on the epileptic focus location,patients were divided into those with medial temporal lobe seizures(MTLS)and those with lateral temporal lobe seizures(LTLS).The Engel classification was used to evaluate operation effectiveness,and the Kaplan-Meier analysis was used to detect seizure-free duration.Results:The mean follow-up time was 25.7±4.8 months.Effectiveness was 63.3%for Engel I(n=19),13.3%for Engel II,3.3%for Engel III,and 20.0%for Engel IV.According to the SEEG,60.0%(n=18)had MTLS,and 40.0%(n=12)had LTLS.Compared with the MTLS group,the operation age of those with LTLS was significantly greater(26.9±6.9 vs.29.9±12.5 years,t=-0.840,P=0.009)with longer epilepsy duration(11.9±6.0 vs.17.9±12.1 years,t=-1.801,P=0.038).Patients with MTLS had a longer time interval between ictal onset to seizure(67.3±59.1 s vs.29.3±24.4 s,t=2.017,P=0.008).The most common SEEG ictal pattern was a sharp/spike-wave rhythm in the MTLS group(55.6%)and low-voltage fast activity in the LTLS group(58.3%).Compared with the LTLS group,patients with MTLS had a more favorable prognosis(41.7%vs.77.8%,P=0.049).Post-operative recurrence was more likely to occur within three months after the operation for both groups,and there appeared to be a stable longterm outcome.Conclusion:Patients with MTLS,who accounted for three-fifths of patients with TLE,showed a more favorable surgical outcome.

Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome

Background： Repetitive transcranial magnetic stimulation （rTMS） is a noninvasive technique used to alter cortex excitability that has been proposed as an efficient method for treating brain hyperexcitability or hypoexcitability disorders. Tile aim of this study was to investigate whether high-fi-equency rTMS could have any beneficial effects in restless legs syndrome （RLS）. Methods： Fourteen patients with RLS were given high-frequency rTMS （15 Hz, 100% motor threshold） to tile leg representation motor cortex area of the frontal lobe for 14 sessions over 18 days. Patients were diagnosed according to the international criteria proposed by the International Restless Legs Syndrome Study Group in 2003. The International RLS Rating Scale （1RLS-RS）, Pittsburgh Sleep Quality Index （PSQI）, Hamilton Anxiety Scale （llAMA） and Hamilton Depression Scale were used to evaluate the severity of RLS, sleep quality, anxiety and depression, respectively. The scale scores were evaluated at four-time points （baseline, end of the 14th session, and at 1- and 2-month posttreatrnent）. One-way analysis of variance was used to compare scale scores at different time points. Results： There was significant improvement in the 1RLS-RS （from 23.86 ± 5.88 to 11.21 ± 7.23, P 〈 0.05）, PSQ1 （frorn 15.00 ± 4.88 to 9.29 ± 3.91, P 〈 0.05）, and HAMA （from 17.93 ± 7.11 to 10.36 ± 7.13, P 〈 0.05） scale scores at the end of 14th session, with ongoing effects lasting for at least 2 months. Conclusions： High-17equency rTMS can markedly alleviate the motor system symptoms, sleep disturbances, and anxiety in RLS patients. These restllts suggest that rTMS might be an option for treating RLS.

A Special Electroencephalography Pattern Might Help in the Diagnosis of Antibody-positive Encephalitis

Background： Patterns observed with electroencephalography （EEG） for patients who have encephalitis are usually known as generalized nonspecific cerebral abnormalities. The aim of this study was to investigate the presence of a special EEG pattern for patients with encephalitis and to explore features related to this special and uncommon pattern. Methods： EEG monitoring was performed for every patient aged 〉15 years with encephalitis who was hospitalized between December 2011 and March 2014. Clinical characteristics and EEG recordings were collected and evaluated. Results： Filly-two patients with encephalitis were enrolled in our study with a 2-h median EEG recording time, and extreme beta brushes （EBBs） occurred in 17 patients （32.7%）. Its presence was not significant regarding gender, age, psychiatric medication use, EEG rhythmic disorganization （P 〉 0.05）. Nevertheless, among the patients with EBBs, nine patients （52.9%） had epileptic seizures that had a significant detection rate （P 〈 0.05）： moreover, the cerebrospinal fluid （CSF） or serum of 15 patients （88.2%） with EBBs was positive for antibodies （P 〈 0.05）. Four patients （23.5%） who had EBB had corresponding regional distributions on neurnimaging scans. The EBBs completely correlated with the regional distributions of spike discharges for four patients. Conclusion： EBB is a special EEG pattern for patients with encephalitis, especially those with epileptic seizures or who have antibody-positive CSF/serum, and should be considered in clinical practice.

Protocol on transcranial alternating current stimulation for the treatment of major depressive disorder:a randomized controlled trial

Background:Transcranial alternating current stimulation(tACS)offers a new approach for adult patients with major depressive disorder(MDD).The study is to evaluate the efficacy and safety of tACS treating MDD.Methods:This is an 8-week,double-blind,randomized,placebo-controlled study.Ninety-two drug-naive patients with MDD aged 18 to 65 years will receive 20 daily 40-min,77.5-Hz,15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks(week 4),following a 4-week observation period(week 8).The primary outcome is the remission rate defined as the 17-item Hamilton depression rating scale(HDRS-17)score≤7 at week 8.Secondary outcomes are the rates of response at weeks 4 and 8 and rate of remission at week 4 based on HDRS-17,the proportion of participants having improvement in the clinical global impression-improvement,the change in HDRS-17 score(range,0-52,with higher scores indicating more depression)over the study,and variations of brain imaging and neurocognition from baseline to week 4.Safety will be assessed by vital signs at weeks 4 and 8,and adverse events will be collected during the entire study.Discussion:The tACS applied in this trial may have treatment effects on MDD with minimal side effects.Trial registration:Chinese Clinical Trial Registry,ChiCTR1800016479;http://www.chictr.org.cn/showproj.aspx?proj=22048.

Antibody prevalence and immunotherapy response in Chinese patients with epilepsy and encephalopathy scores for patients with different neuronal surface antibodies

Background:The scale assessment was helpful in predicting the presence of antibodies to autoimmune encephalitis.This study aimed to evaluate the application of antibody prevalence in Chinese patients with epilepsy and encephalopathy(APE2-CHN)and response to immunotherapy in Chinese patients with epilepsy and encephalopathy(RITE2-CHN)for patients with different neuronal surface antibodies.Methods:A total of 1365 patients with epileptic seizures as the prominent feature in Xuanwu Hospital,Capital Medical University,from June 2016 to June 2020 were enrolled in our study.Of these,915 patients with epilepsy of unknown etiology whose serum and/or cerebrospinal fluid samples were examined for autoimmune antibodies were selected.All patients were scored with antibody prevalence in patients with epilepsy and encephalopathy(APE2),response to immunotherapy with epilepsy and encephalopathy(RITE2),APE2-CHN,and RITE2-CHN scores.Results:Of the 915 patients,191 patients were positive for neural-surface specific antibodies(115 N-methyl-D-aspartate receptor(NMDAR)Ab,47 leucine-rich glioma-inactivated protein 1(LGI1)Ab,8 contactin-associated protein 2(CASPR2)Ab,4 AMPA2RAb,and 11 GABAR-B-Ab;3 CASPR2-Ab and LGI1-Ab,2 NMDAR-Ab and CASPR2-Ab,and 1 NMDAR-Ab and myelinoligodendrocyte glycoprotein[MOG]Ab).The sensitivity and specificity of APE2≥4 in predicting the presence of neural-surface specific antibodies in our study were 74.35%and 81.77%,respectively,and the sensitivity and specificity of APE2-CHN≥4 were 75.92%and 84.53%,respectively.Eight cases had an APE2 score<4 and APE2-CHN score≥5;all these patients had memory decline as the prominent manifestation.We divided the patients into six groups according to the different antibodies.APE2-CHN scores showed higher sensitivity for the prediction of NMDAR-Ab,but lower sensitivity for LGI1-Ab.A total of 187/191(97.91%)patients received immunotherapy and 142/191(74.35%)patients benefited from the treatments.The patients who were positive for LGI1-Ab with RITE2-CHN≥8 responded well to immunotherapy.Conclusions:APE2-CHN had the highest value for predicting the positivity of NMDAR-Ab and RITE2-CHN evaluated the response of immunotherapy for anti-LGI1 encephalitis appropriately.However,RITE2 and RITE2-CHN do not appear to be good predictors of immunotherapy outcomes for patients with specific neuronal-surface antibodies and high APE2-CHN scores are often indicative of a poor response to immunotherapy.

igh-frequency Oscillations and the Seizure Onset Zones in Neocortical Epilepsy

Background： To study the characters of high-frequency oscillations （HFOs） in the seizure onset zones （SOZ） and the nonseizure onset zones （NSOZ） in the electrocorticography （ECoG） of patients with neocortical epilepsy. Methods： Only patients with neocortical epilepsy who were seizure-free after surgery as determined with ECoG were included. We selected patients with normal magnetic resonance imaging before surgery in order to avoid the influence of HFOs by other lesions. Three minutes preictal and 1 0 rain interictal ECoG as recorded in 39 channels in the SOZ and 256 channels in the NSOZ were analyzed. Ripples and fast ripples （FRs） were analyzed by Advanced Source Analysis soltware （ASA, The Netherlands）. Average duration of HFOs was analyzed in SOZ and NSOZ separately. Results： For ripples, the permillage time occupied by HFOs was 0.83 in NSOZ and 1.17 in SOZ during the interictal period. During preictal period, they were 2.02 in NSOZ and 7.93 in SOZ. For FRs, the permillage time occupied by HFOs was 0.02 in NSOZ and 0.42 in SOZ during the interictal period. During preictal period, they were 0.03 in NSOZ and 2 in SOZ. Conclusions： High-frequency oscillations are linked to SOZ in neocortical epilepsy. Our study demonstrates the prevalent occurrence of HFOs in SOZ. More and more burst of HFOs, especially FRs, means the onset of seizures.