Research Progress on Individualized Treatment of Splenic Aneurysm

Splenic artery aneurysm has a hidden onset and atypical symptoms.There are various diagnostic methods for splenic aneurysms,among which ultrasound is the first choice for aneurysm screening.The diagnostic rate of CTA and DSA reaches 100%.In clinical practice,it is necessary to integrate medical history,symptoms and signs,and multiple imaging results to improve the diagnostic rate.In terms of treatment plans,both intervention and surgical procedures have their strengths,and the application of intervention will be more extensive.We need to adhere to the principle of individualization and choose a reasonable treatment plan for patients.At present,there are many reports on pregnant women with large splenic aneurysms both domestically and internationally.Some scholars believe that large splenic aneurysms may be related to hormonal imbalances during pregnancy,and the specific pathogenic mechanism will become a hot topic in future research.

Value of multiple models of diffusion-weighted imaging to predict hepatic lymph node metastases in colorectal liver metastases patients

BACKGROUND About 10%-31% of colorectal liver metastases(CRLM)patients would concomitantly show hepatic lymph node metastases(LNM),which was considered as sign of poor biological behavior and a relative contraindication for liver resection.Up to now,there’s still lack of reliable preoperative methods to assess the status of hepatic lymph nodes in patients with CRLM,except for pathology examination of lymph node after resection.AIM To compare the ability of mono-exponential,bi-exponential,and stretchedexponential diffusion-weighted imaging(DWI)models in distinguishing between benign and malignant hepatic lymph nodes in patients with CRLM who received neoadjuvant chemotherapy prior to surgery.METHODS In this retrospective study,97 CRLM patients with pathologically confirmed hepatic lymph node status underwent magnetic resonance imaging,including DWI with ten b values before and after chemotherapy.Various parameters,such as the apparent diffusion coefficient from the mono-exponential model,and the true diffusion coefficient,the pseudo-diffusion coefficient,and the perfusion fraction derived from the intravoxel incoherent motion model,along with distributed diffusion coefficient(DDC)andαfrom the stretched-exponential model(SEM),were measured.The parameters before and after chemotherapy were compared between positive and negative hepatic lymph node groups.A nomogram was constructed to predict the hepatic lymph node status.The reliability and agreement of the measurements were assessed using the coefficient of variation and intraclass correlation coefficient.RESULTS Multivariate analysis revealed that the pre-treatment DDC value and the short diameter of the largest lymph node after treatment were independent predictors of metastatic hepatic lymph nodes.A nomogram combining these two factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients,with an area under the curve of 0.873.Furthermore,parameters from SEM showed substantial repeatability.CONCLUSION The developed nomogram,incorporating the pre-treatment DDC and the short axis of the largest lymph node,can be used to predict the presence of hepatic LNM in CRLM patients undergoing chemotherapy before surgery.This nomogram was proven to be more valuable,exhibiting superior diagnostic performance compared to quantitative parameters derived from multiple b values of DWI.The nomogram can serve as a preoperative assessment tool for determining the status of hepatic lymph nodes and aiding in the decision-making process for surgical treatment in CRLM patients.

Comparing the efficacy and safety of low,medium,and high dosages of selexipag for treating pulmonary hypertension:A systematic review and meta-analysis

Background:The maintenance dosage of selexipag is categorized as low,medium or high.In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension(PAH),we performed a sys-tematic review and meta-analysis.Methods:Studies assessing PAH risk stratification indices,such as the World Health Organization functional class(WHO-FC),six-minute walk distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,right atrial pressure(RAP),cardiac index(CI)and mixed venous oxygen saturation(SvO2),were included.Results:Thirteen studies were included.Selexipag led to improvements in the 6MWD(MD:24.20 m,95%CI:10.74-37.67),NT-proBNP(SMD:-0.41,95%CI:-0.79-0.04),CI(MD:0.47 L/min/m^(2),95%CI:0.17-0.77)and WHO-FC(OR:0.564,95%CI:0.457-0.697).Subgroup analysis demonstrated that all three dosages improved the 6MWD.A moderate dosage led to improvements in the CI(MD:0.30 L/min/m^(2),95%CI:0.15-0.46)and WHO-FC(OR:0.589,95%CI:0.376-0.922).Within 6 months of treatment,only the WHO-FC and CI were significantly improved(OR:0.614,95%CI:0.380-0.993;MD:0.30 L/min/m^(2),95%CI:0.16-0.45,respectively).More than 6 months of treatment significantly improved the 6MWD,WHO-FC and NT-proBNP(MD:40.87 m,95%CI:10.97-70.77;OR:0.557,95%CI:0.440-0.705;SMD:-0.61,95%CI:-1.17-0.05,respectively).Conclusions:Low,medium,and high dosages of selexipag all exhibited good effects.When treatment lasted for more than 6 months,selexipag exerted obvious effects,even in the low-dosage group.This finding is important for guiding individualized treatments.

Peginterferon and ribavirin treatment for hepatitis C virus infection

Pegylated interferon α (IFNα) in combination with ribavirin is currently recommended as a standard-of-care treatment for chronic hepatitis C virus (HCV) infection. This combination therapy has drastically improved the rate of sustained virological response, specifically in difficult-to-treat patients. Recently, individualized treatment, such as response-guided therapy, is being developed based on host-, HCV- and treatment-related factors. Furthermore, modified regimens with currently available medications, novel modified IFNα and ribavirin or combinations with specifically targeted antiviral therapy for HCV agents, are currently being investigated. The purpose of this review is to address some issues and epoch-making topics in the treatment of chronic HCV infection, and to discuss more optimal and highly individualized therapeutic strategies for HCV-infected patients.

Incidence of Interpersonal Violence among Individuals with Drug Addiction Receiving Compulsory Treatment: A Survey at Two Drug Detention Centers in Hunan, China

Drug dependence is a serious global health problem.To assist individuals with drug addiction,China alone has established 678 Compulsory Detoxification Detention Centers （CDDCs） that treat over300,000i ndividuals who are required by national law to receive compulsory treatment;because community-based outpatient treatment failed.

Individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet

Objective To summarize the indication,method and effect of individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet. Methods The clinical data of 32 cases of obstruction of fourth ventricle outlet treated by individual flexible endoscopic

Advances in molecular classification of bladder cancer

Bladder cancer is the second most common tumor in the urinary system after prostate cancer.It is highly heterogeneous and its developmental mechanism involves abnormal alterations in the structure and function of multiple genomes.Researching the molecular classification of bladder cancer by using molecular biology techniques is important for defining the pathogenesis of the disease and selecting therapeutic schedule.This paper will review the progress of molecular classification studies of bladder cancer.

Predicting lymph node metastasis in colorectal cancer:An analysis of influencing factors to develop a risk model

BACKGROUND Colorectal cancer(CRC)is a significant global health issue,and lymph node metastasis(LNM)is a crucial prognostic factor.Accurate prediction of LNM is essential for developing individualized treatment strategies for patients with CRC.However,the prediction of LNM is challenging and depends on various factors such as tumor histology,clinicopathological features,and molecular characteristics.The most reliable method to detect LNM is the histopathological examination of surgically resected specimens;however,this method is invasive,time-consuming,and subject to sampling errors and interobserver variability.AIM To analyze influencing factors and develop and validate a risk prediction model for LNM in CRC based on a large patient queue.METHODS This study retrospectively analyzed 300 patients who underwent CRC surgery at two Peking University Shenzhen hospitals between January and December 2021.A deep learning approach was used to extract features potentially associated with LNM from primary tumor histological images while a logistic regression model was employed to predict LNM in CRC using machine-learning-derived features and clinicopathological variables as predictors.RESULTS The prediction model constructed for LNM in CRC was based on a logistic regression framework that incorporated machine learning-extracted features and clinicopathological variables.The model achieved high accuracy(0.86),sensitivity(0.81),specificity(0.87),positive predictive value(0.66),negative predictive value(0.94),area under the curve for the receiver operating characteristic(0.91),and a low Brier score(0.10).The model showed good agreement between the observed and predicted probabilities of LNM across a range of risk thresholds,indicating good calibration and clinical utility.CONCLUSION The present study successfully developed and validated a potent and effective risk-prediction model for LNM in patients with CRC.This model utilizes machine-learning-derived features extracted from primary tumor histology and clinicopathological variables,demonstrating superior performance and clinical applicability compared to existing models.The study provides new insights into the potential of deep learning to extract valuable information from tumor histology,in turn,improving the prediction of LNM in CRC and facilitate risk stratification and decision-making in clinical practice.

Targeting of circulating hepatocellular carcinoma cells to prevent postoperative recurrence and metastasis

Currently,the main treatment for hepatocellular carcinoma(HCC)involves the surgical removal of tumors or liver transplantation.However,these treatments are often not completely curative,as they are associated with a risk for postoperative recurrence and metastasis.Circulating tumor cells(CTCs)are increasingly recognized as the main source for recurrence and metastasis after radical hepatectomies are performed.Many studies have demonstrated the association between the presence of either pre-or postoperative CTCs and an increased risk for HCC recurrence.To improve the therapeutic outcome of HCC,a personalized,comprehensive and multidisciplinary approach should be considered,involving the application of appropriate diagnostic and therapeutic measures targeting HCC CTCs in different stages throughout the course of treatment.This article proposes some HCC CTC-based strategies for the treatment of HCC,including the monitoring of HCC CTCs before,during and after radical hepatectomy,therapeutic targeting of HCC CTCs,prevention of the generation and colonization of CTCs,as well as the use of CTC indexes for the selection of indications,prediction of prognoses,and planning of individualized therapeutic regimens.Innovation and technological development of therapies targeting CTCs,as well as their translation into clinical practice,will help to effectively reduce postoperative recurrence and metastasis,and significantly prolong the survival of HCC patients.

Surgical dilemmas in the management of colorectal liver metastases: the role of timing

Colorectal cancer(CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases during the course of their disease. The liver surgeon dealing with colorectal liver metastases faces several surgical dilemmas especially in the setting of the timing of operation. Synchronous resectable metastases should be treated prior or after induction chemotherapy? Furthermore in the case of synchronous colorectal liver metastases which organ should we first deal with, the liver or the colon? All these questions are set in the editorial and impulse for further investigation is put focusing on multidisciplinary approach and individualization of treatment modalities.

Simulating the in vivo tumor microenvironment-advances in building a vascularized model of hepatocellular carcinoma through 3D bioprinting

Over the past decade,there has been notable progress in the systemic treatment of liver cancer.However,despite the emergence of new therapeutic strategies,they have not universally achieved success,with patients afflicted by liver diseases frequently displaying resistance to these treatments(1).Consequently,liver cancer remains a global health challenge,and hepatocellular carcinoma(HCC)stands as the fourth most common cause of cancer-related deaths globally,constituting 80-90%of primary liver cancer cases(2,3).This poses a substantial threat to both the survival and overall well-being of individuals.

Task-related functional magnetic resonance imaging-based neuronavigation for the treatment of depression by individualized repetitive transcranial magnetic stimulation of the visual cortex

To determine whether repetitive transcranial magnetic stimulation(rTMS)of the visual cortex(VC)provides effective and welltolerated treatment and whether magnetic resonance imaging(MRI)measures functional change of the VC as a biomarker of therapeutic effect in major depressive disorder(MDD),we performed a sham-controlled,double-blind,randomized,three-arm VC rTMS treatment study in 74 MDD patients.Neuronavigated rTMS(10 Hz,90%of resting motor threshold,1,600 pulses over20 min twice per day)was performed over the VC for five days.Clinical outcome was measured by Hamilton Depression Rating Scale(HAMD-24)at days 0,1,3,5 and after terminating rTMS,with follow-up at four weeks.MRI was measured at days 0 and5.The individualized group exhibited the greatest change in HAMD-24 scores after VC rTMS for 5 days(F=5.53,P=0.005),which were maintained during follow-up period(F=4.22,P=0.016).All patients reported good tolerance.Changes in VC taskrelated functional MRI correlated with symptomatic reduction in the individualized group.Treatment reduced the initially abnormal increase in resting state functional connectivity from the VC to the pre/subgenual anterior cingulate cortex at day 5,especially in the individualized group.We demonstrated therapeutic potential and good tolerance of VC rTMS in MDD patients,indicated by biomarkers of f MRI measurement.

Clinicopathological classification and individualized treatment of breast cancer

Background The clinicopathological classification was proposed in the St. Gallen Consensus Report 2011. We conducted a retrospective analysis of breast cancer subtypes, tumor-nodal-metastatic （TNM） staging, and histopathological grade to investigate the value of these parameters in the treatment strategies of invasive breast cancer.

The frequency and skewed T-cell receptor beta-chain variable patterns of peripheral CD4＋CD25＋ regulatory T-cells are associated with hepatitis B e antigen seroconversion of chronic hepatitis B patients during antiviral treatment

The frequency and T-cell receptor beta-chain variable （TCRBV） patterns of peripheral CD4＋CD25＋ regulatory T-cells （Tregs） are ambiguously altered in chronic hepatitis B （CHB） patients following tenofovir disoproxil fumarate （TDF） treatment. Moreover, the clinical significance of these parameters in relation to hepatitis B e antigen （HBeAg） seroconversion （SC） is largely unknown. In this study, the circulation of Tregs in HBeAg-positive CHB patients was determined by flow cytometry, and the molecular profiles of frequent TCRBV patterns of Tregs were analyzed using a gene melting spectral pattern. The parameters, such as Treg frequency, the number of skewed TCRBV patterns, hepatitis B virus （HBV） DNA levels, and alanine aminotransferase （ALT） levels, were analyzed by comparing their associations in seroconverting and non-seroconverting patients following TDF treatment. The Treg frequency was significantly correlated with the ALT level in seroconverting but not in non-seroconverting patients. Similarly, skewed TCRBV patterns were remarkably associated with HBV DNA levels in the SC group. Six TCRBV families （BV3, BV11, BV12, BV14, BV20, and BV24） were more prevalent than other TCRBV members in seroconverting patients pretreated with TDF, while BV12, BV15, and BV22 were predominant in non-seroconverting patients during TDF treatment. Taken together, the preferential TCRBV patterns may be associated with immune responses related to SC. The dynamic frequency and skewed TCRBV patterns of peripheral Tregs could contribute to predicting SC in CHB patients. Moreover, the conserved TCRBV complementarity-determining region （CDR3） motif may be targeted to develop personalized immunotherapy for CHB patients.

Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children

Objective： Postural tachycardia syndrome （POTS） is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children. Data Sources： The data analyzed in this review are mainly from articles included in PubMed and EMBASE. Study Selection： The original articles and critical reviews about POTS were selected for this review. Results： Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient＇s physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted. Conclusions： The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children.

Amyotrophic Lateral Sclerosis： Precise Diagnosis and Individualized Treatment

INTRODUCTION Amyotrophic lateral sclerosis （ALS） is a progressive neurodegenerative disease characterized by selective death of upper motor neurons （UMNs） and lower motor neurons （LMNs）, typically may die from respiratory failure within 2-5 years of symptorn onset）H About 10% orALS patients are familial whereas the remaining patients are sporadic. ALS is highly heterogeneous in genetic and clinical phenotype, with lack of definitive diagnostic tools, making it extremely difficult to make early diagnosis.

Evaluation of individualized treatment of nonproliferative diabetic retinopathy:a multicenter,randomized,parallel-controlled study

OBJECTIVE:To evaluate the differences in the efficacy of stationary treatment and individualized treatment for patients with nonproliferative diabetic retinopathy(NPDR).METHODS:This study was a randomized,controlled,multicenter clinical trial.Participants with NPDR were randomized into the stationary treatment group or the individualized treatment group.The stationary treatment group was given the basic treatment and Qiming granules,and the individualized treatment group was given the basic treatment,Qiming granules,and individualized Chinese herbal medicines over a 12-week period.The individualized therapeutic formula was also changed over time to adjust to the changes in the clinical presentation of the patient.We conducted observations of fundus retinal exudation and hemorrhage,visual acuity,Traditional Chinese Medicine symptom scores and other indicators.RESULTS:A total of 140 participants with NPDR were randomized into the stationary treatment group or the individualized treatment group,and 132 participants completed this study.Following the 12-week treatment,significant improvements in both primary and secondary outcomes were observed in the stationary and individualized treatment groups.No remarkable difference in the primary outcomes between the two groups was observed.However,there was a significant difference in the Traditional Chinese Medicine symptom scores(18±7 vs 15±6;P<0.05).There were no severe adverse effects.CONCLUSION:Compared with stationary treatment,individualized treatment is more effective at relieving the Traditional Chinese Medicine symptoms and improving vision and fundus lesions at 12 weeks post treatment.

Individualized surgical treatment of hypertensive cerebral hemorrhage

Background Hypertensive cerebral hemorrhage （HCH） is an important cerebrovascular disease that poses significant threat to the health of human being, with high incidence and mortality. With the development of mini- mally invasive techniques, individualized surgical treatment of HCH is very common. Method During 2003- 2012, according to the condition of using craniotomy, hematoma in small bone window craniotomy and hematoma for treatment of 162 cases of hypertensive cerebral hemorrhage patients. Results Among 162 patients with HCH in our study, 24 had recurrent hemorrhage after surgery, with an incidence of recurrent hemorrhage of 14.8%. Among the 24 recurrent hemorrhages, 22 had hemorrhage in primary hematoma site and two subdural hematomas. Among these patients, 16 died, with a mortality of 9.8%. Death rate and recurrent hemorrhage in the small bone window group were lower than that in the craniotomy group, and ＂the difference reached statistical significance （P 〈 0.05）. Conclusions Individuation in treatment of hypertension must be correctly estimated based on disease condition, comprehensive judgment, selection of appropriate treatment options. Even if that we would reduce mortality, improve the success rate of operation and living quality.

Parallel Subgroup Design of a Randomized Controlled Clinical Trial——Comparing the Approaches of Chinese Medicine and Western Medicine

A new method for the comparison of the treatment efficacy for specific diseases or conditions between Chinese medicine and Western medicine, which serve the same medical aim but are based on substantially different theoretical systems, was identified. Abiding by the principle of parallel subgroup design of a randomized controlled trial （PSD-RCT）, participants were recruited following identical inclusion and exclusion criteria and were randomly allocated into two groups to receive treatment using the respective approaches of Chinese medicine and Western medicine. The Chinese medicine group was divided into subgroups according to the theory of Chinese medicine and the Western medicine group was also divided into subgroups according to the theory of Western medicine. The treatment for each subgroup was well defined in the protocol, including major formulae and principles for individualized modifications. The primary outcome measure was ascertained to be directly related to the patients＇ status but independent from both theories of Chinese medicine and Western medicine, while the secondary outcomes were represented by the patient-reported outcomes and some laboratory tests commonly accepted by Chinese medicine and Western medicine. Then, taking functional dyspepsia as an example, the authors explain the framework of the PSD-RCT for efficacy comparisons between Chinese medicine and Western medicine, and recommend that the PSD-RCT can be used to compare treatment efficacy for a specific disease or condition between Chinese medicine and Western medicine, and the comparison among subgroups can provide valuable clues for further studies.

Chinese Medicine in Management of Chronic Disease Endometriosis

Endometriosis(EM),a refractory,highly recurrent and life-threatening chronic disease,requires Iong-term management and Iong-term drug treatment.Our previous studies showed that Chinese medicine(CM)can inhibit the postoperative recurrenee of EM,improve quality of life,shorten the time to conception and increase pregnancy rates.CM produces few adverse reactions with high safety.These characteristics might be associated with the mechanism of CM's inhibition of recurrenee.Therefore,we believe that CM may represent a good choice for Iong-term drug treatment and is worthy of clinical application.