A Prognostic Model Based on Colony Stimulating Factors-related Genes in Triple-negative Breast Cancer

Objective Triple-negative breast cancer(TNBC)is the breast cancer subtype with the worst prognosis,and lacks effective therapeutic targets.Colony stimulating factors(CSFs)are cytokines that can regulate the production of blood cells and stimulate the growth and development of immune cells,playing an important role in the malignant progression of TNBC.This article aims to construct a novel prognostic model based on the expression of colony stimulating factors-related genes(CRGs),and analyze the sensitivity of TNBC patients to immunotherapy and drug therapy.Methods We downloaded CRGs from public databases and screened for differentially expressed CRGs between normal and TNBC tissues in the TCGA-BRCA database.Through LASSO Cox regression analysis,we constructed a prognostic model and stratified TNBC patients into high-risk and low-risk groups based on the colony stimulating factors-related genes risk score(CRRS).We further analyzed the correlation between CRRS and patient prognosis,clinical features,tumor microenvironment(TME)in both high-risk and low-risk groups,and evaluated the relationship between CRRS and sensitivity to immunotherapy and drug therapy.Results We identified 842 differentially expressed CRGs in breast cancer tissues of TNBC patients and selected 13 CRGs for constructing the prognostic model.Kaplan-Meier survival curves,time-dependent receiver operating characteristic curves,and other analyses confirmed that TNBC patients with high CRRS had shorter overall survival,and the predictive ability of CRRS prognostic model was further validated using the GEO dataset.Nomogram combining clinical features confirmed that CRRS was an independent factor for the prognosis of TNBC patients.Moreover,patients in the high-risk group had lower levels of immune infiltration in the TME and were sensitive to chemotherapeutic drugs such as 5-fluorouracil,ipatasertib,and paclitaxel.Conclusion We have developed a CRRS-based prognostic model composed of 13 differentially expressed CRGs,which may serve as a useful tool for predicting the prognosis of TNBC patients and guiding clinical treatment.Moreover,the key genes within this model may represent potential molecular targets for future therapies of TNBC.

High frequency strong current tACS:a new dawn of non-drug therapy for patients with major depressive disorder

A commentary on:Transcranial alternating current stimulation for treating depression:a randomized controlled trial.By Wang H,Wang K,Xue Q,et al.Brain.2022;1451:83-91.doi:10.1093/brain/awab252.Major depressive disorder(MDD)is a common severe mental illness with recurring episodes.The most commonly used treatment is drug therapy,which is associated with a series of side effects and has an efficacy rate below 50%.1 Non-invasive brain stimulation technique has been gradually applied in clinical practice.Transcranial alternating current stimulation(tACS),a form of non-invasive brain stimulation,is a light,wearable piece of equipment for cortical stimulation.It modulates cortical excitability and spontaneous brain activity by applying an electric current to the scalp.

A Review of the Surgical Procedures for the Treatment of Drug-Resistant Epilepsy and Their Seizure Control Outcomes

Background: Drug-resistant epilepsy can be defined as the existence of seizures within 6 months, despite adequate therapy regimens with one or more antiepileptic drugs. Epilepsy surgery has been the standard therapy to help those patients who suffer from drug-resistant epilepsy. The goal of this surgery is to halt or reduce the intensity of seizures. This literature review aims to provide an overview of existing surgical procedures for the treatment of drug-resistant epilepsy and the degree of seizure control they provide based on available literature. Methods: Data were collected from medical journal databases, aggregators, and individual publications. The most used databases were PubMed, Medline and NCBI. Some of the keywords used to search these databases include: “drug resistant epilepsy”, “seizure control”, and “neurosurgery”. Results: Epileptic surgery is divided into resective and non-resective procedures. Studies have shown that a full resection of the epileptogenic brain area increases the probability of seizure eradication, however, the risks of postoperative impairments grow as the resection area is extended. On the other hand, patients who are unsuitable for seizure focus removal by resective surgery, such as those with multifocal seizures or overlapping epileptogenic zone with a functional cortex, may benefit from non-resective surgical options such as Vagus Nerve Stimulation and Responsive Neurostimulation. Conclusion: This literature review discusses the comprehensive treatment of epilepsy, especially the surgical treatment of drug-resistant epilepsy. The reviewed studies have shown that epilepsy surgery has promising outcomes in achieving seizure freedom/reducing seizure frequency with minimal adverse effects when performed correctly with the appropriate choice of surgical candidates.

骶神经磁刺激治疗老年女性药物难治性膀胱过度活动症临床观察

目的探讨骶神经磁刺激对老年女性药物难治性膀胱过度活动症(OAB)的临床疗效。方法选取医院2020年2月至2022年3月收治的抗胆碱能药物治疗失败的老年女性OAB患者60例,按治疗顺序随机分为观察组和对照组,各30例。观察组患者予骶神经磁刺激,对照组患者完成相同流程(但不予刺激强度)。结果治疗后1周及4周时,观察组患者24 h排尿次数、24 h尿急次数均显著少于对照组,OAB症状评分显著低于对照组,尿失禁生活质量评分显著高于对照组(P<0.05);观察组患者初始尿意膀胱容量、急迫尿意膀胱容量、膀胱顺应性均显著大于对照组(P<0.05),逼尿肌过度活动发生率显著低于对照组(P<0.05);两组其他尿流动力学指标无显著差异(P>0.05)。结论骶神经磁刺激能明显改善OAB症状且无创,有望成为老年女性药物难治性OAB新的治疗选择。

高体质量指数和使用促排卵药的交互作用与子宫内膜癌保留生育功能治疗后复发风险的关联分析

目的探讨高体质量指数和使用促排卵药的交互作用与子宫内膜癌(EC)保留生育功能治疗后复发风险的关联。方法选取2021年1月至2023年1月于长治医学院附属和平医院接受保留生育功能治疗的58例早期EC患者,所有患者经孕激素联合宫腔镜治疗均已达到完全缓解,收集并统计患者的临床资料。采用单因素、多因素Logistic回归以及相加模型分析影响早期EC保留生育功能治疗后复发的危险因素及其交互作用。结果58例早期EC患者经治疗后均已达到完全缓解,其中16例出现治疗后复发,42例未出现复发,复发率为27.59%(16/58)。2组患者体质量指数、病灶直径以及是否使用促排卵药物比较差异均有统计学意义(χ^(2)=13.110,P<0.001;χ^(2)=9.166,P=0.002;χ^(2)=8.133,P=0.004)。体质量指数≥25 kg/m^(2)(OR=13.316,95%CI:2.734~23.899)、病灶直径≥2 cm(OR=6.773,95%CI:1.225~12.322)、使用促排卵药物(OR=32.983,95%CI:1.354~64.613)是早期EC患者保留生育功能治疗后复发的危险因素。早期EC患者保留生育功能治疗后复发的危险因素之间存在相加交互作用,体质量指数≥25 kg/m^(2)与病灶直径≥2 cm、体质量指数≥25 kg/m^(2)与使用促排卵药物、病灶直径≥2 cm与使用促排卵药物的交互作用指数分别为2.836、3.609、2.626,超额相对危险度分别为6.936、12.384、5.653。结论体质量指数≥25 kg/m^(2)、病灶直径≥2 cm、使用促排卵药物是早期EC患者保留生育功能治疗后复发的危险因素,且危险因素间具有正向交互作用。

超声引导腹直肌肌内电刺激在上腹开腹手术患者术后镇痛的临床应用

目的探讨超声引导腹直肌肌内电刺激在上腹开腹手术患者术后镇痛的应用效果。方法本研究为前瞻性单中心单盲随机对照试验,选择中山市人民医院2022年5月至2023年8月择期行上腹部开腹手术治疗患者80例,采用随机数表法分为两组,每组各40例,两组术后均行自控静脉静脉镇痛泵,观察组患者手术结束后在超声引导下进行腹直肌肌内电刺激,记录两组围术期阿片类药物使用量、术后前3 d疼痛视觉模拟评分、总住院时长以及不良反应发生情况。结果观察组围术期使用阿片类药物总量少于对照组,差异有统计学意义(P<0.05)。观察组术后前3 d的视觉模拟量表评分均低于对照组,差异有统计学意义(P<0.05)。观察组总住院时长短于对照组,差异有统计学意义(P<0.05)。观察组患者术后不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论在超声引导下行腹直肌肌内电刺激可以减少上腹开腹手术患者围术期阿片类药物使用总量,降低术后视觉模拟量表评分,并且可以缩短总住院时长,减少不良反应发生率。

重复经颅磁刺激联合抗精神病药物治疗精神分裂症的临床效果分析

目的:分析重复经颅磁刺激联合抗精神病药物治疗精神分裂症的临床效果。方法:选取2023年1—6月潍坊市精神卫生中心收治的精神分裂症患者85例作为研究对象,随机分为对照组(n=43)和试验组(n=42)。对照组采用抗精神病药物治疗,试验组在对照组基础上采用重复经颅磁刺激治疗。比较两组治疗效果。结果:治疗后,两组阳性症状、阴性症状、一般精神症状评分低于治疗前,且试验组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组睡眠质量评分低于治疗前,且试验组低于对照组,两组日常生活能力评分高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:重复经颅磁刺激联合抗精神病药物治疗精神分裂症的效果显著,可改善患者临床症状,提高患者睡眠质量、日常生活能力,且安全性较高。

Safety and efficacy of a novel responsive neurostimulation system in China for drug-refractory focal epilepsy:The first-in-man study

To the Editor:Recent studies have characterized drugresistant epilepsy(DRE)as essentially a neural network disease.[1]Detection and disconnection of this pathological epileptic connectome or network can greatly improve seizure outcomes.Our team also proposes the development of the newly emerging branch of epileptic networks neurosurgery(ENN).Responsive neurostimulation(RNS)is an ENN-oriented emerging treatment option without the resection of the seizure-onset zone or epileptic focus and aims to control the seizure or other epileptic manifestations by modulating or disrupting the network’s key nodes(epileptic hubs)in a self-responsive way.

重复经颅磁刺激对首发抑郁症患者执行功能的影响研究

目的通过采集行为学和脑电数据,考察重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对首发抑郁症患者的疗效及对执行功能的影响,初步探讨rTMS治疗抑郁症患者潜在的认知神经影响的机制。方法采用随机数字表法将首发抑郁症患者分为试验组(n=26)和对照组(n=25),试验组患者进行8周的rTMS联合药物治疗,对照组患者仅进行单纯药物治疗。于干预前和干预后采用汉密尔顿抑郁量表24(24-item Hamilton depression rating scale,HAMD-24)、汉密尔顿焦虑量表14(14-item Hamilton anxiety rating scale,HAMA-14)以及行为学工具和事件相关电位(event-related potential,ERP)评估患者的抑郁焦虑状态和执行功能的变化。结果两组抑郁症患者治疗后的HAMD-24评分和HAMA-14评分较干预前均显著下降(P均<0.001),且试验组患者HAMD-24评分显著低于对照组(P<0.05)。Go/Nogo任务中,两组抑郁症患者Nogo条件正确应答数较干预前均明显提升(P均<0.05);Stroop任务中,试验组抑郁症患者不一致条件的正确应答数较干预前明显提升,不一致条件反应时较干预前明显变短,且试验组抑郁症患者不一致条件的正确应答数较对照组明显提升、不一致条件反应时明显变短(P均<0.05)。脑电指标中,试验组抑郁症患者干预后较干预前诱发了更大的Nogo N2波幅和P3波幅(P均<0.05);试验组抑郁症患者的N2差异波波幅和P3差异波波幅显著大于对照组(P均<0.05)。结论rTMS可以加强抑郁症患者的认知神经活动水平,提升执行功能,对抑郁症患者抑郁症状的治疗效果更好。

干扰素刺激基因在肿瘤免疫中作用机制的研究进展

干扰素刺激基因(ISGs)是一种经干扰素诱导、刺激后显著表达的基因。可通过免疫抑制分子的浸润,免疫检查点抑制,免疫编辑等方式抑制或者促进肿瘤细胞的生长浸润。本文对ISGs在肿瘤免疫中的具体作用机制及其在肿瘤药物治疗中发挥的作用作一综述,有望为开发更为精准的治疗策略提供理论基础。

临终患者多感官刺激疗法的最佳证据总结

目的总结安宁疗护中临终患者多感官刺激疗法的最佳证据,为临终患者的生命末期护理提供参考。方法按照“6S”证据金字塔模型,系统检索国内外数据库、指南网站及专业协会网站中关于临终患者多感官刺激的文献,检索时限自2003年1月至2023年11月。根据纳入与排除标准筛选文献后,由2名研究者对纳入的文献进行质量评价、证据提取与汇总。结果最终纳入15篇文献,其中指南1篇,临床决策3篇,证据总结2篇,专家共识1篇,系统评价7篇,随机对照试验1篇。从环境管理、感官刺激2个方面总结12条证据。结论总结的临终患者多感官刺激疗法最佳证据,可作为临床医护人员临终护理的指引或参考。

雌激素经阴道给药治疗卵巢早衰对子宫内膜容受性及微环境的影响

目的探讨雌激素经阴道给药治疗卵巢早衰对子宫内膜容受性及微环境的影响。方法选取2020年1月至2023年1月收治的90例卵巢早衰患者,以随机数字表法分为观察组45例(雌激素经阴道给药)和对照组45例(雌激素口服),连续治疗3个疗程。观察2组临床疗效和不良反应发生情况,记录2组治疗前后促黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇、孕酮水平及子宫内膜厚度(ET)和子宫内膜螺旋动脉搏动指数、阻力指数,测定2组治疗前后血管内皮生长因子(VEGF)、白细胞介素-1β(IL-1β)及转化生长因子-β1(TGF-β1)水平。结果观察组与对照组总有效率分别为93.33%和77.78%,总不良反应发生率分别为8.89%和26.67%,2组间比较差异均有统计学意义(P<0.05)。治疗后2组FSH、LH水平明显降低,雌二醇、孕酮明显上升(P<0.05);治疗后观察组FSH、LH较对照组低,雌二醇较对照组高(P<0.01)。治疗后2组ET明显上升,搏动指数、阻力指数明显降低(P<0.05);且治疗后观察组ET较对照组高,搏动指数、阻力指数较对照组低(P<0.01)。治疗后2组VEGF、IL-1β、TGF-β1较治疗前显著上升,且观察组VEGF、IL-1β、TGF-β1高于对照组(P<0.05,P<0.01)。结论雌激素经阴道给药治疗卵巢早衰效果好,能有效改善性激素水平、子宫内膜容受性和相关血清学指标水平,进而调节微环境,同时不良反应少,安全性高。

经颅磁刺激联合药物干预在难治性精神分裂症患者中的治疗效果及对事件相关电位和认知功能的影响研究

目的 探讨经颅磁刺激联合药物干预在难治性精神分裂症患者中的治疗效果及对事件相关电位和认知功能的影响。方法 目的选取新疆石河子绿洲医院于2019年12月—2023年12月期间住院治疗的难治性精神分裂症患者300例为研究对象,并按照治疗方法不同分为观察组、对照组,其中对照组患者采取单一氨磺必利治疗,观察组患者联合应用经颅磁刺激处理,分析两组临床应用价值。结果 观察组临床疗效98.00%(147/150)优于对照组84.00%(126/150),差异有统计学意义(χ^(2)=17.949,P<0.05)。观察组治疗后完成分类数较对照组高,其余各维度评分均低于对照组,观察组治疗后靶潜伏期P3及N2较对照组下降,观察组治疗后社会功能评分较对照组提升,差异有统计学意义(P均<0.05)。结论 难治性精神分裂症患者采取经颅磁刺激与药物联合指导能够提高临床治疗效果,同时改善患者自身认知功能。

高频重复经颅磁刺激联合药物治疗对帕金森病患者自主神经功能、认知功能及睡眠质量的影响

目的探讨高频重复经颅磁刺激(r TMS)联合药物治疗对帕金森病(PD)患者自主神经功能、认知功能及睡眠质量的影响。方法将2019年1月至2021年11月我院收治的96例PD患者随机分为研究组(n=48)和参照组(n=48)。参照组采用常规药物治疗,研究组在参照组基础上采用高频rTMS治疗,比较两组的自主神经功能、认知功能及睡眠质量。结果治疗1个月后,两组帕金森病自主神经症状量表(SCOPA-AUT)、匹兹堡睡眠质量指数量表(PSQI)评分低于治疗前,简易精神状态检查量表(MMSE)评分高于治疗前(P<0.05);研究组SCOPA-AUT、PSQI评分低于参照组,MMSE评分高于参照组(P<0.05)。结论高频r TMS联合药物治疗可明显改善PD患者的自主神经功能、认知功能,提升其睡眠质量,值得临床推广。

Gastric electrical stimulation for gastroparesis:A goal greatly pursued,but not yet attained

The lack of an effective medical treatment for gastroparesis has pushed the research of new techniques of gastric electrical stimulation (GES) for nearly half a century of experimentation with a large variety of electrical stimuli delivered to the gastric wall of animals and patients with gastroparesis. Three principal methods are currently available: gastric low-frequency/high-energy GES with long pulse stimulation, high-frequency/low-energy GES with short pulse stimulation and neural sequential GES. The first method aims to reset a regular slow wave rhythm, but has variable effects on contractions and requires devices with large and heavy batteries unsuitable for implantation. High-frequency/low-energy GES, although inadequate to restore a normal gastric electro-mechanical activity, improves dyspeptic symptoms, such as nausea and vomiting, giving patients a better quality of life together with a more satisfactory nutritional status and is suitable for implantation. Unfortunately, the numerous clinical studies using this type of GES, with the exception of two, were not controlled and there is a need for definitive verification of the effectiveness of this technique to justify the cost and the risks of this procedure. The last method, which is neural sequential GES, consists of a microprocessor-controlled sequential activation of a series of annular electrodes along the distal two thirds of the stomach and is able to induce propagated contractions causing forceful emptying of the gastric content. The latter method is the most promising, but has been used only in animals and needs to be tested in patients with gastroparesis before it is regarded as a solution for this disease.

Regulative Actions of the Chinese Drugs for Tonifying the Kidney on Gene Expression of the Hypothalamic GnRH,Pituitary FSH,LH and Osteoblastic BGP

It is found that the drugs for nourishing yin to reduce pathogenic fire can significantly down-regulate,and the drugs for tonifying the kidney to replenish essence can up-regulate mRNA expression of the hypothalamic GnRH,pituitary FSH,LH and osteoblastic BGP,indicating that the Chinese drugs for tonifying the kidney can regulate gene expression of the hypothalamic GnRH,pituitary FSH,LH,and osteoblastic BGP,which is possibly one of the main mechanisms of the Chinese drug for tonifying the kidney,regulating ephebic development process and improving skeletal development in sexual precocity children.

Oscillating Mechanical Stimulation of the Craniocervical Region as Physical Therapy for Chronic Migraine: A Pilot Trial

Objective: We conducted a prospective trial of oscillating mechanical stimulation (OS) of the craniocervical region as treatment for drug-refractory chronic migraine (CM). Methods: Ten patients (8 women, 2 men;mean age 47.0 &plusmn;15.1 years) were enrolled. The treatment was administered over an 8-week period to 13, 4, and 9 sites on the face and head, neck, and upper back, respectively, at 5- to 15-pound intensity. The primary outcome measure was the number of days patients suffered a migraine (hereafter “number of migraine days”), and the secondary outcome measures were the six-item Headache Impact Test (HIT-6) and Visual Analog Scale (VAS) scores for migraine pain intensity and the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder (GAD-7) scale scores. Results: Nine patients completed treatment. The number of migraine days remained unchanged, from a mean 21.7 &plusmn;11.6 days/month before treatment to 19.3 &plusmn;7.3 days/month upon completion of treatment. However, the HIT-6 scores improved from 67.0 &plusmn;8.2 to 61.4 &plusmn;7.1 (p = 0.007) after 3 weeks, 61.1 &plusmn;11.5 (p = 0.01) after 6 weeks, and 59.9 &plusmn;11.6 (p = 0.035) upon completion of treatment. Similarly, the VAS scores improved significantly from 7.3 &plusmn;1.7 to 5.7 &plusmn;3.1 (p = 0.018) at 6 weeks and 4.8 &plusmn;2.8 (p = 0.011) upon completion of treatment. The GAD-7, PHQ-9, and allodynia scale scores remained unchanged. Conclusion: Our data suggest that OS is well tolerated and may become a feasible form of treatment for drug-resistant CM.

Drug treatment

920622 Electrophysiological effects of ne-ferine on ischemic ventricular tachyarrhy-thmias.GUO Zhibing(郭治彬), et al. 1st AffiliHosp, Jiangxi Med Coll, Nanchang, 330006.Chin J Cardiol 1992; 20(2): 119-122. The electrophysiological effects of neferine(Nef, 8mg/kg, i. v. )on ischemic ventriculartachyarrhythmias in both normal and

基于无线自供能的植入式微纳集成芯片与集成系统

我国是慢性病大国,癌症、糖尿病、心脏病、癫痫、高血压等疾病已成为首要致死原因,医疗负担占比70%,形势严峻.相比口服,注射等传统给药方式,植入式精准靶向治疗按时按需、精准适量,见效迅速,几乎无副作用,被证实是慢性病的有效治疗方式.目前我国在这一领域刚刚起步,尤其在高端植入微纳集成系统级芯片(System of Chip,SoC)、微纳系统集成和封装可靠性等方面,缺少原创性核心技术和共性技术支撑平台,严重落后于欧美发达国家,相关高端医疗器械及核心部件只能高价进口.因此,需要通过突破相关关键共性技术,核心部件国产化,从创新源头推动高端医疗器械发展,从而加速推动我国医疗器械产业化落地,打破欧美日发达国家垄断.本研究以突破医疗用微纳集成芯片和微纳集成系统关键共性技术为目的,解决了微电子小尺寸、高精度、低功耗等难题.通过三维异质集成构建植入式精准靶向给药系统和迷走神经刺激器,实现精准靶向给药、无线充电、生物电信号采集、电刺激等功能,项目样机已通过生物相容性测试和动物实验验证.

薄型子宫内膜辅助治疗的研究进展

子宫内膜的厚度和结构随月经周期变化而变化。薄型子宫内膜截断值一般认为是超声测量下子宫内膜厚度<7 mm。针对薄型子宫内膜,除了传统的激素调节外,目前已发展出多种辅助治疗手段,如粒细胞集落刺激因子治疗、干细胞治疗、药物治疗、针刺和物理疗法等。已有研究表明,这些方法对子宫内膜具有缩小纤维化面积、增加腺体数量、促进血管生成、增加子宫内膜厚度、改善组织结构等相关作用。这项综述总结了这些辅助治疗手段在修复薄型子宫内膜和提高临床妊娠率方面的关键作用。