Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models

Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.     

基于网络药理学探讨黄精-百合药对抗癌作用的机制

目的:通过网络药理学的方法筛选黄精-百合药对中的有效成分,预测治疗癌症的作用靶点及信号通路,进一步探讨潜在作用机制。方法:使用全称为中药系统药理学分析平台筛选黄精-百合药对中的活性成分和靶点,通过基因疾病关联数据库(Dis Ge NET)与人类孟德尔遗传数据库(OMIM)预测与筛选药对中有效的中药成分作用的疾病靶点。选择生物信息分析学习平台(Omicshare)匹配药物和疾病的靶点,借助复杂网络可视化平台(Cytoscape3. 7. 0)软件构建"药物-成分-疾病"网络。采用蛋白质相互作用网络数据库(String)构建黄精-百合药对治疗癌症的靶点相互作用的网络。最后通过功能注释生物信息学分析平台(DAVID)对黄精-百合药对中关键作用的节点进行生物功能及代谢通路分析。结果:筛选出19个黄精-百合药对的活性成分,根据靶点预测技术预测出相关靶点234个,与疾病靶点有关的活性成分为6个,主要通过调控丝氨酸(Akt)/苏氨酸激酶1(Akt1),Jun原癌基因,AP-1转录因子亚基(JUN),血管内皮生长因子A(VEGFA),基质金属蛋白酶-9(MMP-9),半胱氨酸蛋白酶-3(Caspase-3)等靶蛋白,以及癌症中的蛋白多糖,雌激素信号转导通路,人免疫缺陷病毒1感染,缺氧诱导因子-1(HIF-1)信号通路,肿瘤坏死因子(TNF)信号通路,癌症中的微型核糖核酸(MicroRNAs)等通路发挥抗癌作用。结论:黄精-百合药对治疗癌症的作用体现了中药多成分-多靶点-多途径的特点,为阐释其抗癌治疗的作用机制与物质基础提供了科学依据。     

Comprehensive analysis of the relationship between competitive endogenous RNA (ceRNA) networks and tumor infiltrating-cells in hepatocellular carcinoma

BackgroundThe innovation of immune checkpoint blockade (ICB) represents a promising shift in the treatment of advanced hepatocellular carcinoma (HCC). However, response to ICB has varied largely due to the high tumor heterogeneity and complex tumor microenvironment (TME). The competitive endogenous RNA (ceRNA) network also plays an important role in tumor occurrence and progression, but its relation with tumor-infiltrating immune cells (TICs) remains largely unexplored in HCC. The overriding objective of our study was thus to construct a prognosis-related risk model and to further evaluate the relationship between ceRNA networks and TICs.MethodsDifferentially expressed gene (DEG) analysis was performed to identify the differentially expressed RNAs. Lasso and multivariable Cox regression analyses were used to construct risk models, which were assessed by the area under the receiver operating characteristic curve (AUC of ROC) and Kaplan-Meier (K-M) curves. Then, a single-sample gene set enrichment analysis (ssGSEA) algorithm was adopted to dissect the TICs in HCC samples. Nomograms were constructed and calibration curves were used to verify the discrimination and accuracy of the nomograms. Finally, integration analysis was performed to validate the correlation of ceRNA and TICs.ResultsIn the study, 7 differentially expressed RNAs [5 messenger RNA s (mRNAs) and 2 micro RNAs (miRNAs)] were incorporated to construct a ceRNA risk model. The AUC of the 1-, 3-, and 5-year overall survival (OS) were 0.784, 0.685, and 0.691 respectively. Likewise, 7 types TICs were in the TICs signature model and the AUC of the 1-, 3-, and 5-year OS were 0.706, 0.731, and 0.721 respectively. The integration analysis showed that 7 pairs of mRNA-TICs and 1 pair of miRNA-TICs had a close relation (all correlation coefficients >0.2, P<0.001).ConclusionsThrough constructing two risk models based on ceRNA network and TICs, we identified the hub RNAs and key TICs in the progression and prognosis of HCC, and further explored the relationship between ceRNA and TME. Importantly, targeting these hub RNAs may facilitate the remodeling of the TME and be a potential therapeutic alternative to enhancing the response to ICB, thus improving the prognosis of HCC patients.     

恩度治疗小细胞肺癌脑转移瘤瘤周水肿1例报告及文献复习

目的:探讨治疗脑转移瘤瘤周水肿的方法。方法:总结1例小细胞肺癌脑转移患者的临床资料及恩度治疗脑转移瘤瘤周水肿的效果，并对治疗脑水肿相关文献进行复习。结果:恩度抗血管生成治疗小细胞肺癌脑转移瘤瘤周水肿有很好的临床效果，能够控制脑水肿，减轻临床症状，提高生活质量。结论:恩度可以作为治疗脑转移瘤瘤周水肿的有效药物选择。     

医院临床技能培训中心在应对疫情专项技能培训中的作用——以南通大学第五附属医院临床技能培训中心为例

2019 年底新型冠状病毒肺炎（以下简称新冠肺炎）疫情发生后，为抗击疫情和保障医护人员自身安全，开展了传染病防护技能专项培训。在本医院的临床技能培训中心，按“三区两通道”设置模拟隔离病区、开发传染病防控专项培训课程，对全体医护人员（特别是一线医护人员）进行传染病防护技能、进出隔离病区等项目实景培训及实战练习。以期迅速有效地提升医护人员传染病防护技能和防护下临床操作的熟练度、精准度，在更好地治疗患者的同时，实现了医护人员“零感染”的目标。同时也说明在医院临床技能培训中心设置模拟隔离病区、开设传染病防护技能课程，并纳入常态化培训考核的必要性和重要性。     

Effects and long‐term follow‐up of using umbilical cord blood–derived mesenchymal stromal cells in pediatric patients with severe BK virus‐associated late‐onset hemorrhagic cystitis after unrelated cord blood transplantation

This is a retrospective study to evaluate the efficacy and safety of umbilical cord blood–derived mesenchymal stromal cells (MSCs) for the treatment of pediatric patients with severe BK virus–associated late‐onset hemorrhagic cystitis (BKV‐HC) after unrelated cord blood transplantation (UCBT). Thirteen pediatric patients with severe BKV‐HC from December 2013 to December 2015 were treated with MSCs. The number of MSCs transfused in each session was 1 × 10⁶/kg once a week until the symptoms improved. The median follow‐up time was 1432 (89‐2080) days. The median frequency of MSC infusion was 2 (1‐3), with eight cured cases and five effective cases; the total efficacy rate was 100%. The copy number of urine BKV DNA was 4.43 (0.36‐56.9) ×10⁸/mL before MSC infusion and 2.67 (0‐56.3) ×10⁸/mL after MSC infusion; the difference was not significant (P = .219). There were no significant differences in the overall survival, disease‐free survival, and the incidence of relapse and acute and chronic graft‐versus‐host disease between the MSC infusion group and non‐MSC infusion group. There was also no significant difference in the cytomegalovirus, Epstein‐Barr virus (EBV), and fungal and bacterial infection rates between the two groups. Although umbilical cord blood–derived MSCs do not reduce the number of BKV DNA copies in the urine, the cells have a high efficacy rate and minimal side effects in treating severe BKV‐HC after UCBT among pediatric patients. MSCs do not affect the rates of relapse, long‐term infection, or survival of patients with leukemia.     

中医药院校药事管理专业人才素质培养的研究

国内药事管理专业起步较晚，对该领域人才需求突出；中医药行业药事管理专业人才培养及储备尤为重要。从药事管理学科背景出发，结合中医药行业特点，以北京中医药大学为例；提出中医药院校在药事管理专业教育中，应让学生传承中国传统文化，重视以哲学思维为引领，培养以人为本及融合中庸之道的管理能力，掌握中医药理论+通识管理的特色专业课程知识，具备继承不泥古、创新不离宗等综合素质。