Treatment response

治疗反应
  • 文章类型: Journal Article
    在全球范围内,化脓性汗腺炎(HS)患者中大麻和大麻相关产品的使用正在增加。考虑到潜在的抗炎作用,治疗性的,以及大麻相关产品的疼痛管理益处,我们回顾了主要文献,以评估HS患者使用大麻的患病率和可能目的,并向患者和医师提供建议.使用Embase和OvidMedline数据库对原始研究进行了叙述性审查。该搜索策略得到了图书馆员的确认,并于2023年9月1日进行,使用了针对大麻量身定制的主题标题和关键字的详细列表,大麻相关产品,HS,以及成人和儿科人群。在43项确定的研究中,6符合资格标准,涵盖34,435名患者。患者大多是女性,研究在美国各地进行,加拿大,和法国。研究结果表明,HS患者使用大麻的比例更高,证明疼痛管理的有效性,睡眠,缓解焦虑,瘙痒缓解,提高了生活质量。大麻可能在镇痛中起作用,提高生活质量,疼痛,痒,HS患者的总体心理健康和包括皮肤科医生在内的医疗保健提供者应增加他们对适当使用大麻相关产品的熟悉度。
    The use of cannabis and cannabis-related products among patients with hidradenitis suppurativa (HS) is increasing globally. Given the potential anti-inflammatory, therapeutic, and pain management benefits of cannabis-related products, we reviewed primary literature to evaluate the prevalence and possible purpose for cannabis use among patients with HS and to provide recommendations to patients and physicians. A narrative review of original studies was conducted using Embase and Ovid Medline databases. The search strategy was confirmed by a librarian and conducted on September 1, 2023, using a detailed list of subject headings and keywords tailored to cannabis, cannabis-related products, HS, and both adult and pediatric populations. Among 43 identified studies, 6 met the eligibility criteria and encompassed 34,435 patients. Patients were mostly female, and studies were conducted across the United States, Canada, and France. Findings show higher cannabis use among HS patients, demonstrating efficacy in pain management, sleep, anxiety relief, itch relief, and improved quality of life. Cannabis may play a role in analgesia, improved quality of life, pain, itch, and overall mental health in patients with HS and healthcare providers including dermatologists should increase their familiarity in appropriate use of cannabis-related products.
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  • 文章类型: Journal Article
    背景:三阴性乳腺癌(TNBC)患者肿瘤浸润淋巴细胞(TIL)水平与新辅助治疗(NAT)反应之间的关系尚不清楚。
    目的:研究TIL水平对TNBC患者NAT反应的预测潜力。
    方法:对国家生物技术信息中心PubMed数据库进行了系统搜索,以收集2023年8月31日之前已发表的相关文献。使用系统评价和荟萃分析评估TNBC患者TIL水平与NAT病理完全缓解(pCR)之间的相关性。亚组分析,敏感性分析,并进行了发表偏倚分析.
    结果:本荟萃分析共纳入32项研究。总体荟萃分析结果表明,高TIL亚组TNBC患者NAT治疗后的pCR率明显高于低TIL亚组患者(48.0%vs27.7%)(风险比2.01;95%置信区间1.77-2.29;P<0.001,I2=56%)。亚组分析显示,研究之间的异质性源于研究设计的差异,TIL水平截止,研究人群。纳入研究中可能存在发表偏倚。基于不同NAT协议的荟萃分析显示,在所有协议中,TIL水平高的TNBC患者在NAT治疗后的pCR率都更高(均P≤0.01),不同NAT协议间的统计学差异无统计学意义(P=0.29)。此外,敏感性分析显示,当单独排除纳入的研究时,荟萃分析的总体结果保持一致.
    结论:TILs可作为TNBC患者对NAT治疗反应的预测指标。TIL水平高的TNBC患者比TIL水平低的患者表现出更高的NATpCR率。并且这种预测能力在不同的NAT方案中是一致的。
    BACKGROUND: The association between tumor-infiltrating lymphocyte (TIL) levels and the response to neoadjuvant therapy (NAT) in patients with triple-negative breast cancer (TNBC) remains unclear.
    OBJECTIVE: To investigate the predictive potential of TIL levels for the response to NAT in TNBC patients.
    METHODS: A systematic search of the National Center for Biotechnology Information PubMed database was performed to collect relevant published literature prior to August 31, 2023. The correlation between TIL levels and the NAT pathologic complete response (pCR) in TNBC patients was assessed using a systematic review and meta-analysis. Subgroup analysis, sensitivity analysis, and publication bias analysis were also conducted.
    RESULTS: A total of 32 studies were included in this meta-analysis. The overall meta-analysis results indicated that the pCR rate after NAT treatment in TNBC patients in the high TIL subgroup was significantly greater than that in patients in the low TIL subgroup (48.0% vs 27.7%) (risk ratio 2.01; 95% confidence interval 1.77-2.29; P < 0.001, I 2 = 56%). Subgroup analysis revealed that the between-study heterogeneity originated from differences in study design, TIL level cutoffs, and study populations. Publication bias could have existed in the included studies. The meta-analysis based on different NAT protocols revealed that all TNBC patients with high levels of TILs had a greater rate of pCR after NAT treatment in all protocols (all P ≤ 0.01), and there was no significant between-protocol difference in the statistics among the different NAT protocols (P = 0.29). Additionally, sensitivity analysis demonstrated that the overall results of the meta-analysis remained consistent when the included studies were individually excluded.
    CONCLUSIONS: TILs can serve as a predictor of the response to NAT treatment in TNBC patients. TNBC patients with high levels of TILs exhibit a greater NAT pCR rate than those with low levels of TILs, and this predictive capability is consistent across different NAT regimens.
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  • 文章类型: Journal Article
    背景:影像组学在各种眼科疾病的医学图像分析中具有巨大的潜力。最近,在这一研究领域有许多努力。本系统综述旨在全面评估影像组学在眼科中的优势和局限性。
    方法:符合系统评价和荟萃分析(PRISMA)指南的首选报告项目,我们对预先注册的方案(PROSPERO:CRD42023446317)进行了系统评价.我们探索了PubMed,Embase,和Cochrane数据库对该主题进行了原始研究,并进行了全面的描述性整合。此外,纳入的研究通过影像组学质量评分(RQS)进行质量评估.
    结果:最终从227项研究的初始搜索中选择了41篇文章进行进一步分析。这些文章包括五个疾病类别的研究,涵盖了七个成像模式。影像组学模型表现出强大的性能,曲线下面积(AUC)值大多在0.7-1.0范围内。中度RQS(平均得分为11.17/36)表明大多数研究是回顾性的,无需外部验证的单中心分析。
    结论:影像组学在眼科领域具有广阔的应用前景,协助诊断,早期筛查,和治疗反应的预测。人工智能算法为眼科影像组学模型的构建做出了重要贡献。这项研究强调了影像组学在眼科领域的优势和挑战,并提出了未来改进的潜在途径。
    结论:影像组学代表了一种产生创新成像标记的有价值的方法,提高临床诊断和治疗效率,并在许多眼科疾病的临床背景下帮助决策,从而改善患者的整体预后。
    结论:影像组学在眼科领域引起了广泛的关注。文章包括七种成像模式的五种疾病类别,始终产生的AUC大多高于0.7。目前的研究很少有前瞻性和多中心的研究,强调未来高质量研究的必要性。
    BACKGROUND: Radiomics holds great potential in medical image analysis for various ophthalmic diseases. In recent times, there have been numerous endeavors in this area of research. This systematic review aims to provide a comprehensive assessment of the strengths and limitations of radiomics in ophthalmology.
    METHODS: Conforming to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic review with a pre-registered protocol (PROSPERO: CRD42023446317). We explored the PubMed, Embase, and Cochrane databases for original studies on this topic and made a comprehensive descriptive integration. Furthermore, the included studies underwent quality assessment by the radiomics quality score (RQS).
    RESULTS: A total of 41 articles from an initial search of 227 studies were finally selected for further analysis. These articles included research across five disease categories and covered seven imaging modalities. The radiomics models demonstrated robust performance, with area under the curve (AUC) values mostly falling within 0.7-1.0. The moderate RQS (mean score: 11.17/36) indicated that most studies were retrospectively, single-center analyses without external validation.
    CONCLUSIONS: Radiomics holds promising utility in the field of ophthalmology, assisting diagnosis, early-stage screening, and prognostication of treatment response. Artificial intelligence algorithms significantly contribute to the construction of radiomics models in ophthalmology. This study highlights the strengths and challenges of radiomics in ophthalmology and suggests potential avenues for future improvement.
    CONCLUSIONS: Radiomics represents a valuable approach for generating innovative imaging markers, enhancing efficiency in clinical diagnosis and treatment, and aiding decision-making in clinical contexts of many ophthalmic diseases, thereby improving overall patient prognosis.
    CONCLUSIONS: Radiomics has attracted extensive attention in the field of ophthalmology. Articles included five disease categories over seven imaging modalities, consistently yielding AUCs mostly above 0.7. Current research has few prospective and multi-center studies, underlining the necessity for future high-quality studies.
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  • 文章类型: Journal Article
    目标:兴奋剂,例如哌醋甲酯(MPH)和苯丙胺,代表注意力缺陷/多动障碍(ADHD)的一线药物选择。随机对照试验(RCTs)已在组水平上证明了有益的效果,但无法确定与不同个体反应一致相关的特征。因此,需要更多的个性化方法。实验研究表明,对单剂量的神经生物学反应指示长期反应。目前尚不清楚这是否也适用于临床措施。方法:我们对RCTs进行了系统评价,以测试单剂量兴奋剂的临床反应与长期改善之间的关系。从MED-ADHD数据集中确定了可能合适的单剂量随机对照试验,欧洲ADHD指南组RCT数据集(https://med-adhd.org/),于2024年2月1日更新。使用Cochrane偏差风险(RoB)2.0工具进行质量评估。结果:总共63例单剂量随机对照试验(94%检测MPH,85%的儿童)被确认。其中,只有RCT的二次分析检验了急性和长期临床反应之间的相关性.这表明,在46名患有ADHD的儿童(89%的男性)中,单剂量MPH后的临床改善与4周MPH治疗后的症状改善显着相关。偏倚风险被评为中度。另一个RCT使用近红外光谱,因此不符合纳入标准,报告了22名患有ADHD的儿童(82%为男性)单剂量下的大脑变化与长期临床反应之间的关联。其余的随机对照试验仅报道了单剂量对神经心理学的影响,神经影像学,或神经生理学措施。结论:本系统综述强调了当前知识的重要差距。研究急性和长期反应可能与之相关,可以促进我们对兴奋剂作用机制的理解,并有助于开发分层方法以制定更量身定制的治疗策略。未来的研究需要调查潜在的年龄和性别相关的差异。
    Objectives: Stimulants, such as methylphenidate (MPH) and amphetamines, represent the first-line pharmacological option for attention-deficit/hyperactivity disorder (ADHD). Randomized controlled trials (RCTs) have demonstrated beneficial effects at a group level but could not identify characteristics consistently associated with varying individual response. Thus, more individualized approaches are needed. Experimental studies have suggested that the neurobiological response to a single dose is indicative of longer term response. It is unclear whether this also applies to clinical measures. Methods: We carried out a systematic review of RCTs testing the association between the clinical response to a single dose of stimulants and longer term improvement. Potentially suitable single-dose RCTs were identified from the MED-ADHD data set, the European ADHD Guidelines Group RCT Data set (https://med-adhd.org/), as updated on February 1, 2024. Quality assessment was carried out using the Cochrane Risk of Bias (RoB) 2.0 tool. Results: A total of 63 single-dose RCTs (94% testing MPH, 85% in children) were identified. Among these, only a secondary analysis of an RCT tested the association between acute and longer term clinical response. This showed that the clinical improvement after a single dose of MPH was significantly associated with symptom improvement after a 4-week MPH treatment in 46 children (89% males) with ADHD. The risk of bias was rated as moderate. A further RCT used near-infrared spectroscopy, thus did not meet the inclusion criteria, and reported an association between brain changes under a single-dose and longer term clinical response in 22 children (82% males) with ADHD. The remaining RCTs only reported single-dose effects on neuropsychological, neuroimaging, or neurophysiological measures. Conclusion: This systematic review highlighted an important gap in the current knowledge. Investigating how acute and long-term response may be related can foster our understanding of stimulant mechanism of action and help develop stratification approaches for more tailored treatment strategies. Future studies need to investigate potential age- and sex-related differences.
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  • 文章类型: Journal Article
    免疫治疗是一个快速发展的领域,许多模型试图描述它对免疫系统的影响,特别是与放射治疗配对时。对这种组合的肿瘤反应涉及复杂的时空动态,这使得在所产生的广泛的溶液空间中进行临床或临床前体内研究极其困难。在这次审查中,放射治疗之间相互作用的几种计算机模型,免疫疗法,并检查患者的免疫系统。该研究仅包括以英文发表的数学模型,该模型研究了放射治疗对免疫系统的影响,或免疫检查点抑制剂的免疫放疗效果。研究结果表明,当同时进行放疗和免疫治疗时,预计治疗效果会提高。与单纯放疗或免疫疗法相比。然而,这些模型在放疗和免疫治疗的最佳方案和分割方面不一致.这对应于相关的临床试验,报告了联合治疗改善的治疗效果,然而,临床试验之间的最佳安排有所不同.模型之间的这种差异可以归因于模型方法和建模的特定癌症类型的变化。确定最佳的一般治疗方案和模型具有挑战性。需要使用类似的数据集进行进一步的研究,以评估特定癌症类型和阶段的最佳模型和治疗方案。
    Immunotherapy is a rapidly evolving field, with many models attempting to describe its impact on the immune system, especially when paired with radiotherapy. Tumor response to this combination involves a complex spatiotemporal dynamic which makes either clinical or pre-clinical in vivo investigation across the resulting extensive solution space extremely difficult. In this review, several in silico models of the interaction between radiotherapy, immunotherapy, and the patient\'s immune system are examined. The study included only mathematical models published in English that investigated the effects of radiotherapy on the immune system, or the effect of immuno-radiotherapy with immune checkpoint inhibitors. The findings indicate that treatment efficacy was predicted to improve when both radiotherapy and immunotherapy were administered, compared to radiotherapy or immunotherapy alone. However, the models do not agree on the optimal schedule and fractionation of radiotherapy and immunotherapy. This corresponds to relevant clinical trials, which report an improved treatment efficacy with combination therapy, however, the optimal scheduling varies between clinical trials. This discrepancy between the models can be attributed to the variation in model approach and the specific cancer types modeled, making the determination of the optimum general treatment schedule and model challenging. Further research needs to be conducted with similar data sets to evaluate the best model and treatment schedule for a specific cancer type and stage.
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  • 文章类型: Journal Article
    胶质瘤是中枢神经系统(CNS)原发性恶性肿瘤的最常见类型,恶性程度高,复发率高,生存率差。传统的成像技术仅提供有关解剖位置的信息,形态特征,和增强模式。相比之下,先进的成像技术,如动态对比增强(DCE)MRI或DCECT可以反映组织微循环,包括肿瘤血管增生和血管通透性。尽管一些研究已经使用DCE成像来评估胶质瘤,使用传统示踪剂动力学模型(TKM)(例如Tofts或扩展Tofts模型(ETM))进行数据分析的结果不明确。更先进的模型,如Brix的常规两室模型(Brix),建立了组织均匀性模型(TH)和分布参数(DP)模型,但是它们在临床试验中的应用受到限制。这篇综述试图评估使用常规TKM进行神经胶质瘤研究的问题,例如Tofts或ETM模型,强调DCE成像技术的进步,并提供使用更先进的TKM治疗神经胶质瘤的临床价值的见解。
    Glioma is the most common type of primary malignant tumor of the central nervous system (CNS), and is characterized by high malignancy, high recurrence rate and poor survival. Conventional imaging techniques only provide information regarding the anatomical location, morphological characteristics, and enhancement patterns. In contrast, advanced imaging techniques such as dynamic contrast-enhanced (DCE) MRI or DCE CT can reflect tissue microcirculation, including tumor vascular hyperplasia and vessel permeability. Although several studies have used DCE imaging to evaluate gliomas, the results of data analysis using conventional tracer kinetic models (TKMs) such as Tofts or extended-Tofts model (ETM) have been ambiguous. More advanced models such as Brix\'s conventional two-compartment model (Brix), tissue homogeneity model (TH) and distributed parameter (DP) model have been developed, but their application in clinical trials has been limited. This review attempts to appraise issues on glioma studies using conventional TKMs, such as Tofts or ETM model, highlight advancement of DCE imaging techniques and provides insights on the clinical value of glioma management using more advanced TKMs.
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  • 文章类型: Journal Article
    重度抑郁症(MDD)是一种使人衰弱且普遍存在的精神疾病,具有很高的疾病负担。尽管有各种各样不同的治疗选择,许多患者对最初的治疗尝试没有反应。选择最合适的治疗方法仍然是精神病学的重大临床挑战,强调了开发具有预测效用的生物标志物的必要性。最近,表观遗传修饰DNA甲基化(DNAm)作为MDD治疗结局的潜在预测指标,已引起人们极大的兴趣.这里,我们回顾了迄今为止旨在确定与MDD患者治疗反应相关的DNAm特征的努力.在PubMed数据库中进行了搜索,Scopus,和WebofScience的概念和关键词MDD,DNAM,抗抑郁药,心理治疗,认知行为疗法,电惊厥治疗,经颅磁刺激,和大脑刺激疗法。我们确定了32项涉及与MDD治疗结果相关的DNAm模式的研究。大多数研究(N=25)集中于探索药理学治疗(N=22)中的治疗结果的选择的靶基因,少数研究评估对电惊厥治疗的治疗反应(N=3)。此外,很少有基因组尺度的努力(N=7)来表征与治疗结果相关的DNAm模式.研究与心理治疗相关的DNAm模式的研究相对缺乏,电惊厥治疗,或经颅磁刺激;重要的是,大多数现有的研究样本量有限。鉴于迄今为止研究方法和结果的异质性,在现有的研究结果为临床决策提供依据之前,还需要进行更多的研究.
    Major depressive disorder (MDD) is a debilitating and prevalent mental disorder with a high disease burden. Despite a wide array of different treatment options, many patients do not respond to initial treatment attempts. Selection of the most appropriate treatment remains a significant clinical challenge in psychiatry, highlighting the need for the development of biomarkers with predictive utility. Recently, the epigenetic modification DNA methylation (DNAm) has emerged to be of great interest as a potential predictor of MDD treatment outcomes. Here, we review efforts to date that seek to identify DNAm signatures associated with treatment response in individuals with MDD. Searches were conducted in the databases PubMed, Scopus, and Web of Science with the concepts and keywords MDD, DNAm, antidepressants, psychotherapy, cognitive behavior therapy, electroconvulsive therapy, transcranial magnetic stimulation, and brain stimulation therapies. We identified 32 studies implicating DNAm patterns associated with MDD treatment outcomes. The majority of studies (N = 25) are focused on selected target genes exploring treatment outcomes in pharmacological treatments (N = 22) with a few studies assessing treatment response to electroconvulsive therapy (N = 3). Additionally, there are few genome-scale efforts (N = 7) to characterize DNAm patterns associated with treatment outcomes. There is a relative dearth of studies investigating DNAm patterns in relation to psychotherapy, electroconvulsive therapy, or transcranial magnetic stimulation; importantly, most existing studies have limited sample sizes. Given the heterogeneity in both methods and results of studies to date, there is a need for additional studies before existing findings can inform clinical decisions.
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  • 文章类型: Journal Article
    背景:精神疾病的患病率不同,症状简介,以及男性和女性的疾病课程。然而,精神病患者的性别差异没有得到足够的重视,指导治疗建议。本系统综述旨在总结诊断上情绪稳定剂和抗精神病药的治疗反应和不良反应的性别差异。
    方法:我们遵循PRISMA2020声明(CRD42020212478)进行了系统评价。使用MEDLINE进行文献检索,Embase,CochraneCentral,PsycINFO,WebofScience核心合集,和Scopus数据库。包括比较男性和女性情绪稳定剂或抗精神病药物治疗结果的研究。JBI关键评估清单用于评估偏差风险。
    结果:在4866条记录中,129份报告(14份关于情绪稳定剂,包括不同设计的抗精神病药115)。样本量范围从17到22,774名参与者(中位数=147)。最常见的精神病诊断是精神分裂症谱(n=109,84.5%)和双相情感障碍(n=38,29.5%)。只有四项研究探讨了情绪稳定剂治疗反应的性别差异。在40篇关于抗精神病药物治疗反应的文章中,18表示没有性别差异,而16位显示女性有更好的结果。女性对情绪稳定剂和抗精神病药的不良反应更大。在84项研究中,偏倚风险较低(65.1%)。
    结论:研究中存在显著异质性,无法进行荟萃分析。
    结论:关注情绪稳定剂治疗结果性别差异的研究数量有限。女性对抗精神病药物的反应可能比男性好,但也经历更多的副作用。药代动力学对性别差异的影响值得更多关注。
    BACKGROUND: Psychiatric disorders differ in their prevalence, symptom profiles, and disease courses in men and women. However, sex differences in psychiatric disorders have not received enough attention to guide treatment recommendations. This systematic review aims to summarize sex differences in the treatment responses and adverse effects of mood stabilizers and antipsychotics transdiagnostically.
    METHODS: We conducted a systematic review following the PRISMA 2020 statement (CRD42020212478). A literature search was conducted using MEDLINE, Embase, Cochrane Central, PsycINFO, Web of Science Core Collection, and Scopus databases. Studies comparing mood stabilizer or antipsychotic treatment outcomes in men and women were included. JBI critical appraisal checklists were used to assess bias risk.
    RESULTS: Out of 4866 records, 129 reports (14 on mood stabilizers, 115 on antipsychotics) with varying designs were included. Sample sizes ranged from 17 to 22,774 participants (median = 147). The most common psychiatric diagnoses were schizophrenia spectrum (n = 109, 84.5 %) and bipolar disorders (n = 38, 29.5 %). Only four studies explored sex differences in mood stabilizer treatment response. In 40 articles on antipsychotic treatment response, 18 indicated no sex difference, while 16 showed females had better outcomes. Women had more adverse effects with both mood stabilizers and antipsychotics. The risk of bias was low in 84 (65.1 %) of studies.
    CONCLUSIONS: Substantial heterogeneity among the studies precluded performing a meta-analysis.
    CONCLUSIONS: Number of studies focusing on sex differences in treatment outcomes of mood stabilizers is limited. Women may respond better to antipsychotics than men, but also experience more side effects. The impact of pharmacokinetics on sex differences warrants more attention.
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  • 文章类型: Systematic Review
    背景:鉴于文献中可获得的矛盾数据,本系统综述的目的是研究边缘性人格障碍(BPD)的诊断方法对接受电惊厥治疗(ECT)的重度抑郁症患者急性期反应和早期复发风险的影响.
    方法:在2023年3月根据PRISMA标准在PubMed-Medline数据库中进行了系统的文献综述之后,使用关键字算法(\“电惊厥疗法\”[网状]或电惊厥疗法)和(\“边缘性人格障碍\”[网状]或边缘性人格障碍)鉴定了47篇文章。本系统评价中用于选择文章的纳入标准是:(1)研究BPD对接受ECT治疗的重度抑郁症患者(>18岁)的急性反应和/或早期复发风险的影响的文章。(2)根据国际分类的诊断标准,通过经过验证的筛查测试和/或系统的精神病学访谈来诊断BPD和重度抑郁症。(3)任何类型的研究(横截面,纵向,prospective,回顾性,介入性和实验性),(4)用英语或法语写的文章,(5)2000年1月以后发表的文章。在两位作者根据这些纳入标准对47篇文章进行评估后,本系统综述纳入了7项研究,这些研究调查了通过系统的精神病学访谈或筛查试验诊断的BPD对接受ECT治疗的主要抑郁症患者的急性期反应和早期复发风险的影响.
    结果:与通过筛查测试诊断BPD的三项研究不同,通过系统的精神病学访谈诊断BPD的4项研究表明,在接受ECT治疗的主要抑郁症患者中,这种人格障碍对急性反应或早期复发风险有负面影响.然而,纳入本系统综述的所有研究均提供低水平的科学证据(横断面流行病学研究和回顾性队列研究).
    结论:尽管需要更好的科学质量研究,本系统综述的结果似乎表明,在ECT前评估期间通过系统的精神病学访谈筛查BPD,并在共患BPD的情况下建立适当的治疗策略,可能是有前景的选择,可以使接受ECT治疗的重度抑郁症患者获得更好的急性应答和更好的预防早期复发.
    BACKGROUND: Given the contradictory data available in the literature, the aim of this systematic review was to investigate the impact of the diagnostic method for borderline personality disorder (BPD) on the acute response and the risk of early relapse in major depressed individuals treated with electroconvulsive therapy (ECT).
    METHODS: After a systematic literature review performed during March 2023 in the PubMed-Medline database according to the PRISMA criteria, 47 articles were identified using the keyword algorithm (\"Electroconvulsive Therapy\" [Mesh] or electroconvulsive therapy) and (\"Borderline Personality Disorder\" [Mesh] or borderline personality disorder). The inclusion criteria applied for the selection of articles in this systematic review were: (1) articles investigating the impact of BPD on the acute response and/or the risk of early relapse in major depressed individuals (> 18 years old) treated with ECT, (2) diagnosis of BPD and major depressive disorder by validated screening tests and/or systematic psychiatric interviews based on diagnostic criteria of international classification, (3) any type of study (cross-sectional, longitudinal, prospective, retrospective, interventional and experimental), (4) articles written in English or French, and (5) articles published after January 2000. After assessment of the 47 articles based on these inclusion criteria by two authors, seven studies investigating the impact of BPD diagnosed by systematic psychiatric interview or screening tests on the acute response and the risk of early relapse in major depressed individuals treated with ECT were included in this systematic review.
    RESULTS: Unlike the three studies diagnosing BPD by screening tests, the four studies diagnosing BPD by systematic psychiatric interview demonstrated a negative impact of this personality disorder on the acute response or the risk of early relapse in major depressed individuals treated with ECT. However, all studies included in this systematic review presented a low level of scientific evidence (cross-sectional epidemiological studies and retrospective cohort studies).
    CONCLUSIONS: Despite the need for studies of better scientific quality, the results of this systematic review seem to indicate that screening for BPD by systematic psychiatric interview during the pre-ECT assessment and the establishment of adequate therapeutic strategies in case of comorbid BPD could be promising options to allow better acute response and better prevention of early relapses in major depressed individuals treated with ECT.
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  • 文章类型: Journal Article
    类风湿性关节炎(RA)是一种相对常见的全身性自身免疫性疾病,在全球范围内估计患病率约为1%。患者主要表现为对称性小关节炎性关节炎,涉及免疫反应失调,由于广泛的糜烂损伤导致骨和软骨畸形。引入基于生物的疗法来管理这种改变生命的疾病,在过去的三十年里,显著改善了患者的生活质量。广泛的先天和适应性免疫细胞参与RA的发病机制,细胞因子的复杂相互作用,T细胞,B细胞,和树突状细胞。这些细胞中的一些已经通过使用基于生物制剂的疗法成功地靶向治疗RA。例如,利妥昔单抗治疗可阻断RA患者的B细胞活化,而阿巴蒂普有效阻断RA患者的T细胞活化。尽管取得了这些进展,仍然有一些患者对目前的所有治疗选择都有抵抗力,这鼓励了进一步的研究,以了解介导疾病的主要信号转导途径。在这篇综述中,我们讨论了主要信号通路的作用,包括与RA疾病进展有关的代谢重编程,为了开发更精确部署现有疗法的概念框架,并提供产生这些途径的分子抑制剂的基本原理。对RA中许多细胞内信号通路的了解的提高将补充当前的精准医学策略。特别是对于难以治疗的RA患者,尤其是那些患有多药耐药性疾病的患者。
    Rheumatoid arthritis (RA) is a relatively common systemic autoimmune disease with an estimated prevalence of approximately 1% worldwide. Patients present predominantly with symmetrical small joint inflammatory arthritis, which involves dysregulated immune responses, leading to bone and cartilage deformities due to extensive erosive damage. The introduction of biological based therapies for the management of this life-altering condition, over the past three decades, has led to marked improvements in patients\' quality of life. A wide range of both innate and adaptive immune cells are involved in the pathogenesis of RA, with a complex interplay of cytokines, T-cells, B-cells, and dendritic cells. Some of these cells have been successfully targeted in the treatment of RA by the use of biologics-based therapies. For example, rituximab therapy blocks B cell activation and abatacept effectively blocks T cell activation in patients with RA. Despite these advances, there remain some patients who are resistant to all current therapeutic options, which has encouraged further research into understanding the primary signal transduction pathways that mediate the disease. In this review we discuss the roles of the main signalling pathways, including metabolic reprogramming that have been implicated in RA disease progression, in order to develop a conceptual framework for more precise deployment of existing therapies, and to provide a rationale for producing molecular inhibitors of these pathways. Improved knowledge of the many intracellular signalling pathways in RA will complement current precision medicine strategies, particularly for the patients with difficult-to-treat RA, and especially in those with multidrug resistance disease.
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