Treatment strategies

治疗策略
  • 文章类型: Journal Article
    阑尾的粘液,包括粘液性囊腺瘤和粘液性囊腺癌,代表罕见但具有临床意义的阑尾病变,其特征是阑尾腔内粘蛋白的积累。这篇综述探讨了与粘膜相关的诊断复杂性和治疗策略,强调其准确识别和管理的重要性。由于急性阑尾炎和其他阑尾病变的症状重叠,出现了诊断挑战。需要一种包括成像在内的多维方法,组织病理学分析,和临床相关性。治疗选择范围从阑尾切除术良性病变到更广泛的外科手术,如恶性形式的右半结肠切除术。预后因素,包括组织学亚型和肿瘤大小,影响治疗决策和长期结果。通过综合目前的证据和临床见解,这篇综述旨在为临床医生提供一个全面的框架,以了解阑尾粘液的复杂性,提供可以指导有效管理和未来研究工作的观点。
    Mucocles of the appendix, encompassing mucinous cystadenomas and mucinous cystadenocarcinomas, represent rare but clinically significant appendiceal lesions characterized by the accumulation of mucin within the appendix lumen. This review explores the diagnostic complexities and treatment strategies associated with mucocles, emphasizing the importance of its accurate recognition and management. Diagnostic challenges arise due to overlapping symptoms with acute appendicitis and other appendiceal pathologies, necessitating a multidimensional approach that includes imaging, histopathological analysis, and clinical correlation. Treatment options range from appendectomy for benign lesions to more extensive surgical procedures, such as right hemicolectomy for malignant forms. Prognostic factors, including histological subtype and tumor size, influence treatment decisions and long-term outcomes. By synthesizing current evidence and clinical insights, this review aims to provide a comprehensive framework for clinicians to navigate the complexities of mucocles of the appendix, offering perspectives that can guide effective management and future research endeavors.
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  • 文章类型: Journal Article
    滤泡性甲状腺癌(FTC)是第二常见类型的甲状腺癌,提出了独特的诊断和治疗挑战。这篇综述对FTC的诊断和治疗的最新进展进行了全面分析,强调这些发展对改善患者预后的重要性。我们讨论了诊断技术的发展,包括成像模式的进步,细针穿刺活检,和分子诊断,这提高了FTC检测的准确性和与良性状况的区别。该综述还评估了当前的治疗策略,包括外科手术,放射性碘治疗,和靶向治疗,检查其有效性和对患者预后的影响。此外,我们应对FTC管理中的持续挑战,如治疗指南的可变性和护理的差异。最后,这篇综述探讨了新兴的疗法和未来的研究方向,强调可能进一步优化FTC管理的创新。通过综合当前知识并确定未来的研究机会,这篇综述旨在为完善FTC的诊断和治疗方法做出贡献。
    Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer, presenting unique diagnostic and therapeutic challenges. This review provides a comprehensive analysis of the recent advancements in the diagnosis and treatment of FTC, emphasizing the significance of these developments in improving patient outcomes. We discuss the evolution of diagnostic techniques, including advancements in imaging modalities, fine needle aspiration biopsy, and molecular diagnostics, which have enhanced the accuracy of FTC detection and differentiation from benign conditions. The review also evaluates current treatment strategies, including surgical interventions, radioactive iodine therapy, and targeted therapies, examining their effectiveness and impact on patient prognosis. Additionally, we address ongoing challenges in FTC management, such as variability in treatment guidelines and disparities in care. Finally, the review explores emerging therapies and future research directions, highlighting innovations that may further optimize FTC management. By synthesizing current knowledge and identifying future research opportunities, this review aims to contribute to refining diagnostic and therapeutic approaches for FTC.
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  • 文章类型: Journal Article
    多发性硬化症(MS)是一种以炎症为特征的中枢神经系统(CNS)的异质性自身免疫介导的疾病,脱髓鞘和慢性进行性神经变性。在其广泛而不可预测的神经精神症状中,行为变化很常见,甚至从疾病的早期阶段开始,虽然它们与高级MS的认知缺陷有关。根据DSM-5,行为障碍包括注意力缺陷,反对,挑衅和行为障碍,焦虑,恐慌,强迫症(强迫症),破坏性和情绪障碍,而其他人也包括烦躁,激动,侵略和执行功能障碍。大约30%至80%的MS患者表现出与疾病进展相关的行为变化。它们通常与抑郁症和其他神经精神疾病相结合,但通常与运动障碍无关,提示不同的病理机制。这些和其他改变导致MS的残疾。虽然没有关于MS行为变化的具体神经病理学数据,脱髓鞘动物模型与人类白质和神经炎症异常有相似之处。神经影像学显示前额叶皮质萎缩,半球间抑制和破坏额叶-纹状体-丘脑和额顶网络。这表明MS病理学中脑紊乱的多区域模式,尽管其致病机制有待进一步阐明。社会的好处,心理,报告了行为干预和运动。在对PubMed进行系统分析的基础上,谷歌学者和科克伦图书馆,目前的流行病学,临床,回顾了神经影像学和致病证据,这些证据可能有助于早期识别MS的行为症状,并推广新的治疗目标和策略。
    Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.
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  • 文章类型: Journal Article
    继发性BRAF变异已被确定为驱动基因阳性NSCLC患者对酪氨酸激酶抑制剂(TKIs)的耐药机制。然而,对于这些患者的特征和后续治疗策略仍缺乏共识.我们回顾性分析了2016年5月至2023年12月在浙江省肿瘤医院接受TKIs治疗的驱动基因阳性NSCLC患者的病历。评估这些患者的临床和遗传特征,以及各种治疗策略对生存的影响。这项研究纳入了27例晚期非小细胞肺癌患者,其中BRAF变异发生在靶向治疗开始后28个月的中位时间.多元加速失效时间(AFT)模型表明,与基于化疗的方案组相比,联合靶向治疗组(p<0.001)和针对少发进展的联合局部治疗组(p<0.001)显著延长了患者的生存期.相比之下,继续原始信号通路的靶向单药治疗与较短的生存期相关(p=0.034).每个治疗组的中位总体OS如下:以化疗为基础的方案组,45个月;联合靶向治疗组,59个月;联合局部治疗组对少项进展患者,46个月;靶向单药治疗组,36个月。研究结果表明,联合靶向治疗组(包括TKIs,BRAF抑制剂,和/或MEK抑制剂)和局部治疗组比传统的基于化疗的方案在改善生存率方面更有效。此外,继续沿着原始信号通路进行靶向单药治疗的效果低于基于化疗的方案.
    Secondary BRAF variations have been identified as a mechanism of resistance to tyrosine kinase inhibitors (TKIs) in patients with driver gene-positive NSCLC. Nevertheless, there is still a lack of consensus regarding the characteristics and subsequent treatment strategies for these patients. We retrospectively reviewed the medical records of patients with driver gene-positive NSCLC who received TKIs therapy at Zhejiang Cancer Hospital between May 2016 and December 2023. The clinical and genetic characteristics of these patients were assessed, along with the impact of various treatment strategies on survival. This study enrolled 27 patients with advanced NSCLC, in whom BRAF variations occurred at a median time of 28 months after the initiation of targeted therapy. The multivariate accelerated failure time (AFT) model revealed that, compared to chemotherapy-based regimens group, the combined targeted therapy group (p < 0.001) and the combined local treatment group for oligo-progression (p < 0.001) significantly extended patient survival. In contrast, continuing the original signaling pathway\'s targeted monotherapy was associated with shorter survival (p = 0.034). The median global OS for each treatment group was as follows: chemotherapy-based regimens group, 45 months; combined targeted therapy group, 59 months; combined local treatment group for patients with oligo-progression, 46 months; and targeted monotherapy group, 36 months. Study results indicate that the combination targeted therapy group (including TKIs, BRAF inhibitors, and/or MEK inhibitors) and the localized treatment group are more effective than traditional chemotherapy-based regimens in improving survival. Additionally, continuing targeted monotherapy along the original signaling pathway proves less effective than chemotherapy-based regimens.
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  • 文章类型: Journal Article
    本文综述了眼表微生物组与青光眼的关系,强调其对疾病进展的影响。从全球青光眼意义的概述开始,它强调了了解眼部微生物组的细胞特征和微生物学的重要性。使用短语“眼部微生物组青光眼”在PubMed和Cochrane图书馆数据库上进行了搜索。从Cochrane图书馆返回0条记录,而从PubMed返回21条记录。2017年至2024年共检索到21条结果。这包括一份意见文件,四篇原创研究文章,16条评论这篇综述涵盖了眼表的解剖学,先进的分析方法,和眼部微生物组。它还深入研究了青光眼的生态失调,解决改变的微生物群落及其在疾病进展中的潜在作用。探讨了眼部微生物组和宿主免疫系统之间的复杂相互作用,强调串扰和炎症反应。这篇综述最后讨论了治疗意义,包括调节眼部微生物群和潜在的未来治疗策略。了解健康和青光眼眼睛中的微生物组可以帮助研究人员和临床医生采用创新的眼部健康方法。
    This review explores the connection between the ocular surface microbiome and glaucoma, highlighting its impact on disease progression. Beginning with an overview of global glaucoma significance, it emphasizes the importance of understanding the cellular characteristics and microbiology of the ocular microbiome. A search was conducted on the PubMed and Cochrane Library databases using the phrase \"ocular microbiome glaucoma\". 0 records were returned from the Cochrane Library while 21 were returned from PubMed. A total of 21 results were retrieved from 2017 to 2024. This comprised one opinion paper, four original research articles, and 16 reviews. This review covered the anatomy of the ocular surface, advanced analysis methods, and the ocular microbiome. It also delved into dysbiosis in glaucoma, addressing altered microbial communities and their potential role in disease progression. The intricate interplay between the ocular microbiome and the host\'s immune system is explored, emphasizing crosstalk and inflammatory responses. The review concludes by discussing therapeutic implications, including modulating ocular microbiota and potential future treatment strategies. Understanding the microbiome in healthy and glaucomatous eyes can help researchers and clinicians in innovative approaches to ocular health.
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  • 文章类型: Journal Article
    多发性硬化(MS)是一种以脱髓鞘病理过程为特征的慢性自身免疫性疾病,随后的轴突丢失,和中枢神经系统内的神经变性。尽管有许多有效控制这种情况的疾病改善疗法,有一个新兴的需要,以确定新的治疗靶点,特别是对于MS的渐进形式基于对疾病病理生理学的当代见解,正在进行的努力旨在开发创新的治疗方式。首先,已经广泛研究了单克隆抗体在影响尚未靶向的特定病理途径中的功效。新兴的方法强调细胞机制,例如针对免疫细胞的嵌合抗原受体T细胞疗法,正在吸引越来越多的兴趣。对小胶质细胞的不断发展的理解和在MS发病机理中的铁细胞机制的参与为靶向治疗提供了进一步的途径。此外,创新的治疗策略超越了传统方法,涵盖了针对微生物群组成改变和饮食调整的干预措施.这些辅助疗法有望成为MS整体管理的补充方法。这篇叙述性综述旨在总结目前的治疗方法,并概述MS患者的潜在治疗方法。
    Multiple sclerosis (MS) is a chronic autoimmune disease characterized by pathological processes of demyelination, subsequent axonal loss, and neurodegeneration within the central nervous system. Despite the availability of numerous disease-modifying therapies that effectively manage this condition, there is an emerging need to identify novel therapeutic targets, particularly for progressive forms of MS. Based on contemporary insights into disease pathophysiology, ongoing efforts are directed toward developing innovative treatment modalities. Primarily, monoclonal antibodies have been extensively investigated for their efficacy in influencing specific pathological pathways not yet targeted. Emerging approaches emphasizing cellular mechanisms, such as chimeric antigen receptor T cell therapy targeting immunological cells, are attracting increasing interest. The evolving understanding of microglia and the involvement of ferroptotic mechanisms in MS pathogenesis presents further avenues for targeted therapies. Moreover, innovative treatment strategies extend beyond conventional approaches to encompass interventions that target alterations in microbiota composition and dietary modifications. These adjunctive therapies hold promise as complementary methods for the holistic management of MS. This narrative review aims to summarize current therapies and outline potential treatment methods for individuals with MS.
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  • 文章类型: Journal Article
    结直肠癌(CRC)是全球第三大常见癌症,也是癌症相关死亡的第二大原因。树突状细胞(DC)构成一组异质的抗原呈递细胞,其对于启动和调节先天和适应性免疫应答都是重要的。作为免疫系统的重要组成部分,DC在CRC的发病机制和临床治疗中具有重要作用。DC交叉呈递肿瘤相关抗原以激活T细胞并触发抗肿瘤免疫应答。然而,由于肿瘤微环境的存在,DCs的抗肿瘤免疫功能受损,免疫耐受被促进。这篇综述系统地阐述了不同DC亚群的具体特征和功能,以及DCs在CRC微环境中的免疫应答和耐受性中的作用。此外,还讨论了DC如何促进CRC的进展,以及在现有数据的基础上增强抗肿瘤免疫力的潜在疗法,这将为CRC患者的免疫治疗提供新的观点和方法。
    Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths worldwide. Dendritic cells (DCs) constitute a heterogeneous group of antigen-presenting cells that are important for initiating and regulating both innate and adaptive immune responses. As a crucial component of the immune system, DCs have a pivotal role in the pathogenesis and clinical treatment of CRC. DCs cross-present tumor-related antigens to activate T cells and trigger an antitumor immune response. However, the antitumor immune function of DCs is impaired and immune tolerance is promoted due to the presence of the tumor microenvironment. This review systematically elucidates the specific characteristics and functions of different DC subsets, as well as the role that DCs play in the immune response and tolerance within the CRC microenvironment. Moreover, how DCs contribute to the progression of CRC and potential therapies to enhance antitumor immunity on the basis of existing data are also discussed, which will provide new perspectives and approaches for immunotherapy in patients with CRC.
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  • 文章类型: Journal Article
    背景:三叉神经痛(TN),以神经损伤引起的慢性疼痛为标志,与炎症密切相关。奥图林的作用,炎症和自噬的关键调节因子,在TN中没有完全理解。OTULIN的调节机制,参与调节炎症反应和自噬过程的关键蛋白,仍然没有完全阐明,特别是在TN和神经炎症的背景下。
    方法:采用眶下神经结扎诱导的TN大鼠模型。使用腺病毒载体和短发夹RNA调节OTULIN的表达。通过定量实时聚合酶链反应评估对疼痛和炎症反应的影响,westernblot,免疫荧光,和转录组学分析。
    结果:增强的OTULIN表达显着增加了模型中的头部退缩阈值,并降低了疼痛敏感性和神经炎性标志物。相反,沉默奥图林会加剧疼痛和炎症。转录组数据显示OTULINs对炎症和自噬通路的影响,特异性抑制NLR家族pyrin结构域含3(NLRP3)炎性体和促进自噬。体外实验证明OTULIN抑制小胶质细胞和神经元中的炎症标志物。
    结论:奥图林对调节TN至关重要,通过激活自噬途径和抑制NLRP3炎性体减轻神经性疼痛和神经炎症。
    BACKGROUND: Trigeminal neuralgia (TN), marked by chronic pain from neural damage, is closely associated with inflammation. The role of OTULIN, a key regulator in inflammation and autophagy, is not fully understood in TN. The regulatory mechanism of OTULIN, a key protein involved in modulating inflammatory responses and autophagy processes, remains incompletely elucidated, particularly in the context of TN and neuroinflammation.
    METHODS: An infraorbital nerve ligation-induced rat model of TN was used. OTULIN\'s expression was modulated using adenovirus vectors and short hairpin RNA. The impact on pain and inflammatory responses was assessed via quantitative real-time polymerase chain reaction, western blot, immunofluorescence, and transcriptomic analysis.
    RESULTS: Enhanced OTULIN expression significantly increased head withdrawal thresholds and reduced pain sensitivity and neuroinflammatory markers in the model. Conversely, silencing OTULIN exacerbated pain and inflammation. Transcriptomic data revealed OTULINs influence on both inflammatory and autophagy pathways, specifically in suppressing NLR family pyrin domain containing 3 (NLRP3) inflammasome and promoting autophagy. In vitro experiments demonstrated OTULIN\'s inhibition of inflammatory markers in microglia and neurons.
    CONCLUSIONS: OTULIN is crucial in modulating TN, reducing neuropathic pain and neuroinflammation by activating the autophagy pathway and inhibiting the NLRP3 inflammasome.
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  • 文章类型: Journal Article
    钙蛋白酶,Calpain半胱氨酸蛋白酶超家族的关键成员,以钙依赖性方式进行有限的蛋白质水解。由于在异常激活时各种细胞内蛋白的非特异性切割的可能性,其活性受到严格调节。对2010年至2023年的文献进行了全面回顾,发现有121篇参考文献讨论了心血管和脑血管疾病。钙蛋白酶系统的失调与各种病理现象有关,包括脂质代谢紊乱,炎症,凋亡,和兴奋毒性。尽管最近的研究揭示了钙蛋白酶在心脑血管疾病中的重要作用,确切的机制仍未完全理解。探索钙蛋白酶抑制作为治疗心脑血管疾病的治疗方法的潜力可能会成为未来钙蛋白酶研究的一个引人注目的领域。
    Calpain, a key member of the Calpain cysteine protease superfamily, performs limited protein hydrolysis in a calcium-dependent manner. Its activity is tightly regulated due to the potential for non-specific cleavage of various intracellular proteins upon aberrant activation. A thorough review of the literature from 2010 to 2023 reveals 121 references discussing cardiovascular and cerebrovascular diseases. Dysregulation of the Calpain system is associated with various pathological phenomena, including lipid metabolism disorders, inflammation, apoptosis, and excitotoxicity. Although recent studies have revealed the significant role of Calpain in cardiovascular and cerebrovascular diseases, the precise mechanisms remain incompletely understood. Exploring the potential of Calpain inhibition as a therapeutic approach for the treatment of cardiovascular and cerebrovascular diseases may emerge as a compelling area of interest for future calpain research.
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  • 文章类型: Case Reports
    肝细胞腺瘤(HCA)是一种罕见的良性肝肿瘤,表现出多种亚型,每个都有独特的分子改变。该病例报告描述了一名43岁的有酗酒史的男子,他表现出胃痛。影像学显示肝脏多发病变和乙状结肠炎症,而实验室检查显示中性粒细胞增多和肝酶升高。肿瘤标志物正常。肝活检证实HCA与肝细胞核因子-1α(HNF-1α)失活,以谷氨酰胺合成酶免疫染色阴性为特征,核β-连环蛋白,血清淀粉样蛋白A,C反应蛋白,和肝脏脂肪酸结合蛋白(L-FABP)。由于患者的性别和缺乏典型的危险因素,如激素水平异常,这种情况是独一无二的。男性的HCA,特别是HNF-1α失活,是罕见的,并提出诊断挑战。全面的诊断方法,包括活检和免疫组织化学分析,对于准确的亚型识别至关重要。恶性转化的可能性,尤其是男性患者,强调需要警惕的监测和适当的管理。这个案例强调了在鉴别诊断中考虑HCA的重要性,无论性别和典型的危险因素如何。为与HCA相关的各种演示和风险提供有价值的见解,并强调需要认识和进一步研究,以改善这种罕见疾病的诊断和管理。
    Hepatocellular adenoma (HCA) is an uncommon benign liver tumor that exhibits a variety of subtypes, each distinguished by unique molecular alterations. This case report describes a 43-year-old man with a history of alcoholism who presented with stomach pain. Imaging revealed multiple hepatic lesions and sigmoid colon inflammation, while laboratory tests showed mild neutrophilic leukocytosis and elevated liver enzymes. Tumor markers were normal. A liver biopsy confirmed HCA with hepatocyte nuclear factor-1 alpha (HNF-1α) inactivation, characterized by negative immunostaining for glutamine synthetase, nuclear beta-catenin, serum amyloid A, C-reactive protein, and liver fatty acid-binding protein (L-FABP). This case is unique due to the patient\'s gender and the absence of typical risk factors such as abnormal hormone levels. HCAs in males, particularly with HNF-1α inactivation, are rare and pose diagnostic challenges. Comprehensive diagnostic approaches, including biopsy and immunohistochemical analysis, are crucial for accurate subtype identification. The potential for malignant transformation, particularly in male patients, underscores the need for vigilant monitoring and appropriate management. This case highlights the importance of considering HCA in differential diagnoses regardless of gender and typical risk factors, contributing valuable insights into the diverse presentations and risks associated with HCA, and emphasizing the need for awareness and further research to improve diagnosis and management of this rare condition.
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