Ovarian cancer is a prevalent gynecological malignancy with high mortality and low survival rates. The absence of specific symptoms in early stages often leads to late-stage diagnoses. Standard treatment typically includes surgery followed by platinum and paclitaxel chemotherapy. Exosomes, nanoscale vesicles released by various cell types, are key in intercellular communication, carrying biologically active molecules like proteins, lipids, enzymes, mRNA, and miRNAs. They are involved in tumor microenvironment remodeling, angiogenesis, metastasis, and chemoresistance in ovarian cancer. Emerging research highlights exosomes as drug carriers and therapeutic targets to suppress anti-tumor immune responses. Surface-enhanced Raman scattering (SERS) enables multiplexed, sensitive, and rapid detection of exosome surface proteins, offering advantages such as low background noise, no photobleaching, robustness, and high sensitivity over other detection methods. This review explores the relationship between exosomes and chemoresistance in ovarian cancer, examining the mechanisms by which exosomes contribute to drug resistance and their clinical implications. The goal is to provide new insights into chemoresistance mechanisms, improve diagnosis and intervention strategies, and enhance chemotherapy sensitivity in clinical treatments. In addition, the prospects of exosomes as drug carriers to resist chemical resistance and improve the survival of ovarian cancer patients are summarized. This article emphasizes the role of SERS in detecting ovarian cancer exosomes and advances in exosome detection.

Objective To explore the applicable conditions of the Cox-TEL(Cox PH-Taylor expansion adjustment for long-term survival data)method for analysis of survival data that contain cured patients.Methods The simulated survival data method based on Weibull distribution was used to simulate and generate the survival data with different cure rates,censored rates,and cure rate differences.The Cox-TEL method was used for analysis of the generated simulation data,and its performance was evaluated by calculating its type I error and power.Results Almost all the type I error of the hazard ratios(HRs)obtained by the Cox-TEL method under different conditions were slightly greater than 0.05,and this method showed a good test power for estimating the HRs for data with a large sample size and a large difference in proportions(DPs).For the data of cured patients,the type I error of the DPs obtained by the Cox-TEL method was well around 0.05,and its test power was robust in most of the scenarios.Conclusion The Cox-TEL method is effective for analyzing data of uncured patients and obtaining reliable HRs for most of the survival data with a sample size,a low censored rates,and a large difference in cure rates.The method is capable of accurately estimating the DPs regardless of the sample size,censored rates,or the cure rates.

ObjectiveTo investigate the efficacy and safety of cinobufagin tablets combined with thalidomide/dexamethasone （TD） regimen in the treatment of newly diagnosed multiple myeloma （NDMM） with phlegm and stasis obstruction. MethodsThe clinical data of 50 patients with NDMM of phlegm and stasis obstruction who were hospitalized at the Jiangsu Province Hospital of Chinese Medicine from June 1st， 2015 to July 31th， 2019 were retrospectively analyzed， and they were divided into a control group （bortezomib/dexamethasone-containing regimen， 27 cases） and an observation group （cinobufagin tablets combined with TD regimen， 23 cases）. The clinical efficacy and safety were compared between the two groups after two or three courses of treatment. The primary outcomes were clinical remission rate including overall response rate and deep remission rate， one-year and two-year overall survival rate， and adverse effects. The secondary outcomes were the proportion of plasma cells in bone marrow， hemoglobin， β2-microglobulin， lactate dehydrogenase， serum creatinine， blood urea nitrogen， bone pain score， and KPS functional status score （KPS score） before and after treatment. ResultsIn terms of clinical efficacy， there was no statistically significant difference （P＞0.05） in the overall response rate ［the observation group 69.57%（16/23） vs the control group 70.37% （19/27）］ and deep remission rate ［the observation group 56.52% （13/23） vs the control group 55.56% （15/27）］ between groups after the treatment. The one-year overall survival rates of the observation group and the control group were 90.9% and 92.4%， and the two-year overall survival rates were 81.8% and 80.9% respectively， with no statistically significant differences between groups （P＞0.05）. During the treatment， no renal function injury occurred in both groups. The incidence of peripheral nerve injury in the observation group was 8.70%， which was lower than 48.15% in the control group （P＜0.01）. After the treatment， the proportion of myeloma plasma cells， β2-microglobulin， serum creatinine level， and bone pain score decreased， while the hemoglobin level and KPS score increased in both groups （P＜0.05 or P＜0.01）. Compared between groups after treatment， the bone pain score of the observation group was lower than that of the control group， while the KPS score was higher than that of the control group （P＜0.05）. ConclusionThe clinical efficacy of cinobufagin tablets combined with TD in the treatment of NDMM is equivalent to bortezomib/dexamethasone-containing regimen， but the former is more helpful in relieving the pain and improving the quality of life， and has better safety.

Objective To explore the applicable conditions of the Cox-TEL(Cox PH-Taylor expansion adjustment for long-term survival data)method for analysis of survival data that contain cured patients.Methods The simulated survival data method based on Weibull distribution was used to simulate and generate the survival data with different cure rates,censored rates,and cure rate differences.The Cox-TEL method was used for analysis of the generated simulation data,and its performance was evaluated by calculating its type I error and power.Results Almost all the type I error of the hazard ratios(HRs)obtained by the Cox-TEL method under different conditions were slightly greater than 0.05,and this method showed a good test power for estimating the HRs for data with a large sample size and a large difference in proportions(DPs).For the data of cured patients,the type I error of the DPs obtained by the Cox-TEL method was well around 0.05,and its test power was robust in most of the scenarios.Conclusion The Cox-TEL method is effective for analyzing data of uncured patients and obtaining reliable HRs for most of the survival data with a sample size,a low censored rates,and a large difference in cure rates.The method is capable of accurately estimating the DPs regardless of the sample size,censored rates,or the cure rates.

Objective To standardize the management of narrative pharmaceutical documents,and to promote the standardization of narrative pharmaceutical services.Methods With the help of PaaS cloud computing technology design and development,and with the help of OpenAI technology,narrative material writing and narrative communication activities were assisted.Results The functions of narrative prescription,management of narrative activities,narrative writing and parallel medical records were realized and the resource database of narrative materials was established.Conclusion PaaS cloud computing technology has the advantages of rapid deployment and development of narrative pharmaceutical management forms,and it is combined with OpenAI technology.It can help clinical pharmacists quickly complete the search and writing of clinical cases and narrative materials,and greatly improve the efficiency of narrative pharmaceutical services.

Objective:To detect the microRNAs (miRNAs) and proteins carried by exosomes in the plasma of patients with newly diagnosed Takayasu′s arteritis (TAK) and analyze their possible roles in the pathogenesis of TAK.Methods:Ten patients with newly diagnosed TAK from the Department of Rheumatology and Immunology, Peking Union Medical College Hospital were selected during June-November 2020. Five healthy controls were matched with five patients by age and sex. RNA sequencing and protein mass spectrometry were used to detect miRNAs and proteins, respectively, carried by exosomes in the plasma. Differentially expressed miRNAs (DE-miRNAs) and proteins (DEPs) were screened. Thereafter, hierarchical cluster analysis, function, signal pathway, and protein domain enrichment analysis of DE-miRNAs and DEPs were performed. Finally, miRNAs and proteins related to vasculitis and autoimmunity were identified. The possible roles of the miRNAs and proteins in the pathogenesis of TAK were explored. Enumeration data were compared using Fisher′s exact probability test or Chi-square test, and a P-value<0.05 was considered significant. Results:Compared with the healthy controls, patients with TAK had 29 DE-miRNAs on their plasma exosomes. Among these DE-miRNAs, miR-101-3p, miR-122-5p, miR-143-3p, miR-185-3p, miR-192-5p, miR-194-5p, miR-19a-3p, miR-19b-3p, miR-20b-5p, miR-21-5p, miR-22-3p, miR-335-5p, miR-34a-5p, miR-3613-5p, miR-548ad-5p, miR-590-3p, and miR-7-5p were upregulated; whereas miR-1249-3p, miR-141-3p, miR-199a-5p, miR-199b-5p, miR-200a-3p, miR-200c-3p, miR-204-5p, miR-29c-5p, miR-335-3p, miR-381-3p, miR-4433b-5p, and miR-584-5p were downregulated. Finally, miR-34a-5p, miR-200c-3p, miR-143-3p, miR-22-3p, and miR-21-5p were identified. Among the 357 DEPs screened, 236 DEPs were upregulated, whereas 121 DEPs were downregulated. Finally, kallikrein B1 (KLKB1), kininogen 1 (KNG1), desmoplakin (DSP) were identified.Conclusion:MiR-34a-5p, miR-200c-3p, miR-143-3p, miR-22-3p, miR-21-5p, KLKB1, KNG1, and DSP carried by exosomes in plasma might participate in the pathogenesis of TAK by regulating vascular physiology, inflammation, autoimmunity, and other processes. They may be biomarkers and therapeutic targets of TAK.

Objective:To explore the mechanism of Xijiao Dihuang Ddecoction (XJDHT) against sepsis-induced liver injury based on transcriptomics.Methods:Sixty C57BL/6 mice were randomly (random number) divided into the sepsis group, sepsis treatment with XJDHT and control group, with 20 mice in each group. The sepsis mouse model was established by intraperitoneal (i.p.) injection of lipopolysaccharide (LPS). The control group was intraperitoneally injected with the same amount of normal saline. The sepsis treatment with XJDHT group was injected with XJDHT (crude drug 187.5 mg) twice a day 2 days before modeling. After modeling, gastric feeding was continued twice a day, while the control group and sepsis group were gavaged with the same amount of normal saline. At 72 h after LPS intervention, 9 mice in each group were randomly selected. After anesthesia, part of the liver were taken for small RNA and RNA sequencing and analysis, and part of the liver were taken for pathological examination.Results:XJDHT could improve the histopathological changes of liver in septic mice, and alleviate some abnormally expressed microRNAs (mmu-mir-292a-5p, mmu-mir-871-3p, mmu-mir-653-5p, mmu-mir-293-5p, mmu-mir-155-3p, mmu-mir-346-5p, mmu-mir-187-5p, mmu-mir-3090-3p) and their target genes.Conclusions:XJDHT can reduce the liver histopathological changes in septic mice, and its mechanism may be related to XJDHT regulating the expression of important key genes of liver of sepsis like mmu-mir-187-5p and its target genes such as ADAM8, irak3 and PFKFB3

Objective To observe the effect of Naoxintong capsule on blood lipid and hemorheology in the treatment of type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type.Methods From February 2015 to February 2017,96 type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type who treated in the Traditional Chinese Medicine Hospital of Tongxiang were selected in the research.The patients were randomly divided into two groups according to the digital table,with 48 cases in each group.The control group was treated with routine treatment scheme,while the observation group was added Naoxintong capsule.The blood lipids and hemorheology data before and after treatment were compared between the two groups.Results After treatment,the levels of LDL-C,TG,TC and HDL-C in the observation group were (1.8 ± 0.3) mmol/L,(0.9 ± 0.4) mmol/L,(2.1 ± 0.4) mmol/L,(1.6 ± 0.7) mmol/L,respectively,which were lower than those in the control group [(2.2 ± 0.4) mmol/L,(1.2 ± 0.6) mmol/L,(2.3 ± 0.3)mmol/L,(1.3 ±0.4) mmol/L] (t =5.54,2.88,3.18,2.58,all P ＜0.05).The HCT,ESR,EEP,Fig in the observation group were (41.5 ± 1.3) ％,(16.5 ± 2.1) mm/h,(292.1 ± 18.3) s,(7.6 ± 0.4) g/L,respectively,which were lower than those in the control group[(45.6 ± 1.4)％,(21.1 ± 3.2)mm/h,(332.3 ± 19.2)s,(8.2 ± 0.3) g/L] (t =14.87,8.33,10.50,8.31,all P ＜ 0.05).Conclusion Naoxintong capsule is effective in the treatment of type 2 diabetes mellitus patients complicated with cerebral infarction with Qi deficiency and blood stasis type,and can effectively improve the related indicators of blood lipids and hemorhelogy and stabilize the carotid artery plaque,it is worthy of clinical application.

Objective To study the effect of age-related white matter changes (ARWMC) on first symptomatic ischemic stroke events in the oldsters. Methods For the prospective study, a total of 368 eligible oldsters were enrolled in the study from January 2010 to August 2012. The degrees of ARWMC were assessed by ARWMC scale;according to the scores, they were divided into non ARWMC group, mild-moderate ARWMC group and severe ARWMC group. The patients were followed up once every 3 months. The clinical endpoint events and time (first symptomatic ischemic stroke, myocardial infarction and all-cause death) were recorded. Analyses of variance and Chi-square test were used to compare the differences of clinical data among the 3 groups. COX regression was used to assess the risk differences of first symptomatic ischemic stroke in the oldsters of three groups. Results After an average of follow-up for 48.7 months, 50 participants (13.6％) had first symptomatic ischemic stroke;25 (25.8％) were categorized as the severe ARWMC group, 22 (10.9％) were as the mild-medium group, and 3 (4.4％) were as the non ARWMC group. Among the three groups, the differences in age, history of hypertension, systolic blood pressure, incidence of clinical endpoint events and first symptomatic ischemic stroke, and follow-up time of endpoint events were statistically significant (P<0.05); patients from the severe ARWMC group were the oldest, and had the longest history of hypertension, the highest systolic blood pressure, the highest incidence of clinical end events and first symptomatic ischemic stroke, and the shortest follow-up period for clinical end events. COX regression analysis showed that the risk of first symptomatic ischemic stroke in the severe ARWMC group was about 8 times higher than that in the non ARWMC group (hazard ratio=9.012, 95％CI: 2.310-35.154, P=0.002). Conclusion In oldsters, severe ARWMC often accompany hypertension history and poor blood pressure controll, and it is an independent and serious risk factor for long-term first symptomatic ischemic stroke.

Objective To evaluate clinical efficacy and safety of single puncture and irrigation with Mammotome system in treatment of lactational breast abscess without drainage. Methods 32 patients with lacta-tional breast abscess were treated with ultrasound-guided puncture and irrigation by Mammotome system. Pus was cleared and necrotic material was removed. The residual cavity was irrigated with 3% hydrogen peroxide solution and Kangfuxin solution and no drainage was placed. Breast-feeding on time was encouraged. Results All pa-tients were successfully treated with single puncture and irrigation. The average length of hospital stay was 4 days. Except for 3 cases actively requesting to stop lactating, the other 29 patients continued to breast-feed. There was one case with postoperative hematoma, one with wound granuloma, and no other complications occurred. There was no relapse during the follow-up of 3 to 36 months. All patients were satisfied with the appearance of the breasts. Conclusions Single puncture and irrigation with Mammotome system without drain placement is a safe procedure in treatment of lactational breast abscess with the advantage of minimal invasion, low complication and does not affect breastfeeding.