Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications (ASMs), a condition known as pharmacoresistant epilepsy. The management of pharmacoresistant epilepsy remains an intractable issue in the clinic. Its early prediction is important for prevention and diagnosis. However, it still lacks effective predictors and approaches. Here, a classical model of pharmacoresistant temporal lobe epilepsy (TLE) was established to screen pharmacoresistant and pharmaco-responsive individuals by applying phenytoin to amygdaloid-kindled rats. Ictal electroencephalograms (EEGs) recorded before phenytoin treatment were analyzed. Based on ictal EEGs from pharmacoresistant and pharmaco-responsive rats, a convolutional neural network predictive model was constructed to predict pharmacoresistance, and achieved 78% prediction accuracy. We further found the ictal EEGs from pharmacoresistant rats have a lower gamma-band power, which was verified in seizure EEGs from pharmacoresistant TLE patients. Prospectively, therapies targeting the subiculum in those predicted as "pharmacoresistant" individual rats significantly reduced the subsequent occurrence of pharmacoresistance. These results demonstrate a new methodology to predict whether TLE individuals become resistant to ASMs in a classic pharmacoresistant TLE model. This may be of translational importance for the precise management of pharmacoresistant TLE.
Epilepsy, Temporal Lobe/diagnosis* ; Animals ; Drug Resistant Epilepsy/drug therapy* ; Electroencephalography/methods* ; Rats ; Anticonvulsants/pharmacology* ; Neural Networks, Computer ; Male ; Humans ; Phenytoin/pharmacology* ; Adult ; Disease Models, Animal ; Female ; Rats, Sprague-Dawley ; Young Adult ; Convolutional Neural Networks

Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. Results Ultimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.

Objective:To establish a scoring system for preoperative prediction of the malignant potential of gastric stromal tumors based on gastroscopic and endoscopic ultrasound features, along with validation.Methods:A total of 286 patients who were treated in Jiangsu Province Hospital of Chinese Medicine from January 1, 2017 to December 31, 2023 and diagnosed as having gastric stromal tumors by postoperative pathology were enrolled in the modeling group. According to National Institutes of Health classification system, 227 very-low/low-risk patients were classified into the low malignant potential (LMP) group, and the 59 intermediate/high-risk patients into the high malignant potential (HMP) group. LASSO regression analysis was performed to identify predictive factors for HMP gastric stromal tumors, and a nomogram prediction model was developed. Internal validation using the Bootstrap method was performed on the modeling group, and external validation was performed on data from 85 patients who were treated and diagnosed as having gastric stromal tumors by postoperative pathology in Taizhou People's Hospital from January 1, 2021 to December 31, 2023. The receiver operator characteristic (ROC) curves, calibration curves, and decision curve analyses were employed in both the modeling and external validation groups.Results:Tumor size (coef=0.755), tumor shape (coef=0.015), tumor location (coef=0.008), growth pattern (coef=-0.026), cystic change (coef=0.685), and surface unceration change (coef=-0.545) were the independent predictive factors for HMP gastric stromal tumors. The nomogram-based prediction model constructed using these factors achieved an area under the ROC curve of 0.959 (95% CI: 0.898-0.903) in the modeling group and 0.959 (95% CI: 0.857-1.000) in the external validation group. The model demonstrated good accuracy (0.917) and a Kappa value of 0.737 in internal validation. Calibration curve and decision curve analyses indicated strong calibration and high net benefit in both the modeling and the external validation groups. Conclusion:Tumor size, tumor shape, tumor location, growth pattern, cystic change, and surface ulceration change are independent predictive factors for HMP gastric stromal tumors. The nomogram model developed based on these factors offers effective and convenient visualization for clinicians to predict the malignant potential of gastric stromal tumors preoperatively.

Objective : To investigate the incidence of dental anxiety in pregnant women and its influencing factors. Methods : A total of 2 638 pregnant women in Shanghai were included in this study. Data on demographic and social factors, oral health behaviors and the number of teeth were collected. Participants completed the modified dental anxiety scale (MDAS), and an MDAS score greater than 12 was defined as a dental anxiety disorder. An electronic data capture system (EDC) was used to establish a database, and SPSS 22.0 was used to analyze the degree of anxiety and its influencing factors. Results: A total of 2 638 valid questionnaires were received. The incidence of dental anxiety in pregnant women was 34.9%. The results of a univariate analysis showed that the prevalence of dental anxiety in pregnant women (P<0.001) and MDAS score decreased (P<0.05) with increasing age, annual family income, educational level, frequency of cleaning, frequency of brushing and number of teeth. Conversely, the prevalence of dental anxiety in pregnant women (P<0.05) and MDAS score increased (P<0.05) as the number of pregnancies and gingival bleeding increased. Logistic analysis showed that education level “college” (P = 0.003) and “bachelor and above” (P<0.001), frequency of dental cleaning “semiannually or annually” (P = 0.021) and “biennial” (P<0.001), and frequency of brushing “twice a day” (P<0.001) were significantly associated with dental anxiety in pregnant women and were protective factors (OR<1). The frequency of gingival bleeding “Sometimes”(P<0.001) and the number of teeth “≤ 27” (P<0.001) were also significant risk factors for dental anxiety in pregnant women (OR>1).The results of a negative binomial regression analysis of MDAS showed that the frequency of dental cleaning and the number of teeth were significantly associated with dental anxiety. The frequency of dental cleaning "semiannually or annually" (P<0.001) was a protective factor (OR<1) for pregnant women's dental anxiety. The number of teeth ≤27 (P<0.001) was a risk factor (OR>1) for dental anxiety in pregnant women. Conclusion Educational level, teeth cleaning frequency, teeth brushing frequency, gingival bleeding, and the number of teeth influence dental anxiety in pregnant women. To effectively reduce the prevalence of dental anxiety, dentists should attach great importance to it in clinical practice and enhance pregnant women's awareness of oral hygiene maintenance by disseminating relevant health care knowledge.

Objective To investigate the effects of Ulinastatin(UTI)on the function of splenic lymphocytes from rats with severe acute pancreatitis(SAP).Method Twenty-eight Wister rats(clean grade)were randomly divided into control,sham operation,SAP,and ulinastatin group.No operation was performed in control group.And rats with sham-operation received laparotomy and catheterization into choledocho-pancreatic duct without injection of sodium deoxycholic.Rats in ulinastatin group received ulinastatin injection(50000 U/kg)via tail vein 30 minutes after pancreatitis induced with DCA injected into pancreatic duct.Rats ofother groups were given equal volume of saline.At 2,4 hours after operation,all animals were killed by neck dislocation,and splenocytes were isolated and cultured in RPMI 1640 medium containing 10%fetal calf serum.Proliferation of splenecytes was determined with MIT cellular proliferation assay.Levels of Th1 cytokines(IL-2,IFN-γ)and Th2 cytokine(IL-10)in supematants of splenoeytesweremeasured by ELISA.Quantitative data were expressed as mean±SE.Statistical analyses were performed by Student's t test with SPSS software(version 10.0 for Windows).A P value less than 0.05 Was considered statistically significant. Results The concentration of IL-2, IL-10 and IFN-γ and proliferative activity of splenocytes in SAP group were significantly lower than that in sham operation group.In contrast,the proliferative as well as the eytokine-releasing capacities of the solenecms from rats treated with UTI were significantly increased compared with those from rats with SAP.Conclusions The deficiencies in proliferation and cytokine release in response to antigen stimulation inaplys an anergic state of splenocytes during SAP.Treatment with UTI contributed to the recovery of the immune function by improving proliferative responses and cytokine release of splenocytes.