Objective To analyze the effects of activating transcription factor 3(ATF3)pathway mediated by circSLC8Al on oxidative stress and iron activity of epileptic cells.Methods An epileptic cell model was established using human neuronal-hippocampal cells through Mg2+-free method.The expression levels of circSLC8A1 and ATF3 in healthy control group and model group were detected.Plasmid transfection was used to establish circSLC8A1 knockout group,ATF3 knockout group,circSLC8A1 knockout+ATF3 overexpression group,and ATF3 knockout+circSLC8A1 overexpression group.After 6h transfection,cells were cultured in normal medium for 48h.The cell viability,iron activity,reactive oxygen species(ROS),lactate dehydrogenase(LDH)and glutathione(GSH)of the different intervention groups were detected and compared.Results The expression levels of circSLC8A1,ATF3,ROS,LDH and iron activity in model group were significantly higher than those in healthy control group,while cell activity and GSH expression were significantly lower than those in healthy control group(P＜0.05).Knocking out circSLC8A1 can significantly reduce the expression of circSLC8A1 in epileptic model cells,while knocking out ATF3 can significantly reduce the expression of ATF3 in epileptic model cells(P＜0.05).Knocking out circSLC8A1 or ATF3 will increase the cell viability,decrease the iron activity and relieve the oxidative stress in epileptic model cells.Knocking out circSLC8A1 and overexpressing ATF3 can reverse the above trend,but knocking out ATF3 and overexpressing circSLC8A1 will not lead to the above phenomenon.Conclusion circSLC8A1 can influence the cell activity,oxidative stress and iron activity process of epileptic model cells by mediating ATF3 pathway,which provides some reference for the mechanism of epilepsy and its targeted therapy.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Immune checkpoint inhibitors(ICIs)have revolutionized cancer therapy,but their use is frequently complicated by immune-related adverse events(irAEs),which often require management with corticosteroids or additional immunosuppressive agents.The prognostic impact of these therapeutic strategies in the setting of irAEs has not been systematically elucidated.This systematic review and meta-analysis aimed to evaluate the impact of corticosteroid(CS)and second-line immunosuppressant(IM)use on survival outcomes among patients who developed irAEs during ICI therapy.Following a preregistered protocol(PROSPERO CRD1144835),we systematically searched PubMed,Embase,Web of Science,Cochrane Library,SinoMed,CNKI and Wanfang to identify studies published in the past 10 years(up to May 2025)reporting on the association between CS and IM use and survival outcomes in ICI-treated patients with irAEs.Two reviewers independently performed study selection,data extraction,and quality assessment.Meta-analyses were performed using R software.A total of 11 studies comprising 7 255 patients were included.Meta-analysis showed that CS use versus no use was not significantly associated with overall survival(OS)(HR=0.73,95%CI:0.45-1.18)or progression-free survival(PFS)(HR=0.68,95%CI:0.00-98.01).For post-irAE survival outcomes,higher cumulative CS dose(per 1 000 mg increment)was associated with a mild protective effect on post-irAE OS(HR=0.95,95%CI:0.92-0.98)and post-irAE PFS(HR=0.96,95%CI:0.94-0.99).In contrast to CS alone,IM use in combination with CS was associated with significantly increased risk of disease progression or death for post-irAE OS(HR=1.40,95%CI:1.11-1.76)and post-irAE PFS(HR=1.32,95%CI:1.08-1.62).Sensitivity analyses demonstrated good robustness of the main significant results.Current evidence suggests that CS and IM management strategies may differentially affect survival outcomes in patients with irAEs following ICI therapy.Increased cumulative CS dose is not associated with worse outcomes,whereas the addition of second-line IMs may increase the risk of adverse survival outcomes.Further prospective studies are warranted to optimize irAE management strategies and to balance the risks of immunosuppressive therapy with anticancer efficacy.

Objective:To explore clinical characteristics of multiple sclerosis(MS)patients in Suzhou,and to analyze main factors affecting their prognosis.Methods:General data,clinical symptoms,cerebrospinal fluid and imaging examinations of 51 MS patients admitted to Department of Neurology of the Second Hospital of Soochow University from July 31,2009 to July 31,2021 were retrospectively analyzed,and main factors affecting their prognosis were discussed.Results:Average age of onset of 51 MS patients was(43.3±15.6)years old,female accounted for 56.9%,male/female=1/1.3.Adult onset MS(AOMS)accounted for 62.8%,male/female=1/1.7;late onset MS(LOMS)accounted for 37.2%,male/female=1/0.9.Relapsing remitting MS(RRMS)accounted for 76.5%,and chronic onset accounted for 60.8%.Average annual recurrence rate was 8.8%.The first symptoms were numbness and weakness of limbs.Dizziness and numbness were more common in patients without recurrence after diagnosis of MS,and limb weak-ness and numbness were more common in patients with recurrence.Among lesions of MRI,62.7%(32/51)of periventricular involve-ment,52.9%(27/51)of spinal cord involvement,51.0%(26/51)of infratentorial involvement.Proportion of subtentorial and spinal cord(cervical,thoracic)involved were significantly higher in patients with recurrent MS than without recurrence.Values of albumin,IgG,IgA and IgM in cerebrospinal fluid increased with increase of recurrence times.EDSS score of male was higher than female,and LOMS score was higher than AOMS.MS patients without relapse had a low EDSS score,and median EDSS score at current follow-up was 0(0,1.00)score.MS score with relapse was relatively high,and median EDSS score at current follow-up was 2.75(0.25,7.25)score.Conclusion:MS patients with chronic onset are more common,with a high proportion of LOMS,and proportion of males increases with increasing age of onset.High EDSS score at first onset,cervical,thoracic and subtentorial lesions,increased values of cerebrospinal fluid albumin,IgG,IgA,IgM,age at first onset(50+years old),male associate with poor MS prognosis.

Immune checkpoint inhibitors(ICIs)have revolutionized cancer therapy,but their use is frequently complicated by immune-related adverse events(irAEs),which often require management with corticosteroids or additional immunosuppressive agents.The prognostic impact of these therapeutic strategies in the setting of irAEs has not been systematically elucidated.This systematic review and meta-analysis aimed to evaluate the impact of corticosteroid(CS)and second-line immunosuppressant(IM)use on survival outcomes among patients who developed irAEs during ICI therapy.Following a preregistered protocol(PROSPERO CRD1144835),we systematically searched PubMed,Embase,Web of Science,Cochrane Library,SinoMed,CNKI and Wanfang to identify studies published in the past 10 years(up to May 2025)reporting on the association between CS and IM use and survival outcomes in ICI-treated patients with irAEs.Two reviewers independently performed study selection,data extraction,and quality assessment.Meta-analyses were performed using R software.A total of 11 studies comprising 7 255 patients were included.Meta-analysis showed that CS use versus no use was not significantly associated with overall survival(OS)(HR=0.73,95%CI:0.45-1.18)or progression-free survival(PFS)(HR=0.68,95%CI:0.00-98.01).For post-irAE survival outcomes,higher cumulative CS dose(per 1 000 mg increment)was associated with a mild protective effect on post-irAE OS(HR=0.95,95%CI:0.92-0.98)and post-irAE PFS(HR=0.96,95%CI:0.94-0.99).In contrast to CS alone,IM use in combination with CS was associated with significantly increased risk of disease progression or death for post-irAE OS(HR=1.40,95%CI:1.11-1.76)and post-irAE PFS(HR=1.32,95%CI:1.08-1.62).Sensitivity analyses demonstrated good robustness of the main significant results.Current evidence suggests that CS and IM management strategies may differentially affect survival outcomes in patients with irAEs following ICI therapy.Increased cumulative CS dose is not associated with worse outcomes,whereas the addition of second-line IMs may increase the risk of adverse survival outcomes.Further prospective studies are warranted to optimize irAE management strategies and to balance the risks of immunosuppressive therapy with anticancer efficacy.

Objective To analyze the effects of activating transcription factor 3(ATF3)pathway mediated by circSLC8Al on oxidative stress and iron activity of epileptic cells.Methods An epileptic cell model was established using human neuronal-hippocampal cells through Mg2+-free method.The expression levels of circSLC8A1 and ATF3 in healthy control group and model group were detected.Plasmid transfection was used to establish circSLC8A1 knockout group,ATF3 knockout group,circSLC8A1 knockout+ATF3 overexpression group,and ATF3 knockout+circSLC8A1 overexpression group.After 6h transfection,cells were cultured in normal medium for 48h.The cell viability,iron activity,reactive oxygen species(ROS),lactate dehydrogenase(LDH)and glutathione(GSH)of the different intervention groups were detected and compared.Results The expression levels of circSLC8A1,ATF3,ROS,LDH and iron activity in model group were significantly higher than those in healthy control group,while cell activity and GSH expression were significantly lower than those in healthy control group(P＜0.05).Knocking out circSLC8A1 can significantly reduce the expression of circSLC8A1 in epileptic model cells,while knocking out ATF3 can significantly reduce the expression of ATF3 in epileptic model cells(P＜0.05).Knocking out circSLC8A1 or ATF3 will increase the cell viability,decrease the iron activity and relieve the oxidative stress in epileptic model cells.Knocking out circSLC8A1 and overexpressing ATF3 can reverse the above trend,but knocking out ATF3 and overexpressing circSLC8A1 will not lead to the above phenomenon.Conclusion circSLC8A1 can influence the cell activity,oxidative stress and iron activity process of epileptic model cells by mediating ATF3 pathway,which provides some reference for the mechanism of epilepsy and its targeted therapy.

Objective To construct a predictive model for the severity of depression based on the expression of circular RNAs(circRNAs)in peripheral blood.Methods Selecting 80 patients with depression who visited our hospital from August 2022 to August 2023,they were divided into a mild to moderate group of 49 cases and a severe group of 31 cases.Forty healthy individuals were selected as the healthy group,and after gene chip screening,five circRNAs with significant differences were selected.Further analysis was conducted on the relationship between circRNAs and the severity of depression,and independent risk factors affecting the severity of depression were analyzed,based on the analysis results,construct a depression severity prediction model using a column chart based on the expression of circRNAs in peripheral blood.Results Compared with the healthy group and mild to moderate group,the severe group had circRNA_100679,circRNA_1 03636 relative expression level decreased,circRNA_102802,circRNA_103964,The relative expression level of circRNA_002143 increased(P＜0.05).CircRNA_100679,circRNA_103636 is negatively correlated with the severity of depression(r=-0.594,-0.512,P＜0.05),circRNA_102802,circRNA_103964,circRNA_002143 is positively correlated with the severity of depression(r=0.603,0.425,0.412,P＜0.05).CircRNA_100679,circRNA_102802,circRNA_103636,circRNA_103964,circRNA_002143,family history of mental illness,and 5-hydroxytryptamine(5-HT)are all risk factors for the severity of depression(P＜0.05).The predicted area under the curve of the column chart prediction model based on risk factors such as peripheral blood circRNAs is 0.900,with a 95％CI:0.811-0.945.The model has good discrimination and high internal validation consistency.Conclusion The construction of a column chart model based on circRNAs expression for predicting the severity of depression has good predictive value and can provide reference for the diagnosis and treatment of depression severity in clinical practice.

Objective To investigate the cause of a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae infection(CRKP)in the neurological ICU,to find out the reason for infection and the way of transmission to provide evidence for the prevention and control of nosocomial infection.Methods Four patients with CRKP infection in the department of neurological ICU of a hospital from Au-gust 4 to August 20,2020 were investigated epidemiologically and environmental hygiene monitoring of the ward was carried out.Compre-hensive measures were taken to control the outbreak.Results All four CRKP infection cases were hospital-acquired,and the isolated strains showed consistent drug susceptibility test results,indicating they were the same clone.Environmental hygiene monitoring revealed the presence of the same clone in samples from patient bedside items,suction devices,oxygen therapy equipment,and personal belongings of healthcare workers.After implementing comprehensive corrective measures,no new cases of CRKP infection occurred,and subsequent surface sampling did not isolate any CRKP strains.Conclusion Environmental surface contamination in the neurointensive care unit and inadequate disinfection procedures were likely the main causes of the suspected outbreak of CRKP infection.Prompt identification of the outbreak,activation of emergency response plans,and implementation of corrective measures are crucial for controlling the outbreak of multidrug-resistant bacterial infections in hospitals.After adopting comprehensive measures,there were no new CRKP infection cases.

Objective:To construction the early ambulation scheme for patients after laparoscopic colorectal cancer surgery.Methods:Based on evidence-based nursing method combined with clinical practice, the draft of early ambulation scheme for patients after laparoscopic colorectal cancer surgery was prepared. From August to October 2022, two rounds of correspondence were conducted with 15 experts by Delphi method, and the final draft of early ambulation scheme for patients after laparoscopic colorectal cancer surgery was formed.Results:The coefficient of expert positivity in the two rounds of correspondence was 100%, the coefficient of authority was respectively 0.86 and 0.87, and the Kendall cofficient of concordance was 0.241 and 0.167 ( P<0.001) . The final scheme consisted of preface and text. The text of the scheme contained 2 first-level items, 10 second-level items and 42 third-level items. Conclusions:The early ambulation scheme for patients after laparoscopic colorectal cancer surgery in this study is scientific and feasible, providing references for clinical medical staff to guide early getting out of bed activities for patients after laparoscopic colorectal cancer surgery.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.