Stress is a critical inducer in the onset and progression of many chronic diseases. Prolonged or intense stress can disrupt the overall balance between the nervous, immune, and endocrine systems. The resulting biological signals may act on corresponding receptors in the cervical spine region, leading to adverse pathological changes. The vertebral artery and the surrounding muscular and connective tissues are influenced by biomechanical abnormalities and inflammatory cascades associated with cervical spondylosis of vertebral artery type (CSA), which promotes the release of various hormones. These hormones, through the neuroendocrine-immune system, affect the central nervous system, inducing or exacerbating negative emotional feedback and thereby establishing a "central-local-central" vicious cycle. This article explores the mechanisms underlying the impact of stress on the key CSA symptoms through the neuroendocrine-immune network (NEI) theory, providing a more comprehensive framework for targeted therapeutic interventions in CSA.
Humans ; Neurosecretory Systems/immunology* ; Spondylosis/etiology* ; Vertebral Artery/immunology* ; Stress, Psychological/complications* ; Chronic Disease

Objective·To investigate the pathological and physiological changes underlying noise-induced cochlear nucleus damage and the regulating function of astrocytes on the damage,using a combination of morphological analysis,and molecular biology techniques.Methods·Forty-eight male C57BL/6J mice were randomly divided into two groups and exposed to 110 dB SPL(sound pressure level)broadband noise for 2 hours.Auditory brainstem response(ABR)tests were performed on the mice on days 1,7,14,30,and 90 after the noise exposure.Immunofluorescence staining of cochlear nuclear tissue was conducted to observe cochlear nuclear neurons and auditory synapses,as well as astrocyte activation levels.In addition,the damage to the cochlear nuclear neurons and synapses caused by noise was verified through Western blotting.Results·A significant decrease in cochlear nuclear Bushy cells after noise exposure was observed.The Western blotting results showed that there was severe loss of nerve fibers in cochlear nuclear neurons,indicating that noise caused significant damage to cochlear nucleus neurons.Moreover,a significant loss of auditory synapses labeled with vesicular glutamate transporter 1(Vglutl)was observed,which was the severest on day 14 after noise exposure and slowly recovered on day 90.Interestingly,astrocytes in the cochlear nucleus displayed obvious clustering and activation after noise exposure.By staining with glial fibrillary acidic protein(GFAP),most astrocytes were distributed around the cochlear nucleus,granule cell area,and auditory nerve root before noise exposure,and they had a small size.However,on day 14 after noise exposure,a large number of activated astrocytes aggregated in the ventral cochlear nucleus,and they all showed a pattern of growth around the synapses.Conclusion·Noise exposure leads to significant damage in the cochlear nucleus,and it is possible that astrocytes are involved in its damage and repair processes.These findings will provide a crucial foundation for further understanding the mechanisms of sound signal analysis,integration,and neural plasticity in the cochlear nucleus.

Based on the theory of engineering medicine,a consensus which takes the basic medical ethics of harm reduction as the starting point is proposed to addresses the current clinical problems of a wide variety of radiotherapy setup equipments and methods,large differences by principles,and inaccurate setup.The consensus is formed in two aspects.(1)Advocate coordination of multiple setup methods for joint setup;collect,compare,analyze and screen data on setup methods;determine the operational guidelines and methods for joint setup based on the principle of standardized and unified clinical consistency,with a view to achieving the clinical purpose of greatly ensuring the precision of radiotherapy setup and radiotherapy safety without relying on the golden standard.(2)Standardize the operational methods for tracing setup deviations,so that when the difference in setup leads to poor clinical consistency,the cause of deviation can be traced and the effectiveness of different setups can be screened.Based on the concept of engineering medicine,the consensus is expected to standardize the method of radiotherapy setup,realize accurate radiotherapy,improve treatment effect and show medical ethical care.

Chronic internal carotid artery occlusion, a common clinical lesion caused by atherosclerosis, was also one of the common vascular diseases in the middle and old age. It could slow down the blood flow rate of blood vessels, which leaded to changes in the blood supply of brain tissue, and secondary causes abnormal metabolism of brain nerves and brain tissue. At the same time, long-term cerebral hypoperfusion would induce cognitive impairment, which would seriously affect the quality of life of patients. At present, there were two main treatment methods: drug conservative treatment and intravascular intervention, but there was still a great controversy about the survival of the fittest in these two treatment methods. This paper reported the clinical, imaging, therapeutic strategy and prognosis of a case of severe intracranial and extracranial multiple vessel stenosis and occlusion, in order to provide reference for the early diagnosis and treatment of such patients.

Objective To investigate the related factor underlying the differential vulnerability of inner hair cell(IHC)ribbon synapses to noise exposure.Methods Twenty-eight C57BL/6J mice were randomly divided into the noise exposure group(NED1)and the control group(CTR)with 14 mice in each group.The noise exposure group was exposed to bandpass noise of 2～20 kHz at 103 dB SPL for two hours while the control group was bred in a quiet environment.Before and after noise exposure,auditory brainstem response was conducted to detect the audi-tory function,whole-mount immunofluorescence staining was used to observe the number of inner hair cell ribbon synapses in different turns.The calcium influx of inner hair cells in the apical and middle turn using whole-cell patch clamp recording was analyzed.Furthermore,the immunofluorescence intensity of calpain in inner hair cells from dif-ferent mouse cochlear turns using whole-mount immunofluorescence staining was compared.Western blotting was used to verify that CtBP2 was degraded by calpain.Results After noise exposure,the ABR threshold of 11.3,16.0,22.6,32.0 kHz increased significantly and the number of ribbon synapses of inner hair cells at the middle turn and basal turn of the cochlea decreased significantly.However,whole-cell patch clamp recordings showed that calcium ion channels were fewer but single-channel current was higher at the apical turn of the cochlea.The open probability of calcium ion channels in IHCs showed no significant difference between the apical turn and the middle turn of the cochlea.But the expression level of calpain of the inner hair cells at the middle and basal turn of the basi-lar membrane was significantly higher than that at the apical turn after noise exposure.The western blotting results also showed that CtBP2 was cleaved in a Ca2+-dependent manner by calpain.Conclusion Calpain may be the main related factor that accounts for the vulnerability of ribbon synapses in inner hair cells in the high frequency region of basal membrane.

Based on the theory of engineering medicine,a consensus which takes the basic medical ethics of harm reduction as the starting point is proposed to addresses the current clinical problems of a wide variety of radiotherapy setup equipments and methods,large differences by principles,and inaccurate setup.The consensus is formed in two aspects.(1)Advocate coordination of multiple setup methods for joint setup;collect,compare,analyze and screen data on setup methods;determine the operational guidelines and methods for joint setup based on the principle of standardized and unified clinical consistency,with a view to achieving the clinical purpose of greatly ensuring the precision of radiotherapy setup and radiotherapy safety without relying on the golden standard.(2)Standardize the operational methods for tracing setup deviations,so that when the difference in setup leads to poor clinical consistency,the cause of deviation can be traced and the effectiveness of different setups can be screened.Based on the concept of engineering medicine,the consensus is expected to standardize the method of radiotherapy setup,realize accurate radiotherapy,improve treatment effect and show medical ethical care.

Objective:To analyze the relationship between PD-L1 expression and the degree of infiltration of different types of TILs in triple-negative breast cancer, and the correlation with other pathological features to explore their clinical significance.Methods:Tumor tissues of 199 patients with triple-negative breast cancer in our hospital were selected, and the expression of PD-L1 and the distribution of TILs were analyzed using immunohistochemistry and counted using Image software. The relationship between CD8 +TILs, CD4 +TILs and PD-L1 expression was analyzed and compared, and survival analysis and correlation analysis between PD-L1 expression and pathological information were performed. Results:The density of CD4 + TILs ( χ2=8.75, P=0.003) and CD8 + TILs ( χ2=6.32, P=0.009) infiltration was higher in the PD-L1-positive group compared to that of the PD-L1-negative group. Among PD-L1-positive patients, patients with higher TILs infiltration compared to low infiltrating TILs could achieve longer overall survival time, and the difference was statistically significant ( P1=0.012, P2=0.023, P3=0.010). Patient PD-L1 expression was positively correlated with the number of positive lymph nodes, tumor stage, and ki-67 expression ( Pa=0.032, Pb=0.006, Pc=0.042), and was not related to age or tumor diameter ( Pd=1.031, Pe=0.672) . Conclusions:PD-L1 expression in triple negative breast cancer predicts higher infiltration of CD4 +TILs and CD8 +TILs, while higher infiltration of CD4 +TILs and CD8 +TILs predicts a relatively good survival prognosis.PD-L1 expression is associated with multiple pathological clinical factors and deserves further study to make PD-L1, TILs and other indicators better benefit triple-negative breast cancer patients.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objective:This study aims to analyze the structural characteristics and fibrous structural integrity of the white matter of the brain and their relationship with obsessive-compulsive symptoms in children and adolescents with first-onset obsessive-compulsive disorder (OCD).Methods:Thirty-eight patients with OCD (OCD group) and 35 age-, sex-, and education-matched controls (control group) were included. The brain white matter volume was measured using voxel-based morphometry (VBM) with diffusion tensor imaging (DTI) scans. The tract-based spatial statistics (TBSS), including fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD), were applied to measure the structural integrity of white matter fibres. The independent samples t-test was used to compare FA, MD, and AD values in differential brain areas between the 2 groups. The clinical characteristics of the patients were assessed using the Yale-Brown Obsessive-Compulsive Symptom Scale for Children. Pearson′s correlation analysis was used to analyze the relationship between the severity of the obsessive-compulsive symptoms and the white matter volume of the brain and the FA, MD, and AD values of the significantly different brain areas in the OCD group. Results:Compared to the control group, the OCD group had lower white matter volumes in the left inferior frontal gyrus, right inferior temporal gyrus, right inferior frontal gyrus, left parietal gyrus, and left limbic lobe ( t=-3.67, -4.21, -3.58, -3.70, -4.34, all P<0.01); had higher FA, MD, and AD values in the left corticospinal tract, left superior longitudinal tract; had higher MD and AD values in the right corticospinal tract, right and left anterior thalamic radiations, right and left inferior fronto-occipital gyrus, and left inferior longitudinal gyrus; had higher FA, MD, and AD values in the occipital and frontal part of the corpus callosum radiation; had a lower FA value in the left and right anterior thalamic radiation, left and right inferior frontal gyrus, left cingulate gyrus, left and right inferior longitudinal gyrus, and right superior longitudinal gyrus (temporal); and had a lower AD value in the left hook gyrus and right superior longitudinal gyrus. In the OCD group, the Pearson′s correlation analysis showed that the white matter volume of the right inferior frontal gyrus was negatively correlated with the obsessive-compulsive thinking factor score ( r=-0.355, P<0.05), and the left parietal gyrus was negatively correlated with the total obsessive-compulsive score, the obsessive-compulsive thinking factor score, and the obsessive-compulsive behavior factor score ( r=-0.361, -0.350, -0.376, all P<0.05); that the FA value in the occipital part of the corpus callosum radiation was negatively correlated with the total obsessive-compulsive score and the obsessive-compulsive behavior factor score ( r=-0.410, -0.411, both P<0.05), the MD values in the left and right anterior thalamic radiation were both negatively correlated with total compulsive scores ( r=-0.389, P<0.05; -0.489, P<0.01), the AD values in the left and right anterior thalamic radiation were both negatively correlated with total compulsive scores ( r=-0.446, -0.405, both P<0.05),the MD and AD values in the left and right anterior thalamic radiation were both negatively correlated with compulsive behavior factor scores ( r=-0.558, -0.631, -0.530, -0.539, all P<0.01), and the AD value in the left subfrontal occipital tract was negatively correlated with compulsive total score and compulsive thinking factor score ( r=-0.359, P<0.05; r=-0.499, P<0.01). Conclusion:Children and adolescents with OCD have reduced white matter volume and impaired structural integrity of white matter fibres, involving the cortico-striato-thalamo-cortical circuit and several brain regions, such as the parietal lobe, limbic lobe, corpus callosum, corticospinal tract, and inferior longitudinal tract. The abnormalities in white matter structure and structural integrity of fibres are correlated with the severity of OCD symptoms.

Objective:This study aims to analyze the structural characteristics and fibrous structural integrity of the white matter of the brain and their relationship with obsessive-compulsive symptoms in children and adolescents with first-onset obsessive-compulsive disorder (OCD).Methods:Thirty-eight patients with OCD (OCD group) and 35 age-, sex-, and education-matched controls (control group) were included. The brain white matter volume was measured using voxel-based morphometry (VBM) with diffusion tensor imaging (DTI) scans. The tract-based spatial statistics (TBSS), including fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD), were applied to measure the structural integrity of white matter fibres. The independent samples t-test was used to compare FA, MD, and AD values in differential brain areas between the 2 groups. The clinical characteristics of the patients were assessed using the Yale-Brown Obsessive-Compulsive Symptom Scale for Children. Pearson′s correlation analysis was used to analyze the relationship between the severity of the obsessive-compulsive symptoms and the white matter volume of the brain and the FA, MD, and AD values of the significantly different brain areas in the OCD group. Results:Compared to the control group, the OCD group had lower white matter volumes in the left inferior frontal gyrus, right inferior temporal gyrus, right inferior frontal gyrus, left parietal gyrus, and left limbic lobe ( t=-3.67, -4.21, -3.58, -3.70, -4.34, all P<0.01); had higher FA, MD, and AD values in the left corticospinal tract, left superior longitudinal tract; had higher MD and AD values in the right corticospinal tract, right and left anterior thalamic radiations, right and left inferior fronto-occipital gyrus, and left inferior longitudinal gyrus; had higher FA, MD, and AD values in the occipital and frontal part of the corpus callosum radiation; had a lower FA value in the left and right anterior thalamic radiation, left and right inferior frontal gyrus, left cingulate gyrus, left and right inferior longitudinal gyrus, and right superior longitudinal gyrus (temporal); and had a lower AD value in the left hook gyrus and right superior longitudinal gyrus. In the OCD group, the Pearson′s correlation analysis showed that the white matter volume of the right inferior frontal gyrus was negatively correlated with the obsessive-compulsive thinking factor score ( r=-0.355, P<0.05), and the left parietal gyrus was negatively correlated with the total obsessive-compulsive score, the obsessive-compulsive thinking factor score, and the obsessive-compulsive behavior factor score ( r=-0.361, -0.350, -0.376, all P<0.05); that the FA value in the occipital part of the corpus callosum radiation was negatively correlated with the total obsessive-compulsive score and the obsessive-compulsive behavior factor score ( r=-0.410, -0.411, both P<0.05), the MD values in the left and right anterior thalamic radiation were both negatively correlated with total compulsive scores ( r=-0.389, P<0.05; -0.489, P<0.01), the AD values in the left and right anterior thalamic radiation were both negatively correlated with total compulsive scores ( r=-0.446, -0.405, both P<0.05),the MD and AD values in the left and right anterior thalamic radiation were both negatively correlated with compulsive behavior factor scores ( r=-0.558, -0.631, -0.530, -0.539, all P<0.01), and the AD value in the left subfrontal occipital tract was negatively correlated with compulsive total score and compulsive thinking factor score ( r=-0.359, P<0.05; r=-0.499, P<0.01). Conclusion:Children and adolescents with OCD have reduced white matter volume and impaired structural integrity of white matter fibres, involving the cortico-striato-thalamo-cortical circuit and several brain regions, such as the parietal lobe, limbic lobe, corpus callosum, corticospinal tract, and inferior longitudinal tract. The abnormalities in white matter structure and structural integrity of fibres are correlated with the severity of OCD symptoms.