Epilepsy is a chronic neurological disorder affecting ~65 million individuals worldwide. Abnormal synaptic plasticity is one of the most important pathological features of this condition. We investigated how ubiquitin-specific peptidase 47 (USP47) influences synaptic plasticity and its link to epilepsy. We found that USP47 enhanced excitatory postsynaptic transmission and increased the density of total dendritic spines and the proportion of mature dendritic spines. Furthermore, USP47 inhibited the degradation of the ubiquitinated α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) subunit glutamate receptor 1 (GluR1), which is associated with synaptic plasticity. In addition, elevated levels of USP47 were found in epileptic mice, and USP47 knockdown reduced the frequency and duration of seizure-like events and alleviated epileptic seizures. To summarize, we present a new mechanism whereby USP47 regulates excitatory postsynaptic plasticity through the inhibition of ubiquitinated GluR1 degradation. Modulating USP47 may offer a potential approach for controlling seizures and modifying disease progression in future therapeutic strategies.
Animals ; Receptors, AMPA/metabolism* ; Neuronal Plasticity/physiology* ; Seizures/physiopathology* ; Disease Models, Animal ; Mice, Inbred C57BL ; Mice ; Ubiquitin Thiolesterase/genetics* ; Male ; Excitatory Postsynaptic Potentials/physiology* ; Ubiquitination ; Dendritic Spines/metabolism* ; Hippocampus/metabolism*

Objective To investigate the efficacy and safety of cognitive behavioral therapy （CBT） in the treatment of functional seizures （FS）. Methods Databases including PubMed （MEDLINE）， EMBASE， and the Cochrane Library were searched for randomized controlled trials （RCTs） on CBT in the treatment of FS published from January 2001 to October 2024. Jadad score was used to assess the quality of studies， and stata16 software was used to perform the meta-analysis. Results Four RCTs involving 463 patients were included in this meta-analysis. The analysis showed that CBT could reduce the frequency of FS by ≥50% （OR=0.57， 95%CI 0.36~0.78， P<0.001）， achieve complete remission of seizures （OR=1.83， 95% CI 1.09~3.05， P=0.021）， improve the degree of satisfaction among patients （MD=1.12， 95%CI -2.28~0.04， P=0.050）， and enhance the quality of life and work （OR=0.50， 95%CI 0.47~0.52， P<0.001）. Conclusions While CBT can help achieve full remission in FS， more research is needed to confirm its effectiveness in reducing episodes by over 50% and improving patients’ quality of life， family functioning， social adaptability， and psychological well-being.

AIM:To investigate the effects of γ-synuclein on autophagy and apoptosis of colon cancer cells in-duced by endoplasmic reticulum stress,as well as the protective effect on the cells.METHODS:Gene expression profile chip analysis was performed to compare the cDNA expression profiles between human colon cancer HCT116 cells with γ-synu-clein knockdown and HCT116 cells with control siRNA,and to identify potential molecules related to autophagy and apop-tosis.In colon cancer cell lines,the functional effects of γ-synuclein on autophagy and apoptosis induced by thapsigargin(TG),an endoplasmic reticulum stress-inducing agent,were systematically explored by conducting immunofluorescence staining,Western blot,CCK-8 assay,flow cytometry,and transmission electron microscopy.Western blot was used to de-tect the expression of γ-synuclein protein,autophagy-related proteins[microtubule-associated protein 1 light chain 3(LC3),beclin-1,autophagy-related protein 5(ATG5)and ATG7],and apoptosis-related proteins[poly(ADP-ribose)polymerase(PARP),pro-caspase-3,and pro-caspase-9].To further analyze the mechanism of γ-synuclein in regulating autophagy and apoptosis,extracellular signal-regulated kinase(ERK)inhibitor PD98059,ERK inhibitor SP600125 and c-Jun N-terminal kinase(JNK)activator anisomycin were applied separately to test HCT116 cells transfected with γ-synu-clein siRNA.Subsequently,autophagy proteins,apoptosis proteins,and ERK and JNK pathway-related proteins were de-tected by Western blot.RESULTS:The TG-induced autophagy of colon cancer cells mainly occurred at the early stage(0～24 h),and apoptosis mainly occurred at the late stage(36～48 h).Endoplasmic reticulum stress up-regulated the ex-pression of γ-synuclein in colon cancer cells,which was associated with enhanced autophagy.γ-Synuclein promoted au-tophagy by activating ERK and JNK pathways at the early stage(0～24 h),and inhibited apoptosis by blocking JNK path-ways at the late stage(24～48 h)to protect HCT116 cells.In our model,γ-synuclein was observed to play a critical role in the transition from endoplasmic reticulum stress-induced autophagy to apoptosis.CONCLUSION:In the context of endo-plasmic reticulum stress,γ-synuclein promotes autophagy and inhibits apoptosis by regulating ERK and JNK signaling pathways,thus protecting colon cancer cells.This provides a potential idea for anti-tumor therapy.

Based on the introduction of gut-brain-skin axis, this article discussed the relationship between psychological behavior, intestinal flora, and atopic dermatitis. By combing the literature on the treatment of atopic dermatitis with TCM, it is found that TCM therapy can regulate the relative abundance of intestinal flora, participate in immune metabolism and restore skin barrier function by intervening in the gut-brain-skin axis, so as to achieve the purpose of treating atopic dermatitis.

This article reports two cases of proteinuria caused by anti-vascular endothelial growth factor (VEGF) drugs in the treatment of liver cancer and ovarian cancer, respectively. Hypertension, massive albuminuria and renal insufficiency occurred in the patient with liver cancer during the use of toripalimab/camrelizumab combined with lenvatinib and regorafenib, and urinary protein was 4.02 g/24 h. The patient with ovarian cancer developed hypertension, proteinuria and 1.13 g/24 h urinary protein during the use of bevacizumab. Renal biopsy showed thrombotic microangiopathy in the glomeruli of both patients. Anti-VEGF drugs-associated glomerular microangiopathy was considered. The patient with liver cancer had no improvement after halving the dose of lenvatinib, and the effect was not good after treatment with low-dose corticosteroids combined with renin-angiotensin-aldosterone system inhibitors. After stopping anti-VEGF drugs, the proteinuria in both patients turned negative.

OBJECTIVE To assess the effect of medication therapy management(MTM) on symptom improvement and medication adherence in depressed female patients, and to explore the depression severity and adherence characteristics of female patients of different ages. METHODS A total of 180 female depressed patients from February 2022 to July 2022 were recruited and randomly divided into two groups according to age and depression severity: the control group and the management group,with 90 cases in each group. Patients in the control group were given conventional therapy, while those in the management group were given MTM on top of conventional therapy. The self-rating depression scale(SDS)was applied at enrollment and 3 months after treatment to assess symptom improvement in both groups, and the Morisky Medication Adherence Scale- 8(MMAS-8) was applied at the end of 4, 8 and 12 weeks of treatment to compare adherence differences between the two groups, and subgroup analysis was performed based on stratification factors. RESULTS A total of 147 patients completed all assessments and follow-up, and there was no statistically significant difference in drop-out rate between the control group and the management group(χ2=3.006, P=0.083). Patients who dropped-out with different depression severity were compared with those who did not, with a statistically significant difference(χ2=13.927, P=0.001). For the comparison of SDS scores by age group, the highest SDS scores before and after treatment were found in adolescence, followed by menopause, and the lowest in childbearing age, with statistically significant differences(P＜0.05). The SDS scores of each subgroup of different age groups and each subgroup of different depression severity in the management group were lower than those of the corresponding groups in the control group, with statistically significant differences except for the menopausal subgroup and the mild subgroup(P＜0.05). The overall compliance score of 176 patients was (5.69±1.37) points. In the full assessment the adherence scores were the highest in childbearing, followed by adolescence, and the lowest and the lowest in menopause, with statistically significant difference(χ2=6.61, P=0.037). The adherence scores of the different age groups were higher in the management group than those in the control group,with statistically significant differences in adolescence(χ2=25.573, P＜0.001), childbearing age(χ2=7.772, P=0.005)and menopause(χ2=19.776, P＜0.001) for the full assessment. Except for the 1st and 2nd follow-up in childbearing age, there were statistically significant differences between management group and control group at three age groups in the three follow-up visits(P＜0.05). CONCLUSION The depression severity in female depressed patients varies by age, with the heaviest in adolescence and the least severe in childbearing age. The overall level of medication adherence is low in female patients. The adherence is highest in childbearing age and lowest in menopause. MTM boasts to be effective in promoting symptom improvement and adherence in female depressed patients of different ages.

In order to solve the problems faced by final theoretical examination in the context of organ-system based integrated curriculum, this article analyzes the challenges and demands placed on the final theoretical examination of organ-system based integrated curriculum in undergraduate medical education, and it is pointed out that traditional medical theoretical examinations cannot meet these new demands since they are mainly memorized questions with one knowledge point for each question, as well as a lack of multidisciplinary knowledge fusion. By analyzing the questions in the United States Medical Licensing Examination (USMLE) test, this article summarizes the features of final theoretical examination suitable for organ-system based integrated curriculum and proposes that the final theoretical examination of organ-system based integrated curriculum suitable for Chinese undergraduate medical education can be developed through the translation of USMLE test, item modeling technique, or writing new tests based on the classification of knowledge points. The reform of final theoretical examination in the context of organ-system based integrated curriculum may help to realize the aim and objective of integrated teaching.

Autoimmune encephalitis (AE) is closely related to epileptic seizure, which is a common clinical manifestation or even the only symptom at acute phase of AE. Most patients do not develop seizures after treatment at acute or subacute stages, and these patients are classified as acute symptomatic seizures secondary to AE (ASSAE). Only a minority of patients will eventually develop autoimmune associated epilepsy (AAE). At present, no unified standard for clinical diagnosis is noted between ASSAE and AAE, but some differences exist in definition, pathogenesis, diagnosis and treatment. This paper summarizes the similarities and differences between ASSAE and AAE in the above aspects, aiming at providing help for clinicians to differentiate the diagnosis of the two diseases.

OBJECTIVE To evalu ate the effects of perimenopausal one-day outpatient multidisciplinary model on the cognition of women to menopause hormone therapy （MHT）. METHODS The perimenopausal one-day outpatient service opened by the Third Affiliated Hospital of Chongqing Medical University in 2017 was introduced ，which was participated by doctors ，pharmacists， nutritionists，music psychotherapists ，nurses and other multidisciplinary members to provide systematic ，all-round，humanistic and face-to-face group science popularization and education ，practical experience and Q&A for women in perimenopause or about to enter perimenopause （called“students”）. The students who participated in one-day outpatient service in 2020 were selected as the survey object ， and the questionnaire was CMEI2020KPYJ（ZAMM）00206] designed to analyze the understanding of perimenopausal syndrome，awareness rate of MHT ，willingness to use and concerns. RESULTS A total of 295 students completed the questionnaire. Compared with before participation ， after participated in one-day outpatient service ，the cognition level of the students were all improved significantly ，including perimenopausal age （96.61％ vs. 99.32％，P＝0.037），the importance of perimenopausal health care knowledge （91.19％ vs. 96.95％，P＜0.001），whether the perimenopausal syndrome needs treatment （88.47％ vs. 99.32％，P＜0.001），willingness to use MHT （70.59％ vs. 94.48％ ，P＜0.001），MHT treatment timing （60.50％ vs. 95.17％ ，P＜0.001），reducing the risk of cardiovascular disease （51.68％ vs. 96.55％ ，P＜0.001），delaying aging （69.75％ vs. 97.59％ ，P＜0.001），preventing osteoporosis（65.13％ vs. 97.59％），P＜0.001）；the medical staff were higher than the non-medical staff （P＜0.05）. Totally 90％ of the students said they had gained knowledge about the prevention and treatment of common diseases ，nutrition and guidance， psychological regulation guidance hormone therapy related knowledges and exercise methods ；the proportion of the students who were willing to use MHT for 1 to 5 years（31.09％ vs. 47.93％）increased significantly. The proportion of the students who concerned about the risk of thrombosis （60.24％ vs. 36.81％），weight gain （59.64％ vs. 14.84％）and life-long dependence （52.41％ vs. 18.13％）was significantly reduced ，but that of the students who concerned about cancer risk was not diminished. From 2017 to 2020，the utilization rate of MHT was increased from 2.22％ to 62.16％ in non-medical staff among the students. CONCLUSIONS The multidisciplinary model of perimenopausal one-day outpatient service can improve the awareness of MHT among perimenopausal women ，eliminate misunderstandings ，and increase the utilization rate of MHT.

Objective:To investigate the efficacy and safety of dual wavelength pulsed dye laser combined with 30% supramolecular salicylic acid in the treatment of moderate and severe facial acne.Methods:Sixty patients with moderate and severe acne that visited the Dermatology Department of the First Affiliated Hospital of Chongqing Medical University from May 2020 to January 2021, were selected and randomly divided into observation group and control group, with 30 patients in each group. The observation group was given dual-wavelength pulsed dye laser combined with 30% supramolecular salicylic acid. 30% supramolecular salicylic acid was used once every two weeks, for a total of six times. Dual-wavelength pulsed dye laser was given once a month, for a total of three times. The control group was only given dual-wavelength pulsed dye laser, once a month, a total of three times.Results:Twenty-two cases (73.33%) in the observation group were effective, while 14 cases (46.67%) in the control group were effective. The efficacy of the observation group was better than that of the control group, and the difference was statistically significant (χ 2=4.44, P<0.05). There were no obvious adverse reactions in both groups. Conclusions:Dual-wavelength pulsed dye laser combined with 30% supramolecular salicylic acid is effective and safe in the treatment of moderate and severe facial acne, which is worth popularizing.