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Epilepsy is a chronic nervous system disease, which affects more than 70 million people all over the world. Although more than 30 kinds of antiepileptic drugs (AEDs) have been on the market, about one third of the patients with epilepsy fail to respond to medical treatment, who become drug-resistant epilepsy patients. Identifying the mechanism and developing effective treatment methods for drug-resistant epilepsy have become a hot area in the field of epilepsy research. This review discussed resent advance on the pathogenesis of drug-resistant epilepsy from the transporter hypothesis, neural network hypothesis and target hypothesis, and we also summarized the existing potential treatment methods and research progress of drug-resistant epilepsy, such as surgical resection, deep brain stimulation, ketogenic diet, precise treatment, and traditional Chinese medicine treatment. Our review may provide useful clues for the mechanisms research and clinical treatments of drug-resistant epilepsy.
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With the increase of aging population, the rising demand for cataract surgery, along with the growing demand for post-operative visual quality, the concept of refractive cataract surgery has been put forward, which places more emphasis on the cataract surgical precision.In order to improve the spectacle independence rate, optimize the surgical experience, and obtain the best visual quality, new technologies involving all aspects of cataract surgery are emerging.Ophthalmologists should pay close attention to the updates of biometry measurement, types and design principles of intraocular lens, application of femtosecond technology, surgical assistant system and perioperative management concept, so as to improve the precision and accuracy of cataract surgery.
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With the development and marketing of a variety of new anti-tumor drugs, it the patients with liver cancer were benefited but it also raised a series of new problems. How to develop individualized therapeutic plans for the patients with liver cancer has always been bothering the clinicians. Patient-derived xenograft model retains the histological characteristics, molecular diversity and microenficity of human-derived tumors, and it can help conduct in vitro experiments, which can solve the above problems to a certain extent. This article summarizes the research progress of the application of patient-derived xenograft models on the diagnosis and treatment of primary liver cancer.
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Although surgical resection is currently recognized as the only effective treatment for intrahepatic cholangiocarcinoma (ICC),it is extremely difficult to diagnose because there are no obvious clinical symptoms at the early stage.Patients are often diagnosed at the advanced stage and the lesion cannot be resected which leads to limited systemic chemotherapy.So the mortality is still high.Accurate treatment is a hot topic in the medical field,and more and more attentions have been paid to enhance the treatments of patients.This article reviewed the issues related to surgical treatment,chemotherapy,molecular targeted therapy,and immunotherapy in patients with ICC,and focuses on the latest progress of molecular targeted therapy.
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In the past decades, the targeted therapeutic strategies of anti-cancer drugs based on metabolic regulation has been progressing. The study found that the regulation of over-activated metabolic pathways and the subsequent changes brought to metabolic homeostasis can effectively inhibit tumor growth and metastasis. However, the mechanistic link between cancer metabolism and cell fates has remained unclear. As the advancements of biological mass spectrometry and functional omics, researchers have discovered that endogenous metabolites can interact with multiple proteins as functional ligands, and thus affect the survival and proliferation of cancer cells. Nevertheless, the the direct targets and regulatory mechanisms of most functional metabolites in tumors are still unknown. The missing recognition of them has impeded further exploration of the development of precise targeted drug design based metabolic the phenomenon of tumor metabolic reprogramming. Therefore, the capability of elucidating the direct targets of endogenous metabolites in vivo not only helps to develop drugs based on the leading compounds targeting tumor metabolic, but also provides new ideas for personalized medicines of tumor patients. This review thus focuses on the characteristics of cancer metabolism and how endogenous metabolites affects tumor survival, and introduces current target identification approaches applicable to endogenous compounds, in hope to provide thoughts for developing precise treatment strategies based on cancer metabolism.
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Hilar cholangiocarcinoma (HCCa) is a biliary malignancy that seriously affects the survival of patients.Radical resection is the only cure method for patients to achieve long-term survival.However,due to the low rate of radical resection,its prognosis is poor.In this article,surgical treatment strategies of HCCa in the precision surgery era,3D image evaluation in the curative resection,surgical procedure decision and the preservation of liver parenchyma in the hepatic resection are discussed combined with the research progress at home and abroad.
ABSTRACT
Tissue biopsy is a diagnostic standard as well as the targeted therapy of cancer. However, tissue biopsy has some limitations in the cancer diagnosis , assessment of cancer development, prognosis and genotyping due to tumor heterogeneity and evolution. Circulating tumor DNA (ctDNA) is a kind of circulating DNA fragments released by the tumor cells into the circulation system reflecting the state of tumors. With the emergence of new technology, the ways to detect the specificity and sensitivity of ctDNA have been improved greatly. Furthermore, detection of ctDNA could analyze oncogene and epigenetic changes, which has been widely used in molecular subtyping, assessment of tumor dynamic and burden, evaluation of minimal residual disease and recurrence, prognosis assessment, monitoring of drug resistance and exploration of new therapeutic targets.
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Objective To screen patients with clopidogrel resistance and develop accurate anti-platelet therapy strategies based on CYP2C19 gene polymorphism.Methods A total of 200 patients with acute coronary syndrome/percutaneous coronary angioplasty were selected.The pyrophosphate sequencing technology was using to detect CYP2C19 gene polymorphism for identifying clopidogrel poor metabolizers and guide antiplatelet therapy according to the development of clopidogrel resistance strategies.Results The proportion of patients with clopidogrel resistance (including intermediate metabolizers and slow metabolizers) was about 63.5%.In clopidogrel intermediate metabolizers, 41.4% cases were applied double dosages of clopidogrel and about 20.2% patients were given ticagrelor instead of clopidogrel.For clopidogrel slow metabolizers, approximately 39.3% cases were given doubled dosage of clopidogrel and 46.4% cases were given ticagrelor.Compared with previous data, the proportion of individual treatment of clopidogrel resistance was significantly increased in this study.Conclusion The strategies for the treatment of clopidogrel resistance, which based on the polymorphism of CYP2C19 gene, have been achieved initial success.
ABSTRACT
Tissue biopsy is a diagnostic standard as well as the targeted therapy of cancer. However, tissue biopsy has some limitations in the cancer diagnosis , assessment of cancer development, prognosis and genotyping due to tumor heterogeneity and evolution. Circulating tumor DNA (ctDNA) is a kind of circulating DNA fragments released by the tumor cells into the circulation system reflecting the state of tumors. With the emergence of new technology, the ways to detect the specificity and sensitivity of ctDNA have been improved greatly. Furthermore, detection of ctDNA could analyze oncogene and epigenetic changes, which has been widely used in molecular subtyping, assessment of tumor dynamic and burden, evaluation of minimal residual disease and recurrence, prognosis assessment, monitoring of drug resistance and exploration of new therapeutic targets.
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Radiomics utilizes the high-throughput extraction of large amounts of quantitative features from radiographic images,giving a comprehensive quantification of tumor phenotype.Thus it can provide complementary and interchangeable information for clinical usage,such as differentiating malignant nodules from benign ones,predicting response to treatment,identifying lymph node metastasis,improving individualized treatment selection and monitoring.The advantages of radiomics give it great potential in precise treatment.But much work needs to be done before it could be used in practice.It is imperative that a standard research procedure is needed to verify its reliability and clinical value via multi-central prospective clinical trials.