Temporal and spatial stability of the EM/PM molecular subtypes in adult diffuse glioma / 医学前沿

Detailed characterizations of genomic alterations have not identified subtype-specific vulnerabilities in adult gliomas. Mapping gliomas into developmental programs may uncover new vulnerabilities that are not strictly related to genomic alterations. After identifying conserved gene modules co-expressed with EGFR or PDGFRA (EM or PM), we recently proposed an EM/PM classification scheme for adult gliomas in a histological subtype- and grade-independent manner. By using cohorts of bulk samples, paired primary and recurrent samples, multi-region samples from the same glioma, single-cell RNA-seq samples, and clinical samples, we here demonstrate the temporal and spatial stability of the EM and PM subtypes. The EM and PM subtypes, which progress in a subtype-specific mode, are robustly maintained in paired longitudinal samples. Elevated activities of cell proliferation, genomic instability and microenvironment, rather than subtype switching, mark recurrent gliomas. Within individual gliomas, the EM/PM subtype was preserved across regions and single cells. Malignant cells in the EM and PM gliomas were correlated to neural stem cell and oligodendrocyte progenitor cell compartment, respectively. Thus, while genetic makeup may change during progression and/or within different tumor areas, adult gliomas evolve within a neurodevelopmental framework of the EM and PM molecular subtypes. The dysregulated developmental pathways embedded in these molecular subtypes may contain subtype-specific vulnerabilities.

Effect of ultrasound-guided median nerve block on carpal tunnel syndrome / 临床麻醉学杂志

Objective To observe the clinical effects of ultrasound-guided median nerve block on carpal tunnel syndrome.Methods A total of 40 patients (69 hands,aged 33-61 years,ASA Ⅰ or Ⅱ,were randomly assigned into ultrasound group (group U) and control group (group C),20 cases in each.The ultrasound group underwent ultrasound-guided median nerve blocking,while the control group did through by anatomic landmark palpation.3 ml of 4.5 mg bupivacaine,5 mg triamcinolone acetonide and 100 μg vitamin B12 was injected in a single shot in the two groups.Symptoms and functions were evaluated by Boston carpal tunnel questiormaire (BCTQ) at the onset and after the treatment.Electrophysiological parameters were recorded at the time of pretreatment and post-treatment.Cases receiving two or more and side effects were also recorded.Results Both the symptom severity scale (SSS) and funcational status scores(FSS) of the BCTQ showed significant decrease 1 month after treatment in the two group (P＜0.05).Compared with group C,SSS of group U showed a significant decrease (P＜0.05),while there was no significance difference in FSS.Compared with pretreatment,MDL,SDL3 showed a significant decrease and SNCV showed significant increase 1 month after treatment in the two group (P＜0.05),while there was no significant change in the MNCV.SNCV was quicker in group U than in group C at 1 month after treatment (P＜0.05),while other electrophysiological parameters were not significantly different between the two groups.Less cases with treatment times≥2 and less side effects were found in group U than in group C (P ＜ 0.05).Conclusion Median nerve blocking under ultrasound guidance effectively improves the symptom in patients with carpal tunnel syndrome and reduces complications.