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Objective To investigate the effect of common carotid artery sympathectomy on clinical efficacy and serum inflammatory factors in children with mixed cerebral palsy.Methods Common carotid artery sympathectomy was performed in 50 children with mixed cerebral palsy.The levels of IL-6,IL-10,TNF-α,modified Ashworth spasm score,teacher drooling scale(TDS)grade and gross motor function classification system(GMFCS)were compared before and after operation.Results The levels of IL-6 and TNF-α in 50 children with mixed cerebral palsy after operation were significantly lower than those before operation,and the difference was statistical-ly significant(P＜0.05);but there was no significant difference in the level of IL-10 after operation.The modified Ashworth spasm score and TDS grade after operation were significantly better than those before operation,and the differences were statistically significant(P＜0.05);but there was no significant difference in GMFCS after operation(P＞0.05).The level of TNF-α before and after opera-tion was positively correlated with modified Ashworth spasm score and TDS grade,but there was no correlation between TNF-α level and GMFCS before and after operation,and there was no correlation between IL-6,IL-10 level and modified Ashworth spasm score,TDS salivation grade and GMFCS before and after operation.Conclusion IL-6,IL-10 and TNF-α are involved in the pathogenesis of mixed cerebral palsy,and common carotid artery adventitia sympathectomy can improve clinical symptoms by reducing the levels of IL-6 and TNF-α,which is worth of popularization and application.
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Objective To investigate the therapeutic effect of continuous blood purification on diabetic lactic acidosis(DLA).Methods 60 DLA patients who were treated at our hospital Blood Purification Center from January 2020 to January 2023 were randomly divided into conventional treatment group(Con)and continuous blood purification group(CBP),with 30 cases in each group.The changes of anion gap(AG),pH,lactic acid(Lac),FPG,2 hPG,HbA1c,alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),serum creatinine(Scr),urea nitrogen(BUN),cystatin C(CysC),blood potassium(K+),C-reactive protein(C-RP),acute and chronic health evaluation scoring system Ⅱ(APACHEⅡ)and mortality within 28 days were compared between the two groups.Results After 48 h of treatment,the clearance rate of Lac in CBP group was higher than that in Con group(P<0.05).The pH value of CBP group was higher than Con group.The levels of AG,Lac,FPG,2 hPG,HbA1c,ALT,AST,TBIL,Scr,BUN,CysC,K+,C-RP and APACHEⅡ score were lower in CBP group than those in Con group(P<0.05).The 28-day mortality rate of the CBP group was lower than that of the Con group(P<0.05).Conclusion Continuous blood purification combined with routine treatment in DLA patients can increase Lac clearance and improve the prognosis.
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Objective To compare the therapeutic efficacy of whey protein powder in peritoneal dialysis hypoproteinemia patients.Methods From August 2019 to August 2020,100 patients with peritoneal dialysis hypoproteinemia from the Peritoneal Dialysis Center of the First Affiliated Hospital of Xi'an Jiaotong University were investigated.The patients were separated into 2 groups randomly;the study group were administered whey protein powder and the control group with high protein food.After 32 weeks of treatment,biochemical and biometric indices including hemoglobin(Hb),albumin(ALB),prealbumin(PA),triglyceride(TG),total cholesterol(TC),phosphorus(P),low density lipoprotein(LDL),high density lipoprotein(HDL),serum creatinine(Scr),blood urea nitrogen(BUN),estimated glo-merular filtration rate(eGFR),total spKt/Vurea(TKt/V),total creatinine clearance rate(TCcr),hand grip strength(HG),triceps skinfold(TSF),arm circumference(AMC),mid-arm muscle circumference(MAMC)were compared between groups.Results Compared with 0 week,at 16 and 32 weeks,ALB,PA,and HG were significantly increased in the study group(P＜0.05).Compared with the control group,ALB,PA,and HG increased significantly at 16 and 32 weeks in the study group(P＜0.05).There were no significant differences in TG,TC,HDL,LDL,eGFR,TKt/V,and TCcr at 0,8,16,and 32 weeks between the control and study groups(P＞0.05).Conclusion For patients with peritoneal dialysis hypoproteinemia caused by insufficient protein intake or excessive protein loss,the addition of whey protein during peritoneal dialysis can significantly improve the nutritional status of patients,with greater efficacy than a high protein diet alone.
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Objective:To explore the safety and efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the healthy side-lying running position for the treatment of ureteral stenosis after pelvic surgery.Methods:The data of 92 patients with ureteral stenosis after surgery admitted to Ganzhou People’s Hospital from June 2017 to February 2023 were retrospectively analysed. There were 31 male patients and 61 female patients, with an average age of (46.4±23.3) years. Of the 92 patients, 53 patients had previously undergone stone fragmentation or stone retrieval surgery for urinary system stones, 35 patients had undergone gynecologic laparoscopic surgery for gynecologic diseases, 2 patients had previous intestinal surgery, and 2 patients had undergone laparoscopic ureteral reconstruction surgery. The mean preoperative serum creatinine was (120.33±16.52) μmol/L, the mean blood urea nitrogen was (14.28 ± 2.47) mmol/L, and the mean renal pelvis dilation was (3.23±2.47) cm. All patients were placed in healthy side-lying running position with general anesthesia. The patient's lower limbs were in the oblique supine position, and the angle of the lower limbs was 60-80°. By using a transabdominal approach, the narrow section of the ureter was mobilized and excised under the guidance of ureteroscopy. The posterior wall of the ureter was sutured and a zebra guidewire was placed into the renal pelvis. An F7 double-J stent was then retrogradely advanced over the guidewire. Then the anterior wall of the ureter was anastomosed to complete the surgery. The operation time, average length of hospital stay, perioperative complications, preoperative and postoperative pyelectasis and renal function changes were recorded, and the clinical efficacy were evaluated by comparative analysis.Results:Of the 92 patients, 90 patients were successfully treated with ureterovesical anastomosis. Two patients underwent ureterovesical reimplantation because of the low position and heavy adhesion of the stenosis segment. There were no cases of conversion to open surgery or intraoperative death. The mean surgery duration was (121.52±22.35) min, the mean drainage tube indwelling time was (3.16±1.23) d, and the mean hospital stay was (6.46±2.37) d. A patient with moderate hydronephrosis exhibited postoperative urinary leakage. Two patients developed symptoms of hematuria after ambulation. Following treatment with bed rest, adequate drainage, and appropriate hemostatic medication, all patients recovered smoothly and were discharged. The double J tube was removed 3 months after operation, and the CT reexamination after extubation showed that the degree of pyelectasis was (2.52±1.54) cm, the average serum creatinine was (89.64±15.21) μmol/L, and urea nitrogen was (9.42±1.36) mmol/L, which was all significantly different from that before operation ( P<0.05). The patients were followed up for 6 to 12 months, and there was no ureteral restenosis. Conclusions:Ureteroscopic-assisted laparoscopic ureteroplasty in the healthy side-lying running position is a safe and effective surgical method for the treatment of short segment (narrow segment <3 cm) ureteral cicatrix stenosis after surgery. And this surgical method has the advantages of accurate positioning of the narrow segment, safe and convenient ureteral free, exact ureteral anastomosis, and easy placement of double J tube.
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[Objective]To explore the clinical efficacy of modified Yupingfeng Powder combined with western medicine in the treatment of pregnant women with mild corona virus disease 2019(COVID-19).[Methods]The pregnant women with mild COVID-19 admitted to Shanghai Public Health Clinical Center from April 2022 to June 2022 were divided into treatment group and control group randomly.The control group(52 cases)was treated with western medicine such as Vitamin C,and the treatment group(48 cases)was treated with modified Yupingfeng Powder on the basis of control group.A comparison was made between the two groups in terms of each symptoms scores,incidence of adverse pregnancy outcomes and total effective rate.Besides,the levels of laboratory indicators involving lymphocyte,C reactive protein(CRP),interleukin-2 receptor(IL-2R)and interleukin-6(IL-6)were also be compared.The negative changes of virus nucleic acid and disease outcome were observed in the two groups.[Results]Compared with control group,after treatment cessation,the total symptom score in treatment group significantly decreased(P＜0.001),and the total effective rate significantly increased(P＜0.01).The levels of inflammatory markers including CRP and IL-6 decreased significantly in treatment group(P＜0.001,P＜0.01),while the count of lymphocyte increased significantly(P＜0.001).Besides,there was no difference in the incidence of adverse pregnancy outcomes between the two groups(P＞0.05).[Conclusion]Modified Yupingfeng Powder combined with western medicine can significantly relieve the clinical symptoms of pregnant women with mild COVID-19,while shortening nucleic acid negative conversion time and does not affect the pregnancy outcome,which has certain clinical value and is worthy of clinical application.
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OBJECTIVE To observe the clinical efficacy and safety of camrelizumab combined with sorafenib in the treatment of advanced liver cancer. METHODS Sixty patients with advanced liver cancer who were treated in our hospital from March 2020 to November 2021 were selected as the study subjects， and then were randomly divided into study group and control group， with 30 cases in each group. The control group was treated with Sorafenib tosylate tablets orally （0.4 g，bid）， and the study group was additionally given Camrelizumab for injection intravenously （200 mg， every 3 weeks） based on the control group； for all patients， the treatment was stopped until disease progression or intolerable side effects occurred. The clinical efficacy， progression-free survival （PFS）， total survival （OS） and 1-year survival rate of the two groups were compared， and the incidence of adverse reactions in two groups， and immune-related adverse reactions in the study group during treatment were recorded. RESULTS The objective remission rate of the study group was significantly higher than the control group （36.7% vs. 13.3%， P＜0.05）， and the median OS and median PFS were significantly longer than the control group （OS： 12.6 months vs. 7.9 months； PFS： 8.2 months vs. 5.3 months， P＜0.05）. There was no significant difference in the 1-year survival rate and the incidence of elevated aspartate aminotransferase and alanine aminotransferase， rash or pruritus， anorexia， diarrhea， fatigue and hypertension between the two groups （P＞0.05）. The adverse events immune-related in the study group mainly included 21 cases of reactive capillary hyperplasia （70.0%）， 6 cases of hypothyroidism （20.0%）， and 1 case of immune-associated pneumonia （3.3%）， which were improved or tolerable after symptomatic treatment. CONCLUSIONS Camrelizumab combined with sorafenib in the treatment of advanced liver cancer can effectively control and delay the disease progression， prolong the survival period of patients， and the adverse reactions can be tolerated.
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Early start denver model(ESDM)is a comprehensive early intervention approach for the children with autism spectrum disorder(ASD)between 12-month-old-36-month-old.The model is built upon the theoretical foundations of applied behavior analysis,denver model(DM),and pivotal response treatment,and it is one of the naturalistic developmental behavioral interventions.Compared with the other early intervention methods,ESDM is not limited by the environment of intervention;it encompasses all the areas of development during teaching practice and has been widely adopted for the early intervention of the children with ASD,and achieves the satisfactory therapeutic effect.The ESDM typically uses an intensive one-on-one intervention approach,but variabilities have emerged in its practical application,such as group ESDM(G-ESDM),parent-implemented ESDM(P-ESDM),and peer-mediated ESDM.In particular,G-ESDM and P-ESDM have provided the learning opportunities for more families,showing a broad application prospect.This study reviews the theoretical foundations,teaching models,and the effects of various intervention modalities of the ESDM in the treatment of ASD;combined with the domestic and international research findings,this study offers a reference for further studies on the mechanism of ESDM intervention for ASD.
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Objective To contrast the efficacy and safety of immune checkpoint inhibitor(ICI)combined with radiochemotherapy and concomitant radiochemotherapy in the treatment of advanced esophageal cancer.Methods The clinical data of 67 patients with advanced esophageal cancer who were treated in the Second Hospital of Anhui Medical University from January 2019 to January 2023 were retrospectively analyzed.Patients were divided into combination group(n=35)and radiochemotherapy group(n=32)according to different treatment plans.Progress free survival(PFS),objective remission rate(ORR),disease control rate(DCR)and adverse reactions were compared between two groups.Results The median PFS in combination group was significantly longer than that in radiochemotherapy group(12.6 months vs.6.3 months,χ2=16.288,P<0.001).ORR in combination group was significantly higher than that in radiochemotherapy group(54.3%vs.21.9%,P=0.011).DCR in combination group was significantly higher than that in radiochemotherapy group(77.1%vs.53.1%,P=0.045).The incidence of treatment-related adverse reactions and radiochemotherapy-related adverse reactions in combination group were significantly lower than those in radiochemotherapy group(P<0.05).There were 11 cases of immune-related adverse reactions in combination group,all of which were grade 1-2 adverse reactions.Conclusion ICI combined with radiochemotherapy can improve the curative effect of patients with advanced esophageal cancer,and the adverse reactions are acceptable.
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Objective To analyze the effect of Xiaozhi Decoction in the treatment of hyperlipidemiain different classification of physical constitution in TCM.Methods We screened 206 patients with Hyperlipidemia in our hospital and had been treated with drugs during May 2020 to March 2023.Totally 103 patients in the TCM group were treated with Xiaozhi Decoction,103 patients in the western medicine group were treated with atorvastatin.Selected total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and liver transaminase before and after a period of treatment.The non-high-density lipoprotein cholesterol(non-HDL-C)will be calculated,too.Results In the Phlegm-Dampness constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the TCM group(P<0.05);TC,TG and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The TCM group is superior to the western medicine group in TC,LDL-C,non-HDL-C(P<0.05).In the Qi-Deficiency constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the TCM group(P<0.05);TC,LDL-C and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The TCM group is superior to the western medicine group in non-HDL-C(P<0.05).In the Blood-Stasis constitution,TC,TG,LDL-C and non-HDL-C decreased significantly all in the western medicine group only(P<0.05).The western medicine group is superior to the TCM group in TC,LDL-C,non-HDL-C(P<0.05).In the Yin-Yang Harmony constitution,TC and non-HDL-C decreased significantly both in the TCM group(P<0.05).TC,LDL-C and non-HDL-C decreased significantly all in the western medicine group(P<0.05).The western medicine group is superior to the TCM group in TC,LDL-C,non-HDL-C(P<0.05).Conclusion Xiaozhi Decoction is superior to the the atorvastatin in the treatment of hyperlipidemia for the Phlegm-Dampness constitution and Qi-deficiency constitution groups.But it is not superior to the atorvastatin in the treatment of hyperlipidemia for the Blood-Stasis constitution and Yin-Yang Harmony constitution groups.
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【Objective】 To explore the blood group changes of two acute myeloid leukemia patients with suspected O type, and their relationship with the therapeutic effect. 【Methods】 Serological analysis of ABO blood group of patients was carried out by microcolumn gel method, tube method and absorption-elution test, ABO blood group genotyping was performed by microfluidic chip method. Exons E2 to E7 of ABO gene were amplified by PCR and sequenced by Sanger method. 【Results】 The forward typing of two cases were both O type, but the reverse typing were both A type. The absorption-elution test results all showed detection of antigen A. ABO gene phenotype of the two cases were both A, with genotyping results as A102/A102 and A102/O01, respectively. Sequencing results showed that SNP sites of ABO blood group were 467T/T, 261G/delG and 467C/T, respectively.In one case, the intensity of anti-A agglutination reaction changed significantly from weak to strong with the progress of treatment. 【Conclusion】 For clinical samples of acute myeloid leukemia patients with ABO forward and reverse typing discrepancy and suspected O type, the result of reverse typing should be valued, and absorption-elution test should be performed to further confirm the ABO blood type combining the genetic test results, so as to develop appropriate blood transfusion strategies for patients.
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ObjectiveTo observe the clinical effect of crocin tablets （CRO） combined with micropump infusion of doxorubicin in the prevention of acute cardiotoxicity in the patients with diffuse large B-cell lymphoma （DLBCL） and explore the related mechanism. MethodThe patients with DLBCL treated in the Huangshi Central Hospital from October 2022 to October 2023 were selected， and 92 patients who met the inclusion criteria were randomly assigned to a control group and an observation group at a ratio of 1∶1， with 46 patients in each group. The control group underwent conventional intravenous infusion of doxorubicin， and the observation group received CRO combined with micropump infusion of doxorubicin. The changes of abnormal ECG， myocardial injury markers， cardiac function indicators， oxidative stress， inflammatory mediators， and hemorheological indexes before and after chemotherapy were compared between the two groups. ResultThe incidence of abnormal ECG in the observation group was 23.91% （11/46）， which was lower than that （54.35%， 25/46） in the control group （χ2=8.944， P<0.01）. On day 8 after chemotherapy， the abnormal rates of creatine kinase-MB （CK-MB） and cardiac troponin I （cTnI） in the observation group were lower than those in the control group （χ2=4.423， 4.857， both P<0.05）. Compared with the control group after chemotherapy， the observation group showed lowered level of N-terminal pro-B-type natriuretic peptide， elevated left ventricular ejection fraction and levels of total antioxidant capacity and superoxide dismutase （P<0.01）， declined levels of interleukin-6 and tumor necrosis factor-α （P<0.01）， and decreased low whole blood viscosity， high whole blood viscosity， plasma viscosity， and fibrinogen （P<0.01）. ConclusionCRO combined with micropump infusion of doxorubicin can mitigate acute cardiotoxicity， reduce the incidence of abnormal ECG， protect cardiomyocytes， and improve the cardiac function by exerting the antioxidant and anti-inflammatory effects and improving blood flow.
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BACKGROUND:Rheumatoid arthritis is a chronic autoimmune disease characterized by joint pain,swelling,and dysfunction.Acupuncture,as a traditional medical treatment,has proved its effectiveness and safety in many diseases.However,the efficacy of acupuncture in the treatment of rheumatoid arthritis remains controversial.Therefore,the purpose of this study is to evaluate and explore the effect of Tiaodu Tongmai acupuncture in the treatment of preclinical rheumatoid arthritis of different ages through the generalized estimating equation,and to provide a basis for the application of acupuncture in rheumatoid arthritis. OBJECTIVE:To investigate the effect of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis(pre-RA)patients at different ages based on generalized estimating equation. METHODS:A total of 123 patients with preclinical rheumatoid arthritis treated from January to September 2023 were selected as the study objects and divided into study group(n=64)and control group(n=59)according to different treatment methods.The study group was given Tiaodu Tongmai acupuncture treatment,and the control group was given acetaminophen tablets.The baseline balance was adjusted by propensity score matching method.The clinical efficacy and cytokine levels before and after treatment between the two groups were compared.The generalized estimating equation model was established to evaluate the efficacy of Tiaodu Tongmai acupuncture therapy on preclinical rheumatoid arthritis patients at different ages. RESULTS AND CONCLUSION:(1)After 0 days of treatment,there were significant differences in joint pain and C-reactive protein expression between study and control groups(P＜0.05).After 4 weeks of treatment,there were significant differences in visual analogue scale scores,joint pain,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 8 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).After 12 weeks of treatment,there were significant differences in visual analogue scale scores,C-reactive protein and erythrocyte sedimentation rate between the two groups(P＜0.05).(2)The total effective rate of the study group was 93.75%,while that of the control group was 79.17%.The clinical efficacy of the study group was significantly better than that of the control group(P＜0.05).(3)There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the study group before and after treatment(P＜0.05).The levels of interleukin-6,interferon-γ,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,metallomatrix proteinase 9,and anti-cyclic citrulline antibody in the control group after treatment were significantly different from those before treatment(P＜0.05).There were significant differences in interleukin-6,interferon-γ,macrophage migration inhibitory factor,rheumatoid factor IgA,rheumatoid factor IgM,metallomatrix proteinase 3,and anti-cyclic citrulline antibody between the two groups after treatment(P＜0.05).(4)After 12 weeks of treatment,the comprehensive efficacy of patients of all ages in the study group was better than that of the control group(P＜0.05).After 8 weeks of treatment,the comprehensive efficacy of patients aged 23-35,36-50,and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy of patients aged 18-22 years old was comparable between the two groups.After 4 weeks of treatment,the comprehensive efficacy of patients aged 36-50 and 51-60 years old in the study group was better than that of the control group(P＜0.05),and the comprehensive efficacy was comparable between the two groups of patients aged 18-22 and 23-35 years.Overall,Tiaodu Tongmai acupuncture therapy has advantages in treating preclinical rheumatoid arthritis patients aged 36-50 and 51-60 years.
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BACKGROUND:Compared with total knee arthroplasty,unicondylar knee arthroplasty has such advantages as quick recovery,low cost and good proprioception,but its high revision rate after operation is also a problem that cannot be ignored.At present,the reasons for the high revision rate after unicondylar knee arthroplasty are not completely clear.Therefore,preoperative strict control of surgical indication may be crucial to improve postoperative outcome and reduce revision rate after unicondylar knee arthroplasty.As an index commonly used in the measurement of imaging,the evaluation of joint space width may have important clinical reference value in the selection of indications for unicondylar knee arthroplasty. OBJECTIVE:To review the measurement of joint space width and its effect on the curative effect and outcome of medial unicondylar knee arthroplasty. METHODS:WanFang and PubMed were used to search the relevant literature published from January 1,1950 to June 1,2023 on the evaluation factors of curative effect of unicondylar knee arthroplasty and the influence of joint space width on the curative effect of unicondylar knee arthroplasty.By summarizing and analyzing the literature,the measurement methods of joint space width,the influence of preoperative medial compartment joint space width on the curative effect of medial compartment joint space width,and the influence of postoperative lateral compartment joint space width on the outcome were reviewed. RESULTS AND CONCLUSION:(1)Although many methods have been used to study and measure knee joint space width,X-ray measurement of joint space width under weight-bearing position is still a common method in daily orthopedic practice to assess the progression of osteoarthritis,and it can moderately reflect the thickness of cartilage.(2)Preoperative medial compartment joint space width of knee joint can affect the efficacy of medial movable platform after unicondylar knee arthroplasty.Patients with knee osteoarthritis whose medial joint space width/lateral joint space width ratio is<40%or medial joint space width≤2 mm may be more suitable for medial movable platform unicondylar knee arthroplasty.(3)Changes in lateral compartment joint space width after medial unicondylar knee arthroplasty also have a certain impact on outcome.Improving the joint matching degree of lateral compartment after surgery can delay the progression of lateral compartment joint degeneration and reduce the prosthesis revision rate.However,relevant clinical studies are still lacking.In conclusion,the imaging measurement of joint space width has important clinical reference value for evaluating the postoperative efficacy and prognosis of medial unicondylar knee arthroplasty.
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Ischemic cerebrovascular disease(ICVD)refers to the degeneration,necrosis,or transient loss of function of local brain tissue due to blood supply disorders,and is one of the common neurological diseases.Exosomes are a subgroup of extracellular vesicles,characterized by good biocompatibility,low toxicity and immunogenicity,and strong designability.The components of exosomes include proteins,lipids,genetic materials,etc.They come from a wide range of sources and can be secreted by various cells under physiological or pathological conditions.The roles and related mechanisms of exosomes from different sources in the treatment of ICVD are different.This article reviews the therapeutic effects and related mechanisms of exesomes derived from mesenchymal stem cells,brain cells,blood,endothelial cells,and macrophages on ICVD,in order to provide reference for the clinical treatment of ICVD.
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Objective: To evaluate the efficacy and safety of neoadjuvant chemotherapy combined with programmed death-1 (PD-1) antibody in operable, borderline or potentially resectable locally advanced esophageal squamous cell carcinoma(ESCC) in the real world. Methods: The study retrospectively analyzed 28 patients with operable or potentially resectable locally advanced ESCC patients treated with preoperative chemotherapy combined with PD-1 inhibitor in Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from April 2020 to March 2021. According to the clinical TNM staging system of the 8th edition of the American Joint Committee on Cancer, there were 1, 15, 10, 1 and 1 case of stage Ⅱ, Ⅲ, ⅣA, ⅣB and unknown stage respectively. The treatment was two cycle of dual drug chemotherapy regimen including taxane plus platinum or fluorouracil combined with PD-1 antibody followed by tumor response assessment and surgery if the patient was eligible for resection. Results: Of the 28 patients, 1, 2, 3 and 4 cycles of chemotherapy combined with PD-1 antibody treatment completed in 1, 21, 5, and 1 patient, respectively. Objective response rate (ORR) was 71.4% (20/28), and disease control rate (DCR) was 100% (28/28). The incidence of adverse events exceeding grade 3 levels was 21.4% (6/28), including 3 neutropenia, 1 leukopenia, 1 thrombocytopenia and 1 immune hepatitis. There was no treatment-related death. Of the 23 patients underwent surgery, R0 resection rate was 87.0% (20/23), 13 patients had down staged to the T1-2N0M0 I stage, the pCR rate was 17.3% (4/23), and the pCR rate of primary tumor was 21.7% (5/23). Four patients received definitive chemoradiotherapy. One patient rejected surgery and other treatment after achieved PR response. Conclusion: Neoadjuvant chemotherapy combined PD-1 inhibitor is safe and has high efficacy in operable, borderline or potentially resectable locally advanced ESCC, and it is a promising regimen.
Subject(s)
Humans , Antibodies/therapeutic use , Antineoplastic Combined Chemotherapy Protocols , Carcinoma, Squamous Cell/surgery , Cisplatin , Esophageal Neoplasms/surgery , Esophageal Squamous Cell Carcinoma/drug therapy , Immune Checkpoint Inhibitors/therapeutic use , Neoadjuvant Therapy , Programmed Cell Death 1 Receptor/therapeutic use , Retrospective Studies , Treatment Outcome摘要
This study compared the effects of Curcuma longa before and after processing with vinegar on the rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation to reveal the mechanism of vinegar processing in improving the role of C. longa in soothing liver and relieving pain. The rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation was established according to the Preparation of the Animal Model of Dysmenorrhea(Draft) and the chronic unpredictable stress me-thod. The changes in the body weight, organ indexes, writhing latency, writhing score, and serum levels of six liver function indicators, sex hormones, pain factors, and blood rheological indicators were measured to evaluate the efficacy of C. longa processed with vinegar or not in treating dysmenorrhea in the rats with syndrome of liver depression and qi stagnation. Compared with the model group, the C. longa group(processed with vinegar or not) showed slow weight loss, increase in writhing latency, and decrease in writhing response(P<0.05). The inhibition rates on writhing in raw C. longa, vinegar-processed C. longa, and positive groups were 33.780%, 64.611%, and 62.466%, respectively. The significantly higher inhibition rate of the vinegar processing group indicated that vinegar-processed C. longa demonstrated more significant therapeutic effect. The vinegar-processed C. longa group showed lower levels of alanine aminotransferase(ALT), alkaline phosphatase(ALP), aspartate aminotransferase(AST), direct bilirubin(DBIL), and total bilirubin(TBIL) and higher level of albumin(ALB)(P<0.05), which indicated that vinegar processing enhanced the therapeutic effect of C. longa on liver injury. The serum levels of estradiol(E_2) and oxytocin(OT) were lower in the vinegar-processed C. longa group(P<0.05), indicating that the vinegar-processed C. longa could regulate the sex hormone levels, reduce the activity of uterine smooth muscle and contraction of uterus, and alleviate the symptoms of dysmenorrhea in rats. Moreover, the vinegar-processed C. longa group showed lower interleukin-6(IL-6) and arginine vasopressin(AVP) levels and higher beta-endorphin(β-EP) level(P<0.05), which indicated that vinegar-processed C. longa regulated the levels of pain factors to exert the pain-relieving effect. Drug intervention decreased the whole blood viscosity low-cut, medium-cut and high-cut values, plasma viscosity, whole blood reduction viscosity low-cut and high-cut values, erythrocyte cumulative pressure, and equation K value of erythrocyte sedimentation rate(P<0.05), and the vinegar-processed C. longa group outperformed other groups. This result indicated that vinegar processing enhanced the function of C. longa in improving the local blood rheology. C. longa processed with vinegar can enter the liver to relieve the da-mage to the heart, liver, kidney, and uterus, repair the liver function, and recover the sex hormone levels and immune function by regulating the levels of sex hormones and pain factors and improving the blood rheology. It activates the pain-relieving mechanism to relieve the pain, protect the liver, and fight inflammation, which is consistent with the theory that vinegar processing facilitates C. longa entering the liver to sooth liver and relieve pain.
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OBJECTIVE@#To observe the variability of hemoglobin (HB) level in patients with renal anemia, and to analyze its relationship with effect of repeated blood transfusion therapeutic in patients.@*METHODS@#A retrospective cohort study and propensity score matching method were used, 60 patients with renal anemia who had effective treatment with repeated blood transfusion in Changzhou No.2 People's Hospital from May 2018 to May 2021 were retrospectively analyzed and set as the effective group; 153 patients with renal anemia who had ineffective treatment with repeated blood transfusion in the hospital in the same period were collected and set as the ineffective group, the propensity score matching method was used, the patients who were effective and ineffective in repeated blood transfusion were matched 1∶1 for analysis; the medical records and laboratory indexes of the two groups were checked; the Hb level of patients within 6 months (1/month) were recorded, the residual standard deviation (Res-SD) of Hb of patients was calculated according to the Hb level and evaluated the variability of Hb level; the relationship between HB variability level and therapeutic effect of repeated blood transfusion in patients with renal anemia was analyzed.@*RESULTS@#After propensity score matching, there was no statistical significant difference between the two groups in terms of baseline data such as age, sex, dialysis age and BMI (P>0.05). The levels of serum albumin and transferrin of patients in the ineffective group were significantly lower than those of patients in the effective group (P<0.05); at 1 and 2 months of the observation period, there was no statistical significant difference in Hb levels of patients in both groups (P>0.05); the Hb level of patients in the ineffective group was significantly lower than that of patients in the effective group at 3, 5 and 6 months, and significantly higher than that of patients in the effective group at 4 months (P<0.05); the Res-SD of male patients and female patients in the ineffective group were respectively significantly higher than that of male patients and female patients in the effective group (P<0.05). Logistic regression analysis results showed that high variability of Hb level (Res-SD) was a risk factor for the ineffective treatment of repeated blood transfusion in patients with renal anemia (OR>1, P<0.05); the decision curve results showed that, when the high-risk threshold was 0.0-1.0, Res-SD predicted the net benefit rates of male and female patients with renal anemia were greater than 0, which was clinically significant, the smaller the high-risk threshold in the above range, the greater the net benefit rate.@*CONCLUSION@#The therapeutic effect of repeated blood transfusion in patients with renal anemia may be related to the variability of Hb level.
Subject(s)
Humans , Male , Female , Retrospective Studies , Hemoglobins/therapeutic use , Anemia/therapy , Chronic Disease , Blood Transfusion , Kidney Diseases摘要
Since the Guangdong alliance launched the centralized procurement of Chinese patent medicine， manufacturers have engaged in fierce price competition to obtain the qualification for selection. In order to ensure that manufacturers have lowered the price without decreasing quality， the evaluation criteria for the quality of Chinese patent medicine is constructed on the basis of the characteristics of traditional Chinese medicine. The evaluation criteria consist of the production process and therapeutic effect evaluation. The evaluation indicators involve raw materials， processing and clinical use covering the whole life cycle of Chinese patent medicine. The evaluation of production process includes 3 secondary indicators （the quality of traditional Chinese medicine， the quality of traditional Chinese medicine decoction pieces and the quality of Chinese patent medicines） and 13 tertiary indicators （standardized production， quality inspection， processing specifications， technical processes， safety risk control， etc.）， which fully reflect the quality control of key links in the production of Chinese patent medicine. The therapeutic effect evaluation includes 5 secondary indicators （theoretical origin of formulation， proactive research by production enterprises， evidence-based medical evidence， clinical use， and technological embodiment） and 18 tertiary indicators （theoretical sources， post-market effectiveness re- evaluation， clinical guidelines， expert consensus， etc.） to assess the quality and efficacy of Chinese patent medicine from multiple perspectives and levels. This study is a useful supplement to the scheme of centralized procurement of Guangdong alliance， which can not only provide data support for selecting “low-cost and high-quality” Chinese patent medicine， but also provide information reference for hospitals to make procurement decisions.
摘要
Objective To evaluate the efficacy and safety of modified Yupingfeng granules(MYG)combined with probiotics in the treatment of patients with chronic spontaneous urticaria(CSU).Methods Patients with CSU who attended Guang'anmen Hospital,China Academy of Chinese Medical Sciences from June 2021 to June 2023 were enrolled.According to the random number table method,CUS patients were divided into MYG group(loratadine combined with MYG)and MYGP group[loratadine combined with MYG and probiotics(live combined bacillus subtilis and enterococcus enteric-coated capsules)].The urticaria activity score(UAS7),dermatological life quality index(DLQI)and TCM pattern score were used to evaluate the efficacy.The differential levels of inflammatory factors[serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]and immune factors(peripheral blood CD3+,CD4+,CD8+,CD4+/CD8+ levels),IgE were detected and compared before and after treatment.The treatment efficacy betwenen tow groups and occurrence of adverse reactions during treatment was observed and compared.Three months after the completion of treatment,the recurrence of the two groups was compared.Results A total of 240 patients with CSU were included in the study,including 120 patients in the MYG group and 120 in the MYGP group.After treatment,USA7,DLQI,TCM pattern score,IL-6,TNF-α,CD8+ and IgE in the MYGP group were significantly lower than those in the MYG group,while CD3+,CD4+ and CD4+/CD8+ were significantly higher than those in the MYG group(P<0.05).The total effective rate of CSU patients in the MYGP group was significantly higher than that in the MYG group(P<0.05),while the incidence of adverse reactions and recurrence were significantly lower than those in the MYG group(P<0.05).Conclusion The efficacy of probiotics combined with MYG adjuvant therapy for CSU is significantly better than that of MYG monotherapy adjuvant therapy,which can significantly improve the treatment effect,reduce inflammatory factors,regulate immune function,improve quality of life,reduce the recurrence rate and adverse reaction rate of CSU,and have high safety.
摘要
Primary immune-privileged site large B-cell lymphoma(IP-DLBCLs)is a general term introduced in the 5th edition of the World Health Organization(WHO)Classification of Lymphoid Tumors and refers to a group of aggressive B-cell lymphomas that originate in sites behind the immune barrier in immunocompetent patients.Anatomical-derived immune sanctuaries(such as the blood-brain,blood-retinal,and blood-testicular barriers)and immunomodulatory systems that share the same immunophenotype and molecular characteristics cur-rently include the central nervous,vitreoretinal,and testes systems and large B-cell lymphomas.The primary immune-privileged site large B-cell lymphoma prognosis is relatively poor,with no standard treatment plan.Toll-like receptor-mediated nuclear factor kappa B(NF-κB)(via MYD88 mutation)and B-cell receptor(BCR)(via CD79B mutation)pathway activation was the core pathogenesis mechanism in all three sys-tems(central nervous,vitreoretinal,and testes),presenting a potential common treatment target.Bruton's tyrosine kinase(BTK)is a central molecule in the above signaling pathway,thus BTK inhibitors present a reasonable therapeutic drug choice for such diseases.This article re-views the mechanism of action,clinical studies,adverse reactions,and drug resistance of BTK inhibitors in primary immune-priviledged site large B-cell lymphoma treatment.