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BACKGROUND: Iron deficiency anemia (IDA) is a prevalent nutritional disorder during pregnancy. Clinical studies indicate that incorporating Chinese patent medicines (CPMs) with oral iron (OI) in treating IDA in pregnancy can reduce adverse effects and improve clinical outcomes. Nonetheless, the comparative efficacy of different CPMs remains unclear. AIM: To assess the safety and effectiveness of different CPMs for treating IDA during pregnancy using network meta-analysis. METHODS: We conducted a search for randomized controlled trials (RCTs) that combined CPM and OI for IDA treatment in pregnancy, spanning from 2013 to the present. Data analysis was performed using Rev Man 5.3 and Stata 14.0 on literature that satisfied the quality criteria. RESULTS: The analysis included 45 RCTs, encompassing 4422 pregnant patients with IDA. Six CPMs were examined, including Shengxuebao Mixture, Shengxuening Tablets (SXN), Yiqi Weixue CPMs (YQWX), Jianpi Shengxue CPMs (JPSX), Yiqi Buxue Tablets, and Compound Hongyi Buxue Oral Liquid (FFHY). Findings indicated that FFHY + OI significantly improved the clinical effective rate. SXN + OI was most effective in boosting red blood cells counts and hemoglobin levels. YQWX + OI showed superior results in improving serum ferritin, and SXN + OI was most effective in increasing serum iron levels. JPSX + OI was optimal in reducing adverse pregnancy outcomes, while YQBX + OI effectively minimized adverse events. A cluster analysis suggested that SXN + OI could be the potentially optimal therapeutic regimen for IDA in pregnancy. CONCLUSION: This study demonstrates that the combination of OI with CPMs offers better outcomes than OI alone. Based on clinical efficacy and other measured outcomes, SXN + OI emerges as the most effective treatment modality for improving the health of pregnant patients with IDA.
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BACKGROUND: Malignant peritoneal mesothelioma (MPM) originates from the mesothelial and subcutaneous cells of the abdominal cavity. Its diagnose is difficult due to its nonspecific and vague symptoms, and it should be differentiated from alcoholic cirrhosis and liver and pancreatic cancers. Misdiagnosis and missed diagnosis can easily occur when MPM presents with other diseases. To the best of our knowledge, no case of MPM concurrent with alcoholic cirrhosis has been reported. CASE SUMMARY: A 63-year-old man presented to our hospital with abdominal distension for 20days. He had a history of alcohol consumption for nearly 30 years and no history of special drug use or toxic exposure. After treatment for alcoholic cirrhosis in a community hospital, his symptoms did not improve significantly. The patient underwent exploratory laparotomy and surgical resection. Pathologic examination showed an epithelioid MPM. He was treated with chemotherapy and intraperitoneal hyperthermic perfusion after surgery. Currently, he is in a stable condition and tumor recurrence has not occurred. CONCLUSION: Misdiagnosis and missed diagnosis of MPM can easily occur because of its insidious onset. Therefore, there is a need to understand. MPM in clinical practice, make the correct diagnosis, and provide timely and effective treatment.
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BACKGROUND: Surgery is the main treatment for resectable esophageal cancer but not for advanced esophageal cancer with distant metastasis. PDT is a therapeutic strategy for dysphagia and select unresectable esophageal cancer, with tremendous advantages of minimal invasiveness and organ-preserving treatment modality. PDT prevents tumor progression and growth by inducing vascular injury and local acute inflammatory responses. Immunotherapy, combined with PDT, may contribute to the efficacy of PDT in the treatment of esophageal cancer and reduce the probability of tumor recurrence. CASE REPORT: A 54-year-old male patient with advanced esophageal cancer was hospitalized in the author's hospital on 20th April 2020, who had been treated with two cycles of chemotherapy at the local hospital but failed. In this case, after metal stent implantation, the patient underwent a remarkable and successful treatment of PDT combined with sintilimab, a PD-1 inhibitor. An additional immune checkpoint inhibitor and chemotherapy offer the opportunity to eliminate residual and invisible tumors. The patient had an excellent prognosis that not only the primary lesion was cured, but also the metastatic lymph nodes were significantly reduced, with no tumor recurrence in the last endoscopic review. CONCLUSION: PDT in combination with immunotherapy is a promising strategy to eliminate primary and metastatic esophageal cancer by generating local and systemic antitumor responses, especially after interventional esophageal stent implantation for relief of obstruction.
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Neoplasias Esofágicas , Fotoquimioterapia , Neoplasias Esofágicas/tratamento farmacológico , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Fotoquimioterapia/métodos , StentsRESUMO
BACKGROUND: Submucosal hematoma (SH) is one of the rare causes of upper gastrointestinal bleeding. As a rare and critical disease in clinical practice, it should be paid more attention to by clinicians to avoid missed diagnosis and misdiagnosis. Most of the esophageal submucosal hematomas have clear causes, including retrosternal pain, dysphagia, etc. Here, we report a rare case of SH extending from the hypopharynx to the lower esophagus caused by oral administration of hirudin and panax notoginseng powder, with atypical clinical manifestation. Such a long submucosal hematoma has rarely been reported. CASE SUMMARY: The patient was a 60-year-old male with a history of gastritis, hypertension, coronary heart disease, and coronary stent implantation. The patient developed chest tiredness and heartburn after taking 10 capsules of a homemade mixture of hirudin and notoginseng powder in the previous 2 d. He did not have hematemesis or black stool. Gastroscopy and chest computed tomography confirmed the diagnosis of SH, which ranged from the pharynx to the lower esophagus and was 35-40 cm in length. After the diagnosis was confirmed, we performed active conservative treatment on the patient, and the patient recovered well and remained asymptomatic during the 26-mo follow-up. CONCLUSION: SH is rare, and cases with atypical clinical symptoms may lead to misdiagnosis and missed diagnosis. Ignorance of this disease can lead to serious clinical consequences. Conservative therapy is effective and the prognosis is good.
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OBJECTIVE: To explore and analyze the effect of liquid dressing in relieving pain and preventing incision adhesion after circumcision and its clinical application value. METHODS: Ninety male patients underwent circumcision in Hangzhou Third People's Hospital from September to November 2019, with the incision covered with liquid dressing + vaseline gauze (group A, n = 30), liquid dressing alone (group B, n = 30) or vaseline gauze only (group C, n = 30). At 2, 4 and 6 days after surgery, we compared the Visual Analogue Scale (VAS) pain intensity at dressing change, incision bleeding after dressing removal and incidence of postoperative complications among the three groups of patients. RESULTS: At 2, 4 and 6 days after surgery, the VAS pain score and incidence of incision bleeding were significantly lower in groups A and B than in C (P < 0.05). At 2 days, both the VAS pain score and incidence of incision bleeding were markedly decreased in group A as compared with those in group B (P < 0.05). At 4 and 6 days, the VAS pain score remained lower in group A than in B (P < 0.05), but the incidence rate of incision bleeding showed no significant difference between the two groups (P > 0.05). No statistically significant differences were observed in the incidence of postoperative complications among the three groups (P > 0.05). CONCLUSIONS: Liquid dressing can reduce pain intensity at dressing change, prevent incision adhesion and consequent dressing change-induced tearing and bleeding, and therefore promote incision healing after circumcision. Its combination with vaseline gauze can achieve an even better effect.
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Bandagens/classificação , Circuncisão Masculina , Cicatrização , Humanos , Masculino , Dor/prevenção & controle , Medição da DorRESUMO
OBJECTIVE: To observe the clinical effects of the 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on condyloma acuminata with high-risk human papillomavirus (HPV) infection and cellular immunoactivity in the local tissue of the patient. METHODS: From January 2015 to January 2017, we treated 47 cases of condyloma acuminata with high-risk HPV infection in our hospital by simple excision of the wart (the control group, n = 21) or 1ï¼5 times of ALA-PDT plus wart excision (the observation group, n = 26) and observed the changes in the number of warts and recurrence at 6 months after surgery. We excised all the warts in the control group and those >5 mm before ALA-PDT and >2 mm at 48 hours after 1ï¼5 times of ALA-PDT in the observation group, followed by examination of the counts of CD4+ and CD8+ T cells, CD4+ / CD8+ ratio, and number of CD68+ macrophages in the local tissue by immunohistochemistry. RESULTS: In the control group, the warts were completely removed in all the 21 cases but recurred in 9 (42.9%) at 6 months after surgery. In the observation group, 5 times of ALA-PDT achieved complete removal of the warts in 16 (61.5%) of the 26 patients, partial removal in 7 (26.9%), and inefficient removal in 3 (11.5%), with a total effective removal rate of 88.5% (23/26), a significantly lower 6-month recurrence rate (11.5% ï¼»3/26ï¼½) than in the control (P < 0.05), but no such severe complications as festering, scarring and pigmentation. Compared with the control group and the baseline, the observation group showed remarkable increases after 1, 3 and 5 times of ALA-PDT in the counts of CD4+ T lymphocytes (31.21 ± 6.23 and 30.27 ± 5.63 vs 56.88 ± 4.72, 54.67 ± 2.84 and 42.62 ± 2.31, P < 0.05) and CD8+ T cells (25.31 ± 3.51 and 27.35 ± 3.78 vs 48.87 ± 2.47, 45.41 ± 3.17 and 37.58 ± 3.32, P < 0.01) and the CD4+ / CD8+ ratio (1.21 ± 0.52 and 1.09 ± 0.37 vs 1.68 ± 0.52, 1.63 ± 0.45 and 1.42 ± 0.13, P < 0.05 or P < 0.01), but exhibited no significant change in the count of CD68+ macrophages in the local tissue (23.31 ± 1.54 and 20.25 ± 1.28 vs 22.31 ± 2.73, 23.17 ± 2.41 and 21.35 ± 3.72, P > 0.05). CONCLUSIONS: ALA-PDT, with its advantages of high efficiency, little invasion and high safety, is effective for the treatment of condyloma acuminata with high-risk HPV infection and it can also improve cellular immunoactivity in the local tissue and reduce recurrence.
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Ácido Aminolevulínico , Condiloma Acuminado , Infecções por Papillomavirus , Fotoquimioterapia , Ácido Aminolevulínico/uso terapêutico , Condiloma Acuminado/complicações , Condiloma Acuminado/imunologia , Condiloma Acuminado/cirurgia , Condiloma Acuminado/terapia , Humanos , Infecções por Papillomavirus/complicações , Fármacos Fotossensibilizantes , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the infection of reproductive Mycoplasma genitalium (MG) detected by real-time fluorescence constant-temperature simultaneous amplification and testing (SAT) of nucleic acid among patients present at the clinics of urology, gynecology or venereal diseases. METHODS: We retrospectively analyzed the clinical data on 5 711 patients with suspected genitourinary tract (GUT) infection present at the clinics of urology, gynecology or sexually transmitted diseases in Hangzhou Third People's Hospital, Shaoxing People's Hospital and General Hospital of Eastern Theater Command from January 2018 to December 2018. The patients were aged 16ï¼73 (38.77 ± 11.32) years, 3 425 males and 2 286 females. We collected urine samples from 3 666, GUT secretion samples from 2 095, and both urine and GUT samples from 50 of the patients. Using the SAT technique, we detected the infections of MG, Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) in the patients. RESULTS: Of the 5 711 patients, 294 (5.15%) were found MG-positive, with a significantly higher positive rate in the males than in the females (5.96% ï¼»206/3 425ï¼½ vs 3.85% ï¼»88/2 286ï¼½, P < 0.05). The laboratory results with the urine and GUT secretion samples from 50 of the cases showed a consistency rate of 100%. Simple MG infection accounted for 52.04% in the 294 MG-positive cases, 63.11% in the 206 MG-positive males, and 26.13% in the 88 females, with a significantly higher positive rate in the males than in the females (P < 0.05). MG combined with UU infection had the highest rate among the mixed infections in both the males and females and in those aged ≤20 years, even higher in the females than in the males (P < 0.05) and in the ≤20-year-old males than in the ≤20-year-old females (8.65% ï¼»9/104ï¼½ vs 5.13% ï¼»4/78ï¼½, P < 0.05). There were statistically significant differences in the MG-positive rate among different age groups (χ2 = 32.74, P < 0.05). CONCLUSIONS: Among patients with suspected GUT infection, the MG-positive rate is higher in men than in women, with MG + UU-positive as the most common mixed infection, and it decreases with the increase of age. The results of SAT of urine and GUT secretion have a high consistency rate.
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Infecções por Mycoplasma/diagnóstico , Técnicas de Amplificação de Ácido Nucleico , Infecções Urinárias/diagnóstico , Adolescente , Adulto , Idoso , China , Chlamydia trachomatis , Coinfecção/diagnóstico , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Mycoplasma genitalium , Neisseria gonorrhoeae , Estudos Retrospectivos , Temperatura , Ureaplasma urealyticum , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
RATIONALE: Radiation enteritis (RE) is one of the serious complications caused by the radiotherapy and it can occur in any segment of the intestine, including small intestine, colon, and rectum. It can cause a number of serious problems of the intestine, such as chronic ulcers, bleeding, intestinal stenosis, intestinal fistula, and perforation. At present, there is no standard treatment guideline for the RE. PATIENT CONCERNS: A 54-year-old male patient received surgery and chemotherapy for rectal cancer and radiofrequency ablation (RFA) for a single metastatic carcinoma of the liver. Three years later, he was diagnosed with recurrent lesion in the rectal anastomotic stoma and was treated with radiotherapy with a total dose of 70 Gy. Following this, he had persistent abdominal pain and diarrhea for 1 year. DIAGNOSES: Colonoscopy confirmed a diagnosis of RE. INTERVENTIONS: Since intestinal probiotics, intestinal mucosal protectants, antidiarrheal drugs, and other treatments were not effective; the patient was treated by RFA. OUTCOMES: Clinical symptoms of the patient were gradually decreased after the RFA. Colonoscopy examination was performed 3 months later and intestinal mucosa was found to have healed well. LESSONS: RFA is an effective treatment for patients with RE, and it is expected to be one of the standard treatments for the RE.
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Ablação por Cateter/métodos , Enterite/etiologia , Lesões por Radiação/cirurgia , Neoplasias Retais/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colonoscopia/métodos , Enterite/cirurgia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/cirurgia , Resultado do TratamentoRESUMO
AIM: To explore the correlation between Helicobacter pylori (H. pylori)-associated gastric diseases and colorectal neoplasia. METHODS: Patients included in this study underwent a colonoscopy and esophago-gastro-duodenoscopy (EGD) along with histopathological measurement between March 2012 and March 2015 at Qi-Lu Hospital of Shandong University, who also had results of H. pylori detection. A total of 233 cases were selected. Demographic data, H. pylori infection status (including results of rapid urease tests and gastric mucosa pathological examinations) and histopathological examination results of gastric and colorectal mucosa were gathered and analyzed. The statistical analysis focused on the prevalence of colorectal neoplasms among patients with various histopathological categories of the stomach. ORs and their 95%CI were calculated to describe the strengths of the associations. RESULTS: The incidence rates of colorectal adenoma without high-grade intraepithelial neoplasia (HGIEN) (OR = 2.400, 95%CI: 0.969-5.941), adenoma with HGIEN (5.333, 1.025-27.758) and adenocarcinoma (1.455, 0.382-5.543) were all higher for patients with H. pylori-associated gastritis than for those in the control group. The incidence rate of colorectal adenoma with HGIEN (3.218, 0.767-13.509) was higher in patients with intestinal metaplasia than in the control group, while the incidence rates of adenoma without HGIEN (0.874, 0.414-1.845) and adenocarcinoma (0.376, 0.096-1.470) were lower in the intestinal metaplasia group than in the control group. The incidence rate of colorectal adenoma without HGIEN (3.111, 1.248-7.753) was significantly higher in the gastric intraepithelial neoplasia group than in the control group, while the rates of adenoma with HGIEN (1.481, 0.138-15.941) and adenocarcinoma (2.020, 0.561-7.272) were higher in the gastric intraepithelial neoplasia group. Incidence rates of colorectal adenoma without HGIEN (1.067, 0.264-4.314), adenoma with HGIEN (2.667, 0.231-30.800) and adenocarcinoma (2.182, 0.450-10.585) were all higher in the gastric adenocarcinoma group than in the control group. CONCLUSION: H. pylori infection as well as H. pylori-associated gastric diseases are risk factors for colorectal neoplasia.
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Adenocarcinoma/microbiologia , Adenoma/microbiologia , Carcinoma in Situ/microbiologia , Neoplasias Colorretais/microbiologia , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenoma/diagnóstico , Adenoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/epidemiologia , Distribuição de Qui-Quadrado , China/epidemiologia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Bases de Dados Factuais , Feminino , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Gastrite/diagnóstico , Gastrite/epidemiologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Sulforaphane (SFN), which is highly enriched in cruciferous vegetables, has been investigated for its cancer chemopreventive properties and ability to induce autophagy. Uridine 5'-diphospho (UDP)-glucuronosyltransferase (UGT)1A induction is one of the mechanisms that is responsible for the cancer chemopreventive activity of SFN. The current study demonstrates that rapamycin may enhance the chemopreventive effects of SFN on Caco-2 cells; this may be partially attributed to nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2)- and human pregnane X receptor (hPXR)-mediated UGT1A1, UGT1A8 and UGT1A10 induction. These results indicate that targeting autophagy modulation may be a promising strategy for increasing the chemopreventive effects of SFN in cases of colon cancer.
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The vehicle activity survey, including traffic flow distribution, driving condition, and vehicle technologies, were conducted in Shanghai. The databases of vehicle flow, VSP distribution and vehicle categories were established according to the surveyed data. Based on this, a dynamic vehicle emission inventory simulation method was designed by using the real time traffic information data, such as traffic flow and average speed. Some roads in Shanghai city were selected to conduct the hourly vehicle emission simulation as a case study. The survey results show that light duty passenger car and taxi are major vehicles on the roads of Shanghai city, accounting for 48% - 72% and 15% - 43% of the total flow in each hour, respectively. VSP distribution has a good relationship with the average speed. The peak of VSP distribution tends to move to high load section and become lower with the increase of average speed. Vehicles achieved Euro 2 and Euro 3 standards are majorities of current vehicle population in Shanghai. Based on the calibration of vehicle travel mileage data, the proportions of Euro 2 and Euro 3 standard vehicles take up 11% - 70% and 17% - 51% in the real-world situation, respectively. The emission simulation results indicate that the ratios of emission peak and valley for the pollutants of CO, VOC, NO(x) and PM are 3.7, 4.6, 9.6 and 19.8, respectively. CO and VOC emissions mainly come from light-duty passenger car and taxi, which has a good relationship with the traffic flow. NO(x) and PM emissions are mainly from heavy-duty bus and public buses and mainly concentrate in the morning and evening peak hours. The established dynamic vehicle emission simulation method can reflect the change of actual road emission and output high emission road sectors and hours in real time. The method can provide an important technical means and decision-making basis for transportation environment management.