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1.
Hinyokika Kiyo ; 70(6): 173-177, 2024 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-38967030

RESUMO

A 74-year-old man visited the urology clinic with the chief complaint of urinary retention in December 2014. Serum level of initial prostate specific antigen (PSA) was 50 ng/ml and he was diagnosed with Gleason Score 4+4 prostate adenocarcinoma with regional lymphadenopathy (cT3aN1M0). PSA level had declined after the treatment with combined androgen blockade. In November 2018, he was diagnosed with castration resistant prostate cancer (CRPC) as local progression was detected by computed tomography (CT) while PSA level did not increase. Since local symptoms worsened, resulting in repeated hematuria after the treatment with enzalutamide, palliative radiation therapy to the prostate (45 Gy) was performed. Five months later, follow-up CT showed multiple metastasis in bilateral lung and left testicle. Serum level of neuron-specific enolase (NSE) was 24.4 ng/ml without an elevated in serum PSA level. He received rebiopsy of the prostate, but no malignant findings were observed. Consequently, bilateral orchiectomy was performed for diagnosis of left testicular tumor. Pathological examination revealed metastasis of neuroendocrine prostate cancer (NEPC). Chemotherapy using cisplatin and irinotecan was administered after orchiectomy. Complete response of lung lesions was achieved and serum level of NSE decreased within normal range. No recurrence has been confirmed for 4 years after the completion of chemotherapy.


Assuntos
Neoplasias da Próstata , Masculino , Humanos , Idoso , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Neoplasias da Próstata/tratamento farmacológico , Terapia Combinada , Neoplasias de Próstata Resistentes à Castração/patologia , Neoplasias de Próstata Resistentes à Castração/terapia , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Fatores de Tempo , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Orquiectomia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia
2.
BMC Pulm Med ; 24(1): 314, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961405

RESUMO

BACKGROUND: Massive hemoptysis is characterized by its life-threatening nature, potentially leading to airway obstruction and asphyxia. The objective of this study was to evaluate the clinical effectiveness of combining endobronchial tamponade with bronchial artery embolization (BAE) in the treatment of massive hemoptysis. METHODS: Between March 2018 and March 2022, a total of 67 patients with massive hemoptysis who underwent BAE were divided into two groups: the combination group (n = 26) and the BAE group (n = 41). Technical and clinical success rates were assessed, and adverse events were monitored following the treatment. Blood gas analysis and coagulation function indicators were collected before and after the treatment, and recurrence and survival rates were recorded during the follow-up period. RESULTS: All patients achieved technical success. There were no significant differences in the clinical success rate, recurrence rates at 3 and 6 months, and mortality rates at 3 months, 6 months, and 1 year between the combination group and the BAE group. However, the hemoptysis recurrence rate at 1 year was significantly lower in the combination group compared to the BAE group (15.4% vs. 39.0%, P = 0.039). No serious adverse events were reported in either group. After treatment, the combination group showed higher levels of arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), fibrinogen (FIB), and D-dimer (D-D) compared to the BAE group (P < 0.05). Multivariate regression analysis demonstrated a significant correlation between combined therapy and hemoptysis-free survival. CONCLUSION: Combination therapy, compared to embolization alone, exhibits superior efficacy in improving respiratory function, correcting hypoxia, stopping bleeding, and preventing recurrence. It is considered an effective and safe treatment for massive hemoptysis.


Assuntos
Artérias Brônquicas , Embolização Terapêutica , Hemoptise , Humanos , Hemoptise/terapia , Hemoptise/etiologia , Embolização Terapêutica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Estudos Retrospectivos , Terapia Combinada , Adulto , Recidiva , Broncoscopia/métodos , Gasometria
3.
Trials ; 25(1): 442, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961460

RESUMO

BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.


Assuntos
Dor Crônica , Terapia com Luz de Baixa Intensidade , Cervicalgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Cervicalgia/terapia , Cervicalgia/fisiopatologia , Cervicalgia/diagnóstico , Terapia com Luz de Baixa Intensidade/métodos , Dor Crônica/terapia , Dor Crônica/fisiopatologia , Dor Crônica/diagnóstico , Terapia Combinada , Resultado do Tratamento , Medição da Dor , Avaliação da Deficiência , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Terapia por Exercício/métodos , Fatores de Tempo , Qualidade de Vida
4.
Zhonghua Gan Zang Bing Za Zhi ; 32(6): 565-571, 2024 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-38964901

RESUMO

Hepatocellular carcinoma (HCC) is a common type of poorly prognosticated malignant tumor. Surgical resection is the preferred treatment method for early-stage HCC. However, at the time of the initial diagnosis, fewer than 30% of patients with liver cancer are suitable for radical therapy. Systemic therapy plays an important role in the treatment process of patients with intermediate- to advanced-stage HCC, as it can effectively extend patients' survival time. With an emphasis on the status and role of systemic therapy for comprehensive management of HCC, this article summarizes the latest progress at home and abroad in the past five years, including first-line combined immunotherapy for advanced-stage HCC, second-line therapy selection, perioperative systemic therapy application, and combined therapy of systemic and local. Currently, the treatment model combined with local therapy has already become a new research hotspot in the treatment of advanced-stage HCC. Nevertheless, in the future, individualized and precise systemic therapeutic strategies will need further exploration.


Assuntos
Carcinoma Hepatocelular , Imunoterapia , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Imunoterapia/métodos , Terapia Combinada
5.
Int Ophthalmol ; 44(1): 305, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38954120

RESUMO

PURPOSE: To compare the results of intravitreal bevacizumab (IVB) monotherapy and combined intravitreal bevacizumab and laser photocoagulation (LPC) therapies applied in the same session to patients with aggressive retinopathy of prematurity (A-ROP) in our clinic. METHODS: The study included 67 eyes of 37 patients diagnosed with A-ROP and treated. Forty-nine eyes treated with anti-vascular endothelial growth factor agent injection monotherapy for A-ROP treatment were included in the first group. The second group consisted of 18 eyes that received injection therapy and LPC treatment. The clinical findings of the two groups were investigated, and their treatment results were compared. RESULTS: Recurrence was observed in 19 of the 49 (38%) eyes in the first group, but there was no recurrence in any of the cases in the second group. While only IVB was applied to eight cases with recurrence, the combination of LPC and IVB treatment was applied to 11 cases. A second recurrence was detected in two of the eight cases that had received IVB monotherapy as a treatment for recurrence and in three of the 11 cases that had received LPC and IVB. The treatment outcomes of the two groups did not statistically significantly differ (P = 0.181). CONCLUSION: We consider that the combined simultaneous LPC and IVB treatment we applied in A-ROP cases is an effective approach, particularly for cases where there are concerns about the patient's ability to attend follow-up appointments.


Assuntos
Inibidores da Angiogênese , Bevacizumab , Injeções Intravítreas , Fotocoagulação a Laser , Retinopatia da Prematuridade , Humanos , Bevacizumab/administração & dosagem , Bevacizumab/uso terapêutico , Retinopatia da Prematuridade/tratamento farmacológico , Retinopatia da Prematuridade/terapia , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/cirurgia , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/uso terapêutico , Fotocoagulação a Laser/métodos , Feminino , Masculino , Recém-Nascido , Estudos Retrospectivos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Terapia Combinada , Idade Gestacional , Seguimentos , Lactente
8.
Cancer Immunol Immunother ; 73(9): 167, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38954010

RESUMO

BACKGROUND: Radiotherapy (RT) synergizes with immune checkpoint blockade (ICB). CD1c(BDCA-1)+/CD141(BDCA-3)+ myeloid dendritic cells (myDC) in the tumor microenvironment are indispensable at initiating effector T-cell responses and response to ICB. METHODS: In this phase II clinical trial, anti-PD-1 ICB pretreated oligometastatic patients (tumor agnostic) underwent a leukapheresis followed by isolation of CD1c(BDCA-1)+/CD141(BDCA-3)+ myDC. Following hypofractionated stereotactic body RT (3 × 8 Gy), patients were randomized (3:1). Respectively, in arm A (immediate treatment), intratumoral (IT) ipilimumab (10 mg) and avelumab (40 mg) combined with intravenous (IV) pembrolizumab (200 mg) were administered followed by IT injection of myDC; subsequently, IV pembrolizumab and IT ipilimumab/avelumab were continued (q3W). In arm B (contemporary control arm), patients received IV pembrolizumab, with possibility to cross-over at progression. Primary endpoint was 1-year progression-free survival rate (PFS). Secondary endpoints were safety, feasibility, objective response rate, PFS, and overall survival (OS). RESULTS: Thirteen patients (10 in arm A, eight non-small cell lung cancer, and five melanoma) were enrolled. Two patients crossed over. One-year PFS rate was 10% in arm A and 0% in arm B. Two patients in arm A obtained a partial response, and one patient obtained a stable disease as best response. In arm B, one patient obtained a SD. Median PFS and OS were 21.8 weeks (arm A) versus 24.9 (arm B), and 62.7 versus 57.9 weeks, respectively. An iatrogenic pneumothorax was the only grade 3 treatment-related adverse event. CONCLUSION: SBRT and pembrolizumab with or without IT avelumab/ipilimumab and IT myDC in oligometastatic patients are safe and feasible with a clinically meaningful tumor response rate. However, the study failed to reach its primary endpoint. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT04571632 (09 AUG 2020). EUDRACT: 2019-003668-32. Date of registration: 17 DEC 2019, amendment 1: 6 MAR 2021, amendment 2: 4 FEB 2022.


Assuntos
Anticorpos Monoclonais Humanizados , Células Dendríticas , Ipilimumab , Radiocirurgia , Humanos , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Radiocirurgia/métodos , Células Dendríticas/imunologia , Ipilimumab/uso terapêutico , Ipilimumab/administração & dosagem , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias/terapia , Neoplasias/imunologia , Trombomodulina/uso terapêutico , Idoso de 80 Anos ou mais , Terapia Combinada , Células Mieloides , Glicoproteínas , Antígenos CD1
9.
J Cancer Res Clin Oncol ; 150(7): 333, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38955827

RESUMO

OBJECTIVE: To explore the effect and mechanism of relaxin (RLX) in the growth and metastasis of livercancer after combination treatment with transarterial chemoembolization (TACE). MATERIALS AND METHODS: HCCLM3 and Huh-7 cells were adopted to evaluate the effect of tumor proliferation, migration, and invasion after RLX administration in vitro. The rabbit VX2 model was used to evaluate the biosafety, doxorubicin penetration, local tumor response, tumor metastasis, and survival benefit of RLX combined with TACE treatment. RESULTS: RLX did not affect the proliferation, migration, or invasion of HCCLM3 and Huh-7 cells, and the expression of E-cadherin and HIF-1α also remained unchanged while the MMP-9 protein was upregulated in vitro. In the rabbit VX2 model, compared to the normal saline group (NS), RLX group (RLX) and TACE mono-therapy group (TACE), the group that received TACE combined with RLX (TACE + RLX) showed an improved local tumor response and survival benefit. Furthermore, TACE combined with RLX was found to reduce tumor metastasis. This combination therapy reduced the fibrotic extracellular matrix in the tumor microenvironment, allowing for better penetration of doxorubicin, improved infiltration of CD8+ T cells and affected the secretion of cytokines. Additionally, RLX combined with TACE was able to decrease the expression of HIF-1α and PD-L1. The biosafety of TACE combined with RLX was also confirmed. CONCLUSION: RLX synergized with TACE by mitigating the fibrotic extracellular matrix and tumor hypoxic microenvironment, improving the therapeutic effect and inhibiting metastasis during the treatment of liver cancer.


Assuntos
Quimioembolização Terapêutica , Neoplasias Hepáticas , Relaxina , Animais , Quimioembolização Terapêutica/métodos , Coelhos , Relaxina/administração & dosagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/tratamento farmacológico , Doxorrubicina/administração & dosagem , Humanos , Terapia Combinada , Proliferação de Células/efeitos dos fármacos , Linhagem Celular Tumoral , Modelos Animais de Doenças , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/tratamento farmacológico , Metástase Neoplásica
10.
BMC Med ; 22(1): 281, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38972988

RESUMO

BACKGROUND: The increase in population aging highlights the growing prevalence of mild cognitive impairment, prompting the adoption of interventions that combine physical exercise and cognitive training to improve health and cognitive performance in older adults. The aim of this study was to analyze the efficacy of a combined program on physical and cognitive health in older people with cognitive impairment. METHODS: A 12-week randomized controlled clinical trial involving 95 participants (aged 72.12 ± 4.25 years), 47 individuals participated in a control group (CG) that only underwent cognitive stimulation, while 48 individuals were in an experimental group (EG) that participated in a combined program. Balance was measured using the Tinetti scale, upper body strength was assessed with the arm curl test, lower body strength was evaluated with the 30-s chair stand test, flexibility was tested using the back scratch test and chair sit-and-reach test, physical function was measured with the Timed Up and Go test, cognitive function was assessed using the Mini Mental State Examination, cognitive impairment was evaluated with the Montreal Cognitive Assessment, verbal fluency was tested with the Isaac test, and executive functions were assessed using the Trail Making Test. RESULTS: The results of the study show significant improvements in both physical and cognitive aspects, such as balance, gait, upper and lower body strength, flexibility, physical function, cognitive function, cognitive impairment, verbal fluency, and executive functions in the group that carried out the intervention compared to the control group. CONCLUSION: A combined program for older individuals with mild cognitive impairment leads to enhancements in physical and cognitive health. These improvements underscore the importance of integrating physical exercise with cognitive training as an effective strategy for enhancing overall health and quality of life in older adults. TRIAL REGISTRATION: NCT05503641.


Assuntos
Cognição , Disfunção Cognitiva , Humanos , Disfunção Cognitiva/terapia , Idoso , Masculino , Feminino , Cognição/fisiologia , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Resultado do Tratamento , Idoso de 80 Anos ou mais , Exercício Físico/fisiologia , Terapia Combinada , Treino Cognitivo
11.
Clin Exp Dent Res ; 10(4): e927, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38973212

RESUMO

OBJECTIVES: Helicobacter pylori gastric infection strongly correlates with gastric diseases such as chronic gastritis, functional dyspepsia, and complications such as peptic ulcers and gastric cancer. In developing countries, systemic therapies are not usually successful due to elevated antibiotic resistance. Additionally, oral H. pylori infection and periodontal disease correlate with gastric treatment failures. This study aimed to explore the effect of an integral therapy, comprising oral hygiene and concomitant systemic treatment, to increase the eradication of gastric infection and recurrences. MATERIALS AND METHODS: A prospective, randomized, four-arm, parallel-group, open-label clinical trial was conducted to investigate the efficacy of integral therapy to eradicate gastric H. pylori infection and avoid recurrences in double-positive (real-time PCR oral and gastric infection) patients. Oral hygiene involved mouthwash with neutral electrolyzed water (NEW), with or without periodontal treatment. One hundred patients were equally distributed into four groups: NS, NS-PT, NEW, and NEW-PT. All patients had concomitant systemic therapy and additionally, the following oral treatments: mouthwash with normal saline (NS), periodontal treatment and mouthwash with normal saline (NS-PT), mouthwash with NEW (NEW), and periodontal treatment and mouthwash with NEW (NEW-PT). Gastric and oral infection and symptoms were evaluated one and four months after treatments. RESULTS: Integral therapy with NEW-PT increased gastric eradication rates compared with NS or NS-PT (84%-96% vs. 20%-56%; p < 0.001). Even more, a protective effect of 81.2% (RR = 0.1877; 95% CI: 0.0658-0.5355; p = 0.0018) against recurrences and 76.6% (RR = 0.2439; 95% CI: 0.1380-0.4310; p < 0.001) against treatment failure (eradication of infection and associated symptoms) was observed in patients from the NEW and NEW-PT groups. CONCLUSIONS: Implementation of oral hygiene and systemic treatment can increase the eradication of gastric infection, associated symptoms, and recurrences. NEW is recommended as an antiseptic mouthwash due to its efficacy and short- and long-term safety.


Assuntos
Antibacterianos , Infecções por Helicobacter , Helicobacter pylori , Antissépticos Bucais , Higiene Bucal , Humanos , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Masculino , Feminino , Antissépticos Bucais/uso terapêutico , Antissépticos Bucais/administração & dosagem , Estudos Prospectivos , Adulto , Pessoa de Meia-Idade , Higiene Bucal/métodos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Resultado do Tratamento , Recidiva , Prevenção Secundária/métodos , Idoso , Terapia Combinada
12.
Arch Esp Urol ; 77(5): 591-597, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38982789

RESUMO

BACKGROUND: Urinary incontinence (UI) is a common complication after radical prostatectomy (RP). It has a great influence on the postoperative quality of life of patients. This study aims to explore the clinical efficacy of low-frequency electrical pulse acupoint stimulation combined with pelvic floor muscle exercise in the treatment of UI after RP. METHODS: The clinical data of 129 patients with UI after receiving RP in our hospital from July 2020 to July 2023 were retrospectively analysed. A total of 65 patients who received pelvic floor muscle exercise from July 2020 to January 2022 were set as the reference group. Of these patients, four were excluded, resulting in the inclusion of 61 cases. A total of 64 patients who received low-frequency electrical pulse acupoint stimulation combined with pelvic floor muscle exercise from February 2022 to July 2023 were classified into the observation group. Of these patients, four were excluded, and 60 cases were finally included. SPSS 23.0 was used to analyse the use of urine pads, recovery time of urinary control and improvement of urination in the two groups. RESULTS: Before treatment, no significant difference existed in the use of urine pads, urination condition, maximum flow rate, maximum cystometric capacity, maximum urethral closure pressure, abdominal leak point pressure and scores on Short-Form-36 Health Survey (SF-36) in both groups (p > 0.05). After treatment, the observation group had significantly lower use of urinary pads, urination frequency and leakage times; Significantly shorter recovery time of urinary control (p < 0.05); And significantly higher maximum flow rate, maximum cystometric capacity, maximum urethral closure pressure, abdominal leak point pressure and SF-36 scores than the reference group (p < 0.05). CONCLUSIONS: The combination of low-frequency electrical pulse acupoint stimulation and pelvic floor muscle exercise can improve clinical symptoms, shorten the recovery time of urinary control and improve urodynamics and quality of life in patients with UI after RP.


Assuntos
Diafragma da Pelve , Complicações Pós-Operatórias , Prostatectomia , Incontinência Urinária , Humanos , Prostatectomia/efeitos adversos , Masculino , Incontinência Urinária/etiologia , Incontinência Urinária/terapia , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Terapia por Exercício/métodos , Pontos de Acupuntura , Terapia Combinada , Resultado do Tratamento , Eletroacupuntura/métodos
13.
PLoS One ; 19(7): e0306863, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38980838

RESUMO

BACKGROUND: Although clear cell sarcoma of kidney (CCSK) is rare, it is the second most common renal tumor in children after Wilms' tumor. NWTS and SIOP are two major groups which had made tremendous efforts on renal tumors, but the strategies are different, for NWTS follows the upfront surgery principle providing definite pathology and the SIOP follows the upfront chemotherapy principle, each has its own advantages. Here we aimed to evaluate the outcomes of CCSK in China following NWTS strategies to analyze the prognostic factors. METHODS: For this multicenter retrospective study, a total of 54 patients were enrolled from three children's hospitals, between April 2003 and December 2021. Treatment comprised upfront radical nephrectomy, followed by radiotherapy and intensive chemotherapy. Clinical records were regularly updated. Prognostic factors and survival rates were evaluated. RESULTS: The 54 enrolled patients had a median age of 37 months (range, 4 months to 11.4 years). The stage distribution was 16% stage I (n = 9), 30% stage II (n = 16), 39% stage III (n = 21), and 15% stage IV (n = 8). Among stage IV, metastasis sites included the lung (n = 6), bone (n = 1), and intra-orbital/cervical lymph node (n = 1). After a median follow-up of 5.6 years, the 5-year event-free survival (EFS) was 82.4±5.4%, and overall survival was 88.1±4.6%. The EFS was 100% for stage I, 93.8 ±6.1% for stage II, 71.1±10.0% for stage III, and 68.6±18.6% for stage IV. Univariate analysis revealed that staging (III/IV), tumor rupture, and inferior vena cava tumor thrombus were inferior prognostic factors. Multivariate analysis revealed that tumor rupture was independent poor prognostic factor (P = 0.01, HR 5.9). Among relapsed patients, relapse occurred a median of 11 months after diagnosis (range, 4-41 months), and 50% (4/8) achieved a second complete remission after multiple treatment. None of the six lung metastasis patients received lung RT, only one patient developed a relapse and was salvaged by RT after relapse. CONCLUSIONS: Tumor rupture was independent poor prognostic factor. Upfront surgery of NWTS strategies can make a definite pathology diagnosis, but how to reduce tumor rupture during surgery is important especially in developing countries. The outcomes of patients with stage I-III CCSK in China were comparable to findings in other developed countries. Better outcomes were achieved in stage IV CCSK by using an intensive chemotherapy regimen including carboplatin, which require further confirmation by AREN0321. Lung RT may be safely omitted in selected patients who achieve a compete radiographic response after 6 weeks of systemic treatment (including surgery). Treatment should be encouraged even in CCSK cases with metastasis and relapse.


Assuntos
Neoplasias Renais , Nefrectomia , Sarcoma de Células Claras , Humanos , Sarcoma de Células Claras/patologia , Sarcoma de Células Claras/terapia , Masculino , Feminino , Criança , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Pré-Escolar , China/epidemiologia , Lactente , Estudos Retrospectivos , Prognóstico , Resultado do Tratamento , Taxa de Sobrevida , Estadiamento de Neoplasias , Terapia Combinada
14.
BMJ Open ; 14(7): e084939, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38986560

RESUMO

INTRODUCTION: Keloids, benign fibroproliferative tumours characterised by excessive fibroblast proliferation and over-deposition of extracellular matrix, pose a therapeutic challenge with high recurrence rates. Betamethasone (diprospan) injection (BI) is one of the most common non-invasive therapies for keloids. Pulsed dye laser (PDL) has the function of closing microvessels, which may become one of the auxiliary treatment methods of BI and may enhance its curative effect. Some studies suggest that the combination of a dual-wavelength dye laser (DWL) and BI may offer superior efficacy. This randomised controlled trial aims to evaluate whether the combined therapy of DWL+BI outperforms BI alone in treating keloids. METHODS AND ANALYSIS: This single-centre, parallel positive control, randomised trial evaluates the efficacy and safety of DWL (585 nm PDL+1064 nm neodymium-doped yttrium aluminium garnet) combined with BI for keloid treatment. Enrolling 66 adult patients, participants are randomised into DWL+BI or BI groups in a 1:1 ratio. Over 12 weeks, each group undergoes four treatment sessions, ensuring blinding for outcome assessors. Data collection occurs at multiple time points (4, 12, 24 and 52 weeks), with primary outcomes assessing the Vancouver Scar Scale (VSS) improvement rate 24 weeks after the last intervention. Secondary outcomes include VSS improvement rates, changes in keloid volume, changes in relative perfusion index measured by laser speckle contrast imaging, Patient and Observer Scar Assessment Scale results and patient satisfaction. Safety assessments include vital signs, laboratory tests, pregnancy tests and self-reports of adverse reactions. ETHICS AND DISSEMINATION: The results will be presented in peer-reviewed journals and at international conferences. This study is approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Register (ChiCTR2400080148).


Assuntos
Betametasona , Queloide , Lasers de Corante , Humanos , Queloide/terapia , Queloide/tratamento farmacológico , Betametasona/administração & dosagem , Betametasona/uso terapêutico , Lasers de Corante/uso terapêutico , Adulto , Feminino , Ensaios Clínicos Controlados Aleatórios como Assunto , Masculino , Terapia Combinada , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Resultado do Tratamento , Pessoa de Meia-Idade , Adulto Jovem , Adolescente
15.
Zhongguo Zhen Jiu ; 44(7): 792-6, 2024 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-38986592

RESUMO

OBJECTIVE: To observe the clinical effect of nape seven needles combined with pressing moxibustion for cervical vertigo (CV). METHODS: A total of 70 patients with CV were randomized into an observation group and a control group, 35 cases in each group. In the observation group, nape seven needles combined with pressing moxibustion was delivered, once a day, 6 times a week, for consecutive 2 weeks. In the control group, betahistine hydrochloride tablet and aceclofenac dispersible tablet were given orally, for 2 weeks and 3 days respectively. Before and after treatment, the evaluation scale for cervical vertigo (ESCV) score was observed, the plasma levels of neuropeptide Y (NPY), endothelin-1 (ET-1) and calcitonin gene related peptide (CGRP) were detected, the hemorheologic and hemodynamic indexes were measured, and the clinical efficacy was evaluated after treatment in the two groups. RESULTS: After treatment, the scores of dizziness, daily life and work ability, psychological and social adaptability, and headache, as well as the total scores of ESCV were increased compared with those before treatment (P<0.01, P<0.05) in the two groups, and the score and total score of neck and shoulder pain of ESCV was increased compared with that before treatment (P<0.01) in the observation group; each sub-item score and total score of ESCV in the observation group were higher than those in the control group (P<0.01, P<0.05). After treatment, the plasma levels of NPY and ET-1 were decreased compared with those before treatment (P<0.01), while the plasma levels of CGRP were increased compared with those before treatment (P<0.01, P<0.05) in the two groups; the plasma levels of NPY and ET-1 in the observation group were lower than those in the control group (P<0.01), the plasma level of CGRP in the observation group was higher than that in the control group (P<0.01). After treatment, the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity were decreased compared with those before treatment (P<0.01, P<0.05), the mean velocity of basilar artery (BA), left vertebral artery (LVA) and right vertebral artery (RVA) were increased compared with those before treatment (P<0.05) in the two groups; the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity in the observation group were lower than those in the control group (P<0.01), and the mean velocity of BA, LVA and RVA in the observation group were higher than those in the control group (P<0.05). The total effective rate in the observation group was 91.4% (32/35), which was superior to 71.4% (25/35) in the control group (P<0.05). CONCLUSION: Nape seven needles combined with pressing moxibustion can effectively alleviate the clinical symptoms, and improve the hemorheology and hemodynamics in CV patients.


Assuntos
Terapia por Acupuntura , Moxibustão , Vertigem , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Vertigem/terapia , Vertigem/fisiopatologia , Idoso , Peptídeo Relacionado com Gene de Calcitonina/sangue , Resultado do Tratamento , Terapia Combinada , Neuropeptídeo Y/sangue , Endotelina-1/sangue , Pontos de Acupuntura , Adulto Jovem
16.
Zhongguo Zhen Jiu ; 44(7): 765-9, 2024 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-38986588

RESUMO

OBJECTIVE: To explore the clinical effect of acupuncture combined with repeated transcranial magnetic stimulation (rTMS) for mild to moderate post-stroke depression. METHODS: Ninety patients with mild to moderate post-stroke depression were randomly divided into a combination group (30 cases, 4 cases dropped out), an acupuncture group (30 cases, 3 cases dropped out) and a rTMS group (30 cases, 5 cases dropped out). All the three groups received basic treatment, the combination group was treated with acupuncture combined with rTMS, the acupuncture group was treated with acupuncture, and the rTMS group was treated with rTMS. The acupuncture was applied at Baihui (GV 20), Yintang (GV 24+) , Danzhong (CV 17) and bilateral Shenmen (HT 7), Taichong (LR 3), Neiguan (PC 6). All the three groups were treated once a day, 5 times a week for 4 weeks. The Hamilton depression scale (HAMD-17) score, Pittsburgh sleep quality index (PSQI) score and event-related potential were compared among the three groups before and after treatment. RESULTS: After treatment, the HAMD-17 scores and PSQI scores in the three groups were reduced compared with those before treatment (P<0.01) , and the HAMD-17 score and PSQI score in the combination group were lower than those in the acupuncture group and the rTMS group (P<0.05). After treatment, the latency of event-related potential (P300, mismatch negativityï¼»MMNï¼½) in the three groups was shortened compared with that before treatment (P<0.05), and the latency of event-related potential in the combination group was shorter than that in the acupuncture group and the rTMS group (P<0.05). CONCLUSION: Acupuncture combined with rTMS can effectively alleviate the depressive state of patients with mild to moderate post-stroke depression, improve the sleep quality and the latency of event-related potential P300 and MMN.


Assuntos
Terapia por Acupuntura , Depressão , Acidente Vascular Cerebral , Estimulação Magnética Transcraniana , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Depressão/terapia , Depressão/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Terapia Combinada , Pontos de Acupuntura , Resultado do Tratamento , Adulto
17.
Zhongguo Zhen Jiu ; 44(7): 833-7, 2024 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-38986597

RESUMO

The paper introduces professor ZHANG Weihua's experience in treatment of cervical spondylotic radiculopathy (CSR) with ulna-tibia needling therapy combined with decompression-loosening manual manipulation. Using "palpating, detecting and imaging observing", professor ZHANG Weihua gives the accurate diagnosis for the location, the stage and the severity of the disease. According to the nature of the disease, CSR is treated in three stages. He proposes the academic thought, "taking the tendons as the outline, regarding the meridians as the essential, rooting at qi and blood, co-regulating tendons and bones". The ulna-tibia needling therapy and decompression-loosening manual manipulation are combined in treatment. In the ulna-tibia needling therapy, the acupuncture is delivered at the lower 1/3 of the cutaneous regions of taiyang and shaoyang meridians, on the ulnar region (belt-like distribution). The decompression-loosening manual manipulation is operated in 3 steps, i.e. relaxing the nape region, decompressing and relaxing (includes positioning rotational wrenching, upward and backward elevation) and supination wrenching, and analgesia and regulating tendons; and the manipulation for analgesia and regulating tendons is supplemented to enhance the effect.


Assuntos
Terapia por Acupuntura , Radiculopatia , Espondilose , Humanos , Terapia por Acupuntura/métodos , Terapia por Acupuntura/instrumentação , Espondilose/terapia , Radiculopatia/terapia , Masculino , Pessoa de Meia-Idade , Ulna , Terapia Combinada , Feminino , Adulto , Descompressão Cirúrgica/métodos , Manipulações Musculoesqueléticas/métodos , Pontos de Acupuntura
18.
Zhongguo Zhen Jiu ; 44(7): 838-44, 2024 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-38986598

RESUMO

This article summarizes and discusses the collaborative effects of acupuncture and medication in treatment, including four aspects, named "acupuncture synergizing the effects of medication", "medication advancing the effects of acupuncture", "coordination of acupuncture and medication", and "antagonism of acupuncture and medication". Regarding "acupuncture synergizing the effects of medication", the actions of acupuncture are predominant, which affects the absorption and metabolism of drugs in the body, increases drug concentration in blood, enhances the targeting effect of drugs, guides meridian tropism, alleviates the drug dose and adverse reactions, avoids the first pass effect and accelerates the drug bioavailability. As for "medication advancing the effects of acupuncture", the synergistic effect of acupuncture is obtained by medication, besides, the medication itself may supplement the drug property to the needles during acupuncture pretreatment so as to increase the therapeutic effect. In terms of "coordination of acupuncture and medication", and "antagonism of acupuncture and medication", there are the underlying co-effects of acupuncture and medication in the body, and the action targets may be same or different between them, thus, it needs to be further explored.


Assuntos
Terapia por Acupuntura , Humanos , Terapia Combinada
19.
Zhongguo Zhen Jiu ; 44(7): 803-6, 2024 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-38986594

RESUMO

OBJECTIVE: To observe the clinical efficacy of acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) for postpartum urinary retention. METHODS: A total of 120 patients with postpartum urinary retention were randomly divided a triple-combination group, a double-combination group, and a massage group, with 40 patients in each group. All groups received standard postpartum care to stimulate urination. The patients in the massage group received rapid acupoint massage at the bilateral Shuidao (ST 28); the patients in the double-combination group additionally received acupoint sticking of self-made Tongquan powder at bilateral Shuidao (ST 28); the patients in the triple-combination group further received moxibustion at bilateral Shuidao (ST 28). The treatment was given once in all three groups. After 5 hours of treatment completion, bladder residual volume was measured; the time and volume of first urination as well as total urination volume after 5 hours of treatment completion were recorded; the patients' sensation of urination smoothness, satisfaction rate, length of hospital stay, and hospital costs were evaluated. RESULTS: The triple-combination group showed significantly lower residual urine volumes (P<0.05), earlier first urination time (P<0.05, P<0.001), and higher first urination volumes and total urination volumes after 5 hours of treatment completion compared to the other two groups (P<0.05, P<0.001). The sensation of urination smoothness and patient satisfaction were also significantly better in the triple-combination group (P<0.001, P<0.05). The double-combination group had higher volume of first urination and total urination volume after 5 hours of treatment completion than the massage group (P<0.05), and better sensation of urination smoothness and patient satisfaction (P<0.05). There was no significant difference in the length of hospital stay and costs among the three groups (P>0.05). The total effective rates were 100.0% (40/40) for the triple-combination group, 90.0% (36/40) for the double-combination group, and 70.0% (28/40) for the massage group, with the triple-combination group significantly outperforming the other two groups (P<0.05, P<0.001), and double-combination group outperforming the massage group (P<0.05). CONCLUSION: Acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) could effectively improve urination in patients with postpartum urinary retention, and enhance patient satisfaction.


Assuntos
Pontos de Acupuntura , Massagem , Moxibustão , Período Pós-Parto , Retenção Urinária , Humanos , Feminino , Moxibustão/métodos , Retenção Urinária/terapia , Retenção Urinária/fisiopatologia , Adulto , Adulto Jovem , Terapia Combinada , Resultado do Tratamento , Micção , Transtornos Puerperais/terapia , Gravidez
20.
Alzheimers Res Ther ; 16(1): 147, 2024 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961421

RESUMO

BACKGROUND: Multimodal lifestyle interventions can benefit overall health, including cognition, in populations at-risk for dementia. However, little is known about the effect of lifestyle interventions in patients with prodromal Alzheimer's disease (AD). Even less is known about dietary intake and adherence to dietary recommendations within this population making it difficult to design tailored interventions for them. METHOD: A 6-month MIND-ADmini pilot randomized controlled trial (RCT) was conducted among 93 participants with prodromal AD in Sweden, Finland, Germany, and France. Three arms were included in the RCT: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management, and social stimulation); 2) multimodal lifestyle intervention + medical food product; and 3) regular health advice (control group). Adherence to dietary advice was assessed with a brief food intake questionnaire by using the Healthy Diet Index (HDI) and Mediterranean Diet Adherence Screener (MEDAS). The intake of macro- and micronutrients were analyzed on a subsample using 3-day food records. RESULTS: The dietary quality in the intervention groups, pooled together, improved compared to that of the control group at the end of the study, as measured with by HDI (p = 0.026) and MEDAS (p = 0.008). The lifestyle-only group improved significantly more in MEDAS (p = 0.046) and almost significantly in HDI (p = 0.052) compared to the control group, while the lifestyle + medical food group improved in both HDI (p = 0.042) and MEDAS (p = 0.007) during the study. There were no changes in macro- or micronutrient intake for the intervention groups at follow-up; however, the intakes in the control group declined in several vitamins and minerals when adjusted for energy intake. CONCLUSION: These results suggest that dietary intervention as part of multimodal lifestyle interventions is feasible and results in improved dietary quality in a population with prodromal AD. Nutrient intakes remained unchanged in the intervention groups while the control group showed a decreasing nutrient density. TRIAL REGISTRATION: ClinicalTrials.gov NCT03249688, 2017-07-08.


Assuntos
Doença de Alzheimer , Sintomas Prodrômicos , Humanos , Doença de Alzheimer/dietoterapia , Doença de Alzheimer/prevenção & controle , Masculino , Feminino , Idoso , Projetos Piloto , Estilo de Vida , Dieta Mediterrânea , Exercício Físico , Dieta/métodos , Terapia Combinada , Pessoa de Meia-Idade , Dieta Saudável/métodos
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