BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for r...BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.展开更多
BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the explora...BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the exploration of nutritional interventions as adjunct therapies.This study evaluated the impact of combining preconception and prenatal supplementation with myo-inositol,probiotics,and trace elements on mood,quality of life,and fetal development in depressed mothers.This retrospective cohort study included 314 pregnant women who were diag-nosed with mild to moderate depression,as determined by a Zung self-rating depression scale score of less than 69.The participants were divided into an intervention group(n=161)receiving myo-inositol,probiotics,and trace elements and a control group(n=153)without supplementation.Supplementation comm-enced 3 months before conception and continued through pregnancy.Psychiatric symptoms and quality of life were evaluated using the positive and negative affect schedule-now,state-trait anxiety inventory,Patient Health Ques-tionnaire-8,and World Health Organization Quality of life Assessment:Brief Version scales preconception and postpartum.Fetal development metrics were assessed via ultrasound,and neonatal outcomes were recorded.RESULTS The intervention group presented significant reductions in gestational diabetes mellitus(13.04%vs 23.53%,P=0.016)and gestational hypertension(3.73%vs 9.15%,P=0.049).Higher levels of inositol,iron,zinc,and probiotics were observed near term in the intervention group.Postpartum mood assessments indicated lower anxiety and depression scores for the intervention group,with significant improvements in the positive and negative affect schedule-now(P=0.002),trait anxiety(P=0.002),and Patient Health Questionnaire-8(P=0.018)scores.The World Health Organization Quality of life Assessment:Brief Version scores improved in the psychological(P=0.041)and environmental(P=0.009)domains postpartum.Fetal biparietal diameter and femoral length were greater in the intervention group alongside better neonatal body length and reduced neonatal unit admissions(2.48%vs 7.84%,P=0.031).CONCLUSION Combined supplementation with myo-inositol,probiotics,and trace elements from preconception through pregnancy may reduce pregnancy-related complications,enhance mood and quality of life,and improve fetal growth metrics.展开更多
Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanica...Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.展开更多
BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical ...BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.展开更多
In this paper we shall offer a separation axiom for frames inspired by the Hausdorff separation axiom for topological spaces. We call it separated condition. This is a condition on topology OX equivalent to the ...In this paper we shall offer a separation axiom for frames inspired by the Hausdorff separation axiom for topological spaces. We call it separated condition. This is a condition on topology OX equivalent to the T O space X being Hausdorff. The class of separated frames includes that of strong Hausdorff frames and that of S frames. We shall show that the class of separated frames is a class closed under the formation of coproducts and subspaces, and the space Fil( L ) is Hausdorff for any separated frame L . Therefore there is a contravariant adjunction between the category TOP 2 of Hausdorff topological spaces and the category FRAM 2 of separated frames.展开更多
We introduce first a sort of gray-scale morphological dilations and erosions, which might have some further applications in image analysis. Then we show that the dilation and the erosion defined here form adjunctive p...We introduce first a sort of gray-scale morphological dilations and erosions, which might have some further applications in image analysis. Then we show that the dilation and the erosion defined here form adjunctive pairs. The duality between the dilation and the erosion and some other properties, such as homothety, of these operators are discussed the Commuting property with translation and as well.展开更多
In this paper, we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category. We mainly discuss the relationship between closure operators and adjunctions...In this paper, we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category. We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.展开更多
AIM:To investigate the adjunct anticancer effect of Astragalus polysaccharides in H22 tumor-bearing mice.METHODS:To establish a solid tumor model,5.0 × 10 6 /mL H22 hepatoma cells were inoculated subcutaneously i...AIM:To investigate the adjunct anticancer effect of Astragalus polysaccharides in H22 tumor-bearing mice.METHODS:To establish a solid tumor model,5.0 × 10 6 /mL H22 hepatoma cells were inoculated subcutaneously into the right armpit region of Kunming mice(6-12 wk old,18-22 g).When the tumors reached a size of 100 mm 3,the animals were treated as indicated,and the mice were randomly assigned to seven groups(n = 10 each).After ten days of treatment,blood samples were collected from mouse eyes,and serum was harvested by centrifugation.Mice were sacrificed,and the whole body,tumor,spleen and thymus were weighed immediately.The rate of tumor inhibition and organ indexes were calculated.The expression levels of serum cytokines,P-glycoprotein(P-GP) and multidrug resistance(MDR) 1 mRNA in tumor tissues were detected using enzyme-linked immunosorbent assay,Western blotting,and quantitative myeloid-derived suppressor cells reverse transcription-polymerase chain reaction,respectively.RESULTS:The tumor inhibition rates in the treatment groups of Adriamycin(ADM) + Astragalus polysaccharides(APS)(50 mg/kg),ADM + APS(100 mg/kg),and ADM + APS(200 mg/kg) were significantly higher than in the ADM group(72.88% vs 60.36%,P = 0.013;73.40% vs 60.36%,P = 0.010;77.57% vs 60.36%,P = 0.001).The spleen indexes of the above groups were also significantly higher than in the ADM group(0.65 ± 0.22 vs 0.39 ± 0.17,P = 0.023;0.62 ± 0.34 vs 0.39 ± 0.17,P = 0.022;0.67 ± 0.20 vs 0.39 ± 0.17,P = 0.012),and the thymus indexes of the ADM + APS(100 mg/kg) and ADM + APS(200 mg/kg) groups were significantly higher than in the ADM group(0.20 ± 0.06 vs 0.13 ± 0.04,P = 0.029;0.47 ± 0.12 vs 0.13 ± 0.04,P = 0.000).APS was found to exert a synergistic antitumor effect with ADM and to alleviate the decrease in the sizes of the spleen and thymus induced by AMD.The expression of interleukin-1α(IL-1α),IL-2,IL-6,and tumor necrosis factor-α(TNF-α) was significantly higher in the ADM + APS(50 mg/kg),ADM + APS(100 mg/kg) and ADM + APS(200 mg/kg) groups than in the ADM group;and IL-10 was significantly lower in the above groups than in the ADM group.APS could increase IL-1α,IL-2,IL-6,and TNF-α expression and decrease IL-10 levels.Compared with the ADM group,APS treatment at a dose of 50-200 mg/kg could downregulate MDR1 mRNA expression in a dose-dependent manner(0.48 ± 0.13 vs 4.26 ± 1.51,P = 0.000;0.36 ± 0.03 vs 4.26 ± 1.51,P = 0.000;0.21 ± 0.04 vs 4.26 ± 1.51,P = 0.000).The expression level of P-GP was significantly lower in the ADM + APS(200 mg/kg) group than in the ADM group(137.35 ± 9.20 mg/kg vs 282.19 ± 20.54 mg/kg,P = 0.023).CONCLUSION:APS exerts a synergistic anti-tumor effect with ADM in H22 tumor-bearing mice.This may be related to its ability to enhance the expression of IL1α,IL-2,IL-6,and TNF-α,decrease IL-10,and downregulate MDR1 mRNA and P-GP expression levels.展开更多
In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, ...In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.展开更多
AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10...AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10 times upper limit of normal range （ULN） were ret- rospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period. Relevant clinical information was obtained from medical records. Alternative causes of ALT eleva- tions were examined for each patient, including bili- ary abnormality, viral hepatitis, hemodynamic injury, malignancy, DILI or undetermined and other causes. All suspected DILI cases were causality assessed usingthe Council for International Organizations of Medical Sciences scale, and only the cases classified as highly probable, probable, or possible were diagnosed as DILI. Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors. RESULTS： A total of 129 cases with ALT 〉 i0 ULN were identified. Hemodynamic injury （n = 46, 35.7%）, DILl （n = 25, 19.4%） and malignancy （n = 21, 16.3%） were the top three causes of liver injury. Peak ALT val- ues were lower in DILI patients than in patients with hemodynamic injury （14.5 5.6 ULN vs 32.5 ：I： 30.7 ULN, P = 0.001）. Among DILI patients, one （4%） case was classified as definite, 19 （76%） cases were clas- sified as probable and 5 （20%） as possible according to the ClOMS scale. A hepatocellular pattern was ob- served in 23 （92%） cases and mixed in 2 （8%）. The extent of severity of liver injury was mild in 21 （84%） patients and moderate in 4 （16%）. Before discharge, 10 （40%） patients were recovered and the other 15 （60%） were improved. The improved patients tended to have a higher peak ALT （808 ＋ 348 U/L vs 623 ＋ 118 U/L, P = 0.016） and shorter treatment duration before discharge （8 ＋ 6 d vs 28 ~ 12 d, P = 0.008） compared with the recovered patients. Twenty-two drugs and 6 herbs were found associated with DILl. Antibacterials were the most common agents causing DILI in 8 （32%） cases, followed by glucocorticoids in 6 （24%） cases. Twenty-four （96%） cases received treatment of DILl with at least one adjunctive drug. Agents for treatment of DILI included anti-inflammatory drugs （e.g., glycyr- rhizinate）, antioxidants （e.g., glutathione, ademetionine 1,4-butanedisulfonate and tiopronin）, polyene phospha- tidyl choline and herbal extracts （e.g., protoporphyrin disodium and silymarin）. Diagnosis of DILl was not mentioned in the discharge letter in 60% of the cases. Relative to prevalent cases and cases from wards of internal medicine, incident cases and cases from surgi- cal wards had a higher risk of missed diagnosis in dis- charge letter [odds ratio （OR） 32.7, 95%CI （2.8-374.1）,CONCLUSION： DILI is mostly caused by use of anti- bacterials and glucocorticoids, and constitutes about one fifth of hospitalized patients with ALT 〉 10 ULN. DILI is underdiagnosed frequently.展开更多
Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver cancer with a global increasing trend in recent years. Symptoms tend to be vague and insidious in development, often are diagnosed at an advanced stage whe...Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver cancer with a global increasing trend in recent years. Symptoms tend to be vague and insidious in development, often are diagnosed at an advanced stage when only palliative approaches can be used with a median survival rate of months. Comparing with HCC, ICC tends to spread to lymph nodes early, and is rarely limited to the regional lymph nodes, with a frequent postoperative recurrence. Surgery is the only choice of curative therapy for ICC, but recently no consensus has been established for operation. Thus, more data from multiple centers and more cases are needed. Generally speaking, current adjunctive therapy cannot clearly improve survival. Further research is needed to find more effective radio- and chemotherapeutic regimens.展开更多
Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy.Yet,efficacy of the current gold standard colonic preparation method-high-volume oral administration of purgative agen...Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy.Yet,efficacy of the current gold standard colonic preparation method-high-volume oral administration of purgative agents 12-24 h prior to the procedure-is limited by several factors,such as patient compliance(due to poor palatability and inconvenience of the dosing regimen)and risks of complications(due to drug interactions or intolerance).Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent,with the aim of lessening unpleasant side effects(such as bloating)and reducing the large ingested volume requirement.Several promising adjunctive agents are bisacodyl,magnesium citrate,senna,simethicone,metoclopramide,and prokinetics,and each are being investigated for their potential.This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents.While the comparative analysis ofthese adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method,they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone.To aid in this clinical endeavor,a subjective grade was assigned to each adjunct to indicate its practical value.In addition,the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives.展开更多
Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperact...Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.展开更多
Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient a...Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient and leads to a lifelong burden.Recently,the diagnosis of nerve injuries has been improved and likewise surgical reconstruction has undergone significant developments.However,the problem of slow nerve regeneration has not been solved.In a recent meta-analysis,we have shown that the application of low-intensity ultrasound promotes nerve regeneration experimentally and thereby can improve functional outcomes.Here we want to demonstrate the experimental effect of low intensity ultrasound on nerve regeneration,the current state of investigations and its possible future clinical applications.展开更多
The coronavirus disease(COVID-19)pandemic has led to a global struggle to cope with the sheer numbers of infected persons,many of whom require intensive care support or eventually succumb to the illness.The outbreak i...The coronavirus disease(COVID-19)pandemic has led to a global struggle to cope with the sheer numbers of infected persons,many of whom require intensive care support or eventually succumb to the illness.The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected.To date,there is no specific anti-COVID-19 treatment.However,the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome,especially in the severe to critically ill.While many of these adjunctive drugs are being investigated in clinical trials,professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use.This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.展开更多
Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Ob...Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.展开更多
Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsis...Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.展开更多
Treatment of type 1 diabetes(T1 D) is currently based exclusively on insulin replacement therapy. However, there is a need for better glycemic control, lower hypoglycemia rates, more effective weight management, and f...Treatment of type 1 diabetes(T1 D) is currently based exclusively on insulin replacement therapy. However, there is a need for better glycemic control, lower hypoglycemia rates, more effective weight management, and further reduction of cardiovascular risk in people with T1 D. In this context, agents from the pharmaceutical quiver of type 2 diabetes are being tested in clinical trials, as adjunctive to insulin therapies for T1 D patients. Despite the limited amount of relevant evidence and the inter-class variability, it can be said that these agents have a role in optimizing metabolic control, assisting weight management and reducing glycemic variability in people with T1 D. Specific safety issues, including the increased risk of hypoglycemia and diabetic ketoacidosis, as well as the effects of these treatments on major cardiovascular outcomes should be further assessed by future studies, before these therapeutic choices become widely available for T1 D management.展开更多
OBJECTIVE: To evaluate current evidence on the efficacy and safety of Cordyceps sinensis(cordyceps)or its fermented products used as an adjunctive treatment in patients undergoing maintenance hemodialysis.METHODS: The...OBJECTIVE: To evaluate current evidence on the efficacy and safety of Cordyceps sinensis(cordyceps)or its fermented products used as an adjunctive treatment in patients undergoing maintenance hemodialysis.METHODS: The Cochrane Central Register of Controlled Trials(CENTRAL), EMBASE, MEDLINE, China National Knowledge Infrastructure(CNKI) and Wanfang Database were searched for relevant randomized controlled trials up to March 2016. Two review authors independently selected trials for inclusion,extracted data, assessed the methodological quality and rated the quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach.RESULTS: Twelve studies involving 655 participants were included. Evidence of low to moderate-quality showed that cordyceps plus conventional treatment compared to conventional treatment alone significantly improved C-reactive protein [standardized mean difference(SMD)-0.61; 95% confi-dence intervals(CI)-1.00 to-0.22], high-sensitivity C-reactive protein [weighted mean difference(WMD)-3.44 mg/L; 95% CI-3.89 to-2.99], serum albumin(WMD 3.07 g/L; 95% CI 1.59 to 4.55),malondialdehyde(WMD-1.95 nmol/L; 95% CI-2.24 to-1.66), and hemoglobin(WMD 9.56 g/L;95% CI 3.65 to 15.47) levels. However, there was no significant improvement for serum creatinine and low-density lipoprotein cholesterol. Overall, most trials either did not monitor adverse events or poorly documented them.CONCLUSION: Given the small number of trials included, the unclear methodological quality of the included trials, and the high heterogeneity in pooled analyses, the evidence obtained in this review is insufficient to recommend the use of cordyceps as adjunctive treatment in hemodialysis patients.展开更多
文摘BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.
文摘BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the exploration of nutritional interventions as adjunct therapies.This study evaluated the impact of combining preconception and prenatal supplementation with myo-inositol,probiotics,and trace elements on mood,quality of life,and fetal development in depressed mothers.This retrospective cohort study included 314 pregnant women who were diag-nosed with mild to moderate depression,as determined by a Zung self-rating depression scale score of less than 69.The participants were divided into an intervention group(n=161)receiving myo-inositol,probiotics,and trace elements and a control group(n=153)without supplementation.Supplementation comm-enced 3 months before conception and continued through pregnancy.Psychiatric symptoms and quality of life were evaluated using the positive and negative affect schedule-now,state-trait anxiety inventory,Patient Health Ques-tionnaire-8,and World Health Organization Quality of life Assessment:Brief Version scales preconception and postpartum.Fetal development metrics were assessed via ultrasound,and neonatal outcomes were recorded.RESULTS The intervention group presented significant reductions in gestational diabetes mellitus(13.04%vs 23.53%,P=0.016)and gestational hypertension(3.73%vs 9.15%,P=0.049).Higher levels of inositol,iron,zinc,and probiotics were observed near term in the intervention group.Postpartum mood assessments indicated lower anxiety and depression scores for the intervention group,with significant improvements in the positive and negative affect schedule-now(P=0.002),trait anxiety(P=0.002),and Patient Health Questionnaire-8(P=0.018)scores.The World Health Organization Quality of life Assessment:Brief Version scores improved in the psychological(P=0.041)and environmental(P=0.009)domains postpartum.Fetal biparietal diameter and femoral length were greater in the intervention group alongside better neonatal body length and reduced neonatal unit admissions(2.48%vs 7.84%,P=0.031).CONCLUSION Combined supplementation with myo-inositol,probiotics,and trace elements from preconception through pregnancy may reduce pregnancy-related complications,enhance mood and quality of life,and improve fetal growth metrics.
文摘Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.
文摘BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.
文摘In this paper we shall offer a separation axiom for frames inspired by the Hausdorff separation axiom for topological spaces. We call it separated condition. This is a condition on topology OX equivalent to the T O space X being Hausdorff. The class of separated frames includes that of strong Hausdorff frames and that of S frames. We shall show that the class of separated frames is a class closed under the formation of coproducts and subspaces, and the space Fil( L ) is Hausdorff for any separated frame L . Therefore there is a contravariant adjunction between the category TOP 2 of Hausdorff topological spaces and the category FRAM 2 of separated frames.
基金Supported by the National Natural Science Foundation of China（11671293, 11271282）
文摘We introduce first a sort of gray-scale morphological dilations and erosions, which might have some further applications in image analysis. Then we show that the dilation and the erosion defined here form adjunctive pairs. The duality between the dilation and the erosion and some other properties, such as homothety, of these operators are discussed the Commuting property with translation and as well.
基金Supported by the National Natural Science Foundation of China(Grant Nos.1117119610871121)
文摘In this paper, we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category. We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.
文摘AIM:To investigate the adjunct anticancer effect of Astragalus polysaccharides in H22 tumor-bearing mice.METHODS:To establish a solid tumor model,5.0 × 10 6 /mL H22 hepatoma cells were inoculated subcutaneously into the right armpit region of Kunming mice(6-12 wk old,18-22 g).When the tumors reached a size of 100 mm 3,the animals were treated as indicated,and the mice were randomly assigned to seven groups(n = 10 each).After ten days of treatment,blood samples were collected from mouse eyes,and serum was harvested by centrifugation.Mice were sacrificed,and the whole body,tumor,spleen and thymus were weighed immediately.The rate of tumor inhibition and organ indexes were calculated.The expression levels of serum cytokines,P-glycoprotein(P-GP) and multidrug resistance(MDR) 1 mRNA in tumor tissues were detected using enzyme-linked immunosorbent assay,Western blotting,and quantitative myeloid-derived suppressor cells reverse transcription-polymerase chain reaction,respectively.RESULTS:The tumor inhibition rates in the treatment groups of Adriamycin(ADM) + Astragalus polysaccharides(APS)(50 mg/kg),ADM + APS(100 mg/kg),and ADM + APS(200 mg/kg) were significantly higher than in the ADM group(72.88% vs 60.36%,P = 0.013;73.40% vs 60.36%,P = 0.010;77.57% vs 60.36%,P = 0.001).The spleen indexes of the above groups were also significantly higher than in the ADM group(0.65 ± 0.22 vs 0.39 ± 0.17,P = 0.023;0.62 ± 0.34 vs 0.39 ± 0.17,P = 0.022;0.67 ± 0.20 vs 0.39 ± 0.17,P = 0.012),and the thymus indexes of the ADM + APS(100 mg/kg) and ADM + APS(200 mg/kg) groups were significantly higher than in the ADM group(0.20 ± 0.06 vs 0.13 ± 0.04,P = 0.029;0.47 ± 0.12 vs 0.13 ± 0.04,P = 0.000).APS was found to exert a synergistic antitumor effect with ADM and to alleviate the decrease in the sizes of the spleen and thymus induced by AMD.The expression of interleukin-1α(IL-1α),IL-2,IL-6,and tumor necrosis factor-α(TNF-α) was significantly higher in the ADM + APS(50 mg/kg),ADM + APS(100 mg/kg) and ADM + APS(200 mg/kg) groups than in the ADM group;and IL-10 was significantly lower in the above groups than in the ADM group.APS could increase IL-1α,IL-2,IL-6,and TNF-α expression and decrease IL-10 levels.Compared with the ADM group,APS treatment at a dose of 50-200 mg/kg could downregulate MDR1 mRNA expression in a dose-dependent manner(0.48 ± 0.13 vs 4.26 ± 1.51,P = 0.000;0.36 ± 0.03 vs 4.26 ± 1.51,P = 0.000;0.21 ± 0.04 vs 4.26 ± 1.51,P = 0.000).The expression level of P-GP was significantly lower in the ADM + APS(200 mg/kg) group than in the ADM group(137.35 ± 9.20 mg/kg vs 282.19 ± 20.54 mg/kg,P = 0.023).CONCLUSION:APS exerts a synergistic anti-tumor effect with ADM in H22 tumor-bearing mice.This may be related to its ability to enhance the expression of IL1α,IL-2,IL-6,and TNF-α,decrease IL-10,and downregulate MDR1 mRNA and P-GP expression levels.
基金Supported by Framework of one research project of the Spanish Society of Cardiology for Clinical Research in Cardiology 2012
文摘In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease.
基金Supported by Zhejiang Provincial Bureau of Education,No.200908690Zhejiang Provincial Bureau of Health,No.2012KYA090
文摘AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10 times upper limit of normal range （ULN） were ret- rospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period. Relevant clinical information was obtained from medical records. Alternative causes of ALT eleva- tions were examined for each patient, including bili- ary abnormality, viral hepatitis, hemodynamic injury, malignancy, DILI or undetermined and other causes. All suspected DILI cases were causality assessed usingthe Council for International Organizations of Medical Sciences scale, and only the cases classified as highly probable, probable, or possible were diagnosed as DILI. Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors. RESULTS： A total of 129 cases with ALT 〉 i0 ULN were identified. Hemodynamic injury （n = 46, 35.7%）, DILl （n = 25, 19.4%） and malignancy （n = 21, 16.3%） were the top three causes of liver injury. Peak ALT val- ues were lower in DILI patients than in patients with hemodynamic injury （14.5 5.6 ULN vs 32.5 ：I： 30.7 ULN, P = 0.001）. Among DILI patients, one （4%） case was classified as definite, 19 （76%） cases were clas- sified as probable and 5 （20%） as possible according to the ClOMS scale. A hepatocellular pattern was ob- served in 23 （92%） cases and mixed in 2 （8%）. The extent of severity of liver injury was mild in 21 （84%） patients and moderate in 4 （16%）. Before discharge, 10 （40%） patients were recovered and the other 15 （60%） were improved. The improved patients tended to have a higher peak ALT （808 ＋ 348 U/L vs 623 ＋ 118 U/L, P = 0.016） and shorter treatment duration before discharge （8 ＋ 6 d vs 28 ~ 12 d, P = 0.008） compared with the recovered patients. Twenty-two drugs and 6 herbs were found associated with DILl. Antibacterials were the most common agents causing DILI in 8 （32%） cases, followed by glucocorticoids in 6 （24%） cases. Twenty-four （96%） cases received treatment of DILl with at least one adjunctive drug. Agents for treatment of DILI included anti-inflammatory drugs （e.g., glycyr- rhizinate）, antioxidants （e.g., glutathione, ademetionine 1,4-butanedisulfonate and tiopronin）, polyene phospha- tidyl choline and herbal extracts （e.g., protoporphyrin disodium and silymarin）. Diagnosis of DILl was not mentioned in the discharge letter in 60% of the cases. Relative to prevalent cases and cases from wards of internal medicine, incident cases and cases from surgi- cal wards had a higher risk of missed diagnosis in dis- charge letter [odds ratio （OR） 32.7, 95%CI （2.8-374.1）,CONCLUSION： DILI is mostly caused by use of anti- bacterials and glucocorticoids, and constitutes about one fifth of hospitalized patients with ALT 〉 10 ULN. DILI is underdiagnosed frequently.
文摘Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver cancer with a global increasing trend in recent years. Symptoms tend to be vague and insidious in development, often are diagnosed at an advanced stage when only palliative approaches can be used with a median survival rate of months. Comparing with HCC, ICC tends to spread to lymph nodes early, and is rarely limited to the regional lymph nodes, with a frequent postoperative recurrence. Surgery is the only choice of curative therapy for ICC, but recently no consensus has been established for operation. Thus, more data from multiple centers and more cases are needed. Generally speaking, current adjunctive therapy cannot clearly improve survival. Further research is needed to find more effective radio- and chemotherapeutic regimens.
文摘Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy.Yet,efficacy of the current gold standard colonic preparation method-high-volume oral administration of purgative agents 12-24 h prior to the procedure-is limited by several factors,such as patient compliance(due to poor palatability and inconvenience of the dosing regimen)and risks of complications(due to drug interactions or intolerance).Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent,with the aim of lessening unpleasant side effects(such as bloating)and reducing the large ingested volume requirement.Several promising adjunctive agents are bisacodyl,magnesium citrate,senna,simethicone,metoclopramide,and prokinetics,and each are being investigated for their potential.This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents.While the comparative analysis ofthese adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method,they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone.To aid in this clinical endeavor,a subjective grade was assigned to each adjunct to indicate its practical value.In addition,the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives.
文摘Attention deficit hyperactivity disorder(ADHD) manifests by high levels of inattention, impulsiveness and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. While hyperactivity declines over time, inattention and executive function difficulties persist, leading to functional deficits. Adolescents and adults with ADHD have pervasive impairment in interpersonal and family relationships. They may develop addiction, delinquent behavior and comorbid psychiatric disorders. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. Mindfulness training, derived from Eastern meditation practices, may improve self-regulation of attention. It may also be a useful strategy to augment standard ADHD treatments and may be used as a potential tool to reduce impairments in patients with residual symptoms of ADHD. Clinically, this would manifest by an increased ability to suppress task-unrelated thoughts and distractions resulting in improved attention, completion of tasks and potential improvement in occupational and social function.
文摘Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient and leads to a lifelong burden.Recently,the diagnosis of nerve injuries has been improved and likewise surgical reconstruction has undergone significant developments.However,the problem of slow nerve regeneration has not been solved.In a recent meta-analysis,we have shown that the application of low-intensity ultrasound promotes nerve regeneration experimentally and thereby can improve functional outcomes.Here we want to demonstrate the experimental effect of low intensity ultrasound on nerve regeneration,the current state of investigations and its possible future clinical applications.
文摘The coronavirus disease(COVID-19)pandemic has led to a global struggle to cope with the sheer numbers of infected persons,many of whom require intensive care support or eventually succumb to the illness.The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected.To date,there is no specific anti-COVID-19 treatment.However,the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome,especially in the severe to critically ill.While many of these adjunctive drugs are being investigated in clinical trials,professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use.This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.
文摘Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as inpatients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.
基金supported by the University of Macao(SRG2014-00019-FHSMYRG2015-00230 FHS+4 种基金MYRG2016-00005-FHS)the Affiliated Brain Hospital of Guangzhou Medical University(2016YFC0906302816713342014Y2-001052015BAI13B02)
文摘Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.
文摘Treatment of type 1 diabetes(T1 D) is currently based exclusively on insulin replacement therapy. However, there is a need for better glycemic control, lower hypoglycemia rates, more effective weight management, and further reduction of cardiovascular risk in people with T1 D. In this context, agents from the pharmaceutical quiver of type 2 diabetes are being tested in clinical trials, as adjunctive to insulin therapies for T1 D patients. Despite the limited amount of relevant evidence and the inter-class variability, it can be said that these agents have a role in optimizing metabolic control, assisting weight management and reducing glycemic variability in people with T1 D. Specific safety issues, including the increased risk of hypoglycemia and diabetic ketoacidosis, as well as the effects of these treatments on major cardiovascular outcomes should be further assessed by future studies, before these therapeutic choices become widely available for T1 D management.
基金Postgraduate Research Grant(No.PG130-2016A)of Institute of Research Management and Monitoring,University of Malaya,Kuala Lumpur,Malaysia
文摘OBJECTIVE: To evaluate current evidence on the efficacy and safety of Cordyceps sinensis(cordyceps)or its fermented products used as an adjunctive treatment in patients undergoing maintenance hemodialysis.METHODS: The Cochrane Central Register of Controlled Trials(CENTRAL), EMBASE, MEDLINE, China National Knowledge Infrastructure(CNKI) and Wanfang Database were searched for relevant randomized controlled trials up to March 2016. Two review authors independently selected trials for inclusion,extracted data, assessed the methodological quality and rated the quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluation approach.RESULTS: Twelve studies involving 655 participants were included. Evidence of low to moderate-quality showed that cordyceps plus conventional treatment compared to conventional treatment alone significantly improved C-reactive protein [standardized mean difference(SMD)-0.61; 95% confi-dence intervals(CI)-1.00 to-0.22], high-sensitivity C-reactive protein [weighted mean difference(WMD)-3.44 mg/L; 95% CI-3.89 to-2.99], serum albumin(WMD 3.07 g/L; 95% CI 1.59 to 4.55),malondialdehyde(WMD-1.95 nmol/L; 95% CI-2.24 to-1.66), and hemoglobin(WMD 9.56 g/L;95% CI 3.65 to 15.47) levels. However, there was no significant improvement for serum creatinine and low-density lipoprotein cholesterol. Overall, most trials either did not monitor adverse events or poorly documented them.CONCLUSION: Given the small number of trials included, the unclear methodological quality of the included trials, and the high heterogeneity in pooled analyses, the evidence obtained in this review is insufficient to recommend the use of cordyceps as adjunctive treatment in hemodialysis patients.
