The present study aims to examine the effectiveness of the combination of solution-focused therapy and narrative therapy in marital adjustment of incompatible women. This research is a pretest-posttest quasi-experimen...The present study aims to examine the effectiveness of the combination of solution-focused therapy and narrative therapy in marital adjustment of incompatible women. This research is a pretest-posttest quasi-experimental study design with a nonequivalent control group. The statistical population comprises all the incompatible women who referred to the counseling clinics of Neyshabour in May 2016 (1500 admission per month). The research sample consists of 24 incompatible women who were selected through Randomand available sampling method. For data collection, Marital Adjustment Scale by Spinner was applied. The data were analyzed using the analysis of covariance test and with the aid of SPSS-22 software. The findings demonstrated that the combination of solution-focused therapy and narrative therapy is significantly effective in marital adjustment of incompatible women (P < 0.05). Thus, it can be stated that the combination of solution-focused therapy and narrative therapy can help to promote adjustment among incompatible women.展开更多
A number of prominent solution-focused brief therapists have expressed the view that, to its detriment, this school of therapy tends to downplay emotion. Accordingly, we contend that, given that emotion is a primal bi...A number of prominent solution-focused brief therapists have expressed the view that, to its detriment, this school of therapy tends to downplay emotion. Accordingly, we contend that, given that emotion is a primal binding force, the bonding component of the crucially important therapeutic alliance risks being compromised in the current practice of this approach. We further argue that the prioritization of the depiction of actions that accompany the emotion expressed by the client over the actual participation in this emotion by the therapist tends to superficialize therapeutic communication. This is especially likely to happen when the therapist lapses into a formulaic, action-soliciting interrogatory mode in response to the emotion expressed by the client. In addition, we claim that the incorporation of emotion- and body-based approaches into the solution-focused canon could remedy the affective lacuna referred to above. We note, however, that such a modification would most likely face stiff resistance from some of the gatekeepers of solution-faced therapy, in particular those who subscribe to the “surface-only” descriptive approach advocated by the philosopher Ludwig Wittgenstein. And yet, the effectiveness of depth-oriented therapies, such as sensorimotor psychotherapy and somatic experiencing, is supported by neurophysiological considerations. Finally, we suggest that these therapies, and even creativogenic elements of psychoanalysis, can actually synergize solution-focused brief therapy through the generation of affect-laden images, sensations and thoughts that lend themselves to the realization of outcomes desired by the client, which is the raison d’etre of solution-focused brief therapy. This paper pleads for the incorporation of the above-noted depth approaches into solution-focused brief therapy with a view to augmenting its effectiveness through a stronger therapeutic bond owing to an increased emotional engagement on the part of the therapist.展开更多
BACKGROUND Improving mental health is crucial for patients who require wound treatment.AIM To analyze the effects of solution-focused brief therapy(SFBT)combined with vacuum sealing drainage on the psychological healt...BACKGROUND Improving mental health is crucial for patients who require wound treatment.AIM To analyze the effects of solution-focused brief therapy(SFBT)combined with vacuum sealing drainage on the psychological health of patients undergoing wound treatment,providing a basis for selecting wound treatment protocols.METHODS A total of 102 patients undergoing wound treatment were included,with the study period from March 2020 to March 2024.Sex was not a factor,and patients were randomly assigned to two groups of 51 cases each.The control group received negative pressure wound therapy(NPWT),while the experimental group received NPWT plus SFBT.The recovery of wounds,granulation tissue scores,and psychological health levels were compared between the two groups.Statistical analysis was conducted using SPSS Windows software version 26.0 and GraphPad Prism 8.0.RESULTS Post-treatment,the levels of high-sensitivity C-reactive protein,white blood cell count,and lactate dehydrogenase in the experimental group were significantly lower than those in the control group(P<0.05).The two groups had no significant difference in granulation tissue scores(P<0.05).The psychological health level in the experimental group was significantly higher than in the control group(P<0.05).CONCLUSION The combination of SFBT and NPWT accelerates wound healing,promotes granulation tissue growth,and improves psychological well-being,making it a valuable approach for clinical application.展开更多
Objective:The aim of our study was to perform a systematic review and meta-analysis of the efficacy of short-term protocols for Helicobacter pylori eradication and to review the safety and adverse profiles of these er...Objective:The aim of our study was to perform a systematic review and meta-analysis of the efficacy of short-term protocols for Helicobacter pylori eradication and to review the safety and adverse profiles of these eradication protocols.Methods:Literatures were located through electronic searches by PubMed,Medline,ISI Web of Knowledge,and Cochrane Library using the relevant terms.Abstracts of important meetings were searched manually in some journal supplements.Additional bibliographies were identified from the reference lists of identified studies.Three independent reviewers systemically identified randomized controlled trials(RCTs) comparing short-duration protocols vs.7-d proton pump inhibitor(PPI)-based triple protocols,as well as studies reporting eradication rates of short-duration protocols for H.pylori.Summary effect size was calculated as relative risk(RR) and 95% confidence intervals(CI) using Review Manager 4.2,and P<0.05 was defined as statistically significant in all analyses.Results:Among 90 abstracts retrieved,15 studies were analyzed,including a total of 30 treatment regimens with 1856 subjects.Mean intention-to-treat(ITT) cure rates of 63.2% and 81.3% were achieved with short-term protocols and 7-d PPI-containing protocols,respectively.Per-protocol(PP)-based overall cure rates were 66.6% and 86.1%,respectively.Short-term therapy was inferior to 7-d triple regimen(P<0.00001).After sub-analysis,however,comparing the effects of ≥3-d protocols and 7-d triple protocols,the cumulative ITT RR was 0.95(P=0.26),and PP RR was 0.95(P=0.10),without significant heterogeneity.Moreover,slightly fewer adverse-effects were found in short-term protocols.Conclusions:Although more economical,short-duration protocols are inferior to 7-d PPI-based triple protocols with regarding to eradication rate of H.pylori.Protocols of more than 3 d,however,may be equivalent to 7-d protocols.展开更多
Objective: to evaluate the short-term effect of emergency interventional therapy in patients with acute myocardial infarction. Methods: a total of 140 patients with acute myocardial infarction admitted to our hospital...Objective: to evaluate the short-term effect of emergency interventional therapy in patients with acute myocardial infarction. Methods: a total of 140 patients with acute myocardial infarction admitted to our hospital from January 2017 to January 2019 were selected as the research object. They were divided into the observation group and the control group according to the different treatment methods. The patients in the observation group were treated with emergency PCI intervention, while the patients in the control group were treated with conventional thrombolytic therapy, and were compared. Results: the study found that the success rate of the patients in the observation group after PCI operation was significantly higher than that in the control group, and the occurrence rate of death was significantly lower than that in the control group. The incidence of complications in the observation group was lower than that in the control group in terms of sudden death, heart failure and myocardial infarction recurrence. At the same time, through the comparison of the postoperative reexamination data of the two groups of patients, it was found that the postoperative physical recovery status of the patients in the observation group was significantly better than that of the patients in the control group, and the above-mentioned comparative data were statistically significant (P < 0.05). Conclusion: the implementation of emergency PCI operation for patients with acute myocardial infarction has obvious short-term effect and high survival rate. It not only effectively reduces the occurrence rate of complications, but also significantly improves the impaired cardiac function of patients and accelerates the recovery of patients' health, which is worthy of promotion.展开更多
For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained careful...For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained carefully to the patient to obtain his informed consent.External beam radiotherapy is now delivered by intensity modulated radiotherapy,considered as the gold standard.From a radiotherapy perspective,low-risk localized prostate cancer is treated by image guided intensity modulated radiotherapy,or brachytherapy if patients meet the required eligibility criteria.Intermediate-risk patients may benefit from intensity modulated radiotherapy combined with 4e6 months of androgen deprivation therapy;intensity modulated radiotherapy alone or combined with brachytherapy can be offered to patients unsuitable for androgen deprivation therapy due to co-morbidities or unwilling to accept it to preserve their sexual health.High-risk prostate cancer,i.e.high-risk localized and locally advanced prostate cancer,requires intensity modulated radiotherapy with long-term(≥2 years)androgen deprivation therapy with luteinizing hormone releasing hormone agonists.Post-operative irradiation,either immediate or early deferred,is proposed to patients classified as pT3pN0,based on surgical margins,prostate-specific antigen values and quality of life.Whatever the techniques and their degree of sophistication,quality assurance plays a major role in the management of radiotherapy,requiring the involvement of physicians,physicists,dosimetrists,radiation technologists and computer scientists.The patients must be informed about the potential morbidity of radiotherapy and androgen deprivation therapy and followed regularly during and after treatment for tertiary prevention and evaluation.A close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.展开更多
AIM: To investigate the long-term role of a 3-d rabeprazole-based triple therapy in patients with Helicobacter pylori (H pylori)-infected active peptic ulcers. METHODS: We prospectively studied 115 consecutive patient...AIM: To investigate the long-term role of a 3-d rabeprazole-based triple therapy in patients with Helicobacter pylori (H pylori)-infected active peptic ulcers. METHODS: We prospectively studied 115 consecutive patients with H pylori-infected active peptic ulcers. H pylori infection was confirmed if any two of H pylori DNA, histology, and rapid urease test were positive. Patients were assigned to either an open-labeled 3-d course of oral amoxicillin 1 000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d., or 7-d course of oral amoxicillin 1 000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d. Subsequently, all patients received oral rabeprazole 20 mg once daily until the 8th wk. Three months after therapy, all patients were followed-up endoscopically for the peptic ulcer, H pylori DNA, histology, and rapid urease test. One year after therapy, H pylori infection was tested using the 13C-urea breath test. RESULTS: The ulcer healing rates 3 mo after therapy were 81.0% vs 75.4% for the 3-d and 7-d groups [intention-to-treat (ITT) analysis, P=0.47] respectively, and 90.4% vs 89.6% for the 3-d and 7-d groups [per-protocol (PP) analysis, P=0.89] respectively. The eradication rates 3 mo after therapy were 75.9% vs 73.7% for the 3-d and 7-d groups (ITT, P=0.79) respectively, and 84.6% vs 87.5% for the 3-d and 7-d groups (PP, P=0.68) respectively. One year after therapy, seventy-five patients returned to receive the 13C-urea breath test, and the eradication rates were 78.4% vs 81.6% in 3-d and 7-d groups (PP, P=0.73) respectively. CONCLUSION: Our study showed the eradication rates against H pylori infection 3 and 12 mo after triple therapy were not different between the 3-d and 7-d rabeprazole-based groups. Therefore, the 3-d rabeprazole-based triple therapy may be an alternative treatment for peptic ulcers with H pylori infection.展开更多
Photodynamic therapy(PDT)is a new minimally invasive technique for the treatment of tumors.Compared with traditional treatments such as surgery,radiotherapy and chemotherapy,PDT has the advantages of targeted killing ...Photodynamic therapy(PDT)is a new minimally invasive technique for the treatment of tumors.Compared with traditional treatments such as surgery,radiotherapy and chemotherapy,PDT has the advantages of targeted killing of primary and recurrent tumor cells,less damage to surrounding normal tissue,less complications and high repetition rate.The purpose of this study was to investigate the short-term efficacy and adverse reactions of photodynamic therapy in advanced elderly patients with esophageal-gastric junction adenocarcinoma without surgical indications.A patient with advanced adenocarcinoma of esophagus and fundus was treated with photodynamic therapy under gastroscope.Intravenous drip of Cipofen(hematoporphyrin injection 150mg/0.9%saline 250ml)for 1 hour to keep the patient away from light.48 hours after administration,photodynamic therapy was performed with"Leimai"PDT630-A photodynamic therapy apparatus,3cm columnar optical fiber,laser treatment wavelength of 630nm,transmission efficiency of 0.70,output power of 1.4W,irradiation at the lower segment of the esophagus and cardia for 150s.The curative effect was evaluated by comparing gastroscopy before and after photodynamic therapy.Before treatment,there were proliferative lesions in the lower part of esophagus and cardia,erosion and necrosis on the surface,stricture of esophageal cavity,huge ulcer near gastric fundus,filthy moss and dam-like hyperplasia and eminence of surrounding mucosa.After treatment,the local mucosa at the entrance of cardia became white and there was no bleeding.Within four days after treatment,the symptoms of nausea and vomiting disappeared;the adverse reaction of retrosternal discomfort began to occur on the second day after operation,and the adverse reaction was not improved after photodynamic therapy.Photodynamic therapy has a significant short-term effect on advanced elderly patients with adenocarcinoma of the esophagogastric junction,which can significantly alleviate the clinical symptoms and relieve the pain of the patients.However,the adverse reactions can not be ignored.Therefore,photodynamic targeting therapy for tumor needs to be futher studied.It is believed that with the continuous development of high-performance photosensitizers and new generation lasers,and the continuous progress of endoscopy and image guidance technology,photodynamic therapy will become an important adjuvant or palliative treatment for tumor prevention and treatment.展开更多
Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.T...Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.展开更多
AIM:To investigate the possibility of shortening the duration of peginterferon(Peg-IFN)plus ribavirin(RBV) combination therapy by incorporating interferon-β (IFN-β)induction therapy. METHODS:A one treatment arm,coho...AIM:To investigate the possibility of shortening the duration of peginterferon(Peg-IFN)plus ribavirin(RBV) combination therapy by incorporating interferon-β (IFN-β)induction therapy. METHODS:A one treatment arm,cohort prospective study was conducted on seventy one patients.The patients were Japanese adults with genotype 1b chronic hepatitis C,HCV-RNA levels of≥5.0 Log IU/mL or 100 KIU/mL,and platelet counts of≥90 000/μL.The treatment regimen consisted of a 2 wk course of twicedaily administration of IFN-βfollowed by 24 wk PegIFN plus RBV combination therapy.We prolonged the duration of the Peg-IFN plus RBV therapy to 48 wk if the patient requested it. RESULTS:The patients,including 44%males,were characterized by an median age of 63 years(range: 32-78 years),an median platelet count of 13.9(range: 9.1-30.6)×10 4 /μL,62%IFN-na?ve,and median HCV- RNA of 6.1(range:5.1-7.2)Log IU/mL.The sustained virologic response(SVR)rates were 34%(Peg-IFN:1-24 wk,n=61,95%confidence interval(CI): 24%-47%)and 55%(Peg-IFN:20-24 wk,n=31,95% CI:38%-71%,P<0.001;vs Peg-IFN:1-19 wk).TheSVR rate when the administration was discontinued early was 13%(Peg-IFN:1-19 wk,n=30,95%CI: 5%-30%),and that when the administration was prolonged was 50%(Peg-IFN:25-48 wk,n=10,95% CI:24%-76%,P<0.05;vs Peg-IFN:1-19 wk).In the patients who received 20-24 wk of Peg-IFN plus RBV,only the higher platelet count(≥130 000/μL) was significantly correlated with the SVR(odds ratio: 11.680,95%CI:2.3064-79.474,P=0.0024).In 45% (14/31)of the patients with a higher platelet count (≥130000/μL)before therapy,the HCV-RNA level decreased to below 3.3 Log IU/mL at the completion of IFN-β,and their SVR rate was 93%(13/14)after 20-24 wk administration of Peg-IFN plus RBV. CONCLUSION:These results suggest the possibilities of shortening the duration of Peg-IFN plus RBV combination therapy by actively reducing HCV-RNA levels using the IFN-βinduction regimen.展开更多
This article presents a case study for the ＂community＂ approach to social work. It is the case of an elderly client whose social adaptation level had multiple problems associated with weakened networks at a higher r...This article presents a case study for the ＂community＂ approach to social work. It is the case of an elderly client whose social adaptation level had multiple problems associated with weakened networks at a higher rate area of seniors in Japan. Specifically, the ＂community＂ approach adopted here was the Refined Short-term Reconstructing Meaningful Life-worlds （RSRM）, which defines ＂community＂ as a circular system of speech acts and meaning construction. This social constructionist approach is shown to improve the client＇s adaptation level in the ＂community＂ where a differentiation force is activated using circular questions. This force allows the client to make beneficial life-worlds. The RSRM also has a concrete intervention procedure. First, the client, who was in her eighties with depression, delusional disorder, slight dementia, and urination neurosis, was encouraged to tell her problematic story. To differentiate speech acts in her ＂community＂, circular questions, positive reframing and solution-focused skills were used. Then she was encouraged to practice her newly acquired speech acts in her ＂community＂. She regained the ability to communicate with other persons with confidence, and she could extend the ＂community＂ networks to practice her newly acquired communication skills. Through her practices in her extended ＂community＂, her multivariate problems were resolved.展开更多
With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated f...With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated for mental health. The main and first symptom of this disorder is the loss of memory; hence, understanding the hippocampal formation is the key to tackling dementia. In 2007, a milestone book titled "Hippocampus Book" was published. One of the authors/editors is the 2014 Nobel Laureate in Physiology and Medicine, Professor John O'Keefe. It is a MUST-READ encyclopedia about the hippocampal formation, for those who wish to commit themselves to helping the patients with dementia. The formation consists of the hippocampus,entorhinal cortex, subiculum, presubiculum, parasubiculum, and dentate gyrus. The hippocampus is further divided into CA1, CA2, and CA3. The entorhinal cortex is the gateway of receiving all sensory information from the neocortex, while the subiculum is the exit for the efferent projections to the neocortex. Memory is divided into short-term and long-term memory. The former does not require protein synthesis while the latter does. The electrophysiological activities of creating these memories are short-term potentiation and long-term potentiation respectively. In most cases, the entorhinal cortex is the first structure to be damaged, and even short-term memory cannot be created. However, all except spatial memory are stored in the neocortex. Damage to the hippocampal formation would not affect the storage and retrieval of memories. Hence, past memories may remain intact in the early phases of the disorder. This devastating progressive disease has no cure. However, the highly plastic hippocampal formation may offer us some hope. It is the responsibility of the pharmaceutical industries to develop new drugs. Clinicians should add their efforts to the endeavor. The author would suggest that they explore insulin-like growth factors,brain stimulation, cell transplantation, and animal-assisted therapy to find some innovative solutions to help patients with dementia. As the current status of neuroscience stands, the animal-assisted therapy seems to stand out among all methods. It alleviates symptoms and stabilizes the ailment.展开更多
文摘The present study aims to examine the effectiveness of the combination of solution-focused therapy and narrative therapy in marital adjustment of incompatible women. This research is a pretest-posttest quasi-experimental study design with a nonequivalent control group. The statistical population comprises all the incompatible women who referred to the counseling clinics of Neyshabour in May 2016 (1500 admission per month). The research sample consists of 24 incompatible women who were selected through Randomand available sampling method. For data collection, Marital Adjustment Scale by Spinner was applied. The data were analyzed using the analysis of covariance test and with the aid of SPSS-22 software. The findings demonstrated that the combination of solution-focused therapy and narrative therapy is significantly effective in marital adjustment of incompatible women (P < 0.05). Thus, it can be stated that the combination of solution-focused therapy and narrative therapy can help to promote adjustment among incompatible women.
文摘A number of prominent solution-focused brief therapists have expressed the view that, to its detriment, this school of therapy tends to downplay emotion. Accordingly, we contend that, given that emotion is a primal binding force, the bonding component of the crucially important therapeutic alliance risks being compromised in the current practice of this approach. We further argue that the prioritization of the depiction of actions that accompany the emotion expressed by the client over the actual participation in this emotion by the therapist tends to superficialize therapeutic communication. This is especially likely to happen when the therapist lapses into a formulaic, action-soliciting interrogatory mode in response to the emotion expressed by the client. In addition, we claim that the incorporation of emotion- and body-based approaches into the solution-focused canon could remedy the affective lacuna referred to above. We note, however, that such a modification would most likely face stiff resistance from some of the gatekeepers of solution-faced therapy, in particular those who subscribe to the “surface-only” descriptive approach advocated by the philosopher Ludwig Wittgenstein. And yet, the effectiveness of depth-oriented therapies, such as sensorimotor psychotherapy and somatic experiencing, is supported by neurophysiological considerations. Finally, we suggest that these therapies, and even creativogenic elements of psychoanalysis, can actually synergize solution-focused brief therapy through the generation of affect-laden images, sensations and thoughts that lend themselves to the realization of outcomes desired by the client, which is the raison d’etre of solution-focused brief therapy. This paper pleads for the incorporation of the above-noted depth approaches into solution-focused brief therapy with a view to augmenting its effectiveness through a stronger therapeutic bond owing to an increased emotional engagement on the part of the therapist.
文摘BACKGROUND Improving mental health is crucial for patients who require wound treatment.AIM To analyze the effects of solution-focused brief therapy(SFBT)combined with vacuum sealing drainage on the psychological health of patients undergoing wound treatment,providing a basis for selecting wound treatment protocols.METHODS A total of 102 patients undergoing wound treatment were included,with the study period from March 2020 to March 2024.Sex was not a factor,and patients were randomly assigned to two groups of 51 cases each.The control group received negative pressure wound therapy(NPWT),while the experimental group received NPWT plus SFBT.The recovery of wounds,granulation tissue scores,and psychological health levels were compared between the two groups.Statistical analysis was conducted using SPSS Windows software version 26.0 and GraphPad Prism 8.0.RESULTS Post-treatment,the levels of high-sensitivity C-reactive protein,white blood cell count,and lactate dehydrogenase in the experimental group were significantly lower than those in the control group(P<0.05).The two groups had no significant difference in granulation tissue scores(P<0.05).The psychological health level in the experimental group was significantly higher than in the control group(P<0.05).CONCLUSION The combination of SFBT and NPWT accelerates wound healing,promotes granulation tissue growth,and improves psychological well-being,making it a valuable approach for clinical application.
基金(No. 2008C33053) supported by the Science and Technology Program of Zhejiang Province,China
文摘Objective:The aim of our study was to perform a systematic review and meta-analysis of the efficacy of short-term protocols for Helicobacter pylori eradication and to review the safety and adverse profiles of these eradication protocols.Methods:Literatures were located through electronic searches by PubMed,Medline,ISI Web of Knowledge,and Cochrane Library using the relevant terms.Abstracts of important meetings were searched manually in some journal supplements.Additional bibliographies were identified from the reference lists of identified studies.Three independent reviewers systemically identified randomized controlled trials(RCTs) comparing short-duration protocols vs.7-d proton pump inhibitor(PPI)-based triple protocols,as well as studies reporting eradication rates of short-duration protocols for H.pylori.Summary effect size was calculated as relative risk(RR) and 95% confidence intervals(CI) using Review Manager 4.2,and P<0.05 was defined as statistically significant in all analyses.Results:Among 90 abstracts retrieved,15 studies were analyzed,including a total of 30 treatment regimens with 1856 subjects.Mean intention-to-treat(ITT) cure rates of 63.2% and 81.3% were achieved with short-term protocols and 7-d PPI-containing protocols,respectively.Per-protocol(PP)-based overall cure rates were 66.6% and 86.1%,respectively.Short-term therapy was inferior to 7-d triple regimen(P<0.00001).After sub-analysis,however,comparing the effects of ≥3-d protocols and 7-d triple protocols,the cumulative ITT RR was 0.95(P=0.26),and PP RR was 0.95(P=0.10),without significant heterogeneity.Moreover,slightly fewer adverse-effects were found in short-term protocols.Conclusions:Although more economical,short-duration protocols are inferior to 7-d PPI-based triple protocols with regarding to eradication rate of H.pylori.Protocols of more than 3 d,however,may be equivalent to 7-d protocols.
文摘Objective: to evaluate the short-term effect of emergency interventional therapy in patients with acute myocardial infarction. Methods: a total of 140 patients with acute myocardial infarction admitted to our hospital from January 2017 to January 2019 were selected as the research object. They were divided into the observation group and the control group according to the different treatment methods. The patients in the observation group were treated with emergency PCI intervention, while the patients in the control group were treated with conventional thrombolytic therapy, and were compared. Results: the study found that the success rate of the patients in the observation group after PCI operation was significantly higher than that in the control group, and the occurrence rate of death was significantly lower than that in the control group. The incidence of complications in the observation group was lower than that in the control group in terms of sudden death, heart failure and myocardial infarction recurrence. At the same time, through the comparison of the postoperative reexamination data of the two groups of patients, it was found that the postoperative physical recovery status of the patients in the observation group was significantly better than that of the patients in the control group, and the above-mentioned comparative data were statistically significant (P < 0.05). Conclusion: the implementation of emergency PCI operation for patients with acute myocardial infarction has obvious short-term effect and high survival rate. It not only effectively reduces the occurrence rate of complications, but also significantly improves the impaired cardiac function of patients and accelerates the recovery of patients' health, which is worthy of promotion.
文摘For a patient suffering from non-metastatic prostate cancer,the individualized recommendation of radiotherapy has to be the fruit of a multidisciplinary approach in the context of a Tumor Board,to be explained carefully to the patient to obtain his informed consent.External beam radiotherapy is now delivered by intensity modulated radiotherapy,considered as the gold standard.From a radiotherapy perspective,low-risk localized prostate cancer is treated by image guided intensity modulated radiotherapy,or brachytherapy if patients meet the required eligibility criteria.Intermediate-risk patients may benefit from intensity modulated radiotherapy combined with 4e6 months of androgen deprivation therapy;intensity modulated radiotherapy alone or combined with brachytherapy can be offered to patients unsuitable for androgen deprivation therapy due to co-morbidities or unwilling to accept it to preserve their sexual health.High-risk prostate cancer,i.e.high-risk localized and locally advanced prostate cancer,requires intensity modulated radiotherapy with long-term(≥2 years)androgen deprivation therapy with luteinizing hormone releasing hormone agonists.Post-operative irradiation,either immediate or early deferred,is proposed to patients classified as pT3pN0,based on surgical margins,prostate-specific antigen values and quality of life.Whatever the techniques and their degree of sophistication,quality assurance plays a major role in the management of radiotherapy,requiring the involvement of physicians,physicists,dosimetrists,radiation technologists and computer scientists.The patients must be informed about the potential morbidity of radiotherapy and androgen deprivation therapy and followed regularly during and after treatment for tertiary prevention and evaluation.A close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.
基金Supported by the grant from China Medical University Hospital,Taichung, Taiwan, China
文摘AIM: To investigate the long-term role of a 3-d rabeprazole-based triple therapy in patients with Helicobacter pylori (H pylori)-infected active peptic ulcers. METHODS: We prospectively studied 115 consecutive patients with H pylori-infected active peptic ulcers. H pylori infection was confirmed if any two of H pylori DNA, histology, and rapid urease test were positive. Patients were assigned to either an open-labeled 3-d course of oral amoxicillin 1 000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d., or 7-d course of oral amoxicillin 1 000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d. Subsequently, all patients received oral rabeprazole 20 mg once daily until the 8th wk. Three months after therapy, all patients were followed-up endoscopically for the peptic ulcer, H pylori DNA, histology, and rapid urease test. One year after therapy, H pylori infection was tested using the 13C-urea breath test. RESULTS: The ulcer healing rates 3 mo after therapy were 81.0% vs 75.4% for the 3-d and 7-d groups [intention-to-treat (ITT) analysis, P=0.47] respectively, and 90.4% vs 89.6% for the 3-d and 7-d groups [per-protocol (PP) analysis, P=0.89] respectively. The eradication rates 3 mo after therapy were 75.9% vs 73.7% for the 3-d and 7-d groups (ITT, P=0.79) respectively, and 84.6% vs 87.5% for the 3-d and 7-d groups (PP, P=0.68) respectively. One year after therapy, seventy-five patients returned to receive the 13C-urea breath test, and the eradication rates were 78.4% vs 81.6% in 3-d and 7-d groups (PP, P=0.73) respectively. CONCLUSION: Our study showed the eradication rates against H pylori infection 3 and 12 mo after triple therapy were not different between the 3-d and 7-d rabeprazole-based groups. Therefore, the 3-d rabeprazole-based triple therapy may be an alternative treatment for peptic ulcers with H pylori infection.
文摘Photodynamic therapy(PDT)is a new minimally invasive technique for the treatment of tumors.Compared with traditional treatments such as surgery,radiotherapy and chemotherapy,PDT has the advantages of targeted killing of primary and recurrent tumor cells,less damage to surrounding normal tissue,less complications and high repetition rate.The purpose of this study was to investigate the short-term efficacy and adverse reactions of photodynamic therapy in advanced elderly patients with esophageal-gastric junction adenocarcinoma without surgical indications.A patient with advanced adenocarcinoma of esophagus and fundus was treated with photodynamic therapy under gastroscope.Intravenous drip of Cipofen(hematoporphyrin injection 150mg/0.9%saline 250ml)for 1 hour to keep the patient away from light.48 hours after administration,photodynamic therapy was performed with"Leimai"PDT630-A photodynamic therapy apparatus,3cm columnar optical fiber,laser treatment wavelength of 630nm,transmission efficiency of 0.70,output power of 1.4W,irradiation at the lower segment of the esophagus and cardia for 150s.The curative effect was evaluated by comparing gastroscopy before and after photodynamic therapy.Before treatment,there were proliferative lesions in the lower part of esophagus and cardia,erosion and necrosis on the surface,stricture of esophageal cavity,huge ulcer near gastric fundus,filthy moss and dam-like hyperplasia and eminence of surrounding mucosa.After treatment,the local mucosa at the entrance of cardia became white and there was no bleeding.Within four days after treatment,the symptoms of nausea and vomiting disappeared;the adverse reaction of retrosternal discomfort began to occur on the second day after operation,and the adverse reaction was not improved after photodynamic therapy.Photodynamic therapy has a significant short-term effect on advanced elderly patients with adenocarcinoma of the esophagogastric junction,which can significantly alleviate the clinical symptoms and relieve the pain of the patients.However,the adverse reactions can not be ignored.Therefore,photodynamic targeting therapy for tumor needs to be futher studied.It is believed that with the continuous development of high-performance photosensitizers and new generation lasers,and the continuous progress of endoscopy and image guidance technology,photodynamic therapy will become an important adjuvant or palliative treatment for tumor prevention and treatment.
基金supported by grants from the Science&Technology Key Program of Zhejiang China(2017C03051)the National Science&Technology Major Project of China(2017ZX10203201)。
文摘Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.
文摘AIM:To investigate the possibility of shortening the duration of peginterferon(Peg-IFN)plus ribavirin(RBV) combination therapy by incorporating interferon-β (IFN-β)induction therapy. METHODS:A one treatment arm,cohort prospective study was conducted on seventy one patients.The patients were Japanese adults with genotype 1b chronic hepatitis C,HCV-RNA levels of≥5.0 Log IU/mL or 100 KIU/mL,and platelet counts of≥90 000/μL.The treatment regimen consisted of a 2 wk course of twicedaily administration of IFN-βfollowed by 24 wk PegIFN plus RBV combination therapy.We prolonged the duration of the Peg-IFN plus RBV therapy to 48 wk if the patient requested it. RESULTS:The patients,including 44%males,were characterized by an median age of 63 years(range: 32-78 years),an median platelet count of 13.9(range: 9.1-30.6)×10 4 /μL,62%IFN-na?ve,and median HCV- RNA of 6.1(range:5.1-7.2)Log IU/mL.The sustained virologic response(SVR)rates were 34%(Peg-IFN:1-24 wk,n=61,95%confidence interval(CI): 24%-47%)and 55%(Peg-IFN:20-24 wk,n=31,95% CI:38%-71%,P<0.001;vs Peg-IFN:1-19 wk).TheSVR rate when the administration was discontinued early was 13%(Peg-IFN:1-19 wk,n=30,95%CI: 5%-30%),and that when the administration was prolonged was 50%(Peg-IFN:25-48 wk,n=10,95% CI:24%-76%,P<0.05;vs Peg-IFN:1-19 wk).In the patients who received 20-24 wk of Peg-IFN plus RBV,only the higher platelet count(≥130 000/μL) was significantly correlated with the SVR(odds ratio: 11.680,95%CI:2.3064-79.474,P=0.0024).In 45% (14/31)of the patients with a higher platelet count (≥130000/μL)before therapy,the HCV-RNA level decreased to below 3.3 Log IU/mL at the completion of IFN-β,and their SVR rate was 93%(13/14)after 20-24 wk administration of Peg-IFN plus RBV. CONCLUSION:These results suggest the possibilities of shortening the duration of Peg-IFN plus RBV combination therapy by actively reducing HCV-RNA levels using the IFN-βinduction regimen.
文摘This article presents a case study for the ＂community＂ approach to social work. It is the case of an elderly client whose social adaptation level had multiple problems associated with weakened networks at a higher rate area of seniors in Japan. Specifically, the ＂community＂ approach adopted here was the Refined Short-term Reconstructing Meaningful Life-worlds （RSRM）, which defines ＂community＂ as a circular system of speech acts and meaning construction. This social constructionist approach is shown to improve the client＇s adaptation level in the ＂community＂ where a differentiation force is activated using circular questions. This force allows the client to make beneficial life-worlds. The RSRM also has a concrete intervention procedure. First, the client, who was in her eighties with depression, delusional disorder, slight dementia, and urination neurosis, was encouraged to tell her problematic story. To differentiate speech acts in her ＂community＂, circular questions, positive reframing and solution-focused skills were used. Then she was encouraged to practice her newly acquired speech acts in her ＂community＂. She regained the ability to communicate with other persons with confidence, and she could extend the ＂community＂ networks to practice her newly acquired communication skills. Through her practices in her extended ＂community＂, her multivariate problems were resolved.
文摘With the fast-growing aging population, dementia has become a health priority.However, in the past, medicine was largely dealing with physical disorders, and not enough knowledge and experience have been accumulated for mental health. The main and first symptom of this disorder is the loss of memory; hence, understanding the hippocampal formation is the key to tackling dementia. In 2007, a milestone book titled "Hippocampus Book" was published. One of the authors/editors is the 2014 Nobel Laureate in Physiology and Medicine, Professor John O'Keefe. It is a MUST-READ encyclopedia about the hippocampal formation, for those who wish to commit themselves to helping the patients with dementia. The formation consists of the hippocampus,entorhinal cortex, subiculum, presubiculum, parasubiculum, and dentate gyrus. The hippocampus is further divided into CA1, CA2, and CA3. The entorhinal cortex is the gateway of receiving all sensory information from the neocortex, while the subiculum is the exit for the efferent projections to the neocortex. Memory is divided into short-term and long-term memory. The former does not require protein synthesis while the latter does. The electrophysiological activities of creating these memories are short-term potentiation and long-term potentiation respectively. In most cases, the entorhinal cortex is the first structure to be damaged, and even short-term memory cannot be created. However, all except spatial memory are stored in the neocortex. Damage to the hippocampal formation would not affect the storage and retrieval of memories. Hence, past memories may remain intact in the early phases of the disorder. This devastating progressive disease has no cure. However, the highly plastic hippocampal formation may offer us some hope. It is the responsibility of the pharmaceutical industries to develop new drugs. Clinicians should add their efforts to the endeavor. The author would suggest that they explore insulin-like growth factors,brain stimulation, cell transplantation, and animal-assisted therapy to find some innovative solutions to help patients with dementia. As the current status of neuroscience stands, the animal-assisted therapy seems to stand out among all methods. It alleviates symptoms and stabilizes the ailment.
