This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initiall...This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.展开更多
The global prevalence of metabolic-associated fatty liver disease(MAFLD)is on the rise,seriously threatening human health.Currently,no specific approved drugs are available for its treatment.This paper reviews the pat...The global prevalence of metabolic-associated fatty liver disease(MAFLD)is on the rise,seriously threatening human health.Currently,no specific approved drugs are available for its treatment.This paper reviews the pathogenesis of MAFLD,covering aspects like lipid accumulation and insulin resistance,oxidative stress,endoplasmic reticulum stress(ERS),lipotoxicity-induced hepatocyte damage,and fibrosis.It also elaborates on multiple treatment approaches for MAFLD,including metabolic regulation,improvement of the gut-liver axis interaction,modulation of immune and inflammatory pathways,enhancement of the adipose tissue-liver interaction,alleviation of fibrosis,prevention of hepatocyte injury,and traditional Chinese medicine(TCM)external therapies.Additionally,natural product research advancements,individual Chinese medicine components,and mixed herbal formulas for MAFLD treatment is provided.Many natural products and traditional Chinese medicines exhibit favorable effects in regulating lipid metabolism,anti-inflammation,and anti-oxidation,offering new directions and potential drug options for MAFLD treatment.This is expected to provide a reference for future clinical treatment and drug development.展开更多
Adult hippocampal neurogenesis is linked to memory formation in the adult brain,with new neurons in the hippocampus exhibiting greater plasticity during their immature stages compared to mature neurons.Abnormal adult ...Adult hippocampal neurogenesis is linked to memory formation in the adult brain,with new neurons in the hippocampus exhibiting greater plasticity during their immature stages compared to mature neurons.Abnormal adult hippocampal neurogenesis is closely associated with cognitive impairment in central nervous system diseases.Targeting and regulating adult hippocampal neurogenesis have been shown to improve cognitive deficits.This review aims to expand the current understanding and prospects of targeting neurogenesis in the treatment of cognitive impairment.Recent research indicates the presence of abnormalities in AHN in several diseases associated with cognitive impairment,including cerebrovascular diseases,Alzheimer's disease,aging-related conditions,and issues related to anesthesia and surgery.The role of these abnormalities in the cognitive deficits caused by these diseases has been widely recognized,and targeting AHN is considered a promising approach for treating cognitive impairment.However,the underlying mechanisms of this role are not yet fully understood,and the effectiveness of targeting abnormal adult hippocampal neurogenesis for treatment remains limited,with a need for further development of treatment methods and detection techniques.By reviewing recent studies,we classify the potential mechanisms of adult hippocampal neurogenesis abnormalities into four categories:immunity,energy metabolism,aging,and pathological states.In immunity-related mechanisms,abnormalities in meningeal,brain,and peripheral immunity can disrupt normal adult hippocampal neurogenesis.Lipid metabolism and mitochondrial function disorders are significant energy metabolism factors that lead to abnormal adult hippocampal neurogenesis.During aging,the inflammatory state of the neurogenic niche and the expression of aging-related microRNAs contribute to reduced adult hippocampal neurogenesis and cognitive impairment in older adult patients.Pathological states of the body and emotional disorders may also result in abnormal adult hippocampal neurogenesis.Among the current strategies used to enhance this form of neurogenesis,physical therapies such as exercise,transcutaneous electrical nerve stimulation,and enriched environments have proven effective.Dietary interventions,including energy intake restriction and nutrient optimization,have shown efficacy in both basic research and clinical trials.However,drug treatments,such as antidepressants and stem cell therapy,are primarily reported in basic research,with limited clinical application.The relationship between abnormal adult hippocampal neurogenesis and cognitive impairment has garnered widespread attention,and targeting the former may be an important strategy for treating the latter.However,the mechanisms underlying abnormal adult hippocampal neurogenesis remain unclear,and treatments are lacking.This highlights the need for greater focus on translating research findings into clinical practice.展开更多
Mitophagy is closely associated with the pathogenesis of secondary spinal cord injury.Abnormal mitophagy may contribute significantly to secondary spinal cord injury,leading to the impaired production of adenosine tri...Mitophagy is closely associated with the pathogenesis of secondary spinal cord injury.Abnormal mitophagy may contribute significantly to secondary spinal cord injury,leading to the impaired production of adenosine triphosphate,ion imbalance,the excessive production of reactive oxygen species,neuroinflammation,and neuronal cell death.Therefore,maintaining an appropriate balance of mitophagy is crucial when treating spinal cord injury,as both excessive and insufficient mitophagy can impede recovery.In this review,we summarize the pathological changes associated with spinal cord injury,the mechanisms of mitophagy,and the direct and indirect relationships between mitophagy and spinal cord injury.We also consider therapeutic approaches that target mitophagy for the treatment of spinal cord injury,including ongoing clinical trials and other innovative therapies,such as use of stem cells,nanomaterials,and small molecule polymers.Finally,we highlight the current challenges facing this field and suggest potential directions for future research.The aim of our review is to provide a theoretical reference for future studies targeting mitophagy in the treatment of spinal cord injury.展开更多
Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating ga...Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating gastric ulcers.Traditional formulations are less effective due to their limited water solubility and bioavailability.Methods:The study used solubility tests,pseudo-ternary phase diagrams,and central composite design(CCD)to optimize.The formulation was optimized by varying the oil concentration(10–40%)and surfactant/cosurfactant ratio(0.33–3.00),and then tested for droplet size,drug content,emulsification,phase stability,and in vitro dissolution.Results:The study found that the optimized formulation contained 14%Capmul PG 8NF oil,62%Labrasol surfactant,and 24%Tween 80 cosurfactant.This combination generated an average droplet size of 111.02 nm and improved drug release properties.Furthermore,the formulation was stable without phase separation,with a drug content of 88.2–99.8%.Conclusion:SMEDDS significantly improves lafutidine delivery by increasing solubility and absorption,thereby overcoming oral administration challenges.The system quickly formed small droplets in water and released the drug in 15 min.Enhancing lafutidine’s bioavailability may improve its efficacy in treating gastric ulcers,resulting in better patient outcomes and potentially lower dosing frequency.展开更多
Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory v...Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory versus degenerative dichotomy.This was based on a broad misconception regarding essentially all neurodegenerative conditions,depicting the degenerative process as passive and immune-independent occurring as a late byproduct of active inflammation in the central nervous system(CNS),which is(solely)systemically driven.展开更多
Professor GAO Yu-chun＇s experience in treatment of stroke was systematically summarized in this study.Regulating governor vessel and unblocking brain was used to balance yin and yang and regulate vital activity,and n...Professor GAO Yu-chun＇s experience in treatment of stroke was systematically summarized in this study.Regulating governor vessel and unblocking brain was used to balance yin and yang and regulate vital activity,and nourishing water to moisten wood was used to restore essence,which were adopted as guiding principles.Qi and blood was observed carefully,acupoint property was known well,and time,acupoints and fomula were selected based on pattern differentiation.Opposing needling and contralateral collateral needling were combined,and needling was used to control the spirit and regulate qi,so as to flatly regulate qi-blood and yin-yang.At the same time,spleen and stomach functions were reinforced and protected.It was emphasized to regulate the mind and body simultaneously for stroke patients,which indicated professor GAO＇s academic ideas and clinical experience of careful observation of qi and blood,flat regulation of yin and yang,and treating disease according to its origin.展开更多
The diagnosis and treatment of hemospermia presents significant difficulty, especially if it persists or recurs. In this retrospective study, we assessed whether transurethral seminal vesiculoscopy is feasible and eff...The diagnosis and treatment of hemospermia presents significant difficulty, especially if it persists or recurs. In this retrospective study, we assessed whether transurethral seminal vesiculoscopy is feasible and effective in the diagnosis and treatment of hemospermia. To address this complex condition, we report our experience in a population of patients treated with transurethral seminal vesiculoscopy. From February 2006 to July 2008, 72 hemospermic patients underwent transurethral seminal vesiculoscopy examination and treatment at our urology center. Transurethral seminal vesiculoscopy was performed by a 7-F or 8-F rigid ureteroscope. The endoscopic procedure was conducted through the normal anatomic route of the seminal tracts. In this series, the mean follow-up period was 21.7 months. Definite diagnosis was made for 93.1% patients, and 94.4% patients were cured or showed a decrease in their symptoms. Postoperative complications were not observed in the study. Our study proves that transurethral seminal vesiculoscopy is effective in the diagnosis and treatment of hemospermia with minimal complication.展开更多
BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectom...BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC. METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5: 1). RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients. CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.展开更多
BACKGROUND： Autoimmune pancreatitis （ALP） is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China...BACKGROUND： Autoimmune pancreatitis （ALP） is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China. METHODS： One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients. RESULTS： The median age of the patients at onset was 57 years （range 23-82） with a male to female ratio of 8.1：1. The common manifestations of the patients included obstructive jaundice （49 patients, 49.0%）, abdominal pain （30, 30.0%）, and acute pancreatitis （11, 11.0%）. Biliary involvement was one of the most extrapancreatic manifestations （64, 64.0%）. Fifty-six （56.0%） and 43 （43.0%） patients were classified into focal- type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% （43/62） and 92.0% （69/75） patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked （〉10 ceUs/HPF） IgG4 positive cells were found in 20 （74.1%） patients.Steroid treatment and surgery as the main initial treatments were given to 41 （41.0%） and 28 （28.0%） patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%. CONCLUSIONS： Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.展开更多
AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestina...AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestinal bleeding(UGIB, LGIB).METHODS A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016(n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTS Primary hemostasis and clinical success of bleeding lesions(without rebleeding) was achieved in 88/100(88%) and 78/100(78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET(4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET(OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7(35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSION Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.展开更多
OBJECTIVE:To study and analyze the etiology and pathogenesis,diagnosis and prescription for cases of diabetic nephropathy(DN) treated by Professor Zhongying Zhou(Prof.Zhou) with the help of dada mining technique,so as...OBJECTIVE:To study and analyze the etiology and pathogenesis,diagnosis and prescription for cases of diabetic nephropathy(DN) treated by Professor Zhongying Zhou(Prof.Zhou) with the help of dada mining technique,so as to inherit his clinical experience and academic thoughts.METHODS:After pretreatment of the medical record information,statistical software SPSS 13.0 was used to analyze and process the standardized data using the descriptive analysis,cluster analysis and association rules.RESULTS:Ninety-four entries derived from Traditional Chinese Medicine(TCM) four-diagnostic information were selected.Through data mining,the highest frequency was yellow-thin-greasy tongue coating,followed by dark tongue,and then by thready-slippery pulse.The main self-conscious symptoms were limb numbness,dry mouth,frequent micturition,etc.With respect to pathogenesis,the etiology related to kidney reached 73.46%.The frequency of pathological factors for deficiency,blood stasis,heat,dampness,phlegm and dryness were 137.65%,80.25%,78.40%,48.77%,21.60%,and 14.20% respectively.A total of 236 kinds of herbs were used 2913 person times,averaging 17.98 herbs per prescription.CONCLUSION:The pathological location of DN is in the kidney.The pathogenesis of the disease is deficiency in origin and excess in superficiality,the former of which include deficiency of the liver and kidney,and deficiency of both Qi and Yin.The main pathological factors are blood stasis,heat,dampness,phlegm,and dryness;and they act upon each other to form the complex pathogenesis in terms of blood stasis-heat,dampness-heat,phlegm-heat,and dryness-heat.All the above factors are always crucial in the aggravation of DN throughout the whole course of its pathological evolution.展开更多
AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retros...AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.展开更多
Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian diffe...Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian differentiation. She believes that the differentiation of lesion is core and the early judgment is critical for the better therapeutic effects on intractable facial paralysis. The local acupoints are selected in the guide of the theory of meridian sinew and stimulated on the base of three-needling theory. The distal acupoints are decided in light of the syndrome differentiation, of which, Hégǔ(合谷 LI 4), Zúsānlǐ(足三里ST 36) and Taichōng(太冲 LR 3) are the basic acupoints. Additionally, Professor ZHAO lays the emphasis on the 5 th branch of facial nerve(cervical branch) in diagnosis and treatment.展开更多
AIM: To review evidence supporting pharmacological treatments for treatment-resistant depression(TRD) and to discuss them according to personal clinical experience.METHODS: Original studies, clinical trials, systemati...AIM: To review evidence supporting pharmacological treatments for treatment-resistant depression(TRD) and to discuss them according to personal clinical experience.METHODS: Original studies, clinical trials, systematic reviews, and meta-analyses addressing pharmacological treatment for TRD in adult patients published from 1990 to 2013 were identified by data base queries(Pub Med, Google Scholar e Quertle Searches) using terms: "treatment resistant depression", "treatment refractory depression", "partial response depression", "non responder depression", "optimization strategy", "switching strategy", "combination strategy", "augmentation strategy", selective serotonin reuptake inhibitors antidepressants(SSRI), tricyclic antidepressants(TCA), serotonin norepinephrine reuptake inhibitors antidepressants, mirtazapine, mianserine, bupropione, monoamine oxidase inhibitor antidepressant(MAOI), lithium, thyroid hormones, second generation antipsychotics(SGA), dopamine agonists, lamotrigine, psychostimulants, dextromethorphan, dextrorphan, ketamine, omega-3 fatty acids, S-adenosil-L-metionine, methylfolat, pindolol, sex steroids, glucocorticoid agents. Other citations of interest were further identified from references reported in the accessed articles. Selected publications were grouped by treatment strategy:(1) switching from an ineffective antidepressant(AD) to a new AD from a similar or different class;(2) combining the current AD regimen with a second AD from a different class; and(3) augmenting the current AD regimen with a second agent not thought to be an antidepressant itself.RESULTS: Switching from a TCA to another TCA provides only a modest advantage(response rate 9%-27%), while switching from a SSRI to another SSRI is more advantageous(response rate up to 75%). Evidence supports the usefulness of switching from SSRI to venlafaxine(5 positive trials out 6), TCA(2 positive trials out 3), and MAOI(2 positive trials out 2) but not from SSRI to bupropione, duloxetine and mirtazapine. Three reviews demonstrated that the benefits of intraand cross-class switch do not significantly differ. Data on combination strategy are controversial regarding TCA-SSRI combination(positive results in old studies, negative in more recent study) and bupropion-SSRI combination(three open series studies but not three controlled trails support the useful of this combination) and positive regard mirtazapine(or its analogue mianserine) combination with ADs of different classes. As regards the augmentation strategy, available evidences supported the efficacy of TCA augmentation with lithium salts and thyroid hormone(T3), but are conflicting regard the SSRI augmentation with these two drugs(1 positive trial out of 4 for lithium and 3 out of 5 for thyroid hormone). Double-blind controlled studies showed the efficacy of AD augmentation with aripiprazole(5 positive trials out 5), quetiapine(3 positive trials out 3) and, at less extent, of fluoxetine augmentation with olanzapine(3 positive trials out 6), so these drugs received the FDA indication for the acute treatment of TRD. Results on AD augmentation with risperidone are conflicting(2 short term positive trials, 1 short-term and 1 long-term negative trials). Case series and open-label trials showed that AD augmentation with pramipexole or ropinirole, two dopamine agonists, could be an effective treatment for TRD(response rate to pramipexole 48%-74%, to ropinirole 40%-44%) although one recent double-blind placebo-controlled study does not support the superiority of pramipexole over placebo. Evidences do not justify the use of psychostimulants, omega-3 fatty acids, S-adenosil-Lmetionine, methylfolate, pindolol, lamotrigine, and sex hormone as AD augmentation for TRD. Combining the available evidences with our experience we suggest treating non-responders to one SSRI bupropion or mirtazapine trial by switching to venlafaxine, and nonresponders to one venlafaxine trial by switching to a TCA or, if TCA are not tolerated, combining mirtazapine with SSRI or venlafaxine. In non-responders to two or more ADs(including at least one TCA if tolerated) current AD regimen could be augmented with lithium salts(mainly in patients with bipolar depression or suicidality), SGAs(mostly aripiprazole) or DA-agonists(mostly pramipexole). In patients with severe TRD, i.e., non-responders to combination and augmentation strategies as well as to electroconvulsive therapy if workable, we suggest to try a combination plus augmentation strategy.CONCLUSION: Our study identifies alternative effective treatment strategies for TRD. Further studies are needed to compare the efficacy of different strategies in more homogeneous subpopulations.展开更多
Yan Si Xue(咽四穴)refer to four points in the throat summarized by Prof.Sheng Canruo in his long-year clinical experience based on the combination of TCM theory and the knowledge of modernmedical anatomy.By taking “Y...Yan Si Xue(咽四穴)refer to four points in the throat summarized by Prof.Sheng Canruo in his long-year clinical experience based on the combination of TCM theory and the knowledge of modernmedical anatomy.By taking “Yan Si Xue” as main points,and other differential adjunct points,Prof.Sheng has obtained satisfactory therapeutic results in treating various throat diseases such ashoarseness,paralysis of vocal cord,dysphonia after radiotherapy on throat tumor,vocal nodules,disorder of the glossopharyngeal nerve,hysteric aphasia,and acute or chronic laryngopharyngitis.展开更多
Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various...Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.展开更多
The professor Wei-hua ZHANG’s experiences in treatment of primary dysmenorrhea with"warmingunblocking needling method"was introduced in this paper.Prof.Zhang believes that obstruction is the crucial in path...The professor Wei-hua ZHANG’s experiences in treatment of primary dysmenorrhea with"warmingunblocking needling method"was introduced in this paper.Prof.Zhang believes that obstruction is the crucial in pathogenesis of primary dysmenorrhea no matter of the excess or the deficiency syndrome.Warming and unblocking principle is the essential in treatment.Hence,an unique therapeutic method is innovated,named warming-unblocking needling method,including three-layer and two-direction warming needling technique at Sanyinjiao(三阴交SP6),two-layer rotating warming-unblocking technique at Zhongji(中极CV3)and one-layer and two-direction warming needling technique at Ciliao(次髎BL32).In this set of needling procedure,acupoint is viewed as a three-dimensional hierarchical structure.A layered and multidirectional needling technique is adopted at main acupoints to enhance the sensations of diqi and to generate heat effect in the local.Additionally,moxibustion is combined to intensify warming and unblocking effect.Simultaneously,the supplementary acupoints are used in response to symptoms.All of the acupoints coordinately warm up the uterus,promote meridian circulation and stop pain.Hence,this therapeutic method achieves relatively excellent effect and deserves to be promoted in practice.展开更多
文摘This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.
基金supported by the National Natural Science Foundation of China(82574477)the Jiangsu Provincial Traditional Chinese Medicine Science and Technology Development Plan(QN202426)+5 种基金Jiangsu Province“333 High-level Talents Training Project”((2024)3-0189)Youth Talent Support Project of the Jiangsu Association for Science and Technology(TJ-2023-053)Shanxi Provincial Department-Municipal Key Laboratory Cultivation Base for Quality Enhancement and Utilization of Shangdang Chinese Medicinal Materials(KF202401)Fundamental Research Program of Shanxi Province(202403021221211)the research project supported by the Shanxi Scholarship Council of China(No.2023-158)Open Project of Key Laboratory of Tibetan Medicine Basic Research,Ministry of Education.
文摘The global prevalence of metabolic-associated fatty liver disease(MAFLD)is on the rise,seriously threatening human health.Currently,no specific approved drugs are available for its treatment.This paper reviews the pathogenesis of MAFLD,covering aspects like lipid accumulation and insulin resistance,oxidative stress,endoplasmic reticulum stress(ERS),lipotoxicity-induced hepatocyte damage,and fibrosis.It also elaborates on multiple treatment approaches for MAFLD,including metabolic regulation,improvement of the gut-liver axis interaction,modulation of immune and inflammatory pathways,enhancement of the adipose tissue-liver interaction,alleviation of fibrosis,prevention of hepatocyte injury,and traditional Chinese medicine(TCM)external therapies.Additionally,natural product research advancements,individual Chinese medicine components,and mixed herbal formulas for MAFLD treatment is provided.Many natural products and traditional Chinese medicines exhibit favorable effects in regulating lipid metabolism,anti-inflammation,and anti-oxidation,offering new directions and potential drug options for MAFLD treatment.This is expected to provide a reference for future clinical treatment and drug development.
基金supported by Technological Innovation 2030-Major Projects of“Brain Science and Brain-like Research,”No.2022ZD0206200(to XG)the National Natural Science Foundation of China,No.82371245(to SJ),82102246(to XD),81701092(to XG)+2 种基金the Natural Science Foundation of Shandong Province,No.ZR2020MH129(to SJ)Shanghai Municipal Key Clinical Specialty,No.shslczdzk03601Shanghai Engineering Research Center of Peri-operative Organ Support and Function Preservation,No.20DZ2254200。
文摘Adult hippocampal neurogenesis is linked to memory formation in the adult brain,with new neurons in the hippocampus exhibiting greater plasticity during their immature stages compared to mature neurons.Abnormal adult hippocampal neurogenesis is closely associated with cognitive impairment in central nervous system diseases.Targeting and regulating adult hippocampal neurogenesis have been shown to improve cognitive deficits.This review aims to expand the current understanding and prospects of targeting neurogenesis in the treatment of cognitive impairment.Recent research indicates the presence of abnormalities in AHN in several diseases associated with cognitive impairment,including cerebrovascular diseases,Alzheimer's disease,aging-related conditions,and issues related to anesthesia and surgery.The role of these abnormalities in the cognitive deficits caused by these diseases has been widely recognized,and targeting AHN is considered a promising approach for treating cognitive impairment.However,the underlying mechanisms of this role are not yet fully understood,and the effectiveness of targeting abnormal adult hippocampal neurogenesis for treatment remains limited,with a need for further development of treatment methods and detection techniques.By reviewing recent studies,we classify the potential mechanisms of adult hippocampal neurogenesis abnormalities into four categories:immunity,energy metabolism,aging,and pathological states.In immunity-related mechanisms,abnormalities in meningeal,brain,and peripheral immunity can disrupt normal adult hippocampal neurogenesis.Lipid metabolism and mitochondrial function disorders are significant energy metabolism factors that lead to abnormal adult hippocampal neurogenesis.During aging,the inflammatory state of the neurogenic niche and the expression of aging-related microRNAs contribute to reduced adult hippocampal neurogenesis and cognitive impairment in older adult patients.Pathological states of the body and emotional disorders may also result in abnormal adult hippocampal neurogenesis.Among the current strategies used to enhance this form of neurogenesis,physical therapies such as exercise,transcutaneous electrical nerve stimulation,and enriched environments have proven effective.Dietary interventions,including energy intake restriction and nutrient optimization,have shown efficacy in both basic research and clinical trials.However,drug treatments,such as antidepressants and stem cell therapy,are primarily reported in basic research,with limited clinical application.The relationship between abnormal adult hippocampal neurogenesis and cognitive impairment has garnered widespread attention,and targeting the former may be an important strategy for treating the latter.However,the mechanisms underlying abnormal adult hippocampal neurogenesis remain unclear,and treatments are lacking.This highlights the need for greater focus on translating research findings into clinical practice.
基金supported by the National Natural Science Foundation of China,Nos.82371389,82071382(to MZ)the Priority Academic Program Development of Jiangsu Higher Education Institutions,PAPD(to MZ)+4 种基金Jiangsu Maternal and Child Health Research Key Project,No.F202013(to HS)Jiangsu 333 High Level Talent Training Project,2022(to HS)Gusu District Health Talent Training Project,No.2024145(to HS)Suzhou BenQ Medical Center Project,No.H220918(to MZ)Undergraduate Training Program for Innovation and Entrepreneurship,Soochow University,No.202410285091Z(to MZ)。
文摘Mitophagy is closely associated with the pathogenesis of secondary spinal cord injury.Abnormal mitophagy may contribute significantly to secondary spinal cord injury,leading to the impaired production of adenosine triphosphate,ion imbalance,the excessive production of reactive oxygen species,neuroinflammation,and neuronal cell death.Therefore,maintaining an appropriate balance of mitophagy is crucial when treating spinal cord injury,as both excessive and insufficient mitophagy can impede recovery.In this review,we summarize the pathological changes associated with spinal cord injury,the mechanisms of mitophagy,and the direct and indirect relationships between mitophagy and spinal cord injury.We also consider therapeutic approaches that target mitophagy for the treatment of spinal cord injury,including ongoing clinical trials and other innovative therapies,such as use of stem cells,nanomaterials,and small molecule polymers.Finally,we highlight the current challenges facing this field and suggest potential directions for future research.The aim of our review is to provide a theoretical reference for future studies targeting mitophagy in the treatment of spinal cord injury.
文摘Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating gastric ulcers.Traditional formulations are less effective due to their limited water solubility and bioavailability.Methods:The study used solubility tests,pseudo-ternary phase diagrams,and central composite design(CCD)to optimize.The formulation was optimized by varying the oil concentration(10–40%)and surfactant/cosurfactant ratio(0.33–3.00),and then tested for droplet size,drug content,emulsification,phase stability,and in vitro dissolution.Results:The study found that the optimized formulation contained 14%Capmul PG 8NF oil,62%Labrasol surfactant,and 24%Tween 80 cosurfactant.This combination generated an average droplet size of 111.02 nm and improved drug release properties.Furthermore,the formulation was stable without phase separation,with a drug content of 88.2–99.8%.Conclusion:SMEDDS significantly improves lafutidine delivery by increasing solubility and absorption,thereby overcoming oral administration challenges.The system quickly formed small droplets in water and released the drug in 15 min.Enhancing lafutidine’s bioavailability may improve its efficacy in treating gastric ulcers,resulting in better patient outcomes and potentially lower dosing frequency.
文摘Active inflammation in“inactive”progressive multiple sclerosis:Traditionally,the distinction between relapsing-remitting multiple sclerosis and progressive multiple sclerosis(PMS)has been framed as an inflammatory versus degenerative dichotomy.This was based on a broad misconception regarding essentially all neurodegenerative conditions,depicting the degenerative process as passive and immune-independent occurring as a late byproduct of active inflammation in the central nervous system(CNS),which is(solely)systemically driven.
基金Supported by Project of Hebei Provincial Science and Technology Department:14277706D2014 project of scientific research on traditional Chinese medicine of Hebei Provincial Administration of Traditional Chinese Medicine:2014038
文摘Professor GAO Yu-chun＇s experience in treatment of stroke was systematically summarized in this study.Regulating governor vessel and unblocking brain was used to balance yin and yang and regulate vital activity,and nourishing water to moisten wood was used to restore essence,which were adopted as guiding principles.Qi and blood was observed carefully,acupoint property was known well,and time,acupoints and fomula were selected based on pattern differentiation.Opposing needling and contralateral collateral needling were combined,and needling was used to control the spirit and regulate qi,so as to flatly regulate qi-blood and yin-yang.At the same time,spleen and stomach functions were reinforced and protected.It was emphasized to regulate the mind and body simultaneously for stroke patients,which indicated professor GAO＇s academic ideas and clinical experience of careful observation of qi and blood,flat regulation of yin and yang,and treating disease according to its origin.
文摘The diagnosis and treatment of hemospermia presents significant difficulty, especially if it persists or recurs. In this retrospective study, we assessed whether transurethral seminal vesiculoscopy is feasible and effective in the diagnosis and treatment of hemospermia. To address this complex condition, we report our experience in a population of patients treated with transurethral seminal vesiculoscopy. From February 2006 to July 2008, 72 hemospermic patients underwent transurethral seminal vesiculoscopy examination and treatment at our urology center. Transurethral seminal vesiculoscopy was performed by a 7-F or 8-F rigid ureteroscope. The endoscopic procedure was conducted through the normal anatomic route of the seminal tracts. In this series, the mean follow-up period was 21.7 months. Definite diagnosis was made for 93.1% patients, and 94.4% patients were cured or showed a decrease in their symptoms. Postoperative complications were not observed in the study. Our study proves that transurethral seminal vesiculoscopy is effective in the diagnosis and treatment of hemospermia with minimal complication.
文摘BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare presentation of chronic cholecystitis, characterized by xanthogranuloma, severe fibrosis and foam cells, and can be a cause of difficulty in cholecystectomy. Patients with XGC are frequently misdiagnosed intraoperatively as having carcinoma of the gallbladder and are treated with extensive excision. This study aimed at providing proper surgical treatment for patients with XGC. METHODS: The clinical data of 33 patients with XGC definitely diagnosed by pathological examination over a period of 10 years were analyzed retrospectively (mean age of onset, 60 years; male/female ratio, 1.5: 1). RESULTS: Preoperatively, the 33 patients were examined by abdominal B-ultrasonography while 20 of them were further examined by computed tomography (CT). Intraoperatively, XGC associated with cholecystolithiasis was found in 97.0% of the patients, thickening of the gallbladder wall in 90.9%, xanthogranulomatous tissue invading into other tissues in 87.9%, XGC associated with choledocholithiasis in 15.2%, and Mirizzi syndrome in 9.1%. In addition, a gallbladder fistula was observed in 4 patients. Open cholecystectomy was performed on 15 patients, partial cholecystectomy on 7, cholecystectomy and partial liver wedge resection on 5, and gallbladder cancer radical correction on 6. The intraoperative misdiagnosis rate was 24.2%. Frozen-section examination was carried out in 9 patients. Postoperative complications were observed in 5 patients. CONCLUSIONS: XGC is difficult to diagnose either preoperatively or intraoperatively and definite diagnosis depends exclusively on pathological examination. Firm adhesions of the gallbladder to neighboring organs and tissues are common and lead to difficulty in surgical treatments. The mode of operation depends on specific conditions in varying cases, and since frozen-section examination plays an important role in determining the nature of the lesions, intraoperative frozen-section examination should be carried out to differentiate XGC from carcinoma of the gallbladder.
基金supported by grants from the National Natural Science Foundation of China (81270541)Disciplinary Joint Research Projects of Changhai Hospital (CH125510312)
文摘BACKGROUND： Autoimmune pancreatitis （ALP） is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China. METHODS： One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients. RESULTS： The median age of the patients at onset was 57 years （range 23-82） with a male to female ratio of 8.1：1. The common manifestations of the patients included obstructive jaundice （49 patients, 49.0%）, abdominal pain （30, 30.0%）, and acute pancreatitis （11, 11.0%）. Biliary involvement was one of the most extrapancreatic manifestations （64, 64.0%）. Fifty-six （56.0%） and 43 （43.0%） patients were classified into focal- type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% （43/62） and 92.0% （69/75） patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked （〉10 ceUs/HPF） IgG4 positive cells were found in 20 （74.1%） patients.Steroid treatment and surgery as the main initial treatments were given to 41 （41.0%） and 28 （28.0%） patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%. CONCLUSIONS： Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.
文摘AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestinal bleeding(UGIB, LGIB).METHODS A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016(n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as < or ≥ 7 and were compared with the original Rockall data. Differences between FLET and SLET were calculated. Univariate and multivariate analysis were performed to evaluate the factors that influenced rebleeding after OTSC placement.RESULTS Primary hemostasis and clinical success of bleeding lesions(without rebleeding) was achieved in 88/100(88%) and 78/100(78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET(4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET(OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores < 7(35% vs 10%, P = 0.034). No significant differences were observed in patients with scores < or ≥ 7 in rebleeding and rebleeding-associated mortality.CONCLUSION Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.
基金Supported by Jiangsu Province College Natural Science Research Project (No. 09KJD360001)Scientific and Technological Innovation and Achievements Transformation Special Projects of Jiangsu Province (BM2009903)
文摘OBJECTIVE:To study and analyze the etiology and pathogenesis,diagnosis and prescription for cases of diabetic nephropathy(DN) treated by Professor Zhongying Zhou(Prof.Zhou) with the help of dada mining technique,so as to inherit his clinical experience and academic thoughts.METHODS:After pretreatment of the medical record information,statistical software SPSS 13.0 was used to analyze and process the standardized data using the descriptive analysis,cluster analysis and association rules.RESULTS:Ninety-four entries derived from Traditional Chinese Medicine(TCM) four-diagnostic information were selected.Through data mining,the highest frequency was yellow-thin-greasy tongue coating,followed by dark tongue,and then by thready-slippery pulse.The main self-conscious symptoms were limb numbness,dry mouth,frequent micturition,etc.With respect to pathogenesis,the etiology related to kidney reached 73.46%.The frequency of pathological factors for deficiency,blood stasis,heat,dampness,phlegm and dryness were 137.65%,80.25%,78.40%,48.77%,21.60%,and 14.20% respectively.A total of 236 kinds of herbs were used 2913 person times,averaging 17.98 herbs per prescription.CONCLUSION:The pathological location of DN is in the kidney.The pathogenesis of the disease is deficiency in origin and excess in superficiality,the former of which include deficiency of the liver and kidney,and deficiency of both Qi and Yin.The main pathological factors are blood stasis,heat,dampness,phlegm,and dryness;and they act upon each other to form the complex pathogenesis in terms of blood stasis-heat,dampness-heat,phlegm-heat,and dryness-heat.All the above factors are always crucial in the aggravation of DN throughout the whole course of its pathological evolution.
文摘AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.
基金Supported by "Double Hundred Project" of Beijing Administration of Traditional Chinese MedicineThe Fund for Beijing Science & Technology Development of TCM:QN2016-13
文摘Professor Jiping ZHAO has unique thoughts on the diagnosis and treatment of peripheral facial paralysis.She pays the great attention to clinical differentiation in treatment with acupuncture, especially meridian differentiation. She believes that the differentiation of lesion is core and the early judgment is critical for the better therapeutic effects on intractable facial paralysis. The local acupoints are selected in the guide of the theory of meridian sinew and stimulated on the base of three-needling theory. The distal acupoints are decided in light of the syndrome differentiation, of which, Hégǔ(合谷 LI 4), Zúsānlǐ(足三里ST 36) and Taichōng(太冲 LR 3) are the basic acupoints. Additionally, Professor ZHAO lays the emphasis on the 5 th branch of facial nerve(cervical branch) in diagnosis and treatment.
文摘AIM: To review evidence supporting pharmacological treatments for treatment-resistant depression(TRD) and to discuss them according to personal clinical experience.METHODS: Original studies, clinical trials, systematic reviews, and meta-analyses addressing pharmacological treatment for TRD in adult patients published from 1990 to 2013 were identified by data base queries(Pub Med, Google Scholar e Quertle Searches) using terms: "treatment resistant depression", "treatment refractory depression", "partial response depression", "non responder depression", "optimization strategy", "switching strategy", "combination strategy", "augmentation strategy", selective serotonin reuptake inhibitors antidepressants(SSRI), tricyclic antidepressants(TCA), serotonin norepinephrine reuptake inhibitors antidepressants, mirtazapine, mianserine, bupropione, monoamine oxidase inhibitor antidepressant(MAOI), lithium, thyroid hormones, second generation antipsychotics(SGA), dopamine agonists, lamotrigine, psychostimulants, dextromethorphan, dextrorphan, ketamine, omega-3 fatty acids, S-adenosil-L-metionine, methylfolat, pindolol, sex steroids, glucocorticoid agents. Other citations of interest were further identified from references reported in the accessed articles. Selected publications were grouped by treatment strategy:(1) switching from an ineffective antidepressant(AD) to a new AD from a similar or different class;(2) combining the current AD regimen with a second AD from a different class; and(3) augmenting the current AD regimen with a second agent not thought to be an antidepressant itself.RESULTS: Switching from a TCA to another TCA provides only a modest advantage(response rate 9%-27%), while switching from a SSRI to another SSRI is more advantageous(response rate up to 75%). Evidence supports the usefulness of switching from SSRI to venlafaxine(5 positive trials out 6), TCA(2 positive trials out 3), and MAOI(2 positive trials out 2) but not from SSRI to bupropione, duloxetine and mirtazapine. Three reviews demonstrated that the benefits of intraand cross-class switch do not significantly differ. Data on combination strategy are controversial regarding TCA-SSRI combination(positive results in old studies, negative in more recent study) and bupropion-SSRI combination(three open series studies but not three controlled trails support the useful of this combination) and positive regard mirtazapine(or its analogue mianserine) combination with ADs of different classes. As regards the augmentation strategy, available evidences supported the efficacy of TCA augmentation with lithium salts and thyroid hormone(T3), but are conflicting regard the SSRI augmentation with these two drugs(1 positive trial out of 4 for lithium and 3 out of 5 for thyroid hormone). Double-blind controlled studies showed the efficacy of AD augmentation with aripiprazole(5 positive trials out 5), quetiapine(3 positive trials out 3) and, at less extent, of fluoxetine augmentation with olanzapine(3 positive trials out 6), so these drugs received the FDA indication for the acute treatment of TRD. Results on AD augmentation with risperidone are conflicting(2 short term positive trials, 1 short-term and 1 long-term negative trials). Case series and open-label trials showed that AD augmentation with pramipexole or ropinirole, two dopamine agonists, could be an effective treatment for TRD(response rate to pramipexole 48%-74%, to ropinirole 40%-44%) although one recent double-blind placebo-controlled study does not support the superiority of pramipexole over placebo. Evidences do not justify the use of psychostimulants, omega-3 fatty acids, S-adenosil-Lmetionine, methylfolate, pindolol, lamotrigine, and sex hormone as AD augmentation for TRD. Combining the available evidences with our experience we suggest treating non-responders to one SSRI bupropion or mirtazapine trial by switching to venlafaxine, and nonresponders to one venlafaxine trial by switching to a TCA or, if TCA are not tolerated, combining mirtazapine with SSRI or venlafaxine. In non-responders to two or more ADs(including at least one TCA if tolerated) current AD regimen could be augmented with lithium salts(mainly in patients with bipolar depression or suicidality), SGAs(mostly aripiprazole) or DA-agonists(mostly pramipexole). In patients with severe TRD, i.e., non-responders to combination and augmentation strategies as well as to electroconvulsive therapy if workable, we suggest to try a combination plus augmentation strategy.CONCLUSION: Our study identifies alternative effective treatment strategies for TRD. Further studies are needed to compare the efficacy of different strategies in more homogeneous subpopulations.
文摘Yan Si Xue(咽四穴)refer to four points in the throat summarized by Prof.Sheng Canruo in his long-year clinical experience based on the combination of TCM theory and the knowledge of modernmedical anatomy.By taking “Yan Si Xue” as main points,and other differential adjunct points,Prof.Sheng has obtained satisfactory therapeutic results in treating various throat diseases such ashoarseness,paralysis of vocal cord,dysphonia after radiotherapy on throat tumor,vocal nodules,disorder of the glossopharyngeal nerve,hysteric aphasia,and acute or chronic laryngopharyngitis.
基金the grants from National S&T Major Project(2017ZX10203205)the Medical Science and Technology Project of Zhejiang Province(2014KYA082)+1 种基金the Fundamental Research Funds for the Central Universities(2018FZA7002)the Shulan Talent Foundation.
文摘Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.
基金Supported by the Second Construction Project of National Physician Master Inheritance Studio:2015,10Shaanxi Provincial Construction Project of Wei-hua Zhang’s Inheritance Studio of Traditional Chinese Medicine(201901-2021.12):2019022Academic School Inheritance Program of Traditional Chinese Medicine Administration Bureau,Shaanxi Province(Shaanxi TCM[2018]No.40-Shaanxi Program of Guo’s Acupuncture Academic School Inheritance Studio)。
文摘The professor Wei-hua ZHANG’s experiences in treatment of primary dysmenorrhea with"warmingunblocking needling method"was introduced in this paper.Prof.Zhang believes that obstruction is the crucial in pathogenesis of primary dysmenorrhea no matter of the excess or the deficiency syndrome.Warming and unblocking principle is the essential in treatment.Hence,an unique therapeutic method is innovated,named warming-unblocking needling method,including three-layer and two-direction warming needling technique at Sanyinjiao(三阴交SP6),two-layer rotating warming-unblocking technique at Zhongji(中极CV3)and one-layer and two-direction warming needling technique at Ciliao(次髎BL32).In this set of needling procedure,acupoint is viewed as a three-dimensional hierarchical structure.A layered and multidirectional needling technique is adopted at main acupoints to enhance the sensations of diqi and to generate heat effect in the local.Additionally,moxibustion is combined to intensify warming and unblocking effect.Simultaneously,the supplementary acupoints are used in response to symptoms.All of the acupoints coordinately warm up the uterus,promote meridian circulation and stop pain.Hence,this therapeutic method achieves relatively excellent effect and deserves to be promoted in practice.
