Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in le...Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.展开更多
Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibi...Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.展开更多
Objective:To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:This was a multi...Objective:To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:This was a multicenter randomized double-blinded placebo controlled study that took place in 7 provinces of China that enrolled 244 patients(aged 18e80 years)who had acute exacerbation of COPD with the traditional Chinese syndrome pattern of phlegm-heat obstructing lung.Participants were divided into experimental and control groups.The experimental group received 4.5 g of rhubarb granules twice daily and the control group received placebo granules.Both groups also received conventional Western therapy consisting of oxygen therapy,an antibiotic,expectorant,and a bronchodilator.Treatment lasted 10 days.Symptom scores for cough,sputum volume and color,wheezing and chest tightness before treatment and on days 3,5,7,and 10 during the treatment were recorded.Lung function,arterial blood gas and levels of serum inflammatory factors,interleukin-4(IL-4),interleukin-8(IL-8),and interleukin-10(IL-10)and tumor necrosis factor-alpha(TNF-a),before and after treatment were measured.Results:The sample size of the full analysis set(FAS)was 244 participants,and the sample size of per protocol set(PPS)was 235.Following 10 days’treatment,symptom scores of the experimental group were markedly lower than those of the placebo group(FAS:mean difference1.67,95%CI:e2.66 to0.69,P Z 0.001;PPS:mean difference1.55,95%CI:2.56 to0.54,P Z 0.003).Lung function in the experimental group was significantly higher than in the placebo group(FEV1,FAS:mean difference 0.12,95%CI:0.06 to 0.18;P<0.001;PPS:mean difference 0.12,95%CI 0.05 to 0.18;P<0.001.FVC:FAS:mean difference 0.16,95%CI:0.06 to 0.26;P Z 0.002;PPS:mean difference 0.16,95%CI 0.05 to 0.26;P Z 0.003.FEV1%,FAS:mean difference 5.95,95%CI:3.36 to 8.53;P<0.001;PPS:mean difference 5.92,95%CI 3.28 to 8.56;P<0.001.).PaO2,PaCO2,as well as serum inflammatory factors were also improved when compared to the placebo group.There were no significant differences in the incidence rate of adverse reaction between the two groups.Conclusions:Compared with placebo,rhubarb granules significantly reduced symptom scores,improved blood oxygen level,controlled systemic inflammatory response,without significant adverse effects.Thus,rhubarb may be a beneficial adjuvant method for treating the phlegm-heat obstructing the lung syndrome pattern of AECOPD.展开更多
BACKGROUND Stenting as a bridge to curative surgery(SBTS)for obstructing colon cancer(OCC)has been associated with possibly worse oncological outcomes.AIM To evaluate the recurrence patterns,survival outcomes,and colo...BACKGROUND Stenting as a bridge to curative surgery(SBTS)for obstructing colon cancer(OCC)has been associated with possibly worse oncological outcomes.AIM To evaluate the recurrence patterns,survival outcomes,and colorectal cancer(CRC)-specific death in patients undergoing SBTS for OCC.METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined.Primary outcomes were recurrence patterns,overall survival(OS),cancer-specific survival(CSS),and CRC-specific death.OS and CSS were estimated using the Kaplan-Meier curves.Competing risk analysis with cumulative incidence function(CIF)was used to estimate CRC-specific mortality with other cause-specific death as a competing event.Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death.Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.RESULTS 28 patients(45.2%)developed metastases after a median period of 16 mo.Among the 18 patients with single-site metastases:Four had lung-only metastases(14.3%),four had liver-only metastases(14.3%),and 10 had peritoneum-only metastases(35.7%),while 10 patients had two or more sites of metastatic disease(35.7%).The peritoneum was the most prevalent(60.7%)site of metastatic involvement(17/28).The median follow-up duration was 46 mo.26(41.9%)of the 62 patients died,of which 16(61.5%)were CRC-specific deaths and 10(38.5%)were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%;1-, 3-, and5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mowas liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two ormore recurrence sites were predictive of CRC-specific death.CONCLUSIONThe peritoneum was the most common metastatic site among patients undergoing SBTS. Liveronlyrecurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors ofCRC-specific death.展开更多
Objective:To explore the molecular mechanism of the prescription for the syndrome of cold-damp-ness obstructing the lung in the treatment of corona virus disease 2019(COVID-19).Methods:The medicinals for the treatment...Objective:To explore the molecular mechanism of the prescription for the syndrome of cold-damp-ness obstructing the lung in the treatment of corona virus disease 2019(COVID-19).Methods:The medicinals for the treatment of the syndrome of cold-dampness obstructing the lung,such as Cangzhu(Rhizoma Atractylo-dis),Chenpi(Pericarpium Gitri Reticulatae),Houpo(Cortex Magnoliae Officinalis),Huoxiang(Herba Agastachis),Caoguo(Fructus Tsaoko),Mahuang(Herba Ephedrae),Qianghuo(Rhizoma et Radix Notoptery-gi),Shengjiang(Rhizoma Zingiberis Recens),Binlang(Semen Arecae)in the Diagnosis and Treatment Pro-gram of COVID-19(Trial Version 6)were taken as research subjects,and the combination of these nine me-dicinals can be called Hanshi Zufei Fang(寒湿阻肺方,HSZFF).The active components and targets of each single Chinese materia medica was screened and obtained through the Traditional Chinese Medicine Systems Pharmacology(TCMSP)database.The target information related to COVID-19 was retrieved through the Gene-Cards disease-related target database.The medicinal prediction targets were mapped to the disease target to ob-tain the intersection targets.The DAVID database was applied to perform gene ontology(GO)enrichment anal-ysis and kyoto encyclopedia of genes and genomes(KEGG)pathway analysis on the targets;GraphPad Prism 5.0 software was applied to plot the biological process(BP)of GO enrichment analysis,cellular component(CC),molecular function(MF)histograms;OmicShare online software was applied to make KEGG advanced bubble chart;Cytoscape software was applied to visualize the interaction with the targets and Chinese materia medica-components-targets results.Results:Totally 56 key active components of 9 Chinese materia medica for cold-dampness obstructing lung syndrome were screened,and 55 targets were obtained.The results of GO and KEGG enrichment analysis showed that the compound prescription mainly regulated the body's immune re-sponse and reduced inflammation by regulating such signaling pathways of inflammatory response and immune regulation as TNF signaling pathway,HIF-1 signaling pathway,Toll-like receptor signaling pathway,infuenza A signaling pathway,T cell receptor signaling pathway.Conclusion:HSZFF can eliminate infl ammation and inhibit virus by regulating immune inflammatory factors closely related to the occurrence and development of diseases through multi-component and multi-target.展开更多
BACKGROUND Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here,...BACKGROUND Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.CASE SUMMARY The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography(CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis,and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly.Systemic chemotherapy with modified FOLFOX6(mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.CONCLUSION This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.展开更多
From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all...From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all the patients, 14 cases were treated by primary resection with anastomosis. Anastomotic leakage occurred in 6 cases, and 5 of them were died. Of 25 cases with the traditional staged management, the tumors were resected only in 20 cases, and not resectable in the other 5 patients. 19 with modified Hartmann's procedure and 26 with extended right hemlcolectomy with ileorectal or low ileosigmoid anastomosis gave satisfactory results. In terms of this series, the five-year survival rate in primary resection group was significantly higher than that in staged resection group (P< 0. 05). It is suggested that extented right hemlcolectomy or modified Hartmann' s procedure in cases of acute cancerous obstruction of the left colon would be favord.展开更多
BACKGROUND Self-expandable metal stents(SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer(CRC). Among possible complications of SEMS positioning, re-obstruction is the...BACKGROUND Self-expandable metal stents(SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer(CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.CASE SUMMARY A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors(splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents(1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.CONCLUSION Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.展开更多
BACKGROUND The incidence of intestinal malrotation in adults has been reported to only be about 0.2%.Duodenal web as a cause of intestinal obstruction is rare,with an incidence of about 1:20000-1:40000.Furthermore,whe...BACKGROUND The incidence of intestinal malrotation in adults has been reported to only be about 0.2%.Duodenal web as a cause of intestinal obstruction is rare,with an incidence of about 1:20000-1:40000.Furthermore,when described,these conditions are usually seen in early life and very infrequently in adulthood.CASE SUMMARY We report a case of a middle-aged woman with intestinal malrotation who presented with a three-month history of right-sided abdominal pain,early satiety,and a 22-pound weight loss.Patient underwent an esophagogastroduodenoscopy,which demonstrated numerous retained pills in a deformed first portion of the duodenum,concerning for a partial gastric outlet obstruction.An upper gastrointestinal series showed marked distention of the proximal duodenum with retained debris and the presence of a windsock sign,increasing the suspicion of a duodenal web.The patient subsequently underwent surgical intervention where a duodenal web with two lumens was noted and resected,opening the duodenum.There were over 150 pill capsules that were removed.The patient is doing well after this intervention.CONCLUSION Both intestinal malrotation and duodenal webs are infrequently encountered in the adult population.These pathologies can also present with nonspecific abdominal symptoms such as chronic abdominal pain and nausea.Hence,providers might not consider these pathologies in the differential for patients who present with vague symptoms which can lead to delay in management and increased mortality and morbidity.展开更多
Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasi...Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasis obstructing the LuòMàis pattern is the pathological basis,and the formation of phlegm and blood stasis is the key pathological factor for cardiocerebral vascular multimorbidity,implying that the treatment of cardiocerebral vascular multimorbidity should focus on eliminating phlegm and blood stasis simultaneously.Based on the discovery of modern medicine that cardiocerebral vascular multimorbidity is mostly related to lipid deposition,inflammation,atherosclerosis,microcirculation disorders,and hemodynamics,it is believed that the core pathological features of cardiocerebral vascular multimorbidity include atherosclerosis and microcirculation disorders,coinciding with the pathological mechanism that phlegm and blood stasis are formed and then obstruct the Luò Màis in the heart and brain in TCM.This paper combined modern medicine and TCM theories,analyzed the pathogenesis of coronary heart disease and ischemic stroke from the perspective of phlegm and blood stasis obstructing the Luò Màis pattern,and discussed the multimorbidity mechanism so as to provide theoretical basis for clinical treatment.展开更多
Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focus...Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions,leading to disease progression and a negative impact on quality of life.This review proposes a paradigm shift to focus on bladder health preservation,as the bladder is an end organ that cannot be transplanted.Therefore,earlier diagnosis and timely surgical treatment within the“window of curability”are required.We introduce the Man vs Prostate“Five Stages of Bladder Health”to provide the needed framework to build the next iterations of BPH/BPO care.This patient-facing decision-making aid categorizes BPH/BPO progression.It integrates clinical observations with underlying patho-physiology and patient experience.This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages,the possible consequences of not taking action,and the goal to prevent late-stage disease:stageⅠ,BPO;stageⅡ,detrusor over-activity;stageⅢ,urgency incontinence;stageⅣ,acute retention;and stageⅤ,detrusor underactivity.On an individual patient basis,tran-sitions are not distinct,stages can coexist,and stages can be skipped.Although promising,this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy.The concept of the“window of curability”emphasizes the need for therapeutic intervention at the optimal time.By identifying patients in earlier stages and initiating appropriate treatment,disease progression can be potentially stabilized or even reversed while aiming to opti-mally preserve detrusor function.Along with the Man vs Prostate staging system,this framework provides a structure for future research,shared decision making,and personalized treatment strategies.This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices,focus on earlier intervention within the“window of curability,”and prioritize bladder health preservation.展开更多
Objective:To study the efficacy of modified Wuzhuyu Decoction Granule(加减吴茱萸汤颗粒剂,MWDG)in the treatment of migraine patients with cold and stasis obstructing meridian syndrome.Methods:This study was a randomize...Objective:To study the efficacy of modified Wuzhuyu Decoction Granule(加减吴茱萸汤颗粒剂,MWDG)in the treatment of migraine patients with cold and stasis obstructing meridian syndrome.Methods:This study was a randomized,double-blind,placebo-controlled trial.A total of 78 migraine patients with cold and stasis obstructing meridian syndrome were recruited and randomly assigned by a ratio of 2:1 into a treatment group(51 cases)and a placebo group(27 cases).Patients in the treatment group were treated with MWDG while placebo granules were applied in the control group.The treatment course lasted for 12 weeks with a follow-up of 4 weeks.The primary outcome measures included frequency and days of migraine attacks and the secondary outcome measures were analgesics consumption and visual analogue scale(VAS)scores.All outcome assessments were conducted respectively at baseline,the 4th,8th and 12th week,and the end of follow-up.Results:In the treatment group,significant decrease in frequency of migraine attacks were observed since the 4th week and that of analgesics consumption since the 8th week(both P〈0.05).While,in the placebo group,significant decrease in frequency of migraine attacks were observed since the 8th week and that of analgesics consumption since the 12th week(both P〈0.05).No significant decrease in days of migraine attacks and VAS scores of migraine pain were observed in both groups.Between the two groups,there were significant differences in VAS scores and intensity of pain appeared in the 8th week(P〈0.05).However,no significant differences were found in days and frequency of migraine attacks and analgesics consumption(P〉0.05).Conclusions:MWDG was probably effective in the treatment of migraine especially for alleviating pain intensity.Furthermore,MWDG could reduce the frequency of migraine attacks and analgesics consumption sooner than the placebo.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both co...BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the man...OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.展开更多
Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 ...Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the au...This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.展开更多
基金supported by the National Cancer Institute(T32,CA 236621-5).
文摘Annular pancreas is a rare congenital anomaly formed by a thin band of pancreatic tissue that encircles the descending duodenum and leads to partial or complete obstruction.Annular pancreas is estimated to occur in less than 5/100,000 people;however,the true incidence is unknown given that annular pancreas is frequently asymptomatic and only an incidental finding on cross-sectional imaging or autopsy examination.1,2 When symptomatic,patients typically present with abdominal pain,nausea and vomiting,or postprandial fullness due to gastric outlet obstruction.3 Other and less common presentations include peptic ulcer disease,biliary obstruction,or symptoms of acute or chronic pancreatitis.
文摘Biliary obstructions can lead to infections of the biliary system, particularly in patients with occluded biliary stents. Fungal organisms are frequently found in bili-ary aspirates of patients who have been on antibiotics and have stents; however, fungal masses, or "balls", that fully obstruct the biliary system are uncommon and exceedingly diff icult to eradicate. We present 4 cases of obstructing fungal cholangitis in patients who had metal biliary stents placed for pancreatic malignancies, and subsequently required aggressive antifungal administration along with endoscopic and radiologic interventions. This report also reviews approaches previously undertaken to manage severe obstructing fungal cholangitis.
基金This study was funded by the China National Key Basic Research Project through The Ministry of Science and Technology(No.2009CB522704).
文摘Objective:To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method:This was a multicenter randomized double-blinded placebo controlled study that took place in 7 provinces of China that enrolled 244 patients(aged 18e80 years)who had acute exacerbation of COPD with the traditional Chinese syndrome pattern of phlegm-heat obstructing lung.Participants were divided into experimental and control groups.The experimental group received 4.5 g of rhubarb granules twice daily and the control group received placebo granules.Both groups also received conventional Western therapy consisting of oxygen therapy,an antibiotic,expectorant,and a bronchodilator.Treatment lasted 10 days.Symptom scores for cough,sputum volume and color,wheezing and chest tightness before treatment and on days 3,5,7,and 10 during the treatment were recorded.Lung function,arterial blood gas and levels of serum inflammatory factors,interleukin-4(IL-4),interleukin-8(IL-8),and interleukin-10(IL-10)and tumor necrosis factor-alpha(TNF-a),before and after treatment were measured.Results:The sample size of the full analysis set(FAS)was 244 participants,and the sample size of per protocol set(PPS)was 235.Following 10 days’treatment,symptom scores of the experimental group were markedly lower than those of the placebo group(FAS:mean difference1.67,95%CI:e2.66 to0.69,P Z 0.001;PPS:mean difference1.55,95%CI:2.56 to0.54,P Z 0.003).Lung function in the experimental group was significantly higher than in the placebo group(FEV1,FAS:mean difference 0.12,95%CI:0.06 to 0.18;P<0.001;PPS:mean difference 0.12,95%CI 0.05 to 0.18;P<0.001.FVC:FAS:mean difference 0.16,95%CI:0.06 to 0.26;P Z 0.002;PPS:mean difference 0.16,95%CI 0.05 to 0.26;P Z 0.003.FEV1%,FAS:mean difference 5.95,95%CI:3.36 to 8.53;P<0.001;PPS:mean difference 5.92,95%CI 3.28 to 8.56;P<0.001.).PaO2,PaCO2,as well as serum inflammatory factors were also improved when compared to the placebo group.There were no significant differences in the incidence rate of adverse reaction between the two groups.Conclusions:Compared with placebo,rhubarb granules significantly reduced symptom scores,improved blood oxygen level,controlled systemic inflammatory response,without significant adverse effects.Thus,rhubarb may be a beneficial adjuvant method for treating the phlegm-heat obstructing the lung syndrome pattern of AECOPD.
文摘BACKGROUND Stenting as a bridge to curative surgery(SBTS)for obstructing colon cancer(OCC)has been associated with possibly worse oncological outcomes.AIM To evaluate the recurrence patterns,survival outcomes,and colorectal cancer(CRC)-specific death in patients undergoing SBTS for OCC.METHODS Data from 62 patients undergoing SBTS at a single tertiary centre over ten years between 2007 and 2016 were retrospectively examined.Primary outcomes were recurrence patterns,overall survival(OS),cancer-specific survival(CSS),and CRC-specific death.OS and CSS were estimated using the Kaplan-Meier curves.Competing risk analysis with cumulative incidence function(CIF)was used to estimate CRC-specific mortality with other cause-specific death as a competing event.Fine-Gray regressions were performed to determine prognostic factors of CRC-specific death.Univariate and multivariate subdistribution hazard ratios and their corresponding Wald test P values were calculated.RESULTS 28 patients(45.2%)developed metastases after a median period of 16 mo.Among the 18 patients with single-site metastases:Four had lung-only metastases(14.3%),four had liver-only metastases(14.3%),and 10 had peritoneum-only metastases(35.7%),while 10 patients had two or more sites of metastatic disease(35.7%).The peritoneum was the most prevalent(60.7%)site of metastatic involvement(17/28).The median follow-up duration was 46 mo.26(41.9%)of the 62 patients died,of which 16(61.5%)were CRC-specific deaths and 10(38.5%)were deaths owing to other causes. The 1-, 3-, and 5-year OS probabilities were 88%, 74%, and 59%;1-, 3-, and5-year CSS probabilities were 97%, 83%, and 67%. The highest CIF for CRC-specific death at 60 mowas liver-only recurrence (0.69). Liver-only recurrence, peritoneum-only recurrence, and two ormore recurrence sites were predictive of CRC-specific death.CONCLUSIONThe peritoneum was the most common metastatic site among patients undergoing SBTS. Liveronlyrecurrence, peritoneum-only recurrence, and two or more recurrence sites were predictors ofCRC-specific death.
基金We thank for the funding support from the National Natural Science Foundation of China(81873285)。
文摘Objective:To explore the molecular mechanism of the prescription for the syndrome of cold-damp-ness obstructing the lung in the treatment of corona virus disease 2019(COVID-19).Methods:The medicinals for the treatment of the syndrome of cold-dampness obstructing the lung,such as Cangzhu(Rhizoma Atractylo-dis),Chenpi(Pericarpium Gitri Reticulatae),Houpo(Cortex Magnoliae Officinalis),Huoxiang(Herba Agastachis),Caoguo(Fructus Tsaoko),Mahuang(Herba Ephedrae),Qianghuo(Rhizoma et Radix Notoptery-gi),Shengjiang(Rhizoma Zingiberis Recens),Binlang(Semen Arecae)in the Diagnosis and Treatment Pro-gram of COVID-19(Trial Version 6)were taken as research subjects,and the combination of these nine me-dicinals can be called Hanshi Zufei Fang(寒湿阻肺方,HSZFF).The active components and targets of each single Chinese materia medica was screened and obtained through the Traditional Chinese Medicine Systems Pharmacology(TCMSP)database.The target information related to COVID-19 was retrieved through the Gene-Cards disease-related target database.The medicinal prediction targets were mapped to the disease target to ob-tain the intersection targets.The DAVID database was applied to perform gene ontology(GO)enrichment anal-ysis and kyoto encyclopedia of genes and genomes(KEGG)pathway analysis on the targets;GraphPad Prism 5.0 software was applied to plot the biological process(BP)of GO enrichment analysis,cellular component(CC),molecular function(MF)histograms;OmicShare online software was applied to make KEGG advanced bubble chart;Cytoscape software was applied to visualize the interaction with the targets and Chinese materia medica-components-targets results.Results:Totally 56 key active components of 9 Chinese materia medica for cold-dampness obstructing lung syndrome were screened,and 55 targets were obtained.The results of GO and KEGG enrichment analysis showed that the compound prescription mainly regulated the body's immune re-sponse and reduced inflammation by regulating such signaling pathways of inflammatory response and immune regulation as TNF signaling pathway,HIF-1 signaling pathway,Toll-like receptor signaling pathway,infuenza A signaling pathway,T cell receptor signaling pathway.Conclusion:HSZFF can eliminate infl ammation and inhibit virus by regulating immune inflammatory factors closely related to the occurrence and development of diseases through multi-component and multi-target.
基金Supported by National High-Tech R and D Program of China(863Program),No.2015AA033602Personnel Training Program of Beijing Chao-Yang Hospital Affiliated to Capital Medical University,No.CYXZ-2017-09
文摘BACKGROUND Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.CASE SUMMARY The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography(CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis,and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly.Systemic chemotherapy with modified FOLFOX6(mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.CONCLUSION This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.
文摘From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all the patients, 14 cases were treated by primary resection with anastomosis. Anastomotic leakage occurred in 6 cases, and 5 of them were died. Of 25 cases with the traditional staged management, the tumors were resected only in 20 cases, and not resectable in the other 5 patients. 19 with modified Hartmann's procedure and 26 with extended right hemlcolectomy with ileorectal or low ileosigmoid anastomosis gave satisfactory results. In terms of this series, the five-year survival rate in primary resection group was significantly higher than that in staged resection group (P< 0. 05). It is suggested that extented right hemlcolectomy or modified Hartmann' s procedure in cases of acute cancerous obstruction of the left colon would be favord.
文摘BACKGROUND Self-expandable metal stents(SEMSs) are frequently used in the setting of palliation for occluding, inoperable colorectal cancer(CRC). Among possible complications of SEMS positioning, re-obstruction is the most frequent. Its management is controversial, potentially involving secondary stent-in-stent placement, which has been poorly investigated. Moreover, the issue of secondary stent-in-stent re-obstruction and of more-than-two colonic stenting has never been assessed. We describe a case of tertiary SEMS-in-SEMS placement, and also discuss our practice based on available literature.CASE SUMMARY A 66-year-old male with occluding and metastatic CRC was initially treated by positioning of a SEMS, which had to be revised 6 mo later when a symptomatic intra-stent tumor ingrowth was treated by a SEMS-in-SEMS. We hereby describe an additional episode of intestinal occlusion due to recurrence of intra-stent tumor ingrowth. This patient, despite several negative prognostic factors(splenic flexure location of the tumor, carcinomatosis with ascites, subsequent chemotherapy that included bevacizumab and two previously positioned stents(1 SEMS and 1 SEMS-in-SEMS)) underwent successful management through the placement of a tertiary SEMS-in-SEMS, with immediate clinical benefit and no procedure-related adverse events after 150 d of post-procedural follow-up. This endoscopic management has permitted 27 mo of partial control of a metastatic disease without the need for chemotherapy discontinuation and, ultimately, a good quality of life until death.CONCLUSION Tertiary SEMS-in-SEMS is technically feasible, and appears to be a safe and effective option in the case of recurrent SEMS obstruction.
文摘BACKGROUND The incidence of intestinal malrotation in adults has been reported to only be about 0.2%.Duodenal web as a cause of intestinal obstruction is rare,with an incidence of about 1:20000-1:40000.Furthermore,when described,these conditions are usually seen in early life and very infrequently in adulthood.CASE SUMMARY We report a case of a middle-aged woman with intestinal malrotation who presented with a three-month history of right-sided abdominal pain,early satiety,and a 22-pound weight loss.Patient underwent an esophagogastroduodenoscopy,which demonstrated numerous retained pills in a deformed first portion of the duodenum,concerning for a partial gastric outlet obstruction.An upper gastrointestinal series showed marked distention of the proximal duodenum with retained debris and the presence of a windsock sign,increasing the suspicion of a duodenal web.The patient subsequently underwent surgical intervention where a duodenal web with two lumens was noted and resected,opening the duodenum.There were over 150 pill capsules that were removed.The patient is doing well after this intervention.CONCLUSION Both intestinal malrotation and duodenal webs are infrequently encountered in the adult population.These pathologies can also present with nonspecific abdominal symptoms such as chronic abdominal pain and nausea.Hence,providers might not consider these pathologies in the differential for patients who present with vague symptoms which can lead to delay in management and increased mortality and morbidity.
基金supported by the Special Fund for the Inheritance and Innovation of Traditional Chinese Medicine Theories under the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences[Grant number:KYG-202404].
文摘Coronary heart disease and ischemic stroke are common cardiovascular and cerebrovascular diseases with a high multimorbidity rate.According to the theory of traditional Chinese medicine(TCM),the phlegm and blood stasis obstructing the LuòMàis pattern is the pathological basis,and the formation of phlegm and blood stasis is the key pathological factor for cardiocerebral vascular multimorbidity,implying that the treatment of cardiocerebral vascular multimorbidity should focus on eliminating phlegm and blood stasis simultaneously.Based on the discovery of modern medicine that cardiocerebral vascular multimorbidity is mostly related to lipid deposition,inflammation,atherosclerosis,microcirculation disorders,and hemodynamics,it is believed that the core pathological features of cardiocerebral vascular multimorbidity include atherosclerosis and microcirculation disorders,coinciding with the pathological mechanism that phlegm and blood stasis are formed and then obstruct the Luò Màis in the heart and brain in TCM.This paper combined modern medicine and TCM theories,analyzed the pathogenesis of coronary heart disease and ischemic stroke from the perspective of phlegm and blood stasis obstructing the Luò Màis pattern,and discussed the multimorbidity mechanism so as to provide theoretical basis for clinical treatment.
文摘Benign prostatic hyperplasia(BPH)and benign prostatic obstruction(BPO)remain significant contributors to male lower urinary tract symptoms,often leading to bladder damage and dysfunction.The traditional approach focuses on the management of bothersome symptoms through the use of BPH medications and may delay essential interventions,leading to disease progression and a negative impact on quality of life.This review proposes a paradigm shift to focus on bladder health preservation,as the bladder is an end organ that cannot be transplanted.Therefore,earlier diagnosis and timely surgical treatment within the“window of curability”are required.We introduce the Man vs Prostate“Five Stages of Bladder Health”to provide the needed framework to build the next iterations of BPH/BPO care.This patient-facing decision-making aid categorizes BPH/BPO progression.It integrates clinical observations with underlying patho-physiology and patient experience.This categorization highlights how untreated BPH/BPO can progress to more serious and pressing stages,the possible consequences of not taking action,and the goal to prevent late-stage disease:stageⅠ,BPO;stageⅡ,detrusor over-activity;stageⅢ,urgency incontinence;stageⅣ,acute retention;and stageⅤ,detrusor underactivity.On an individual patient basis,tran-sitions are not distinct,stages can coexist,and stages can be skipped.Although promising,this proposed staging system requires further validation through prospective randomized clinical trials to confirm its clinical value and prognostic accuracy.The concept of the“window of curability”emphasizes the need for therapeutic intervention at the optimal time.By identifying patients in earlier stages and initiating appropriate treatment,disease progression can be potentially stabilized or even reversed while aiming to opti-mally preserve detrusor function.Along with the Man vs Prostate staging system,this framework provides a structure for future research,shared decision making,and personalized treatment strategies.This paradigm shift necessitates a collaborative effort among urologists to reevaluate current practices,focus on earlier intervention within the“window of curability,”and prioritize bladder health preservation.
基金Supported by the"Eleventh Five-Year Plan"of China State Science&Technology Ministry(No.2007BAI20B053)National Natural Science Foundation of China(No.81273688)
文摘Objective:To study the efficacy of modified Wuzhuyu Decoction Granule(加减吴茱萸汤颗粒剂,MWDG)in the treatment of migraine patients with cold and stasis obstructing meridian syndrome.Methods:This study was a randomized,double-blind,placebo-controlled trial.A total of 78 migraine patients with cold and stasis obstructing meridian syndrome were recruited and randomly assigned by a ratio of 2:1 into a treatment group(51 cases)and a placebo group(27 cases).Patients in the treatment group were treated with MWDG while placebo granules were applied in the control group.The treatment course lasted for 12 weeks with a follow-up of 4 weeks.The primary outcome measures included frequency and days of migraine attacks and the secondary outcome measures were analgesics consumption and visual analogue scale(VAS)scores.All outcome assessments were conducted respectively at baseline,the 4th,8th and 12th week,and the end of follow-up.Results:In the treatment group,significant decrease in frequency of migraine attacks were observed since the 4th week and that of analgesics consumption since the 8th week(both P〈0.05).While,in the placebo group,significant decrease in frequency of migraine attacks were observed since the 8th week and that of analgesics consumption since the 12th week(both P〈0.05).No significant decrease in days of migraine attacks and VAS scores of migraine pain were observed in both groups.Between the two groups,there were significant differences in VAS scores and intensity of pain appeared in the 8th week(P〈0.05).However,no significant differences were found in days and frequency of migraine attacks and analgesics consumption(P〉0.05).Conclusions:MWDG was probably effective in the treatment of migraine especially for alleviating pain intensity.Furthermore,MWDG could reduce the frequency of migraine attacks and analgesics consumption sooner than the placebo.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
基金Nanchong City Science and Technology Plan Project:the Application of Tongli Shugan Liqi Method in the Treatment of Adhesive Intestinal Obstruction and its Effect on Inflammatory Indicators Interleukin-6,C-reactive protein and Procalcitonin(21YFZJ0108)。
文摘OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.
文摘Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
文摘This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.
