Efficacy of galantamine combined with Fufang Haishe Jiaonang in the treatment of Alzheimer's disease in 52 patients / 中国基层医药

Objective:To investigate the efficacy of galantamine combined with Fufang Haishe Jiaonang in the treatment of Alzheimer's disease and its effects on serum levels of inflammatory factors, Aβ1-42 protein, and Tau protein. Methods:A total of 104 patients with Alzheimer's disease who received treatment in Jiaozhou People's Hospital from January 2019 to January 2021 were included in this study. They were randomly divided into a control group and an observation group ( n = 52/group). The control group was given galantamine treatment. The observation group was given galantamine combined with Fufang Haishe Jiaonang. All patients were treated for 3 months. Clinical efficacy was compared between the two groups. Before and after treatment, serum inflammatory factor, Aβ1-42 protein, Tau protein, Mini-Mental State Examination score, and The Quality of Life in Alzheimer's Disease Seale score were compared between the two groups. Adverse reactions were observed during the treatment. Results:Total response rate in the observation group was significantly higher than that in the control group [92.31% (48/52) vs. 76.92% (40/52), χ2 = 4.73, P < 0.05]. After treatment, serum levels of interleukin-6, interleukin-8, tumor necrosis factor-alpha, and Tau protein in the observation group were significantly lower than those in the control group, and Aβ1-42 protein level in the observation group was significantly higher than that in the control group ( t = 16.78, 6.94, 5.16, 2.91, 2.55, all P < 0.05). After treatment, Mini-Mental State Examination score and The Quality of Life in Alzheimer's Disease (QOL-AD) Seale score were increased in each group ( t = 13.48, 6.34, 18.58, 14.45, all P < 0.001), and they were significantly higher in the observation group than the control group ( t = 5.86, 7.25, both P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Galantamine combined with Fufang Haishe Jiaonang for the treatment of Alzheimer's disease can better reduce clinical symptoms and signs, regulate serum levels of inflammatory factors, Aβ1-42 protein, and Tau protein, and improve the mental state and quality of life.

Efficacy and safety of stress ulcer prophylaxis in septic patients: a retrospective cohort study based on large database / 中华危重病急救医学

Objective:To evaluate the effects and safety of stress ulcer prophylaxis (SUP) versus no prophylaxis in adult septic patients at risk of gastrointestinal bleeding (GIB).Methods:A retrospective cohort study was conducted, the data was extracted from Electronic Intensive Care Unit-Collaborative Research Database (eICU-CRD). All patients who received proton pump inhibitor (PPI) or H 2 receptor antagonist (H 2RA) or combined/sequential use for SUP within the first 48 hours of intensive care unit (ICU) admission were enrolled in the SUP group, those who did not received any SUP were enrolled in the non-SUP group. The differences of in-hospital mortality, length of ICU stay (LOS), the incidence of GIB and secondary infection complications between the two groups were compared. Propensity score matching (PSM) was conducted to balance the distributions of study variables between the two groups. Further subgroup analysis was performed according to whether SUP was used for more than 3 days. Multivariate Logistic regression analysis was conducted to analyze the factors influencing the outcome of GIB and secondary pneumonia. Results:A total of 11 413 patients were included in the final analysis, with 9 799 patients in SUP group and 1 614 in non-SUP group. A 1∶1 PSM created 1 600 patients in each cohort. ① Baseline characteristics: compared with SUP group, patients in non-SUP group were older [years old: 69.0 (56.0, 80.0) vs. 67.0 (56.0, 78.0)], acute physiology and chronic health evaluation Ⅳ (APACHEⅣ) score and sequential organ failure assessment (SOFA) score were significantly lower [APACHEⅣ score: 65 (50, 73) vs. 72 (58, 87), SOFA score: 5 (4, 7) vs. 7 (5, 9)], higher rates of underlying diseases such as hypertension and diabetes [hypertension: 15.6% (252/1 614) vs. 12.2% (1 196/9 779), diabetes: 4.5% (72/1 614) vs. 3.3% (325/9 779), both P < 0.05], indicating that patients in the SUP group were more severe. ② Comparison of clinical outcome: before PSM, SUP group had significantly higher in-hospital mortality [17.2% (1 688/9 799) vs. 10.9% (176/1 614)], longer LOS [days: 4.4 (2.9, 7.7) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia than non-SUP group [11.3% (1 112/9 799) vs. 6.8% (110/1 614)], with significant differences (all P < 0.05). There was no significant difference in the incidence of GIB and Clostridium difficile infection (CDI) between the two groups. After PSM, no significant differences were observed between the two groups with regard to in-hospital mortality, incidence of GIB and CDI. However, the SUP group had longer LOS [days: 3.9 (2.8, 6.6) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia [10.9% (174/1 600) vs. 6.8% (108/1 600)] compared with non-SUP group, the differences were statistically significant (all P < 0.05). Subgroup analysis showed that compared with SUP < 3 days group, patients in SUP ≥ 3 days group had higher disease severity score [APACHEⅣ score: 66 (51, 79) vs. 62 (48, 72), SOFA score: 6 (4, 8) vs. 5 (4, 7), both P < 0.05], in addition, patients in SUP≥3 days group had higher in-hospital mortality, incidence of GIB and secondary pneumonia (16.4% vs. 10.7%, 6.1% vs. 1.8%, 19.0% vs. 8.6%, respectively), and longer ICU LOS [days: 6.6 (4.1, 11.8) vs. 3.5 (2.6, 5.3), all P < 0.05]. ③ Multivariate Logistic regression analysis showed that SUP≥3 days group was associated with more GIB than that of non-SUP group [odds ratio ( OR) = 1.84, 95% confidence interval (95% CI) was 1.07-3.08, P = 0.030], and the incidence of GIB was less in SUP < 3 days group than that of non-SUP group ( OR = 0.57, 95% CI was 0.34-0.94, P = 0.020). When compared with non-SUP group, the risk of secondary pneumonia was increased both in SUP≥ 3 days group and SUP < 3 days group ( OR values were 2.95 and 1.34, 95% CI were 2.10-4.13 and 1.01-1.77, P values were < 0.001 and 0.040, respectively). Conclusion:Among critically ill adult patients with sepsis at risk for GIB, SUP showed no effect on reducing in-hospital mortality, the rate of GIB and CDI, but was associated with increased risk of secondary pneumonia and prolonged LOS.

Effect of Zhongyi paste on inflammatory pain in mice by regulation of the extracellular regulated protein kinases 1/2– cyclooxygenase-2–prostaglandin E2 pathway

Background@#Zhongyi paste is a traditional Chinese medicine herbal paste that is externally applied to reduce inflammation and relieve pain. @*Methods@#An acute foot swelling inflammation model in C57BL/6J mice was established by carrageenan-induced pathogenesis. Zhongyi paste raised the pain threshold and also reduced the degree of swelling in mice with carrageenan-induced foot swelling. @*Results@#Analysis indicated that serum tumor necrosis factor-alpha, interleukin-1 beta, and prostaglandin E2 (PGE2) cytokine levels and PGE2levels in the paw tissue of the mice were decreased by Zhongyi paste treatment. The quantitative polymerase chain reaction and western blot results showed that Zhongyi paste downregulated the mRNA and protein expression of extracellular signal-regulated kinase 1/2 (ERK1/2), and cyclooxygenase-2 (COX-2), and also downregulated the mRNA expression of PGE2 . At the same time, the Zhongyi paste exerted a stronger effect as an external drug than that of indomethacin, which is an oral drug, and voltaren, which is an externally applied drug. @*Conclusions@#Our results indicated that Zhongyi paste is a very effective drug to reduce inflammatory swelling of the foot, and its mechanism of action is related to regulation of the ERK1/2–COX-2–PGE2 pathway.

The mini-open anterolateral lumbar interbody fusion (MO-ALLIF)with self-anchored stand-alone cage in lumbar revision surgery / 中华骨科杂志

Objective To evaluate the safety and efficacy of the mini-open anterolateral lumbar interbody fusion (MO-ALLIF) in lumbar revision surgery.Methods Seventeen patients,seven male and ten female,who underwent revision lumbar surgeries using MO-ALLIF with self-anchored stand-alone polyetheretherketone (PEEK) cage in a single center between April 2013 and April 2016 were studied retrospectively.There were 14 of sing-level cases and 3 of double-level cases.Among them,11 cases were L4.5,4 cases were L3,4,5 cases were L5S1.There were 2 cases of cage migration,3 cases of pseudarthrosis,6 cases of recurrent lumbar disc herniation of the same level,and 6 cases of lumbar disc herniation on the adjacent level.The average age was 53.9±7.2 years (range,41-65 years).The clinical manifestation was low back pain and/or leg pain.The operation time,blood loss,and perioperative complications were evaluated.Oswestry disability index (ODI) and visual analog scale (VAS) score of leg and back pain were analyzed preoperatively and at each time point of follow-up postoperatively.Radiological evaluation including fusion,global lumbar lordosis,disc height on the operation level,foraminal height on the operation level,and subsidence were assessed.Results The average follow-up time was 22.7±8.6 months(12-48 months).Among the seventeen patients that participated in this study with a total of 20 segments,only one patient suffered from peritoneal rupture,but no symptom was observed after suturing.No other approach-related complications were found in all cases.The mean operation time was 74.0± 15.5 minutes.The average blood loss was 122.4±28.8 ml.All patients involved achieved solid fusion at the last followup (12 months post-operation) with no cage migration.Significant differences were observed between the pre-and post-operation status,with respect to the back pain VAS,leg pain VAS and ODI scores.The post-operative lumbar lordosis,disc height on the operation level and foraminal height on the operation level,were also significantly improved when compared with the pre-operative ones.Conclusion MO-ALLIF with self-anchored stand-alone PEEK cage is a modification of both anterior lumbar interbody fusion and oblique lumbar interbody fusion,which is safe and effective in some revision lumbar surgery with minor surgical trauma,low access-related complication rates,and satisfactory clinical and radiological results.

Association between Diet and Lifestyle Habits and Irritable Bowel Syndrome: A Case-Control Study

BACKGROUND/AIMS: Recent papers have highlighted the role of diet and lifestyle habits in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this association in developing countries. The aim of this study was to evaluate the association between diet and lifestyle habits and IBS. METHODS: A food frequency and lifestyle habits questionnaire was used to record the diet and lifestyle habits of 78 IBS subjects and 79 healthy subjects. Cross-tabulation analysis and logistic regression were used to reveal any association among lifestyle habits, eating habits, food consumption frequency, and other associated conditions. RESULTS: The results from logistic regression analysis indicated that IBS was associated with irregular eating (odds ratio [OR], 3.257), physical inactivity (OR, 3.588), and good quality sleep (OR, 0.132). IBS subjects ate fruit (OR, 3.082) vegetables (OR, 3.778), and legumes (OR, 2.111) and drank tea (OR, 2.221) significantly more frequently than the control subjects. After adjusting for age and sex, irregular eating (OR, 3.963), physical inactivity (OR, 6.297), eating vegetables (OR, 7.904), legumes (OR, 2.674), drinking tea (OR, 3.421) and good quality sleep (OR, 0.054) were independent predictors of IBS. CONCLUSIONS: This study reveals a possible association between diet and lifestyle habits and IBS.

Risk factors for false negative diagnosis of obscure gastrointestinal bleeding by capsule endoscopy / 中华消化内镜杂志

ObjectiveTo analyze the risk factors for false negative diagnosis of obscure gastrointestinal bleeding (OGIB) by capsule endoscopy.MethodsA total of 133 OGIB inpatients,104 in true positive group and 29 in false negativc group,were reviewed.The features of demography,diseases and capsule endoscopy were collected and then analyzed,which included 10 variables like age,sex,time of bleeding,diseases accompanied,type and location of the disease,hemoglobin concentration,transit time of CE,quality of CE pictures and type of purgative agents.All data were analyzed with t test,and all the enumeration data were analyzed with chi square test.Logistic regression was used to analyze the correlation between the factors and results of diagnosis.ResultsAge ( t =2.095,P =0.038 ),concentration of hemoglobin ( t =2.143,P=0.034),type (X2 =20.222,P ＜0.001) and location (X2 =33.732,P ＜0.001) of the diseases,image quality of the CE (X2 =9.219,P =0.002 ) and the type of purgative agents (X2 =6.999,P =0.024) were found to have statistical differences between the two groups.Chi-square and partition Chi-square test revealed the occurrence of civerticulosis and lesion location,i.e.lower ileum and ileumcecum,were of statistical difference between the two groups (X2 =22.233,P ＜ 0.001 and x2 =24.412,P ＜ 0.001 ).Univariate logistic regression showed diverticulosis ( OR =0.102,P ＜0.001 ),lower bowel diseases ( OR =0.110,P ＜0.001 ),poor quality of CE pictures ( OR =0.258,P =0.004 ) and the use of sodium phosphate agent ( OR =0.367,P =0.027) were risk factors for false negative diagnosis,while older age facilitated diagnosis ( OR =1.024,P =0.041 ).However,multivariate logistic regression showed no statistic significance in type of purgative agent ( P =0.05 ) or the concentration of hemoglobin ( P =0.394).Furthermore,elder age facilitated positive diagnosis ( OR =1.031,P =0.032),while diverticulosis ( OR =0.118,P =0.001 ),lower bowel diseases ( OR =0.145,P =0.001 ) and poor quality of CE pictures ( OR =0.245,P =0.016) were correlated with higher probability of false negative diagnosis.ConclusionAge,disease type,disease location and image quality exert great influence on CE diagnosis.Diverticulosis,lower location of the diseases and poor CE image quality are risk factors for false negative diagnosis.

The clinical value of capsule endoscopy image screening system / 中华消化内镜杂志

ObjectiveTo evaluate the clinical value of capsule endoscopy (CE) image screening system developed by our group.MethodsBetween March 2011 and June 2011,50 patients (29 males and 21 females with a mean age of 45.7(45.7 ± 4.1 ) ) underwent CE in our department.CE images were reviewed,and processed by the screening system at the rate of 50％,60％,70％,80％ and 90％,respectively.After reviewing the remaining and the deleted frames,the endoscopists calculated the remaining rate of the lesions by recording the number of lesions of all patients and the number of remaining lesions.The procedure time and the total number of the frames of each case were also recorded.ResultsA total of 39 patients of 50 had lesions and the detection rate was 78％.91 lesions were detected in the 39 patients,most of whom had more than 2 lesions.When the prescribed deletion rate was less than or equal to 60％,the lesion remaining rate reached 100％,with a mean frames of the cases of 46 242,and the mean processing time of 15.62 min.ConclusionWith all the lesions remained,the system can delete 60％ similar frames in a very short time,which greatly reduces the diagnosis time and workload for endoscopist,and improves the efficiency of capsule endoscopy.

Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH).</p><p><b>METHODS</b>From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed.</p><p><b>RESULTS</b>All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01).</p><p><b>CONCLUSIONS</b>Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.</p>

Learning curve of full endoscopic technique for the surgical treatment of lumbar disc herniation / 中华骨科杂志

ObjectiveTo evaluate the learning curve of utilizing the full endoscopic technique for the surgical treatment of lumbar disc herniation.MethodsFrom August 2008 to February 2009,30 patients with lumbar disc herniation underwent lumbar discectomy by the full endoscopic-only approach were retrospectively analyzed.The patients were divided into three groups of 10 sequential cases each.Group of early time consisted of the first 10 cases,Group of medium term the subsequent 10 cases,and Group of later time the last 10 cases.The clinical evaluation data included operative time,length of hospital stay,leg and back pain visual analogue scale (VAS),and complications.ResultsAll patients were observed prospectively for (1.61±0.22) years.There was no measurable intraoperative bleeding,no postoperative infections and symptomatic recurrences in the three groups.Compared to group of early time,the operative time in group of medium term was significantly decreased(P＜0.05).The patients in group of later time had much less operative time than that in group medium term(P＜0.05).There was no significant difference with length of hospital stay between the three groups (P＞0.05).The improvement of leg and back VAS in each group was similar:there was a significant improvement 3 months post-operation compared with pre-operation (P ＜0.05),but no statistical difference between 3 months post-operation and final foliow-up(P＞0.05).The complication rate was 12.5％ for group of early time,10％ for group of medium term,and 0 for group of later time.There were two cases conversed to an open procedure for group of early time compared with 0 cases in both other groups.ConclusionExcellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by full endoscopic technique.However,attention must be paid to the steep learning curve with use of this complex technique.Obtaining microsurgical experience and suitable patient selection can help shorten the learning curve and decrease the complications.