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@#Most salivary gland stones involve the submandibular gland, which often cause recurrent swelling and pain of the glands after meals, and used to be the main reasons for the gland removals. With the trend of minimally invasive treatment, gland preservation and functional recovery in the diagnosis and the treatment of submandibular lithiasis have been paid more and more attention. New equipment and technologies such as CBCT and sialendoscopy, which are widely used in clinical practice, have contributed a lot to the accurate orientation and minimally invasive treatment of stones, and enriched the managements of submandibular lithiasis. Based on our experience and the review of relevant literature, this paper attempts to summarize the treatment strategies for submandibular stones distributed in different parts of the duct: ① emphasizing on the integrity and functions of the organ; ② endoscopy and minimal invasiveness come first; ③ scientific classifications and personal managements. Appropriate treatment options should be selected according to the features of the stones: endoscopic lithotomy helps a lot in removing those located in the anterior or middle part of the duct; endoscopic lithotomy or/and sialolithotomy are needed according to the features of hilar stones; the regular follow-up is required for the intraglandular stones. Meanwhile, the evaluation of the gland function is also important. After the removals of sunmandibular stones, the functions of the glands should be promoted to restore as far as possible.
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The tumor contains abundant new vessels, which are unevenly distributed, irregular, and branch-disordered. Angiopoietin (Ang) and tyrosine kinase receptor Tie mediate stable maturation of angiogenesis. Ang1 mainly plays a role in promoting vascular stabilization, and Ang2 is highly expressed in vessels, which makes the structure and function of vessels abnormal. Leaked vessels provide opportunities for invasion and metastasis of circulating tumor cells. Targeting the Ang/Tie axis to correct the abnormal state of vessels and promote its normalization, combined with chemotherapy drugs or immunotherapy, play a synergistic effect against tumors. This article summarizes the role of Ang/Tie axis in tumor angiogenesis and metastasis, and it aims to provide new ideas and strategies for clinical treatment of tumors.
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Since the outbreak of the COVID-19 pandemic in early December 2019, 81 174 confirmed cases and 3242 deaths have been reported in China as of March 19, 2020. The Chinese people and government have contributed huge efforts to combat this disease, resulting in significant improvement of the situation, with 58 new cases (34 were imported cases) and 11 new deaths reported on March 19, 2020. However, as of March 19, 2020, the COVID-19 pandemic continues to develop in 167 countries/territories outside of China, and 128 665 confirmed cases and 5536 deaths have been reported, with 16 498 new cases and 817 new deaths occurring in last 24 hours. Therefore, the world should work together to fight against this pandemic. Here, we review the recent advances in COVID-19, including the insights in the virus, the responses of the host cells, the cytokine release syndrome, and the therapeutic approaches to inhibit the virus and alleviate the cytokine storm. By sharing knowledge and deepening our understanding of the virus and the disease pathogenesis, we believe that the community can efficiently develop effective vaccines and drugs, and the mankind will eventually win this battle against this pandemic.
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Humans , Betacoronavirus , China , Epidemiology , Coronavirus Infections , Epidemiology , Therapeutics , Pandemics , Pneumonia, Viral , Epidemiology , TherapeuticsABSTRACT
An increasing number of studies have shown that intestinal microbes play an important role in maintaining liver homeostasis. The liver is closely linked to the intestine through the portal vein, and the transfer of intestinal microbcs, and their metabolites to the liver can affect the normal physiological function of the liver. Willi the deepening of research on intestinal microbes in recent years, a large number of studies have found that intestinal microbes play an important role in the development of chronic liver diseases. and more and more studies have shown that the regulation of intestinal microbes may be a potential therapeutic target for chronic liver diseases. This article summarizes the role of intestinal microbes in the development of chronic liver diseases and its related mechanisms in recent years, aiming to provide a reference for the prevention and treat-ment of chronic liver diseases.
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ABSTRACT Gait disorders may be associated with cognitive impairment, and slow speed predicts cognitive impairment and dementia. Objective: To investigate the relationships between cognitive function and gait performance in patients with Parkinson's disease (PD) who attended a hospital neurorehabilitation program. Methods: Descriptive and inferential statistics (Pearson's correlation) were used for data analysis. The cognitive functions were evaluated through Digit Span, Mental Control, Trail Making Test, Phonemic Verbal Fluency Task, and Addenbrooke's Cognitive Examination III. The motor function was assessed through 10-meter walk test, Mini BESTest and Timed Up and Go Test. Results: A total of 65 patients were included in this study. Of these, 66.15% were males, mean age was 61.14 (8.39) years, mean educational was 12 (8) years, disease progression time was 5.45 (4.37) years. 64.61% were in stages I and II of the Hoehn and Yahr stage. The correlation analyses showed that balance skills are significantly correlated with the ability to switch attention between two tasks and visuospatial function. The function mobility showed a significant correlation with cognitive tests. Conclusion: Data suggest the importance of the aspects of switch attention and mental flexibility in gait, evidencing the greater difficulty for double tasks.
RESUMO Alterações na marcha podem estar associadas ao comprometimento cognitivo, e a velocidade lenta prediz comprometimento cognitivo e demência. Objetivo: Investigar as relações entre a capacidade cognitiva e o desempenho da marcha em pacientes com doença de Parkinson (DP) que participaram de um programa de neurorreabilitação hospitalar. Métodos: A estatística descritiva e inferencial (correlação de Pearson) foi utilizada para análise dos dados. As funções cognitivas foram avaliadas por meio do Teste de Extensão de Dígitos, Controle Mental, Teste de Trilha, Tarefa de Fluência Verbal Fonêmica, Exame Cognitivo de Addenbrooke III. A função motora foi avaliada através do teste de caminhada de 10 metros, Mini BESTest e Timed Up and Go Test. Resultados: Um total de 65 pacientes foi incluído neste estudo. Destes, 66,15% eram do sexo masculino, com média de idade de 61,14 (8,39) anos, com escolaridade média de 12 (8) anos, tempo de evolução da doença de 5,45 (4,37) anos. 64,61% estavam nos estágios I e II do estágio Hoehn e Yahr. As análises de correlação mostraram que as habilidades de equilíbrio estão significativamente correlacionadas com a capacidade de alternar a atenção entre duas tarefas e a função visuoespacial. A função mobilidade apresentou correlação significativa com os testes cognitivos. Conclusão: Os dados sugerem a importância dos aspectos de troca de atenção e flexibilidade mental na marcha, evidenciando a maior dificuldade para tarefas duplas.
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Humans , Parkinson Disease , Therapeutics , CognitionABSTRACT
Objective:To investigate the regularity of cervical lymph node metastasis of hypopharyngeal carcinoma and its influence on patient prognosis,to guide the therapeutic strategies for hypopharyngeal carcinoma.Methods:A total of 140 hypopharyngeal squmous cell carcinoma patients who received surgery in Tianjin Medical University Cancer Institute and Hospital from January 2000 to December 2016 were analyzed retrospectively.χ2test was adopted for the analysis of the counting data,and Kaplan-Meier method was used for survival analysis,and the Cox regression model was used to analyze the factors affecting the prognosis.Results:The total rate of lymph node metastasis was 68.6% of the total 140 patients.The rate of occult lymph node metastasis in cN0 patients was 25.0%.The rate of bilateral lymph node metastases was 25%.The most common areas of lymph node metastasis are region II,Ⅲ,andⅣ.The rates of lymph node metastasis were 10.7%,10.4%,7.9% in regionⅠ,ⅤandⅥ,respectively.The total rate of extranodal extension were 66.7%.Univariate analysis showed that cervical lymph node metastasis was closely related to tumor pathological grade(P=0.012),and was not related to gender,age,primary tumor site,tumor T stage(P<0.05).The 3-year and 5-year overall survival rates of patients were 61.0% and 49.1%, respectively.Cox regression analysis showed that the diameter of metastatic lymph nodes(P=0.012),number(P=0.039),and extranodal extension(P=0.010)were significantly related to the survival of patients with hypopharyngeal carcinoma.When the diameter of metastatic lymph nodes≥2.8 cm,number≥2,with extranodal extension,the prognosis is poor.Conclusions:Hypopharyngeal carcinoma has a dismal prognosis,with high rate of lymph node metastasis.Cervical lymph node metastasis is an important factor of the prognosis.The active treatment strategy for the lymph nodes is the key to improve the therapeutic effect of hypopharyngeal carcinoma.
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Objectives:To observe the clinical features and factorsrelated to treatment decision for hospitalizedpatients with mitral regurgitation (MR). Methods:A total of 3 450 consecutivepatients with transthoracic echocardiography (TTE) confirmed moderate to severe MR admitted in our hospital from 2014-01-01 to 2015-12-31 were enrolled. Base on therapeutic method, the patients were divided into 2 groups:Surgery group, n=1 845 and Medication group, n=1 605. The baseline data including TTE results were collected, clinical features were compared between 2 groups and factors related to treatment decision were analyzed. Results:Mean age of this patient cohort was (54.8±13.8) years including 26.99% (931/3 450) patients aged ≥65 years. The most common etiology was primary MR, 324 (9.39%) patients were asymptomatic at admission and decreased left ventricular ejection fraction (LVEF) was evidenced in 55.28% (1 907) patients. Total in-hospital mortality was 0.75% (26). Compared with Medication group, the patients in Surgery group were younger ([52.65±12.01] years vs [57.39±15.25] years), prevalence of severe MR (56.69% vs 26.79%) and primary MR (89.49% vs 39.00%), as well as LVEF value ([61.62±9.20] % vs [48.00±17.53] %) were higher (all P＜0.001).Logistic regression analysis indicated that age (OR=0.561, 95% CI 0.503-0.627), MR etiology (OR=3.062, 95% CI 2.565-3.654), MR grade (OR=0.103, 95% CI 0.085-0.126) and LVEF (OR=2.478, 95% CI 2.147-2.860) were the determinants for treatmentdecision making in hospitalized patients with moderate to severe MR. Conclusions:In this patient cohort, there are considerable proportion of aged patients with moderate to severe MR. Primary MRis the major etiology. 46.52% patients received conservative therpay instead of surgery, older age,secondary MR, moderate MR and decreased LVEF are the major reasons for choosing conservative therapy in this patient cohort.
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Chronic kidney disease (CKD) is a major disease that threatens human health. With the progression of CKD, the risk of cardiovascular death increases, which is associated with the elevated levels of uremic toxins (UTs). Representative toxins such as indoxyl sulfate and p-cresyl sulfate are involed in CKD progression and cardiovascular events inseparable from the key role of endothelial dysfunction. The therapeutic strategies of UTs are aimed at signaling pathways that target the levels and damage of toxins in modern medicine. There is a certain relevance between toxins and "turbid toxin" in the theory of Chinese medicine (CM). CM treatments have been demonstrated to reduce the damage of gut-derived toxins to the heart, kidney and blood vessels. Modern medicine still lacks evidence-based therapies, so it is necessary to explore the treatments of CM.
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Humans , Intestinal Mucosa , Metabolism , Medicine, Chinese Traditional , Renal Insufficiency, Chronic , Drug Therapy , Signal Transduction , Toxins, Biological , Metabolism , Uremia , MetabolismABSTRACT
ABSTRACT Human epidermal receptors (HER1/2/3/4) belong to the class of receptor-type tyrosine kinases. After binding a ligand, dimerization, it will ocurr activation of intracellular kinases after two-dimensional and cytoplasmic tail reciprocal transphosphorylation. This transphosphorylation recruits signaling pathways such as Ras/Raf/MEK/Erk1-2, PI3-K/AKT and JAK/STAT, which can affect the cell cycle, cytoskeleton reorganization, apoptosis, metastasis, differentiation, angiogenesis and transcription. HER deregulation is found in epithelial, mesenchymal and nervous neoplasms and is associated with poor prognosis and tumor severity. Since HER are promiscuous proteins when subjected to mutations, resultant modifications confer cellular metabolic superiority and activate complex, interconnected and overlapping networks of cytoplasmic signaling. Moreover, overexpression of HER1/2 is involved in tumor resistance to radiation and anti-hormone therapies. Indeed, HER2 expression is up to 100-fold higher in 25-30% of invasive breast cancers. These characteristics support the development of resistance to anti-HER1/2 chemotherapy such as monoclonal antibodies and tyrosine kinase inhibitors. Then, the challenges in research with HER-positive cancers include planning therapeutic strategies against known resistance mechanisms and identifying novel mechanisms as a way to overcome and control cell growth and malignant progression.
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Protein-Tyrosine Kinases , Molecular Biology/classification , Neoplasms , Signal Transduction , Receptor Protein-Tyrosine Kinases , Drug Therapy, Combination/statistics & numerical dataABSTRACT
The rapid development of immunotherapy has exceeded that of standard treatment modes, which include surgery, radio-therapy, chemotherapy, and targeted therapy. Immunotherapy is more durable and less toxic than traditional cancer therapies. More-over, immune checkpoint therapy is an important component of immunotherapy and has been evaluated in preclinical and clinical tri-als and proven to exhibit broad prospects. However, its clinical benefits are limited to a small subset of patients with a subset of tumor types. Therefore, reasonable comprehensive therapeutic strategies are needed to overcome this limitation. Gene targeted therapy, ra-diotherapy, chemotherapy, and tumor vaccine affect the immune system through different mechanisms, and these could provide theo-retical bases for comprehensive treatments. In this review, immune checkpoint therapy and its potential comprehensive therapies with other cancer treatments are introduced.
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Hepatitis B virus (HBV) infection has been one of the most important public health problems,however,no complete cure is currently available.Although interferon (IFN)-α has been clinically used as a drug for chronic hepatitis B therapy because of its advantages including a higher rate of HBsAg/HBeAg seroconversion and a lower rate of recurrence after cessation of treatment,only 20％ -40 ％ of patients respond well to IFN therapy,thus hampering its clinical application.In recent years,based on the in vitro HBV replication and infection cell models,animal models and patient cohort with hepatitis B and by using a variety of methods,studies have been made.On the one hand,to identify new mechanisms underlying the IFN-and IFN-induced genes-mediated anti-HBV activities and signaling transduction,on the other hand,to reveal the effect and mechanisms of HBV replication and viral proteins in regulating the innate immune signaling pathways and IFN induction and antiviral action,based on which new strategies and approaches for optimization of IFN-based therapy and for a HBV cure have been further explored.This review mainly introduces the research findings of author's group and the future development is prospected.
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Tomando dois casos clínicos como eixo condutor, discute-se a relação necessária entre processos de adoecimento psíquico e estratégias terapêuticas. O primeiro caso se caracteriza por um psiquismo tomado pelo barulho do embate ininterrupto com seu objeto interno/externo; o segundo, pelo silêncio de um mundo interno desertificado. A compreensão dos respectivos processos de adoecimento determina duas estratégias terapêuticas distintas: desativação do binômio angústia-defesa no primeiro caso e revitalização psíquica no segundo.
By building this paper upon two clinical vignettes, the author discusses the necessary relationship between the psychopathological processes and therapeutic strategies. The first case is characterized by a psyche that is taken by the noise of an uninterrupted collision with its internal/external object. The other case is characterized by the silence of an inner world that becomes desert. Understanding these cases and their respective psychopathological processes defines two different therapeutic strategies: deactivation of the anxiety-defense binomial (i.e., anxietydefense mechanisms) in the first case, and psychic revitalization in the second case.
Tomando dos casos como eje conductor, la autora analiza la relación necesaria entre los procesos psicopatológicos y la especificidad de las estrategias terapéuticas. El primer caso se caracteriza por una psique tomada por el ruido de la lucha ininterrumpida con su objeto interno/ externo; el segundo, por el silencio de un mundo interno desertificado. La comprensión de los procesos psicopatológicos determina las estrategias terapéuticas necesarias: la desactivación del binomio angustia-defensa en el primer caso, y la revitalización psíquica en el segundo.
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El trastorno por déficit atencional es una problemática que ha aumentado su prevalencia en la población infanto juvenil chilena. La preocupación respecto del mismo se relaciona con el impacto en el desarrollo evolutivo del niño, resultando imprescindible un diagnóstico oportuno que permita acceder a un tratamiento adecuado a las necesidades del niño. El presente artículo se centrará en las principales estrategias terapéuticas basadas en la evidencia para su abordaje, junto con el desarrollo de una propuesta psicoterapéutica desde el constructivismo evolutivo.
Attention deficit disorder is a disease that has increased its prevalence in Chilean children and adolescents. It is of concern because of its impact on child development; that is why early diagnosis is essential to allow access to a treatment adjusted to focus on each child Ìs needs. This article will focus on evidence-based therapeutic strategies and the development of a psychotherapeutic proposal from the developmental constructivism perspective.
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Humans , Child , Adolescent , Psychotherapy/methods , Attention Deficit Disorder with Hyperactivity/therapy , Attention Deficit Disorder with Hyperactivity/drug therapyABSTRACT
Cardiovascular disease is a serious threat to human health and quality of life ,and it has become the leading cause of death in human.Thus,looking for effective drugs to reduce the mortality and morbidity of such a disease has become a problem to be solved.Due to its good efficacy of activating blood circula-tion and dissipating blood stasis,salvia miltiorrhiza has been widely used in the treatment of cardiovascular disease and ob-tained a good curative effect.Salvianolic acid B is one of the main water-soluble components of salvia miltiorrhiza extract and studies have shown that salvianolic acid B possesses many biolog-ical activities,which not only has a good protective effect on my-ocardial infarction,but could significantly alleviate myocardial ischemia-reperfusion injury.This article reviews the research progress of salvianolic acid B in cardiovascular diseases,and al-so includes discussion about the mechanisms of salvianolic acid B in the regulation of cardiovascular diseases,which may provide references for follow-up research and clinical treatment.
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El material que se presenta es parte de una investigación en curso, respecto de las intervenciones de médiums durante sesiones de videncia con consultantes que padecen un estado de duelo prolongado por la muerte de una persona querida. En este caso se trata de un duelo familiar, de difícil tramitación. Los consultantes, una pareja, han perdido a su hijo adolescente en un accidente automovilístico. Se comentan los resultados del análisis de una sesión de clarividencia protagonizada por el médium Gordon Smith con Colin y Pat, padres del joven fallecido -el video documental fue presentado en Mediums, the New Therapists, programa emitido por la señal del canal Infinito-.Se analizan las intervenciones del médium a partir de los deseos en los actos del habla -escenas desplegadas- y sus probables funciones, las que permiten realizar hipótesis acerca del modo en que ejerce con eficacia la función sanadora. También se analizan los deseos del médium en el nivel de las palabras, cuestión que nos orienta en cuanto a su disposición subjetiva. Finalmente, se analizan los componentes paraverbales y los desempeños motrices en los episodios de mediumnidad. Se discuten los resultados obtenidos. El método de investigación es el Algoritmo David Liberman ADL-.
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Speech , Parapsychology , Grief , Psychoanalysis , Psychology , Spiritual TherapiesABSTRACT
Patients with advanced lung cancer should be given proper hospice care .Doctors should not only practice protective medicine on the foundation of laws and regulations , informing the patients about their conditions tactfully , but also try their best to provide the patients with optimal therapeutic strategies , taking the patient's physi-cal tolerance, economy, etc.into account and achieving the goal of humanized and individualized therapy .Mean-while, the construction of professional medical -nursing institution is in urgent need .Only providing general nurs-ing in multiple aspects of illness , mental health , social functions , can we relieve the pain both physically and men-tally, and improve the patient's quality of their terminal times .
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A esquistossomose mansônica é classificada pelo Ministério da Saúde como uma doença negligenciada, causada pelo trematódeo intravascular Schistosoma mansoni. As precárias condições de higiene estão diretamente relacionadas às áreas endêmicas, bem como à pobreza e ao baixo desenvolvimento econômico. Na atualidade, o praziquantel é o fármaco de escolha utilizado para o tratamento dessa patologia. No entanto, o mesmo é relativamente tóxico devido à sua baixa solubilidade, além de relatos acerca de parasitas resistentes ao tratamento. Nesse contexto, faz-se necessário buscar novas alternativas terapêuticas que possam ser utilizadas no tratamento dessa doença. Esta revisão trata da busca por uma nova quimioterapia e sugere a possibilidade de que formas mais adequadas de vetorização de medicamentos já existentes sejam capazes de associar vantagens terapêuticas ao fármaco de escolha para o tratamento proposto, de forma que a população infectada receba seus benefícios.
Manson´s schistosomiasis is classified by the Ministry of Health as a neglected disease caused by the intravascular trematode Schistosoma mansoni. Endemic areas are directly related to poor hygienic conditions, as well as poverty and a low level of economic development. Currently, praziquantel is the drug of choice used to treat this condition, but it is relatively toxic, due to its low solubility, and there are reports of the parasite developing resistance to the treatment. In this context, there is a need to search for new therapeutic agents that can be used to treat this disease. This review covers the search for a new chemotherapy and suggests the possibility that the best existing drug vectorization systems may be able to combine therapeutic advantages with the drug of choice for the treatment, to the benefit of the infected population.
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Schistosomiasis mansoni , Schistosoma/pathogenicityABSTRACT
Objective To investigate the incidence, main relative risk factors and preventive therapeutic strategies of hypertension. Methods Investigating the incidence, main relative risk factors and complications of hypertension at 520 inhabitants over 35 years with the way of Questionnaire survey at the Zhao incidence of hypertension complicated with coronary heart disease, analysis shows that smoking, drinking, high-fat diet, high-salt diet, no exercise and family history were main risk factors of hypertension. Conclusion The morbidity of hypertension in this community were higher, the main risk factors were smoking, drinking, high-fat diet, high-salt diet, no exercise and family history. Carry out regular health education in accordance with the main relative risk factors, establishing and improving personal health file, fulfil hierarchical management system gradually, promote a reasonable diet and raise the awareness of self-care had important effect in reducing the morbidity and improving the life quality in patients with hypertension. Meanwhile, it's a long-term and arduous task for Community Doctor.
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The target therapy of trastuzumab (herceptin) opened up a new way to the treatment of breast cancer. Nowadays at least 6 prospective randomized controlled trials (RCT) have proved that trastuzumab could significantly prolong the disease free survival (DFS) and overall survival (OS) of Her-2 positive early breast cancer patients. This article summarized these data and gave the basic principles and strategies of adjuvant therapy with trastuzumab for our daily clinical practice.
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Neuropathic pain is often refractory to intervention because of the complex etiology and an incomplete understanding of the mechanisms behind this type of pain. Glial cells, specifically microglia and astrocytes, are powerful modulators of pain and new targets of drug development for neuropathic pain. Glial activation could be the driving force behind chronic pain, maintaining the noxious signal transmission even after the original injury has healed. Glia express chemokine, purinergic, toll-like, glutaminergic and other receptors that enable them to respond to neural signals, and they can modulate neuronal synaptic function and neuronal excitability. Nerve injury upregulates multiple receptors in spinal microglia and astrocytes. Microglia influence neuronal communication by producing inflammatory products at the synapse, as do astrocytes because they completely encapsulate synapses and are in close contact with neuronal somas through gap junctions. Glia are the main source of inflammatory mediators in the central nervous system. New therapeutic strategies for neuropathic pain are emerging such as targeting the glial cells, novel pharmacologic approaches and gene therapy. Drugs targeting microglia and astrocytes, cytokine production, and neural structures including dorsal root ganglion are now under study, as is gene therapy. Isoform-specific inhibition will minimize the side effects produced by blocking all glia with a general inhibitor. Enhancing the anti-inflammatory cytokines could prove more beneficial than administering proinflammatory cytokine antagonists that block glial activation systemically. Research on therapeutic gene transfer to the central nervous system is underway, although obstacles prevent immediate clinical application.