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BACKGROUND:Extracorporeal shock wave therapy,as its potential benefits for various musculoskeletal diseases,has received widespread attention.Increasingly studies have demonstrated that it has excellent effects such as pain relief and functional recovery.However,bibliometric analysis in the domain of extracorporeal shock wave therapy for pain is relatively lacking. OBJECTIVE:To visually analyze the studies related to extracorporeal shock wave therapy for pain and to sort out the knowledge structure and explore its research status as well as hot trends in this field at home and abroad. METHODS:The publications related to extracorporeal shock wave therapy for pain from 2002 to 2022 in Web of Science Core Collection database and CNKI database were searched.Visual analysis using Citespace software was performed to produce the diagrams and interpret their meanings. RESULTS AND CONCLUSION:A total of 2 101 studies were included.The number of documents issued showed a fluctuating upward trend and the United States and China had certain advantages in the number of documents issued.The issuing institutions are mainly universities and hospitals and the issuing authors mostly belonged to independent teams.The exchange between issuing institutions and authors needed to be strengthened and the degree of cross-institutional and cross-regional cooperation was low.Keyword visual analysis indicated that extracorporeal shock wave therapy has been widely used in musculoskeletal diseases and further studies should focus on multidisciplinary in-depth study and observation of the clinical efficacy of combined therapy.The studies on the topic of extracorporeal shock wave therapy treating pain mainly focus on musculoskeletal diseases,including plantar fasciitis,scapulohumeral periarthritis,and tennis elbow.In recent years,combined treatment with ultrasound-guided injection therapy,traditional Chinese treatment techniques and expansion of new fields become research trends and hotspots of concern.
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AIM: To evaluate the therapeutic effect of emedastine difumarate eye drops combined with fluorometholone eye drops on allergic conjunctivitis.METHODS: Retrospective study. A total of 115 patients(230 eyes)with allergic conjunctivitis who received treatment from June 2020 to August 2022 were selected, and they were divided into the observation group(56 cases, 112 eyes)and the control group(59 cases, 118 eyes)according to whether to use fluorometholone eye drops combined with the conventional use of emedastine difumarate eye drops. The clinical symptoms and signs, tear film break-up time(BUT), corneal fluorescein staining score and complications of the two groups were observed before treatment and at 4 wk after treatment.RESULTS: After treatment, the scores of eye symptoms and signs in the two groups were decreased, and the observation group was lower than the control group(P<0.05); BUT of the two groups was longer than that before treatment, and the observation group was longer than that of the control group(P<0.05); The corneal fluorescein staining scores of the two groups decreased, and those of the observation group were lower than those of the control group(P<0.05); There was no significant difference in the total incidence of complications between the two groups after treatment(3.6% vs 5.1%; P>0.05).CONCLUSION: With high therapeutic safety and effectiveness, the combination of emedastine difumarate eye drops and fluorometholone eye drops in the treatment of allergic conjunctivitis can significantly reduce the patient's symptom and sign scores, prolong BUT, promote a decrease in corneal fluorescein staining scores, improve efficacy, and do not increase the risk of complications.
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Collateral vessels in cutaneous regions are the channel of qi， blood and body fluids transmission among the skin and striae and interstices， and is also the path of pathogens invasion. It is believed that the key pathogenesis of polymorphic light eruption （PLE） was toxins damaging to the skin， in which the cutaneous collaterals fail to nourish， insecurity of the muscle surface as the basis of disease， the pathogens offending qi collaterals and heat constraint to toxins as the driving factors， gradually affecting fluid collaterals and dryness-dampness coexist as the middle link， and latent pathogens in blood level and waiting for the opportunity to onset as the final stage. It is proposed that the basic treatment is to resolve toxins and tranquilize collaterals， and the internal and external treatments are combined together. The internal treatment is to resolve toxins， strengthen collaterals， and assist in unblocking the collaterals， and the modified self-prescribed Wuteng Decoction （五藤饮） plus Yigong Powder （异功散） were selected as the basic formulas， which promotes the discharge of toxin pathogens and strengthens the power of the cutaneous collaterals to protect against pathogens. For external treatment， according to the performance of skin lesions， scraping， tapping with medicinal solution， ointment were selected to drive away pathogens and resolve toxins， and soothe the cutaneous collaterals. In the early stage， the skin temperature rose with itching， tingling and no rash， scraping with the self-prescribed Yinhuangcao Clearing Oil （银黄草清解油） could be used to activate blood and regulate qi， relieve heat and resolve toxins； if the lesions showed erythema， pimples， itching， tapping with the self-prescribed Qian'ai Xunxi Formula （千艾熏洗方） could be used to diffuse qi and fluid， unblock the collaterals and clean toxins； if the skin lesions thickened with scales， the self-prescribed Yufu Ointment （愈肤膏） for external application could be used to resolve toxins and activate collaterals， moisten skin and heal up sore.
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The membranous tube of sanjiao （三焦） is not only the path of the transport of fluid and qi， but the way of the invasion of pathogenic factors， therefore， it cooperates with the skin mucous membrane physically and influence on each other pathologically. It is believed that the core pathogenesis of chronic urticaria is pathogens intruding sanjiao， membrane collaterals acute spasm， and fluid and qi disturbance， of which defense qi insufficiency and pathogens intruding sanjiao initiates the disease， while struggle between healthy and pathogenic qi and membrane collaterals acute spasm is the intermediate stage， and disturbed fluid， qi and blood movement is the terminal stage. Following the core treatment principle of dredging sanjiao， the internal treatment is to open striae and interstices and dispel pathogens out using self-made Guben Shufeng Decoction（固本疏风汤）modifications， and the external treatment is to dredge and regulate membrane collaterals， move qi and fluid， and treat sanjiao simultaneously， commonly using cutting therapy on Danzhong （RN 17） to move qi and fluid， seal umbilical therapy on Shenque （RN 8） to supplement and nourish ying-wei （营卫）， and natural moxibustion on Xuehai （SP 10） to move blood and unblock collaterals.
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Immune checkpoint inhibitors(ICIs)mainly including the CTL antigen 4(CTLA-4)and PD-1/PD-L1,which would offer a notable clinical benefit for non-small cell lung cancer(NSCLC)patients.By strengthening the antitumor immune re-sponse of the body,ICIs lead to immune-related adverse events(irAEs),including checkpoint inhibitor pneumitis(CIP).Although the clinical incidence of CIP is relatively low,some serious cases may prolong or terminate of immunotherapy,even life threateing.This article tries to summarize the clinical manifestations,pathological characteristics,biological mechanism,susceptible population,diagnosis and differential diagnosis,and integrated traditional Chinese and Western medicine treatment of CIP,in order to understand CIP more clearly.
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Breast cancer brain metastasis (BCBM) is the second most common brain metastasis cancer, which is usually characterized by multiple lesions. Radiotherapy is an important local treatment for BCBM, which includes stereotactic radiotherapy, whole brain radiotherapy (WBRT) combined with simultaneous integrated boost and WBRT (such as conformal WBRT and hippocampal avoidance - WBRT) . Meanwhile, systemic treatment of BCBM has progressed rapidly, showing a positive effect in delaying the incidence of brain metastases, maintaining asymptomatic or unprogressive brain metastases, and delaying initial or salvage local treatments. In recent years, some studies have shown that radiotherapy combined with systemic treatment for BCBM has better application prospect compared with radiotherapy alone. In this article, the radiotherapy progress of brain metastases, the role of systemic therapy in BCBM, and the clinical research of radiotherapy combined with systemic therapy were reviewed, aiming to provide some reference for clinical research in this field.
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Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 porciento) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 porciento de los casos y el control tumoral en el 80,7 porciento. El estado de la preservación auditiva solo fue informado en el 50 porciento de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta(AU)
Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 ) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 percent of cases; and tumor control, in 80.7 percent. Hearing preservation status was reported in only 50 percent of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior(AU)
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Humanos , Neuroma Acústico/diagnóstico por imagen , Literatura de Revisión como Asunto , Bases de Datos BibliográficasRESUMEN
【Objective】 To investigate the efficacy of in vitro local high-frequency hyperthermia combined with drugs in the treatment of type Ⅲb chronic prostatitis (CP). 【Methods】 A total of 148 patients with type Ⅲb CP treated in our hospital during Jun.2020 and Jun.2022 were randomly divided into control group (n=74) and combination group (n=74). The control group received only drug treatment, while the combination group received extracorporeal local high-frequency hyperthermia treatment. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum urinary flow rate (MFR), average urinary flow rate (AFR) and International Index of Erectile Function-5 (IIEF-5) score were compared between the two groups. 【Results】 There were no significant differences between the two groups in terms of NIH-CPSI, MFR, AFR and IIEF-5 score before treatment(P>0.05). After treatment, these indexes increased in both groups (P<0.05), and the improvements in the combination group were more significant (P<0.05). 【Conclusion】 Medication combined with in vitro local high-frequency hyperthermia is effective in improving the clinical symptoms of type Ⅲb CP, which is worth clinical promotion.
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Given the important position and function of the hypopharynx, the preservation of organ function and survival improvement are equally important. The optimal role of multi-disciplinary combined treatment modality becoming increasingly important. The optimal laryngeal preservation strategy for hypopharyngeal cancer is under continuous exploration. With the constant research of surgery, radiotherapy, chemotherapy, and molecular targeted therapy, new laryngeal preservation strategies continue to emerge. Herein, we primarily summarize the advances in multi-disciplinary combined treatment and the future direction in the treatment of hypopharyngeal carcinoma.
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As a basic source for the theoretical system of traditonal Chinese medicine （TCM）， the Inner Canon of Yellow Emperor （《黄帝内经》） made the point of “treatment with combination of diverse methods and prescriptions”，which is one of the characteristics of TCM in treating diseases. This paper discussed the therapeutic idea of “diverse methods and prescriptions” from five dimensions， including time， population， regions， diseases， and treatments， and proposed that “combined treatment” is an effective measure to embody the idea of “diverse methods and prescriptions”. That is to say， by taking the combination of the concept of holism and syndrome differentiation and treatment as the starting point， combining pharmacological and non-pharmacological therapies， and treating both internal and external diseases through multiple ways and methods， the goal to treat the disease at the root， and keep yin at peace and yang compact can be achieved. Finally， it is suggested to guide the clinical practice with “treatment with combination of diverse methods and prescriptions”， providing new ideas for clinical diagnosis and treatment.
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Social anxiety disorder is a common anxiety disorder in which a key feature is interpersonal avoidance accompanied by generalized problems with emotion identification and emotion regulation. In response to the gap in these therapeutic priorities in other therapies, emotion-focused therapy has emerged to fill the part of the treatment of emotions with an emphasis on the relational process. The paper reviews the recent studies related with the treatment of social anxiety disorder with emotion-focused therapy. The results suggest that the main points of social anxiety onset in an emotion-focused perspective are traumatic emotional experiences and self-criticism, and that the therapeutic focus of emotion-focused therapy is on dealing with the traumatic emotional scenario behind the anxiety and exposing it to adaptive emotions to be transformed. It also works better in combination with other more mainstream therapies. This suggests that emotion-focused therapy is a promising approach for the clinical treatment of social anxiety disorder and looks forward to the development of a more integrated treatment approach in the clinic.
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Resumen La leishmaniasis tegumentaria en Bolivia es producida mayoritariamente por L. braziliensis. Las manifestaciones clínicas son ulceras, que pueden generar lesiones satélites próximas a la inicial. Las drogas de primera elección para el tratamiento son los antimoniales pentavalentes; aunque con una eficacia variable. La falta de respuesta a estas drogas, induce al empleo de otras, consideradas como de segunda elección. Sin embargo, en todos los casos existe la posibilidad de falla terapéutica. El presente caso muestra la remisión de las lesiones usando tratamiento combinado de pentamidina, miltefosina y paromomicina, en un paciente con antecedente de falta de respuesta a la monoterapia con Glucantime®. La remisión de la enfermedad alcanzada al final de la terapia, probablemente sea resultado de la acción lítica simultánea de las tres drogas utilizadas y a la restauración de la respuesta inmune del paciente. Hasta los 21 meses de control pos tratamiento, todas las lesiones se mantuvieron cicatrizadas y ausencia de otras nuevas.
Abstract The tegumentary leishmaniasis in Bolivia is mainly caused by L. braziliensis. The clinical manifestations are ulcerative lesions which can generate satellite lesions close to the initial one. The first choice drugs for treatment are pentavalent antimonials; although with variable effectiveness. Lack of response to these drugs leads to the use of other alternatives, considered as second-choice drugs. However, in all cases there is the possibility of therapeutic failure. The present case shows the remission of the lesions using a combined treatment of pentamidine, miltefosine and paromomycin, in a patient with a history of lack of response to monotherapy with Glucantime® The remission of the disease achieved at the end of combined therapy is probably the result of the simultaneous lytic action of the three drugs used and the restoration of the patient's immune response. Up to 21 months of post-treatment control, all the lesions remained healed and the absence of new ones.
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@#Indocyanine green (ICG) is a fluorescence indicator characterized by low trauma, a long effect time, low cytotoxicity, and high imaging resolution. It has been widely used in biomedical applications. However, ICG is not widely used in the treatment of oral cancer. This article reviews the application of ICG in the diagnosis and treatment of oral cancer. The results of a literature review showed that in the diagnosis and treatment of oral cancer, ICG mainly plays a role through the enhanced permeability and retention (EPR) effect of fluorescent substances and in coupling with various tumor-specific antibodies. For tumor visualization, ICG can focus on the primary tumor and lymph node metastasis by coupling the specific tumor antibodies and the EPR effect to guide the complete resection of the primary tumor and the determination of neck lymphadenectomy. In the reconstruction of the oral, head and neck regions, semi-quantitative measurement of ICG fluorescence intensity can be used to design a guide for a vascularized flap during the operation, for early detection of flap crisis after the operation, and to guide clinical flap exploration opportunities. In nonsurgical treatments of oral cancer, such as photothermal therapy and photodynamic therapy, ICG, as an important component of photosensitive nanomaterials, has attracted the attention of many scholars. ICG has good application prospects in the resection, reconstruction, visualization and nonsurgical treatment of oral cancer.
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BACKGROUND: In recent years, some scholars have proposed the use of medial femoral neck support plate combined with cannulated screw internal fixation to treat Pauwels type III femoral neck fracture. This method can reduce the incidence of complications such as nonunion of the femoral neck fracture and femoral head necrosis. However, it is still controversial whether this treatment can accelerate fracture healing and reduce femoral head necrosis in clinic. OBJECTIVE: Meta-analysis was performed to evaluate the difference in the efficacy of femoral medial support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation for the treatment of Pauwels type III femoral neck fracture. METHODS: Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search for and collect the clinical Chinese and English literature of the trials regarding Pauwels III femoral neck fracture treated with internal femoral support plate combined with cannulated screw internal fixation and simple cannulated screw internal fixation. Two evaluators independently conducted quality evaluation, data extraction and cross-checking of the included studies, and finally performed meta-analysis on the collected data using RevMan 5.3 software. RESULTS AND CONCLUSION: (1) After screening, 5 related clinical trials were included, including 4 randomized controlled trials and 1 retrospective cohort study, for a total of 243 patients with Pauwels III femoral neck fracture. (2) Meta-analysis results showed that compared with simple cannulated internal fixation, operation time was longer [MD=23.19, 95%C/(8.32, 38.06), P=0.002], intraoperative blood loss was more [MD=83.48, 95%C/(32.08, 134.89), P=0.001], and healing time was shorter [MD=-1.56, 95%C/(-1.89, -1.24), P < 0.000 01], the incidence of complications was lower [RD=-0.07, 95%C/(-0.11, -0.02), P=0.003], and hip Harris score was higher [MD=7.39, 95%C/(3.18, 60), P=0.000 6] in the femoral medial support plate combined with cannulated screw internal fixation. However, there was no statistically significant difference in the excellent and good rate of hip function between the two treatments [OR=1.29, 95%C/(0.02, 74.86), P=0.90]. (3) In the treatment of Pauwels type III femoral neck fracture, compared with simple cannulated nail fixation, cannulated screws combined with medial support plate can shorten healing time, reduce postoperative complications and elevate postoperative Harris score.
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BACKGROUND: Comparative study results between the treatment efficiency of acupuncture plus other combination therapy and western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focus on comparison of the efficacy between single acupuncture treatment, acupuncture plus western medicine combination therapy and western medicine, but there is a lack of investigation on acupuncture combined with other therapies. It is difficult to fully understand the efficacy of acupuncture. OBJECTIVE: To compare the effects of acupuncture therapy, conventional western medicine and Chinese medicine on osteoporosis treatment by network meta-analysis. METHODS: A search was performed on the CNKI, VIP, WanFang, SinoMed, PubMed, and Cochrane Library databases to include the randomized controlled trials of different acupuncture treatments for osteoporosis. Relevant data were extracted after screening the literature according to relevant inclusion and exclusion criteria, and the quality of the included literature was evaluated. Literature data analysis and mapping were performed using Stata 14.0 software. RESULTS AND CONCLUSION: Thirty-four randomized controlled trials were included, involving seven interventions, such as single acupuncture treatment, single western medicine treatment, single Chinese medicine treatment, acupuncture plus western medicine combination therapy, acupuncture plus Chinese medicine combination therapy, Chinese medicine + western medicine treatment, acupuncture + Chinese medicine + western medicine combined treatment. (1) In the treatment efficiency, acupuncture combined with traditional Chinese medicine is the best in the treatment of primary osteoporosis, and acupuncture combined with traditional Chinese medicine, acupuncture combined with western medicine and acupuncture combined with traditional Chinese medicine western medicine were significantly better than traditional Chinese medicine combined with western medicine (P 0.05). In the included studies, a very small number of patients developed acupuncture and blood stasis after acupuncture, but no fainting or unreported, and no other side effects were found. To conclude, acupuncture combined with other therapies can improve the efficiency, increase the bone mineral density and alleviate pain.
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@#AIM: To observe the effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis. <p>METHODS: Forty cases(80 eyes)of grade II-Ⅳ CCH with liver-kidney Yin deficiency were randomly divided into two groups: combined treatment group and artificial tears group, which were treated with Qi Jing Mingmu decoction combined with artificial tears and simple artificial tears respectively. The international ocular surface disease index(OSDI), tear break-up time(BUT)and Schirmer Ⅰ test(SⅠt)were observed and the clinical effects were compared after 3mo treatment. For CCH patients with grade III or above, followed up for 3mo or more and willing to operate, the loose conjunctival tissue was removed and the cell aging related β-gal staining was performed on frozen sections. The results were statistically analyzed. <p>RESULTS: The OSDI score(14.53±2.68), BUT 9.25±3.02s and SⅠt(8.95±3.57mm/5min)of combined treatment group were significantly better than those of artificial tears group after 3mo treatment(all <i>P</i><0.05). After drug treatment, 7 cases(7 eyes)in artificial tears group and 4 cases(4 eyes)in combined treatment group of CCH patients were treated by operation. The positive rate of aging cells in combined treatment group was significantly lower than that in artificial tears group(16.00±7.84 <i>vs </i>39.00±14.09, <i>P</i>=0.013).<p>CONCLUSION: Qi Jing Mingmu decoction combined with artificial tears to treat CCH is more effective than simple artificial tears in relieving ocular symptoms, improving tear film and promoting tear secretion. Combined treatment can also reduce the cell aging in CCH, which can be used as a safe and effective treatment method in addition to surgical operation.
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@#AIM: To observe the effects of Qi Jing Mingmu decoction combined with artificial tears on the clinical results and cell aging of conjunctivochalasis. <p>METHODS: Forty cases(80 eyes)of grade II-Ⅳ CCH with liver-kidney Yin deficiency were randomly divided into two groups: combined treatment group and artificial tears group, which were treated with Qi Jing Mingmu decoction combined with artificial tears and simple artificial tears respectively. The international ocular surface disease index(OSDI), tear break-up time(BUT)and Schirmer Ⅰ test(SⅠt)were observed and the clinical effects were compared after 3mo treatment. For CCH patients with grade III or above, followed up for 3mo or more and willing to operate, the loose conjunctival tissue was removed and the cell aging related β-gal staining was performed on frozen sections. The results were statistically analyzed. <p>RESULTS: The OSDI score(14.53±2.68), BUT 9.25±3.02s and SⅠt(8.95±3.57mm/5min)of combined treatment group were significantly better than those of artificial tears group after 3mo treatment(all <i>P</i><0.05). After drug treatment, 7 cases(7 eyes)in artificial tears group and 4 cases(4 eyes)in combined treatment group of CCH patients were treated by operation. The positive rate of aging cells in combined treatment group was significantly lower than that in artificial tears group(16.00±7.84 <i>vs </i>39.00±14.09, <i>P</i>=0.013).<p>CONCLUSION: Qi Jing Mingmu decoction combined with artificial tears to treat CCH is more effective than simple artificial tears in relieving ocular symptoms, improving tear film and promoting tear secretion. Combined treatment can also reduce the cell aging in CCH, which can be used as a safe and effective treatment method in addition to surgical operation.
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Abstract This study assessed the performance of two pilot units, a conventional activated sludge (CAS) and an Integrated Fixed-Film Activated Sludge (IAS), in the treatment of leachate from sanitary landfill combined with domestic sewage, with the aim of removing organic substances. In order to assess the possible impacts on treatment, three experimental phases were designed using influent leachate contributions of 5%, 10%, and 20% of the total BOD load. Overall, the results showed that no significant changes in the behavior of biological processes. The IAS unit presented average BOD removal efficiencies of above 88%, 87% and 80% for the three leachate load contributions of 5%, 10% and 20% studied. The CAS unit presented lower average efficiency with a 5% leachate contribution (64%), but displayed a similar performance to the IAS unit in the other phases (82% and 80%); similar quantitative aspects were observed for both treatment processes with regards to biomass composition analysis. The kinetic coefficients related to heterotrophic metabolism did not indicate negative effects on treatment efficiency as a result of the increase in leachate addition, with values of 2.8; 2.8 and 2.7 d-1 obtained respectively for each phase with the CAS unit, and 2.0; 1.5 and 1.6 d-1 with the IAS unit, representing similar values to those found in the literature (1.5 a 5.0 d-1). The results reinforced the conclusion that the leachate load introduced did not cause inhibition or significant alterations to heterotrophic metabolism, and, therefore, to the removal of organic matter.
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Humanos , Animales , Contaminantes Químicos del Agua/metabolismo , Líquido Percolado , Lodos Activados , /métodos , Biomasa , Proyectos Piloto , Reactores Biológicos , Bacterias Heterotróficas , Materia OrgánicaRESUMEN
Abstract Objective To evaluate the factors associated with the need for insulin as a complementary treatment to metformin in pregnant women with gestational diabetes mellitus (GDM). Methods A case-control study was performed from April 2011 to February 2016 with pregnant women with GDM who needed complementary treatments besides diet and physical exercise. Those treated with metformin were compared with those who, in addition to metformin, also needed the combination with insulin. Maternal characteristics and glycemic control were evaluated. Multinomial logistic regression models were developed to evaluate the influence of different therapies on neonatal outcomes. Results A total of 475 pregnant women who needed pharmacological therapy were evaluated. Of these, 366 (77.05%) were submitted to single therapy with metformin, and 109 (22.94%) needed insulin as a complementary treatment. In the analysis of the odds ratio (OR), fasting glucose (FG)<90 mg/dL reduced the odds of needing the combination (OR: 0.438 [0.235-0.815]; p=0.009], as well as primiparity (OR: 0.280 [0.111-0.704]; p=0.007]. In obese pregnant women, an increased chance of needing the combination was observed (OR: 2,072 [1,063-4,039]; p=0,032). Conclusion Obesity resulted in an increased chance of the mother needing insulin as a complementary treatment to metformin, while FG<90 mg/dL and primiparity were protective factors.
Resumo Objetivo Avaliar os fatores associados à necessidade de insulina como tratamento complementar à metformina em gestantes com diabetes mellitus gestacional (DMG). Métodos Um estudo caso-controle foi realizado de abril de 2011 a fevereiro de 2016 comgestantes portadoras de DMG que necessitaram de tratamentos complementares além de dieta e exercícios físicos. Aquelas tratadas commetformina foram comparadas com aquelas que, além da metformina, também precisaram de combinação com insulina. Foram avaliadas as características maternas e de controle glicêmico. Modelos de regressão logística multinomial foram construídos para avaliar a influência das diferentes terapias nos desfechos neonatais. Resultados Foram avaliadas 475 gestantes que necessitaram de terapia farmacológica. Destas, 366 (77,05%) utilizaram terapia única com metformina, e 109 (22,95%) necessitaram de insulina como tratamento complementar. Na análise da razão de possibilidades (RP), a glicemia de jejum (GJ)<90mg/dL reduziu as chances de necessidade da combinação (RP: 0,438 [0,235-0,815]; p=0,009), bem como a primiparidade (RP: 0,280 [0,111-0,704]; p=0,007). Em gestantes obesas, foi observada uma chance maior de necessidade da combinação (RP: 2.072 [1.063-4.039]; p=0,032). Conclusão A obesidade resultou em um aumento na chance de a mãe precisar de insulina como tratamento complementar à metformina, enquanto a GJ<90 mg/dL e a primiparidade foram fatores de proteção.
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Humanos , Femenino , Embarazo , Adulto , Diabetes Gestacional/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Metformina/uso terapéutico , Paridad , Glucemia/metabolismo , Estudios de Casos y Controles , Diabetes Gestacional/dietoterapia , Diabetes Gestacional/sangre , Quimioterapia Combinada , Terapia por Ejercicio , Obesidad Materna/complicaciones , Obesidad Materna/dietoterapia , Obesidad Materna/sangreRESUMEN
Bullous pemphigoid is a chronic obstinate dermatological disease. Hormone is the main therapeutic method, but the disease course is rather long, relapse is frequently seen and difficult to be radically cured; many complications may occur such as pulmonary infection, etc. From traditional Chinese medicine (TCM) basic principal points of view "lung governing skin and hair" and "strengthen the body resistance to eliminate pathogenic factors", the author explored the TCM therapy of bullous pemphigoid. By using clearing away lung heat and invigorating lung qi as the main principles supplemented by invigorating spleen and kidney, eliminating phlegm and blood stasis for treatment of such disease, relatively satisfactory therapeutic results were obtained.