尼莫地平联合亚低温疗法治疗SAH后脑血管痉挛的疗效观察

目的探讨尼莫地平联合亚低温疗法治疗蛛网膜下腔出血(SAH)后脑血管痉挛的疗效。方法 93例SAH后脑血管痉挛患者随机分为两组。在常规治疗基础上,对照组采用亚低温疗法治疗,观察组采用尼莫地平联合亚低温疗法治疗。比较两组的治疗效果。结果观察组的总有效率为95.74%,高于对照组的80.43%(P <0.05)。治疗后,观察组的IL-6、 TNF-α、 hs-CRP水平均低于对照组,动脉平均血流速度高于对照组(P <0.05)。结论尼莫地平联合亚低温疗法治疗SAH后脑血管痉挛的效果显著,可有效抑制机体炎性反应,提升动脉平均血流速度。     

Myricetin as a Promising Molecule for the Treatment of Post-Ischemic Brain Neurodegeneration

The available drug therapy for post-ischemic neurodegeneration of the brain is symptomatic. This review provides an evaluation of possible dietary therapy for post-ischemic neurodegeneration with myricetin. The purpose of this review was to provide a comprehensive overview of what scientists have done regarding the benefits of myricetin in post-ischemic neurodegeneration. The data in this article contribute to a better understanding of the potential benefits of myricetin in the treatment of post-ischemic brain neurodegeneration, and inform physicians, scientists and patients, as well as their caregivers, about treatment options. Due to the pleiotropic properties of myricetin, including anti-amyloid, anti-phosphorylation of tau protein, anti-inflammatory, anti-oxidant and autophagous, as well as increasing acetylcholine, myricetin is a promising candidate for treatment after ischemia brain neurodegeneration with full-blown dementia. In this way, it may gain interest as a potential substance for the prophylaxis of the development of post-ischemic brain neurodegeneration. It is a safe substance, commercially available, inexpensive and registered as a pro-health product in the US and Europe. Taken together, the evidence available in the review on the therapeutic potential of myricetin provides helpful insight into the potential clinical utility of myricetin in treating neurodegenerative disorders with full-blown dementia. Therefore, myricetin may be a promising complementary agent in the future against the development of post-ischemic brain neurodegeneration. Indeed, there is a scientific rationale for the use of myricetin in the prevention and treatment of brain neurodegeneration caused by ischemia.     

A Vicious Cycle of Osteosarcopenia in Inflammatory Bowel Diseases—Aetiology,Clinical Implications and Therapeutic Perspectives

Sarcopenia is a disorder characterized by a loss of muscle mass which leads to the reduction of muscle strength and a decrease in the quality and quantity of muscle. It was previously thought that sarcopenia was specific to ageing. However, sarcopenia may affect patients suffering from chronic diseases throughout their entire lives. A decreased mass of muscle and bone is common among patients with inflammatory bowel disease (IBD). Since sarcopenia and osteoporosis are closely linked, they should be diagnosed as mutual consequences of IBD. Additionally, multidirectional treatment of sarcopenia and osteoporosis including nutrition, physical activity, and pharmacotherapy should include both disorders, referred to as osteosarcopenia.     

Incretin Hormones in Obesity and Related Cardiometabolic Disorders: The Clinical Perspective

The prevalence of obesity continues to grow rapidly worldwide, posing many public health challenges of the 21st century. Obese subjects are at major risk for serious diet-related noncommunicable diseases, including type 2 diabetes mellitus, cardiovascular disease, and non-alcoholic fatty liver disease. Understanding the mechanisms underlying obesity pathogenesis is needed for the development of effective treatment strategies. Dysregulation of incretin secretion and actions has been observed in obesity and related metabolic disorders; therefore, incretin-based therapies have been developed to provide new therapeutic options. Incretin mimetics present glucose-lowering properties, together with a reduction of appetite and food intake, resulting in weight loss. In this review, we describe the physiology of two known incretins—glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), and their role in obesity and related cardiometabolic disorders. We also focus on the available and incoming incretin-based medications that can be used in the treatment of the above-mentioned conditions.     

Impact of Mixed Cognitive Intervention Training on Early Onset Dementia

ObjectivesThe aim of this study was to investigate the impact of mixed cognitive intervention training using spaced retrieval training, and errorless learning in participants with early onset dementia. This was based on reality orientation therapy for cognitive function, depression, and occupational performance of patients.MethodsTwo early onset vascular dementia patients (> 65 years) with mild or moderate impairment were enrolled in a pre-test - post-test single-subject research design study. Prior to the study, the caregivers were interviewed about meaningful times, people, places, and areas of interest for the participant. A list of individual training words were selected based upon this information, and the participant was instructed to recall them after a 45-second, 90-second, 6-minute, and 12-minute delay. Baseline (3 sessions), intervention (20 sessions), and a second baseline period (3 sessions) were conducted. Activities of daily living were measured, and cognition was measured using the Consortium to Establish a Registry of Alzheimer’s Disease Korean version, whilst depression was measured using the Korean Form Geriatric Depression Scale, and task performance and satisfaction measured by the Canadian Occupational Performance Measure.ResultsAfter intervention, both participants showed improvements in activities of daily living (ADL), word list memory/recognition, trail making A, occupational performance, and satisfaction improvement, which was clinically significant in 1 participant who also had a reduced score in the scale of depression classifying him as not depressed.ConclusionSpaced retrieval training and errorless learning based on reality orientation therapy is an effective intervention in patients with early onset dementia and mild or moderate impairment.     

Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.     

Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial

ObjectivesTo compare online cognitive-behavioral therapy (CBT) with and without telephone support respectively to online psychoeducation in a randomized controlled trial (RCT) in caregivers of people with dementia with mild anxiety or depression.DesignThree-arm parallel-group RCT comparing online CBT with and without telephone support respectively to online psychoeducation.Setting and ParticipantsOnline study with caregivers of people with dementia.MeasuresThe primary outcome measure was mental health measured by General Health Questionnaire–12 (GHQ-12) at 26 weeks. Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS); the Relative Stress Scale (RSS) and the Short Sense of Competency Questionnaire. The primary analysis focused on people completing GHQ-12 at both baseline and 26 weeks, evaluated using analysis of covariance.Results638 people were randomized to the 3 treatment arms, of whom 208 were included in the analysis population. There were significant improvements in GHQ-12 in all treatment arms compared to baseline (P < .001 for all interventions), but neither CBT with nor without telephone support conferred any significant advantage compared to psychoeducation. For the secondary outcomes, there were no significant differences between CBT with telephone support and psychoeducation, but CBT without telephone support was less effective than psychoeducation with respect to HADS depression subscale [mean difference 1.86, 95% confidence interval (CI) 0.61, 3.11; P = .004] and caregiver stress (RSS mean difference 3.11, 95% CI 0.13, 6.09; P = .04). Good safety was achieved in all 3 treatment arms, with no deaths or serious adverse events.Conclusions and ImplicationsOnline CBT with telephone support and psychoeducation both achieved significant benefits over 26 weeks compared with baseline in mental health and mood, but there were no advantages for CBT compared with the psychoeducation intervention. CBT without telephone support was less effective with respect to mood outcomes than psychoeducation and should not be recommended based on current evidence.     

经导管肝动脉化疗栓塞联合立体定向放射治疗对不可切除原发性肝癌的疗效分析

目的:分析经导管肝动脉化疗栓塞(TACE)联合立体定向放射治疗(SRT)治疗不可切除原发性肝癌的疗效及不良反应。方法:选取56例不可切除肝癌患者,根据治疗方法的不同将其分为TACE联合SRT组(联合组,32例)和单纯TACE组(单纯组,24例),联合组采用TACE联合SRT方法,单纯组采用单纯TACE治疗方法。依据实体瘤疗效评价标准(RECIST)1.1版进行近期疗效评价,观察记录治疗相关不良反应。结果:联合组近期有效率为84.3%,1年局部控制率为71.9%,单纯组近期有效率为79.2%,1年局部控制率为45.8%,近期有效率两组间差异无统计学意义(x~2=0.254,P>0.05),1年局部控制率联合组显著优于单纯组,差异有统计学意义(x~2=3.899,P<0.05)。两组间不良反应差异无统计学意义。结论:SRT联合TACE治疗不可切除肝癌局部控制率高,耐受性好,可以作为一种可靠而有效的治疗方法。     

射野孔径形状控制器对直肠癌快速容积旋转调强放射治疗计划质量、机器传输能力和准确性的影响研究

目的:研究Eclipse15.5治疗计划系统中射野孔径形状控制器(ASC)对直肠癌快速(RapidArc)容积旋转调强放射治疗(VMAT)计划质量、机器传输能力和剂量传输准确性的影响。方法:选取医院收治的20例直肠癌患者,对每个病例生成ASC"off"、ASC"verylow"、ASC"moderate"和ASC"veryhigh"共4组RapidArc对照计划。其中ASC调节等级分别设置为关闭(off)、非常低(verylow)、中等(moderate)和非常高(veryhigh),其他计划参数设置保持一致,使用射野剂量系统(PD)验证剂量传输的准确性。主要评价指标包括剂量体积直方图(DVH)、Paddick适形指数(PCI)、梯度指数(GI)、均质性指数(HI)、剂量率(DoseRate)、机架转速(GantrySpeed)、机器跳数(MUs)、每角度机器跳数(MU/deg)和Gamma通过率,采用单因素方差分析和Kruskal-Wallis秩和检验检测4组ASC计划之间各项统计指标的差异。结果:4组ASC计划间除计划靶区平均剂量(PTV D_med)差异有统计学意义(F=3.243,P=0.027)外,其他DVH、PCI、GI和HI指标差异均无统计学意义。机器传输能力中ASC为very low、moderate和very high的MUs较off分别下降14.4%、20.9%和29.6%。4组计划间DoseRate、MU/deg和MUs差异有统计学意义(x²=16.621,x²=16.007,x²=15.877;P=0.001)。剂量传输准确性中4组计划间3%/3 mm和2%/2 mm的Gamma通过率差异均无统计学意义。结论:计划设计过程中需考虑ASC对各项计划指标的影响,应根据计划的复杂性和临床需要调整ASC的等级。