Can we expect progress in the treatment of fibrosis in the course of chronic pancreatitis?

Chronic pancreatitis (CP) is a necroinflammatory process characterized by loss of both exocrine and endocrine function. To date, the disease has been treated symptomatically. Real advances in CP management can be expected once the pathophysiology of the disease is elucidated and individual stages of its development are properly managed. A key role in the CP pathogenesis is played by activation of pancreatic stellate cells (PSCs) that cooperate with the remaining pancreatic cells. All these cells produce cytokines, growth factors, angiotensin and other substances, which paracrinally or autocrinally induce further, persistent activation of PSCs. The activated PSCs are capable of producing and modifying the extracellular matrix. An optimal therapeutic preparation should exert beneficial effects on all the above-mentioned phenomena observed in CP. The most promising treatment modalities include blocking of the renin-angiotensin system (RAS), activation of peroxisome proliferator-activated receptors gamma (PPAR-γ), influence on the remaining PSC signaling pathways, blocking of substances produced by activated PSCs, and antioxidants. The findings of many recent experimental studies are highly encouraging; however, their efficacy should be confirmed in well-designed clinical trials.     

Stem cells combined with three-dimensional scaffolds for the treatment of osteoporotic bone defects北大核心

BACKGROUND: Stem cells combined with a three-dimensional scaffold have great potential for the treatment of osteoporotic bone defects. OBJECTIVE: To introduce the application of stem cells combined with the three-dimensional scaffold in repairing osteoporotic bone defects. METHODS: A computer-based search of PubMed, Web of Science, Springerlink, Medline, WanFang and CNKI databases was performed for relevant articles published from 2007 to 2017 with “stem cells, scaffold, osteoporosis, bone defects” as key words in English and Chinese, repsectively. Initially, 142 articles were retrieved, and finally 45 articles were included in result analysis. RESULTS AND CONCLUSION: Due to the potential of self-renewal and multilineage differentiation, stem cells can be used to repair or regenerate damaged tissues, which are considered as an ideal cell source for the treatment of diseases in orthopedics. The suitable scaffold can provide a favorable microenvironment for repairing the attachment and growth of the cells related to the bone defect, which can promote the healing without additional side effects. Furthermore, stem cells combined with three-dimensional scaffolds provide a promising clinical application for the treatment of osteoporotic bone defects by regulation of bone metabolism. In addition, gene-modified stem cells with three-dimensional scaffolds bring a huge potential in the treatment of osteoporotic bone defects. In conclusion, the combination of stem cells and three-dimensional scaffolds provides a new approach for the treatment of osteoporotic bone defects, which may be one of the future therapeutic strategies. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

Inpatient treatment of women with postpartum psychiatric disorders – the role of the male partners

Summary Postpartum psychiatric disorders are stressful events for all members of the family. The male partners contribute to the women’s coping process. To evaluate the men’s supportive function we investigated 31 partners of 34 women with postpartum psychiatric disorders. Three male partners were unreachable although we tried to contact them intensively. All the women examined were in-patients of a mother-child unit after delivery. The men’s behaviour in the relationship, in their role as a partner, and as a father were rated in a categorical-qualitative way. We found that nearly one third of the male partners can be described as “supportive”. This finding strongly correlates with the subjective experience of the corresponding wives of being supported by the male partners. However in the subgroup of women who had already suffered from prepartum psychiatric disorders with onset before index-delivery, the majority of the male partners were rated and experienced as “non-supportive”. Additionally, ten of these men suffered from several DSM-IV/ICD-10 based psychiatric disorders themselves. Using the standardised questionnaire “operationalisierte psychodynamische Diagnostik” (OPD) we describe the higher ego-strength of the supportive male partners. We found that there was a reduction in the length of stay in the hospital in the families with supportive male partners.     

The Application of chronic cerebellar stimulationin the treatment of epliepsy

Dependingupontheanalysisofelectrophysiologicalcharacteristics,cerebellarisaregularorganizationofbodymovement,Itsmainfunctionisco-operationwithcerebellarcortexandmotionnucleusbelowcortexasoptionalmotion.Itplaysanimportantroleinpromotingmotiontogetco-ordination.PhysiologistedemonstratedtheexistenceofaninhibitorymechanisminthereticularStructuresofthecerebellumCerebellumelectronicexcitationmaaycauseup-streaminhibitionofcerebellarcortexanddownstreaminhibitionofspinalcordreflexes.Chroniccerebellars…     

Body psychotherapy for the treatment of severe mental disorders – an overview

The evidence base for the effectiveness of body psychotherapy (BPT) in the treatment of severe mental disorders has improved much over the last decade; both methodologically robust randomised controlled trials and also qualitative studies demonstrated how BPT can contribute substantially to the treatment portfolio and help address chronic conditions and disorder-specific psychopathology. This paper summarises how BPT is utilised for the treating a range of severe mental disorders including mania and schizophreniform psychosis, personality disorder and severe anxiety as well as depressive disorders. The intervention strategies are related to specific body-oriented phenomena, i.e. disturbances of body experience and body-mind regulation disorders; the approaches are described in the context of a new theoretical paradigm of BPT as embodied and embedded relational psychotherapy, aiming to facilitate improved self/affect regulation. For each specific illness, a short sketch of the cardinal symptoms and body image phenomenology is followed by a summary of disorder-specific intervention strategies of BPT for severe mental illness.     

Contribution to the epidemiology of postnatal depression in Germany – implications for the utilization of treatment

Summary Using a longitudinal screening model, 772 mothers were screened for postnatal depression after delivery in Stuttgart (Germany). This model contained the Edinburgh Postnatal Depression Scale (EPDS) and the Hamilton Depression Scale (HAMD). The first screening was 6–8 weeks after delivery with the EPDS. Mothers with high scores in the first screening had a second screening 9–12 weeks after delivery with the EPDS at least three weeks after the first. Mothers with high scores in both screenings were investigated with the Hamilton Depression Scale (HAMD).Classification was performed with the DSM-IV. After observation until the third month after delivery, 3.6% (N = 28) of the 772 mothers were diagnosed with postnatal depression. Various methods of therapy were offered to those mothers. 18% (N = 5) accepted one or more of these methods of treatment. The rest of the mothers with postnatal depression refused – mostly for attitudinal or practical reasons. 13.4% of the mothers showed high scores in the first screening but not in the second. For those mothers a longitudinal observation is currently being performed to distinguish between a depressive episode and a depression with oscillating symptoms.     

Retrospective evaluation of the treatment for breast cancer: how does the patient's personal experience of the treatment affect later adjustment to the illness?

The aim of the present study was the evaluation of patients' treatment experience for breast cancer and its possible associations with the illness adjustment process. To examine perception and experience of treatment during the diagnostic and the inpatient phase, as well as during chemo-and radiotherapy and during after-care, a self-compiled questionnaire was employed. To assess illness adjustment, the German version of the Hospital Anxiety and Depression Scale, the "Freiburger Fragebogen zur Krankheitsverarbeitung" and the "Ver?nderungsfragebogen des Erlebens und Verhaltens" were used. 126 patients participated in the study, all diagnosed for breast cancer during the past 5 years. We found an association between negative experience of all treatment phases (doctor-patient relationship, communication) and impaired adjustment process reflected by high anxiety and depression scores and more problematic coping strategies.     

Hydroxyapatite/beta-tricalcium phosphate scaffolds combined with adipose-derived stem cells for the treatment of spinal defects in rabbits北大核心

BACKGROUND: Repair of bone defects is not only a clinical problem, but also a hot topic in the field of orthopedics. Although autologous bone grafting is considered as the “gold standard” for bone repair, its use is limited due to the limited source of autogenous bone, bone infections and pains that are easy to occur in the donor region. Allograft bones are always associated with immune rejection, slow healing, and infection. Therefore, it is imminent to develop new materials for bone repair. OBJECTIVE: To explore the effect of rabbit adipose-derived stem cells (rADSCs) as seed cells and hydroxyapatite/p-tricalcium phosphate (HA/β-TCP) composite as a carrier on the repair of rabbit vertebral defects. METHODS: Thirty-eight 3-month-old New Zealand white rabbits were selected, ond two of them were used to culture rADSCs in vitro. Passage 3 rADSCc were inoculated on HA/β-TCP scaffolds and then cultured in vitro for 2 weeks. A 5 mmx5 mmx3 mm bone defect was prepared at the anterior edge of L4/5 vertebral body in the remaining 36 rabbits. These model rabbits were then randomized into cell-scaffold composite group, scaffold group and control group with no intervention, with 12 rabbits in each group. rADSCs/HA/β-TCP composite and HA/β-TCP scaffold were implanted into the cell-scaffold and HA/β-TCP groups, respectively. Anteroposterior and lateral DR of the spine and Lane-Sandhu X-ray wera performed at 4, 8, 12 postoperative weeks. All rabbits wera sacrificed at 12 postoperative weeks and specimens were collected for grass and histopathological observations. RESULTS AND CONCLUSION: Under the grass observation, bone defects in the cell-scaffold group were essentially replaced by new bone tissues, which was significantly better than that in the scaffold group and control group. At 12 postoperative weeks, the material implanted was basically absorbed in the cell-scaffold group, partially absorbed in the scaffold group and poorly absorbed in the control group in which there was a clear boundary with the surrounding tissues and patchy calcifed shadows were visible. X-ray results showed that the repair effect in the cell-scaffold group was better than that in the scaffold group and control group (P < 0.05). Histopathological findings showed the marked absorption of the iplant in the cell-scaffold group, partial residual in the scaffold group with some fibrous calluses and osteoid tissues, and a large amount of fiber tissues and a small amount of calluses in the control group. Overall, the rADSCs/HA/β-TCA has a good ability to repair bone defects. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

Direct-acting antiviral agents in the treatment of chronic hepatitis C—Real-life experience from clinical practices in Pakistan

This study aims to evaluate the clinical effectiveness in terms of sustained virological response (SVR), predictors of SVR and safety of available second-generation generic direct-acting antivirals in Pakistani chronic hepatitis C patients. This is a retrospective study conducted in multiple centers of Pakistan from January 2015 to January 2019. The samples include patients infected with chronic hepatitis C virus, regardless of virus genotype, cirrhosis, or prior treatment. A total of 993 patients were included in the present study, with the majority receiving sofosbuvir with daclatasvir (95%), sofosbuvir with daclatasvir and ribavirin (4%), and sofosbuvir with ribavirin (1%). There were 96% cases of chronic hepatitis, 3% cases compensated cirrhosis, and 1% cases of decompensated cirrhosis. Genotype 3 (99.6%) was the most common genotype. Overall SVR after 12 weeks was 98% for all treatment regimens. High SVR12 was observed with sofosbuvir in combination with daclatasvir (98.5%), then sofosbuvir in combination with daclatasvir and ribavirin (90.2%) and sofosbuvir in combination with ribavirin (75%). SVR rates were high in chronic hepatitis C patients (98.2%) as compared with cirrhotic patients (92.1%) and it was high in treatment-naive (98.8%) then interferon experienced patients (90.1%). In multivariate binary logistic regression analysis, patients’ education status, treatment strategy, viral load, and alanine aminotransferase had a statistically significant association with SVR at 12 weeks. No major adverse events occurred which required treatment discontinuation. Generic oral direct acting antiviralss (sofosbuvir with daclatasvir) achieved higher SVR12 rates and were well tolerated in this large real-world cohort of genotype 3 infected patients.     

Efficacy and safety of the Bushen tiaochong recipe combined with alendronate sodium for the treatment of postmenopausal senile degenerative osteoporosis: Study protocol for a randomized controlled trial北大核心

BACKGROUND: Alendronate sodium is a commonly used western medicine for the treatment of osteoporosis, but it has many adverse reactions. The main component of the traditional Chinese medicine, known as the Bushen Tiaochong recipe, is Epimedium brevicornu Maxim. (epimedium). Pharmacological studies have shown that the main active ingredient of Epimedium is icariin. Icariin has an estrogen-like effect, can prevent against bone loss and improve bone strength, and has a definite effect on the treatment of postmenopausal senile degenerative osteoporosis. OBJECTIVE: To testify the hypothesis that the Bushen Tiaochong recipe combined with alendronate sodium will be more effective, as well as safer and more reliable than alendronate sodium alone for the treatment of postmenopausal senile degenerative osteoporosis. METHODS: Two hundred patients with postmenopausal senile degenerative osteoporosis will be randomly assigned to an observation group and a control group. In the control group, patients will be given alendronate sodium tablets 10 mg/d and calcium carbonate D3 chewable tablets 0.6 g/d. In the observation group, patients will receive the same treatment as the control group and the Bushen Tiaochong recipe, simmering, twice per day (once in the morning and once in the evening). The duration of treatment will be 6 months in both groups. The primary outcome measure is the overall efficacy 6 months after treatment in both groups. The secondary outcome measures are Visual Analogue Scale scores for waist and back pain; lumbar spine (L2–4) bone mineral density; serum levels of calcium, phosphorus, alkaline phosphatase, osteocalcin, estradiol, follicle stimulating hormone, luteinizing hormone, interleukin-1, and interleukin-6 before and 6 months after treatment; and incidence of adverse reactions 6 months after treatment. This trial has been approved by the Ethics Committee of the Affiliated Hospital of Qinghai University of China (approval number: QHY1703F). The study protocol will be conducted in accordance with the Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be obtained from all participants. The recruitment of subjects will begin in January 2018. Samples and data will be collected from January to December 2018. Outcome measures will be analyzed in March 2019. This trial will be completed in April 2019. The results of the trial will be reported in a scientific conference or disseminated in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-ONC-17013947). DISCUSSION: We hope to verify that the Bushen Tiaochong recipe combined with alendronate sodium provides better results than alendronate sodium alone for the treatment of postmenopausal senile degenerative osteoporosis. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

The biological impact of living with chronic breathlessness – A role for the hypothalamic–pituitary–adrenal axis?

Breathlessness is a common and distressing symptom in advanced cardiorespiratory disease, with recognised psychological, functional and social consequences. The biological impact of living with chronic breathlessness has not been explored. As breathlessness is often perceived as a threat to survival, we propose that episodic breathlessness engages the stress-response, as regulated by the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, we hypothesise that chronic breathlessness causes excessive stimulation of the HPA axis, resulting in dysfunctional regulation of the HPA axis and associated neuropsychological, metabolic and immunological sequelae. A number of observations provide indirect support for this hypothesis. Firstly, breathlessness and the HPA axis are both associated with anxiety. Secondly, similar cortico-limbic system structures govern both breathlessness perception and HPA axis regulation. Thirdly, breathlessness and HPA axis dysfunction are both independent predictors of survival. There is a need for direct observational evidence as well as experimental data to investigate this hypothesis which, if plausible, could lead to the identification of a new biomarker pathway to support breathlessness research.     

Leptin – A novel pharmacological agent for treatment of women with overactive bladder symptoms?

Overactive bladder is a common condition and is significantly known to affect quality of life in both men and women. It is usually associated with urinary urgency, frequency, nocturia with or without urinary incontinence. The exact aetiology of overactive bladder is unknown. The two main theories put forward include (a) disruption of central control of the bladder by excessive suprapontine excitation or reduced suprapontine inhibition (b) Peripheral abnormality due to excessive cholinergic excitation (increases release of acetylcholine which is calcium dependent) or reduced neuropeptidergic inhibition. The other factors which contribute to its cause include increase in caffeine intake and behavioural problems. Therefore the initial treatments are based on excluding pathology and implementing behavioural changes, bladder training and caffeine reduction. Anticholinergic drugs are the main pharmacological agents used in the treatment of overactive bladder and they are usually used in conjunction with the above treatment methods. Recently, an increase in serum leptin levels has been associated with overactive bladder symptoms. This possibly is not true because leptin actually reduces Ca2+ influx in the smooth muscle. The addition of increasing doses of leptin on uterine smooth muscle (in vitro) has shown to inhibit spontaneous as well as induced uterine contractions (myometrial biopsies taken from obese women) by reducing Ca2+ influx in obese women compared to normal weight women. We believe it may have similar action on the bladder and therefore expect inhibition of the bladder detrusor smooth muscle contraction rather than stimulation which may lead to overactive bladder symptoms. This action can be considered anticholinergic rather than cholinergic and therefore should improve overactive bladder symptoms. So could this hormone (leptin) be used as a new novel agent for treating women suffering with overactive bladder symptoms?     

Leptin – A novel pharmacological agent for treatment of women with overactive bladder symptoms?

Overactive bladder is a common condition and is significantly known to affect quality of life in both men and women. It is usually associated with urinary urgency, frequency, nocturia with or without urinary incontinence. The exact aetiology of overactive bladder is unknown. The two main theories put forward include (a) disruption of central control of the bladder by excessive suprapontine excitation or reduced suprapontine inhibition (b) Peripheral abnormality due to excessive cholinergic excitation (increases release of acetylcholine which is calcium dependent) or reduced neuropeptidergic inhibition. The other factors which contribute to its cause include increase in caffeine intake and behavioural problems. Therefore the initial treatments are based on excluding pathology and implementing behavioural changes, bladder training and caffeine reduction. Anticholinergic drugs are the main pharmacological agents used in the treatment of overactive bladder and they are usually used in conjunction with the above treatment methods. Recently, an increase in serum leptin levels has been associated with overactive bladder symptoms. This possibly is not true because leptin actually reduces Ca2+ influx in the smooth muscle. The addition of increasing doses of leptin on uterine smooth muscle (in vitro) has shown to inhibit spontaneous as well as induced uterine contractions (myometrial biopsies taken from obese women) by reducing Ca2+ influx in obese women compared to normal weight women. We believe it may have similar action on the bladder and therefore expect inhibition of the bladder detrusor smooth muscle contraction rather than stimulation which may lead to overactive bladder symptoms. This action can be considered anticholinergic rather than cholinergic and therefore should improve overactive bladder symptoms. So could this hormone (leptin) be used as a new novel agent for treating women suffering with overactive bladder symptoms?