Analysis of Etiology,Diagnosis,and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy

Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.

Kleptomania:Recent Advances in Symptoms,Etiology and Treatment

Kleptomania is a kind of uncontrollable impulse and behavior of stealing,and it is also a serious disease.At present,studies on pathological theft at home and abroad are not sufficient,and the understanding of the symptoms,etiology and treatment of this disease is very insufficient.This article focuses on the latest development of symptoms, etiology and treatment of kleptomania,providing a reference for people to further identify, treat and study the disease.

Microscopic colitis: A review of etiology, treatment and refractory disease

Microscopic colitis is a common cause of chronic,nonbloody diarrhea. Microscopic colitis is more common in women than men and usually affects patients in their sixth and seventh decade. This article reviews the etiology and medical management of microscopic colitis. The etiology of microscopic colitis is unknown, but it is associated with autoimmune disorders, such as celiac disease, polyarthritis, and thyroid disorders. Smoking has been identified as a risk factor of mi-croscopic colitis. Exposure to medications, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, and selective serotonin reuptake inhibitors, is suspected to play a role in microscopic colitis, although their direct causal relationship has not been proven. Multiple medications, including corticosteroids, anti-diarrheals, cholestyramine, bismuth, 5-aminosalicylates, and immunomodulators, have been used to treat microscopic colitis with variable response rates. Budesonide is effective in inducing and maintaining clinical remission but relapse rate is as high as 82% when budesonide is discontinued. There is limited data on management of steroid-dependent microscopic colitis or refractory microscopic colitis. Immunomodulators seem to have low response rate 0%-56% for patients with refractory microscopic colitis. Response rate 66%-100% was observed for use of anti-tumor necrosis factor(TNF) therapy for refractory microscopic colitis. Anti-TNF and diverting ileostomy may be an option in severe or refractory microscopic colitis.

Review: The vital role of traditional Chinese medicine (TCM) in the prevention and treatment of COVID-19 and the etiology and pathogenic mechanism of COVID-19 based on TCM theory

"Yi"is defined in traditional Chinese medicine theory as the general pathological conditions of epidemics.Throughout thousands of years of history,TCM has been playing an essential role in preventing and treating epidemics in China.Showing significant efficacy against severe acute respiratory syndrome(SARS)in 2002 and 2003,a medical intervention involving TCM was applied at the beginning of the pandemic of the corona virus disease 2019(COVID-19),and has been found with good preventive and curative value in clinical practice.In this study,the etiology and pathogenic mechanism of COVID-19 was discussed on a TCM theory basis,and the clinically effective prevention and treatment methods/prescriptions were summarized.It is suggested that TCM has been playing a unique and vital role in preventing and treating COVID-19,and thus contributes greatly to public health.

TCM diagnosis and treatment theory of chronic complete occlusion of coronary artery based on etiology and pathogenesis

Chronic total occlusive disease of the coronary artery belongs to the category of"chest palsy"and"true heart pain"in traditional Chinese medicine.Its etiology has two aspects:deficiency of blood,blood stasis,qi stagnation,and phlegm.Failure can be caused by deficiency or disease.The pathogenesis of this disease is caused by obstruction of the heart pulse,and its pathogenesis can be transformed into each other.The theory of traditional Chinese medicine believes that the general rule is not painful.Therefore,the treatment of coronary CTO lesions should be based on the combination of Tong and Tong tonic.The chronic complete occlusive disease of the coronary artery can be treated through Xuanbi Tongyang,Huoxue Tongluo,and Aroma Wentong.Based on the Chinese medicine's understanding of the etiology and pathogenesis of coronary CTO lesions,it provides a basis for the diagnosis and treatment of traditional Chinese medicine,solves the problems of interventional medicine in western medicine,and gives play to the unique advantages of traditional Chinese medicine for clinical diagnosis and treatment.

Combination treatment of inflammatory bowel disease:Present status and future perspectives

The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to say that in these patients,not only the scientific background of the gastroenterologist is tested,but also the abundance of“gifts”that he should possess(insight,intuition,determ-ination,ability to take initiative,etc.)for the successful outcome of the treatment.In daily clinical practice,depending on the severity of the attack,IBD is treated with one or a combination of two or more pharmaceutical agents.These combin-ations include not only the first-line drugs(e.g.,mesalazine,corticosteroids,antibiotics,etc)but also second-and third-line drugs(immunosuppressants and biologic agents).It is a fact that despite the significant therapeutic advances there is still a significant percentage of patients who do not satisfactorily respond to the treatment applied.Therefore,a part of these patients are going to surgery.In recent years,several small-size clinical studies,reviews,and case reports have been published combining not only biological agents with other drugs(e.g.,immunosuppressants or corticosteroids)but also the combination of two biologi-cal agents simultaneously,especially in severe cases.In our opinion,it is at least a strange(and largely unexplained)fact that we often use combinations of drugs in a given patient although studies comparing the simultaneous administration of two or more drugs with monotherapy are very few.As mentioned above,there is a timid tendency in the literature to combine two biological agents in severe cases unresponsive to the applied treatment or patients with severe extraintestinal manifestations.The appropriate dosage,the duration of the administration,the suitable timing for checking the clinical and laboratory outcome,as well as the treatment side-effects,should be the subject of intense clinical research shortly.In this editorial,we attempt to summarize the existing data regarding the already applied combination therapies and to humbly formulate thoughts and suggestions for the future application of the combination treatment of biological agents in a well-defined category of patients.We suggest that the application of biomarkers and artificial intelligence could help in establishing new forms of treatment using the available modern drugs in patients with IBD resistant to treatment.

Etiology and Treatment of Post-surgical Blepharoptosis

Purpose: To investigate the etiology and the treatment of acquired blepharoptosis inpatients,.especially secondary to surgery.Methods: The clinical records of 65 consecutive patients with acquired ptosis were reviewed from an eye center and a comprehensive hospital..Potential factors responsible for acquired ptosis were investigated..Surgical management principles and post-operative exposure keratitis are discussed.Results:.The top three causes of acquired ptosis were postsurgical ptosis(20 / 65, 30.8%), traumatic ptosis(17 / 65,26.2%) and senile aponeurotic ptosis(12 / 65, 18.5%). Twenty patients had post-surgical ptosis secondary to orbital surgery(8 / 20, 40.0%), enucleation and hydroxyapatite(HA) artificial eye implantation(4 / 20, 20%), eyelid surgery(3 / 20,15%), cataract or glaucoma surgery(2 / 20, 10%), conjunctive surgery(2 / 20, 10%).and superior oblique muscle surgery(1 / 20, 5%). The levator palpebrae superioris(LPS) muscle of ten eyes(10 / 20, 50%) was found during exploration and reattached to the tarsal plate, with shortening of the LPS. Nine eyes(9 / 20, 45%) underwent a frontalis suspension(FS) operation because the LPS muscle was missing. One(1 / 20, 5%)patient was not operated on due to a poor Bell's phenomenon.Two patients(2 / 65, 3.1%)—one patient with post-surgical ptosis and another with aponeurotic ptosis—developed exposure keratitis after ptosis correction.Conclusion: Post-surgical ptosis is one of the most common causes of acquired ptosis. It is important to explore LPS muscle during surgery. LPS reattachment is performed if the muscle is found; otherwise, a FS operation is chosen. Exposure keratitis after correction should be monitored.

Has Coca-Cola treatment become the first-line therapy for gastric bezoars,both in general and specifically for western countries?

Phytobezoars is a rare disease and less common in Western countries.The stomach is the primary site for these formations,and endoscopic treatment involving fragmentation and extraction has traditionally been the most effective approach.However,medical treatments using enzymatic and chemical agents,such as cellulase and Coca-Cola,aimed at dissolving the bezoars,have also been utilized,showing varying degrees of resolution success.Notably,the oral dissolution treatment with Coca-Cola has emerged as a promising,simpler,and more costeffective method.The study by Liu et al represents an important step in clinical research on this topic,despite some limitations that need addressing for a more comprehensive understanding of its findings.Key considerations for future research include sample size calculation,endoscopic procedure details,outpatient vs.inpatient treatment,and detailed cost calculations.The study's exclusions,such as patients with upper gastric surgery,phytobezoars older than 14 d,and cases of gastroparesis,limit its applicability to broader populations,especially in Western countries.Given the promising outcomes of the Coca-Cola treatment,it's advocated as a first-line therapy for phytobezoars.Nonetheless,further research is essential to overcome these limitations.However special situations such as perforation or small bowel obstruction will require surgical treatment.

Obstructive Sleep Apnea, Prevalence, Etiology &Role of Dentist &Oral Appliances in Treatment: Review Article

Objective: The aim of this article is to provide a detailed description for obstructive sleep apnea regarding its signs and symptoms, the way it is diagnosed, the risk factors, management, the role of dentists and oral appliances in treatment and consequences of untreated condition. Material and Method: Electronic searching was done in PubMed, Medline, EMBASE and CENTRAL databases. Inclusion criteria were: dental, oral and maxillofacial oriented articles. Exclusion criteria: cardiac, obesity and non dental oriented articles were excluded. Result: 59 articles meet the criteria. Conclusion: Obstructive sleep apnea (OSA) is a potentially life threatening disorder characterized by repeated collapse of the upper airway during sleep, with periodic cessation of breathing for more than ten seconds. The frequency of obstructive sleep apnea has been found to increase with age;ranging from two percent among children to two and half percent - six percent among adolescents. Overnight polysomnographic test at specialized sleep clinics remains the gold standard for diagnosing obstructive sleep apnea disorder. Management of this condition can be performed via surgical and non surgical methods. Continuous positive airway pressure represents the first line of treatment for most patients with obstructive sleep apnea.

Research Progress on Integrated Chinese and Western Medicine Treatment of Tourette Syndrome in Children

Tourette syndrome is a common neuropsychiatric disorder that affects the physical and mental health of children.Early detection,diagnosis,and treatment are crucial to prevent serious impacts on the affected children,their families,and society.In recent years,there has been an increasing trend towards using a combination of methods in the clinical treatment of children with Tourette syndrome.This approach has achieved remarkable results,leading to a reduction in the rate of Tourette syndrome symptoms in children.In recent years,a combination of clinical methods has been used to treat children with Tourette syndrome,resulting in significant improvement in control rates.This article reviews the etiology of infantile Tourette syndrome and the progress made in Chinese and Western medicine treatments,providing a reference for further treatment of the condition.

Analysis of the Clinical Value of Surgical Treatment and Postoperative Anti-Infection Treatment of Acute Suppurative Appendicitis

Objective: To explore the clinical value of surgical treatment and postoperative anti-infection treatment for acute suppurative appendicitis. Methods: A total of 116 patients with acute suppurative appendicitis were enrolled in this study. The collection period was from December 2021 to December 2023. The patients were randomly grouped into a control group (surgical treatment) and an observation group (surgical treatment and postoperative anti-infection treatment), of 58 patients each. At the end of the treatment, the results of each index of the two groups were compared. Results: The length of hospitalization time, exhaust time, and incidence of complications in the observation group were shorter than those of the control group (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05). Conclusion: It is crucial to perform anti-infective treatment promptly after surgical treatment in patients with acute suppurative appendicitis. It can effectively prevent the occurrence of complications and improve the clinical efficacy. Hence, it is worthy of research and promotion.

Globus pharyngeus:A review of its etiology,diagnosis and treatment

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.

Research on the aetiology and treatment of premature ovarian insufficiency

Premature ovarian insufficiency,as a complex gynaecological disease,seriously threatens the physical and mental health of women of childbearing age.The main reasons for its pathogenesis are summarized.As a complex gynaecological disease,premature ovarian insufficiency seriously threatens the physical and mental health of women of childbearing age.The causes of the disease mainly include genetic defects,autoimmune disorders,radiotherapy and chemotherapy,infection,surgery,adverse environmental exposures and other factors.In more than half of cases,the cause remains unclear.In the clinic,hormone replacement therapy is used mainly to relieve the symptoms of oestrogen deficiency.This article reviews the research progress on the causes and treatment of premature ovarian insufficiency in recent years.

The etiology,clinical features and medical treatment of somatotroph adenomas

Somatotroph adenomas lead to hypersecretion of growth hormones(GH)and may cause mass effects.Patients with somatotroph adenomas may present with acral and soft tissue enlargement,joint pain,heart and respiratory failure,diabetes mellitus and hypertension,resulting in increased morbidity and mortality.Early diagnosis and treatment are therefore important in prolonging life and improving quality of life.Recent studies depicted the landscape of genetic and epigenetic changes in sporadic somatotroph adenomas.New approaches are being developed for genetic testing,diagnosis and surveillance,which are helpful in early diagnosis,treatment and disease control of somatotroph adenomas.Data suggest that patients with somatotroph adenomas are best treated with multidisciplinary teams composed of neuro-endocrinologists,neurosurgeons,radiation oncologists and other specialists.This mini-review summarizes in a concise way the up-to-date discussion on the etiology,new diagnostic techniques and novel treatments of somatotroph adenomas.

Gaucher disease:New developments in treatment and etiology

Gaucher disease (GD) is an autosomal recessive disease which if undiagnosed or diagnosed late results in devastating complications. Because of the heterozygous nature of GD, there is a wide spectrum of clinical presentation. Clinicians should be aware of this rare but potentially treatable disease in patients who present with unexplained organomegaly, anemia, massive splenomegaly, ascites and even cirrhosis of unknown origin. The treatment options for adult type GD include enzyme replacement treatment (ERT) and substrate reduction treatment (SRT) depending on the status of the patient. Future treatment options are gene therapy and "smart molecules" which provide specifi c cure and additional treatment options. In this review, we present the key issues about GD and new developments that gastroenterologists should be aware of.

Antiviral treatment standards for hepatitis B:An urgent need for expansion

The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.

Significance of Primary Treatment Selection in the Efficiency of Wastewater Treatment in Constructed Wetlands (CWs)

This research explores strategies to enhance the efficiency of secondary treatment in Vertical Flow Constructed Wetlands (CW) in Montenegro. The focus is on selecting appropriate primary treatment methods alongside three distinct substrate types to improve wastewater treatment efficacy. The study examines the combination of two primary treatments with different substrate types in constructed wetlands (CW1, CW2, and CW3). The primary treatments include the existing wastewater treatment plant (WWTP) in Podgorica, involving coarse material removal through screens, inert material separation in aerated sand traps, and sediment and suspended matter removal in primary sedimentation tanks. The Extreme Separator (ExSep) was employed to evaluate its efficacy as a primary treatment method. The research demonstrates that the efficiency of CW can be significantly enhanced by selecting suitable primary treatment methods and substrates in Podgorica’s conditions. The most promising results were achieved by combining ExSep as a primary treatment with secondary treatment in CW-3. The removal efficiencies after CW3 for COD, BOD, and TSS exceeded 89%, 93%, and 91%, respectively. The outcomes underscore the significance of primary treatment in mitigating pollutant loads before discharge into the constructed wetlands, emphasizing potential areas for further optimization in wastewater treatment practices to enhance environmental sustainability and water quality management.

Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare occurrence alongside atrioventricular malformations. Exciting prospects include the use of autologous bone marrow transplant and the potential role of Connexin 43 protein treatment in the development of moyamoya disease.

Current Status of Stem Cells in the Treatment of Premature Ovarian Failure

Premature ovarian failure (POF) is a prevalent cause of female infertility. POF features include estrogen hypofunction, amenorrhea, infertility, and high gonadotropin levels. The etiology of POF is genetic diseases, autoimmune diseases, enzyme defects and environmental factors. The development of Regenerative medicine has made stem cell and exosome (EXOs) therapy effective for POF. This review discusses POF stem cell research and development.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .