Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.

Effectiveness of sensory integration therapy in children,focusing on Korean children:A systematic review and meta-analysis

BACKGROUND Sensory integration intervention is highly related to the child's effective interaction with the environment and the child's development.Currently,various sensory integration interventions are being applied,but research methodological problems are arising due to unsystematic protocols.This study aims to present the optimal intervention protocol by presenting scientific standards for sensory integration intervention through meta-analysis.AIM To prove the effectiveness of sensory integration therapy,examine the latest trend of sensory integration studies in Korea,and provide clinical evidence for sensory integration therapies.METHODS The database of Korean search engines,including RISS,KISS,and DBpia,was used to search for related literature published from 2001 to October 2020.The keywords,“Children”,“Sensory integration”,“Integrated sensory”,“Sensorymotor”,and“Sensory stimulation”were used in this search.Then,a meta-analysis was conducted on 24 selected studiesRISS,KISS,and DBpia,was used to search for related literature published from 2001 to October 2020.The keywords,“Children”,“Sensory integration”,“Integrated sensory”,“Sensorymotor”,and“Sensory stimulation”were used in this search.Then,a meta-analysis was conducted on 24 selected studies.RESULTS Sensory integration intervention has been proven effective in children with cerebral palsy,autism spectrum disorder,attention deficit/hyperactivity disorder,developmental disorder,and intellectual disability in relation to the diagnosis of children.Regarding sensory integration therapies,1:1 individual treatment with a therapist or a therapy session lasting for 40 min was most effective.In terms of dependent variables,sensory integration therapy effectively promoted social skills,adaptive behavior,sensory processing,and gross motor and fine motor skills.CONCLUSION The results of this study may be used as therapeutic evidence for sensory integration intervention in the clinical field of occupational therapy for children,and can help to present standards for sensory integration intervention protocols.

Comparison of efficacy and safety between late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy for cervical cancer complicated with pelvic lymph node metastasis

Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.

The orthodox therapy of cardiovascular diseases integrated by ozone-therapy is able to normalize the redox system

Cardiovascular diseases such as chronic limb ischemia, cardiomyopathies and stroke represent the first cause of death. Moreover, type-II diabetes, chronic obstructive pulmonary disease and age-related macular degeneration are also progressive pathologies complicated by a chronic inflammation that might be able to maintain progressive chronic oxidative stress. Orthodox medicine has provided excellent drugs which slow down the progression of these diseases but minimally reverse the oxidative stress conditions. Administration of antioxidants is unable to balance the oxidant excess. Today, all the biochemical and molecular mechanisms of ozone therapy have been clarified and it has been demonstrated that ozone therapy can reactivate the fundamental Nrf2 system and be able to restore the innate antioxidant defense mechanisms composed of several highly protective enzymes. This paper proposes to integrate the orthodox treatment with ozone therapy for improving clinical results.

Comprehensive Therapy of Pancreatic Cancer by Integrative Traditional and Western Medicine

In recent 20 years, there has been an increasing trend in the incidence of pancreatic cancer both at home and abroad. An estimated 31 860 new cases and 31 270 deaths are expected to occur in the United States in 2004 due to this disease, the 4th and 5th leading cause of cancer death for men and women respectively. In China, new cases of pancreatic cancer continue to increase and are 6

Therapeutic Effects of Integrated Traditional Chinese Medicine and Western Medicine in Treating Severe Acute Respiratory Syndrome

Objective: To improve the effects of treatment of severe acute re spiratory syndrome (SARS) and to explore the clinical significance of integrate d traditional Chinese medicine and western medicine (ICWM) in the treatment of S ARS and its influence on the chief indexes in the process of the disease. Methods: The clinical study involving observation of 135 patients of SARS was conducted in the randomized, synchronously controlled and open way. The patients were divided into two groups, 68 in the ICWM group and 67 in the c ontrol group, all of whom were treated with the same basic treatment of western medicine, but to the ICWM group, Chinese drugs for clearing Heat, detoxifying an d removing Dampness were given additionally. The comprehensive effect on relievi ng fever, cell mediated immunity, pulmonary inflammation and secondary infect ion was compared between the two groups. Results: The therapeutic effect in the ICWM group was better than that in the control group in such aspects as steadily lowering body temperature, alleviating general symptoms, accelerating the absorption of pulmonary infiltra tion and easing cellular immunity suppression. Conclusion: The therapeutic effect of ICWM is better in treating SARS than that of western medicine alone.

Multimodal integrated intervention for children with attentiondeficit/hyperactivity disorder

BACKGROUND Attention-deficit/hyperactivity disorder(ADHD)is one of the most common disorders in child and adolescent psychiatry,with a prevalence of more than 5%.Despite extensive research on ADHD in the last 10 to 20 years,effective treatments are still lacking.Instead,the concept of ADHD seems to have become broader and more heterogeneous.Therefore,the diagnosis and treatment of ADHD remains challenging for clinicians.AIM To investigate the effects of a multimodal integrated intervention for children with ADHD.METHODS Between March 2019 and September 2020,a total of 100 children with ADHD who were diagnosed and treated at our hospital were assessed for eligibility,two of whom revoked their consent.A case-control study was conducted in which the children were equally assigned,using a randomized number table,to either a medication group(methylphenidate hydrochloride extended-release tablets and atomoxetine hydrochloride tablets)or a multimodal integrated intervention group(medication+parent training+behavior modification+sensory integration therapy+sand tray therapy),with 49 patients in each group.The clinical endpoint was the efficacy of the different intervention modalities.RESULTS The two groups of children with ADHD had comparable patient characteristics(P>0.05).Multimodal integrated intervention resulted in a significantly higher treatment efficacy(91.84%)than medication alone(75.51%)(P<0.05).Children who received the multimodal integrated intervention showed lower scores in the Conners Parent Symptom Questionnaire and the Weiss Functional Impairment Rating Scale than those treated with medication alone(P<0.05).The Sensory Integration Scale scores of children in the multimodal integrated intervention group were higher than those of children in the medication group(P<0.05).Children who received the multimodal integrated intervention had higher compliance and family satisfaction and a lower incidence of adverse events than those treated with medication alone(P<0.05).CONCLUSION Multimodal integrated intervention effectively alleviated symptoms associated with ADHD in children.It enhanced their memory and attention with high safety and parental satisfaction,demonstrating good potential for clinical promotion.

Non-Pharmalogical Interventions towards Behavioural and Psychological Symptoms of Dementia—An Integrated Literature Review

The objective of this integrated literature review was to identify and examine effectiveness of non-pharmacological interventions towards BPSD. Database searches were documented following the PRISMA flow diagram and included papers were judged by the researchers using the SAHTAASS protocol. Coding of the papers was carried out using Polit and Beck matrix for literature review. It was concluded that several non-pharmacological interventions showed a positive influence on BPSD such as stimulating interventions, social and personalized activities and physical exercise. Also, education/training of healthcare professionals and equipment in form of a structured BPSD protocol resulted in decreased BPSD.

Efficacy of Sensory Integration Therapy in Improving Gross Motor Coordination and Grip Control in Down Syndrome Children

This work was carried out to investigate the efficacy of sensory integration therapy in improving gross motor coordination and grip control in Down syndrome children. Thirty children were enrolled in this study and randomly assigned into two groups: group A received (sensory integration therapy program plus specific physiotherapy training) and group B received (specific physiotherapy training program only). Motor coordination test measures (Balancing backward, Hopping, Jumping from side to side and Transferring boxes) to test and follow gross motor coordination, handheld dynamometer to test and follow grip control ability and kinesthesia test to test and follow awareness of joint position and movement. These measurements were taken before initial treatment and after 12 weeks of treatment. The children parents in both groups A and B were instructed to complete 3 hours of the home routine program. Data analysis was available on the 30 Down syndrome children participating in the study. The difference between pre- and post-treatment results was more significant in Motor coordination test measures in the study group than the control group. Grip control ability and kinesthesia test demonstrate representative improvement in the study groups (p = 0.0001) while insignificant in the kinesthesia control group and significant in a grip control group. The addition of sensory integration therapy program to specific physiotherapy training is recommended in improving gross motor coordination and grip control abilities in Down syndrome, so this suggested approach may be used as a selective choice for improving posture control and hand functions in Down syndrome children.

Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients

Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.

CLINICAL ANALYSIS ON INTEGRATED TREATMENT OF 2240 CASES OF PERIPHERAL FACIAL PARALYSIS BY STAGES IN PLATEAU REGION

Objective. To observe the therapeutic effect of integrated treatment of peripheral facial paralysis by stages in Qinghai plateau area. Methods： A total of 2 240 cases of peripheral facial paralysis treated with integrated approaches by stages were assigned to treatment group, and other 75 cases treated with acupuncture therapy assigned to control group. In treatment group, patients were treated with 1 ） medication （ Prednisone, Dipazol, etc） and TDP （“special electromagnetic spectrum”） plus ultrashort irradiation in the early stage;2） TDP plus ultrasonic wave irradiation and acupuncture of Yangbai （阳白 GB 14） to Yuyac （鱼腰EX-HN 4, penetration needling）, etc in the medium stage; 3） medium-frequency irradiation and electroacupuncture （EA） of muscle motor joints and acupoints （GB-14, etc）. Patients of control group were treated with conventional acupuncture therapy （GB-14, etc）. Results： After treatment, of the 2 240 patients in treatment group, 2 072 （92.5%） were cured, 120 （5.3%） effective, 33 （ 1.5% ） improved, and 15 （0.7%） failed. The total effective rate was 99.3%. Of the 75 cases in control group, 46 （61.3%） were cured, 16 （21.3%） effective, 9 （12.0%） improved, and 4 （5.4%） ineffective. The total effective rate was 94.6%. The cure rate and the total effective rate of treatment group were significantly higher than those of control group respectively （x^2=29.379, P〈0.01; x^2 =5. 716, P〈0. 025）. Conclusion： The therapeutic effect of integrated approaches （medication, acupuncture, electromagnetic ＋ ultrashort wave ＋ ultrasonic wave ＋ medium-frequency wave irradiation） is significantly superior to that of simple acupuncture therapy in treating peripheral facial paralysis.

Establishment of Integrated Diagnosis and Treatment and Whole-Course Management Model of Major Depressive Disorder

Integrated diagnosis,treatment and whole-course management model of major depressive disorder(MDD)is an integrated drug-psychological-physical comprehensive treatment model based on rapid biological-psychological-social evaluation for treating patients with major depressive disorder.This paper comprehensively evaluates the clinical efficacy and biochemical indexes of patients,and carries out symptom evaluation,problem classification,disease diagnosis and etiological analysis of visitors from the three dimensions about physiology,psychology and society.Then,according to the symptoms and causes of different dimensions,this paper formulates personalized drug,psychological and physical therapy programs,and constantly optimizes and adjusts the treatment plan in the treatment process,so as to cure both the symptoms and the root causes,providing a reliable strategy for the treatment of clinical MDD,and establishing a standardized characteristic model for further promotion and application of this technology.At present,the project has been used in the member units of Taihe Medical Group and Shiyan City and its surrounding areas,the market response is good,and will be gradually promoted to the whole country in the later stage.

Analysis on the therapeutic effects of integrated traditional Chinese and Western medicine on ulcerative colitis and its effects on coagulation function and inflammatory factors

Objective:To analyze the therapeutic effects of Integrated Traditional Chinese and Western Medicine on ulcerative colitis (UC) and its effects on coagulation function and inflammatory factors.Methods: 220 cases of patients with UC were selected as the research subjects and randomly divided into the observation group and the control group, 110 cases were included into each group. The patients in the control group were treated with single western medicine, while the patients in the observation group were treated with enema treatment of traditional Chinese Medicine. The clinical therapeutic effects of the two groups were evaluated and compared. The blood coagulation indexes of the activated partial thromboplastin time (APTT), prothrombin time (PT), the plasma fibrinogen (Fib), the D dimer (D-D) of two groups patients who in the treatment were detected and compared. The serum tumor necrosis factor (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) levels of the patients in the two groups were measured and compared.Results: The clinical efficiencies of the observation group and the control group were 97% and 75%, the clinical efficiencies and the therapeutic effects of the observation group were better than those in the control group, there were statistically significant differences between the two groups. The plasma Fib levels and the plasma D-D levels after the treatment of the patients in the two groups were significantly lower than those before the treatment, the difference was statistically significant. The plasma Fib levels and the plasma D-D levels after the treatment of the patients in the observation group were lower than those in the control group, the difference was statistically significant. The serum inflammatory factors levels after the treatment of the patients in the two groups were significantly lower than those before the treatment, the difference was statistically significant. The serum inflammatory factors levels after the treatment of the patients in the observation group were lower than those in the control group, the difference is powerful and have statistically significant.Conclusion: The application of Integrated Traditional Chinese and Western Medicine in the treatment of UC can improve the therapeutic effect significantly, correct imbalance of the patients' coagulation dissolution function, reduce the degree of inflammatory reaction, which benefits to promote of the patients' rehabilitation, reduce the incidence of complications and improve the prognosis of patients.

Advances in the management of arteriosclerosis of the lower extremity:Integrating Western and Chinese medicine approaches

This editorial provides a commentary on the recent article.The paper reviews current literature and explores innovative treatment strategies for lower extremity arteriosclerosis obliterans(LEASO)through an integrative approach.It highlights the effectiveness of combination therapies that merge traditional Chinese medicine(TCM)with Western medical practices,suggesting that such integrative methods may improve patient compliance and outcomes through personalized care.This paper stresses the importance of rigorous clinical trials to evaluate the efficacy and safety of TCM interventions within LEASO treatment protocols,advocating for evidence-based validation of these combined therapies.Our recommendations emphasize accurate diagnosis,appropriate pharmacological in-terventions,the use of advanced surgical and endovascular techniques,and the inclusion of TCM to address underlying dysfunctions.Additionally,continuous monitoring,patient education,and lifestyle modifications are essential to slow disease progression and achieve optimal patient outcomes.The paper concludes by calling for further research to develop standardized treatment protocols that effectively integrate both Western and Chinese medical approaches in managing LEASO.

近5年油腻型头皮脂溢性皮炎的研究进展

脂溢性皮炎是发生在皮脂腺丰富部位的慢性、复发性、炎症性皮肤病,多发于头面部,若发于头部则称为“头皮脂溢性皮炎”。油腻型头皮脂溢性皮炎以头发油腻多脂、瘙痒起白屑为主要特征,因此临床见头发油腻兼其他症状者,可参照此病论治。头发油腻发亮极大程度地影响了人们的外在形象,故此病的治疗受到了广泛的关注。文章整理近5年油腻型头皮脂溢性皮炎治疗的相关文献,从现代医学、中医学、中西医结合以及日常清洁控油护理的角度,总结其研究进展。

中西医结合阶梯疗法治疗肥胖症临床报道1例

肥胖是一种慢性代谢性疾病,与2型糖尿病、心血管疾病、高血压病、癌症、代谢综合征和慢性肾脏疾病的患病风险呈线性相关,未来由此引起的肥胖健康负担将急剧增加。因此如何治疗肥胖及其继发性疾病,已成为患者、医生和社会迫切需要解决的问题。目前防治肥胖的中西医方法较多,但如何将中西医方法进行整合,实现临床效果最大化,仍然是值得探索的问题。近几年,作者在代谢与肥胖专病门诊的临床实践中,尝试使用中西医结合阶梯疗法治疗肥胖症,希冀探索出整合中西医方法的治疗模式。此文呈现1例疗程近2年的中西医结合阶梯疗法治疗肥胖症的典型案例。

基于脑-肠-菌轴探讨调补肝脾法治疗功能性消化不良的作用机制

功能性消化不良(FD)作为临床常见疾病,其发病机制在现代医学方面被证实与胃肠动力、内脏敏感性、胃肠微生态等直接相关。脑-肠-菌轴作为一条人体的特殊通路,可较好地阐释其复杂的病理机制。中医药在FD的治疗方面有着十分确切的效果。从中医理论角度,脾胃之“运”“化”与现代医学胃肠动力、营养代谢等具有高度相似之处;而肝主疏泄影响脾胃气机,调畅情志影响思维等功能将中枢系统与胃肠道联系在一起,与现代医学“脑-肠-菌轴”高度相似。文章从中西医两方面论治FD,加强了对其病因病机与治则治法的认识,并拓展了中医调补肝脾法的思路。

腹腔镜无张力疝修补术联合补中益气汤治疗腹股沟疝临床观察

目的探讨应用腹腔镜无张力疝修补术联合补中益气汤治疗腹股沟疝的临床效果。方法选择2020年1月—2021年12月的腹股沟疝患者90例作为观察对象,根据入院顺序随机分组,对照组(45例)接受单纯的腹腔镜无张力疝修补术治疗,研究组(45例)接受腹腔镜无张力疝修补术联合中药补中益气汤治疗,观察手术后两组的疼痛评分、住院时间、术后复发率及治疗前后中医证候评分。结果手术后,研究组疼痛评分、住院时间及术后复发率均明显低于对照组,各项中医证候评分和总分明显优于对照组(P<0.05)。两组患者术后并发症发生情况对比,差异无统计学意义(P>0.05)。结论针对腹股沟疝行腹腔镜无张力疝修补术联合补中益气汤治疗,可帮助患者有效缩短住院时间、缓解疼痛程度,并改善其中气不足表现、降低术后复发率,值得临床推广应用。

基于免疫调节与抗氧化作用探讨圣愈汤治疗肾性贫血的临床价值

目的探讨圣愈汤联合西药治疗肾性贫血(RA)的临床效果及对免疫调节和氧化应激的影响。方法将80例维持性血液透析伴有中度RA患者随机等分成两组,对照组予红细胞生成刺激剂及铁剂治疗,观察组在对照组基础上加用圣愈汤治疗。观察两组临床疗效及治疗前后T淋巴细胞亚群、血红蛋白(Hb)、血细胞比容(Hct)、丙二醛(MDA)、超氧化物歧化酶(SOD)、C反应蛋白(CRP)及白细胞介素-6(IL-6)水平,记录不良反应情况。结果观察组治疗总有效率为87.50%(35/40),高于对照组的70.00%(28/40)(P<0.05)。治疗后,观察组T淋巴细胞亚群水平改善,且优于对照组(P<0.05);两组Hb、Hct水平高于治疗前,且高于对照组(P<0.05);观察组MDA降低、SOD升高,且优于对照组(P<0.05)。两组治疗前后CRP、IL-6水平比较,差异无统计学意义(P>0.05)。结论圣愈汤联合西药治疗RA患者,可有效提高临床效果,减轻氧化应激反应,调节免疫状态,安全性高,值得推广。