Clinical Experience in TCM Treatment of Chronic Cervicitis

Chronic cervicitis is a common disease in the female reproductive system, which may be the inducing factor for carcinoma of uterine cervix. It is clinically manifested by sticky and foul leukorrhagia, contact hemorrhage, pain in the lower limbs or lumbosacral region, dysmenorrhea and infertility. ……

Pharmacological intervention for chronic phase of spinal cord injury

Spinal cord injury is an intractable traumatic injury. The most common hurdles faced during spinal cord injury are failure of axonal regrowth and reconnection to target sites. These also tend to be the most challenging issues in spinal cord injury. As spinal cord injury progresses to the chronic phase, lost motor and sensory functions are not recovered. Several reasons may be attributed to the failure of recovery from chronic spinal cord injury. These include factors that inhibit axonal growth such as activated astrocytes, chondroitin sulfate proteoglycan, myelin-associated proteins, inflammatory microglia, and fibroblasts that accumulate at lesion sites. Skeletal muscle atrophy due to denervation is another chronic and detrimental spinal cord injury–specific condition. Although several intervention strategies based on multiple outlooks have been attempted for treating spinal cord injury, few approaches have been successful. To treat chronic spinal cord injury, neural cells or tissue substitutes may need to be supplied in the cavity area to enable possible axonal growth. Additionally, stimulating axonal growth activity by extrinsic factors is extremely important and essential for maintaining the remaining host neurons and transplanted neurons. This review focuses on pharmacotherapeutic approaches using small compounds and proteins to enable axonal growth in chronic spinal cord injury. This review presents some of these candidates that have shown promising outcomes in basic research(in vivo animal studies) and clinical trials: AA-NgR(310)ecto-Fc(AXER-204), fasudil, phosphatase and tensin homolog protein antagonist peptide 4, chondroitinase ABC, intracellular sigma peptide,(-)-epigallocatechin gallate, matrine, acteoside, pyrvate kinase M2, diosgenin, granulocyte-colony stimulating factor, and fampridine-sustained release. Although the current situation suggests that drug-based therapies to recover function in chronic spinal cord injury are limited, potential candidates have been identified through basic research, and these candidates may be subjects of clinical studies in the future. Moreover, cocktail therapy comprising drugs with varied underlying mechanisms may be effective in treating the refractory status of chronic spinal cord injury.

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms,and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms,which often make early diagnosis difficult,thus losing the best treatment opportunity.Once cerebral infarction occurs,the consequences are difficult to recover.This is also an important reason for the high misdiagnosis rate and mortality of this disease.In this paper,the characteristics of the disease were analyzed to provide clinical reference.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot program.Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes.If proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients.AIM To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care.METHODS The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.RESULTS The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera Hospital throughout 2022.The HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge.CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach.The coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient complexity.The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of care to be replicated.

Inflammasome links traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease

Traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease are three distinct neurological disorders that share common pathophysiological mechanisms involving neuroinflammation. One sequela of neuroinflammation includes the pathologic hyperphosphorylation of tau protein, an endogenous microtubule-associated protein that protects the integrity of neuronal cytoskeletons. Tau hyperphosphorylation results in protein misfolding and subsequent accumulation of tau tangles forming neurotoxic aggregates. These misfolded proteins are characteristic of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease and can lead to downstream neuroinflammatory processes, including assembly and activation of the inflammasome complex. Inflammasomes refer to a family of multimeric protein units that, upon activation, release a cascade of signaling molecules resulting in caspase-induced cell death and inflammation mediated by the release of interleukin-1β cytokine. One specific inflammasome, the NOD-like receptor protein 3, has been proposed to be a key regulator of tau phosphorylation where it has been shown that prolonged NOD-like receptor protein 3 activation acts as a causal factor in pathological tau accumulation and spreading. This review begins by describing the epidemiology and pathophysiology of traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease. Next, we highlight neuroinflammation as an overriding theme and discuss the role of the NOD-like receptor protein 3 inflammasome in the formation of tau deposits and how such tauopathic entities spread throughout the brain. We then propose a novel framework linking traumatic brain injury, chronic traumatic encephalopathy, and Alzheimer's disease as inflammasomedependent pathologies that exist along a temporal continuum. Finally, we discuss potential therapeutic targets that may intercept this pathway and ultimately minimize long-term neurological decline.

Optimizing chronic kidney disease management:The potential of a multi-strain probiotic formulation

Chronic kidney disease(CKD),which represents a significant global health concern,is characterized by a gradual decline in kidney function,leading to complications such as electrolyte imbalance,cardiovascular disease,and immune dysfunction.Standard CKD management includes dietary modifications,ketoana-logues supplementation,blood pressure and blood glucose control,hydration maintenance,and treatment of the underlying causes.Emerging evidence has indicated a significant role of the gut microbiota in CKD,and that dysbiosis of the gut microbiota contributes to the progression of CKD towards end-stage renal disease.Probiotics and prebiotics have recently garnered attention owing to their potential to enhance gastrointestinal health and well-being by restoring the balance of the gut microbiota.Specific probiotic strains,including Lactobacillus and Bifidobacterium,promote beneficial bacterial growth,suppress harmful bacteria,and exert anti-inflammatory,antihypertensive,and antidiabetic effects.The combination of Streptococcus thermophilus,Lactobacillus acidophilus,Bifidobacterium longum,and Bacillus coagulans has demonstrated potential as a therapeutic formulation for CKD management in various studies,highlighting its promise in treating CKD;however,supporting evidence remains limited,making it crucial to conduct further investigations to determine the specific effects of different probiotic formulations on outcomes in patients with CKD.

Intravenous iron in chronic kidney disease without anaemia but iron deficiency:A scoping review

Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in non-anaemic individuals with CKD and ID,focusing on safety,efficacy,and emerging therapeutic implications.Current diagnostic markers,including serum ferritin,transferrin saturation,and reticulocyte haemoglobin content,are reviewed alongside their limitations in the context of inflammation and variability.The pathophysiology of ID in CKD is explored,highlighting the roles of hepcidin,hypoxia-inducible factor pathways,and uraemic toxins.Comparative studies reveal that IV iron offers a more rapid correction of iron stores,improved com-pliance,and fewer gastrointestinal side effects compared to oral iron.Evidence from trials such as“iron and heart”and“iron and muscle”suggests potential benefits of IV iron on functional capacity and fatigue,though findings were sta-tistically non-significant.Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations,with newer formulations like ferric derisomaltose demonstrating favourable safety profiles.This review underscores the need for standardized screening protocols for ID in CKD,even in the absence of anaemia,to facilitate earlier intervention.Future research should prioritise robust outcome measures,larger sample sizes,and person-specific treatment strategies to optimise dosing and administration frequency.Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes,quality of life,and long-term health in people with CKD.

Safety and efficacy of sodium bicarbonate for treating metabolic acidosis in chronic kidney disease:A systematic review and metaanalysis

BACKGROUND Kidney dysfunction and reduced filtration capacity due to chronic kidney disease(CKD)lead to a shift in the body's acid-base balance,ultimately causing metabolic acidosis(MA).Sodium bicarbonate has been used as a supplement to alleviate the symptoms and reverse the acidosis,and it may even slow the progression of CKD.However,its safety profile and overall effectiveness are uncertain.AIM To conduct a systematic review and meta-analysis of clinical trials assessing sodium bicarbonate's safety and efficacy for treating CKD-induced MA.METHODS Medline,Scopus,EMBASE,and Cochrane Central were systematically searched from inception until May 2024 to select all relevant randomized control trials(RCTs)and non-RCT(NRCTs)evaluating the effectiveness of sodium bicarbonate in correcting MA in end-stage renal disease patients.In addition,ClinicalTrials.gov,Medrxiv.org,and Google Scholar were searched for other literature.A random-effects meta-analysis was performed to derive mean differences(MD)and risk ratios(RR)with their 95%CI for continuous and dichotomous outcomes respectively.RESULTS Following a systematic search of the databases,20 RCTs and 2 and NRCTs comprising 2932 patients were included in our study.The results revealed that sodium bicarbonate significantly increased serum bicarbonate in CKD patients(MD:2.59,95%CI:0.95-4.22;P=0.02;I2=95%).However,there was a non-significant increase in estimated glomerular filtration rate(eGFR)in patients on sodium bicarbonate therapy(MD:0.93,95%CI:-1.88-3.75;P=0.52;I2=93%).Upon assessment of the safety profile of sodium bicarbonate,no significant association was found in the outcomes of death/prolonged hospitalization(RR:1.05,95%CI:0.84-1.32;P=0.66;I2=0%),or gastrointestinal disorders(RR:1.64,95%CI:0.35-7.66;P=0.53;I2=76%),or worsening edema(RR:1.26,95%CI:0.94-1.68;P=0.12;I2=37%)when compared to control.CONCLUSION Sodium bicarbonate therapy may halt worsening kidney function by correcting serum bicarbonate levels and treating MA.Although sodium bicarbonate does not significantly improve the eGFR,it may potentially prevent CKD progression while maintaining an overall favorable safety profile.

Small bites,big impact:The importance of evening snacks in patients with advanced chronic liver disease

People with advanced chronic liver disease(ACLD)have an enhanced risk of malnutrition,which has multifactorial etiology and is mainly linked to a reduced energy and protein intake;malnutrition is critical for patients with cirrhosis since it is often associated with sarcopenia,a skeletal muscle depletion with a loss of muscle mass and function.Late-evening snacks have been extensively studied,and guidelines are recommended to counteract the effects of prolonged fasting at night in patients with ACLD.However,it has not been fully explored whether late evening snacking is clarified as a milestone to address the nutritional needs of people with ACLD or whether it has a potential role in improving body compo-sition.In this randomised control trial,Yu et al demonstrated that long-term nocturnal snacks have the potential to significantly improve body composition by body fat mass,visceral fat area and body cell mass in patients with ACLD.While the improvement in skeletal muscle mass was minor,the promising results in other compositions provide hope for future research and patient care.

Transition from acute kidney injury to chronic kidney disease in liver cirrhosis patients:Current perspective

In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.

Clinical features of abnormalα-fetoprotein in 15 patients with chronic viral hepatitis B after treatment with antiviral drugs

BACKGROUND Liver function of chronic hepatitis B(CHB)patients is essentially normal after treatment with antiviral drugs.In rare cases,persistently abnormally elevatedα-fetoprotein(AFP)is seen in CHB patients following long-term antiviral treatment.However,in the absence of imaging evidence of liver cancer,a reasonable expla-nation for this phenomenon is still lacking.AIM To explore the causes of abnormal AFP in patients with CHB who were not diag-nosed with liver cancer.METHODS From November 2019 to May 2023,15 patients with CHB after antiviral treatment and elevated AFP were selected.Clinical data and quality indicators related to laboratory testing,imaging data,and pathological data were obtained through inpatient medical records.RESULTS All patients had increased AFP and significantly elevated IgG.Cancer was excluded by imaging examination.Only four patients had elevated alanine ami-notransferase,10 had elevated aspartate aminotransferase,nine had elevated total bilirubin,and two had antinuclear antibodies.The liver biopsy and histopatho-logical examination indicated that 14 patients had rosette,moderate,or higher interfacial inflammation,lymphocyte infiltration,and severe hepatic fibers(11 cases),which was consistent with the pathological features of autoimmune hepa-titis(AIH).After 8-12 week of hormone therapy,the levels of AFP and IgG,and liver function returned to normal(P<0.05).CONCLUSION For patients with CHB and elevated AFP after antiviral treatment,autoimmune hepatitis should be considered.CHB with AIH is clinically insidious and difficult to detect,and prone to progression to cirrhosis.Liver puncture pathological examination should be performed when necessary to confirm diagnosis.

Determinants of generalized anxiety and construction of a predictive model in patients with chronic obstructive pulmonary disease

BACKGROUND Patients with chronic obstructive pulmonary disease(COPD)frequently experience exacerbations requiring multiple hospitalizations over prolonged disease courses,which predispose them to generalized anxiety disorder(GAD).This comorbidity exacerbates breathing difficulties,activity limitations,and social isolation.While previous studies predominantly employed the GAD 7-item scale for screening,this approach is somewhat subjective.The current literature on predictive models for GAD risk in patients with COPD is limited.AIM To construct and validate a GAD risk prediction model to aid healthcare professionals in preventing the onset of GAD.METHODS This retrospective analysis encompassed patients with COPD treated at our institution from July 2021 to February 2024.The patients were categorized into a modeling(MO)group and a validation(VA)group in a 7:3 ratio on the basis of the occurrence of GAD.Univariate and multivariate logistic regression analyses were utilized to construct the risk prediction model,which was visualized using forest plots.The model’s performance was evaluated using Hosmer-Lemeshow(H-L)goodness-of-fit test and receiver operating characteristic(ROC)curve analysis.RESULTS A total of 271 subjects were included,with 190 in the MO group and 81 in the VA group.GAD was identified in 67 patients with COPD,resulting in a prevalence rate of 24.72%(67/271),with 49 cases(18.08%)in the MO group and 18 cases(22.22%)in the VA group.Significant differences were observed between patients with and without GAD in terms of educational level,average household income,smoking history,smoking index,number of exacerbations in the past year,cardiovascular comorbidities,disease knowledge,and personality traits(P<0.05).Multivariate logistic regression analysis revealed that lower education levels,household income<3000 China yuan,smoking history,smoking index≥400 cigarettes/year,≥two exacerbations in the past year,cardiovascular comorbidities,complete lack of disease information,and introverted personality were significant risk factors for GAD in the MO group(P<0.05).ROC analysis indicated that the area under the curve for predicting GAD in the MO and VA groups was 0.978 and 0.960.The H-L test yieldedχ^(2) values of 6.511 and 5.179,with P=0.275 and 0.274.Calibration curves demonstrated good agreement between predicted and actual GAD occurrence risks.CONCLUSION The developed predictive model includes eight independent risk factors:Educational level,household income,smoking history,smoking index,number of exacerbations in the past year,presence of cardiovascular comorbidities,level of disease knowledge,and personality traits.This model effectively predicts the onset of GAD in patients with COPD,enabling early identification of high-risk individuals and providing a basis for early preventive interventions by nursing staff.

Prevalence and clinical characteristics of chronic kidney disease among patients with newly diagnosed ketosis-onset diabetes

BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ketosis-onset diabetes remains controversial and requires further investigation.AIM To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.METHODS This real-world study included 217 patients with type 1 diabetes mellitus(T1DM),698 with ketosis-onset diabetes,and 993 with non-ketotic T2DM.The prevalence and clinical characteristics of CKD were compared among the three groups.Risk factors associated with CKD were evaluated using binary logistic regression for each group.RESULTS After adjusting for age and sex,the prevalence of CKD among patients with ketosis-onset diabetes(17.8%)was significantly higher than that in those with T1DM(8.3%,P=0.007),but was not statistically different compared to those with non-ketotic T2DM(21.7%,P=0.214).Furthermore,some risk factors for CKD,including age,and serum uric acid and C-reactive protein levels,in patients with ketosis-onset diabetes were similar to those with T2DM,but significantly different from those with T1DM.CONCLUSION The prevalence,clinical characteristics,and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM.These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.

Meta-analysis of the association between chronic periodontitis and chronic kidney disease

BACKGROUND Many scholars have performed several clinical studies have investigated the association between chronic periodontitis(CP)and chronic kidney disease(CKD).However,there are still differences between these research results,and there is no unified conclusion.Therefore,a systematic review is required to understand this issue fully.AIM To explore the correlation between CP and CKD.METHODS Literature on the correlation between CP and CKD,as well as the clinical attachment level(CAL)and pocket probing depth(PPD)of CKD and non-CKD,were retrieved from PubMed,Embase,the Cochrane Library,and Web of Science repositories until January 2024.After the effective data were extracted,data processing and statistics were performed using Stata 12.0.RESULTS Of the 22 studies,13 were related to CP and CKD,and 9 reported CAL and PPD in patients with CKD and healthy controls.Meta-analysis of the correlation between CP and CKD revealed that CKD probability in people with CP was 1.54 times that of healthy individuals[relative risk=1.54,95%confidence interval(CI):1.40-1.70],and CP incidence in patients with CKD was 1.98 times that of healthy individuals[overall risk(OR)=1.98,95%CI:1.53-2.57].Meta-analysis of CAL and PPD evaluations between CKD patients and healthy individuals showed that CAL and PPD levels were higher in CKD patients[standard mean difference(SMD)of CAL=0.65,95%CI:0.29-1.01;SMD of PPD=0.33,95%CI:0.02-0.63].CONCLUSION A bidirectional association exists between CP and CKD.CKD risk is increased in CP patients and vice versa.Periodontal tissue or tooth loss risks increase over time in CKD patients.

Genetic Evidence for Causal Association Between Hypertension and Chronic Pain:A Bidirectional Two-Sample Mendelian Randomization Study

Objective The extent to which the association between hypertension and chronic pain in observational studies is either causally linked or influenced by other shared risk factors has not been substantially addressed.In the present study,Mendelian randomization(MR)was employed to examine the potential causal relationship between hypertension and risk of chronic pain.Methods The study data were derived from the pooled dataset of the genome-wide association study(GWAS),enabling the evaluation of the causal effects of hypertension on various types of chronic pain including chronic headache as well as chest,abdominal,joint,back,limb,and multisite chronic pain.We performed a bidirectional two-sample MR analysis using random effect inverse variance weighting(IVW),MR-Egger,weighted median,and weighted mode,quantified by odds ratio(OR).Results Genetically predicted essential hypertension was associated with an increased risk of chronic headache(OR=1.007,95%CI:1.003-1.011,P=0.002)and limb pain(OR=1.219,95%CI:1.033-1.439,P=0.019).No potential causal associations were identified between chronic pain and essential hypertension in the reverse direction MR(P>0.05).In addition,there was no potential causal association between secondary hypertension and chronic pain(P>0.05).Conclusion This study provided genetic evidence that a unidirectional causal relationship exists between essential hypertension and the increased risks of chronic headache and limb pain,and no causal relationship was found between secondary hypertension and chronic pain.These findings offer theoretical underpinnings for future research on managing hypertension and chronic pain.

Complex Regional Pain Syndrome: Outpatient Pain Management in the Chronic Setting: A Case Report

Background: Complex Regional Pain Syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a neuropathic pain condition that usually develops after an injury to an extremity. CRPS can be a debilitating condition with high levels of pain and reduced function. Aim: This case report aims to discuss the multimodal approach in the management of a patient who presented with ongoing poorly controlled pain secondary to CRPS from an injury that happened years prior. Case Presentation: A 45-year-old female was involved in a motor vehicle accident where her right leg was injured. She underwent several surgeries and developed CRPS that significantly reduced her mobility and quality of life. She presented to the pain clinic years after her initial injury and a multimodal regimen was started for her resulting in significantly improved function. Conclusion: CRPS can be a severely debilitating condition. While early diagnosis and management are important, ongoing management in the outpatient chronic pain setting is important in maintaining a good level of function.

Clinical efficacy of magnetic vibration magnetoelectric therapy in the treatment of chronic prostatitischronic pelvic pain syndrome

BACKGROUND The prominent symptoms of chronic pelvic pain syndrome(CPPS)are urogenital pain,lower urinary tract symptoms,psychological problems,and sexual dysfunction.Traditional pharmacological treatments have poor efficacy and more untoward reaction and complications.Magnetic vibration magnetoelectric therapy is a non-invasive form of physiotherapy.Nevertheless,its effectiveness in improving urinary discomfort and relieving pain in patients requires further exploration.AIM To investigate the clinical efficacy of the magnetic vibration magnetoelectric therapy instrument in the treatment of chronic prostatitis(CP)/CPPS.METHODS Seventy patients with CP/CPPS were collected from the outpatient clinic and ward of the Department of Male Medicine,Jiangsu Province Hospital of Traditional Chinese Medicine,and were treated with magnetic vibration magnetoelectric therapy once a day for a period of 14 d.National Institutes of healthchronic prostatitis symptom index(NIH-CPSI),international index of erectile function 5(IIEF-5),premature ejaculation diagnostic tool(PEDT),generalized anxiety disorder(GAD),patient health questionnaire,the pain catastrophizing scale(PCS)and traditional Chinese medicine syndrome(TCMS)scores were performed before and after treatment.RESULTS The total effective rate of treatment was 58.5%,and the total NIH-CPSI score,pain symptoms,voiding symptoms,quality of life,IIEF-5,PEDT,GAD,PCS and TCMS scores all decreased significantly(P<0.05).CONCLUSION Magnetic vibration magnetotherapy is effective in improving urinary discomfort,relieving pain,improving quality of life,improving sexual dysfunction and relieving negative emotions such as anxiety in patients with CP/CPPS.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

Potential efficacy and mechanism of medicinal plants on chronic kidney disease-associated vascular calcification:a review

Vascular calcification is a crucial risk factor that affects the incidence and mortality of cardiovascular disease in chronic kidney disease patients.Modern medicine relies on calcium-phosphorus binding agents,calcium mimetics,active vitamin D,and hemodialysis to prevent and treat vascular calcification,however,their efficacy is unsatisfactory and adverse reactions often occur.Medical plant therapy can act as an integrative regulator in patients with chronic kidney disease-associated vascular calcification,which can significantly improve patients’symptoms,but its specific mechanism has not been fully elucidated yet.In this paper,we reviewed the domestic and international theoretical studies on the pathogenesis mechanism of chronic kidney disease-associated vascular calcification in recent years,summarized eight active ingredients of medicinal plants as well as four compound formulas for improving chronic kidney disease-associated vascular calcification,and explored the mechanism of action of herbal medicine,which will provide a new strategy for promoting the prevention and treatment of vascular calcification.

Treatment and Clinical Management of Chronic Thromboembolic Pulmonary Hypertension:An Update of Literature Review

Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.