Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction(HFrEF)and nonalcoholic fatty liver disease(NAFLD)are two common comorbidities that share similar pathophysiological mechanisms.There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD.This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD.Pharmacological therapies,including angiotensinconverting enzyme inhibitors/angiotensin receptor blockers,mineralocorticoids receptor antagonist,and sodium-glucose cotransporter-2 inhibitors,have been shown to reduce fibrosis and fat deposits in the liver.However,there are currently no data showing the beneficial effects of sacubitril/valsartan,ivabradine,hydralazine,isosorbide nitrates,digoxin,or beta blockers on NAFLD in patients with HFrEF.This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities.Further research is needed in patients with coexisting HFrEF and NAFLD,with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.

Treatment for paraganglioma with stereotactic radiotherapy

BACKGROUND Paragangliomas(PG)are rare neoplasms of neuroendocrine origin that tend to be highly vascularized,slow-growing,and usually sporadic.To date,common treatment options are surgical resection(SR),with or without radiation therapy(RT),and a watch-and-wait approach.AIM To evaluate the local control and effectiveness of exclusive fractionated stereotactic RT(FSRT)treatment in unresectable PG(uPG).METHODS We retrospectively evaluated patients with uPG(medically inoperable or refused SR)treated with FSRT with a Cyberknife System(Accuray Incorporated,Sunnyvale,California).Toxicity and initial efficacy were evaluated.RESULTS From May 2009 to January 2023,6 patients with a median age of 68(range 20-84)were treated with FSRT.The median delivered dose was 21 Gy(range 20-30 Gy)at a median isodose line of 75.5%(range 70%-76%)in 4 fractions(range 3-5 fractions).The median volume was 13.6 mL(range 12.4-65.24 mL).The median cumulative biological effective dose and equivalent dose in 2-Gy fractions were 70 Gy and 37.10 Gy respectively.Site of origin involved were the timpa-nojugular glomus(4/6),temporal bone,and cervical spine.In 1 of the 6 patients,the follow-up was insufficient;5 of 6 patients showed a 5-year overall survival and 5-year progression-free survival of 100%.We observed negligible toxicities during and after RT.The majority of patients showed stable symptoms during follow-up.Only 1 patient developed spine metastases.CONCLUSION Our preliminary results on this small cohort of patients suggest that FSRT could be an effective and safe alternative to SR.

CLINICAL STUDY IN ACCELERATED HYPERFRACTIONATED IRRADIATION IN THE TREATMENT OF LOCAL ADVANCED NON-SMALL CELL LUNG CANCER

Objective To evaluate the effect of accelerated hyperfractionated irradiation (AHFJ) and conventional fractionated irradiation (CFI) for local advanced non- small cell lung cancer (NSCLC). Methods The patients of AI-IFJ group were irradiated to large-field target volume by a daily fraction of 2Gy, and small-field target volume by a daily fraction of 1Gy with more than 6h interval. The total dose of large-field target volume was SOGy/25Fx/SW and of small-field target volume was 7SGy/SOFx/5W. The patients in CFI group were irradiated by a daily fraction of 2Gy to the total dose of 66Gy/33Fx/6. 6W. After 3 months of radiotherapy, the tumor response rates of complete recovery (CR), partial recovery (PR), and no change (NC) and 1- and 2- year survival rate in the two groups were observed. Results The tumor response rates of CR,PR,NC in AHFI group and CFI group were 22.9%(8/35), 60.0%(21/35), 17.1%(6/35) and 11.4% (4/35), 51.4% (18/35), 37.2% (13/35) respectively (P>0. 05). All patients were followed up 2 years or more. The 1- and 2- year survival rates in AHFI group and CFI group were 62.9% (22/35), 31 .4% (11/35) and 42.9% (15/35) , 17.1% (6/35) respectively (P< 0.05). The incidences of esophagitis and pneumonitis in AHFI group and CFI group were 34.3% (12/35), 22. 9% (8/35) and 40.0% (14/35), 17.1% (6/35)(P>0. 05). Conclusion In comparison with CFI, AHFI may increase 1- and 2- year sur-vival rate after treatment of local advanced non-small cell lung cancer, while the radio-reactions, either early or late, did not increase significantly.

Effect of Stereotactic Body Radiation Therapy on Diverse Organ Lesions in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

Objective The combination of stereotactic body radiation therapy(SBRT)and immune checkpoint inhibitors(ICIs)is actively being explored in advanced non-small-cell lung cancer(NSCLC)patients.However,little is known about the optimal fractionation and radiotherapy target lesions in this scenario.This study investigated the effect of SBRT on diverse organ lesions and radiotherapy dose fractionation regimens on the prognosis of advanced NSCLC patients receiving ICIs.Methods The medical records of advanced NSCLC patients consecutively treated with ICIs and SBRT were retrospectively reviewed at our institution from Dec.2015 to Sep.2021.Patients were grouped according to radiation sites.Progression-free survival(PFS)and overall survival(OS)were recorded using the Kaplan-Meier method and compared between different treatment groups using the log-rank(Mantel-Cox)test.Results A total of 124 advanced NSCLC patients receiving ICIs combined with SBRT were identified in this study.Radiation sites included lung lesions(lung group,n=43),bone metastases(bone group,n=24),and brain metastases(brain group,n=57).Compared with the brain group,the mean PFS(mPFS)in the lung group was significantly prolonged by 13.3 months(8.5 months vs.21.8 months,HR=0.51,95%CI:0.28–0.92,P=0.0195),and that in the bone group prolonged by 9.5 months with a 43%reduction in the risk of disease progression(8.5 months vs.18.0 months,HR=0.57,95%CI:0.29–1.13,P=0.1095).The mPFS in the lung group was prolonged by 3.8 months as compared with that in the bone group.The mean OS(mOS)in the lung and bone groups was longer than that of the brain group,and the risk of death decreased by up to 60%in the lung and bone groups as compared with that of the brain group.When SBRT was concurrently given with ICIs,the mPFS in the lung and brain groups were significantly longer than that of the bone group(29.6 months vs.16.5 months vs.12.1 months).When SBRT with 8–12 Gy per fraction was combined with ICIs,the mPFS in the lung group was significantly prolonged as compared with that of the bone and brain groups(25.4 months vs.15.2 months vs.12.0 months).Among patients receiving SBRT on lung lesions and brain metastases,the mPFS in the concurrent group was longer than that of the SBRT→ICIs group(29.6 months vs.11.4 months,P=0.0003 and 12.1 months vs.8.9 months,P=0.2559).Among patients receiving SBRT with<8 Gy and 8–12 Gy per fraction,the mPFS in the concurrent group was also longer than that of the SBRT→ICIs group(20.1 months vs.5.3 months,P=0.0033 and 24.0 months vs.13.4 months,P=0.1311).The disease control rates of the lung,bone,and brain groups were 90.7%,83.3%,and 70.1%,respectively.Conclusion The study demonstrated that the addition of SBRT on lung lesions versus bone and brain metastases to ICIs improved the prognosis in advanced NSCLC patients.This improvement was related to the sequence of radiotherapy combined with ICIs and the radiotherapy fractionation regimens.Dose fractionation regimens of 8–12 Gy per fraction and lung lesions as radiotherapy targets might be the appropriate choice for advanced NSCLC patients receiving ICIs combined with SBRT.

非剥脱点阵激光联合透明质酸钠复合溶液注射治疗颈部老化疗效观察

目的:观察非剥脱点阵激光联合透明质酸钠复合溶液注射治疗颈部老化的临床疗效。方法:选取2020年7月-2022年7月于笔者医院就诊的30例颈部老化女性就医者,按随机数字表法分为对照组和联合组各15例。对照组给予1 565 nm M22-ResurFx非剥脱点阵激光治疗;联合组给予1 565 nm M22-ResurFx非剥脱点阵激光联合透明质酸钠复合溶液注射治疗。对照组激光治疗3次;联合组激光及透明质酸钠复合溶液联合治疗3次,收集每次治疗前、后照片,评估治疗前、后就医者颈部老化的改善程度和治疗后不良反应。结果:联合组改善率为66.67%,明显高于对照组的20.00%(P<0.05);联合组就医者满意率为80.00%,高于对照组的53.33%;联合组颈部老化分级明显优于对照组(P<0.05)。激光治疗后治疗区域均即刻出现红斑及风团,3~5 d消退,无结痂及出血发生。两组均未有其他严重不良反应发生。结论:非剥脱点阵激光联合透明质酸钠复合溶液注射治疗颈部老化疗效好,患者满意度高,值得临床推广应用。

宣肺化湿止咳汤联合西药治疗咳嗽变异性哮喘临床观察

目的研究宣肺化湿止咳汤治疗咳嗽变异性哮喘的临床效果及对呼出气一氧化氮(FeNO)数值的影响。方法选择2018年7月—2019年12月收治的120例咳嗽变异性哮喘患者作为研究对象,40例采用沙美特罗替卡松粉(舒利迭)吸入治疗作为西药组,40例采用宣肺化湿止咳汤治疗作为中药组,最后40例采用二者联合治疗作为联合组。观察三组治疗效果、咳嗽症状积分、FeNO水平、咳嗽生活质量以及不良反应情况。结果联合组的治疗总有效率为97.5%(39/40),明显高于西药组的80.0%(32/40)、中药组的82.5%(33/40),差异有统计学意义(P<0.05);治疗后联合组FeNO水平低于西药组和中药组,莱切斯特咳嗽问卷(LCQ)评分高于西药组和中药组,日间积分与夜间积分均低于西药组和中药组,差异均有统计学意义(P<0.05);西药组和中药组FeNO水平、LCQ评分、日间积分与夜间积分对比,差异无统计学意义(P>0.05)。结论宣肺化湿止咳汤联合西药治疗咳嗽变异性哮喘,效果较好,能明显减轻患者临床症状,提高生活质量,降低炎症反应,值得临床应用及推广。

肾动脉狭窄介入治疗中的血流动力学评估进展

肾动脉狭窄是导致继发性高血压及肾功能不全的常见原因,介入治疗是重要的治疗方法之一。既往大规模随机对照研究表明,介入治疗相比单纯药物治疗可能无法为动脉粥样硬化性肾动脉狭窄患者带来获益,但这些研究存在选择偏倚等缺陷,其结论引发了广泛争议。现主要探究肾动脉狭窄的血流动力学评估方法,总结血流动力学指导的介入治疗对患者预后的预测能力,并对血流动力学评估下介入治疗在肾动脉狭窄患者中的应用及发展作出展望。

顾仁樾教授辨证治疗射血分数保留性心力衰竭的经验

顾仁樾教授临证论治射血分数保留性心力衰竭,认为其病位在心脾,又关乎五脏,病机为本虚标实,本虚以心脾亏虚为先,心脾气虚为主,又以气虚为导,逐渐演变为气虚损阳,标实以水饮、血瘀为甚。并根据病情阶段变化形成病机演变,发病之初,以心脾气虚为主,水饮兼瘀;进展期逐渐演变为脾阳亏虚、心阳不振,水饮血瘀并重;后期气阴两虚,阴阳俱损。故治疗当标本兼顾,分阶段分别运用运脾、益心、利水、化瘀等治法。治疗过程中应当兼顾他脏,温阳恰当,并注重病证结合。

点阵二氧化碳激光联合光动力治疗肛门尖锐湿疣复发因素分析

目的:通过回顾性分析点阵二氧化碳(carbon dioxide,CO_(2))激光联合5-氨基酮戊酸光动力疗法(5-aminolevulinic acid photodynamic therapy,ALA-PDT)治疗肛门尖锐湿疣(condyloma acuminatum,CA)患者的临床资料,以评估影响术后复发的因素。方法:收集2015年4月─2022年12月间在南通大学附属南通第三医院皮肤科接受点阵CO_(2)激光联合光动力治疗的肛门CA患者,分为复发组和治愈组,分析两组患者的临床资料,采用Cox回归模型对患者的临床特征进行单因素及多因素回归分析。结果:56例肛门CA患者纳入分析,其中复发8例,未复发48例,复发率为14.28%。单因素及多因素Cox回归分析表明,点阵CO_(2)激光次数(>1次)与肛门CA复发呈正相关[HR=13.0,95%CI(2.1,79.9),P=0.006],不合并基础疾病与复发呈负相关[HR=0.1,95%CI(0,0.4),P=0.003]。结论:CO_(2)激光次数及合并基础疾病是点阵CO_(2)激光联合光动力治疗肛门CA复发的独立影响因素。

围术期氧疗的研究进展

目的氧疗是围术期麻醉管理的重要组成部分。氧疗是把双刃剑,氧浓度过高可产生肺不张、氧化应激,给机体造成损伤,过低又会导致低氧血症,影响氧合。因此,围术期氧疗如何选择合适的吸氧浓度一直是麻醉管理的热点问题。本文将围绕围术期氧疗对机体的影响、不同类型患者吸入氧浓度的选择作一综述,以期为围术期精准氧疗提供理论参考。

基于“动则生阳”论治射血分数保留的心力衰竭

射血分数保留的心力衰竭(Heart Failure with Preserved Ejection Fraction,HFpEF)为本虚标实之证。本虚即为心、肺、脾、肾之阳虚,其中心阳亏虚是本虚之核心;标实则是水饮、痰浊、瘀血之阴实,其中瘀血贯穿疾病始终。研究通过剖析“动则生阳”理论内涵,发现广义的“动”除了指运动疗法外,还包括“动药”。阳气在人体生命活动中起主导作用,气主动而属阳,故阳气主动。若阳气亏虚,则当顺应阳气“动”的特性而补足阳气,因此《黄帝内经》提出“动则生阳”理论。基于此,笔者在“动则生阳”理论的指导下创“武医结合”之法,将“动药”与中医运动疗法联合应用于HFpEF的治疗。风药升生以化阳,虫药走窜而通阳,风药升生之力与虫药走窜之功除标实而助阳势、化阳气。太极拳、八段锦皆能温壮阳气,以益本虚。本治疗方法旨在顺应阳气“动”的特性而“生阳”,从而改善HFpEF的临床症状,促使身体向愈。“动药”与中医运动疗法的联合应用是“武医结合”防治HFpEF的体现,既可为临床诊疗提供新的思路,同时也丰富了中医治疗HFpEF的理论体系。

伊曲康唑联合点阵激光及光动力治疗皮肤近平滑念珠菌病1例

患者,男,59岁,双上肢皮肤结节、破溃、坏死6个月余。完善皮肤镜、皮损组织病理、特殊染色、真菌培养、DNA-病原微生物宏基因组检测,确诊为皮肤近平滑念珠菌病。予以口服伊曲康唑胶囊、复方甘草酸苷片,点阵激光联合光动力治疗3次,6周后皮损愈合。

射血分数保留型心力衰竭临床诊断及治疗的研究进展

射血分数保留型心力衰竭(HFpEF)的病死率较高且发病率不断增加,可能成为未来心力衰竭的主要类型,是心血管疾病中的重要问题。尽管近年HFpEF的研究取得了一些重要进展,但其发病机制仍未完全清楚,患者的预后及病死率并未得到明显改善。由于HFpEF合并症较多、病理机制复杂、传统心力衰竭治疗药物不能有效改善HFpEF患者的预后,目前仍缺乏精准的诊断方法和有效的临床治疗策略。探索和开发有效的诊断及治疗方法具有重要的临床意义。本文就近年来HFpEF诊断和治疗方面取得的研究进展及未来研究方向作一综述。

射血分数保留型心力衰竭的病理生理及治疗药物进展

射血分数保留型心力衰竭在心力衰竭中占40%~71%,是一种涉及心、肾、肺、血管系统和脂肪组织等的多系统疾病,严重影响患者的生活水平。近年来,随着医疗研究水平不断提升,射血分数保留型心力衰竭临床治疗取得一定的效果,但患者仍然存在预后不良情况,复发率升高而生活质量下降。文章通过对射血分数保留型心力衰竭近年国内外相关研究报道进行综述,发现其病理生理机制主要与高血压、冠脉疾病和冠脉微血管功能障碍、左心功能不全、右心室功能障碍和肺动脉疾病、激素系统异常、肥胖、系统性炎症和代谢异常相关,通常使用利尿剂、RAAS抑制剂、SGLT2is、MRA和他汀类药物进行治疗,不同分型的动物模型的构建也为射血分数保留型心力衰竭临床诊治提供一些有价值参考。

基质血管组分治疗膝骨关节炎的研究进展

膝骨关节炎(Knee Osteoarthritis,KOA)是临床上发病率最高的骨关节炎,治疗不当或不及时将有致残的风险。脂肪来源的基质血管组分(Stromal vascular fraction,SVF)作为一种新型的干细胞治疗方法,近年来已在临床上用于治疗膝骨关节炎,具有排斥反应小、安全性高、临床疗效好等特点。本文对SVF临床使用的安全性,以及制备提取途径、回输方法、治疗KOA的机制与疗效等进行综述,以期为SVF在临床进一步推广与应用提供参考和思路。

Attributable Causes of Breast Cancer and Ovarian Cancer in China:Reproductive Factors,Oral Contraceptives and Hormone Replacement Therapy

Objective： To provide an evidence-based, consistent assessment of the burden of breast cancer attributable to reproductive factors （RFs, including nulliparity, mean number of children, age at first birth and breastfeeding）, use of oral contraceptives （OCs, restricted to the age group of 15-49 years）, and hormone replacement therapy （HRT）, as well as of the burden of ovarian cancer attributable to the mean number of children in China in 2005. Methods： We derived the prevalence of these risk factors and the relative risk of breast and ovarian cancer from national surveys or large-scale studies conducted in China. In the case of RFs, we compared the exposure distributions in 2001 and counterfactual exposure. Results： Exposure of RFs in 2002 was found to account for 6.74% of breast cancer, corresponding to 9,617 cases and 2,769 deaths, and for 2.78% of ovarian cancer （712 cases, 294 deaths）. The decrease in mean number of children alone was responsible for 1.47% of breast cancer and 2.78% of ovarian cancer. The prevalence of OC use was 1.74% and the population attributable fraction （PAF） of breast cancer was 0.71%, corresponding to 310 cases and 90 deaths. The PAF of breast cancer due to HRT was 0.31%, resulting in 297 cases and 85 deaths. Conclusion： RFs changes in China contributed to a sizable fraction of breast and ovarian cancer incidence and mortality, whereas HRT and OCs accounted for relatively low incidence of breast cancer in China.

Therapeutic applications of adipose-derived stromal vascular fractions in osteoarthritis

Osteoarthritis(OA)is considered to be a highly heterogeneous disease with progressive cartilage loss,subchondral bone remodeling,and low-grade inflammation.It is one of the world's leading causes of disability.Most conventional clinical treatments for OA are palliative drugs,which cannot fundamentally cure this disease.The stromal vascular fraction(SVF)from adipose tissues is a heterogeneous cell population.According to previous studies,it contains a large number of mesenchymal stem cells,which have been used to treat OA with good therapeutic results.This safe,simple,and effective therapy is expected to be applied and promoted in the future.In this paper,the detailed pathogenesis,diagnosis,and current clinical treatments for OA are introduced.Then,clinical studies and the therapeutic mechanism of SVF for the treatment of OA are summarized.

The effectiveness of the mononuclear fraction of autologous bone marrow in the treatment of experimental chronic limb ischemia

Objective To study of the effectiveness of using autologous mononuclear fraction of bone marrow for the treatment of chronic limb ischemia. Methods Results of autologous mononuclear fraction of bone marrow in 90 laboratory Wistar rats on a background of creating chronic limb ischemia was presented. Sampling was carried out from the bone marrow of the femur of the animal. The mononuclear fraction of bone marrow autologous 4 × 106 cells in a volume of 200 microliter were injected into the ischemic limb of the two points,in each of which 100 microliter:(1)Paravessel directly below the inguinal ligament at the level of the sacroiliac joint in the area of the anatomical location of collaterals in the projection of the internal iliac artery and its branches;(2)Intramuscularly in gastrocnemius muscle anterior-lateral surface of the middle third of the leg. Results In the experimental group of rats treated with autologous mononuclear fraction of bone marrow,the level of microcirculation compared with the intact group of animals on day 21 was higher than 6. 1% by day 28% ~ 31. 2%; compared with the control group-day 10 increased by 111% at day 21,85. 7% on day 28% ~ 97%. Conclusion Proposed method of treating pathogenically justified and can be recommended for use in clinical practice in the treatment of patients with chronic obliterating diseases of lower limb arteries.

Fat Grafting for Rejuvenation and Regeneration with Stromal Vascular Fraction Gel

Lipotransfer has become a powerful regenerative tool,largely because of its cellular components,the stromal vascular fraction(SVF).However,the clinical separation of cells with collagenase is strictly legislated.In 2017,Yao et al.postulated a novel fat-derived product mechanically concentrating SVF cells and an extracellular matrix(ECM)and named it stromal vascular fraction gel(SVF-gel).This review discussed the protocol of SVF-gel and its component as well as its inner structure.The histologic examination and the retention rate after the transplantation of SVF-gel were also rendered.Moreover,we summed up the rejuvenating and regenerative use of SVF-gel and introduced its possible mechanism.