Late effects of the treatment of childhood cancer

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies,with more than 80%of children with cancer who have access to contemporary treatment being cured.However,the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes,referred to as late effects,which appear months to years after the completion of cancer treatment.Research has shown that 60%to 90%of childhood cancer survivors(CCSs)develop one or more chronic health conditions,and 20%to 80%of survivors experience severe or life-threatening complications during adulthood.Therefore,understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies

Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.

Controversies around the treatment of peritoneal metastases of colorectal cancer

In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.

Advancing treatment strategies:Insights from network meta-analysis of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma

This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.

Efficacy,safety and treatment satisfaction of transition to a regimen of insulin degludec/aspart:A pilot study

BACKGROUND There is a lack of clinical evidence on the efficacy and safety of transitioning from a thrice-daily pre-mixed insulin or basal-prandial regimen to insulin degludec/aspart(IDegAsp)therapy,with insufficient data from the Chinese population.AIM To demonstrate the efficacy,safety,and treatment satisfaction associated with the transition to IDegAsp in type 2 diabetes mellitus(T2DM).METHODS In this 12-week open-label,non-randomized,single-center,pilot study,patients with T2DM receiving thrice-daily insulin or intensive insulin treatment were transitioned to twice-daily injections of insulin IDegAsp.Insulin doses,hemoglobin A1c(HbA1c)levels,fasting blood glucose(FBG),hypoglycemic events,a Diabetes Treatment Satisfaction Questionnaire,and other parameters were assessed at baseline and 12-weeks.RESULTS This study included 21 participants.A marked enhancement was observed in the FBG level(P=0.02),daily total insulin dose(P=0.03),and overall diabetes treatment satisfaction(P<0.01)in the participants who switched to IDegAsp.There was a decrease in HbA1c levels(7.6±1.1 vs 7.4±0.9,P=0.31)and the frequency of hypoglycemic events of those who switched to IDegAsp decreased,however,there was no statistically significant difference.CONCLUSION The present findings suggest that treatment with IDegAsp enhances clinical outcomes,particularly FBG levels,daily cumulative insulin dose,and overall satisfaction with diabetes treatment.

The emerging role of mesenchymal stem cell-derived extracellular vesicles to ameliorate hippocampal NLRP3 inflammation induced by binge-like ethanol treatment in adolescence

Our previous studies have reported that activation of the NLRP3(NOD-,LRR-and pyrin domain-containing protein 3)-inflammasome complex in ethanol-treated astrocytes and chronic alcohol-fed mice could be associated with neuroinflammation and brain damage.Mesenchymal stem cell-derived extracellular vesicles(MSC-EVs)have been shown to restore the neuroinflammatory response,along with myelin and synaptic structural alterations in the prefrontal cortex,and alleviate cognitive and memory dysfunctions induced by binge-like ethanol treatment in adolescent mice.Considering the therapeutic role of the molecules contained in mesenchymal stem cell-derived extracellular vesicles,the present study analyzed whether the administration of mesenchymal stem cell-derived extracellular vesicles isolated from adipose tissue,which inhibited the activation of the NLRP3 inflammasome,was capable of reducing hippocampal neuroinflammation in adolescent mice treated with binge drinking.We demonstrated that the administration of mesenchymal stem cell-derived extracellular vesicles ameliorated the activation of the hippocampal NLRP3 inflammasome complex and other NLRs inflammasomes(e.g.,pyrin domain-containing 1,caspase recruitment domain-containing 4,and absent in melanoma 2,as well as the alterations in inflammatory genes(interleukin-1β,interleukin-18,inducible nitric oxide synthase,nuclear factor-kappa B,monocyte chemoattractant protein-1,and C–X3–C motif chemokine ligand 1)and miRNAs(miR-21a-5p,miR-146a-5p,and miR-141-5p)induced by binge-like ethanol treatment in adolescent mice.Bioinformatic analysis further revealed the involvement of miR-21a-5p and miR-146a-5p with inflammatory target genes and NOD-like receptor signaling pathways.Taken together,these findings provide novel evidence of the therapeutic potential of MSC-derived EVs to ameliorate the hippocampal neuroinflammatory response associated with NLRP3 inflammasome activation induced by binge drinking in adolescence.

Variations in quantifying patient reported outcome measures to estimate treatment effect

In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.

AVAPS通气模式联合TCM监测在慢性阻塞性肺疾病急性加重期患者脱机中的应用价值

目的探讨AVAPS通气模式联合经皮氧/二氧化碳检测仪(TCM)监测在慢性阻塞性肺疾病急性加重(AECOPD)患者有创-无创序贯通气中的应用价值。方法选取行有创通气的老年慢阻肺患者120例,根据无创呼吸机的不同通气模式,将患者脱机后随机分为S/T组及AVAPS组,每组患者60例。所有患者在“出窗”时记录呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_(2))、吸氧浓度(FiO_(2))、序贯性器官功能衰竭评分(SOFA)、白细胞总数、降钙素原、血小板、白蛋白及肌酐等指标,并记录无创机械通气6h后呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_(2))及吸氧浓度(FiO_(2))等指标。同时记录二氧化碳分压(PaCO_(2)),行经皮二氧化碳分压(PtcCO_(2))监测,比较PtcCO_(2)与PaCO_(2)的相关性及治疗前后各生理参数的差异。比较两组患者48h再插管率、距插管时间、ICU住院时间。分析撤机后行无创机械通气6h后PtcCO_(2)变异度对48h再插管的预测效能。结果两组患者“出窗”时各生理参数及PtcCO_(2)值,均无统计学差异(P>0.05)。与S/T组比较,无创通气6h后,AVAPS组的生理参数RR、HR、PtcCO_(2)变异度及ROX指数均有所改善,差异有统计学意义(P<0.05),且AVAPS组的48h再插管率优于S/T组,且距插管时间更长(P<0.05)。ROC曲线分析显示,通气6h后的PtcCO_(2)变异度对AVAPS组患者48h再插管具有一定的诊断效能,其敏感度为92.30%,特异度为82.60%,AUC为0.898。结论AVAPS通气模式联合PtcCO_(2)在重症慢阻肺有创-无创“序贯”治疗的运用,能有更好的生理参数,更低的再插管率,以及更为优势的“人机协调性”。

Advances in TCM Treatment of Gastric Cancer and Studies on the Apoptosis

The significance of apoptosis in gastric cancer is now widely recognized, and the induction of apoptosis as a new approach to treat gastric cancer has aroused great interest. In recent years, studies on certain TCM drugs for treating gastric cancer and for inducing apoptosis have brought about great attention both at home and abroad. The following is a summary made in this aspect.

基于TCM模式的护理干预对胃癌手术患者负性情绪及生活质量的影响

分析胃癌手术患者在倡导TCM的理念下所实施的护理,对其心态和生活健康情况的影响。方法 将2021年3月至2022年3月本院接诊的胃癌手术患者共计92例全部作为研究对象,进行研究分析,利用红蓝球法分为对照组、观察组,每个小组46例患者。对照组实施传统护理,观察组在TCM的理念下进行护理。对比两组护理后的心态、睡眠和生活健康情况。结果 观察组总体心态好转情况均好于对照组,差异表现显著(P<0.05);观察组睡眠好转情况强于对照组,差异表现显著(P<0.05);观察组生活健康评分比对照组更好,差异显著(P<0.05)。结论 对于胃癌手术患者,可采取TCM的理念下的康复护理,能够显著改善患者的心理状态,提高其睡眠情况,同时生活更加健康。

Clincal Experience in TCM Treatment of Refractory Nephrotic Syndrome

Refractory nephrotic syndrome, characterized by a long lingering course, is difficult to be treated in clinic. Through many years’ clinical practice, the author holds that an active TCM treatment can

TCM Stage Differentiation Treatment of Diabetic Gangrene——An Observation on Microcirculatory Changes

Microcirculatory changes and therapeutic effects in 39 non-insulin dependent diabetes mellitus (NIDDM) cases were evaluated. Under the same basic treatment in both groups, the treatment group (21 cases) was treated with TCM drugs according to its stages and compared with the control group (18 cases, treated with 654-2). The results showed that the microcirculatory cumulative scores were significantly decreased in both groups (P<0.05), but the decrease in the treatment group was more marked (P<0.05). In the treatment group, 15 cases were cured, 3 markedly effective, 2 effective and 1 ineffective; while in the control group, 13 cases were cured, 1 markedly effective and 4 ineffective. Statistically, there is no significant difference between the 2 groups (P>0.05) in therapeutic effects.

The TCM-Combined Treatment for Aphasia Due to Cerebrovascular Disorders

To evaluate the therapeutic effects of scalp acupuncture(with the cluster needling,a longneedle-retention and an intermittent manipulation)combined with the Schuell's stimulation andpsychological care for treatment of aphasia due to cerebrovascular disorders.Method:36 eligible cases ofaphasia were randomly assigned into a treatment group and a control group.The scoring system forassessment of aphasia in speaking Chinese set by CMA Neurological Branch and that of BADE wereadopted for grading the severity/degree of aphasia before and after the treatment.Results:The totaleffective rate in the treatment group was 84.21%,and that in the control group was 70.59%,with a verystatistically significant difference(P<0.01).Conclusion:The combined scheme produced a bettertherapeutic effect.

Review Present Situation and Prospects of TCM Treatment of Parkinson's Disease

Parkinson's disease (PD) is a chronic degenerative disease of the nervous system marked by tremor,muscle rigidity, hypokinesis, abnormal posture, and pathologically, selective loss of dopaminergic neurons in the substantia nigra of the midbrain and obvious decrease of dopamine content in the striatum.It is encountered mostly in the middle-aged and old persons and is one of main causes inducing their deformity. The morbidity of this disease tends to increase with gradual aging of the population. In recent years, TCM treatment of this disease has obtained gratifying achievements. A review follows.

Treatment of Functional Retrograde Ejaculation with Acupuncture and TCM Herbal Drugs

Acupuncture at the Taichong (LR 3), Sanyinjiao (SP 6) and Ciliao (BL 32) points combined with TCM drugs for soothing the liver, replenishing the kidney, freeing the seminal passage, and eliminating the stasis showed effective for functional retrograde ejaculation in 25 cases. The total effective rate of 68.0% was significantly better than imipramine used in the control group (P<0.05).

Discussion on the TCM Treatment of Hypertension from Pathogenetic Viewpoints of Modern Medicine

The ideal hypotensive agent should possess three essentials, i.e. to depress the blood pressure surely and steadily, and to block the renin-angio-tensin system (RAS)(1). Currently, Western medical treatment could depress the blood pressure rapidly and surely through reducing blood volume and dilating blood vessels, while traditional Chinese medicine (TCM) shows its superiorities in al-

TCM Treatment of Infectious Atypical Pneumonia——A Report of 16 Cases

Objective: To probe into the mechanism on TCM treatment of infectious atypical pneumonia (severe acute respiratory syndrome, SARS) and evaluate its feasibility and effectiveness. Method: Twelve TCM prescriptions of herbal drugs (orally or iv) were used to treat 16 cases of SARS without using glucocorticoids, anti-viral agents, immune-regulators or antibiotics (in case there was no definite bacterial infections). The symptoms, signs, chest roentgenograms and lab examinations were carefully monitored and recorded for evaluation of the effectiveness. Results: The average fever abatement time was 4.44±1.46days and the mean absorption time of gross pulmonary infiltration was 10.87±2.92 days. No exacerbation occurred during the treatment. Conclusion: TCM intervention could effectively control and alleviate the symptoms and prevent the disease from exacerbation.

TCM Treatment of Rheumatoid Arthritis by Supplementing the Kidney and Invigorating the Blood Circulation

The therapeutic effects in treating the intermediate and late rheumatoid arthritis by supplementing the kidney and invigorating blood circulation were observed. In the 43 cases of the treatment group, No. 2 Qu Feng Shi Ling capsules (祛风湿灵胶囊2号) and Fenbid (芬必得) were prescribed, while in the 39 cases of the control group Lei Gong Teng Tablets (雷公藤总甙片) and Fenbid were given. The results showed that the total effective rate in the treatment group was more satisfactory than that in the control (P<0.05 or P<0.01). With less toxic effects, the former could better improve the local swelling and lower the blood viscosity.

Clinical Observation on Treatment of Moderate and Severe Periodical Mastalgia with TCM Hot-wet Compress Therapy

[Objectives] To observe the clinical therapeutic efficacy of local hot-wet compress therapy of digestion ointment prescription on the patients with moderate and severe mastalgia. [Methods] Firstly,60 patients with mastalgia were selected,and divided into the experimental group and control group( 30 cases for each group). The control group was treated with acupuncture at distal point,and the experimental group was treated with TCM local hot-wet compress therapy combined with acupuncture at distal point. Then,the clinical therapeutic efficacy of two groups was compared. [Results]The experimental group was superior to the control group in relieving the breast pain,improving emotional integral,reducing breast lumps,improving lump texture,and improving TCM syndrome integral( P < 0. 05). [Conclusions]The digestion ointment prescription local hot-wet compress therapy has a significant therapeutic effect on treatment of mastalgia and can significantly improve the breast pain symptom of patients.

SARS-CoV-2 Infected Cases with Untraceable Epidemic Origin:Its Values,Identification and TCM Treatment in Preventing Recurrence

During the outbreak of coronavirus disease 2019(COVID-19),the identification of a SARS-CoV-2 infected case with untraceable epidemic origin has three values:(1)the region has community transmission of the virus;(2)a certain portion of population in the community is getting immunized and more individuals have already been immunized;(3)an unpredictable future risk exists for regions where there are no infected cases with untraceable epidemic origin.Minimizing or avoiding the aggregation infection through individuals with no clinical symptoms is crucial and possible as its occurrence is mainly attributed to the local environment as opposed to the super spreader with or without clinical symptoms.As infected cases are not necessarily positive with gene test by definition,proper application of gene test is crucial in the identification of asymptomatic cases.In the early stage of an outbreak of infectious disease,gene test can be used to identify asymptomatic cases but it should not be used to exclude cases with typical clinical symptoms and signs.In the middle or late stages of an outbreak gene test should be applied in evaluation of infection rate of the population of a region,in addition to be used in spreader identification and isolation.Although asymptomatic cases are attributed to the overwhelming effect of personalized defense against pathogens,they are still a source of infection.Asymptomatic cases are considered to be Qi deficiency and with lingering toxicity in traditional Chinese medicine(TCM).Treatment in such cases,typically,involves therapy focused on replenishing the Qi,tonifying the lung,clearing the fever,and detoxification in order to return to a normal health condition.The recommended Chinese medicines include Qing Fei Pai Du Decoction,Yi Qi Qu Du Decoction,Xuan Fei Bai Du Granule,Lian Hua Qing Wen Capsule(Granule),and Jin Hua Qing Gan Granule,etc.