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

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

Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Combination Activity of Standard Antituberculosis Drugs and Extracts of Medicinal Plants Commonly Used in Traditional Treatment of Tuberculosis in Uganda

Introduction: Resistance to antituberculosis drugs and adverse drug reactions remain the leading causes of tuberculosis therapeutic failure globally. Despite the increasing acceptance of medicinal plant use in combination with conventional antituberculosis drugs in treatment of tuberculosis (TB) in Uganda, there is paucity of knowledge on their combination effect. Aim: This research aimed to determine combination activity of standard antituberculosis drugs with extracts of Zanthoxylum leprieurii Guill. & Perr. and Rubia cordifolia L., the two common antituberculosis medicinal plants in Uganda, against pansensitive (H37Rv) and multi-drug resistant (MDR) Mycobacterium tuberculosis strains. Materials and Methods: Two reference MTB strains (H37Rv and MDR strain) were inoculated on Middlebrook 7H11 medium containing a combination of standard antituberculosis drugs and methanol extracts of Z. leprieurii and R. cordifolia at varying concentrations. The number of colonies on the plates was observed and counted weekly for up to 8 weeks. In vitro combination activity was determined using proportion method. Mean percentage inhibition was calculated for the reduction of number of colonies on drug-extract combination medium in relation to drug-extract-free control medium. Results: Drug-extract combinations showed good combination activity against Mycobacterium tuberculosis strains when compared with individual standard anti-TB drugs. This was more exhibited against MDR strain. There was however a reduction in percentage inhibition when extracts were combined with ethambutol and streptomycin against H37Rv strain. Conclusions: Zanthoxylum leprieurii and Rubia cordifolia in combination with standard anti-TB drugs exhibited increased in vitro activity against Mycobacterium tuberculosis, especially MDR-TB strain. This justifies the local use of these plants in traditional treatment of tuberculosis especially in resistant cases in Uganda.

World Class Elite Breaststrokers Downward Kick EMG Muscle Activity of the Gluteus Maximus, Quadriceps Femoris, Hamstring, Gastrocnemius Medialis, Rectus Abdominal, and Erector Spinae

This study analyzed the difference between using a downward breaststroke kick and a horizontal breaststroke kick in a sample of world class elite swimmers.We compared average muscle activity of the gluteus maximus,quadriceps femoris(vastus medialis and rectus femoris),hamstring/long head of the biceps femoris,gastrocnemius medialis,rectus abdominal,and erector spinae when using the downward breaststroke kick technique.We find that when this sample of swimmers utilized the downward breaststroke kick,max speed and velocity per stroke increased,measured by 12,788 EMG samples,where the results are highly correlated to duration of the aerodynamic buoyant force in breaststroke kick technique.The increases in performance observed from measuring the world class elite swimmers is highly correlated to the duration of the kick aerodynamic buoyant force.Among this sample of elite swimmers,the longer a swimmer demonstrates a buoyant force breaststroke kick,the lower the time in a 100 breaststroke.

Heterogeneous information phase space reconstruction and stability prediction of filling body–surrounding rock combination

Traditional research believes that the filling body can effectively control stress concentration while ignoring the problems of unknown stability and the complex and changeable stress distribution of the filling body–surrounding rock combination under high-stress conditions.Current monitoring data processing methods cannot fully consider the complexity of monitoring objects,the diversity of monitoring methods,and the dynamics of monitoring data.To solve this problem,this paper proposes a phase space reconstruction and stability prediction method to process heterogeneous information of backfill–surrounding rock combinations.The three-dimensional monitoring system of a large-area filling body–surrounding rock combination in Longshou Mine was constructed by using drilling stress,multipoint displacement meter,and inclinometer.Varied information,such as the stress and displacement of the filling body–surrounding rock combination,was continuously obtained.Combined with the average mutual information method and the false nearest neighbor point method,the phase space of the heterogeneous information of the filling body–surrounding rock combination was then constructed.In this paper,the distance between the phase point and its nearest point was used as the index evaluation distance to evaluate the stability of the filling body–surrounding rock combination.The evaluated distances(ED)revealed a high sensitivity to the stability of the filling body–surrounding rock combination.The new method was then applied to calculate the time series of historically ED for 12 measuring points located at Longshou Mine.The moments of mutation in these time series were at least 3 months ahead of the roadway return dates.In the ED prediction experiments,the autoregressive integrated moving average model showed a higher prediction accuracy than the deep learning models(long short-term memory and Transformer).Furthermore,the root-mean-square error distribution of the prediction results peaked at 0.26,thus outperforming the no-prediction method in 70%of the cases.

Research and Practice of Flipped Classroom Teaching Mode of Integrated Business English Course Under MOOC Environment

As an online course-teaching mode,Massive Open Online Course(MOOC)has drawn great attention from both teachers and students.It is necessary to give full play to the advantages of MOOC resources and to enhance teachers’consciousness of“identity remodeling”in the process of Integrated Business English flipping classroom teaching.Combining the advantages of MOOC and flipped classroom teaching during before-,during-,and after-class will greatly help promote the overall quality of business English teaching in universities.

The Integration Strategy of Class Teacher Management and Mathematics Teaching

The professional and moral education of high school mathematics teachers will make classroom management work better,but their work pressure will also lead to classroom management problems.To do a good job in high school class teacher management and organically integrate it with mathematics teaching,we need to start from two aspects:mathematics teaching class teachers and class teacher work teaching,and penetrate mathematical thinking into daily classroom management,moral education,and classroom culture construction.Based on the attributes of the subject,we guide high school students to reflect after class to stimulate their self-management initiative through the cultivation of qualified class representatives.In addition,it is necessary to skillfully resolve classroom generative problems,change the roles of teachers and students,and integrate classroom management with mathematics teaching.

A Study on the Effects of Different Interaction Combinations and Language Levels on Continuous Writing in Online Environments

This study was conducted with non-English sophomore students,aiming to explore the effects of different interaction combinations and language levels on continuous writing in an online environment,and compare the differences in lexical alignments and composition quality of learners with different interaction combinations and language levels in the same continuous writing task through experiments.The results show that the mean values of the word-phrase alignment of the paired group were higher than those of the individual group in different interaction combinations,and the two groups showed significant differences;in terms of composition quality,the individual group was better than the paired group,but there was no significant difference between the two groups in terms of task continuation.Secondly,the word-phrase alignment and composition scores of the different language-level groups were higher than those of the same language-level groups,and there was a significant difference between the two groups in terms of word-phrase alignments,but not in terms of composition scores.The results of this study can be useful and informative for second language teachers in future continuous teaching in online environments.

A Case Study on the Effectiveness of Pre-Class Activities in Higher Vocational English Classes: Taking Pingliang Vocational and Technical College as an Example

Based on Bloom’s“effective teaching theory,”this paper proposes pre-class activities to improve students’enthusiasm and autonomy in English learning.These include sentence construction,situational dubbing,famous quotes,English songs,English games,Chinese stories,regional cultures,and theme debates,which combine life,interest,and inspiration as the main characteristics.The activities can enhance the sense of participation and achievement of all students to achieve the purpose of effective teaching.

The Research on the Logic and Value of“Two Combinations”

Through the comprehensive analysis of the connotation and logic,inheritance and innovation and the value of social governance,and the dialectical relationship of“two combination”,the inheritance of the idea of Marxism,the inheritance of excellent traditional culture and the governance of contemporary society.

A Case Report on Treating Progressive Supranuclear Palsy with a Combination of Chinese and Western Medicine

A case of progressive supranuclear palsy in a 66-year-old woman is presented.The patient complained of“progressive stiffness of both lower limbs for five years,accompanied by choking and coughing for more than 1 year,”and was diagnosed with paralysis in traditional Chinese medicine(TCM),which was characterized by a deficiency of liver and kidney,and phlegm and blood stasis blocking the collaterals.Western medicine diagnosed it as progressive supranuclear palsy.The patient was diagnosed with“Parkinson’s disease”several times in the past and was given“polybasic hydrazide”and“amantadine hydrochloride tablets,”etc.The patient did not have significant symptomatic relief,so she sought further treatment with a combination of traditional Chinese and Western medicine.Based on the concept of deficiency and excess,this disease is categorized as a paralytic disease in Chinese medicine,and the onset of the disease is closely related to the deficiency of the body after a long period of illness,with wind,phlegm,blood stasis,and deficiency as the main pathogenetic mechanism.The treatment is based on the combination of disease and evidence,with traditional Chinese medicine and acupuncture as the main treatments,supplemented by intermediate-frequency pulsed electrical stimulation,transcranial repetitive magnetic stimulation,medicated canisters,wax therapy,traditional Chinese medicine guasha,and acupoint injections.Western medicine is based on symptomatic treatment,and the patient’s symptoms were relieved significantly after the combination of Chinese and Western medicine.

Back to the drawing board:Overview of the next generation of combination therapy for inflammatory bowel disease

Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a combined biologic and immunomodulator,as well as emerging data on the future potential of dual-biologic therapy(DBT).While current evidence for DBT is limited,encouraging safety profiles and ongoing trials suggest a brighter future for this approach.The importance of controlled trials should be stressed in establishing new treatment paradigms.Ongoing prospective randomized trials of DBT and perhaps future combinations of biologics and small molecule therapies will hopefully guide the next generation of IBD care.

Grain Yield,Biomass Accumulation,and Leaf Photosynthetic Characteristics of Rice under Combined Salinity-Drought Stress

Simultaneous stresses of salinity and drought often coincide during rice-growing seasons in saline lands,primarily due to insufficient water resources and inadequate irrigation facilities.Consequently,combined salinity-drought stress poses a major threat to rice production.In this study,two salinity levels(NS,non-salinity;HS,high salinity)along with three drought treatments(CC,control condition;DJ,drought stress imposed at jointing;DH,drought stress imposed at heading)were performed to investigate their combined influences on leaf photosynthetic characteristics,biomass accumulation,and rice yield formation.Salinity,drought,and their combination led to a shortened growth period from heading to maturity,resulting in a reduced overall growth duration.Grain yield was reduced under both salinity and drought stress,with a more substantial reduction under the combined salinity-drought stress.The combined stress imposed at heading caused greater yield losses in rice compared with the stress imposed at jointing.Additionally,the combined salinity-drought stress induced greater decreases in shoot biomass accumulation from heading to maturity,as well as in shoot biomass and nonstructural carbohydrate(NSC)content in the stem at heading and maturity.However,it increased the harvest index and NSC remobilization reserve.Salinity and drought reduced the leaf area index and SPAD value of flag leaves and weakened the leaf photosynthetic characteristics as indicated by lower photosynthetic rates,transpiration rates,and stomatal conductance.These reductions were more pronounced under the combined stress.Salinity,drought,and especially their combination,decreased the activities of ascorbate peroxidase,catalase,and superoxide dismutase,while increasing the contents of malondialdehyde,hydrogen peroxide,and superoxide radical.Our results indicated a more significant yield loss in rice when subjected to combined salinity-drought stress.The individual and combined stresses of salinity and drought diminished antioxidant enzyme activities,inhibited leaf photosynthetic functions,accelerated leaf senescence,and subsequently lowered assimilate accumulation and grain yield.

A proteomic landscape of pharmacologic perturbations for functional relevance

Pharmacological perturbation studies based on protein-level signatures are fundamental for drug discovery. In the present study, we used a mass spectrometry (MS)-based proteomic platform to profile the whole proteome of the breast cancer MCF7 cell line under stress induced by 78 bioactive compounds. The integrated analysis of perturbed signal abundance revealed the connectivity between phenotypic behaviors and molecular features in cancer cells. Our data showed functional relevance in exploring the novel pharmacological activity of phenolic xanthohumol, as well as the noncanonical targets of clinically approved tamoxifen, lovastatin, and their derivatives. Furthermore, the rational design of synergistic inhibition using a combination of histone methyltransferase and topoisomerase was identified based on their complementary drug fingerprints. This study provides rich resources for the proteomic landscape of drug responses for precision therapeutic medicine.

Dietary exposure to sulfamethazine,nanoplastics and their binary mixture disrupts the spermatogenesis of marine medaka(Oryzias melastigma)

In the coastal environment,the co-occurrence of antibiotic and nanoplastic pollution is common.Investigating their individual and combined toxicity to marine organisms is of great necessity.In the present study,the reproductive toxicity of sulfamethazine(SMZ)and nanoplastics(polystyrene,PS)via the dietary route on the spermatogenesis of marine medaka(Oryzias melastigma)was examined.After 30 d of dietary exposure,SMZ alone decreased the gonadosomatic index(GSI)value(~35%)and the proportion of undifferentiated type A spermatogonia(A_(und))(~40%),probably by disrupting the testicular sex hormone production,the spermatogenesis-related growth factor network and the balance of apoptosis.Individual exposure to PS did not affect the GSI value or the proportions of germ cells at different developmental stages,but dysregulated the expression of several spermatogenesis-related genes.Interestingly,the presence of PS alleviated the decreased GSI value caused by SMZ.This alleviation effect was achieved by enhancing the spermatogonia differentiation instead of reversing the suppressed self-renewal of A_(und),suggesting that the mixture of PS and SMZ could cause reproductive effects in a different way.These findings expand our knowledge of threats of ubiquitous antibiotic and nanoplastic pollution to fish reproduction and population.

BLS-identification:A device fingerprint classification mechanism based on broad learning for Internet of Things

The popularity of the Internet of Things(IoT)has enabled a large number of vulnerable devices to connect to the Internet,bringing huge security risks.As a network-level security authentication method,device fingerprint based on machine learning has attracted considerable attention because it can detect vulnerable devices in complex and heterogeneous access phases.However,flexible and diversified IoT devices with limited resources increase dif-ficulty of the device fingerprint authentication method executed in IoT,because it needs to retrain the model network to deal with incremental features or types.To address this problem,a device fingerprinting mechanism based on a Broad Learning System(BLS)is proposed in this paper.The mechanism firstly characterizes IoT devices by traffic analysis based on the identifiable differences of the traffic data of IoT devices,and extracts feature parameters of the traffic packets.A hierarchical hybrid sampling method is designed at the preprocessing phase to improve the imbalanced data distribution and reconstruct the fingerprint dataset.The complexity of the dataset is reduced using Principal Component Analysis(PCA)and the device type is identified by training weights using BLS.The experimental results show that the proposed method can achieve state-of-the-art accuracy and spend less training time than other existing methods.

A Bioequivalence Study of Empagliflozin/Metformin Fixed-Dose Combination in Healthy Subjects under Fasting Conditions

Background: This study evaluated the bioequivalence of empagliflozin 12.5 mg/metformin 1000 mg tablets compared to Synjardy® (Empagliflozin 12.5 mg/metformin 1000 mg) tablets in healthy male subjects under fasting conditions. Methods: This was a phase I, randomized, single-dose, two-period, two-sequence, crossover study to evaluate the bioequivalence (BE) profiles of two fixed-dose combinations (FDCs) of empagliflozin/metformin. Cmax, AUC0-t and AUC0-∞ from test and reference formulations were evaluated to access BE. The plasma concentrations were measured using a validated liquid chromatography-mass spectrometry (LC-MS/MS) method. Of the 24 subjects enrolled, 23 completed both periods of the study. The two formulations test and reference were considered bioequivalent if 90% confidence interval (CI) fell within 80.00% - 125.00% for Cmax, AUC0-t and AUC0-∞. Tolerability and safety were assessed throughout the study. Results: The pharmacokinetic (PK) parameters were similar between the test product (T) and reference product (R) Synjardy®. The 90% CI of the test/reference ratios of log-transformed PK parameters point estimates was Cmax: 89.87% (85.68% - 94.27%), AUC0-t: 87.91% (83.65% - 92.39%) and AUC0-∞: 87.16% (82.80% - 91.75%) to empagliflozin and Cmax: 92.19% (87.95% - 96.65%), AUC0-t: 91.38% (84.42% - 98.91%) and AUC0-∞: 93.78% (83.82% - 104.93%) to metformin respectively (90% CI for all PK parameters fell within 80.00% - 125.00%). Conclusion: Our results demonstrated BE between the test and reference formulations of oral tablets of empagliflozin 12.5 mg/metformin 1000 mg (FDC) in healthy male subjects under fasting conditions.

Infl uence of altitude and tree class on climate-growth relationships in a larch plantation in subtropical China

Precise quantifi cation of climate-growth relationships can make a major contribution to scientifi c forest management.However,whether diff erences in the response of growth to climate at diff erent altitudes remains unclear.To answer this,264 trees of Larix kaempferi from 88 plots,representing diff erent altitudinal ranges(1000-2100 m)and tree classes were sampled and used to develop tree-ring chronologies.Tree-ring growth(TRG)was either positively(dominant)or negatively(intermediate and suppressed)correlated with climate in diff erent tree classes at diff erent altitudes.TRG was strongly correlated with growing season at low altitudes,but was less sensitive to climate at middle altitudes.It was mainly limited by precipitation and was highly sensitive to climate at low altitudes.Climate-growth relationships at high altitudes were opposite compared to those at low altitudes.TRG of dominant trees was more sensitive to climate change compared to intermediate and suppressed trees.Climate factors(annual temperatures;moisture,the number of frost-free days)had diff erent eff ects on tree-ring growth of diff erent tree classes along altitudinal gradients.It was concluded that the increase in summer temperatures decreased water availability,resulting in a signifi cant decline in growth rates after 2005 at lower altitudes.L.kaempferi is suitable for planting in middle altitudes and dominant trees were the best sampling choice for accurately assessing climate-growth relationships.

Pressure stimulated current in progressive failure process of combined coal-rock under uniaxial compression:Response and mechanism

Effective monitoring of the structural health of combined coal-rock under complex geological conditions by pressure stimulated currents(PSCs)has great potential for the understanding of dynamic disasters in underground engineering.To reveal the effect of this way,the uniaxial compression experiments with PSC monitoring were conducted on three types of coal-rock combination samples with different strength combinations.The mechanism explanation of PSCs are investigated by resistivity test,atomic force microscopy(AFM)and computed tomography(CT)methods,and a PSC flow model based on progressive failure process is proposed.The influence of strength combinations on PSCs in the progressive failure process are emphasized.The results show the PSC responses between rock part,coal part and the two components are different,which are affected by multi-scale fracture characteristics and electrical properties.As the rock strength decreases,the progressive failure process changes obviously with the influence range of interface constraint effect decreasing,resulting in the different responses of PSC strength and direction in different parts to fracture behaviors.The PSC flow model is initially validated by the relationship between the accumulated charges of different parts.The results are expected to provide a new reference and method for mining design and roadway quality assessment.

Development of multi-functional anchorage support dynamic-static coupling performance test system and its application

In underground engineering with complex conditions,the bolt(cable)anchorage support system is in an environment where static and dynamic stresses coexist,under the action of geological conditions such as high stresses and strong disturbances and construction conditions such as the application of high prestress.It is essential to study the support components performance under dynamic-static coupling conditions.Based on this,a multi-functional anchorage support dynamic-static coupling performance test system(MAC system)is developed,which can achieve 7 types of testing functions,including single component performance,anchored net performance,anchored rock performance and so on.The bolt and cable mechanical tests are conducted by MAC system under different prestress levels.The results showed that compared to the non-prestress condition,the impact resistance performance of prestressed bolts(cables)is significantly reduced.In the prestress range of 50–160 k N,the maximum reduction rate of impact energy resisted by different types of bolts is 53.9%–61.5%compared to non-prestress condition.In the prestress range of 150–300 k N,the impact energy resisted by high-strength cable is reduced by76.8%–84.6%compared to non-prestress condition.The MAC system achieves dynamic-static coupling performance test,which provide an effective means for the design of anchorage support system.