Objective To investigate the effects of exogenous bone morphogenetic protein(BMP) and transforming growth factor-β(TGF-β) on biomechanical property for ulna of fracture healing.Methods Thirty-six adult rabbits were made the model of right ulnar fracture and treated locally with TGF-β/PLA, BMP/PLA，TGF-β+BMP/PLA or PLA(as control group). Fracture healing was evaluated by measurement of the mechanical parameters and geometric parameters.Results As compared with control group, the geometric parameters, the bending broken load, the ultimatebending strength, the bending elastic modulus, the ultimate flexural strength, the flexural elastic modulus, the ultimate compressing strength, the compressingelastic modulus, and the ultimate tensile strength for ulna of fracture healingincreased significantly in the treatment groups(P＜0.01). These parameters were higher in TGF-β+BMP/PLA group than in TGF-β/PLA group or in BMP/PLA group andin TGF-β/PLA group than in BMP/PLA group(P＜0.05). There was no significant difference in bone density between the treatment groups and control group. Conclusion Local application of exogenous TGF-β and BMP canincrease the callus formation and enhance biomechanical strength of bone after fracture healing. A combination of TGF-β and BMP has synergetic effect in enhancing fracture healing.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
目的:探讨小剂量吲哒帕胺联合比索洛尔治疗原发性高血压患者的安全性和疗效。方法: 60例初诊的高血压Ⅰ级、Ⅱ级患者,随机分为治疗组及对照组。治疗组予以吲哒帕胺25mg/次,及比索洛尔25mg/次,每天早晨7时服药1次;对照组单用吲哒帕胺25mg/次,每天早晨7时口服1次,疗程8周。结果: 两组患者血压(收缩压及舒张压)均有下降,但以治疗组血压下降明显。治疗组显效13例,有效14例;对照组显效8例,有效15例;治疗组总有效率为90%,治疗组无效率为10%;对照组有效率767%,无效率233%,2组疗效差异有统计学意义(Plt;005)。两组不良反应相似,治疗前后生化指标变化差别无统计学意义。结论:比索洛尔联合吲哒帕胺治疗原发性高血压安全有效,对糖、脂代谢无明显影响。
Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
Both bariatric surgery and pharmacotherapy, particularly glucagon-like peptide-1 receptor agonist (GLP-1RA), are effective interventions for obesity, yet each has its own advantages and limitations. Drawing on the “bridging” concept from cancer therapy, this commentary explores an innovative obesity management strategy that involves the combined application of GLP-1RA and bariatric surgery during the perioperative period, with the aim of optimizing treatment outcomes. The present analysis focuses specifically on the potential value of this approach: preoperatively, GLP-1RAs serve as a “bridging therapy” to promote weight loss and reduce surgical risks in severely obese patients; postoperatively, they might be used to manage weight rebound or insufficient weight loss. This multimodal integrated strategy is designed to overcome the inherent limitations of single therapies and offer patients more comprehensive treatment options. Emphasizing that future research must urgently focus on optimizing treatment parameters (e.g., timing, dosage), evaluating long-term safety and efficacy, and establishing patient selection criteria for combination therapy. Integrating surgical and pharmacological treatments, this comprehensive strategy based on the oncological “bridging” concept represents a highly promising paradigm shift in obesity management.
ObjectiveTo investigate the working principles, recent advances, and combined therapeutic efficacy of irreversible electroporation (IRE) in pancreatic cancer treatment when integrated with conventional therapies (e.g., surgery, chemotherapy, radiotherapy, immunotherapy), and to evaluate its potential for improving patient survival outcomes and quality of life. MethodsA comprehensive analysis of recent IRE researches in pancreatic cancer was performed, elucidating therapeutic mechanisms, technical merits, clinical limitations, and combinatorial effects with conventional therapies through examination of clinical trials and prospective studies. ResultsIRE induces irreversible nanopores in tumor cell membranes via high-intensity electric fields, disrupting membrane integrity and triggering apoptotic cell death. Notably, it promotes immunogenic cell death, activating dendritic cells and initiating tumor-specific immune responses. When combined with surgery, chemotherapy, radiotherapy, or immunotherapy, IRE enhances therapeutic efficacy, prolongs survival in locally advanced pancreatic cancer patients, reduces postoperative recurrence rates, and significantly improves quality of life. ConclusionsAs a non-thermal ablation technique, IRE demonstrates unique advantages in localized pancreatic cancer treatment, particularly for surgically ineligible patients, and serves as a potent adjunct to traditional therapies. With technological refinements and accumulating clinical evidence, IRE is poised to play an increasingly pivotal role in future oncology practice.
ObjectiveTo develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment, and then provide pillars for early use of polytherapy.MethodsThis is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology, the Third Xiangya Hospital of Central South University from January 2019 to July 2020. Patients were divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy. The influencing factors were screened out by single factor analysis and binary logistic regression analysis. And on the basis of this β value, a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed. And the receiver operating curve (ROC curve) was used to evaluate the effectiveness of the scale.ResultsBased on a standard of 75% reduction in seizures during the observation period, 138 cases (73%) were effective with monotherapy plan, while 51 cases (23%) were unsatisfactory. Regression analysis showed that multiple forms of seizures, status epilepticus (t2), brain damage, and the number of seizures ≥ 7 times before treatment are independent risk factors for poor outcome of monotherapy. The resulting score sheet has a total score of 12 points; the area under the ROC curve is 0.779, and the critical score is 6 points (sensitivity: 0.314; specificity: 0.957). Patients with more than this score have a strong probability of poor response in monotherapy.ConclusionThis prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated, and thus has reference function for the early selection of polytherapy.
Objective To investigate the effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. Methods Seventy-six patients who received traditional treatment between October 2020 and March 2021 were included in the traditional treatment group, and 82 patients who entered the emergency fast track for dangerous upper gastrointestinal bleeding between April 2021 and September 2021 were included in the fast-track treatment group. The patients in the traditional treatment group were treated with the traditional single-subject diagnosis and treatment mode, and the patients in the fast-track treatment group were treated according to the multidisciplinary diagnosis and treatment procedures of emergency fast track for dangerous upper gastrointestinal bleeding. The length of emergency stay, 24-hour endoscopic completion rate, effective rate, and length of hospital stay were compared between the two groups. Results The length of emergency stay [(3.75±3.19) vs. (6.51±4.72) h], the effective rate (96.3% vs. 85.5%) and the length of hospital stay [(8.26±2.51) vs. (11.07±2.79) d] were significantly better in the fast-track group than those in the traditional treatment group (P<0.05). There was no significant difference in the 24-hour endoscopic completion rate between the two groups (96.3% vs. 96.1%, P>0.05). Conclusion Compared with the traditional treatment mode, the fast-track treatment mode can significantly improve the treatment efficiency, and reduce the lengths of emergency stay and hospital stay.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
目的 评估替比夫定与阿德福韦酯联合治疗优化阿德福韦酯单药治疗应答不佳的阳性慢性乙型肝炎患者的疗效。 方法 选择2008年6月－2009年8月间共26例阿德福韦酯治疗至少12个月且病毒学应答不佳的乙型肝炎病毒e抗原（HBeAg），阳性的慢性乙型肝炎患者，在10 mg阿德福韦酯治疗的基础上，加用600 mg替比夫定。肝功能和乙型肝炎病毒（HBV） DNA每3个月评估1次，乙型肝炎两对半和腹部B型超声每半年评估1次。 结果 在第1年的治疗期间，所有患者血清HBV DNA水平均呈进行性下降，其中24例（92.3%）血清HBV DNA水平在联合治疗12个月时低于检测值下限，有25例（96.2%）患者丙氨酸转氨酶水平复常。治疗6个月时，分别有7例（26.9%）和2例（7.7%）患者发生HBeAg消失和血清学转换；治疗12个月时，分别有11例（42.3%）和8例（30.8%）患者发生HBeAg消失和血清学转换。整个治疗期间，26例患者均未出现病毒学突破。 结论 阿德福韦酯单药治疗应答不佳时，加用替比夫定可有效控制病毒，使患者获得较好的病毒学、生化学和免疫学应答。Objective To evaluate the curative efficacy of telbivudine combined with defovir dipivoxil on positive-HBeAg chronic hepatitis B patients with suboptimal response to adefovir dipivoxil. Methods A total of 26 HBeAg-positive patients with suboptimal response to adefovir dipivoxil (treated with adefovir dipivoxil for more than 12 months) were treated with adefovir dipivoxil 10 mg in addition to telbivudine 600 mg between June 2008 and August 2009. Liver function and serum hepatitis B virus (HBV) DNA tests were assessed at the baseline and 3-month intervals, whereas HBV serological markers and abdominal ultrasonography were carried out every 6 months. Results During the first year of treatment, all patients showed a progressive decline of serum HBV DNA levels; while undetectable serum HBV DNA and normalization of alanine aminotransferase was achieved in 24(92.3%) and 25 (96.2%) patients, respectively, at the end of the first year of treatment. The 6- and 12-month cumulative rates of HBeAg loss were 26.9% (7/26) and 42.3% (11/26), respectively; and corresponding cumulative rates of HBeAg/anti-HBe seroconversion were 7.7% (2/26) and 30.8 (8/26), respectively. During the observation period, no virological breakthrough was detected. Conclusion Telbivudine combined with defovir dipivoxil may be a good choice for patients with suboptimal response to adefovir dipivoxil, which could induce effective viral inhibition and help patients obtain more virological, biochemical and immunological responses.