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Frontiers in Endocrinology 2024Diabetic nephropathy (DN) is a major microvascular complication of diabetes and a common cause of chronic kidney disease. There is currently a lack of effective... (Review)
Review
Diabetic nephropathy (DN) is a major microvascular complication of diabetes and a common cause of chronic kidney disease. There is currently a lack of effective treatments for DN, and the prognosis for patients remains poor. Hirudin, one of the primary active components derived from leeches, demonstrates anti-coagulant, anti-fibrotic, anti-thrombotic, and anti-inflammatory properties, exhibiting significant protective effects on the kidneys. In recent years, there has been a surge of interest in studying the potential benefits of hirudin, especially in its role in the management of DN. This article delves into the mechanisms by which hirudin contributes to the treatment of DN and its clinical efficacy.
Topics: Animals; Humans; Diabetic Nephropathies; Hirudins; Kidney; Medicine, Chinese Traditional; Leeches; Diabetes Mellitus
PubMed: 38344666
DOI: 10.3389/fendo.2024.1296843 -
Arquivos Brasileiros de Oftalmologia 2021A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right...
A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.
Topics: Conjunctival Diseases; Ecchymosis; Eyelids; Female; Headache; Humans; Leeching; Middle Aged
PubMed: 33787665
DOI: 10.5935/0004-2749.20210057 -
Journal of Molecular Biology Mar 2020Harnessing the translational potential of the GLP-1/GLP-1R system in pancreatic beta cells has led to the development of established GLP-1R-based therapies for the... (Review)
Review
Harnessing the translational potential of the GLP-1/GLP-1R system in pancreatic beta cells has led to the development of established GLP-1R-based therapies for the long-term preservation of beta cell function. In this review, we discuss recent advances in the current research on the GLP-1/GLP-1R system in beta cells, including the regulation of signaling by endocytic trafficking as well as the application of concepts such as signal bias, allosteric modulation, dual agonism, polymorphic receptor variants, spatial compartmentalization of cAMP signaling and new downstream signaling targets involved in the control of beta cell function.
Topics: Animals; Cyclic AMP; Diabetes Mellitus, Type 2; Glucagon-Like Peptide 1; Glucagon-Like Peptide-1 Receptor; Humans; Incretins; Insulin; Insulin Secretion; Insulin-Secreting Cells; Polymorphism, Single Nucleotide; Signal Transduction
PubMed: 31446075
DOI: 10.1016/j.jmb.2019.08.009 -
Plastic and Reconstructive Surgery.... Dec 2019Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option...
Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue to promote healing and can serve as a nonsurgical option for plastic surgery patients with concern for tissue compromise. Although there is a wealth of documentation on medicinal leech therapy, the surgical space currently lacks an updated summary of proper indications, use, and risks as they pertain to plastic surgical patients. The purpose of this article is to provide a platform for understanding the recent literature as it relates to reconstruction to improve understanding of indications and necessary considerations in using hirudotherapy. Topics examined include basics of hirudotherapy, indications in plastic surgery, implementation (leech application, number and duration of therapy, and removal), risks (infection and bleeding), and alternative treatments. The evidence provided will aid in physician understanding and implementation, patient counseling, and the informed consent process.
PubMed: 32537302
DOI: 10.1097/GOX.0000000000002555 -
Cureus Aug 2023Patients presenting with a post-invasive procedure hematoma can be treated with medicinal leeches to evacuate the hematoma. Our patient, a postmenopausal woman in her...
Patients presenting with a post-invasive procedure hematoma can be treated with medicinal leeches to evacuate the hematoma. Our patient, a postmenopausal woman in her 60s, with a past medical history of hypothyroidism, presented to the outpatient clinic with pain, redness, warmth, and swelling on her right thigh. Ten days prior, the patient had undergone a subcutaneous pellet implant procedure in the right thigh for hormonal replacement therapy. The patient developed post-procedure cellulitis and soft tissue infection and was treated with antibiotics. The patient developed a progressively enlarged hematoma at the implant site. The hematoma was treated with medicinal leeches. Two weeks after treatment, the implant area healed. The patient had a family history of von Willebrand disease and a history of prolonged bleeding during childbirth, menstruation, and dental procedures. A von Willebrand panel was obtained, and the results were consistent with a new diagnosis of von Willebrand disease.
PubMed: 37700963
DOI: 10.7759/cureus.43338 -
Cureus Jul 2021Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the world. Critical limb ischemia is a complication of PAD that leads to severe pain...
Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the world. Critical limb ischemia is a complication of PAD that leads to severe pain at rest, numbness, and absent or diminished pulses in the legs or feet. Revascularization with surgery or endovascular intervention is required to re-establish blood flow to the affected areas. Failure to respond to medical and/or surgical treatment can lead to amputations. The decision to amputate one's limb can be very challenging. Here, we report a patient with critical limb ischemia who refused a below-the-knee amputation and self-treated with medicinal leech therapy, or hirudotherapy. His symptoms including his pain, burning, and numbness improved significantly following six months of therapy.
PubMed: 34377606
DOI: 10.7759/cureus.16270 -
Bulletin of Emergency and Trauma 2023Leech therapy (Hirudotherapy) is a method used in the treatment of many diseases since ancient times. Although many complications have been reported following the use of...
Leech therapy (Hirudotherapy) is a method used in the treatment of many diseases since ancient times. Although many complications have been reported following the use of this method, no systemic life-threatening bleeding has yet been described. A-43-year-old male patient was diagnosed with upper gastrointestinal bleeding following leech application that he had received for infertility one week earlier. The complications of hirudotherapy typically spontaneously improve due to the local effects of this treatment. The most frequently reported complications are local infections, and less commonly allergies and prolonged local bleeding can occur. However, in this case report, we describe a life-threatening upper gastrointestinal bleeding as a new complication. Gastrointestinal bleeding appearing a week after leech therapy does not necessarily mean that leeches caused gastrointestinal bleeding in this case. Nevertheless, considering the development time of gastrointestinal bleeding, it can be deduced that it was possibly due to hirudotherapy. Patients should be informed about alarming symptoms that can indicate complications following leech application.
PubMed: 36818053
DOI: 10.30476/BEAT.2023.97246.1403 -
Cureus Jul 2020The principle of negative pressure technique dates back to the earliest civilizations; during the Roman era, the technique of using dome-shaped cupping glasses was used...
Clinical Applications and Benefits of Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management: A Novel Approach for Comorbid Wounds.
The principle of negative pressure technique dates back to the earliest civilizations; during the Roman era, the technique of using dome-shaped cupping glasses was used to create the suction needed to promote healing. This technique was used throughout the 19th century. In 1821, a British physician named Dr. Francis Fox invented the "glass leech" technique. Thereafter in 1952, an innovative approach was introduced to the treatment of serious, complex wounds through the use of sub-atmospheric or negative pressure known as "negative pressure wound therapy" (NPWT). Later, the "vacuum-assisted closure", or VAC therapy system founded by Dr. Louis Argenta in 1990 revolutionized the advanced wound care market, and still remains the most clinically proven alternative for the treatment of complex, hard-to-heal wounds. These therapies utilize a foam dressing that is conformed to the wound bed. When sealed and placed under negative (vacuum) pressure, the system creates a unique wound-healing environment that has been shown to promote the wound-healing process, reduce edema, prepare the wound bed for closure, promote the formation of granulation tissue and remove infectious materials. The negative pressure therapy system addresses patient quality of life through an easy-to-use system designed to assist surgeons in the management and treatment of comorbid wounds, and open abdomen and other wound complications to help achieve primary fascial closure. Comorbidities can be defined as a concurrence of multiple chronic diseases in the same patient. Closed-incision negative pressure therapy (CINPT) has revolutionized the way in which caregivers treat the most serious, complex wounds or comorbid wounds. Wound healing can be achieved by the host's innate and adaptive immune defence mechanisms as in an uninfected simple surgical incision through the skin or by combination of the host's defence mechanisms and therapeutic modalities. It has been confirmed in some clinical researches that growth factors exert amazing effects on wound-healing promotion and skin function restoration without any obvious side effects. In this review, we have hypothesized a novel modality, focusing on the treatment of wound complications secondary to comorbidity by a combination of negative pressure therapy followed by a positive pressure infusion with growth factor concentrates.
PubMed: 32874798
DOI: 10.7759/cureus.9469 -
BioRxiv : the Preprint Server For... Sep 2023Movement flexibility and automaticity are necessary to successfully navigate different environments. When encountering difficult terrains such as a muddy trail, we can...
Movement flexibility and automaticity are necessary to successfully navigate different environments. When encountering difficult terrains such as a muddy trail, we can change how we step almost immediately so that we can continue walking. This flexibility comes at a cost since we initially must pay deliberate attention to how we are moving. Gradually, after a few minutes on the trail, stepping becomes automatic so that we do not need to think about our movements. Canonical theory indicates that different adaptive motor learning mechanisms confer these essential properties to movement: explicit control confers flexibility, while forward model recalibration confers automaticity. Here we uncover a distinct mechanism of treadmill walking adaptation - an automatic stimulus-response mapping - that confers both properties to movement. The mechanism is flexible as it learns stepping patterns that can be rapidly changed to suit a range of treadmill configurations. It is also automatic as it can operate without deliberate control or explicit awareness by the participants. Our findings reveal a tandem architecture of forward model recalibration and automatic stimulus-response mapping mechanisms for walking, reconciling different findings of motor adaptation and perceptual realignment.
PubMed: 37808648
DOI: 10.1101/2023.09.25.559267 -
Practical Radiation Oncology 2023To assess the degree of pathologic complete response (pCR), postoperative surgical complication rates, and oncological outcomes in women with locally advanced breast...
PURPOSE
To assess the degree of pathologic complete response (pCR), postoperative surgical complication rates, and oncological outcomes in women with locally advanced breast cancer or high-risk breast cancers treated with neoadjuvant radiation therapy (NART).
METHODS AND MATERIALS
This retrospective, multi-institutional review involved 138 clinically staged patients with 140 breast cancers treated with NART between January 2014 and February 2021. Treatments involved sequential neoadjuvant chemotherapy and NART, followed by mastectomy with or without axillary surgery and immediate autologous breast reconstruction. Descriptive statistics were used to assess patient and disease features, treatment regimens, pathologic response, and factors affecting postoperative complications. Kaplan-Meier curves were performed to assess locoregional recurrence-free, distant metastasis-free, and overall survival outcomes.
RESULTS
Median age was 47 years (interquartile range, 42-52). The median follow-up was 35.2 months (interquartile range, 17.1-46.5). pCR was achieved in 36.4% (as defined by Chevallier classification) or 42.1% (as defined by Miller-Payne scores) of patients. Greater pCR rates were achieved for HER2+ (73.8%-85.7%) and triple-negative phenotypes (47.6%-57.1%). There were 21 grade 3 surgical complications including 10 grade 3B breast events and 8 grade 3B donor-site events, where surgical reintervention was required. At 3-years' follow-up, the locoregional recurrence-free survival was 98.1%, distant metastasis-free survival was 83.6%, and overall survival was 95.3%%.
CONCLUSIONS
NART is feasible to facilitate a single-stage mastectomy and immediate autologous breast reconstruction. This study demonstrated comparable rates of postoperative complication to standard of care, and high rates of pCR, which translates to high rates of locoregional control, distant metastasis-free survival, and overall survival.
Topics: Female; Humans; Breast Neoplasms; Mastectomy; Neoadjuvant Therapy; Retrospective Studies; Australia; Neoplasm Recurrence, Local; Antineoplastic Combined Chemotherapy Protocols
PubMed: 36599393
DOI: 10.1016/j.prro.2022.12.004