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Journal of Ethnopharmacology Jun 2024Urolithiasis represents a predominant concern within urology due to its high recurrence rate and consequential surgical complications. Traditional Chinese Medicine... (Review)
Review
ETHNOPHARMACOLOGICAL RELEVANCE
Urolithiasis represents a predominant concern within urology due to its high recurrence rate and consequential surgical complications. Traditional Chinese Medicine (TCM), with a history spanning over 2000 years in treating kidney diseases, not only offers a less invasive and cost-effective option for treating and preventing urolithiasis, but also serves as a pharmacological treasure trove for the development of anti-urolithic drugs.
AIM OF THE STUDY
With the continuous deepening of research on the anti-urolithic effects of Chinese medicines, the pharmacological mechanisms of TCMs against urolithiasis are continuously evolving. Therefore, it is essential to summarize the current research status, clinical effectiveness, and mechanisms of TCM in treating and preventing urolithiasis, to ascertain its potential in anti-urolithic treatments, and to provide a reference for future anti-urolithiasis drug research.
METHODS
The electronic databases such as PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) have been utilized to retrieve relevant literature spanning from 2000 to September 2023, using keywords "Traditional Chinese Medicine" and "Urolithiasis". Then we conducted a visual analysis of the current status of related research, as well as a systematic organization of the therapeutic effects and underlying mechanisms of anti-urolithic TCMs.
RESULTS
Through the organization of research models, therapeutic effects, and active ingredients of 31 potential anti-urolithic TCMs, we have systematically summarized the underlying mechanisms of TCMs in management of urolithiasis. Mechanistically, Chinese herbs facilitate stone expulsion by enhancing diuresis, instigating anti-spasmodic effects, and promoting ureteral peristalsis when addressing calculi. They also harbor the potential to dissolve pre-existing stones. In terms of stone recurrence prevention, TCM compounds obstruct stone formation through targeting the sequence of crystal adhesion, nucleation, growth, and aggregation to inhibit stone formation. Additionally, TCM's significant roles include stifling oxidative stress, augmenting urinary stone inhibitors, and harmonizing oxalate metabolism, all of which are critical actions in stone prevention.
CONCLUSION
The anti-urolithic mechanism of TCM is multifaceted. Investigating the anti-urolithiasis mechanisms of TCM not only illuminates the potential of Chinese medicine in treating and preventing urolithiasis, but also uncovers active molecules and targets for drug treatment against calculus formation.
PubMed: 38950794
DOI: 10.1016/j.jep.2024.118502 -
The Journal of Thoracic and... Jun 2024Aortic root replacement requires construction of a composite valve-graft and reimplantation of coronary arteries. This study assessed the feasibility of valve-in-valve...
OBJECTIVE
Aortic root replacement requires construction of a composite valve-graft and reimplantation of coronary arteries. This study assessed the feasibility of valve-in-valve transcatheter aortic valve implantation after aortic root replacement.
METHODS
A retrospective review was conducted on 74 consecutive patients who received a composite valve-graft at a single institution from 2019 to 2021. Forty patients had bioprosthetic valves with adequate postoperative gated computed tomographic angiography scans. Computational simulations of balloon and self-expanding transcatheter valve deployments were performed. The modeled coronary distances were compared to traditional, manually measured valve-to-coronary distances.
RESULTS
There was a statistically significant difference in the modeled versus manual measurements of valve to coronary distances were for all patients regardless of valve type or coronary artery analyzed (p <0. 05). Most patients are low risk for coronary obstruction per three-dimensional modeling including those with a valve-to-coronary distance <4 millimeters. Only one patient (2.5%) was at risk for coronary obstruction for the left coronary artery using a ballonvalve. No other valve combination was considered high risk of coronary obstruction. Five patients (12.5%) were at risk for possible valve stent deformation at the outflow, due to angulation at the graft anastomosis.
CONCLUSIONS
Following aortic root replacement, all patients were candidates for Valve-in-Valve using one or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines and balloon-expandable valves may be at higher risk of coronary obstruction.
PubMed: 38950772
DOI: 10.1016/j.jtcvs.2024.06.024 -
The Journal of Thoracic and... Jun 2024To characterize changes in ventricular morphology in patients with hypertrophic cardiomyopathy(HCM) who develop left ventricular outflow tract(LVOT) obstruction.
OBJECTIVE
To characterize changes in ventricular morphology in patients with hypertrophic cardiomyopathy(HCM) who develop left ventricular outflow tract(LVOT) obstruction.
METHODS
We reviewed HCM patients with LVOT obstruction who underwent septal myectomy from May 2012 to June 2023. Among 68 patients initially without obstruction, documented up to 7.6 years (IQR,6.3-9.4) before the operation, a comparison was made with 78 nonobstructive HCM patients over a similar period. Patients who did not develop obstruction were matched with those who did on sex, age, and maximum septal wall thickness during the initial echocardiography, identifying 41 matched pairs. Echocardiographic data, including 5 measures of angulation, were compared between the groups.
RESULTS
The median interval between echocardiographic assessments was 7.5 years (IQR,6.3-8.1) among obstructive versus 7.3 years (IQR,6.2-9.0) in nonobstructive patients. Obstructive patients were more likely to have hypertension at both times. The maximum septal wall thickness increased within both groups (both p<0.001), but the magnitude of increase was not different between groups (p=0.130). Obstructive patients exhibited a greater increase in left ventricular (LV) mass (p<0.001) compared to nonobstructive patients (p=0.004). Aortic angulation significantly increased in 4 of the 5 measurements(all p<0.001) in obstructive patients, while nonobstructive patients showed no change. Anterior and posterior mitral valve(MV) leaflet lengths and coaptation lengths remained similar in both groups over time.
CONCLUSIONS
The development of LVOT obstruction in patients with HCM was associated with progressive LVOT angulation and increased LV hypertrophy, as reflected by LV mass. Progression to obstruction was not related to changes in the MV leaflet morphology.
PubMed: 38950769
DOI: 10.1016/j.jtcvs.2024.06.022 -
Journal of the American Society of... Jun 2024Latent left ventricular outflow tract obstruction (LVOTO) is an important cause of symptoms in patients with hypertrophic cardiomyopathy (HCM) but can be challenging to...
BACKGROUND
Latent left ventricular outflow tract obstruction (LVOTO) is an important cause of symptoms in patients with hypertrophic cardiomyopathy (HCM) but can be challenging to provoke.
OBJECTIVES AND METHODS
To examine the value of postprandial resting and stress echocardiography and utilization of invasive or enhanced drug therapies (surgical myectomy, alcohol septal ablation, disopyramide and mavacamten) in patients with postprandial LVOTO. Consecutive HCM patients without LVOTO underwent routine and postprandial echocardiography at rest, with provocation (Valsalva and standing) and after symptom-limited treadmill stress.
RESULTS
Among 252 patients (mean age 58 years, 39% women), postprandial LVOT gradients were higher compared with routine echocardiography at rest (median 9.0 [0-38.0] vs 0 [0-14.0] mmHg, p<0.0001) and with provocation (18.5 [0-70.3] vs 1.5 [0-41.0] mmHg, p<0.0001). Postprandial exercise (PPXSE) gradients were higher in a subset of 44 patients who underwent both postprandial and fasting stress echocardiography, (47.0 [5.3-81.0] vs 17.5 [0-46.0] mmHg, p<0.0001). In total, 49 (19.5%) patients achieved the ≥50 mmHg threshold under routine conditions (rest/provocation); 90 (35.7%) additional patients achieved postprandial gradients ≥50 mmHg (rest/provocation/exercise), 38 (15.1%) with PPXSE alone. A total of 71 patients were treated with 91 invasive or enhanced drug therapies, 32 (45.1%) of whom had gradients ≥50 mmHg only after eating (rest/provocation) and 8 (11.3%) only with PPXSE, with symptom relief in the majority.
CONCLUSIONS
Postprandial echocardiography was useful at unmasking LVOTO in more than one third of patients who did not have high gradients otherwise. Eating before echocardiography is a powerful provocative tool in the evaluation of patients with HCM.
PubMed: 38950755
DOI: 10.1016/j.echo.2024.06.011 -
Clinical Immunology (Orlando, Fla.) Jun 2024Interleukin-2 (IL-2) holds promise for the treatment of cancer and autoimmune diseases, but its high-dose usage is associated with systemic immunotoxicity. Differential...
Interleukin-2 (IL-2) holds promise for the treatment of cancer and autoimmune diseases, but its high-dose usage is associated with systemic immunotoxicity. Differential IL-2 receptor (IL-2R) regulation might impact function of cells upon IL-2 stimulation, possibly inducing cellular changes similar to patients with hypomorphic IL2RB mutations, presenting with multiorgan autoimmunity. Here, we show that sustained high-dose IL-2 stimulation of human lymphocytes drastically reduces IL-2Rβ surface expression especially on T cells, resulting in impaired IL-2R signaling which correlates with high IL-2Rα baseline expression. IL-2R signaling in NK cells is maintained. CD4+ T cells, especially regulatory T cells are more broadly affected than CD8+ T cells, consistent with lineage-specific differences in IL-2 responsiveness. Given the resemblance of cellular characteristics of high-dose IL-2-stimulated cells and cells from patients with IL-2Rβ defects, impact of continuous IL-2 stimulation on IL-2R signaling should be considered in the onset of clinical adverse events during IL-2 therapy.
PubMed: 38950723
DOI: 10.1016/j.clim.2024.110288 -
Gene Jun 2024Chronic Obstructive Pulmonary Disease (COPD) is characterized by high morbidity, disability, and mortality rates worldwide. RNA-binding proteins (RBPs) might regulate...
BACKGROUND
Chronic Obstructive Pulmonary Disease (COPD) is characterized by high morbidity, disability, and mortality rates worldwide. RNA-binding proteins (RBPs) might regulate genes involved in oxidative stress and inflammation in COPD patients. Single-cell transcriptome sequencing (scRNA-seq) offers an accurate tool for identifying intercellular heterogeneity and the diversity of immune cells. However, the role of RBPs in the regulation of various cells, especially AT2 cells, remains elusive.
MATERIALS AND METHODS
A scRNA-seq dataset (GSE173896) and a bulk RNA-seq dataset acquired from airway tissues (GSE124180) were employed for data mining. Next, RNA-seq analysis was performed in both COPD and control patients. Differentially expressed genes (DEGs) were identified using criteria of fold change (FC ≥ 1.5 or ≤ 1.5) and P value ≤ 0.05. Lastly, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and alternative splicing identification analyses were carried out.
RESULTS
RBP genes exhibited specific expression patterns across different cell groups and participated in cell proliferation and mitochondrial dysfunction in AT2 cells. As an RBP, AZGP1 expression was upregulated in both the scRNA-seq and RNA-seq datasets. It might potentially be a candidate immune biomarker that regulates COPD progression by modulating AT2 cell proliferation and adhesion by regulating the expression of SAMD5, DNER, DPYSL3, GBP5, GBP3, and KCNJ2. Moreover, AZGP1 regulated alternative splicing events in COPD, particularly DDAH1 and SFRP1, holding significant implications in COPD.
CONCLUSION
RBP gene AZGP1 inhibits epithelial cell proliferation by regulating genes participating in alternative splicing in COPD.
PubMed: 38950687
DOI: 10.1016/j.gene.2024.148736 -
Respiratory Medicine Jun 2024The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs.
BACKGROUND
The Phase III slope from a single breath nitrogen washout test provides information about ventilation heterogeneity (VH) in the lungs.
PURPOSE
To determine if the Phase III slope from the exhaled tracer gas concentration during a standard, single breath DCO test using rapid gas analysis provides similar information about VH.
BASIC PROCEDURES
Retrospective analysis of clinical pulmonary function laboratory data including spirometry, lung volumes, and DCO. The normalized Phase III slope from the exhaled CH concentration (SnCH) was compared among different patterns of physiologic abnormality and with VA/TLC as an indicator of VH.
MAIN FINDINGS
SnCH was the steepest in the group with "Obstruction and Low DCO", with significant differences between this group and the "Normal", "Obstruction with Normal DCO", "Mixed Obstruction and Restriction" and "Isolated Low DCO" groups. SnCH was steeper in current and former smokers compared to non-smokers. Among the entire study sample, SnCH correlated with VA/TLC (Spearman rho = -0.56, p<0.01) and remained a significant determinant of VA/TLC by regression modeling.
PRINCIPAL CONCLUSIONS
The SnCH derived from a standard, single breath DCO test using rapid gas analysis varied among distinct patterns of physiologic abnormalities and was associated with VA/TLC as a measure of VH.
PubMed: 38950682
DOI: 10.1016/j.rmed.2024.107725 -
Facts, Views & Vision in ObGyn Jun 2024Obstructive defecation syndrome (ODS) is frequently associated with pelvic organ prolapse (POP) and compromises the quality of life in affected patients. In cases...
Laparoscopic resection rectopexy (RRP) combined with mesh sacrocolpopexy (SCP) for obstructed defecation syndrome with pelvic organ prolapse in an interdisciplinary approach.
BACKGROUND
Obstructive defecation syndrome (ODS) is frequently associated with pelvic organ prolapse (POP) and compromises the quality of life in affected patients. In cases conservative treatment fails surgical therapy is required.
OBJECTIVES
The video case study combines a laparoscopic resection rectopexy (RRP) with a mesh sacrocolpopexy (SCP) in an interdisciplinary surgical approach.
MATERIALS AND METHODS
In this video an 86-year-old woman with ODS and POP, suffering from a dolichocolon with rectal intussusception, an apical prolapse after total hysterectomy 1990, and occasional stress urinary incontinence underwent interdisciplinary laparoscopic surgery. A tubular anterior rectal and sigmoid resection with suture rectopexy as in a resection rectopexy (RRP) was combined with a sacrocolpopexy (SCP) using a synthetic mesh.
MAIN OUTCOME MEASURES
Surgical outcome including postoperative morbidity, functional bowel evacuation, and POP reconstitution as in POP-Q score after surgery were documented.
RESULTS
No intra- or postoperative complications occurred. At 6 months follow-up clinical outcomes for ODS, bowel dysfunction, and faecal control were improved. Anatomical outcome for POP and stress urinary incontinence symptoms were corrected.
CONCLUSIONS
We report a promising interdisciplinary surgical approach as a single treatment option for the complex medical condition of women suffering from ODS and POP combining laparoscopic RRP with SCP. This surgical approach proved to be feasible, safe, and effective.
PubMed: 38950538
DOI: 10.52054/FVVO.16.2.017 -
International Journal of Pediatric... Jun 2024Investigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a...
OBJECTIVES
Investigate the implications of Congenital Nasal Pyriform Aperture Stenosis (CNPAS) on neonatal nasal airflow through computational fluid dynamics (CFD), create a virtual rhinomanometry, and simulate the prospective outcomes post-virtual surgical intervention.
METHODS
CT scanning of a neonate diagnosed with CNPAS and a control model were used to execute CFD simulations. The segmentation file of the CNPAS underwent manual modifications to simulate a virtual surgical procedure, resulting in a geometry that mirrors a post-operatively corrected patient. Virtual rhinomanometry was reconstructed, and airflow dynamics within the nasal cavity were systematically assessed. The results of the three models were compared.
RESULTS
In the CNPAS model, airflow dynamics underwent discernible alterations, with the principal airflow corridor confined to the nasal cavity's upper region. There was a marked pressure drop around the nasal valve, and diminished velocities. This first model of virtual surgery has allowed us to observe that the airflow parameters trended toward the control model, reintroducing an airflow trajectory between the lower and middle turbinates. Virtual rhinomanometry presented near-complete nasal obstruction in the CNPAS model, which showed considerable improvement after the virtual surgery.
CONCLUSION
CFD highlights the aerodynamic changes resulting from CNPAS. It also allows for the creation of virtual rhinomanometry and the performance of virtual surgeries. Virtual surgery confirms the therapeutic potential of pyriform aperture enlargement techniques used in clinical practice to improve nasal respiratory function. Future research will investigate additional surgical scenarios and the application of these findings to optimize surgical interventions for CNPAS.
PubMed: 38950452
DOI: 10.1016/j.ijporl.2024.112025 -
Rhinology Jul 2024The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and...
BACKGROUND
The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS).
METHODS
CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS.
RESULTS
In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency.
CONCLUSIONS
We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.
PubMed: 38950374
DOI: 10.4193/Rhin24.145