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Autologous fat grafting and adipose-derived stem cells therapy for acute burns and burn-related scar: A systematic review 治疗急性烧伤和烧伤相关瘢痕的自体脂肪移植和脂肪源性干细胞疗法:系统综述
IF 1.5 Q2 Medicine Pub Date : 2024-03-06 DOI: 10.4103/tcmj.tcmj_189_23
Fanny Evasari Lesmanawati, Carolus Aldo Windura, I. Saputro, Lynda Hariani
ABSTRACT The objective of this study was to analyze all available research on the application of autologous fat grafting (AFG) and adipose-derived stem cells (ADSC) to present evidence-based recommendations, particularly in the clinical treatment of acute burns and burn-related scars. We conducted a systematic search of PubMed, COCHRANE, and EMBASE, as well as a manual search of previous reviews’ reference lists up. The risk of bias (RoB) was assessed using RoB 2.0 and ROBINS-I, where appropriate. Six eligible studies were selected (2 randomized clinical trials [RCT], 1 retrospective cohort, and 3 experimental studies) with subjects ranging from 3 to 100. Only one study evaluated the use of AFG for acute burns. Improvements in wound healing, vascularization, scar characteristics, and tissue architecture were generally observed in some studies, supported by molecular markers, while one study reported nonsignificant results. Subjective patient satisfaction was reported to have improved. Functional outcomes improvement in the treated regions was minimal. However, study heterogeneity arose mainly from treatment protocols. Cautious results interpretation due to potential bias, especially in selection and confounding domains, and limited clinical trials are important to note. More studies are needed to evaluate. AFG and ADSC hold potential as valuable treatment options for burn-related scars, supported by a body of evidence, but further well-designed RCT are needed. The efficacy of acute burn settings is yet to be further evaluated since evidence is limited.
摘要 本研究旨在分析有关自体脂肪移植(AFG)和脂肪源性干细胞(ADSC)应用的所有现有研究,以提出循证建议,尤其是在急性烧伤和烧伤相关疤痕的临床治疗中。 我们对PubMed、COCHRANE和EMBASE进行了系统检索,并对以往综述的参考文献列表进行了人工检索。我们酌情使用 RoB 2.0 和 ROBINS-I 评估了偏倚风险 (RoB)。 共筛选出 6 项符合条件的研究(2 项随机临床试验 [RCT]、1 项回顾性队列研究和 3 项实验研究),受试者从 3 人到 100 人不等。只有一项研究评估了 AFG 在急性烧伤中的应用。一些研究普遍观察到伤口愈合、血管生成、疤痕特征和组织结构有所改善,并得到分子标记物的支持,而一项研究报告的结果并不显著。据报道,患者的主观满意度有所提高。治疗区域的功能结果改善甚微。不过,研究的异质性主要来自治疗方案。需要注意的是,由于潜在的偏倚(尤其是在选择和混杂因素方面)以及有限的临床试验,对结果的解释必须谨慎。需要更多的研究来进行评估。 AFG和ADSC有可能成为治疗烧伤相关疤痕的重要选择,这一点已得到大量证据的支持,但仍需进一步开展设计良好的临床试验。由于证据有限,急性烧伤环境的疗效还有待进一步评估。
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引用次数: 0
A prospective review of the health-promoting potential of Jing Si Herbal Tea. 静思凉茶促进健康潜力的前瞻性研究。
IF 1.5 Q2 Medicine Pub Date : 2024-01-12 eCollection Date: 2024-01-01 DOI: 10.4103/tcmj.tcmj_194_23
Tsung-Jung Ho, Tanvir Ahmed, Marthandam Asokan Shibu, Yu-Jung Lin, Cheng Yen Shih, Pi-Yu Lin, Shinn-Zong Ling, Chien-Yi Chiang, Wei-Wen Kuo, Chih-Yang Huang

Traditional Chinese medicine (TCM) has gained considerable attention over the past few years for its multicomponent, multitarget, and multi-pathway approach to treating different diseases. Studies have shown that TCMs as adjuvant therapy along with conventional treatment may benefit in safely treating various disorders. However, investigations on finding effective herbal combinations are ongoing. A novel TCM formula, "Jing Si Herbal Tea (JSHT)," has been reported recently for their health-promoting effects in improving overall body and mental health. JSHT is a combination of eight herbs recognized in Chinese herbal pharmacopoeia for their anti-viral, anti-aging, and anti-cancer properties as well as protective effects against cardiovascular, metabolic, neural, digestive, and genitourinary diseases. Thus, to better understand the beneficial effects of the ingredients of JSHT on health, this review intends to summarize the preclinical and clinical studies of the ingredients of JSHT on human health and diseases, and possible therapeutic effects with the related mode of actions and future prospects for their application in complementary therapies.

传统中医药(TCM)以其多成分、多靶点、多途径的方法治疗不同疾病,在过去几年里受到了广泛关注。研究表明,中药作为常规治疗的辅助疗法,可以安全地治疗各种疾病。然而,寻找有效中药组合的研究仍在进行中。最近有报道称,一种新颖的中药配方 "静思草本茶(JSHT)"在改善整体身体和精神健康方面具有促进健康的作用。静思凉茶 "由八种中草药组合而成,具有抗病毒、抗衰老、抗癌以及预防心血管、代谢、神经、消化和泌尿生殖系统疾病的功效,已被载入《中国中草药药典》。因此,为了更好地了解 JSHT 成分对健康的有益影响,本综述旨在总结 JSHT 成分对人类健康和疾病的临床前和临床研究,以及可能的治疗效果和相关作用模式,以及在辅助疗法中的应用前景。
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引用次数: 0
High-intensity aerobic exercise training improves exercise capacity, dyspnea, and fatigue in patients with severe asthma using triple inhaler. 高强度有氧运动训练可改善使用三重吸入器的重症哮喘患者的运动能力、呼吸困难和疲劳。
IF 1.5 Q2 Medicine Pub Date : 2024-01-12 eCollection Date: 2024-01-01 DOI: 10.4103/tcmj.tcmj_171_23
Lun-Yu Jao, Po-Chun Hsieh, Yao-Kuang Wu, I-Shiang Tzeng, Mei-Chen Yang, Wen-Lin Su, Chou-Chin Lan

Objectives: Asthma is a chronic respiratory disease that affects millions of people worldwide and causes severe symptoms such as wheezing, coughing, and breathing difficulty. Despite modern treatments, 3%-10% of patients develop severe asthma, which requires high-dose medications, and they may still experience frequent and severe symptoms, exacerbations, and psychological impacts. This study aimed to investigate the effects of high-intensity aerobic exercise training (HIAET) in patients with severe asthma.

Materials and methods: Patients with severe asthma were recruited, and cardiopulmonary exercise tests, dyspnea, and leg fatigue scores were performed before HIAET. Participants underwent a 12-week hospital-based HIAET, which involved exercising twice weekly to reach 80% of their peak oxygen uptake (VO2).

Results: Eighteen patients with severe asthma underwent HIAET, which resulted in significant improvement in peak VO2 (1214.0 ± 297.9-1349.4 ± 311.2 mL/min, P = 0.004) and work rate (80.6 ± 21.2-96.2 ± 24.8 watt, P < 0.001) and decrease in dyspnea (5.1 ± 1.8-4.1 ± 1.2, P = 0.017) and fatigue scores (5.2 ± 2.3-4.0 ± 1.2, P = 0.020) at peak exercise. No significant changes were observed in spirometry results, respiratory muscle strength, or circulatory parameters.

Conclusion: HIAET can lead to improved exercise capacity and reduced dyspnea and fatigue scores at peak exercise without changes in spirometry, respiratory muscle strength, and circulatory parameters.

目的:哮喘是一种慢性呼吸道疾病,影响着全球数百万人,并导致喘息、咳嗽和呼吸困难等严重症状。尽管采用了现代治疗方法,但仍有3%-10%的患者发展为需要大剂量药物治疗的重症哮喘,而且他们仍可能出现频繁而严重的症状、病情加重和心理影响。本研究旨在探讨高强度有氧运动训练(HIAET)对重症哮喘患者的影响:招募重症哮喘患者,在进行 HIAET 前进行心肺运动测试、呼吸困难和腿部疲劳评分。结果:18 名重症哮喘患者接受了为期 12 周的医院 HIAET,每周锻炼两次,以达到峰值摄氧量(VO2)的 80%:结果:18 名重症哮喘患者接受了 HIAET,其峰值 VO2(1214.0 ± 297.9-1349.4 ± 311.2 mL/min,P = 0.004)和工作率(80.6 ± 21.2-96.2 ± 24.8 瓦特,P < 0.001),呼吸困难(5.1 ± 1.8-4.1 ± 1.2,P = 0.017)和疲劳评分(5.2 ± 2.3-4.0 ± 1.2,P = 0.020)在运动峰值时有所下降。肺活量测定结果、呼吸肌力量或循环参数均无明显变化:结论:HIAET 可提高运动能力,减少运动高峰时的呼吸困难和疲劳评分,而肺活量测定、呼吸肌力量和循环参数不会发生变化。
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引用次数: 0
Current treatment concepts for Achilles tendon rupture. 跟腱断裂的当前治疗理念。
IF 1.5 Q2 Medicine Pub Date : 2024-01-12 eCollection Date: 2024-01-01 DOI: 10.4103/tcmj.tcmj_113_23
Chen-Chie Wang, Pei-Yu Chen, Kai-Chiang Yang, Chung-Li Wang, Ing-Ho Chen

Achilles tendon rupture is a common and primary cause of lower limb tendon injury suffered during sports-related activities. The causes of Achilles tendon rupture include the calf muscle and tendon overuse, poor tendon quality, and various medical conditions. Historically, acute Achilles tendon rupture was treated conservatively. However, historical techniques are now associated with an increased risk of rerupture. To address this problem, open repair has been proposed. Open repair is associated with a reduced risk of rerupture; however, it is also closely associated with wound complications, like wound infection, whose treatment is time-consuming and costly. Therefore, minimally invasive Achilles tendon repair has been proposed as a promising option with acceptable functional outcomes. Nevertheless, despite its benefits, minimally invasive Achilles tendon repair is associated with increased risks of sural nerve injury and rerupture. In this review, we evaluate the currently used treatment strategies for acute Achilles tendon rupture and their historical evolution to provide evidence-based recommendations for physicians.

跟腱断裂是运动相关活动中常见的下肢肌腱损伤的主要原因。跟腱断裂的原因包括小腿肌肉和肌腱过度使用、肌腱质量差以及各种疾病。历史上,急性跟腱断裂多采用保守治疗。然而,历史上的技术现在却增加了再次断裂的风险。为了解决这一问题,有人提出了开放式修复术。开放式修复可降低再次断裂的风险,但也与伤口感染等伤口并发症密切相关,而伤口感染的治疗费时又费钱。因此,微创跟腱修复术被认为是一种很有前景的选择,其功能效果可以接受。然而,尽管微创跟腱修复术有很多优点,但它也增加了韧带神经损伤和跟腱再次断裂的风险。在这篇综述中,我们评估了目前用于急性跟腱断裂的治疗策略及其历史演变,从而为医生提供循证建议。
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引用次数: 0
A meta-analysis of alveolar bone grafting using bone substitutes in cleft lip and palate patients. 对唇腭裂患者使用骨替代物进行牙槽骨移植的荟萃分析。
IF 1.5 Q2 Medicine Pub Date : 2024-01-12 eCollection Date: 2024-01-01 DOI: 10.4103/tcmj.tcmj_125_23
Indri Lakhsmi Putri, Pascalis Fabian, Citrawati Dyah Kencono Wungu

In individuals with cleft lip and palate (CLP), an alveolar bone graft (ABG) is carried out for alveolar cleft closure. Several sources for ABG include autologous bone, xenologous bone, and alloplastic substitutes. Autologous bone has been the preferred source for ABG. Alloplastic substitutes might serve as an alternative. This study aimed to compare the outcomes between autologous and alloplastic as sources for ABG. This study made use of eight web databases. Randomized control trials (RCTs) and non-RCTs were included. CLP patients with alveolar cleft with imaging studies, computed tomography (CT scan) and/or cone beam CT scan, and bone graft volume within 6-12 months postintervention were selected. Bone graft volume within 6-12 months postintervention was assessed. Three studies met the inclusion criteria. After 6-12 months of follow-up, there were no statistically significant differences in bone graft volume between autologous and alloplastic bone grafts (fixed-effect model estimate value = 0.21; confidence interval - 0.301-0.730; P = 0.414). The limitations include small research sample sizes, a high likelihood of bias among included studies, and different alloplastic materials from each included study. Autologous and alloplastic bone grafts showed similar effectiveness in alveolar bone grafting. Further clinical trial studies with bigger sample sizes and similar interventions are needed as evidence for future reviews.

对于唇腭裂患者来说,牙槽骨移植(ABG)可用于牙槽裂的闭合。牙槽骨移植的几种来源包括自体骨、异种骨和异体替代物。自体骨一直是 ABG 的首选来源。异体替代物可作为一种替代方法。本研究旨在比较自体骨和异体骨作为 ABG 来源的结果。本研究使用了八个网络数据库。研究纳入了随机对照试验(RCT)和非RCT试验。研究选取了具有影像学检查、计算机断层扫描(CT 扫描)和/或锥形束 CT 扫描以及干预后 6-12 个月内的植骨量的牙槽骨裂的 CLP 患者。评估干预后 6-12 个月内的植骨量。三项研究符合纳入标准。随访 6-12 个月后,自体骨移植和异体骨移植的骨量差异无统计学意义(固定效应模型估计值 = 0.21;置信区间 - 0.301-0.730;P = 0.414)。研究的局限性包括研究样本量较小、纳入的研究之间很可能存在偏差,以及每项纳入研究的异体材料不同。自体骨移植和异体骨移植在牙槽骨移植中显示出相似的效果。今后的综述需要更多样本量更大、干预措施类似的临床试验研究作为证据。
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引用次数: 0
Exercise training influence on cognitive capacity and mental health within chronic obstructive pulmonary disease – A pilot study 运动训练对慢性阻塞性肺病患者认知能力和心理健康的影响--一项试点研究
IF 1.5 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.4103/tcmj.tcmj_128_23
Cheng-Siao Hong, Yu-Chih Shen, En-Ting Chang, Hui-Chuan Hou, Yi-Jen Chen
ABSTRACT Although pulmonary rehabilitation and regular exercise have improved negative emotions and cognitive capacity within cases of chronic obstructive pulmonary disease (COPD), influence by exercise training upon different cognitive and memory functions in COPD is still controversial. This investigation aimed to assess whether cognitive performance and mental health are affected by the benefits of exercise training within cases of COPD. This pilot investigation included thirty-three patients with Global Initiative for Chronic Obstructive Lung Disease stage ≥B. Based on the subjects’ rights, all included patients could choose to join either the exercise group or the control group, according to their free will. Twelve patients were assigned to receive exercise treatment over a 2-month period, while the remaining 16 patients were assigned to the control group. Cognitive capacity outcomes were measured using the Wechsler Memory Scale-III Word List Test, Stroop task, and psychomotor vigilance task (PVT). Mood states were assessed through the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Most cases demonstrated major improvement for BDI and BAI scorings post-60-day therapy. During PVT, the omission rate decreased, while the hit rate increased, indicating an improvement in attention performance. Furthermore, this investigation found a significant increase in immediate verbal and recognition memory for word–list test. However, no major performance shifts were found on Stroop analysis. This investigation demonstrated that a 2-month exercise training program resulted in significant improvement in negative emotions, immediate memory, recognition memory, and attention.
摘要 虽然肺康复和定期锻炼能改善慢性阻塞性肺病(COPD)患者的负面情绪和认知能力,但运动训练对慢性阻塞性肺病患者不同认知和记忆功能的影响仍存在争议。本调查旨在评估运动训练对慢性阻塞性肺病患者的认知能力和心理健康是否有影响。 这项试点调查包括 33 名全球慢性阻塞性肺病倡议≥B 期的患者。基于受试者的权利,所有患者均可根据其自由意愿选择加入运动组或对照组。12名患者被分配到运动组接受为期2个月的运动治疗,其余16名患者被分配到对照组。认知能力采用韦氏记忆量表-III单词表测试、Stroop任务和精神运动警觉任务(PVT)进行测量。情绪状态通过贝克抑郁量表(BDI)和贝克焦虑量表(BAI)进行评估。 经过 60 天的治疗,大多数病例的贝克抑郁量表和贝克焦虑量表评分均有显著改善。在 PVT 期间,遗漏率下降,而命中率上升,这表明注意力表现有所改善。此外,这项调查还发现,单词表测试中的即时口头记忆和识别记忆有了显著提高。然而,在 Stroop 分析中没有发现明显的成绩变化。 这项调查表明,为期两个月的运动训练计划能显著改善消极情绪、即时记忆、识别记忆和注意力。
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引用次数: 0
Factors affecting vancomycin-resistant Enterococcus faecium colonization of in-hospital patients in different wards 影响不同病房住院病人耐万古霉素肠球菌定植的因素
IF 1.5 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.4103/tcmj.tcmj_117_23
Yun-Cheng Wang, Lih-Shinn Wang, Tsung-Cheng Hsieh, Hui-Chun Chung
ABSTRACT The prevalence of vancomycin-resistant Enterococcus faecium (VRE) infection at a medical center in Eastern Taiwan rose to 80.6%, exceeding the average prevalence of 55.6% among all medical centers nationwide during the same period. In recent years, the number of cases of VRE infection detected among hospitalized patients has increased annually. However, most of these patients in different wards are asymptomatic carriers. Therefore, restricting active screening to high-risk units will not improve the current situation, and it is necessary to review the risk factors for VRE colonization to provide a reference for future infection control policies. Between 2014 and 2019, there were 3188 VRE-positive cultures reported at our institution, as per the electronic medical records system. In the medical and surgical wards, patients who received penicillin (odds ratios [ORs]: 2.84 and 4.16, respectively) and third-generation cephalosporins (ORs: 3.17 and 6.19, respectively) were at higher risk of VRE colonization. In intensive care units, the use of carbapenems (OR: 2.08) was the most significant variable. This study demonstrated that the risk factors for VRE colonization differed between wards. Thus, policies should be established according to the attributes of patients in each ward, and active screening tests should be performed according to individual risks, instead of a policy for comprehensive mass screening.
摘要 台湾东部某医疗中心耐万古霉素肠球菌(VRE)感染率高达 80.6%,超过同期全国医疗中心 55.6% 的平均感染率。近年来,在住院病人中发现的 VRE 感染病例逐年增加。然而,这些住在不同病房的患者大多是无症状的病毒携带者。因此,仅限于对高风险病房进行主动筛查并不能改善目前的状况,有必要重新审视VRE定植的风险因素,为今后的感染控制政策提供参考。 根据电子病历系统显示,2014 年至 2019 年期间,我院共报告了 3188 例 VRE 阳性培养。 在内科和外科病房,使用青霉素(几率比 [ORs]:分别为 2.84 和 4.16)和第三代头孢菌素(ORs:分别为 3.17 和 6.19)的患者出现 VRE 定植的风险较高。在重症监护病房,使用碳青霉烯类(OR:2.08)是最重要的变量。 这项研究表明,不同病房的 VRE 定植风险因素各不相同。因此,应根据每个病房患者的属性制定相应的政策,并根据个体风险进行积极的筛查测试,而不是制定全面的大规模筛查政策。
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引用次数: 0
Effect of hypoalbuminemia on mortality in cirrhotic patients with spontaneous bacterial peritonitis 低白蛋白血症对自发性细菌性腹膜炎肝硬化患者死亡率的影响
IF 1.5 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.4103/tcmj.tcmj_211_23
T. Hung, P. Ko, Chih-Ying Wang, C. Tsai, Hsing-Feng Lee
ABSTRACT The impact of hypoalbuminemia on the short-term and long-term mortality of cirrhotic patients with spontaneous bacterial peritonitis (SBP), both with and without renal function impairment, remains insufficiently elucidated based on population-based data. We retrieved data from Taiwan’s National Health Insurance Database encompassing 14,583 hospitalized patients diagnosed with both cirrhosis and SBP during the period from January 1, 2010, to December 31, 2013. Prognostic factors influencing 30-day and 3-year survival were computed. Furthermore, the impact of hypoalbuminemia on the mortality rate among SBP patients, with or without concurrent renal function impairment, was also assessed. The 30-day mortality rates for patients with SBP, comparing those with hypoalbuminemia and those without, were 18.3% and 29.4%, respectively (P < 0.001). Similarly, the 3-year mortality rates for SBP patients with hypoalbuminemia and those without were 73.7% and 85.8%, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for patients’ gender, age, and comorbid conditions, substantiated that individuals with hypoalbuminemia exhibit an inferior 30-day survival (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.51–1.74, P < 0.001) and reduced 3-year survival (HR: 1.57, 95% CI: 1.50–1.63, P < 0.001) in comparison to those lacking hypoalbuminemia. Among SBP patients with renal function impairment, those presenting hypoalbuminemia also experienced diminished 30-day survival (HR: 1.81, 95% CI 1.57–2.07, P < 0.001) as well as reduced 3-year survival (HR: 1.70, 95% CI 1.54–1.87, P < 0.001). Likewise, in SBP patients without renal function impairment, the presence of hypoalbuminemia was associated with poorer 30-day survival (HR: 1.54, 95% CI 1.42–1.67, P < 0.001) and 3-year survival (HR: 1.53, 95% CI 1.46–1.60, P < 0.001). Among cirrhotic patients with SBP, the presence of hypoalbuminemia predicts inferior short-term and long-term outcomes, regardless of renal function.
ABSTRACT 低白蛋白血症对自发性细菌性腹膜炎(SBP)肝硬化患者短期和长期死亡率的影响,无论是有还是没有肾功能损害,基于人群数据的研究仍然不够深入。 我们从台湾国民健康保险数据库中检索了 2010 年 1 月 1 日至 2013 年 12 月 31 日期间 14,583 名同时被诊断为肝硬化和自发性细菌性腹膜炎的住院患者的数据。计算了影响 30 天和 3 年生存率的预后因素。此外,还评估了低白蛋白血症对同时伴有或不伴有肾功能损害的 SBP 患者死亡率的影响。 有低白蛋白血症和没有低白蛋白血症的 SBP 患者的 30 天死亡率分别为 18.3% 和 29.4%(P < 0.001)。同样,有低白蛋白血症和无低白蛋白血症的 SBP 患者的 3 年死亡率分别为 73.7% 和 85.8%(P < 0.001)。根据患者的性别、年龄和合并症进行调整后的 Cox 比例危险回归分析证实,与无低白蛋白血症的患者相比,低白蛋白血症患者的 30 天存活率较低(危险比 [HR]:1.62,95% 置信区间 [CI]:1.51-1.74,P <0.001),3 年存活率较低(HR:1.57,95% 置信区间 [CI]:1.50-1.63,P <0.001)。在肾功能受损的 SBP 患者中,出现低白蛋白血症的患者的 30 天生存率也会降低(HR:1.81,95% CI 1.57-2.07,P <0.001),3 年生存率也会降低(HR:1.70,95% CI 1.54-1.87,P <0.001)。同样,在无肾功能损害的 SBP 患者中,低白蛋白血症与较差的 30 天生存率(HR:1.54,95% CI 1.42-1.67,P<0.001)和 3 年生存率(HR:1.53,95% CI 1.46-1.60,P<0.001)相关。 在患有 SBP 的肝硬化患者中,无论肾功能如何,低白蛋白血症的存在都预示着较差的短期和长期预后。
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引用次数: 0
Urine biomarker could be a useful tool for differential diagnosis of a lower urinary tract dysfunction 尿液生物标志物是鉴别诊断下尿路功能障碍的有用工具
IF 1.5 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.4103/tcmj.tcmj_221_23
Wan-Ru Yu, Yuan-Hong Jiang, J. Jhang, H. Kuo
ABSTRACT A precision diagnosis of lower urinary tract dysfunctions (LUTD) such as bladder outlet obstruction, detrusor overactivity (DO), interstitial cystitis/bladder pain syndrome (IC/BPS), dysfunctional voiding (DV), or detrusor underactivity (DU) needs invasive videourodynamic study. Exploring non-invasive tools to help screening LUTD is necessary for clinicians in their daily practice. This article reviews recently clinical studies of using urinary inflammatory proteins and oxidative stress biomarkers in the identification of specific LUTD among men and women with lower urinary tract symptoms (LUTS). Some important findings have been reported: (1) Using urine chemokines CXCL-1 and interleukin-8 (IL-8), we may discriminate overactive bladder (OAB) symptoms in women between DO and urinary tract infection. (2) Urinary levels of oxidative stress biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and 8-isoprostane have a potential being used as a tool to identify women with mixed DO and stress urinary incontinence. (3) Urine levels of total antioxidant capacity (TAC), and prostaglandin E2 (PGE2) are positively correlated with voiding detrusor pressure in patients with DU. (4) Urine levels of brain-derived neurotrophic factor (BDNF) and PGE2 were significantly higher in the DU patients with detrusor function recovery. (5) Women with DV had higher urinary levels of tumor necrosis factor-alpha (TNF-α) and 8-OHdG, and urinary IL-2 level was significantly lower. (6) Urine level of 8-isoprostane was higher in the patients with idiopathic DO and neurogenic DO. (7) Higher urine cytokine levels of monocyte chemoattractant protein-1 (MCP-1), regulated on activation, normal T-cell expressed and secreted (RANTES), CXCL-10, IL-7, and eotaxin-1 in patients with IC/BPS than controls. (8) The urine levels of IL-8, CXCL-10, BDNF, IL-6, and RANTES were significantly higher in patients with Hunner’s IC than non-Hunner’s IC. (9) Male patients with IC/BPS had a significantly higher level of eotaxin, MCP-1, TNF-α, 8-OHdG, and TAC. Combining a higher eotaxin and a higher TNF-α can provide a satisfactory diagnostic value in discriminating IC/BPS from other LUTD in men. These studies provide evidence that measurement of cluster of urine biomarkers could be used as a diagnostic tool to differentiate different LUTD in patients with similar LUTS.
摘要 要精确诊断下尿路功能障碍(LUTD),如膀胱出口梗阻、逼尿肌过度活动(DO)、间质性膀胱炎/膀胱疼痛综合征(IC/BPS)、排尿功能障碍(DV)或逼尿肌活动不足(DU),需要进行有创视频动态检查。探索非侵入性工具来帮助筛查 LUTD 对临床医生的日常工作很有必要。本文回顾了近期关于使用尿液炎症蛋白和氧化应激生物标志物在有下尿路症状(LUTS)的男性和女性中识别特定 LUTD 的临床研究。报告了一些重要发现:(1)利用尿液趋化因子 CXCL-1 和白细胞介素-8(IL-8),我们可以将女性膀胱过度活动症(OAB)症状区分为 DO 和尿路感染。(2)尿液中的氧化应激生物标志物,如 8-羟基脱氧鸟苷(8-OHdG)和 8-异前列腺烷,有可能被用作鉴别混合型 DO 和压力性尿失禁妇女的工具。(3)尿液中的总抗氧化能力(TAC)和前列腺素 E2(PGE2)水平与尿失禁患者的排尿压力呈正相关。(4) 尿液中的脑源性神经营养因子(BDNF)和前列腺素 E2 水平在排尿功能恢复的 DU 患者中明显较高。(5)患有 DV 的女性尿液中肿瘤坏死因子-α(TNF-α)和 8-OHdG 水平较高,尿液中 IL-2 水平明显较低。(6)特发性 DO 和神经源性 DO 患者尿液中 8-异前列腺素水平较高。(7)IC/BPS 患者尿液中单核细胞趋化蛋白-1(MCP-1)、活化调节、正常 T 细胞表达和分泌(RANTES)、CXCL-10、IL-7 和 eotaxin-1 等细胞因子水平高于对照组。(8)亨纳氏 IC 患者尿液中的 IL-8、CXCL-10、BDNF、IL-6 和 RANTES 水平明显高于非亨纳氏 IC 患者。(9)男性 IC/BPS 患者的 eotaxin、MCP-1、TNF-α、8-OHdG 和 TAC 水平明显更高。将较高的 eotaxin 和较高的 TNF-α 结合在一起,可在鉴别 IC/BPS 和其他男性 LUTD 方面提供令人满意的诊断价值。这些研究提供的证据表明,尿液生物标志物群的测量可作为一种诊断工具,用于区分具有类似 LUTS 的患者的不同 LUTD。
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引用次数: 0
The influence of uremic toxins on low bone turnover disease in chronic kidney disease 尿毒症毒素对慢性肾病低骨转换病的影响
IF 1.5 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.4103/tcmj.tcmj_212_23
Giou-Teng Yiang, Wen-Lin Su, Cai-Mei Zheng, Min-Tser Liao, Tong-Hong Cheng, Chien-Lin Lu, Kuo-Cheng Lu
ABSTRACT Uremic toxins play a crucial role in the development of low bone turnover disease in chronic kidney disease (CKD) through the induction of oxidative stress. This oxidative stress disrupts the delicate balance between bone formation and resorption, resulting in a decline in both bone quantity and quality. Reactive oxygen species (ROS) activate nuclear factor kappa-B and mitogen-activated protein kinase signaling pathways, promoting osteoclastogenesis. Conversely, ROS hinder osteoblast differentiation by facilitating the binding of Forkhead box O proteins (FoxOs) to β-catenin, triggering apoptosis through FoxOs-activating kinase phosphorylation. This results in increased osteoblastic receptor activator of nuclear factor kappa-B ligand (RANKL) expression and decreased nuclear factor erythroid 2-related factor 2 levels, compromising antioxidant defenses against oxidative damage. As CKD progresses, the accumulation of protein-bound uremic toxins such as indoxyl sulfate (IS) and p-cresyl sulfate (PCS) intensifies oxidative stress, primarily affecting osteoblasts. IS and PCS directly inhibit osteoblast viability, induce apoptosis, decrease alkaline phosphatase activity, and impair collagen 1 and osteonectin, impeding bone formation. They also reduce cyclic adenosine 3’,5’-monophosphate (cAMP) production and lower parathyroid hormone (PTH) receptor expression in osteoblasts, resulting in PTH hyporesponsiveness. In summary, excessive production of ROS by uremic toxins not only reduces the number and function of osteoblasts but also induces PTH hyporesponsiveness, contributing to the initiation and progression of low bone turnover disease in CKD.
摘要 尿毒症毒素通过诱导氧化应激,在慢性肾脏病(CKD)低骨转换疾病的发病过程中起着至关重要的作用。这种氧化应激破坏了骨形成和骨吸收之间的微妙平衡,导致骨量和骨质下降。活性氧(ROS)激活核因子卡巴-B 和丝裂原活化蛋白激酶信号通路,促进破骨细胞生成。相反,ROS 会促进叉头盒 O 蛋白(FoxOs)与 β-catenin 结合,通过 FoxOs 激活激酶磷酸化引发细胞凋亡,从而阻碍成骨细胞分化。这导致成骨细胞核因子卡巴-B 配体受体激活剂(RANKL)表达增加,核因子红细胞 2 相关因子 2 水平降低,从而削弱了抗氧化防御氧化损伤的能力。随着慢性肾功能衰竭的发展,蛋白结合型尿毒症毒素(如硫酸吲哚酯(IS)和对甲酚硫酸盐(PCS))的积累会加剧氧化应激,主要影响成骨细胞。IS 和 PCS 直接抑制成骨细胞的活力,诱导细胞凋亡,降低碱性磷酸酶的活性,损害胶原蛋白 1 和骨连接蛋白,阻碍骨形成。它们还能减少环腺苷酸 3',5'-单磷酸(cAMP)的产生,降低成骨细胞中甲状旁腺激素(PTH)受体的表达,导致 PTH 反应低下。总之,尿毒症毒素产生过多的 ROS 不仅会减少成骨细胞的数量和功能,还会诱导 PTH 反应性低下,从而导致慢性肾脏病中低骨转换疾病的发生和发展。
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Tzu Chi Medical Journal
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