Alternative therapies in health and medicine最新文献

Background: The tibia is one of the most vulnerable bones in the human body, accounting for 13.7% of the total fractures. Most tibial fractures (distal articular surface) are caused by high-violence trauma. In recent years, with the rapid development of China's industry, the incidence of tibial fractures has shown an increasing trend.

Aim: To investigate the effect of internal fixation of tibial fractures per suprapatellar approach on fracture union and knee function recovery.

Methods: A total of 100 patients with tibial shaft fractures who underwent operations in our hospital were selected as the subjects. They were divided into a suprapatellar group (suprapatellar approach for intramedullary nail fixation) and a subpatellar group (subpatellar approach for intramedullary nail fixation) according to a prospective randomized study, with 50 cases in each group. The operative time, blood loss, X-ray irradiation times, fracture healing time, postoperative knee pain score, knee Lysholm score, and surgical complication rate were compared between the two groups.

Results: There were no significant differences in operative time, blood loss, and fracture healing time between the suprapatellar and subpatellar groups (P > .05). The number of X-ray irradiations needed and visual analog scale (VAS) scores were lower in the suprapatellar group than those in the subpatellar group (P < .05). The Lysholm score was used to evaluate knee function 6 months postoperatively, and swelling and pain scores were higher in the subpatellar group than in the suprapatellar group (P < .05). However, there were no significant differences in the knee Lysholm total score between the two groups (P > .05). There were also no significant differences in postoperative complications between the two groups (P > .05).

Conclusion: Suprapatellar intramedullary nailing reduced the number of intraoperative X-ray irradiations. Postoperative knee joint pain caused by intramedullary nailing was less, which was beneficial to the early functional knee joint exercise.

Context: The neutrophil to lymphocyte ratio (NLR) or platelet to lymphocyte ratio (PLR) is an inflammation marker of acute ischemic stroke, but the predictive value of NLR and PLR before and after thrombolysis for short-term prognosis in acute ischemic stroke patients after thrombolysis remains largely obscure. This study attempts to clarify the predictive value of NLR and PLR before and after thrombolysis for short-term prognosis in acute ischemic stroke patients after thrombolysis.

Design: A retrospective study was carried out in the Affiliated Hospital of Hangzhou Normal University involving 120 patients visiting the neurology department of our hospital from May 2019 to October 2022 and meeting the selection criteria. The participants were assigned to the good prognosis group and the poor prognosis group based on the modified Rankin scale score. Laboratory data collected include NLR and PLR at admission as well as NLR and PLR collected from venous blood within 24 h after thrombolysis.

Results: Age, hyperlipidemia, atrial fibrillation, rheumatic heart disease, and National Institutes of Health Stroke Scale (NIHSS) scores after thrombolysis depicted statistical significance between both groups (P < .05). Hyperlipidemia, atrial fibrillation, and NIHSS scores before thrombolysis were independent risk elements for adverse prognosis (P < .05). NLR and PLR before and after thrombolysis in the poor prognosis group depicted an elevation relative to that in the good prognosis group (P < .05). The area under the curve of NLR or PLR predicting adverse prognosis after thrombolysis depicted an elevation relative to that before thrombolysis (P < .05).

Conclusion: The predictive value of NLR and PLR post-thrombolysis for short-term prognosis in acute ischemic stroke patients depicts an elevation relative to pre-thrombolysis; our study provides effective predictive indicators for short-term prognosis in acute ischemic stroke patients.

Circular RNAs (circRNAs) have emerged as essential regulators in cardiovascular disease, including acute myocardial infarction (AMI). This study investigated the role of circRNA Pum1_0014 in myocardial infarction (MI) and its underlying mechanisms using an H9C2 cell model. Through Sanger sequencing, nucleic acid electrophoresis, RNase R, and transcriptional inhibition experiments, Pum1_0014 was identified as a novel circRNA. The cell localization of circRNA Pum1_0014 was detected by qPCR and fluorescence in situ hybridization, and the results revealed that circRNA Pum1_0014 is predominantly located in the cytoplasm. StarBase (URL: http://starbase.sysu.edu.cn/) and TargetScan (URL: https://www.targetscan.org/vert_80/) were used to predict circRNA Pum1_0014 targeting miRNAs and miRNA targeting mRNA, and the results identified miR-146a-5p as a potential target of Pum1_0014, which in turn targets NF2. The plasmid encoding the mutant circRNA Pum1_0014 or the 3'UTR mutant NF2 was constructed, and the interaction between Pum1_0014 and miR-146a-5p or miR-146a-5p and NF2 was detected by luciferase reporter gene assay. The results confirmed the interactions between Pum1_0014, miR-146a-5p, and NF2. In the MI cell model, upregulation of circRNA Pum1_0014 and NF2 and downregulation of miR-146a-5p were observed. Knockdown of circRNA Pum1_0014 inhibited NF2 expression and activated the VEGF/PAK1 pathway, reducing cardiomyocyte apoptosis. Conversely, inhibition of miR-146a-5p and overexpression of NF2 had opposite effects. These findings suggest that circRNA Pum1_0014 acts through the miR-146a-5p/NF2 axis to reduce cardiomyocyte apoptosis in MI via the VEGF/PAK1/NF2 pathway.

Background: Diabetic retinopathy (DR) substantially threatens ocular health, necessitating the accurate and prompt assessment of its onset and progression. Optical coherence tomography angiography (OCTA) is a valuable tool for evaluating periocular microvascular indicators, offering insights crucial for diagnosing and treating DR.

Objective: This meta-analysis aims to evaluate the progression of diabetic retinopathy (DR) by examining periocular microvascular indicators using optical coherence tomography angiography (OCTA). The objective is to provide substantive evidence for the future diagnosis and treatment of DR.

Methods: We analyzed the relevant research retrieved from PubMed and Web of Science until January 2023. The inclusion and exclusion criteria were carefully applied to select eligible studies. Quality assessment was performed using the Newcastle-Ottawa Scale, with studies scoring 4 or less excluded. Meta-analysis was conducted using Revman 5.3 software and focused on key indicators, including peripapillary vascular length density (pVLD) and peripapillary vascular density (pVD). Heterogeneity was assessed using I2 and P values, with effect sizes determined via fixed-effect or random-effects models based on heterogeneity levels.

Results: Six studies involving 839 DR-afflicted eyes and 3209 non-DR eyes were included after screening. All selected articles exhibited high reference value, with quality scores ranging from 5 to 8 points. The meta-analysis demonstrated that DR patients displayed significantly lower pVD and pVLD in the superficial (SCP) and deep capillary plexus (DCP) compared to non-DR patients (P < .05). These findings remained consistent across different effect models, reaffirming their validity.

Conclusions: Patients with DR exhibit reduced levels of pVD and pVLD in the SCP and DCP compared to non-DR individuals. OCTA examination of periocular microvascular indicators emerges as an effective tool for assessing the onset and progression of DR.

Objective: To evaluate the anti-fracture effect and adverse effects of teriparatide versus bisphosphonate on postmenopausal osteoporosis. This study will provide evidence-based practice for the clinical selection of more effective and safer drugs for these patients.

Methods: We searched PubMed, Embase, and the Cochrane Library from database inception to July 2022. The keywords included "fracture"; "teriparatide", "bisphosphonate", "postmenopausal women", and "osteoporosis". Randomized controlled trials (RCTs) comparing teriparatide versus bisphosphonates on the risk of fracture and adverse effects in postmenopausal osteoporosis were included in the analysis.

Results: Finally, 3376 participants were recruited in all 5 RCTs. The results revealed that teriparatide could decrease the rate of clinical vertebral fracture (OR=1.97, 95% CI=1.43-2.73, I2 = 0%, P < .0001) and new vertebral fractures (OR=2.44, 95% CI=1.70-3.50, I2 = 0%, P < .00001) compared with bisphosphonate. AE results refer to the type and frequency of adverse effects related to drug treatment. The rate of treatment discontinuous due to AEs (OR=0.63, 95% CI=0.48-0.83, I2 = 44%, P = .0009) with teriparatide was significantly greater than that with bisphosphonate. However, there was no significant difference in the incidence of adverse events to death (OR=0.59, 95% CI=0.30-1.18, I2 = 0%, P = .13). The proportion of patients reporting adverse events in the teriparatide versus bisphosphonate groups was consistent across subgroups, except for the rate of dizziness (OR=0.53, 95% CI=0.31-0.90, I2 = 49%, P = .02).

Conclusions: Among postmenopausal women with osteoporosis, clinical vertebral fractures and new vertebral fractures decreased more in patients receiving teriparatide than in those receiving bisphosphonate. Although there were no differences in adverse events across subgroups, patients receiving teriparatide had a higher rate of dizziness than those receiving bisphosphonate.The results of this work will provide a reference for clinicians to select appropriate anti-osteoporosis drugs by comprehensively considering individual differences such as fracture risk and dizziness tolerance.

Background: Non-alcoholic fatty liver disease (NAFLD) has emerged as a global health crisis, affecting a quarter of the world's population, and is anticipated to become a leading cause of liver transplantation and hepatocellular carcinoma by 2030. Conventional pharmacotherapy for NAFLD remains imperfect. In this context, Unani medicine offers a promising alternative for managing NAFLD.

Objective: This review aims to compile information on Unani medications used for the treatment of NAFLD, aiming to provide evidence of their efficacy and delve into the mechanisms through which these Unani drugs exert their therapeutic effects in NAFLD.

Methods: A comprehensive exploration of classical Unani literature was conducted, referencing well-established texts to extract pertinent information regarding NAFLD and its treatment in Unani Medicine. Electronic databases, including PubMed, Science Direct, and Google Scholar, were systematically searched to gather information on the efficacy of Unani drugs in the treatment of NAFLD.

Results: Unani medicine offers a rich repository of single herbs and compound formulations. There is a description of about 32 single herbs and 18 compound formulations for the treatment of NAFLD. These drugs act due to their Musakhkhin (calorific), Mudirr (diuretics), Mufattiḥ (deobstruent), Muqawwῑ-i-Jigar (hepatoprotective), and Muḥallilat (anti-inflammatory) action. The bioactive components present in these drugs possess antioxidant, hypolipidemic, anti-inflammatory, hypoglycemic, and hepatoprotective activities. These actions of Unani drugs closely align with the multifaceted nature of NAFLD pathogenesis, and thus effective in the treatment of NAFLD.

Conclusion: The findings led us to conclude that the use of Unani medicines can improve clinical outcomes in NAFLD, as demonstrated by various clinical and experimental trials. However, further clinical trials are essential to provide a safe and effective option for addressing this prevalent liver condition.

Objective: To investigate the preference of elderly patients for "Internet + Nursing Service", so as to provide reference for accurately matching their service needs.

Methods: Based on discrete choice experiments, the elderly patients' "Internet + Nursing Service" choice preference questionnaire was prepared, and 410 elderly patients were interviewed face-to-face. The Conditional Logit Model was used for quantitative analysis of the experimental data.

Results: The six attributes included in the study had a significant impact on the elderly patients' preference for "Internet + Nursing Service" (P < .05). Among non-economic attributes, "medical insurance reimbursement ratio -70%" has the highest utility (.263, P < .001), with "hospital size - larger (.205, P < .05)" and "medical insurance reimbursement ratio -50%" (.188, P < .05) ranking second and third, respectively. The relative importance of the attribute of medical insurance reimbursement proportion is the highest (26.44%), and the relative importance of service content is the lowest (9.78%). If the proportion of medical insurance reimbursement increases from 30% to 70%, patients are willing to pay 202.9 yuan, and the probability of choosing "Internet + Nursing Service" increases by 6.1%.

Conclusion: Patients prefer to choose a higher proportion of medical insurance reimbursement, a larger medical institution, a higher level of nurses, low single service costs, a basic package, and "Internet + Nursing Service" led by the government and hospitals. Improvement of the price and medical insurance payment policy is recommended, along with the enhancement of the ability of primary nursing services, strengthening of the management of Internet enterprise platforms, and scientific assessment of the needs of patients for personalized nursing services.

Objective: Previous studies showed the PRP have the therapeutic effects for KOA, but the more detail roles remained unclear and therefore this study was carried on to explore the deeper mechanisms for PRP.

Methods: NRS and WOMAC scores were used to evaluate the clinical efficacy before surgery, 1 month and 6 months after surgery, and the postoperative joint structure changes (n = 24). Examination of pathology of the femoral condyle plate in rats using HE staining (n = 6); Angiogenesis experiments were used to investigate the effect of different groups of cell culture supernatants on the tubular structure formation capacity of HUVECs (n = 3). Observe the proliferation of chondrocytes using clonal formation experiments (n = 3). Western blot was used to analyze the PI3K/AKT signaling pathway and the expression of exosome-secretion-related proteins (n = 3).

Results: In clinical studies, PRP can reduce patients' NRS and WOMAC scores and alleviate the progression of knee arthritis; In rat experiments, PRP reduced damage from knee arthritis and lowered Mankin's score. PRP improves tubular formation of HUVECs and the proliferation capacity of chondrocytes. Compared with the blank control group, the protein expression levels of PI3K, AKT, mTOR, P27, and cyclinD1 in the PRP group were increased. Compared with the PRP group, the protein expression levels of PI3K, AKT, mTOR, P27, and cyclinD1 in the PRP+Axitinib group supplemented with VEGFRs inhibitor and PI3K inhibitor group were significantly decreased. The effect of the LY294002 +PRP group was better than that of the above groups. Macrophage-derived exosomes activate HIF-1a and COX-2 in endothelial cells to promote chondrocyte repair of KOA.

Conclusion: PRP can promote chondrocytes proliferation and repair by activating the PI3K/AKT signaling pathway, thereby exerting anti-OA effects. It provides new targets and methods for the clinical treatment of OA.

Context: The ongoing COVID-19 pandemic has heightened concerns about respiratory system disorders. In Unani Medicine's literature, chronic bronchitis, referred to as Iltihab al-Shu'ab Muzmin, is significant within the realm of respiratory disorders.

Objective: The study intended to examine the perspectives of Greco-Arabic physicians, from Raban Tabari to Azam Khan, as well as that of Western physicians, exploring the definitions, signs, symptoms, pathophysiology, diagnosis, principles of treatment, and preventive measures for chronic bronchitis.

Design: The research team performed a narrative review by reviewing important Unani classical textbooks and by searching scientific databases, including PubMed, ScienceDirect, and Google Scholar from their dates of inception until August 2023. The search used the keywords chronic bronchitis, Iltihab al-Shu'ab Muzmin, chronic obstructive pulmonary diseases, Unani, and Greco-Arabic.

Setting: The study took place at the Regional Research Institute of Unani Medicine, Patna, India.

Results: The alignment between the symptoms that Unani physicians categorize as Su'al (cough) and Iltihab al-Shu'ab Muzmin (chronic bronchitis) is evident.

Conclusions: Unani philosophers have described risk factors, clinical features, pathology, and principles of management, showing farsightedness a thousand years ago. Contemporary Unani practitioners may obtain guidance from the work of the system's stalwarts.