Treatment approaches

治疗方法
  • 文章类型: Journal Article
    骨关节炎(OA)提出了一个日益增长的健康问题,带来巨大的社会和医疗负担。目前的管理侧重于症状缓解,缺乏改变疾病的选择。新兴研究表明钠通道Nav1.7是OA治疗的关键靶标。临床前研究证明卡马西平在Nav1.7阻滞中的疗效,在动物模型中提供显著的关节保护。然而,需要进行人体试验来验证这些发现.卡马西平的重新利用为OA管理带来了希望,潜在的革命性治疗范式。进一步的研究对于弥合临床前证据和临床应用之间的差距至关重要。为改善OA管理和提高患者生活质量提供希望。
    Osteoarthritis (OA) presents a growing health concern, with substantial societal and healthcare burdens. Current management focuses on symptom relief, lacking disease-modifying options. Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment. Preclinical studies demonstrate carbamazepine\'s efficacy in Nav1.7 blockade, offering significant joint protection in animal models. However, human trials are needed to validate these findings. Carbamazepine\'s repurposing holds promise for OA management, potentially revolutionizing treatment paradigms. Further research is essential to bridge the gap between preclinical evidence and clinical application, offering hope for improved OA management and enhanced patient quality of life.
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  • 文章类型: Journal Article
    这篇评论文章探讨了由于垃圾填埋场和空旷地区越来越多地处置城市固体废物而导致的垃圾渗滤液相关挑战。垃圾渗滤液的成分包括抗生素(0.001至100μg),重金属(0.001至1.4g/L),溶解的有机和无机成分,和异型生物,包括多环芳烃(10-25μg/L)。常规治疗方法,如生物(微生物和植物修复)和物理化学(电化学和基于膜的)技术,是可用的,但在成本方面面临限制,准确度,和环境风险。为了克服这些挑战,这项研究倡导人工智能(AI)和机器学习(ML)的集成,以通过预测分析和优化的操作参数来增强治疗效果。它严格评估顽固的渗滤液成分带来的风险,并评估各种处理方式的性能,既独立又与生物和物理化学过程串联。值得注意的是,物理化学处理已证明对各种污染物的污染物去除率高达90%,而综合生物方法已达到95%以上的去除效率。然而,固体废物组合物的异质性质进一步使处理方法复杂化。因此,支持向量回归等高级机器学习算法的集成,人工神经网络,提出了遗传算法来完善渗滤液处理工艺。这篇综述为不同的利益相关者,特别是研究人员提供了有价值的见解,决策者和实践者,寻求加强废物处理基础设施并促进可持续的垃圾渗滤液管理实践。通过利用AI和ML工具以及对渗滤液复杂性的细微理解,一条有希望的途径出现,以有效解决这一环境挑战,同时减轻潜在的不利影响。
    This review article explores the challenges associated with landfill leachate resulting from the increasing disposal of municipal solid waste in landfills and open areas. The composition of landfill leachate includes antibiotics (0.001-100 μg), heavy metals (0.001-1.4 g/L), dissolved organic and inorganic components, and xenobiotics including polyaromatic hydrocarbons (10-25 μg/L). Conventional treatment methods, such as biological (microbial and phytoremediation) and physicochemical (electrochemical and membrane-based) techniques, are available but face limitations in terms of cost, accuracy, and environmental risks. To surmount these challenges, this study advocates for the integration of artificial intelligence (AI) and machine learning (ML) to strengthen treatment efficacy through predictive analytics and optimized operational parameters. It critically evaluates the risks posed by recalcitrant leachate components and appraises the performance of various treatment modalities, both independently and in tandem with biological and physicochemical processes. Notably, physicochemical treatments have demonstrated pollutant removal rates of up to 90% for various contaminants, while integrated biological approaches have achieved over 95% removal efficiency. However, the heterogeneous nature of solid waste composition further complicates treatment methodologies. Consequently, the integration of advanced ML algorithms such as Support Vector Regression, Artificial Neural Networks, and Genetic Algorithms is proposed to refine leachate treatment processes. This review provides valuable insights for different stakeholders specifically researchers, policymakers and practitioners, seeking to fortify waste disposal infrastructure and foster sustainable landfill leachate management practices. By leveraging AI and ML tools in conjunction with a nuanced understanding of leachate complexities, a promising pathway emerges towards effectively addressing this environmental challenge while mitigating potential adverse impacts.
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  • 文章类型: Journal Article
    目的:乳腺癌在65岁及以上的女性中很常见。由于临床研究中很少包括这些患者,因此该年龄段患者的乳腺癌治疗缺乏证据。然而,众所周知,未接受标准治疗的老年乳腺癌患者的生存率显着降低。几个因素,包括患者合并症,性能状态,预期寿命,和肿瘤的病理和分子特征,会影响治疗的结果。在这项研究中,我们旨在通过在多中心数据集中的老年人群中评估这些因素来更新该领域的知识.
    方法:这项回顾性研究分析了335名65岁及以上的乳腺癌患者的数据,这些患者在五个肿瘤中心接受了辅助放疗(Kartal博士LutfiKirdar培训和研究医院,伊斯坦布尔,梅兰医学院-NecmettinErbakan大学,Konya,Prof.CemilTascioglu市医院,伊斯坦布尔,Umraniye培训和研究医院,伊斯坦布尔,伊斯坦布尔肿瘤医院,伊斯坦布尔)在2010年5月至2022年9月之间。人口统计,临床,并收集病理资料,包括年龄,性别,临床症状,肿瘤特征,治疗方法,和结果。统计分析,包括描述性统计,Kaplan-Meier分析,对数秩检验,和Cox回归分析,使用IBMSPSSStatisticsforWindows执行,版本22(2013年发布;IBMCorp.,Armonk,纽约,美国),显著性水平为p<0.05。
    结果:对335例乳腺癌患者的肿瘤特征和生存时间进行分析。在结果中,性能状态,T级,神经周浸润是影响老年乳腺癌患者生存的因素。在多变量分析中,可以看出,表现状况作为独立的预后因素发挥了重要作用.
    结论:老年年龄组乳腺癌的治疗需要个性化的方法,考虑到患者的整体健康状况,预期寿命,和合并症。
    OBJECTIVE: Breast cancer is common among women aged 65 and over. There is a significant lack of evidence regarding the treatment of breast cancer in patients in this age group due to the rare inclusion of these patients in clinical studies. However, it is known that survival in elderly patients with breast cancer is significantly reduced in those not receiving standard therapy. Several factors, including patients\' comorbidities, performance status, life expectancy, and tumor pathological and molecular characteristics, can affect the outcomes of treatment. In this study, we aimed to update the knowledge in this field by assessing these factors among the geriatric population in our multicenter dataset.
    METHODS: This retrospective study analyzed data from 335 breast cancer patients aged 65 and over who received adjuvant radiotherapy at five oncology centers (Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Meram Medical Faculty - Necmettin Erbakan University, Konya, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Umraniye Training and Research Hospital, Istanbul, and Istanbul Oncology Hospital, Istanbul) between May 2010 and September 2022. Demographic, clinical, and pathological data were collected, including age, gender, clinical symptoms, tumor characteristics, treatment approaches, and outcomes. Statistical analyses, including descriptive statistics, Kaplan-Meier analysis, log-rank test, and Cox regression analysis, were performed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), with a significance level of p < 0.05.
    RESULTS: The tumor characteristics and survival time of 335 breast cancer patients were examined. In the results, performance status, T stage, and perineural invasion were found to be factors affecting the survival of elderly breast cancer patients. In multivariate analysis, it was seen that performance status played an important role as an independent prognostic factor.
    CONCLUSIONS: The treatment of breast cancer in the geriatric age group necessitates a personalized approach, taking into account the patient\'s overall health status, life expectancy, and comorbidities.
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  • 文章类型: Journal Article
    白塞氏病是一种病因不明的全身性炎症性疾病。这种疾病表现出不同的临床症状,最常见的复发性口腔和生殖器溃疡,皮肤损伤,和葡萄膜炎,虽然它可以影响多个器官系统。由于缺乏明确的诊断测试,诊断主要是临床。和管理涉及多学科方法来控制炎症和管理症状。目前的治疗策略涉及皮质类固醇,免疫抑制剂,and,越来越多,生物疗法。Behçet病在丝绸之路沿线表现出更高的患病率,表明环境和遗传因素的作用。尽管在了解其临床特征和治疗方法方面取得了重大进展,我们对其发病机制的理解仍然存在差距。未来的研究需要阐明疾病的病理生理学和优化治疗策略。
    Behçet\'s disease is a systemic inflammatory disorder of unknown etiology. The disease manifests with diverse clinical symptoms, most commonly recurrent oral and genital ulcers, skin lesions, and uveitis, though it can affect multiple organ systems. Diagnosis is primarily clinical due to the lack of a definitive diagnostic test, and management involves a multidisciplinary approach to control inflammation and manage symptoms. Current treatment strategies involve corticosteroids, immunosuppressive agents, and, increasingly, biological therapies. Behçet\'s disease exhibits a higher prevalence along the Silk Road, suggesting a role of environmental and genetic factors. Despite significant progress in understanding its clinical characteristics and treatment approaches, gaps remain in our understanding of its pathogenesis. Future research is needed to elucidate the disease\'s pathophysiology and optimize treatment strategies.
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  • 文章类型: Journal Article
    胰腺导管腺癌(PDAC)通常诊断为晚期,无法治愈,阶段,预后极差。全身化疗代表了术前的标准治疗,佐剂和姑息性设置,这只与生存率的适度改善有关。最近,癌症基因组测序的进展揭示了PDAC的分子异质性,并确定了BRCA中具有独特可操作畸变的小患者亚组,NTRK,NRG1和错配修复基因为这种肿瘤的更个性化方法铺平了道路。然而,PDAC治疗朝着成功的精确方法的发展提出了许多挑战。在这次审查中,我们讨论PDAC目前的标准治疗方法,从早期到晚期疾病,我们说明了精准医学对这种致命癌症的机遇和挑战。
    Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed at an advanced, incurable, stage and has an extremely poor prognosis. Systemic chemotherapy represents the standard treatment either in the pre-operative, adjuvant and palliative setting, which is associated with only modest improvement in survival. More recently, advances in cancer genomic sequencing have unravelled the molecular heterogeneity of PDAC and identified small patient subgroups harbouring unique actionable aberrations in BRCA, NTRK, NRG1 and mismatch repair genes paving the way to a more personalised approach for this tumour. However, the evolution of PDAC treatment towards a successful precision approach presents many challenges. In this review, we discuss the current standard treatments of PDAC, from early stage to advanced disease, and we illustrate the opportunities and challenges of precision medicine for this deadly cancer.
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  • 文章类型: Journal Article
    氮(N)在垃圾填埋场的积累是一个紧迫的环境问题,由于其来源和重大的环境影响。然而,对垃圾填埋场中的氮的关注和研究相对有限,因为它被其他更突出的污染物所掩盖。这项研究全面考察了垃圾填埋场中氮的来源,包括每年贡献3.9亿吨氮的食物垃圾,工业排放,和污水处理厂的废水。垃圾填埋场中N对环境的影响主要表现在N2O排放和高N浓度的渗滤液中。为了应对这些挑战,这项研究提出了各种缓解和管理策略,包括N2O还原措施和新型NH4+去除技术,如电化学技术,膜分离过程,基于藻类的过程,和其他高级氧化工艺。然而,需要更深入地了解垃圾填埋场氮素循环的复杂性,由于缺乏长期监测数据以及存在复杂的相互作用和反馈机制。为了最终实现优化的N管理并最大程度地减少垃圾填埋场对环境的不利影响,未来的前景应该强调监测和建模技术的进步,加强对微生物生态学的理解,贯彻循环经济原则,创新处理技术的应用,以及全面的垃圾填埋场设计和规划。
    Nitrogen (N) accumulation in landfills is a pressing environmental concern due to its diverse sources and significant environmental impacts. However, there is relatively limited attention and research focus on N in landfills as it is overshadowed by other more prominent pollutants. This study comprehensively examines the sources of N in landfills, including food waste contributing to 390 million tons of N annually, industrial discharges, and sewage treatment plant effluents. The environmental impacts of N in landfills are primarily manifested in N2O emissions and leachate with high N concentrations. To address these challenges, this study presents various mitigation and management strategies, including N2O reduction measures and novel NH4+ removal techniques, such as electrochemical technologies, membrane separation processes, algae-based process, and other advanced oxidation processes. However, a more in-depth understanding of the complexities of N cycling in landfills is required, due to the lack of long-term monitoring data and the presence of intricate interactions and feedback mechanisms. To ultimately achieve optimized N management and minimized adverse environmental impacts in landfill settings, future prospects should emphasize advancements in monitoring and modeling technologies, enhanced understanding of microbial ecology, implementation of circular economy principles, application of innovative treatment technologies, and comprehensive landfill design and planning.
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  • 文章类型: Journal Article
    癌症仍然是全球最紧迫的健康挑战之一。需要对创新的治疗方法进行持续的研究。本文探讨了影响癌症的两个关键因素:ncRNAs和纳米疗法。ncRNAs的作用,包括microRNA和长链非编码RNA,在癌症发病机理中,programming,并阐明了治疗抗性。此外,纳米疗法的潜力,利用纳米级材料进行靶向药物递送并增强治疗效果,正在调查。通过全面分析ncRNA失调的分子机制和纳米疗法在癌症治疗中的前景,这篇文章旨在提供有价值的见解,以对抗癌症的新的治疗策略。
    Cancer remains one of the most pressing health challenges globally, necessitating ongoing research into innovative therapeutic approaches. This article explores two critical factors influencing cancer: ncRNAs and nanotherapy. The role of ncRNAs, including microRNAs and long non-coding RNAs, in cancer pathogenesis, progression, and treatment resistance is elucidated. Additionally, the potential of nanotherapy, leveraging nanoscale materials for targeted drug delivery and enhanced therapeutic efficacy, is investigated. By comprehensively analyzing the molecular mechanisms underlying ncRNA dysregulation and the promise of nanotherapy in cancer treatment, this article aims to provide valuable insights into novel therapeutic strategies for combating cancer.
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  • 文章类型: Journal Article
    传染病长期以来对全球健康构成重大威胁,需要不断创新治疗方法。然而,最近的开创性研究揭示了以前被忽视的疾病发病机制参与者——人类微生物组。这篇综述文章讨论了微生物组和传染病之间的复杂关系,并揭示了其作为宿主-病原体相互作用的关键介质的作用。我们探索了利用这个动态生态系统开发创新治疗策略的巨大潜力,这些策略可以彻底改变传染病的管理。通过探索最新进展和新兴趋势,这篇综述旨在为通过针对微生物组对抗传染病提供一个新的视角。
    Infectious diseases have long posed a significant threat to global health and require constant innovation in treatment approaches. However, recent groundbreaking research has shed light on a previously overlooked player in the pathogenesis of disease-the human microbiome. This review article addresses the intricate relationship between the microbiome and infectious diseases and unravels its role as a crucial mediator of host-pathogen interactions. We explore the remarkable potential of harnessing this dynamic ecosystem to develop innovative treatment strategies that could revolutionize the management of infectious diseases. By exploring the latest advances and emerging trends, this review aims to provide a new perspective on combating infectious diseases by targeting the microbiome.
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  • 文章类型: Systematic Review
    背景:患有乳腺癌的男性经历了独特的身体和情感挑战。然而,对这些经历的透彻了解,包括心理社会影响和支持性护理需求,受到的关注较少。在某些设置中,患有乳腺癌的男性在医疗保健系统中遭受耻辱,他们的护理需求没有得到优先考虑。这会影响提供的专业支持水平,因此,他们的健康和福祉结果恶化。这篇综述探讨了不同背景下男性乳腺癌(MBC)的经验和治疗方式的差异。
    方法:所有主要研究设计,包括定性,定量,以及报告经验的混合方法研究,本系统综述包括MBC的治疗方法和结局.六个数据库(Embase,Medline,PsycINFO,全球卫生,CINAHL和WebofScience)搜索了2000年1月至2023年9月的文章。基于结果的收敛综合用于数据分析,并使用PRISMA指南进行报告。
    结果:在筛选的研究中(n=29,687),44人符合预定标准,被列入。我们与MBC的经验和治疗方法有关的发现大致分为三个部分。主题1-通过对男性气质的威胁导航:描述男性如何经历疾病,反映在检测,诊断,接受乳腺癌,和披露。主题2-通过治疗导航:捕获在诊断后接受乳腺癌治疗/管理的经验。主题3-应对和支持系统:描述MBC患者如何应对疾病,处理过程,善后/康复护理,和可用的支撑结构。
    结论:男性在乳腺癌诊断后经历了无数的问题,尤其是他们的阳刚之气.迫切需要在公众和医疗保健从业人员中开展MBC的意识创建工作,这可能会改变男性促进早期诊断的看法,坚持治疗,治疗后监测,肿瘤结果和更好的生活质量。对培训的考虑,MBC专业医疗从业者的教育和发展将提供必要的知识和技能,通过采用以人为本和针对男性的护理策略来加强他们的实践。对MBC的专业护理干预和支持不应在诊断阶段后结束,而应扩展到整个治疗连续体和后期护理,包括未来针对MBC特定临床试验的研究。
    背景:PROSPERO注册号.CRD42021228778。
    BACKGROUND: Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts.
    METHODS: All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines.
    RESULTS: Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1-Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3-Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures.
    CONCLUSIONS: Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials.
    BACKGROUND: PROSPERO Registration No. CRD42021228778.
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  • 文章类型: Journal Article
    肘管综合征(CuTS)是一种神经性疾病,其特征是肘部尺神经受到压迫或刺激,导致广泛的症状,从疼痛和麻木到肌肉无力和手功能受损。这篇全面的综述深入探讨了CuTS处理方法的不同景观,强调早期干预的重要性。这篇综述探讨了这些策略是如何通过采取包括休息在内的保守措施来缓解症状并提高患者的幸福感的。夹板,药物,物理治疗,和生活方式的调整。非手术医疗干预,包括神经滑翔练习,超声引导下的神经注射,和矫形装置,被认为是缓解症状的替代疗法。手术干预,如减压程序和新兴技术,进行了详细的讨论,强调他们的适应症和预期结果。在整个审查过程中,强调了以患者为中心的护理的关键作用,强调需要尊重个人偏好和目标的量身定制的治疗计划。认识到每个CuTS案例的独特性质,提倡患者和医疗保健提供者之间的共同决策,确保干预措施符合特定的患者需求。随着研究的进展,诊断方面有希望的发展,外科技术,药物疗法为更有效地管理CuTS提供了希望,为改善症状缓解和增强神经功能铺平道路。
    Cubital tunnel syndrome (CuTS) is a neuropathic condition characterized by the compression or irritation of the ulnar nerve at the elbow, resulting in a wide spectrum of symptoms ranging from pain and numbness to muscle weakness and impaired hand function. This comprehensive review delves into the diverse landscape of CuTS treatment approaches, emphasizing the importance of early intervention. The review explores how these strategies aim to alleviate symptoms and enhance patient well-being by beginning with conservative measures encompassing rest, splinting, medications, physical therapy, and lifestyle adjustments. Non-surgical medical interventions, including nerve gliding exercises, ultrasound-guided nerve injections, and orthotic devices, are considered alternative therapies for symptom relief. Surgical interventions, such as decompression procedures and emerging techniques, are discussed in detail, highlighting their indications and expected outcomes. Throughout this review, the critical role of patient-centered care is underscored, emphasizing the need for tailored treatment plans that respect individual preferences and goals. Recognizing the unique nature of each CuTS case, shared decision-making between patients and healthcare providers is advocated, ensuring that interventions align with specific patient needs. As research advances, promising developments in diagnosis, surgical techniques, and drug therapies offer hope for more effective management of CuTS, paving the way for improved symptom relief and enhanced nerve function.
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