Acupuncture Chon, Tony Y., MD; Lee, Mark C., MD
Mayo Clinic proceedings,
10/2013, Letnik:
88, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Abstract Worldwide, acupuncture is integral to everyday medical practice. In recent decades its practice has gained popularity in the United States. With increasing evidence of its clinical efficacy, ...acupuncture is now a widely practiced treatment modality in complementary and integrative medicine. According to the 2007 National Health Interview Survey, an estimated 3.1 million US adults and 150,000 children had acupuncture in the previous year. The National Health Interview Survey also estimated that between 2002 and 2007, acupuncture use among adults increased by approximately 1 million people. Patients want more information from their clinicians about the use of acupuncture and its safety and efficacy. Although many clinicians may recommend acupuncture, they often believe they are not sufficiently informed to discuss acupuncture with their patients. This article provides answers to the most frequently asked questions regarding acupuncture.
Purpose: Recent reports have shown that a portion of the liver can tolerate higher radiation doses, which can be further accomplished by the application of 3-dimensional conformal radiotherapy ...(3-DCRT). The purpose of this study was to investigate the efficacy and toxicity of 3-DCRT combined with transcatheter arterial chemoembolization (TACE) for HCC in the cirrhotic patients.
Methods and materials: From 1994 to 2000, 50 HCC patients with liver cirrhosis (LC) were included in this study. The degree of LC was Child A in 38 and Child B in 12. The UICC stages were II in 12, III in 16, and IVa in 22. The mean tumor size was 8.3±3.5 cm. Patients were treated with TACE and then followed by 3-DCRT within 7–14 days. 3-DCRT planning was used to define both the target and normal liver volumes. The total dose of radiation (mean 50.1±8.3 Gy) was determined by the fractional volume of normal liver receiving 50% of the isocenter dose.
Results: A partial response (PR) was observed in 33 patients (66%). A subsequent surgical resection was successful in three patients, showing complete necrosis in one and near total necrosis in two. Most common acute toxicity was alteration in liver function test (13 patients) and none of the patients showed an acute toxicity more than grade 3. Subacute and chronic toxicity involved radiation induced liver disease (RILD) (six patients) and gastrointestinal toxicity (seven patients; ulcer in five and hemorrhagic mucositis in two). The actuarial survival rate at 3 years was 43% from the commencement of radiotherapy.
Conclusions: Radiotherapy using 3-DCRT combined with TACE can achieve a substantial tumor response and survival rate for HCC in the cirrhotic patients.
We show that a mobile phone can serve as an accurate monitor for several physiological variables, based on its ability to record and analyze the varying color signals of a fingertip placed in contact ...with its optical sensor. We confirm the accuracy of measurements of breathing rate, cardiac R-R intervals, and blood oxygen saturation, by comparisons to standard methods for making such measurements (respiration belts, ECGs, and pulse-oximeters, respectively). Measurement of respiratory rate uses a previously reported algorithm developed for use with a pulse-oximeter, based on amplitude and frequency modulation sequences within the light signal. We note that this technology can also be used with recently developed algorithms for detection of atrial fibrillation or blood loss.
Spontaneous bacterial peritonitis (SBP) is a prototypical infectious disease of cirrhotic patients. It has been suggested that cirrhotic patients' response to infection is less effective because of ...differences in the inflammatory and immune reactions. This study aimed to investigate the expression of the inflammatory cytokines monocyte chemotactic protein-1 (MCP-1) and interleukin-10 (IL-10) in cirrhotic patients with SBP. The MCP1 and IL-10 levels in the sera and ascitic fluids of cirrhotic patients with (n = 40) or without SBP (n=17) were serially analyzed by ELISA. In the non-SBP group, the mean MCP-1 levels in sera and ascites were 53.0 +/- 45.8 pg/mL and 197.5 +/- 109.5 pg/mL, respectively, and the IL-10 levels were 10.9 +/- 9.5 pg/mL and 77.6 +/- 79.7 pg/mL, respectively. In the SBP group, the mean MCP-1 levels in serum and ascites before treatment were 164.7 +/- 126.4 pg/mL and 365.3 +/- 583.0 pg/mL, respectively, and the IL-10 levels were 31.4 +/- 44.1 pg/mL and 188.1 +/- 189.5 pg/mL, respectively. The sera MCP-1 and ascites IL-10 levels differed significantly between the two groups. In the SBP group, sera and ascitic MCP-1 and IL-10 levels fell during treatment. The low MCP-1 and IL-10 levels on the seventh day of treatment were found to have a statistically significant relationship to patient survival. MCP-1 and IL-10 levels in sera and ascites may be related to the clinical course of SBP.
Background/Aims
: Analysis of isolated hepatic stellate cells (HSCs) from the injured liver may provide direct information on HSC apoptosis. However, it has not been established whether apoptotic ...HSCs would be isolated using the usual density gradient centrifugation method. The aim of this study was to observe the serial pattern of proliferation and apoptosis in isolated HSCs in comparison with that of liver tissue sections in CCl
4 induced acute liver injury.
Methods
: Male Sprague–Dawley rats were treated with a single intraperitoneal injection of carbon tetrachloride (CCl
4) and were killed at various time points after the treatment.
Results
: HSC proliferation showed a maximal increase at 32 h after CCl
4 injection. Apoptosis of HSC, examined by quantitative analysis of annexin-V-fluorescein isothiocyanate (FITC
)staining, showed the maximal increase at 64 h. Apoptosis of HSC in liver tissue sections examined by counting desmin and Tdt-mediated-dUTP biotin nick end labeling (TUNEL) double staining cells, peaked at 64 h. The number of TUNEL positive HSCs in liver tissue sections correlated significantly with annexin-V-FITC binding of isolated HSC.
Conclusions
: Studying apoptosis using apoptotic HSCs isolated by a usual density gradient centrifugation method from injured tissue sections would be feasible since it correlated with in vivo apoptosis of HSC.
A huge nodular hepatocellular carcinoma located at the anterior superior portion of the left lobe in a patient with hepatocellular carcinoma was treated with transcatheter arterial chemoembolization ...through the left hepatic artery. Three months later, however, there was a re-elevation of the serum alpha-fetoprotein level and evidence of a marginal recurrence at the left side of the previously embolized tumor was noted on the postembolization computed tomographic scan. Although the hepatic artery was intact in the second hepatic arteriography, we found that the right internal mammary artery was feeding the recurred hepatocellular carcinoma. This internal mammary artery was successfully treated with Lipiodol-transcatheter arterial chemoembolization. However, an ischemic lesion occurred in the skin of the anterior chest and abdominal wall several days after internal mammary artery embolization. We report here a very rare case of ischemic skin lesion on the anterior chest and abdominal wall following transcatheter arterial chemoembolization of the right internal mammary artery. This internal mammary artery was embolized because it had developed a collateral tumor feeding vessel following the initial chemoembolization of a hepatocellular carcinoma.
Objectives
To examine the association between nutritional status and frailty in older adults.
Design
Cross-sectional study.
Setting
Community-dwelling older adults were recruited from 10 study sites ...in South Korea.
Participants
1473 volunteers aged 70–84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.
Measurements
Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried’s frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.
Results
Of the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio OR: 1.59, 95% confidence interval CI: 1.09–2.32) and frail (OR: 3.30, 95% CI: 1.96–5.54).
Conclusion
Poor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.
: Purpose: Rapid and accurate diagnosis of spontaneous bacterial peritonitis (SBP) is mandatory for timely treatment in cirrhotic patients. The purpose of this study was to assess the usefulness of ...two different reagent strips, the UriSCAN and the Multistix10SG, for the rapid bedside diagnosis of SBP.
Methods: A total of 75 paracenteses in 53 cirrhotic patients with ascites were performed. All ascitic fluid was analyzed with the two reagent strips, and compared with the manual cell count with differential and ascitic fluid culture. SBP was defined as an ascitic polymorphonuclear cell count ≥250/mm3.
Results: SBP was diagnosed in 18 of the 75 samples. If we considered the positive UriSCAN result of 2 or more, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were all 100%. When we considered the positive UriSCAN result of 3, the sensitivity, specificity, PPV, and NPV were 67%, 100%, 100%, and 89%, respectively. When we considered the positive Multistix10SG result of 3, the sensitivity, specificity, PPV, and NPV were 50%, 100%, 100%, and 87%, respectively.
Conclusion: Urine reagent strip might be useful for rapid and accurate diagnosis of SBP in cirrhotic patients with ascites.
To clarify the mechanisms and factors involved in the regulation of mouse IL-2Rβ gene expression, we isolated the 5′-flanking region of IL-2Rβ gene and investigated the promoter activity. Here we ...elucidated the positive regulatory regions, the most potent of which are located between −50 to −30
bp and −164 to −135
bp. These regions contain a potentially functional Ets and Egr-1-binding sites whose mutations abrogate promoter activity. Data from electrophoretic mobility shift assay indicate that Ets and Egr-1, but not Sp1, bind to the positive regulatory regions, −50 to −30
bp and −164 to −135
bp, respectively. Furthermore, recruitment of Ets and Egr-1 at endogenous IL-2Rβ promoter segments in an IL-2-dependent F7 cells was verified by the chromatin immunoprecipitation assay. This study for the first time delineates the molecular mechanisms underlying regulation of mouse IL-2Rβ gene transcription by Ets family proteins, partially with Egr-1, and thereby further elucidates the molecular basis of lymphocyte activation and differentiation.
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