Alternative Treatment Research Articles

Antibacterial activity of coriander seeds extract (Coriandrum sativum) against the growth of Streptococcus mutans

Background: Streptococcus mutans is the main cause of dental caries, previously known as part of the normal flora in the oral cavity which plays a role in the process of fermenting carbohydrates to produce acid, and causes tooth demineralization. Chemical-based medicinal products such as toothpaste and mouthwash. Continuous use of chemicals can cause side effects for users such as hypersensitivity, therefore an alternative treatment from natural ingredients such as coriander seeds which can inhibit bacterial growth is needed. Objective: This research aims to determine the lowest concentration of coriander seed extract in 0,75%, 1.5%, 3% inhibiting the growth of Streptococcus mutans. Methods: This study was conducted by soaking the test discs in coriander seed extract concentrations of 0.75%, 1.5% and 3%. each disc was inserted into the bacterial culture to be cultured, incubated and seen whether there was a clear zone or not. Result: Test results showed a clear zone at a concentration 1.5% with an average diameter of 1.5 mm, at concentration of 3% an average diameter of 3.7 mm and at concentration of 0.75% did not show clear zone. Conclusion: Based on the results of the study, the lowest concentration of coriander seed extract was obtained which was able to inhibit the growth of Streptococcus mutans bacteria, is at concentration of 1.5%, the diameter of the inhibition zone of coriander seed extract had weak antibacterial activity.

Investigating the Social Correlates Associated With Getting Help After a Suicide or Not: An Important Unexamined Bereavement Question

Seeking to provide more systematic information on treatment-seeking and those not seeking help after a suicide, we investigated demographic, experiential and grief problems related correlates among recently suicide bereaved adults, conducting an on-line survey of a sample of U.S. 1,132 adults who lost a loved one to suicide during the last six years. Focusing upon first-degree relative loss survivors ( n = 222) we hypothesized those not seeking help would be more likely to report conventional religiosity, greater social support and more use of alternative treatment modalities. Instead, we found those not seeking help were almost twice as likely to not attend religious services, compared to help seekers. Social support enhanced the bereaved individuals’ pursuit of treatments and those who did not obtain help appeared reluctant to getting non-traditional treatment support. Help seekers were more likely to experience post-traumatic growth and less likely to see suicide loss survivorship as stigmatizing.

A randomized phase II trial on the addition of dutasteride to combined androgen blockade therapy versus combined androgen blockade therapy alone in patients with advanced or metastatic salivary duct carcinoma – the DUCT study protocol

BackgroundSalivary duct carcinoma (SDC) is a rare and aggressive subtype of salivary gland cancer, frequently associated with incurable recurrences and distant metastases (R/M). Proliferation of SDC relies on androgen receptor (AR) signalling, prompting the use of combined androgen blockade (CAB, i.e., luteinizing hormone-releasing hormone agonist and/or AR antagonists) to R/M SDC patients. However, only a subset of patients benefits from such treatments. We have shown that response to CAB is associated with steroid 5α-reductase 1 (SRD5A1) mRNA expression. SRD5A1 catalyses the intracellular conversion of testosterone into the more potent AR-agonist dihydrotestosterone. This conversion can be inhibited by dutasteride, a potent SRD5A1-inhibitor, which is currently prescribed for benign prostatic hyperplasia. We hypothesize that repurposing dutasteride to target AR signalling in SDC could enhance therapeutic response and clinical outcome in SDC patients.MethodsThis prospective, open-label, randomized controlled phase II clinical trial, is designed to investigate whether dutasteride as an adjunct drug to CAB improves response rate and clinical outcome in patients with AR-positive R/M SDC. Patients are divided in two cohorts based on their prior systemic treatments. In cohort A, CAB-naïve patients (n = 74) will be randomly assigned to either a control arm (Arm 1) receiving CAB (goserelin 10.8 mg/3m and bicalutamide 50 mg/OD) or an experimental arm (Arm 2) where dutasteride (0.5 mg/OD) is added to the CAB regimen. In cohort B, patients with disease progression after adjuvant or first-line palliative CAB therapy (max. n = 24) will receive goserelin, bicalutamide, and dutasteride to assess whether the addition of dutasteride can overcome therapy resistance. The primary endpoints are the objective response rate and duration of response. Secondary endpoints are progression-free survival, overall survival, clinical benefit rate, quality of life, and safety. Translational research will be performed to explore molecular target expression differences and their correlation with clinical outcome.DiscussionThe DUCT study addresses an unmet medical need by investigating the repurposing of dutasteride to enhance treatment response and improve clinical outcome for patients with R/M SDC, especially those with limited alternative treatment options, such as HER2-negative cases. By repurposing a registered low-cost drug, this trial’s findings could be readily applied into clinical practice.Trial registrationClinicaltrials.gov Identifier: NCT05513365. Date of registration: August 24, 2022.Protocol versionCurrent protocol version 4.0, February 21, 2024.

Clinical efficacy of unilateral laminotomy for bilateral decompression in the treatment of adjacent segment disease after lumbar fusion.

To assess the clinical impact of unilateral laminotomy for bilateral decompression (ULBD) in managing patients with adjacent vertebrae following lumbar fusion. A retrospective analysis was conducted on 21 patients, with a mean age of 67.4 years, who underwent ULBD for adjacent vertebra disease at our department from January 2021 to November 2023. We reviewed demographic data, surgical techniques, imaging studies, and patient-reported outcomes. The study compared Visual Analog Scale (VAS) scores, Numeric Rating Scale (NRS) scores, Japanese Orthopaedic Association (JOA) scores, Short Form-36 (SF-36) scores, and imaging outcomes before surgery, immediately post-surgery, and at 1 month, 6 months, and 12 months post-surgery. Evaluation of 21 patients with adjacent segment disease (ASD) (13 males, 8 females; mean age 67.42 years) was performed with follow-ups at various intervals post-surgery. Postoperative VAS, NRS, JOA, and SF-36 scores showed significant improvements compared to preoperative scores. Immediately after surgery, there were significant improvements in NRS score (2.76 ± 0.70 vs. 3.71 ± 0.85, P < 0.05) and JOA score (15.38 ± 1.02 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. Similarly, at 12 months post-surgery, significant improvements were observed in NRS score (1.52 ± 0.51 vs. 3.71 ± 0.85, P < 0.05) and JOA score (25.0 ± 1.10 vs. 9.29 ± 1.01, P < 0.05) compared to preoperative scores. The clinical satisfaction rate was 95.0% among all patients, with postoperative imaging examinations revealing a significant decompression effect. No complications were reported among the surgical patients. This study suggests that endoscopic ULBD can be a safe and effective technique for managing symptomatic ASD, providing satisfactory clinical outcomes for patients with ASD. Endoscopic ULBD may serve as an alternative treatment option for ASD with lumbar stenosis.

Patients’ Experiences With Complementary and Alternative Treatments to Manage Chemotherapy Symptoms

This phenomenological study aims to explore the experiences of individuals undergoing chemotherapy, focusing on their symptoms and the use of complementary and alternative treatments to cope with these challenges. Thirteen individuals diagnosed with cancer in a city in the central region of Turkey were interviewed using a semi-structured, in-depth approach in this phenomenological study. The criterion sampling method was employed to select participants, and interviews continued until data saturation was achieved. Thematic analysis was applied to the audio-recorded and transcribed interviews. The study adhered to the COREQ checklist for reporting qualitative research. The data analysis revealed 2 main categories (effects of cancer and chemotherapy on individuals, the use of complementary and alternative treatments to cope with the symptoms of patients receiving chemotherapy) and 6 themes (psychological effects, social impacts, physical effects, social practices, psychological practices, and physical practices). The study demonstrated that individuals faced significant psychological, physical, and social challenges due to cancer, posing difficulties in coping. The symptoms had a substantial negative impact on individuals. The research identified the use of various alternative methods, such as yoga, the Mediterranean diet, and music therapy, as coping strategies. It is recommended that individuals undergoing chemotherapy explore complementary and alternative treatment methods to effectively manage symptoms.

Mobilization of Endogenous CD34+/CD133+ Endothelial Progenitor Cells by Enhanced External Counter Pulsation for Treatment of Refractory Angina.

Adult stem cell therapy via intramyocardial injection of autologous CD34+ stem cells has been shown to improve exercise capacity and reduce angina frequency and mortality in patients with refractory angina (RA). However, the cost of such therapy is a limitation to its adoption in clinical practice. Our goal was to determine whether the less costly, less invasive, and widely accessible, FDA-approved alternative treatment for RA patients, known as enhanced external counterpulsation (EECP), mobilizes endogenous CD34+ stem cells and whether such mobilization is associated with the clinical benefits seen with intramyocardial injection. We monitored changes in circulating levels of CD34+/CD133+ and CD34+/KDR+ cells in RA patients undergoing EECP therapy and in a comparator cohort of RA patients undergoing an exercise regimen known as cardiac rehabilitation. Changes in exercise capacity in both cohorts were monitored by measuring treadmill times (TT), double product (DP) scores, and Canadian Cardiovascular Society (CCS) angina scores between pre- and post-treatment treadmill stress tests. Circulating levels of CD34+/CD133+ cells increased in patients undergoing EECP and were significant (β = -2.38, p = 0.012) predictors of improved exercise capacity in these patients. CD34+/CD133+ cells isolated from RA patients could differentiate into endothelial cells, and their numbers increased during EECP therapy. Our results support the hypothesis that mobilized CD34+/CD133+ cells repair vascular damage and increase collateral circulation in RA patients. They further support clinical interventions that can mobilize adult CD34+ stem cells as therapy for patients with RA and other vascular diseases.

Active pharmaceutical contaminants in drinking water: myth or fact?

Global water availability has been affected by a variety of factors, including climate change, water pollution, urbanization, and population growth. These issues have been particularly acute in many parts of the world, where access to clean water remains a significant challenge. In this context, preserving existing water bodies is a critical priority. Numerous studies have demonstrated the inadequacy of conventional water treatment processes in removing active pharmaceutical ingredients (APIs) from the water. These pharmaceutical active compounds have been detected in treated wastewater, groundwater, and even drinking water sources. The presence of APIs in water resources poses a significant threat not only to aquatic organisms but also to human health. These emerging contaminants have the potential to disrupt endocrine systems, promote the development of antibiotic-resistant bacteria, and bioaccumulate in the food chain, ultimately leading to unacceptable risks to public health. The inability of current conventional treatment methods to effectively remove APIs from water has raised serious concerns about the safety and reliability of water supplies. This issue requires immediate attention and the development of more effective treatment technologies to safeguard the quality of water resources and protect both aquatic ecosystems and human health. Other treatment methods, such as nanotechnology, microalgal treatment, and reverse osmosis, are promising in addressing the issue of API contamination in water resources. These innovative approaches have demonstrated higher removal efficiencies for a wide range of APIs compared to conventional methods, such as activated sludge and chlorination, which have been found to be inadequate in the removal of these emerging contaminants. The potential of these alternative treatment technologies to serve as effective tertiary treatment. To address this critical challenge, governments and policymakers should prioritize investment in research and development to establish effective and scalable solutions for eliminating APIs from various water sources. This should include comprehensive studies to assess the performance, cost-effectiveness, and environmental sustainability of emerging treatment technologies. The emerging contaminants should be included in robust water quality monitoring programs (Aus der Beek et al. in Environ Toxicol Chem 2016;35(4):823-835), with strict regulatory limits enforced to protect public health and the environment. By doing so, the scientific community and regulatory authorities can work together to develop a multi-barrier approach to safeguarding the water resources and ensuring access to safe, clean water for all. This review explores the potential of alternative treatment technologies to serve as viable solutions in the fight against API contamination. Innovative approaches, including nanotechnology, microalgal treatment, and reverse osmosis, have demonstrated remarkable success in addressing this challenge, exhibiting higher removal efficiencies compared to traditional methods.

Septic tanks as a pathway for emerging contaminants to the aquatic environment–Need for alternative rural wastewater treatment?

Septic tanks (STs) as a decentralised approach to community wastewater treatment were investigated as a pathway for emerging contaminants (ECs) entering the aquatic environment. A broad range of ECs were examined in five community STs (population equivalents 217–475) and receiving rivers in Scotland over 12 months. All 68 studied ECs were detected at least once in ST influent or effluent at a broad concentration range from ng L−1 – μg L−1 which can surpass freshwater predicted no-effect concentrations. Pharmaceuticals with acute use, such as antibiotics and antifungals, had high monthly variability and concentrations can exceed those previously found in centralised wastewater treatment works. Differences between the STs demonstrate the impact of localised prescription and population behaviour on EC concentrations. The similarities in concentrations between influent and effluent, suggest limited or no removal of ECs in STs. Hence, dilution of the discharges is required to mitigate environmental risk. Although the contribution of ECs sorbed to suspended solids to the total EC concentration was generally small (<10%), higher contributions (>30%) were observed for fluoroquinolone antibiotics (ofloxacin and ciprofloxacin), antidepressants (fluoxetine), and antifungals (clotrimazole). A wide range of ECs were also detected in rivers upstream and downstream of the ST discharge points, and concentrations increased by up to 95% downstream. In general, risk quotients (RQs) in the rivers were low, indicating small risk for the environment. However, higher RQs (>1) were found for ibuprofen, diclofenac and ciprofloxacin in a few samples. Therefore, reducing their concentration by improving ST performance or through sustainable medicines use may be needed at low dilution locations to mitigate any risk.

Multifunctional gallium doped bioactive glasses: a targeted delivery for antineoplastic agents and tissue repair against osteosarcoma

Osteosarcoma (OS) is the mostly commonly occurring primary bone cancer. Despite comprehensive treatment programs including neoadjuvant chemotherapy and tumour resection, survival rates have not improved significantly since the 1970s. Survival rates are dramatically reduced for patients who suffer a local recurrence. Furthermore, primary bone cancer patients are at increased risk of bone fractures. Consequently, there is an urgent need for alternative treatment options. In this paper we report the development of novel gallium doped bioactive glass that selectively kill bone cancer cells whilst simultaneously stimulating new bone growth. Here we show, using a combination of 3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide, LIVE/DEAD assays and image analysis, that bioactive glasses containing gallium oxide are highly toxic and reduce both the proliferation and migration of bone cancer cells (Saos-2) in a dose dependant manner. Glasses containing 5 mol% gallium oxide reduced the viability of OS cells by 99% without being cytotoxic to the non-cancerous normal human osteoblasts (NHOst) control cells. Furthermore, Fourier transform infrared and energy-dispersive x-ray spectroscopy results confirmed the formation of an amorphous calcium phosphate/hydroxyapatite like layer on the surface of the bioactive glass particulates, after 7 d incubating in simulated body fluid, indicating the early stages of bone formation. These materials show significant potential for use in bone cancer applications as part of a multimodal treatment.

Unravelling the Antioxidant and Antimicrobial Effect of Tecoma Stans Extracts

Infectious diseases are a serious public health problem responsible for approximately 13.7 million deaths annually. The emergence of multidrug-resistant bacterial and fungi species highlights the urgent need to search for alternative treatment options. In this regard, medicinal plants traditionally used for the treatment of infections as well as associated symptoms constitute a starting point for the search of endogenous solutions. This study was designed to investigate the antimicrobial and antioxidant properties of Tecoma stans extracts. The extracts were prepared by maceration using hydroethanolic solution (30:70, v/v) solvent. Then the obtained extract was fractioned by liquid-liquid partitioning using different solvent with increase polarity (hexane, ethylacetate, n-butanol, and water). The qualitative composition was studied using colorimetric methods. Total phenolic and total flavonoids compounds were determine using Folin Cioclateu and Aluminium Chloride methods respectively. The antioxidant activity was performed targeting DPPH, ABTS scavenging and FRAP assays. The antimicrobial activity was done using microdilution coupled with resazurin based assay. The phytochemical study of T. stans hydroethanolic extract revealed the presence of tannins, flavonoids, polyphenols, cardiac glycosides, quinones and coumarins. metabolites. The quantity of polyphenols in T. stans hydroethanolic extract was 291,139 ± 3,164 - 882,918 ± 3,154 mgEQ/100 gMS while that of flavonoids was 3,965 ± 0,138 -303,266 ± 1,178 mgEQ/100 gMS. The T. stans hydroethanolic total extract displayed no antioxidant activity targeting DPPH and ABTS free radicals at the concentrations (SC50 &gt;500). But extracts and fractions showed a good reducing potential (SC50 ranging from 7.89 ± 0.61 tio 39.88 ± 1.10 µg/mg). Likewise, T. stans hydroethanolic extract exhibited antimicrobial activity with the MIC spanning from 1 mg/mL to 32 mg/mL toward Escherichia coli, Staphylococcus aureus, Streptococcus .........

Is Baricitinib Effective and Safe for Patients with Difficult-to-Treat Rheumatoid Arthritis? Comparative Data with the Rheumatoid Arthritis Group of Rheumatoid Arthritis Not Difficult to Treat

Objective: This study investigates the efficacy and safety of baricitinib, an oral targeted synthetic disease-modifying antirheumatic drugs (DMARDs), in patients with difficult-to-treat rheumatoid arthritis (D2T RA) compared to those without, aiming to determine its potential as an alternative treatment for D2T RA. Subject and Methods: A total of 78 patients participated in this retrospective cohort study, with 33 meeting the D2T RA criteria and 45 in the non-D2T RA group. Various clinical and laboratory parameters, adverse events, and disease activity indices were assessed, alongside drug efficacy and survival rates. Results: Patients with D2T RA exhibited higher seronegativity, prior use of b-DMARDs and c-DMARDs, and longer disease duration. Both groups experienced reductions in VAS and DAS28 scores, as well as SDAI, CDAI, HAQ, CRP, and ESR levels at baseline and 3, 6, and 12 months post-baricitinib initiation, with sustained efficacy observed over 12 months. The most prevalent adverse event was infection (28.21%). Although initial drug survival rates were similar between groups, the non-D2T RA group demonstrated higher rates at 24 months (46.70% vs. 59.40%). Subgroup analyses showed comparable survival rates between D2T RA and non-D2T RA groups, whether treated with baricitinib alone or in combination with methotrexate or leflunomide. Conclusion: Despite potential treatment resistance, patients meeting the D2T RA criteria shared similar safety and efficacy profiles with those non-D2T RA. Baricitinib emerges as a promising treatment option for D2T RA patients, offering effectiveness and safety comparable to the non-D2T RA group.

Methotrexate versus Ciclosporin in the Treatment of Severe Atopic Eczema in Children: An economic evaluation.

Ciclosporin (CyA) and methotrexate (MTX) are both frequently prescribed drugs for the treatment of atopic dermatitis (AD) in children and young people (CYP). CyA has historically been the most commonly used conventional systemic treatment for severe paediatric AD, but MTX is being increasingly used as an alternative first-line conventional systemic treatment, especially in middle- and low-income settings. We found that methotrexate provides an effective and low-cost first-line systemic treatment for severe AD and is a suitable alternative to ciclosporin.

Finite element analysis evaluation of hypothetical alternative treatment scenarios for neglected developmental dysplasia of the hip.

The study aimed to evaluate three different degrees of correction in the surgical treatment of neglected developmental dysplasia of the hip (DDH) using finite element models based on computed tomography. Three tridimensional FEA models of hypothetical post-operative (PO) outcomes were developed, based on three tridimensional CT of a pediatric patient diagnosed with luxated neglected DDH: One with the acetabular index of the contralateral hip (CLAT); another based on a theoretical Bombelli biomechanical model (BMB); and another recreating the patient's actual PO. The stresses in the affected hip were greater than those in the unaffected hip. CLAT showed the greatest stress and the smallest loading zone (LZ). In contrast, BMB showed the smallest stress and the biggest LZs. The approach based on the BMB gave the best results in terms of the distribution of the stresses over the hip, whereas the worst was CLAT. Qualitatively, estimating the stability and range of movement of the hip, the PO case was considered the best.

Gaps in knowledge and recurrent urinary tract infections in women.

The focus of this review is to present recent literature and gaps in knowledge (GIKs) surrounding the current and future treatment and prevention of uncomplicated recurrent urinary tract infections (rUTIs) in women. Recurrent urinary tract infections are common, significantly reduce quality of life, and create a substantial economic burden to the healthcare system. They are disproportionately affecting the postmenopausal women. Antibiotics, which are used for the treatment and prophylaxis of uncomplicated rUTI, have become problematic, as there is a global rise in allergy and resistance to these agents and their use is associated with further antimicrobial resistance. Thus, in recent decades, several alternative, nonantibiotic approaches have been evaluated. There is a critical need for a concerted and standardized methodology for diagnosing, treating, and monitoring women with rUTIs. Additionally, novel nonantibiotic alternative treatment and preventive measures for UTIs are desperately required to address the global issue of antibiotic recalcitrance in all age groups, and specifically older women. Research efforts have sought to develop alternative and more effective techniques; many of which appear to be promising, but require additional evaluation and validation through clinical trials.

In-situ CrFeCoNi medium entropy alloying coating via electrospark powder deposition

Medium or high-entropy alloys have led to widespread interest in their preparation, property control, and applications. The ability to apply these new alloys as coatings on conventional materials allows alternative surface treatment methods. This study used electrospark deposition with powder feedstock, to form MEA coating with fine-tuned compositions on steel substrate. Single-phase CrFeCoNi MEA using optimized ESD parameters and powder formulation. The phase and composition of MEA coatings and their hardness were also characterized. The coating showed two orders of magnitude reduction in specific wear rate coefficient compared with that of bare A516 steel substrate. This study demonstrates that the powder-based ESD technique can be used to create in-situ M/HEA coatings for applications requiring improved properties.

Therapeutic Advances in Psoriasis: From Biologics to Emerging Oral Small Molecules.

Psoriasis is a persistent, inflammatory condition affecting millions globally, marked by excessive keratinocyte proliferation, immune cell infiltration, and widespread inflammation. Over the years, therapeutic approaches have developed significantly, shifting from conventional topical treatments and phototherapy to more sophisticated systemic interventions such as biologics and, recently, oral small-molecule drugs. This review seeks to present a comprehensive investigation of the existing psoriasis treatment options, focusing on biologic agents, oral small molecules, and emerging treatments. Several categories of biologic treatments have received regulatory approval for psoriasis, including TNF-α, IL-17, IL-12/23, and IL-23 inhibitors. Biologics have revolutionized the treatment of psoriasis. These targeted therapies offer significant improvement in disease control and quality of life, with acceptable safety profiles. However, limitations such as cost, potential immunogenicity, and administration challenges have driven the exploration of alternative treatment modalities. Oral small molecules, particularly inhibitors of Janus kinase (JAK), have emerged as options due to their convenience and efficacy. These agents represent a paradigm shift in the management of the condition, offering oral administration and targeted action on specific signaling pathways. In addition to existing therapies, the review explores emerging treatments that hold promise for the future of psoriasis care. These include innovative small-molecule inhibitors. Early-stage clinical trials suggest these agents may enhance outcomes for psoriasis patients. In conclusion, the therapeutic landscape of psoriasis is rapidly evolving, emphasizing targeted, patient-centered treatments. Ongoing research and development are expected to lead to more personalized and effective management strategies for this complex condition.

Alternative treatment methods for bovine mastitis: prospects and limitations (review)

Mastitis remains the most common problem of dairy industry despite the preventive measures and treatment schemes being developed. Antibacterial drugs remain first line agents for therapy of the mammary gland inflammatory diseases in animals. Taking into account the risks associated with antibiotic therapy, such as decreased drug effectiveness due to occurrence of bacterial resistant strains, food safety issues, environmental impact and restrictions on the use of antibacterial drugs in veterinary medicine, an increasing number of scientific studies are addressing new therapeutic agents that can serve as an alternative to conventional therapy. The aim of this review is to give an idea of currently available literature data on alternative methods for the prevention and treatment of mastitis in cattle that are not associated with antibiotics. In general, a significant number of in vitro studies aimed at finding new effective and safe drugs are yielding promising results. This review describes the following alternative remedies: probiotics, bacteriocins, bacteriophages, phage enzymes (endolysins), nanoparticles, plant extracts, essential oils and immunobiological agents (vaccines). Understanding the mechanisms of their action will allow recommending the best treatment option for mastitis in each specific case. These treatment methods can potentially reduce use of antibiotics and increase animal productivity, however more in vivo studies are needed to prove the effectiveness of antibiotics used directly in the conditions of farm settings.

A novel approach to hallucal sesamoid pathology utilizing a 3D printed patient specific total sesamoid replacement implant: Case series

BackgroundSesamoidectomy can be associated with multiple complications secondary to loss of the intrinsic function of the excised sesamoid. We sought to mitigate these complications by preserving sesamoid function with a total sesamoid replacement (TSR) in lieu of sesamoidectomy. MethodPatient specific 3D printed TSR implants were designed and implanted for three patients who had exhaustively failed conservative measures. Follow up ranges from 7-36 months during which we evaluated for complications, symptom resolution, and patient satisfaction. ResultAll patients had complete resolution of pain between 3.5-12 months postop and have remained satisfied with their outcome. No evidence of the aforementioned complications was observed. ConclusionTSR may represent a viable alternative treatment option for most cases in which sesamoidectomy would otherwise be considered. Level of evidenceIV, case series.

The Potential of Emerging Medicinal Plants and their Phytoconstituents in Treating Alzheimer's Disease

Backgrounds: Alzheimer's disease (AD) impacts a total of 30 million individuals worldwide, resulting in the impairment of brain cells. Despite the approval of medications, there are still poor results and adverse effects that continue to exist, which has led to continued research for more effective treatments. Objectives: We prioritize the study of medicinal plants and their bioactive chemicals to attract researchers and pharmaceutical companies interested in producing powerful herbal medicines and semi-synthetic drugs for the treatment of Alzheimer's disease, although minimizing any potential adverse effects. Methods: This review investigate the effective use of medicinal plants and their phytochemicals in the treatment of AD to manage its growth and relieve symptoms via improving cognitive deficits. Result: These medicinal plants and their phytochemicals contribute to the treatment of AD by protecting against cell damage induced by beta amyloid, improving memory and learning abilities, functioning as nerve tonics, and exhibiting strong antioxidant and anti-inflammatory activities. Furthermore, they have demonstrated therapeutic benefits in the management of AD. The finding suggests that several phytoconstituents/ plant metabolites are present in numerous anti-Alzheimer's plants known for their anti-Alzheimer's properties such as rosmarinic acid, quercetin, kaempferol, gallic acid, β-sitosterol, oleic acid and linalool. In addition, this article emphasizes the anti- Alzheimer's disease significance of various important phytochemicals. Conclusions: The review proposes that medicinal plants and their bioactive phytochemicals hold potential as a viable alternative treatment for AD. The utilization of these medicinal plants can improve memory and decrease the likelihood of developing Alzheimer's disease in the future.

Single-branched stent-graft with on-table fenestration for the management of zone 2 landing TEVAR with an isolated left vertebral artery: a pilot study

BackgroundIt is challenging to simultaneously conduct total endovascular repair and reconstruct the left subclavian artery (LSA) and isolated left vertebral artery (ILVA) in patients who had an ILVA and required zone 2 anchoring. This pilot study reported the initial application experience of thoracic endovascular aortic repair (TEVAR) with a proximal zone 2 landing for aortic arch reconstruction in patients with ILVA.MethodsThis study was a retrospective consecutive single-center case series analysis, which involved four patients with ILVA who required zone 2 anchoring and received TEVAR combined with a single-branched stent graft and concomitant on-table fenestration between March 2021 and December 2022.ResultsThe postoperative follow-up period was 6–27 months, and no postoperative deaths or other primary complications occurred. There were no signs of a stroke or spinal cord ischemia, as well as no chest or back pain. The postoperative computed tomography angiography showed unobstructed ILVA and LSA, no stent stenosis and displacement, and no signs of endoleak.ConclusionThe outcome suggested that this technique might be a feasible, safe, and alternative treatment for such patients. Further studies with larger samples and longer follow-up periods are needed to confirm our findings.