Clinical Efficacy Of Combination Therapy Research Articles

A retrospective study of combination therapy with glucocorticoids and pirfenidone for PD-1 inhibitor-related immune pneumonitis.

Immune checkpoint inhibitor pneumonitis (ICIP) is thought to be a self-limiting disease; however, an effective treatment option does not currently exist. This study aimed to determine the clinical efficacy of combination therapy with glucocorticoids and pirfenidone for ICIP related to programmed cell death protein-1 (PD-1) inhibitors. We conducted a retrospective analysis of 45 patients with advanced non-small cell lung cancer who developed ICIP following PD-1 inhibitor and albumin-bound paclitaxel or carboplatin treatment at our hospital. The PD-1 inhibitor was discontinued, and glucocorticoids were used alone or in combination with pirfenidone to treat ICIP. The relevant clinical data of these patients were collected and analyzed. Compared with the glucocorticoid alone group, the glucocorticoid-pirfenidone group showed significant improvement in forced vital capacity (FVC), carbon monoxide diffusing capacity [%], peripheral capillary oxygen saturation, and 6-minute walk distance (P < .05). There were benefits with respect to the St. George's Respiratory Questionnaire score and the recurrence rate of ICIP, but there was no significant difference between the 2 groups (P > .05). Adding pirfenidone to glucocorticoid treatment was shown to be safe and may be more beneficial than glucocorticoids alone for improving pulmonary interstitial lesions, reversing ICIP, and preventing its recurrence.

Combination of H1 and H2 Histamine Receptor Antagonists: Current Knowledge and Perspectives of a Classic Treatment Strategy.

Histamine receptor antagonists, which can bind to specific histamine receptors on target cells, exhibit substantial therapeutic efficacy in managing a variety of histamine-mediated disorders. Notably, histamine H1 and H2 receptor antagonists have been extensively investigated and universally acknowledged as recommended treatment agents for numerous allergic diseases and acid-related disorders, respectively. Historically, the combination of H1 and H2 receptor antagonists has been considered a classic treatment strategy, demonstrating relatively superior efficacy compared with single-drug therapies in the treatment of diverse histamine-mediated diseases. The latest emerging studies have additionally suggested the underlying roles of histamine and H1R and H2R in the development of anxiety disorders, arthritic diseases, and postexercise hypotension. Nevertheless, there is still a lack of systematic reviews on the clinical efficacy of combination therapy, greatly limiting our understanding of its clinical application. Here, we present a comprehensive overview of the current knowledge and perspectives regarding the combination of H1 and H2 histamine receptor antagonists in various histamine-mediated disorders. Furthermore, we critically analyze the adverse effects and limitations associated with combination therapy while suggesting potential solutions. Our review can offer a systematic summary and promising insights into the in-depth and effective application of the combination of H1 and H2 receptor antagonists.

Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study.

A rotator cuff tear is a prevalent ailment affecting the shoulder joint. The clinical efficacy of combined therapy remains uncertain for partial rotator cuff tears. In this study, we integrated extracorporeal shockwave therapy (ESWT) with platelet-rich plasma (PRP) injection, juxtaposed with PRP in isolation. Both cohorts exhibited significant improvements in visual analogue scale (VAS), Constant-Murley score (CMS), degrees of forward flexion, abduction, internal rotation, and external rotation, and the sum of range of motion (SROM) over the six-month assessment period. The application of ESWT in conjunction with PRP exhibited notable additional enhancements in both forward flexion (p = 0.033) and abduction (p = 0.015) after one month. Furthermore, a substantial augmentation in the range of shoulder motion (SROM) (p < 0.001) was observed after six months. We employed isobaric tag for relative and absolute quantitation (iTRAQ) to analyze the differential plasma protein expression in serum samples procured from the two groups after one month. The concentrations of S100A8 (p = 0.042) and S100A9 (p = 0.034), known to modulate local inflammation, were both lower in the ESWT + PRP cohort. These findings not only underscore the advantages of combined therapy but also illuminate the associated molecular changes.

Evaluating the One-Year Efficacy of Combined Anti-VEGF and Dexamethasone Implant Treatment for Macular Edema in Retinal Vein Occlusions.

BACKGROUND Retinal vein occlusion-induced macular edema (RVO-ME) is a significant global cause of vision loss, with the effectiveness of combined anti-vascular endothelial growth factor (anti-VEGF) drugs and dexamethasone implantation (DEX I) being a relevant, yet not thoroughly explored, area of interest.The aim of this study was to evaluate the 1-year clinical efficacy of combination therapy using anti-vascular endothelial growth factor (VEGF) drugs and dexamethasone implantation (DEX I) in the treatment of macular edema secondary to retinal vein occlusion (RVO-ME). MATERIAL AND METHODS This retrospective study analyzed data from 34 RVO-ME patients treated at the Inner Mongolia Chaoju Eye Hospital between January 2020 and December 2021. All patients underwent initial DEX I treatment, followed by the introduction of anti-VEGF drugs, and were observed for one year. Retinal structural and vascular changes were measured using spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). The study also evaluated shifts in best corrected visual acuity (BCVA) throughout the observation period. RESULTS Following the combined therapy, patients showed significant improvements in BCVA, intraocular pressure (IOP), central retinal thickness (CRT), and retinal vessel density (VD) (all P<0.05). Upon stratifying the results by RVO type, patients with branch retinal vein occlusion (BRVO)-ME displayed more significant BCVA improvement and CRT reduction at various post-treatment intervals compared to those with central retinal vein occlusion (CRVO)-ME (all P<0.05). CONCLUSIONS The combined use of anti-VEGF drugs and DEX I showed promising one-year efficacy in treating RVO-ME, with greater improvements noted in patients with BRVO-ME compared to those with CRVO-ME. Despite the positive results, close monitoring of IOP elevation, a notable side effect, remains crucial.

Clinical efficacy of combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs in the treatment of novel coronavirus pneumonia: A prospective interventional study

IntroductionThe National Administration of Traditional Chinese Medicine of the People’s Republic of China (NATCM) and the State Administration of Traditional Chinese medicine (TCM) advocated a combination therapy of TCM and anti-viral drugs for novel coronavirus pneumonia (NCP) to improve the efficacy of clinical treatment. MethodsForty-six patients diagnosed with NCP were sequentially divided into intent-to-treat population: the experimental group (combination of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs; n = 23) and the control group (anti-viral drugs only) (n = 23). The two groups were compared in terms of duration of fever, cough symptom score, fatigue, appetite, dyspnea, out-of-bed activities, chest computer tomography (CT) recovery, virological clearance, average length of hospital stay, and clinical effective rate of drug. After 6 days of observation, patients from the control group were divided into as-treated population: experimental subgroup (n = 14) to obtain clinical benefit and control subgroup (n = 9). ResultsThere was a significant improvement in the duration of fever (1.087 ± 0.288 vs 4.304 ± 2.490), cough (0.437 ± 0.589 vs 2.435 ± 0.662; P < 0.05), chest CT evaluation (82.6% vs 43.4%; P < 0.05), and virological clearance (60.8% vs 8.7%; P < 0.05) in patients of the experimental group compared with patients in the control group. Further observation in as-treated population reported that cough (0.742 ± 0.463 vs 1.862 ± 0.347; P < 0.05) and fatigue (78.5% vs 33.3%; P < 0.05) were significantly relieved after adding FuXi-Tiandi-Wuxing Decoction to the existing treatment. ConclusionAn early treatment with combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs significantly relieves the clinical symptoms of NCP, shows improvement in chest CT scan, improves virological clearance, shortens average length of hospital stay, and reduces the risk of severe illness. The effect of FuXi-Tiandi-Wuxing Decoction in NCP may be clinically important and require further consideration.

Combination Therapy With Diquafosol Sodium and Sodium Hyaluronate in Eyes With Dry Eye Disease After Small Incision Lenticule Extraction.

To evaluate the clinical efficacy of combination therapy with diquafosol sodium and sodium hyaluronate in dry eye patients after small incision lenticule extraction (SMILE). A prospective randomized controlled study was conducted on consecutive patients who were diagnosed with dry eye disease (DED) and ready to accept SMILE from January 2021 to December 2021. The participants were randomly allocated to either a combination with diquafosol sodium 3% and sodium hyaluronate 0.3% group (DQS group, n=40) or a sodium hyaluronate 0.3% group (HA group, n=41). Dry eye disease parameters included tear film break-up time (TBUT), Shirmer I test (SIT), corneal and conjunctival fluorescein staining score (FS score), and Ocular Surface Disease Index (OSDI); tests were conducted before surgery and at 1 week, 1 month, and 3 months after surgery. At 1 week after surgery, there were no statistically significant overall differences in DED parameters between the 2 groups. At postoperative month 1, the FS score was significantly lower in the DQS group than in the HA group (1.20±1.06 vs. 1.83±1.41 respectively, p=0.026). At 3 months after the surgery, the DQS group was significantly superior to the HA group in OSDI (12.98±7.29 vs. 16.82±8.25, p=0.029), TBUT (5.83±2.02 vs. 4.24±0.94, p=0.0002), and SIT (7.75±3.92 vs. 5.24±3.42, p=0.003). Our study showed that combination therapy with diquafosol and hyaluronate was beneficial for improving both signs and symptoms of dry eye patients after small incision lenticule extraction.

Clinical efficacy of combination therapy of arterial hypertension in patients with chronic glomerulonephritis with different blood pressure salt sensitivity

Arterial hypertension is the main factor in the progression of CKD of any etiology; therefore, effective antihypertensive therapy is a crucial task of healthcare practice. In this work, the authors aim to study the comparative effectiveness of various types of combined antihypertensive therapy in patients with different blood pressure salt sensitivity.

Clinical efficacy of combined therapy in children with stage 4 neuroblastoma

To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

Tolerability of memantine monotherapy versus adding memantine as combination therapy

IntroductionPrior studies have focused on the clinical efficacy of combination therapy, donepezil and memantine, for patient's diagnosed with Alzheimer's disease. As a result, it has become increasingly routine for providers to prescribe both medications for all-cause neurodegenerative disorders in variable stages of disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy. This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders. Materials & MethodsThe study is an IRB approved retrospective chart review that includes 175 patients diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84). Only side effects reported to and recorded by a neurocognitive subspecialist at Jefferson's Memory Disorder Center from 2016 to 2019 were included. Results & DiscussionThe odds of a patient reporting side effects on combination therapy in comparison with those patients on memantine monotherapy reporting side effects were significantly greater (OR = 4.33, CI 95% (1.62, 11.52), p = 0.003). In our patient sample, more than 80% of the patients reporting side effects qualified as polypharmacy or excessive polypharmacy (Table 2). As a result, variable polypharmacy (p = 0.047) was statistically significant in the in a binary logistic regression model for predicting outcomes for patients on combination therapy (Table 3). Therefore, as a patient progresses to moderate-severe stages of disease, we recommend switching CI monotherapy to memantine monotherapy as opposed to adding memantine as combination therapy for those patients on more than 10 other medications to increase tolerability. Given the limitations of a smaller sample size, variables such as severity of disease, renal and liver impairment as well as medication dosing were not significant predictors (Table 3) for those reporting side effects on combination therapy.

Combination Drug Therapy for the Management of Alzheimer's Disease.

Alzheimer’s disease (AD) is the leading cause of dementia worldwide. Even though the number of AD patients is rapidly growing, there is no effective treatment for this neurodegenerative disorder. At present, implementation of effective treatment approaches for AD is vital to meet clinical needs. In AD research, priorities concern the development of disease-modifying therapeutic agents to be used in the early phases of AD and the optimization of the symptomatic treatments predominantly dedicated to the more advanced AD stages. Until now, available therapeutic agents for AD treatment only provide symptomatic treatment. Since AD pathogenesis is multifactorial, use of a multimodal therapeutic intervention addressing several molecular targets of AD-related pathological processes seems to be the most practical approach to modify the course of AD progression. It has been demonstrated through numerous studies, that the clinical efficacy of combination therapy (CT) is higher than that of monotherapy. In case of AD, CT is more effective, mostly when started early, at slowing the rate of cognitive impairment. In this review, we have covered the major studies regarding CT to combat AD pathogenesis. Moreover, we have also highlighted the safety, tolerability, and efficacy of CT in the treatment of AD.

Influence of selenium yeast combined with levothyroxine sodium on outcomes in type 2 diabetes mellitus patients complicated with chronic lymphocytic thyroiditis

Objective To investigate the clinical efficacy of combination therapy of selenium yeast and levothyroxine sodium in the treatment of type 2 diabetes mellitus complicated with chronic lymphocytic thyroiditis(CLT). Methods A total of 96 patients with type 2 diabetes mellitus complicated with CLT who admitted to Wenling Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were randomly divided into control group and treatment group according to the digital table, with 48 patients in each group.On the basis of stable blood sugar control, the control group received routine treatment with levothyroxine sodium tablets.The treatment group was given selenium yeast on the basis of the control group.The blood glucose, thyroid, clinical efficacy within 3 months of treatment were recorded. Results The total effective rate of the study group was 95.83%(46/48), which was significantly higher than 68.75%(33/48) of the control group(χ2=12.080, P 0.05). Conclusion The clinical efficacy of selenium yeast and levothyroxine in the treatment of type 2 diabetes with CLT is significantly better than traditional treatment. Key words: Diabetes mellitus, type 2; Thyroiditis; Lymphocytes; Selenium compounds; Thyroxine; Blood glucose; C-Peptide

Dynamics of Activated CD8+ T-cells and Decreased Osteoclasts in the Tumor Microenvironment are Associated with Clinical Efficacy of Anti-PD-L1 and Anti-CD38 Combination Treatment in Relapsed or Refractory Multiple Myeloma

Dynamics of Activated CD8+ T-cells and Decreased Osteoclasts in the Tumor Microenvironment are Associated with Clinical Efficacy of Anti-PD-L1 and Anti-CD38 Combination Treatment in Relapsed or Refractory Multiple Myeloma

Efficiency of combined therapy of figuratum and parainfectious erythemas with the use of immunomodulators of different origins and MNRI

The aim of the study was to study the etiopathogenesis of erythema, comparative study of the clinical efficacy of combination therapy with the use of immunomodulators in erythema, the study of the dynamics of immunological parameters as a result of therapy.Materials and methods. The study included 215 adult patients with erythema. Before treatment and 1.5 months after therapy in patients have been studied: the expression of TLRs on MLPC and skin cells by flow cytometry with the use of the mat for TLR2, TLR3, TLR4, TLR5, TLR6, TLR7, TLR8, TLR9 (Caltag Laboratories, USA) using a flow cytometer FC-500 (Beckman Coulter, USA); the subpopulation composition of peripheral blood lymphocytes; the levels of pro-inflammatory and regulatory cytokines in the serum by the method of solid-phase ELISA using test systems company «Biosource» (Austria); the main classes of immunoglobulins (IgG, IgM, IgA) in serum.Results. It was shown that these pathogenetic and diagnostic significance of viruses of the family nerpesviri-dae, bacterial contamination by different types of microorganisms (Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus spp., Proteus vulgaris). A substance containing antigens of conditionally pathogenic microorganisms, and the use of neuro sensorimotor reflex integration (MNRI) contributed to the decline in the number and severity of recurrences of erythema, the extension of the range expressed Toll-like receptors; increase of lymphocytes with immunophenotype CD3+, CD4+, CD25+, CD95+; increase in IFN-y, decreased IL-4; largely reduced the level of total IgE than other types of therapy.Conclusion. The inclusion in therapy of patients with erythema, immunomodulator of bacterial origin and MNRI promotes increase of clinical efficiency and correlates with the correction of immunological disorders.

P056 DIFFERENCE IN CLINICAL EFFICACY AND SAFETY PROFILE IN CROHN’S DISEASE PATIENTS TREATED WITH INFLIXIMAB ACCORDING TO TIMING FOR ADDITION OF THIOPURINE

Although clinical efficacy of combination therapy with infliximab (IFX) and thiopurine has been demonstrated in Crohn’s disease (CD), it remains uncertain when to add thiopurine in CD patients treated with IFX. The present study aimed to clarify appropriate timing for the addition of thiopurine in CD patients treated with IFX. We performed a retrospective analysis of CD patients treated with IFX as the first-line biologic during the period between June 2002 and July 2018 at our institution. Patients were classified into early combination (EC) group and late combination (LC) group; EC group includes patients who were initiated thiopurine prior to IFX or simultaneously. LC group includes patients who were initiated IFX monotherapy or those who were added thiopurine after losing response to IFX. We then compared adherence rate of IFX between EC and LC groups using the Kaplan-Meier method and the log-rank test. We also compared adverse events (AEs) rates between the two groups. A total of 176 patients were included in the present study [64% men, median age, 23 (10-75) years], and the mean observation period was 72.5 months [range; 1-182 months]. 49 patients were classified into EC group and 127 patients were into LC group. The mean observation period and CRP level at the start of IFX were not significantly different between the two groups (69.9 months vs. 73.5 months; p=0.61, 1.13 mg/dl vs. 1.20 mg/dl; p=0.77). The mean period of taking thiopurine were significantly longer in EC group than LC group (58.8 months vs. 21.8 months; p<0.01). The cumulative IFX adherence rates showed no significant difference between the two groups (p = 0.46). 19 patients (38.7%) in the EC group and 28 patients (22%) in the LC group experienced AEs, and the rate was significantly higher in the EC group compared to LC group (p = 0.03). Serious AEs including pneumonia and pancreatitis requiring hospitalization were identified in 4 cases (8.2%) in the EC group, and 6 cases (4.7%) in the LC group, whereas the rate was not different between the two groups (p = 0.36). The addition of thiopurine after loss of response to IFX monotherapy might be an alternative to the early combination therapy in CD when considering safety profile during treatments, whereas more precise analysis with regard to disease control should be necessary.

P056 DIFFERENCE IN CLINICAL EFFICACY AND SAFETY PROFILE IN CROHN’S DISEASE PATIENTS TREATED WITH INFLIXIMAB ACCORDING TO TIMING FOR ADDITION OF THIOPURINE

Although clinical efficacy of combination therapy with infliximab (IFX) and thiopurine has been demonstrated in Crohn’s disease (CD), it remains uncertain when to add thiopurine in CD patients treated with IFX. The present study aimed to clarify appropriate timing for the addition of thiopurine in CD patients treated with IFX. We performed a retrospective analysis of CD patients treated with IFX as the first-line biologic during the period between June 2002 and July 2018 at our institution. Patients were classified into early combination (EC) group and late combination (LC) group; EC group includes patients who were initiated thiopurine prior to IFX or simultaneously. LC group includes patients who were initiated IFX monotherapy or those who were added thiopurine after losing response to IFX. We then compared adherence rate of IFX between EC and LC groups using the Kaplan-Meier method and the log-rank test. We also compared adverse events (AEs) rates between the two groups. A total of 176 patients were included in the present study [64% men, median age, 23 (10-75) years], and the mean observation period was 72.5 months [range; 1-182 months]. 49 patients were classified into EC group and 127 patients were into LC group. The mean observation period and CRP level at the start of IFX were not significantly different between the two groups (69.9 months vs. 73.5 months; p=0.61, 1.13 mg/dl vs. 1.20 mg/dl; p=0.77). The mean period of taking thiopurine were significantly longer in EC group than LC group (58.8 months vs. 21.8 months; p<0.01). The cumulative IFX adherence rates showed no significant difference between the two groups (p = 0.46). 19 patients (38.7%) in the EC group and 28 patients (22%) in the LC group experienced AEs, and the rate was significantly higher in the EC group compared to LC group (p = 0.03). Serious AEs including pneumonia and pancreatitis requiring hospitalization were identified in 4 cases (8.2%) in the EC group, and 6 cases (4.7%) in the LC group, whereas the rate was not different between the two groups (p = 0.36). The addition of thiopurine after loss of response to IFX monotherapy might be an alternative to the early combination therapy in CD when considering safety profile during treatments, whereas more precise analysis with regard to disease control should be necessary.

Effects of manual acupuncture combined with donepezil in a mouse model of Alzheimer's disease.

To explore whether combined therapy with donepezil and acupuncture is better than treatment with donepezil or acupuncture individually in a rat model of Alzheimer's disease. In this study, we randomly divided 40 7.5-month-old senescence-accelerated mouse prone 8 (SAMP8) male mice into four groups: SAMP8, SAMP8+D, SAMP8+MA and SAMP8+D+MA. An additional 10 7.5-month-old SAMR1 male mice were included as a healthy control group (SAMR1). Mice in the SAMP8+D group were given donepezil at a dose of 0.65 µg/g/day; mice in the SAMP8+MA group underwent manual acupuncture at GV20, GV26 and Yintang for 20 min per day; mice in the SAMP8+D+MA received both donepezil and manual acupuncture; and mice in the SAMR1 and SAMP8 groups underwent restraint only to control for the effects of handling. After the 15-day treatment, the Morris water maze test, micro-PET(positron-emission tomography), H&E (haematoxylin and eosin) staining, and immunohistochemistry were used to study the differences between donepezil (SAMP8+D), acupuncture (SAMP8+MA), and donepezil combined with acupuncture (SAMP8+D+MA) therapy for the treatment of Alzheimer's disease. We found that, compared with the untreated SAMP8 group, donepezil, manual acupuncture, and combined therapy with donepezil and manual acupuncture all improved spatial learning and memory ability, the level of glucose metabolism in the brain, and the content of Aβ amyloid in the cortex. Moreover, combined therapy outperformed treatment with donepezil or acupuncture individually in the SAMP8 mice. This study shows that the combination of manual acupuncture and donepezil in an Alzheimer's disease animal model is superior to acupuncture and donezepil alone. However, randomised controlled trials should be undertaken to clarify the clinical efficacy of combination therapy.

Clinical efficacy of combination therapy with Butylphthalide and fibrinolytic enzyme for acute cerebral infarction

Objective To evaluate the clinical efficacy of Butylphthalide combined with fibrinolytic enzyme in the treatment of acute cerebral infarction. Methods A total of 60 elderly patients with acute cerebral infarction who had missed the opportunity of thrombolytic therapy were enrolled in this study from January 2014 to December 2016 at Zhengzhou University Second Affiliated Hospital.Patients were randomly divided into an observation group(n=30)and a control group(n=30). Patients in the control group were treated with fibrinolytic enzyme alone, and those in the observation group received Butylphthalide combined with fibrinolytic enzyme.Peak flow velocity and mean flow velocity of the middle cerebral artery were analyzed and compared between the two groups before and after treatment.Data on clinical safety, efficacy, the national institutes of health stroke scale(NIHSS)and the Barthel score were also compared between the two groups. Results After treatment, the peak velocity 〔(74.60±4.31)cm/s vs.(69.19±3.36)cm/s〕 and average velocity 〔(38.71±2.29)cm/s vs.(34.01±2.01)cm/s〕 of the middle cerebral artery were significantly increased in the treatment group compared with those in the observation group(both P<0.05). Meanwhile, the clinical efficacy was significantly higher in the observation group(96.7% vs.73.3%, P<0.05). Moreover, NIHSS scores 〔(5.91±3.51)vs.(8.31±3.09)〕and Barthel scores 〔(71.29±3.81)vs.(53.60±4.33)〕 were significantly improved in the treatment group compared with those in the observation group(both P<0.05). In addition, there were no obvious adverse reactions during treatment in the two groups. Conclusions Butylphthalide combined with plasmin can safely and effectively improve cerebral hemodynamics and prognosis in patients with acute cerebral infarction. Key words: Brain infarction; Plasmin

The results of combined conservative treatment after photoselective laser vaporization of the prostate gland over her benign hyperplasia

The objective: to evaluate the clinical efficacy of combined therapy with Serenoa repens extract (Prostamol Uno) and selective α-adrenoblocker (Flosin) in patients with BPH stage II III after performing Photoselective Laser Vaporization of the Prostate (PLVP).Materials and methods. The patients were divided into four clinical groups. Patients in group 1 (n = 17) did not take medical treatment after FSLVP, follow up was established for them. Patients in the 2nd group (n = 28) received monotherapy with Prostamol Uno, which they took before bedtime 1 capsule daily for 3 years. Patients in 3rd group (n = 27) received Flosin in a dose of 0.4 mg, 1 capsule per day in the morning after eating for 3 years. Persons in the 4th group (n = 29) received combination therapy: Prostamol Uno 1 capsule per day before bedtime and Flosin in a dose of 0.4 mg, 1 capsule per day in the morning, after eating, for 3 years. The examination carried out in the period after 1 and 3 years.Results. As a result of the study, it was found that the best results were observed in patients who received combined conservative therapy with Serenoa repens extract and tamsulosin after PLVP.Conclusions. Rehabilitation in persons with BPH, who under went minimally invasive interventions PLVP require long term therapy with a combination of palm extract Sabal (Prostamol Uno) and selective α-blocker (Flosin). Combination therapy with Prostamol Uno and Floxin is pathogenetically highly effective and safe, which facilitates the rapid elimination of irritative and obstructive symptoms, with an improvement in the patient’s quality of life.

Rationale of combination therapy with antioxidants in medical management of Peyronie&amp;rsquo;s disease: results of clinical application

Peyronie’s disease (PD) is a connective tissue disorder involving the tunica albuginea of the corpora cavernosa of the penis. We have published several studies describing a “combined therapy” for PD patients, but the present study aims to clearly demonstrate how the association between various antioxidants in PD treatment can significantly increase the likelihood of therapeutic success. We used the following substances: silymarin, ginkgo biloba, vitamin E, bilberry, topical diclofenac sodium, and pentoxifylline (PTX). We analyzed the therapeutic impact and possible side effects of one or more antioxidants in patients with early-stage PD. To clearly prove that it is possible to achieve better results when combining more than one agent, we designed this study with five treatment groups, corresponding, respectively, to the administration of a single oral antioxidant; two oral antioxidants; three oral antioxidants; five oral antioxidants + local diclofenac; and five oral antioxidants + local diclofenac + PTX by perilesional injection. One hundred and twenty patients were assigned to five groups of treatment designed according to the abovementioned study aim. Outcomes after 6 months of treatment showed that combined antioxidant therapy is effective in treating PD. Statistical analysis showed significant differences between the treatment groups with regard to: improvement and disappearance of penile pain; percentage of reduction in the volume of penile plaque; reduction in penile curvature; recovery of erectile function in patients with erectile dysfunction; increase in the International Index of Erectile Function score; and reduction of psychosexual impact. Furthermore, we observed that the clinical efficacy of combined therapy is greater when topical use of diclofenac gel and perilesional injection of PTX are added to oral treatment with more than one antioxidant. Although several articles have already been published reporting the effectiveness of combined treatment in PD, this is the first study clearly proving how, as the number of substances used in treatment rises, a proportionally greater therapeutic effect is achieved.

Combination therapy versus pharmacotherapy, endoscopic variceal ligation, or the transjugular intrahepatic portosystemic shunt alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized controlled trials.

Patients with liver cirrhosis and variceal hemorrhage are at increased risk of rebleeding. We performed a meta-analysis toassess the clinical efficacy of combination therapy (pharmacotherapy and endoscopic variceal ligation (EVL)) compared with pharmacotherapy, EVL, or transjugular intrahepatic portosystemic shunt (TIPS) alone in the prevention of rebleeding and mortality. A literature search of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, up until November 2016, identified relevant randomized controlled trials. Data analysis was performed using Stata 12.0. Regarding overall mortality, combination therapy was as effective as EVL, pharmacotherapy, and TIPS (relative risk (RR) = 0.62, 95% confidence interval (CI): 0.36-1.08, RR=1.05, 95% CI: 0.68-1.63, and RR=1.39, 95% CI: 0.92-2.09, respectively). Combination therapy was as effective as EVL and pharmacotherapy alone in reducing blood-related mortality (RR=0.43, 95% CI: 0.15-1.25, and RR=0.42, 95% CI: 0.17-1.06), whereas TIPS was more effective than combination therapy (RR=5.66, 95% CI: 1.02-31.40). This was also the case for rebleeding; combination therapy was more effective than EVL and pharmacotherapy alone (RR=0.57, 95% CI: 0.41-0.79, and RR=0.65, 95% CI: 0.48-0.88), whereas TIPS was more effective than combination therapy (RR=9.42, 95% CI: 2.99-29.65). Finally, regarding rebleeding from esophageal varices, combination therapy was as effective as EVL alone (RR=0.59, 95% CI: 0.33-1.06) and was more effective than pharmacotherapy alone (RR=0.58, 95% CI: 0.40-0.85), although was less effective than TIPS (RR=2.20, 95% CI: 1.22-3.99). TIPS was recommended as the first choice of therapy in the secondary prevention of esophageal variceal bleeding.