Clinical Observations Research Articles

Pharmacological Basis of Differences in Dose Response, Dose Equivalence, and Duration of Action of Inhaled Corticosteroids.

Asthma treatment guidelines classify inhaled corticosteroid (ICS) regimens as low, medium, or high dose. However, efficacy and safety are not independently assessed accordingly. Moreover, differences in ICS duration of action are not considered when a dose regimen is selected. We investigated the efficacy and safety implications of these limitations for available ICS molecules. Published pharmacodynamic and pharmacokinetic parameters were used, alongside physiological and pharmacological principles, to estimate the efficacy and safety of available ICS molecules. Extent and duration of glucocorticoid receptor (GR) occupancy in the lung (efficacy) and cortisol suppression (systemic exposure and safety) were estimated. Some ICS regimens (e.g., fluticasone furoate, fluticasone propionate, and ciclesonide) rank high for efficacy but low for systemic exposure, contrary to how ICS dose equivalence is currently viewed. Differences in dose-response relationships for efficacy and systemic exposure were unique for each ICS regimen and reflected in their therapeutic indices. Notably, even low doses of most ICSs can generate high GR occupancy (≥ 90%) across the entire dose interval at steady state, which may explain previously reported difficulties in obtaining dose responses within the clinical dose range and observations that most clinical benefit typically occurs at low doses. The estimated post dose duration of lung GR occupancy for ICS molecules was categorized as 4-6h (short), 14-16h (medium), 25-40h (long), or > 80h (ultra-long), suggesting potentially large differences in anti-inflammatory duration of action. In a real-world clinical setting where there may be poor adherence to prescribed therapy, our findings suggest a significant therapeutic advantage for longer-acting ICS molecules in patients with asthma.

Folate induces stemness and increases oxygen consumption under glucose deprivation by notch-1 pathway activation in colorectal cancer cell.

Evidence for folate's protective effects on neural tube defects led the USA and Chile to start mandatory folic acid (FA) fortification programs, decreasing up to 50%. However, ∼30% of the population consuming fortified foods reach supraphysiologic serum levels. Although controversial, several epidemiological and clinical observations suggest that folate increases cancer risk, giving concern about the risks of FA supplementation. The Cancer stem cells (CSCs) model has been used to explain survival to anticancer therapies. The Notch-1 pathway plays a role in several cancers and is associated with the stemness process. Different studies show that modulation of metabolic pathways regulates stemness capacity in cancer. Supraphysiologic concentrations of FA increase the proliferation of HT-29 cells by Notch-1 activation. However, whether folate can induce a stemness-like phenotype in cancer is not known. We hypothesized that FA protects from glucose deprivation-induced cell death through Notch-1 activation. HT-29 cells were challenged with glucose deprivation at basal (20 nM) and supraphysiological (400 nM) FA and 5-MTHF concentrations. We analyzed changes in stemness-like gene expression, cell death and different energetic metabolic functions. Supraphysiological concentrations of FA increased stemness-like genes, and improved survival and oxygen consumption, inducing AMPK phosphorylation and HSP-70 protein expression. We evaluated the Notch-1 pathway using the DAPT and siRNA as inhibitors, decreasing the stemness-like gene expression and preventing the FA protection against glucose deprivation-induced cell death. Moreover, they decreased oxygen consumption and AMPK phosphorylation. These results suggest that FA protects against glucose deprivation. These effects were associated with AMPK activation, a critical metabolic mediator in nutrient consumption and availability that activates the Notch-1 pathway.

Long-term results of treatment of a patient with basilar invagination complicated by distal kyphosis and compressive ischemic cervical myelopathy: a clinical case and a brief literature review

Objective. To present a clinical case of surgical correction of a craniovertebral anomaly complicated after 8 years by distal junctional kyphosis, stenosis, antelisthesis of the C5 vertebra and compressive ischemic cervical myelopathy in the C5–C6 segment.Material and Methods. When treating a 56-year-old patient with multiple anomalies of the craniovertebral region, differentiated surgical technologies were consistently used due to the development of late complications. The sequence and rationale for surgical decision making is described.Results. Initially, the patient underwent transoral decompression and posterior occipitocervical fixation, and after 8 years - reinstallation of the system with distal extension of the instrumentation zone to the C7 vertebra with indirect posterior decompression of the spinal cord, anterior discectomy with direct decompression and cage fixation at the C5–C6 level. Regression of myelopathic syndrome, correction of orthopedic status and significant improvement in functional status were achieved.Conclusion. A rare clinical observation demonstrates a combination of basilar invagination with assimilation of the atlas, which has provided rationale for two-stage surgical treatment in one surgical session (1st stage – transoral resection of the dens and 2/3 of the C2 vertebral body with anterior decompression of the spinal cord, and 2nd stage – occipitocervical fixation). The use of extended systems in this case caused the development of a clinically significant syndrome of the distal adjacent level, which required repeated surgical treatment after 8 years.

Clinical observation of extraction-site incisional hernia after laparoscopic colorectal surgery.

Laparoscopic colorectal cancer surgery increases the risk of incisional hernia (IH) at the tumor extraction site. To investigate the incidence of IH at extraction sites following laparoscopic colorectal cancer surgery and identify the risk factors for IH incidence. This study retrospectively analyzed the data of 1614 patients who underwent laparoscopic radical colorectal cancer surgery with tumor extraction through the abdominal wall at our center between January 2017 and December 2022. Differences in the incidence of postoperative IH at different extraction sites and the risk factors for IH incidence were investigated. Among the 1614 patients who underwent laparoscopic radical colorectal cancer surgery, 303 (18.8%), 923 (57.2%), 171 (10.6%), and 217 (13.4%) tumors were extracted through supraumbilical midline, infraumbilical midline, umbilical, and off-midline incisions. Of these, 52 patients developed IH in the abdominal wall, with an incidence of 3.2%. The incidence of postoperative IH was significantly higher in the off-midline incision group (8.8%) than in the middle incision groups [the supraumbilical midline (2.6%), infraumbilical midline (2.2%), and umbilical incision (2.9%) groups] (χ2 = 24.985; P < 0.05). Univariate analysis showed that IH occurrence was associated with age, obesity, sex, chronic cough, incision infection, and combined diabetes, anemia, and hypoproteinemia (P < 0.05). Similarly, multivariate analysis showed that off-midline incision, age, sex (female), obesity, incision infection, combined chronic cough, and hypoproteinemia were independent risk factors for IH at the site of laparoscopic colorectal cancer surgery (P < 0.05). The incidence of postoperative IH differs between extraction sites for laparoscopic colorectal cancer surgery. The infraumbilical midline incision is associated with a lower hernia rate and is thus a suitable tumor extraction site.

Secondary Cardiovascular Disease Prevention Deficit Persists over the Years: A Multicenter Cross-Sectional Study Involving 1003 Consecutive Patients from Greece

Purpose: Lipid lowering treatments (LLTs) can reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Despite the availability of potent LLTs, our clinical observations suggest an inadequate use of such agents. To evaluate this treatment deficit, we designed the present study. Methods: We reviewed the charts of all patients with a history of ASCVD (coronary artery disease—CAD; carotid stenosis—CS; or peripheral artery disease—PAD) diagnosed prior to their first visit to one of our clinics. We recorded their gender, age, ASCVD risk factors (diabetes, hypertension, tobacco use, body mass index), lipid values during that visit and the LLT used. We estimated the rates of the attainment of guideline-specific lipid goals by year, and assessed factors influencing the likelihood of treatment success. Results: Overall, n = 1003 subjects were recruited: CAD n = 703 (70.1%), PAD n = 168 (16.8%), CS n = 325 (32.4%); age 64.7 ± 11.2 years; n = 376 (37.5%) females; n = 642 (64.0%) had diabetes; n = 740 (73.8%) had hypertension; n = 299 (29.8%) were former and n = 367 (36.6%) were current smokers. An appropriate LLT was used in 361 (36.0%) subjects, n = 159 (15.9%) were on no treatment, n = 483 (48.2%) were receiving inadequate therapy, n = 434 (43.3%) were on a high-intensity LLT and n = 361 (36.0%) had achieved the year-specific LDL goals. Success rates ranged from 5.7% to 81.5%, with the lowest being 2020–2023 (5.7–14.5%), p &lt; 0.001. The use of a combination of LLTs and PCSK9 inhibitors led to higher rates of LDL-C goals achievement (p &lt; 0.001). Discussion: Recent secondary ASCVD risk prevention guidelines’ goals are rarely achieved in daily clinical practice, producing a major treatment deficit in this population. Newer systematic interventions are needed to curb this public health issue.

Neurofibromatoses: pathomorphological and clinical polymorphism, efficacy of targeted therapy

Neurofibromatoses are a group of inherited monogenic diseases with variable expression, characterized by the development of multiple tumors in tissues of neuroectodermal origin. Despite the similarity of phenotypic manifestations, each form differs in the spectrum of clinical manifestations, onset age of the first symptoms, severity of course, and approaches to treatment, the results of which are reflected in the prognosis and patients’ quality of life. The article analyzes the data from domestic and foreign studies on various forms of neurofibromatosis. The diagnostic criteria, pathogenesis, molecular considerations, and clinical manifestations, as well as treatment, including the example of 2 own clinical observations are discussed in this article.

Expert opinion on the clinical use of a combination of antihistamines with leukotriene receptor antagonists in the management of allergic rhinitis in Indian settings

Background: Various clinical studies have reported that the combination of montelukast and levocetirizine was effective in alleviating residual symptoms and the improvement of quality of life associated with allergic rhinitis. However, there was a dearth of data regarding the prescription practice among clinical practitioners. So, this study aims to gather clinicians' opinion regarding the use of antihistamines, with a special focus on the combined use of antihistamines with leukotriene receptor antagonists for the management of AR in Indian settings. Methods: The multiple-response questionnaire-based survey involving 19 questions gathered information on current recommendations, clinical observations, clinical experience of specialists in AR management, and the use of montelukast with levocetirizine in routine settings. Results: Out of 388 participants, approximately 84% of respondents preferred a combination of antihistamines and leukotriene receptor antagonists for managing AR. Additionally, 36% stated that 26 to 50% of patients presenting to routine practice may require montelukast and antihistamine combination as treatment. Around 61% endorsed the combination of antihistamines with leukotriene receptor antagonists as the preferred AR treatment strategy. In long-term AR management, 65% of clinicians rated montelukast with levocetirizine as excellent, and 78% of respondents reported montelukast confers additive benefits when combined with antihistamines. Conclusions: The significant preference for the combined use of antihistamines and leukotriene receptor antagonists underscores their perceived efficacy in AR treatment. The combination of antihistamines with leukotriene receptor antagonists emerges as the favored strategy for managing AR.

The Effect of the Pituitary Gland on the Hormone Prolactin and Its Relationship to Menstrual Irregularity According to Obesity

Background; Thyroid dysfunction has a substantial effect on the functioning of menstruation and the fertility of women. Hypothyroidism often coincides with increased prolactin levels, which worsens the disease. Research objectives; A cross-sectional study was undertaken in the infertility outpatient department of the University Teaching Hospital in Iraq, specifically examining the medical records of women who had undergone infertility evaluations. The study examined pertinent historical information, clinical observations, and findings from several investigations, such as thyroid function testing and blood prolactin level assessment. Descriptive and inferential statistical techniques were used to ascertain the prevalence and associations between predictors and outcome variables. Aim of the study; The objective of this study was to evaluate the prevalence of thyroid diseases among infertile women who are seeking treatment at the outpatient department of University Teaching Hospital in Iraq. Furthermore, it sought to examine the correlation between hypothyroidism and hyperprolactinemia with obesity, a subject that has not been thoroughly studied in our population. Novelty; Out of the 200 participants, the largest group, comprising 90 individuals (42%), were categorized as obese. The mean body mass index (BMI) of the subjects was 24 ± 4 kg/m2. The prevalence of thyroid disorder was 18%, with hypothyroidism representing 13% and hyperthyroidism representing 4%. No significant correlation was observed between BMI and hyperprolactinemia in people diagnosed with thyroid illness. Furthermore, no noteworthy correlation was found between BMI and hyperprolactinemia as an isolated condition. Nevertheless, a notable direct association was observed between thyroid stimulating hormone (TSH) and prolactin levels. Thyroid abnormalities and hyperprolactinemia are common in women who have difficulty getting pregnant. Therefore, it is advisable to regularly screen for these problems during the initial evaluation of infertility. While there was no notable association between BMI and thyroid illness and hyperprolactinemia, it is important to acknowledge the potential influence of weight gain on infertility, especially given that the majority of participants in the research were obese.

Ophthalmological complications of the new coronavirus infection COVID-19. Clinical cases

The outcomes and complications of the coronavirus infection are of interest to specialists in many fields of medicine, including ophthalmologists.Purpose: to analyze the clinical features of ophthalmic complications in patients with coronavirus infection COVID-19.Materials and methods. Four patients aged 37 to 70 years with ophthalmic inflammatory complications with coronavirus infection were examined and treated.Results. In 2 cases, eye damage was observed in the acute phase of COVID infection. It included deep keratitis, iridocyclitis, and exacerbation of rhinosinusitis complicated by osteomyelitis, orbital phlegmon with loss of vision. In the remaining 2 cases, in the post-COVID period (2 and 5 months after the disease, respectively), acute dacryoadenitis with the dry eye syndrome and subacute episcleritis was observed. In addition to anti-COVID therapy, all patients underwent specific ophthalmic therapy, which in 1 case included surgical intervention.Conclusion. The cases presented demonstrate eye damage against the background of coronavirus infection with the involvement of various eye structures into the inflammatory process. The ophthalmological manifestations were severe, with complications in the acute phase of COVID and in the early post-COVID period. Clinical observations indicate the need for additional specific therapy of coronavirus infection complications, along with the basic anti-COVID treatment.

Interdisciplinary approach to diagnosis of life-threatening form of albinism: Germanic-Pudlac syndrome case type 1

The Hermansky-Pudlak syndrome (OMIM#203300) is a hereditary genetically heterogeneous disease with an autosomal recessive type of inheritance. There are 11 clinical-genetic subtypes with similar clinical manifestations, but some type may difference with each other clinically. The most common is type 1 Hermansky-Pudlak syndrome. Purpose: Describe the features of the clinical picture and diagnosis of Hermansky-Pudlak syndrome type 1. Materials and methods: complex clinic-instrumental and molecular-genetic results from 2 patients from one family with incoming diagnosis of albinism are used. Result: An interdisciplinary approach to the diagnosis of albinism and a step-by-step molecular-genetic study help to verify the clinical-genetic diagnosis in a family. The clinical case demonstrated clinical polymorphism within one family. Two patients have similar dermatological and ophthalmological clinical picture, but have difference in bronchopulmonary system and the blood system. Probang-female has a history of prolonged repeated bleeding, coagulogram changes, obstructive bronchitis, albino phenotype and eyes failure. Her brother has a similar albino phenotype and eyes failure. The pathogenic variant NM_000195.5: c.1189del was revealed in a homozygous state in 13 exon of the HPS1 gene and Hermansky-Pudlak syndrome type 1 was confirmed by molecular analysis. Conclusion: On the example of this clinical observation of a family with Hermansky-Pudlak syndrome 1 type features of differential diagnosis of albinic states are shown, it is noted that complex examination of patients is necessary, molecular-diagnostics genetic analysis and constant follow up of a hematologist, ophthalmologist, pulmonologist, allergologist, dermatologist, gastroenterologist, geneticist and pediatrician.

Protein-Losing Enteropathy after Fontan Operation: A Clinical Case Description

The clinical observation of a boy with protein-losing enteropathy after the Fontan operation is presented. The boy, S.M., 2 years old, was admitted with complaints of abdominal pain, bloating, enlarged abdomen, frequent watery stools, and peripheral edema in the arms and legs. The child was diagnosed with a congenital heart defect at birth, for which Fontan surgery was performed. One month later, diarrhea and swelling appeared on the face, arms, and legs. Edema was temporarily relieved by symptomatic therapy. At the age of 2, the child was hospitalized in the gastroenterology department of our center. Examinations revealed low levels of total protein and albumin, and an increase in alpha-1 antitrypsin values. The diagnosis of protein-losing enteropathy after the Fontan operation was established. The child was prescribed a diet enriched with medium-chain triglycerides, spironolactone, and prednisolone. After 6 months of follow-up, no edema was observed, and the child’s overall condition was satisfactory. However, over the past year until the present, the boy has experienced slight swelling in the arms, legs, and face, requiring periodic albumin transfusions. Fontan operation and protein-losing enteropathy represent different aspects of medicine; however, sometimes one diagnosis becomes a consequence of another. As a collective of authors, we conducted the research, processed the data, obtained results, and we believe that we are correct. We affirm that the responsibility for the results and activity in writing the material remains with the authors.

The use of raman-fluorescent medical technologies to assess the effect of physical and chemical factors on the mineralization of hard tooth tissues in normal and noncarious lesions

BACKGROUND: Assessment of the rapid state of mineralization of hard tooth tissues in normal and in various carious and noncarious lesions based on objective in situ methods is an unsolved and urgent issue in dental science and practice.&#x0D; AIM: To substantiate the need for the clinical application in situ of express digital raman-fluorescent technology to increase the objectivity and effectiveness of assessing the degree of mineralization of hard tooth tissues in carious (initial form) and noncarious (wedge-shaped defect, pathological erasability) lesions under the influence of various physical and chemical factors on tissues.&#x0D; MATERIALS AND METHODS: A survey of 80 patients aged 25–50 years was conducted; the patients were divided into three groups: comparison and with carious and with noncarious (wedge-shaped defect, pathological erasability) lesions of hard dental tissues. In each group, changes in hygienic conditions and mineralization parameters of hard tooth tissues were assessed by the difference in the spectral intensity of raman-fluorescent measurements before and after controlled and/or uncontrolled hygienic treatment. Previously, under experimental conditions, the effects of various physical (mechanical processing, X-ray irradiation on the LNK-268 installation) and chemical (citric acid, hydroxylapatite (GAP) dry and moistened) factors on the hard tissues of the tooth were studied. Simultaneously, “locally” in real time, the mineralization parameters of the hard tissues of the tooth were recorded before and after hygienic treatment. In this study, we used an installation of the “InSpectrM” type in our modification.&#x0D; RESULTS: Experimental studies have shown the effectiveness and objectivity of the use of raman-fluorescence diagnostics to assess the hygienic condition and mineralization of hard dental tissues. The objectivity of the assessment of mineralization in a moistened state was investigated (dry GAP, 702 rel. units; wet GAP, 1520 rel. units), and the absence of the effect of radiation on the mineralization of hard tissues of the teeth (p 0.95) was revealed.&#x0D; Clinical observations showed that in patients with a wedge-shaped defect and increased erasability of hard tooth tissues, the hygienic condition is 5–10% worse than that in patients with intact tooth tissues and initial formation of caries. The main difference in the condition of hard tissues of teeth with noncarious lesions is a statistically significantly reduced (p 0.95) mineralization of hard tissues of the tooth, requiring remineralizing therapy immediately after hygienic treatment.&#x0D; CONCLUSION: In experimental and clinical conditions, the objectivity and effectiveness of the use of express raman-fluorescent technologies to assess the mineralization of hard tooth tissues when exposed to various physical and chemical factors in normal conditions, with carious (initial form) and noncarious (wedge-shaped defect, pathological erasability) lesions, are substantiated.

Primary Radial Nerve Lesions in Humerus Shaft Fractures-Revision or Wait and See.

Background: This study investigates the surgical state-of-the-art procedure for humeral shaft fractures with primary radial nerve palsy based on its own case series in relation to the current and established literature. Methods: Retrospective review of treated cases between January 2018 and December 2022 describing radial nerve palsy after humerus shaft fractures, radiological fracture classification, intraoperative findings, surgical procedure, patient follow-up and functional outcome. Results: A total of 804 patients (463 women and 341 men) with humerus shaft fractures were identified. A total of 33 patients showed symptomatic lesions of the radial nerve (4.1%). The primary lesion was identified in 17 patients (2.1%). A broad and inhomogeneous distribution of fractures according to the AO classification was found. According to the operative reports, the distraction of the radial nerve was found eleven times, bony interposed three times and soft tissue constricted/compressed three times. In every case the radial nerve was surgically explored, there was no case of complete traumatic nerve transection. Four intramedullary nails and thirteen locking plates were used for osteosynthesis. Complete recovery of nerve function was seen in 12 cases within 1 to 36 months. Three patients still showed mild hypesthesia in the thumb area after 18 months. Two patients were lost during follow-up. Conclusions: With this study, we support the strategy of early nerve exploration and plate osteosynthesis in humeral fractures with primary radial nerve palsy when there is a clear indication for surgical fracture stabilisation. In addition, early exploration appears sensible in the case of palsies in open fractures and secondary palsy following surgery without nerve exposure as well as in the case of diagnostically recognisable nerve damage. Late nerve exploration is recommended if there are no definite signs of recovery after 6 months. An initial wait-and-see strategy with clinical observation seems reasonable for primary radial nerve palsies without indication for surgical fracture stabilisation.

Use of daratumumab in combination with lenalidomide and dexamethasone (D-Rd regimen) in therapy of elderly patients with newly diagnosed multiple myeloma with high-risk cytogenetics. Clinical observation

Multiple myeloma (MM) is a B cell lymphoproliferative disease characterized by clonal proliferation of plasma cells and heterogenous progression. Successes in MM therapy are in large part based on the study of molecular and genetic features of disease pathogenesis and identification of high-risk chromosomal abnormalities determining prognosis and antitumor response. Elderly patients with newly diagnosed MM with high-risk cytogenetics who are not candidates for autologous stem cell transplantation should receive programs of antitumor therapy which increase progression-free survival and overall survival with satisfactory tolerability and minimal toxicity. Use of monoclonal antibodies in triplets at early stages allow to achieve deeper antitumor response, the absence of minimal residual disease in a greater number of observations, and improve survival in all patient subgroups.A clinical observation of a 75-year-old female patient with newly diagnosed MM with high-risk cytogenetics and multiple bone plasmacytomas with massive extraosseous components is presented. During D-Rd regimen therapy, after 8 daratumumab administrations very good partial remission was achieved which has been maintained for 20 months. Significant improvement in quality of life with satisfactory treatment tolerability and absence of adverse events are observed

Dynamic Observation in Children and Adolescents Following Management of Differentiated Thyroid Cancer

Differentiated thyroid cancer (DTC) is one of the most common malignancies within the endocrine system, with a progressively increasing incidence over recent decades. In the structure of DTC, occurrence in the pediatric age group is relatively rare and is associated with excellent prognoses in terms of disease-specific survival. However, the prevalence of advanced disease in children and the frequency of recurrences present interdisciplinary teams with questions regarding the optimal management approach for such patients, focusing not on achieving disease eradication but preserving and maintaining quality of life. Notably, the presence of oncological pathology, coupled with fluctuations in thyroid hormone levels due to therapeutic interventions, underscores the importance of maintaining psychological and physiological well-being that are affected by the increased frequency of anxiety and depressive symptoms in children and their parents, as well as cognitive and physical functioning. These symptoms may exacerbate against the backdrop of hypothyroidism and directly correlate with TSH levels. To maintain quality of life during the period of dynamic observation and risk group re-stratification, we proposed a method of reduced thyroid hormone doses as an alternative to discontinuing thyroid hormones to assess stimulated thyroglobulin when reaching a threshold TSH level &gt;30 mIU/L. The method was implemented in 2 pediatric patients, showing positive outcomes in terms of absence of hypothyroidism-related complaints, preservation of free thyroid hormone fractions, achievement of adequate target TSH levels, and informative tumor marker indicators. The results of our study underscore the importance of an individualized approach to the management of children with DTC and demonstrate the potential effectiveness of the reduced dose method in maintaining the quality of life of these patients. Further research and clinical observations are necessary for a deeper understanding of the applicability of this method and its impact on longterm outcomes.

Treatment of patients with multiple primary malignant neoplasms (solid tumors and malignant diseases of the hematopoietic tissue) using systems for independent prolonged infusion therapy. Clinical observations

Study of the problem of multiple primary malignant neoplasms (MPMNs) becomes more important and significant in modern clinical oncology. MPMN is a varied group of independent tumors of varying origin located in one or several organs. Due to introduction of single-use elastomeric microinfusion pumps into the clinical practice, continuous cyclical drug outpatient and in-hospital treatment of oncological patients with MPMNs can be performed. Significant successes of specific therapy led to increased lifespan of patients with MPMNs. Prolonged administration of drugs using infusion pump with set velocity allows to deliver cytostatics into the patient’s body in strictly controlled amounts. The article presents 2 clinical cases of effective antitumor treatment of patients with MPMNs using infusion pum

Mechanisms of Bushenyiqi decoction in the treatment of asthma: an investigation based on network pharmacology with experimental validation.

Background and purpose: The Bushenyiqi decoction (BYD), a contemporary prescription of traditional Chinese medicine (TCM), has been observed to significantly ameliorate asthma symptoms in patients based on clinical observations. Although multi-component and multi-target characteristics are important attributes of BYD treatment, its pharmacological effect on asthma and the underlying mechanism of action remain unclear. Method: Network pharmacology: the asthma-related genes were retrieved from the GeneCards and OMIM database. The active constituents of BYD and their corresponding target genes were collected from the TCMSP database. The underlying pathways associated with overlapping targets between BYD and asthma were identified through GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analysis. Experimental validation: pulmonary function tests, enzyme-linked immunosorbent assay (ELISA), Hematoxylin and eosin (HE), periodic acid-Schiff (PAS), and Masson's trichrome stainings were conducted to validate the efficacy of BYD in ameliorating airway inflammation in allergic asthma mice. Western blot (WB) and molecular docking were performed to confirm the involvement of the underlying pathway in BYD treatment of asthma. Results: The results of animal experiments demonstrated that BYD may improve airway responsiveness and suppress airway inflammation in allergic asthma mice. The network pharmacological analysis revealed the involvement of 11 potentially key active components, 9 potential key targets, and the phosphatidylinositol3 kinase-RAC-α serine/threonine-protein kinase (PI3K/AKT) signaling pathway in the mechanism of action of BYD for asthma treatment. Our findings have confirmed that BYD effectively alleviated airway inflammation by targeting interleukin 6 (IL-6), epidermal growth factor receptor (EGFR), and hypoxia inducible factor 1 alpha (HIF1A), with quercetin, kaempferol, and luteolin performing as the pivotal active constituents. BYD may potentially reduce inflammatory cell infiltration in lung tissues by regulating the PI3K/AKT signaling pathway. Conclusion: In conclusion, the integration of network pharmacology and biological experiments has demonstrated that key constituents of BYD, such as quercetin, kaempferol, and luteolin, exhibit targeted effects on IL-6, EGFR, and HIF1A in combating asthma-related inflammation through inhibition of the PI3K/AKT signaling pathway. The findings of this investigation provide evidence supporting the effectiveness of TCM's "bushenyiqi" therapy in asthma management, as corroborated by contemporary medical technology.

A case of hemolytic-uremic syndrome that developed in a 5-year-old child due to acute intestinal infection with hemocolitis

Purpose: to demonstrate a case of hemolytic-uremic syndrome (HUS) in a 5-year-old child associated with an acute intestinal infection of unknown etiology, occurring with hemocolitis. Results. During clinical and laboratory observation, edematous syndrome, oligoanuria, severe microangiopathic hemolytic anemia (decrease in hemoglobin, haptoglobin, increase in Lactate dehydrogenase), thrombocytopenia, consumption coagulopathy, hyperazotemia, acute kidney injury (AKI) according to KDIGO grade 2 (increase in serum creatinine more than 2 times) developed. As part of complex therapy with balanced crystalloid solutions with stimulation of diuresis, it was possible to achieve rapid restoration of diuresis on the 2nd day of hospital stay without the use of renal replacement therapy; he also received antibiotics, anticoagulants, transfusion of fresh frozen plasma and red blood cell suspension. Hyperazotemia was relieved within 5 days, as was thrombocytopenia. The follow-up recovery of renal function showed.

Understanding acupuncture anesthesia from a foreign perspective： reviewing Acupuncture Anesthesia in the People's Republic of China.

"Acupuncture Anesthesia in the People's Republic of China： A Trip Report of the American Acupuncture Anesthesia Study Group" (Report for short) is the first extraterritorial systematic investigation and evaluation report in the history of acupuncture anesthesia in China. After Report was released to the public, it has not drawn much attention in China. At the moment when acupuncture anesthesia is extended to perioperative treatment, by reviewing the Report, the differences in understanding acupuncture anesthesia were analyzed from a foreign perspective. Report involves the clinical observation of surgery under acupuncture anesthesia, the analysis on the factors of acupuncture anesthesia in therapeutic effects and the relevant mechanisms, and the differences in the research methods and foci on the recognition of acupuncture anesthesia between China and foreign countries. In association with the development of acupuncture anesthesia during the past 65 years and the conclusion in Report, the paper briefly describes the development and perfection of acupuncture anesthesia, the historical verification to the conclusions in Report and the limitations in modern acupuncture anesthesia. It provides some inspiration for the development of acupuncture anesthesia, acupuncture-moxibustion medicine and life science in the future.

Clinical case of gonadotropinoma, which occurs for a long time under the guise of hyperprolactinemia

The prevalence of pituitary adenomas in the population among tumors of the central nervous system is about 17%. Pituitary adenomas are divided into non-functional (about 36–54%), characterized by the absence of secretory activity, and functional (about 46–64%), secreting hormones or their subunits. The most common are prolactinomas (32–51%), somatotropinomas (9– 11%), corticotropinomas (3–6%), the frequency of gonadotropins and thyrotropins is low and amounts to less than 1% of cases. This article presents a clinical observation of a patient with gonadotropinoma, which has been occurring for a long time under the guise of hyperprolactinemia.