British Medical Journal (Clinical research ed.)最新文献

{"title":"Successful integration of interdisciplinary pain rehabilitation and spinal cord stimulation for chronic naive back pain","authors":"","doi":"10.33140/mcr.06.10.01","DOIUrl":"https://doi.org/10.33140/mcr.06.10.01","url":null,"abstract":"Spinal cord stimulation for naive back pain is a therapeutic option that is rarely considered, especially when conventional stimulation parameters are used. Interdisciplinary pain rehabilitation program is another less feasible but effective therapeutic approach for the management of chronic pain that is not usually used in conjunction with interventional procedures.This case report presents a successful integration of an interdisciplinary pain rehabilitation program with an interventional procedure spinal cord stimulation using conventional stimulation parameters in a patient with chronic, predominantly nociceptive to nociplastic, naïve back pain.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86101762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing efficacy in lung adenocarcinoma after targeted therapy, Covid 19 disease and radiosurgery of brain metastasеs","authors":"","doi":"10.33140/mcr.06.030","DOIUrl":"https://doi.org/10.33140/mcr.06.030","url":null,"abstract":"Lung adenocarcinoma is a common disease, in which high mortality is due to both men and women. In the article we present a 58-year-old man who has been diagnosed with metastatic pulmonary adenocarcinoma/T2B N2 M1a in 2018, on the occasion of dry irritating cough and shortness of breath. Also a positive EGFR mutations has been proven. Targeted therapy (TT) with gefitinib has been carried out for two years till 2020. The patient has been switched on osimertinib in 2020 due to local progression. Brain metastasis has been found in 2021. Radiosurgery (RS) with a singal fraction 15Gy was conducted for treatment of 4 brain metastases . The patient was infected after RS with Covid 19 in April 2021. Patients with specific EGFR mutations can be effectively treated with TT. After treatment with TT, brain metastases of pulmonary adenocarcinoma with specific EGFR mutations are more radiоsensibility and responded very well by high single radiation dose realized by radiosurgery (RS). Despite the worsened prognosis, including Covid 19 disease, by combining TT and RS, we achieved three-year survival in metastatic lung adenocarcinoma.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78754367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About help from physicists in fighting sars-cov-19 and its mutations","authors":"","doi":"10.33140/mcr.06.031","DOIUrl":"https://doi.org/10.33140/mcr.06.031","url":null,"abstract":"Annotation: Currently, the SARS-CoV-19 (COVID-19) coronavirus pandemic is the main threat to all of humanity. This threat is constantly growing as new and more aggressive mutations emerge. The main ways of fighting viruses are currently recognized: vaccination, disinfection, quartzization and isolation. However, they all have their own advantages and disadvantages. The analysis of these shortcomings and the search for ways to eliminate them is an important and urgent task, which is the main goal of the work performed. Methods: a critical analysis of the emerging problems of traditional ways and methods of biophysical impact on viruses. Scientific novelty lies in the rationale for a new biophysical way to combat COVID-19 and in setting the tasks that are required to he solve. Results of work: Vaccination is considered to be the most effective method of combating COVID-19. However, it has weakened, but not prevented, the spread of viruses, as it acts in pursuit of his new mutations. This leads to local periods of lack of immune protection, in which the only way is used - the introduction of restrictions on the lifestyle and activities of people, up to rigid isolation. Other traditional ways to combat COVID-19 involve disinfection and quartzing. However, the entry of an infected person into this area after they have been carried out nullifies their results and leads to the need for new disinfection. Therefore, all traditional methods are limited by the time and conditions of their implementation and the duration of effective action, and most importantly, they require a large investment of time, intellectual, technical, economic and labor resources to achieve the desired result (especially the creation of vaccines). Since all of them did not solve the problem of eliminating the pandemic and destroying viruses, but only slowed down their spread, it is proposed to discuss another way-their destruction by the method of resonant oscillations (vibrations) created by electromagnetic fields from external sources. On the basis of this, the 1st task was formulated for further work: search for the resonant frequency range destroying viruses, and the 2nd task the search for the frequency range that activates the virus, in order to exclude its appearance in the development of new electronic systems and technical devices. The need for a fundamental solution to these problems at the level of state and non-state health organizations with the wide involvement of physicists and biophysicists is brought up for discussion by the scientific community of all countries of the world. Such a path could create the basis for their quick and effective solution.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81439818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arizona Reopening Phase 3 and COVID-19: Returning to Normal","authors":"","doi":"10.33140/mcr.06.032","DOIUrl":"https://doi.org/10.33140/mcr.06.032","url":null,"abstract":"Arizona is about the same size as Italy, and the sixth largest in size of the United States 50 states. The state’s Reopening Phase 3 began on March 5, 2021. There were declines in the weekly COVID-19 cases from March through June. In July and August, the cases rose as the Delta variant spread throughout the United States. Arizona had passed one million case milestone. This six-month longitudinal study examined the changes in the numbers of vaccinations given, new COVID-19 cases, hospitalized cases, deaths, testing given, and the weekly positively percentages during Reopening Phase 3. The data source used was from the Arizona Department of Health Services COVID-19 dashboard database. Even with the case surges, the new normal was low number of severe cases, manageable hospitalization numbers, and very low number of deaths.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90647706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data on camrelizumab in digestive system cancers: a retrospective observational study","authors":"","doi":"10.33140/mcr.06.09.01","DOIUrl":"https://doi.org/10.33140/mcr.06.09.01","url":null,"abstract":"Objective: To explore the clinical efficacy and safety of camrelizumab in the treatment of digestive system malignancies in the real world. Methods: A retrospective study was designed. A total of 34 patients with advanced gastrointestinal cancer who received camrelizumab treatment in the xx hospital from July 2019 to May 2020 were included. The follow-up endpoint was set for October 30, 2020. The primary endpoint was objective response rate (ORR) and safety. Secondary endpoint measures included progression-free survival (PFS), and overall survival (OS). Cox regression was used for the analysis of factors associated with PFS. Results: As the best response, only 5 patients achieved a partial response and 10 patients had disease progression, with an ORR of 14.31%. Compared with gastric cancer, the ORR of esophageal cancer (3.0% vs 0.0%) (P<0.05). The PFS was 4.5 months (2-10 months). OS ranged from 4 to 11 months, and median OS has not been reached. Multivariate Cox regression analysis showed that gastric cancer (HR=1.695, 95% CI:11.216–2.435, P<0.05) was associated with still shorter PFS, and camrelizumab combined with other drugs (HR=0.512, 95% CI: 0.095–0.737, P<0.01) was associated with PFS in patients. The most common AEs were anemia (41.2%, 14/34) in all grades 1 to 2. Grade 3 AEs occurred in 3 patients (2.9%), including 1 case of immune pneumonitis, 1 case of hemangioma, and 1 case of transaminase increased. Other adverse events included diarrhea, nausea, neutropenia, thrombocytopenia, reactive cutaneous capillary proliferation (RCCEP), fatigue, and hypothyroidism, all of which did not exceed 12%. Conclusion: Camrelizumab is effective and safe in the treatment of patients with digestive system malignancies, but the overall response rate is limited.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81354327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression a common condition in older hospitalized chronic patients-a transversal study","authors":"","doi":"10.33140/mcr.06.09.02","DOIUrl":"https://doi.org/10.33140/mcr.06.09.02","url":null,"abstract":"Objective: To examine the prevalence of depression among older hospitalized patients and its relation to chronic diseases. Method: A transversal study was conducted in a Regional Hospital in South Albania which included a total of 100 hospitalized chronic patients. The study lasted one month and the Patient Health Questionnaire (PHQ-9) was used for the data collection. Each participant completed a validated Albanian version of the questionnaire. Patients diagnosed with various pathologies who presented for examination but were not admitted to the hospital were excluded from the study. For the data analyses were used descriptive statistics. Results: Participants’ mean age was 55.9 ± 18.45. 46 % of patients were female and 54% were male. The results of variables assessing the depression were as follows: 24% of female patients report “Little interest or pleasure in doing things” nearly every day; 15% of female and 11% of male patients report “Feeling down, depressed, or hopeless”; 39% of female and 24% of male patients feel “tired or have little energy”. The diagnosis was significantly associated with the trend for depression, p<0.05. The most frequent diagnoses diagnosis were hypertension, diabetes, and stroke respectively 23.00%, 14.00%, and 10.00%. Conclusion: Depressive symptoms occur more commonly in older hospitalized patients with chronic diseases. They require a longer rehabilitation time, which influences the day hospital stay. For improving the quality of care and life of this patient a routine depression screening and more support from nurses are recommended.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83544050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberrant neuroplasticity in autism spectrum disorder","authors":"Jayaraman, Anusha, Mundkur, Nandini","doi":"10.33140/mcr.06.08.06","DOIUrl":"https://doi.org/10.33140/mcr.06.08.06","url":null,"abstract":"Developments have taken place within the neurobiology research in Autism spectrum disorder (ASD), and results from these studies indicate that the brain in ASD is related to aberrant neuroplasticity. Transcranial magnetic stimulation (TMS) has quickly evolved to become a widely used, safe, and non-invasive neuroscientific tool to analyze a spread of neuroscience processes, as neuroplasticity. The diagnostic and therapeutic potential of TMS in ASD is setting out to be realized. during this article, we concisely reviewed the proof of aberrant neuroplasticity in ASD, steered future directions in assessing neuroplasticity exploitation repetitive TMS (rTMS), and mentioned the potential of rTMS in rectifying aberrant neuroplasticity in ASD.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85004764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic diabetes solutions: physiologic insulin resensitization","authors":"B. Loveridge, Tori R. Tucker, Melanie St Laurent, Scott A. Hepford, M. Alexander, J. Lakey","doi":"10.33140/mcr.06.08.03","DOIUrl":"https://doi.org/10.33140/mcr.06.08.03","url":null,"abstract":"Diabetes is a disease currently affecting over 30 million Americans and is a leading cause of amputation, blindness, and chronic kidney disease. Treatment of diabetes with medications and lifestyle modifications alone have not eliminated these complications, because in part they lack the ability to restore the periodic cycles and rest periods of insulin that exist in healthy physiology. Insulin is excreted in a cyclical and oscillatory pattern by the pancreas, that is critical to maintain adequate insulin sensitivity at the insulin receptor level. Administration of exogenous insulin bio identically matching this physiologic profile is more effective at controlling blood glucose level and reducing complications of diabetes than standard drug therapy and lifestyle modifications alone. This matching of physiological insulin helps reduce inflammatory cascades responsible for a number of diabetic complications. In this article, we will review how insulin is secreted and functions physiologically and highlight a dynamic insulin delivery modality that mimics normal secretion profiles. This biomimicry reduces insulin exposure, which appears to reduce the progression to or worsening of insulin resistance. We will review how administration of insulin in this manner has been associated with reduction of diabetic complications.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72671988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of narrated group discussions on the interpretational ability of medical students: a prospective observational study","authors":"","doi":"10.33140/mcr.06.08.01","DOIUrl":"https://doi.org/10.33140/mcr.06.08.01","url":null,"abstract":"Background: Clinical decision making is predominantly knowledge-based perception, interpretation under terms of uncertainty. It is unclear whether interpretational ability can be improved. We evaluated the effect of a narrated group-discussions course (NGDC) on the interpretational ability of first-year medical students. Objective: To evaluate the effect of our course on first year medical students in respect to: a) their interpretational abilities b) their attitude towards studying literature and the core subjects. Method: Using a pre-post questionnaire, of a semester-long course, among two consecutive classes, the authors evaluated the participant’s interpretational ability and depth of understanding when analyzing four complex passages. Results: Out of 235 students, 146 (62%) responded to both questionnaires. There was a significant increase in the participant’s interpretational ability (P=0.003). ninety one participants (38%) improved their level of understanding in at least one out of the four passages, and 37 participants (25%) improved in two passages. A multivariate analysis revealed that the improvement in the interpretational ability was associated with younger age (P=0.034, CI 95%=0.64-0.98, OR=0.79), positive pre-course attitude and motivation (P<0.001, CI 95%=1.43-3.05, OR=2.09), and lack of a prior literature background (P=0.064, CI 95%=0.17-1.05, OR=0.43). Conclusion: Our data suggests that NGDC may improve and refine interpretational ability. Further studies are required to establish the short- and long-term impact of this change and whether it can be translated into better clinical decision making.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79002039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of adjuvant phosphatidylcholine in the management of egyptian patients with non alcoholic fatty liver disease (NAFLD)","authors":"","doi":"10.33140/mcr.06.08.05","DOIUrl":"https://doi.org/10.33140/mcr.06.08.05","url":null,"abstract":"Background and Aim: Non-Alcoholic Fatty Liver Disease (NAFLD) has become the most common liver disorder with increased liver related and non-related complications and mortality as a result of increasing obesity, type 2 diabetes and metabolic syndrome (MetS). The current study aims to evaluate the efficacy of adjuvant phosphatidylcholine in treating patients with NAFLD. Methods: This interventional randomized controlled study recruited 100 patients with NAFLD and MetS randomized into: a control group (n=50) that received standard care of life style modifications and an intervention group (n=50) that received phosphatidylcholine (2100 gm/day) plus standard care. Both groups received health education through clinical pharmacist for achieving sustainable weight loss for 6 months. Body mass index (BMI), waist and hip circumference, liver function, lipid profile, homeostasis model of assessment-insulin resistance (HOMA-IR) score, NAFLD-fibrosis score, steatosis score and liver stiffness measurement by transient elastography were recorded at baseline, 3 and 6 months. Results: Intervention group showed significantly (p<0.05) higher number with normalized; alanine aminotransferase, total cholesterol and low density lipoprotein at midpoint and endpoint, aspartate amiontransferase at midpoint and high density lipoproteins and malondaldehyde at endpoint. Intervention group showed a significantly higher participants’ number who shifted to more favorable category of NAFLD-fibrosis score (p=0.02), radiological fibrosis stage (p=0.015) at endpoint, radiological steatosis grades and HOMA-IR score at midpoint and endpoint (p<0.05). Additionally, significant number of participants in intervention group (34%) lost MetS components compared to (10%) in control group at endpoint (p=0.004). Conclusion: Adjuvant phosphatidylcholine has shown laboratory, radiological and clinical benefits in the management of Egyptian patients with NAFLD and ameliorate MetS parameters.","PeriodicalId":9304,"journal":{"name":"British Medical Journal (Clinical research ed.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80516432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}