Efficacy and safety of Trang Phuc Linh Plus tablets in patients with irritable bowel syndrome-diarrhea

A double-blind, randomized, phase II clinical trial was conducted within a 14-week follow-up including 2 weeks of the non-drug run-in period, 8 weeks of medication, and 4 weeks of follow-up after discontinuation. The objective of the study was to evaluate the efficacy and safety of Trang Phuc Linh Plus in irritable diarrhea syndrome patients. Group I took Trang Phuc Linh Plus 3 tablets/time x 2 times/day for 8 weeks; Group II took placebo 3 tablets/time x 2 times/day for 8 weeks. Patients will be re-examined, tested, and evaluated over the phone for symptom recurrence and adverse events (AEs). This study showed that the Trang Phuc Linh Plus tablets tended to improve symptoms in patients suffering from irritable bowel syndrome with diarrhea, suggesting its safety and tolerability.

Dissatisfaction Risk Factors of Patients after Laminectomy for Thoracic Ossification of Ligamentum Flavum: A Retrospective Cohort Study of Different Follow-Up Periods

Objectives. To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods. Methods. This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient’s Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized. Results. At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain ( P < 0.05 ). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up ( P < 0.05 ). There were no significant differences in other variables between the two groups ( P > 0.05 ). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence ( P < 0.05 ). There were also significant differences in the JOA score and symptom recurrence at the final follow-up ( P < 0.05 ). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group. Conclusions. In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

Postoperative recurrence after ileocaecal resection for fibrostenotic terminal ileal Crohn's disease is a significant issue for patients as it can result in symptom recurrence and requirement for further surgery. There are very few modifiable factors, aside from smoking cessation, that can reduce the risk of postoperative recurrence. Until relatively recently, the surgical technique used for resection and anastomosis had little or no impact on postoperative recurrence rates. Novel surgical techniques such as the Kono-S anastomosis and extended mesenteric excision have shown promise as ways to reduce postoperative recurrence rates. This manuscript will review and discuss the evidence regarding a range of surgical techniques and their potential role in reducing disease recurrence. Some of the techniques have been shown to be associated with significant benefits for patients and have already been integrated into the routine clinical practice of some surgeons, while other techniques remain under investigation. Current techniques such as resection of the mesentery close to the intestine and stapled side to side anastomosis are being challenged. It is looking more likely that surgeons will have a major role to play when it comes to reducing recurrence rates for patients undergoing ileocaecal resection for Crohn's disease.

Peroral endoscopic myotomy for management of cricopharyngeal bars (CP-POEM): a retrospective evaluation

Background Cricopharyngeal bars (CPBs) are a unique etiology of oropharyngeal dysphagia. Symptomatic patients are managed with endoscopic dilation or surgical myotomy. Cricopharyngeal peroral endoscopic myotomy (CP-POEM) is an emerging technique for the management of dysphagia due to CPBs. This study evaluated technical success, clinical success, adverse events, and long-term recurrence following CP-POEM. Methods Consecutive patients who underwent POEM for management of CPBs between May 2015 and December 2020 at four tertiary care centers were included. Primary outcome was clinical success (defined as improvement of dysphagia score to ≤ 1). Secondary outcomes were technical success, rate and severity of adverse events, procedure duration, and symptom recurrence. Results 27 patients (mean age 69 years; 10 female) underwent CP-POEM during the study period. The most common presenting symptoms at the time of index procedure were dysphagia (26; 96.3 %) and regurgitation (20; 74.1 %). Clinical and technical success were achieved in all patients. Mild/moderate adverse events occurred in two patients (7.4 %). CP-POEM significantly reduced the median dysphagia score. Conclusions CP-POEM was a safe and effective treatment for symptomatic CPBs. Although symptom recurrence was low, long-term outcome data are needed. CP-POEM should be considered as a management option for symptomatic CPBs at centers with POEM expertise.

Co-existent ocular myasthenia gravis and Graves’ disease in a 5 year old

Myasthenia gravis and Graves’ disease are known to co-exist in adults, yet there have only been a small number of paediatric cases reported. We report a 5 year old female who was diagnosed with ocular myasthenia gravis after presenting with unilateral ptosis and subsequently found also to have Graves’ disease. She was treated successfully with pyridostigmine, corticosteroids and carbimazole without symptom recurrence or progression to generalised myasthenia gravis. The aetiology of the coexistence is not fully understood, nor is the relationship between the two disorders’ presentation and treatment. We discuss the variation in clinical presentation of myasthenia gravis between populations and when associated with autoimmune thyroid disease, potential HLA-related genetic susceptibility and the varying approaches to treatment of the co-existent disorders.

Traditional Chinese Medicine Based On Tongjiang Methodology Combined With Proton Pump Inhibitors (PPIs) De-Escalation In Treating Non-Erosive Reflux Disease: A Study Protocol For A Multicentred, Randomized Controlled Clinical Trial

Background: Non-erosive reflux disease (NERD) is characterized by typical gastroesophageal reflux symptoms, such as heartburn and regurgitation, but an absence of oesophageal mucosal damage during upper gastrointestinal endoscopy. Although proton pump inhibitors (PPIs) are the first line therapy, almost 50% of patients with NERD fail to respond to this treatment. Traditional Chinese medicine (TCM) can better relieve the symptoms of NERD. Therefore, a randomized controlled trial (RCT) was designed to investigate the efficiency of TCM granules based on Tongjiang (TJ) methodology combined with PPIs de-escalation therapy for NERD patients who did not respond to PPIs alone. Method: This multicentred, double-blinded, RCT with two parallel groups will recruit 174 participants who will be randomized into the TCM granules combined with PPIs de-escalation group (n=87) and the TCM granules placebo combined with PPIs de-escalation group (n=87). Both groups of participants will receive 6 weeks of treatment and 4 weeks of follow-up, and all participants will be assessed for related symptoms, mental health status and quality of life at each visit. The primary outcome measurements include Visual Analogue Scale (VAS) for heartburn and regurgitation and the major symptoms scale. The secondary outcome measurements include PPI withdrawal rate, symptom recurrence rate, minor symptoms scale, SF-36, PRO, SAS, SDS, GERD–HRQL and TCM syndromes scales.Discussion: Previous research has shown that TCM is capable to alleviate NERD symptoms. This trial will help to provide a better understanding of the synergistic efficiency of the combination of TCM and PPIs, to explore whether the dosage of PPIs can be reduced after the supplement of TCM granules and to provide a feasible plan to reduce dependencies or withdraw NERD patients from PPIs. The outcome of this trial is expected to reduce the symptom recurrence rates, lessen patients’ physical and psychological burdens, and achieve good social benefits.Trial registration number: Clinicaltrials.gov: NCT04340297

Treatment of trigeminal and glossopharyngeal neuralgia in an adolescent: a case report

Background Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. Case presentation A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. Discussion We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management.

Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth

Thermal ablation (TA) for benign thyroid nodules (BTNs) is widely accepted as an effective and safe alternative to surgery. However, studies on the long-term outcomes of TA have reported problems with nodule regrowth and symptom recurrence, which have raised the need for adequate control of regrowth. Therefore, a more complete TA with a longer-lasting treatment effect may be required. In this study, we review and discuss long-term outcomes and regrowth of BTNs following TA and evaluate factors affecting the long-term outcomes. We also discuss the management of regrowth based on long-term outcomes.

Fifty Shadows of Mesenteric Ischemia

A 66-year-old female presented to the emergency department with sudden onset of central abdominal pain irradiated to the back. Blood tests were unremarkable. Computed tomography scan showed acute focal ischaemia of small bowel loops sustained by an encircling omental band around a mid ileal loop, which was released on urgent mini-laparotomy. The ischaemic loops were covered with hot moist gauzes for several minutes until the normal luster and peristaltic wave returned. Indocyanine green fluorescence angiography confirmed sufficient bowel perfusion and viability. The patient was discharged 5 days after surgery and did not experience any symptom recurrence up to 6 months later. Mesenteric or colonic ischaemia may respectively affect the small or large intestine. The small intestine is able to compensate for a 75% reduction in mesenteric perfusion for up to 12 hours. If promptly treated, resection may be successfully avoided.