补骨脂及其经典方剂的谱-毒关系研究

补骨脂是临床常用的补益类中药,近年来补骨脂相关制剂不良反应事件频发,如何保障其临床合理用药是领域内的难点问题。本文以尚无不良反应报道、安全性较高的二神丸、四神丸经典类方与补骨脂进行毒性的比较研究,从整体水平评价补骨脂、二神丸、四神丸的急性毒性作用,测定补骨脂的LD50值为53.9 g/kg。二神丸LD50值为68.3 g/kg,具有配伍减毒作用。四神丸无法测定LD50值,MTD值为41.0 g/kg,配伍减毒效果更显著。进一步通过谱-毒相关分析发现补骨脂中13个化合物在二神丸、四神丸配伍后显著降低,初步提示了二神丸、四神丸配伍减毒的物质基础,为后续配伍减毒机理研究提供科学参考。

Cardioprotection of Shenfu preparata on cardiac myocytes through cytochrome P450 2J3

To evaluate whether Shenfu injection （SFI） protects against cardiac myocyte injury induced by Fupian injection （FPI） in vitro. METHODS： H9c2 cells were separately treated with FPI, Renshen injection （RSI） and SFI. Cell viability, lactate dehydrogenase （LDH） release, spontaneous beating rate of primative cardical cells, caspase-3/7 activity, cell apoptosis, and cytochrome P450 2J3 （CYP2J3） mRNA expression were analyzed. RESULTS： The viability of H9c2 cells treated with SFI （37 and 75 mg/mL） was significantly higher than that of H9c2 cells treated with FPI （25 and 50 mg/mL） （P〈0.05, P〈0.01, respectively）. LDH activity of H9c2 cells treated with SFI （75 mg/mL） was significantly decreased （P〈0.01） compared with that of H9c2 cells treated with FPI （50 mg/mL）. SFI （150 mg/mL） significantly attenuated FPI （100 mg/mL）-induced spontaneous beating rate decrease in primary myocardial cells after 4-hour treatment. Compared with FPI （12 and 25 mg/mL）, SFI （18 and 37 mg/mL） treatment could effectively reverse the change of caspase-3/7 activity （P〈0.01 and P〈0.01, respectively）. Compared with FPI （6 and 25 mg/mL）, apoptotic cells decreased significantly （P〈0.05, P〈0.01, respectively） when H9c2 cells were incubated with SFI （9 and 37 mg/mL）. The expression of CYP2J3 mRNA was down-regulated by FPI, while RSI and SFI could up-regulate the expression of CYP2J3 （P〈0.01）, which suggested the potential mechanism of protection of RSI against cardiac myocyte damage induced by FPI treatment. CONCLUSION： These observations indicate that SFI has the potential to exert cardioprotective effects against FPI toxicity. The effect was possibly correlated with the activation of CYP2J3.

A (H1N1) Influenza Pneumonia with Acute Disseminated Encephalomyelitis:A Case Report

INTRODUCTION A 56-year-old Chinese female patient with A （H1N1） influenza pneumonia accompanied by acute disseminated encephalomyelitis （ADEM） of the Central Nervous System （CNS） is described in this article. The patient had typical clinical manifestation, and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus of A （H1N1） influenza can infect CNS, and we should pay more attention to patients of A （H1N1） influenza pneumonia with neurological complications.

A rare occurrence of a hereditary Birt-Hogg-Dubésyndrome:A case report

BACKGROUND Birt-Hogg-Dubé(BHD)syndrome is a rare autosomal dominant disease caused by germline mutations in the folliculin(FLCN)protein gene,which usually manifests as cutaneous fibrofolliculoma,pulmonary cysts,renal cell carcinoma,and spontaneous pneumothorax.CASE SUMMARY A 26-year-old woman with no history of smoking was admitted to the Respiratory Department of our hospital due to intermittent wheezing that lasted for 8 mo.She had experienced recurrent spontaneous pneumothorax more than four times during the past 8 mo.After admission,the patient again suffered from left pneumothorax without a clear reason.Lung computed tomography(CT)showed multiple low-density cystic changes in both lungs.Physical examination on admission revealed multiple white dome-shaped papules in the neck,the nape,and behind the ear.In addition,the patient had a family history of spontaneous pneumothorax.Her mother had suffered from pneumothorax four times(at age 36,37,42,and 50 years).Her second maternal aunt had suffered from a right pneumothorax at the age of 40.The multidisciplinary diagnosis of BHD,which included the Respiratory Department,Radiology Department,Pathology Department,and Dermatological Department,was BHD and was later confirmed by family genetic testing.The same variation(FLCN gene)was found in the patient’s mother and aunt.CONCLUSION This case highlights the importance of multidisciplinary diagnosis and a treatment platform for the diagnosis of BHD.

Transcriptional regulation effect of constituents in Polygonum multiflorum Thunb. based on human progesterone X receptor(hPXR) mediated CYP3A4 rapid screening system

OBJECTIVE This study investigated transcriptional regulation of the main chemical con.stituents of Polygonum multiflorum Thunb.including Stilbene Glucoside(THSG) and anthraquinone constituents(Emodin,Rhein,Aloeemodin,Chrysophanol and Physcion) and six potential liver injury constituents(gallic acid,quercetin,luteolin,kaempferol,resveratrol) on mediated by PXR CYP3A4.Early establishment of pregnane X receptor mediated CYP3A4 drug induced rapid screening technique was used to determine the effects of these constituents.METHODS First,effect of constituents on the cell activity was detected by MTS cell viability assay.IC50 was calculated.Second,the expression vector and reporter vector were co-transfected into Hep G2 cells,10 μmol·L^(-1) Rifampicin as a positive control,10 μmol·L^(-1) Ketoconazole as a negative control.After treated with different concentrations of(the an.thraquinone constituents concentrations were 2.5,5 and 10 μmol·L^(-1);the concentrations of Gallic Acid,Quercetin,Luteolin,Kaempferol,Apigenin,Resveratrol concentrations were 5,10 and 20 μmol·L^(-1)) for24 h,the cells were tested for dual luciferase activity.RESULTS The results show that the inhibitory ef.fect of THSG,Chrysophanol,Emodin,Rhein and Aloeemodin on CYP3A4 was inhibited by co-transfec.tion of pcDNA3.1 and pGL4.17-CYP3A4.The expression of pcDNA3.14-PXR and pGL4.17-CYP3A4 was induced by the four constituents.Besides,Emodin has a directly inducing effect.Four anthraqui.none constituentscan induce the effect of CYP3A4 by PXR,but Emodin can directly induce CYP3A4.THSG can inhibit CYP3A4,but in the presence of PXR plasmid can induce CYP3A4.For the six poten.tial liver injury constituents,results show that the plasmid pcDNA3.1 was cotransfected with pGL4.17-CYP3A4 regulation of Gallic Acid and Resveratrol on CYP3A4 inhibitory effects of Quercetin,Luteolin,Kaempferol have an induce effect;after pcDNA3.14-PXR and pGL4.17-CYP3A4 cotransfected,Quercetin,Luteolin,Kaempferol,Apigenin,Resveratrol have induced effect,three constituents' induc.tion effect had significant difference.CONCLUSION 12 kinds of Polygonum multiflorum Thunb.constit.uents have inhibitory or activating effects on CYP3A4,after the participation of PXR,9 components have induced effects on CYP3A4,and the induction effect of 6 components has significant difference.The results suggested that we should pay attention to potential drug interactions when combined with Polygonum multiflorum Thunb.,and improve safety and efficacy.

Meta-analysis of clinical efficacy and safety of kidney Tonifying therapy in the treatment of interstitial lung disease

Objective:To evaluate the efficacy and safety of kidney tonifying therapy in the treatment of Interstitial Lung Disease(ILD).Methods:We searched Wanfang Data,CNKI,CBM,VIP,Pub Med,EMBASE,Web of science and Cochrane Library for Randomized Controlled Trials(RCTs)of kidney tonifying therapy in the treatment of ILD.The retrieval time was from the establishment of the database to December 15,2020.Rev man 5.3 software was used to analyze and summarize the collected literature,and the methodological quality of the included studies was evaluated by the bias risk assessment scale of Cochrane Collaboration Network.Results:A total of 15 articles with 1045 patients were included.The results of meta-analysis showed that compared with the control group treated with conventional western medicine alone,kidney tonifying therapy or combined with conventional western medicine was beneficial to improve the clinical total effective rate[RR=1.33(95%CI 1.24-1.43),P<0.00001].At the same time,compared with the control group treated with routine western medicine,kidney tonifying therapy or combined with routine western medicine can improve cough and wheezing symptoms of patients[MD=-0.62(95%CI-0.78~-0.46),P<0.00001]and MD=-0.79(95%CI-0.18~-0.49),P<0.00001].However,there was no significant improvement in 6-minute walk test and lung function(DLCO%)(P>0.05);only one study reported 7 patients with adverse reactions,but after corresponding treatment,the symptoms were significantly relieved.The analysis of the characteristics of intervention measures in the treatment group showed that there were a total of 80 traditional Chinese medicines involved,of which Shu Dihuang appeared the most frequently,and the tonic drugs were used the most.The two meridians of the lung and kidney appear most frequently.Among the four qi and five flavors,warm and sweet medicines have the highest frequency.Conclusion:Adopting kidney-tonifying method or combined with conventional Western medicine treatment can improve the total clinical effectiveness of patients.Adopting kidney-tonifying method or combined with conventional Western medicine treatment to improve symptoms such as coughing and wheezing.No serious adverse reactions have been reported,and the safety is reliable.Due to the low quality of the included literature,the results of this study need to be verified by high-quality,large sample randomized controlled trials.

Successful Treatment of Coronavirus Disease with Integrated Traditional Chinese and Western Medicine: A Case Report

Background:Coronavirus disease(COVID-19)is a new outbreak infectious disease,caused by severe acute respiratory syndrome coronavirus 2.Nearly 80,000 people have got infected in China in just 2 months.Up to now,there still has no specific effective treatment for this disease.While integrated traditional Chinese and Western medicine has definite curative effect,could significantly reduce the disease mortality and shorten the course of treatment.Case Report:Here we report a 31-year-old female case of COVID-19 in a family cluster in Beijing.She reported low fever,cough with a little white sputum,fatigue,watery diarrhea,anorexia on admission.The COVID-19 in Traditional Chinese Medicine(TCM)belonged to plagues caused by dampness toxin.The patient was treated with TCM from dampness combined with antiviral drug abidol.After four visits,the patient was significantly improved with symptoms disappearing,chest-computed tomography dissipating,viral nucleic acid turning negative.She discharged and donated 200 ml convalescent plasma after 19 days hospitalization.Conclusion:The present case demonstrated that integrated traditional Chinese and Western medicine could treat COVID-19 effectively.However,clinical randomized controlled trials are warranted to verify the precise clinical efficacy.

Respiratory Failure, Hepatic Failure, and Hemoptysis with Thrombocytopenia in a 79-Year-Old Man

To the Editor： Langerhans cell histiocytosis （LCH） is a rare disease that usually occurs in the first two decades of life. Multisystem-LCH （MS-LCH） mainly affects youth. Bone, lung, and skin are the most common systems involved. Here, we report a case from China of MS-LCH in a 79-year-old patient with bone marrow, liver, spleen, and lung involvement, but without bone and skin involvement.