化药合并三黄清胃丸治疗寒热错杂型消化性溃疡的疗效评价

目的:评价三黄清胃丸治疗寒热错杂型消化性溃疡的临床疗效。方法:选取2013年1月至2013年12月我院门诊和住院收治的寒热错杂型消化性溃疡患者94例,随机分为对照组和治疗组各47例,对照组给予化药治疗,治疗组在化药治疗的基础上加三黄清胃丸内服。评价胃镜疗效、Hp疗效、中医症候疗效以及不良反应发生情况和远期复发情况。结果:经过4周治疗后,治疗组痊愈率为65.96%,总有效率为93.62%,显著高于对照组的51.06%和82.98%(P<0.05);治疗组治疗后14C-DPM值均显著低于治疗前和对照组,且Hp转阴率显著高于对照组(P<0.05);治疗组痊愈率和总有效率明显高于对照组(P<0.05),但不良反应发生率和远期复发率均显著低于对照组(P<0.05)。结论:与单纯的化药治疗相比,加服三黄清胃丸治疗寒热错杂型消化性溃疡能显著提高近远期临床疗效,且不良反应较少。

祛痰／抗氧化药治疗慢性阻塞性肺疾病中国专家共识

慢性阻塞性肺疾病简称慢阻肺，是以持续性气流受限且呈进行性发展为特征，可以预防和治疗的疾病。我国对7个地区20245名成年人进行调查，结果显示40岁以上人群中慢阻肺的患病率高达8．2％。全球疾病负担研究发现，2013年慢阻肺在中国疾病负担排名居第4位。其急性加重会加速肺功能下降，降低生活质量，并产生极高的医疗费用。因急性加重入院治疗≥3次的慢阻肺患者死亡风险比无急性加重患者高出4倍。

家属互动参与模式对氧气驱动雾化给药治疗肺炎患儿的干预效果

目的探讨家属互动参与模式对氧气驱动雾化给药治疗肺炎患儿的干预效果。方法选择我院儿科进行氧气驱动雾化给药治疗的肺炎患儿88例,随机将其分为对照组与观察组各44例。给予对照组常规护理,观察组在对照组基础上实施家属互动参与模式护理,对比2组干预效果。结果观察组治疗总有效率为95.5%,明显高于对照组的81.8%(P<0.05);观察组患儿的各项临床症状消失时间均较对照组短(P<0.05);观察组患儿的治疗依从性及家长护理满意度分别为93.2%,97.7%,显著高于对照组的77.3%,84.1%(P<0.05)。结论在肺炎患儿接受氧气驱动雾化给药治疗过程中实施家属互动参与模式护理,可加快患儿病情恢复,提升患儿治疗依从性及家长护理满意度,值得大力推广。

“替尼类”抗肿瘤新药迎来并喷

酪氨酸激酶抑制剂是近10年来脱颖而出的抗肿瘤小分子靶向制剂，研发管线中的新产品接二连三的进入临床。在学术推广与临床适应症拓宽的带动下，这一类药物表现的特异性作用，抑制了癌细胞的生长，显示出抗肿瘤化药治疗的优势。在群雄逐鹿的新药治疗领域中，预示着未来抗肿瘤药物研发的发展方向。

乳癌晚期并发症辨证治疗探要

乳癌晚期 ,包括乳癌已经通过手术治疗后和不能手术治疗者 ,再通过放疗、化疗以后所产生的常见并发症 ,如先出现以饮食减少为主的肢体乏力精神萎靡 ;继则见白细胞急剧下降、贫血或全血减少 ;再则可有患侧肢水肿、全身浮肿和口干、烦躁乃至低热持续不退以及全身疼痛等 。

Cytochrome P450 Directed Prodrug Activation Therapy in Research of Cancer Enzymology

Cancer enzymology is a promising filiation of bio-medical sciences. In thepast decades, enzymes, such as GST(glutathione S-transferase) , PKC(protein kinase C) , Topo(DNAtopoisomerases), TK(tyrosine kinase), CD (bacterial cytosine deaminase), CPG2(carboxypeptidase G2) ,and PNP (purine nucleoside phosphorylase), have been known to bear close relations to cancer. Theirspecific expression and influence on the process of tumor initiation, promotion and progressionattract scientists to apply them as a biochemical marker of certain malignant tumor, a predictor ofresponse in cancer chemotherapy; to apply them to drug design, tumor prevention and as adjuvant toradiotherapy or surgery.

CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE PLUS ATOMIZED HERBAL MEDICINE IN THE TREATMENT OF LUMBAR INTERVERTEBRAL DISC PROTRUSION

Objective To observe the therapeutic effect of acupuncture combined with atomized herbal medicine in the treatment of protrusion of lumbar intervertebral disc. Methods A total of 211 patients with lumbar intervertebral disc protrusion were randomized into two groups, with 106 cases being in trealment group and 105 in control group. The treatment was given once everyday, 12 days as one course of treatment. After two courses of treatment, the results were analyzed. Results The curative rate was 97.1% in the treatment group and 81.0% in the control group. Conclusion Acupuncture together with herbal medicine for the protrusion of lumbar intervetebral disc was better in effect than acupuncture only.

Antitumor and synergistic effect of Chinese medicine “Bushen huayu jiedu recipe” and chemotherapy on transplanted animal hepatocarcinoma

AIM： To investigate the antitumor and synergistic effect of Chinese medicine “Bushen huayu jiedu recipe” （recipe for invigorating the kidney, removing blood stasis and toxic substances） and chemotherapy on mice hepatocarcinoma. METHODS： Bushen huayu jiedu recipe （BSHYJDR） consisting of Chinese Cassia Bark, Psoralea, Zedoary, Rhubarb, etc. is equal to 1.5 g/mL liquid of originated herbs after being decoded, filtered, and concentrated. Kunming mice, weighing 18-22 g, were injected with 0.2 mL ascitic hepatocarcinoma H22 containing 1 × 10^7 cells/mL into armpit of the right forelimb of mice. After 24 h, the mice were weighed and randomly divided into tumor-bearing model control group, cisplatin （DDP） group, BSHYJDR high dosage group, low dosage BSHYJDR group, DDP combined with high and low dosage BSHYJDR group, 10 mice in each group. DDP group received injection intraperitoneally （ip） at the dosage of 1 mg/kg （equal to 1/10 LD50）, once a day for 4 d. High and low dosage BSHYJDR groups received intragastric BSHYJDR at the dosages of 26.6 and 13.3 g/kg （20 and 10 times each of clinical adult dosage） respectively, while tumor-bearing model group received the equal volume of distilled water once a day for 10 d. On the 11^th d, the mice were weighed and killed, then the tumor was dissected and weighed, the repression rate （RR） was calculated according to the mean weight of tumor （MWT）. RESULTS： Compared to the model group （MWT： 1.30±0.73）, DDP group （MWT： 0.41±0.09, RR： 68.46%） had a significant difference in the inhibition of hepatocarcinoma H22 （P〈0.01）. High dosage BSHYJDR group （MWT： 0.69±0.29, RR： 46.92%） also had a significant difference in inhibition （P〈0.05）, while no difference was found in low dosage BSHYJDR group （MVVT： 0.85±0.34, RR： 34.62%） （P〉0.05）. When DDP was combined with high dosage BSHYJDR （MWT： 0.29±0.17, RR： 77.69%） and low dosage BSHYJDR （MWT： 0.38±0.21, RR： 70.77%） respectively, we could see improvement of the inhibition effect of DDP on transplanted hepatocarcinoma H22. DDP combined with high dosage BSHYJDR had a significant difference （P〈0.001） compared to DDP, while DDP combined with low dosage BSHYJDR only had a little improvement that is not remarkable. CONCLUSION： Chinese medicine BSHYJDR in combination with chemotherapy can inhibit transplanted hepatocarcinorna in mice.

Importance of performance status for treatment outcome in advanced pancreatic cancer

Despite progress in the treatment of advanced and metastatic pancreatic cancer （PC）, the outcome of this disease remains dismal for the majority of patients. Given the moderate efficacy of treatment, prognostic factors may help to guide treatment decisions. Several trials identified baseline performance status as an important prognostic factor for survival. Unfit patients with a Kamofsky performance status （KPS） below 70% only have a marginal benefit from chemotherapy with gemcitabine （Gem） and may often benefit more from optimal supportive care. Once, however, the decision is taken to apply chemotherapy, KPS may be used to select either mono- or combination chemotherapy. Patients with a good performance status （KPS = 90%-100%） may have a significant and clinically relevant survival benefit from combination chemotherapy. By contrast, patients with a poor performance status （KPS ≤ 80%） have no advantage from intensified therapy and should rather receive single-agent treatment.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Drug treatment of functional dyspepsia

Symptomatic improvement of patients with functional dyspepsia after drug therapy is often incomplete and obtained in not more than 60% of patients. This is likely because functional dyspepsia is a heterogeneous disease. Although great advance has been achieved with the consensus definitions of the Rome I and II criteria, there are still some aspects about the definition of functional dyspepsia that require clarification. The Rome criteria explicitly recognise that epigastric pain or discomfort must be the predominant complaint in patients labelled as suffering from functional dyspepsia. However, this strict definition can create problems in the daily primary care clinical practice, where the patient with functional dyspepsia presents with multiple symptoms. Before starting drug therapy it is recommended to provide the patient with an explanation of the disease process and reassurance. A thorough physical examination and judicious use of laboratory data and endoscopy are also indicated. In general, the approach to treat patients with functional dyspepsia based on their main symptom is practical and effective. Generally, patients should be treated with acid suppressive therapy using proton-pump inhibitors if the predominant symptoms are epigastric pain or gastroesophageal reflux symptoms. Although the role of Helicobacter pylori （H pylon） in functional dyspepsia continues to be a matter of debate, recent data indicate that there is modest but clear benefit of eradication of H pylori in patients with functional dyspepsia. In addition, H pylori is a gastric carcinogen and if found it should be eliminated. Although there are no specific diets for patients with FD, it may be helpful to guide the patients on healthy exercise and eating habits.

Effect of Qi-protecting powder (Huqi San) on expression of c-jun, c-fos and c-myc in diethylnitrosamine-mediated hepatocarcinogenesis

To study the inhibitory effect of Huqi San （Qi- protecting powder） on rat prehepatocarcinoma induced by diethylinitrosamine （DEN） by analyzing the mutational activation of c-fos proto-oncogene and over-expression of c-jun and c-myc oncogenes. METHODS： A Solt-Farber two-step test model of prehepatocarcinoma was induced in rats by DEN and 2-acetylaminofluorene （AAF） to investigate the modifying effects of Huqi San on the expression of c-jun, c-fos and c-myc in DEN-mediated hepatocarcinogenesis. Huqi San was made of eight medicinal herbs containing glycoprival granules, in which each milliliter contains 0.38 g crude drugs. T-glutamy-transpeptidase-isoenzyme （T-GTase） was determined with histochemical methods. Level of 8-hydroxydeoxyguanosine （OHdG） formed in liver and c-jun, c-fos and c-myc proto-oncogenes were detected by immunohistochemical methods. RESULTS： The level of 8-OHdG, a mark of oxidative DNA damage, was significantly decreased in the liver of rats with prehepatocarcinoma induced by DEN who received 8 g/kg body weight or 4 g/kg body weight Huqi San before （1 wk） and after DEN exposure （4 wk）. Huqi San- treated rats showed a significant decrease in number of T-GT positive foci （P 〈 0.001, prevention group： 4.96-0.72 vs 29.46-2.17; large dose therapeutic group： 7.53-0.88 vs 29.46-2.17）. On the other hand, significant changes in expression of c-jun, c-fos and c-myc were found in Huqi San-treated rats. CONCLUSION： Activation of c-jun, c-fos and c-myc plays a crucial role in the pathogenesis of liver cancer.Huqi San can inhibit the over-expression of c-jun, c-fos and c-myc oncogenes and liver preneolastic lesions induced by DEN.

Epinephrine injection therapy versus a combination of epinepnrine injection and endoscopic hemoclip in the treatment of bleeding ulcers

AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.

Atherosclerosis： from biology to pharmacological treatment

A recent explosion in the amount of cardiovascular risk has swept across the globe. Primary prevention is the preferred method to lower cardiovascular risk. Lowering the prevalence of obesity is the most urgent matter, and is pleiotropic since it affects blood pressure, lipid profiles, glucose metabolism, inflammation, and atherothrombotic disease progression. Given the current obstacles, success of primary prevention remains uncertain. At the same time, the consequences of delay and inaction will inevitably be disastrous, and the sense of urgency mounts. Pathological and epidemiological data confirm that atherosclerosis begins in early childhood, and advances seamlessly and inexorably throughout life. Risk factors in childhood are similar to those in adults, and track between stages of life. When indicated, aggressive treatment should begin at the earliest indication, and be continued for many years. For those patients at intermediate risk according to global risk scores, C-reactive protein, coronary artery calcium, and carotid intima-media thickness are available for further stratification. Using statins for primary prevention is recommended by guidelines, is prevalent, but remains under prescribed. Statin drugs are unrivaled, evidence-based, major weapons to lower cardiovascular risk. Even when low density lipoprotein cholesterol targets are attained, over half of patients continue to have disease progression and clinical events. Though clinical evidence is incomplete, altering or raising the blood high density lipoprotein cholesterol level continues to be pursued. The aim of this review is to point out the attention of key aspects of vulnerable plaques regarding their pathogenesis and treatment.

Concomitant-chemoradiotherapy-associated oral lesions in patients with oral squamous-cell carcinoma

Objective:Oral squamous-cell carcinoma(OSCC)accounts for >90% of oral cancers affecting adults mostly between the fourth to seventh decades of life.The most common OSCC treatment is concomitant chemoradiotherapy(CCRT)having both locoregional and distant control,but CCRT has acute and chronic toxic effects on adjacent normal tissue.This study aimed to determine the side effects of CCRT on the oral mucosa and to characterize the clinicopathology of oral lesions in patients with OSCC.Methods:This descriptive,cross-sectional study was certified by the Ethical Review Committee(UHS/Education/126-12/2728)of the University of Health Sciences,Lahore,Pakistan.OSSC patients(n=81)with various histological subtypes,grades,and stages were recruited,and findings on their oral examination were recorded.These patients received 70,90,and 119 Gy of radiotherapy dosages in combination with the chemotherapy drugs cisplatin and 5-fluorouracil.Data were analyzed using SPSS 20.0.Results:The most common presentation of OSCC was a nonhealing ulcer(63%) involving tongue(55.6%).Clinical findings included mucositis(92.6%)and xerostomia of mild,moderate,and severe degrees in 11.1%,46.9%,and 35.8% cases,respectively.Ulcers(87.7%),palpable lymph nodes(64.2%),limited mouth opening(64.2%)and fistula(40.7%) were also observed.In females,the association of radiotherapy dosage with limited mouth opening,xerostomia,and histological grading was statistically significant(P<0.05).The association of chemotherapy drugs with xerostomia(P=0.003)was also statistically significant.Conclusions:CCRT induced mucositis,xerostomia,and trismus in patients with OSCC.

Effective siRNA targets screening for human telomerase reverse transcriptase

AIM: To study the inhibitory effects of siRNAs targeting different hTERT sequences and to screen the effective siRNA sequence.METHODS: Five double-stranded siRNAs targeting coding and non-coding regions of hTERT gene were designed and synthesized by T7 transcription system in vitro. siRNA4sequence was screened by full length gene targeting technique and the rest of the siRNA sequences were selected randomly. After being purified by ethanol precipitation, the siRNAs were transfected to the human hepatocellular carcinoma cell (HepG2) by Lipofectamine 2000TM. At 48-72 h after siRNAs transfection, MTT assay,RT-PCR and Western-blot were applied to evaluate the effects of siRNAs on cell growth, mRNA and protein expression level of hTERT gene, respectively.RESULTS: Compared to the control cells, the cells treated with the five double-stranded siRNAs exhibited different degrees of inhibition of cell proliferation in a dose-dependent manner. siRNA2 and siRNA4, exhibited obvious effects of inhibiting hTERT mRNA and protein expression in HepG2cells.CONCLUSION: siRNAs targeting different hTERT sequences have significantly various inhibitory effects on hTERT gene expression. The siRNA sequence screened by full length gene targeting technique has comparable inhibitory effect with the rest siRNA sequences screened by random selection, suggesting that siRNAs and antisense oligonucleic acids may have the same effective target sites. Compared with chemical synthesis method,synthesizing double-stranded siRNA by T7 transcription system in vitro is a rapid, simple, and inexpensive method suitable for screening high-effect siRNA targeting site for specific gene.

HER2 over-expression and response to different chemotherapy regimens in breast cancer

Purpose: To exam the relationship between HER2 over-expression and different adjuvant chemotherapies in breast cancer. Patients and Methods: A total of 1625 primary breast cancer patients who received post-surgery adjuvant chemotherapy in Tianjin Cancer Hospital,China,from July 2002 to November 2005 were included in the study. Among them,600 patients were given CMF (CTX+MTX+5-Fu) regimen,600 given CEF (CTX+E-ADM+5-Fu) regimen,and 425 given anthracyclines plus taxanes regimen,with mean follow-up time of 42 months. Results: In CMF treatment group,the 3-year disease free survival (DFS) in HER2 over-expressed patients was lower than that of the HER2-negative ones (89.80% vs 91.24%,P=0.0348); in node-positive subgroup,the 3-year DFS was 84.72% in HER2 over-expressed patients,and 90.18% in the HER-2-negative ones (P=0.0271). Compared to CMF regimen,anthracyclines and anthracyclines plus taxanes regimens are more effective (P<0.05) in node-positive HER2 over-expression than those in the node-negative. Conclusion: HER2 over-expression is an independent index for predicting poor prognosis and short DFS for breast cancer patients. HER2 over-expressed patients are resistant to CMF regimen chemo-therapy,but sensitive to anthracyclines-based or anthracyclines plus taxanes regimen. HER2 expression can be taken as a marker for therapies in breast cancer.

Targeting key signalling pathways in oesophageal adenocarcinoma:A reality for personalised medicine?

Cancer treatments are rapidly changing.Curative treatment for oesophageal adenocarcinoma currently involves surgery and cytotoxic chemotherapy or chemoradiotherapy.Outcomes for both regimes are generally poor as a result of tumor recurrence.We have reviewed the key signalling pathways associated with oesophageal adenocarcinomas and discussed the recent trials of novel agents that attempt to target these pathways.There are many trials underway with the aim of improving survival in oesophageal cancer.Currently,phase 2 and 3 trials are focused on MAP kinase inhibition,either through inhibition of growth factor receptors or signal transducer proteins.In order to avoid tumor resistance,it appears to be clear that targeted therapy will be needed to combat the multiple signalling pathways that are in operation in oesophageal adenocarcinomas.This may be achievable in the future with the advent of gene signatures and a combinatorial approach.