微粉化对栀子等20种植物药细胞组织的影响

目的 通过显微镜直观20种植物药的细粉与微粉，并对细胞尺度进行比较，揭示一般粉碎细粉150～180μm的颗粒中大多数细胞组织是完整的。而微粒47μm以下细胞组织中大多破碎。破壁细胞中的内容物可直接接触溶媒其主要成分可以全部直接进入溶媒被人体吸收，从而达到提高药材利用度。方法 采用柴田粉碎机、ZM型震动粉碎机处理20种植物药，并对细粉、微粉采用显微镜图像分析仪直观比较细胞组织及尺度。结果 显微直观20种植物药微粉与细粉尺度，微粉化工艺有助于药材有效成分的溶出。结论 微粉与细粉的比较。微粉细胞组织破壁率大于细粉。

Surgery for Crohn's disease in the era of biologicals:A reduced need or delayed verdict?

Crohn's disease(CD) is a chronic inflammatory bowel disease that can affect the entire gastrointestinal tract.Ultimately,up to 70% of all patients will need surgery,despite optimized medical therapy.Moreover,about half of the patients will need redo-surgery because of disease recurrence.The introduction of anti-tumor necrosis factor(TNF) drugs(Infliximab in 1998) revolutionized the treatment of CD.Different randomized trials assessed the efficacy of anti-TNF treatment not only to induce,but also to maintain,steroid-free remission.Furthermore,these agents can rapidly lead to mucosal healing.This aspect is important,as it is a major predictor for long-term disease control.Subgroup analyses of responding patients seemed to suggest a reduction in the need for surgery at median-term follow up(1-3 years).However if one looks at population surveys,one does not observe any decline in the need for surgery since the introduction of Infliximab in 1998.The short follow-up term and the exclusion of patients with imminent surgical need in the randomized trials could bias the results.Only 60% of patients respond to induction of anti-TNF therapy,moreover,some patients will actually develop resistance to biologicals.Many patients are diagnosed when stenosing disease has already occurred,obviating the need for biological therapy.In a further attempt to change the actual course of the disease,top down strategies have been progressively implemented.Whether this will indeed obviate surgery for a substantial group of patients remains unclear.For the time being,surgery will still play a pivotal role in the treatment of CD.

Albendazole versus metronidazole treatment of adult giardiasis:An open randomized clinical study

AIM:To investigate the efficacy and tolerability of albendazole and metranidazole treatment in giardiasis. METHODS:The open comparative randomized trial was carried out prospectively from December 1999 to July 2001 in Duzce City of Turkey.The diagnosis was based on the presence of signs and symptoms compatible with giardiasis including a positive stool examination of giardia cysts or trophozoite.Metranidazole group consisted of 29 patients and was given metranidazole 500 mg,three times a day for 5 d and albendazole group was consisted of 28 patients and was given albendazole 400 mg/d for 5 d. RESULTS:There were no significant differences in demographical and therapeutical effects and patient's compliance between both groups.But side effects were seen more in metranidazole group than in albendazole group. CONCLUSION:Albendazole is as effective as metranidazole in adults' giardiasis.Albendazole has less side effect potentials than metranidazole in the treatment of giardiasis.

Effects of telbivudine and entecavir for HBeAg-positive chronic hepatitis B: A meta-analysis

AIM:To compare the effects of telbivudine (LDT) and entecavir (ETV) in treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B by meta-analysis. METHODS:We conducted a literature search using PubMed, MEDLINE, EMBASE, the China National Knowledge Infrastructure, the VIP database, the Wanfang database and the Cochrane Controlled Trial Register for all relevant articles published before April 1, 2012. Randomized controlled trials (RCTs) comparing LDT with ETV for treatment of HBeAg-positive chronic hepatitis B were included. The data was analyzed with Review Manager Software 5.0. We used relative risk (RR) as an effect measure, and reported its 95% CI. Meta-analysis was performed using either a fixedeffect or random-effect model, based on the absence or presence of significant heterogeneity. Two reviewers assessed the risk of bias and extracted data indepen- dently and in duplicate. The analysis was executed using the main outcome parameters including hepatitis B virus (HBV) DNA undetectability, alanine aminotransferase (ALT) normalization, HBeAg loss, HBeAg seroconversion, drug-resistance, and adverse reactions. Meta-analysis of the included trials and subgroup analyses were conducted to examine the association between pre-specified characteristics with the therapeutic effects of the two agents. RESULTS:Thirteen eligible trials (3925 patients in total) were included and evaluated for methodological quality and heterogeneity. In various treatment durations of 4 wk, 8 wk, 12 wk, 24 wk, 36 wk, 48 wk, 52 wk, 60 wk and 72 wk, the rates of HBV DNA undetectability and ALT normalization in the two groups were similar, without statistical significance. At 4 wk and 8 wk of the treatment, no statistical differences were found in the rate of HBeAg loss between the two groups, while the rate in the LDT group was higher than in the ETV group at 12 wk, 24 wk, 48 wk and 52 wk, respectively (RR 2.28, 95% CI 1.16, 7.03, P = 0.02; RR 1.45, 95% CI 1.16, 1.82, P = 0.001; RR 1.45, 95% CI 1.11, 1.89, P = 0.006; and RR 1.86, 95% CI 1.04, 3.32, P = 0.04). At 4 wk, 8 wk, 60 wk and 72 wk of the treatment, there were no significant differences in the rate of HBeAg seroconversion between the two groups, while at 12 wk, 24 wk, 48 wk and 52 wk, the rate in the LDT group was higher than in the ETV group (RR 2.10, 95% CI 1.36, 3.24, P = 0.0008; RR 1.71, 95% CI 1.29, 2.28, P = 0.0002; RR 1.86, 95% CI 1.36, 2.54, P < 0.0001; and RR 1.87, 95% CI 1.21, 2.90, P = 0.005). The rate of drug-resistance was higher in the LDT group than in the ETV group (RR 3.76, 95% CI 1.28, 11.01, P = 0.02). In addition, no severe adverse drug reactions were observed in the two groups. And the rate of increased creatine kinase in the LDT group was higher than in the ETV group (RR 5.58, 95% CI 2.22, 13.98, P = 0.0002). CONCLUSION:LDT and ETV have similar virological and biomedical responses, and both are safe and well tolerated. However, LDT has better serological response and higher drug-resistance.

Long-term stroke rates after catheter ablation or antiarrhythmic drug therapy for atrial fibrillation： a meta-analysis of randomized trials

Background Atrial fibrillation （AF） is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. Methods ＆ Results PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences （RDs） and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients （0.64%） in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients （0.23%） in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy （RD： 0.003, 95% CI： -0.006 to 0.012, P = 0.470）, and no evidence of heterogeneity was observed （I^2 = 0, P = 0.981）. No potential publication bias was found. There was also no difference in mortality between the two groups （RD： -0.004, 95% CI： -0.014 to 0.006, P = 0.472）. Conclusions This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.

Effect of Sanhuangwuji powder,anti-rheumatic drugs,and ginger-partitioned acupoint stimulation on the treatment of rheumatoid arthritis with peptic ulcer:a randomized controlled study

OBjECTIVE:To observe the efficacy and safety of oral Sanhuangwuji powder,anti-rheumatic drugs(ARDs),and ginger-partitioned acupoint stimulation at Zusanli(ST 36) on the treatment of rheumatoid arthritis(RA) complicated by peptic ulcer.METHODS:This prospective randomized controlled study included 180 eligible inpatients and outpatients randomly assigned to an ARD treatment(n = 60),ginger-partitioned stimulation(n =60),or combination treatment(n = 60).Patients assigned to the ARD group were given oral celecoxib,methotrexate,and esomeprazole.Patients assigned to theginger-partitioned stimulation group were given ginger-partitioned acupoint stimulation at Zusanli(ST 36) in addition to the ARDs.Patients in the combination treatment group were given oral Sanhuangwuji powder,ginger-partitioned acupoint stimulation at Zusanli(ST 36),and ARDs.All patients were followed up for 2 months to evaluate clinical effects and safety.The study was registered in the World Health Organization database at the General Hospital of Chengdu Military Area Command Chinese People's Liberation Army(ChiCTR-TCC12002824).RESULTS:The combination treatment group had significantly greater improvements in RA symptoms,laboratory outcomes,and gastrointestinal symptom scores,compared with the other groups(P < 0.05).The peptic ulcer healing rate in the combination treatment group was significantly greater than that in the ARD treatment group(x^2 = 16.875,P < 0.05) and the ginger-partitioned stimulation group(x^2 = 6.171,P<0.05).CONCLUSION:Combination treatment with ginger-partitioned acupoint stimulation at Zusanli(ST36),oral Sanhuangwuji powder,and ARDs had a better clinical effect for RA with complicated peptic ulcer,compared with ARD treatmentalone or in combination with ginger-partitioned acupoint stimulation.

Potassium dehydroandrographolide succinate injection for treatment of infantile pneumonia:a systematic review and Meta-analysis

OBJECTIVE:To evaluate systematically the clinical efficacy and safety of potassium dehydroandrographolide succinate injection(PDS) in treatment of infantile pneumonia.METHODS:Randomized controlled trials(RCTs) of infantile pneumonia treated by PDS were searched in China National Knowledge Infrastructure Database,China Science and Technology Journal Database,Wanfang Database,Chinese Biomedical Literature Database,PubMed,and Cochrane Library,from January 1979 to July 2013.Two reviewers independently retrieved the RCTs and extracted the information.The quality of included studies was assessed by the Cochrane risk of bias,and a Meta-analysis was conducted with Review Manager 5.2 software.RESULTS:A total of 9 studies with 1056 participants were included.The quality of the studies was generally no high,only one study mentioned the random method.The Meta-analysis indicated that PDS was significantly superior to the conventional therapy in the total effective rate[relative risk(RR)=1.21,95%CI(1.14,1.27),P<0.000 01],the time of temperature recovery[mean difference(MD)=-1.43,95%CI(-1.75,-1.11),P<0.000 01],rale disappeared and cough relieving[MD=-1.44,95%CI(-1.93,-0.90),P<0.000 01].Six adverse drug reactions from five studies mainly represented rash and diarrhea,and no serious ADRs were reported.CONCLUSION:Based on this systematic review,PDS was proved effective and relatively safe in treatment of infantile pneumonia.However the articles enrolled in the study were not high in quality,studies with higher quality should be conducted for assessment of efficacy and safety of PDS in treatment of infantile pneumonia.