基于“脑玄府失调-血脑屏障受损”理论探讨创伤后应激障碍的辨治思路

近年来疫情肆虐,灾难多发,创伤后应激障碍的发病率逐年上升。玄府理论由来已久,经后世发挥,在各学科的临床应用中显示了突出的疗效,尤其是脑相关疾病。本文基于中医脑玄府理论,结合大脑微观结构血脑屏障探讨创伤后应激障碍的发病机制,血脑屏障受损参与了创伤后应激障碍的发生发展,血脑屏障与中医脑玄府理论在生理、病理上密切相关,认为脑玄府失调-血脑屏障受损是创伤后应激障碍的核心病机,扶正补玄、祛邪清玄和安神养玄为创伤后应激障碍核心治法,虫类、风类药物是治疗创伤后应激障碍的要药,以期为创伤后应激障碍的治疗提供新的思路与方法。

基于玄府理论探讨手足综合征论治

基于玄府理论,文章认为玄府郁闭、气液宣通失常是手足综合征的核心病机,从化疗药物戕害阳气,玄府失养而开阖不利,到玄府郁闭,阳郁化热,日久郁热生燥,玄府气津不布,肌肤失润,玄府因虚致郁,又因郁致虚,玄府郁闭始终贯穿手足综合征发生发展过程。对此以开玄通府为总治则,提出温阳开玄、清热通玄、养阴润玄等治法,并始终重视风类药物的应用,为手足综合征的临床诊疗提供新思路与新方法。

李佩文教授基于“骨玄府”理论辨治乳腺癌骨转移经验

基于玄府理论,骨玄府发挥着沟通内外、运行气血、滋养骨骼、支撑运动的作用,具有以通为用,贵开忌阖的特点。李佩文教授分别从气、痰、瘀、毒互结致骨玄府郁闭及精、气、血、津亏虚使骨玄府痿闭两方面解析乳腺癌骨转移的发病及进展原因,提出本病核心病机为骨玄府失和。李佩文教授以调养玄府为关键治则治法,以开通玄府与充养玄府为治疗总纲,通过行气通玄、化痰利玄、化瘀开玄、解毒护玄以开解玄府郁结,益气充玄、补血养玄、生津润玄、填精补玄以补充玄府营养。风药具有辛散窜透之性,不仅发挥行气、化痰、活血、解毒等功效,开通骨玄府,且引诸药达病位发挥疗效,是治疗乳腺癌骨转移的要药。根据辨证分型选择逍遥散、大黄■虫丸、补中益气汤、龟鹿二仙胶等为主方,随证灵活配伍风药,疗效确切,为临床治疗乳腺癌骨转移提供了重要的思路。

Treatment of dyslipidemia in the elderly

Dyshpidemia is a well-established risk factor for atherosclerosis. Treating dyslipidemia in elderly patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.

Bisphosphonate use and gastrointestinal tract cancer risk:Meta-analysis of observational studies

AIM:To perform a meta-analysis of observational studies to further elucidate the relationship between oral bisphosphonate use and gastrointestinal cancer risk.METHODS:Systematic literature search was conducted in MEDLINE,EMBASE,and the Cochrane Library to identify studies through January 2011.Search terms were "bisphosphonates" or trade names of the drugs,and "observational studies" or "cohort studies" or "case-control studies".Two evaluators reviewed and selected articles on the basis of predetermined selection criteria as followed:(1) observational studies(casecontrol or cohort studies) on bisphosphonate use;(2) with at least 2 years of follow-up;and(3) reported data on the incidence of cancer diagnosis.The DerSimonian and Laird random effects model were used to calculate the pooled relative risk(RR) with 95% confidence interval(CI).Two-by-two contingency table was used to calculate the outcomes not suitable for meta-analysis.Subgroup meta-analyses were conducted for the type of cancer(esophageal,gastric and colorectal cancers).Sensitivity analyses were performed to examine the effect sizes when only studies with long-term follow-up(mean 5 years;subgroup 3 years) were included.RESULTS:Of 740 screened articles,3 cohort studies and 3 case-control studies were included in the analyses.At first,4 cohort studies and 3 case-control studies were selected for the analyses but one cohort study was excluded because the cancer outcomes were not categorized by type of gastrointestinal cancer.More than 124 686 subjects participated in the 3 cohort studies.The mean follow-up time in all of the cohort studies combined was approximately 3.88 years.The 3 casecontrol studies reported 3070 esophageal cancer cases and 15 417 controls,2018 gastric cancer cases and 10 007 controls,and 11 574 colorectal cancer cases and 53 955 controls.The percentage of study participants who used bisphosphonate was 2.8% among the cases and 2.9% among the controls.The meta-analysis of all the studies found no significant association between bisphosphonate use and gastrointestinal cancer.Also no statistically significant association was found in a meta-analysis of long-term follow-up studies.There was no negative association between bisphosphonate use and the incidence of esophageal cancer in the overall analysis(RR 0.96,95% CI:0.65-1.42,I 2 = 52.8%,P = 0.076) and no statistically significant association with long-term follow-up(RR 1.74,95% CI:0.97-3.10,I 2 = 58.8%,P = 0.119).No negative association was found in the studies reporting the risk of gastric cancer(RR 0.89,95% CI:0.71-1.13,I 2 = 0.0%,P = 0.472).In case of colorectal cancer,there was no association between colorectal cancer and bisphosphonate use(RR 0.62,95% CI:0.30-1.29,I 2 = 88.0%,P = 0.004) and also in the analysis with long-term follow-up(RR 0.61,95% CI:0.28-1.35,I 2 = 84.6%,P = 0.011).CONCLUSION:Oral bisphosphonate use had no significant effect on gastrointestinal cancer risk.However,this finding should be validated in randomized controlled trials with long-term follow-up.

Meta-analysis of the effect of statin use and pancreatic cancer risk

Statin has been proposed to have a capacity to reduce the risk of pancreatic cancer,while the obtained results are not consistent.To gain a clearer picture of the relationship between statin use and pancreatic cancer,the present meta-analysis took into consideration data from eight cohort studies,ten case-control studies and three RCTs.We searched all relevant studies on the effect of statin use on the risk of pancreatic cancer using PubMed,Embase and the Cochrane library database from inception to July 30,2018.The following search terms were used:(1)statin("statins","statin","3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors","atorvastatin","cerivastatin","fluvastatin","lovastatin","pravastatin","rosuvastatin","simvastatin");(2)pancreatic cancer("cancer","neoplasm","malignancy").We manually examined the references of the relevant articles and reviews to identify additional studies.A total of 21 studies,published between 2001 and July 2018 and involving 1148680 cases and 2177842 controls,fulfilled the selection criteria.The pooled results revealed a significant relationship between statin use and pancreatic cancer risk(OR=0.84,95%CI 0.72-0.98,P=0.000,I^2=84.30).However,lipophilic statins(OR=1.07,95%CI 0.97-1.18,P=0.651,I^2=0.0%)had no significant effect on the risk of pancreatic cancer.In contrast,short-term statin use(OR=0.72,95%CI 0.54-0.96,P=0.000,I^2=80.1%)and long-term statin use(OR=0.70,95%CI 0.54-0.92,P=0.000,12=79.8%)significantly reduced pancreatic cancer risk.Notably,the high heterogeneity among the selected studies was eliminated by excluding the three studies that focused on restricted populations.Statin could significantly reduce the risk of pancreatic cancer.