Surgical treatment of metachronous rectal liver and lungmetastases： A combined videolaparoscopic andvideothoracoscopic approach

To the Editor：We read with tremendous interest the paper by Del Fabbroet al. [1]. In this thorough article, the authors meticulously underlinethe advantages of a modified j-shaped incision for the simultaneoustreatment of difficult liver colorectal metastases （CRM） and right-lung CRM, reporting their experience in a cohort of 11 patients.

Reply to： Surgical treatment of metachronous rectal liver andlung metastases： A combined videolaparoscopic and videothoracoscopic approach

The Author Reply：We thank Dr. Sucameli et al. for the interest toward our article[1] and for the opportunity for further discussing on this issue,providing a case report of single metastastic fore sites in the liverand lung both treated in a minimal access fashion. However, giventhe interest of the authors insight, it appears misleading when related to that discussed in our report which was clearly referred toother patients＇ profiles. Indeed, they described a case with a singleperipheral nodule in the right lung and a single liver metastasesin segment 5. This uncommon situation （less than 2% of patientsaccording to the LiverMetSurvey registry [2]）, is obviouslya more than reasonable indication for a mini-invasive approach.However, our patients received surgery for complex oncological involvementof the liver： as described, this means large and/or multiplelesions, in contact or invading the hepatic veins at caval confluence.For such conditions we have introduced original surgicalapproaches [3,4]： in such conditions we would select a J-shapedthoracophrenolaparotomy for the liver per se [5]. This incision forsuch complex conditions other than allowing the liver clearance in a single operation rather than in staged approach [6], allows justin case the removal of lung nodules. Therefore, we thank again theauthors for their interest to our report, and furthermore we congratulatefor the original management of the shared clinical case.However, the condition recalled by the authors is related to a scenariooncologically and surgically at the opposite side of that discussedin our paper and for that somehow suggesting a comparisonis misleading.

Anlotinib in combination with Envolizumab plus Etoposide for the treatment of EX-SCLC:a case report

Background:Small cell lung cancer(SCLC)is an aggressive malignant tumor with strong immunosuppressive effects,characterized by rapid doubling time and poor prognosis.Currently,effective therapeutic options are urgently needed for Extensive-stage small-cell lung Cancer.Case description:In the present case,a combination therapy of anlotinib,envolizumab,and etoposide was administered to treat an 80-year-old female patient with extensive-stage SCLC accompanied by mediastinal lymph node and bone metastasis.After two cycles of treatment,the tumor lesions in the right lungs decreased from 5.04*3.44 cm to 1.65*1.42 cm.As of now,no significant mass is seen there and no serious adverse reactions in this patient.Until September 2023,she has survived for 18 months with no disease progression.Conclusions:Research shows that Alectinib,in combination with evolocumab plus etoposide,could be an original,viable therapeutic option for the treatment option of patients with extensive-stage SCLC.

Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion

AIM To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.METHODS A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus,stomach, duodenum and jejunum), per anal (colon and rectum ) and percutaneous transhepatic ( biliary )installation of metallic stent. Among them, 205 cases received drug infusion by cannulation of tumor supplying artery with Seldingers technique.RESULTS Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8 - 43 weeks among those with intraarterial drug infusion, which was later than 4 - 26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3 - 105) weeks,which was significantly longer than 15 (3- 24) weeks of the latter group.CONCLUSION Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.

The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang on the concentration of trace elements in the main organs of COPD rats

Objective:To test two theories from traditional Chinese medicine:'exterior -interior relationship between the lung and large intestine' and 'treating from the intestine principle for lung disorders'.The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang (XBCQT) on the concentration of three trace elements-copper (Cu),zinc (Zn),and manganese (Mn)-was observed in the tissues of the lung,small intestine,large intestine,and stomach of rats suffering from chronic obstructive pulmonary disease (COPD).Methods:Thirty-five male Wistar rats were divided randomly and equally into five groups:control;model;Fei treatment (A);Chang treatment (B);and Fei-Chang treatment (C).A rat model of COPD was prepared by tracheal injection of lipopolysaccharide plus exposure to cigarette smoke.Treatments with medicinal herbs started day-22 of administration and exposure to cigarette smoke for 7 days.The control group and model group were administered physiologic (0.9%) saline solution via the stomach.After 7 days of intervention,the tissues of the lung,small intestine,large intestine,and stomach were removed.Inductively coupled plasma-atomic emission spectroscopy was used to detect the levels of Cu,Zn,and Mn in those tissues.Results:Compared with the control group,the Cu concentration in the tissues of the small intestine,large intestine,and stomach increased significantly in the model group (P <.05);the Mn concentration in the tissues of the lung,large intestine,and stomach increased significantly in the model group (P <.05);the Zn concentration in the tissues of the lung and large intestine decreased significantly in the model group (P <.05).In comparison of the model group:the Cu concentration in the tissues of the lung and large intestine decreased significantly in the B group (P <.05);the Mn concentration in the tissues of the lung,small intestine,and large intestine decreased significantly in the B group (P <.05);the Zn concentration in the tissues of the lung,small intestine,and large intestine increased significantly in the B group (P <.05).For the A group versus C group comparison,the Zn concentration in the tissues of the small intestine and stomach increased significantly in the latter (P <.05).Conclusion:This study showed that 'treating from the intestine' using Xuan Bai Cheng Qi Tang and its modified formulae can regulate the concentration of trace elements in the main organs of COPD rats.This may be one of the mechanisms for intestine-based treatment for COPD.

Unusual presentation of metastatic adenocarcinoma of the lung

On September 2013, a 62-year-old man with metastatic adenocarcinoma of the lung complained tenderness and pain of the first terminal phalange of his right hand. The biopsy confirmed metastatic adenocarcinoma of the lung to the finger. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient's right hand. The patient received magnetic resonance-guided focused ultrasound surgery treatment to the phalange because he showed few improvement of clinical symptoms and persistence of moderate pain after radiotherapy. After magnetic resonance-guided focused ultrasound surgery, the clinical symptoms improved significantly. No serious adverse effects were reported and the patient compliance was very high. Our patient showed improvement of clinical symptoms after combined treatment. The patient remains in good health conditions.

健脾祛湿和络方治疗特发性膜性肾病内涵探讨

从多维论治角度结合部分健脾祛湿和络方的研究进展,阐释健脾祛湿和络方有效治疗特发性膜性肾病(IMN)的中医学内涵。IMN以脾虚证、肾虚证为核心证候,健脾祛湿和络方立方以调理脾胃为基础,脾肾同治。从肺肾相关、肠肾相关、肺与大肠相表里等理论看,健脾祛湿和络方亦体现出了脾肺同治、肠肾同治、肠肺同治的中医学内涵,脾、肺、肠、肾相结合的多维论治是健脾祛湿和络方取效之根本。

基于“肺与大肠相表里”讨论调节肠道菌群在儿童肺炎中的应用

肺炎是儿童常见疾病,是导致5岁以下儿童死亡的主要原因之一,而细菌是发展中国家儿童肺炎中最常见的病原体,临床上治疗药物以抗生素为主,但全球细菌耐药形势严峻,已成为威胁人类健康的重要问题。中医认为,“肺与大肠相表里”,强调“肺肠同治”,现代医学提出“肺-肠轴”,发现肠道菌群的变化影响肺系疾病的发生、发展及转归,并提出通过干预菌群治疗肺系疾病。本文旨在讨论益生菌在儿童肺炎中肺肠同治作用,为临床治疗儿童肺炎提供新思路。

A Comparative Study of The Regular Pattern of Syndrome and Treatment of Lung-intestine Related Diseases in Ancient and Modern Medical Cases Based on Data Mining

Objective: To analyze the similarities and differences of the applications of "the lung and large intestine being interior-exteriorly related"between the ancient and modern clinical practices, and to reveal the theory meaning.Method: Based on the ancient and modern medical cases database, 245 ancient medical records and 373 modern medical records were studied with the general statistical description and analysis of association rules, and the results were compared to summarize the similarities and differences of the regular pattern of syndrome and treatment on lung-large intestine related diseases in ancient and modern medical records.Results: In modern medical cases, intestinal diseases appeared with the main symptom of constipation due to deficiency of lung qi and qi stagnation of large intestine were always treated by purgation together with replenishing and restoring lung qi. In ancient medical cases, large intestine heat was always caused by lung heat and a variety of diarrhea symptoms appeared. They were always treated by clearing heat and moistening lungs. In addition, the symptom of bound stool caused by qi stagnation of large intestine due to lung qi stagnation was always treated by lowering lung qi to regulate and smooth large intestine qi. And Armeniae Amarum Semen was used by both as a core medicinal herb.Conclusion: Ascending-descending of qi movement is the core of the lung and large intestine relationship. In other words, the lung and the large intestine communicate through qi.

基于“肺与大肠相表里”理论和“整体观念”探讨慢性肺系病合并功能性便秘的诊治思路

慢性肺系病和功能性便秘均是临床常见的难治性疾病,且易合并出现。对二者分别进行干预是现代医学的常规治疗模式,但疗效及安全性均不能令人满意。课题组在临床实践中发现,中医药治疗慢性肺系病合并功能性便秘具有独特的优势。笔者在中医“肺与大肠相表里”理论和“整体观念”指导下,提出慢性肺系疾病合并功能性便秘的病机涉及肺失宣肃致腑气不通、大肠传导失司致肺气上逆、脾失健运、肾精亏损、气血两虚、久病瘀滞等方面,治疗当以“肺肠合治”为总则,辅以健脾益肾、补气养血以扶本虚,行气化瘀以祛实邪,并据此整理临床常用方药,系统总结了本病的中医诊治思路。

汪悦教授应用肺肠合治法治疗原发性干燥综合征思路探析

原发性干燥综合征(pSS)是以口眼干为主要表现。中医认为,该病属“燥痹”范畴,病机多为津液失常。古人素有“肺主通调水道”“大肠主津”“肺与大肠相表里”之说,汪悦教授在此基础上守正创新,应用肺肠合治法治疗原发性干燥综合征,通过麦冬地芍汤加减化裁治疗该病,取得良好疗效。麦冬地芍汤功擅“养肺布津,增液润肠”,在pSS的治疗中有着“肺肠同润,充盈水道”“三络同治,布散肺津”“脏腑同养,未病先防”的特点。基础研究表明麦冬地芍汤可能通过VIP/cAMP/PKA/AQP5信号通路发挥作用,附验案一则以资佐证。

宣白承气汤对痰热壅肺型慢性阻塞性肺疾病急性加重期患者肠道微生态及炎症因子的影响

目的 观察宣白承气汤对慢性阻塞性肺疾病急性加重期(AECOPD)(痰热壅肺证)的临床疗效、肠道微生态、炎症指标及二氧化碳分压(PaCO_(2))的影响。方法 将80例AECOPD(痰热壅肺证)患者随机分为两组,对照组实施西医的常规治疗,观察组则另外加上宣白承气汤治疗,疗程均为7 d,观察并记录两组患者治疗前后中医证候积分、肠道微生物菌种丰度、C反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞百分比(N%)及PaCO_(2)的变化。结果 观察组临床疗效显著优于对照组(P<0.05)。治疗后,观察组咳嗽、喘息等中医证候积分显著低于对照组(P<0.05),两组患者乳杆菌、拟杆菌、双歧杆菌以及肠杆菌丰度均升高(P<0.05),且与对照组比较,观察组患者乳杆菌、拟杆菌、双歧杆菌以及肠杆菌丰度明显升高(P<0.05)。两组PaCO_(2)、CRP、PCT、N%较治疗前均降低(P<0.05),且低于同期对照组(P<0.05)。结论 宣白承气汤可改善AECOPD(痰热壅肺证)患者的临床症状及肠道微生态,可一定程度改善患者二氧化碳潴留,并有效降低患者CRP、PCT、N%比水平。

肠道菌群与肺癌相关研究进展

肺癌是世界上最致命和最常见的恶性肿瘤之一,肺癌的主要治疗方法包括手术、化疗、放疗、靶向治疗和免疫治疗等,随着这些治疗方案的成熟、改进,肺癌患者的预后明显改善,尤其靶向治疗药物的问世,使肺癌患者的生存期显著提高。然而,肺癌依旧是中国人群癌症死亡的主要原因,如何降低肺癌发生率、提高肺癌预后,仍是研究的热点。近年来,越来越多学者开始关注肠道菌群与肺癌之间的关系,大量研究发现肺癌患者肠道菌群的菌群构成、丰度与健康人群相比存在差异性,而肠道菌群本身或者其代谢产物可通过对宿主多系统的调节,影响肺肿瘤微环境、肺癌治疗药物的疗效及治疗相关副作用等。肠道菌群在肺癌发生发展以及后续治疗中都存在着不容忽视的影响力。

基于“肺与大肠相表里”综述中药干预肺系疾病对肺、肠组织炎性因子及菌群变化

肺是维系呼吸道健康的重要门户,各种原因如感染细菌或病毒、接触过敏原、吸烟、遗传因素等均可引起肺部疾病,引发不同程度的炎症反应。呼吸道感染可伴随不同程度的肠道症状,即“肺病及肠”,故“肺与大肠相表里”这一中医理论在临床对此类症状疾病的治疗中应用广泛,且疗效显著。文章通过对近年来相关文献的研究,试从肺、肠道组织炎症因子、菌群变化等角度出发,综述中医药治疗肺系疾病的作用机制及疗效,以期为日后的研究开展新方向。

ROS-responsive nanoparticles targeting inflamed colon for synergistic therapy of inflammatory bowel disease via barrier repair and anti-inflammation

The destruction of the intestinal barrier is likely to cause an increase in intestinal permeability and cause pathological damage.Numerous studies have demonstrated that intestinal barrier function plays an important role in the occurrence and development of inflammatory bowel disease(IBD).Oral administration is the most common route for intestinal diseases.In this study,a synergistic strategy is proposed for IBD management through active barrier repair combined with anti-inflammatory treatment,which can interrupt the pathological process of IBD,resulting in the significantly improved efficacy of existing treatments.Based on the specific pH values and high reactive oxygen species(ROS)levels in inflammatory sites of IBD,an orally administrated ROS-responsive drug delivery system targeting inflamed colon has been designed,and confirmed in vitro and in vivo.The anti-inflammatory drug dexamethasone acetate(Dex)and the barrier function regulator LY294002 are delivered by the synthesized nanocarrier to treat IBD synergistically by inhibiting inflammation and actively repairing the intestinal barrier through tight junctions(TJs).The accumulation of nanocarriers in the inflamed colon and synergistic efficacy has been validated in mice with colitis.In brief,a drug delivery system and a therapeutic strategy for IBD are successfully developed.

间质性肺疾病合并肺癌的机制及治疗进展

间质性肺疾病(interstitial lung disease,ILD)患者肺癌发生率高,合并ILD的肺癌患者生存期短、病死率高、治疗难度大。ILD及肺癌有共同的危险因素及相似的发病机制。肺癌治疗常可引起ILD及ILD急性加重。一些靶向两者相似发病机制的药物在肺癌合并ILD的治疗中展现出良好疗效。本文就ILD合并肺癌的发病机制、治疗风险及治疗进展进行综述,以期提高临床医师对该病的诊治水平。

肺肠合治法治疗脓毒症胃肠功能障碍患者的临床疗效及对其胃肠功能的影响

目的 探讨肺肠合治法治疗脓毒症胃肠功能障碍患者的临床疗效及对其胃肠功能的影响。方法 选取2020年10月—2022年2月期间常熟市中医院(新区医院)重症医学科收治的80例脓毒症胃肠功能障碍患者为研究对象,按随机数字表法将其分为对照组和研究组,每组各40例。对照组给予常规西医治疗,研究组在对照组治疗的基础上给予肺肠合治法治疗。均连续治疗7 d。观察比较两组患者临床疗效,治疗前后中医证候积分、胃肠功能、胃肠激素、炎症因子[降钙素(Proccalcitonin,PCT)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-4(Interleukin-4,IL-4)]水平及安全性。结果 治疗后研究组总有效率97.50%(39/40)明显高于对照组82.50%(33/40),差异有统计学意义(P<0.05)。治疗后两组患者中医证候身体发热、烦渴、腹部胀满、按之疼痛、胸痛、气促、口臭或口干积分均较治疗前降低,差异有统计学意义(P<0.05);且研究组中医证候身体发热、烦渴、腹部胀满、按之疼痛、胸痛、气促、口臭或口干积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者腹腔内压力、胃残留量、GIF评分均较治疗前降低,肠鸣音均较治疗前增多,差异有统计学意义(P<0.05);且研究组腹腔内压力、胃残留量、GIF评分均明显低于对照组,肠鸣音明显多于对照组,差异有统计学意义(P<0.05)。治疗后两组患者胃动素、血管活性肠肽水平均较治疗前升高,胃泌素水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组胃动素、血管活性肠肽水平均明显高于对照组,胃泌素水平低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PCT、TNF-α水平均较治疗前降低,IL-4水平均较治疗前升高,差异有统计学意义(P<0.05);且研究组PCT、TNF-α水平均明显低于对照组,IL-4水平明显高于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者均未出现不良反应,且便常规、尿常规、血常规均正常。结论 肺肠合治法能够有效调节脓毒症胃肠功能障碍患者胃肠功能,疗效显著。

“脑肠同治”针刺疗法治疗脑卒中后认知障碍的临床效果

目的观察“脑肠同治”针刺疗法治疗脑卒中后认知障碍(PSCI)的临床效果。方法选取2021年1月至2022年1月福建中医药大学附属康复医院收治的100例PSCI患者作为研究对象,采用随机数字表法分为对照组及治疗组,每组50例。对照组口服多奈哌齐,治疗组行针刺治疗及口服多奈哌齐。4周干预治疗后,比较两组患者有效率和治疗前后日常生活活动能力量表(ADL)、蒙特利尔认知评估测试(MoCA)、简易精神状态检查量表(MMSE)评分变化。结果治疗组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的ADL、MoCA、MMSE比较,差异无统计学意义(P>0.05);治疗后,两组患者的MMSE、MoCA、Barthel指数评分均高于本组治疗前,差异有统计学意义(P<0.05)。结论“脑肠同治”针刺疗法可提高PSCI患者的认知能力,提高患者的生活质量,具有较高的临床价值。

基于伏邪理论从“寒热-痰瘀-虚劳”角度分期辨治肺痿

肺痿是以肺叶痿弱为特征的慢性肺脏虚损性疾病,以咳唾涎沫、气短为主症,与现代医学特发性肺纤维化(IPF)相类似。临床以咳嗽、进行性呼吸困难、喘促胸闷为主要表现,甚则呼吸衰竭危及生命。肺痿属于古代疑难杂症,现代医学治疗亦十分棘手。汉代张机从“寒热-痰瘀-虚劳”的角度阐述了肺痿的主要病机,开创了治疗肺痿之先河。肺痿的病因病机复杂多样,病情迁延难愈,与伏邪理论“伏而不发”的特点不谋而合。因此,基于伏邪理论,结合中西医病机特点,进一步探讨肺痿早期、进展期、终末期3个阶段的分期论治思路,以期为肺痿不同阶段论治提供新的辨证论治思路。

非小细胞肺癌免疫检查点抑制剂相关性肺炎研究进展及中西医结合治疗

免疫检查点抑制剂(ICIs)主要包括细胞毒性T淋巴细胞抗原4(CTLA-4)抑制剂和程序性细胞死亡蛋白1/配体1(PD-1/PD-L1)抑制剂,为非小细胞肺癌(NSCLC)患者带来显著的治疗效益。但是,在增强机体抗肿瘤免疫反应的同时,ICIs产生免疫相关不良事件(irAEs),包括免疫检查点抑制剂相关性肺炎(CIP)。虽然CIP临床发病率较低,但在一些严重病例中可能导致免疫治疗的延迟或终止,甚至危害生命。本文拟从CIP的临床表现、病理特征、生物学机制、易感人群、诊断与鉴别诊断以及中西医结合治疗等角度进行总结,以期更加清晰地认识CIP。