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.

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.

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.

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.

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

AIM: To study the palliative treatment of malignant obstruction 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, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger's 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 intra-arterial 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 13 (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.

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.

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.

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.

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。

肺肠同治理论下宣白承气汤结合肠内营养支持在慢性阻塞性肺疾病急性加重期治疗中的应用价值

【目的】探析肺肠同治理论指导下宣白承气汤结合肠内营养支持在慢性阻塞性肺疾病急性加重(AECOPD)治疗中的应用价值。【方法】将92例AECOPD肺热腑实型患者随机分为观察组和对照组,每组各46例。2组患者均给予常规对症治疗,在此基础上,对照组给予肠内营养支持干预,观察组给予宣白承气汤结合肠内营养支持干预,疗程为2周。观察2组患者治疗前后血清白蛋白(albumin,ALB)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,TF)等营养指标及肠道菌群分布的变化情况,并比较2组患者的临床疗效及不良反应发生率。【结果】(1)疗效方面,治疗2周后,观察组的总有效率为97.83%(45/46),对照组为82.61%(38/46),组间比较(χ^(2)检验),观察组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)营养指标方面,治疗后,2组患者的血清ALB、PA、TF水平均较治疗前明显升高(P<0.05),且观察组对血清ALB、PA、TF水平的升高幅度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(3)肠道菌群分布方面,治疗后,2组患者的乳杆菌、双歧杆菌菌种数量均较治疗前明显升高(P<0.05),肠球菌菌种数量均较治疗前明显降低(P<0.05),且观察组对肠道乳杆菌、双歧杆菌菌种数量的升高幅度及对肠球菌菌种数量的降低幅度均明显优于对照组,差异均有统计学意义(P<0.05或P<0.01)。(4)不良反应方面,观察组的不良反应发生率为4.35%(2/46),明显低于对照组的19.57%(9/46),组间比较,差异有统计学意义(P<0.05)。【结论】肺肠同治理论指导下宣白承气汤结合肠内营养支持应用于AECOPD肺热腑实型患者临床效果显著,可有效改善患者营养状态及肠道菌群失衡,降低不良反应发生风险。

从“肺与大肠相表里”阐释针灸治疗哮喘的理论内涵

针灸治疗肺系疾病有深厚的理论根源和得天独厚的优势,并有丰富的临床应用经验。“肺与大肠相表里”理论指导下针灸“肺肠同治”对改善哮喘症状及气道炎症反应具有重要意义。基于“肺与大肠相表里”理论,主要从肺与大肠组织相连、经络相通、功能上相互为用以及病理上的相互影响等方面,系统阐释肺与大肠的特殊关系,进而阐释“肺肠同治”针灸治疗哮喘的理论内涵和意义,为临床“肺肠同治”针灸治疗哮喘的推广和应用提供理论基础,更好地指导临床实践。

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。

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。

基于“肺-肠轴”交互作用探讨宣白承气汤在肺系疫病治疗中的意义

肺系疫病是由外感疫毒引起的急性呼吸道传染病,消化道症状为其常见兼证被视为疾病的传变。“肺-肠轴”交互作用与中医“肺与大肠相表里”理论具有一致性,均阐释了肺与大肠的协调与统一。医家多认为肺系疫病的治疗应从肺肠同治的角度出发,宣肺以畅达气机,泻下以通调水道。本文通过分析古代与现代医家对肺系疫病的研究以及患者的症状,基于“肺与大肠相表里”理论,从宣肺通腑的角度出发,探讨宣白承气汤肺肠同治原则在肺系疫病治疗中的意义,给肺系疫病以新的诊疗思路,提供新的治疗途径。

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。

重症肺炎从肠论治探析

肺与大肠相表里是中医整体观念的诸多表现形式之一,对医者的临床诊疗具有极大的指导意义。本文通过探讨中西医对重症肺炎的认识;肺与大肠的病理、生理相互影响;肺肠相关性的现代研究,以从肠治肺、肺肠合治角度来治疗重症肺炎。以大柴胡汤、黄连解毒汤法泄热通腑;以麻杏石甘汤、宣白承气汤法宣肺顺气;以玉屏风散、桂枝加龙骨牡蛎汤法补肺涩肠,培土生金。肺与大肠相表里理论下的肺肠合治原则避免了肺病治肺、肠病治肠的惯性模式,为重症肺炎的治疗提供了中医思路的支持。

“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。

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。