Use of Chinese Herbal Medicine Therapies in Comprehensive Hospitals in Central China: A Parallel Survey in Cancer Patients and Clinicians

Summary： Chinese herbal medicine （CHM）, as the largest application category of traditional Chinese medicine （TCM）, is widely accepted among cancer patients in China. Herbal slice （HS） and Chinese patent drug （CPD） are commonly used CHM in China. This study aimed to investigate the utilization of CHM among clinicians and cancer patients in central China. Five hundred and twenty-five patients and 165 clinicians in 35 comprehensive hospitals in central China were asked to complete an anonymous questionnaire that was designed to evaluate the use of CHM. The results showed that 90.74% clinicians and 72.24% cancer patients used CHM during cancer treatment. The educational backgrounds of the clinicians and the age, education level, annual income, and cancer stage of the cancer patients were re- lated to use of CHM. More than 90% clinicians and cancer patients had used CPD. Comparatively, the percentage of HS use was 10% lower than that of CPD use among clinicians and cancer patients. More clinicians preferred to use CHM after surgery than cancer patients did （20.41% vs. 5.37%）. Enhancing physical fitness and improving performance status were regarded as the most potential effect of CHM on cancer treatment （85.71% among clinicians and 94.07% among cancer patients）, in comparison with directly killing tumor cells （24.49% among clinicians and 31.36% among patients）. As for refusal rea- sons, imprecise efficacy was the unanimous （100%） reason for clinicians＇ rejection of CHM, and 95.58% patients objected to using CHM also for this reason. Furthermore, the side effects of CHM were more concerned by clinicians than by patients （33.33% vs. 15.81%）. In conclusion, our survey revealed that CHM was popularly accepted by clinicians and cancer patients in central China. The reasons of use and rejection of CHM were different between clinicians and cancer patients.

Impact of cardiologist intervention on guideline-directed use of statin therapy

BACKGROUND Statins have an important and well-established role in the prevention of atherosclerotic cardiovascular disease(ASCVD).However,several studies have reported widespread underuse of statins in various practice settings and populations.Review of relevant literature reveals opportunities for improvement in the implementation of guideline-directed statin therapy(GDST).AIM To examine the impact of cardiologist intervention on the use of GDST in the ambulatory setting.METHODS Patients with at least one encounter at the adult Internal Medicine Clinic(IMC)and/or Cardiology Clinic(CC),who had an available serum cholesterol test performed,were evaluated.The 2 comparison groups were defined as:(1)Patients only seen by IMC;and(2)Patients seen by both IMC and CC.Patients were excluded if variables needed for calculation of ASCVD risk scores were lacking,and if demographic information lacked guideline-directed treatment recommendations.Data were analyzed using student t-tests or χ^2,as appropriate.Analysis of Variance was used to compare rates of adherence to GDST.RESULTS A total of 268 patients met the inclusion criteria for this study;211 in the IMC group and 57 in the IMC-CC group.Overall,56%of patients were female,mean age 56 years(±10.65,SD),22%Black or African American,56%Hispanic/Latino,14%had clinical ASCVD,13%current smokers,66%diabetic and 63%hypertensive.Statin use was observed in 55%(n=147/268)of the entire patient cohort.In the IMC-CC group,73.6%(n=42/57)of patients were prescribed statin therapy compared to 50.7%(n=107/211)of patients in the IMC group(P=0.002).In terms of appropriate statin use based on guidelines,there was no statistical difference between groups[IMC-CC group 61.4%(n=35/57)vs IMC group,55.5%(n=117/211),P=0.421].Patients in the IMC-CC group were older,had more cardiac risk factors and had higher proportions of non-white patients compared to the IMC group(P<0.02,all).CONCLUSION Although overall use of GDST was suboptimal,there was no statistical difference in appropriate statin use based on guidelines between groups managed by general internists alone or co-managed with a cardiologist.These findings highlight the need to design and implement strategies to improve adherence rates to GDST across all specialties.

Gene targeted and immune therapies for nodal and gastrointestinal follicular lymphomas

Follicular lymphoma(FL)is the most common indolent B-cell lymphoma(BCL)globally.Recently,its incidence has increased in Europe,the United States,and Asia,with the number of gastrointestinal FL cases expected to increase.Genetic abnormalities related to t(14;18)translocation,BCL2 overexpression,NF-κB pathway-related factors,histone acetylases,and histone methyltransferases cause FL and enhance its proliferation.Meanwhile,microRNAs are commonly used in diagnosing FL and predicting patient prognosis.Many clinical trials on novel therapeutics targeting these genetic abnormalities and immunomodulatory mechanisms have been conducted,resulting in a marked improvement in therapeutic outcomes for FL.Although developing these innovative therapeutic agents targeting specific genetic mutations and immune pathways has provided hope for curative options,FL treatment has become more complex,requiring combinatorial therapeutic regimens.However,optimal treatment combinations have not yet been achieved,highlighting the importance of a complete understanding regarding the pathogenesis of gastrointestinal FL.Accordingly,this article reviews key research on the molecular pathogenesis of nodal FL and novel therapies targeting the causative genetic mutations.Moreover,the results of clinical trials are summarized,with a particular focus on treating nodal and gastrointestinal FLs.

Off-label use of targeted therapies in oncology

Off-label use is defined by the prescription of a marketed drug outside the conditions described in the summary of product characteristics.In oncology,off-label prescribing of targeted therapies may occur in patients with other tumor types expressing the same target.Agents associated to phenotypic approaches such as therapies against the tumoral vasculature(anti-angiogenic drugs) and new immunotherapies(checkpoint inhibitors) also carry the potential of alternative indications or combinations.Off-label use of targeted therapies is little documented and appears to be in the same range than that regarding older drugs with wide variations among agents.When compared with older agents,off-label use of targeted therapies is probably more rational through tumoral genotyping but is faced with a limited clinical support,reimbursement challenges related to the very high pricing and the cost of genotyping or molecular profiling,when applicable.

An Overview of the Connection between Hoarding Disorder and Substance Use Disorder

This essay explores the connections between Hoarding Disorder and Substance Use Disorder,two distinct mental health conditions with clear diagnostic criteria in the DSM-5.Hoarding Disorder,marked by excessive possession accumulation and difficulties in letting go,affects 2-6%of the global population,leading to severe consequences.Potential causes include genetic predisposition,neural issues,and traumatic experience.Substance Use Disorder is influenced by more societal factors.Both disorders share a comorbidity in Attention-Deficit/Hyperactivity Disorder(ADHD).Network analysis shows a strong direct relationship between Hoarding Disorder and ADHD,while social influences increase ADHD prevalence in Substance Use Disorder individuals.Moreover,both disorders benefit from Cognitive Behavioral Therapy(CBT).Exposure and Ritual Prevention effectively address hoarding symptoms,while CBT for Substance Use Disorder focuses on the interplay between thoughts,emotions,and actions.Despite being classified as a mental illness in DSM-5,Hoarding Disorder receives less attention than Substance Use Disorder.This essay aims to raise awareness of Hoarding Disorder by highlighting its commonalities with Substance Use Disorder in terms of causes,comorbidities,and treatment approaches.

Multifunctional biodegradable nanoplatform based on oxaliplatin prodrug cross-linked mesoporous polydopamine for enhancing cancer synergetic therapy

Due to the limitations of conventional chemotherapy including side effects,poor prognosis,and drug resistance,there is an urgent need for the development of a novel multi-functional combined therapy strategy.Dopamine-modified oxaliplatin prodrug(OXA-DA)was successfully synthesized in this study to ameliorate the organ distribution of oxaliplatin for improving the drug efficacy and reducing toxic side effects,and OXA-DA was applied to develop a porous oxaliplatin cross-linked polydopamine nanoparticle for loading siPD-L1 to construct multifunctional nanoplatform.The multifunctional nanoplatform was modified with poly(2-ethyl-2-oxazoline)(PEOz),which occurred charge reversal in the tumor microenvironment,and exerted the lysosomal escape effect in tumor cells to improve the bioavailability of small interfering RNA targeting programmed cell death-ligand 1(siPD-L1).The pH-responsive charge reversal,photothermal,biodegradation,lysosomal escape ability,PD-L1 protein degradation,toxicity properties and multiple antitumor effects were comprehensively evaluated in vitro and in vivo experiments.The findings indicated that OXA-DA-siPD-L1@PDA-PEOz excellently induced tumor cell necrosis and apoptosis as a result of the synergistic effect of chemo-photothermal therapy,and upregulated CD8+T cells produced interferon-γ(IFN-γ)to further attack the tumor cells.In conclusion,the novel nanoplatform-mediated chemo/photothermal/immunotherapy has promising clinical applications in the treatment of malignant tumors.

Glutathione-depleted cyclodextrin pseudo-polyrotaxane nanoparticles for anti-inflammatory oxaliplatin(Ⅳ) prodrug delivery and enhanced colorectal cancer therapy

Oxaliplatin(Oxa) is the first-line chemotherapeutic drug for the treatment of colorectal cancer(CRC). However, long-term Oxa chemotherapy can induce inflammation and increase the levels of cyclooxygenase-2(COX-2) and prostaglandin E2(PGE2), which can promote tumor metastasis. Moreover,high glutathione(GSH) levels in CRC cells significantly reduce Oxa sensitivity and seriously restrict the clinical application of Oxa. Herein, an Oxa(Ⅳ) prodrug with anti-inflammatory properties(desmethyl naproxe, DN) and GSH-depleting cyclodextrin pseudo-polyrotaxane carriers were prepared and further self-assembled into micellar nanoparticles(designated DNPt@PPRI). The relesae of DN from DNPt@PPRI can reduce the level of PGE2 to inhibit inflammation and tumor metastasis by decreasing COX-2 protein,and also synergize with Oxa to inhibit tumor. More importantly, GSH depletion can reduce the detoxification of Oxa and further enhance chemotherapy-induced apoptosis. DNPt@PPRI have a good GSH depletion ability to enhance the sensitivity of Oxa, indicating a potential in the synergistic chemotherapy and chemo-sensitization of colorectal cancer.

奥沙利铂与卡培他滨化疗方案联合贝伐珠单抗靶向治疗结肠癌对患者生命质量的影响

目的探讨奥沙利铂与卡培他滨化疗方案联合贝伐珠单抗靶向治疗结肠癌对患者生命质量的影响。方法选取2021年1月至2022年1月抚州市第一人民医院肿瘤内科收治的60例结肠癌患者作为研究对象,随机分为观察组与对照组,每组30例。对照组实施奥沙利铂、卡倍他滨化疗方案,观察组在对照组基础上联合贝伐珠单抗靶向治疗,比较两组临床疗效、治疗前后外周血T淋巴细胞亚群水平、不良反应发生情况及治疗前后卡氏功能状态(KPS)评分。结果观察组总缓解率(OR)、疾病控制率(DCR)均高于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD4^(+)水平及CD4^(+)/CD8^(+)均高于治疗前,CD8^(+)水平均低于治疗前,且观察组CD4^(+)水平及CD4^(+)/CD8^(+)均高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义;治疗后,两组KPS评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论奥沙利铂、卡培他滨化疗方案联合贝伐珠单抗靶向治疗结肠癌疗效显著,不仅可有效控制患者病情进展,还能强化机体免疫功能,维持免疫系统正常状态,且用药安全性较高,能进一步提高患者生命质量。

Oxaliplatin加5-FU/LV:一线治疗进展期结直肠癌

1文献类型治疗2证据水平1b3文献来源De Gramont A, Figer A, Seymour M, et al.Leucovorin and fluorouacil with or without oxaliplatin as first-line treatment in advanced colorectal cancer [J]. J Clin Oncol, 2000,18(16)

Combination of "low-dose" ribavirin and interferon alfa-2a therapy followed by interferon alfa-2a monotherapy in chronic HCV-infected nonresponders and relapsers after interferon alfa-2a monotherapy

AIM To report on the efficacy, safety and tolerability of interferon alfa-2a combined with a "low dose" of ribavirin for relapsers and non responders to alpha interferon monotherapy.METHODS Thirty-four chronic hepatitis C virus-infected non-responders to interferon alfa2a monotherapy (a course of at least 3 months treatment) and 13 relapsers to interferon alfa 2a monotherapy (a dose of 3 to 6 million units three times per week for at least 20 weeks but not more than 18 months) were treated with the same dose of interferon alfa-2a used before (3 to 6 million units three times per week) and ribavirin (10 mg/ kg daily) for 6 months. In complete responders, interferon alfa-2a was administered for further 6 months at the same dose used before as monotherapy.RESULTS Seven (20.6%) of 34 non-responders stopped the combined therapy due to adverse events, including two patients with histological and clinical Child A cirrhosis. In 17/27 (63%)non-responders, the combined therapy was stopped after three months because of non-response. Ten of the 27 non-responders completed the 1;2-month treatment course. At a mean follow up of 28 months (16- 37 months)after the treatment, 4/10 (15%) previous non-responders still remained complete responders,All 13 previous relapsers completed the 12-month treatment course. At a mean follow up of 22months (9 - 36 months) after treatment, 6/13(46%) the previous relapsers were stillsustained complete responders.CONCLUSION Our treatment schedule of the combined therapy for 6 months of interferon alfa2a with a low dose of ribavirin (10 mg/kg/day)followed by 6 months of interferon alfa-2amonotherapy is able to induce a sustainedcomplete response rate in 15% of non-responders and 46% of relapsers with chronic hepatitis C virus-related liver diseases comparable to those obtained with the standarddoses of ribavirin 1000 - 1200 mg/day.Randomized prospective controlled trials using lower total amounts of ribavirin in combination with interferon should be performed.

Design,delivery and efficacy testing of therapeutic nucleic acids used to inhibit hepatitis C virus gene expression in vitro and in vivo

Despite major achievements in the treatment ofchronic hepatitis C with the combination ofinterferons and the nucleoside analog ribavirin themajority of patients with chronic hepatitis C virus(HCV) infection cannot be treated effectively.Toimprove this response rate we used antisensetechnologies to inhibit HCV translation as possibleadditional option for experimental treatment.Antisense oligodeoxynucleotides(ODN) are

Internet addiction and problematic Internet use: A systematic review of clinical research

AIM: To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science.METHODS: Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders(DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions(including problematic Internet use) more generally. RESULTS: The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving(1) treatment seeker characteristics;(2) psychopharmacotherapy;(3) psychological therapy; and(4) combined treatment. CONCLUSION: A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

Neoadjuvant sorafenib combined with gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma

This paper reports the first case of a patient with hepatocellular carcinoma with lymph node metastasis treated by sorafenib combined with gemcitabine plus oxaliplatin,with a partial response and normalization of α fetoprotein,which allowed curative surgery.The potential synergy between these three drugs needs to be confirmed,and is currently being investigated in a randomized phase Ⅱ trial.

High-intensity focused ultrasound extracorporeal ablation of liver tissuesin rabbits

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Chemotherapy rechallenge in metastatic colon cancer:A case report and literature review

BACKGROUND Colorectal cancer(CRC)is the third leading cause of cancer-related death in males and females in the United States.Approximately,20%-22%of patients have metastatic disease at the time of presentation,and 50%-60%will develop metastasis over the course of their disease.Despite advances in systemic therapies,there remains a paucity of effective third-and later-line therapies for patients with ongoing disease progression.However,rechallenging chemoresistant CRC tumors with previously administered therapies is an emerging concept that may be a life-prolonging option for heavily treated metastatic colorectal cancer(mCRC).CASE SUMMARY A 41-year-old man with no previous medical history initially presented with worsening diffuse abdominal tenderness.Computed tomography was significant for a splenic flexure mass and hepatic lesions concerning for metastatic disease.He underwent a colectomy with anastomosis.Postoperative pathology was diagnostic for moderately to well-differentiated adenocarcinoma(T4bN1bM1a).He received adjuvant 5-fluorouracil,leucovorin,and oxaliplatin(FOLFOX),but therapy was discontinued due to the development of atrial fibrillation.Additional workup indicated a carcinoembryonic antigen level of 508.2 ng/mL,and mutational analysis found that the tumor was microsatellite instability-high and KRAS/BRAF wild-type.He was started on irinotecan with oxaliplatin(IROX),and bevacizumab(14 cycles),developed disease progression,was transitioned to FOLFOX and cetuximab,and then eventually three cycles of pembrolizumab.Following disease progression,he was rechallenged with IROX therapy,as he previously responded well to oxaliplatin-based therapy.The IROX rechallenge provided this patient with a ten-month survival benefit,decreased metastatic burden,and marked improvement in his clinical condition.CONCLUSION Rechallenge of previous lines of well-tolerated systemic chemotherapy regimens may be a valuable therapeutic strategy in patients with heavily-treated mCRC.

小剂量阿帕替尼联合一线化疗方案在晚期胃癌转化治疗中的价值

目的分析小剂量阿帕替尼联合一线化疗方案在晚期胃癌转化治疗中的效果。方法选取2018年2月—2020年1月铜陵市人民医院收治的晚期胃癌患者158例,并随机分为对照组和研究组,每组79例。对照组给予奥沙利铂、替吉奥治疗,研究组在对照组基础上口服甲磺酸阿帕替尼片。两组均行6疗程转化治疗后评价效果,并自治疗起随访1年。比较两组抗肿瘤疗效、肿瘤标志物的变化及药物不良反应发生情况,统计两组手术切除及1年生存情况。结果治疗期间共脱落9例。研究组客观缓解率、临床控制率高于对照组(P<0.05)。研究组治疗前后细胞增殖抗原(PCNA)、环氧合酶-2(COX-2)、血管内皮生长因子(VEGF)的差值高于对照组(P<0.05)。两组治疗期间白细胞减少、中性粒细胞减少、乏力、贫血、手足综合征、蛋白尿、口腔炎、血压升高发生率比较,差异均无统计学意义(P>0.05)。研究组R0切除率高于对照组(P<0.05)。研究组1年生存曲线优于对照组(P<0.05)。结论小剂量阿帕替尼联合一线化疗方案用于晚期胃癌转化治疗可提高抗肿瘤疗效,降低肿瘤标志物水平,提高R0切除率及近期生存率,且安全性良好。

Analogous Systems Principles and Concepts of Traditional Chinese Medicine and Congruence Couple Therapy

This article explicates the analogous principles and concepts between traditional Chinese medicine(TCM)and congruence couple therapy(CCT).Although originating out of vastly different times and places,TCM and CCT share a view of health based on systems understanding to facilitate the interconnections of the parts of an organism rather than focusing on eliminating symptoms.Both approaches aim to release Qi(气)and vitality by removing blockages through adjusting the interactions,adaptation,and balance of multiple elements and Yin‑Yang energies.The goal is to liberate the Qi or life force through improved holistic balance and cooperation.While TCM focuses on interventions at the level of the body,CCT focuses on the attention,awareness,acknowledgement,and alignment of the four human dimensions consisting of the intrapsychic,interpersonal,intergenerational,and universal‑spiritual.In light of the current trend toward increasing mental,substance use,and neurological disorders,in particular among countries of middle and low income,dialogue to explore these compatibilities between TCM and CCT is conducive to the continuous evolution of TCM and Western therapies to address not only physical health but also the exigencies of contemporary addiction and mental health care within a mind–body relationship matrix.

奥沙利铂联合表柔比星介入治疗原发性肝癌的临床疗效分析

目的深入研究奥沙利铂+表柔比星介入治疗原发性肝癌的临床效果。方法回顾性分析2020年3月—2021年3月在吉林省肿瘤医院接受治疗的76例原发性肝癌患者的临床资料,根据治疗方法分为两组,各38例。研究组采用奥沙利铂+表柔比星治疗、参照组采用奥沙利铂+吉西他滨治疗。比较两组患者的临床疗效。结果治疗前,两组的肿瘤标志物比较,差异无统计学意义(P>0.05);治疗后,研究组的甲胎蛋白、缺氧诱导因子-1α、高尔基体蛋白低于参照组,差异有统计学意义(P<0.05)。治疗前,两组肝功能指标比较,差异无统计学意义(P>0.05);治疗后,研究组肝功能指标优于对照组,差异有统计学意义(P<0.05)。研究组的并发症发生率低于参照组,差异有统计学意义(P<0.05)。研究组的治疗总有效率(97.37%)高于参照组(65.79%),差异有统计学意义(χ^(2)=12.608,P<0.001)。结论给予患者奥沙利铂+表柔比星介入治疗,在控制肝癌疾病进展的同时,还能改善其肿瘤标志物等指标,不易引发一系列不良反应,安全性较高。

RALOX-HAIC联合免疫检查点抑制剂及靶向药物治疗中晚期肝癌的疗效分析

目的:探讨雷替曲塞+奥沙利铂方案肝动脉灌注化疗(RALOX-HAIC)联合免疫及靶向药物三联治疗中晚期肝细胞癌(hepatocellular carcinoma,HCC)的疗效与安全性。方法:回顾性分析2020年6月至2021年12月收治于南方医科大学南方医院39例行RALOX-HAIC联合靶免治疗的中晚期HCC患者,以首次HAIC治疗为起点,以患者疾病进展、死亡、不可耐受不良反应为终点,按照RECIST 1.1标准进行疗效评估,随访时间截至2022年10月。主要研究终点为客观缓解率(objective response rate,ORR),次要研究终点为疾病控制率(disease control rate,DCR)、中位无进展生存期(median progression-free survival,mPFS)、中位总生存期(median overall survival,mOS)及安全性。结果:ORR为41.0%,DCR达87.2%,m PFS为7.3个月(95%CI:5.0~9.6),mOS为14.6个月(95%CI:10.8~18.5),其中1例患者成功转化行手术治疗后完全缓解至今。常见的不良反应有HAIC术后发热、腹痛;化疗药物引起的骨髓抑制;肝功能异常、高血压、手足综合征等,无治疗相关死亡事件发生。结论:RALOX-HAIC联合免疫检查点抑制剂及靶向药物治疗中晚期HCC的DCR高,安全性良好,不良反应可耐受,为后续前瞻性临床研究奠定了基础。

化疗联合贝伐珠单抗靶向治疗晚期结直肠癌患者的临床效果

目的探讨化疗联合贝伐珠单抗靶向治疗方案对晚期结直肠癌的临床效果。方法选取2020年6月至2021年6月河北省张家口市第一医院收治的120例晚期结直肠癌患者,按照随机数字表法将其分为观察组(60例)和对照组(60例)。对照组给予奥沙利铂联合卡培他滨化疗,观察对照组基础上给予贝伐单抗靶向治疗。观察两组临床疗效、不良反应情况、生存质量及肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA)199、CA125水平。结果观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。治疗后,两组情绪功能、躯体功能评分升高,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组CEA、CA125和CA199水平均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论化疗联合贝伐珠单抗治疗晚期结肠癌患者效果显著,不良反应发生率低且能够降低肿瘤标志物的水平,能够改善患者生存质量。