Progress in diagnosis and treatment of small cell lung cancer with integrated traditional Chinese and Western medicine

Lung cancer is one of the most common major diseases that seriously threaten human health,lung cancer includes small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC).Although patients with SCLC account for about 20%of the total number of patients with lung cancer,the mortality rate is much higher than that of patients with NSCLC.Integrated traditional Chinese and Western medicine has obvious advantages in the treatment of patients with SCLC.According to the relevant literature reports on the treatment of SCLC in recent years,this article will summarize the research progress of integrated traditional Chinese and western medicine in the treatmentof SCLC from the aspects of traditional Chinese medicine(TCM)combined with surgery,chemotherapy,radiotherapy,and molecular targeted therapy.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Interpretation of Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 7)

On March 3,2020,the National Health Commission and the National Administration of Traditional Chinese Medicine of China jointly promulgated the Notice on Printing and Distributing the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 7).The content has been revised and supplemented on the basis of the Version 6,including etiological characteristics and pathological changes in lung,heart,kidney,spleen,liver,gallbladder,esophagus,stomach and intestinal mucosal epithelium.In particular,the diagnosis and treatment methods of traditional Chinese medicine are supplemented.It provides an evidence-based diagnosis and treatment protocol for the treatment and recovery of suspected and confirmed cases of novel coronavirus pneumonia with traditional Chinese medicine and Western medicine.

Understanding of Traditional Chinese Medicine and Western Medicine on Swimming Shoulder

Swimming shoulder refers to shoulder pain syndrome which is caused by repeated impinges on shoulder joints among swimmers.It is one of the most common causes of shoulder pain among swimmers with high incidence.Swimming shoulder can affect the systematization of swimmers’training and the improvement of their training level and performance,which is a difficult problem for many swimmers,coaches,medical staff and sports medical doctors.Therefore,attention should be paid to the treatment of swimming shoulder in daily diagnosis and treatment.

An Expert Consensus of Integrated Chinese and Western Medicine Treatment on Lung Cancer

Lung cancer is a malignant tumor of the lung originating from the bronchial mucosa,glands or alveolar epithelium.With the population aging and environmental pollution getting increasingly severe,lung cancer has become the malignant tumor with the highest incidence and mortality rate in China,seriously endangering people’s life and health.However,there is no standardized guideline for the integrated Chinese and Western medicine treatment of lung cancer in China.In order to standardize and improve integrated Chinese and Western medicine diagnosis and treatment of lung cancer in China,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,together with oncologists from the Sun Yat-sen University Cancer Center,compiled this consensus under the coordination of the Medical Policy Department of the National Administration of Traditional Chinese Medicine,taking into account the main results of the pilot project of Chinese and Western Medicine Clinical Collaboration for Major Difficult Diseases(lung cancer).

Clinical research progress of ischemic heart failure and prospect of traditional Chinese medicine

缺血性心力衰竭作为心力衰竭最常见的类型之一,如何诊疗始终为临床关注的重点。近年来,对于生物标志物的研究为临床诊断、病理分层和评价预后提供了帮助。常规治疗方面,新药物的临床应用及非药物治疗方式的发展带来了更多选择。同时,在中医辨证理论的指导下,中医药治疗也发挥着越来越重要的作用,展现了广阔前景。

Analysis of novel coronavirus pneumonia treatment with Chinese herbal compound

Objective: To analyze the prescription law of TCM compound in the treatment of new coronavirus pneumonia, and provides reference for the clinical treatment of new coronavirus pneumonia. Methods: Collected Collected 24 novel coronavirus pneumonia related diagnostic and therapeutic plans issued by the National Health Council and the Chinese medicine authority from January 26, 2020 to March 8th ,the filtered solution involved in the formula, establishing database of traditional Chinese medicine compound prescription for the treatment of new crown pneumonia, the frequency of using frequency analysis methods of analysis and clustering analysis and association rules analysis to sort out data mining analysis of traditional Chinese medicine compound. Results: In this study, a total of 159 TCM compounds were included in the treatment of new crown pneumonia from the country and 23 provinces, municipalities and autonomous regions, involving 189 TCM compounds. A total of 62 high-frequency traditional Chinese medicines (frequency ≥ 11) were obtained, mainly including licorice, almond, ephedra, gypsum, Poria cocos, Huoxiang, etc The drug types are mainly heat-clearing drugs, vacuous drugs, moisture-curing drugs, and surfactant drugs. The main effect of the medicine was warm, cold, lukewarm and flat, the main effect of the medicine was bitter and bitter, and the main effect of the medicine was the lung, stomach and spleen. Cluster analysis results according to the performance of traditional Chinese medicine treatment of new crown pneumonia high frequency drugs into 7 classes;Association rule analysis results in 29 common drug pairs. Conclusion: In the treatment of pneumonia caused by new coronavirus infection with traditional Chinese medicine, the following characteristics are presented: the number of times of supplementing qi and Yin is more than that of attacking evil and maintaining health;The method of dispersing and solving the attack of wet, beneficial, wet, permeable and wet medicine fully embodies a variety of ways to drive away evil;In terms of drugs, heat-clearing drugs, deficiency drugs, dampness drugs and surface drugs are the main ones, highlighting that the basic treatment method is to dissolve dampness and detoxify, and replenish qi and Yin. In summary, this study can provide reference for guiding clinical drug use and developing new drugs.

原发性干燥综合征合并血细胞减少中医诊治研究进展

原发性干燥综合征(pSS)是一种慢性炎症性自身免疫病,除累及外分泌腺之外,还可累及多器官、系统,其中以血液系统受累最为常见,多表现为一系或多系血细胞减少。目前对于pSS合并血细胞减少缺乏统一公认的治疗方案,西医治疗多以糖皮质激素、免疫抑制剂为主,而中医药治疗本病具有较好疗效。通过总结pSS合并血细胞减少的中医诊治经验,并对相关研究进行综述后发现,现代医家认为pSS核心病机为气阴亏虚,久之则产生热、毒、瘀等多种病理产物,相互影响,导致全身气血津液失常,引起血细胞减少。本病病位多责之于肝、脾、肾,治以滋阴、益气、养血之法,辅以清热解毒、化瘀通络之法,并根据其合并血细胞减少类型的不同以及是否使用糖皮质激素用药各有侧重。中医药治疗本病较西药治疗能够更好地改善血细胞水平且不良事件发生率更低,具有一定优势。

动态不确定因果图在中医诊断中的应用探讨

动态不确定因果图(DUCG)已成为中医药领域新兴的、先进的知识表示与推理模型。为更好地应用DUCG为中医临床提供诊断推理与决策支持,在归纳总结DUCG中医药领域研究与应用情况的基础上,分析现阶段DUCG在中医诊断中存在的主要问题,包括中医术语规范统一和中医药知识库质量问题、推理算法和模型建造的方法选择与设计问题、DUCG中医诊断模型的平台化和产品化问题等,并据此展开应用思路与方法探讨,提出应深挖DUCG的技术内涵,根据临床实际需求选择精准、高效的推理建模方法,建立符合中医药理论思想、具有中医特色的智能辅助诊断模型,加强DUCG协同研究平台及产品的开发应用。

儿童流行性感冒中西医结合诊疗指南

儿童是流行性感冒的高发人群及重症病例的高危人群。流行性感冒早期干预,特别是在轻症阶段给予中西医结合的干预措施对疾病的预后具有重要意义。本指南基于文献检索及评价、专家访谈、组内讨论、专家论证会、公开征求意见等制订流程,形成《儿童流行性感冒中西医结合诊疗指南》。此次制订提出指南适用范围、规范性引用文件、术语和定义、诊断、治疗,旨在为儿童流行性感冒中西医结合临床实践、诊疗规范和质量评价提供重要参考。

卒中相关睡眠障碍中西医诊疗研究进展

卒中相关睡眠障碍(stroke-related sleep disorders,SSD)是指在卒中后首次出现或卒中前已有的睡眠障碍在卒中后持续存在或加重,并达到睡眠障碍诊断标准的一组临床综合征。作为卒中常见的并发症,不仅会影响卒中患者的康复和生活质量,还会增加卒中复发和焦虑、认知能力下降等精神障碍的风险。目前西医治疗SSD主要是运用镇静催眠类药物、抗精神病类药物,见效快的同时存在成瘾性、疗效不稳定等问题。中医药作为治疗SSD的一种有效手段,可减轻患者痛苦,提高生活质量,与西医联合治疗能够达到相得益彰的效果。文章就近年文献中对SSD中西医治疗进展进行论述,为临床SSD的治疗提供参考。

中医舌诊客观化研究进展

该文对舌诊的发展进行简要介绍,阐述了舌诊图像信息的采集、预处理以及分析技术等舌诊客观化研究及近5年的关于舌诊客观化在呼吸系统、循环系统、消化系统、泌尿系统、内分泌系统等方面临床应用进行综述,旨在为舌诊客观化研究提供参考,为舌诊的深入全面发展提供新思路。

卵巢癌中西医结合诊疗指南

卵巢癌病死率位于女性生殖系统恶性肿瘤之首,严重威胁女性健康。本指南工作组在遵循循证医学原则的基础上,参考国际国内最新临床实践指南制订方法,客观评价卵巢癌中西医结合诊治证据,广泛征求中医学、临床医学、方法学等多学科专家的意见,最终形成本指南,旨在为中西医结合诊治卵巢癌的临床实践提供参考。

中医药治疗冠状动脉微血管疾病证治规律及作用机制研究

目的:基于文献探讨中医药治疗冠状动脉微血管疾病(CMVD)的证治特征及用药规律,并借助网络药理学和分子对接技术探讨核心药对治疗CMVD的作用机制。方法:系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed数据库自建库以来至2022年11月1日收录的有关CMVD中医诊治研究的文献,对中医证治规律进行分类统计,并挖掘中药复方的核心药对,利用TCMSP、GeneCards、DisGeNET、TTD、OMIM、STRING、Metascape数据库和Cytoscape软件分析核心药对与疾病间互作关系及相关通路,最后使用分子对接技术对核心化学成分与关键靶点进行对接验证。结果:获得符合要求的文献160篇,CMVD中医证型主要为气虚血瘀证,中药复方涉及药物89味,支持度最高的药对为黄芪-丹参。黄芪-丹参中槲皮素、木犀草素、山柰酚、异鼠李素等成分可通过作用于白细胞介素6(IL6)、胱天蛋白酶3(CASP3)、缺氧诱导因子1A(HIF1A)、过氧化物酶体增殖物激活受体γ(PPARG)等多个靶点影响糖尿病并发症中的晚期糖基化产物(AGE)-晚期糖基化终末产物受体(RAGE)通路、缺氧诱导因子1(HIF-1)通路、核转录因子κB(NF-κB)通路等来干预CMVD。分子对接结果显示核心活性成分与关键靶点对接良好。结论:中医药治疗CMVD多以益气活血法为主,其核心药对黄芪-丹参治疗CMVD的潜在作用机制可能与抗炎症反应、改善氧化应激、调节细胞凋亡相关。

数据挖掘在中医名家辨治血液病中的研究应用

血液病因其高危险性和低治愈率严重地威胁着患者的身心健康。中医治疗血液病有着明显的优势,名中医在辨治血液病方面具有丰富的经验,且临床疗效显著。但是由于中医的辨证依据大多是个人主观思考,无法广泛地指导临床,所以通过数据挖掘技术全面客观地总结临床医家的经验、辨证、方药,将更有利于挖掘出规范化的理法方药及应用规律,以科学、高效的方法实现中医药的继承和创新。

骨关节炎发病机制及治疗研究进展

骨性关节炎(OA)是一种以关节逐渐退变为主要特征的慢性骨性关节疾病,患者症状上多表现为关节疼痛或畸形。临床上最常见的OA为膝骨性关节炎(KOA)。KOA患病率日益升高且中老年人居多,其发病机制尚未完全明确,但越来越多的研究表明多种蛋白酶在微观层面上起着重要作用。由于该疾病导致的关节疼痛与功能障碍,会严重影响着人民健康及生活质量,给患者家庭与社会带来了多重负担,由此可见对KOA治疗方法进行研究显得尤为重要。逐年增加的临床治疗结果表明手术治疗、中医治疗与机器人辅助治疗均可带来良好的治疗效果。现就通过概述KOA患者发病机制、诊治进展,旨在为KOA的临床治疗工作提供参考,为患者的生活质量提供保障。

癌因性疲乏的中医证候特征及其与甲状腺功能水平的相关性研究

背景 中西医结合下的多学科参与是癌因性疲乏(CRF)未来诊疗模式的发展方向。然而,缺乏辨证选方的标准和依据限制了中医药在西医和国际范围内的应用。CRF患者的疲乏感常伴随着代谢和能量平衡的异常,甲状腺功能在机体能量代谢和调节方面扮演着重要角色。目的 分析CRF的中医证候特征并探讨其与甲状腺功能水平之间的相关性,为CRF的中西医结合诊疗和机制研究提供参考。方法 纳入2021年就诊于中国中医科学院西苑医院肿瘤科门诊及病房的肿瘤患者为研究对象,收集患者一般资料。采用中文版Piper疲乏修订量表(RPFS-CV)评估患者疲乏情况。收集入组患者当日或次日的甲状腺功能检测结果,包括三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素、抗甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体。由自拟CRF中医四诊信息表收集CRF患者中医证候特征。采用Spearman秩相关分析探讨RPFS-CV疲乏评分与甲状腺功能指标的相关性,采用点二列相关分析探讨RPFS-CV疲乏评分和甲状腺功能指标与CRF中医证候的相关性。结果 纳入159例CRF患者,常见的肿瘤种类依次为肺癌(50例,31.4%)、乳腺癌(23例,14.5%)、头颈部肿瘤(21例,13.2%)、直肠癌(21例,13.2%)、结肠癌(18例,11.3%);中位确诊年限为2.15(3.16)年;88例(55.3%)患者发生了复发转移,40例(45.5%)患者为局部复发,38例(43.2%)患者为寡转移,中位转移年限为1.50(2.83)年;91例(57.2%)为晚期患者,101例(63.5%)患者接受过抗肿瘤治疗,57例(35.8%)患者接受化疗。中医证候中,虚证频率超过10%从高到低分别为气虚证、心虚证、脾虚证;实证中出现频次超过20次的从高到低分别为气滞证、寒湿证。RPFS-CV疲乏评分中位数超过4分的证候从高到低分别为寒湿证、气滞证、脾虚证、心虚证、肝虚证、湿热证、气虚证。RPFS-CV疲乏评分与气虚证、脾虚证、心虚证、肝虚证、寒湿证、气滞证呈正相关(P<0.05)。RPFS-CV疲乏评分与FT_(3)、T_(3)呈负相关(P<0.05)。气虚证与T_(4)、肾虚证与TPO-Ab、气滞证与FT_(4)呈正相关(P<0.05),湿热证与T_(3)、T_(4)呈负相关(P<0.05)。结论 CRF患者疲乏情况与中医证候及甲状腺功能水平密切相关,进一步的研究将有助于深入理解这些关联,并促进中医和西医在CRF疾病管理中的协同发展。

中西医结合诊治痛风的经验总结及典型病例分析

痛风是与高尿酸血症、尿酸盐沉积密切相关的进展性代谢疾病,难以根治。本文对中西医结合诊治痛风的研究进展进行综述,并通过该院3例典型病例,总结中西医结合治疗痛风的流程和经验,以期为痛风的临床诊治提供参考。

甲亢性心脏病的临床诊疗思路

笔者认为甲亢性心脏病以肝、心为主,波及肺脾肾;治疗上以益气养心、宁心安神、温阳利水为主,配合疏肝解郁、活血化瘀、涤痰散结;在临床上可收到较好疗效。

基于德尔菲法确定《子宫腺肌病中西医结合诊疗指南》的临床问题

目的:基于德尔菲法形成《子宫腺肌病中西医结合诊疗指南》的临床问题,形成子宫腺肌病的规范性、实用性中西医结合诊疗指南。方法:基于德尔菲法,结合前期文献研究结果,采用问卷星编制调查问卷,向全国13个省(市、自治区)的34名专家进行两轮函询。结果:两轮德尔菲法均发放34份问卷,问卷回收率为100%,两轮函询积极系数均为100%,权威系数均>0.70,变异系数分别为0.00~0.38、0.13~0.37,肯德尔和谐系数分别为0.229、0.100(P<0.05);共形成了30个临床问题,凝练后最终形成10个必须在指南中形成推荐意见或说明的临床问题。结论:本研究通过两轮德尔菲法调查确定了需要纳入《子宫腺肌病中西医结合诊疗指南》的临床问题,为指南的后续制定工作奠定了良好基础。