小金胶囊治疗甲状腺结节药物经济学研究

目的:通过成本-效果和成本-效用分析评价小金胶囊与对照药小金丸相比治疗甲状腺结节的经济学优劣,为甲状腺结节的临床治疗和相关医药政策的制订提供参考。方法:采用前瞻性队列研究设计,选择全国各地13家医院中,从统一约定的同一时点开始,研究者选用2种研究药物进行治疗的全部符合纳排标准的病例,以周为单位竞争性纳入,计划小金胶囊队列纳入前300例,小金丸队列纳入前100例患者,进行为期6个月的随访调查。以中医证候疗效、结节体积缩小为主要效果指标,质量调整生命年为效用指标,进行成本-效果和成本-效用分析。结果:共纳入454例病例,因调查表格填写不完整而剔除1例,完成随访的病例小金胶囊队列共353例、小金丸队列共100例,基线时有3个关键变量在2个队列间比较,差异有统计学意义(P0.05),因此根据这3个变量进行分层分析。中医证候疗效方面,分层1中小金胶囊的有效性和经济性均优于对照药,分层2中小金胶囊相对于对照药更具经济性,分层3中小金胶囊经济性虽然稍差,但有效性明显要优于对照药,为了达到较好的有效性,选用小金胶囊是值得的;结节体积缩小方面,小金胶囊各分层成本-效果比较与中医证候疗效结果基本一致,且治疗效果相对于对照药的优势更加突出。成本-效用分析结果表明,小金胶囊在各分层人群中相对于对照药均更具经济性。结论:小金胶囊在甲状腺结节的治疗中与对照药相比具有一定的有效性和经济性优势。     

超微粉碎工艺通心络胶囊治疗中风病的临床研究

目的：评价超微粉碎工艺的通心络胶囊治疗中风病（气虚血瘀络阻型）的临床疗效和安全性。方法：采用随机、双盲、不同工艺不同剂量平行对照的非劣效性试验设计方法,选择病程在2周以上3个月以内、神经功能缺损评分为8～30分、总的生活能力评分在2～5级的中风病恢复期患者144例,其中试验组72例,对照组72例。试验组服用超微粉碎工艺的通心络胶囊,规格每粒0.26 g,1次4粒,1日3次；对照组服用普通粉碎工艺的通心络胶囊,规格每粒0.38 g,1次4粒,1日3次；疗程28 d。结果：中风病综合疗效,试验组与对照组总有效率分别为91.3%和87.3%,两组比较差异无统计学意义。两组总有效率差值的95%可信区间下限为-4.57%,大于预设的非劣效性界值-15%,非劣效性检验合格。试验期间发生3例不良反应,其中试验组1例,对照组2例。结论：超微粉碎工艺的通心络胶囊对于气虚血瘀络阻型中风病患者疗效确切,与普通粉碎工艺的通心络胶囊疗效相当,且服用安全。     

武汉抗疫1号方治疗社区隔离人群发热的疗效分析

目的探索武汉抗疫1号方治疗武汉社区隔离状态发热人群的疗效,分析中医药在“武昌模式”中防治新冠肺炎的效果。方法采用病例系列报告的方法,对武汉地区多个社区隔离状态发热人群进行观察性研究;通过“渔歌医疗平台”记录患者相关信息和诊疗数据,以发热治愈时间和治愈率为主要疗效指标,分析武汉抗疫1号方对隔离状态发热人群的疗效。结果纯中药武汉抗疫1号方的疗效优于非纯武汉抗疫1号方人群,纯中药武汉抗疫1号方发热中位治愈时间为1 d、治愈率为82.7%,非纯中药组治疗发热中位治愈时间为2 d、治愈率为62.7%,差异有统计学意义(P<0.05)。4类发热人群使用纯中药武汉抗疫1号方治疗,发热中位治愈时间均为1 d,治愈率:状态不明者66.7%、密切接触者75.0%、疑似病例80.8%、确诊病例92.6%。对于确诊病例,使用纯中药武汉抗疫1号方与非纯中药的发热中位治愈时间均为1 d,治愈率分别为92.6%、75.5%。结论纯中药武汉抗疫1号方对于隔离状态发热人群的疗效优于非纯中药组,1 d可以看到明显的退热效果;其具有“通用方”的特性,不仅对确诊病例有效,也适合疑似病例、密切接触者的防治,为武汉抗疫1号方治疗新冠肺炎提供了证据。     

两种不同古典针刺手法的实时中枢整合特征研究:一项基于近红外光谱成像技术的随机交叉试验研究方案（英文）

Background:Reinforcing-reducing manipulations are a crucial part of acupuncture therapy.The reinforcing manipulation with heat sensation(RMHS) and the reducing manipulation by inducing cool sensation(RMCS) are two representative methods of reinforcing-reducing manipulations.This trial aims to investigate the characteristic of cerebral responses to these two typical acupuncture manipulations.Methods:A total of 35 healthy participants will be included and receive acupuncture stimulation with RMHS ...     

Recommendations for Acupuncture in Clinical Practice Guidelines of the National Guideline Clearinghouse

Objective: To organize the clinical practice guidelines(CPGs) related to acupuncture included in the National Guideline Clearinghouse(NGC) to systematically summarize the diseases and disorders most commonly treated with acupuncture, the strength of recommendations for acupuncture and the quality of evidence. Methods: The NGC database was systematically searched for guidelines that included acupuncture as an intervention. Two independent reviewers studied the summaries and the full texts of the guidelines and included guidelines based on the inclusion and exclusion criteria. Thirty-nine guidelines were collected with 80 recommendations. The Appraisal of Guidelines for Research and Evaluation(AGREE) Ⅱ instrument was used to assess the quality of these guidelines. Results: Of the 80 recommendations on acupuncture, 49 recommendations were clearly for acupuncture, 25 recommendations were against acupuncture and 6 recommendations did not indicate any clear recommendations, 37 recommendations were for painful diseases/disorders, and 12 recommendations were for non-painful diseases/disorders. Locomotor system disorders were the most common in the painful diseases/disorders category. Out of all the recommendations for acupuncture, most recommendations(87.76%) were weak in strength, and most of the evidence(40.84%) was of low quality. Conclusion: In the National Guideline Clearinghouse, the recommendations for acupuncture focus on painful diseases/disorders. The recommendations in the guidelines are not high in strength, and most of the evidence is moderate or low in quality.     

利用UPLC/Q-TOF-MS/MS主成分分析和T-test探讨生半夏与法半夏有毒成分的差异

目的：从化学成分探讨生半夏与法半夏的差异。方法：制备生半夏和法半夏样品并采用UPLC/Q-TOF-MS/MS测定,通过主成分分析(PCA)和T检验分析研究两组样品之间的差别,并确定相应的化学标记物。UPLC/Q-TOF-MS/MS可准确地测定得到荷质比和MS/MS 的碎片数据,通过参考文献或数据库对照相应数据我们可以鉴别相应化合物。结果：甘草苷、甘草素、溶血磷脂酰胆碱(LPC)是最具特征的化学标记物。由于LPC可导致炎症反应的发生,炮制前后LPC的减少是减毒的原因之一;甘草苷和甘草素有治疗炎症的作用且能减少肝损伤作用,其在炮制后的法半夏中的增加也是减毒的原因。结论：该方法不仅可探索传统中药炮制后减毒的机制还可分别对炮制前后中药的质量进行控制。     

Gynura procumbens aqueous extract alleviates nonalcoholic steatohepatitis through CFLAR-JNK pathway in vivo and in vitro

Objective: The present work was to investigate the protective effects of the aqueous extract of Gynura procumbens(GPAE) against nonalcoholic steatohepatitis(NASH) in mice and NCTC-1469 cells.Methods: C57 BL/6 J mice were fed with methionine and choline-deficient(MCD) diet and administered simultaneously with GPAE(500 and 1000 mg/kg/d, respectively) by gavage for six weeks. The biomarkers of NASH in serum and liver were determined. NCTC-1469 cells were pretreated with 0.25 mmol/L palmitic acid(PA) plus 0.5 mmol/L oleic acid(OA) for 24 h or treated with adenovirus expressing short-hairpin RNA against CFLAR(Ad-sh CFLAR) for 24 h and then treated with GPAE(80 and 160 μg/m L, respectively)for 24 h, and the content of cellular biomarkers of NASH was detected.Results: In mice treated with MCD, GPAE could decrease the levels of serum ALT, AST, the content of hepatic TG, TC and MDA, repress the activities and protein expression of CYP2 E1 and CYP4 A and the phosphorylation of JNK, increase the activities of HO-1, CAT and GSH-Px, up-regulate the m RNA expression of PPARα, FABP5, CPT1α, ACOX, SCD-1, mGPAT, MTTP and the protein expression of CFLAR and NRF2.In NCTC-1469 cells treated with PA and OA, GPAE could decrease the content of cellular TG and ROS, promote the uptake of 2-NBDG, up-regulate the protein expression of CFLAR and NRF2. In NCTC-1469 cells treated with Ad-sh CFLAR, GPAE up-regulated the mRNA and protein expression of CFLAR, down-regulated the phosphorylation of JNK, and increased the protein expression of NRF2 and p IRS1.Conclusion: These results indicated that the activation on CFLAR-JNK pathway might be the main antiNASH mechanism of GPAE, which on the one hand promote the β-oxidation and efflux of fatty acids in liver, and finally reduce hepatic lipid accumulation, on the other hand increase the activities of antioxidant enzymes and inhibit the activities of ROS generation enzymes by activating NRF2, and therefore attenuates hepatic oxidative stress damage.     

Towards a scientific rationale for traditional properties of Chinese medicinal plants: “natures” and “flavors”

Objective: According to theory of Chinese medicine property, the ecological environment shapes properties(natures and flavors) of Chinese materia medica(CMM) and there are close relationships between certain natures and flavors. However, to date these observations have not been validated scientifically in the context of the whole flora of a region. The present study aims to address this gap.Methods: We collected geographical distributions of 3637 vascular plant species native to the Xinjiang region of northwest China, of which around 812 are medicinal plants. The CMM property characters of these medicinal plants were also collected. All medicinal plants were then analyzed in the occurrence of their natures(cold, cool, neutral, warm, and hot) and flavors(sweet, bitter, sour, salty, and pungent). Possible correlations between these properties and environmental factors, notably climate, as well as correlations with plant species richness of the wider native flora of Xinjiang were then investigated using permutation test and regression.Results: Cold species(38.5%) were more numerous than warm(21.0%) and neutral(22.3%), while bitter species(43.3%) were more numerous than pungent(25.6%), sweet(22.4%) and sour(6.7%) ones. Species with bitter flavor were most commonly also cold(48.6%) in nature, sour flavor usually coincided with cold(44.2%) or cool nature(26.0%), whereas pungent or sweet species tended to be warm(34.4%, 28.4%) or neutral(27.8%, 28.4%). The percentages of species of cold/cool nature, bitter flavor were higher in mountainous regions, and the percentages of warm/neutral and pungent/sweet/sour were higher in basins. The percentages of species of cold/cool, bitter were positively correlated with actual evapotranspiration(AET),and also plant species richness but had a bell-shaped relationship with potential evapotranspiration(PET),whereas the inverse situation was shown for warm/neutral and pungent/sweet/sour species.Conclusion: Analysis of the data in Xinjiang region of China supports the qualitative observations concerning natures and flavors in traditional theory of Chinese medicine property. Specifically,(i) certain natures and flavors co-occur more frequently than if randomly distributed;(ii) correlations between proportions of natures and flavors and climatic variables suggest a role for the environment in shaping the properties of CMM.