A randomized placebo-controlled trial of traditional Chinese medicine as an add-on therapy to oral montelukast in the treatment of mild persistent asthma in children

ObjectivesTraditional Chinese medicine are commonly used for treatment of asthma. However, there are only very limited data about its efficacy in children. Therefore, we aimed to determine the efficacy of augmented Yu Ping Feng San (aYPFS) as an add-on to oral montelukast compared with montelukast alone for treatment of mild persistent asthma in children.DesignA single centre, placebo-controlled, double-blinded, randomized control trial was carried out. Participants with age 6–18 years who had mild persistent asthma were randomized according to random number list to receive either aYPFS plus montelukast for 24 weeks or placebo plus montelukast for 24 weeks. Primary outcome measure was lung function parameters. Secondary outcome measures were Asthma Control Test™ (ACT™) and Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores, symptom-free days, short-acting β2-agonist use, use of rescue oral corticosteroids, days of hospitalization for asthma and number of emergency consultation with GPs or AED department.ResultsTwenty-eight participants were randomized to aYPFS group and twenty-nine to placebo group. There was no significant difference in baseline characteristics. There was significant improvement in ACT™ score in aYPFS group (up to 6.9% change from baseline) (p = 0.016) but not in the control group. There were no significant differences between groups in other primary and secondary outcome parameters. Dropout because of adverse effects is comparable in both groups.ConclusionTraditional Chinese medicine aYPFS as an add-on to montelukast improved symptoms of asthma control. Further studies with larger sample size are needed to evaluate its efficacy and safety in childhood asthma.     

纳武利尤单抗在非小细胞肺癌治疗中的研究进展

肺癌是全球癌症死亡的主要原因之一。其中非小细胞肺癌(non-small cell lung cancer,NSCLC)占所有肺癌病例的85%以上,尽管化疗及靶向治疗改善了患者临床疗效,但预后仍欠佳。免疫治疗的发展改变了NSCLC患者的治疗策略。纳武利尤单抗是一种针对程序性死亡受体-1(programmed cell death-1,PD-1)的完全人源化的IgG4单克隆抗体,是首个被批准用于晚期NSCLC治疗的免疫检查点抑制剂。纳武利尤单抗已经成为晚期NSCLC治疗的主要药物,但临床上尚缺乏预测疗效的生物标志物。本文针对纳武利尤单抗的作用机制、药代动力学、单药治疗、联合治疗、不良反应和潜在生物标志物的最新进展进行综述。     

结直肠癌肝转移差异表达基因与信号通路分析

目的：探讨结直肠癌（colorectal cancer, CRC）肝转移的关键基因和分子机制，为CRC肝转移的治疗提供潜在靶点和生物标志物。方法: 基于生物信息学方法从GEO 数据库下载CRC 肝转移基因表达数据集，筛选差异表达基因（differentially expressed gene, DEG），利用DAVID 在线工具对DEG进行GO和KEGG富集分析，构建蛋白互作（protein-protein interaction, PPI）网络图，筛选出CRC关键基因并进行预后分析。结果: 从183 例CRC组织标本和39 例CRC肝转移组织标本中筛选出321 个DEG，其中上调基因153 个、下调基因168 个。GO和KEGG富集分析结果显示，DEG的功能主要涉及蛋白质激活级联反应、炎症反应、细胞外基质、血小板脱颗粒、补体与凝血级联反应等。PPI 网络图筛选出8 个CRC 关键基因为ALB、APOB、FGA、F2、APOA1、SERPINC1、FGG和AHSG。生存分析发现，SERPINC1、FGG表达高的患者预后不良（均P<0.05）。结论: DEG的生物学功能和信号通路与CRC肝转移的发生发展相关，8 个CRC关键基因可能是CRC肝转移治疗的潜在靶点，SERPINC1、FGG可能成为新的预后标志物。     

正骨手法配合三维骨科牵引固定架固定治疗三踝骨折疗效观察

目的:评价正骨手法配合三维骨科牵引固定架固定治疗三踝骨折的临床疗效。方法:自2008年12月—2011年1月通过正骨手法配合新型改良外固定器治疗三踝骨折病人22例,根据X线表现、患者主诉及AOFAS评分系统对患足功能恢复进行疗效评价。结果:经过10~25个月的随访,本组22例病人,其中优17例,良3例,一般2例;总优良率:90.9%。结论:正骨手法配合三维骨科牵引固定架治疗三踝骨折疗效满意。     

基于现代文献的慢性肺源性心脏病中医证候研究

目的 研究慢性肺源性心脏病中医证候分布特点,总结其基本规律.方法 检索1989 - 2009年与中医证候相关的慢性肺源性心脏病文献,对中医证候分类进行整理,建立数据库,对所涉及的中医证候名称进行规范,对规范前后的中医证候进行频次统计分析.结果 纳入文献120篇,涉及中医证候类型225种,出现频率＞1％的证候类型占7.6...     

分步斜扳手法治疗腰椎间盘突出症的临床疗效观察

目的:评价腰椎分步斜扳手法治疗腰椎间盘突出症的安全性和有效性。方法:选择门诊收治的腰椎间盘突出症患者65例,通过中央在线网络随机系统实现随机入组,分为分步斜扳手法治疗组(32例)和骨盆牵引对照组(31例),另外脱落病例1例,剔除病例1例。1个疗程结束后采用JOA腰痛疾患疗效评定表、视觉模拟评分法(VAS评分),分别对症状体征、日常生活能力等综合方面,以及腰腿疼痛进行疗效评定,量化比较两组疗法的治疗效果。结果:疗程结束后治疗组疗效控制7例,显效16例,有效8例,无效1例。对照组疗效控制4例,显效10例,有效13例,无效4例。治疗组的临床有效率为96.86%,高于对照组87.10%(P0.05)。治疗组治疗后JOA腰痛疾患表评分、腰腿痛VAS评分改善明显(P0.001),且优于对照组(P0.01)。结论:分步斜扳手法操作技术具有操作简便、可重复性强、疗效明显、安全性高的优点,且易于掌握,便于在临床应用中推广使用。     

拇外翻微创术跖骨远端位移内侧纵弓顶角与胼胝痛的关系

目的通过X线的二维测定探讨中西医结合微创技术治疗拇外翻,跖骨远端位移(跖屈或跖移)、足内侧纵弓顶角与胼胝痛(VAS)三者之间的关系。方法自2006年7月～2007年6月,笔者于手术治疗拇外翻(均采用同一术式:中西医结合微创技术)42例79足。手术前后摄负重正侧位X线片,测量内侧纵弓顶角;并进行症状体征检查,记录胼胝及胼胝痛(VAS)。根据VAS量表将研究对象分为疼痛加重组、疼痛减轻组。各组研究对象又根据远端跖骨块的位置改变情况分为两组:跖屈或跖移(向背侧成角)组;非跖屈或跖移组。比较各组间内侧纵弓顶角差的差异。平均随访时间6.5个月。结果胼胝及胼胝痛术后加重5足,其余均减轻。术后胼胝及胼胝痛的变化与术后远端跖骨块位置情况比较,P<0.05;术后胼胝及胼胝痛的变化与手术前后内侧纵弓顶角差比较,P<0.05;术后远端跖骨块位置情况与手术前后内侧纵弓顶角差比较,P<0.05。差异均有显著性。结论通过截骨远端跖骨块足够的跖移、跖屈可以减小足内侧纵弓顶角,弥补因短缩引起的内侧纵弓高度的丢失,减少术后胼胝疼痛等并发症发生的概率。     

以重症肺炎入院确诊艾滋病3例病例分析

目的提高非感染科医生对艾滋病（AIDS）的早期识别能力,减少误诊。方法回顾性分析总结望京医院呼吸科2011年6月-2013年1月期间确诊的3例因重症肺炎住院治疗的AIDS患者的临床特点。结果 AIDS发生肺部感染时病情重,3例均诊断为卡氏肺孢子虫（PCP）肺炎,均合并Ⅰ型呼吸衰竭,影像学均表现为间质感染,同时合并口腔念珠菌感染,与普通社区获得性肺炎（CAP）不同。结论 AIDS患者症状、影像学改变与体征不匹配,其发病特点、影像学表现与普通CAP有明显差别,据此可以提高AIDS的早期诊断率。     

Chinese Medicine Improves Postoperative Quality of Life in Endometriosis Patients: A Randomized Controlled Trial

Objective:To investigate the effect of Chinese medicine(CM) and Western medicine(WM) on quality of life(QOL) after conservative surgery for endometriosis.Methods:A total of 320 patients with endometriosis were randomized into two groups by using random block design,CM group(160 cases,activating blood circulation and removing blood stasis treatment based on syndrome differentiation) and WM group(160 cases,gonadotropin-releasing hormone agonist or gestrinone treatment) after conservative surgery.Treatment was given for 3-6 months(according to the revised American Fertility Society scoring system stage),and the World Health Organization QOL-BREF(WHOQOL-BREF) was applied to patients before and after treatment to assess QOL.Results:There were 136 cases in the CM group and 141 cases in the WM group completing therapy.In the CM group,the use of the WHOQOL-BREF showed that the physical,psychological and environmental scores post- treatment were significantly higher than those at pre-treatment(P<0.05),and for 12 items(pain and discomfort, energy and fatigue,sleep and rest,mobility,activities of daily living,work capacity,negative feelings,health and social care:accessibility and quality,participation in and opportunities for recreation/leisure activities,appetite, QOL score,overall health status and QOL),the difference in scores was significant(P<0.05).In the WM group,4 items(pain and discomfort,opportunities for acquiring new information and skills,QOL score,overall health status and QOL) had significantly different scores post-treatment compared with those at pre-treatment(P<0.05).Before treatment,the QOL in the two groups of patients showed no significant difference(P>0.05).After treatment,the scores for physical health in the CM group were significantly higher than those of the WM group(P<0.05) and the scores of 4 items(mobility,activities of daily living,sexual activity,QOL score) in the CM group were significantly higher than those in the WM group(P<0.05).Conclusions:CM and WM treatment could improve the QOL of patients with endometriosis after conservative surgery.CM treatment is more effective than WM.     

肝纤维化中医理论源流

肝纤维化中医理论源流包括病名、病因、病机、证治、方药、流派等方面。先秦时期阴阳五行学说对腹部疾病描述蕴含了古人有关肝纤维化的早期理解。秦汉时期中医典籍已有肝纤维化理、法、证、治、方、药、术记载,包括病名归属范围广、邪毒蕴结肝络病机、阴阳和合诊治境界及辨证论治———方证对应体系;魏晋隋唐医药学全面继承发展,"肝王以胃气为本"说、"推陈致新"药证论、热毒内蕴肝络证治观点相继提出;宋金元时期学派纷呈,见解独到,如气机郁结肝络证治观点、推崇脾胃学说;至明清,肝纤维化中医认识已比较完善成熟,经方时方通变论、痰瘀内阻肝络论、经络病证论等注重临证通变;近代至今,中西医汇通。中医为体,西医为用,发挥中医药疗效优势,主导着当前论治肝纤维化的研究。