Holistic Approach to Functional Constipation: Perspective of Traditional Persian Medicine

Traditional Persian medicine (TPM) proposes a different viewpoint to the chronic diseases. Diagnosis and implemented treatment are based on individual differences among patients. Constipation or Ea''teghal-e-batn is a condition in which the patient develops difficult or painful defecation. Based on TPM concepts, the first digestion step starts from halq (oral cavity), and ends via defecation from the maq''ad (anus). Avicenna believed that four faculties, ha''zemeh (digestive), ja''zebeh (absorptive), ma''sekeh (retentive) and da''fe''eh (propulsive), are involved in the process of digestion and absorption of the ingested food and expelling the waste materials. The bowel movement and appearance of the stool is a measure for evaluating the gastrointestinal healthy function. Defecation should be with no pain and fecal material should have no burning and acuity. Low food intake or foods with dry temperament, dryness of gastrointestinal tract, diaphoresis and heavy exercise as well as intestine sensory loss were discussed as main causes of constipation. Management of constipation in TPM includes dietary schemes, oil massages and subsequently simple herbal medicines. According to TPM theories, the first step in treating a disease is the elimination of disease causes (asbab e-maraz) and also providing the causes of health (asbab-e-sehhat). Health care providers should know the proper condition which the herbal medicines should be administered in and be able to guide the patients about the benefits and hazards of herbal remedies, commonly used in their living origin.     

中药注射剂安全性的分析与思考

中药注射剂安全性是社会关注的热点问题,正确认识中药注射剂不良反应,将能避免社会民众产生误解或认识错位。目前中药注射剂的生产原料、生产工艺以及突出安全性的质量监控是影响中药注射剂安全性的关键所在,针对各品种临床存在的问题,加强中药注射剂安全性的基础研究,在说明书明确临床药物配伍及使用规范,强化相关物质、不溶性微粒、热原、过敏物质等注射剂安全性质控,确实保证中药注射剂用药安全。      

非酒精性脂肪肝中医证型及临床生化指标相关性研究

目的 探讨非酒精性脂肪肝（NAFLD）患者的中医证型分布规律、特征及其临床因素的相关性。方法 以249例NAFLD患者为研究对象,将其辨证分为湿浊内停证、肝郁脾虚证、湿热蕴结证、痰瘀互结证、脾肾两虚证共5种证型,探讨各中医证型与年龄、性别、BMI及血清生化指标的相关性。结果 ①证型占比:湿浊内停证30.1%,肝郁脾虚证28.1%、湿热蕴结证25.7%、痰瘀互结证8.8%、脾肾两虚证7.2%;②男女比例约1.39∶1,湿热内蕴、湿浊内停证患者以男性为主（P<0.05）;肝郁脾虚证者则以女性为主（P<0.01）;③湿热内蕴证组ALT升高最为显著,与湿浊内停证、肝郁脾虚证组比较存在统计学差异（P<0.05）。湿浊内停证TC升高最为显著,与肝郁脾虚证、湿热内蕴证、脾肾两虚证组相比,均存在统计学差异（P<0.05）。结论 NAFLD中医证型以湿浊内停证、肝郁脾虚证、湿热内蕴证最为常见;男性发病率高于女性;湿热内蕴证患者更易出现ALT损伤;湿浊内停证更容易出现TC升高。      

Effect of Soothing Gan (Liver) and Invigorating Pi (Spleen) Recipes on TLR4-p38 MAPK Pathway in Kupffer Cells of Non-alcoholic Steatohepatitis Rats

Objective: To investigate the mechanism of inflammatory-mediated toll-like receptor 4(TLR4)-p38 mitogen-activated protein kinase(p38 MAPK) pathway in Kupffer cells(KCs) of non-alcoholic steatohepatitis(NASH) rats and the intervention effect of soothing Gan(Liver) and invigorating Pi(Spleen) recipes on this pathway. Methods: After 1 week of acclimatization, 120 Sprague-Dawley male rats were randomly divided into 8 groups using a random number table(n=15 per group): normal group, model group, low-dose Chaihu Shugan Powder(柴胡疏肝散, CHSG) group(3.2 g/kg), high-dose CHSG group(9.6 g/kg), low-dose Shenling Baizhu Powder(参苓白术散, SLBZ) group(10 g/kg), high-dose SLBZ(30 g/kg) group, and low-and highdose integrated recipe(L-IR, H-IR) groups. All rats in the model and treatment groups were fed with a high-fat diet(HFD). The treatments were administrated by gastrogavage once daily and lasted for 26 weeks. The liver tissues were detected with hematoxylin-eosin(HE) and oil red O staining. Levels of liver lipids, serum lipids and transaminases were measured. KCs were isolated from the livers of rats to evaluate the mRNA expressions of TLR4 and p38 MAPK by real-time fluorescence quantitative polymerase chain reaction, and proteins expressions of TLR4, p-p38 MAPK and p38 MAPK by Western blot. Levels of inflammatory cytokines including tumor necrosis factor α(TNF-α), interleukin(IL)-1 and IL-6 in KCs were measured by enzyme-linked immunosorbent assay. Results: After 26 weeks of HFD feeding, HE and oil red O staining showed that the NASH model rats successfully reproduced typical pathogenesis and histopathological features. Compared with the normal group, the model group exhibited significant increases in body weight, liver weight, liver index, serum levels of total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol, and aspartate aminotransferase as well as TC and TG levels in liver tissues, and significant decrease in serum level of high-density lipoprotein cholesterol(P0.05 or P0.01), while those indices were significantly ameliorated in the H-IR group(P0.05 or P0.01). Higher levels of TNF-α, IL-1 and IL-6 in KCs were observed in the model group compared with the normal group(P0.01). Significant decreases in TNF-α, IL-1 and IL-6 were observed in the H-SLBZ, H-IR and L-IR groups compared with the model group(P0.05 or P0.01). The m RNA expressions of TLR4 and p38 MAPK and protein expressions of TLR4, p38 MAPK and p-p38 MAPK in KCs in the model group were significantly higher than the normal group(P0.01), while those expression levels in the L-IR and H-IR groups were significantly lower than the model group(P0.05 or P0.01). Conclusions: Inflammation in KCs might play an important role in the pathogenesis of NASH in rats. The data demonstrated the importance of TLR4-p38 MAPK signaling pathway in KCs for the anti-inflammatory effect of soothing Gan and invigorating Pi recipes.     

中药经皮给药脂质体的研究与展望

中药经皮给药有悠久的应用历史,脂质体作为新型载体用于中药活性成分的经皮给药可以提升药物在局部的皮内滞留或（和）透皮吸收效果,从而显著改善药效。该文从皮肤屏障的特点、中药经皮给药概况、脂质体促进经皮吸收的机制与影响因素、中药经皮给药脂质体的皮内滞留、中药经皮给药脂质体的透皮吸收等5个方面对相关研究进展进行了综述,涉及常规脂质体以及传递体、醇质体、萜质体、甘油体、表面修饰脂质体等新型脂质体的应用,并提出了坚持正确的研究方向、提升制剂技术水平和提高研究技术水平三方面的展望。      

Relation of Blood Arsenic Concentration with Effect and Safety of Arsenic-Containing Qinghuang Powder (青黄散) in Patients with Myelodysplastic Syndrome

Objective: To investigate the relation of blood arsenic concentration(BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder(青黄散, QHP) in patients with myelodysplastic syndrome(MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L(P0.05), the absolute neutrophil count increased from 0.81±0.48×10~9/L to 1.08±0.62×10~9/L(P0.05), and no significant changes were observed in platelet counts(P0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L(P0.05), 3 months with 33.56±15.28 μg/L(P0.05), and 6 months with 36.78±11.92 μg/L(P0.05), respectively, as compared with those before treatment(4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months(P0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases(8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions(22.39±10.38 vs. 37.89±11.84, μg/L, P0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment(40.41±11.69 vs. 23.84±12.03, μg/L, P0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.     

《内经》所蕴含的中医肾病证治思路探讨

邹氏肾科医术非物质文化遗产团队根据《内经》相关理论结合团队临床实践对常见肾病的中医证治思路进行探讨,认为肾气不足为肾病发病之因,肾元衰竭是发病之本。临床中需注意未病先防、既病防变,强调治病必求于本。根据临床实际情况,分别提出从脾肾、从肝肾、从肺论治肾病,常用治法有健脾温肾、扶正渗利、清肝解毒、养肝滋阴、平肝潜阳、疏肝活络、疏风宣肺、清热宣肺、清热利咽、和法缓治、活血化瘀、疏滞泄浊等法。      

中国人眼颅压力梯度参考区间的临床研究

目的探讨中国人群眼颅压力梯度参考区间,为建立基于眼颅压力梯度的开角型青光眼诊疗新体系提供理论标准。 方法横断面研究。对2010年8月至2019年8月首都医科大学附属北京同仁医院神经内科需行腰椎穿刺的受试者共200例。其中,男性97例,女性103例,年龄区间12~79岁,平均(47.0±14.7)岁。对受试者进行眼压、颅压及全身基本参数测量。性别资料采用频数和百分比描述;年龄、身高、体重、眼压、颅内压、平均动脉压、体质指数及眼颅压力梯度等连续定量资料采用 ±s描述。对于少量缺失数据,采用马尔科夫链蒙特卡洛模拟(MCMC)对缺失数据进行多重插补。采用95%分位数法确定参考值范围,对于连续定量资料的多组间比较采用单因素方差分析,两两比较采用两独立样本t检验。 结果根据全体受试者测定人群眼压参考区间为9.015 mmHg~20.265 mmHg(1 mmHg＝0.133 kPa)。人群颅压参考区间为6.179 mmHg~14.921 mmHg。人群眼颅压力梯度参考区间为-2.987 mmHg~11.047 mmHg。眼颅压力梯度临床诊疗参考区间为0.423 mmHg~10.508 mmHg。以年龄进行分组,<30岁人群眼颅压力梯度参考区间为-2.968 mmHg~9.028 mmHg;30岁~50岁人群眼颅压力梯度参考区间为-2.466 mmHg~11.606 mmHg;>50岁人群眼颅压力梯度参考区间为-2.466 mmHg~11.606 mmHg。三组间眼颅压力梯度差异无统计学意义(F＝2.041,P>0.05)。以性别进行分组,男性眼颅压力梯度参考区间为-2.769 mmHg~10.089 mmHg;女性眼颅压力梯度参考区间为-3.137 mmHg~11.877 mmHg。两组间眼颅压力梯度的差异无统计学意义(t＝-1.413,P>0.05)。以体质指数(BMI)进行分组,BMI<21 kg/m²的人群眼颅压力梯度参考区间为-1.437 mmHg~11.577 mmHg;21 kg/m²2的人群眼颅压力梯度参考区间为-3.046 mmHg~11.026 mmHg;BMI>23 kg/m²的人群眼颅压力梯度参考区间为-3.947 mmHg~10.087 mmHg。不同BMI分组间,眼颅压力梯度差异有统计学意义(F＝6.109,P<0.05)。 结论眼颅压力梯度临床诊疗参考区间为0.423 mmHg~10.508 mmHg,可作为开角型青光眼临床诊疗的新指标。同时,还为开角型青光眼病因学诊断及个体化治疗的进一步深入研究,提供新的实践基础与研究方向。     

Responsiveness and minimal clinically important difference of the Chinese version of the Low Vision Quality of Life Questionnaire after cataract surgery

AIM: To investigate the Chinese version of the Low Vision Quality of Life Questionnaire (CLVQOL) as an instrument for obtaining clinically important changes after cataract surgery. METHODS: Patients underwent cataract surgery in Shanghai General Hospital, Shanghai Jiao Tong University, who fit the inclusion criteria were recruited. Two CLVQOLs were administered, including a preoperative CLVQOL and a CLVQOL at the end of the 3mo follow-up period, and were completed using face-to-face interviews or phone interviews conducted by trained investigators. The minimal clinically important difference (MCID) was calculated using an anchor-based method and a distribution method. In addition, the responsiveness of the questionnaire was measured. RESULTS: A total of 155 residents were enrolled. The average visual acuity (VA) preoperatively was 0.08 (SD=0.05), and it increased to 0.47 (SD=0.28) at the end of follow-up. Statistically significant positive changes in the CLVQOL scores indicated significant improvement of vision related quality of life after cataract surgery. With the larger value between the two results as the final value, the MCID values of the CLVQOL (scores of the four scales as well as the total score) were 8.94, 2.61, 4.34, 3.10 and 17.63, respectively. The CLVQOL has both good internal and external responsiveness. CONCLUSION: CLVQOL scores are appropriate instruments for obtaining clinically important changes after cataract surgery. This study is an effective exploration for establishing cataract surgery efficacy standards, which helps clinical and scientific research workers in ophthalmology to gain a more in-depth understanding when using CLVQOL.