中药复方抗食管癌研究进展

食管癌是恶性程度高、侵袭能力强、预后较差的一类上消化道恶性肿瘤，属中医学“噎膈”范畴。中药复方在抗肿瘤方面具有显著优势。通过查阅国内外相关文献，获知构成食管癌（噎膈）的证素包括气滞、痰、气虚、血瘀、阴虚等，中医临床辨证多分为痰气交阻、气阴两虚、津亏热结、气虚痰湿、痰热互结、痰瘀互结、热毒瘀结、正虚毒蕴等，大半夏汤、启膈散、旋覆代赭汤、六君子汤、沙参麦冬汤、通幽汤等为临床常用方剂，其中启膈散、六君子汤、通幽汤等经体内外实验研究已证明可通过直接抑制肿瘤细胞增殖、或促进凋亡、影响肿瘤微环境、调节细胞能量代谢、抑制血管生成等机制发挥抗食管癌作用，且中药复方通过靶向非编码单链RNA分子（microRNA）发挥抗食管癌作用的研究越来越多，发现临床收效良好的复方大半夏汤、参赭培气汤、小陷胸汤、人参半夏汤、六神丸等尚无深入的机制研究，古籍所载的吴茱萸汤、通关散等复方却于现代少有应用。因此，该文将中医经典古籍中专药专方、现代临床常用复方及实验研究进行梳理，以期推广中药复方抗食管癌的治疗方法，发挥中西医结合治疗的协同优势。     

Going to the doctor with enhancement in mind – An ethnographic study of university students’ use of prescription stimulants and their moral ambivalence

Aims: The aim of this qualitative research is to show how the alcohol socialization process – i.e. the ways children and young people get acquainted with alcohol – can generate very diverse experiences and meanings in different cultural contexts.

Method: A total of 16 focus groups were conducted in Italy and Finland, divided by age (4 groups), gender and socio-cultural level. A total of 190 participants took part in the study.

Findings: The findings support the hypothesis that the alcohol socialization process takes place in very different ways and assumes diverse meaning in the two countries involved in the study. In Italy the relationship with alcohol takes place as part of a gradual process and participants’ first memories of drinking alcohol are connected to positive values. In Finland, on the other hand, often the first experiences of drinking overlap with the first experiences of intoxication and alcohol images reflect an ambiguous relation with this substance, closely related to its intoxicating effects.

Conclusions: Results show that the alcohol socialization process can take very different forms and meanings according to a specific drinking cultures. Thus, further comparative research should take into more consideration the implication of these substantial differences.     

基于数据挖掘的吕英教授治疗自闭症语言障碍的用药规律分析＊

目的 基于中医传承辅助平台软件（TCMISS，V2.5）对吕英教授治疗自闭症语言障碍的处方进行数据挖掘，探索其病因病机及组方规律。方法 收集吕英教授治疗自闭症语言障碍的医案，将其方药信息录入TCMISS，借助该平台集成的关联规则、改进互信息法、复杂系统熵聚类法、无监督熵层次聚类法等分析方法探索吕英教授治疗自闭症语言障碍的药物组方规律。结果 共筛选出120个医案，包含处方共120首，涉及中药89味，其中使用频次前6味中药为桂枝、鸡蛋花、白术、泽泻、石膏、桔梗，药性以寒、温为主，药味以甘、苦居多，归经多属肺、脾、肝经。通过关联规则分析所得的用药模式中，使用频次最高的为桂枝与鸡蛋花、桂枝与泽泻、白术与桂枝，进一步分析得到的核心药物为泽泻、桂枝、白术，为五苓散的药物组成，并基于复杂熵聚类方法演化出6首新处方。结论 吕英教授治疗自闭症语言障碍以阳明“气血津”不足和三焦气化功能失常为主要病机线路，清解阳明伏火、加强阳明本体液津血的生化化生及恢复三焦气化功能正常为主要治法，其核心代表方剂为木防己汤和五苓散。     

Qingre Quyu Granule(清热祛瘀颗粒)Stabilizes Plaques through Inhibiting the Expression of Tenascin-C in Patients with Severe Carotid Stenosis

Objective:To investigate the therapeutic effects of Qingre Quyu Granule(清热祛瘀颗粒,QQG)on the patients with severe carotid stenosis,and to explore the mechanism of it.Methods:Ninety-six patients with severe carotid stenosis were enrolled in the study and were classified into a QQG group(n=48) and a control group(n=48) randomly using consecutively numbered envelopes.The patients in the QQG group were given QQG and Western medicine,those in the control group were given Western medicine merely,the course of treatment was 16 weeks.All patients went through endarterectomy after treatment.Plaques were subjected to the analysis of CD3,CD68,soluble intercellular adhesion molecule 1(ICAM-1),matrix metalloprotease-9(MMP-9),CD40 L,tenascin-C,and collagen content lipid content by immunohistochemistry or polarized light analysis.Results:By the end of experiment,the expressions of CD3,CD68,ICAM-1,MMP9,CD40 L and tenascin-C on the plaques were statistically significant lower in the QQG group compared with the control group(P0.01).The lipid content of the plaque was also significantly lower in the QQG group compared with the control group(P0.01).The interstitial collagen in the tissue sections of the plaques was also significantly higher in the QQG group in comparison with the control group(P0.01).Conclusion:QQG could stabilize carotid artery plaques through inhibiting pro-inflammation factors and restraining the tenascin-C and MMP9 pathway.