系统中药学指导下的益母草多维评价研究

系统中药学是基于现代中药学学科的开创者凌一揆教授"大中药"的思想,是研究中药复杂系统品种、品质、制药、药性、功效、应用等关键要素发生、发展、变化的科学。本文论述了系统中药学的科学内涵,报告了在系统中药学指导下益母草"品质制性效应"的研究实践。     

甲状腺未分化癌发生肺转移的危险因素分析

目的:探讨甲状腺未分化癌(anaplastic thyroid carcinoma,ATC)发生肺转移的危险因素。方法:回顾性分析2010年至2015年SEER数据库中被确诊为ATC的405例患者临床病理资料。通过对年龄、种族、性别、原发灶最大径、原发灶数量、甲状腺外组织侵犯、食管侵犯、气管侵犯、中央区淋巴结转移、颈侧区淋巴结转移10个因素进行单因素分析,进而对单因素分析中有统计学差异的指标行多因素Logistic回归分析,寻找ATC患者发生肺转移的危险因素。结果:405例ATC患者中,发生肺转移107例,未发生肺转移298例。单因素分析显示:原发灶最大径>4 cm、甲状腺外组织侵犯、颈侧区淋巴结转移是预测发生肺转移的显著性因素(均P<0.05)。多因素Logistic回归分析显示:原发灶最大径>4 cm及颈侧区淋巴结转移是ATC患者发生肺转移的独立危险因素(均P<0.05)。结论:原发灶最大径>4 cm、颈侧区淋巴结转移的ATC患者极易发生肺转移,因此,一定要认真参考病理结果,若发现存在以上肺转移危险因素,则积极采取多模式治疗方案,并缩短随访时间,行相关检查(如胸部CT扫描、PET-CT等)。     

左、右半结肠癌肝转移患者射频消融治疗疗效及生存的对比分析

目的:探讨原发部位分别位于左、右半结肠的结肠癌肝转移患者行超声引导下肝转移瘤射频消融术后的生存差异及预后影响因素分析。方法:回顾性分析2010年1月至2015年12月于我科行射频消融治疗的结肠癌肝转移患者100例，其中左半结肠癌62例，右半结肠癌38例，分析原发部位不同的结肠癌肝转移患者在进行超声引导下射频消融治疗后的生存情况。结果:左半结肠癌肝转移患者射频消融术后1、3、5年总体生存率及中位生存期均高于右半结肠癌肝转移患者（88.71% vs 73.68%、62.90% vs 30.02%、49.72% vs 26.33%、55个月 vs 23个月），且二者生存曲线差异具有统计学意义（P＜0.05）。经Log-rank检验及COX多因素分析，左、右半结肠癌肝转移患者射频消融治疗术后的生存情况存在差异。此外，原发灶淋巴结转移情况、患者术前CA199水平及原发灶分化程度是患者射频消融治疗术后生存情况的影响因素。结论:左半结肠癌肝转移患者射频消融术后整体生存率明显高于右半结肠癌肝转移患者，左半结肠癌与右半结肠癌肝转移患者在射频消融治疗术后生存状况存在明显差异。     

老年侵袭性纤维瘤的临床特征与外科治疗

目的探讨60岁以上老年侵袭性纤维瘤(AF)患者的临床特征、手术疗效及生存预后。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2008年1月至2019年1月收治的22例老年AF患者的临床病理资料。结果22例患者中男10例,女12例;年龄60～80岁,平均年龄649岁。腹内型AF 6例,肿瘤均位于小肠系膜;腹壁型AF 1例;腹外型AF 15例,其中肿瘤位于胸壁4例,肩背臀部5例,头颈部6例。平均肿瘤直径为55 cm。切缘阳性者4例,分别位于头颈部2例、臀部1例、胸壁1例,其中3例患者术后行化疗／放疗。全组中位随访时间为37个月,共4例患者在我院手术后复发,均为腹外型AF。其中,复治者3例,切缘阳性者2例。中位复发时间为25个月,随访期间1例患者死于肿瘤复发。结论老年AF患者通过根治性手术切除可获得令人满意的治疗效果。初次手术疗效对老年AF患者至关重要,在尽可能保留器官组织功能的前提下确保足够手术切除范围。对于无法达到R0切除的患者,应考虑术后辅助治疗以控制局部复发。     

Safety and Preliminary Efficacy of Ramucirumab in Combination with FOLFOX4 in Patients with Advanced Hepatocellular Carcinoma: A Nonrandomized,Open‐Label,Phase Ib Study

Lessons Learned

• The combination of ramucirumab (8 mg/kg intravenous, day 1 every 2 weeks) and FOLFOX4 as first‐line treatment in patients with advanced hepatocellular carcinoma (HCC) was not sufficiently tolerated.
• Preliminary efficacy data suggest that the combination may provide clinical benefit to patients with HCC.
• Dose modification and patient selection should be considered for the future development of ramucirumab plus FOLFOX chemotherapy for advanced HCC.

BackgroundThe objective of this study was to investigate the safety, preliminary efficacy, pharmacokinetics, and immunogenicity of ramucirumab plus FOLFOX4 as first‐line treatment in patients with advanced hepatocellular carcinoma (HCC).MethodsPatients received ramucirumab (8 mg/kg) intravenously (IV) on day 1, followed by FOLFOX4 (oxaliplatin 85 mg/m² IV on day 1, folinic acid 200 mg/m² IV, bolus fluorouracil [5‐FU] 400 mg/m², and a continuous infusion of 5‐FU 600 mg/m² over 22 hours, on days 1 and 2) every 2 weeks. The primary endpoint was to assess the safety and tolerability of the combination therapy.ResultsEight patients (6 men, 2 women) were treated; all eight patients experienced at least one treatment‐emergent adverse event (TEAE) of grade ≥3. Dose‐limiting toxicities occurred in three patients (37.5%): hepatic hemorrhage (grade 4), blood bilirubin increased (grade 3), and febrile neutropenia (grade 3). Two patients discontinued study because of hepatic hemorrhage (grade 4) and blood bilirubin increase (grade 3). Six deaths occurred due to progressive disease, and no deaths due to TEAEs.ConclusionThere were no unexpected safety findings with ramucirumab plus FOLFOX4 based on the known safety and toxicity of this regimen. The combination was not sufficiently tolerated in patients with advanced HCC at the specified dose and schedule.     

35例新型冠状病毒肺炎患者中医临床特征分析

目的分析广东省新型冠状病毒肺炎患者临床资料及中医证候,为该病的防治提供科学依据。方法将2020年1月23日至2020年2月14日本院收治的35例新型冠状病毒肺炎患者纳为研究对象,收集患者的基本情况、流行病学史及疾病史,通过血液生化分析及胸部CT检查患者临床情况,由5名高级职称中医师对患者舌象进行诊断,并根据《广东省新型冠状病毒感染的肺炎中医药治疗方案(试行第一版)》进行辨证。结果新型冠状病毒肺炎患者年龄分布较广,平均年龄为(44.00±15.17)岁,以男性居多,57.14%的患者有武汉及周边地区旅居史,42.86%的患者有确诊患者接触史;50%以上的患者淋巴细胞绝对值降低,CD3、CD4和、CD8降低以及C反应蛋白增加;胸部CT显示,80%以上的患者出现肺部病变,其中双肺病变占60%,病变类型以斑块状阴影居多;多数患者伴有发热(85.71%)、咳嗽(80.00%)、肌肉酸痛(42.86%)、乏力(40.00%)等临床症状;患者的证型主要是湿邪郁肺(45.71%),其次为邪热壅肺(37.14%),病机特点以湿为主,其次为热;舌苔以腻苔为主,舌质以红和淡红为主。结论新型冠状病毒肺炎患者的中医证型以湿邪郁肺为主,致病特点以"湿"为主,可针对性地采取中医治疗。     

Basic fibroblast growth factor promotes doxorubicin resistance in chondrosarcoma cells by affecting XRCC5 expression

Chondrosarcoma is the second most common form of bone cancer and is characterized by its ability to produce an extracellular matrix of the cartilage. High-grade chondrosarcoma is highly aggressive and can metastasize to other parts of the body. Chondrosarcoma is resistant to both conventional chemotherapy and radiotherapy; hence, the current main treatment is still surgical resection. Doxorubicin (Dox) has been shown to significantly improve patient survival compared with untreated chondrosarcoma. However, for patients with metastasis, surgical resection alone can hardly treat them. In addition, drug resistance is one of the leading causes of death in patients with chondrosarcoma. Secreted proteins can mediate cell-cell interactions in the cancer microenvironment, which may be associated with the development of drug resistance. In the present study, chondrosarcoma cells were treated with Dox, the conditioned medium was then collected and changes in secreted proteins were analyzed using the antibody array. Results showed that the Dox-treated group had the highest secretion of basic fibroblast growth factor (bFGF), indicating the effect of bFGF on Dox sensitivity in chondrosarcoma. Furthermore, lentiviral-mediated knockdown and treatment of exogenous recombinant protein were employed to further investigate the effect of bFGF on Dox resistance. Results demonstrated that bFGF can promote the expression of X-ray repair cross-complementing protein 5 (XRCC5), leading to Dox resistance. Secreted bFGF is likely to be detected in serum, in addition to being a biomarker for predicting Dox resistance, the combination of Dox and bFGF/XRCC5 blockers may be a new therapeutic strategy to improve the efficacy of Dox in future.     

LncRNA UCA1对肺癌细胞放射敏感性影响及机制研究

目的 研究长链非编码RNA (LncRNA) UCA1对肺癌细胞增殖、凋亡及放射敏感性影响及其机制。方法 运用qRT-PCR法检测肺癌细胞A549、H1299和人正常肺细胞HBE中UCA1、miR-513a-5p表达。将si-con组(转染si-con)、si-UCA1组(转染si-UCA1)、miR-513a-5p组(转染miR-513a-5p mimics)、miR-NC组(转染miR-NC)、IR+si-con组(转染si-con+照射)、IR+si-UCA1组(转染miR-NC+照射)、IR+miR-513a-5p组(转染miR-513a-5p mimics+照射)、IR+miR-NC组(转染miR-NC+照射)、IR+si-UCA1+anti-miR-513a-5p组(共转染si-UCA1和anti-miR-513a-5p+照射)均用脂质体法转染至A549、H1299细胞,然后部分组进行4Gy照射。MTT法检测各组细胞增殖,克隆形成实验检测细胞增敏比,流式细胞术检测各组细胞凋亡,双荧光素没报告基因检测实验检测各组细胞的荧光活性。结果 与HBE细胞相比,A549、H1299细胞中UCA1表达显著升高(P<0.05),miR-513a-5p表达显著降低(P<0.05)。抑制UCA1、过表达miR-513a-5p均可明显抑制A549、H1299细胞增殖、促进凋亡、提高放射敏感性(放射增敏比为1.897、2.146和1.615、1.872)。miR-513a-5p可抑制野生型UCA1细胞的荧光活性,且UCA1可负向调控miR-513a-5p的表达。抑制miR-513a-5p可逆转抑制UCA1对细胞的放射敏感性的增强作用。结论 抑制LncRNA UCA1可增强放射对肺癌细胞敏感性,其机制可能与靶向抑制miR-513a-5p有关。     

基于中医临床证候探讨新型冠状病毒肺炎在岭南地区的疫性特点

目的:通过分析广东省第二人民医院收治的新型冠状病毒肺炎(以下简称新冠肺炎)患者的临床资料,从中医临床证候探讨该病在岭南地区的疫性特点,更好地指导临床辨证治疗。方法:收集广东省第二人民医院收治的36例新冠肺炎患者的临床资料,其中输入病例20例,本地病例16例,分析全部病例、输入病例和本地病例的临床资料和证候特点。结果:新冠肺炎患者年龄分布较广,平均年龄45岁,以男性居多,55.56%的患者为外地输入病例,44.44%的患者为本地感染病例。全部病例证型以湿邪郁肺型和邪热壅肺型为主,分别占44.44%和38.89%;91.67%的患者呈现“湿”的病理特点,72.22%的患者呈现“热”的病理特点。其中输入病例证型以湿邪郁肺型为主,占65.00%,100%的患者呈现“湿”的病理特点,55.00%呈现“热”的病理特点;本地病例证型以邪热壅肺为主,占56.25%,93.75%的患者呈现“热”的病理特点,81.25%呈现“湿”的病理特点。结论:本次疫病在岭南地区的疫性属于以湿邪和热邪为主导的“湿热疫”,病机特点为湿热并重;输入性病例多表现为以湿邪为患的“湿疫”,有化热的趋势和倾向,病机特点为湿重于热;本地病例多表现为以热邪为主的“温热疫”,病机特点为热重于湿。此次新冠肺炎不同地区存在不同疫性的可能,辨证和治疗要遵守三因制宜的原则。