对86例寒湿凝滞证原发性痛经患者不同子宫位置与三阴交穴效应关系的分析

目的通过对一项针刺治疗寒湿凝滞证原发性痛经的临床试验的相关数据进行分析,探讨寒湿凝滞证原发性痛经子宫位置与三阴交穴效应的关系。方法按照中央完全随机方案将96例寒湿凝滞证原发性痛经患者随机均等分为期望得气组和期望不得气组,排除子宫位置资料不全者最终纳入86例,于治疗前通过超声对每位受试者子宫位置进行评估,当疼痛视觉模拟量表(VAS-P)值≥40 mm时,取双侧三阴交穴,期望得气组以Φ0.3×40 mm一次性无菌管针直刺1~1.2寸,每10分钟行平补平泻手法30秒;期望不得气组以Φ0.18×13 mm一次性无菌管针弹入即可,不施手法,两组均留针30分钟后缓慢平和的将针渐渐退出,进行疗效检测。采用疼痛视觉模拟评分量表(VAS-P)值评价两组治疗前、起针即刻(针刺30分钟)和起针后10分钟(40分钟)的疼痛情况。并比较各子宫位置反应者比例(治疗前后VAS-P值降低50%及以上患者的比例)、总体有效率、起针即刻效应(治疗前VAS-P值-起针即刻VAS-P值)与起针后效应(治疗前VAS-P值-起针后10分钟VAS-P值)。数据采用重复测量的方差分析、卡方检验、单因素方差分析或非参数检验。结果不同子宫位置间治疗前后各时点VAS-P值、反应者率、总体有效率、起针即刻效应与后效应比较均无显著统计学差异(P≥0.05)。结论现有统计结果提示子宫位置可能与三阴交穴效应无关,其结果有待于前瞻性临床随机对照试验的证实。     

90例中药配合穴位敷贴法治疗支气管哮喘的安全性观察

目的:探究针对支气管哮喘的治疗中选择中药配合穴位敷贴法的效果,并评价其安全性。方法:自2012年7月—2014年7月,选取我院收治支气管哮喘患者共90例作为此次的研究对象,随机将患者分为对照组共同研究组各45例,分别给予两组患者不同的治疗措施,并对比分析其治疗结局。结果:研究组患者各项临床症状的改善状况较为显著,发作次数较低,其治疗的总有效率为93.3%,显著优于对照组,组间差异显著具有统计学意义(P0.05)。结论:针对支气管哮喘的治疗中选择中药配合穴位敷贴的方法有助于降低发作的次数,促进临床症状的快速改善,且该治疗方法对患者的身体机能造成的不良反应较小,安全性较高,值得推广。     

中药穴位贴敷对肿瘤化疗后呕吐治疗效果的Meta分析

目的通过系统评价分析中药穴位贴敷治疗恶性肿瘤化疗后呕吐的疗效。方法计算机检索Cochrane Library、Pub Med、JBI图书馆、EMBASE、Web of Sciences、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)、万方数据资源系统中关于将中药穴位贴敷法用于治疗恶性肿瘤化疗后呕吐的随机对照试验(RCT),检索时限为建库至2019年03月。根据澳大利亚JBI循证卫生保健中心的随机对照试验评价标准进行文献筛选,由2位评价者严格按照文献纳入及排除标准独立进行资料的分析和提取,采用RevMan 5.3软件进行Meta分析。结果共纳入19篇RCT研究,包含1646例患者,共涉及12个中医穴位。筛选出出现频率较多的穴位,并将其分为4个亚组(内关+足三里,足三里+中脘,足三里+内关+中脘,三个穴位均不含)进行分析。各亚组Meta分析的结果和整体Meta分析结果均证实,中药穴位贴敷组的治疗效果均优于对照组[合并OR=0.21,Z=11.93,95%CI=(0.18,0.25),P<0.001],且各亚组之间差异无统计学意义(P=0.400)。结论中药穴位贴敷治疗恶性肿瘤化疗后呕吐疗效显著,但受纳入文献质量的限制,本研究尚不能得到较为可靠的结论。     

Chronic Pain,Psychopathology, and DSM-5 Somatic Symptom Disorder

Unlike acute pain that warns us of injury or disease, chronic or persistent pain serves no adaptive purpose. Though there is no agreed on definition of chronic pain, it is commonly referred to as pain that is without biological value, lasting longer than the typical healing time, not responsive to treatments based on specific remedies, and of a duration greater than 6 months. Chronic pain that is severe and intractable has detrimental consequences, including psychological distress, job loss, social isolation, and, not surprisingly, it is highly comorbid with depression and anxiety. Historically, pain without an apparent anatomical or neurophysiological origin was labelled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust as well as implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone. Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, somatic symptom disorder overpsychologizes people with chronic pain; it has low sensitivity and specificity, and it contributes to misdiagnosis, as well as unnecessary stigma. Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain.     

Immunophenotyping does not improve predictivity of the local lymph node assay in mice

The local lymph node assay (LLNA) is a regulatory accepted test for the identification of skin sensitizing substances by measuring radioactive thymidine incorporation into the lymph node. However, there is evidence that LLNA is overestimating the sensitization potential of certain substance classes in particular those exerting skin irritation. Some reports describe the additional use of flow cytometry‐based immunophenotyping to better discriminate irritants from sensitizing irritants in LLNA. In the present study, the 22 performance standards plus 8 surfactants were assessed using the radioactive LLNA method. In addition, lymph node cells were immunophenotyped to evaluate the specificity of the lymph node response using cell surface markers such as B220 or CD19, CD3, CD4, CD8, I‐A^κ and CD69 with the aim to allow a better discrimination above all between irritants and sensitizers, but also non‐irritating sensitizers and non‐sensitizers. However, the markers assessed in this study do not sufficiently differentiate between irritants and irritant sensitizers and therefore did not improve the predictive capacity of the LLNA. Copyright © 2014 John Wiley & Sons, Ltd.     

Probabilistic hazard assessment for skin sensitization potency by dose–response modeling using feature elimination instead of quantitative structure–activity relationships

Supervised learning methods promise to improve integrated testing strategies (ITS), but must be adjusted to handle high dimensionality and dose–response data. ITS approaches are currently fueled by the increasing mechanistic understanding of adverse outcome pathways (AOP) and the development of tests reflecting these mechanisms. Simple approaches to combine skin sensitization data sets, such as weight of evidence, fail due to problems in information redundancy and high dimensionality. The problem is further amplified when potency information (dose/response) of hazards would be estimated. Skin sensitization currently serves as the foster child for AOP and ITS development, as legislative pressures combined with a very good mechanistic understanding of contact dermatitis have led to test development and relatively large high‐quality data sets. We curated such a data set and combined a recursive variable selection algorithm to evaluate the information available through in silico, in chemico and in vitro assays. Chemical similarity alone could not cluster chemicals' potency, and in vitro models consistently ranked high in recursive feature elimination. This allows reducing the number of tests included in an ITS. Next, we analyzed with a hidden Markov model that takes advantage of an intrinsic inter‐relationship among the local lymph node assay classes, i.e. the monotonous connection between local lymph node assay and dose. The dose‐informed random forest/hidden Markov model was superior to the dose‐naive random forest model on all data sets. Although balanced accuracy improvement may seem small, this obscures the actual improvement in misclassifications as the dose‐informed hidden Markov model strongly reduced " false‐negatives" (i.e. extreme sensitizers as non‐sensitizer) on all data sets. Copyright © 2015 John Wiley & Sons, Ltd.     

Predicting full thickness skin sensitization using a support vector machine

To assess the public’s propensity for allergic contact dermatitis (ACD), many alternatives to in vivo chemical screening have been developed which generally incorporate a small panel of cell surface and secreted dendritic cell biomarkers. However, given the underlying complexity of ACD, one cell type and limited cellular metrics may be insufficient to predict contact sensitizers accurately. To identify a molecular signature that can further characterize sensitization, we developed a novel system using RealSkin, a full thickness skin equivalent, in co-culture with MUTZ-3 derived Langerhan’s cells. This system was used to distinguish a model moderate pro-hapten isoeugenol (IE) and a model strong pre-hapten p-phenylenediamine (PPD) from irritant, salicylic acid (SA). Commonly evaluated metrics such as CD86, CD54, and IL-8 secretion were assessed, in concert with a 27-cytokine multi-plex screen and a functional chemotaxis assay. Data were analyzed with feature selection methods using ANOVA, hierarchical cluster analysis, and a support vector machine to identify the best molecular signature for sensitization. A panel consisting of IL-12, IL-9, VEGF, and IFN-γ predicted sensitization with over 90% accuracy using this co-culture system analysis. Thus, a multi-metric approach that has the potential to identify a molecular signature may be more predictive of contact sensitization.     

A review on the efficacy and safety of gabapentin in the treatment of chronic cough

Introduction: Effective antitussives available to control cough are limited. Consolidation among different afferent branches of the vagus nerve is needed to bring about cough. A general, widely accepted view is that the chronic increase in the sensitivity of the cough reflex is associated with inflammatory hypersensitivity such as from gastro-esophageal reflux disease. There is increasing evidence that an important mechanism is a sensory disorder of the laryngeal branches of the vagus nerve. Neuromodulating drugs are effectively used in the treatment of chronic pain and neuropathic disorders and may have a role in the treatment of refractory chronic cough (CC).

Areas covered: Current evidence on the efficacy and safety of gabapentin in the treatment of CC is reviewed. Relevant randomized controlled trials, case reports and reviews were identified through a PubMed search of English-language literature referring to cough, sensory neuropathy and gabapentin over the last 10 years.

Expert opinion: Gabapentin appears to be effective and well tolerated in the treatment of CC and in other sensory neuropathic disorders. Relevant clinical trials investigating its efficacy and safety profile in the treatment of cough are limited and further studies are needed. Gabapentin has been shown to cause minimal to no toxicity in overdose.     

Hexyl cinnamal: consideration of skin-sensitizing properties and suitability as a positive control

Background: Hexyl cinnamal (HCA) is a widely used fragrance chemical, the low skin-sensitizing potency of which has made it a common choice for the use as a positive control for predictive toxicology assays. However, HCA is commonly negative in current candidate in vitro alternatives test methods.

Objective: To review the evidence that HCA is a classifiable skin sensitizer against the standards set by the Globally Harmonized Scheme (GHS), and determine whether it represents an appropriate choice for a positive control substance for predictive testing.

Methods: Using the GHS criteria, mechanistic data, and in vitro, in vivo and human evidence relating to HCA and skin sensitization have been reviewed.

Results: The chemistry of HCA is consistent with potential for skin sensitization and predictive in vivo test data support this conclusion. However, the human data are relatively sparse, consistent with HCA possessing a low capacity to induce skin sensitization under conditions of consumer exposures.

Conclusions: Using GHS criteria (and applying a precautionary approach) HCA would classify as a weaker skin sensitizer than predicted by the local lymph node assay (LLNA). However, given the human experience, it is necessary to consider whether HCA is the most appropriate choice for use as a positive regulatory control.     

Acupoint Herbal Patching with or without ConventionalTreatment for Stable Chronic Obstructive PulmonaryDisease: a Systematic Review of RandomizedControlled Trials

Objective: To evaluate the effectiveness and safety of AHP with or without CT for people with COPD at stable stage. Methods: We searched randomized controlled trials comparing AHP (with or without CT) with no intervention, placebo, or CT from six databases. Two authors selected studies, extracted data and evaluated risk of bias of included trials. RevMan 5.2 software was used to analysis data. Results: Twenty one RCTs (2327 participants) were included. AHP of non-sanfu applied on no fixed dates with CT significantly decreased the mean frequency of acute exacerbation of COPD (times per year) (MD: ?1.24; 95% CI: ?2.02 to ?0.46; 2 trials), and improved the lung function parameters and quality of life. The AHP with CT showed no better effect in 6-minute walking distance (6MWD) and hospitalization. In addition, AHP applied at sanfu (specific dates based on lunar calendar) with CT had significant effect for 6MWD. One trial reported skin irritation and found no significant difference between two groups. Another trial reported two patients had eyes discomfort, which was inferred as the adverse effects of seretide. Conclusion: AHP used as adjunct to CT, appears to be effective than CT alone in patients with stable COPD. However, further large, rigorously designed trials are warranted to confirm these potential effects.