A trial of lactase in the management of infant colic

Objective: To investigate transient lactose intolerance as a factor in the aetiology of infant colic.
Design: We undertook a randomized, double-blind, crossover trial of lactase and placebo drops added to milk formula to determine whether this method of reducing lactose intake affected infant colic.
Subjects: Infants with colic were referred from clinics in keeping with Wessel's modified criteria.
Interventions: Infants were randomly allocated to add either lactase or placebo drops to their formula feeds for 1 week, followed by 2 days 'wash out'. The addition was changed for the second week so that subjects served as their own control. The formulas were kept refrigerated for 24 h before ingestion. The parents kept a diary of their baby's crying time.
Results: Thirteen babies completed the trial, of whom nine were boys. The mean birth weight was 3.7 kg (8.2 lb). Colic symptoms began in less than 1 month in 12 of the babies. The effect of the lactase was to reduce crying time by 1.14 h per day (CI 0.23–2.05). The reduction in crying time was significant ( t =2.75, d.f.=11, P =0.019). Conclusion: Transient lactose intolerance may have a role in the aetiology of infant colic. Lactase drops require prior incubation with milk formula to be effective. The response to lactase in this study supports 'colic', i.e. spasm of the large intestine as a factor in these infants' discomfort.     

方剂代谢物组学新假说

药效物质基础是方剂研究的核心之一。要弄清方剂多成分、多靶点作用,首先要弄清是什么成分、什么途径、什么靶点。以大承气汤为代表的攻下方剂临床疗效确切,但药效物质基础不清,体内作用靶点不明。从方剂体内成分及疗效出发,采用高效液相色谱-质谱-质谱联用法研究大承气汤在急性胰腺炎模型的方剂药效成分及药动学;再将方剂吸收进入体内的成分作为药物进行方剂来源成分的药效学研究,联用代谢物组学方法从代谢物变化出发探索方剂作用多靶点的生化-药效物质基础,阐明方剂作用途径和药效学,以探索大承气汤治疗具有"阳明腑实证"的急性胰腺炎的药效物质基础和作用的确切靶点;从中医学整体观出发,创新性运用代谢物组学的整体分析方法研究"阳明腑实证"的证本质,从而建立方剂代谢物组学新假说。     

谈先秦时期复方的产生及其特点与成就

详细分析了先秦时期与医学密切相关的各种文献、传说及出土考证等,认为复方产生于战国早期至中期,探讨了促进复方产生的各种原因以及复方产生对中医治疗学的影响,认为时至战国末期,复方水平仍然不高,结构比较简单,还没有能够取代单味药物占据临床治疗的主体,《五十二病方》代表了先秦时期方剂发展的最高水平与成就。     

Calculated versus measured creatinine clearance for dosing methotrexate in the treatment of primary central nervous system lymphoma

Background High-dose methotrexate (HDMTX) (≥3 g/m²), the cornerstone of therapy for primary CNS lymphoma (PCNSL), is commonly dosed using a measured 24 h creatinine clearance (CrCl) every 2–4 weeks. Because these collections are cumbersome and at times unreliable, the use of a calculated CrCl was evaluated as a potential alternative. Methods A retrospective analysis was performed on data from all 287 treatment cycles from the 25 patients with PCNSL who participated in a multi-center phase II clinical trial of HDMTX conducted by the New Approaches to Brain Tumor Therapy (NABTT) CNS Consortium. Results The 25 patients had a median age of 61 years (range 32–75). Seventeen (68%) were men. The patients received a median of 14 (range 2–21) HDMTX treatments. For 256 of 287 treatments (89%), data were available to compare the measured and calculated (using the Cockcroft–Gault equation) CrCl. The average measured CrCl was 93 ml/min (95% CI, 89–96 ml/min), and the average calculated CrCl was 107 ml/min (95% CI, 102–112 ml/min). The Pearson correlation coefficient (r) was 0.49 (P < 0.0001) between the measured and calculated CrCl. The average MTX dose determined using measured CrCl was 14.1 g (95% CI, 13.6–14.5 g), and the average MTX dose determined using calculated CrCl was 14.7 g (95% CI, 14.2–15.1 g). MTX doses based on measured and calculated CrCl were significantly correlated (r = 0.72, P < 0.0001). Of the 256 HDMTX treatments evaluated, 158 (62%) had reliable 48 h serum MTX levels documented. Forty-seven levels (30%) were within target range (0.3–1 μmol/l), 99 levels (62%) were below target range (<0.3 μmol/l), 12 levels (8%) were in the range associated with mild toxicity range (>1–3 μmol/l), and no levels were in the range associated with severe toxicity (>3 μmol/l). Of these 158 treatments, the use of a calculated rather than measured CrCl would have yielded an identical MTX dose for 48 treatments (30%), a higher MTX dose for 62 treatments (40%), and a lower MTX dose for 48 treatments (30%). This distribution was not significantly different among the subsets of below target, within target range, and above target MTX levels (P = 0.87). Conclusions In this cohort of patients with PCNSL, there is significant correlation between the calculated and measured CrCl. MTX doses determined using calculated and measured CrCl are not significantly different. For these patients, there is no clear association between the method of determining CrCl and serum MTX levels. As a result, calculated CrCl is a reasonable alternative to measured CrCl in this patient population and would avoid the inconvenience and potential inaccuracies associated with measured CrCl. Presented in abstract format at the Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, June 2–6, 2006.     

The estimation of the thyroid volume before surgery—an important prerequisite for minimally invasive thyroidectomy

INTRODUCTION: Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). MATERIALS AND METHOD: In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. RESULTS: Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. CONCLUSIONS: We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.     

Effect of formula thickened with locust bean gum on gastric emptying in infants

AIM: We investigated the effects of milk-based formulas thickened with two different concentrations of locust bean gum on gastric emptying in infants with recurrent regurgitation episodes. METHODS: Thirty-nine infants with three or more episodes of regurgitation per day but no complications who were fed mainly with infant formula were studied. We first compared gastric emptying in infants fed with formulas thickened with two different concentrations of locust bean gum (HL-350, 0.35 g/100 mL; HL-450, 0.45 g/100 mL) or a regular formula (HL-00). To evaluate gastric emptying, we measured antral cross-sectional areas ultrasonographically at various time points after feeding. Next, to investigate the clinical effect of thickened formulas on regurgitation episodes, 27 infants with episodes were assigned randomly to receive HL-350 and HL-00 or HL-450 and HL-00 for 1 week each. RESULTS: Antral cross-sectional areas at 60, 90, 120 and 150 min with HL-450, and at 60 min with HL-350, were greater than with HL-00. The median gastric emptying rate at 120 min with HL-450 (52.8%) was lower than with HL-00 (97.9%; P = 0.0019), while HL-350 (80.3%) and HL-00 did not differ significantly. The mean number of regurgitation episodes was significantly smaller when infants were fed with either HL-350 or HL-450 than with HL-00. CONCLUSIONS: HL-450, a thickened formula with typical commercially available concentrations of locust bean gum, slowed gastric emptying in infants with gastroesophageal reflux.     

参附注射液对大鼠移植胰缺血再灌注损伤的保护作用和机制

目的：探讨参附注射液对大鼠移植胰缺血再灌注损伤的保护作用及其机制。方法：正常SD大鼠为阴性对照组（NC组，n=6），糖尿病SD大鼠24只随机分为阳性对照组（PC组，n=6）、参附预处理组（SF组，n=6）、红参预处理组（HS组，n=6）和附子预处理组（FZ组，n=6）。除对照组外各组均行胰腺移植，24只SD大鼠为供体。SF、HS和FZ组在移植前1日及术前30min经静脉分别予受体注射参附注射液（10mg／kg）、红参注射液（9mg／kg）、附子注射液（1mg／kg），NC组和PC组在移植前1日及术前30min经静脉予受体注射同等容积生理盐水。检测各组再灌注前、后血糖；再灌注后2h血清中TNF-α和一氧化氮（NO）的含量、移植胰组织中超氧化物歧化酶（SOD）、髓过氧化物酶（MPO）和丙二醛（MDA）含量；用TUNEL法观察移植胰组织细胞凋亡情况，Western Blot法检测移植胰组织Bax和Bcl-2蛋白表达情况。结果：再灌注后SF组、HS组和FZ组较PC组血糖低，血清中TNF-α含量低，NO含量高：再灌注后SF组、HS组和FZ组较PC组移植胰组织中SOD活性高，MDA含量低，MPO活性低，凋亡指数低，Bcl-2表达高．Bax表达低，Bcl-2／Bax比值高。结论：参附注射液对大鼠移植胰的缺血再灌注损伤具有保护作用，机制可能是提高SOD的活性，增加内源性NO的合成，减少TNF-α分泌，减轻嗜中性粒细胞（PMNs）黏附与聚集，上调Bcl-2和下调Bax基因表达。     

Effects of SYJN,a Chinese herbal formula,on chronic unpredictable stress-induced changes in behavior and brain BDNF in rats

Aim of the study

Suyu-Jiaonang (SYJN) is a Chinese herbal formula that contains four herbs: Bupleurum chinense DC, Curcuma aromatica Salisb., Perilla frutescens (Linn.) Britt., and Acorus tatarinowii Schott. Previous studies conducted in our laboratory have revealed an antidepressant-like effect of the formula in various mouse models of behavioral despair. The present study aimed to investigate whether SYJN could produce antidepressant-like effects in chronic unpredictable stress (CUS)-induced depression model in rats and its possible mechanism(s).

Materials and methods

Rats were subjected to an experimental setting of CUS. The effect of SYJN treatment on CUS-induced depression was examined using behavioral tests including the sucrose consumption and open field tests. The mechanism underlying the antidepressant-like action of SYJN was examined by measuring brain-derived neurotrophic factor (BDNF) protein and mRNA expression in brain tissues of CUS-exposed rats.

Results

Exposure to CUS for 4 weeks caused depression-like behavior in rats, as indicated by significant decreases in sucrose consumption and locomotor activity (assessed in the open field test). In addition, it was found that BDNF protein and mRNA levels in the hippocampus and frontal cortex were lower in CUS-treated rats, as compared to controls. Daily intragastric administration of SYJN (1300 or 2600 mg/kg) during the 4-week period of CUS significantly suppressed behavioral changes and attenuated the CUS-induced decrease in BDNF protein and mRNA levels in the hippocampus and frontal cortex.

Conclusion

The results suggest that SYJN alleviates depression induced by CUS. The antidepressant-like activity of SYJN is likely mediated by the increase in BDNF expression in brain tissues.     

麦门冬合千金苇茎汤效应部位的化学成分

目的:研究麦门冬合千金苇茎汤效应部位的化学成分。方法:采用有机溶剂提取,反复硅胶柱色谱和重结晶法进行分离纯化,根据化合物的理化性质和波谱数据鉴定其结构。结果:从麦门冬合千金苇茎汤乙酸乙酯部位分离得到12个化合物,分别鉴定为:芒柄花素(formononetin,1)、甘草素(liquiritigenin,2)、异甘草素(isoliquiritigenin,3)、20(R)-人参皂苷Rg3[20(R)-ginsenoside Rg3,4]、丁二酸(succinic acid,5)、异香草酸(isovanillic acid,6)、尿嘧啶(uracil,7)、琥珀酸酐(succinicanhydride,8)、甘露醇(D-mannitol,9)、对羟基苯甲酸(p-hydroxybenzoic acid,10)、β-谷甾醇(β-sitosterol,11)、豆甾醇(stig-masterol,12)。结论:所得成分大部分来源于甘草、人参、半夏、苇茎;根据文献报道分析,其中化合物1～4可能是该合方治疗肺癌的效应物质基础。     

Parental response to health risk information: experimental results on willingness-to-pay for safer infant milk formula

Enterobacter sakazakii, a pathogen that can be found in powdered infant milk formula, can cause adverse health effects on infants. Using Vickrey auction, this study examines parents' willingness to pay (WTP) for a quality assurance label on powdered infant milk formula. The influence of ambiguity with the incidence rate information and provision of safe-handling information on WTP are also evaluated using three experimental treatments. Our findings generally imply that parents significantly value a quality assurance label. The mean price premium parents are willing to pay for the safer and quality assurance labelled powdered infant milk formula ranges from 61 to 133 Eurocents per 100 grams (53-116% of the base price per 100 grams) depending on the treatment. While no ambiguity effects are generally found, provision of safe-handling information significantly reduced WTP to 39-69 Eurocents per 100 grams depending on the treatment.