针药结合治疗脑卒中后假性球麻痹吞咽障碍研究进展

吞咽障碍是脑卒中后常见的并发症之一,目前针药结合治疗本病具有较好的临床疗效。综述近年来针药结合治疗脑卒中后假性球麻痹吞咽障碍的文献,以期对本病未来的临床工作有些许启发。目前以针药结合为主治疗本病的方法包括毫针结合内服中药、穴位贴敷、穴位注射、中药穴位离子导入以及毫针与中药以其他形式的结合,包括中药药棒、药枕、中药点舌、氧驱雾化吸入、灌肠等。针药结合治疗本病具有同效相须、异效互补、反效制约的治疗特点,也存在不少问题亟待解决。     

正交试验优化复方三草滴丸制备工艺

目的 优选复方三草滴丸制备工艺的最佳条件,并测定滴丸中熊果酸的含量。方法 以滴丸的硬度、圆整度、拖尾度、黏连为评价指标,采用正交试验设计方法优选滴丸制备工艺;采用HPLC测定滴丸中熊果酸的含量。结果 滴丸的最佳制备工艺：药物与基质配比为1∶2,PEG 4000与PEG 6000的配比为2∶1,适宜料温为80℃,滴速为每分钟40滴;HPLC测得滴丸中熊果酸的含量为0.992 5 mg·g^-1。结论 复方三草滴丸制备工艺简便、可行,得到的滴丸圆整度较高、色泽较亮、成形良好、质量可控。熊果酸含量测定方法稳定、可靠,可用于滴丸的质量控制。     

枸橘药材的本草考证及质量分析

目的:通过对枸橘药材的研究,分析枸橘药材药用历程和质量标准,为其质量评价提供科学依据。方法:通过查阅文献与实地调查,从名称、药用历史及地理分布3方面完成对枸橘药材的本草考证;运用薄层色谱法,HPLC对枸橘、枳实及枳壳中的辛弗林、柚皮苷、橙皮苷及新橙皮苷进行定性及定量分析。辛弗林参考2015年版《中国药典》中枳实的含量测定方法,柚皮苷、橙皮苷及新橙皮苷参考2015年版《中国药典》中枳壳的含量测定方法。结果:本草考证得知,枸橘在历史上最早作枳实使用,宋朝时期枸橘果实不再作为枳实与枳壳的唯一正品来源,明清时期枸橘与枳实、枳壳明确区分开来,酸橙果实成为枳实与枳壳的正品来源至今;质量分析得到,枸橘中含有辛弗林、柚皮苷、橙皮苷及新橙皮苷,但含量较枳实、枳壳低,枳实、枳壳中指标性成分均符合2015年版《中国药典》标准。结论:枸橘药材曾作为枳实和枳壳的正品来源,该研究得出枸橘具有枳实和枳壳相同的指标成分,为开发新的药用资源提供了参考依据。     

活血化瘀中药抗肿瘤转移作用的研究进展

血瘀证与血液的高黏状态密切相关,而多数恶性肿瘤患者有血瘀证的表现,气滞血瘀贯穿于肿瘤的各个病理阶段及其整个发病过程。活血化瘀中药有改善肿瘤患者血瘀状态的确切作用,因而其被用于治疗恶性肿瘤,并用于抗肿瘤转移,其作用可能机制在于纠正肿瘤细胞的缺氧微环境、抑制肿瘤转移相关黏附分子表达、增强其对化疗药物的敏感性、抑制肿瘤微血管生成等方面。但是,改善患者血瘀状态是否能降低肿瘤的转移率尚存争议,在某些肿瘤及肿瘤转移的某些环节上可能有促进肿瘤转移作用,对这一问题需要警惕。     

231例药物性肝损伤临床分析

目的对近4年多我院收治的药物性肝损伤(DILI)患者进行回顾性分析,以提高临床医师对此病的认识。方法对2003年1月至2007年6月期间在我院就诊的231例诊断为药物性肝病的患者进行回顾性分析,并根据Maria药物性肝损伤评分标准进行评价。结果231例患者中,Maria评分≥14分者69例,10～13分119例,6～9分43例,其中抗结核药物引起的肝损伤患者依次为24例(34.78%)、72例(60.50%)及14例(32.56%)。涉及药物频率由高至低,主要为抗结核药47.62%(110/231),中草药18.61(43/231),其他抗生素7.36%(17/231),其他药物26.41%(61/231)。临床分型:肝细胞损伤型84.42%(195/231),胆汁淤积型6.49%(15/231),混合型9.10%(21/231)。结论Maria评分表在对抗结核药物引起的肝损伤进行评估时,其分值相对较低。抗结核药及中草药引起的肝损伤最为常见,应引起临床医生重视。     

The Severity of Toxic Reactions to Ephedra: Comparisons to Other Botanical Products and National Trends from 1993–2002

Objective. Ephedra is a botanical product widely used to enhance alertness, as a weight loss aide, and as a decongestant. Its reported adverse effects led the Food and Drug Administration (FDA) to ban ephedra-containing products in the United States in 2004. This study's purpose was to compare toxicity from botanical products containing ephedra to nonephedra products. Methods. The Toxic Exposure Surveillance System (TESS), a national poison center database, was utilized to determine the number and outcomes of cases involving botanical products reported from 1993–2002. Cases listing both a botanical product and any other drugs or chemicals were excluded a priori. Ten-year hazard rates (moderate outcomes + major outcomes + deaths per 1000 exposures) were used to compare botanical product categories. Results. There were 21,533 toxic exposures with definitive medical outcomes reported over the 10 yrs where a botanical product was the only substance involved. Of these, 4,306 (19.9%) had moderate or major medical outcomes and there were two deaths, for an overall hazard score of 200 per 1000 exposures. The number of ephedra reports to poison centers increased 150-fold over the 10-yr period. The hazard rate for products that contained only ephedra was 250 per 1000 exposures and 267 per 1000 exposures for products that contained ephedra and additional ingredients; whereas the hazard score for only nonephedra botanical products was 96 per 1000 exposures. The rate ratios for multibotanical products with ephedra (RR 1.33; 95% C.I. 1.27–1.40) and for single-ingredient ephedra products (RR 1.25; 95% C.I. 1.11–1.40) were both two to six times higher than those of other common botanical products. Yohimbe-containing products had the highest hazard score (417) and rate ratio (2.08; 95% C.I. 1.59–2.80). Conclusion. Ephedra-containing botanical products accounted for a significant number of toxic exposures with severe medical outcomes reported to poison centers. Hazard rate analysis suggests poison center–reported events involving ephedra-containing botanical products were much more likely to result in severe medical outcomes than those involving nonephedra-containing botanical products. These data support recommendations by policymakers that the sale of ephedra should be prohibited to protect consumers. Our data suggest that the botanical product, yohimbe, may also be associated with unacceptably high risks of toxicity and should receive close scrutiny from health policymakers.     

Herbal hepatotoxicity: Analysis of cases with initially reported positive re-exposure tests

BackgroundPositive re-exposure tests are diagnostic hallmarks for hepatotoxicity.ObjectiveTo test validity of positive re-exposures in herb induced liver injury.MethodsWe searched Medline database for cases of herb induced liver injury with positive re-exposures and analysed 34 cases for positive re-exposure test criteria of baseline alanine aminotransferase < 5N before re-exposure, and re-exposure alanine aminotransferase ≥ 2× baseline alanine aminotransferase. Re-exposure test was negative, if baseline alanine aminotransferase < 5N combined with re-exposure alanine aminotransferase < 2× baseline alanine aminotransferase, or if baseline alanine aminotransferase ≥ 5N regardless of the re-exposure alanine aminotransferase including no available re-exposure alanine aminotransferase result.ResultsIn 21/34 cases (61.8%), criteria for a positive re-exposure were fulfilled, with negative tests in 6/34 cases (17.6%) or uninterpretable ones in 7/34 cases (20.6%). Confirmed positive re-exposure tests established potential of herb induced liver injury for Aloe, Chaparral, Chinese herbal mixtures, Chinese Jin Bu Huan, Chinese Syo Saiko To, Germander, Greater Celandine, Green tea, Kava, Mistletoe, Polygonum multiflorum, and Senna, with up to 4 case reports per herb.ConclusionsAmong 34 cases of herb-induced liver injury with initially reported positive re-exposure tests, 61.8% of the cases actually fulfilled established test criteria and provided firm diagnoses of herb induced liver injury by various herbs.