Research progress on magnetic resonance imaging-guided proton therapy for tumors

With the application of magnetic resonance imaging (MRI)-guided photon therapy, the concept of combining real-time MRI guidance with proton therapy, namely, MRI-guided proton therapy (MRPT), has attracted widespread attention. It is expected that MRPT canmitigate the uncertaintiesduring the treatment of proton therapy to make full use of the physical advantages of protons. However, multiple electromagnetic interactions between proton therapy and MRI-guided systems may lead to mutual interference between the two systems. This article review the research progress on the MRPT system, aiming to provide certain reference for the design of MRPT system.     

氯氮平片辅助治疗PD合并精神障碍患者的有效性及不良反应研究

目的:对氯氮平片在帕金森病(Parkinson’s disease,PD)合并精神障碍辅助治疗中的应用价值予以探讨。方法:选取50例我院2013年1月1日—2019年6月30日接诊的PD合并精神障碍患者进行研究,按照随机数表法分为对照组和观察组。对照组用多巴丝肼,观察组联合氯氮平片,对比治疗效果。结果:观察组疾病治疗总有效率96.00%(24/25)高于对照组68.00%(17/25),差异有统计学意义(P<0.05),不良反应发生率8.00%(2/25)与对照组20.00%(5/25)差异无统计学意义(P>0.05);观察组UPDRD评分、VGI-S评分和BPRS评分明显低于对照组,差异有统计学意义(P<0.05)。结论:氯氮平片辅助治疗PD合并精神障碍患者,既可提高临床疗效,也不会增加用药后不良反应,安全性高,值得推广。     

从六对论治谈国医大师吕仁和应用芍药经验

辨证论治是中医学治疗的特色。吕仁和教授提出的“六对论治”辨证思路，包括对病论治、对病辨证论治、对病分期辨证论治、对症论治、对症辨证论治和对症辨病与辨证论治相结合，为临床辨证提供了完善的思路。芍药为吕仁和教授临床常用中药，以其应用经验为切入点，结合病案系统介绍吕仁和教授“六对论治”学术思想。介绍将四逆散化裁，赤、白芍同用以柔肝养血、活血化瘀，针对肝气郁滞证候；以“三丹汤”中牡丹皮、丹参、赤芍同用，针对肾脏病“微型癥瘕”病机；以赤、白芍大剂量生用通便泻浊对症治疗等临床用药经验。     

Clinicopathological features and prognostic analysis of metastatic pulmonary sarcomatoid carcinoma: a SEER analysis

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer (NSCLC). Metastases are often detected at the first diagnosis. Despite high rates of distant metastasis, there is insufficient data describing the characteristics of PSC metastasis.MethodsWe performed a Surveillance, Epidemiology, and End Results (SEER) database-based analysis of clinicopathological features and prognosis of distant metastasis in PSC patients. Data queried for this analysis included PSC patients in the database between 2010 and 2016.ResultsA total of 934 patients met the criteria for inclusion in the analysis and included, at the time of diagnosis, 512 (54.8%) patients with metastasis, including bone (n=152; 16.3%), brain (n=108; 11.6%), liver (n=70; 7.5%), lung (n=142; 15.2%) metastases. Binary logistic regression showed that patients with giant cell carcinoma [odds ratio (OR) 4.023, 95% confidence interval (CI): 2.113–7.661, P<0.001] and spindle cell carcinoma (OR 3.151, 95% CI: 1.699–5.843, P<0.001) were associated with metastasis. Log-rank test and Kaplan-Meier plots indicated poor prognosis in metastatic patients [the 1-, 3-, and 5-year overall survival (OS) rates were 14.1%, 5.5%, and 4.8%, respectively]. Multivariable analysis showed younger and chemotherapy as improved prognostic factors of PSC patients with single metastasis site.ConclusionsThe SEER database-based analysis revealed the clinical features of distant metastasis of PSC and showed that different histological types posed distinct metastasis potential. Besides, age and chemotherapy were the independent prognostic factors of PSC patients with single metastasis site.     

上颌侧切牙腭根遗漏、钙化伴侧壁穿孔显微根管外科手术一例

目的报道一例上颌侧切牙根管治疗术后腭根遗漏、钙化伴侧壁穿孔病例,探讨根管治疗规范及侧壁穿孔显微根管外科手术治疗方法。方法患者,女,40岁,主诉左上前牙唇侧脓包1周,查体见22牙颊侧黏膜见瘘管口,舌窝见树脂补体,影像学检查示22牙单根双根管,颊根充填达尖,腭根遗漏且根尖1/3段无明显根管影像,根中1/3段远中根面处高密度充填物影像突破侧壁,外被半月形低密度透射区。复诊显微镜下寻及腭根根管口、疏通钙化并常规热牙胶充填,三氧化矿物凝聚体(MTA)充填穿孔处。显微根管外科手术清理侧壁穿孔外炎性软组织,MTA倒充填。结果术后10 d瘘管消失,术后4和52个月X线片示根中1/3段远中根面高密度MTA阻射影,外围半月形透射影缩小,骨密度增高。结论对于牙髓病学的根管治疗病例,术前应仔细阅读影像片,术后若发现低密度透射影像围绕侧壁根充物,则考虑侧壁穿孔,建议行MTA牙体内充填或并行显微根管外科手术封闭穿孔,密切观察。     

HPLC波长切换法同时测定益安宁丸中7种活性成分

目的建立HPLC波长切换法同时测定益安宁丸中7种活性成分的方法。方法采用HPLC法,同时测定益安宁丸中三七皂苷R_1、五味子醇甲、丹酚酸B、五味子酯甲、人参皂苷Rg_1、人参皂苷Rb_1、丹参酮Ⅱ_A的含量,采用Shim-pack GIST-C18色谱柱(250 mm×4.6 mm,5μm),流动相为乙腈-0.1%磷酸水溶液,梯度洗脱:0～5 min,5%乙腈;5～12 min,5%～12%乙腈;12～17 min,12%～20%乙腈;17～30 min,20%乙腈;30～36 min,20%～50%乙腈;36～45 min,50%～80%乙腈;45～70 min,80%乙腈;检测波长203 nm(三七皂苷R_1、人参皂苷Rg_1、人参皂苷Rb_1)、220 nm(五味子酯甲)、250nm(五味子醇甲)、268nm(丹酚酸B)和270nm(丹参酮Ⅱ_A),体积流量1.0 mL/min,柱温35℃,进样量10μL。结果三七皂苷R_1、五味子醇甲、丹酚酸B、五味子酯甲、人参皂苷Rg_1、人参皂苷Rb_1、丹参酮Ⅱ_A检测质量浓度的线性范围分别为0.015～0.150、0.077～0.766、0.006～0.062、0.009～0.092、0.050～0.503、0.067～0.670、0.011～0.108 mg/mL;平均加样回收率分别为99.5%、99.8%、99.2%、98.9%、96.9%、98.8%、97.1%。结论该方法简单、有效、结果准确,可用于益安宁丸中上述7种活性成分的同时测定。     

张宁教授“固本泻浊法”治疗肾病综合征经验浅谈

肾病综合征是儿童和成人常见的肾脏疾病之一，激素治疗常不能达到满意的效果，并会出现多种不良反应。张宁教授运用中医治疗肾病综合征经验丰富，认为肾病综合征病性虚实夹杂，脾肾亏虚为本，肝失疏泄、湿热内阻、瘀血停滞为标。标实的病理因素由本虚引起及加重。治以“固本泻浊法”，健脾益肾，兼以调肝养血、清热化湿、活血化瘀，提高了临床疗效，减少了不良反应。     

近5年针灸治疗卵巢早衰的基础与临床研究进展

卵巢早衰(premature ovarian failure,POF)通常是指小于40岁的女性发生的闭经超过4个月,伴有2个周期以上(间隔1个月以上)血清生殖内分泌激素水平测定失常为主要特征的疾病,POF临床表现众多,主要有月经失调甚则闭经,并伴有潮热盗汗、心悸、情绪波动、生殖器萎缩、性功能减退、阴道刺激及瘙痒等症状。各种不同因素导致POF,具有多种健康风险,包括心理疾病、不孕症、骨质疏松症、自身免疫紊乱、缺血性心脏病的发生以及死亡率的增加[1-3]。目前POF仍无针对性疗法,西医治疗方法为雌孕激素替代疗法(hormone replacement therapy,HRT)、促排卵治疗、卵母细胞捐赠技术、免疫疗法、冷冻保存移植、基因治疗[4],近年来还出现了干细胞疗法[5],但这些方法具有一定的不良反应或存在相关伦理问题,疗效也不够确定,而针灸治疗本病作为一种有别于西医传统治疗手段的方法,近年来受到越来越多学者的重视。     

Scutellarin,a modulator of mTOR,attenuates hepatic insulin resistance by regulating hepatocyte lipid metabolism via SREBP‐1c suppression

High levels of consumption of saturated lipids have been largely associated with the increasing prevalence of metabolic diseases. In particular, saturated fatty acids such as palmitic acid (PA) have been implicated in the development of insulin resistance (IR). Scutellarin (Scu) is one of the effective traditional Chinese medicines considered beneficial for liver diseases and diabetes. In this study, we investigated the effect of Scu on IR and lipid metabolism disorders in vitro and in high fat diet (HFD)‐fed mice. In vitro, we found that Scu decreased insulin‐dependent lipid accumulation and the mRNA expression of CD36, Fasn, and ACC in PA‐treated HepG2 cells. Additionally, Scu upregulated Akt phosphorylation and improved the insulin signalling pathway. Moreover, Scu downregulated mammalian target of rapamycin (mTOR) phosphorylation and the n‐SREBP‐1c protein level and also reduced lipid accumulation via the mTOR‐dependent pathway, as confirmed by the molecular docking of Scu to mTOR. In HFD‐fed C57BL/6 mice, Scu improved oral glucose tolerance, pyruvate tolerance and the IR index and also increased the Akt phosphorylation level. Moreover, Scu reduced hepatocyte steatosis, decreased lipid accumulation and triglyceride levels, inhibited mTOR phosphorylation, and decreased the SREBP‐1c level in the liver. Taken together, these findings suggest that Scu ameliorates hepatic IR by regulating hepatocyte lipid metabolism via the mTOR‐dependent pathway through SREBP‐1c suppression.