SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine

OBJECTIVE: The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine(TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients.METHODS: Sim TCM presents five major attributes for simulation: representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding, and test reproducibility. RESULTS: Simulations using data from patients diagnosed with hypertension and post-stroke sensorymotor impairments yielded no signifi cant differences between expected and simulated frequencies of patterns(P = 0.22 or higher). Time for convergence of simulations varied from 9.90 s(9.80, 10.27) to 28.31 s(26.33, 29.52). The ratio iteration prof ile necessary for convergence varied between 1:1 and 5:1.CONCLUSION: This model is directly connected to forthcoming models in a large project to design and implement the SuiteTCM: Pront TCM, SciTCM, DiagTCM, StudentTCM, ResearchTCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine. The software is freely available for download at: http://suitetcm.unisuam.edu.br.     

A traditional Chinese herbal medicine compound preparation versus interventional therapy after resection of small hepatocellular carcinoma:22-year follow-up

OBJECTIVE:To compare the long-term effectiveness of compound Ruanjianhugan(RJH)tablets and interventional therapy(IT) in patients after resection of small hepatocellular carcinoma(HCC).METHODS:A retrospective study was conducted in 399 patients after resection of small HCC who were admitted between January 1987 and December 2008 in the Department of Hepatobiliary Surgery and Center of Minimlly Invasive Surgery,First Affiliated Hospital of Guangxi Medical University.Four groups were based on different therapy modes:a TCM-only(TCMO) group,a TCM combined with interventional therapy(TCM-IT) group,an interventional therapy-only(ITO) group,and a simple operation(SO) group.Prognostic factors were correlated with overall survival(OS) and OS rates were calculated with the Kaplan-Meier method,and multivariate analyses for factors affecting survival were evaluated by the Cox proportional hazard model.RESULTS:The median OS was 151.20 months in the TCM-IT group,43.87 months in the ITO group,and 20.77 months in the SO group.All survival rates of the TCMO group were higher than those of the other three groups(>50%).The 5-,10-,and 15-year OS in the TCMO and ITO patients were 83.94%,45.50%,and 71.22% and 33.34%,55.58%,and 9.26%,respectively(risk ratio,0.209;95% confidence interval,0.126-0.347;P=0.000).Multivariate analysis revealed that the independent risk factors were therapy mode(P=0.000),sex(P=0.005),family history(P=0.011),TNM Classification of Malignant Tumor staging(P=0.000),medical care-seeking behavior(P=0.021),and maximum diameter(P=0.030).CONCLUSION:Long-term oral use of compound RJH tablets may improve OS for small HCC after resection compared with IT.     

Unified-Planning, Graded-Administration, and Centralized-Controlling: A Management Modality for Treating Acquired Immune Deficiency Syndrome with Chinese Medicine in Henan Province of China

Henan Province in China has a major epidemic of human immunodeficiency virus/acquired immune deficiency syndrome(HIV/AIDS).Chinese medicine(CM) has been used throughout the last decade,and a management modality was developed,which can be described by unified-planning,gradedadministration,and centralized-controlling(UGC).The UGC modality has one primary concept(patient-centered medicine from CM theory),four basic foundations(classifying administrative region,characteristics of CM on disease treatment,health resource conditions,and distribution of patients living with HIV),six important relationships(the "three uniformities and three combinations," and the six relationships therein guide the treatment of AIDS with CM),and four key sections(management,operation,records,and evaluation).In this article,the authors introduce the UGC modality,which could be beneficial to developing countries or resource-limited areas for the management of chronic infectious disease.     

Chinese Medicine Might Be A Promising Way for A Solution to Arsenic Nephrotoxicity

Arsenic from environmental contamination is a risk factor for kidney disease, and the clinical use of arsenic also triggers a new concern that the potential kidney damage caused by exposure to clinical doses of arsenic trivalent. So far, the undergoing mechanisms contributing to arsenic nephrotoxicity mostly remain unclear, and universally accepted methods for preventing this complication are limited too. Ancient Chinese medical scientists recognized the toxicity of arsenic long ago, and there were some records of Chinese herbs against arsenic poisoning in ancient books of Chinese medicine. In the past decade, several herbal formulations, as well as some potentially active compounds extracted from Chinese herbs, have been employed to prevent arsenic nephrotoxicity both in vivo and in vitro and showed better therapeutic effects. The present paper thus summarizes and discusses these Chinese medicine methods in preventing such a public health problem. In addition, we call for large, well-designed, randomized, and controlled clinical trials to be performed to further assess the efficacy and safety of these potential methods of Chinese medicine againstvarsenic nephrotoxicity.     

代谢组学在中药研究中的应用

In recent years, a novel analytical technology, metabolomics is widely used in the modernresearch of Chinese medicine （CM）. Metabolomics adopts a ＂top-down＂ strategy to reflect the function oforganisms from terminal symptoms of metabolic network and understand metabolic changes of a completesystem caused by interventions. As a holistic approach, metabolomics technology, including nuclear magneticresonance, gas chromatography-mass spectrometry, and liquid chromatography-mass spectrometry, favorableto express the meaning of basic theories of CM, CM syndrome and Chinese herb. Therefore, we believe thatmetabolomics technology will greatly benefit to development for the research of CM in the light of modernsciences.     

循证医学在中医药临床研究中的应用

随着循证医学的兴起与发展，为实现中医药临床研究思路与方法学的创新与突破提供了有益的启示，中医药必须重视并应用以国际评估标准进行科研设计和评价方法的规范化研究，使其研究成果更加科学可信，并在获得已有成果的基础上不断提高中医药临床及科研水平。如何从现有大量的中医药临床研究资料中获取循证医学所需的最佳证据，在充分发挥中医药整体观和辨证论治的前提下，应用循证医学方法，使中医药的疗效评价更加客观化、标准化，是目前亟待解决的问题。对此，本文提出：一是必须加强设计规范严谨的中医药临床随机对照试验；二是建立系统的中医药临床疗效评价指标体系；三是大力开展中医药治疗性研究文献的系统评价。由此推进中医药临床研究逐步走向科学化、规范化、现代化的发展轨道。     

Chinese Medicine Amygdalin and β-Glucosidase Combined with Antibody Enzymatic Prodrug System As A Feasible Antitumor Therapy

Amarogentin is an efficacious Chinese herbal medicine and a component of the bitter apricot kernel.It is commonly used as an expectorant and supplementary anti-cancer drug.β-Glucosidase is an enzyme that hydrolyzes the glycosidic bond between aryl and saccharide groups to release glucose.Upon their interaction,β-glucosidase catalyzes amarogentin to produce considerable amounts of hydrocyanic acid,which inhibits cytochrome C oxidase,the terminal enzyme in the mitochondrial respiration chain,and suspends adenosine triphosphate synthesis,resulting in cell death.Hydrocyanic acid is a cell-cycle-stage-nonspecific agent that kills cancer cells.Thus,β-glucosidase can be coupled with a tumor-specific monoclonal antibody.β-Glucosidase can combine with cancer-cell-surface antigens and specifically convert amarogentin to an active drug that acts on cancer cells and the surrounding antibodies to achieve a kil ing effect.β-Glucosidase is injected intravenously and recognizes cancer-cel-surface antigens with the help of an antibody.The prodrug amarogentin is infused after β-glucosidase has reached the target position.Coupling of cell membrane peptides with β-glucosidase allows the enzyme to penetrate capillary endothelial cells and clear extracellular deep solid tumors to kill the cells therein.The Chinese medicine amarogentin and β-glucosidase will become an important treatment for various tumors when an appropriate monoclonal antibody is developed.     

Effect of Sangu Decoction (三骨汤) on metastatic bone destruction in rats with mammary cancer

Objective:To study and evaluate the effect of Sangu Decoction(SGD,三骨汤) on the bone destruction due to mammary cancer metastasis.Methods:Metastasis rat mammary tumor-1 cells were transplanted into the left hind limb tibia of SD rats to establish the bone metastasis of the mammary cancer model.The modeled rats were treated with SGD for observing its effect on rats’ pain behavior,including 50% paw withdrawal threshold(50%PWT) after von Frey fiber stimulation,burden difference of bilateral feet,and thermal withdrawal latency(TWL),with zoledronic acid as the positive control.Moreover,the damage in the tibia sample of rats was scored by an iconographic method,and the bone mineral density(BMD) as well as the bone mineral content(BMC) were estimated.Results:The model established showed characteristics of mixed metastasis,revealing the manifestations of tumor development,bone destruction,cancerous pain,etc.In the SGD-treated group,50%PWT was prolonged(8.13±4.76 vs.2.30±2.19),and TWL was longer(3.48±0.62 s vs.2.89±0.26 s) than those in the control group,respectively(P<0.05 or P<0.01).Iconographic scoring also showed improvement of BMD(0.134±0.009 vs.0.120±0.007,P<0.01) and an elevating trend of BMC in the SGD-treated group.Conclusion:SGD could effectively alleviate the cancerous pain of bone metastasis and mitigate the metastasis that cause osteolytic destruction of bone.     

Meta分析在中医药循证医学中的应用

循证医学的思想最早产生于20世纪80年代,强调“以病人为中心”,认为临床医疗（包括治疗、诊断、预防）与医疗卫生决策,均应以现有的、可获得的最佳科学研究证据为依据,而且以多个随机对照试验（RCT）的系统综述的结论最可靠。如今,循证医学在我国得到了广泛的应用。中医循证医学的起步较晚,主要限于定性评价。因此,如何利用Meta分析等定量评价的手段,建立中医药疗效系统评价体系,提高中医药循证医学水平,已经成为适应中医药发展的迫切要求。     

中风中医康复治疗临床实践分析

目的：探讨中风中医康复治疗的临床实践效果。方法：随机抽取我院在2011年10月—2012年10月期间收治的120例中风患者的临床资料进行回顾性分析,根据治疗方法的不同,将本组患者分为两组,对照组和观察组,每组60例,其中对照组患者采用西医治疗,观察组患者则采用中医康复治疗,对两组患者治疗效果给予综合评价。结果：对照组治疗有效率为80.0%,观察组治疗有效率为96.7%,观察组治疗效果明显高于对照组,差异显著,具有统计学意义,P〈0.05;观察组远期治疗效果明显优于对照组,差异显著,具有统计学意义,P〈0.05。结论：中风中医康复治疗,能够真正改善患者功能障碍和日常生活状况。     

祖国医学在肿瘤康复中的应用

肿瘤康复是一门新兴的学科,随着中西医结合事业的发展,祖国医学在诸如改善器官功能、减轻放射治疗及化疗的毒副反应,纠正恐癌及有病乱投医的心理障碍,晚期肿瘤的减轻痛苦、延长寿命、提高生活质量等方面将发挥越来越大的作用。     

缺血性中风早期中医康复方案研究

对中风患者进行早期康复治疗具有重要的临床意义,而中医康复治疗经临床反复验证具有确切的疗效。课题组在查阅相关文献及前期研究的基础上制定了缺血性中风早期中医康复方案。     

新型冠状病毒肺炎恢复期患者的中医康复策略

新型冠状病毒肺炎(以下简称"新冠肺炎")恢复期患者的康复问题,日益受到重视.基于新冠肺炎恢复期患者的主要临床问题,结合中医药康复理念和技术方法,从评估和干预两方面提出了相应的对策.其中,评估方面,主要有正气受损和余邪未尽两个方面,前者包括伤气、伤阴、伤形、伤神,后者包括夹痰、夹瘀;此外,还要兼顾患者的体质、年龄、性别等...     

Application Status of Chinese Medicine on Cancer Rehabilitation: A Preliminary Questionnaire Survey

Objective: To investigate the application status of Chinese medicine (CM) in cancer rehabilitation, so as to provide references for improving the level of CM cancer rehabilitation. Methods: A survey questionnaire regarding "application status of CM rehabilitation in cancer patients" for oncologists (doctor version) and cancer patients (patient version) were developed, respectively. From September 2014 to November 2016, a total of 1,000 doctors from oncology department in 48 hospitals and 2,000 cancer patients from CM oncology department from 8 hospitals in China were recruited in this survey. The psychological, nutrition and exercise rehabilitation guidance for cancer patients provided by doctors, their mastery conditions regarding cancer staging treatment and CM syndrome differentiation, and recommendation from doctors on CM rehabilitation were investigated. Cancer patients'' awareness on the importance of psychological, nutrition and exercise rehabilitation, as well as their knowledge and needs for rehabilitation were also analyzed. The impact of gender, age, professional title, hospitals grades of physicians on their knowledge of cancer staging treatment and CM syndrome differentiation, and the relationship between gender, age, education level and economic conditions and patient''s knowledge along with the needs of CM rehabilitation were further analyzed. Results: Totally 1,000 questionnaires were issued to doctors and 963 questionnaires returned, among which 948 were valid representing a response rate of 94.80%. A total of 2,000 questionnaires were issued to patients and 1,705 valid data finally returned with a response rate of 85.25%. The survey showed that cancer patients generally paid much attention to psychological, nutritional and sports rehabilitation, and had a strong demand for CM rehabilitation. Knowledge of CM rehabilitation was not well provided by oncologists, and the rehabilitation guidance as well as CM rehabilitation measures were obviously insufficient in cancer patients. Educational and economic levels were positively correlated with cognition level of CM rehabilitation knowledge among cancer patients (Kendall-taub correlation coefficients=0.130, 0.057, respectively; P<0.05). Gender and education level were positively correlated with the patients'' willingness for taking CM measures (Kendall-tau_b correlation coefficient=0.057, 0.105, respectively; P<0.05). Age was negatively correlated with intention of applying CM measures (kendall-taub correlation coefficient=–0.105, P<0.05). Conclusions: Health education and professional training for both cancer patients and oncologists should be strengthened and CM rehabilitation knowledge among cancer patients and oncologists should be improved, so as to give full play to CM in cancer rehabilitation.     

Evidence-based Chinese Medicine for Rheumatoid Arthritis

Chinese medicine (CM) has long been adopted for treatment of rheumatoid arthritis (RA). CM approaches RA as it does for other diseases by holistic treatment, focusing on the whole body condition, and giving a variety of applications in accordance with the stage and symptoms of the disease. For seeking the best evidence of CM in making decisions for the care of RA individual patients, a number of clinical studies have been conducted in China to gain credibility with the researchers’ unremitting efforts. But the heterogeneity in many of these clinical trials and the low quality of design in some previous studies present an obstacle to the meaningful systematic reviews (SR) and meta-analysis. Some favorable results in improvement of response to biomedicine and reduction of severe adverse reactions of conventional RA therapy should be carefully interpreted and need further research. Fortunately, more appropriate quality assurance and control of CM researches are raised for the implementation of CM in RA therapy to pave the evidence-based way. Guidelines for the diagnosis and treatment of RA recommend evidence to the clinicians. In future, randomized controlled trials (RCT) with smart and flexible design as a good approach to evaluate the effectiveness will be widely used in CM for RA clinical study, with better research methods suitable for certain CM clinical researches. The development of evidence-based CM for RA will be full of challenge and opportunity, but we have full confidence.     

略论中医康复疗法

通过对有关目前我国中医康复医疗的优势与现状以及中医康复学的理论体系进行研究和分析,认为中医康复医疗是目前拥有较完备的理论基础、行之有效、简便易行的方法,是对现代治疗康复方法的较好补充,而且通过一系列方法措施的执行,将会使中医康复医疗更加系统化、规范化,也必将会使中医康复医疗在临床康复医疗中发挥更加强大的作用。     

中医养生康复思想发展史概览

中医养生康复学虽是一门新兴学科,但伴随着医疗实践活动,就已开始了养生康复知识的积累,并随着中医学的发展而不断发展。本文从商周、春秋战国、汉晋六朝、隋唐、宋金元、明清、中华人民共和国成立后７个历史时期,概述了中医养生康复学术思想发展简况     

中医临证思维方法的探讨

中医学是中华民族宝贵的文化遗产，闪烁着历代前贤的思想光辉，对中华民族的繁衍和医疗保健做出了巨大贡献。它的发展是建立在医疗实践的基础上，是历代医家在其长期医疗活动中，不断总结经验，逐步形成理，法方，药诸方面的比较完整的理论体系，并逐步完善了辨证论治的思维方法，本文结合个人临证体会及前人的经验，分析讨论了中医临证时各种具体的思维方法，以期探求科学的规律。     

中西医结合快速康复外科在妇科腹腔镜围手术期的应用

【目的】观察中西医结合快速康复外科（FTS）在妇科腹腔镜围手术期的作用。【方法】将226例行腹腔镜手术患者随机分为试验组（即中西医结合FTS组）和对照组（即传统治疗组）各113例。观察2组术后首次肛门排气时间、下床活动时间、住院时间及术后并发症的发生率。【结果】试验组术后首次肛门排气时间和下床活动时间较对照组早,住院时间较对照组显著缩短（P＜0.05）;试验组术后并发症发生率为0.9%,显著低于对照组的4.4%（P＜0.05）。【结论】中西医结合快速康复外科治疗能促进肠蠕动,缩短肛门排气时间,有效地促进妇科腹腔镜术后胃肠功能的恢复,减少患者术后并发症,加快术后康复进程。