Integration of Complementary and Alternative Medicine into Family Practices in Germany: Results of a National Survey

More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (,Heilpraktiker'). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34 %) returned the questionnaire and 444 (15 %) returned the postcard. Altogether, 886 of the 1471 responding FPs (60 %) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55 %), a rather negative attitude by 127 FPs (14 %). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.     

从1型组胺受体途径探索当归芍药散异病同治原理的研究构想

“异病同治”体现了中医辨证论治特色优势的重要思想,探讨经典名方异病同治原理是传承发展中医药基础理论的良好切入点。前期文献挖掘和实验研究表明,源自《金匮要略》的经典方剂当归芍药散的主要病机是“肝郁脾虚”,其广泛药理活性与组胺介导的生理病理功能有相似性,并通过组胺1型受体发挥抑制水肿、镇痛、镇静等活性;继而提出新的研究构想“当归芍药散可通过整合调节组胺受体表达及信号转导途径达到异病同治目的,肝郁脾虚病机可能与组胺能系统功能紊乱有关,而位于下丘脑的组胺能神经元可能是调控的中心”,课题组正开展相关研究,以期为阐释当归芍药散的作用机理提供参考依据,为探讨中药复方的异病同治原理提供思路方法借鉴,从而进一步为探讨“肝郁脾虚”的科学内涵奠定基础。     

中医理论现代化的路径与目标:逆向对接,创造新医学

中医理论现代转化是中医药全面现代化的基石，实现它的原则有三；保持中医本色，参照西医理法，遵循现代规范；目标是建立超越中西医的，更为先进的新医学体系；路径为逆向对接，形成中医学的现代版-信息医学。     

电针诱导神经生长因子透血脑屏障效应及其机制分析

目的:观察电针"百会"哑门"诱导外源性神经生长因子(NGF)透过血脑屏障的效应及其促透效应与蛋白激酶C(PKC)信号传导通路的相关性。方法:采用急性反复脑缺血再灌注法制造脑缺血学习记忆障碍大鼠模型,3周后,将动物随机分为模型对照组、NGF组(尾静脉注射NGF)、电针组(电针"百会"哑门")、NGF+电针组(尾静脉注射NGF,同时"百会"哑门"通以电针)、NGF+H7+电针组(尾静脉注射NGF后注射异喹啉磺酰类H7,同时"百会"哑门"通以电针),另设假手术组,每组均8只大鼠。采用ELISA法检测各组大鼠脑组织中NGF含量。结果:NGF组大鼠脑组织中NGF含量与模型对照组比较,差异无统计学意义(P>0.05);NGF+电针组大鼠脑组织中NGF含量与假手术组、模型对照组、NGF组及电针组比较均明显升高,差异均有统计学意义(P<0.01);NGF+H7+电针组与NGF+电针组比较,脑组织中NGF含量有下降趋势,但差异不具统计学意义(P>0.05)。结论:"百会"哑门"电针能诱导NGF透过血脑屏障,使大鼠脑组织中NGF含量明显提高,该促透作用与PKC信号通路相关性不明显。     

理肺化纤方对肺纤维化CTGF和FN信号 转导通路影响的研究

目的:用气管注射博莱霉素方法模拟肺纤维化模型,观察理肺化纤方对肺纤维化结缔组织生长因子(CTGF)信号转导通路和纤维连接蛋白(FN)信号转导通路的影响,探讨其防治肺纤维化的机制。方法:Wistar大鼠100只,随机分为5组:正常对照组、模型组、醋酸泼尼松片组、理肺化纤方组、醋酸泼尼松片加理肺化纤方组,每组20只。采用气管内滴注博莱霉素造模法造模,各组均于造模后第2天开始ig给药,醋酸泼尼松片组大鼠给予醋酸泼尼松片0.9 mg.kg-1 ig,理肺化纤方治疗组用理肺化纤方水煎液ig 3.78 g.kg-1,醋酸泼尼松片加理肺化纤方治疗组给醋酸泼尼松片和理肺化纤方水煎液ig,正常对照组和模型组给等容积生理盐水ig,各组动物分别于7,28 d随机处死10只,末次给药后2 h经腹主动脉放血法处死,取血,肺组织置于4%中性甲醛固定,肺组织病理切片HE染色和Masson染色观察肺泡炎和肺纤维化改变,血清羟脯氨酸(Hyp)含量测定法检测大鼠的肺纤维化程度;免疫组化方法观察CTGF,FN在肺组织中的表达。结果:与正常组比较,模型组大鼠肺泡炎及肺纤维化评分,血清Hyp含量,CTGF,FN表达均明显升高,差异具有统计学意义(P<0.05);与模型组比较,治疗组大鼠肺泡炎及肺纤维化评分,血清Hyp,CTGF,FN含量均明显降低,差异有统计学意义(P<0.05)。结论:理肺化纤方可能通过抑制大鼠肺组织CTGF,FN的表达,从而具有抗肺纤维化的作用。     

丹参注射液对鸡胚额骨分离细胞培养生长影响的组织化学观察

孵育12天的鸡胚额骨用胰酶制成分离细胞悬液。共获得3×10~6个细胞,均分为5份,分别加 Eagle 培养液或0.1%、0.2%、0.4%和0.8%丹参 Eagle 培养液,在CO_2培养箱内进行培养。逐日进行活体观察。至培养26天收获。标本作 HE、AS、ARS 染色和 AlP-AcP 反应以进行比较。发现:丹参能促进成骨细胞样细胞成熟,分泌胶原性物质和 AlP,并使钙盐在胶原基质上沉积,形成骨小结节。但是过高浓度的丹参能导致对成骨细胞样细胞生长的抑制。丹参的合适实验浓度为0.2%。     

联合靶向阻断EGFR和mTOR信号通路增强紫杉醇对子宫内膜癌细胞化疗敏感性

目的 观察紫杉醇联合阻断表皮生长因子受体(EGFR)信号通路抑制剂RG - 14260和阻断哺乳动物雷帕霉素靶蛋白(mTOR)信号通路抑制剂雷帕霉素(Rapamycin)对子宫内膜癌细胞株Ishikawa的影响.方法 紫杉醇、RG -14260、Rapamycin单独和联合处理Ishikawa细胞后,MTT法和细胞克隆形成法检测细胞增殖抑制率和存活率;流式细胞仪检测细胞凋亡率及周期分布;Transwell法检测细胞体外侵袭力.结果 紫杉醇、RG -14260与Rapamycin均可抑制Ishikawa细胞增殖、诱导细胞凋亡、减少S期细胞数量、降低细胞侵袭力,三者联合应用呈协同效应(P＜0.01).结论 紫杉醇联合RG-14260及Rapamycin靶向治疗剂能协同性地抑制子宫内膜癌细胞生长、降低其侵袭力,这种作用可能是通过增加G1期细胞阻滞及凋亡来实现的.     

影像学检查在单发肺肿块诊断中的meta分析

目的评价几种影像学检查方法对单发肺肿块恶性病变的诊断价值。同时创建一个根据各种诊断方法的临床数据建立的线图及图表来帮助诊断恶性病变。方法对CT、PET、MR及SPECT在诊断恶性肿块中的作用做回顾性分析。每一种诊断方法对单发性肺肿块恶性病变鉴别的阳性及阴性似然比均被再次仔细计算。各种诊断方法的阳性似然比分别为CT3.91（95%可信区间2.42,5.40）,MRI4.57（3.03,6.1）,PET5.44（3.56,7.32）及SPECT5.16（4.03,6.30）。阴性似然比为：CT0.10（0.03,0.16）,MRI0.08（0.03,0.12）,PET0.06（0.02,0.09）、SPECT0.06（0.04,0.08）。结论对于所有诊断方法来说它们之间诊断价值的差异是非常小的。SPECT似乎应该成为单发肺肿块诊断的首选方法。     

应用临床护理路径对住院高血压病人进行健康教育

目的:探讨临床护理路径对住院高血压病人进行健康教育。方法:将60例高血压患者随机分为实验组和对照组,实验组采用制定临床护理路径进行护理,对照组按常规模式进行护理,对比两组病人在住院期间接受教育后知识效果评价、病人对护士的满意度和服药依从性的差异。结果:与对照组相比,实验组病人能按医生要求按时长期口服降压药物以达到稳定血压,控制病情,减少并发症;同时对护士的满意度及病人对疾病认识重要性明显提高(P<0.05)。结论:应用临床护理路径对住院高血压病人进行健康教育后,病人对疾病认识有所提高,树立了正确健康信念,提高了护理服务质量。     

基于信号通路的中药治疗2 型糖尿病胰岛素抵抗的研究进展

胰岛素抵抗与2型糖尿病的发病密切相关。中药治疗2型糖尿病胰岛素抵抗具有安全、多靶点等优势,已成为目前的研究热点。越来越多的临床和实验研究表明,中药可以有效地改善胰岛素抵抗。其中中药通过胰岛素信号转导通路干预胰岛素抵抗的研究在阐明中药作用机制方面尤为重要,本文基于信号通路对IRS、PI3K/Akt、AMPK、GLUT、GSK-3、NF-κB、p38 MAPK、JNK、Nrf2、PPARs、PTP1B等主要靶标对在中药干预胰岛素抵抗的机制作了总结,以期为以后的相关研究提供基础。     

Hsp70在TLR信号途径中对肿瘤细胞增殖的影响

目的:研究Hsp70在TLR信号途径中对肿瘤细胞增殖的影响。方法:将体外培养的H22细胞分成对照组和用Hsp70刺激的实验组,设计基因表达的引物、PCR扩增、RT-PCR检测两组细胞的TLR2和TLR4的mRNA表达水平,Western blot检测β-catenin水平,对培养10天后的H22细胞进行计数。结果:Hsp70分别处理H22细胞8h后,基因TLR2、TLR4mRNA的表达均明显上调;Hsp70促进H22细胞中β-catenin上调表达;Hsp70处理组的细胞增殖倍数高于对照组。结论:Hsp70在TLR信号途径中具有促进肿瘤细胞增殖作用。     

葛根素通过调控PI3K/AKT信号通路影响食管鳞状细胞癌体内外生长和转移

目的:探究葛根素对食管鳞状细胞癌体内外生长和转移的影响及机制。方法:MTT实验确定葛根素给药浓度为20、40、80μmol/L,取TE-13细胞,设置空白对照组、葛根素20、40、80μmol/L给药组,CCK-8法检测细胞增殖能力、细胞划痕实验检测细胞迁移能力、细胞侵袭实验检测细胞侵袭能力、软琼脂克隆形成实验检测细胞生长能力、流式细胞术检测细胞凋亡及细胞周期、Western blot检测细胞磷脂酰肌醇-3激酶(phosphatidylinositol 3-kinase,PI3K)和蛋白激酶B(Protein Kinase B,PKB,又称Akt)磷酸化水平;构建TE-13细胞裸鼠皮下移植瘤模型,并设置模型对照组、葛根素25mg/kg、50 mg/kg、100 mg/kg灌胃给药组,检测给药期间小鼠瘤体积变化,给药结束后取肿瘤组织称重、Western blot检测瘤组织中PI3K和Akt磷酸化水平,取肺组织拍照,苏木精-伊红染色法(hematoxylin-eosin staining,HE staining)检测肺组织肿瘤转移情况。结果:相较于空白对照组,葛根素20、40、80μmol/L组细胞增殖、迁移、侵袭能力显著下降、克隆形成数目显著减少、细胞凋亡显著增加、细胞周期显著阻滞、PI3K和Akt磷酸化水平明显降低(P <0. 05);相较于模型对照组,葛根素25、50、100μmol/L灌胃给药组小鼠瘤体积生长缓慢、肺组织转移节点显著减少、肿瘤组织PI3K和Akt磷酸化水平明显降低(P <0. 05)。结论:葛根素能够抑制食管鳞状细胞癌的体内外生长和转移,其机制可能为抑制PI3K/AKT信号通路。     

乙酰紫草素通过PI3K/Akt信号通路诱导前列腺癌PC-3细胞凋亡的研究

目的：研究乙酰紫草素（ASK）对人前列腺癌PC-3细胞的诱导凋亡作用及相关的分子机制。方法：利用CCK-8实验检测ASK对体外培养PC-3细胞的杀伤作用;利用流式细胞术实验检测ASK处理后PC-3细胞凋亡情况;利用Western blotting检测凋亡蛋白和AKT信号通路蛋白的表达。结果：CCK-8实验证明ASK能够以时间和浓度依赖性抑制前列腺癌PC-3细胞的增殖;流式细胞术实验证明ASK能够诱导人前列腺癌PC-3细胞线粒体依赖性凋亡;Western blotting证明ASK能够有效抑制前列腺癌PC-3细胞中的AKT信号通路。结论：ASK能够有效抑制人前列腺癌PC-3细胞增殖,并能够有效诱导PC-3细胞发生线粒体依赖性凋亡,其机制可能是通过调控PI3K/Akt信号通路来实现,说明ASK具有一定的抗前列腺癌的潜力。     

大柴胡汤加减对胆囊胆固醇结石湿热证小鼠FXR/FGF15/FGFR4信号通路的影响

目的:基于法尼酯衍生物X受体(FXR)/成纤维细胞生长因子15(FGF15)/成纤维细胞生长因子受体4(FGFR4)通路观察大柴胡汤加减对胆囊胆固醇结石(CS)湿热证模型小鼠的影响,以从方证对应的角度,探讨CS湿热证的分子生物学机制.方法:将48只6周龄小鼠随机分为空白组、模型组、大柴胡汤加减组(23.4 g·kg-1...     

基于问卷调查制定脑病科实习生临床路径带教计划

目的 通过问卷调查制定脑病科实习生临床路径带教计划.方法 选取2019年1月—12月在安徽中医药大学第二附属医院脑病六科实习的医学生,共79名,参与问卷调查.调查项目包括中西医基础理论知识、中西医基础操作技能和临床业务能力3部分.统计分析调查表中各条目的选择人数,并计算所占比.结果 问卷调查表发放79份,收回79份.7...     

Quantitative methods in ethnobotany and ethnopharmacology: Considering the overall flora—Hypothesis testing for over- and underused plant families with the Bayesian approach

Ethnopharmacological relevance

We introduce and explain the advantages of the Bayesian approach and exemplify the method with an analysis of the medicinal flora of Campania, Italy. The Bayesian approach is a new method, which allows to compare medicinal floras with the overall flora of a given area and to investigate over- and underused plant families. In contrast to previously used methods (regression analysis and binomial method) it considers the inherent uncertainty around the analyzed data.

Materials and methods

The medicinal flora with 423 species was compiled based on nine studies on local medicinal plant use in Campania. The total flora comprises 2237 species belonging to 128 families. Statistical analysis was performed with the Bayesian method and the binomial method. An approximated χ²-test was used to analyze the relationship between use categories and higher taxonomic groups.

Results

Among the larger plant families we find the Lamiaceae, Rosaceae, and Malvaceae, to be overused in the local medicine of Campania and the Orchidaceae, Caryophyllaceae, Poaceae, and Fabaceae to be underused compared to the overall flora. Furthermore, do specific medicinal uses tend to be correlated with taxonomic plant groups. For example, are the Monocots heavily used for urological complaints.

Conclusions

Testing for over- and underused taxonomic groups of a flora with the Bayesian method is easy to adopt and can readily be calculated in excel spreadsheets using the excel function Inverse beta (INV.BETA). In contrast to the binomial method the presented method is also suitable for small datasets. With larger datasets the two methods tend to converge. However, results are generally more conservative with the Bayesian method pointing out fewer families as over- or underused.     

雷公藤内酯醇靶向Th17-IL-17通路预防鼠微创前列腺癌

目的证明雷公藤内酯醇靶向Th17-IL-17通路预防鼠微创前列腺癌。方法在Pten阴性模型鼠上,在6~12周期间用雷公藤内酯醇处理,以DMSO作为空白对照。所有小鼠在12周龄处死,剖检。所有小鼠在12周龄时进行前列腺表型分析。结果雷公藤内酯醇治疗可降低Pten阴性小鼠微侵袭前列腺癌的形成。雷公藤内酯醇干预组的前列腺增生减少,细胞凋亡增加,血管生成减少,以及炎症细胞浸润也减少。经上皮细胞-间充质转化(全名Epithelial-Mesenchymal Transition,简称EMT)标记实验检测,与对照处理组比较,雷公藤内酯醇治疗前列腺组织中有较弱的EMT表型。结论首次证实雷公藤内酯醇可靶向Th17-IL-17通路预防鼠微创前列腺癌模型。     

Investigation into the toxicological effects of Catha edulis leaves: a short term study in animals

In this study the short term (3 months) toxicological effects of varying levels of Catha edulis leaves were examined on the plasma concentration of liver enzymes and the histopathology of tissue sections of various organs including the liver, kidneys, spleen and testis. Both the biochemical and histopathological data demonstrated, initial signs of Catha edulis toxicity. Our results show a significant increase in plasma levels of alkaline phosphatase (ALP) and alanine aminotransferase (ALT) with all levels of Catha edulis leaves tested and throughout the treatment period. The increase of ALP was more prominent than that of ALT. The plasma levels of aspartate aminotransferase (AST) were only moderately increased at the higher dose (30%) in the later stages of treatment. In addition, a time-dependent gradual increase in indirect bilirubin with a concomitant decrease in direct bilirubin levels was observed with the 30% Catha edulis with no signs of haemolysis. The histopathology of tissue sections of the liver displayed evidence of congestion of the central liver veins as well as acute hepatocellular degenerative and regenerative activities in the tissue sections obtained from animals treated with both 20% and 30% Catha edulis. Similarly, histopathological examination of the tissue sections of the kidneys showed some lesions, and the degree of the lesion increased as the dose of Catha edulis leaves increased including: the presence of fat droplets particularly seen in the upper cortical tubules; acute cellular swelling; hyaline tubules; and acute tubular nephrosis. In contrast, Catha edulis treatment did not affect the spleen and increased the rate of spermatogenesis in male rabbits with the spermatozoa being quite evident, the Leydig cells were in good condition and were not affected by the doses given.     

黄芪-莪术基于C5a/NETs途径抑制Lewis肺癌小鼠肿瘤转移的机制

目的 基于补体C5a/C5a受体（C5aR）对中性粒细胞胞外诱捕网（NETs）形成的调控机制,探讨黄芪-莪术（HQ-EZ）改善高凝状态、抑制肿瘤生长转移的机制。方法 40只雄性C57BL/6小鼠随机分为4组,其中设空白组,另外3组建立Lewis肺癌小鼠模型后分为模型组、黄芪-莪术组、PMX53组,每组各10只。建模后第3天开始给药,中药组按8.2 g·kg^-1剂量连续14 d给予中药浓煎液灌胃,PMX53组分别于第3、6、9、12、15天按1 mg·kg^-1剂量给予腹腔注射PMX53;每2 d测量小鼠体质量和肿瘤长短径,末次给药次日各组小鼠行活体肺部microCT检测转移瘤情况,麻醉后眼球取血,处死剖取肺脏、瘤块,观察肺脏大体情况,称取瘤重计算抑瘤率,酶联免疫吸附试验（ELISA）检测血清和肿瘤组织中补体C5a、中性粒细胞弹性蛋白酶（NE）、瓜氨酸化组蛋白-H3（Cit-H3）、髓过氧化物酶（MPO）、基质金属蛋白酶-9（MMP-9）、NETs、血管性血友病因子（vWF）、组织因子（TF）、P-选择素含量,原位末端转移酶标记法（TUNEL）检测肿瘤组织细胞凋亡情况,苏木素-伊红（HE）染色观察肺内转移情况,免疫荧光（IF）观察肿瘤组织内NETs等的表达情况,蛋白免疫印迹法（Western blot）检测肿瘤组织C5aR、MPO、Cit-H3蛋白表达情况。结果 与空白组比较,模型组肺内可见肿块,肺内X射线透射度低区域增多,模型组肺脏大体可见结节灶及多处出血灶,整体肺脏颜色较深;小鼠血清补体C5a、NETs及相关蛋白、vWF、TF、P-选择素水平显著增高（P<0.01）。与模型组比较,HQ-EZ组与PMX53组肺内转移灶数量较少,X射线透射度低区域相对较少,肺脏大体未见明显结节,整体肺脏颜色相对较浅;与模型组比较,两用药干预组肿瘤生长曲线较缓,瘤重显著降低（P<0.01）,肿瘤细胞凋亡率显著升高（P<0.01）,血清和肿瘤组织中补体C5a、NETs及相关蛋白、vWF、TF、P-选择素水平明显降低（P<0.05）,补体C5aR、MPO、Cit-H3的蛋白表达水平明显降低（P<0.05）。结论 黄芪-莪术通过抑制补体C5a/C5aR通路抑制了NETs的表达,进一步改善机体的高凝状态,起到抑制肿瘤生长转移的作用。     

中药方剂配伍研究近况

方剂 ,古称汤头 ,它是在辨证的基础上 ,根据病情选择适当的药物 ,按一定的法度加以组合 ,并确定一定的用量比例 ,制成一定的剂型应用于临床的中药组合。现代科学多层次、多学科的研究 ,以其阐明配伍规律的实质 ,即复方的药效物质及作用机理 ,赋予中药配伍理论新的科学内涵。1　配伍原则的研究方剂组方不是简单的药物叠加 ,而是遵循一定的原则 ,以君臣佐使进行组方。这种组方原则始见于《内经》,其设计甚为周密 ,既主次分明 ,配合严密 ,又相互兼顾 ,相互制约。拆方研究证实许多传统名方中君药的药理作用常是该方的主要药效体现。例如瓜蒌薤白…