恶性肿瘤多学科诊疗模式下中医证候变量因素初探

中医药参与恶性肿瘤多学科诊疗模式，发挥增效减毒、减少复发转移等作用，中西医协同诊疗在肿瘤领域逐渐成为共识。临床实践发现，手术、放疗、化疗、内分泌治疗、靶向治疗、免疫治疗等现代医学疗法作用于机体，会引起舌脉、症状的相应改变，可能成为改变证候的主要因素。应当详细辨析现代医学疗法寒热阴阳属性及其对中医证候的影响，精准运用中药增效减毒；把握现代医学疗法的证候演变趋势，预判病势，从而提高多学科诊疗时中医辨治精准性，促进肿瘤中西医结合治疗效益最大化。     

Efficacy of poly (lactic-co-glycolic acid) and tetrandrine-loaded nanomicrospheres in the treatment of dry eye北大核心

Objective To discover a nano-drug with anti-inflammatory, sustained-release, and biocompatible properties aimed at blocking the dry eye formation pathway. Methods Nano-microspheres (Tet-ATS@PLGA) composed of tetrandrine (Tet) and poly (lactic-co-glycolic acid) (PLGA) were prepared using the thin-film hydration method, and their stability at room temperature (25 ℃), encapsulation efficiency, and drug loading were tested. Normal rabbit eyes without intervention were recruited in the normal group, and dry eye models were randomly divided into the control group (without any intervention), ATS group (intervened by artificial tears), Tet-ATS group (intervened by artificial tears and Tet), and Tet-ATS@PLGA group (intervened by Tet-ATS@PLGA). Flow cytometry was performed to detect the apoptosis of inflammatory corneal epithelial cells in each group after 24 hours of intervention. The staining of corneal epithelial cells, tear film break-up time (BUT), and surface tear secretion (detected by the Schirmer test strip) were recorded after 14 days of intervention. The thickness of corneal epithelial cells as well as the shape and number of bulbar conjunctival goblet cells were monitored by hematoxylineosin staining. Corneal proteins were extracted for the enzyme-linked immunosorbent assay to measure the expression levels of vascular endothelial growth factor (VEGF), interleukin-1β (IL-1β), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α). The independent samples t-test was carried out for comparison among groups. Results The encapsulation efficiency and drug loading of Tet-ATS@PLGA nano-drug were 77.43% and 30.26%, respectively. The drug was stable at room temperature and easy to release when the ocular surface temperature stood at 33 ℃. Compared with other groups, BUT and the amount of tear secretion in the Tet-ATS@PLGA group were the largest, the thickness of corneal epithelial cells was close to the normal value, bulbar conjunctival goblet cells recovered the most, the apoptosis of inflammatory corneal epithelial cells after 24 hours of intervention was the most significant, and the expression levels of VEGF, IL-1β, TNF-α, and PGE2 were the lowest (all P<0.05). Conclusion Tet-ATS@PLGA nano-drug can effectively act on inflammatory corneal epithelial cells in rabbits, promote apoptosis of inflammatory cells, and block the inflammatory response of dry eyes by inhibiting the expression of VEGF, IL-1β, TNF-α, and PGE2, thus improving tear secretion on the ocular surface. © The Author(s) 2023.     

从“阴火论”论述恶性肿瘤化疗相关性潮热的治则

“阴火论”是金元医家李东垣《脾胃论》的核心思想之一，即由于饮食劳倦，喜怒忧恐，内伤脾胃，中气不足所引起的内伤发热。本文作者通过对恶性肿瘤化疗后出现潮热症状的临床病例分析研究发现，这种化疗相关性潮热辨证以脾虚为基础，从病因病机上均符合李东垣“阴火”之说，治疗上以东垣“甘温除大热”之法为基础，后期兼顾肾阳，疗效显著。