中医药对癌症支持性治疗的科学证据

辅助与替代疗法已被越来越多用于已发展国家的癌症患者。在各种另类疗法中,只有少数像中医药般既具坚实理论、又有完备的治病方法,包括对癌症的治疗。近年,许多证据表明中医药是有效的癌症支持性治疗,可在常规治疗的治疗期间和治疗后应用。本文特归纳一些已发表的临床报告和荟萃分析,综述中医药治疗方案对癌症支持性治疗的证据,其中包括中药材、针灸和气功治疗。     

CEOP treatment results and validity of the International Prognostic Index in Chinese patients with aggressive non-Hodgkin's lymphoma

From 1991 to 1997, we have treated 78 newly diagnosed patients with aggressive non-Hodgkin's lymphoma with a modified CHOP regimen in which epirubicin (60 mg/m2) was used in place of doxorubicin (50 mg/m2), i.e. CEOP (cyclophosphamide, epirubicin, vincristine and prednisolone). The median age was 41 years (range: 17 to 67). Sixty-four (82 per cent) had diffuse large cell (Working Formulation category G) histology. The median LDH level was 453 u/l. Thirty-three (42.3 per cent) and 45 (57.7 per cent) had stage I/II and stage III/IV disease, respectively. Fifty-five of 78 (71 per cent) CEOP-treated patients achieved CR, and the projected DFS and OS were both 65 per cent. In an earlier cohort of patients (from 1985-1991) treated with second or third-generation chemotherapy regimens (m-BACOD, MACOP-B, ProMACE-CytaBOM), CR was achieved in 95/123 (77 per cent) patients and the projected DFS and OS were 62 per cent and 55 per cent. There was no significant difference in the clinical characteristics, CR rates (p = 0.26), DFS (p = 0.38) or OS (p = 0.68) between patients who received CEOP or second/third-generation chemotherapy regimens. Of the patients treated with CEOP, 37.9 per cent, 28.8 per cent, 24.2 per cent and 9.1 per cent were in the age-adjusted International Index L, LI, HI and H risk groups, with CR rates of 82 per cent and 57 per cent in the L/LI and HI/H risk groups (p = 0.03). Moreover, patients in the L, LI and HI/H risk groups had significantly different projected DFS (87 per cent, 62 per cent and 39 per cent, p = 0.02) and OS (85 per cent, 80 per cent and 36 per cent, p = 0.006). In conclusion, CEOP is an effective regimen and the age-adjusted International Index is valid for Chinese patients with aggressive NHL.     

Nuclear translocation of beta-catenin in hereditary and carcinogen- induced intestinal adenomas

The physical interaction between beta-catenin and the adenomatous polyposis coli (APC) gene, and the ability of APC to regulate cytoplasmic levels of beta-catenin suggest a role for beta-catenin in colorectal carcinogenesis. In this study, we found that beta-catenin immunoreactivity was detected exclusively in the cell membrane and cytoplasm of morphologically normal intestinal epithelial cells with predominant distribution in the differentiated nonproliferative cell population. In contrast, beta-catenin was localized predominantly in the nucleus of adenomas from Min/+ mice and transgenic mice expressing a mutant truncated form of the APC gene (Apc(delta716) mice). Beta- catenin was expressed predominantly at the cell membrane and cytoplasm of the nontransformed rat intestinal epithelial (RIE-1) cells in culture, whereas predominantly nuclear localization of beta-catenin was observed in the human colon cancer cell line SW480. In the azoxymethane (AOM) treated rats, overexpression and nuclear localization of beta- catenin was observed in all adenomas. Previous studies have indicated the incidence of APC mutations amongst AOM-induced tumors to be 15% or less. These results demonstrate that nuclear localization of beta- catenin is a common event in colorectal tumorigenesis.      

Prevalence and risk factors of lumbar spondylolisthesis in elderly Chinese men and women

Objective

A screening survey for osteoporotic fractures in men and women in Hong Kong represents the first large-scale prospective population-based study on bone health in elderly (≥65 years) Chinese men and women. This study aims to identify the prevalence and potential risk factors of lumbar spondylolisthesis in these subjects.

Methods

The lateral lumbar radiographs of 1,994 male and 1,996 female patients were analysed using the Meyerding classification.

Results

Amongst the men, 380 (19.1 %) had at least one spondylolisthesis and 43 (11.3 %) had slips at two or more levels; 283 had anterolisthesis, 85 had retrolisthesis, whereas 12 subjects had both anterolisthesis and retrolisthesis. Amongst the women, 499 (25.0 %) had at least one spondylolisthesis and 69 (13.8 %) had slips at two or more levels; 459 had anterolisthesis, 34 had retrolisthesis, whereas 6 subjects had both anterolisthesis and retrolisthesis. Advanced age, short height, higher body mass index (BMI), higher bone mineral density (BMD) and degenerative arthritis are associated with spondylolisthesis. Lower Physical Activity Scale for the Elderly (PASE) score was associated with spondylolisthesis in men; higher body weight, angina and lower grip strength were associated with spondylolisthesis in women.

Conclusion

The male/female ratio of lumbar spondylolisthesis prevalence was 1:1.3 in elderly Chinese. Men are more likely to have retrolisthesis.

Key Points

? The prevalence of spondylolisthesis is 19.1 % in elderly Chinese men. ? The prevalence of spondylolisthesis is 25.0 % in elderly Chinese women. ? Men are more likely to have retrolisthesis. ? Anterolisthesis is most commonly seen at the L4/L5 level. ? Retrolisthesis is most commonly seen at the L3/L4 level.     

Improving quality and reducing inequality in heart failure

The popular annual autumn meeting of the British Society for Heart Failure (BSH) boasted a line-up of internationally recognised authorities in heart failure. Held in London on 28^th—29^th November 2019, the meeting’s focus was on improving quality and reducing inequality. Drs Sanjay S Bhandari and Daniel CS Chan report its highlights.     

Stimulating the discussion on saliva substitutes: a clinical perspective

Xerostomia is a significant problem commonly faced by patients and oral health practitioners. There is no cure for this condition, which commonly manifests as a side effect of medications, head and neck irradiation and other systemic conditions, such as Sjögren's syndrome and type 2 diabetes. It may also arise idiopathically. Therefore, treatment is palliative and takes the form of oral lubricants and saliva substitutes which aim to reduce symptoms associated with xerostomia as well as prevent oral disease secondary to it. Recently there has been an expansion of the number and range of products available in Australia for the palliative management of xerostomia. It is imperative then that oral health professionals have a sound understanding of the advantages and disadvantages of using such products as patients tend to be well informed about new products which are commercially available. This article discusses some of the most commonly available products used for the symptomatic relief and preventive management of xerostomia. Amongst the plethora of products available to the patient suffering from xerostomia, no single product or product range adequately reproduces the properties of natural saliva and therefore consideration of patients' concerns, needs and oral health state should be taken into account when formulating a home care regime. With Australia's ageing population and its heavier reliance on medications and treatments which may induce xerostomia, oral health professionals are likely to encounter this condition more than ever before and therefore an understanding of xerostomia and its management is essential to patient care.     

The response effect of pheochromocytoma (PC12) cell lines to oxidized multi-walled carbon nanotubes (o-MWCMTs)

Background

The applications of oxidized carbon nanotubes (o-CNTs) have shown potentials in novel drug delivery including the brain which is usually a challenge. This underscores the importance to study its potential toxic effect in animals. Despite being a promising tool for biomedical applications little is known about the safety of drugs in treating brain diseases. The toxicity of oxidized multi-walled carbon nanotubes (o-MWCNTs) are of utmost concern and in most in-vitro studies conducted so far are on dendritic cell (DC) lines with limited data on PC12 cell lines.

Objectives

We focused on the effect of o-MWCNTs in PC12 cells in vitro: a common model cell for neurotoxicity.

Methods

The pristine multi-walled carbon nanotubes (p-MWCNTs) were produced by the swirled floating catalytic chemical vapour deposition method (SFCCVD). The p-MWCNTs were then oxidized using purified H₂SO₄/HNO₃ (3:1v/v) and 30% HNO₃ acids to produce o-MWCNTs. The Brunauer-Emmett-Teller (BET), transmission electron microscopy (TEM), Scanning electron microscopy (SEM), thermogravimetric analyser (TGA) and Raman spectroscopy techniques were used to characterize the MWCNTs. The PC12 cells were cultured in RPMI medium containing concentrations of o-MWCNTs ranging from 50 to 200 µg/ml.

Results

The o-MWCNTs demonstrated slight cytotoxicity at short time period to PC12 neuronal cells whilst at longer time period, no significant (p > 0.05) toxicity was observed due to cell recovery.

Conclusion

In conclusion, the o-MWCNTs did not affect the growth rate and viability of the PC12 cells due to lack of considerable toxicity in the cells during the observed time period but further investigations are required to determine cell recovery mechanism.