中药复方及单体治疗结肠癌药效与机制研究进展

结肠癌（CRC）是全世界至今未攻克的消化系统常见的恶性肿瘤之一。目前治疗CRC的临床手段均具有一定局限性,疗效不尽人意,从而导致治疗中途被迫停止或疗效欠佳。因此,寻找和研发具有治疗潜力、针对性强、不良反应小、经济性的新型候选药物迫在眉睫。中医药在改善上述症状方面具有西医不可替代的优势,并且中医药学历史悠久,君臣佐使、辨证用药具有调节人体状态的实践基础。近年来中医药在CRC的临床治疗领域有着显著的成效,尤其已有临床应用实践基础的中药复方及单体为干预治疗CRC提供了新的治疗方案,疗效确切、优势突出。具体体现在提高生活质量、改善临床症状,减轻化疗不良反应、延长生存期等方面。因此该文从CRC的现状、中医辨证论治基础上以“结肠癌”“中医药”“复方”及“单体”等为关键词,检索查阅近些年中英文相关文献。主要从“益气健脾”“清热解毒”“滋补肝肾”“补气养血”4个方面较为系统地介绍了中药复方及单体在治疗CRC领域的新进展。但因中药多组分、多靶点、多途径的特点,在今后仍然需要不断地深入探索中药复方及单体在治疗CRC领域的应用,以期使患者病痛和不良反应最小化、治疗效果最大化。为CRC治疗提供更宽广的前景和思路,为基于物质基础深入研究药效作用与机制提供参考。     

DESCRIBING COMMUNITY-BASED REHABILITATION SERVICES IN INDONESIA BY USING THE INTERNATIONAL CLASSIFICATION OF SERVICE ORGANIZATION IN REHABILITATION 2.0

ObjectiveDescribing rehabilitation services in a standardized way is a challenge. The International Classification of Service Organizations in Rehabilitation (ICSO-R) 2.0 was published for this purpose. The ICSO-R was criticized for being tested mainly in high-income countries, and because the testing in lower-income countries did not include community-based rehabilitation services. Therefore, this study was performed to describe community-based rehabilitation services by using ICSO-R 2.0.MethodsThe ICSO-R 2.0 was used to describe 8 community-based rehabilitation services located in 3 cities in 3 different provinces in Indonesia: 6 community-based rehabilitation services in Bandung, West Java; 1 in Tanah Datar, West Sumatra; and 1 in Gowa, South Sulawesi.ResultsAll the community-based rehabilitation services were owned by the government, as a public body, and in the context of the community. The 6 community-based rehabilitation services in Bandung, West Java, are under the government city of Bandung, while the other 2, from Tanah Datar and Gowa, are integrated within primary healthcare centres. Social welfare supports all 6 community-based rehabilitation services in Bandung. The other 2 community-based rehabilitation services are supported by their respective primary healthcare centres.ConclusionThe ICSO-R 2.0 is a feasible tool to describe rehabilitation services, including community-based rehabilitation.LAY ABSTRACTThe International Classification of Service Organizations in Rehabilitation (ICSO-R) 2.0 was published as a framework to support describing rehabilitation service organizations. The process of development of the ICSO-R did not include Community-Based Rehabilitation Services. Therefore, to rectify this, ICSO-R 2.0 was used for this study. Eight community-based rehabilitation services were surveyed, located in 3 cities in Indonesia; namely Bandung, Tanah Datar, and Gowa. This study found that ICSO-R 2.0 can be used to describe rehabilitation services not only in hospitals, but also in the community.Key words: International Classification of Service Organizations in Rehabilitation, ICSO-R, classification, community-based rehabilitation, rehabilitation, health service organization

Strengthening rehabilitation in health systems has become a worldwide agenda. It was accelerated after the launched of the United Nations Convention on the Rights of People with Disabilities (UN-CRPD; (1)), particularly article 26, which mentions habilitation and rehabilitation. Later, the adoption of the Global Disability Action Plan of WHO in 2014 (2), Rehabilitation 2030: A Call for Action (3), and Recommendations for Rehabilitation in the Health System (4) clearly stated the need to strengthen rehabilitation services. In addition, rehabilitation services are also mentioned in the World Report on Disability (1–3, 5).Rehabilitation services have 2 definitions. The first definition is “a set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments” (5). This definition describes rehabilitation programmes for health conditions (rehabilitation at the micro-level). Another defines rehabilitation services based on how the rehabilitation service is organized (6, 7). The latter definition is related to rehabilitation at the meso-level of the health system (8). Responding to the latter definition, which was not clearly defined, the International Society of Physical and Rehabilitation Medicine – World Health Organization Liaison Committee (ISPRM-WHO LC) working group published its first proposal, which is called the International Classification of Service Organizations in Rehabilitation (ICSO-R) (6). Following testing and review by international experts, the second version was published recently (ICSO-R 2.0) (7). ICSO-R 2.0 consists of 2 dimensions; service providers and service delivery. These dimensions consist of 9 and 14 categories, respectively.According to the Rehabilitation Recommendations of WHO (4), rehabilitation services should be integrated into the health system, including availability both in hospitals and the community. In Indonesia, rehabilitation services should be integrated into tertiary and secondary hospitals (9). In addition, rehabilitation services are also available at rehabilitation medicine practices, organized by physical and rehabilitation medicine (PRM) physicians, physiotherapists (PTs), occupational therapists (OTs), and speech and language therapists (SLT). In Indonesia, at the community level, rehabilitation services are delivered at communitybased rehabilitation (CBR) services, particularly in areas where rehabilitation services at the hospital are unavailable or lacking.CBR is one type of rehabilitation service that is mostly provided in the community (10). It was originally established to give access to people with disability where there was no access to rehabilitation services in hospital. Many studies have reported on rehabilitation programmes for different health conditions, provided at CBRs, such as schizophrenia (11), stroke (12), spinal cord injury (13), and post knee arthroplasty patients (14).Structurally, CBRs can be categorized as one type of rehabilitation service organization. However, to the best of our knowledge, there has been no study describing CBRs as an organization delivering services, or describing how CBRs are organized systematically. Before publishing the ICSO-R 2.0, the testing of the first version of the ICSO-R was performed mostly at tertiary or academic level hospitals. Therefore, this study aimed to review the feasibility of using the ICSO-R 2.0 to describe CBR services.     

Surface marker patterns of T cells and expression of interleukin-2 receptor in measles infection

The surface marker patterns of T cells of Ghanaian children during measles infection were studied and an attempt was made to demonstrate T cell activation and viability in vitro after activation in vivo by measles virus. The frequencies of CD4⁺ and CD8⁺ naive T cells in measles patients were high while their memory T cells were remarkably reduced with no sign of proliferation even at the acute phase of the illness. The reduction of memory T cells was prolonged during the convalescent phase (2 months after onset). The anti-CD3 monoclonal antibody-induced expression of interleukin-2 receptor α chain (IL-2R/CD25) was significantly suppressed; however, the addition of phorbol 12-myristate 13-acetate or ionomycin caused a remarkable recovery of CD25 expression. On simple culture, an appreciable proportion of T cells from measles patients died rapidly in contrast with only a few T cells from healthy controls doing so. The suppression of CD25 expression was still demonstrated during the convalescent phase of the disease. Taken together these results suggest unresponsiveness and activation-induced cell death of T cells during severe measles infection in Ghanaian children. Furthermore the prolonged abnormalities of T cells (i.e. decreased memory T cells and inhibition of CD25 expression during the convalescent phase) might be related to post-measles infection immunosuppressive status.