Efficacy observation on prevention of chemotherapy-related anemia by combined therapy of traditional Chinese medicine in malignant tumors / 肿瘤研究与临床

Objective:To explore the effect of combined therapy of traditional Chinese medicine on prevention of chemotherapy-related anemia in malignant tumors.Methods:Seventy-nine patients with malignant tumors diagnosed in Zibo Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were selected, and the patients were divided into experimental group (40 cases) and control group (39 cases) according to the random number table method. The control group received chemotherapy and the experimental group received chemotherapy and combined therapy of traditional Chinese medicine (Wuhong Tang combined with moxibustion). The hemoglobin (Hb) level, Karnofsky score and adverse effects were recorded before and on days 7, 14 and 21 after chemotherapy in the two groups.Results:The Hb level in the experimental group was higher than that in the control group [(117±28) g/L vs. (100±31) g/L] on day 21 after chemotherapy, and the difference was statistically significant ( t = -3.08, P = 0.030). The total effective rate of the experimental group was higher than that of the control group [85% (34/40) vs. 66.7% (26/39)], but the difference was not statistically significant ( χ2 = 4.96, P = 0.084). Karnofsky scores were (77±9) points and (77±12) points before and on day 21 after treatment in the experimental group, with no statistical difference ( t = -0.50, P = 0.623); Karnofsky scores were (78±10) points and (67±9) points in the control group, with statistical difference ( t = 8.32, P < 0.001). There was no statistical difference in Karnofsky score before treatment between the two groups ( t = 1.85, P = 0.068), but the experimental group was higher than the control group on day 21 after treatment ( t = 4.88, P < 0.001). The difference in the incidence of nausea and vomiting between the two groups was not statistically significant ( P > 0.05), and no chemotherapy-related hepatic, renal or cardiac adverse reactions were observed in either group. Conclusions:Combined therapy of traditional Chinese medicine could effectively prevent chemotherapy-related anemia and improve the quality of life of patients.

The progress of combined therapy of omalizumab and allergen immunotherapy in children with moderate to severe allergic asthma / 国际儿科学杂志

Allergen immunotherapy(AIT)is considered the treatment capable of modifying the natural history of allergic respiratory disorders.The adverse reactions associated with AIT limit its clinical use in moderate to severe allergic asthma.Omalizumab is currently approved for the treatment of allergic asthma, chronic spontaneous urticaria, allergic rhinitis and other allergic diseases.A few trials have demonstrated the clinical efficacy of AIT and omalizumab combination therapy in children with moderate to severe allergic asthma.This review summarizes the research progress, mechanisma and application of omalizumab combined with AIT in children with moderate to severe allergic asthma.

The efficacy of radiotherapy based combined therapy for unresectable locally invasive bladder cancer and its associated factors analysis / 中华肿瘤杂志

Objective: Retrospective analysis of the efficacy and influencing factors of bladder preservation integrated therapy for unresectable invasive bladder cancer confined to the pelvis was done, also including the bladder function preservation and adverse effects analysis. Methods: Sixty-nine patients with unresectable locally invasive bladder cancer who received radiotherapy-based combination therapy from March 1999 to December 2021 at our hospital were selected. Among them, 42 patients received concurrent chemoradiotherapy, 32 underwent neoadjuvant chemotherapyand 43 with transurethral resection of bladder tumors (TURBT) prior to radiotherapy. The late adverse effect of radiotherapy, preservation of bladder function, replase and metastasis and survival were followed-up. Cox proportional hazards models were applied for the multifactorial analysis. Results: The median age was 69 years. There were 63 cases (91.3%) of uroepithelial carcinoma, 64 of stage Ⅲ and 4 of stage Ⅳ. The median duration of follow-up was 76 months. There were 7 grade 2 late genito urinary toxicities, 2 grade 2 gastrointestinal toxicities, no grade 3 or higher adverse events occurred. All patients maintained normal bladder function, except for 8 cases who lost bladder function due to uncontrolled tumor in the bladder. Seventeen cases recurred locally. There were 11 cases in the concurrent chemoradiotherapy group with a local recurrence rate of 26.2% (11/42) and 6 cases in the non-concurrent chemoradiotherapy group with a local recurrence rate of 22.2% (6/27), and the difference in local recurrence rate between the two groups was not statistically significant (P=0.709). There were 23 cases of distant metastasis (including 2 cases of local recurrence with distant metastasis), including 10 cases in the concurrent chemoradiotherapy group with a distant metastasis rate of 23.8% (10/42) and 13 cases in the non-concurrent chemoradiotherapy group with a distant metastasis rate of 48.1% (13/27), and the distant metastasis rate in the non-concurrent chemoradiotherapy group was higher than that in the concurrent chemoradiotherapy group (P=0.036). The median 5-year overall survival (OS) time was 59 months and the OS rate was 47.8%. The 5-year progression-free survival (PFS) time was 20 months and the PFS rate was 34.4%. The 5-year OS rates of concurrent and non-concurrent chemoradiotherapy group were 62.9% and 27.6% (P<0.001), and 5-year PFS rates were 45.4% and 20.0%, respectively (P=0.022). The 5-year OS rates of with or without neoadjuvant chemotherapy were 78.4% and 30.1% (P=0.002), and the 5-year PFS rates were 49.1% and 25.1% (P=0.087), respectively. The 5-year OS rates with or without TURBT before radiotherapy were 45.5% and 51.9% (P=0.233) and the 5-year PFS rates were 30.8% and 39.9% (P=0.198), respectively. Multivariate Cox regression analysis results showed that the clinical stage (HR=0.422, 95% CI: 0.205-0.869) was independent prognostic factor for PFS of invasive bladder cancer. The multivariate analysis showed that clinical stages (HR=0.278, 95% CI: 0.114-0.678), concurrent chemoradiotherapy (HR=0.391, 95% CI: 0.165-0.930), neoadjuvant chemotherapy (HR=0.188, 95% CI: 0.058-0.611), and recurrences (HR=10.855, 95% CI: 3.655-32.638) were independent prognostic factors for OS of invasive bladder cancer. Conclusion: Unresectable localized invasive bladder cancer can achieve satisfactory long-term outcomes with bladder-preserving combination therapy based on radiotherapy, most patients can retain normal bladder function with acceptable late adverse effects and improved survival particularly evident in patients with early, concurrent chemoradiotherapy and neoadjuvant chemotherapy.

Research progress on traditional Chinese medicine compounds combined with external therapy in treatment of hyperplasia of mammary glands / 中国中药杂志

Hyperplasia of mammary glands is a benign breast disease with disordered breast structure. Nowadays, the incidence rate of breast hyperplasia in women is increasing year by year, and the etiology is related to the imbalance of estrogen and progesterone in the body. The symptoms include breast pain, breast nodules, or nipple discharge, which can develop into breast cancer in the context of psychological pressure. Therefore, it is timely and effectively necessary for people to treat the symptoms. At present, traditional Chinese medicine(TCM) often treats breast hyperplasia by oral drug, external application, acupuncture, moxibustion, and massage, while western medicine often uses hormone therapy or surgery. TCM can regulate hormone levels to treat breast hyperplasia. Acupuncture, moxibustion, and other methods can stimulate acupoints to reduce breast lumps. However, since TCM is easy to produce hepatorenal toxicity after long-term use and simple external treatment is slow to take effect, rapid and effective treatment is difficult to be achieved. Although western medicine can inhibit the disease, it is easy to produce toxic and side effects if taken for a long time. In addition, surgery can only remove the focus and the recurrence rate is high. Some studies have found that the combination of oral and external use of TCM compounds has a significant effect, with mild toxic and side effects, few adverse reactions, and a low recurrence rate. Based on the relevant literature in recent years, this article reviewed the combination of oral and external treatment of TCM in the treatment of hyperplasia of mammary glands, discussed the effectiveness, clinical evaluation indexes, and mechanism, and pointed out the existing shortcomings to explore a comprehensive therapy worthy of clinical application.

A Biological Trial on the Effect of Vitamin E and C Combination Therapy on Chronic Paraquat Toxicity

Paraquat (1,1-dimethyl-4-4-bipiridinium dichloride (PQ) is a non-selective contact herbicide that is a major source of free radicals and generates superoxide anion, and reactive oxygen species (ROS) which causes severe oxidative damage. Vitamin C is a water-soluble vitamin that plays a role using its biological characteristic as a suitable antioxidant in cells� defense against oxygen deprivation and increasing tissue protection from oxidative stress. Vitamin E is a free-radical scavenger renowned for its anti-inflammatory and antioxidant properties. The purpose of the study was to determine the short-term therapeutic effect of a vitamin E and C combination treatment on paraquat-induced male albino rats. For the study, 200 male albino rats were used. The rats were divided into four major categories namely A, B, C, and D with 50 rats each. The "A" group received no paraquat, but the "B," "C," and "D" groups received 0.02g, 0.04g, and 0.06g of paraquat respectively every two weeks for three months. These groups were subsequently subgrouped into two with 25 rats per subgroup. The "A" group was divided into two "A0" and "AVE"; 揃� was subgrouped into 揃0� and BVEC� 揅� was subgrouped into 揅0� and 揅VEC� and 揇� was subgrouped into 揇0� and 揇VEC�. A0, B0, C0 and D0 were subgroups without Vit E and C combined treatment while AVEC, BVEC, CVEC and DVEC were subgroups with combined treatment with 500mg of vitamin E and 2000mg/l of C medicated water every week for two months. Blood was drawn for the analysis of hematogical parameters (Hemoglobin concentration [Hb], Packed Cell volume [PCV], Total White blood cell count [T-WBC], Neutrophils and Lymphocytes). There was a significant variation in the hematological parameters among the "A0", "B0", "C0", and "D0" at p-value<0.05. There was also significant variation in the hematological parameters between the "AVEC", "BVEC", "CVEC", and "DVEC", p-value < 0.05. Consequently, it was also observed that there were significant variations in intra-group comparisons of Hb and PCV, p-value<0.05, whereas other markers were not statistically different. This study found that combining vitamin E and C has a therapeutic effect on 慴lood anemia indicators� but not the immunity of male albino rats after one month of weekly treatment. As a result, a weekly treatment with Vit E and C combination therapy can alleviate PQ toxicity by ameliorating anemia but not affecting the immune system of male albino rats.

Clinical efficacy of interventional treatment combined with immunotherapy plus anti-angio-genesis targeted therapy in conversion therapy of advanced hepatocellular carcinoma / 中华消化外科杂志

Targeted therapy is one of the conventional treatments for advanced hepato-cellular carcinoma (HCC). In recent years, immunotherapy has created a new era of HCC treatment. The combination of targeted therapy and immunotherapy has synergistic effects, which taking survival benefits to patients with advanced HCC. Local therapy, represented by interventional treatment, can rapidly control the development of tumor and promote the expression and releasing of tumor antigen. On the basis of local therapy and combination of immunotherapy plus targeted therapy, it can offer the possibility to prolong the survival of patients, and even obtain the chance of cure. The authors introduce the diagnosis and treatment of an advanced HCC patient with inter-ventional treatment combined with immunotherapy plus anti-angiogenesis targeted therapy. Results show that patient achieving pathological complete response and undergoing resection after conver-sion therapy. The patient has a good prognosis with a better quality of live.

Clinical efficacy of hepatic arterial infusion chemotherapy combined with atelizumab plus bevacizumab on first line treatment of advanced hepatocellular carcinoma / 中华消化外科杂志

The treatment of advanced hepatocellular carcinoma (HCC) is limited and the prognosis is poor, which seriously endangers the public health. Results of clinical trials have confirmed the validity of atelizumab plus bevacizumab in patients with advanced HCC. The authors introduce the clinical experience of a patient with stage Ⅲa HCC undergoing local therapy of hepatic artery chemoembolization, and combined with atelizumab plus bevacizumab. The results show that patient with successfully transformational therapy, and receiving surgical resection with a good clinical effect.

Influence of Multidisciplinary Combined Therapy on Curative Effect of Liver Cancer Treatment / 肿瘤防治研究

Liver cancer is one of the common malignant tumors in China, and the treatment effect is poor. The current treatment plan is still surgery-based comprehensive treatment, and multidisciplinary combined therapy is currently the main mode of liver cancer treatment. With the increased number of new technologies and methods of liver cancer treatment being applied clinically, the prognosis of liver cancer patients has significantly improved. This article explains the selection mechanism for optimal individualized combined treatment plans to improve the curative effect of liver cancer treatment based on the different conditions of liver cancer patients and types of liver cancer.

A Case of Obstructive Sleep Apnea Successfully Treated with Kampo Medicine and Western Medicine / 日本東洋医学雑誌

We report a case of obstructive sleep apnea improved with the treatment both of Kampo medicine and Western medicine. The patient aged 52 years old was struggling with daytime drowsiness. Through the sleep test, he was diagnosed as severe obstructive sleep apnea (OSA) and was received a continuous positive airway pressure therapy (CPAP). Generally, positive air from CPAP applies through the nose and usage reports were recorded in the device. If having nasal congestion, it may be hard to continue CPAP. In this case he had a severe nasal congestion, and he nearly became CPAP failure. It was clear from the poor usage reports. Using Eppikajutsuto for nasal congestion, he felt decrease of nasal congestion. By switching to Shoseiryuto or kakkontokasenkyusin’i from Eppikajutsuto with reference to CPAP usage and nasal CT images, CPAP was continued effectively. Eventually, his daytime sleepiness disappeared.To continue CPAP, which is one of Western medicine, Kampo medicine was useful. On the other hand, to evaluate the effectiveness of Kampo medicine, Western medicine was necessary. CPAP reports and nasal CT images, which are Western medicine, contributed to the switch to Kampo medicine. This case showed the worth of the combined therapy of Kampo medicine with Western medicine.

Combined Therapy of Lung and Intestine in Treatment of Lung Diseases： A Review / 中国实验方剂学杂志

The theoretical origin of the combined therapy of lung and intestine can be traced back to the Inner Canon of Huangdi （《黄帝内经》）， which explains the physiological and pathological interaction between the lung and the large intestine. In recent years， researchers have investigated the scientific essence of the "lung-intestine axis" theory from many aspects， which enriches the relevant theoretical basis， and applied it to the treatment of COVID-19， acute lung injury， and other lung diseases. The close relation between lung and intestine in many aspects embodies the holistic conception of traditional Chinese medicine and explains the holistic theory of interrelation between organs， which correlate to each other physiologically and pathologically. Intestinal microecological disorders can affect lung immune function and cause respiratory diseases， and respiratory diseases are usually accompanied by gastrointestinal symptoms. Lung diseases can be prevented and treated by regulating intestinal flora. According to histoembryology， the epithelial tissue of the lung and intestine comes from primitive foregut. In immunology， both lung and intestine contain mucosa-associated lymphoid tissue， and the pathological changes of the respiratory tract are also closely related to intestinal microorganisms. The tissue origin of lung and large intestine， the correlation of mucosal immunity， and the synchronization of ecological changes provide a scientific basis for the combined therapy of lung and intestine. Therefore， this paper summarizes the theoretical origin， modern research mechanism， and clinical application of combined therapy of lung and intestine， in order to provide a new direction for its application in clinical and scientific research.

Effect of Combined Therapy of Lung and Intestine on VIP and p38 MAPK Signaling Pathways in Bronchial Asthma Mice / 中国实验方剂学杂志

ObjectiveTo observe the therapeutic effects of the combined therapy of lung and intestine， a common treatment for pulmonary diseases in traditional Chinese medicine （TCM）， on bronchial asthma mice， and further detect the changes of vasoactive intestinal peptide （VIP） and p38 mitogen-activated protein kinase （p38 MAPK） signaling pathway-related proteins which are closely related to the pathogenesis of asthma， in order to elucidate the mechanism of the combined therapy of lung and intestine in the treatment of bronchial asthma. MethodA total of 60 Kunming mice were randomly divided into normal group， model group， dexamethasone group （0.5 mg·kg-1·d-1）， TCM group （2.73 g·kg-1·d-1）， and lung-intestine treatment group （6.825 g·kg-1·d-1）， 12 mice in each group. All mice except the normal group were sensitized by ovalbumin to induce bronchial asthma. After 30 days of intragastric administration， serum and lung tissue samples were obtained. The content of VIP， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in the serum of mice in each group was detected by enzyme-linked immunosorbent assay （ELISA）. The mRNA levels of TNF-α， IL-6， and p38 MAPK in lung tissues of mice were detected by real-time quantitative polymerase chain reaction （Real-time PCR）， and the protein levels of TNF-α， IL-6， p38 MAPK， and phosphorylated p38 MAPK （p-p38 MAPK） in lung tissues of mice were assayed by Western blot （WB）. ResultCompared with the normal group， the model group showed decreased content of serum VIP （P<0.05）， increased content of TNF-α and IL-6 （P<0.05）， up-regulated mRNA levels of TNF-α， IL-6， and p38 MAPK， and elevated protein levels of TNF-α， IL-6， and p-p38 MAPK/p38 MAPK in lung tissues （P<0.05）. Compared with the model group， the treatment groups exhibited increased content of serum VIP， TNF-α， and IL-6 （P<0.05）， down-regulated mRNA levels of TNF-α， IL-6， and p38 MAPK， and lower protein levels of TNF-α， IL-6， and p-p38 MAPK/p38 MAPK in lung tissues （P<0.05）. As compared with the lung-intestine treatment group， the serum TNF-α and IL-6 levels in the dexamethasone group were increased （P<0.05）， and the mRNA and protein levels of TNF-α and IL-6 in lung tissues were down-regulated （P<0.05）， while the levels of p38 MAPK， VIP mRNA， and p-p38 MAPK/p38 MAPK protein in lung tissues were up-regulated （P<0.05）. The serum VIP， TNF-α， and IL-6 levels in the TCM group were decreased （P<0.05）， and the mRNA levels of TNF-α， IL-6， p38 MAPK and protein levels of TNF-α， IL-6， p-p38 MAPK/p38 MAPK in lung tissues were up-regulated （P<0.05）， while the level of VIP mRNA in lung tissues was down-regulated （P<0.05）. ConclusionThrough increasing endogenous VIP and inhibiting the excessive activation of p38 MAPK signaling pathway， the combined therapy of lung and intestine can reduce the release of inflammatory factors， inhibit pulmonary inflammation response， and treat bronchial asthma.

Mechanism of Combined Therapy of Lung and Intestine in Alleviating Pulmonary Edema in Treatment of Acute Lung Injury Based on VIP/cAMP/PKA/AQPs Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo explore the mechanism of the combined therapy of lung and intestine （Mahuangtang + Da Chengqitang） in alleviating pulmonary edema in rats with acute lung injury （ALI） induced by lipopolysaccharide （LPS）. MethodWistar rats were randomly divided into blank group， model group， low-， medium-， and high-dose groups with combined therapy of lung and intestine， and positive control group. LPS （10 mg·kg-1） was given （ip） to induce ALI in rats. After modeling， the blank group was given normal saline （25 mL·kg-1）， the combined therapy of lung and intestine treatment groups were given （ig） low- （5 g·kg-1）， medium- （7.5 g·kg-1）， and high-dose （10 g·kg-1） Mahuangtang and Da Chengqitang， and the positive control group was given dexamethasone （5 mg·kg-1）. Medications were administered 0， 8， and 16 h after LPS injection for 3 times. Then lung tissue and serum were collected after administration. The lung tissues were stained with haematoxylin-eosin （HE）， and the pulmonary edema score was evaluated. The dry/wet （D/W） weight ratio of lung tissues in each group was measured， and the content of serum vasoactive intestinal peptide （VIP） in rats was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein levels of aquaporin-1 （AQP1）， AQP5， VIP， cyclic adenosine monophosphate （cAMP）， phosphorylated protein kinase A （p-PKA）， and PKA in lung tissues of rats in each group. The level of VIP mRNA in lung tissues of rats was detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， the model group exhibited obvious lung injury， increased edema score， decreased D/W ratio （P<0.01）， declined AQP1， AQP5， cAMP， and p-PKA/PKA in lung tissues （P<0.05， P<0.01）， elevated VIP content （P<0.01）， and up-regulated levels of VIP protein and mRNA in lung tissues （P<0.05， P<0.01）. Compared with the model group， combined therapy of lung and intestine treatment groups showed alleviated lung injury， increased D/W ratio （P<0.01）， elevated AQP1， AQP5， VIP， cAMP， and p-PKA/PKA in lung tissues （P<0.05， P<0.01）， and up-regulated VIP levels in lung tissues （P<0.05， P<0.01）. ConclusionThe combined therapy of lung and intestine can alleviate ALI-induced lung tissue edema， and the mechanism may be related to the activation of the VIP/cAMP/PKA signaling pathway， which further promotes the expression of AQP1 and AQP5 and enhances the water metabolism of lung tissue.

Effect of Combined Therapy of Lung and Intestine on NF-κB Inflammatory Pathway and Macrophage Polarization in LPS-induced Acute Lung Injury Rats / 中国实验方剂学杂志

ObjectiveTo investigate the effect of combined therapy of lung and intestine （Mahuangtang + Da Chengqitang） on lipopolysaccharide （LPS）-induced acute lung injury （ALI） in rats and its protective mechanism. MethodWistar rats were randomly divided into blank group， model group， low-， medium-， and high-dose groups with combined therapy of lung and intestine ， and dexamethasone group. LPS （10 mg·kg-1） was given （ip） to induce ALI in rats. The general state of rats in each group was observed and recorded. The body temperature of rats in each group was recorded 0-8 h after modeling by means of anal temperature measurement. Serum and lung tissues were collected 24 h after modeling. Serum levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and arginase-1 （Arg-1） were determined by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein levels of nuclear factor kappa B p65 （NF-κB p65）， phosphorylated NF-κB p65 （p-NF-κB p65）， NF-κB inhibitor α （IκBα）， and phosphorylated IκBα （p-IκBα） in lung tissues of rats. The levels of classically activated （M1） macrophage marker CD80 and IL-1β and macrophage markers F4/80 and IL-10 were detected by double immunofluorescence. ResultCompared with the blank group， the model group showed increased body temperature and thermal response index （TRI）， elevated serum levels of pro-inflammatory factor TNF-α and IL-1β and anti-inflammatory factor IL-10 （P<0.01）， up-regulated protein levels of p-NF-κB p65 and p-IκBα in lung tissues （P<0.01）， and increased levels of F4/80， CD80， and IL-1β in lung tissues （P<0.01）. Compared with the model group， the lung-intestine combined treatment groups and the dexamethasone group exhibited decreased body temperature and TRI in rats （P<0.01）， declined serum levels of inflammatory factor TNF-α and IL-1β （P<0.05， P<0.01）， elevated serum levels of anti-inflammatory factor IL-10 and Arg-1 （P<0.05， P<0.01）， down-regulated protein levels of p-NF-κB p65 and p-IκBα in lung tissues （P<0.05， P<0.01）， decreased levels of CD80 and IL-1β， and increased levels of IL-10 in lung tissues （P<0.01）， while the level of F4/80 was not significantly changed. ConclusionThe combined therapy of lung and intestine can obviously alleviate the fever and inflammatory state of ALI rats， and the mechanism may be related to the inhibition of NF-κB inflammatory pathway and the polarization of lung tissue macrophages to anti-inflammatory phenotype.

Application of nanomedicines targeting non-glucose nutrients in tumor starvation therapy / 中国药科大学学报

@#Starvation therapy is an emerging oncological treatment that targets the abnormally elevated nutrient uptake and metabolic pathways to inhibit and kill tumors. In addition to glucose, the targets of starvation therapy also include other nutrients in tumor cells.However, concerns like ineffective targeting and drug tolerance probably have an impact on their clinical translation.Nanomaterial-assisted starvation treatment has been developing quickly in recent years to address these concerns.In this review, several exemplary nanomedicines for starvation therapy and combined starvation therapy with other therapies were offered.They target nutrients other than glucose metabolism, including lactic acid, amino acids, and lipids, using nanomaterials to improve the efficacy of starvation therapy.This review provides reference for further development of nanomedicines with starvation treatment effect.

Determinação do número de mulheres com endometriose em consultórios médicos particulares no município de Cruz Alta-RS / Determination of the number of women with endometriosis in private medical offices in the county of Cruz Alta ­ RS / Determinando el número de mujeres con endometriosis en consultores médicos privados en Cruz Alta-RS

Objetivo: determinar o número de mulheres diagnosticadas com endometriose em consultórios médicos particulares do munícipio de Cruz Alta ­ RS. Método: transversal, prospectivo e descritivo, com cinco médicos ginecologistas que responderam à um questionário sobre as formas de diagnóstico e tratamento da endometriose. Resultados: os resultados demonstraram que a média de mulheres com endometriose foi de quatro pacientes por médico (total de 20 pacientes). A forma de diagnóstico mais utilizada foi a videolaparoscopia, relatada por 80% dos médicos, e as principais formas de tratamento foram por meio dos Análogos do Gonadotrofina (GnRH), como a Gosserrelina e os progestogénos como o Dienogest®. Conclusão: verifica-se que houve um número elevado de mulheres diagnosticadas com endometriose em consultórios particulares no município de Cruz Alta

Objective: to determine the number of patients diagnosed with endometrioses in private medical consultancies in the municipality of Cruz Alta ­ RS. Method: cross-sectional, prospective and descriptive, with five gynecologist doctors who will answer a question about the forms of diagnosis and treatment of endometriose. Results: the results showed that by means of women with endometrium, there were four patients per doctor (total of 20 patients). The most commonly used form of diagnosis was videolaparoscopy, reported by 80% of doctors, and the main forms of treatment were by two Gonadotrophin Analogs (GnRH), such as Gosserrelin and progestogens such as Dienogest®. Conclusion: it was verified that there was a high number of patients diagnosed with endometrioses in private clinics in municipal Cruz Alta

Objetivo: determinar el número de mulheres diagnosticadas con endometriose en consultas médicas particulares del municipio de Cruz Alta ­ RS. Método: transversal, prospectivo y descriptivo, con cinco médicos ginecologistas que responden a un cuestionario sobre formas de diagnóstico y tratamiento de la endometriosis. Resultados: los resultados demostraron que un medio de mulheres com endometriosis de cuarto pacientes por médico (total de 20 pacientes). Una forma de diagnóstico más precisa para una videolaparoscopia, relatada por 80% de dos médicos, y como formas principales de tratamiento de forma por medio de Análogos do Gonadotrofina (GnRH), como Gosserrelina y os progestogénos como o Dienogest®. Conclusión: verifique que tiene un número elevado de multas diagnosticadas con endometrio en consultas particulares no municipales de Cruz Alta

Características y manejo del cáncer de mama precoz en mujeres añosas asistidas en la Unidad Docente Asistencial de Mastología del Hospital de Clínicas en el período 2011-2018 / Characteristics and management of early breast cancer in elderly women assisted in the Mastology Care Teaching Unit of the Hospital de Clínicas in the period 2011-2018 / Características e manejo do câncer de mama precoce em idosas atendidas na Unidade de Ensino de Mastologia do Hospital de Clínicas no período de 2011-2018

Introducción: Existen pocas pautas para el tratamiento del cáncer de mama (CM) en pacientes añosas, lo que puede conducir al sub o sobre tratamiento. Objetivo: Conocer las características, manejo y la evolución del CM precoz en mujeres añosas. Material y métodos: Estudio observacional, descriptivo, transversal. Se recolectaron datos relacionados con las características clínico-patológicas y la evolución de pacientes de 70 años o más tratadas por CM en el período comprendido entre el 1/1/ 2011 y el 31/12/ 2018, asistidas en el Hospital de Clínicas. Se utilizaron herramientas de estadística descriptiva y para calcular la sobrevida global (SVG) se utilizó el método de Kaplan-Meier. Resultados: se incluyeron 31 pacientes; la edad mediana al diagnóstico fue 76,8 años; las características clínico-patológicas fueron: carcinoma ductal: 71%; GH 1-2: 74,2%; estadio I: 54,8 %; sin metástasis axilares: 80,6 %; HER2-RE/RP+ 80,6%; HER2+ 16,7%, y triple negativas 3,2%. El 29% de las pacientes fueron diagnosticadas mediante tamizaje poblacional y el 74,2% recibieron tratamiento según pautas vigentes, mientras que el 38,7% fueron subtratadas y el 16,1% sobretratadas. La mediana de SVG fue de 98,7 meses. Conclusiones: Una minoría de las pacientes fue diagnosticada mediante tamizaje poblacional, el tipo histológico más frecuente fue el ductal y la prevalencia de los tumores HER2-RE/RP+ fue mayor que en las pacientes más jóvenes. La mayoría de las pacientes recibió tratamiento estandar.

Introduction: There are few guidelines for the treatment of breast cancer (BC) in older patients, which can lead to under- or over-treatment. Objective: To understand the characteristics, management and evolution of early BC in older women. Material and methods: Observational, descriptive, cross-sectional study. Data were collected on the clinical-pathological characteristics and evolution of patients aged 70 years or older, treated for BC in the period from 1/1/ 2011 to 31/12/ 2018, at the Hospital de Clínicas. Descriptive statistical tools were used and the Kaplan-Meier method was applied to calculate the overall survival (OS) rate. Results: 31 patients were included; median age at diagnosis was 76.8 years old; the clinical-pathological characteristics were: ductal carcinoma: 71%; HG 1-2: 74.2%; stage I: 54.8%; no axillary metastases: 80.6%; HER2-ER/PR+ 80.6%; HER2+ 16.7%, and triple negative 3.2%. Of all the patients, 29% were diagnosed through screening and 74.2% were treated according to current guidelines, while 38.7% were under-treated and 16.1% over-treated. The median OS was 98.7 months. Conclusions: A minority of patients were diagnosed by screening, the most frequent histological type was ductal and the prevalence of HER2-RE/RP+ tumors was higher than in younger patients. Most patients received standard treatment.

Introdução: Existem poucas diretrizes para o tratamento do câncer de mama (CM) em pacientes idosos, o que pode levar ao sub ou excesso de tratamento. Objetivo: Conhecer as características, manejo e evolução do MC precoce em mulheres idosas. Material e métodos: estudo observacional, descritivo e transversal. Foram coletados dados relacionados às características clínico-patológicas e à evolução dos pacientes com 70 anos ou mais atendidos por CM no período de 01/01/2011 a 31/12/2018, atendidos no Hospital de Clínicas. Ferramentas de estatística descritiva foram usadas e o método de Kaplan-Meier foi usado para calcular a sobrevida global (SVG). Resultados: 31 pacientes foram incluídos; a mediana de idade ao diagnóstico foi de 76,8 anos; as características clínico-patológicas foram: carcinoma ductal: 71%; GH 1-2: 74,2%; estágio I: 54,8%; sem metástases axilares: 80,6%; HER2-RE / RP + 80,6%; HER2 + 16,7% e triplo negativo 3,2%. 29% dos pacientes foram diagnosticados por triagem populacional e 74,2% receberam tratamento de acordo com as diretrizes atuais, enquanto 38,7% foram subtratados e 16,1% supertratados. O SVG médio foi de 98,7 meses. Conclusões: A minoria dos pacientes foi diagnosticada por rastreamento populacional, o tipo histológico mais frequente foi ductal e a prevalência de tumores HER2-RE / RP + foi maior do que em pacientes mais jovens. A maioria dos pacientes recebeu tratamento padrão.

Manejo clínico de la hipertensión arterial pulmonar. Relevancia del ventrículo derecho / Relevance of right ventricle in the clinical management of pulmonary arterial hypertension

Resumen La hipertensión arterial pulmonar (HAP) requiere procesos estructurados de diagnóstico y estratificación de riesgo, siendo la función del ventrículo derecho (VD) un marcador pronóstico central. Los principales objetivos terapéuticos en la HAP son mejorar y/o intentar revertir la disfunción del VD y mantener condición de bajo riesgo. Actualmente existen múltiples fármacos con diferentes mecanismos de acción cuya combinación en doble o triple terapia ha mostrado mejores resultados que la monoterapia. Evidencia actual demuestra la importancia de incorporar tempranamente prostanoides parenterales al esquema, mejorando la funcionalidad del VD y la supervivencia. En esta revisión se refleja el papel de la función del VD en el diagnós tico, pronóstico y seguimiento de la HAP. Se recomienda la evaluación sistemática y estandarizada del VD, así como el inicio temprano de tratamiento combinado en riesgo intermedio-alto para obtener las metas de alcanzar y mantener un riesgo bajo y/o evitar la progresión de la HAP.

Abstract Pulmonary arterial hypertension (PAH) requires structured processes of diagnosis and risk stratifica tion, being the function of the right ventricle (RV) a hallmark prognosis determinant. The main therapeutic goals in PAH are to improve and try to revert RV dysfunction and maintaining a low risk. Currently, there are multiple treatments with different mechanisms of action, the combination of which in double or triple therapy has shown improved results compared to monotherapy. Recent clinical evidence shows the importance of early incorpora tion of parenteral prostanoids to the scheme, improving RV function and survival. In this review, we discuss the role of the RV function in the diagnosis, prognosis, and follow-up of PAH. We recommend the systematic and standardised evaluation of the RV as well as the early initiation of combined treatment in cases of intermediate-high risk to try to reach and keep the patient with PAH at a low risk and / or avoid the progression of PAH.

Mesenchymal stem cells in the treatment of spinal cord injury: Cell therapy and combination of new drugs and biomaterials / 中国组织工程研究

BACKGROUND: The treatment of spinal cord injury is mainly to improve the inflammation microenvironment of the injury site, as well as the regeneration and repair of neural function. Mesenchymal stem cells have the characteristics of easy proliferation in vitro, multi-directional differentiation, and suppression of secondary inflammation and immunomodulation, which makes the transplantation of mesenchymal stem cells for various refractory tissue injury diseases including spinal cord injury become a potential cell therapy. OBJECTIVE: To summarize the preclinical and clinical research of mesenchymal stem cells in the treatment of spinal cord injury in recent years, and put forward the problems and development directions of mesenchymal stem cells in experimental research. METHODS: We searched the articles published in Wanfang databases, CNKI and PubMed databases from 2000 to 2020. The key words were “mesenchymal stem cells, spinal cord injury, cell transplantation, immunomodulation, combination therapy, biomaterials” in Chinese and English, respectively. RESULTS AND CONCLUSION: (1) Mesenchymal stem cells from different sources play the role of anti-inflammatory, inducing axon and neuron regeneration in animal models and clinical experiments, and effectively improve the neural function of the damaged area. (2) The exosomes derived from mesenchymal stem cells show the effects of immunomodulation and angiogenesis in the disease model of spinal cord injury. (3) In order to maximize the potential of mesenchymal stem cells, exploring cell pretreatment, combined with new drugs or biological materials is the research direction of mesenchymal stem cells in the treatment of spinal cord injury.

Meta-analysis of the efficacy of platelet-rich plasma combined with cannulated screw fixation for the treatment of femoral neck fracture / 中国组织工程研究

BACKGROUND: Numerous studies have reported the effectiveness of platelet-rich plasma in promoting and improving bone healing. However, due to the limitations of methods, follow-up and study design, many orthopedicians still doubt the clinical effect of platelet-rich plasma combined with cannulated screw fixation in the treatment of fracture and nonunion. OBJECTIVE: To evaluate the difference in efficacy between platelet-rich plasma combined with cannulated screw fixation and simple cannulated screw fixation in the treatment of femoral neck fracture using meta-analysis system. METHODS: The Cochrane Library, PubMed, Wanfang Medical Network, China National Knowledge Infrastructure, and China Journal Full-text Database were used to search and collect clinical randomized controlled trials of platelet-rich plasma combined with cannulated screw fixation and cannulated screw fixation for the treatment of femoral neck fractures. Two reviewers independently evaluated the quality of the included studies, extracted data and checked each other. Meta-analysis was utilized to analyze the collected data with RevMan 5. 3 software. RESULTS AND CONCLUSION: (1) Seven clinical randomized controlled trials were selected for meta-analysis, totally 760 patients. There were 380 cases undergoing platelet-rich plasma combined with cannulated screw fixation and 380 cases undergoing cannulated screw fixation. (2) The meta-analysis showed that compared with the cannulated screw fixation group, fracture healing time was shorter [MD=-1. 86, 95%CI(-2. 97, -0. 75), P=0. 001]; healing rate was higher [OR=6. 51, 95%CI(3. 36, 12. 62), P < 0. 000 01]; necrosis rate was lower [OR=0. 25, 95%CI(0. 15, 0. 44), P < 0. 000 01]; Harris scores at 1, 3, 6, 9, and 12 months postoperatively were higher [MD=4. 95, 95%CI(4. 12, 5. 77), P < 0. 000 01; MD=19. 78, 95%CI(18. 45, 21. 11), P < 0. 000 01; MD=17. 16, 95%CI(10. 39, 23. 92), P < 0. 000 01; MD=12. 66, 95%CI(10. 60, 14. 71), P < 0. 000 01; MD=10. 17, 95%CI(5. 98, 14. 36), P < 0. 000 01] in the platelet-rich plasma combined with cannulated screw fixation group. (3) Platelet-rich plasma combined with cannulated screw fixation for femoral neck fracture is more effective than that of cannulated screw fixation alone. Combined treatment can accelerate the fracture healing of patients, improve the healing rate, reduce necrosis rate, and promote the recovery of postoperative hip joint function.

The role of tumor-associated macrophages (TAMs) in tumor progression and relevant advance in targeted therapy

Macrophages have a leading position in the tumor microenvironment (TME) which paves the way to carcinogenesis. Initially, monocytes and macrophages are recruited to the sites where the tumor develops. Under the guidance of different microenvironmental signals, macrophages would polarize into two functional phenotypes, named as classically activated macrophages (M1) and alternatively activated macrophages (M2). Contrary to the anti-tumor effect of M1, M2 exerts anti-inflammatory and tumorigenic characters. In progressive tumor, M2 tumor-associated macrophages (TAMs) are in the majority, being vital regulators reacting upon TME. This review elaborates on the role of TAMs in tumor progression. Furthermore, prospective macrophage-focused therapeutic strategies, including drugs not only in clinical trials but also at primary research stages, are summarized followed by a discussion about their clinical application values. Nanoparticulate systems with efficient drug delivery and improved antitumor effect are also summed up in this article.