Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review.

OBJECTIVE: To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential. METHODS: We performed a sensitive search strategy and searched systematically the Medline, Embase, Web of Science and Cochrane Library databases from inception to 2 June 2016. Abstracts from major rheumatology meetings and major trial registers were also searched to retrieve all randomized controlled trials that interested us. RESULTS: Seven studies with 709 patients were included. No significant heterogeneity was found between these trials. For RA patients treated with MTX, those supplied with folate were less likely to have elevated transaminase (odds ratio [OR] 0.15; 95% confidence interval [95% CI] 0.10, 0.23 [p < 0.00001]) and gastrointestinal side-effects such as nausea and vomiting (OR 0.71; 95% CI 0.51, 0.99 [p = 0.04]). Folate appeared to promote compliance to MTX as it reduced patient withdrawal compared to placebo (OR 0.29; 95% CI 0.21, 0.42 [p < 0.00001]). There was no statistical difference for mouth sores between folate and placebo (OR 0.83; 95% CI 0.57, 1.22 [p = 0.35]). As the markers of disease activity in those trials were not consistent, it was impossible to decide whether folate supplementation reduced MTX efficacy. Besides, we compared high-dose folate (≥25 mg per week) and low-dose folate (≤10 mg per week) on MTX efficacy, finding no statistical difference (OR 2.07; 95% CI 0.81, 5.30 [p = 0.13]), nor on MTX toxicity (OR 1.56; 95% CI 0.80,3.04 [p = 0.19]). CONCLUSION: Folate supplementation can reduce the incidence of hepatotoxicity and gastrointestinal side-effects of MTX in patients with RA. It can also reduce patient withdrawal from MTX treatment. Although it tended to reduce mouth sores, it had no statistical significance. No significant difference was found between high-dose folate and low-dose folate on MTX efficacy or toxicity.

Nanoparticles based on glycyrrhetinic acid modified porphyrin for photodynamic therapy of cancer.

Self-assembled small molecules, as a novel form of drug presentation, have splendid capabilities for water stability and cell endocytosis. Photodynamic therapy (PDT) is regarded as a promising cancer treatment because it is less invasive and has fewer side effects. In this work, an amphiphilic glycyrrhetinic acid-porphyrin conjugate (TPP-GA) was designed and synthesized, and this could self-assemble into nanoparticles (TPP-GA NPs) in water. The morphology of the TPP-GA NPs was observed using transmission electron microscopy (TEM) and their stability in water was revealed by dynamic light scattering (DLS). The PDT effect of the TPP-GA NPs was confirmed by means of in vitro experiment, after photostability verification. It could be conceived that the application of TPP-GA NPs for PDT is a feasible choice and this work shows progress in the self-assembly of amphiphilic small organic molecules.

[The effect of hyperbaric oxygen therapy on treatment of late healed wounds after pharyngeal and laryngeal surgery].

OBJECTIVE: To investigate effect of hyperbaric oxygen (HBO) therapy on treatment of late healed wounds after pharyngeal and laryngeal carcinomas surgery. METHOD: Eighty-three patients with late healed wounds after pharyngolaryngectomy were divided into two groups, which were HBO treatment group (n = 48) and control group (n = 35) by random. 48 cases were treated with the general therapeutic measure along with HBO (the pressure is 2 x 10(5) Pa, 110 minutes per day for 5 to 10 days). The other 35 cases were treated with the general therapy without HBO as control. RESULT: There were fresh granulation erupted from the wound of entry after 3 or 4 days of HBO) treatment, then the granulation and the new blood capillary erupted continually to fill the wound surface, and the wound of entry was healed over finally. In the HBO and the control groups, the average healing time was 27.50 and 45.00 days (P < 0.01) in the wound by necrosectomy of the myocutaneous flap or forearm flap, 8. 50 and 14.09 days (P < 0.01) in the pharyngeal fistula, 5.93 and 8.62 days (P < 0.01) in the infected or fluid-filled wound. CONCLUSION: HBO therapy is an effective and powerful treatment for late healed postoperative wounds in pharyngeal and laryngeal carcinomas surgery.