BACKGROUND:In recent years, malignant tumors have gradually become one of the main causes of death for Chinese residents, of which lung cancer ranks first in both the incidence and mortality in China.OBJECTIVE:To mine the text of traditional Chinese medicine (TCM) clinical medical cases after data cleaning, analyze it, and study the experience of TCM doctors in treating non-small cell lung cancer (NSCLC).METHODS:The applied approach was based on the data mining methods of decentralized and hierarchical system clustering of data from a drug and prescription database. This study involved 215 patients, 287 cases, and 147 types of clinical drugs.RESULTS:The data analysis of the clinical treatment of NSCLC in TCM showed that Erchen Decoction was the main method for the treatment of non-small cell lung cancer in clinical treatment of non-small cell lung cancer. Junjian recipes were close to each other, with Banzhilian, Lobelia, Shanci Mushroom, Hedyotis diffusa to anticancer and detoxify.CONCLUSION:This study analyzed the core TCM prescription for NSCLC by collecting the empirical essence and characteristics of specific medications. It has some guiding scientific significance for the clinical treatment of lung cancer.

心系主要包括心及与之相关联的血脉、面、舌、脑络、小肠等.通过收集心系临床病案,在参考中医古籍及专家意见的基础上,系统归纳并规范了心系的病位、病性特征症,总结了临床上常见的心系基础证与复合证,为心系病证的诊断提供参考.

The purpose of this study was to investigate the value of cryptococcal capsular polysaccharide antigen detection in diagnosing pulmonary cryptococcosis in immunocompetent and immunocompromised patients. The clinical data of 51 patients with pulmonary cryptococcosis were collected. The diagnostic sensitivity and specificity of cryptococcal capsular polysaccharide antigen detection were analyzed. The difference in diagnostic sensitivity of was compared between immunocompetent and immunocompromised patients. Among the 51 pulmonary cryptococcosis patients, 42 tested positive and 9 tested negative. The sensitivity was 82.4% and the specificity was 100.0%. The diagnostic sensitivity is not related to the gender and age, but shows certain association with immunocompetence in the patients.

Background Developing liquid biopsy technology with higher sensitivity and specificity especially for low-frequency mutations remains crucial. This study demonstrated superior performance of the newly developed digital PCR (dPCR) kit for ctDNA-based EGFR p.T790M detection in metastatic non-small-cell lung cancer (NSCLC) against ARMS-PCR. Methods This large-scale, multi-centered diagnostic study recruited 1,045 patients including 1,029 patients diagnosed with advanced NSCLC and 16 patients with specific samples between April 1st 2018 and November 30th 2019. EGFR p.T790M in plasma samples from mNSCLC patients were tested using dPCR with ADx-ARMS PCR and Cobas® EGFR Mutation Test V2 as comparator assays to confirm cut-off value for dPCR and evaluate its performance against ARMS-PCR-based assays. Efficacy was evaluated for patients with EGFR p.T790M detected by dPCR or ARMS-PCR, who underwent Osimertinib treatment. Results The sensitivity, specificity, and concordance of dPCR against ADx-ARMS PCR was 98.15%, 88.66% and 90.16%, respectively for 1,026 plasma samples. Additional 9.26% patients were detected positive by dPCR. The majority of those samples had a mutation allele frequency between 0.1% and 1%. In 45 paired tissue and plasma samples, the sensitivity improved from 30.77% to 53.85% by dPCR with the specificity over 90%. The response of Osimertinib in 74 EGFR p.T790M-positive patients detected by dPCR, including 26 determined as negative by ARMS-PCR, were evaluated to have an ORR of 44.59% and a DCR of 90.54%. Conclusions dPCR is a sensitive and accurate tool for ctDNA-based EGFR p.T790M detection due to its significantly improved sensitivity without compromising specificity, and dPCR is equivalent to ARMS-PCR as a companion diagnostic tool while benefiting more patients under Osimertinib treatment. Trial Registration Chinese Clinical Trial Registry identifier: ChiCTR2100043147.

Background Lung cancer is one of the most common cancer worldwide, invasion and metastasis are still the bottleneck in the clinical setting. More diagnostic markers and drug targets need to be clarified. Therefore, we screened abnormal spindle-like microcephaly-associated protein (ASPM) as our candidate gene, which is associated with the poor prognosis. The aim of the present study was to understand the roles of ASPM in cell invasion in non-small cell lung cancer (NSCLC). Methods Gene Expression Omnibus (GEO) datamining was used to identify ASPM. Transwell invasion assay, quantitative reverse transcription polymerase chain reaction (qRT-PCR), and Western blot analysis were performed to discover the molecular functions of ASPM. Overexpression and small interfering mediated knockdown techniques have been used to study the cell invasion hallmarks of cancer. Results ASPM stood out among all the candidate genes from GEO datamining. ASPM in lung cancer tissues has been associated with poor overall survival rate. The protein levels of ASPM has been validated using lung cancer patients’ tissues, which upregulation of ASPM expression has been found in lung cancer patients. Silencing of ASPM decreased the cell invasion reflected by epithelial-mesenchymal transition (EMT) biomarkers: downregulation of vimentin and upregulation of E-cadherin. Matrix metalloproteinase (MMP) 2/9 protein levels were also affected upon transient knockdown of ASPM. Furthermore, the suppression of ASPM markedly inhibited the Wnt/β-catenin signaling pathway in vitro. The ectopic expression of ASPM had the opposite effect. The inhibition of β-catenin in ASPM-overexpressing lung cancer cells reduced the expression of EMT markers. The inhibitory effects on the Wnt/β-catenin signaling pathway were attenuated in cancer cells when ASPM was silenced. These findings demonstrated that the silencing of ASPM strongly reduced cell invasion in lung cancer. Conclusions ASPM promoted NSCLC invasion through EMT and by affecting the MMP family of proteins. The Wnt/β-catenin signaling pathway played an indispensable role in the ASPM-mediated NSCLC EMT-invasion cascade.

目的:探究穴位贴敷联合常规西药治疗慢性阻塞性肺疾病(COPD)稳定期患者的疗效及对肺功能、生命质量、细胞因子的影响.方法:选取2016年12月至2018年8月南京脑科医院收治的COPD稳定期患者65例作为研究对象,按照就诊顺序编号随机分为对照组(n=32)和观察组(n=33).对照组常规西药治疗,观察组在对照组基础上加用穴位贴敷,2组均同时治疗8周.观察2组治疗前、治疗后肺功能、生命质量、炎性反应递质、免疫功能变化并比较;治疗后进行疗效比较.结果:治疗后2组用力肺活量(FVC)、第一秒钟用力呼气容积(FEV1)、FEV1/FVCF较治疗前均显著升高,差异有统计学意义(P＜0, 05);观察组以上指标均显著高于对照组,差异有统计学意义(P＜0.05).治疗后2组肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)、辅助性T细胞17(Th17)较治疗前显著下降,调节性T细胞(Treg)、白细胞介素4(IL-4)、IL-10较治疗前均显著升高,差异有统计学意义(P＜0.05),治疗后观察组Treg、IL-4、IL-10显著高于对照组,余显著低于对照组,差异有统计学意义(P＜0.05).治疗后2组呼吸症状、活动受限、疾病影响较治疗前显著下降,差异有统计学意义(P＜0.05),治疗后观察组以上指标显著低于对照组,差异有统计学意义(P＜0.05).治疗后观察组临床控制率、治疗有效率显著高于对照组,差异有统计学意义(P＜0.05).5)治疗后2组IgE、CD4+、CD8+、CD4+/CD8+较治疗前均显著下降,差异有统计学意义(P＜0.05),而IgA、IgM比较,差异无统计学意义(P＞0.05),治疗后观察组IgE、CD4+、CD8+、CD4+/CD8+显著低于对照组,差异有统计学意义(P＜0.05).结论:穴位贴敷联合常规西药能改善COPD稳定期肺功能,抑制炎性反应,改善气道高反应性,从而提高疗效和生命质量.

目的 通过磁共振扩散加权成像(DWI)、T2WI、T1 WI各序列和增强CT的比较,探讨DWI对于区分中央型肺癌与阻塞性肺不张的价值.方法 对2015年3月至2017年12月收治的48例中央型肺癌合并阻塞性肺不张的患者行胸部MRI及增强CT扫描,MRI扫描序列包括:T1 WI-Vibe、T2WI-HASTE、DWI(b=50,800 s/mm2).分析中央型肺癌合并肺不张的MRI各序列信号特点和增强CT表现,测量DWI和T2WI的信号强度、计算图像的对比噪声比,并测量肿瘤与肺不张的ADC值.结果 48例图像均能满足诊断需要.DWI对肿瘤与肺不张的区分能力明显高于T1 WI及CT增强(P＜0.01).DWI与T2WI序列的区分能力无统计学差异(P＞0.05).DWI联合T2WI能对43例肿瘤与肺不张进行区分,区分能力高于T2WI(P ＜0.01),亦高于DWI单独使用,但差异无统计学意义(P＞0.05);DWI图像的对比噪声比高于T2WI,瘤体的DWI信号强度高于肺不张,瘤体的ADC值低于肺不张(P＜0.01).结论 通过评价DWI信号特点和ADC值的测量,DWI联合T2WI序列有助于中央型肺癌肿瘤与阻塞性肺不张的区分.

目的 利用生物信息学方法分析非小细胞肺癌(NSCLC)基因表达谱芯片,筛选差异基因,分析其与预后的关系.方法 从GEO数据库下载芯片数据(GSE19804、GSE27262、GSE18842),利用GEO2R软件筛选差异基因,通过基因本体(GO)和京都基因与基因组百科全书(KEGG)进行差异基因的功能及通路富集分析,用STRING数据库构建蛋白-蛋白相互作用网络,Cytoscape筛选出核心基因.Kaplan-Meier plotter数据库进行预后分析,采用实时荧光定量PCR(QPCR)检测目的基因在NSCLC组织中的表达.结果 共筛选出401个差异表达基因,GO分析结果表明差异基因主要参与血管生成、细胞粘附、调节细胞增殖等生物学过程.通过Cytoscape软件筛选出29个核心基因.预后分析显示ASPM低表达患者的总生存期较高表达患者明显延长.QPCR显示ASPM在NSCLC组织中高表达,差异有统计学意义.结论 ASPM在NSCLC组织中高表达,与患者的预后相关,可能是NSCLC潜在的治疗靶点.

Objective To investigate the clinical efficacy and adverse reactions of bronchial artery embolization in the treatment of hemoptysis.Methods The clinical data of 145 patients with hemoptysis were retrospectively analyzed,including 84 with bronchiectasis,35 with pulmonary tuberculosis,12 with lung cancer,9 with pulmonary infection,and 5 with unexplained hemoptysis.Bronchial artery embolization was performed with different embolization agents.The therapeutic efficacy of embolization was evaluated.Results The total effective rate in the 145 patients with hemoptysis was 93.1％ (135/145),and the recurrence rate was 6.9％ (10/145).There were 15 cases of fever and 10 of chest pain after the operation,and the patients were recovered in 2-3 d after symptomatic treatment.Conclusion Bronchial artery embolization is effective in the treatment of massive or recurrent hemoptysis.According to the etiology and vascular condition,individualized selection of embolization agents may improve the success rate of embolization and reduce complications.

目的探明心气虚证的主症、次症和舌脉表现,客观揭示心气虚证的本质,以指导临床辨证,并为病证的规范化及客观化服务。方法搜集古今文献及临床病案资料621例心气虚证患者,建立数据库,利用因子分析的方法对资料进行分析。结果心气虚证是以神疲乏力、胸闷、心悸为主症,以头晕、目眩、自汗、失眠等为次证、舌脉表现多见舌淡白、苔薄白、脉细弱等,心气虚可以进一步发展为心阳虚,也可波及肺、肾等其他脏腑,从而出现病位相兼与病性相兼。结论因子分析法可以应用于五脏系统病证规范研究,可以为病证规范化提供方法学研究平台。

Objective: To establish a syndrome differentiation model and program of Traditional Chinese Medicine (TCM) based on fuzzy recognition. Method: According to the syndrome differentiation system of five zang-organs, combined with approaching principle in the fuzzy mathematics, the fuzzy recognition model of heart system basic syndrome was established first, and then the program was designed based on this model. 200 medical records of heart system were tested retrospectively with the program. Result: The accurate rate of syndrome differentiation program was 84.5% Conclusion: The nonlinear mapping between heart basic syndromes and symptoms could be simulated by using fuzzy recognition. The thought of this paper could be applied to syndrome differentiation system of five zang-organs, which would provide methodology for syndrome standardization.

Objective To observe the efficacy and adverse effect of pemetrexed single or plus carboplatin as second-line therapy in the treatment of elderly patients with advanced lung adenocarcinoma.Methods The clinical data of 56 patients with advanced lung adenocarcinoma were analyzed,27 patients recived the pemetrexed monotherapy,29 patients recived the pemetrexed plus carboplatin,and the efficacy and adverse effects were assessed.Results There were no case with CR in 56 patients.In pemetrexed monotherapy,there was 2 cases of PR,14 cases of SD,11 cases of PD,the DCR was 59.3%,median PFS was 3.5 months,and median OS was 9.1 months.;in combination group,there was 3 case of PR,16 case of SD,10 case of PD,the DCR was 65.5%,median PFS was 3.9 months,and median OS was 9.8 months.There were no significant differences in DCR,median PFS and median OS between two groups(P0.05).The common adverse effects were myelosuppression,gastrointestinal reactions and rashes.Conclusion Pemetrexed is efficacious and tolerable as a second-line therapy for elderly patients with advanced lung adenocarcinoma.

The heart system mainly contains the heart,vessels,face,tongue,brain meridians,and small intestine.The paper established the disease location characters,concept and manifestation of basic syndromes(including location and nature characters of diseases) via specifying common symptoms,clinical epidemiological survey,and suggestions from experts,which made a conclusion of commonly-seen disease location with the accompanied symptoms and disease nature with the accompanied symptoms.

Purpose To investigate the effect and mechanism of norcantharidin(NCTD) on invasion of human breast cancer cell line MCF-7 in vitro.Methods MTT assay was used to determine MCF-7 cell proliferation,Transwell kit was used to determine cell migration,treated with NCTD on 200,400,600 μmol/L,to detect the expression of CXCR4 and CXCL12 in the control and treatment groups by real time PCR and Western blot.Results NCTD had inhibitive effects on proliferation and invasion of human breast cancer cell line MCF-7 in a dose-dependent manner,with the IC50 value of 582 μmol/L at 24 h,and the expression of CXCR4 was decreased in NCTD groups in vitro.Conclusion NCTD in vitro inhibits invasion and metastasis of human beast cancer cell line MCF-7 through the down regulation to the expression of CXCR4.

中医药现代化的根本标志不是与现代科学的融合程度,而是满足社会需求的程度.中医药现代化经历了中西医结合论、科学论、重构论、主体论四个进程.现阶段实现中医药现代化的发展思路是:逐步完善自身理论,在"证素辨证"上结合脏腑辨证,建立符合中医临床诊疗思维统一的辨证体系;最大程度发挥自身价值,寻找自身的优势病种,总结中医药辨证和用药规律;运用循证医学研究方法,建立适合中医自身特点的疗效评价体系;消除中西医之间的壁垒,建立双重诊断,选择最优化治疗.

The checkup of the type of tongue coatings is an important part of traditional Chinese medicine(TCM) diagnosis and the microorganisms take a significant role in the formation of tongue coatings.In the present study some different tongue coatings samples of lung cancer patients were collected for molecular analysis through PCR-based DGGE.The result of DGGE showed that different samples of the same type of tongue coating exhibited a high degree of similarity,which indicated that tongue coating type was related with the microorganisms.Analysis and identification of the component of microorganisms can promote the standardization of TCM diagnosis.

Objective To observe the toxic reaction of gefitinib to advanced non-small cell lung cancer after failed chemotherapy.Methods 41 cases with non-small cell lung cancer having experienced failure of chemotherapy orally took gefitinib 250 mg once per day until disease gets serious or they had intolerable adverse reaction,meanwhile efficacy and adverse drug reactions were evaluated.Results Of the 41 patients,the occurrence rate of skin rash was 60.98%,diarrhea was 26.83%,and one case caught serious interstitial lung disease.Conclusion The efficacy of gefitinib is very good in treating advanced non-small cell lung cancer,but there are such side effects as skin rash,diarrhea,liver and kidney impairment,pulmonary interstitial fibrosis and so on.

Objective: To understand the tongue coating microbial diversities of different TCM tongue coating types. Materials and methods: We extracted the total microbial genome DNA of each tongue coating sample from two group subjects: the thin-white tongue coating type group and the yellow and greasy fur tongue coating type group. The tongue coating microbial diversities of two groups were detected by PCR-based DGGE. Results: the tongue coating microbial diversities had relative high intragroup similarity between subjects with the same TCM tongue coating type and had intergroup difference between two TCM tongue coating types. Conclusions: PCR-based DGGE can be used to detect the tongue coating microbial diversities of different TCM tongue coating types as an effective tool, and the tongue coating microbial diversities may take a significant role in the formation of different TCM tongue coating types.

<正>吴承玉教授从医30余载,在诊治肿瘤方面积累了丰富的经验,在稳定病灶、预防复发和转移、减少患者痛苦、改善生活质量、延长生存时间等方面疗效显著。笔者有幸侍诊吴师左右,现将吴师诊治肿瘤的经验与思路介绍如下: