乳房水肿是乳腺癌保乳术后常见的并发症,是因手术、放疗等治疗因素损伤乳房淋巴管结构所致,目前西医对于乳房水肿尚无特效的治疗方法.中医古籍虽未见有关乳房水肿的描述,但本病的发病特征与水气病相似,病机多与瘀血阻滞、气滞水停、火邪耗气伤络相关.因此,本文将从水气病角度详细探讨本病病因病机,并阐述发汗解表、化瘀通阳、行气健脾等内治法则,及中医外治法对本病治疗的指导作用及临床应用价值,以进一步为乳腺癌保乳术后乳房水肿的中医诊疗拓展思路.

目的 系统评价针刺治疗化疗相关周围神经病变的临床疗效.方法 计算机检索中国知网、万方数据库、维普数据库、PubMed、Cochrane Library中英文数据库,检索时间均从建库至2020年4月20日.由2名独立研究者独立完成文献筛选、资料提取、偏倚风险评价后,采用RevMan5.3和Stata15.0软件进行Meta分析.结果 纳入18项研究,共包括904例患者,其中试验组453例,对照组451例.Meta分析结果显示,针刺能改善患者腓总神经的运动神经传导速度[SMD=0.58,95％CI(0.13,1.03)]及感觉神经传导速度[SMD=0.40,95％CI(0.18,0.61)],并改善癌痛的疼痛数字评分法(NRS)评分[SMD=﹣1.36,95％CI(﹣1.96,﹣0.76)],但两组患者正中神经传导速度的差异无统计学意义(P>0.05).结论 本研究结果表明针刺能有效改善患者腓总神经传导速度,并缓解疼痛症状.但本研究结论仍需更多大样本、高质量的随机对照试验来进一步验证.

目的:通过对乌梅丸进行网络药理学分析和实验验证,探讨该方治疗乳腺癌肺转移的潜在靶点及作用机制.方法:通过TCMSP数据库建立乌梅丸有效成分和靶点数据集,GeneCards数据库及OMIM数据库建立乳腺癌肺转移相关靶点数据集,并将中药靶点和疾病靶点数据相匹配.通过Cytoscape 3.6.0软件进行中药-活性成分-治疗靶点的网络分析,STRING数据库分析关键靶点蛋白间的相互作用关系.利用生物学信息注释数据库进行靶点基因本体(GO)分析以及京都基因与基因组百科全书(KEGG)信号通路富集分析.结果:共发现乌梅丸治疗乳腺癌肺转移有108个可能的重要靶点,包括白细胞介素-6(IL6),半胱氨酸蛋白酶-3(CASP3),血管内皮生长因子A(VEGFA),表皮生长因子受体(EGFR),丝裂原活化蛋白激酶8(MAPK8)等,GO富集分析得到乳腺癌肺转移相关的29个细胞组分(CC),1 218个生物学过程(BP)及125个分子功能(MF),KEGG富集分析得到与乳腺癌肺转移相关的118条通路(P＜0.05),包括MAPK信号通路、细胞凋亡途径等.体外实验表明,乌梅丸的有效成分肉桂醛具有诱导乳腺癌MCF7细胞凋亡、抑制增殖和迁移的作用,一定程度验证了网络药理学的预测结果.结论:乌梅丸对乳腺癌肺转移的治疗作用是多靶点、多途径、多机制的,本研究结果为乌梅丸的临床应用提供了一定证据支持.

在浆细胞性乳腺炎的肿块期或脓肿形成之前,内服中药可促进肿块及脓肿消散,配合中药外敷则相得益彰.若患者失治误治,病情迁延至脓肿期或即将破溃,采用中医清创术配合祛腐药线引流,脓清后垫棉绑缚.中医辨证论治的思路贯穿本病治疗的各个方面,对于皮瓣内卷、肤色瘀黑、水肿增厚、创面苍白的“阴性皮瓣”,则不宜急于收口,治疗应刮除水肿肉芽及坏死皮缘,使其成为创面红活、血色鲜红的“阳性皮瓣”后,方可收口.对于瘘管期患者,虽然中医手术扩创配合术后换药是治疗本病的主要手段,但内服中药可起到良好的辅助作用.对于抵触手术治疗的患者,采用疏肝、健脾、补肾分期辨证配合中药外敷治疗本病,可基本摒弃手术切除的治疗方法.虽然中医治疗浆细胞性乳腺炎具有一定优势,但还需要在以下方面突破:①个体化诊治与规范化诊治相结合,优化外治方法,改进术式,兼顾美容效果;②明确并统一中医外治法的诊疗操作规范;③改进研究方法,例如建立浆细胞性乳腺炎中医诊疗数据库;④拓展研究范围,关注中医疗法对患者生存质量改善作用等.希望随着研究的不断深入,能使中医对浆细胞性乳腺炎的治疗更加系统化和规范化.

Lung cancer has become one of the most threatening malignant tumors in human life.Its morbidity and mortality rank is the first place in malignant tumors,so it is particularly important to screen for lung cancer.With the widespread use of low-dose CT,the detection rate of pulmonary nodules is increasing,and its research is also in-depth.This article described the status of lung cancer screening,factors of benign and malignant pulmonary nodules.It could provide the basis information for prevention and treatment of the lung cancer and pulmonary nodules.

Objective To observe the effect of Shenqi Xiaozhi decoction on lipid metabolism in ICR obese mice.Methods ICR mice overfeeding obesity models established by high fat diet were randomly divided into model group and observation group(n =8).Eight ICR mice fed with normal diet were normal group.The normal group and model group had distilled water garage;the observation group had Shenqi Xiaozhi decoction garage.Twelve weeks after treatment,liver weight,liver index,liver and kidney function indexes[alanine aminotransferase (ALT),aspartate aminotransferase(AST),blood urea nitrogen,serum creatinine],blood lipid indexes[triacylglycerol,total cholesterol,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),free fatty acid(FFA)] and body fat index were analyzed.Results Twelve weeks after treatment,liver weight,ALT,AST,blood urea nitrogen,serum creatinine levels in observation group were significantly lower than those in model group(P ＜ 0.01 or P ＜ 0.05);total cholesterol,triacylglycerol,LDL-C and FFA levels in observation group were significantly lower and HDL-C was significantly higher than those in model group [(6.8 ± 1.1) mmol/L vs (10.2 ± 1.3) mmol/L,(1.48 ± 0.22) mmol/L vs (2.05 ± 0.24) mmol/L,(1.32 ± 0.44) mmol/L vs (2.06 ±0.59)mmol/L,(0.73 ±0.14)mmol/L vs (1.00 ±0.17) mmol/L,(7.9 ± 1.1) mmol/L vs (5.6 ± 1.2) mmol/L](P ＜0.01 or P ＜0.05).Body fat contents of mice 6,12 weeks after treatment in model group were significantly higher than those in normal group;body fat contents of mice 6,12 weeks after treatment in observation group were significantly lower than those in model group[(10.3 ± 1.8) ％ vs (13.3 ± 3.5) ％,(11.7 ± 2.8) ％ vs (18.3 ±4.6) ％] (P ＜ 0.01 or P ＜ 0.05).Conclusion Shenqi Xiaozhi decoction treating ICR obese mice can restore liver and kidney function,reduce liver weight and body fat,and effectively regulate blood lipid.

阳和汤出自《外科证治全生集》,是治疗阴疽的代表方剂.现代医家根据其“化阴布阳”的治疗特点,广泛应用于治疗肿瘤、呼吸、消化、内分泌、神经、风湿免疫、乳腺、周围血管、骨科、皮肤、妇科、儿科等各类疾病,效如桴鼓.文章通过回顾近几年相关文献,对阳和汤治疗各种疾病的临床研究进行总结,为现代医家应用阳和汤提供广阔思路.

Objective To study the effect of punicalagin on lipid metabolism and oxidative stressin experimental diabetic mice. Methods The diabetic mice model was induced by injection intraperitonallyof streptozotocin. They were divided into the model, highest and lowest punicalagin groups, compared witha control normal group. Fasting blood glucose and body weight in all mice were performed at 5 weeks andbefore dosing. After 5 weeks treatment, all mice were executed and serum lipid, malondialdehyde, superoxidedismutase, glutataione, nitric oxide as well as cata-lase in serum were detected. Results Comparedwith model group, body weight and FBG were reduced with the treatment of punicalagin. MDA, NO, TC,TG , FFA and LDL-C were declined (P< 0.01), as well as HDL-C was increased significantly(P< 0.01).At the same time, SOD and GSH were increased significantly(P<0.01) , as well as CAT was unchanged inthe punicalagin group. Conclusion Body weight and FBG in diabetic mice can be reduced with treatingpunicalagin, and dysregulation of lipid metabolism and oxidative stress were improved obviously.