BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide, with the fourth highest mortality among all cancers. Reportedly, in addition to adenomas, serrated polyps, which account for 15%-30% of CRCs, can also develop into CRCs through the serrated pathway. Sessile serrated adenomas/polyps (SSAs/Ps), a type of serrated polyps, are easily misdiagnosed during endoscopy. AIM To observe the difference in the Wnt signaling pathway expression in SSAs/Ps patients with different syndrome types. METHODS From January 2021 to December 2021, patients with SSAs/Ps were recruited from the Endoscopy Room of Shanghai Traditional Chinese Medicine-Integrated Hospital, affiliated with Shanghai University of Traditional Chinese Medicine. Thirty cases each of large intestine damp-heat (Da-Chang-Shi-Re, DCSR) syndrome and spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome were reported. Baseline comparison of the general data, typical tongue coating, colonoscopy findings, and hematoxylin and eosin findings was performed in each group. The expression of the Wnt pathway-related proteins, namely β-catenin, adenomatous polyposis coli, and mutated in colorectal cancer, were analyzed using immunohistochemistry. RESULTS Significant differences were observed with respect to the SSAs/Ps size between the two groups of patients with different syndrome types (P = 0.001). The other aspects did not differ between the two groups. The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups, which was manifested as β-catenin protein translocation into the nucleus. However, SSAs/Ps patients with DCSR syndrome had more nucleation, higher β-catenin expression, and negative regulatory factor (adenomatous polyposis coli and mutated in colorectal cancer) expression (P < 0.0001) than SSA/P patients with Pi-Wei-Xu-Ruo syndrome. In addition, the SSA/P size was linearly correlated with the related protein expression. CONCLUSION Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis. A high-quality colonoscopic diagnosis was essential. The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.

OBJECTIVE:To explore the therapeutic effect and mechanism of Dachengqi decoction on patients with mild acute pancreatitis (MAP).METHODS:A parallel randomized controlled trial was conducted. Sixty-eight patients with acute pancreatitis (AP) admitted to Shanghai Traditional Chinese Medicine (TCM)-Integrated Hospital from March 2018 to February 2021 were enrolled. Referring to the condition on admission of the patients and whether they agreed to receive the Dachengqi decoction or not, they were divided into conventional treatment group and Dachengqi decoction group according to the principle of 1:1 equal randomness. Meanwhile, 20 healthy volunteers were recruited as controls. Both groups of patients were treated with octreotide, fasting, gastrointestinal decompression, antipyretic and analgesic, anti-inflammatory, inhibition of gastric acid and pancreatic juice secretion, maintenance of electrolyte balance and other western conventional medicine. The patients in the Dachengqi decoction group received Dachengqi decoction orally on the basis of routine treatment, 100 mL each time, twice a day, for seven consecutive days. The inflammation parameters [white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6)] before and after treatment and the recovery time of gastrointestinal function (first exhaust time, time to recover bowel sounds, first defecation time) of patients were recorded. 16S rRNA gene sequencing of stool samples was recorded, and normalized data were obtained after quality control and other related processing. The data were subjected to diversity analysis (Alpha diversity and Beta diversity) and linear discriminant analysis effect size analysis (LEfSe analysis) to observe changes in the gut microbiota of MAP patients. Spearman rank correlation coefficient was used to analyze the correlation between inflammatory indexes and microorganisms at the intestinal genus level. Blood, urine, stool samples, renal function, and electrocardiogram (ECG) during treatment of MAP patients were detected to assess the safety of the treatment.RESULTS:Of the 68 patients with AP, 16 were excluded from moderate-severe AP, 4 were not collected or voluntarily abandoned treatment. Finally, 48 patients with MAP were enrolled, 24 in the conventional treatment group and 24 in the Dachengqi decoction group. The inflammation parameters levels at 7 days of treatment in both groups were significantly lower than those before treatment. CRP, PCT and IL-6 levels in the Dachengqi decoction group were significantly lower than those in the conventional treatment group [CRP (mg/L): 8.50 (3.50, 13.00) vs. 16.00 (9.25, 29.75), PCT (μg/L): 0.06 (0.03, 0.08) vs. 0.09 (0.05, 0.11), IL-6 (ng/L): 6.36 (3.96, 10.79) vs. 13.24 (6.69, 18.87), all P < 0.05]. The first exhaust time, time to recover bowel sounds and first defecation time in the Dachengqi decoction group were significantly shorter than those in the conventional treatment group [first exhaust time (days): 1.62±0.65 vs. 2.80±0.65, time to recover bowel sounds (days): 1.13±0.58 vs. 2.31±0.76, first defecation time (days): 3.12±0.75 vs. 4.39±0.76, all P < 0.05]. The analysis of intestinal microflora diversity showed that both the diversity and abundance of microbial communities were the highest in the healthy control group and the lowest in the conventional treatment group. In addition, the coincidence degree of microbial communities in healthy controls and MAP patients was small, while the coincidence degree of MAP patients among different treatment methods was relatively large. LEfSe analysis showed that Dachengqi decoction reduced the relative abundance of Escherichia coli-Shigella and Clostridium erysipelae, and increased the relative abundance of three beneficial bacteria, namely Lactobacillus, Rombutzia and Brutella. In the intestines of MAP patients, Lactobacillus mucilaginus and Lactobacillus conjunctus were significantly enriched. Correlation analysis showed that positive correlations between Escherichia coli-Shigella and the four inflammatory indicators including WBC, CRP, PCT, IL-6 were statistically significant (r value was 0.31, 0.41, 0.57, 0.43, respectively, all P < 0.05). There was no significant correlation between other bacteria and inflammatory indicators. During the treatment, there was no obvious abnormality in blood, urine and feces, renal function and ECG of MAP patients.CONCLUSIONS:Dachengqi decoction could reduce inflammatory responses and promote recovery of intestinal microecological balance and gastrointestinal function in patients with MAP by regulating the composition of intestinal flora. No significant adverse effects were observed during the treatment period.

目的 探讨逍遥散对四氯化碳诱导的急性肝损伤小鼠的保护作用及其机制.方法 将48只雄性ICR小鼠按体重随机分成正常组、模型组、逍遥散低剂量组、逍遥散中剂量组、逍遥散高剂量组、双环醇组,每组8只.逍遥散低、中、高剂量组分别给予1 g/mL、2 g/mL、3 g/mL(按生药量计算)逍遥散灌胃,双环醇组给予110 mg/kg双环醇片悬液灌胃,每日1次,连续1周.随后除正常组外,其余组采用四氯化碳腹腔注射制作急性肝损伤模型,24 h后处死各组小鼠并收集血清及肝组织样本.采用全自动生化分析仪测定小鼠血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)水平,病理组织切片HE染色观察肝脏损伤情况并半定量评估其程度,比色法检测肝组织中丙二醛(MDA)、超氧化物歧化酶(SOD)含量,ELISA法检测肝组织中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量,蛋白质印迹法(Western blot)测定肝组织中Janus激酶2(JAK2)、信号传导与转录激活因子3(STAT3)、B淋巴细胞瘤-2(Bcl-2)、半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)蛋白表达情况.结果 与正常组比较,模型组小鼠血清ALT、AST、LDH水平均显著升高(P均<0.05);HE染色显示小叶中央静脉周围肝细胞损伤严重,伴有中性粒细胞浸润;肝组织中MDA、IL-6、TNF-α含量及p-JAK2、p-STAT3、cleaved-Caspase3蛋白表达量均显著升高(P均<0.05),肝组织中SOD含量及p-Bcl-2蛋白表达量均显著下降(P均<0.05).与模型组比较,逍遥散各剂量组和双环醇组小鼠血清ALT、AST、LDH水平均显著降低(P均<0.05);HE染色显示炎症程度及肝细胞受损轻;肝组织中MDA、IL-6、TNF-α 含量及p-JAK2、p-STAT3、cleaved-Caspase3蛋白表达量均显著降低(P均<0.05),肝组织中SOD含量及p-Bcl-2蛋白表达量均显著升高(P均<0.05),且逍遥散各剂量组上述指标均呈剂量依赖性改善(P均<0.05).结论 逍遥散可以显著减轻四氯化碳诱导的急性肝损伤,其机制可能与抑制JAK2-STAT3信号通路及其下游炎症级联和凋亡信号有关.

目的 观察逍遥散联合恩替卡韦对肝郁脾虚型乙型肝炎肝硬化代偿期患者的肝纤维化指标、门静脉压力的影响,比较正常人及肝郁脾虚型乙型肝炎肝硬化代偿期患者治疗前后血清中铁代谢相关指标,并初步探讨联合用药的作用机制.方法 采用随机数字表法将72例患者分为两组,各36例,治疗组予逍遥散联合恩替卡韦治疗,对照组仅予恩替卡韦治疗,两组疗程均为6个月;观察患者治疗前后总体疗效、肝纤维化指标、肝纤维化评分、腹部彩超参数(包括门静脉内径、脾厚度、脾长度)以及血清铁、铁蛋白、总铁结合力、铁调素(hepcidin)等指标变化.结果 治疗组总有效率为90.00％,对照组总有效率为66.67％,治疗组总体疗效优于对照组(P<0.05).治疗后两组纤维化指标HA、LN、IV-COL、PIIINP各项均较治疗前明显下降,且两组间比较,差异均有统计学差异(P<0.05);治疗组患者治疗后APRI、GPR指数均较前明显下降(P<0.05).两组治疗后APRI、FIB-4、GPR各项指数改善治疗组疗效均优于对照组(P<0.05).与健康人比较,肝郁脾虚型乙肝肝硬化代偿期患者血清中铁、铁蛋白、hepcidin显著升高,总铁结合力显著下降(P<0.05).治疗后治疗组血清中铁、铁蛋白、hepcidin明显下降,总铁结合力明显升高(P<0.05);对照组血清中铁、铁蛋白、明显下降(P<0.05);治疗组改善血清铁、总铁结合力、hepcidin的疗效优于对照组(P<0.05).结论 逍遥散联合恩替卡韦在改善肝纤维化方面疗效优于单用恩替卡韦.联合用药能够在一定程度上改善患者铁过载水平,其作用机制可能与调节机体铁代谢平衡有关.

目的:观察十宝润肠方治疗泻药依赖性便秘患者的临床疗效及作用机制.方法:选择泻药依赖性便秘患者60例,采用随机数字表法分为观察组和对照组,每组30例.观察组予十宝润肠方治疗,对照组予杜密克治疗,两组疗程均为4周.观察两组PAC-SYM便秘自评量表评分、PAC-QOL便秘生活量表评分及血清5-羟色胺(5-hydroxytryptamine,5-HT)水平.结果:对照组治疗后PAC-SYM量表评分中粪便性状及直肠症状有显著改善(P<0.05),但腹部症状无明显改善(P>0.05);观察组各维度评分均较治疗前改善(P<0.05),且在改善直肠症状及腹部症状方面疗效优于对照组(P<0.05).两组PAC-QOL量表各维度评分均较治疗前降低(P<0.05),观察组生理状态及满意度评分均较对照组改善显著(P<0.05);两组心理状态及担忧度评分比较,差异无统计学意义(P>0.05).观察组治疗后血清5-HT水平显著升高(P<0.05),对照组治疗后血清5-HT水平无明显变化(P>0.05),且观察组5-HT水平改善优于对照组(P<0.05).结论:十宝润肠方治疗泻药依赖性便秘可明显改善患者临床症状,其作用可能与调节血清5-HT含量有关.

目的 通过制作慢性铁过载诱导的大鼠肝纤维化模型,观察逍遥散对肝纤维化的改善作用及对体内铁代谢过程的影响,并通过功效拆方研究,探索逍遥散中疏肝药、健脾药、养血药在整方疗效中的作用及地位.方法 通过腹腔注射右旋糖酐铁50 mg/kg/d,连续7周制作慢性铁过载诱导的大鼠肝纤维化模型,药物干预在造模同时每日通过灌胃的方式给予逍遥散全方、逍遥散去疏肝药、逍遥散去健脾药、逍遥散去养血药、去铁胺(DFO).使用全自动生化分析仪检测血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清铁(SI)、铁蛋白(SF)水平;肝组织进行病理组织学检测,包括HE染色、Masson染色、苦味酸-天狼星红染色等;免疫组化检测肝组织α-平滑肌肌动蛋白(α-SMA)、I型胶原蛋白(COL-1)的表达水平;采用火焰原子吸收光谱法检测大鼠肝组织铁含量.结果 与对照组比较,模型组大鼠肝功能ALT、AST明显升高,病理切片HE染色符合肝纤维化镜下表现,Ishak纤维化评分显著升高,Masson染色、苦味酸-天狼星红染色可见胶原纤维沉积明显,免疫组化结果提示肝组织内α-SMA、COL-1表达显著上升,血清铁、铁蛋白、肝脏总铁含量均显著升高.与模型组比较,逍遥散全方及各功效拆方组可明显降低大鼠肝功能ALT、AST,改善病理过程如Ishak评分及胶原染色半定量等均显著下降,肝组织α-SMA、COL-1表达显著降低,血清铁、铁蛋白、肝脏总铁含量亦明显下降,阳性对照药物去铁胺结果与逍遥散全方相仿.与逍遥散全方相比,逍遥散各功效拆方组均较整方疗效有显著降低.结论 逍遥散可显著改善慢性铁过载诱导的大鼠肝纤维化,其方中疏肝药、健脾药、养血药均对改善铁过载及纤维化有一定作用.推测逍遥散抑制铁过载维持铁稳态的作用可能是其疏肝、健脾、养血功效的核心机制.

目的 观察十宝润肠方治疗气阴两虚型泻药依赖性便秘患者的临床近远期疗效、安全性及对肠黏膜屏障功能的影响.方法 选择2019年1—12月上海中医药大学附属上海市中西医结合医院、上海中医药大学附属市中医医院收治的气阴两虚型泻药依赖性便秘患者60例作为患者组,采用随机数字表法将患者分为2组,每组30例,另选择健康志愿者30例作为健康组.治疗组予十宝润肠方治疗,对照组予杜密克治疗,2组疗程均为4周.观察并记录2组患者治疗前后的中医症状积分,比较2组临床疗效;在治疗结束后停药随访2周、4周,观察比较2组患者便秘复发情况;同时观察2组患者治疗前后血、尿、粪三大常规,血清肌酐、尿素氮水平和心电图,进行安全性评估;检测3组肠黏膜屏障功能指标D-乳酸、二胺氧化酶、细菌内毒素水平并进行比较分析.结果 治疗后治疗组排便频率、排便不尽感、乏力积分均明显低于对照组(P均<0.05);治疗组总有效率为83.3％(25/30),对照组总有效率为53.3％(16/30),治疗组总体疗效优于对照组(P<0.05);停药后4周内治疗组复发率显著低于对照组(P<0.05);治疗前后2组患者安全性相关指标无明显异常;未见明显不良反应.患者组血清D-乳酸、二胺氧化酶、细菌内毒素水平显著高于健康组;2组患者治疗后血清D-乳酸、二胺氧化酶、细菌内毒素水平均显著降低(P均<0.05),且治疗组均明显低于对照组(P均<0.05).结论 十宝润肠方对气阴两虚型泻药依赖性便秘有良好的近远期疗效,其机制可能与改善肠黏膜屏障功能有关,且该方无明显不良反应.

目的 探讨白芍总苷对葡聚糖硫酸钠(dextran sulfate sodium,DSS)诱导的小鼠炎症性肠病(inflammatory bowel disease,IBD)模型的作用及相关机制研究.方法 将50只SPF级C57BL/6小鼠随机分成正常组(N组)、模型组(M组)、柳氮磺吡啶组(L组)、低剂量白芍总苷组(BL组)、高剂量白芍总苷组(BH组),每组10只.M组及治疗组小鼠自由饮用30 g/L DSS,同时予以相应药物灌胃1次;N组自由饮水、进食,连续7 d后处死.期间每天记录小鼠体质量及粪便情况,进行结肠炎疾病活动指数(disease activity index,DAI)评分,利用结肠组织HE染色进行组织病理学评价,利用ELISA法检测血清中IL-8、IL-10、IL-23、IL-36、CCL20、CCR6的表达.结果 与M组比较,用药组DAI评分均显著降低(P<0.05或P<0.01),各用药组之间差异无统计学意义(P>0.05);与M组比较,用药组均可下调IL-8、IL-23、IL-36、CCL20和CCR6的表达,上调IL-10的表达,并以L组、BH组最为显著(P<0.05或P<0.01);病理组织学结果显示,L组、BH组结肠组织的炎症反应得到了显著改善.结论 白芍总苷可以有效调节炎症因子表达,减少结肠组织的炎症损伤,并改善小鼠的腹泻及便血症状.

Background Fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI or DW-MRI) are tools for the diagnosis of pancreatic cancer. However, comparison of their diagnostic performance remains unknown. Purpose To indirectly compare the diagnostic value of DWI and FDG-PET/CT in the detection of pancreatic cancer. Material and Methods A literature search of PubMed, Embase, and Cochrane Library electronic databases for articles published through May 2018 yielded 875 articles. For the meta-analysis, we included 26 studies evaluating the efficacy of DWI and FDG-PET/CT for determining pancreatic cancer with a total of 1377 patients. QUADAS (Quality Assessment of Diagnostic Accuracy Studies) was used to assess the study quality. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curves (AUC) with their 95% confidence intervals were calculated for each individual study. Results There were no significant differences between DWI and FDG-PET/CT for sensitivity, specificity, PLR, NLR, or DOR, while DWI AUC was higher than that of FDG-PET/CT for the detection of pancreatic cancer. Conclusion The diagnostic value of both DWI and FDG-PET/CT were comparable and, hence, both techniques seem to be equally useful tools for the diagnosis of pancreatic cancer.

目的:观察逍遥散联合恩替卡韦治疗肝郁脾虚型乙肝后肝硬化代偿期患者30例的临床有效性及安全性.方法:采用随机数字表法将72例患者分为治疗组与对照组,每组各36例,治疗组实际纳入30例,予逍遥散联合恩替卡韦治疗,对照组实际纳入33例,仅予恩替卡韦治疗,2组疗程均为6个月.观察并比较2组患者治疗前后的中医证候积分、肝功能、乙肝病毒载量水平及乙肝五项结果,并计算2组中医证候临床疗效;同时观察并记录2组治疗前后血尿粪三大常规、血肌酐、尿素氮水平和心电图的改变进行安全性评估.结果:治疗组中医证候总有效率96.67％,明显高于对照组的78.79％(P<0.05);治疗组较对照组能显著改善烦躁抑郁、倦怠乏力、多思多虑、善太息等中医证候(P<0.05);2组患者安全性指标检测无统计学差异.结论:逍遥散联合恩替卡韦治疗肝郁脾虚型乙肝后肝硬化代偿期可显著提高临床疗效,改善临床症状,且安全无不良反应,值得临床推广应用和做进一步深入研究.

患者男性,52岁,突发上腹痛6 h来诊.疼痛呈持续性,无放射痛,无呕吐、腹泻、黄疸.既往有胃溃疡病史.查体:神清,T37.8℃,痛苦面容,平卧位,巩膜皮肤无黄染,心肺(-),上腹部压痛,轻度肌卫,无反跳痛,肝浊音界存在,移动性浊音(-),肠鸣音减弱.

目的:探讨软肝煎药物血清对肝星状细胞(HSC)的免疫保护作用.方法:先采用不同两种种族的动物血清培养人肝星状细胞株(Lx-1),研究不同种族的血清对同一细胞的免疫损伤作用,然后再采用对Lx-1细胞株损伤小的血清组与软肝煎药物血清组进行比较来研究对肝星状细胞的免疫保护作用.结果:在测定LDH活性中,小牛血清组与大鼠血清组比较,各组浓度均有非常显著性差异(P＜0.01).药物血清组与大鼠血清组比较,各组浓度均有非常显著性差异(P＜0.01).药物血清组5%与10%比较无显著性差异(P＞0.05),浓度5%、10%两组与浓度20%比较有非常显著性差异(P＜0.01).结论:软肝煎药物血清对肝星状细胞有很好的免疫保护作用;培养细胞最好使用与培养细胞同一种族的血清.