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Nivolumab is an anti-programmed cell death (anti-PD-1) monoclonal antibody, which is a new drug for tumor immunotherapy. A 73-year-old female patient with colorectal cancer 3 years after surgery was treated in the Endocrinology Department of Third Xiangya Hospital, Central South University, who developed severe hypothyroidism resulting from treatment with nivolumab. After 4 months treatment of nivolumab, this patient presented with symptoms such as fatigue, dizziness, jaundice and palpebral edema, with decreased levels of FT3 and FT4 and elevated levels of TSH. Subsequently, nivolumab treatment was terminated. This patient's symptoms were relieved and thyroid function returned to normal after thyroxine replacement therapy. The clinical diagnosis was considered to be nivolumab-induced autoimmune thyroid damage, which was an immune-related adverse reaction in the treatment.
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Aged , Female , Humans , Antibodies, Monoclonal , Hypothyroidism , Nivolumab , ThyroxineABSTRACT
OBJECTIVE： To study the mechanism of couplet medicine of Tripterygium hypoglaucum-Spatholobus suberectus in the treatment of rheumatoid arthritis （RA）. METHODS： The RA targets were retrieved and obtained by therapeutic target database （TTD）， DrugBank and DisGeNET databases， and the protein protein interaction （PPI） network was constructed to screen its key targets. Using oral bioavailability（OB）≥30％， drug like（DL）≥0.18 and drug half-life （HL） ≥4 h as index， active components were obtained from couplet medicine of T. hypoglaucum-S. suberectus by using TCM systematic pharmacological analysis platform （TCMSP） and TCM integrated database （TCMID）， and the targets were predicted. The active component-target network of couplet medicine of T. hypoglaucum-S. suberectus was constructed. Systems Dock Web Site online platform and Genomics platform were used to screen the active component and common targets of RA of couplet medicine of T. hypoglaucum-S. suberectus； KEGG signaling pathways of common targets were analyzed by using Cluego plug-in unit of Cytoscape 3.2.1 software. RESULTS： Totally 1 956 RA targets were retrieved， involving 11 key targets [such as IL-6， TNF， VEGFA]. The couplet medicine contained 30 active components （including luteolin， erythroxanthin， β-sitosterol and triptolide） and 229 targets. There were 37 common targets for couplet medicine of T. hypoglaucum-S. suberectus and RA （including MMP2， TNF， VEGFA）. KEGG signaling way involved cell apoptosis， IL-17 signaling pathway， Th17 cell differentiation pathway and TNF signaling pathway. CONCLUSIONS： The couplet medicine of T. hypoglaucum-S. suberectus may play a role in the treatment of RA by acting on cell apoptosis， IL-17 signaling pathway and other signaling pathways through MMP2， TNF， and VEGFA target. The results of this study can provide a reference for further study on the mechanism of the effects of couplet medicine of T. hypoglaucum-S. suberectus on RA.
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Uarthritis is a common inflammatory arthritis, which has been well known as the White Tiger arthritis in traditional Chinese medicine. This article discussed the pathogenesis of blood stasis and the related studies in hyperuricemia, acute and chronic phase of Uarthritis. It suggested that blood stasis is a crucial pathogeny of uarthritis. Thus, the chinese herb medicine of blood circulation drugs should beapplied in all the phases of Uarthritis.
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Objective To evaluate the efficacy and safety of Shuangyi Qushi Tongluo Capsules (SQTC) for the treatment of knee osteoarthritis (KOA).Methods A multi-center,randomized,parallel-controlled trial was carried out in 240 cases of KOA patients.The patients were divided into trial group (N =120) and control group (N =120),which was given SQTC,Xianlinggubao capsules respectively for 8 weeks.Before treatment,and 2,4 and 8 weeks after treatment,we recorded the scores of clinical symptoms and traditional Chinese medical syndromes,Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores and knee function scores.After treatment,the clinical efficacy and adverse reaction were observed.Results (1) After treatment for 8 weeks,the clinical efficacy of the trial group was superior to that of the control group (P ＜ 0.05).(2) The trial group had better effect on improving the visual analogue scale (VAS) scores of knee pain,VAS scores of limitation of motion and time for morning stiffness than the control group after treatment for 8 weeks(P ＜ 0.05 or P ＜ 0.01).(3) After treatment for 4 and 8 weeks,the trial group had better effect on improving scores of traditional Chinese medical syndromes,WOMAC scores and Japanese Orthopedic Association(JOA) scores than the control group (P ＜ 0.05 or P ＜ 0.01).(4) Before and after treatment,the results of blood,urine and stool routine examination,liver and kidney function,and electrocardiography showed no significant changes.Conclusion SQTC are effective and safe in treating KOA,and can start an effect shortly.
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Jingui Yaolue is a part ofTreatise on Cold-Attack and Miscellaneous Diseases. Because of the archaic words, students lost the interest on it. So it became the questions that how to make students interested in learning theJingui Yaolue and to make traditional Chinese medicine(TCM) classical guide clinical treatment. Thus, a try has been made to teach the TCM classic in the clinical practice apprentice setting rather than the classrooms. Here, some experiences about apprentice teaching in clinical practice of Jingui Yaolue were shared.
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OBJECTIVE:To offer the literature basis for clinical safe drug use by literature research about ADR induced by Yishen juanbi pill. METHODS:Using“Yishen juanbi pill”as searching word,related literatures about ADR induced by Yishen juanbi pill were collected from CNKI,and then the occurrence of ADR was summarized and analyzed. RESULTS:A total of 15 literatures were included,involving 58 patients. Primary disease were mainly rheumatoid arthritis (28 cases,48.28%);organs/systems involved in ADR were digestive system (77 cases, 76.24%). Main clinical manifestations were epigastric discomfort, pernicious vomiting,diarrhea,etc. No obvious ADR was found. ADR-inducing dose was mainly 8 g,tid(47 cases,92.16%);ADR-inducing drug combination were two-drug combination (33 cases,56.90%). Fifty-eighe cases of ADR were recovered after treatment,and main treatment was drug withdrawal or symptomatic treatment. CONCLUSIONS:Although Yishen juanbi pill may induce ADR,those ADR can disappear spontaneously after drug withdrawal or the symptoms are recovered after symptomatic treatment. Yishen juanbi pill is a relatively safe Chinese patent medicine of anti-inflammatory,but ADR monitoring should be strengthened during application.
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Objective To evaluate the effectiveness and safety of Shuangyi Qushi Tongluo Capsules ( SQTC) in treating ankylosing spondylitis (AS), and to explore the synergistic action of SQTC combined with sulfasalazine. Methods A randomized and parallel-controlled trial was carried out in 80 AS patients. The enrolled subjects were evenly randomized into testing group and control group. Both groups were given oral use of sulfasalazine enteric-coated tablets, and the testing group was additionally given oral use of SQTC, which is mainly composed of silky ant (Formica Fusca), black-winged Termitidae, Scorpio, Radix Ginseng, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Flos Carthami, Radix Salviae Miltiorrhizae, Radix Achyranthis Bidentatae, Caulis Spatholobi, Herba Epimedii, and Radix Morindae Officinalis. The treatment for the two groups covered 24 weeks. On treatment week 4, 12, 24, we recorded the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), visual analog scale (VAS) scores of rachialgia, patients’ general assessment (PGA), VAS scores of night pain, spondylitis scores, Bath Ankylosing Spondylitis Functional Index ( BASFI) , Bath Ankylosing Spondylitis Metrology Index ( BASMI) , scores of the quality of life ( QOL) , erythrocyte sedimentation rate ( ESR) , C-reactive protein ( CRP). Moreover, the adverse reaction of the two groups was also monitored. Results ( 1) Compared with the control group, testing group had high ASAS 20 percentage on treatment week 4, 12 and 24 (P0.05). Conclusion SQTC are effective and safe in treating AS, starting an effect shortly and having synergistic effect on salfasalazine for the treatment of AS.
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Objective To observe the effect of Duanteng Yimu decoction (DYD) on bone turnover markers of C-terminal telopeptide of type Ⅰ collagen (CTX-Ⅰ) and N-terminal propeptide of type Ⅰ procollagen ( PⅠNP) of adjuvant-induced arthritis (AA) rats. Methods Seventy-two SD rats were divided into 9 groups, and complete Freund's adjuvant was injected into the rats to establish adjuvant-induced arthritis rat model. After medication for 36 days, the pedal swelling, the serum levels of CTX-Ⅰand PⅠNP, and ankle X-ray photographic scores were observed. Results The pedal swelling degrees and ankle X-ray scores in medication groups were lower than those in the model group ( P0.05). The CTX-Ⅰlevel in low-dose DYD group was decreased (P<0.05). Conclusion Caulis Celastri has two-way effects on CTX-Ⅰlevel of female AA rats, and its side effects can be reduced by Radix Dipsaci and Herba Leonuri, but their antagonism effect will disappear with the increase of the dose of Caulis Celastri.
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Objective To observe the therapeutic effect of adjunctive treatment with Qiangzhu Recipe for ankylosing spondylitis(AS). Methods Forty-eight AS patients were evenly randomized into observation group and control group according to the admission order. The observation group was given Qiangzhu Recipe together with sulfasalazine and celecoxib orally, and the control group received oral use of sulfasalazine and celecoxib. Four weeks constituted one treatment course, and the treatment covered 3 courses. The main clinical outcomes of the patients included Bath AS functional index ( BASFI) , Bath AS disease activity index ( BASDAI) , pain visual analog scale ( VAS) scores, global VAS scores, spinal mobility indexes ( finger-to-floor distance, occiput -wall distance, thoracic mobility, Schober test, scoliolosis test) , and laboratory inflammatory indicators of erythrocyte sedimentation rate (ESR) and C-reactive protein. Moreover, the incidence of adverse reaction was also recorded. Results (1) After treatment for 4, 8, and 12 weeks, the percentage of the patients arriving at the degree of ASAS20 was 16.67%, 33.34%, and 70.83% respectively in the observation group, and was 8.33%, 29.17%, and 58.33% in the control group; the percentage of the patients arriving at the degree of ASAS40 was 4.17%, 20.83%, and 37.50% respectively in the observation group, and was 0.00%, 12.50%and 25.00% in the control group. The differences of the percentage of the patients arriving at the degree of ASAS20 and ASAS40 were insignificant between the two groups (P>0.05). (2) After treatment, symptoms were much relieved, spinal mobility was improved, and inflammatory indicators of ESR and CRP were alleviated in the two groups ( P0.05 compared with the control group). Conclusion Adjunctive treatment with Qiangzhu Recipe exerts certain synergistic action on sulfasalazine and celecoxib in treating ankylosing spondylitis.
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Objective To investigate the effects of alcohol extract of Kunmu decoction on proliferation and apoptosis of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS). Methods Synovial tissues were obtained from patients with active RA received joint replacement or arthroscopy. The surface antigen and the amount of apoptotic cells were determined by flow cytometry. The inhibitive effect was detected by MTT assay. Results The CD90+surface antigen of synoviocytes was (94.78 ± 0.98)%. The inhibitive effect on the proliferation in all treatment groups were in a time-and dose-dependent manner. The apoptosis rate was increased in a dose-dependent manner among all dosage alcohol extract groups. Conclusion Kunmu decoction might inhibit proliferation and induce apoptosis of RA-FLS.
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Objective To develope effective TCM antirheumatic drug and provide theoratical basis of establishing TCM effect evaluation system of RA,the effect of modified Guizhishaoyaozhimu Decoction on RA was evaluated by SF-36 questionnaire. Methods Evaluation of 59 cases in a RCT (random control test) study was based on SF-36 questionnaire. Treatment group was given modified Guizhishaoyaozhimu decoction bid,while control group was given MTX 10 mg,one time a week with celecoxib 200 mg,qd. Observation last on 24 weeks and comparing patients’ quality of life was done at the beginning and end point. Results There was significant difference between two groups on improving physical functioning,role-physical,body pain,social function,and role-emotional (P 0.05). Conclusions Modified Guizhishaoyaozhimu decoction has better effect on improve RA patients’ quality of life than MTX.