In vivo and in Vitro Component Identification and Pharmacokinetic Analysis of Houpo Wenzhongtang Based on Rats with Deficiency-cold of Spleen and Stomach / 中国实验方剂学杂志

ObjectiveTo identify the chemical components of Houpo Wenzhongtang in vivo and in vitro and to analyze the pharmacokinetic properties of the index components in rats with deficiency-cold of spleen and stomach. MethodThe chemical components of Houpo Wenzhongtang was analyzed and identified by ultra performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry（UPLC-Q-TOF-MS/MS）. Six rats were randomly selected from 18 SD rats as the blank group， and the remaining rats were given lard and cold vinegar for a long time to construct a rat model with deficiency-cold of spleen and stomach. After successful modeling， the rats were randomly divided into the model group and Houpu Wenzhongtang group（13.5 g·kg-1， calculated as crude drug）. The administration group was given the corresponding dose of Houpu Wenzhongtang by gavage， and the blank group and the model group were given the same amount of distilled water by gavage. Enzyme-linked immunosorbent assay（ELISA） were used to measure gastrin（GAS） and motilin（MTL） levels in each group. At the same time， plasma samples were collected at different time points after administration， and blood-entry prototype components and metabolites of Houpo Wenzhongtang were analyzed by UPLC-Q-TOF-MS/MS. On this basis， plasma concentrations of magnolol， honokiol， alpinetin and hesperidin in Houpo Wenzhongtang were determined by ultra performance liquid chromatography coupled with triple quadrupole/linear ion trap mass spectrometry（UPLC-QTRAP-MS/MS）， and the pharmacokinetic parameters were calculated using DAS 2.0 software. ResultA total of 79 chemical components， including 44 flavonoids and 11 lignans， were identified in Houpo Wenzhongtang. Meanwhile， 18 blood-entry prototype components and 27 metabolites were identified， the main metabolic pathways of metabolites were glucuronidation， sulfation， oxidation and hydrolysis， and phase Ⅰ and phase Ⅱ were the two primary forms of metabolism. Pharmacokinetic results showed that among the four index components， the time to peak（tmax） values of magnolol and honokiol were consistent and exhibited similar drug metabolism characteristics， the tmax of alpinetin was the shortest， and the absorption rate was the fastest， which had the earliest peak plasma concentration levels， and hesperidin had the shortest mean residence time（MRT0-t） and the highest metabolic rate in rats. ConclusionThis study clarifies the blood-entry prototype components and their metabolites of Houpo Wenzhongtang in the rat model of deficiency-cold of spleen and stomach， and reveals the pharmacokinetic characteristics of the main active ingredients， which can provide a scientific basis for the study of pharmacodynamic material basis of this formula and its clinical application in treating the syndrome of deficiency-cold of spleen and stomach.

Meta-analysis of the efficacy and safety of immune checkpoint inhibitors in the treatment of metastatic colorectal cancer / 中国药房

OBJECTIVE To systematically evaluate the efficacy and safety of immune checkpoint inhibitors （ICIs） in the treatment of metastatic colorectal cancer （mCRC）， so as to provide evidence-based reference for clinical practice. METHODS PubMed， the Cochrane Library， Web of Science， Embase， CNKI， Wanfang and VIP databases were searched to collect randomized controlled trials （RCT） of ICIs （trial group） versus traditional chemotherapy or optimal supportive treatment （control group） in the treatment of mCRC from the establishment of the database to June 1， 2022. After literature screening and data extraction， Cochrane Systematic Review Manual 5.1.0 was used to evaluate the quality of the included literature， and RevMan 5.4 software was used for meta-analysis and sensitivity analysis. RESULTS A total of 4 RCTs were included， involving 833 patients. Meta-analysis showed that the overall survival （OS） [HR＝0.77， 95%CI （0.64， 0.94）， P＝0.01] and progression-free survival （PFS） [HR＝0.67， 95%CI （0.57， 0.79）， P＜0.000 01] were significantly higher in trial group than control group； the difference was not statistically significant when comparing the incidence of grade 3 and above adverse events in the two groups [RR＝1.22， 95%CI （0.77， 1.94）， P＝0.39]. Subgroup analysis by mutation pattern showed that patients with mismatch repair proficiency and low levels of microsatellite instability （pMMR-MSS） mCRC patients in trial group had significantly higher PFS than control group （P＜0.05）. The results of sensitivity analysis showed that the results were robust. CONCLUSIONS Compared with traditional chemotherapy or optimal supportive treatment， ICIs can prolong the OS and PFS of mCRC patients， and maybe has more advantages in pMMR-MSS mCRC patients； the safety of ICIs is equivalent to that of traditional chemotherapy or optimal supportive treatment.

Meta-analysis of the efficacy of immune checkpoint inhibitors in the treatment of NSCLC with different KRAS genotypes / 中国药房

OBJECTIVE To evaluate the efficacy of immune checkpoint inhibitors （ICIs） in the treatment of non-small cell lung cancer （NSCLC） with different KRAS genotypes. METHODS Retrieved from PubMed， the Cochrane Library， Web of Science， Embase， CNKI， Wanfang data and VIP， randomized controlled trials （RCTs） about ICIs alone， combined use of various ICIs or ICIs combined with traditional chemotherapy （trial group） versus traditional chemotherapy （control group） for NSCLC were collected from the inception of the databases to April 1， 2023. After screening literature， extracting data and evaluating quality， meta-analysis， sensitivity analysis and publication bias analysis were conducted by using RevMan 5.4 software. RESULTS A total of 7 RCTs involving 5 980 patients were included. The results of the meta-analysis showed that overall survival （OS） [HR＝ 0.79， 95%CI （0.72， 0.87）， P＜0.000 01] and progression-free survival （PFS） [HR＝0.63， 95%CI （0.50， 0.80）， P＝0.000 2] of trial group were significantly longer than those of control group； furthermore， the OS of KRAS mutant type [HR＝0.63， 95%CI （0.53， 0.75）， P＜0.000 01] and KRAS wild type [HR＝0.87， 95%CI （0.78， 0.98）， P＝0.02]， PFS of KRAS mutant type [HR＝ 0.58， 95%CI （0.43， 0.78）， P＝0.000 3] and KRAS wild type [HR＝0.68， 95%CI （0.47， 0.99）， P＝0.04] in the trial group were all significantly longer than in the control group. Subgroup analysis by different treatment regimens showed that the OS of KRAS mutant type patients receiving first- and second-line treatment regimens， using ICIs alone and those receiving ICIs combined with traditional chemotherapy as well as PFS of KRAS mutant type and wild type patients receiving first-line treatment regimens in the trial group were all significantly longer than in the control group （P＜0.05）. Sensitivity analysis results indicated that the findings of this study were robust. Publication bias results showed that the possibility of publication bias in this study was small. CONCLUSIONS ICIs show significant efficacy in NSCLC patients， and NSCLC patients benefit equally regardless of whether KRAS mutations occur.

Comparison of dosimetric differences in unintended irradiation of ipsilateral axillary region between intensity modulated proton and photon therapy for whole breast irradiation / 肿瘤

Objective:This study aimed to compare the dosimetric differences in unintended irradiation to the ipsilateral axillary region between intensity-modulated radiation therapy(IMRT)and intensity-modulated proton therapy(IMPT)in patients receiving whole breast irradiation(WBI). Methods:A total of 20 patients with early breast cancer who received WBI at our center between August and September 2022 were included in this study.One IMPT plan and one IMRT plan were formulated for each patient,with prescription dose of 4005 cGy(RBE)in 1 5 fractions.Dosimetric parameters of axillary lymph nodes(ALN)level Ⅰ,Ⅱ,Ⅲ,Rotter's lymph nodes(RN),and the axillary-lateral thoracic vascular junction(ALTJ)were compared between IMPT and IMRT plans. Results:All plans met the criteria of CTV V95％Dose≥95％.IMPT showed significantly better conformity index(0.97 vs 0.95,P=0.0003)and homogeneity index(0.05 vs 0.07,P=0.0301)compared to IMRT.The mean dose of the heart[27.48 vs 114.74 cGy(RBE),P＜0.0001]and ipsilateral lung[356.66 vs 498.89 cGy(RBE),P＜0.0001]were significantly lower in the IMPT plan compared to the IMRT plan.The mean dose,V50％Dose,V80％Dose,V90％Dose,and V95％Dose of ALNⅠ,ALN Ⅱ,ALN Ⅲ and RN in the IMPT plan were significantly lower than those in the IMRT plan(all P＜0.01),with the most significant difference observed in the dosimetric parameters of the axillary region inferior to the axillary vein[mean dose:79.75 vs 995.31 cGy(RBE),P＜0.0001].The mean dose and serial dosimetric parameters(V5,V10,V15,V20,V25,V30,and V35)of the ALTJ were also significantly lower in IMPT plans compared to IMRT plans. Conclusion:IMPT demonstrates lower unintended irradiation dose in the inferior axillary region and reduces dose volume in the ALTJ region compared to IMRT.When employing IMPT,the clinical target volume(CTV)should be delineated based on the individual locoregional recurrence risk for patients with positive sentinel lymph nodes who omitted axillary lymph node dissection.For high-risk patients,the axillary region should be included in the CTV to ensure efficacy,while for low-risk patients,excluding the axillary region can help mitigate the risk of breast cancer-related lymphedema.

Breast cancer related lymphedema:from evaluation of risk to patient management / 肿瘤

Breast cancer-related lymphedema(BCRL)is one of the most common complications after multidiscipline treatment of breast cancer,which manifests as upper limb swelling and skin changes and significantly affects limb function and quality of life.The occurrence and development of BCRL are affected by many factors including surgery,radiotherapy,drugs,infection,trauma,and so on.Therefore,it is important to identify the potential risk factors to establish individualized prevention strategies.Evidence-based risk assessment models for BCRL could help clinicians to identify high-risk patients and apply prospective surveillance to treat BCRL at early stage.For patients with advanced lymphedema,conservative treatment and surgical treatment could be delivered to relieve symptoms and improve their conditions.This article comprehensively reviewed the risk factors,prospective surveillance,intervention,and research progress of BCRL,to provide reference for multidisciplinary collaboration as well as clinical diagnosis and treatment in this field.

Effects of moxibustion on behaviors and tryptophan metabolism-related products in mice with irritable bowel syndrome / 针灸推拿医学（英文版）

Objective: To observe the effect of moxibustion on behaviors and related products of tryptophan (Trp) metabolism in the colon of mice with irritable bowel syndrome (IBS), and to explore the mechanism of moxibustion in the IBS treatment.Methods: Twenty-four mice were randomly divided into a normal group, a model group, a moxibustion group, and a probiotic group, with 6 mice in each group. The visceral pain model of IBS was established by enema with 2,4,6-trinitrobenzene sulfonic acid (TNBS) solution. Mice in the moxibustion group were treated with mild moxibustion at bilateral Zusanli (ST36), and those in the probiotic group were treated with probiotics such as Bifidobacterium by gavage. Abdominal withdrawal reflex (AWR) test, elevated plus-maze (EPM) test, and forced swimming test (FST) were performed after treatment. The expression levels of 5-hydroxytryptamine (5-HT) and tryptophan hydroxylase 1 (TPH1) in the colon were detected by immunofluorescence, and the expression levels of Trp, kynurenine (Kyn), and indole-2,3-oxygenase (IDO) in the colon were detected by enzyme-linked immunosorbent assay. Results: Compared with the normal group, the AWR scores were increased significantly in the model group under different pressure values (P<0.01), the open-arm staying time and open-arm entries in the EPM test were decreased significantly (P<0.01, P<0.05), the motionless time in the FST was increased significantly (P<0.01), and the expression levels of colonic Trp, TPH1, IDO, 5-HT, and Kyn were increased significantly (P<0.01) in the models. Compared with the model group, the AWR scores were differently decreased (P<0.05 or P<0.01), the open-arm entries in the EPM test were increased (P<0.05), the motionless times in the FST were decreased (P<0.05), and the colonic expression levels of Trp, TPH1, IDO, and 5-HT were decreased (P<0.01 or P<0.05) in the moxibustion and probiotic groups; the open-arm staying time was significantly increased in the moxibustion group (P<0.01), and the colonic expression level of Kyn was significantly decreased in the probiotic group (P<0.01). Conclusion: Moxibustion at Zusanli (ST36) improves visceral pain and pain mood and down-regulates the expression levels of colonic TPH1, IDO, Trp, 5-HT, and Kyn in IBS mice.

Update on salivary gland transplantation in severe dry eye / 中华实验眼科杂志

As a chronic eye disease caused by multiple factors, the treatment of dry eye disease (DED) should be individualized according to the cause and severity of the disease.In patients with severe DED who have lost lacrimal secretion but have not suffered severe damage to the salivary glands, autologous salivary gland transplantation may help bring hope to these patients if conventional treatments are not effective enough.According to the literature, the three major salivary glands and the minor salivary glands have been used as lacrimal gland replacements.Studies have shown that submandibular glands not only have a high gland survival rate after transplantation, but also maintain secretory activity after transplantation and therefore successfully serve as lacrimal gland replacement.During the up to 180-month follow-up period, the subjective symptoms and signs of DED such as dryness, foreign body sensation, and other objective indicators related to DED such as visual acuity and tear film break-up time are effectively improved.Among the minor salivary glands, the labial glands have been proven to maintain secretory function during the up to ten-year follow-up period after transplantation according to the literature, and have therefore become an alternative lacrimal gland replacement.This review summarized the indications, surgical techniques, efficacy evaluation, modulation of salivary flow and complications of the surgery, involving three major salivary glands, parotid, submandibular and sublingual glands, and minor salivary glands among which labial glands are most commonly used.

Clinical and bronchoscopy characteristics of Mycoplasma pneumoniae pneumonia in children with 23S rRNA resistance gene positive in bronchoalveolar lavage fluid / 中华实用儿科临床杂志

Objective:To investigate clinical and bronchoscopy characteristics of Mycoplasma pneumoniae pneumonia in children with 23S rRNA resistance gene positive in bronchoalveolar lavage fluid(BALF), and find clinical indicators that can identify Mycoplasma pneumoniae drug resistance early.Methods:The clinical data of 61 hospita-lized children diagnosed with Mycoplasma pneumoniae pneumonia as subjects from October 2017 to June 2018 in the Department of Pediatric Respiratory Medicine of Shengjing Hospital Affiliated to China Medical University were analyzed retrospectively.Bronchoscopy was performed on each subject and the BALF was taken and used to detect the 2063 site mutation of the 23S rRNA V region gene in BALF, and they were divided into drug-resistant gene positive group and drug-resistant gene negative group.The clinical manifestations, relevant laboratory data, imaging data, and bronchoscopy findings in different load groups were compared.Statistical methods such as t test, rank sum test, χ2 test, Fisher′ s exact probability method, and multivariate Logistic regression analysis were used to analyze the data. Results:Among the 61 children, 38 cases (62.30%) were in the drug resistance gene positive group, and 23 cases (37.70%) were in the drug resistance gene negative group.There were no significant differences in gender and age between the two groups (all P>0.05). The days of hospitalization and fever in the children with positive drug resistance genes were longer than those in the negative drug resistance gene groups, and they were more likely to have refractory mycoplasma pneumoniae pneumonia(RMPP) and extra pulmonary complications, with statistically significant differences ( P<0.05), but there were no significant differences in hypoxemia ( P>0.05). There were significant differences in white blood cell(WBC), C-reactive protein(CRP), procalcitonin(PCT), D-Dimer (D-D) and interleukin-6 (IL-6) between the two groups (all P<0.05). Except that the WBC level in the drug-resistant gene-positive group was lower than that in the drug-resistant gene-negative group, the rest of the test results indicated that the drug-resistant gene-positive group was higher than the drug-resistant gene-negative group.There were no significant differences in the concentrations of serum lactate dehydrogenlase(LDH)and IL-6 in BALF ( P>0.05). In this study, Logistic regression analysis was performed on several statistically significant laboratory indicators.It was found that WBC was more sensitive to identify drug resistance genes, and the optimal critical value was 8.55×10 9/L.The specificity of D-D in identifying drug resistance genes was higher, and the optimal cut-off value was 523 μg/L.In the drug resistance gene positive group, 35 cases (92.11%) showed extensive lung consolidation/atelectasis on imaging, and the drug resistance gene negative group was 13 cases (56.52%), with statistically significant differences ( P<0.05). The drug resistance gene-positive group mainly showed mucosal erosion, necrosis, phlegm plug/plastic phlegm plug and bronchitis stenosis, with a total of 19 cases (50.00%). In the drug resistance gene negative group, the main manifestations of mucosal longitudinal wrinkle, flocculent and viscous secretions were 14 cases (60.88%), with statistically significant differences ( P<0.05). Conclusions:The point mutation of 23S rRNA V region gene is closely related to the clinical characteristics of children with Mycoplasma pneumoniae pneumonia.Children with A2063G mutation are more prone to have RMPP and extrapulmonary complications, and their imaging manifestation and bronchoscopy are more severe.The levels of leukocytes and D-D in the blood have significance for the early identification of drug resistance.The systemic excessive immune inflammatory response caused by Mycoplasma pneumoniae pneumonia with drug-resistant gene positive needs to be valued.

Research progress and controversies of individualized local treatment of breast ductal carcinoma in situ / 中华放射肿瘤学杂志

With the widespread adoption of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has been dramatically increased. The spectrum of local treatment advances from mastectomy to breast conservation surgery plus whole breast irradiation (WBI), and hypofractionated WBI or accelerated partial breast irradiation. Although the efficacy of WBI on reducing local recurrence is clear, such benefit in the low-risk DCIS is still controversial. Further studies are required to establish a more precise local recurrence risk stratification system for better tailoring local treatment in patients with DCIS. In this review, the latest advances and controversies in surgery, radiation therapy and local recurrence risk stratification system for patients with DCIS were summarized.

The impact of a magnetic field on the dose distribution using the Bebig 60Co HDR sources / 中华放射肿瘤学杂志

Objective To evaluate the impact of an external magnetic field on the dose distribution and electronic disequilibrium region around a Bebig type 60Co HDR brachytherapy source and to judge the feasibility of applying MRI scanner during brachytherapy.Methods The source model was established based on the Monte Carlo package Geant4 software.The simulated geometries consisted of the 60Co source inside a water phantom of 10.0cm× 10.0cm× 10.0cm in size.The magnetic field strength of the 0T,1.5T and 3.0T was considered,respectively.The voxels with a size of 0.2 mm,0.5 mm and 0.5 mm were established along the x-,y-and z-axis.The influence of the magnetic field on the Kerma (kinetic energy released to matter) distribution and dose distribution within the 10.0mm region from the source center was evaluated.Furthermore,the ratio of the Kerma to dose as a function of the distance to the center source was acquired.Results The 1.5T magnetic field exerted no effect on the dose distribution adjacent to 60Co HDR brachytherapy source,whereas3.0T magnetic field caused significant increase in the dose distribution within r＜6 mm from the source center.The dose distribution was increased by 40％ at r=5.4 mm from the source center.The ratio of Kerma to dose was less than 1 within the region of 1.2 mm＜r＜6.0 mm,suggesting that 3.0T magnetic field can lead to electronic disequilibrium within a larger region from the source center.Conclusions For Bebig 60Co HDR brachytherapy source,it is safe and reliable to apply1.5T external magnetic field.Nevertheless,3.0T magnetic field can cause high dose risk.Consequently,safety assessment and verification should be delivered prior to clinical application.

Advances in radiotherapy for breast cancer in 2018 / 中华放射肿瘤学杂志

In 2018, studies of radiotherapy for breast cancer mainly focus on three aspects: shorten course of radiotherapy: efficacy and safety of weekly hypofractionated whole breast irradiation (FAST and FAST FORWARD) and dose escalated intensity-modulated radiotherapy to whole breast (IMPORT HIGH); reduction in treatment volume: safety and efficacy of APBI (NSABP/RTOG 0413 and RAPID), and individualize radiotherapy decision: optimization of definition of low-risk breast cancer using clinicopathologic parameters, genomic assays and molecule subtypes. The individualized radiotherapy will be the mainstream orietation of development.

Dosimetric study of cardioulmonary volume dose of internal mammary node irradiation under inverse-planned intensity-modulated radiation therapy / 中华放射肿瘤学杂志

Objective:To explore whether internal mammary node irradiation (IMNI) can control the normal tissue volume dose within a reasonable range under inverse-planned intensity-modulated radiation therapy (IP-IMRT).Methods:The patients with breast cancer received postmastectomy combined with radiotherapy from January 2015 to July 2016 in Department of Radiation Oncology in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively screened and sampled. The prescription dose was 50 Gy/25 times. The whole heart and ipsilateral lung were outlined on CT scan, and the dose-volume histogram parameters were quantified in the RT planning system (ADAC Pinnacle).Results:For the left breast cancer patients ( n=67) who received IMNI, the total heart dose-volume histogram parameters in 2016 were significantly decreased compared with those in 2015. The D mean in 2015 was (976.65±411.16) cGy, significantly larger than (687.47±134.65) cGy in 2016( P=0.008). Among the same sampled population, the percentage of whole heart D mean at the doses of 12 Gy, 10 Gy, 8 Gy was 33.3%, 33.3%, and 66.7% in 2015, and 0%, 3.8%, and 11.5% in 2016, respectively. For the right breast cancer patients ( n=65) , D mean, V 2Gy, V 10Gy, V 15Gy and V 20Gy of the heart in the IMNI group were significantly higher than those in the non-IMNI group in 2016(all P<0.05). For the ipsilateral lung, D mean, V 10Gy, V 20Gy, and V 30Gy in the IMNI group were remarkably higher than those in the non-IMNI group (all P<0.05). Conclusions:IMNⅡs found to be associated with increased cardiopulmonary dose volume with IP-IMRT technique. Nevertheless, with the practical experience of IMRT and the increasing awareness of cardiac dose limitation, it is feasible to control the cardiac dose increment within a limited range.

Progress of macrolide-resistant mycoplasma pneumoniae pneumonia in children / 国际儿科学杂志

Mycoplasma pneumoniae pneumonia is one of the common community-acquired pneumonia.Macrolides are the drugs of first choice for the treatment of mycoplasma pneumoniae pneumonia in children.The macrolide resistance in Asia is severe and has a rising trend year by year.The mechanism is mainly the 23S rRNA gene mutation.Children infected with drug-resistant strains are more likely to have clinical manifestations of severe pneumonia, and even acute respiratory distress syndrome.The increased resistance of mycoplasma pneumoniae is related to the high frequency and long application time of macrolides.This article reviews the research progress, status, mechanism, clinical manifestations and its relationship with macrolide-resistant mycoplasma pneumoniae pneumonia in children.

Study on Quality Standard Improvement for Compound Child Antifebrile Suppository / 中国药房

OBJECTIVE：To improve the quality standard of Compound child antifebrile suppository. METHODS ：Based on the previous quality standard ，TLC identification methods were established for artificial cow-bezoar and Baphicacanthis Cusiae Rhizoma et Radix. HPLC method was established for content determination of choleic acid （CA），hyodeoxycholic acid （HDCA） and paracetamol. RESULTS ：TLC chromatogram of artificial cow-bezoar and Baphicacanthis Cusiae Rhizoma et Radix all showed the same color spots in the same position as the corresponding substance control or reference medicinal material ，while the negative samples had no interference. HPLC was performed on Welch Xtimate C 18 column（CA，HDCA）or Agilent ZORBAX SB-C 18 column（paracetamol）with mobile phase consisted of acetonitrile-0.5％ formic acetic acid （by gradient elution ，CA and HDCA ）or methanol-water（20∶80，V/V，paracetamol）at the flow rate of 1.0 mL/min. ELSD was used with a nitrogen flow-rate of 2.0 L/min at a drift tube temperature of 105 ℃（CA，HDCA）. The detection wavelength was set at 244 nm（paracetamol）. The linear ranges of CA，HDCA，paracetamol were 0.150 0-4.500 0，0.212 5-6.375 0，0.081 9-1.638 5 μg（all r＞0.999 2）. RSDs of precision ， reproducibility and stability tests were all lower than 3％（n＝6 or n＝7）. The average recoveries were 100.35％，101.39％， 98.81％（all RSD ＜3％，n＝6）. CONCLUSIONS ：Based on previous quality standard of Compound child antifebrile suppository ， TLC method is used to identify artificial cow-bezoar and Baphicacanthis Cusiae Rhizoma et Radix ，and the contents of CA ，HDCA and paracetamol are determined by HPLC ，which can effectively improve the quality control standard of the preparation.

Study on Chemical Constituents of Petroleum Ether Part from Whole Herbs of Pteris vittata / 中国药房

OBJECTIVE： To study the chemical constituents from the petroleum ether part from whole herbs of Pteris vittata. METHODS： The petroleum ether part from whole herbs of P. vittata was separated and isolated by silica gel column， gel column， recrystallization and TLC. The structures of the compounds were identified according to physicochemical properties and spectrum data （1H-NMR and 13C-NMR）. RESULTS： A total of 11 compounds were isolated and identified from the petroleum ether part from whole herbs of P. vittata， as （2R）-acetyl pterosin B （Ⅰ）， palmitic acid （Ⅱ）， hop-22（29）-ene （Ⅲ）， epifriedelanol （Ⅳ）， lupenone （Ⅴ）， olean-18-en-3-one （Ⅵ）， stigmasterol （Ⅶ）， β-sitosterol （Ⅷ）， 22-hydroxyhopane （Ⅸ）， ergosterol （Ⅹ）， β-sitosterol acetate （Ⅺ）. CONCLUSIONS： Compounds Ⅰ-Ⅶ and Ⅸ-Ⅺ are isolated from this plant for the first time， and can provide theoretic reference for further studying bioactive pharmacodynamic substances in P. vittata and enriching chemical component data.

Delay in initiating postmastectomy radiotherapy is associated with inferiorsurvival outcomes for locally advanced breast cancer patients treated with neoadjuvant chemotherapy and mastectomy / 中华放射肿瘤学杂志

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.

Therapeutic strategies of axillary treatment for early breast cancer patients with positive sentinel lymph nodes / 中华放射肿瘤学杂志

For patients with positive sentinel lymph nodes, axillary lymph node dissection ( ALND) is the conventional treatment. However, ALND can cause seroma, the upper limb dysfunction, edema and alternative complications. Z0011, IBCSG 23-01 and AMAROS phaseⅢrandomized controlled clinical trials recommend ALND after sentinel lymph node biopsy in N0 patients, which provides a novel option for axillary lymph node treatment, but also brings new challenges to the decision of adjuvant radiotherapy. In this paper, based upon these three clinical trials and latest literatures related to the risk of axillary lymph node metastasis and recurrence, the therapeutic strategies including surgery and adjuvant radiotherapy for patients with positive sentinel lymph nodes are reviewed and summarized.

Radiological features of non-small-cell lung cancer with brain metastases in a single center: an implication for the HA-WBRT approach / 中华放射肿瘤学杂志

Objective Whole brain radiotherapy ( WBRT) remains the primary treatment for patients with multiple brain metastases ( BM). Hippocampal avoidance WBRT ( HA-WBRT) offers the feasibility of less cognitive function impairment than conventional WBRT.WBRT yields better control rate of intracranial distant progression than stereotatic body radiotherapy (SBRT).This study aims to understand the distribution characteristics of BM within the cranial structures by analyzing imaging features and define the safe margin during HA-WBRT. Methods Clinical data of patients diagnosed with BM by enhanced MRI in Ruijin Hospital from July 2011 to July 2016 were retrospectively analyzed. The distance between the intracranial lesion closest to the hippocampus and the hippocampus was measured. Results A total of 146 patients (90 male and 56 female) with 630 BM lesions were reviewed. Sixty-four patients were diagnosed with non-small-cell lung cancer complicated with BM during the initial admission. In the other 82 patients, the average time from the initial diagnosis to the diagnosis of BM was (14.5±14. 3) months. In total,486 (77. 1％) BM lesions were situated beyond the tentorium. The average diameter of the largest intracranial lesion was (12.5± 10. 3) mm (95％CI:10. 8-14. 2). All 630 BM lesions were distributed as follows:138 (21. 9％) in the cerebellum, 182 ( 28. 9％) in the frontal lobe, 114 ( 18. 1％) in the temporal lobe, 78 (12. 4％) in the parietal lobe,87(12. 7％) in the occipital lobe,28(4. 4％) in the thalamus and 10(1. 6％) in the brainstem. The frequency of hippocampal involvement was 3. 4％(5 mm),4. 8％(10 mm) and 8. 2％(20 mm). The univariate and multivariate logistic analyses indicated that with the risk of hippocampal involvement in patients aged> 60 years was significantly increased (OR= 11. 576 P= 0. 042). Conclusions The probability of brain metastasis within 10 mm around the hippocampus is low. HA-WBRT can control the intracranial lesions and reduce cognitive impairment,which is a safe and feasible treatment method.

Development of Intelligent Management System for Diabetes Medication Knowledge Base / 中国药师

Objective:To develop the intelligent management system for diabetes medication knowledge base with the help of community hospital information platform.Methods:Based on the China Type 2 Diabetes Prevention Guide (2013 edition),National Essential Drugs (2012 edition) and the relevant package inserts,the knowledge base of diabetes medication was established.Results:The information platform could make interception beforehand,warning in the process of medication and provide attentions for physicians after treatment to determine rational medication.Conclusion:The intelligent management system for diabetes medication knowledge base can promote physicians to firmly grasp the principles of drug treatment,simplify treatment regimen,select effective drugs with reasonable prices and provide individualized treatment.

Role and mechanism of microRNA-15b in the regulation of epithelial-mesenchymal transition of peritoneal mesothelial cells / 中华肾脏病杂志

Objective To explore the role and mechanism of microRNA-15b in the regulation of epithelial-mesenchymal transition (EMT) of human peritoneal mesothelial cells (HPMCs).Methods PCR assay was used to determine the expression of microRNA-15b in the HMrSV5 induced by 138mmol/L high glucose for 24 h.MicmRNA-15b mimic or inhibitor was transfected into human peritoneal mesothelial cells (HMrSV5) to over-express or down-regulate microRNA-15b.The cells were then incubated with 138 mmol/L high glucose for 24 h,and the expressions of E-cadherin(E-Cad),Vimentin (VIM),Fibronectin(FN) and Smad7 were detected by real-time PCR and Western blotting respectively.Results microRNA-15b in the HMrSV5 ceils was over-expressed and down-regulated.Increased level of microRNA-15b was obtained in HMrSV5 cells treated with high glucose.In vitro,high glucose led to the up-regulation of vimentin as well as fibronectin and the down-regulation of E-cadherin in HMrSV5 cells (all P ＜ 0.05),which indicated EMT and fibrosis.Suppression of microRNA-15b by transfection with microRNA-15b inhibitor partially reversed the EMT and fibrosis changes (P ＜ 0.05),while over-expression of microRNA-15b by transfection with microRNA-15b mimic obviously enhanced the EMT and fibrosis changes (P ＜ 0.05).Conclusions MicroRNA-15b mediates high glucose induced EMT in human peritoneal mesothelial cells by the inhibition of Smad7 possibly.MicroRNA-15b maybe a new target for the prevention and treatment of peritoneal fibrosis during peritoneal dialysis (PD).