Progress in research methods or strategies of compatibility mechanism of traditional Chinese medicine prescriptions / 中国药房

Compound formulas of traditional Chinese medicines （TCM）， also known as prescription in clinic， refers to a form of medication in which several TCMs are selectively combined according to the certain compatibility principles and the needs of patient’s condition， based on syndrome differentiation and treatment. At present， the methods and strategies for investigating the compatibility mechanisms of TCM prescriptions mainly focus on the following two aspects: analysis of pharmacological substances （including chemical composition analysis of TCM， ingredients of TCM analysis in blood， and pharmacokinetic analysis） and pharmacological signaling pathways analysis （involving network pharmacology analysis， signal pathway indicator detection， and metabolomics analysis）. In future research， the compatibility relationships of TCM prescriptions should be explored according to the principles of “Qiqing Hehe”，“ Shengjiang Fuchen”，“ Junchen Zuoshi”， and “Siqi Wuwei”. The regularity of TCM prescriptions compatibility should be shown in the change regularity of chemical components， pharmacokinetics， pharmacological pathways， and chemical compositions of various ratios of TCMs. Based on the insurance of holistic efficacy of TCM prescriptions， the underlying mechanisms of compatibility should be uncovered， which will provide references for the optimization of clinical applications of prescriptions and new directions for the creation of innovative TCM prescriptions.

Treatment of severe aplastic anemia and hematopoietic stem cell transplantation / 器官移植

Severe aplastic anemia (SAA) is a severe bone marrow failure syndrome caused by multiple causes, which is clinically manifested with severe anemia, infection and bleeding. The complex pathogenesis of SAA has not been fully understood. SAA is characterized with acute onset, severe disease condition and rapid progression. At present, with the in-depth study of SAA and the improvement of diagnosis and treatment, the therapeutic strategy for SAA has been evolved from classical immunosuppressive therapy based on antithymocyte globulin and cyclosporine to the application of thrombopoietin receptor agonist and combined treatment based on allogeneic hematopoietic stem cell transplantation, which may promote the reconstruction of hematopoietic function of SAA patients to varying degree and significantly improve survival and clinical prognosis, becoming the research hotspot of SAA treatment. In this article, new advances in the treatment of SAA at home and abroad were reviewed.

Analysis of incidence rate and influencing factors of thyroid nodules / 中国综合临床

Objective:To explore the relationship between the occurrence of thyroid nodules with normal thyroid function and age, sex, diet and thyroid related hormones.Methods:From February 2012 to November 2018, the data of 2 454 people who had thyroid nodule screening in Shijingshan Hospital of Beijing were analyzed retrospectively.All the data were classified and summarized to analyze the factors that may affect the occurrence of thyroid nodule.Results:In all 2 454 patients, 909 patients with Thyroid nodule were detected, the detection rate was 37.04%(909/2 454), the detection rate was 32.87%(164/499)in males and 38.11%(745/1 955) in females, which was significantly higher than that in males (χ 2=4.684, P=0.030). Multivariate Logistic regression analysis showed that gender ( OR 0.608, 95% P 0.0471-0.784), age ( OR 0.944, 95% CI 0.935-0.953), iodized salt intake ( OR 0.646, 95% CI 0.447-0.934), free triiodothyronine(FT)3 ( OR 1.562, 95% CI 1.374-1.775), free thyroxine (FT)4 ( OR 0.924, 95% CI 0.889-0.960), thyroid stimulating hormone(TSH) ( OR 1.111, 95% CI 1.059-1.167) (all P<0.05), were thyroid nodules independent risk factors of thyroid nodule.The seafood intake ( OR 0.867, 95% P 0.674-1.115, P=0.266) is not anindependent risk factor for thyroid nodules occur. Conclusion:The occurrence of thyroid nodule is closely related to many factors, among which gender, age, iodized salt intake, FT3, FT4 and TSH are the independent risk factors.

Clinical features and prognosis of acute myeloid leukemia patients with incomplete blood recovery at the time of achieving morphologic complete remission / 白血病·淋巴瘤

Objective To analyze the clinical features and prognosis of acute myeloid leukemia (AML) patients with incomplete blood recovery [platelet count (Plt) < 100 ×109/L or absolute neutrophil count (ANC)<1.0×109/L] at the first time of achieving morphologic complete remission(CR). Methods The clinical data of 302 AML patients (non-M3) who were treated at the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2015 were retrospectively reviewed. They were divided into CR group (Plt≥100×109/L and ANC≥1.0×109/L) and CR with incomplete blood recovery group (Plt<100×109/L or ANC<1.0 ×109/L) according to the condition of blood count at the first time of achieving morphologic CR. The clinical features and prognostic differences between the two groups were compared, and univariate analysis and mutivariate analysis were performed to compare the recurrence and survival of AML with incomplete blood recovery. Results Two hundred and sixteen (71.5%) patients were in CR group and 86 (28.5%) were in CR with incomplete blood recovery group. There was no statistically difference between the two groups in terms of age, high white blood cell, peripheral blasts ratio, France-American-Britain (FAB) type, cytogenetic risk classification and FLT3-ITD/NPM1 gene mutation (all P>0.05). Bone marrow blasts before therapy and the proportion of bone marrow CR in the first course of chemotherapy in CR group were higher than those in CR with incomplete blood recovery group (both P< 0.05), and the proportion of minimal residual disease (MRD) positive patients was lower in CR group (P=0.004). Bone marrow proliferation at the time of achieving morphologic CR was more active in CR group (P=0.001). The 3-year relapse rate in CR group was lower than that in CR with incomplete blood recovery group (P= 0.003), and overall survival (OS) rate and disease-free survival (DFS) rate were higher than those in CR with incomplete blood recovery group (both P< 0.05). Multivariate prognostic analysis for relapse, OS rate and DFS rate showed that high risk karyotype,≥2 courses of induction therapy and neutrophils not recovery were independent risk factors for AML patients with incomplete blood recovery (all P>0.05). In addition, FLT3-ITD positive was an independent risk factor for OS rate(P< 0.001), and peripheral blood blasts ≥0.60 was an independent risk factor for DFS rate (P= 0.047). Conclusions AML patients with incomplete blood recovery at the first time of achieving morphologic CR have a poor prognosis. AML patients with high-risk karyotype, ≥2 courses of induction therapy, incomplete neutrophils recovery may have a worse prognosis, and they should be regarded as high-risk groups and given more aggressive treatment.

Clinical Observation of Diltiazem Combined with Cyclosporine in the Treatment of Nephrotic Syndrome Complicated with Acute Renal Injury / 中国药房

OBJECTIVE:To observe therapeutic efficacies and safety of diltiazem combined with ciclosporine in the treatment of nephrotic syndrome complicated with acute renal injury. METHODS:A total of 66 patients with nephrotic syndrome and cute kid-ney injury were randomly divided into control group(30 cases)and observation group(36 cases). Control group was given routine treatment;observation group was additionally given Diltiazem hydrochloride tablet 5 mg orally,twice a day,and Ciclosporin soft capsules 1.5 mg/(kg·d)orally,twice a day. Treatment course of 2 groups lasted for 20 d. Clinical efficacies of 2 groups were ob-served. The serum creatinine and kidney injury molecule 1(KIM-1),24 h urine volume,24 h urine protein levels,AKI classifica-tion,follow-up and recurrence were observed before and after treatment as well as the occurrence of ADR. RESULTS:The remis-sion rate of observation group was significantly higher than that of control group,and recurrence rate was significantly lower than control group,with statistical significance(P0.05). After 2 weeks and 1 month of treatment of observatiom groups,and after 1 month of treatment of control group,serum creatinine levels,KIM-1 and 24 h urine protein of observation group were significantly lower than before treatment,and the observation group was significantly lower than the control group;24 h urine and the ratio of gradeⅠby AKI classification were significantly more than before treatment,and the observation group was significantly more than the control group,with statistical significance(P0.05). CONCLUSIONS:Based on routine treatment,diltiazem combined with ciclosporin shows significant therapeutic efficacy in the treatment of nephrotic syn-drome and acute renal injury with good safety.