This paper explored the clinical thinking way in treating disease by integration of traditional Chinese and western medicine(ITCWM). In accordance with the challenge and problems the subject of ITCWM faced, the standard of diagnosis, treatment and evaluation of therapeutic response should be established. The combination of symptoms-differentiation with special prescription/drug for special disease to increase the accuracy of treatment is the developing direction for clinical medicine and ITCWM. Absorption and utilization of modern science and technique is the prerequisite for breaking through in ITCWM theory. The key of combining two different medical theories is to look for link joint.

The stem cell hypothesis for cancer suggests that only a specific subset of cancer cells within each tumor is responsible for tumor initiation and propagation,termed cancer stem cells(CSCs),which have a character of self-renewal and multilineage differentiation,and responsible for the recurrence,metastasis and resistance to therapy.The CSC of pancreatic cancer were isolated and identified in 2007,and recent data has been reported to confirm the change of the related signal pathway,the relationship with metastasis,therapy resistance and the puzzle.This review article summarizes the latest advances with regard to the pancreatic cancer stem cells.

Background and purpose:Advanced pancreatic cancer is characteristic of poor treatment eff icacy and short survival time. Gemcitabine is considered as front-line therapy for advanced pancreatic cancer. Gemcitabine combinations have shown a favorable impact on survival. We compared gemcitabine-based combination cheme therapy and gemcitabine(GEM) alone in patients with advanced pancreatic cancer through Meta analysis in phase Ⅲ clinical trials. Methods:MEDLINE and EMBASE searches were supplemented by information from trial registers of phase Ⅲ randomized controlled trials(RCTs) for GEM-based combination therapy and GEM alone for advanced pancreatic cancer. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available RCTs. The Meta-analysis involved 6-months and 1-year survival rate and objective remission rate(ORR) . Results:The Meta-analysis included 20 RCTs. The result of our Meta-analysis showed that there was signifi cant improvement in the GEM combination group with regard to the 1-year survival rate(RR:0.87,95%:(0.78,0.96) ,P=0.008) . The other result of our meta-analysis showed no signifi cant difference between two groups. Conclusion:GEM-based combination therapy may be effective with regard to the survival rate compared with GEM alone.

Purpose:To study the effect of the herbal decoction Qingyi Xiaoji Formula(QYXJ) on the proliferation of human pancreatic cancer cell line SW1990 in vivo and to explore the mechanism of its functions by means of cDNA microarray.Methods:Tumor-burdened nude mice were randomized into control group,5-FU group,and QYXJ groups at different dosages.After treatment,inhibiting rates of tumor growth were calculated.Tumor mRNA of the control group and the QYXJ group at moderate dose was extracted.The fluorescent cDNA probes were prepared,labeled with two different dyes Cy3 and Cy5,and then hybridized with cDNA microarray and scanned for fluorescent intensity.The genes with different expression were identified through the analysis of gene expression profile.Results:Inhibition rates of tumor growth in the QYXJ groups were 21.31%,38.16% and 29.09%,in the dose of 18 g/kg,36 g/kg,and 72 g/kg respectively.7 genes with reduced expression were identified,the functions of which were oncogene,protein translation and synthesis,DNA synthesis and repair,cell signal transduction,etc.Conclusions:QYXJ decoction may inhibit the proliferation of pancreatic cancer in vivo,possibly by blocking the action of an oncogene and its downstream signaling,or by regulation of protein synthesis in cancer cells.

OBJECTIVE: To observe the correlation between serum level of TXB2, 6-Keto-PGF1alpha and liver metastasis. METHODS: The metastatic model was made by injection of W256 carcinosarcoma. Rats were randomly divided into two groups: rats with blood stasis group and control group. Rats in control group were given normal saline via abdominal cavity once a day. Rats in blood stasis group were injected adrenalin in the fourteenth day. Tumor size and liver metastasis were observed. Serum TXB2 and 6-Keto-PGF1alpha were tested by radioimmunoassay. RESULTS: Tumor size in rats with blood stasis was significantly smaller than that of the control group (P<0.01). Occurrence of liver metastasis in rats with blood stasis was significantly lower than that of the control group (P<0.01). The values of 6-Keto-PGF1alpha, TXB2, and TXB2/6-Keto-PGF1alpha were higher in the group with blood stasis. CONCLUSION: In the status of blood stasis, W256 carcinosarcoma grows slowly, and liver metastasis increases insignificantly, with the elevations of 6-Keto-PGF1alpha, TXB2 and TXB2/6-Keto-PGF1alpha.

Objective To observe the efficacy of inhaled tiotropium bromide combined with budesonide/formoterol on reducing the frequency of acute episodes of symptom exacerbation and improving lung function,health status in chronic obstructive pulmonary disease (COPD). Methods Eighty-six patients with COPD were divided into 3 groups, combination group[29 cases, inhaled budesonide/formoterol (160 μg/4.5 μg, twice one day ) and tiotropium bromide ( 18 μg, once one day)], budesonide/formoterol group( 29 cases, 160 μg/4.5 μg, twice one day) and tiotropium bromide group(28 cases, 18 μg, once one day). The treatment continued for 3 months. Results Lung function, symptoms and health status improved obviously in three groups. The forced expiratory volume in one second (FEV1) of combination group after treatment was (1.24±0.18) L , which was improved by 11.7% compared with before treatment. It was significantly higher than that in budesenide/formoterol group and fiotropium bromide group (P < 0.01 ). The rescue medication consumptions and the times of acute episode of combination group were significantly decreased compared with those in the other groups,and there was significant difference (P <0.01). The SGRQ score of combination group was (35.6±13.9) points which was significantly lower than that of budesonide/formoterol group and tiotropium bromide group,and there was significant difference (P < 0.01 ).There was no statistical difference in the adverse events occurred in three groups (P > 0.05 ). Conclusions Combination treatment produces better control of symptoms and lung function and has no greater risk of sideeffects, compared with the treatment of budesonide/formoterol alone and tiotropium bromide alone. The combination treatment should be considered for patients with COPD.

Objective: To investigate the effects of Qingyi Huaji (QYHJ) decoction, a compound traditional Chinese herbal medicine, on tumor inhibition rate and serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) in nude mice with transplanted tumors of human pancreatic cancer. Methods: The tumor-bearing mice model was established by subcutaneously inoculating with xenografts of pancreatic cancer into the right armpit of 40 BALB/c nude mice. After successful modeling, the mice were randomly divided into untreated group (Arabic gum), capecitabine group, low-dose QYHJ decoction group (36 g/kg) and high-dose QYHJ decoction group (72 g/kg), with 10 mice in each group. Citrate buffer solution (containing 5% Arabic gum), capecitabine suspension and QYHJ decoction were administered to four groups by gavage respectively. After 5-week treatment, the concentrations of serum IL-6, IL-8 and TNF-alpha were examined by enzyme-linked immunosorbent assay (ELISA) using blood sample from eye socket. Then the mice were euthanized by cervical dislocation. Tumor weight and the tumor inhibition rate were calculated. Results: Tumor weight in the low-dose QYHJ decoction group decreased significantly as compared with the untreated group (P<0.05). Serum levels of IL-6 and TNF-alpha in low- and high-dose QYHJ groups were extremely significantly lower than those in the untreated group (P<0.01). Serum level of IL-8 in the low-dose QYHJ group was significantly lower than that in the untreated group (P<0.05). Correlation analysis showed that transplanted tumor weight of the mice was linearly positively correlated with serum levels of IL-6, IL-8 or TNF-alpha (P<0.01). Conclusion: Conventional dose of QYHJ decoction is effective in suppressing pancreatic carcinoma in nude mice. The mechanism may be related to down-regulation of serum cytokines such as IL-6, IL-8 and TNF-alpha.

Smoothened (SMO) is a member of sonic hedgehog homology (SHH) signaling pathway. It plays a key role as a bridge between patched-1 (PTCH-1) and Gli. Aberrant SHH expression can be detected in various malignant tissues, and the expression in pancreatic cancer stem cells is higher apparently. SHH signals are closely associated with self-duplication of cancer stem cells, formation of tumor vessels as well as matrixes. SMO antagonists such as cyclopamine, GDC-0449 and so on show potential to inhibit activity of SHH signaling, and arrest the growth as well as metastases of tumors. Recently, a few of SMO antagonists have been studied in phase I clinical trials and some are in phase II, meanwhile, phase I or II trials of SMO antagonists to treat pancreatic cancer are performed currently. As the classical SMO antagonist, cyclopamine is extracted from a medicinal plant. Perhaps researchers may be able to determine more effective SMO-targeting drugs from herbal medicines in the future.

To observe the effects of Shengmai Injection on enhancing efficacy and reducing toxicity of 5-fluorouracil (5-FU).