Neurological diseases encompass a wide range of conditions， and their incidence and mortality rates have been increasing year by year， severely endangering the health and lives of patients. Chaihu Guizhi Ganjiangtang is a recognized prescription formulated by ZHANG Zhongjing， which has a wide application in clinical practices. It exerts the effects of harmonizing and releasing Shaoyang， warming the spleen to dispel cold， and producing fluid and astringing Yin. Clinical studies have confirmed that Chaihu Guizhi Ganjiangtang， with modified herbs or in combination with acupuncture， moxibustion， or Western medicine， exhibits remarkable efficacy， minimal adverse reactions， and high safety in the treatment of neurological diseases such as insomnia， depression， anxiety disorders， dizziness， headache， perimenopausal syndrome （PMS）， diabetic peripheral neuropathy （DPN）， post-stroke restless legs syndrome （RLS）， bipolar disorders， and tic disorders in children. Modern pharmacological studies have pointed out that the main active ingredients of single herbs in the whole formula and composition of Chaihu Guizhi Ganjiangtang， such as saikosaponins， estradiol， cinnamaldehyde， baicalin， oroxindin， gingerol， 6-shogaol， glycyrrhizic acid， and liquiritin， can exert multi-target and multi-pathway effects， including reducing oxidative stress， alleviating neuroinflammation， inhibiting ferroptosis， microglial cell activation， and neuroapoptosis， and regulating neurotransmitter levels， estrogen levels， synaptic plasticity， neuronal autophagy level， and gluconeogenic metabolism. By reviewing relevant literature in recent years， this article summarized the clinical research and mechanism of action of Chaihu Guizhi Ganjiangtang in the treatment of neurological diseases and put forward corresponding suggestions， providing references for in-depth research.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

Objective:To investigate the frequency and severity of systemic reactions (SRs) to standardized house dust mite subcutaneous immunotherapy (SCIT) in patients with perennial allergic rhinitis (AR), and to analyze the clinical risk factors.Methods:The clinical data of 362 patients including 209 males and 153 females, aged from 5 to 55 years old receiving SCIT at the Department of Otorhinolaryngology, the Third People′s Hospital of Changzhou were collected from May 2014 to July 2017. The SRs were classified as early-onset and delayed-onset, and 4 grades (grade Ⅰ to Ⅳ) to assess severity. The records of SRs were retrospectively analyzed, including the numbers/frequencies, symptoms and signs, onset of reaction and treatment. And the relationships between SRs and patient′s age, gender, allergen injection dose, accompanied allergic diseases were explored. All the statistical analyses were conducted using SPSS 19.0.Results:There were 57 cases (15.75%) of SRs in 362 patients. All the patients received a total of 12 308 injections and 111 SRs (0.90%) were observed. Among them, 31 (27.93%) were early-onset reactions and 80 (72.07%) were delayed-onset reactions; most of the SRs were grade Ⅰ reactions ( n=83, 74.78%), followed by grade Ⅱ ( n=25, 22.52%), grade Ⅲ ( n=3, 2.70%), and no fatal reactions occurred. The incidence of SRs in patients>14 years old was higher than that in patients ≤14 years old according to the number of cases and injections (35.14% vs 13.54%, 2.34% vs 0.76%, χ 2 value was 11.679, 28.162, respectively, all P<0.05), but no significant differences of SRs were observed in gender (18.66% vs 11.76%, 5.98% vs 5.62%, χ 2 value was 3.166, 0.095, respectively, all P>0.05). Fifteen SRs (13.51%) occurred during the build-up phase and 96 (86.49%) during the maintenance phases. SRs could occur in lots of dose phases, and 95 (85.59%) were distributed at high concentrations more than 40 000 SQ-U. The incidence of SRs in patients with multiple allergic diseases was significantly higher than that in patients with AR alone, with asthma or atopic dermatitis (30.67% vs 11.85%, χ 2=15.875, P<0.001). Meanwhile, the incidence of SRs in patients with pure AR was also significantly lower than that in patients with other allergic diseases (5.26% vs 20.56%, χ 2=13.783, P<0.001). Conclusions:The incidence of SRs is less than 1% according to the injection times, the severity of SRs is mostly slight, and the safety and tolerance are good during standardized house dust mite SCIT in perennial AR patients. Delayed-onset SRs are more common. The incidence of SRs is significantly correlated with age, high dose of allergen vaccine injection, and concomitant other allergic diseases (asthma, atopic dermatitis, etc).

Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.

Objective To summarize the current status and trend of hypoglycemic agents of diabetic inpatients in different departments of Chinese PLA General Hospital.Methods The clinical data of diabetic patients admitted to Chinese PLA General Hospital from January 2000 to May 2014 were collected(those hospitalized in the department of endocrinology were excluded).A total of 10 041 patients were selected by stratified random sampling.The type of hypoglycemic agents in different departments and the variation on anti-hyperglycemic drugs with time were retrospectively analyzed.Results Of all the patients in non-endocrinological wards, 50.2% were treated with insulin, 36.9% with metformin, 21.3% with α-glycosidase inhibitor, and 18.9% with sulfonylureas.Metformin, α-glucosidase inhibitors, pre-mixed 30R, and insulin glargine were more commonly used than other anti-hyperglycemic agents, accounting for 36.9%, 21.0%, 14.0%, 8.7%, respectively.Metformin, sulfonylureas, α-glucosidase inhibitor, and different types of insulin were more widely applied in internal medicine while insulin therapy was more frequently used in surgical department.During the past 15 years, the proportions of insulin, glinides, α-glucosidase inhibitor, and thiazolidinediones application were gradually increased, while the proportions of sulfonylureas and metformin treatment were on the decline trend.Conclusion Most of the inpatients were treated with oral antidiabetic drugs.Metformin, α-glucosidase inhibitor, pre-mixed 30R, and insulin glargine were the most frequently prescribed agents for the inpatients.

Objective To evaluate the effect of intrathecal oxytocin on neuropathic pain in rats.Methods Thirty-six SPF male Sprague-Dawley rats,aged 4-6 weeks,weighing 100-150 g,were divided into 4 groups (n =9 each) using a random number table:control group (group C),neuropathic pain group (group NP),neuropathic pain plus normal saline group (group NPN) and neuropathic pain plus oxytocin group (group NPO).The neuropathic pain model was made by partial sciatic nerve injury in NP,NPN and NPO groups.In group NPO,oxytocin l0 μl (0.1 μg) was intrathecally injected on the day of establishing the model and 1 and 2 days after establishing the model,and then normal saline 10 μl was given for tube sealing at 9 a.m.and 4 p.m.every day.In group NPN,normal saline 20 μl was given for tube sealing at the corresponding time points.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before establishing the model and 1,2,3,4,5,6 and 7 days after establishing the model.The expression of the astrocyte marker glial fibrillary acidic protein (GFAP) and a specific marker of microglia ionized calcium-binding adaptor molecule 1 (IBa-1) was detected by Western blot at 1 day before establishing the model and 3 and 7 days after establishing the model.Results Compared with group C,the MWT was significantly decreased,TWL was shortened and the expression of GFAP and IBa-1 was up-regulated at each time point in NP and NPN groups (P＜0.05).There was no significant difference in MWT,TWL GFAP and IBa-1 at each time point between group NPN and group NP (P＞0.05).Compared with NP group,MWT was significantly increased at 2-4 days after establishing the model,TWL was prolonged at 1-4 days after establishing the model,the expression of IBa-1 was down-regulated on 3 days after establishing the model,and the expression of GFAP was downregulated on 3 and 7 days after establishing the model in group NPO (P＜0.05).Conclusion Oxytocin can reduce neuropathic pain,and the mechanism may be related to inhibiting activation of glial cells in the spinal cord of rats.

[Summary] There is a huge population of adults with pre-diabetes in China ,and the majority of whom are impaired glucose tolerance(IGT) patients. IGT is not only a risk factor for type 2 diabetes ,but is also closely related to diabetic microvascular and macrovascular complications. Preventing or delaying the development of diabetes by intervention on IGT has become imperative. When lifestyle intervention alone cannot achieve the ideal goal of diabetes prevention ,pharmacological intervention should be considered. This review will discuss thepathophysiology of IGT ,and the effectiveness ,safety and pharmacoeconomics of IGT pharmacological intervention.

Objective To evaluate the effectiveness and safety on once-daily (OD) insulin detemir (IDet) in Chinese patients with type 2 diabetes mellitus (T2DM) who were treated with different types or combinations of oral anti-diabetic drugs (OADs).Methods The SOLVETM study was a 24-week observational study on the initiation of IDet OD in T2DM patients with uncontrolled hyperglycemia on diet,exercise,and one or more OADs.Subjects were grouped based on the numbers of OADs taken before (＞ 2-OAD,2-OAD,and 1-OAD groups).Efficacy and safety endpoints were evaluated and compared in different groups.Results This study includes 3 272 patients,among them 464 (14.2％) were treated with more than 2OADs,1511 (46.2％) with 2OADs,and 1 218 (37.2％) with 1OAD before the study.The mean glycosylated hemoglobin A1c (HbA1c) was 8.4％,8.3％,8.4％ at baseline,and 7.3％,7.2％,7.1％ at the end of 24-week in each 3 groups (all P ＜0.001 vs.baseline values).The HbA1c reductions were not statistically significant different among groups.Body weight tended to decrease in patients from all groups,however,only that in the 2-OAD group reached statistically significance.No major hypoglycaemia events were reported.However,the overall minor hypoglycaemia rate in the 2-OAD group was higher at the end of the study than that at baseline (P ＜ 0.05).No differences in the rate of nocturnal minor hypoglycaemia were observed in all groups after IDet treatment.Conclusion Initiation of IDet OD was effective and well-tolerated in Chinese patients with T2DM whose glycemia was poorly controlled on OADs irrespective of the number of OADs taken before.(registration number NCT00825643)

Hyperthyroidism and acromegaly formed an unusual association.An acromegaly patient with a toxic thyroid adenoma was reported here,including clinical features,treatment,and final outcomes.The association of thyroid disease with acromegaly was reviewed.

Objective To assess the significance of insulin tolerance test(ITT) in clinical diagnosis of adult growth hormone deficiency(GHD).Methods Eighty-two patients with an established diagnosis of adult GHD [53males,29 females,mean age (30.9 ± 12.3) years (18-65 years)] were reviewed retrospectively for evaluating the GH response to ITT in the General Hospital of the People' s Liberation Army.Control data for peak GH after ITT were obtained in 15 healthy subjects [9 males,6 females,mean age (26.7 ± 5.6) years (22-41 years)].Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the diagnostic cut-off point of peak GH and GH increment response to ITT.Results (1) Mean peak GH response to ITT was significantly higher in 15 controls compared with 82 patients (the median 14 μg/L vs 0.62 μg/L,P =0.001).The cut-off point of the peak GH(chemiluminescent immunoassay,CLIA) response to ITT in adult GHD was 4.935 μg/L (AUC 0.993).(2) Mean GH increment was significantly higher in 15 controls compared with 82 patients (the median 13.17 μg/L vs 0.19 ug/L,P＜0.001).The cut-off point of the GH increment was 4.088 μg/L(AUC 0.937),with a 91.5％ sensitivity and 100％ specificity.(3) The peak GH showed even higher diagnostic value than the GH increment after ITT.(4)The above mentioned cut-off points (peak GH less than 4.935 μg/L and 5 μg/L) had a coincidence with a 95.1％ sensitivity and 100％ specificity,respectively.Conclusion The current guidelines for the diagnosis of adult GHD based on the optimal cut-off point of the peak GH(CLIA) response to ITT less than 5 μg/L turned to be of reliable diagnostic value in our country.