| 1.BackgroundColorectal cancer is one of the most common malignant tumors that seriously affect human health.In 2014,the incidence rate of colorectal cancer was third in China,and the mortality rate was fifth.The GLOBOCAN 2020 cancer incidence rate and mortality estimates provided by the international agency for research on cancer show that in 2020,24.8 of 100 thousand people in China had colorectal cancer.At present,the recommendation of standardized diagnosis and treatment guidelines for colorectal cancer is still a multidisciplinary comprehensive treatment plan based on tumor staging.With the deepening of understanding of colorectal cancer and the attention to the quality of life and treatment outcome of patients in the treatment process,how to strengthen the perioperative management and accelerate the rehabilitation process of patients with curable colorectal cancer,gradually become a hot issue of clinical concern.In 2018,Professor Yang Yufei’s team of Xiyuan Hospital of China Academy of Chinese Medical Sciences was approved as a major difficult project of the State Administration of traditional Chinese medicine,namely the construction project of clinical cooperation ability of Chinese and western medicine for major difficult diseases(colorectal cancer)[No.medical administration letter of Chinese Medicine Office(2018)275].Professor Jia Xiaoqiang,tutor of Xiyuan Hospital of China Academy of Chinese Medical Sciences,and Professor Wu Aiwen,assistant tutor of Peking University Cancer Hospital,jointly undertake the sub topic of "study on the intervention scheme of integrated traditional Chinese and western medicine in perioperative period of colorectal cancer".Under the guidance of my tutor and assistant tutor,I have done some research on this topic.2.Objectivesa.To investigate the cognition of medical staff on the intervention measures of integrated traditional Chinese and western medicine in perioperative period of colorectal cancer;b.Explore the mechanism of acupoint application of traditional Chinese medicine in gastrointestinal dysfunction after colorectal cancer surgery based on network pharmacology;c.To evaluate the efficacy and safety of acupoint application of traditional Chinese medicine in perioperative period of colon cancer through randomized,double-blind and placebo study;d.To explore the application mode of integrated traditional Chinese and western medicine in perioperative period of colorectal cancer.3.Methodsa.Questionnaire survey:A cross-sectional survey was conducted to investigate the cognition of medical staff on the intervention measures of integrated traditional Chinese and western medicine in perioperative period of colorectal cancer.The online survey platform of "Tencent questionnaire"was used to create the questionnaire,and the research team members send the questionnaire QR code and questionnaire link to the respondents through WeChat or SMS.The questionnaire mainly covers the outcome indicators,the best intervention method,the best intervention time,the awareness of integrated Chinese and western medicine intervention and other issues.b.Network pharmacology research:The pharmacology database and analysis platform of traditional Chinese medicine system were used to retrieve the active ingredients and target information of traditional Chinese medicine Zubian paste.Using "gastroenteric dysfunction" as the key word,the targets of gastrointestinal dysfunction were screened in Gene cards database,NCBI gene database and OMIM database.The protein-protein interaction network was constructed,the key target information was screened by topological analysis,and then the biological process and pathway were analyzed.Finally,the active component target disease pathway network of traditional Chinese medicine Zubian paste was constructed.c.Clinical study:Prospective,randomized,controlled,placebo-controlled method was used to observe the patients who met the inclusion criteria in the gastrointestinal center of Peking University Cancer Hospital.The experimental group adopted the optimized scheme of integrated traditional Chinese and western medicine for colon cancer perioperative enhanced recovery after surgery.Based on the ERAS of gastrointestinal center of Peking University Cancer Hospital,the Chinese and western ERAS was formed by integrating the proven safe and effective acupoint application method of traditional Chinese medicine(TCM)in the ERAS of Xiyuan Hospital of China Academy of Chinese Medical Sciences.The control group was treated with Chinese and western ERAS,with the placebo zubian paste.After the patients were enrolled,the daily exhaust,defecation,urination,pain and complications were recorded,and tongue coating photos were saved.This clinical research protocol has passed the ethical review of Peking University Cancer Hospital,registered with clinical trials,and hired a third-party monitoring company to supervise.d.Qualitative research:Based on the above research,qualitative interviews were conducted with doctors,nurses,patients and their families in the gastrointestinal center of Peking University Cancer Hospital with the consent of the interviewees.The main topics of the interview were:Whether he or his family has a history of TCM diagnosis and treatment in the past,how the effect was and the attitude towards the development of traditional Chinese medicine and integrated traditional Chinese and western medicine.On this basis,this paper discusses the suggestions and methods of promoting the integration of traditional Chinese and western medicine in western medicine hospitals.4.Resultsa.Questionnaire research:A total of 255 questionnaires were distributed and 244 valid questionnaires were collected,covering 16 provinces in China.61.06%participants had graduate education;The hospitals working in the first-tier cities accounted for 72.95%;48.77%worked in TCM hospitals;86.89%of them worked in tertiary hospitals;TCM doctors accounted for 45.08%,western doctors 32.79%,nurses 14.34%;students accounted for 7.79%;51.64%the doctors have been engaged in this profession for more than 10 years.86.36%traditional Chinese medicine doctors thought that oral Chinese medicine was the best intervention,61.25%western medicine doctors recommended acupuncture,65.71%nurses suggested the moxibustion,and 73.68%medical students approved the oral Chinese medicine and enema.The medical staff in the first tier cities agreed that the intervention of traditional Chinese medicine within 7 days after operation and before operation was the best;Medical staff in non-first tier cities pay more attention to intervention treatment 7 days after surgery and within 24 hours after surgery.85.45%Chinese medicine doctors and 85%western medicine doctors were most concerned about the occurrence and treatment of complications;83.33%TCM nurses paid attention to the quality of life,the occurrence of complications,the recovery of exhaust function and defecation function;90.91%the nurses concerned about the quality of life;89.47%medical students were most concerned about the quality of life.91.82%Chinese medicine doctors,85.00%western medicine doctors,91.30%western medicine nurses,100%Chinese medicine nurses and students thought that it was necessary to combine the intervention measures of traditional Chinese medicine with the rehabilitation of patients with colorectal cancer.b.Network pharmacology research:The traditional Chinese medicine Zubian paste(Rhizoma Atractylodis,Radix Aucklandiae,Radix Angelicae dahuricae,Radix Gleditsiae,areca)in this research scheme was composed of 78 active components screened out in the pharmacology database and analysis platform of traditional Chinese medicine system,and 65 targets were obtained after unified naming and de duplication by UniProt database.3 366 genes were retrieved from Gene cards database,303 genes from NCBI database and 36 targets from OMIM database.After the combined deletion of genes in the three databases,3397 disease-related genes were obtained.The intersection of the target proteins of traditional Chinese medicine and the target proteins of gastrointestinal disorders was screened by Venn map,and 48 interaction targets were obtained.The PPI network of colorectal cancer target was constructed by string database,and the biological species was set as "Homo sapiens"to get PPI network.There are 48 nodes and 210 edges in the network,and the average degree is 8.75.Through the network analyzer tool for topology analysis,through the degree sorting,the genes with scores higher than the average score were selected as the key targets,and a total of 18 key targets were screened out.The biological processes,molecular functions and cell components of go were enriched to obtain 849 biological processes,74 of which were related to molecular functions and 25 to cell composition.The common targets of drug diseases were enriched by KEGG pathway analysis,and the items with corrected p value≤0.05 were screened,and a total of 73 signaling pathways were enriched.3.Clinical study:A total of 142 colon cancer subjects were included,and 10 patients were lost(2 cases were transferred to ICU after operation,4 cases were reddened,2 cases were rejected subjectively,and 2 cases were lost to follow-up).A total of 132 subjects completed the clinical study.There were no significant differences in age,gender,TNM stage,nerve invasion,vascular tumor thrombus and preoperative neoadjuvant therapy between the two groups(P>0.05).The baseline is comparable.Among the main outcomes,the complication rate of the experimental group was 15.63%;The complication rate of the control group was 23.53%,the experimental group was lower than the control group,but the difference was not so significant between them(P>0.05).In the secondary outcome indicators,the time of recovery of exhaust function and defecation function between the experimental group and the control group was significantly different(P<0.05).There was no significant difference in defecation time between the experimental group and the control group(P>0.05).There was no significant difference between the two groups(P>0.05).VAS score,the experimental group compared with the control group,pain relief effect was more obvious(P<0.05).There was no difference in length of stay between the two groups(P>0.05).During the study period,there was no abnormal safety index related to acupoint application of traditional Chinese medicine.According to the "skin reaction" in American NCI grading standard ctcae-5.0,there were 2 cases of grade I adverse reactions(skin redness)in the experimental group and 2 cases of grade I adverse reactions(skin pruritus)in the control group,which were improved after stopping the application treatment,no obvious abnormality was found at 30 days follow-up.4.Qualitative interview research:A total of 4 medical staff and 5 patients and their families were interviewed.Through the communication and discussion with them,it is found that they are more recognized to TCM and have had direct or indirect experience of TCM treatment.This paper summarizes the difficulties encountered in the implementation of rehabilitation programs of traditional Chinese medicine and integrated traditional Chinese and western medicine in western medicine hospitals,which mainly include the following aspects:(1)patients have doubts or do not recognize the curative effect of traditional Chinese medicine treatment,(2)the surgeons in western hospital have doubts or disapproval of TCM treatment,(3)western hospital was lack of TCM treatment qualification and related treatment personnel.To promote the development of traditional Chinese medicine,the strong support of government departments and the curative effect of traditional Chinese medicine were needed.5.ConclusionBefore this clinical study,literature review and mechanism confirmation were carried out.The clinical trials were registered on the International Trial Registration Platform and supervised by a third-party monitoring company,which ensured the reliability of the evidence level of evidence-based medicine in this study.According to the results of randomized,double-blind,placebo-controlled clinical trials,eras is safe and effective,which can accelerate the recovery of postoperative exhaust function and reduce the incidence of surgical complications to a certain extent.Compared with placebo,ERAS with Chinese medicine paste did not cause serious adverse events or aggravate the patient’s condition.In conclusion,western and Chinese eras regimen can benefit postoperative patients with colon cancer.The promotion of ERAS in China and the West needs to pay attention to the whole process follow-up of patients and the use of information platform.Traditional Chinese medicine hospital and western medicine hospital can complement each other through scientific research cooperation,clinical cooperation and teaching cooperation,so as to continuously improve the standardization level of traditional Chinese medicine and western medicine. |
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