Objectives: Most national standard therapeutic guidelines recommend a 52-week trastuzumab regimen for breast cancer treatment. In contrast, the Iranian national guideline (published by the Ministry of Health) recommends a nine-week regimen. We assessed the differences between current routine practice amongst Iranian specialists and the guidelines for trastuzumab treatment and HER2 receptor testing in breast cancer. MethOds: 128 Iranian hematology oncologists and radiotherapy oncologists were asked to complete an online anonymous questionnaire. Concurrently, a 3-year retrospective claims database analysis was conducted using data from the Social Security Organization, a health insurer which covers approximately 50% of the Iranian population, to enable comparisons with the questionnaire results. Results: With a 41% (52/128) response rate, doctors reported a relatively high absolute adherence (86%) to the guideline for HER2 receptor testing but a low rate of absolute adherence (6%) to the guideline for duration of trastuzumab treatment. Doctors indicated that the planned duration was 9 weeks in only 32% of patients; in most cases, the plan was 52-week treatment. Patients with a 9-week treatment plan received trastuzumab for 8.6 weeks on average while patients with 52-week plans received treatment for 29.2 weeks. The general trends found in the survey were confirmed in the claims database analysis of 830 HER2 positive patients. cOnclusiOns: When it comes to trastuzumab use, Iranian doctors appear to rely more on the medical literature than on national guidelines developed by the Ministry of Health. Policymakers, doctors and the general public should try to reach some consensus about the optimal way to treat eligible patients. This is particularly necessary in low-middle income countries, whose limited budget cannot easily accommodate all of the innovative technologies to come. Inventive reimbursement policies may form part of the solution as long as the experiences from other countries are examined.

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Background Researches and practice of Chinese medicine indicated that Agrimonia Pilosa Ledeb could improve insulin resistance (IR) and treat type 2 diabetes (T2DM). Flavonoid component (FC) was collected from Agrimonia Pilosa Ledeb. The aim of this study was to elucidate the effects of FC on glucose metabolism to improve IR by suppressing oxidative stress and inflammation. Methods By overdosed glucose and insulin or high-fat diet to establish adipocytes or mice IR model. The uptake of 2-NBDG and glucose consumption were measured to verify insulin sensitivity in vitro and vivo. Reactive oxidative species (ROS) were detected by flow cytometry, activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were also measured. Meanwhile, factors related to insulin signal pathway such as PPARγ, insulin receptor substrate-1 (IRS-1) and GLUT4, factors related to oxidative stress such as NF-E2-related factor 2 (Nrf2), and expression and secretion of inflammatory cytokines such as NF-κB, IL-1β, IL-6 and TNF-α were tested. Furthermore, the JNK/PI3K/Akt signal pathway were also explored. Results FC ameliorated the impaired glucose metabolism significantly. Further study indicated that FC could promote the expression related to insulin signal pathway to improve insulin resistance. What’s more, it could not only upregulated PPARγ with the similar efficacy as pioglitazone (Piog) straightway. But FC also decreased the endogenous ROS, lowered the content of MDA, increased the activity of SOD and expression of Nrf2 to facilitate oxidative homeostasis. It also attenuated expression and secretion of inflammatory cytokines obviously. At last, the underling mechanism JNK/PI3K/Akt pathway was improved in adipocytes and adipose tissue. Conclusion FC could ameliorate glucose metabolism and improve IR. It exerted these effects by suppressing oxidative stress and inflammation. FC from Agrimonia Pilosa Ledeb has a good prospect to be drugs or functional foods for IR and T2DM.