Effect of Chinese medicine Qinggan Huoxuefang on inducing HSC apoptosis in alcoholic liver fibrosis rats

AIM： To investigate the effect of Qinggan Huoxuefang （QGHXF） on improvement of liver function and pathology in rats, and to analyze the mechanism. METHODS： Wistar rats were divided into three groups at random： normal control group （12）, micro-amount carbon tetrachlodde group （CCh）（12） and model group A （60）. The model group A was ingested with the mixture （500 mL/L alcohol, 8 mL/kg per day; corn oil, 2 mL/kg per day; pyrazole, 24 mg/kg per day） once a day and intraperitoneal injections of 0.25 mL/kg of a 250 mL/L solution of CCh in olive oil twice a week for 12 wk. The CCh group received intraperitoneal injections only. At the end of 8 wk the model group A （60） was divided into 5 subgroups： model group, Xiaochaihu Chongji （XCH） group, QGHXF high dose group, moderate dose group and low dose group, and were given the drugs respectively. At the end of 12 wk, all the rats were killed and blood samples collected, as well as liver tissue. Blood samples were used for evaluation of alanine transaminase （ALT）, aspartate aminotransferase （AST）, alkaline phosphatase （ALP）, gamma-glutamyltransferase （y-GT）. Liver specimens were obtained for routine HE, apoptosis gene array and flow cytometry analysis. RESULTS： A liver fibrosis animal model was successfully established. Fibrosis was obviously reduced in QGHXF high dose group, and no fibrosis formed in CCh group. Compared with model group the QGHXF group and XCH group could obviously decrease the level of ALT, AST, ALP, and GGT （P〈0.05）. QGHXF high dose group was better than XCH group in ALT （615± 190 vs 867± 115）,and AST（1972 ± 366 vs 2777 ± 608）. Moreover, QGHXF could reduce liver inflammation, fibrosis-induced hepatic stellate cell （HSC） apoptosis and regulate apoptosis gene expression. The HSC apoptosis rates of QGHXF groups were 22.4±3.13, 13.79±2.26 and 10.07± 1.14, higher than model group, 6.58±1.04 （P〈 0.05）. Compared to model group, 39 genes were up-regulated, 11 solely expressed and 17 down-regulated in high dose group. CONCLUSION： QGHXF can improve liver fibrosis and induce HSC apoptosis.

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

BACKGROUND Infliximab trough level(ITL)severely affects therapeutic outcomes of Crohn’s disease(CD)patients under infliximab(IFX).Recently,frontier research has focused on identifying ITL based on different therapeutic targets.Although previous studies have elaborated clinical value of ITL monitoring on short-term outcomes in CD patients during therapy,studies contraposing the predictive value of ITL on long-term endoscopic outcomes in CD patients are still scarce domestically and overseas.AIM To explore the predictive value of ITL in combination with inflammatory biomarkers on long-term endoscopic outcomes in CD with clinical remission during IFX maintenance therapy.METHODS CD patients with endoscopic remission under long-term IFX maintenance therapy in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2012 to December 2020 were collected.ITL and inflammatory biomarkers were continuously monitored during the therapy.The Step I study was conducted from weeks 14 to 54 of IFX treatment.The Step II study was conducted from weeks 54 to 108 of IFX treatment.Endoscopic outcomes were defined as endoscopic activity(Crohn’s disease endoscopic index of severity score>2 points or Rutgeerts score>i1)and endoscopic remission(Crohn’s disease endoscopic index of severity score≤2 points or Rutgeerts≤i1).Endoscopic relapse free survival was defined as endoscopic remission at the beginning of the study stage and maintaining endoscopic remission during the study stage.RESULTS At week 14,low ITL[odds ratio(OR)=0.666,95%confidence interval(CI):0.514-0.862,P<0.01]and high fecal calprotectin(FCP)level(OR=1.002,95%CI:1.001-1.004,P<0.01)increased the risk of endoscopic activity at week 54.At week 54,low ITL(OR=0.466,95%CI:0.247-0.877,P<0.01)and high C-reactive protein(CRP)level(OR=1.590,95%CI:1.007-2.510,P<0.01)increased the risk of endoscopic activity at week 108.At week 14,ITL≤5.60μg/mL[area under the curve(AUC)=0.83,95%CI:0.73-0.90,P<0.001]and FCP>238μg/g(AUC=0.82,95%CI:0.72-0.89,P<0.001)moderately predicted endoscopic activity at week 54.ITL≤5.60μg/mL in combination with FCP>238μg/g indicated 82.0%possibility of endoscopic activity.At week 54,ITL≤2.10μg/mL(AUC=0.85,95%CI:0.72-0.93,P<0.001)and CRP>3.00 mg/L(AUC=0.73,95%CI:0.60-0.84,P=0.012)moderately predicted moderate endoscopic activity at week 108.ITL≤2.10μg/mL in combination with CRP>3.00 mg/L indicated 100.0%possibility of endoscopic activity.From weeks 14 to 54 of IFX treatment,patients with ITL>5.60μg/mL had higher rate of endoscopic relapse free survival than those with ITL≤5.60μg/mL(95.83%vs 46.67%).From weeks 54 to 108 of IFX treatment,patients with ITL>2.10μg/mL had higher rate of endoscopic survival free relapsed rate than those with ITL≤2.10μg/mL(92.68%vs 30.77%).CONCLUSION Combination of ITL,CRP,and FCP contribute to long-term endoscopic prognosis monitoring.During IFX maintenance treatment,low ITL,high CRP level,and high FCP level were independent risk factors of CD patients with clinical remission in adverse endoscopy outcomes within 1-year follow-up.

Effects of Integrative Chinese and Western Medicine on Arterial Oxygen Saturation in Patients with Severe Acute Respiratory Syndrome

Objective: To evaluate the effects of treatment of integrative Chinese and Western medicine (ICWM) on arterial oxygen saturation (SaO2) in patients with severe acute respiratory syndrome (SARS). Methods:The non-randomized, controlled trial was conducted on 447 SARS patients treated synchronously with western conventional treatment (WM group, n = 171) alone and ICWM (ICWM group, n = 276). The changes of the cases with normal level (≥95% ) or abnormal level (<95% ) SaO2 were observed dynamically. Results: In the 3rd-14th day of the therapeutic course, the percentage of patients with normal SaO2 in the ICWM group was higher than that in the WM group (OR = 0.5178, P = 0.0038), and this tendency was more evident in patients of the severe type (OR = 0. 18, P = 0. 0001). However, the statistical significance of difference was only shown in patients for whom the ICWM treatment started in the early period after the onset (≤7 days after it, OR = 0.3803, P = 0.006), but not shown in those who received ICWM treatment later in the mid-late period of SARS ( P>0. 05). Conclusion: ICWM treatment, particularly when it is used for intervention in the early stage, is beneficial for maintaining normal SaO2 in SARS patients.

XS0601 REDUCES THE INCIDENCE OF RESTENOSIS: A PROSPECTIVE STUDY OF 335 PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN CHINA

Background XS0601, consisting of active ingredients （Chuangxiongol and paeoniflorin）, has been shown to inhibit arterial neointimal hyperplasia in animal models and in preliminary human studies. The objective of this study was to evaluate the safety and efficacy of XS0601 in preventing restenosis following percutaneous coronary intervention （PCI）. Methods A multi-center, randomized, double-blind, placebo-controlled trial was conducted. A total of 335 patients were randomized into treatment with the oral administration of XS0601, or a placebo for 6 months after successful PCI. Angiographic follow-up was scheduled at 6 months, and clinical follow-ups performed at 1, 3 and 6 months after PCI. The primary end point was angiographic restenosis. The secondary end points were the combined incidence of death, target lesion nonfatal myocardial infarction, repeat angioplasty, and coronary artery bypass graft surgery. Results A total of 308 patients （91.9%） completed the study and 145 cases （47.1%） received angiographic follow-up. The restenosis rates were significantly reduced in the XS0601 group as compared with the placebo group （26.0% vs. 47.2%, P 〈 0.05）, and the minimum lumen diameter （MLD） was greater [（2.08 ± 0.89） mm for XS0601 vs. （1.73 ± 0.94） mm for placebo, P 〈 0.05]. XS0601 also significantly reduced the combined incidence of major adverse cardiac event （10.4% in the XS0601 group vs. 22.7% in the placebo group, P 〈 0.05）. The incidence of recurrent angina at 3 and 6 months after PCI was also significantly reduced in XS0601 group （7.1% and 11.0%） as compared with those in placebo group （19.5% and 42.9%） （P 〈 0.05）. No significant side effects occurred within the 6-month follow-up period in the XS0601 group.Conclusion Administration of XS0601 for 6 months is demonstrated to be safe and effective in reducing restenosis in post-PCI patients.

Effectiveness and safety of auricular acupoint bloodletting in treatment of insomnia:an assessor-blinded pilot randomized controlled trial

OBJECTIVE: To evaluate the effectiveness and safety of auricular acupoint bloodletting in treatment of insomniaMETHODS: Participants(n = 60) with insomnia were randomized into two groups to receive treatment of auricular acupoint bloodletting: low frequency group, 1 times/week for five weeks(n = 30);high frequency group, 2 times/week for two weeks(n = 30). The following outcomes were measured blindly at baseline, after first treatment, 4 weeks,and 8 weeks: Pittsburgh sleep quality index scale(PSQI).RESULTS: The groups were balanced at baseline for insomnia and demographic characteristics. There were no significant differences between the groups in terms of any of the outcomes, at the first follow-up time point. However, the therapeutic effect of LFG(once per week) is obviously lower than that of HFG(twice per week). In addition, there was no significant difference in the side effects between the two groups.CONCLUSION: The treatment of insomnia with different frequencies of auricular acupoint bloodletting is effective and has less side effects. More reasonable treatment frequencies are worth further study.

Syndrome Classification Based on Manifold Ranking for Viral Hepatitis

Treatment determination based on syndrome differentiation is the key of Chinese medicine. A feasible way of improving the clinical therapy effectiveness is needed to correctly differentiate the syndrome classifications based on the clinical manifestations. In this paper, a novel data mining method based on manifold ranking （MR） is proposed to explore the relation between syndromes and symptoms for viral hepatitis. Since MR could take the symptom data with expert differentiation and the symptom data without expert differentiation into the task of syndrome classification, the clinical information used for modeling the syndrome features is greatly enlarged so as to improve the precise of syndrome classification. In addition, the proposed method of syndrome classification could also avoid two disadvantages in previous methods： linear relation of the clinical data and mutually exclusive symptoms among different syndromes. And it could help exploit the latent relation between syndromes and symptoms more effectively. Better performance of syndrome classification is able to be achieved according to the experimental results and the clinical experts.

Xiyanping injection therapy for children with mild hand foot and mouth disease:a randomized controlled trial

OBJECTIVE: To evaluate the clinical effects of Xiyan-ping injection intervention in pediatric patients with mild hand foot and mouth disease(HFMD).METHODS: A total of 329 patients were stratified and block-randomized for symptomatic treatment of HFMD and assigned to one of the following groups: Western Medicine(group A, n = 103), Xiyanping injection(group B, n = 109), or Xiyanping injection and symptomatic treatment using Western Medicine(group C, n = 117). During the trial, fever,rash, ulcers of the mouth were observed among participants in each group before and after treatment, and conversion rates from mild to severe HFMD were measured.RESULTS: After 3-7 days' treatment, no significant differences in the conversion rates from mild to severe HFMD were observed among the three groups(P > 0.05). There was a significantly low number of patients with the onset time of antifebrile effect,vanished time of hand and foot rashes and cumulative time for the ulcers in the mouth vanished,among the three groups(P < 0.05, P < 0.01). The onset time of antifebrile effect of patients in groups B and C were markedly shorter compared with those in group A(P < 0.05, P < 0.01); there was no statically significant difference observed between groups B and C(P > 0.05). No significant differences were observed in the time for body temperature recovery among the three groups(P > 0.05). There were no significant differences in adverse effects among the three groups(P > 0.05).CONCLUSION: Xiyanping injection together with use of Western Medicine is most effective for symptomatic treatment of mild HFMD. No severe adverse reactions were observed.