Potential regulatory effects of stem cell exosomes on inflammatory response in ischemic stroke treatment

The high incidence and disability rates of stroke pose a heavy burden on society.Inflammation is a significant pathological reaction that occurs after an ischemic stroke.Currently,therapeutic methods,except for intravenous thrombolysis and vascular thrombectomy,have limited time windows.Mesenchymal stem cells(MSCs)can migrate,differentiate,and inhibit inflammatory immune responses.Exosomes(Exos),which are secretory vesicles,have the characteristics of the cells from which they are derived,making them attractive targets for research in recent years.MSC-derived exosomes can attenuate the inflammatory response caused by cerebral stroke by modulating damage-associated molecular patterns.In this review,research on the inflammatory response mechanisms associated with Exos therapy after an ischemic injury is discussed to provide a new approach to clinical treatment.

Benefit-Risk Assessment of Chinese Medicine Injections for Primary Liver Cancer Based on Multi-criteria Decision Analysis

ObjectiveTo evaluate the benefit-risk of 3 commonly used Chinese medicine injections, Aidi Injection (ADI), Cinobufagin Injection (CINI) and Compound Kushen Injection (CKI), in the treatment of primary liver cancer (PLC), so as to provide a reference for clinical decision-making.MethodsRandomized controlled trials (RCTs) of ADI, CINI and CKI in the treatment of PLC published in the databases of China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, SinoMed, PubMed, Cochrane Library, and Web of Science were retrieved from January 2020 to October 2022. The data of benefit and risk indicators were combined to obtain the effect value. The multi-criteria decision analysis (MCDA) model was applied to build the decision tree. The benefit value, risk value and benefit risk value of the 3 injections in PLC treatment were calculated. Monte Carlo simulation was carried out to calculate the 95% confidence interval and probability of differences among the 3 injections, so as to optimize the evaluation results.ResultsA total of 71 RCTs were included. The benefit values of ADI, CINI and CKI combined with transcatheter arterial chemoembolization (TACE) were 42, 38 and 36, respectively. The risk values were 42, 25 and 37, respectively. The benefit risk values were 42, 31 and 37, respectively. The benefit risk differences of ADI vs. CINI, ADI vs. CKI, and CKI vs. CINI were 11 (−0.86, 17.75), 5 (−5.01, 11.09), and 6 (−1.87, 12.63), respectively. The probability that ADI superior to CINI, ADI superior to CKI, and CKI superior to CINI was 96.26%, 77.27%, and 92.62%, respectively.ConclusionBased on the results of MCDA model, CINI combined with TACE has the greatest risk in the treatment of the PLC. Considering the efficacy and safety, the possible priority of the 3 Chinese medicine injections combined with TACE in the treatment of PLC is ADI, CKI and CINI.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Effectiveness of Chinese herbal medicine combined with conventional medicine on acute exacerbation of chronic obstructive pulmonary disease:a systematic review and Meta-analysis

OBJECTIVE:To systematically evaluate the efficacy and safety of Chinese herbal medicine(CHM) combined with conventional Western Medicine(CWM) on acute exacerbation of chronic obstructive pulmonary disease(AECOPD) based on high-quality randomized placebocontrolled trials.METHODS:We searched PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure Database,Chinese Biomedical Literature Database,China Science and Technology Journal Database,and Wanfang databases for randomized placebo-controlled trials of CHM treatment for AECOPD from inception to June 4,2021.The Cochrane Collaboration’s tool and the Grading of Recommendations,Assessment,Development and Evaluation were used to assess the risk of bias and the evidence quality of the included studies.Revman 5.3 software was used for Meta-analysis.RESULTS:A total of 9 trials involving 1591 patients were included.The Meta-analysis showed that based on CWM treatment,CHM group had significant advantages over the placebo group in ameliorating clinical total effective rate [RR = 1.29,95% CI(1.07,1.56),P = 0.007,low quality] and TCM symptom scores [MD =-2.99,95% CI(-4.46,-1.53),P < 0.0001,moderate quality],improving arterial blood gas results [PaO_(2):MD = 4.51,95% CI(1.97,7.04),P = 0.0005,moderate quality;PaCO_(2):MD =-2.87,95% CI(-4.28,-1.46),P < 0.0001,moderate quality],reducing CAT scores [MD =-2.08,95% CI(-2.85,-1.31),P < 0.000 01,moderate quality],length of hospitalization [MD =-1.87,95% CI(-3.33,-0.42),P = 0.01,moderate quality],and acute exacerbation rate [RR = 0.60,95% CI(0.43,0.83),P = 0.002,moderate quality].No serious CHM-related adverse events were reported.CONCLUSIONS:The current evidence indicates that CHM is an effective and well-tolerated adjunct therapy for AECOPD patients receiving CWM.However,considering the high heterogeneity,this conclusion requires confirmation.

Serum proteomic approach in patients with Qi deficiency and blood stasis syndrome in coronary heart disease:to explore therapeutic mechanism of Yiqi Huoxue decoction

OBJECTIVE To explore the curative effect and mechanism of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome.METHODS The patients with coronary heart disease of Qi deficiency and blood stasis syndrome were treated with Yiqi Huoxue decoction for 3 months,and the changes of cardiac function were observed.61 serum samples(including 29 cases of disease group and 32 cases of Yiqi Huoxue expression group)were analyzed by non labeled proteomics.The disease group was used as the control group,and the protein with expression level difference of more than 1.2 folds(P<0.05)was screened.The molecular function,biological pathway and protein interaction of the different proteins were analyzed by bioinformatics,so as to identify the molecular and biological pathway of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome.RESULTS Clinical treatment found that Yiqi Huoxue decoction can improve TCM syndrome score and left ventricular ejection fraction,regulate blood glucose and blood lipid levels,prolong thrombin time,and improve heart function.The results of proteomic quantitative analysis showed that there were 69 proteins with different expression levels in the disease group.Bioinformatics analysis results showed that Yiqi Huoxue decoction may regulate ApoA1,alpha-2 and other proteins to act on HDL assembly,platelet degradation,PI3K Akt signaling pathway,and then play a therapeutic role in coronary heart disease with Qi deficiency and blood stasis syndrome.CONCLUSION Yiqi Huoxue decoction can effectively improved the heart function decline caused by Qi deficiency and blood stasis syndrome of coronary heart disease.It mainly act on energy metabolism and platelet activation pathway by activating HDL assembly and platelet degradation signal pathway proteins.This study can provide reference for the follow-up treatment mechanism of Qi deficiency and blood stasis syndrome of coronary heart disease.

Correlation analysis of TCM syndrome types with T lymphocytes and biochemical indices in patients with HBV-related primary liver cancer

Objective:To investigate the correlation between T lymphocytes and biochemical indices in patients with Primary liver cancer(PLC)associated with hepatitis B virus(HBV)and TCM syndrome differentiation.Methods:263 HBV-related PLC patients who were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2018 to December 2019 were retrospectively collected.There were 127 cases of liver depression and spleen deficiency syndrome(48.3%),48 cases of spleen deficiency and dampness syndrome(18.3%),31 cases of liver and gallbladder dampness and heat syndrome(11.8%),35 cases of liver and blood stasis syndrome(13.3%),and 22 cases of liver and kidney Yin deficiency syndrome(8.4%).The general data,T cell subsets,oncology and virology indicators,oncology characteristics,biochemical indicators and other data were counted.Epidata and Excel were used to collect and summarize the data,and SPSS26.0 software was used for statistical analysis.Results:There was no significant difference in gender and age distribution among the five syndrome types(χ^(2)=5.462,F=1.979,ALL P>0.05).The differences among T lymphocyte count(χ^(2)=57.785,P<0.001),CD4(+)T cell count(χ^(2)=47.103,P<0.001)and CD8(+)T lymphocyte count(F=12.760,P<0.001)were statistically significant.The T lymphocyte count,CD4(+)T lymphocyte count and CD8(+)T lymphocyte explicit count in patients with liver and kidney Yin deficiency syndrome were significantly lower than those in the other four syndrome types.AFP(χ^(2)=89.986,P<0.001),CEA(χ^(2)=95.501,P<0.001),CA199(χ^(2)=30.044,P<0.001)of the five syndrome types increased successively from the syndrome of liver depression and spleen deficiency to the syndrome of liver and kidney Yin deficiency,and the difference was statistically significant.There were statistically significant differences in the inner diameter of main portal vein,portal vein cancer thrombin and extrahepatic metastasis among the five syndrome types(ALL P<0.001).The main symptoms of portal vein cancer thrombin and extrahepatic metastasis were liver-gallbladder dampness-heat syndrome and liver-blood stasis syndrome.The differences among PLT(χ^(2)=39.234,P<0.001),Alb(χ^(2)=75.171,P<0.001),TBil(χ^(2)=51.140,P<0.001),AST(χ^(2)=55.881,P<0.001),PT(χ^(2)=21.515,P<0.001)were statistically significant.PLT and Alb decreased successively from the syndrome of liver depression and spleen deficiency to the syndrome of liver and kidney Yin deficiency.PLT and Alb of the syndrome of liver depression and spleen deficiency were significantly higher than those of the other four groups,and TBil and AST of the syndrome of liver and gallbladder dampness and heat were significantly higher than those of the other four groups.PT of liver and kidney Yin deficiency was significantly higher than that of the other four groups.The lymphocyte count,CD4(+) lymphocyte count and CD8(+) lymphocyte count were negatively correlated with AFP,PT and TBil(ALL P<0.05),and positively correlated with PLT(P<0.05).T lymphocyte count was positively correlated with AIb(P<0.05).Conclusion:This study found that patients with liver depression and spleen deficiency syndrome have better cellular immune function,liver function and prognosis.Patients with liver and kidney Yin deficiency have lower cellular immunity,worse liver function,and worse prognosis.Portal vein carcinoma embolus and extrahepatic metastasis were mainly characterized by dampness and heat of liver and gallbladder and blood stasis of liver.Patients with lower lymphocyte counts have poorer blood clotting,worse the liver reserve,and the higher the risk of further cancer.

Ultrasound features of primary non-Hodgkin’s lymphoma of the palatine tonsil:A case report

BACKGROUND Lymphomas are the second most common malignancy of the head and neck.In this region,the vast majority of extranodal lymphomas are located in the palatine tonsil,accounting for about 51%.Tonsillar lymphomas are aggressive tumors with intermediate-or high-grade histology.We here report a case of primary non-Hodgkin’s lymphoma of the palatine tonsil and analyze its ultrasound features.CASE SUMMARY A 40-year-old man presented with right palatine tonsil swelling for 2 mo after a cold,accompanied by dysphagia,snoring,and suffocation.He had no sore throat,fever,or history of upper respiratory tract infection or tuberculosis.The patient was generally in good health and denied other diseases.He was diagnosed with acute tonsillitis initially and treated with antibiotics for 7 d.However,there was no improvement with the treatment.Tonsil biopsy and ultrasound-guided biopsy of the biggest lymph node of the right neck showed the typical pathology of non-Hodgkin lymphoma.CONCLUSION Primary lymphoma of the tonsils is rare,and its diagnosis is challenging.Ul-trasound is a useful modality in diagnosing oropharyngeal diseases,and can clearly show the features of this tumor,but the final diagnosis should be estab-lished by histology.

Mechanism of Yinchenhao decoction in the treatment of jaundice based on network pharmacology

Objective:This study aimed to examine the mechanism of classic ancient prescription of Chinese medicine Yinchenhao decoction in treating jaundice based on network pharmacology.Method:An oral bioavailability of≥30%,a drug likeness of≥0.18,and literature studies were used to screen for Yinchen(Artemisiae scopariae herba),Zhizi(Gardeniae fructus),Dahuang(Rhei radix et rhizome)in the Chinese Medicine System Pharmacology Database and Analysis Platform.The active ingredient was introduced into the PubChem database to collect drug component targets and import into the Uniprot database for gene standardization.The target gene of Yinchen(Artemisiae scopariae herba)was screened via Human Gene Database(GeneCards).Then,use the Cytoscape 3.7.2 software was used for network visualization analysis,and the R3.6.1 software was used for gene ontology functional and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses.Results:We collected a total of 47 active constituents of classic ancient prescription of Chinese medicine Yinchenhao decoction,of which 17 were related to jaundice;189,9 targets of jaundice were screened,of which 41 were interdigitated with the targets of classic ancient prescription of Chinese medicine Yinchenhao decoction.Gene ontology functional enrichment analysis revealed 111 biological processes,14 cellular components,and 28 molecular functions,and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis showed 34 Kyoto Encyclopedia of Genes and Genomes pathways including hepatocellular carcinoma,PI3K-Akt signaling pathway,HIF-1 signaling pathway,prolactin signaling pathway,and non-alcoholic fatty liver disease.Conclusion:Based on the network pharmacology,the analysis of jaundice and classic ancient prescription of Chinese medicine Yinchenhao decoction provides a novel idea and direction for the study of classic ancient prescription of Chinese medicine Yinchenhao decoction in the treatment of jaundice.

Compound Kushen injection combined with chemotherapy in the treatment of gastric cancer: a meta-analysis of randomized controlled trials

Objective: This study aims to systematically evaluate the efficacy and safety of compound kushen injection (CKI) in combination with chemotherapy in patients with gastric cancer (GC). Methods: A comprehensive electronic search was conducted by searching PubMed, EMBASE, Cochrane Library, Chinese Biological Medical disc, China National Knowledge Infrastructure and Wanfang databases (the last update January 20, 2018). All randomized controlled trials (RCTs) of CKI plus chemotherapy versus chemotherapy alone in GC patients were identified. The quality of each study was evaluated using the Jadad’s scale, and the meta-analysis was performed using Review Manager 5.3 and STATA 14 software. Results: A total of nine studies on 688 cases were included in this study. The results showed that CKI combined with chemotherapy had a better effect on improving patients’ overall response rate (ORR) and life quality. The consequences of Egger’s and Begg’s tests showed there was no significant publication bias. Conclusion: The current evidence showed that CKI may enhance the clinical efficacy of chemotherapy, improve the quality of life and increase the safety in patients with gastric cancer.

Construction of an Early Warning Model for Ischemic Stroke Recurrence Based on Generalized Estimating Equation

Objective:To explore the appropriate modeling method of the early warning model of ischemic stroke recurrence in TCM.Methods:This was a prospective,multi-center and registered study conducted in 7 clinical subcenters from 8 provinces and 10 cities in China between 3rd November 2016 and 27th April,2019.1,741 patients with first-ever ischemic stroke were recruited.Univariate analysis was carried out using distance correlation coefficient,mutual information entropy,and statistical correlation test.Multivariate analysis adopted multi-factor Cox regression model and combined with expert opinions in the field of stroke to determine modeling variables.The generalized estimating equation of longitudinal data and the Cox proportional hazard regression model of cross-sectional data were used to construct and compare in the early warning model of ischemic stroke recalls.The area under the ROC curve(AUC value)was used to evaluate the early warning capability of the model.Results:The follow-up time was 1-3 years,and the median follow-up time was 1.42 years(95%CI:1.37-1.47).Recurrence events occurred in 175 cases,and the cumulative recurrence rate was 10.05%(95%CI:8.64%-11.47%).The AUC values of the TCM syndrome and TCM constitution model were 0.71809 and 0.72668 based on the generalized estimating equation and the AUC values.Conclusion:The generalized estimating equation may be more suitable for the construction of early warning models of stroke recurrence with TCM characteristics,which provides a certain reference for the evaluation of secondary prevention of ischemic stroke.

Risk Factors Associated with Recurrence within 90 Days of Ischemic Stroke Onset in Chinese Medicine Hospital: A National Cross-Sectional Study in China

Objective:The short-and long-term risk factors for stroke recurrence may be different.This study is aimed to determine the risk factors for recurrence within 90 days in patients with ischemic stroke in China.Method:This was cross-sectional registry-based study in Chinese medicine hospitals from eight provinces and ten cities in China between November 3,2016 and May 28,2018.Two thousand one hundred and twenty patients with ischemic stroke aged between 35 and 80 years.Stroke recurrence was defined as an outcome indicator.Computed tomography/magnetic resonance imaging was used as a diagnostic tool for stroke recurrence.Patients’age,sex,height,weight,body mass index(BMI),education level,medical history,family history,smoking,and drinking were recorded.Routine laboratory examinations were performed.Associated factors were investigated by calculating the odds ratio(OR)using logistic regression modeling.Results:In all,2120 patients were included in the study,712(33.6%)of whom were women and 1408(66.4%)were men,with a mean age of 62.84±9.35 years.Eighty-two patients experienced stroke recurrence within 90 days,and the accumulative recurrence rates of stroke were 3.9%(95%confidence interval[CI],3.0%–4.7%).The binary logistic analysis showed that previous history of one(OR=8.113;95%CI,4.497–14.637),two(OR=8.848;95%CI,4.025–9.449),or≥3 ischemic strokes(OR=24.599;95%CI,9.307–65.018),and BMI<18.5 kg/m2(OR=2.842;95%CI,1.000–8.075)were independently associated with stroke recurrence within 90 days.Conclusions:The accumulative recurrence rate of ischemic stroke was 3.9%within 90 days.Number of previous history of ischemic stroke and BMI<18.5 kg/m2 were independent risk factors for stroke recurrence.Medical history and solar terms of ischemic stroke were not found to be associated with stroke recurrence within 90 days.Effective secondary prevention for patients with a previous history of ischemic stroke is urgently needed to address this stroke recurrence burden.

Efficacy of scraping therapy on blood pressure and sleep quality in stage Ⅰ and Ⅱ essential hypertension: A systematic review and meta-analysis

Background Scraping therapy is widely used in treating stage I and II essential hypertension in China.However,there has been no systematic evaluation of the efficacy of scraping therapy on blood pressure and sleep quality in stage I and II essential hypertension.Search strategy Seven electronic databases(PubMed,Scopus,Cochrane Library,Web of Science,EBSCO,China National Knowledge Infrastructure and Wanfang Data electronic databases)were searched from inception to December 2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“scraping therapy,”“scraping,”“Guasha,”“Gua sha,”“hypertension,”and“high blood pressure”during the database searches.Inclusion criteria Randomized controlled trials(RCTs)were included if they recruited patients with stage I and II essential hypertension and included a scraping therapy intervention.The intervention group received antihypertensive drugs and scraping therapy,while the control group only took antihypertensive drugs.Data extraction and analysis Review Manager 5.4.0 and STATA 15.1 were used to enter all the relevant outcome variables to conduct the meta-analysis.The quality of the selected RCTs was assessed using the PEDro scale.The sensitivity analysis was carried out by iteratively excluding individual studies and repeating the analysis to determine the stability of the findings and identify any studies with greater influence on the outcome.Subgroup analysis was performed to find the source of heterogeneity.Funnel plots were used to evaluate the publication bias of included studies.Results Nine RCTs including 765 participants were selected.Meta-analysis showed that scraping therapy combined with medication had an advantage over the use of medication alone in lowering systolic blood pressure(mean difference[MD]=?5.09,95%confidence interval[CI]=?6.50 to?3.67,P<0.001)and diastolic blood pressure(MD=?2.66,95%CI=?3.17 to?2.14,P<0.001).Subgroup analysis showed that scraping therapy improved sleep quality in middle-aged patients with hypertension,but the efficacy was better in elderly patients(MD=?7.91,95%CI=?8.65 to?7.16,P<0.001)than in middle-aged patients(MD=?2.67,95%CI=?4.12 to?1.21,P=0.0003).Conclusion The available evidence indicates that scraping therapy has significant effects on patients with stage I and II hypertension,and it improves sleep quality for elderly patients with hypertension better than for middle-aged ones.Scraping therapy can be an adjunctive treatment for stage I and II essential hypertension.However,further high-quality studies are needed to verify its effectiveness and the best therapeutic strategies.

Efficacy and safety of Weichang’an pill(胃肠安丸)combined with Western Medicine on gastrointestinal diseases:a systematic review and Meta-analysis

OBJECTIVE:To systematically evaluate the efficacy and safety of Weichang’an pill(胃肠安丸,WCA)combined with Western Medicine(WM)for the treatment of gastrointestinal diseases.METHODS:Eight databases,including China National Knowledge Infrastructure Database,Wanfang Data,China Science and Technology Journal Database,SinoMed,PubMed,Web of Science,Cochrane Library,and Embase,were searched for randomized controlled trials(RCTs)of WCA from inception to 30 September 2021.We independently screened the literature,extracted data,and then evaluated the bias risk,effectiveness,safety,and other indicators of the included articles.RESULTS:A total of 33 RCTs were included in this study with 3368 patients.After analysis,it was found that WCA combined with WM could effectively prevent and treat antibiotic-associated gastrointestinal reaction,functional dyspepsia(FD),irritable bowel syndrome,rotavirus diarrhea(RVD),and ulcerative colitis(UC);no serious adverse reactions occurred.Moreover,compared with the control group,the experimental group showed significantly improved symptoms and some biochemical parameters.CONCLUSIONS:WCA combined with WM for the treatment of gastrointestinal diseases had better clinical efficacy than the control group,without serious adverse reactions.Notably,in the treatment of FD,RVD,and UC,WCA improved clinical symptoms and biochemical indicator expression.Nevertheless,owing to the restricted quality and quantity of the literature,the results need to be further studied using high-quality RCTs.

Effect of Comprehensive Therapy based on Chinese Medicine Patterns on Self-Efficacy and Effectiveness Satisfaction in Chronic Obstructive Pulmonary Disease Patients

Objective: To evaluate the effect of comprehensive therapy based on Chinese medicine(CM) patterns on self-efficacy and satisfaction with its effectiveness in patients with chronic obstructive pulmonary disease(COPD). Methods: A total of 216 patients were randomly divided into the trial group(n=108) and the control group(n=108) based on the stratified and block randomization design. Patients in the trial group were treated with conventional Western medicine combined with Bufei Jianpi Granules(补肺健脾颗粒), Bufei Yishen Granules(补肺益肾颗粒), and Yiqi Zishen Granules(益气滋肾颗粒) according to the CM patterns respectively, and patients in the control group were treated with conventional Western medicine. The COPD Self-Efficacy Scale(CSES) and the Effectiveness Satisfaction Questionnaire for COPD(ESQ-COPD) were employed in a 6-month treatment and in further 6 month follow-up visit. Results: Among the 216 patients, 191 patients(97 in the trial group and 94 in the control group) fully completed the study. After 12-month treatment and follow-up, the mean scores of the trial group all continued to increase over time, which were significantly higher than those of the control group(P<0.05), and the improvement in the following trial group domain: negative affect domain(12.13%), intense emotional arousal domain(12.21%), physical exertion domain(11.72%), weather/environmental domain(13.77%), behavioral risk domain(7.67%) and total score(10.65%). The trial group also exhibited significantly higher mean scores in the ESQ-COPD(P<0.05) and the improvement in the following domain: capacity for life and work domain(30.59%), clinical symptoms domain(53.52%), effect of therapy domain(35.95%), convenience of therapy domain(35.54%), and whole effect domain(52.47%). Conclusions: Bufei Jianpi Granules, Bufei Yishen Granules and Yiqi Zishen Granules can improve the self-efficacy and satisfaction of COPD patients.

Clinical efficacy of comprehensive therapy based on traditional Chinese medicine patterns on patients with pneumoconiosis: a pilot double-blind, randomized, and placebo-controlled study

Effective therapy options for pneumoconiosis are lacking.Traditional Chinese medicine(TCM)presents a favorable prospect in the treatment of pneumoconiosis.A pilot study on TCM syndrome differentiation can evaluate the clinical efficacy and safety of TCM and lay a foundation for further clinical research.A double-blind,randomized,and placebo-controlled trial was conducted for 24 weeks,in which 96 patients with pneumoconiosis were randomly divided into the control and treatment groups.Symptomatic treatment was conducted for the two groups.The treatment group was treated with TCM syndrome differentiation,and the control group was treated with placebo.The primary outcomes were the six-minute walking distance(6MWD)and the St.George Respiratory Questionnaire(SGRQ)score.The secondary outcomes were the modified British Medical Research Council Dyspnea Scale(mMRC),Chronic Obstructive Pulmonary Disease Assessment Test(CAT),Hospital Anxiety and Depression Scale(HADS),and pulmonary function.Only 83 patients from the 96 patients with pneumoconiosis finished the study.For the primary outcome,compared with the control groups,the treatment group showed a significantly increased 6MWD(407.90 m vs.499.51 m;95%confidence interval(CI)47.25 to 135.97;P<0.001)and improved SGRQ total score(44.48 vs.25.67;95%CI 27.87 to 9.74;P<0.001).The treatment group also significantly improved compared with the control group on mMRC score(1.4 vs.0.74;95%CI 1.08 to 0.23;P=0.003),CAT score(18.40 vs.14.65;95%CI 7.07 to 0.43;P=0.027),and the total symptom score(7.90 vs.5.14;95%CI 4.40 to 1.12;P<0.001).No serious adverse events occurred.This study showed that TCM syndrome differentiation and treatment had a favorable impact on the exercise endurance and quality of life of patients with pneumoconiosis.

Traditional Chinese medicine in the treatment of idiopathic pulmonary fibrosis based on syndrome differentiation:Study protocol of an exploratory trial

Background: Idiopathic pulmonary fibrosis(IPF) has a poor prognosis and is often a kind of heavy financial burden to patients. Currently, few treatments are available for IPF. Clinical practice of traditional Chinese medicine(TCM), using a syndrome differentiation approach, offers some treatment success in IPF. However, there is no sufficient evidence-based study of the role of TCM in IPF management to make strong conclusions. This study evaluates the efficacy and safety of TCM in the treatment of IPF.Methods and design: A multicenter, exploratory, randomized, double-blind and placebo-controlled trial is planned. A total of 80 patients will be enrolled in the study, which will include 26 weeks of treatment.Participants will be randomly assigned into TCM group or control group in a 1:1 ratio. The TCM group will be given TCM granules based on syndrome differentiation. Formulae include Bao-fei Hua-xian granule for lung qi deficiency, Jin-shui Huan-xian granule for lung-kidney qi deficiency and Yang-qing Kang-xian granule for yin deficiency and inner heat. The control group will be given a corresponding TCM granule placebo. The efficacy and safety of interventions will be evaluated by the outcome variables,including frequencies of acute exacerbations, pulmonary function, clinical symptoms, dyspnea, healthrelated quality of life(HRQo L), 6-minute walk distance and safety indicators.Discussion: It is hypothesized that TCM will decrease the frequency of adverse events, improve pulmonary function and HRQo L, based on our clinical experience. This trial is the first study of TCM treatment in IPF that is based on syndrome differentiation and will evaluate the efficacy and safety of TCM in IPF.

Potential Mechanisms and Effects of Chinese Medicines in Treatment of Diabetic Atherosclerosis by Modulating NLRP3 Inflammasome:A Narrative Review

Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3(NLRP3)is an intracellular sensor that detects endogenous danger signals and environmental irritants to assemble into the NLRP3 inflammasome.Activation of the NLRP3 inflammasome leads to the secretion of the proinflammatory cytokines interleutkin(IL)-1β and IL-18 and induces pyroptosis.Recent studies have shown that the NLRP3 inflammasome participates in the initiation and progression of diabetic atherosclerosis through pathological mechanisms such as β-cell dysfunction,insulin resistance,endothelial cell dysfunction,monocyte adhesion and infiltration,and smooth muscle cell proliferation and migration.In diabetic atherosclerosis,Chinese medicine has been proven effective for the inflammatory response mediated by the NLRP3 inflammasome.This review summarizes the latest progress on the NLRP3 inflammasome in the pathogenesis and potential Chinese medicine treatment of diabetic atherosclerosis.

Effectiveness and safety of Pingxiao capsule(平消胶囊)as adjuvant therapy in treatment of breast cancer:a systematic review and Meta-analysis

OBJECTIVE:To systematically review the effectiveness and safety of Pingxiao capsule(平消胶囊)adjuvant chemotherapy in the treatment of breast cancer.METHODS:A total of 8 databases including the Cochrane Library,PubMed,EMBASE,Engineering Index,Chinese Biomedical Literature Database,Wanfang database,China National Knowledge Infrastructure Database,and China Science and Technology Journal Database were searched for the Randomized Controlled Trials(RCTs)of Pingxiao capsule combined with chemotherapy in the treatment of breast cancer published before June 2022.Two researchers independently screened the literature,extracted data,and evaluated the risk of bias.R language was used for estimating risks of bias of included studies,data analysis,and plotting.RESULTS:A total of 15 RCTs involving 1272 patients were included in this study.Meta-analysis results indicated that compared with chemotherapy alone,Pingxiao capsule combined with chemotherapy could significantly improve breast cancer patients'objective response rate of breast cancer patients[rate ratio(RR)=1.35,95%confidence interval(CI)(1.12,1.63),P=0.0017],the disease control rate[RR=1.16,95%CI(1.08,1.25),P<0.0001],the quality of life[RR=1.42,95%CI(1.16,1.74),P=0.007],and the level of the immune cells[CD3+:standardized mean difference(SMD)=1.42,95%CI(0.76,2.09),P<0.001;CD4+:SMD=1.18,95%CI(0.70,1.66),P<0.001].In addition,Pingxiao capsule combined with chemotherapy can also significantly reduce CD8+level(P<0.0001)and reduce the symptoms of decreased white blood cell count[SMD=0.62,95%CI(0.39,0.85),P<0.0001],and the occurrence of adverse reactions such as gastrointestinal adverse reactions and limb pain(P<0.05).CONCLUSIONS:Pingxiao capsule can significantly improve the efficacy of chemotherapy,the quality of life and immune function of patients,and reduce the clinical side effects caused by chemotherapy.However,highquality randomized clinical trials with large samples are required for further verification of these results.

Chemical approaches for the stereocontrolled synthesis of 1,2-cis-β-D-rhamnosides

In carbohydrate chemistry,the stereoselective synthesis of 1,2-cis-glycosides remains a formidable challenge.This complexity is comparable to the synthesis of 1,2-cis-β-D-mannosides,primarily due to the adverse anomeric andΔ-2 effects.Over the past decades,to attainβ-stereoselectivity in D-rhamnosylation,researchers have devised numerous direct and indirect methodologies,including the hydrogen-bond-mediated aglycone delivery(HAD)method,the synthesis ofβ-D-mannoside paired with C6 deoxygenation,and the combined approach of 1,2-trans-glycosylation and C2 epimerization.This review elaborates on the advancements inβ-Drhamnosylation and its implications for the total synthesis of tiacumicin B and other physiologically relevant glycans.

Efficacy and safety of Kangxian Huanji Granule as adjunctive treatment in acute exacerbation of idiopathic pulmonary fibrosis:An exploratory randomized controlled trial

Background:Acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF)is an important occurrence in the natural history of idiopathic pulmonary fibrosis(IPF),associated with high hospitalization rates,high mortality and poor prognosis.At present,there is no effective treatment for AE-IPF.Chinese herbal medicine has some advantages in treating IPF,but its utility in AE-IPF is unclear.Objective:The treatment of AE-IPF with Kangxian Huanji Granule(KXHJ),a compound Chinese herbal medicine,lacks an evidence-based justification.This study explores the efficacy and safety of KXHJ in patients with AE-IPF.Design,setting,participants and interventions:Wedesigned a randomized,double-blind,placebo-controlled,exploratory clinical trial.A total of 80 participants diagnosed with AE-IPF were randomly assigned to receive KXHJ or a matching placebo;the treatment included a 10 g dose,administered twice daily for 4 weeks,in addition to conventional treatment.Participants were followed up for 12 weeks after the treatment.Main outcome measures:The primary endpoints were treatment failure rate and all-cause mortality.Secondary endpoints included the length of hospitalization,overall survival,acute exacerbation rate,intubation rate,the modified British Medical Research Council(mMRC)score,and the St George’s Respiratory Questionnaire for IPF(SGRQ-I)score.Results:The rate of treatment failure at 4 weeks was lower in the intervention groupcompared to the control group(risk ratio[RR]:0.22;95%confidence interval[CI]:0.051 to 0.965,P=0.023).There was no significant difference in all-causemortality at 16 weeks(RR:0.75;95%CI:0.179 to 3.138;P>0.999)or in the acute exacerbation rate during the 12-week follow-up period(RR:0.69;95%CI:0.334 to 1.434;P=0.317).The intervention group had a shorter length of hospitalization than the control group(mean difference[MD]:–3.30 days;95%CI,–6.300 to–0.300;P=0.032).Significant differences in the mean change from baseline in the mMRC(between-group difference:–0.67;95%CI:–0.89 to–0.44;P<0.001)and SGRQ-I score(between-group difference:–10.36;95%CI:–16.483 to–4.228;P=0.001)were observed after 4 weeks,and also in the mMRC(between-group difference:–0.67;95%CI:–0.91 to–0.43;P<0.001)and SGRQ-I(between-group difference:–10.28;95%CI,–15.838 to–4.718;P<0.001)at 16 weeks.The difference in the adverse events was not significant.Conclusion:KXHJ appears to be effective and safe for AE-IPF and can be considered a complementary treatment in patients with AE-IPF.As a preliminary exploratory study,our results provide a basis for further clinical research.