Consensus on diagnostic criteria for Yin deficiency syndrome in hypertension:a modified Delphi study

OBJECTIVE:To reach consensus on the diagnostic criteria for Yin deficiency syndrome in hypertension(YDSH)patients by a modified Delphi method.METHODS:Our study was consistent with T/CACM 1032-2017.The methodology of RAND/UCLA appropriateness was used to develop consensus guidance statements.A nationwide panel of experienced clinical experts from 19 provinces was constructed.These experts were all prominent in Traditional Chinese Medicine(TCM)of cardiovascular diseases.This consensus process consisted of two rounds of questionnaires and a final round of consultation to analyze the weight score of each item.Moreover,the data extraction process is carried out independently by third-party researchers(LIANG Junya,SUN Yang,and DU Xiaona).When there is disagreement in all three rounds,the expert panel group(odd number)are invited to vote,and the one with more votes wins.In the questionnaires,participants were asked to rate the appropriateness of each syndrome item using a nine-point Likert scale.The consensus was defined as a panel median rating 1-3 or 7-9 without disagreement.And then the diagnostic criteria of YDSH were formed according to the weight score in the final round.RESULTS:Twenty-eight experts(84.8%)participated in the first round,and thirty-one(93.9%)finished the second round.After two rounds,the consensus of YDSH was reached on 11 items(25.6%),including symptoms,signs,and pulse condition.Twenty-one experts(63.6%)completed the final round in which they used a grading system for each item.Red tongue with scanty fur had the highest weighting(22.8%),followed by heat in the palms and soles(20.1%).CONCLUSIONS:The consensus-based diagnostic criteria for YDSH,formed by a modified Delphi method,can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our YDSH criteria.

Moxibustion alleviates decreased ovarian reserve in rats by restoring the PI3K/AKT signaling pathway

Objective:Moxibustion,a common therapy in traditional Chinese medicine,has potential benefits for treating decreased ovarian reserve(DOR).The present study investigates the protective effect of moxibustion in a rat model of DOR and explores the possible mechanisms.Methods:Sixty-four female Sprague-Dawley rats were randomly divided into four groups:control,DOR,moxibustion(MOX),and hormone replacement therapy(HRT).The DOR rat model was established by intragastric administration of 50 mg/kg Tripterygium glycoside suspension(TGS),once daily for 14 days.MOX and HRT treatments were given from the day TGS administration was initiated.The ovarian reserve function was evaluated by monitoring the estrus cycle,morphological changes in ovaries,levels of serum estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),and anti-Mullerian hormone(AMH),pregnancy rate and embryo numbers.Terminal-deoxynucleotidyl transferase-mediated nickend-labeling staining was used to identify ovarian granulosa cell apoptosis,while the protein and m RNA expressions of Bax,B-cell lymphoma-2(Bcl-2),phosphatidylinositol 3-kinase(PI3 K)and protein kinase B(AKT)in ovarian tissues were examined by immunohistochemistry,Western blot and quantitative reverse transcription-polymerase chain reaction.Results:Compared with the DOR group,MOX improved the disordered estrous cycle,promoted follicular growth,reduced the number of atresia follicles,increased the concentrations of serum E2 and AMH,and decreased serum FSH and LH concentrations.More importantly,the pregnancy rate and embryo numbers in DOR rats were both upregulated in the MOX treatment group,compared to the untreated DOR model.Further,we found that the MOX group had reduced apoptosis of ovarian granulosa cells,increased Bcl-2 expression and reduced expression of Bax.Furthermore,the PI3 K/AKT signaling pathway was triggered by the moxibustion treatment.Conclusion:Moxibustion improved ovarian function and suppressed apoptosis of ovarian granulosa cells in a rat model of DOR induced by TGS,and the mechanism may involve the PI3 K/AKT signaling pathway.