Clincal Experience in TCM Treatment of Refractory Nephrotic Syndrome

Refractory nephrotic syndrome, characterized by a long lingering course, is difficult to be treated in clinic. Through many years’ clinical practice, the author holds that an active TCM treatment can

Risk assessment models of integrative medicine indicators for malignant transformation of chronic atrophic gastritis:A registry study protocol

Objective:Traditional Chinese medicine(TCM)and modern medicine have both been used in arresting malignant transformation of chronic atrophic gastritis(CAG)in China with good therapeutic effect.However,no studies have been undertaken to assess the risk of malignant transformation in CAG patients using both modern medicine and TCM features.Our study aimed to develop risk assessment models for malignant transformation of CAG combining indicators of both TCM and modern medicine.These models will facilitate early warning and control of malignant transformation of CAG from the perspective of evidence-based integrative medicine.Methods:In the proposed registry study,a total of 1000 eligible CAG patients will be recruited from four hospitals in China.A 10-year follow-up study will be conducted both on-site and off-site to track the events of malignant transformation.Frequency analysis and chi-squared tests will be used to perform the comparative analysis on the prevalence of malignant transformation events and indicators in TCM or modern medicine in different groups.A multivariate Cox proportional hazard model will be used to perform correlation analyses of malignant transformation events and factors of TCM or modern medicine.Conclusion:The proposed study has been designed with a large sample size and long follow-up period,in which wide-ranging modern medicine and TCM indicators can be gathered over the whole process of malignant transformation of CAG.Based on this study,risk assessment models for malignant transformation ofCAGmaybe constructed fromthe perspective of integrative medicine.This may provide clinicians and patients with an optimized early warning system as well as prevention strategies for malignant transformation of CAG.

Effectiveness of Acupoint Application in Patients with Pharyngeal Pain: Evidence from CHUNBO, A Prospective Real-World Study

Objective: To assess the outcomes after acupoint application in patients with pharyngeal pain in a real-world settings, and analyze the characteristics of effective population and prescription characteristics of acupoint application. Methods: Based on CHUNBO platform, patients with pharyngeal pain who were candidates for acupoint application on the basis of physician-evaluation, were enrolled in a nationwide, prospective, 69-week multicenter observational study from August 2020 to February 2022. Propensity score matching(PSM) was used to match the confounding factors and the association rules were used to analyze the characteristics of effective population and prescription characteristics of acupoint application. Outcome assessments included the disappearance rate of pharyngeal pain(within 3, 7, and 14 days), disappearance time of pharyngeal pain, as well as adverse events. Results: Of 7,699 enrolled participants, 6,693(86.9%) received acupoint application and 1,450(21.7%) with non-acupoint application. After PSM, there were 1,004 patients each in the application group(AG) and non-application group(NAG). The disappearance rate of pharyngeal pain in the AG at 3, 7, and 14 days were all higher than those in the NAG(P<0.05). The disappearance time of pharyngeal pain in the AG were shorter than that in the NAG(logrank P<0.001, hazard ratio=1.51, 95% confidence interval: 1.41–1.63). The median age of effective cases was 4 years, mainly 3–6 years old(40.21%). The disappearance rate of pharyngeal pain in the application group with tonsil diseases was 2.19 times higher than that in the NAG(P<0.05). The commonly used acupoints for the effective cases were Tiantu(RN 22), Shenque(RN 8) and Dazhui(DU 14). The commonly used herbs for the effective cases were Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae. Among them, Natrii sulfas was applied to RN 8 most frequently(support 84.39%). A total of 1,324(17.2%) patients experienced AEs, and mainly occurred in the AG, with significant difference in the incidence of AEs between goups(P<0.05). All AEs reported were the first grade, and the average regression time of AEs was 2.8 days. Conclusions: Acupoint application in patients with pharyngeal pain resulted in improved effective rate and shortened duration, especially children aged 3–6 years old, and those with tonsil diseases. Acupoint of RN 22, RN 8 and DU 14, herbs of Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae were the most commonly used in the treatment of pharyngeal pain.

Clinical research of acupoint application for "treatment of winterdisease in summer" used to prevent and treat bronchial asthma inchildren

OBJECTIVE:To preliminarily analyze key factors influencing curative effect through clinical observations of acupoint application for "treatment of win-ter disease in summer" used to prevent and treat bronchial asthma in children.METHODS:In an observational study and prospective cohort study,we observed children in remission of asthma at three class Ⅲ grade A TCM hospitals in Liaoning,Hubei,and Chengdu.RESULTS:A total of 609 children conformed to diagnostic and inclusive standards for remission of bronchial asthma.Through follow-up visits,we observed their skin reactions and the time and chance of treatment with different therapies in the three hospitals;we also compared and analyzed different drugs,acupoints,and preparations.We found that the key Chinese drugs were Bai Jie Zi(Semen Sinapis Albae) and Yian Hu Suo(Rhizoma Corydalis);the key acupoints were Feishu(BL 13),Gaohuang(BL 43),Dingchuan(EX-B1),Tiantu(CV 22),and Shanzhong(CV 17);and the best preparation was a mixture of drugs,ginger juice,and musk.Acupoint application was practiced on the hottest days of summer and the coldest days of winter for 0.5 to 2 h with the lowest rate of asthma relapse.CONCLUSIONS:The present data analysis shows that the curative effect of acupoint application for "treatment of winter disease in summer" may be influenced by recipes of Chinese drugs,preparations,prescriptions of acupoints,chance,time,and skin reactions.A curative effect is the result of the comprehensive action of these factors.

Appraisal of Clinical Practice Guidelines for Ischemic Stroke Management in Chinese Medicine with Appraisal of Guidelines for Research and Evaluation Instrument:A Systematic Review

Objective： To systematically review the clinical practice guidelines （CPGs） for ischemic stroke in Chinese medicine （CM） with the Appraisal of Guidelines for Research and Evaluation （AGREE II） instrument. Methods： CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG- related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based （EB） guideline, consensus based with no explicit consideration of evidence based （CB-EB） guideline and consensus based （CB） guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE II instrument, and compared the CPGs＇ recommendations on CM pattern classification and treatment. Results： Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion： The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.

Compound Zhebei granules combined with chemotherapy for the treatment of refractory acute leukemia: a randomized clinical trial

OBJECTIVE: To observe the effect of compound Zhebei granules(CZBG) with chemotherapy in the treatment of refractory acute leukemia.METHODS: In this multicenter, double-blind, placebo-controlled clinical trial, we used a central(online) randomization system to assign 235 patients to two treatment groups. A total of 118 patients received chemotherapy combined with CZBG(4 g,twice daily) and 117 patients received chemotherapy plus placebo. The clinical efficacy was evaluated at the end of one chemotherapeutic cycle.RESULTS: In the full analysis set, in which deaths due to disease progression were regarded as inefficacy, the rates of complete remission(CR) and partial remission(CR + PR) were 32.35% and 50.00%,respectively, for the chemotherapy combined with CZBG group, and 23.08% and 35.58%, respectively,for the chemotherapy plus placebo group. There was a statistically significant difference between the two groups according to a ysis set(PPχ2test(P < 0.05). In the per protocol analS), the CR(33.67%),CR+PR(52.04%) response rates for the chemotherapy plus CZBG group were significantly different from the response rates of the control group(CR:24.24% and CR+PR: 37.37%), respectively(P < 0.05).CONCLUSION: CZBG plus chemotherapy can improve the clinical remission rate of refractory acute leukemia after one just one therapeutic cycle.