Expert Consensus on Clinical Diseases Responding Specifically to Traditional Chinese Medicine：Fibromyalgia Syndrome / 中国实验方剂学杂志

Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.

Methodological Evaluation of Advantages of Traditional Chinese Medicine Treatment of Sjögren's Syndrome / 中国实验方剂学杂志

Screening and evaluating the diseases responding specifically to traditional Chinese medicine （TCM） will help to highlight the advantages of TCM treatment， and the evaluation method should be standardized with consideration to the unique characteristics of the diseases. The incidence of Sjögren's Syndrome （SS） is increasing year by year， while the pathogenesis of this disease remains unclear. Modern therapies for this disease include biological agents and immunosuppressants， which generally have unsatisfactory efficacy. The TCM treatment of SS focuses on the harmony of the physical and mental health. The Rheumatology Branch of the China Association of Chinese Medicine organizes experts in TCM， Western medicine， and evidence-based medicine to form working groups. Delphi method and bibliometric method were used for analysis， and SS was selected as a disease responding specifically to TCM. Furthermore， the evaluation system was established for this disease， and the consensus regarding this disease was reached after seminar discussion. This paper summarized the whole process of the evaluation of the advantages of TCM treatment of SS. First， because TCM atomization is widely used in clinical practice and enriches TCM administration methods， this therapy is included after other non-drug therapies were taken as characteristic therapies. Second， the evaluation indicators of therapeutic effect should be determined with consideration to international acceptance and the current research status. Third， the expression method should be accurate， standardized， and objective， highlight the natural advantages of TCM， and avoid arbitrary extension. This paper provides a reference for clinicians to explore other diseases responding specifically to TCM.

Correlation analysis of physical indicators with fasting plasma glucose and blood pressure indicators in low-aged and high-aged elderly people in Guangxi / 中华老年医学杂志

Objective:To analyze the relationship between physical indicators and blood pressure or fasting plasma glucose levels in the young-old and oldest-old.Methods:Totally 1 516 subjects from the Guangxi Natural Longevity Cohort were screened in this study and physical examination parameters included body mass index(BMI), waist circumference(WC), waist-to-height ratio(WHtR), fasting plasma glucose(FPG)and blood pressure, and the correlations between them were analyzed.Results:The overweight elderly and overweight young elderly groups had an increased risk of concurrent hypertension and impaired fasting glucose, compared with both elderly people with normal BMI and young elderly people with normal BMI( OR=2.66, 95% CI: 1.90-3.72; OR=3.03, 95% CI: 2.11-4.34). Elderly people with general obesity and young elderly people with general obesity were more likely to have hypertension( OR=5.25, 95% CI: 2.07-13.28; OR=4.75, 95% CI: 1.84-12.21), impaired fasting glucose( OR=2.95, 95% CI: 1.00-8.69; OR=3.06, 95% CI: 1.04-9.02), and concurrent hypertension and impaired fasting glucose( OR=7.94, 95% CI: 3.04-20.72; OR=8.68, 95% CI: 3.28-22.94), whereas underweight young elderly had a reduced risk of hypertension( OR=0.27, 95% CI: 0.09-0.80). Elderly people in the central obesity group(WC)showed increased risk of hypertension( OR=1.39, 95% CI: 1.04-1.84)and concurrent hypertension and impaired fasting glucose( OR=2.39, 95% CI: 1.75-3.27), compared with those in the non-central obesity group.Young elderly people with central obesity had increased risk of hypertension( OR=1.46, 95% CI: 1.07-2.00), impaired fasting glucose( OR=1.62, 95% CI: 1.14-2.28), and concurrent hypertension and impaired fasting glucose( OR=3.03, 95% CI: 2.13-4.32); both elderly people and young elderly people in the central obesity group(WHtR)had increased risk of hypertension( OR=1.35, 95% CI: 1.03-1.76; OR=1.55, 95% CI: 1.13-2.14), impaired fasting glucose( OR=1.42, 95% CI: 1.04-1.94; OR=1.62, 95% CI: 1.13-2.31), and concurrent hypertension and impaired fasting glucose( OR=2.20, 95% CI: 1.60-3.02; OR=3.22, 95% CI: 2.14-4.84). In the elderly group, BMI was correlated with diastolic blood pressure and WHtR was correlated with the fasting blood glucose level. Conclusions:The levels of fasting plasma glucose and blood pressure increase with elevated physical indicator values(BMI, WC, WHtR)in the Guangxi elderly population, and the risk of developing hypertension, impaired fasting glucose, and concurrent hypertension and impaired fasting glucose increases in elderly patients with general obesity and central obesity, with a higher risk in low-aged elderly patients.

The current situation of the diagnosis of fibromyalgia syndrome / 中华风湿病学杂志

Objective:To investigate the currentstatus of the diagnosis of fibromyalgia syndrome (FMS), and analyze the related factors in order to improve the diagnostic level of the disease.Methods:A survey was carried out, A "FMS diagnosis table" was developed. The demographic data and past medical experience of patients were recorded. The rates of misdiagnosis and missed diagnosis were calculated. The specific misdiagnosed cases were recorded and analyzed. According to the previous diagnosis history, patients were divided into misdiagnosed group, missed diagnosis group and correct diagnosis group. The demographic characteristics, medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed, and compared with the correct diagnosis group. The reasons for missed diagnosis or misdiagnosis were explored.Results:A total of 277 patients were included in the survey. Only 19.1%(53 cases) of patients were correctly diagnosed, 22.7%(63 cases) of patients were misdiagnosed, 58.1% of patients were missed. The mean time from first symptom to disease diagnosis was (51.0±81.2) months. They were often misdiagnosed as osteoarthritis ( n=21, 33.3%), rheumatoid arthritis ( n=13, 20.6%), lumbar disease ( n=12, 19.0%), and anxiety and depression ( n=11, 17.4%). Patients' social and economic status such as age, income, educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate. In terms of demographic characteristics, the correctly diagnosed group had a lower average age of (44±13) years ( t=8.64/9.20, P<0.05), a higher proportion of employees, a higher monthly income ( χ2=7.10/6.87, P<0.05), and a higher education level ( χ2=7.12, P<0.05). In terms of visits, the rate of visits to other medical institutions (private hospitals) in the missed diagnosis group was higher, and the number of doctors visited was also lower. In terms of illness, the diffuse pain index (WPI) score and FMS symptom severity (SSS) score were lower in the missed diagnosis group. Conclusion:The current situation of the diagnosis of FMS in China is not optimistic, and the diagnosis should be differentiated from osteoarthritis, rheumatoid arthritis, cervical and lumbar diseases, and cardiac diseases. In order to reduce the misdiagnosis and missed diagnosis of this disease, it is necessary to strengthen the public education, improve the understanding of this disease in primary care doctors, and physicians in orthopedics, acupuncture and pain departments.

Research progress of gastrointestinal microflora mechanism of fibromyalgia syndrome and prospect of related TCM research / 国际中医中药杂志

Patients with fibromyalgia syndrome (FMS) offen shows Gastrointestinal symptoms. The composition of gastrointestinal flora and the abundance of some flora always changes in FMS, and the metabolic activities of flora may be related to the symptoms of FMS. The treatment of FMS by regulating liver and spleen with Traditional Chinese Medicine and regulating qi movement with traditional exercises can achieve better efficacy, and its efficacy mechanism may be related to the improvement of intestinal flora metabolism.

Effect of Modified Yiweitang on Fatigue Symptom of Primary Sjörgren′s Syndrome / 中国实验方剂学杂志

Objective:To observe the effect of modified Yiweitang on fatigue symptom and immunological indicators in primary Sjörgren′s Syndrome (pSS). Method:By random, control, single-blind method, 116 cases of patients with pSS were divided into treatment group and control group, with 58 cases in each group. The treatment group was given modified Yiweitang, a dose a day, twice a day， and the control group was given hydroxychloroquine sulfate (HCQ) 200 mg/time, twice a day. The treatment lasted for six months. Visual analogue scale (VAS) of fatigue symptoms, total traditional Chinese medicine (TCM) syndrome score, TCM fatigue score, rheumatoid factor (RF) and serum immunoglobulin G (IgG) were used to compare two groups before and after treatment. Result:After treatment, the treatment group had a better efficacy on TCM syndromes than control group (Z=3.712, P<0.05). After treatment, the treatment group were superior to control group in improvement of TCM fatigue score and VAS score of fatigue symptom (P<0.05). After 6 months of treatment, IgG level in treatment group decreased significantly compared with before treatment, with statistical differences (P<0.05), but no difference between treatment group and control group. After treatment, RF in two groups showed no significant decrease compared with before treatment. The incidence of adverse reactions in the treatment group and the control group were 1.75%（1/57） and 25.49%（13/51）, respectively. Conclusion:Compared with HCQ, modified Yiweitang can significantly alleviate fatigue and overall symptoms of patients of pSS, both of which can reduce serum IgG, and the efficacy of modified Yiweitang is more obvious than hydroxychloroquine sulfate. Both drugs had no significant effect on RF level of pSS patients. After long-term administration, modified Yiweitang is safer than hydroxychloroquine sulfate in the treatment of pSS.

Regularity of prescription and medication of Jiang Quan in treating rheumatoid arthritis / 中国中药杂志

The data mining method was used to analyze and summarize the prescription and medicate regularities of chief physician Jiang Quan in the treatment of rheumatoid arthritis,in order to provide references for the clinical treatment of rheumatoid arthritis. Totally 121 prescriptions of rheumatoid arthritis treated by chief physician Jiang Quan from 2007 to 2017 were collected and input into the Chinese medicine inheritance auxiliary system. The " prescription statistics" function of the software " statistical report" system,and the " prescription analysis" function of the " data analysis" system,the data mining methods such as rule analysis,integration correlation,complex system entropy clustering,and unsupervised entropy hierarchical clustering,were used to analyze the prescription regularity of chief physician Jiang Quan. A total of 121 prescriptions were included,involving 144 herbs,in which 30 herbs had a higher frequency of more than 20 times,20 two-herb combinations had a frequency of more than 59 times; after evolution,14 core combinations and 7 new prescriptions were obtained. Among the prescriptions in the treatment of rheumatoid arthritis,those for clearing heat and dampness,promoting blood circulation and removing blood stasis had a higher frequency,and the core prescriptions were modified " Qingre Huoxue Decoction" and modified " Ermiao Pills". The newly evolved prescriptions not only reflected director Jiang Quan' s method of treating rheumatoid arthritis by clearing away heat and dampness and promoting blood circulation by the,but also included the treatment methods of removing wind and removing dampness,dredging collaterals and removing phlegm,nourishing Yin and clearing heat,nourishing Yin and nourishing kidney,nourishing blood and nourishing Qi. The method can be used to analyze the pathogenetic changes of the mutual knot of phlegm and blood stasis,injury of Qi and blood,long-term implication on liver and kidney. At the same time,it also reflects the treatment principles of treating phlegm and strengthening the evil.

Polymorphisms of mTORC1 genes and risk of primary colorectal adenocarcinoma in Chinese populations / 中华病理学杂志

Objective@#To study the associations between variants of mTORC1 of PI3K/AKT/mTOR pathway and colorectal cancer.@*Methods@#In this hospital-based case-control study, at the First Affiliated Hospital, Xinjiang Medical University from 2000 to 2013, 665 primary colorectal cancer cases and 695 cancer-free controls were genotyped at 10 potentially functional single nucleotide polymorphism (SNPs) loci of mTORC1 (mTOR: rs1034528, rs2295080; Raptor: rs1062935, rs3751934; mLST8: rs3160, rs26865; DEPTOR: rs2271900, rs4871827; AKT1S1: rs2290774, rs2353005) to assess their associations with risk of colorectal cancer by Logistic regression analysis.@*Results@#In single-locus analysis, found a significantly decreased risk of colorectal cancer associated with mLST8 rs26865 by recessive genetic model, especially in populations of ≤68 years of age (OR=0.64; 95%CI=0.43-0.96, P=0.031), female (OR=0.61; 95%CI=0.38-0.99, P=0.046), non-smoking (OR=0.55; 95%CI=0.35-0.87, P=0.010). mTOR rs1034528 CC genotypes were associated with higher risk of colorectal cancer in >68-year-old populations (OR=3.34; 95%CI=1.12-9.91, P=0.030). Raptor rs3751934 CA/AA genotypes were associated with lower colorectal cancer risk in population of body mass index(BMI)>25 kg/m2 (OR=0.68; 95%CI=0.47-0.98, P=0.038); and AKT1S1 rs2290774 CC genotypes were associated with lower colorectal cancer risk in non-smoking population (OR=0.67; 95%CI=0.45-0.99, P=0.048). Furthermore, found that populations carrying more than two low-risk genotypes were associated with lower colorectal cancer risk, compared with that of populations carrying less than two low-risk genotypes (OR=0.74, 95%CI=0.58-0.95, P=0.017), especially in population of ≤68 years of age, male and BMI>25 kg/m2, and non-smoking.@*Conclusions@#SNPs of mTORC1-related genes individually or jointly contribute to colorectal cancer susceptibility in Chinese. Further studies of larger cohorts are needed to validate the findings.

Metabolomics applied in Chinese medicine syndromes: a bibliometric analysis / 中国组织工程研究

BACKGROUND: Metabolomics is a branch of systems biology taking systematic study, high-throughput detection and data processing as means, information modeling and systematic integration as targets, which can be used for recognizing metabolic indexes, provide evidence for individualized diagnosis and treatment and guide syndrome differentiation in the clinic. OBJECTIVE: To analyze the literature features and research status of metabolomics applied in the field of Chinese medicine syndromes so as to provide reference for its application in Chinese medicine syndromes. METHODS: Databases of CNKI, WanFang, CBM, PubMed, Web of Science and Medline were retrieved for the articles addressing metabolomics applied in Chinese medicine syndromes published before June 2017. The literature database was established, and then the literature and research features were analyzed using bibliometrics and data mining. RESULTS AND CONCLUSION: Totally 499 articles were enrolled, including 371 journal articles from journals (74.35%), 30 conference papers (6.01), 98 dissertations (19.64), and the 371 journal papers were published in 124 journals (32 of Chinese core journals (45.28%), and 10 SCI cited journals (3.77%)). In the articles, 7 types of disease systems (mainly in digestive system and circulatory system) were classified according to the statistics, involving 23 diseases and 39 interventions. In summary, there is still a lack of standardized classification for metabolomics applied in Chinese medicine syndromes and the quality of literature is poor. We should conduct more animal experiments and explore the essence and intervention measurements of syndromes, thereby controlling the disease occurrence and development.

Research status of metabonomics in arthritis: a bibliometric analysis / 中国组织工程研究

BACKGROUND: Mechanisms undelying diagnosis and treatment of arthritis can be analyzed by metabonomics to study the metabolites. The combination of metabonomics and bibliometrics can systematically clarify the research status of osteoarthritis. OBJECTIVE: To analyze and summarize the research status of metabonimics in arthritis, and to prospect the future tendency. METHODS: CNKI, VIP, WanFang, CBM, PubMed, EBSCO, Web of Science and Elsevier databases were searched for the articles addressing the metabonimics in arthritis published before May 2017. The keywords were "metabolomics and arthritis" in English and Chinese, respectively. Initially 201 articles were retrieved, and finally 59 articles were included based on the inclusion and exclusion criteria for basic information and result analysis. RESULTS AND CONCLUSION: (1) Literature of metabonomics on arthritis began to be reported from 2007, and the number of literature increased with time. (2) The first author's affiliations were concentrated in universities 37(63%), hospitals 15 (25%) and institutes 7 (12%). (3) The articles included 44 articles from journals (75%), 12 dissertation (19%), 4 conference papers (7%), and the 44 papers were published in 38 kinds of journals. (4) Totally 36 articles were funded, 29 articles (49%) funded by the National Natural Science Foundation, 18 (31%) funded by department-level foundation, 10 (17%) funded by provincial foundation, 5 (8%) foreign foundation and 5 (8%) funded by school foundation. (5) The types of arthritis were mainly rheumatoid arthritis 40 (68%), osteoarthritis 7 (12%), gouty arthritis 6 (10%) and others 6 (10%). (6) The main research directions were metabonomis on treatment effectiveness 30 (51%), pathogenesis of arthritis 17 (29%), Chinese medicine syndromes 6 (10%) and research progress 6 (10%). (7) Metabolomics samples in the literature included the body fluid samples 53 (90%) and tissue samples 6 (10%). (8) Metabonomics analysis techniques included liquid chromatography-mass spectrometry 33 (56%), nuclear magnetic resonance technology 15 (25%), gas chromatography-mass spectrometry 10 (17%), NMR combined with GC-MS 1 (2%). In summary, metabonomics has been extensively applied in arthritis and has been an issue of concern. Understanding the side events in Chinese medicines for arthritis based on metabonomics can provide reference for the following prospective study and clinical application.

The progress of traditional Chinese medicine in treating fibromyalgia syndrome / 国际中医中药杂志

The article reviewed the progress of traditional Chinese medicine in treating fibromyalgia syndrome and summarized the status and feature of different therapies in recent years in order to provide idea for the further researches. In addition, the article also discussed the problems and solutions of the researches.

GLP-1/GIP/Gcg receptor Triagonist improves the cognitive behaviors in triple-transgenic mice of Alzheimer's disease / 生理学报

Alzheimer's disease (AD) is a progressively neurodegenerative disorder, which seriously affects human health but is still irreversible up to now. Recent studies indicate that type 2 diabetes mellitus (T2DM) is an important risk factor for AD, and the drugs used for treatment of T2DM have shown some neuroprotective effects in the treatment of AD. Glucagon-like peptide-1 (GLP-1)/ glucose-dependent insulinotropic polypeptide (GIP)/glucagon (Gcg) receptor Triagonist is a new monomeric polypeptide equally activating the GLP-1/GIP/Gcg receptors, which is built on the basis of GLP-1/Gcg receptor coagonist core sequence, and incorporated with partial amino acids of GIP. Recently, the Triagonist has been reported to be effective in alleviating diabetic complications in rodent models of obesity. The present study observed for the first time the cognitive improvement effects of the Triagonist in the triple-transgenic AD mice (3xTg-AD) by using multiple behavioral techniques, and explored its probable molecular mechanisms using ELISA and Western blot. The results showed that the chronic treatment with the Triagonist (i.p.) significantly reversed the impairments in working memory of 3xTg-AD mice, with an obvious increase in the percentage of correct spontaneous alternation in the Y maze; the Triagonist treatment also improved long-term spatial memory and re-learning ability of 3xTg-AD mice in classical Morris water maze and reverse water maze tests, with decreased escape latency in under water platform tests and increased swimming time in probe tests. ELISA and Western blot experiments showed that the Triagonist up-regulated the levels of cAMP, PKA and p-CREB in the hippocampus of 3xTg-AD mice. These results indicate that GLP-1/GIP/Gcg receptor Triagonist can improve the cognitive behaviors in 3xTg-AD mice, and the up-regulation of hippocampal cAMP/PKA/CREB signal pathway may mediate the neuroprotection of the Triagonist, suggesting that the GLP-1/GIP/Gcg receptor Triagonist may be a novel therapeutic strategy for the treatment of AD.

Real-time measurement of Caflux in hippocampal slice with non-invasive micro-test technique / 生理学报

The deposition of amyloid-β protein (Aβ) in the brain is the most important pathological feature of Alzheimer's disease (AD). The mechanism of Aβ neurotoxicity may be closely related to the disturbance of intracellular Cahomeostasis. Non-invasive micro-test technique (NMT) is a novel technique developed in recent years, which can be used to directly record transmembrane ion influx and efflux in a non-contact way by detecting the diffusion potentials outside of the membrane. The present study examined the effects of Aβpretreatment on glutamate (Glu)-induced Cainflux and low [Ca] solution-induced Caefflux in the hippocampal slices of C57BL/6 mice using NMT. The results showed that: (1) acute administration of Glu (2.5, 5, 10 mmol/L) evoked a persistent transmembrane Cainflux in hippocampal CA1 neurons, with a rapid onset and subsequent decay; (2) pretreatment with Aβ dose-dependently increased the average rate of Cainflux induced by Glu during the initial 5 min, which was blocked by NMDA receptor antagonist D-APV; (3) perfusion with low [Ca] artificial cerebrospinal fluid (aCSF) induced a continuous Caefflux, which was mostly blocked by KB-R7943, a specific antagonist of Na/Caexchanger; (4) Aβpretreatment partially inhibited the low [Ca] aCSF-induced Caefflux. These results indicate that Aβ not only facilitates Cainflux but also inhibits Caefflux, which jointly contribute to the Aβ-induced intracellular Caoverload; the potentiation of Aβ on Glu excitotoxicity is mainly mediated by NMDA receptors, while the target for Aβ to affect Caefflux was mainly Na/Caexchanger. NMT showed multiple advantages in detecting transmembrane Caflux in brain slices, such as non-invasiveness to target cells, fast, convenient and real-time acquisition of Caflux. Therefore, this study provided new experimental evidence for Aβ-induced Caoverload, as well as a novel application for NMT in measuring transmembrane Caflux of neurons in the brain.

Effect of CXCL12/CXCR4/MMP-2 signaling pathway on biological behavior in triple negative breast cancer / 临床与实验病理学杂志

Purpose To investigate the effect of CXCL12/CXCR4 and MMP-2 on the biological behavior of triple-negative breast cancer.Method CXCR4-siRNA and pcDNA3.1-CXCR4were transient transfected of in MDA-MB-231 cell line by liposome,RNA and protein were extracted.The mRNA and protein expressions of CXCR4,CXCL12 and MMP-2 were detected by RT-PCR and Western blot respectively.And the migration and proliferation of the transfected cells were detected by Wound-healing assay and MTF assay.Result The experiment of RT-PCR and Westen blot demonstrated that CXCR4 mRNA and protein level expression declines after the expression CXCR4 was down-regulated (P ＜ 0.01),CXCL12 mRNA and protein level expression increased and MMP-2 mRNA and protein level expression increased after the expression CXCR4 was down-regulated (P＜0.01),MTT assay and Wound-healing assay results showed that the proliferation ability of 72 h cells was decreased,and the wound healing was slow.The experiment of RT-PCR and Westen blot demonstrated that CXCR4 mRNA and protein level expression increased after the expression CXCR4 was up-regulated (P ＜0.01).The CXCL12 mRNA and protein level expression declined and MMP-2 mRNA and protein level expression increased after the expression CXCR4 was up-regulated (P ＜0.01),MTT assay and wound-healing assay results showed that the proliferation ability of 72 h cells was increased,and the wound healing was accelerated.Conclusion CXCL12/CXCR4/ MMP-2 signaling pathway is activated in the triple-negative breast cancer MDA-MB-231 cells,and the inhibition of CXCR4 can reverse the proliferation and migration of malignant biological process.

Effect of External Applying Compound Tripterygium wilfordii Hook F. on Joint Pain of Rheumatoid Arthritis Patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effectiveness and safety of external applying Compound Tripterygium wilfordii Hook F. (TwHF) in relieving joint pain in rheumatoid arthritis (RA) patients.</p><p><b>METHODS</b>In this double-blinded, randomized multicenter trial, a total of 174 moderately active RA patients were enrolled and randomly assigned to the treatment group (treated with Compound TwHF, 87 cases) and the placebo control group (87 cases). Compound TwHF or placebo was externally applied in painful joints, 20 g each time, once per day for 8 weeks. Self-reported joint pain relief was taken as a primary effective indicator. Visual analogue scale for pain (VAS), disease activity score of 28 joints (DAS28), VAS for general health (GH) were evaluated before treatment, at week 4 and after treatment. Erythrocyte sedimentation rate (ESR) and hypersensitive C reactive protein (hs-CRP) were tested before and after treatment. Menstrual changes in females were observed during treatment. Skin irritation occurred during the recording process was assessed using skin irritation strength. Intention to treat (ITT) was statistically analyzed.</p><p><b>RESULTS</b>The joint pain relief rate in the treatment group was 90.8% (79/87 cases), higher than that in the placebo control group (69.0%, 60/87 cases; P = 0.001). VAS pain score, DAS28, VAS for GH score were significantly improved in the two groups at week 4 of treatment and after treatment, as compared with before treatment (P < 0.01). ESR and hs-CRP levels significantly decreased in the treatment group after treatment (P < 0.05, P < 0.01). No difference was found in post-treatment VAS pain score, DAS28, VAS for GH score, ESR, or hs-CRP between the two groups (P > 0.05). Eight adverse events occurred in the treatment group (5 skin allergy, 1 intolerance of medical odor, and 2 mild liver injury), while 3 adverse events occurred in the placebo control group (2 skin allergy, 1 mild liver injury). There was no statistical difference in adverse event between the two groups (P > 0.05). No menstrual change occurred in the treatment group.</p><p><b>CONCLUSION</b>External applying Compound TwHF was an effective and safe way to relieve-joint pain of RA patients, which could be taken as an adjuvant therapy.</p>

Exploring the clinical benefit with intra-articular injections of anti-TNF agent in patients with rheumatoid arthritis / 中国基层医药

Objective To observe the efficacy of intra-articular (IA) blockade of TNF-α by 3 etanercept injections in patients with rheumatoid arthritis (RA).Methods Eighteen moderate activity RA patients with resistant knee synovitis underwent three monthly IA injection of etanercept (25mg).The primary outcomes were visual analogue scale of target knee general health (VAS-TKGH) and VAS target knee Pain Score,and we also collected diameter of target knee joint,VAS fatigue Score,Health Assessment Questionnaire (HAQ),the 28-joint based disease activity score (DAS28) and joint fluid volume,which were all assessed at baseline and every four weeks after IA injection.Results All those 18 patients completed the treatment with the average disease duration of was (8 4.7 ± 54.1) months.After each IA injection,VAS-TKGH was significantly improved than baseline (P =0.03,0.02,0.02).and VAS target knee pain score was also significantly improved than baseline (P =0.03,0.00,0.00).After 3rd IA injection,VAS-TKGH was further reduced compared with those after 1 st and 2nd IA injection (P =0.02,0.03) ; while,VAS target knee pain score was further reduced after 3rd IA injection (P =0.00).Knee joint diameter,VAS fatigue score,HAQ and DAS 28 were significantly lower after 1st IA injection than baseline (P =0.03,0.02,0.03).After 2nd IA injection,VAS fatigue score,HAQ,and DAS28 were significantly further improved compared to treatment once (P =0.00,0.02,0.02) ;after 3rd IA injection,HAQ and DAS28 were further improved compared to those after 2nd IA injection (P =0.01,0.02).Joint fluid volume was significantly decreased after 2nd IA injection (P =0.01).Conclusion The tailor approach of intra-articular injections of anti-TNF agent might benefit RA patients who had resistant synovitis,and the side effect was rare.However,the sample was small and further observation is needed.

External application of compound Tripterygium wilfordii decreased the activity of rheumatoid arthritis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the therapeutic efficacy of external application of Compound Tripterygium wilfordii (CTW) for treating rheumatoid arthritis (RA) on the basis of treatment by integrative medicine.</p><p><b>METHODS</b>Totally 67 active RA patients of damp-heat stagnation syndrome were randomly assigned to the external application group (35 cases) and the placebo group (32 cases). The reaction standard by American College of Rheumatology and Disease Activity Score (DAS) were taken as the indices for therapeutic assessment. A randomized controlled, single blind clinical trial was performed for 4 weeks, with a 3-month follow-up. The statistical analyses were performed using intention to treat analysis set (ITT).</p><p><b>RESULTS</b>After treatment the rate of reaching ACR20 was 34.3% and 12.5% in the external application group and the placebo group respectively. The mean for the average drop of DAS28 ratings was 1.07 in the external application group and 0.40 in the placebo group, showing statistical difference (P < 0.05, P < 0.01). As for the safety, there was no effect on the menstruation in the external application group. Only mild skin allergy occurred in 2 cases of the external application group, but they were alleviated after drug withdrawal.</p><p><b>CONCLUSIONS</b>External application of CTW could control the condition of RA and reduce the disease activity of RA. It had better safety.</p>

Mutation analysis of the HBV reverse transcriptase in nucleos(t)ide-treated patients with chronic HBV infection / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To characterize genotypic resistance within HBV RT region in chronic hepatitis B (CHB) patients with nucleos(t)ide analogue (NA) treatment.</p><p><b>METHODS</b>Serum samples of 229 CHB patients with NA treatment were obtained. Full-length HBV RT sequences were amplified, sequenced and analyzed, on the following NA resistant (NAr) mutations belonging to different NAr pathways.</p><p><b>RESULTS</b>Among 229 HBV isolates, 14.41% (33/229) and 85.59% (196/229) were genotype B and C, respectively; and the patients with HBV genotype C may be more susceptible to develope resistant mutations than patients with HBV genotype B(chi2 = 2.95, P < 0.05). NAr mutations were detected in 63 CHB patients. Mutations were not found at rtI169, rtT184, rtA194 or rtS202. RtM204 mutations were detected at the highest frequency among 63 mutants (40/63, 63.49%) and found to display 11 combination mutation patterns, in which rtM204I were associated with rtL80I/V and rtL180M, and rtM204V were associated with rtL1l80M, respectively. Conclusions There are complicated mutation patterns in the HBV RT region for chronic hepatitis B (CHB) patients with nucleos(t)ide analogue (NA) treatment. RtM204V/I mutation was the highest.</p>

Study on Qingre-Huoxue Recipe in improving clinical symptoms of dampness-heat and blood-stasis syndrome of rheumatoid arthritis / 国际中医中药杂志

Objective To Evaluate the efficacy and safety of Qingre-Huoxue Recipe ( QHR ),Qingre -Huoxue Recipe and Methotrexate(QHR+MTX) in improving clinical symptoms of dampness-heat and blood-stasis syndrome of rheumatoid arthritis.Methods According to multi-center,randomized,and control intervention design,142 RA patients were randomly divided into QHR group (71 cases) and QHR+MTX group (71 cases).With clinical symptoms as evaluation indexes,FAS set and PP set were adapted for analysis.Results FAS set analysis:Both groups can significantly reduce pain VAS score [ (4.82 ± 1.98) vs (4.31 ± 1.85) ],reduce tenderness and swollen joint number[(4.87±4.05)vs(4.20±3.36)、(8.72±6.24)vs(7.14±5.03)respectively],shorten morning stiffness [ (39.56 ± 46.68) min vs (36.65 + 42.58) min] and significantly reduce the symptoms of fatigue[ (4.13 ±2.34) vs (3.74 ±2.20) ],also with good security.But there was no statistically significant difference between the two groups.Conclusion Qingre-Huoxue Recipe with MTX had no significant advantage in improving clinical symptoms in patients with the dampness-heat and blood-stasis syndrom of RA than without MTX.

Discussion on several points of treating hemodynamic cerebral infarction by Buyang-huanwu decoction / 国际中医中药杂志

Tis study discusses the applicable relationship between Buyang-huanwu decoction and hemodynamic cerebral infarction from pathogenesis of Qi asthenia causing blood stasis.pathological features of hemodynamic cerebral infarction and the function and mechanism of Buyang-huanwu decoction and so on.It also investigates the methods of applying Buyang-huanwu decoction to treat hemodynamic cerebral infarction from such aspects as dose,occasion,contraindication and attentions.