Circulating levels of inflammatory cytokines in patients with psoriasis vulgaris of different Chinese medicine syndromes / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate whether the serum levels of inflammation-related cytokines might be different between the healthy individuals and the psoriatic patients diagnosed of three varied Chinese medicine (CM) syndromes [blood-stasis syndrome (BSS), blood-dryness syndrome (BDS) and wind-heat syndrome (WHS)].</p><p><b>METHODS</b>A total of 62 psoriatic patients were recruited and assigned to 3 groups according to their CM syndromes, including 27 patients of BSS, 21 of BDS and 14 of WHS. Another 20 sex- and age-matched healthy subjects were enrolled into the control group. Serum concentrations of multiple cytokines, including monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), soluble CD4O ligand (SCD40L), tumor necrosis factor-α (TNF-α), epidermal growth factor (EGF), interleukin-8 (IL-8), interleukin-17 (IL-17), interferon γ inducible protein-10 (IP-10) and vascular endothelial growth factor (VEGF), were measured by a multiplexed flow cytometric assay.</p><p><b>RESULTS</b>The circulating levels of MIP-1α, TNF-α, IL-8, and IP-10 were significantly increased in the psoriatic patients compared with the healthy controls (P<0.01). Male and female patients tended to have higher serum levels of MCP-1 and IP-10, respectively (P<0.05). Interestingly, compared with the control group, 6 out of the 9 cytokines (MCP-1, MIP-1α, TNF-α, EGF, IL-8 and IP-10) were substantially increased in the BSS group (P<0.05 or P<0.01), whereas only MIP-1α and IL-8 levels were elevated in the BDS group (P<0.05 or P<0.01) concurrent with lowered concentrations of SCD40L and IL-17 (P<0.05). In the WHS group, MIP-1α was the only cytokine whose level was evidently increased (P<0.01), in contrast to IL-17 which was decreased as compared with the control (P<0.05). The psoriatic patients overall owned higher levels of MIP-1α and IL-8 in the circulation which were comparable among the 3 groups of CM syndromes (P<0.01). In contrast, TNF-α level of the BSS group was the highest among the three (P<0.01), followed by the BDS and the WHS groups.</p><p><b>CONCLUSIONS</b>The expression profiles of cytokines in the circulation might not be necessarily identical for psoriatic patients with different CM syndromes. Accordingly, the serum concentrations of certain cytokines could potentially be used as the ancillary indices for the clinical classification of psoriatic CM syndromes.</p>

Analysis on the Chinese medicine syndromes and demographic characteristics of patients with influenza-like illness in clinics of China / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate Chinese medicine (CM) patterns and epidemiological characters of patients with influenza-like illness (ILI) syndromes in clinics in China.</p><p><b>METHODS</b>A prospective multi-center observational epidemiology survey on the clinical CM patterns of ILI and its prevalence was conducted from September 2009 to April 2010. A unified survey questionnaire was developed for data collection of ILI symptoms and CM patterns. Totally 45 hospitals from 22 provinces, municipality cities and autonomous regions of China participated this study. The collected data were input by EPI-data v3.1 and analyzed by SPSS 18.0, which included descriptive analysis and Chi-square test for group comparison.</p><p><b>RESULTS</b>A total of 5,967 ILI patients were included in the study. The proportion of the 18-34 aged group (56.2%) was the largest; students (41.0%) were more than other occupations. Majority of the patients had the wind-heat invading Lung (Fei) syndrome (76%), while in Southwest China mainly wind-heat invading Lung syndrome and wind-cold tightening the exterior syndrome occurred. The typical symptoms of ILI were ranked as fatigue (80.9%), cough (72.2%), sore throat (67.2%), muscular soreness (67.1%), headache (65.4%), aversion to cold (60.1%), thirst (55.1%) and nasal obstruction (48.1%).</p><p><b>CONCLUSIONS</b>The ILI patients in clinics were mainly teenagers and young adults. In regard to CM syndrome, wind-heat invading Lung syndrome prevailed in all regions except the Southwest China. The characteristics of CM syndrome of ILI patients may be relevant to age and region distribution.</p>

Pharmacokinetic study on peoniflorin, astilbin, rosmarinic acid, isofraxidin and liquiritin in rat blood after oral administration of shaolin xiaoyin tablets / 中国中药杂志

To establish a method for the determination of astilbin, peoniflorin, rasmarinci acid, isofraxidin and liquiritin contained in Shaolin Xiaoyin tablets, in order to lay a foundation for designing late-stage dosage forms and clinical medication schemes. In this paper, efforts were made to establish a method for the determination of the blood concentration of the five components and study the in vivo pharmacokinetics in rats. The blood concentration was determined by HPLC. Phenomenex C18 column (4.6 mm x 250 mm, 5 microm) was adopted and eluted with methanol-acetonitrile-0.05% formic acid, the flow rate was 0.8 mL x min(-1), and the wavelength was 275 nm. The samples were processed by the solid phase extraction method. After oral administration of Shaoling Xiaoyin tablets, the rat bloods were collected at different time points to determine the blood concentrations. The experimental results showed that the baseline separation could be adopted for the five components, and astilbin, peoniflorin, rasmarinci acid, isofraxidin and liquiritin showed good linear relations within ranges of 2.48-248, 0.213 6-21.36, 0.531-53.1, 0.704-70.4, 0.253-25.3 mg x L(-1). All the five components could be absorbed in blood and excreted quickly. The method established in this paper is rapid and accurate, and could be used for in vivo analysis on preparations containing similar components. The main components in Shaoling Xiaoyin tablets could be absorbed and excreted quickly, and thus suitable to be made into sustained release tablets. Common preparations are required to be taken for 4-6 times a day.

Determination of isofraxidin and astilbin by HPLC in rat plasma and its application after orally administration the extract of Sarcandra glabra

Sarcandra glaber is a common traditional Chinese medicine used to treat psoriasis and other infectious diseases, isofraxidin and astilbin are the main components of it. In order to study the pharmacokinetics of Sarcandra glabra, an HPLC method for simultaneous determination of isofraxidin and astilbin in rat plasma was established. Plasma samples were prepared using solid phase extraction method. C18 column with a guard was used, mobile phase was consisted of A [methanol] and B[0.1% aqueous acetic acid] with gradient elution as follows: 0 4min, A: 35%, B: 65%; 4 l[O]min, A: 35% 45%, B: 65% 55%; 10 20min, A: 45%, B: 55%. The flow rate was 1.2 mL/min from 0 to 4 min, 1.0 mL/min from 4 to 20 min. The detection wavelength was 300 nm. A linear correlation between drug amount and peak area was established for isofraxidin in the range of 20-320 ng and for astilbin in the range of 19-304 ng. The recovery was over 68% for both compounds, the accuracy was within 8%, and the inter-day and intra-day precisions were all less than 8%. The pharmacokinetics of isofraxidin and astilbin was studied after orally administration the extract of Sarcandra glabra

Melanocortin-4 receptor expression in the rostral ventromedial medulla involved in modulation of nociception in transgenic mice / 华中科技大学学报（医学）（英德文版）

The rostral ventromedial medulla (RVM) is a prominent component of the descending modulatory system involved in the control of spinal nociceptive transmission. In the current study, we investigated melanocortin-4 receptor (MC4R) expression in the RVM, where the neurons involved in modulation of nociception reside. Using a line of mice expressing green fluorescent protein (GFP) under the control of the MC4R promoter, we found a large number of GFP-positive neurons in the RVM [nucleus raphe magnus (NRM) and nucleus gigantocellularis pars α (NGCα)]. Fluorescence immunohistochemistry revealed that approximately 10% of MC4R-GFP-positive neurons coexpressed tyrosine hydroxylase, indicating that they were catecholaminergic, whereas 50%-75% of those coexpressed tryptophan hydroxylase, indicating that they were serotonergic. Our findings support the hypothesis that MC4R signaling in RVM may modulate the activity of serotonergic sympathetic outflow sensitive to nociceptive signals, and that MC4R signaling in RVM may contribute to the descending modulation of nociceptive transmission.

Melanocortin-4 receptor expression in the rostral ventromedial medulla involved in modulation of nociception in transgenic mice / 华中科技大学学报（医学）（英德文版）

The rostral ventromedial medulla (RVM) is a prominent component of the descending modulatory system involved in the control of spinal nociceptive transmission. In the current study, we investigated melanocortin-4 receptor (MC4R) expression in the RVM, where the neurons involved in modulation of nociception reside. Using a line of mice expressing green fluorescent protein (GFP) under the control of the MC4R promoter, we found a large number of GFP-positive neurons in the RVM [nucleus raphe magnus (NRM) and nucleus gigantocellularis pars α (NGCα)]. Fluorescence immunohistochemistry revealed that approximately 10% of MC4R-GFP-positive neurons coexpressed tyrosine hydroxylase, indicating that they were catecholaminergic, whereas 50%-75% of those coexpressed tryptophan hydroxylase, indicating that they were serotonergic. Our findings support the hypothesis that MC4R signaling in RVM may modulate the activity of serotonergic sympathetic outflow sensitive to nociceptive signals, and that MC4R signaling in RVM may contribute to the descending modulation of nociceptive transmission.

Analysis of saponins in Panax notoginseng by UPLC-LTQ-Orbitrap MS/MS / 药学学报

A method for qualitative analysis of constituents in Panax notoginseng by UPLC-LTQ-Orbitrap mass spectrometry was established. Based on the high-resolution mass information, MS/MS fragmentation behaviors and chemical components from literatures, 43 compounds were identified or tentatively characterized. New type saponin aglycone, combined with malonyl-substituted and acetyl-substituted saponins were discovered and plausibly identified in this study. This work could be helpful for the quality control and further phytochemical studies of Panax notoginseng, and provided a good example for the analysis of chemical constituents in traditional Chinese medicine.

Study on the correlation between Chinese medicine syndrome types in influenza A (H1N1) virus and potential biomarkers / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the contents changes of potential biomarkers of patients infected with influenza A (H1N1) virus of different Chinese medicine (CM) syndrome types.</p><p><b>METHODS</b>Eighty-two patients with influenza A (H1N1) virus were differentiated as three syndrome types, i. e., wind-heat invading weifen syndrome (51 cases), heat-toxicity attacking Fei syndrome (22 cases), and superficies tightened by wind cold syndrome (9 cases) according to Chinese medicine syndrome typing. According to patients' willingness and clinical conditions, they were treated by three therapeutic schedules, i. e., herbal therapy, symptomatic treatment, and antiviral therapy. The changes of potential biomarkers contents were detected in the serum of patients of various syndrome types before and after treatment. Results There was no statistical difference in the potential biomarkers contents correlated to symptoms of fever, inflammation and cough, such as PGG2, 20-COOH-LTB4, homocystein, and so on in the serum of patients of various syndrome types before treatment (P > 0.05). There was statistical difference in the potential biomarkers such as 20-OH-LTE4, LTA4, and linolenic acid, etc. between superficies tightened by wind cold syndrome and wind-heat invading weifen syndrome (P < 0.05, P < 0.01). There was statistical difference in the potential biomarkers such as PGF1alpha, prostanoic acid, and etc. between superficies tightened by wind cold syndrome and heat-toxicity attacking Fei syndrome (P < 0.05, P < 0.01). Statistical difference existed in other indices other than dUTP; 5,10-methylene-THF and PGF1alpha in wind-heat invading weifen syndrome and superficies tightened by wind cold syndrome; prostanoic acid, homocysteine, and glucose in superficies tightened by wind cold syndrome when compared with before treatment in the same group (P < 0.05, P < 0.01). The changing tendency of potential biomarkers among different syndrome types was identical. Of them, the change of 6-keto-PGF1alpha content was the most obviously of all indices.</p><p><b>CONCLUSION</b>There was difference in the contents of potential biomarkers of patients infected with influenza A (H1N1) virus of different syndrome types, and our study provided experimental data support for the objectiveness of CM syndrome differentiation from the perspective of metabolic substances.</p>

Disease-syndrome combination clinical study of psoriasis: present status, advantages, and prospects / 中国结合医学杂志

Psoriasis is an immune-abnormal, chronic, proliferative skin disease determined by polygenic inheritance and induced by a number of environmental factors. It causes worldwide concern because of its high-prevalence, harmful and incurable characteristics. Over the years, Chinese medicine (CM) treatment of psoriasis has accumulated a wealth of clinical experience. Disease-syndrome combination, which achieves more satisfactory clinical effect, is the basis to highlight the special CM advantages in treating psoriasis. In this paper, we review the advantages of treating psoriasis with the combination of disease and syndrome, analyze the prospects of research on treating psoriasis combining disease with syndrome. We also make a point that there are several key points for the clinical research of combination of disease and syndrome. It can be expected that carrying out clinical research on the combination of disease and syndrome will help improve the clinical efficacy of medical treatment of psoriasis, which will be the main direction of research in the future.

Oral herbal medicines for psoriasis: a review of clinical studies / 中国结合医学杂志

Various forms of complementary and alternative medicine are used in psoriasis. Among these, herbal medicines are frequently used as systemic and/or topical interventions either as a replacement for or in conjunction with conventional methods. The benefit of such use is unclear. This review is to provide an up-to-date review and discussion of the clinical evidence for the main kinds of herbal therapies for psoriasis. Searches of the biomedical databases PubMed (including MEDLINE), EMBASE and CINAHL were conducted in December 2011 which identified 32 clinical studies, all published in English. Twenty of these primarily tested topical herbal medicines and were thus excluded. The 12 studies that evaluated systemic use of herbal medicines were included in the review. Four were case series studies and the other 8 were controlled trials. In terms of interventions, 4 studies tested the systemic use of plant oils combined with marine oils and 8 studies tested multi-ingredient herbal formulations. The clinical evidence for plant and animal derived fatty acids is inconclusive and any benefit appears to be small. For the multi-herb formulations, benefits of oral herbal medicines were shown in several studies, however, a number of these studies are not controlled trials, a diversity of interventions are tested and there are methodological issues in the controlled studies. In conclusion, there is promising evidence in a number of the studies of multi-herb formulations. However, well-designed, adequately powered studies with proper control interventions are needed to further determine the benefits of these formulations. In addition, syndrome differentiation should be incorporated into trial design to ensure effective translation of findings from these studies into Chinese medicine clinical practice.

A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris by auricular therapy combined with optimized Yinxieling Formula / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of auricular therapy combined with optimized Yinxieling Formula on psoriasis vulgaris.</p><p><b>METHODS</b>A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris was conducted. The patients were randomized to a treatment group (43 cases treated by auricular therapy combined with optimized Yinxieling Formula) and a control group (41 cases treated by optimized Yinxieling Formula alone) according to a random number generated by SPSS 17.0 software. The treatment duration for both groups was 8 weeks. The therapeutic effect was comprehensively measured by the primary outcome measure [Psoriasis Area and Severity Index (PASI) reduction rate] and the secondary outcome measure [PASI, Visual Analogue Scale (VAS), Dermatology Life Quality Index (DLQI), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS)]. The outcomes of both groups were obtained and compared before and after the intervention.</p><p><b>RESULTS</b>The PASI reduction rate in the treatment group was 74.4% (32/43), which was higher than that in the control group (36.6%, 15/41, P<0.01). The PASI scores decreased in both groups after treatment and was lower in the treatment group compared with the control group P<0.01). With stratified analysis, there were significant differences between the PASI scores in the following subgroups: age 18-30, baseline PASI>10 and stable stage (P<0.05). DLQI decreased in both groups on some categories after treatment, but there were no significant differences between the two groups in SDS, SAS and VAS (P >0.05). No obvious adverse reactions were found in either group.</p><p><b>CONCLUSION</b>The therapeutic effect of auricular therapy combined with Optimized Yinxieling Formula was superior to Optimized Yinxieling Formula alone with no obvious adverse reaction.</p>

A preliminary study on the medical expenditure of Chinese medicine and integrative medicine treatment for influenza A (H1N1) in the fever clinics / 中国结合医学杂志

<p><b>OBJECTIVE</b>To analyze the effectiveness of Chinese medicine and integrated Chinese and Western medicine for influenza A (H1N1) in the fever clinics and its relevant expenditure.</p><p><b>METHODS</b>A prospective survey on the clinical epidemic observation and follow-up was conducted from July 2009 to October 2009 with a self-developed questionnaire whose contents including the clinical data of the confirmed 149 H1N1 cases and their relevant therapeutic expenditure. The patients were assigned to the Chinese medicine group (22 cases treated by Chinese medicine alone) and integrative medicine group (124 cases treated by both Chinese medicine and Western medicine). The data were processed with descriptive analysis, t test and χ (2), and sum-rank test.</p><p><b>RESULTS</b>The proportion of clinical recovery of Chinese medicine group (81.8%) was higher than that of integrative medicine group (54.8%) with statistical significance (P=0.02). The average fever durations in both groups were 3.5 to 4 days, showing no significant difference (P=0.86). In the comparisons of average cost of Chinese herbs, drugs, therapies, and total cost, those of the Chinese medicine group were lower than those in the integrative group (P=0.01, P=0.00, P=0.00, P=0.00).</p><p><b>CONCLUSIONS</b>The H1N1 patients in the fever clinic who received Chinese medicine treatment had a higher clinical recovery proportion than those who received integrated Chinese and Western medicine treatment with lower medical cost. However, due to small sample size of the Chinese medicine group in the study, the conclusion needs further confirmation by studies with large sample size.</p>

Launching an epidemiologic investigation on characteristics of syndrome for studying critical syndrome types / 中国中西医结合杂志

Study on syndrome type should be combined with clinic closely to make clear the regularities of distribution and development of syndrome types in diseases, as well as the statues of different syndromes in the genesis and development processes of diseases. Aiming at this issue, the authors bring forward the concept of "critical syndrome types", and suggest that for resolving it, launching an epidemiologic investigation on characteristics of syndrome types is necessary.