Chinese Herbal Medicine Adjusting Brain Microenvironment via Mediating Central Nervous System Lymphatic Drainage in Alzheimer's Disease / 中国结合医学杂志

Due to its complex pathogenesis and lack of effective therapeutic methods, Alzheimer's disease (AD) has become a severe public health problem worldwide. Recent studies have discovered the function of central nervous system lymphatic drainage, which provides a new strategy for the treatment of AD. Chinese herbal medicine (CHM) has been considered as a cure for AD for hundreds of years in China, and its effect on scavenging β-amyloid protein in the brain of AD patients has been confirmed. In this review, the mechanism of central nervous system lymphatic drainage and the regulatory functions of CHM on correlation factors were briefly summarized. The advances in our understanding regarding the treatment of AD via regulating the central lymphatic system with CHM will promote the clinical application of CHM in AD patients and the discovery of new therapeutic drugs.

Mechanism of Linggui Zhugantang in Repairing Blood-brain Barrier Injury of Alzheimer's Disease / 中国实验方剂学杂志

ObjectiveTo observe the effect of Linggui Zhugantang （LG） on the blood-brain barrier （BBB） model of Alzheimer's disease （AD） in vitro and to explore the mechanism of LG in repairing the BBB injury in AD. MethodA total of 50 male SPF rats were randomized into five groups： high-dose （4.8 g·kg-1）， medium-dose （2.4 g·kg-1）， and low-dose （1.2 g·kg-1） LG groups， western medicine （0.5 g·kg-1 donepezil hydrochloride） group， and normal group （normal saline of equivalent volume）. They received （ig） corresponding drugs twice a day for 7 d. Drug-containing serum was respectively collected from the abdominal aorta 1 h after the last administration. The BBB injury of AD in vitro was induced with the cell co-culture method， and 6 groups were designed： normal group， model group， high-， medium-， and low-dose LG groups， and western medicine group. The model group was added with 100 μL amyloid β1-42 （Aβ1-42， final concentration： 5 μmol·L-1）， and high-dose， medium-dose， and low-dose LG groups and the western medicine group were added with corresponding 10% drug-containing serum in addition to the 100 μL Aβ1-42 （final concentration： 5 μmol·L-1）. Cell survival rate was detected by methyl thiazolyl tetrazolium （MTT） assay， expression of BBB-related skeleton proteins （claudin-5， ZO-1， occludin）， matrix metalloproteinase-2 （MMP-2）， and matrix metalloproteinase-9 （MMP-9） by Western blot， and content of inflammatory factors interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） by enzyme-linked immunosorbent assay （ELISA）. BBB Aβ transporter low-density lipoprotein receptor-related protein 1 （LRP-1） and advanced glycation end product receptor （RAGE） at different time points in high-dose， medium-dose， and low-dose LG groups were determined by Real-time PCR and Western blot. ResultCell survival rate of the model group was lower than that of the normal group （P<0.05） and the survival rates of the western medicine group and high-dose LG group was higher than that in the model group （P<0.05）. The skeleton proteins were down-regulated and MMP-2 and MMP-9 were up-regulated in the model group compared with those in the normal group （P<0.05）. The expression of skeleton proteins was higher （P<0.05） and that of MMP-2 and MMP-9 was lower （P<0.05） in the western medicine group and high-dose LG group than in the model group. Compared with the model group， only the medium-dose LG group showed the up-regulation （P<0.05） of claudin-5 （P<0.05） and the decrease （P<0.05） of MMP-2. IL-1β， IL-6， and TNF-α in the model group were up-regulated （P<0.05） compared with those in the normal group， and those inflammatory factors in the western medicine group and high-dose and medium-dose LG groups were lower （P<0.05） than those in the model group. LRP-1 expression was up-regulated and RAGE expression was down-regulated at 3 h compared with those at 0 h （P<0.05）， while the expression of the two became stable at 6， 12， 24， 36 h. At 3 h， LRP-1 expression was down-regulated and RAGE expression was up-regulated in model group compared with those in the normal group at 3 h （P<0.05）. Moreover， the LRP-1 content was higher and RAGE content was lower in the western medicine group and high-dose LG group than in the model group. ConclusionLG can repair the BBB injury in vitro by inhibiting the expression of inflammatory factors and MMP-2， MMP-9， promoting the expression of skeletal proteins， and regulating the balance of transporters.

Discussion on Connotation of "Essence Generating Marrow " Based on Intervention of Guilu Erxian Gum in Perivascular Space of Alzheimer's Disease Patients / 中国实验方剂学杂志

Objective:To study the effect mechanism of Guilu Erxian gum on Alzheimer's disease （AD） from the perspective of regulating perivascular space （PVS），and to explore the scientific connotation of "essence generating marrow". Method:The 80 patients with AD diagnosed by western medicine and kidney deficiency and marrow empty syndrome diagnosed by traditional Chinese medicine were randomly divided into two groups，with 40 cases in each group. Both groups of patients were orally administered with cholinesterase inhibitor Alison，one tablet （5 mg） each time before sleep at night. On this basis，the control group additionally received placebo，while the treatment group was additionally treated with Guilu Erxian gum for 60 days. The Mini-Mental State Examination scale （MMSE）， Wechsler Memory Scale and Activity of Daily Living Scale （ADL） were used before treatment （0 d），as well as 31 d and 61 d after treatment. The number and diameter of PVS in midbrain，basal ganglia，deep insular white matter and semiovale center were counted and their diameters were measured with use of nuclear magnetic resonance imaging （MRI） for head. In addition，the curative effect was evaluated according to MMSE scores on 61 d. Result:There was no significant difference between the two groups 31 d. On 61 d，MMSE and WMS scores increased，while ADL scores decreased as compared with the conditions on 0 d（<italic>P</italic><0.01），and there were significant differences in the three indexes and clinical effective rate between two groups （<italic>P</italic><0.05，<italic>P</italic><0.01） . In addition，there was no significant difference in the number of PVS as compared with the number before treatment and in the comparison between the two groups after treatment，but there was a significant difference in the diameter of PVS（<italic>P</italic><0.01）. Conclusion:Guilu Erxian gum is effective in the treatment of AD，and it can improve the PVS diameter in patients，which may be related to the mechanism of "essence generating marrow ".

Implementation Strategy of Community Lung Rehabilitation Centered on Peer Education: a Qualitative Study / 中国康复理论与实践

Objective:To explore the suggestion and key points of implementing community rehabilitation centered on peer education for patients with chronic obstructive pulmonary disease (COPD). Methods:From June, 2016 to June, 2017, 19 doctors, 15 nurses and 27 patients with COPD were selected for semi-structured interviews with the phenomenological research method, and the data were analyzed using the 7-step analysis method of Colaizzi. Results:The points were as follows: establishment and orientation of group leader education, hospital-community-family interaction mode, collective and individual intervention mode and effect and interaction monitoring. Conclusion:There is still lack of unified standards and teaching materials for the application of peer education in the rehabilitation of COPD patients. COPD community rehabilitation implementation strategies with peer education as the core are formulated to provide further reference for the rehabilitation of COPD patients.

Advances in Pharmacological Mechanism of Linggui Zhugan Tang / 中国实验方剂学杂志

Linggui Zhugan Tang(LGZG), a representative of warming spleen to resolve fluid retention, is widely used in various diseases caused by spleen deficiency and fluid retention (SDFR). Ancient doctors mostly focused on the theme of SDFR to analysis the composition of LGZG. Modern research has now found that most of the components of LGZG contain anti-inflammatory, anti-tumor and immune-modulating effects. At present, the pharmacological research of LGZG mainly involves clearance of β-amyloid (Aβ) and anti-neuroinflammation, regulation of lipid metabolism and insulin resistance, protection of myocardial cells and regulation of liquid metabolism as follow. LGZG can promote the clearance of Aβ by regulating the expression of Aβ transporters, including low-density lipoprotein receptor-associated protein-1 and terminal glycosylation product receptors, as well as reduce the inflammation of nerve cells by inhibiting the secretion of pro-inflammatory factors such as interleukin(IL) -1β,IL-6 and tumor necrosis factor-α(TNF-α) by microglia. The prescription can also affect the lipid metabolism and insulin resistance by regulating the levels of adiponectin, insulin and leptin, thus producing therapeutic effects on metabolic syndrome and non-alcoholic fatty liver disease. The protective mechanism of LGZG on myocardial cells mainly contains inhibition of the over-activation of nuclear transcription factor-κB(NF-κB) signaling pathway,up-regulation of Smad7 expression and down-regulation of Smad3 expression, regulation of inhibitor of nuclear factor kappa-B kinase (IKK)/NF-κB inhibitor (IκB)/NF-κB signaling pathway, inhibition of inflammatory factor production, and down-regulation of Caspase-3 and Caspase-8 expression. In addition,LGZG can also regulate aquaporins to affect water metabolism. And it also has significant antioxidant effects. As is known to all,the functional mechanism of traditional Chinese medicine (TCM) compound is closely related to the network regulation of TCM disease syndromes. Considered from this angle, it is helpful to carry out the "disease-syndrome-formula" research by means of network pharmacology characterized by "disease-target-drug", thus organically exploring the relationship between LGZG and SDFR from the microscopic perspective,and helping to explain the scientific connotation of SDFR and the biological mechanism of warming spleen to resolve fluid retention.

Experience from four dimensions application of classic formulas for treatment of dysmenorrhea / 中国中药杂志

The application of classic formulas from Shanghan Zabing Lun has a long history in treatment of dysmenorrhea. However, the understanding on how to use classic formula in treatment of dysmenorrhea is still insufficient in the traditional Chinese medicine (TCM), mainly limited to syndrome differentiation and the formula-syndrome correlation. The treatment method of syndrome differentiation is flexible and changeable, but the process is tedious and difficult to copy. In addition, its experience is not easy to summarize and pass on, and it is difficult for beginners to comprehend the essence. Formula-syndrome correlation method is accurate, quick acting, but subjective, too mechanical, and will have obvious side effects in case of prescription mistakes. For complex diseases or when suffering from a variety of diseases, the efficacy of formula-syndrome correlation method is not so obvious. By analyzing the advantages and limitations of these two methods, the author has created a four-dimensional therapy which combines the advantages of these two, from four dimensions including disease differentiation, syndromes differentiation, time differentiation, and constitution differentiation in clinical application for dysmenorrheal. Its clinical curative effect is satisfactory. Four-dimensional therapy is a way of thinking, to guide clinicians for accurate diagnosis and precisely choosing drugs; meanwhile, the personalized health guidance is given according to different constitutions and different seasons, which also has certain significance to treat the undiseased.

Imaging Analysis of Giant Cell Reparative Granuloma of Temporal Bone Compared with Operation and Pathology / 中山大学学报(医学科学版)

[Objective] To improve the understanding of CT and MRI features of giant cell reparative granuloma of temporal bone and reduce misdiagnosis.[Methods] The CT and MR images of 4 cases of GCRG of temporal bone were analyzed,compared with their operation and pathology results.[Results] All the lesions of the 4 cases were located in the anterior and lower parts of the temporal bone with widely destruction.The CT images showed expansive destruction of bone with disruption of osseous shell,strip and punctate calcification and ossification in and around the lesion,and osteosclerosis of the adjacent bone,which consistent with the scope of the operation.The MR images showed a large patchy of low signal intensity on both T1-weighted and T2-weighted images,which showed heterogeneous enhancement after injection of contrast.Fibrous proliferation with multiple multinuclear giant cells and hemosiderin deposition were showed under microscope.[Conclusion] The morphological and pathological characteristics of recurrent intraosseous hemorrhage and parcels of granulation tissue in GCRG of the temporal bone could be reflected by CT and MR images,which has certain characteristics and is of important significance to the diagnosis of the tumor.

Guiding Significance of "Mistreatment by Warming Therapy" in Treatment of Non-small Cell Lung Cancer / 中国中西医结合杂志

"Mistreatment by warming therapy" refers to various symptoms/syndromes caused by improper use of fire methods mentioned in Treatise on Febrile Diseases, which are similar to damaged yin induced fire-heat syndrome (injury of yin, consumption of qi, loss of yin, consumption of body fluid) manifested after radiotherapy and/or chemotherapy in modern clinics. Better efficacy was obtained in treating various symptoms/syndromes by using nourishing yin purging fire method. In this paper authors focuses on exploring guiding significance of using "Mistreatment by warming therapy" in treating non-small cell lung cancer (NSCLC).

Effect-of Angong Niuhuang Pill on Th1/Th2 of cerebral infarction patients of phlegm-heat obstructing orifices in China and Indonesia / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Angong Niuhuang Pill (ANP) on Thl/Th2 in cerebral infarction patients and to explore the mechanism of phlegm-heat obstructing orifices.</p><p><b>METHODS</b>Re- cruited were 30 cerebral infarction patients of phlegm-heat obstructing orifices syndrome (PHOOS) both in China and Indonesia. They were assigned to 4 groups according to the use of ANP, the Chinese treatment group, the Indonesia treatment group, the Chinese control group, and the Indonesia control group. Patients in the two control groups received conventional treatment, while those in the two treatment group additionally took ANP for 30 successive days. Their adverse reactions were observe, and levels of INF-γ and IL-4 were detected.</p><p><b>RESULTS</b>The INF-γ level and the INF-γ/IL-4 ratio significantly decreased, and the IL-4 level increased after treatment in the four groups with statistical difference (P < 0.05). Compared with the control group after treatment in the same country, the INF-γ level and the INF-γ/IL-4 ratio were lower, and the IL-4 level was higher in the two treatment groups (P < 0.05). Compared with the two Chinese groups, the INF-γ level and the INF-γ/IL-4 ratio were higher, and the IL-4 level was lower in the two Indonesian groups (P < 0.05). There was no statistical difference in the post-treatment indices between the two treatment groups.</p><p><b>CONCLUSIONS</b>ANP had moderating effect on Th1/Th2 in cerebral infarction pa- tients. Cerebral infarction patients of PHOOS might exist certain relation with Th1/Th2.</p>

Effect of Zhixin Formula on Gliocyte Protein Expressions, TLRs and NF-κB in Bone Cancer Pain Model Rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the analgesic effect of Zhixin Formula (ZF) and its effects on spinal glial fibrillary acidic protein (glial fibillary acidic protein, GFAP, a marker of astrocyte) , CD11b (a maker of microglia), Toll like receptors (TLR2 and TLR4) and nuclear factor κB (NF-κB) in bone cancer pain model rats.</p><p><b>METHODS</b>Totally 20 male SD rats were randomly divided into the blank control group and the bone cancer pain group, 10 in each group. The bone cancer pain model was induced by injecting ascites tumor fluid containing 3 x 10(3) Walker256 cell line from the left tibia. Ethological tests, X-ray test, and HE staining were performed to confirm a successful modeling. After model was successfully established, 70 male SD rats were randomly divided into seven groups, 10 in each group: the blank control group, the bone cancer pain group (as the model group), the Western medicine (WM) group (Tramadol Hydrochloride), the high dose ZF group, the middle dose ZF group, the low dose ZF group, and the Chinese medicine (CM) group (Wulin Zhitong Capsule). Fourteen days after modeling, rats in the high, middle, and low dose ZF groups were administrated by gastrogavage with 9, 4.5, and 2.25 g/kg ZF water condensed preparation respectively, once a day for seven consecutive days. On day 21 MS typical protein expressions including GFAP, CD11b, TLR (2,4) and NF-κB from cornu dorsal medullae spindis L4-L5 were detected by immunohistochemistry, reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.</p><p><b>RESULTS</b>Compare with the blank control group, increased weight in the model group was slow and showed a decreasing trend (P < 0.01), spontaneous ambulatory pain score (SAPS) obviously increased (P < 0.01), paw withdrawal threshold (PWT) obviously decreased in the model group (P < 0.05, P < 0.01). Results of lateral tibial X-ray and HE staining showed obvious changes and damage occurred in bone structures of rats in the model group. Immunohistochemistry showed that GFAP expression significantly increased in the model group (P < 0.05). Protein levels of NF-κB also significantly increased in the model group (P < 0.05). Compared with the model group, CD11b expressions obviously decreased in the middle and high dose ZF groups (P < 0.01). Meanwhile, protein expressions of TLR2 and TLR4, as well as NF-κB also obviously decreased (P < 0.05).</p><p><b>CONCLUSION</b>ZF had analgesic effect, which might be probably related to inhibiting proliferation and activation of gliocytes, as well as activation of TLRs and NF-κB.</p>

Research on the relationship between chinese medical syndrome types and Th1/Th2 in bronchioloalveolar carcinoma by thoracoscopic technique / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the relationship between Chinese medical syndrome types of bronchioloalveolar carcinoma (BAC) and Th1/Th2.</p><p><b>METHODS</b>Totally 60 BAC patients were syndrome typed as qi and yin deficiency syndrome (QYDS) and qi stagnation and phlegm-blood stasis syndrome (QSPSS), 30 cases in each group. Meanwhile, 30 subjects with benign pulmonary nodules were recruited as the control group. The contents of interferon-gamma (INF-gamma), interleukin 4 (IL-4), IL-2, and IL-5 were detected using thoracoscopic technique.</p><p><b>RESULTS</b>As for Th1 (INF-gamma and IL-2), it was ranked from high to low as the control group > the QSPSS group > the QYDS group (P < 0.05). As for Th2 (IL-4 and IL-5), it was ranked from high to low as the QYDS group > the QSPSS group >the control group (P < 0.05). As for Th1/Th2 (INF-gamma/lL-4, IL-2/IL-5), it was ranked from high to low as the control group > the QSPSS group >the QYDS group (P < 0.05).</p><p><b>CONCLUSIONS</b>Compared with the tissue of benign nodules, Th1 function in tumor tissue of BAC patients was weaker and Th2 function stronger. Chinese medical syndrome types of BAC had correlation with Th1/Th2. Patients of excess syndrome had stronger immunity with Th1/Th2 shifting left,while those of deficiency syndrome were predispose to humoral immunity with Thl/Th2 shifting right.</p>

Therapeutic effect of whole body hyperthermia combined with chemotherapy in patients with advanced cancer / 中南大学学报(医学版)

OBJECTIVE@#To determine the short-term efficacy and security of whole body hyperthermia (WBH) combined with chemotherapy for advanced cancer.@*METHODS@#Different chemotherapy regimens were applied in 138 patients with advanced cancer. Among them, 68 patients (Group A) didn't receive any other therapies. The other 70 patients (Group B) received WBH together with chemotherapy. WBH was maintained at 40 degrees C approximately 42 degrees C for 50 approximately 60 min (once or twice every week and 4 times a cycle).@*RESULTS@#In Group A, the rate of complete remission (CR) was 2.9%, partial remission (PR) was 36.8%, stable disease was 35.3%, progressive disease was 25.0%, the overall response rate (CR + PR) was 39.7%; while in Group B, the corresponding figures were 5.7%, 52.9%, 25.7%, 25.0%, and 58.6%, respectively. There was significant difference between the two groups (P < 0.05). The rates of III + IV gastrointestinal tract andmyelosuppression toxicities were 26.5% and 16.2% in Group A, while 27.1% and 18.6% in Group B. No significant difference was found.@*CONCLUSION@#WBH combined with chemotherapy is efficient and safe for advanced cancer, and is worth generalizing extensively.

Analysis and prospects for major musculoskeletal imaging articles at home and abroad during the last decade / 中华放射学杂志

Objective To evaluate the situation of musculoskeletal imaging research at home and abroad and the disparity and consistency between them.Methods Statistic analysis was done with the musculoskeletal articles published in those journals during the last decade,including Chinese Journal of Radiology,Journal of Clinical Radiology,Radiology,American Journal of Roentgenology(AJR)and the British Journal of Radiology(BJR).Results The development of museuloskeletal imaging research was very imbalaneed among different areas and hospitals in China.The rate of clinical research treatise and imaging technique articles at home was 76.3%(357/468)and 10.0%(47/468),respectively,while that was 75.7%(731/966)and 10.8%(105/966),respectively abroad.The rate of MR image technique articles in China was lower than that abroad.The rate of articles on basic research at home and abroad was 5.3%(25/468)and 7.9%(76/966),respectively.The rate of articles about museuloskeletal imaging simply using CT or MR at home was 20.1%(94/468)and 29.7%(139/468),respectively,while that was 5.1%(49/966)and 60.4%(548/966),respectively abroad.The rate of articles about interventional therapy and synthetic imaging at home was 9.2%(43/468)and 29.3%(137/468),respectively,while that was 4.7%(45/966)and 22.5%(217/966),respectively abroad.With regard to the diseases category,the research focused on the bone tumors and the tumor-like disease in China,while in other countries,the research focus had been diverted to the trauma of bone and joint,and the anatomy and disease of muscle and ligament,which was unsatisfactory in China.More focus had been put on imaging anatomy, cartilage disease and osteoporosis in other countries than in China.The research on the radiation dosage the subject received in the examination,the apphcation of Micro-CT and Micro-MR to musculoskeletal imaging was developed in other countries,but it had not been reported in China.Conclusion Although great success has been achieved in the research of musculoskeletal imaging in the last decade,there is still much disparity comparing with other countries,and the research is very imbalanced among different areas and hospitals in China.We should emphasize the application of MRI to musculoskeletal system and pay more attention to the basic research and imaging anatomy research,especially the research on ligament,muscle and cartilage.

Initial study of optimal single-voxel ~1H-MR spectroscopy parameters on femoral bone marrow / 中华放射学杂志

Objective To choose proper proton magnetic resonance spectroscopy(~1XH-MRS) parameters to fit for practical femoral marrow cavity and to produce short-timed,well-repeated and excellent ~1H-MRS images.Methods The tentative study of ~1H-MRS on the normal femoral bone marrow in 26 volunteers was performed with a 1.5 T MR after the informed consent.The single-voxel spectroscopy and stimulated echo acquisition mode were used for ~1H-MRS collection.~1H-MRS parameters for 12 volunteers were 128 acquisitions,1 cm?1 cm?1 cm volume of interest(VOI)size and repeatedly 2—3 times within the same location.~1H-MRS parameters for another:14 volunteers were different numbers of acquisition (128 and 256 times,respectively)and different VOI sizes(2 cm?2 cm?2 cm and 1 cm?1 cm?1 cm, respectively).Results For ~1H-MRS with 1 cm?1 cm?1 cm size of VOI and 128 times of acquisition with the full width haft max of water≤8—12 Hz,the base-line was steady and the signal-noise ratio was high up to 11.31.~1H-MRS was different in the different femoral locations showing the maximum peak sites at near 0.90 ppm(?10~(-6))or 1.65 ppm,but~1H-MRS within the same location was always same or similar with different VOI sizes(1 cm?1 cm?1 cm or 2 cm?2 cm?2 cm)or different numbers of acquisition(128 or 256 times).~1H-MRS acquisition time was not related with the size of VOI but with the numbers of acquisition.128 and 256 times of acquisition cost 199 s and 391 s,respectively.Conclusion With the technique of small size of VOI(1 cm?1 cm?1 cm)and decreased numbers of acquisition(128 times),it is propable to get well-repeated and excellent ~1H-MRS within less time.It is also more practical for clinics to achieve ~1H-MRS of the femoral marrow with the proper technique.