Therapeutic Efficacy of Tian Yuan Acupuncture Method for Liver Cancer Pain and Its Effect on Quality of Life and Adverse Reactions / 上海针灸杂志

Objective To observe the therapeutic efficacy of Tian Yuan acupuncture method in treating liver cancer pain and its effect on quality of life (QOL) and adverse reactions. Method A total of 108 patients with liver cancer were randomized into an observation group and a control group, with 54 cases in each group. The observation group was intervened by Tian Yuan acupuncture method, while the control group was intervened by the three-step analgesic ladder recommended by the World Health Organization (WHO). The clinical efficacies, changes in Visual Analogue Scale (VAS) and QOL, and the occurrence of adverse reactions in the two groups were observed. Result The total effective rate in the observation group was significantly higher than that in the control group (P<0.05); the VAS and QOL scores showed improvement after treatment in both groups and the improvements in the observation group were more significant than those in the control group (P<0.05); adverse reactions occurred in both groups, and the occurrence rate was 25.9％ in the observation group, significantly lower than 53.7％ in the control group (P<0.05).Conclusion Tian Yuan acupuncture method can produce significant clinical efficacy in treating liver cancer pain. It can effectively improve the symptoms of cancer pain and enhance the QOL.

San-Cao Granule () Ameliorates Hepatic Fibrosis through High Mobility Group Box-1 Protein/Smad Signaling Pathway / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the possible mechanism of San-Cao Granule (SCG, ) mediating antiliver fibrosis.</p><p><b>METHODS</b>A total of 60 male Sprague-Dawley rats were randomly divided into the normal control group, porcine serum-treated group, ursodesoxycholic acid (UDCA, 60 mg/kg), SCG (3.6 g/kg) group, SCG (1.8 g/kg) group and SCG (0.9 g/kg) group, with 10 rats in each group. Liver fibrosis was induced with porcine serum by intraperitoneal injection for 8 weeks, except for the normal control group. Then, the rats in the three SCG-treated groups and UDCA group were administered SCG and UDCA respectively for 4 weeks. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), albumin (ALB), total bilirubin (TBIL), hyaluronic acid (HA), laminin (LN), and type IV collagen (IVC) were examined using commercial kits and hepatic histopathology was examined with hematoxylin and eosin and Masson staining. Moreover, the protein expression levels of high mobility group box-1 protein (HMGB1), transforming growth factor β1 (TGF-β1), phosphorylated mothers against decapentaplegic homolog 3 (p-Smad3), Smad7, toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), nuclear factor-kappa B (NF-κB) and α-smooth muscle actin (α-SMA) were determined by western blot, immunohistochemistry and real time quantitative-reverse transcription polymerase.</p><p><b>RESULTS</b>Both SCG (3.6 and 1.8 g/kg) and UDCA significantly ameliorated the liver fibrosis induced by porcine serum as indicated by retarding the serum levels increasing of ALT, AST, TBIL, HA, LN and IVC and preventing the serum level reducing of ALB compared with the model group (all P<0.01). Meanwhile, the collagen deposition was attenuated by SCG and UDCA treatment. Furthermore, SCG markedly reduced the expressions of HMGB1, TGF-β1, p-Smad3, TLR4, MyD88, NF-κB and α-SMA, and enhanced the expression of the Smad7 compared with the model group (all P<0.01).</p><p><b>CONCLUSION</b>SCG ameliorates hepatic fibrosis possibly through inhibiting HMGB1, TLR4/NF-κB and TGF-β1/Smad signaling pathway.</p>

Establishment and reliability evaluation of the design space for HPLC analysis of six alkaloids in Coptis chinensis (Huanglian) using Bayesian approach / 中国天然药物

Coptis chinensis (Huanglian) is a commonly used traditional Chinese medicine (TCM) herb and alkaloids are the most important chemical constituents in it. In the present study, an isocratic reverse phase high performance liquid chromatography (RP-HPLC) method allowing the separation of six alkaloids in Huanglian was for the first time developed under the quality by design (QbD) principles. First, five chromatographic parameters were identified to construct a Plackett-Burman experimental design. The critical resolution, analysis time, and peak width were responses modeled by multivariate linear regression. The results showed that the percentage of acetonitrile, concentration of sodium dodecyl sulfate, and concentration of potassium phosphate monobasic were statistically significant parameters (P < 0.05). Then, the Box-Behnken experimental design was applied to further evaluate the interactions between the three parameters on selected responses. Full quadratic models were built and used to establish the analytical design space. Moreover, the reliability of design space was estimated by the Bayesian posterior predictive distribution. The optimal separation was predicted at 40% acetonitrile, 1.7 g·mL(-1) of sodium dodecyl sulfate and 0.03 mol·mL(-1) of potassium phosphate monobasic. Finally, the accuracy profile methodology was used to validate the established HPLC method. The results demonstrated that the QbD concept could be efficiently used to develop a robust RP-HPLC analytical method for Huanglian.

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome: A 1-year Follow-up Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Deep brain stimulation (DBS) has been a promising treatment for patients with refractory Tourette syndrome (TS) for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus (GPi) DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment.</p><p><b>METHODS</b>Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder (OCD) through the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive-compulsive Scale (Y-BOCS). We used the Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC) to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months (12-99 months).</p><p><b>RESULTS</b>Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline (P < 0.05). The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively (P < 0.05). We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications.</p><p><b>CONCLUSION</b>GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients' quality of life.</p>

Near infrared spectrum monitoring of scale up process for macroporous resin purification of Grardeniae extract / 中国中药杂志

To establish a fast detection method during the purifying process of the extracts from Grardeniae using macroporous resin based on near infrared spectroscopy. First, the ethanol eluent was collected from the purification process of small size sample; and near infrared (NIR) spectrum was collected. Then the content of the geniposide was determined by HPLC method, and partial least squares (PLS) method was used to establish the quantitative model to predict the content of geniposide by NIR spectrum. This model was used to supervise the changes of geniposide concentrations in ethanol eluent during medium scale process. Experimental results showed that the NIR small scale model can accurately predict the concentrations of geniposide in the production process of medium scale. However, with the proceeding of batch processes, the prediction performance of the model was decreased, so model updating method was employed to maintain the model. After twice updates, the NIR quantitative model can accurately predict the concentrations of the geniposide during medium scale process. Therefore, through model updates, the established NIR quantitative model can be applied in different scales of macroporous resin purification processes, to improve the data utilization efficiency of small scale process and save the cost of rebuilding the quantitative model of medium scale.

Causes, Features, and Outcomes of Drug-Induced Liver Injury in 69 Children from China

BACKGROUND/AIMS: Drug-induced liver injury (DILI) is a frequent cause of pediatric liver disease; however, the data on DILI are remarkably limited. METHODS: All 69 children hospitalized with DILI between January 2009 and December 2011 were retrospectively studied. RESULTS: A total of 37.7% of the children had medical histories of respiratory infection. The clinical injury patterns were as follows: hepatocellular 89.9%, cholestatic 2.9%, and mixed 7.2%. Liver biopsies from 55 children most frequently demonstrated chronic (47.3%) and acute (27.3%) hepatitis. Hypersensitivity features, namely, fever (31.9%), rash (21.7%), and eosinophilia (1.4%), were found. Twenty-four children (34.8%) developed chronic DILI. Antibiotics (26.1%) were the most common Western medicines (WMs) causing DILI, and the major implicated herbs were Ephedra sinica and Polygonum multiflorum. Compared with WM, the children whose injuries were caused by Chinese herbal medicine (CHM) showed a higher level of total bilirubin (1.4 mg/dL vs 16.6 mg/dL, p=0.004) and a longer prothrombin time (11.8 seconds vs 17.3 seconds, p=0.012), but they exhibited less chronic DILI (2/15 vs 18/39, p=0.031). CONCLUSIONS: Most cases of DILI in children are caused by antibiotics or CHM used to treat respiratory infection and present with hepatocellular injury. Compared with WM, CHM is more likely to cause severe liver injury, but liver injury caused by CHM is curable.

Mechanical stimulus inhibits the growth of a bone tissue model cultured in vitro △ / 中国医学科学杂志(英文版)

<p><b>OBJECTIVES</b>To construct the cancellous bone explant model and a method of culturing these bone tissues in vitro, and to investigate the effect of mechanical load on growth of cancellous bone tissue in vitro.</p><p><b>METHODS</b>Cancellous bone were extracted from rabbit femoral head and cut into 1-mm-thick and 8-mm-diameter slices under sterile conditions. HE staining and scanning electron microscopy were employed to identify the histomorphology of the model after being cultured with a new dynamic load and circulating perfusion bioreactor system for 0, 3, 5, and 7 days, respectively. We built a three-dimensional model using microCT and analyzed the loading effects using finite element analysis. The model was subjected to mechanical load of 1000, 2000, 3000, and 4000 με respectively for 30 minutes per day. After 5 days of continuous stimuli, the activities of alkaline phosphatase (AKP) and tartrate-resistant acid phosphatase (TRAP) were detected. Apoptosis was analyzed by DNA ladder detection and caspase-3/8/9 activity detection.</p><p><b>RESULTS</b>After being cultured for 3, 5, and 7 days, the bone explant model grew well. HE staining showed the apparent nucleus in cells at the each indicated time, and electron microscope revealed the living cells in the bone tissue. The activities of AKP and TRAP in the bone explant model under mechanical load of 3000 and 4000 με were significantly lower than those in the unstressed bone tissues (all P<0.05). DNA ladders were seen in the bone tissue under 3000 and 4000 με mechanical load. Moreover, there was significant enhancement in the activities of caspase-3/8/9 in the mechanical stress group of 3000 and 4000 με(all P<0.05).</p><p><b>CONCLUSIONS</b>The cancellous bone explant model extracted from the rabbit femoral head could be alive at least for 7 days in the dynamic load and circulating perfusion bioreactor system, however, pathological mechanical load could affect the bone tissue growth by apoptosis in vitro. The differentiation of osteoblasts and osteoclasts might be inhibited after the model is stimulated by mechanical load of 3000 and 4000 με.</p>

Effects of lamivudine on growth of intestinal characteristic bacteria by microcalorimetry in vitro / 药学学报

The study is aimed to investigate the effect of lamivudine on growth and metabolism of three intestinal characteristic bacteria (namely, Bifidobacterium adolescentis, Escherichia coli and Shigella dysenteriae). The growth condition of the three bacteria was quantitatively evaluated by microcalorimetry with four characteristic parameters of the thermal power-time curves, including the growth rate constant (k), thermal power (p), time to peak (t) and calorific value (Q). The results showed that the IC50 value of lamivudine on B. adolescentis was 200 microg x mL(-1), and the IC50 values of lamivudine on S. dysenteriae and E. coli were higher than 3 000 microg x mL(-1) and 6 000 microg x mL(1), respectively. Therefore, lamivudine made different inhibitory effects on the three bacteria, in which the B. adolescentis was most susceptible to lamivudine. This work showed that taking lamivudine chronically is likely to affect the balance of good flora in the intestinal tract, and might increase endotoxin release, leading to inflammation and disease progression in hepatopathy.

Neuronal firing in the ventrolateral thalamus of patients with Parkinson's disease differs from that with essential tremor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although thalamotomy could dramatically improve both parkinsonian resting tremor and essential tremor (ET), the mechanisms are obviously different. This study aimed to investigate the neuronal activities in the ventrolateral thalamus of Parkinson's disease (PD) and ET.</p><p><b>METHODS</b>Thirty-six patients (PD: 20, ET: 16) were studied. Microelectrode recordings in the ventral oral posterior (Vop) and the ventral intermediate nucleus (Vim) of thalamus was performed on these patients who underwent thalamotomy. Electromyography (EMG) was recorded simultaneously on the contralateral limbs to surgery. Single unit analysis and the interspike intervals (ISIs) were measured for each neuronal type. ISI histogram and auto-correlograms were constructed to estimate the pattern of neuronal firing. Mann-Whitney test and Kruskal-Wallis (K-W) test were used to compare the mean spontaneous firing rate (MSFR) of neurons of PD and ET patients.</p><p><b>RESULTS</b>Three hundred and twenty-three neurons were obtained from 20 PD trajectories, including 151 (46.7%) tremor related neuronal activity, 74 neurons (22.9%) with tonic firing, and 98 (30.4%) neurons with irregular discharge. One hundred and eighty-seven neurons were identified from 16 ET trajectories including 46 (24.6%) tremor-related neuronal activity, 77 (41.2%) neurons with tonic firing, and 64 neurons (34.2%) with irregular discharge. The analysis of MSFR of neurons with tonic firing was 26.7 (3.4 - 68.3) Hz (n = 74) and that of neurons with irregular discharge (n = 98) was 13.9 (3.0 - 58.1) Hz in PD; whereas MSFR of neurons with tonic firing (n = 77) was 48.8 (19.0 - 135.5) Hz and that of neurons with irregular discharge (n = 64) was 26.3 (8.7 - 84.7) Hz in ET. There were significant differences in the MSFR of two types of neuron for PD and ET (K-W test, both P < 0.05). Significant differences in the MSFR of neuron were also obtained from Vop and Vim of PD and ET (16.3 Hz vs. 34.8 Hz, 28.0 Hz vs. 49.9 Hz) (K-W test, both P < 0.05), respectively.</p><p><b>CONCLUSION</b>In consistent with recent findings, the decreased MSFR of neurons observed in the Vop is likely to be involved in PD whereas the increased MSFR of neurons seen in the Vim may be a cause of ET.</p>

Neuronal firing in the globus pallidus internus and the ventrolateral thalamus related to parkinsonian motor symptoms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It has been proposed that parkinsonian motor signs result from hyperactivity in the output nucleus of the basal ganglia, which suppress the motor thalamus and cortical areas. This study aimed to explore the neuronal activity in the globus pallidus internus (GPi) and the ventrolateral thalamic nuclear group (ventral oral posterior/ventral intermediate, Vop/Vim) in patients with Parkinson's disease (PD).</p><p><b>METHODS</b>Twenty patients with PD who underwent neurosurgery were studied. Microelectrode recording was performed in the GPi (n = 10) and the Vop/Vim (n = 10) intraoperatively. Electromyography (EMG) contralateral to the surgery was simultaneously performed. Single unit analysis was carried out. The interspike intervals (ISI) and coefficient of variation (CV) of ISI were calculated. Histograms of ISI were constructed. A unified Parkinson's disease rating scale (UPDRS) was used to assess the clinical outcome of surgery.</p><p><b>RESULTS</b>Three hundred and sixty-three neurons were obtained from 20 trajectories. Of 175 GPi neurons, there were 15.4% with tremor frequency, 69.2% with tonic firing, and 15.4% with irregular discharge. Of 188 thalamic neurons, there were 46.8% with tremor frequency, 22.9% with tonic firing, and 30.3% with irregular discharge. The numbers of three patterns of neuron in GPi and Vop/Vim were significantly different (P < 0.001). ISI analysis revealed that mean firing rate of the three patterns of GPi neurons was (80.9 +/- 63.9) Hz (n = 78), which was higher than similar neurons with 62.9 Hz in a normal primate. For the Vop/Vim group, ISI revealed that mean firing rate of the three patterns of neurons (n = 95) was (23.2 +/- 17.1) Hz which was lower than similar neurons with 30 Hz in the motor thalamus of normal primates. UPDRS indicated that the clinical outcome of pallidotomy was (64.3 +/- 29.5)%, (83.4 +/- 19.1)% and (63.4 +/- 36.3)%, and clinical outcome of thalamotomy was (92.2 +/- 12.9)%, (68.0 +/- 25.2)% and (44.3 +/- 27.2)% for tremor, rigidity and bradykinesia, respectively. A significant difference of tremor and rigidity was found between GPi and Vop/Vim (P < 0.05).</p><p><b>CONCLUSIONS</b>Different changes in neuronal firing rate and the pattern in GPi and Vop/Vim are likely responsible for parkinsonian motor signs. The results support the view that abnormal neuronal activity in GPi and Vop/Vim are involved in the pathophysiology of parkinsonism.</p>

Subthalamic deep brain stimulation for Parkinson's disease: correlation of active contacts and electrophysiologically mapped subthalamic nucleus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Subthalamic deep brain stimulation (STN-DBS) has been shown to be effective in the treatment of Parkinson's disease. The site for permanent stimulation is still in debate. This study aimed to assess the position of active contacts in relation to the subthalamic nucleus.</p><p><b>METHODS</b>We reviewed the location of 40 electrodes in 34 patients who underwent STN-DBS. The position of electrode was evaluated by postoperative magnetic resonance imaging (MRI). The position of active contacts was compared with the subthalamic nucleus (STN) determined by intraoperative electrophysiological mapping and postoperative MRI.</p><p><b>RESULTS</b>The average position of the 40 active contacts was (11.7 + or - 1.2) mm lateral, (0.6 + or - 1.3) mm anterior, and (0.7 + or - 1.4) mm vertical to the midcommissural point. The dorsal margin of the STN was (11.6 + or - 1.1) mm lateral, (0.2 + or - 1.1) mm anterior, and (1.3 + or - 1.1) mm vertical to the midcommissural point. When compared with the dorsal margin of the STN, the active contacts were located more dorsally (P = 0.033) and anteriorly (P = 0.012), no significant difference was found in the lateral direction (P = 0.107). When compared with the position of the STN, 26 (65%) of active contacts were located in the region dorsal to the STN, only 13 (32.5%) were located in the upper two-thirds portion of STN.</p><p><b>CONCLUSIONS</b>The site for permanent stimulation appears to be in the subthalamic region dorsal to the STN, close to the dorsal margin of the STN. Besides the dorsal portion of the STN, other structures such as fields of Forel H and zona incerta may also be involved in the therapeutic benefit of deep brain stimulation.</p>

DYT1 mutations amongst early onset primary dystonia patients in China / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the frequency of GAG deletion in the DYT1 gene among early onset primary dystonia patients in China.</p><p><b>METHODS</b>Thirteen patients with early onset primary torsion dystonia were screened for mutation in exon 5 of the DYT1 gene using denaturing high-performance liquid chromatography (DHPLC) and DNA sequencing, and the results were confirmed with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).</p><p><b>RESULTS</b>The GAG deletion mutation which results in Glu302del in exon 5 of the DYT1 gene was found in 5 patients. The detecting results were consistent between with DHPLC and PCR-RFLP. We did not find any other mutations in the DYTI gene.</p><p><b>CONCLUSIONS</b>The GAG deletion in the DYT1 gene is common amongst early onset primary torsion dystonia patients in China. The frequency of DYT1 mutation is not significantly different between European and Asian patients with early onset primary dystonia.</p>

MRI-guided stereotactic biopsy for questionable diseases in brain / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the accuracy and role of magnetic resonance imagine (MRI)-guided stereotactic biopsy for atypical diseases in brain.</p><p><b>METHODS</b>Using MRI volume scan and multiplane reconstruction, MRI-guided stereotactic brain biopsies were performed with CRW stereotactia frame in twenty-six patients whose lesions were atypical or unable to be detected by CT scanning.</p><p><b>RESULTS</b>No serious complication (intracranial hematoma, paralysis) caused by brain biopsy was found in all twenty-six patients. Definite pathologic diagnosis and appropriate treatment were given to these patients. The lesions included gliomatosis cerebri, brain cysticercosis and Krabbe's disease, et al.</p><p><b>CONCLUSIONS</b>MRI-guided stereotactic brain biopsy is more accurate for pathological diagnosis than CT-guided stereotactic brain biopsy. MRI-guided stereotactic biopsy can provide reliable diagnosis and treatment especially for the questionable lesions in brain.</p>

Neuroelectrophysiological basis and surgical treatment of essential tremor / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the relationship between limb tremor and neuronal firing in thalamus (Vim) and retrospectively review the clinical effects and safety of the surgical treatment of essential tremor (ET).</p><p><b>METHODS</b>Forty-two ET patients received microelectrode-guided thalamotomy and 11 cases were quantitatively evaluated with FAHN rating scales pre- and post-operatively.</p><p><b>RESULTS</b>There were electrophysiological tremor-related neurons in ventrolateral part of thalamus. Lesioning of those neurons abolished contralateral limb tremor in all of the patients. No permanent contralateral weakness, dysarthria and hemorrhage were observed.</p><p><b>CONCLUSION</b>"Tremor cell" in thalamus plays a key role in the symptom of ET patients. Destruction of those cells may completely and permanently abolish tremor symptom.</p>