Clinical trials and evaluation of Chinese patent medicine for influenza / 中国中药杂志

The clinical randomized controlled trial(RCT) of Chinese patent medicine in the treatment of influenza were reviewed and analyzed to provide basic information for clinical decision and related research. On the basis of the collection in the Traditional Chinese Medicine(TCM) Clinical Evidence Database System(EVDS), CNKI, Wanfang, VIP, SinoMed, EMbase, PubMed, and Cochrane Library were searched for RCTs of Chinese patent medicine for influenza published from database inception to July 25, 2021. The publication time, sample size, intervention and control measures, course of treatment, outcome indicators, and methodological quality of the trials were analyzed and evaluated. Ninety-two RCTs of Chinese patent medicine for influenza published between 2005 and 2021, were included, among which 17 RCTs(18.48%) had a sample size higher than 200 and the average sample size was about 145. Twenty-seven Chinese patent medicines were involved, including twenty-one oral medicines and six injections. The Chinese patent medicines in trials reported in more than five papers included Lianhua Qingwen Capsules/Gra-nules, Tanreqing Injection, and Reduning Injection. Fourteen intervention protocols were reported, of which Chinese patent medicine+western medicine+conventional treatment vs western medicine+conventional treatment(20.65%) was the most frequently employed. Additionally, 85.87% of the RCTs reported the course of treatment, and 80.43% of the RCTs determined 3-7 d as the intervention course. Forty-five outcome indicators were extracted, which were used 434 times, including symptoms/signs, physicochemical detection, safety events, TCM symptoms/syndromes, quality of life, long-term prognosis, and economic evaluation. Symptoms/signs(61.52%) exhibited the highest frequency. Methodological problems were prevalent in the included trials. The findings reveal that there are few clinical trials on influenza treatment by Chinese patent medicine, and the methodological problems are prominent, affec-ting the reliability and practicability of the trials. In the future research, the value characteristics of Chinese patent medicine should be highlighted and the quality control in the whole process should be strengthened based on the scientific and rigorous design.

Analysis of outcome indexes in randomized controlled trials of traditional Chinese medicine for rheumatic heart disease / 中国中药杂志

The present study analyzed the efficacy evaluation indexes of the randomized controlled trials(RCTs) of Chinese medi-cine in the treatment of rheumatic heart disease to lay the foundation for the construction of the corresponding core outcome index set. Clinical RCTs with a definite diagnosis of rheumatic heart disease were retrieved from CNKI, Wanfang, VIP, Sino Med, Pub Med, EMbase, and Cochrane Library from January 1, 2010, to December 31, 2020. Thirty-five RCTs were included, involving 3 314 patients and 41 efficacy evaluation indexes, which covered seven domains [traditional Chinese medicine(TCM) symptoms/syndromes, symp-toms/signs, physical and chemical examination, quality of life, long-term prognosis, economic evaluation, and safety events]. Physi-cal and chemical examination(56. 91%) and symptoms/signs(29. 27%) were the more frequently applied. The number of indexes used in a single trial ranged from 1 to 15, with an average of 4. The measurement time points of the top five indexes in the frequency of use were as follows: total response rate was reported at five measurement time points, ranging from 14 days to 6 months; left ventri-cular ejection fraction was measured at eight time points ranging from 5 days to 6 months; left ventricular end systolic diameter was measured at six time points, ranging from 5 days to 6 months; interleukin-2(IL-2) and tumor necrosis factor-α(TNF-α) were repor-ted 28 days after treatment. At present, there are many problems in the efficacy outcome indexes of RCTs in the treatment of rheumatic heart disease with TCM, such as large difference in quantity, unclear primary and secondary indexes, unreasonable selection of " surro-gate indexes", insufficient attention to long-term prognostic indexes and safety event indexes, non-standard application of composite in-dexes, long measurement period, and lack of TCM characteristics. It is urgent to establish the core outcome set for TCM treatment of rheumatic heart disease.

Huoxiang Zhengqi formulas for treatment of gastrointestinal type cold：a systematic review and Meta-analysis / 中国中药杂志

This systematic review aims to evaluate the efficacy and safety of Huoxiang Zhengqi formulas in treating gastrointestinal type cold. Seven electronic databases,including CNKI, WanFang Data, Vip, SinoMed, PubMed, Cochrane Library, Embase will be searched from the inception of the study until March 2017.All randomized controlled trials that evaluate the treatment of Huoxiang Zhengqi formulas for gastrointestinal type cold will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool for randomized clinical trials and Review Manager 5.3 software is used for analyzing the data.The results are： eight RCTs and 680 patients are included .Meta-analysis are performed according to the stratification of the treatment strategy. Eight studies report clinical efficacy, among them four studies show Huoxiang Zhengqi formulas are better than western medicine(RR and 95%,1.2[1.08, 1.33]), another four studies showHuoxiang Zhengqi formulas in conjunction with conventional treatment are better than conventional treatment(RR and 95%, 1.32[1.20,1.46]).About symptom remission rate, one study shows the treatment group effect is better than the control group from the following clinical symptoms：chills,fever,bowel diarrhea,the effect of treating sore throat itchy is same with western medicine treatment.No adverse reactions are found about Huoxiang Zhengqi formulas in this study.Current evidence shows that Huoxiangzhengqi formulas are better than Western medicine group and western medicine routine treatment group from clinical efficacy. Limited by the quantity and quality of studies, more large-scale and rigorously designed randomised controlled trials with large sample size are warranted to clarify the conclusions.

Autoimmune Hepatitis-related Cirrhosis: Clinical Features and Effectiveness of Immunosuppressive Treatment in Chinese Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The long-term outcomes of patients with autoimmune hepatitis (AIH) given the immunosuppressive treatment are considered to be preferable. However, little is known about the response of AIH patients with cirrhosis to immunosuppressive treatment. We assessed the effects of immunosuppressive therapy in Chinese AIH patients with cirrhosis from a tertiary hospital.</p><p><b>METHODS</b>Patients with a clinical diagnosis of AIH January 2000 and December 2015 were retrospectively reviewed. Two-hundred and fourteen patients who were followed up and satisfied the simplified AIH criteria were included in the study. Among these patients, 87 presented with cirrhosis when initially diagnosed for AIH. Immunosuppressive treatments were employed in 57 AIH patients who did not present with cirrhosis and 39 patients who presented with cirrhosis. Initial responses to immunosuppressive treatment of patients with and without cirrhosis were analyzed. Independent risk factors were assessed for predicting the prognosis of patients. The t-test and Cox regression statistical analysis were used.</p><p><b>RESULTS</b>In total, 96 AIH patients including 39 with cirrhosis and 57 without cirrhosis underwent immunosuppressive therapy. The overall complete remission after initial immunosuppressive treatment was achieved in 81/96 patients (84.4%), whereas 9/96 (9.4%) achieved incomplete response, and 6/96 (6.3%) occurred treatment failure. Compared to noncirrhotic patients, patients who presented with cirrhosis responded to treatment to a comparable extent regarding complete response (noncirrhosis 50/57 [87.7%] vs. cirrhosis 31/39 [79.5%], P = 0.275), incomplete remission (noncirrhosis 4/57 [7.0%] vs. cirrhosis 5/39 [12.8%], P = 0.338), and treatment failure (noncirrhosis 3/57 [5.3%] vs. cirrhosis 3/39 [7.7%], P = 0.629). Importantly, the remission rate was comparable (54/57 [94.7%] and 36/39 [92.3%], P = 0.629) for noncirrhotic and cirrhotic patients after immunosuppressive therapy. Compared to patients who maintained remission (n = 19) after drug withdrawal, patients who experienced relapse (n = 17) had significantly higher levels of serum immunoglobulin G at entry (15.0 ± 6.5 g/L vs. 22.3 ± 5.8 g/L, t = 2.814, P = 0.004). Moreover, cirrhosis at presentation significantly increased the risk of disease exacerbation (hazard ratio [HR]: 4.603; P = 0.002). The treatment of immunosuppressant (HR: 0.058; P = 0.005) and the level of aspartate aminotransferase at presentation (HR: 1.002; P = 0.017) also increased the risk of disease progression.</p><p><b>CONCLUSIONS</b>The efficacy of initial immunosuppressive treatment in AIH patients with cirrhosis is comparable to that in those without cirrhosis. Cirrhotic patients not treated by immunosuppressants have poor long-term outcomes.</p>

Systematic economic assessment and quality evaluation for traditional Chinese medicines / 中国中药杂志

To learn about the economic studies on traditional Chinese medicines in domestic literatures, in order to analyze the current economic assessment of traditional Chinese medicines and explore the existing problems. Efforts were made to search CNKI, VIP, Wanfang database and CBM by computer and include all literatures about economic assessment of traditional Chinese medicines published on professional domestic journals in the systematic assessment and quality evaluation. Finally, 50 articles were included in the study, and the systematic assessment and quality evaluation were made for them in terms of titles, year, authors' identity, expense source, disease type, study perspective, study design type, study target, study target source, time limit, cost calculation, effect indicator, analytical technique and sensitivity analysis. The finally quality score was 0.74, which is very low. The results of the study showed insufficient studies on economics of traditional Chinese medicines, short study duration and simple evaluation methods, which will be solved through unremitting efforts in the future.

Mechanism of loss of human esophageal cancer-related gene 4 (ECRG4) gene expression in esophageal squamous cell carcinoma cell line EC9706 / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the mechanism of loss of human esophageal cancer-related gene 4 (ECRG4) expression in esophageal squamous cell carcinoma (ESCC.)</p><p><b>METHODS</b>PCR-SSCP and DNA sequencing analysis were used to detect the mutation of ECRG4 exons in esophageal cancer and matched adjacent normal tissues of 80 patients. DNA bisulfite-modifying ssPCR sequencing assay was used to examine the methylation status of ECRG4 promoter in human esophageal squamous cell carcinoma EC9706 cells. The re-expression of ECRG4 mRNA was examined by RT-PCR in EC9706 cells, after treatment with either demethylation drug 5-aza-2'-deoxycytidine or arsenic trioxide.</p><p><b>RESULTS</b>No mutation in the four ECRG4 exons was found in all the ESCC and matched normal adjacent tissues. RT-PCR showed that 11 of 16 CpG islands of ECRG4 promoter were hypermethylated, while ECRG4 mRNA expression level was undetectable in the EC9706 cells. The ECRG4 mRNA was re-expressed after treatment with either demethylation drug 5-aza-2'-deoxycytidine or arsenic trioxide.</p><p><b>CONCLUSION</b>The epigenetic mechanism of methylation is a reason of loss of ECRG4 gene expression in the ESCC cell line EC9706.</p>

Management of life-threatening celiac-hepatic arterial hemorrhage after pancreaticoduodenectomy: usefulness of temporary balloon occlusion / 中华医学杂志(英文版)

When a large visceral artery is ruptured, uncontrolled bleeding may lead to hemodynamic collapse. Use of endovascular occlusion balloon catheter may provide rapid control of hemorrhage and facilitate definitive therapy. We reported two patients with massive hemorrhage from ruptured celiac-hepatic artery after pancreaticoduodenectomy, who were initially treated percutaneously by temporary selective balloon occlusion. They became critically hemodynamic unstable during the angiographic procedure. Through an 8Fr sheath, a 6Fr compliant latex occlusion balloon was placed proximal to the celiac trunk and inflated, and upon patient stabilization surgical revision and stent-graft placement were successfully performed in the two patients, respectively. Temporary selective balloon occlusion provides fast and effective bleeding control for patient with critically uncontrollable visceral arterial hemorrhage, permitting subsequent use of conventional techniques for management of the arterial bleeding source.

Expression of ezrin and CD44-v6 in human esophageal squamous cell carcinoma and its clinical significance / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the expression of ezrin and CD44-v6 in esophageal squamous cell carcinoma, and to evaluate its relationship with lymph node metastasis (LNM) and histological grading.</p><p><b>METHODS</b>The expression of ezrin and CD44-v6 in 71 patients with esophageal squamous cell carcinoma was studied using immunohistochemical (SP) method. The correlation of their expression with relevant clinical data was statistically analyzed.</p><p><b>RESULTS</b>In normal esophageal squamous epithelia, the expression of ezrin was found in 33 cases among 71 cases and the expression of CD44-v6 in 18 cases among 71 cases. In esophageal squamous cell carcinoma, the expression of ezrin was found in 64 cases among 71 cases and CD44-v6 in 58 cases among 71 cases. The expression of ezrin was closely related to LNM. The positive rate of ezrin expression in LNM cases was significantly higher than that in cases without LNM. The expression of CD44-v6 had a close relation to tumor differentiation and LNM. The positive rate of CD44-v6 expression in LNM cases was significantly higher than that in patients without LNM. The expression of ezrin in CD44-v6 positive cases was significantly higher than that of CD44-v6 negative cases. The LNM rate was 60.0% in 48 patients with positive expression of both ezrin and CD44-v6, while none of lymph node metastasis was found in the 6 patients with both negative.</p><p><b>CONCLUSION</b>The test of CD44-v6 and ezrin expression may have significant prognostic value for assessing the degree of malignancy and potential LNM probability of ESCC. Ezrin may become a new target in evaluation of tumor prognosis.</p>

Comparison of retrograde amnesia changes within different injury levels of cerebral concussion in rats / 法医学杂志

OBJECTIVE@#To investigate the retrograde amnesia changes within different injury levels of cerebral concussion in rats.@*METHODS@#A metallic pendulum striker device of brain injury was deployed to duplicate CC models of different injury levels within Sprague-Dawley (S-D) rats. The investigated animals were divided into two groups according to classification standard, that is, Pure Cerebral Concussion (PCC) group and Complicated Cerebral Concussion (CCC) group. One control group was used, and each group included 8 animals. The retrograde amnesia of each group was assessed by Morris Water Maze (MWM) Test from 3 days preinjury to 7 days postconcussion.@*RESULTS@#Compared with the control group, the retrograde amnesia was detected within 3 days in PCC group, and 5 days in CCC group after injury. At the same time, the two groups both manifested space recognition deficit.@*CONCLUSION@#The retrograde amnesia existed in both pure cerebral concussion group and complicated cerebral concussion. Furthermore, the lasting time of retrograde amnesia in animals correlates to the injury level of brain concussion.

Effects of hTERT RNAi on apoptosis of hepatocellular carcinoma cells induced by TRAIL / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the effects of human telomerase reverse transcriptase (hTERT) RNA interference (RNAi) on biological characteristics of hepatocellular carcinoma cell lines HepG2 and SMMC-7721 and on apoptosis induced by tumor necrosis factor-related apoptosis-inducing ligand (TRAIL).</p><p><b>METHODS</b>Small hairpin hTERT (shTERT) sequence was identified by PCR method; hTERT expressions, morphological features, cell proliferation and replicative senescence were respectively determined using RT-PCR, hematoxylin-eosin (HE) staining, growth curve and beta-galactosidase (b-Gal) staining; cell cycle and apoptosis were identified using flow cytometry after propidium iodide (PI) staining and annexin V/PI double staining.</p><p><b>RESULTS</b>shRNA were found in 6/8 HepG2 and 6/6 SMMC-7721 cell clones transformed by the recombined plasmid pSilencer 3.1-H1 neo-shTERT. The interference rates of hTERT on HepG2 and SMMC-7721 were 100% and 43.3% respectively. Cells in G2-M phases increased from 7.1% to 10.6% and from 6.9% to 7.9% respectively; and the percentage of replicative senenscence cells increased from 0 to 20.4% and from 3.6% to 10.0% respectively. The nucleus/cytoplasm ratios of the cells were obviously decreased after hTERT RNAi treatment. Moreover, apoptosis of hepatocellular carcinoma cells and apoptosis induced by TRAIL were strikingly increased by hTERT RNAi (P < 0.05). For example, apoptosis rates were increased from 3.5% to 5.2% in HepG2 cells and from 4.8% to 7.9% in SMMC-7721 cells after hTERT RNAi treatment. Apoptosis rates were increased from 5.3% to 10.4% in HepG 2 cells and from 13.9% to 77.2% in SMMC-7721 cells after being treated by 100 ng/ml TRAIL for 24 h. However, there were no remarkable changes between control cells and untransformed cells.</p><p><b>CONCLUSION</b>hTERT RNAi not only has a significant effect on biological characteristics of hepatocellular carcinoma cells, but also obviously can increase cell apoptosis induced by TRAIL.</p>

The expression of CDld in systemic lupus erythematosus patients with antiphospholipid syndrome / 中华风湿病学杂志

Objective To investigate the association of CDId with APS and laboratory data,by examin- ing the CDld expression of PBMC from systemic lupus erythematosus(SLE)patients with antiphospholipid syndrome.Methods The CDld expression of 20 SLE patients with APS,30 SLE controls and 23 normal con- trois were detected by flow cytometry.The relationship between CDld expression and clinical,laboratory data of patients with SLE was analysed.Results The expression of CDld in PBMC of SLE patients with APS was higher than normal controls,but had no difference with SLE controls.The expression of CDld in monocyte group of SLE patients with APS was higher than normal controls,which had no difference with SLE controls. Highly significant correlations was found between CDld expression and SLEDAI while,negative correlation between CDld expression and complements was discovered.Conclusion The abnormal expression of CDld may play a role in the pathogenesis of SLE,it may be a parameter for assessing disease activity.