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OBJECTIVES@#To evaluate the methodological quality of randomized controlled trials (RCTs) of traditional Chinese medicines for the treatment of gastric precancerous lesions in the past 20 years.@*METHODS@#The RCTs on traditional Chinese medicines for gastric precancerous lesions were searched from the CNKI, Wanfang database, VIP, PubMed, and Embase from January 2001 to December 2021. The retrieved articles were screened, extracted and evaluated based on the 2010 edition of CONSORT statement, Cochrane Risk of Bias Assessment Scale and additional evaluation indicators.@*RESULTS@#A total of 840 papers were included. According to the Cochrane Risk of Bias Assessment Scale, the high risk of bias in the application of randomized methods was 5.95%; the risk of uncertainty for the allocation scheme concealment was 98.93%; the risk of uncertainty for blinding of patients or testers was 98.69%; the risk of uncertainty for blinding of the outcome assessor was 100.00%; the risk of bias for completeness of the outcome data was 2.86%; and the risk of uncertainty for selective reporting was 98.45%. The CONSORT statement evaluating the quality of reporting showed that 100.00% of the RCT articles reported the 8 entries; 36.79% of the literature mentioned the method of randomized sequence generation, but only 27.62% of the literature mentioned who implemented the randomized program, 1.07% of the literature hid the randomized program and 1.31% of the studies were blinded; 36.67% of the literature reported adverse reactions; no literature reported sample size prediction methods. Additional evaluation indicators showed that 17.02% of the studies had ethical approval; 43.81% of the literature specified Chinese medicine evidence; 16.55% of the studies excluded severe heterotrophic hyperplasia; 7.26% of the studies conducted follow-up; and 65.12% of the literature used composite efficacy indicators; 46.67% of the literature applied pathological histological evaluation; 2.62% of the literature applied quality of life evaluation.@*CONCLUSIONS@#The overall risk of bias in RCTs of traditional Chinese medicines for gastric precancerous lesions is high, and the quality of most of the study reports needs to be improved. In the future, it is necessary to strengthen the study design of RCTs and refer to appropriate traditional Chinese medicines evidence grading standards, select study protocols according to different purposes, provide objective and strong evidence for clinical studies on traditional Chinese medicines, and carry out clinical study design and result reporting suitable for traditional Chinese medicines according to the CONSORT principle.
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Humanos , Medicina Tradicional China , Ensayos Clínicos Controlados Aleatorios como Asunto , Lesiones Precancerosas/tratamiento farmacológicoRESUMEN
Scutellariae Radix， Coptidis Rhizoma， and Phellodendri Chinensis Cortex are three commonly used Chinese herbal medicines， and their application in classic famous prescriptions cannot be fully explained by the triple energizer classification method. This study reviewed the ancient materia medica works and elaborated on the functions of the three herbal medicines before the Song dynasty and after the Jin dynasty. The works before the Song dynasty mainly introduced the diseases treated by the three herbal medicines according to the Shennong's Classic of Materia Medica（《神农本草经》）， and the works after the Jin dynasty mainly expounded the indications of the three medicines in the Shennong's Classic of Materia Medica according to the new medical theory. Although all the three herbal medicines can treat heat syndrome， digestive system diseases， skin and mucosa diseases， they act on different targets. Scutellariae Radix can regulate Qi stagnation and reverse caused by the fire syndrome. Coptidis Rhizoma can treat excess fire and purulent bloody stool caused by the deficiency of Zang-fu organs. Phellodendri Chinensis Cortex mainly treats the diseases of the intestine and reproductive system and can kill parasites. In addition， this paper summarized the descriptions about the functions of Scutellariae Radix in eliminating blood blockage， Coptidis Rhizoma in protecting the intestine， and Phellodendri Chinensis Cortex in clearing the liver in ancient books. According to the sentences in the Treatise on Febrile and Miscellaneous Diseases（《伤寒杂病论》）， the application of Scutellariae Radix in Chaihu prescriptions， Coptidis Rhizoma in Baitouweng Decoction， and Phellodendri Chinensis Cortex in Zhizi Baipi Decoction confirms to the indications of the three medicines in the materia medica works before the Song Dynasty. The existing clinical and pharmacological research results confirm the indications of the three herbal medicines in the ancient works. The clinical application of the three medicines should refer to the materia medicia works before the Song dynasty， so as to achieve precise medication.
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Objective:To explore the clinical characteristics and risk factors of sarcopenia in elderly patients with chronic kidney disease (CKD) stage 3-4.Methods:It was a single-center, retrospective observational study. CKD stage 3-4 patients aged ≥60 years old from March 2019 to March 2022 in the Geriatrics Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the study. General data of the patients were collected, and laboratory indicators, muscle strength, physical function and appendicular muscle mass index (ASMI) were measured. According to the diagnostic criteria of sarcopenia, the patients were divided into no sarcopenia CKD group and sarcopenia CKD group. Baseline data between these two groups were compared. Logistic regression analysis was used to analyze the related factors of sarcopenia in elderly CKD stage 3-4 patients.Results:A total of 162 CKD stage 3-4 patients were enrolled in this study, with 89 males (54.9%) and a median age of 75 (69, 82) years. Sarcopenia was diagnosed in 40 cases, and the prevalence was 24.7% (95% CI 18.1%-31.3%). Compared with no sarcopenia CKD group, age, proportion of dementia, cystatin C, urea nitrogen, C-reactive protein (CRP) and ratio of urine protein to creatinine were higher (all P<0.05), while body mass index (BMI), hemoglobin, carbon dioxide combining power, estimated glomerular filtration rate (eGFR), serum albumin and the proportion of regular exercise and using α-ketones were lower in sarcopenia CKD group (all P<0.05). Meanwhile, grip strength, walking speed, short physical performance battery score and ASMI were lower in sarcopenia CKD group (all P<0.05). Multivariable logistic regression analysis results showed that low eGFR ( OR=0.824, 95% CI 0.687-0.987, P=0.036), low BMI ( OR=0.463, 95% CI 0.304-0.704, P<0.001), low serum albumin ( OR=0.459, 95% CI 0.263-0.802, P=0.006) and high CRP ( OR=2.754, 95% CI 1.708-4.439, P<0.001) were the independent related factors of sarcopenia in elderly CKD patients. Conclusions:The prevalence of sarcopenia in elderly CKD stage 3-4 patients is high. Low eGFR, low BMI, low serum albumin and high CRP are the independent risk factors for sarcopenia in elderly CKD stage 3-4 patients.
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Objective:To investigate the effect of improving moderate and severe benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS)on renal function in elderly patients aged 80 years and over.Methods:A total of 129 inpatients with moderate and severe BPH and its associated LUTS(BPH/LUTS)who took tamsulosin combined with finasteride aged 80 years old and over in Geriatric Department of the First Affiliated Hospital of Zhengzhou University were enrolled in the retrospective study from July 2018 to July 2020.Patients were divided into normal blood pressure group(n=51)and hypertension group(n=78)and divided into normal renal function group(n=77)and CKD3a stage group(n=52).Serum creatinine, estimated glomerular filtration rate(eGFR), prostate volume(PV)and post-void residual urine volume(PVR), and International Prostate Symptom Score(IPSS)were compared before versus after 1, 3 and 6 months of treatment.Multivariable linear regression analysis was performed to evaluate the influence of the most relevant factors on renal function in patients with BPH/LUTS.Results:After 1, 3 and 6 months of tamsulosin combined with finastide treatment, the lower urinary tract symptoms of elderly patients with BPH/LUTS were improved, IPSS score and PVR were decreased, and the differences were statistically significant(all P<0.01).PV, serum creatinine and eGFR were not changed after 6 months of treatment(all P>0.05).However, further subgroup analysis showed that serum creatinine level in hypertension group and CKD3a stage group was increased compared with that before treatment, while eGFR in CKD3a stage group was decreased before treatment, and the difference was statistically significant(all P<0.05).Compared with before treatment, serum creatinine and eGFR in hypertensive group improved after 3 months of treatment, and CKD3a group improved after 1 month of treatment, and the differences were statistically significant(all P<0.05).There were no significant changes in serum creatinine and eGFR in normal blood pressure group and normal renal function group after 6 months of treatment(all P>0.05).Multiple linear regression analysis showed that hypertension( β=2.06, P<0.05)and CKD3a stage( β=17.16, P<0.01)were independent risk factors for creatinine changes before and after treatment.Hypertension( β=-2.27, P<0.01), CKD3a stage( β=-11.93, P<0.01)and CKD3A stage( β=-2.27, P<0.01)were independent risk factors for creatinine changes before and after treatment. P<0.01)and PV before treatment( β=-0.11, P<0.05)were independent risk factors for the change of eGFR before and after treatment. Conclusions:Treatment for moderate and severe BPH/LUTS can improve renal function in elderly patients with hypertension or CKD3a.
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Members of the proto-oncogene superfamily are indispensable molecular switches that play critical roles in cell proliferation, differentiation, and cell survival. Recent studies have attempted to prevent the interaction of RAS/GTP with RAS guanine nucleotide exchange factors (GEFs), impair RAS-effector interactions, and suppress RAS localization to prevent oncogenic signalling. The present study aimed to investigate the effect of the natural triterpenoic acid inhibitor glycyrrhetinic acid, which is isolated from the roots of plant species, on RAS stability. We found that glycyrrhetinic acid may bind to the P-loop of RAS and alter its stability. Based on our biochemical tests and structural analysis results, glycyrrhetinic acid induced a conformational change in RAS. Meanwhile, glycyrrhetinic acid abolishes the function of RAS by interfering with the effector protein RAF kinase activation and RAS/MAPK signalling.
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Objective To investigate the clinical features and prognosis of patients with acute leukemia (AL) in pregnancy.Methods The clinical data of 39 cases of acute leukemia in pregnancy at the First Affiliated Hospital of Zhengzhou University from January 2010 to April 2017 were collected.The clinical characteristics and prognosis were analyzed retrospectively.Results Except one case diagnosed before pregnancy,the incidence rates of AL in early,middle and late stage of pregnancy were 23.7 ％ (9/38),52.6 ％ (20/38) and 23.7 ％ (9/38),respectively.31 patients received chemotherapy and the complete response (CR) rates of AL patients in early,middle and late stage of pregnancy were 71.4 ％ (5/7),94.1％ (16/17),and 100.0 ％ (7/7),respectively.Among all the cases,31 patients received a miscarriage or induction of labor,and 8 cases had live births delivered by cesarean section.Twenty-two patients had abnormal karyotypes,which was mainly related to specific chromosomal rearrangement.Acute myeloid leukemia (AML) patients expressed high levels of CD117,CD13,CD33,and CD38,and acute lymphoblastic leukemia (ALL) patients had high expression of CD19,CD38,CD22,cCD79a,and CD58.After induction therapy,10 cases got positive minimal residual disease (MRD),7 of which achieved CR.After that,4 cases recurred,and 7 cases died in total.On the other hand,all the 19 MRD-negative patients achieved CR.Then,5 cases recurred,and 9 cases died intotal.In all patients,29 were AML while the other 10 were ALL,the CR rates in AML and ALL were 95.7 ％ (22/23) and 75.0 ％ (6/8),and the 1-year and 2-year survival rate were 53.1％ and 26.4 ％,respectively.The survival rate of AML patients was higher than that of ALL patients.Conclusions The clinical characteristics of AL patients in pregnancy are complicated and comprehensive treatment is needed.MDR is an important indicator of prognosis,and the prognosis of ALL is worse than that of AML.
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Objective To investigate the mechanism of cellular senescence in ischemia reperfusion injury (IRI)-induced acute kidney injury (AKI) that leads to chronic kidney disease (CKD) in elderly mice.Methods An acute kidney injury model was established in C57B1/6 male mice at ages 8-10 weeks (young group) or 20-24 months (old group) by bilateral IRI.The animals were randomly divided into 4 groups as follows:Young-Sham (n=8),Old-Sham (n=8),Young-IRI (n=8),and Old-IRI groups (n=8).All mice were weighted,and their blood was collected from the tail vein at days 1,3,and 7 after surgery.The mice were killed on day 14 after surgery,and their kidneys were harvested for further analysis.Serum was used for the creatinine test.The changes of the renal tissue morphology and pathology were assessed using hematoxylin-eosin staining and sirius red staining.Immunofluorescence staining of collagen Ⅰ,F4/80,phosphor-histone H3 (p-HH3),and Ki67 were performed to determine the stage of the collagen deposit,macrophage filtration,and cell cycle G2/M arrest.The collagen Ⅰ expression was analyzed using western blot.The expression levels of TNF-α,IL-6,TGF-β,and collagen Ⅰ were determined using real-time PCR.Results Compared with that in the sham group,the serum creatinine levels in both Young-IRI and Old-IR1 groups were obviously increased.The Young-IRI group recovered completely on day 7.The Old-IRI group had higher creatinine levels than the Young-IRI group at each time point.Morphology and pathology analyses revealed that acute injury was repaired in the Young-IRI group,but slight inflammatory cell filtration and collagen deposition were observed in the Old-Sham and Old-IRI groups,respectively.Immunofluorescence staining revealed some F4/80-positive macrophage filtration,collagen Ⅰ deposition,and p-HH3 and Ki67 double-positive nuclear tubular epithelial cells in the Old-Sham group,but considerably more positive results were found in the Old-IRI group.Western blot analysis revealed that collagen Ⅰ expression level was higher in the Old-IRI group than in the Young-IRI group (P ＜ 0.01) and in the Old-Sham group than in the Young-Sham group (P ＜ 0.05).Real-time PCR demonstrated that the mRNA expression levels of cytokines and fibrosis markers,including of TNF-α,IL-6,TGF-β,and collagen Ⅰ,in the Old-Sham and Old-IRI groups were increased as compared with those in the Young-Sham and Young-IRI groups (P ＜ 0.05).Conclusions The levels of kidney inflammation,fibrosis,and cell-cycle arrest are lower in the old mice.After IRI injury,a sustained and ongoing inflammatory reaction is involved and more cells are arrested in the cell cycle G2/M,which inhibit renal repair and promote fibrosis progression.
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Objective To explore the relationship between benign prostatic hyperplasia and renal function in men aged 80 years and over.Methods Eighty-three clinical BPH patients (mean age of 85.8±4.7 years,range of 80-98 years) admitted to Geriatric Department of the First Affiliated Hospital of Zhengzhou University were recruited to this cross-sectional study from January 2017 to June 2017.They were grouped into treatment group (Gt,n=43) and non-treatment group (Gn,n=40) based on their choices for a therapy or observation.The prostate volume (PV) and post-void residual urine volume (PVR) were measured by abdominal ultrasound.A self-reported lower urinary tract symptoms (LUTS) was evaluated by International Prostate Symptoms Score (IPSS).An estimated glomerular filtration rate (eGFR) was calculated based on the serum level of creatinine and other indexes.Spearman and multiple linear regression analysis were applied to analyze correlations between BPH and renal function.Results The systolic and diastolic blood pressures were lower in Gt group than in Gn group (all P＜0.05).The PVR and IPSS were significantly lower in Gt group than in Gngroup[(28.9±16.6) ml vs.(67.3±32.8) ml;(18.2±9.1)vs.(24.7±10.3),all P＜0.05].The serum level of creatinine was lower in Gt group [(73.7±16.3) μmol/L] than in Gn group [(85.4±19.8) μmol/L] (P＜0.05).The eGFR was higher in Gt group[(77.2±11.4) ml · min 1 ·1.73 m-2] than in Gn group[(69.8±13.9) ml · min 1 · 1.73 m-2] (P＜0.05).No statistical differences were observed in PV between Gt group[(24.6 ± 11.4) ml] and Gn group[(27.0 ± 20.8) ml] (P＞0.05).Spearman relation analysis showed that creatinine level was negatively correlated with treatment for BPH (r=-0.337,P＜0.05).Multiple linear regression analysis showed that non-receiving of treatments for BPH was an independent risk factor for an increased creatinine level(r=-0.349,t=-2.802,P＜0.01).Conclusions For men aged 80 years and over,BPH is associated with decreased eGFR,and the treatment for BPH may improve renal function.
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Objective To investigate the effect and mechanism of soluble epoxide hydrolase inhibitor (sEHI) for NF-κB pathway and cell circle arrest of tubular epithelial cell in unilateral ureteral obstruction (UUO) mice model.Methods Thirty-two healthy C57BL/6 male mice performed UUO surgery to induce renal interstitial fibrosis.Animals were randomly divided into 4 groups:sham group (n=8),sEHI (1 mg· kg-1·d-1) group (n=8),UUO group (n=8) and UUO+sEHI (1 mg· kg-1· d-1) group (n=8).Daily sEHI [1-(1-methylsulfonyl-piperidin-4-yl)-3-(4-trifluoromethoxy-phenyl)-urea,TUPS] or 2％ DMSO was applied to mice by oral gavage from day 1 to day 14 after surgery.All mice were sacrificed at day 14 and kidneys were harvested for further analysis.The changes of renal tissue morphology and pathology were observed by Hematoxylin and eosin (HE) and sirius red staining.The expressions of sEH,nuclear factor κB p65 (NF-κB p65) and IκB were measured by Western blotting.The expressions of TNF-α,IL-1β,MCP-1,IL-6,TGF-β,CTGF,collagen-Ⅳ and α-SMA were analyzed by real-time PCR.Immunofluorescence staining of phospho-histone H3 (p-HH3) and Ki67 was performed to determine the stage of cell cycle G2/M arrest.Results The expression and activity of sEH increased in UUO group (P ＜ 0.05).Administration of sEHI inhibited activity of sEH and infiltration of inflammatory cell in tubular interstitial,as well as attenuated tubular damage and tubular interstitial fibrosis.Western blotting analysis revealed administration of sEHI inhibited up-regulated NF-κB p65 and down-regulated IκB in UUO group (P ＜ 0.05).Real-time PCR demonstrated that administration of sEHI obviously decreased the mRNA expression of cytokines and fibrosis markers,including of TNF-α,IL-1 β,MCP-1,IL-6,TGF-β,CTGF,Collagen-Ⅳ,α-SMA (P ＜ 0.05).Immunofluorescence staining showed that there were much more p-HH3 and Ki67 double positive nuclear tubular epithelial cells and interstitial cells in UUO group,compared with Sham group (P ＜ 0.05).Administration of sEHI reduced the number of double positive nuclear cell only in tubular epithelial cells (P ＜ 0.05),but not in interstitial cells.Conclusions In UUO tubular interstitial fibrosis model,sEHI inhibits the activation of NF-κB pathway by down-regulating p65 and up-regulating IκB and ameliorates the infiltration of inflammatory cells.In addition,sEHI plays anti-fibrosis effect by moderating cell cycle G2/M arrest and reducing the excrete of pro-fibrosis factors of tubular epithelial cells.
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Objective To observe the sleeping time and analyze its impact on the psychological state and quality of life of patients with type 2 diabetes .Methods Convenience sampling was used to recruit 365 patients with type 2 diabetes in Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Chinese Medicine between April 2014 and April 2015 .All the patients were divided into two groups according to the six-hour cut-off point of sleeping time .They were investigated by means of World Health Organization Quality of Life-BREF ( WHOQOL-BREF), Diabetes Distress Scale ( DDS) and General Self-Efficacy Scale ( GSES).Data were analyzed by t-test, chi-square test, Mann-Whitney U test and multivariate regression analysis .Results The average sleeping time was 7.03 h, and the sleeping time of 109 patients was less than 6 h.Patients with less sleeping time had lower quality of life and self-efficacy scores as well as higher diabetes distress scores than those with sleeping time more than 6 h.The differences were statistically significant (P<0.05).Regression analysis showed that sleeping time was the factor of quality of life (β=0.117, P=0.047), self-efficacy (β=0.136, P=0.024) and diabetes distress(β=-0.118, P=0.046).Conclusion Sleeping time affects the psychological state and quality of life of patients with type 2 diabetes.The medical should pay more attention to the quality of sleep of such patients .