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ObjectiveThis paper aims to analyze the current status of outcome indicators in randomized controlled trials （RCT） of traditional Chinese medicine （TCM） for treating chronic atrophic gastritis （CAG）， so as to provide references for constructing the core outcome set （COS） of TCM in the treatment of CAG. MethodChina National Knowledge Infrastructure （CNKI）， Wanfang， VIP， SinoMed， PubMed， Embase， and Cochrane Library databases were searched for RCTs of TCM in the treatment of CAG in the last five years. The risk of bias of included studies was evaluated， and the selection status of outcome indicators was statistically analyzed. ResultA total of 150 RCTs were included， with a sample size of 44-398 cases. 164 outcome indicators were reported， with an application frequency of 1 229 times. The outcome indicators were classified into seven indicator domains according to functional attributes， followed by physical and chemical examination （69.41%）， TCM syndrome （12.69%）， symptoms and signs （11.15%）， safety indicators （5.37%）， quality of life （0.65%）， long-term prognosis （0.65%）， and economic evaluation （0.08%）. According to the statistical analysis， there were problems in the selection of outcome indicators in RCTs of TCM for treating CAG， including various indicators， non-standard name reports， unclear primary and secondary indicators， random combination of subjective and objective indicators， neglected patient report outcome indicators， missing long-term prognosis and economic indicators， insufficient reporting of safety indicators， and inconsistent measurement tools and measurement time points. ConclusionIn the past five years， there have been many problems in the selection of outcome indicators in RCTs of TCM for treating CAG. It is necessary to actively promote the construction of the COS of TCM in the treatment of CAG and promote the high-quality development of clinical research of TCM.
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Diarrhea-predominant irritable bowel syndrome （IBS-D） is a chronic functional bowel disorder characterized by abdominal pain and diarrhea， with visceral hypersensitivity and abnormal gastrointestinal dynamics as the pathophysiological basis. The brain-gut interaction plays a role in pain-related functional gastrointestinal disorders， especially IBS-D. 5-Hydroxytryptamine （5-HT）， as an important brain-gut peptide regulating gastrointestinal function， affects brain activity， gastrointestinal motility， pain perception， mucosal inflammation， and immune response through brain-gut interaction and is associated with the occurrence and development of IBS-D. In recent years， traditional Chinese medicine （TCM） has shown great potential to mitigate gastrointestinal symptoms and improve the quality of life with its holistic view and treatment based on syndrome differentiation. Studies have shown that TCM treats IBS-D by regulating the 5-HT signaling pathway. With a focus on syndrome differentiation in TCM， this paper systematically describes the efficacy and mechanism of TCM in treating different TCM syndromes of IBS-D via the 5-HT signaling pathway， aiming to provide a scientific basis for TCM treatment of this disease.
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Purpose@#Intestinal Behcet’s disease (BD) is a systemic autoimmune disease for which treatment options are limited. As a prospective therapeutic strategy for intestinal BD, anti-tumor necrosis factor-alpha (anti-TNF-α) agents have received increasing attention. In this study, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of anti-TNF-α agents for patients with intestinal BD. @*Materials and Methods@#We searched PubMed, Embase, and Cochrane Library databases up to July 1, 2021 and articles that met the eligibility criteria were further assessed. Pooled rates were synthesized by a randomized effects model using Stata software. @*Results@#Eleven clinical trials covering 671 patients with intestinal BD were included. According to compositive data, the pooled rate for remission was 39% [95% confidence interval (CI) 26–52] in patients receiving anti-TNF-α agents. Intestinal symptoms were cured in 70% (95% CI 53–84) of the patients, and the rate for endoscopic healing was 65% (95% CI 52–78). Corticosteroid discontinuation was achieved in 43% (95% CI 28–58) of the patients, and the dose reduction of corticosteroid was 20.43 mg (95% CI 13.4–27.46). There were 239 adverse events and 80 serious adverse events during follow-up. @*Conclusion@#Our study indicated that anti-TNF-α agents may serve as an effective treatment with acceptable safety for patients with intestinal BD. However, more robust evidence from randomized controlled trials is urgently needed to assess the long-term efficacy and safety of anti-TNF-α agents for those patients.
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Multidrug resistance （MDR） has been a main culprit behind the failure of chemotherapy in patients with malignant tumors and a major obstacle to improving the life quality and prolonging the survival of patients. Hepatocellular carcinoma cells， the innate drug-resistant cells， are generally insensitive to radiotherapy and chemotherapy. Moreover， as the early symptoms of hepatocellular carcinoma are atypical， most patients are diagnosed at the advanced stage， with short survival period and high recurrence rate. Thus， the sensitivity to chemotherapy drugs is decreased. This explains how MDR becomes one of the important reasons for the failure of primary hepatocellular carcinoma （PHC） treatment. Therefore， it is an urgent task to search for safe and effective chemosensitizers with little adverse effect in the research on the drug resistance of hepatocellular carcinoma. As Chinese medicine has been widely applied in the treatment of tumors， the mechanisms of compound Chinese medicine prescriptions， Chinese medicine injections， and single Chinese medicinal in reversing chemotherapy resistance in liver cancer have attracted the interest of scholars. According to previous reports， the mechanisms can be summarized as increasing intracellular drug concentration， influencing changes in enzyme activity， inducing apoptosis， reversing abnormalities in cellular signaling pathways， and regulating the tumor microenvironment. Traditional Chinese medicine reduces the chemotherapy resistance of hepatocellular carcinoma cells through multiple targets and multiple pathways， thereby improving the chemotherapy sensitivity of the cancer cells and enhancing the toxicity of chemotherapeutic drugs to hepatocellular carcinoma cells. Therefore， exploring the mechanism of MDR of hepatocellular carcinoma from the perspective of traditional Chinese medicine is important for reversing the MDR and is of great reference value for clinical treatment of hepatocellular carcinoma. However， there are few experimental types and adverse effects available. Thus， the multi-mechanism and multi-target experiments and clinical research should be carried out in the future.
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Objective To determine the mRNA levels of microRNA-223 (miR-223) and NLRP3 in-flammasome components [Nod-like receptor pyrin domain-containing protein 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC) and caspase-1] in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE) and to explore its clinical significance. Methods Real time polymerase chain reaction (PCR) was used to detect the mRNAlevels of miR-223 and NLRP3 inflam-masome components in PBMCs from 35 SLE patients, 30 healthy controls and 20 SLE patients after treatment, and then their correlations with clinical and laboratory parameters [anti-double-stranded deoxyribon-ucleic acid (dsDNA) antibody, anti-nucleosome antibody (AnuA), erythrocyte sedi-mentation rate (ESR)] were evaluated. Data were analyzed using t test or x2 test and Pearson test was used for correlation analysis. Results Com-pared with healthy controls, mRNA levels of miR-223 and Caspase-1 were higher in the PBMCs from SLE patients [(1.17 ±0.15) vs (0.68 ±0.14), t=2.416, P=0.0186; (1.89 ±0.13) vs (1.32 ±0.13), t=3.123, P=0.0027], but the NLRP3 and ASC mRNA expression levels were in the opposite [(0.64 ±0.05) vs (0.98 ±0.06), t=4.442, P<0.01;(0.98±0.08) vs (1.32±0.12), t=2.391, P=0.0198]. Correlation analysis results showed that there was a negative correlation of mRNA levels between the miR-223 and NLRP3 (r=-0.7849, P<0.05), but the miR-223 had no correlation with ASC and caspase-1. The mRNA levels of miR-223 was positively correlated with anti-dsDNA antibody, SLEDAI and ESR (r=0.7035, 0.6923, 0.6873, all P values<0.05), but had no correlation with AnuA. After treatment, the mRNA expression of miR-223 and caspase-1 in PBMCs from SLE patients was significantly reduced [(1.30±0.22) vs (0.79±0.11), t=2.07, P=0.0453; (2.05±0.19) vs (1.50±0.11), t=2.471, P=0.0183], while the mRNA level of NLRP3 increased [(0.69 ±0.08) vs (0.94 ±0.07); t=2.445, P=0.0193]. There was no significant difference in the expression of miR-223 mRNA in PBMCs between lupus nephritis (LN) patients and SLE patients without renal impairment. Conclusion miR-223 and caspase-1 are highly ex-pressed in the PBMCs from patients with SLE, while the mRNA of NLRP3 and ASC is in low expression. The mRNA expression of miR-223 is negatively correlated with NLRP3 and disease activity. Expression of miR-223 mRNA decreases significantly after treatment. So miR-223 may play an important role in the pathogenesis of SLE.
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Objective To determinate the serum level of adiponectin,visfatin and resistin in patients with rheumatoid arthritis (RA) and to explore its role in the development of RA and its clinical significance.Methods Blood samples were collected from 67 cases of RA patients and 65 healthy controls,the serum levels of adiponectin,visfatin and resistin were tested by enzyme linked immunosorbent assay (ELISA).Adipokine levels in different groups were compared using the Mann-Whitney U test.Spearman test and multivariate analysis were used to evaluate the correlation with clinical and laboratory parameters [erythrocyte sedimentation rate (ESR),C reactive protein (CRP),blood platelet (PLT),rheumatoid factor (RF),anti-cyclic citrullinated peptide (CCP),disease activity score (DAS)28].Results The serum level of adiponectin,visfatin and resistin in RA patients were significantly higher than those in healthy controls[8.17(4.51,28.53) μg/ml vs 6.83(4.48,25.32) μg/ml,U=1 663,P=0.019];[6.56(5.34,8.40) ng/L vs 4.24 (3.01,6.65) ng/L,U=762,P=0.001];[10.65 (5.99,20.70) ng/ml vs 6.12 (4.49,9.98) ng/ml,U=1 406.5,P=0.000].The serum level of visfatin was positively correlated with RF in patients with RA (r=0.186,P=0.013),and serum levels of adiponectin,visfatin and resistin were positively correlated with DAS28 (r=0.370,0.263,0.285;P＜0.05).The level of visfatin in RA patients with high activity group was higher than that in the low and moderate activity group [4.37(2.72,7.53)ng/L vs 4.11 (3.11,6.44) ng/L,U=133.5,P=0.019].Conclusion Multivariate analysis has showm that ESR,PLT and DAS28 can significantly affect adiponectin,and CRP can significantly influence resistin.Serum level of adiponectin,visfatin and resistin are elevated and correlate with DAS28,suggesting that they may be involved in the chronic inflammation of RA.
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Objective To study the diagnosis value of giant cell temporal arteritis with high frequency ultrasonography and magnetic resonance imaging.Methods The total of 29 cases testified as giant cell temporal arteritis clinically were assessed by high frequency ultrasonography and magnetic resonance imaging.The 29 cases were assessed by high frequency ultrasonography,the 11 cases were assessed by magnetic resonance imaging,mural thickness and lumen diameter of temporal arteries were examined,and were compared with the biopsy specimens.Meanwhile 30 healthy volunteers were randomly selected as control group,the ultrasonography of normal temporal arteries were analyzed.Results All temporal arteries were diaplayed clearly.27 cases were diagnosed for giant cell temopral arteritis by high frequency ultrasonography in 29 cases,the diagnostic accuracy was 93.1％.The 11 cases were diagnosed by magnetic resonance imaging,the diagnostic accuracy was 100％.The imaging features were mural thickness,the lumen stenosis,and partial temporal arteries occluded,the mural was contrasted by Gd-DTPA.Conclusions High frequency ultrasonography and magnetic resonance imaging are noninvasive methods for giant cell temporal arteritis diagnosis,it is important clinical value for therapy.
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Objective To systematically review the relationship between mycoplasma infection and rheumatoid arthritis (RA).Methods Articles on case-control studies about the relation between mycoplasma infection and RA were collected by literature searching according to the selection criteria.Meta-analyses were performed for the included studies using RevMan 4.3.2 software.The odds ratio (OR) and its corresponding 95％ confidence interval (95％CI) were calculated by Meta-analysis.Results Seventeen casecontrol studies involving 729 RA patients and 1191non-RA controls,such as osteoarthritis (OA),reactive arthritis (ReA),gouty arthritis (GA),healthy controls were included.The results of Meta-analyses showed that there was a significant difference in the infection ratio of mycoplasma between patients with RA and non-RA (OR=4.40,95％CI 2.26 to 8.56,P＜0.01),and sensitivity analysis according to different published date and detection methods showed no difference.There were also significant differences between RA patients and OA patients (OR=11.29,95％CI 5.55 to 22.97,P＜0.01) and healthy controls (OR=6.80,95％CI 3.96 to 11.67,P＜0.01).Conclusion Mycoplasma infection is associated with RA.More evidence are needed to prove whether mycoplasma has played an equal role in RA and ReA,as well as the significant difference of mycoplasma infection between RA and GA groups.
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Objective To explore the association between HLA-Cw alleles with systemic lupuserythematosus. Methods Polymerase chain reaction-sequence specific primer method was used to analyze thedistribution of HLA-Cw01-08 alleles among 108 patients with SLE and 102 healthy controls. The allelefrequencies was compared between various patient groups and the control population. Results The frequencyof HLA-Cw07 alleles in patients with SLE was significantly increased in patients with SLE. Conclusion Theresults indicate that HLA-Cw07 may be the susceptible alleles or may be closely linked to the susceptiblegenes for SLE.
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Objective To investigate the quantity of perforin (PF) expressed on peripheral lymphocytes of active systemic lupus erythematosus (SLE) patients and its distribution in lymphocytes subsets. The effect of glucocorticosteroid on PF expression is also explored. Methods Phenotype analysis of peripheral lymphocytes was carried out by flow cytometry. SLE patients with SLEDAI≥10 (n=16) and normal controls (n=12) were enrolled into this study. The PF expressed on the iymphocytes of SLE patients with disease flares (n=10) Was studied before and after glucocorticosteroid treatment. Results SLE patients with active disease were characterized by higher proportions of PF-positive lymphocytes and higher perforin density. PF and CD8 double positive T cell proportions was evidently increased. The proportions of PF-positive lymphocytes was correlated to SLEDAI (r=0.673). After a short period of glucocorticosteroid therapy, a reduced expression of PF was observed. Conclusion There is an increased expression of perforin in peripheral lymphocytes from SLE patients with active disease. CD8 positive T cell subsets expand significantly in those patients. In addition, the frequency of PF-positive lymphocytes is correlated with SLEDAI. Finally, glucocorticosteroid inhibits the expression of perforin.
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Objective To investigate the diagnostic value of HLA-B27 in ankylosing spondylitis(AS).Methods A diagnostic test was employed in the study.The patients with ankylosing spondylitis and the controls in Shandong Provicial Hospital from 2001—2005 were enrolled in the study.HLA-B27 was detected by flow cytometer assay when recruited.SPSS 13.0 was used for statistical analysis.Results Totally 133 patients with AS and 88 controls were available in the study.HLA-B27 was significantly different between AS group and the controls(P=0.000).The areas below ROC curve was 90.5%.Three cut-off points of HLA-B27,11.55%,46.6% and 85.25%,were selected based on clinical practice and ROCcurve,and the sensitivity was 94.7%,90.2% and 63.6%,the specificity was 56.8%,92.0% and 95.45%.Conclusion HLA-B27 which is more than 46.6% is a valuable marker for the diagnosis of AS.
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Objective To observe the role of the P-glycoprotein (P-GP)in the pathogenesis of colitis in FVB and multiple drug resistance (mdr) gene, mdr1a, knockout (mdr1a~(-/-)) mice. Methods The clinical, pathological and immunohistochemical characteristics were observed in FVB control mice and mdr1a~(-/-) mice with or without inflammation of intestinal tract. The functions of T cell and B cell in these mice were analyzed. Results Approximately 26 of the 124 mdr1a~(-/-) mice were found to have symptoms of colitis such as diarrhea and weight loss in this study, and pathologic changes in these mice were similar to that in the human active ulcerative colitis. CD4~+ T cell and B cell infiltrated into the (proper) lamina were observed by immunohistochemical staining in mdr1a~(-/-) mice with colitis. There were (significant) increases in serum antibody titers of all types in mdr1a~(-/-) mice with active colitis. The levels of IgG1, IgG2a, IgG2b, IgG3, IgA and IgM were 7568, 1876, 823, 234, 897 and 189 ?g/ml, (res-)(pectively), significantly higher than those in FVB mice, which were 623, 102, 54, 42, 32 and 58 ?g/ml, (respectively) ( P
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Objective To investigate whether there is any consistent evidence of linkage across multiple studies,and to identify novel AS susceptibility loci by using GSMA method.Methods Genome-search Meta-analysis(GSMA)method was applied to genome scans of AS and spondyloarthropathy(SpA)to assess evidence for linkage across studies.Results Four AS genome scans including 479 families with 1151 affected individuals were used.Suggesting these BINS most likely contain AS-linked loci;BINS 6p22.3-p21.1,6pter-p22.3,17pter-p12,2p12-q22.1 and 5q34-qter.Four AS genome scans and one SpA scan including 544 families with 1,331 affected individuals were used.The GSMA produced genome-wide evidence for linkage on bin 6p22.3-p21 and 16q23.1-qter.Conclusion This GSMA added the evidence of the HLA loci as the greatest susceptibility factor to AS and shows evidences of chromosome 6,17p,2,5q and 16q as non-HLA susceptibility loci.