Outcome indicators in clinical trials on traditional Chinese medicine treatment of microvascular angina / 中国中药杂志

This study reviewed the current status of the use of outcome indicators in randomized controlled trial(RCT) on traditional Chinese medicine(TCM) treatment of microvascular angina(MVA) and analyzed the existing problems and possible solutions, aiming to provide a basis for the design of high-quality RCT and the establishment of core outcome sets for MVA. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries were searched for the RCT on TCM treatment of MVA according to pre-defined criteria. The Cochrane's risk of bias assessment tool was used to evaluate the methodological quality of the included RCT and the use of outcome indicators was summarized. A total of 69 RCTs were included, from which 100 outcome indicators were extracted, with the frequency of 430. The extracted outcome indicators belonged to 8 domains: response rate, symptoms and signs, physical and chemical examinations, TCM efficacy, safety, quality of life, economic evaluation, and long-term prognosis. The indicators of physical and chemical examinations were the most(70 indicators with the frequency of 211), followed by those of response rate(7 indicators with the frequency of 73) and symptoms and signs(7 indicators with the frequency of 54). The outcome indicators with higher frequency were adverse reactions, angina attack frequency, clinical efficacy, endothelin-1, total duration of treadmill exercise, and hypersensitive C-reactive protein. The RCT on TCM treatment of MVA had the following problems: irregular reporting of adverse reactions, diverse indicators with low frequency, lack of attention to the application of endpoint indicators, insufficient use of TCM differentiation and efficacy indicators, non-standard evaluation criteria and failure to reflect the basic characteristics of TCM. A unified MVA syndrome differentiation standard should be established, on the basis of which an MVA treatment efficacy evaluation system and core outcome indicator set that highlights the characteristics of TCM with patient-reported outcomes as the starting point should be established to improve the clinical research and research value.

Role of HMGB1 in Post-traumatic Endoplasmic Reticulum Stress in Rat Lung Tissues / 法医学杂志

OBJECTIVES@#To explore the role of high mobility group B1 （HMGB1） protein in the post-traumatic endoplasmic reticulum stress （ERS） in rat lung tissues.@*METHODS@#The rat model of acute lung injury was established by crushing the hind limbs of rats with standard weight. The first experiment was to divide rats into postural control group and crush groups （6 h, 18 h and 30 h after crushing）. The second experiment was to divide rats into postural control group, 18 h crush group, HMGB1 inhibitor sodium butyrate （SB） group and 18 h crush+SB group. The protein expression changes of HMGB1 and ERS- related proteins （GRP78, caspase-12, CHOP and IRE1α） in rat lung tissues were detected with Western blotting. Meanwhile, the pathological changes of rat lungs were observed by HE stain.@*RESULTS@#Compared with the postural control group, the expression levels of ERS-related proteins （GRP78, caspase-12, CHOP and IRE1α） and HMGB1 protein in rat lung tissues by crushing the hind limbs of rats were obviously increased. The protein levels reduced at 30 h after crushing but were still higher than those of postural control group and obvious pathological changes of acute lung injury were observed simultaneously in rats. Compared with the 18 h crush group, the expression levels of the ERS-related proteins and HMGB1 protein in rat lung tissues were attenuated in 18 h crush+SB group, and the pathological changes of rat lung injury began to alleviate.@*CONCLUSIONS@#HMGB1-ERS pathway activated by traumatic stress can lead to acute lung injury in rats.

Clinical Analysis of One-Stage Debridement,Bone Grafting and Internal Fixation for the Treatment of Single-Segmental Lumbar Spinal Tuberculosis with Extreme Lateral Approach / 中山大学学报(医学科学版)

[Objective]To analyze the feasibility and clinical efficacy of one-stage debridement,bone grafting and in-ternal fixation for the treatment of single-segmental lumbar spinal tuberculosis with extreme lateral approach.[Methods]Thirteen patients of single-segmental lumbar spinal tuberculosis that received the surgeries from April 2013 to August 2016 were included.The operation duration and the amount of intraoperative blood loss were recorded.The VAS and ODI of the back pain,lumbar kyphosis angle,segment height restoration,and vertebral fusion rate were used to analyze the clinical efficacy.[Results]Thirteen patients were successfully followed up for 13-32 months(mean,20.3 months);the operation duration was 160-280 min(average,214±96)min;the amount of intraoperative blood loss was 150-350 mL, average(average,263±63)mL. At the final follow-up,ESR and CRP were normal and lower back pain(VAS)and Oswestry disability index(ODI)were significantly reduced(7.2±1.6 vs 2.5±1.2 and 63.3±5.4 vs 31.9±3.7,respectively)compared to preoperative values;there were no significant difference in the lumbar kyphosis angle,segment height resto-ration between preoperation(segmental lordosis,7.1°±4.7°;segmental height,64.8 mm±9.3 mm)and the values at final follow-ups(segmental lordosis,5.2°±3.5°;segmental height,69.4 mm±10.5 mm;P>0.05). All cases acquired good lumbar interbody fusion with no internal fixation failure or recurrence of tuberculosis.[Conclusions]Under systemic and routine antituberculosis chemotherapy,one-stage extreme lateral approach debridement,bone graft and internal fixation is effective and feasible for single-segmental lumbar spinal tuberculosis.

Luteolin reduces cardiac dysfunctions in streptozotocin-induced diabetic rats / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To investigate the effects of luteolin (Chinese Traditional Medicine) on cardiac functions and mitochondrial oxidative stress in streptozotocin (STZ)-induced diabetic rats.</p><p><b>METHODS</b>Male SD rats were randomly divided into a normal control group, a luteolin control group, a diabetic group, and diabetic groups orally administered with a low dose (10 mg/(kg x d)) or a high dose of luteolin (100 mg/ (kg x d)) for eight weeks. The body weight, blood glucose, cardiac functions, left ventricular weight, myocardial collagen and reactive oxygen species (ROS) levels were assayed. The cardiac mitochondrial ROS level, superoxide dismutase (SOD) activity and the mitochondrial swelling were measured.</p><p><b>RESULTS</b>Treatment with luteolin had no effect on the blood glucose but reduced the losing of body weight in diabetic rats. High dose of luteolin markedly reduced the ratio of ventricular weight and body weight, increased the left ventricular develop pressure, and decreased the left ventricular end diastolic pressure in diabetic rats. The myocardial levels of ROS and collagen, the cardiac mitochondrial ROS level, and the mitochondrial swelling in diabetic rats were all markedly reduced by high dose of luteolin. Furthermore, high dose of luteolin significantly increased the mitochondrial SOD activity in diabetic rat hearts.</p><p><b>CONCLUSION</b>Treatment with luteolin for 8 weeks markedly improves the cardiac function, which may be related to reducing mitochondrial oxidative stress and mitochondrial swelling in diabetic rats.</p>

Partial endothelium-dependent vasorelaxation of crocetin and its mechanism / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the vasorelaxation effect of crocetin (CCT) and its mechanism.</p><p><b>METHODS</b>Isolated aortic rings from Sprague-Dawley rats were mounted in the organ bath system. The tension of the aorta was recorded.</p><p><b>RESULT</b>CCT significantly provoked concentration-dependent relaxation in both endothelium-intact and-denuded aortic rings pre-constricted by phenylephrine (10⁻⁵ mol/L), and the vasorelaxation in endothelium-intact aortic rings was stronger than that in endothelium-denuded ones. CCT had no significant effects on aortic rings pre-constricted with KCl (6 × 10⁻² mol/L). Pretreatment with eith L-NAME (10⁻⁴ mol/L), an inhibitor of nitric oxide synthase (NOS), or indomethacin (10⁻⁵ mol/L), an inhibitor of cyclooxygenase, for 30 min significantly attenuated the relaxation of endothelium-intact aortic rings induced by CCT. Besides, both tetraethylammonium (a Ca²(+)-activated K(+) channel inhibitor, 5 × 10⁻³ mol/L) and 4-aminopyridine (a voltage-sensitive K(+) channel inhibitor, 10⁻³ mol/L), but not the ATP-sensitive K(+) channel inhibitor glibenclamide (3 × 10⁻⁶ mol/L), significantly attenuated CCT-induced relaxation in endothelium-denuded aortic rings.</p><p><b>CONCLUSION</b>CCT had partial endothelium-dependent relaxation in rat aortas, which may be mediated by activating the endothelial NOS-NO and cyclooxygenase-prostacyclin pathways. The endothelium-independent relaxation in rat aortas induced by CCT may be mediated by Ca²(+)-activated K(+) channels and voltage-sensitive K(+) channels.</p>

Betulinic acid ameliorates impairment of endothelium-dependent relaxation induced by oxidative stress in rat aorta / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of betulinic acid (BA) on relaxation in isolated rat aortic rings and its antioxidant property on oxidative stress of blood vessels.</p><p><b>METHODS</b>Aortic rings were isolated and BA was cumulatively added into organ bath. Isometric tension of endothelium intact or endothelium denuded thoracic aortic rings previously contracted by phenylephrine (PE) was recorded. Then aortic rings were randomly divided into normal control group, BA control group, H(2)O(2) group and BA+H(2)O(2) group, after being previously contracted by PE, isometric tension of endothelium-dependent relaxation induced by Ach was recorded.</p><p><b>RESULT</b>Exposure of intact endothelium rings previously contracted by PE to BA at the concentrations of 10(-7) mol/L-10(-4) mol/L evoked a significant concentration dependent relaxation, which was inhibited by pretreatment with N omega-nitro-L-arginine methyl ester (L-NAME, 10(-4)mol/L), but not by indometacin (10(-5)mol/L). The pD2 value of BA was 5.24 ± 0.04, and the EC(50)value was 2.45 x 10(-6)mol/L. Exposure of endothelium denuded rings previously contracted by PE to BA did not affect the relaxation in isolated aortic rings. ACh induced a dose-dependent relaxation that was weakened by pretreatment with H(2)O(2) (5 10(-4) mol/L) for 15 min. The EC(50) of BA markedly attenuated the inhibition of relaxation induced by H(2)O(2).</p><p><b>CONCLUSION</b>BA can evoke a concentration-dependent relaxation in aortic rings previously contracted by PE, which may be mediated by NO. And the decrease of endothelium-dependent relaxation in rat aortic rings exposed to H(2)O(2) can be markedly attenuated by BA, which may be mediated by reducing oxidative stress and maintaining the activity of NO in aortic rings.</p>

Ginkgo biloba extract protects brain from ischemia/reperfusion injuries / 浙江大学学报·医学版

Ginkgo biloba extract (GBE) is one of the hot spots of drugs extracted from plants recently; it protects brain from ischemia/reperfusion injuries. The mechanism of protective effects includes antioxidation, free radicals clearance, inhibiting the release of excitatory amino acid, anti-inflammation, inhibiting neural apoptosis and other biological effects.