Comparison of the efficacy and acceptability of Chinese herbal medicine in adult patients with heart failure and reduced ejection fraction: study protocol for a systematic review and network meta-analysis.

INTRODUCTION: Heart failure with reduced ejection fraction (HFrEF) is defined as the clinical diagnosis of heart failure (HF) and ejection fraction (EF) ≤40%, which is a severe public healthcare issue and brings a heavy social and economic burden for patients with HFrEF. Chinese herbal medicine (CHM) has a long history in treating HF. Questions concerning the efficacy and acceptability of CHM-related interventions in adult patients with HFrEF led us to use the method of systematic review and network meta-analysis to integrate direct and indirect evidence to create hierarchies for all CHM. METHODS AND ANALYSIS: Nine medical databases, including PubMed, EMBASE (OVID), the Cochrane Library, Google Scholar, Web of Science, CNKI, VIP, Wanfang Database and CBM will be searched from the date of database inception to June 2015 (updated to March 2017) without language and publication status restriction. Completely randomised controlled trials (RCTs) comparing CHM or CHM plus routine treatment with CHM, CHM plus routine treatment, routine treatment, no treatment or placebo for adults with HFrEF will be examined. Our primary outcomes will include all-cause mortality, HF-related death, all-cause rehospitalisation, HF-related rehospitalisation and acceptability (discontinuation due to any adverse events during treatment). Secondary outcomes will include response rate, mean value or mean difference from baseline of surrogate indexes. We will perform the Bayesian network meta-analyses (NMA) for the most frequently reported primary or secondary outcome and the acceptability outcome, if available. Meta-regression, subgroup analyses and sensitivity analyses will be conducted based on prespecified effect modifiers to assess the robustness of the findings. DISSEMINATION: The results of this NMA will provide useful information about the effectiveness and acceptability of CHM in adults with HFrEF, which will also have implications for clinical practice and further research. Findings will be disseminated through peer-reviewed journal publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42016053854.

Conventional Acupuncture for Cardiac Arrhythmia: A Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To exam the effect and safety of conventional acupuncture (CA) on cardiac arrhythmia. METHODS: Nine medical databases were searched until February 2016 for randomized controlled trials. Heterogeneity was measured by Cochran Q test. Meta-analysis was conducted if I2 was less than 85% and the characteristics of included trials were similar. RESULTS: Nine qualified studies involving 638 patients were included. Only 1 study had definitely low risk of bias, while 7 trials were rated as unclear and 1 as high. Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation (Af) and atrial flutter (AF) [relative risk (RR): 1.09; 95% confidence interval (CI): 0.79-1.49; P=0.61; I2=61%, P=0.11]. However, 1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment, and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study, as well as the response rate in CA plus deslanoside group by another study. Meta-analysis of CA plus anti-arrhythmia drug (AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat (VPB) patients (RR, 1.19, 95% CI: 1.05-1.34; P=0.005; I2=13%, P=0.32), and an improvement in quality-of-life score (QOLS) of VPB also showed in 1 individual study. Besides, a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients (MD-21.84 [-27.21,-16.47]) and lower adverse events of CA alone were reported than amiodarone. CONCLUSIONS: CA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia, especially in VPB and Af patients, which mainly based on a pooled estimate and result from 1 study with higher methodological quality. However, we could not reach a robust conclusion due to low quality of overall evidence.

[Effect of selenium on the uptake and translocation of manganese, iron, phosphorus and selenium in rice (Oryza sativa L.)].

A pot experiment was conducted to clarify the effect of selenium on the uptake and translocation of manganese (Mn), iron (Fe) , phosphorus (P) and selenium (Se) in rice ( Oryza sativa L.). The results showed that addition of Se led to the significant increase of Se concentration in iron plaque on the root surface, root, shoot, husk and brown rice, and significant decrease of Mn concentration in shoot, husk and brown rice. At the Se concentrations of 0.5 and 1.0 mg.kg-1 in soil, Mn concentrations in rice shoot decreased by 32. 2% and 35.0% respectively, in husk 22.0% and 42.6% , in brown rice 27.5% and 28.5% , compared with the Se-free treatment. There was no significant effect of Se on the P and Fe concentrations in every parts of rice, except for Fe concentrations in husk. The translocation of P and Fe from iron plaque, root, shoot and husk to brown rice was not significantly affected by Se addition, but Mn translocation from iron plaque and root to brown rice was significantly inhibited by Se addition. Addition of 1.0 mg.kg-1. Se resulted in the decrease of translocation factor from iron plaque and root to brown rice by 38.9% and 37.9%, respectively, compared with the control treatment. The distribution ratios of Mn, Fe, P and Se in iron plaque, root, shoot, husk and brown rice were also affected by Se addition. The results indicated that Mn uptake, accumulation and translocation in rice could be decreased by the addition of Se in soil, therefore, Se addition could reduce the Mn harm to human health through food chain.

A novel sediment microbial fuel cell with a biocathode in the rice rhizosphere.

Wetland plants possess the unique ability to release oxygen as well as organic matter into the rhizosphere. It is understood that microbial fuel cells (MFCs) can use organic matter from plants as key electron donors, but the effect of root excreted oxygen on MFCs is presently unknown. In this study, a novel biocathode was buried in the rice rhizosphere and found to be capable of delivering electrons to root excreted oxygen for oxygen reduction reactions. The voltages between electrodes in the rhizosphere and bulk soil were found to increase initially, but dissipate after approximately 1 month. Results from the MFC and oxygen microelectrode experiments indicated that the oxygen efflux rate from rice roots was dependent on the root maturity. Furthermore, the excreted oxygen from wetland plant roots could be used for the construction of highly efficient biocathodes.