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      2018 Year 24 Vol. 2 Issue

        OriginalPaper

      • Jia-ying Wang,Gui-hua Tian,You-ping Li,Tai-xiang Wu,Zhao-xiang Bian,Liang Du,Hong-cai Shang
        2018, 24(2): 83-86. DOI: 10.1007/s11655-017-2427-7
        Abstract：With the introduction and development of evidence-based medicine in China, it has been spread rapidly in the area of integrative medicine (IM) and has become a new unique discipline. During almost 20 years, as one of the most important parts of evidence-based IM, systematic review (SR)/meta-analysis (MA) of IM have shown a good development momentum in the aspects of quantity, depth, breadth and influence, but also face the harsh situation of the uncontrolled quantity and quality, especially for SRs in Chinese. Therefore, how to supervise and standardize this area effectively becomes a problem to be solved. Based on the experience both at home and abroad, the authors put forward several kinds of solutions for laying the foundation for further development such as promoting the registration system of SR/MA of IM, effectively setting up the regulatory platform of quality and quantity, launching professional training for SR/MA reviewers, forming qualification registration, developing the data transfer and sharing platform to realize the transparency of evidence process.  
        Keywords：Integrative Medicine;systematic review in Chinese;regulation and monitoring   
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        Published：2021-08-27
      • Yan Liu,Li-yun He,Tian-cai Wen,Shi-yan Yan,Wen-jing Bai,Bao-yan Liu
        2018, 24(2): 87-93. DOI: 10.1007/s11655-017-2420-1
        Abstract：To determine whether patterns of enterovirus 71 (EV71)-associated hand, foot, and mouth disease (HFMD) were classified based on symptoms and signs, and explore whether individual characteristics were correlated with membership in particular pattern. Symptom-based latent class analysis (LCA) was used to determine whether patterns of EV71-HFMD existed in a sample of 433 cases from a clinical data warehouse system. Logistic regression was then performed to explore whether demographic, and laboratory data were associated with pattern membership. LCA demonstrated a two-subgroup solution with an optimal fit, deduced according to the Bayesian Information Criterion minima. Hot pattern (59.1% of all patients) was characterized by a very high fever and high endorsement rates for classical HFMD symptoms (i.e., rash on the extremities, blisters, and oral mucosa lesions). Non-hot pattern (40.9% of all patients) was characterized by classical HFMD symptoms. The multiple logistic regression results suggest that white blood cell counts and aspartate transaminase were positively correlated with the hot pattern (adjust odds ratio=1.07, 95% confidence interval: 1.006–1.115; adjust odds ratio=1.051, 95% confidence interval: 1.019–1.084; respectively). LCA on reported symptoms and signs in a retrospective study allowed different subgroups with meaningful clinical correlates to be defined. These findings provide evidence for targeted prevention and treatment interventions.  
        Keywords：hand;foot and mouth disease;pattern classification;enterovirus A;human;Chinese Medicine   
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        Published：2021-08-27
      • Mai Shi,Zhao-lan Liu,Yan-bo Zhu,Mei-yan Xu,Xue-ying Duan,Hui-mei Shi,Bo Jiang,Xiao-mei Zhang,Xiao-han Yu
        2018, 24(2): 94-102. DOI: 10.1007/s11655-015-2113-6
        Abstract：To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus (T2DM) from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control. Patients were individually randomized into intervention group (receiving integrative education, n=120) and control group (receiving usual education, n=120). The primary outcome was the changes in glycosylated hemoglobin A1c (HbA1c) levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models (HLMs) were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQoL scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change. HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group (all P<0.01); and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group P<0.01). There was a significant between-group difference from baseline to 3 months (P=0.044), from 6 to 9 months (P<0.01) and from 9 to 12 months (P<0.01). Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQoL scores respectively (all P<0.05). The number in the intervention group of normal weight increased from 56 at baseline to 81 (6 months), 94 (12 months), the number in the control group were 63 (baseline), 69 (6 months), 70 (12 months), the χ2 of hierarchical analysis of BMI were 6.93 (P=0.075), 10.31 (P=0.016), 15.53 (P<0.01), respectively. Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.  
        Keywords：type 2 diabetes mellitus;health education;Traditional Chinese Medicine;glycosylated hemoglobin A1c;health-related quality of life   
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        Published：2021-08-27
      • Si-wei Li,Xue Feng,Hao Xu,Ke-ji Chen
        2018, 24(2): 103-108. DOI: 10.1007/s11655-017-2419-7
        Abstract：To detect the anticoagulation and antiplatelet effects of different concentrations of puerarin, heparin sodium and tirofiban hydrochloride on the blood samples of healthy volunteers by Sonoclot coagulation and platelet function analyzer. Peripheral blood samples were extracted from 20 healthy volunteers, followed by adding different concentrations of puerarin, heparin sodium and tirofiban hydrochloride. Samples were detected for activated clotting time (ACT), clot rate (CR) and platelet function (PF) by Sonoclot coagulation and platelet function analyzer instrument. For puerarin and heparin sodium, the values of ACT gradually increased, and the values of CR and PF gradually decreased with increasing in drug concentration. There was a linear (or log linear) relationship between ACT, CR, PF value and drug concentration (P<0.01). Corresponding to each value, a regression equation was obtained. For tirofiban hydrochloride, the values of ACT and CR had no significant changes, while PF values gradually decreased with concentration increasing. There was also a linear relationship between PF values and concentrations of tirofiban hydrochloride (P<0.01). Under the same ACT values, the puerarin corresponding CR values (CR = e−0.0062ACT+4.31, P<2.2e-16) were always higher than the corresponding values (CR = e−0.0028ACT+2.79, P-value<2.2e-16) of heparin sodium. For high concentrations of puerarin (e.g. 3.8 mg/600 μL) and tirofiban hydrochloride (e.g. 0.8 μg/600 μL), PF values had no significant difference. However, PF values for high puerarin concentration had a larger variance. Puerarin has similar anticoagulant and antiplatelet effects with the heparin sodium, and may have a lower hemorrhage risk than heparin sodium when obtained the same anticoagulation effect in the concentration range of this experiment. In addition, for high concentration, puerarin had the same antiplatelet function as tirofiban hydrochloride but with a larger individual variability.  
        Keywords：Puerarin;heparin;tirofiban hydrochloride;in vitro;Sonoclot coagulation analyzer;anticoagulation;antiplatelet aggregation   
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        Published：2021-08-27
      • Hong Pan,Li-yuan Lu,Xue-qian Wang,Bin-xue Li,Kathleen Kelly,Hong-sheng Lin
        2018, 24(2): 109-116. DOI: 10.1007/s11655-017-2410-3
        Abstract：To investigate the effect of gambogic acid (GA) on the growth and cell death of castrate resistant prostate cancer (PC) with phosphate and tension homology (PTEN) and p53 genes deleted in vitro and ex vivo, and elucidate the underlying possible molecular mechanisms. PTEN−/−/p53−/− PC cells and Los Angeles prostate cancer-4 (LAPC-4) cells were treated with GA for 24 h and 48 h, then cell viability was determined by cell proliferation assay. PTEN−/−/p53−/− PC cells organoids number was calculated under GA treatment for 1 week. In addition, cell titer glo assay was performed to analyze 3 dimensional cell viability of patients derived xenografts (PDX) 170.2 organoids. Flow cytometry was used to detect apoptotic cells treated with GA. And confocal image was performed to detect the apoptotic mitochondrial morphological changes. Apoptotic cell death related protein levels were measured through Western blot (WB) in GA treated cells and organoids. The expression levels of mitogen-activated protein kinases (MAPKs) pathway related ribonucleic acid (RNAs) and proteins were analyzed by reverse transcription polymerase chain reaction (RT-PCR) and WB, respectively. The treatment of GA significantly reduced cell viability of PTEN−/−/p53−/− PC cells and LAPC-4 in a time- and concentration-dependent manner. In organoids, GA showed strong inhibition towards organoids’ numbers and diameters and continuously led to a complete organoids inhibition with GA 150 nmol/L. Ex vivo results validated that GA 1 μmol/L inhibited 44.6% PDX170.2 organoids growth. As for mechanism, flow cytometry detected continuously increased apoptotic portion under GA treatment from 1.98% to 11.78% (6 h) and 29.94% (8 h, P<0.05). In addition, mitochondrial fragmentation emerged in GA treated cells indicated the mitochondrial apoptotic pathway might be involved. Furthermore, WB detected caspases-3, -9 activation and light chain (LC)-3 conversion with GA treatment. WB revealed decreased activity of MAPK pathway and down-regulation of downstream c-fos oncogene RNA level was detected by RT-PCR before undergoing apoptosis (P<0.05). GA was a potent anti-tumor compound as for PTEN−/−/p53−/− PC, which contributed to cell apoptosis via inhibition of the MAPK pathway and c-fos.  
        Keywords：gambogic acid;prostate cancer;apoptosis;mitogen-activated protein kinase;PTEN−/−/p53−/−   
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        Published：2021-08-27
      • Lin-lin Wang,Wei-wei Li,Cai-sheng Wu,Jin-lan Zhang,Yi-xiang Song,Fang-jiao Song,Hong Fu,Geng-xin Liu,Xue-mei Wang
        2018, 24(2): 117-124. DOI: 10.1007/s11655-016-2270-2
        Abstract：To investigate the relationship between tissue distributions of modified Wuzi Yanzong prescription (加味五子衍宗方, MWP) in rats and meridian tropism theory. A high-performance liquid chromatography with Fourier transform-mass spectrometry (HPLC-FT) method was used to identify the metabolites of MWP in different tissues of rats after continued oral administration of MWP for 7 days. The relationship between MWP and meridian tropism theory was studied according to the tissue distributions of the metabolites of MWP in rats and the relevant literature. Nineteen metabolites, mainly flavanoid compounds, were detected in the different rat tissues and classified to each herb in MWP. Further, it was able to establish that the tissue distributions of the metabolites of MWP were consistent with the descriptions of meridian tropism of MWP available in literature, this result might be useful in clarifying the mechanism of MWP on meridian tropism. In the long run, these data might provide scientific evidence of the meridian tropism theory to further promote the reasonable, effective utilization, and modernization of Chinese medicine. The tissue distributions of MWP in vivo were consistent with the descriptions of meridian tropism of MWP.  
        Keywords：modified Wuzi Yanzong Prescription;Chinese Medicine;tissue distributions;meridian tropism;high-performance liquid chromatography;Fourier transform mass spectrometry   
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        Published：2021-08-27
      • Wei-ning Jiang,Dan Li,Tao Jiang,Jiao Guo,Yan-fen Chen,Jie Wang,Yun Zhou,Chao-yan Yang,Chun-ping Tang
        2018, 24(2): 125-132. DOI: 10.1007/s11655-016-2252-4
        Abstract：To investigate the protective effects of Chinese medicine formulation Chaihu Shugan San (柴胡疏肝散, CHSGS) on nonalcoholic fatty liver disease (NAFLD) in rats with insulin resistance (IR) and its molecular mechanisms. Male Sprague-Dawley rats were randomly divided into six groups: the control group, the model group, Dongbao Gantai group (东宝肝泰, DBGT, 0.09 g methionine/kg), CHSGS high-dose group (CHSG-H, 12.6 g crude drug/kg), CHSGS medium-dose group (CHSG-M, 6.3 g crude drug/kg), and CHSGS low-dose group (CHSG-L, 3.15 g crude drug/kg). After establishing the NAFLD rat model and treatment for 8 weeks, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), free fatty acid (FFA), fasting blood glucose (FBG), fasting insulin (FINS) contents in blood serum, and TC, TG contents in the hepatic homogenate were measured by an automatic biochemical analyzer, and a homeostasis model assessment was applied to assess the status of IR, insulin sensitivity index (ISI), and homeostasis model assessment for insulin secretion (HOMA-IS). The expression levels of adiponectin and leptin mRNA in liver tissue were analyzed by reverse transcription polymerase chain reaction. Pathological changes of livers were observed by hematoxylin-eosin staining of paraffin section. Compared with the model group, the serum levels of TC, TG, FFA, FBG, FINS, IRI, ISI, and the liver levels of TC and TG in CHSG-H, CHSG-M, CHSG-L groups showed significant declines (P<0.01 or P<0.05); the serum levels of HDL-C, HOMA-IS were significantly increased (P<0.01 or P<0.05); the expression of leptin mRNA was dramatically decreased and the expression of adiponectin mRNA was increased in the hepatic tissue (P<0.01 or P<0.05). The fatty deposition of liver cells could also be alleviated. CHSGS could up-regulate the expression of adiponectin mRNA and down-regulate the expression of leptin mRNA on the liver, suggesting the CHSGS had positive therapeutic effect on NAFLD in rats with IR.  
        Keywords：Chaihu Shugan San;nonalcoholic fatty liver disease;lipid metabolism;insulin resistance;adiponectin;leptin;Chinese Medicine   
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        Published：2021-08-27
      • Xiao-li He,Shi-hui Zhao,Wei You,Yu-ying Cai,Yan-yun Wang,Yong-ming Ye,Bao-hui Jia
        2018, 24(2): 133-139. DOI: 10.1007/s11655-016-2265-z
        Abstract：To investigate the preventive treatment effects of electroacupuncture (EA) on cognitive changes and brain damage in senescence-accelerated mouse prone 8 (SAMP8) mice. The 5-month-old male SAMP8 and age-matched homologous normal aging mice (SAMR1) were adopted in this study. EA stimulation at Baihui (GV 20) and Yintang (EX-HN 3) was performed every other day for 12 weeks, 4 weeks as a course. Morris water maze test and Nissl-stained with cresyl violet were used for cognitive impairments evaluation and brain morphometric analysis. Amyloid-β (A β) expression in hippocampus and parietal cortex was detected by immunohistochemistry, and apoptosis was observed by TUNEL staining. After 3 courses of EA preventive treatment, the escape latencies of 8-month-old SAMP8 mice in EA group were significantly shortened than those of un-pretreated SAMP8 mice. Compared with SAMR1 mice, extensive neuronal changes were visualized in the CA1 area of hippocampus in SAMP8 mice, while these pathological changes and attenuate cell loss in hippocampal CA1 area of SAMP8 mice markedly reduced after EA preventive treatment. Furthermore, A β expression in hippocampus and parietal cortex of SAMP8 mice decreased significantly after EA treatment, and neuronal apoptosis decreased as well. EA preventive treatment at GV 20 and EX-HN 3 might improve cognitive deficits and neuropathological changes in SAMP8 mice, which might be, at least in part, due to the effects of reducing brain neuronal damage, decreasing neuronal apoptosis and inhibiting A β-containing aggregates.  
        Keywords：electroacupuncture;senescence-accelerated mouse prone 8 mice;prevention;learning and memory;cognitive impairment;brain damage   
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        Published：2021-08-27
      • Liu-xin Qu,Li-yang Xing,Norman Wanda,Hong Chen,Ming-ju Li,Song Gao,Ping Li
        2018, 24(2): 140-146. DOI: 10.1007/s11655-016-2261-3
        Abstract：To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation (TCSOM) in treating patients with functional abdominal pain syndrome (FAPS) in comparison with Pinaverium Bromide (Dicetel, PBD), and to assess a possible cause for FAPS. Eighty patients with FAPS were randomly and equally assigned to the TCSOM group and PBD group according to the random number table. All patients in the TCSOM group were treated with a maximum of 5 times of spinal manipulations. Patients in the PBD group were instructed to take 50 mg 3 times a day, consistently for 2 weeks. The symptoms of pre- and post-treatment were assessed on a visual analog scale (VAS) pain score. A symptom improvement rating (SIR) was implemented to evaluate the effects of the treatments. The symptoms of 27 cases of the TCSOM group were relieved soon after the first TCSOM treatment and 9 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM group included 30 cases with excellent results, 7 cases with good, and 3 cases with poor. Adverse events to the treatment were not reported. Based on VAS, the PBD group reported 8 cases with excellent results, 10 cases with good and 22 cases with poor. There was a significant difference between the two groups (P<0.01). The displacement of intervertebral discs and/or vertebra in the thoracic or lumbar region seems to be a contributing factor in the symptoms of FAPS. TCSOM is an effective treatment for FAPS.  
        Keywords：functional abdominal pain syndrome;spinal manipulation;orthopedic;Jiaji (EX-B2);Back-Shu acupoints;visual analog scale   
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        Published：2021-08-27
      • Chun-song Yang,Yun-zhu Lin,Qin Guo,Li-li He
        2018, 24(2): 147-155. DOI: 10.1007/s11655-015-1974-z
        Abstract：To evaluate the efficacy and safety of Chinese herbal medicine Xingnaojing Injection (醒脑静注射液) for newborns with hypoxic ischemic encephalopathy (HIE). Literatures were identified by searching the PubMed, EMBASE, Cochrane Library, Cochrane Central, and four Chinese literature databases from the establishment of database to October in 2013. Relevant reference lists were also screened. Two reviewers independently evaluated the methodological quality of included studies. We also conducted the meta-analysis. Thirteen trials involving 1,169 patients were included. There was no trial reported death or disability at the end of follow-up period. Meta-analysis of 4 trials (n=371) showed that there was no significant difference in the reduction of mortality [risk ratios (RR)=0.48, 95% confidence intervals (CI, 0.21, 1.13), P=0.09] between the Xingnaojing and control groups. Meta-analysis of 5 trials (n=359) showed that there was significant difference in reducing the major neurodevelopmental disability [RR=0.36, 95% CI (0.19, 0.66), P=0.001]. Meta-analysis of 6 trials (n=447) showed that there was significant difference in the author self-defined symptom improvement [RR=1.25, 95% CI (1.14, 1.37), P<0.01]. No fatal side-effects were reported. Based on the limited evidence, the routine use of Xingnaojing Injection for treatment of HIE in newborns is not recommended. Further well-conducted trials are justified.  
        Keywords：Chinese Herbal Medicine;newborns;Hypoxic Ischemic Encephalopathy;systematic review   
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      • Di Tan,Jia-rui Wu,Xiao-meng Zhang,Shi Liu,Bing Zhang
        2018, 24(2): 156-160. DOI: 10.1007/s11655-017-2424-x
        Abstract：To systematically evaluate the effectiveness and safety of Sodium Tanshinone II A Sulfonate Injection (STS) as one adjuvant therapy for treating unstable angina pectoris (UAP). Randomized controlled trials (RCTs) of UAP treated by STS were searched in the China National Knowledge Infrastructure Database (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Wanfang Database, the Chinese Biomedical Literature Database (CBM), Web of Science, the Cochrane Library, Embase, and PubMed, which from inception to January, 2016. The Cochrane Risk Assessment Tool was used to evaluate the methodological quality of the RCTs. The Review Manager 5.3 software was used to conduct the metaanalysis. The results showed that 17 RCTs involving 1,372 patients were included. The meta-analysis indicated that the combined use of STS and Western medicine (WM) in the treatment of UAP can obviously improve the total effective rate [risk ratio (RR)=1.31, 95% confidence interval (CI) (1.24,1.39), P<0.0001], and the total effective rate of electrocardiogram [RR=1.43, 95% CI (1.30,1.56), P<0.0001], decrease the level of CRP [mean difference (MD)=–3.06, 95%CI (–3.85,–2.27), P<0.00001], fibrinogen [MD=–1.03, 95% CI (–1.16,–0.89), P<0.00001], and whole blood high shear viscosity [MD=–0.70, 95% CI (–0.92,–0.49), P<0.00001]. Additionally, the occurrence of adverse drug reaction of the experimental group was significantly higher than that of the control group [RR=3.57, 95% CI (1.28, 9.94), P<0.05]. Compared with WM, the combined use of STS was more effective.  
        Keywords：Sodium Tanshinone II A Sulfonate Injection;Chinese Medicine;unstable angina pectoris;randomized controlled trials;systematic review;meta-analysis   
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