Latest Issue
      2019 Year 25 Vol. 9 Issue

        Feature Article

      • Xiang-yu KONG,Cheng-ping WEN
        2019, 25(9): 643-647. DOI: 10.1007/s11655-019-3223-3
        Abstract：Pre-rheumatoid arthritis is the inevitable phase before the actual onset of rheumatoid arthritis and has the crucial clinical significance of early controlling and preventing disease progression. Full understanding, from both Western medicine (WM) and Chinese medicine (CM), could offer new ideas for decision making in clinical and mechanism research. This paper reviews the novel studies of WM and CM to discuss the advantages and potential mechanisms working behind.  
        Keywords：pre-rheumatoid arthritis;Western medicine;Chinese medicine   
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        Hot Topic

      • Yan GUO,Xue REN,Yu-xin CHEN,Teng-jiao WANG
        2019, 25(9): 648-653. DOI: 10.1007/s11655-019-3169-5
        Abstract：As an interdisciplinary subject of medicine and artificial intelligence, intelligent diagnosis and treatment has received extensive attention. The standardization of Chinese medicine (CM) diagnosis has been always a bottleneck in the modernization and globalization of CM. Studying the application technology of artificial intelligence in CM and solving the problems is an urgent need for the development of modern CM in the era of artificial intelligence. Taking the pneumonia with dyspnea and cough in CM as an example, this article gives an overview of intelligent medical technology and application development, brings forward the present technical problems faced and the new advances in intelligent technology on CM diagnosis and treatment.  
        Keywords：artificial intelligence;Chinese medicine;diagnosis and treatment   
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        Original Article

      • Guo-lin WU,Hai-feng LU,Yi-lian CHEN,Qing WANG,Heng CAO,Tian-yi LI
        2019, 25(9): 654-662. DOI: 10.1007/s11655-019-2939-4
        Abstract：Objective:To explore the change of intestinal microecology in patients with primary Sjogren's syndrome (pSS) and correlation with disease activity, and also discuss the therapy effect of Yangyin Yiqi Huoxue Recipe (养阴益气活血方, YYHD).Methods:Sixteen pSS patients were enrolled in the present study, who received 3-month treatment of YYHR, 200 mL orally twice daily. Their pre-and post-test ESSDAI scores, erythrocyte sedimentation rate (ESR) and serum immunoglobulin G (IgG) levels were measured respectively. The 16SrDNA metagenomic sequencing was used to detect and analyze the abundance and diversity of intestinal bacteria flora and the proportion of bacteria at the levels of phylum, family, and genus, in comparision with those of 6 healthy subjects in the control group.Results:The abundance and diversity of intestinal bacteria flora in pSS patients were lower than those of healthy subjects (P<0.05). After the treatment with YYHD, patients' ESSDAI score and levels of IgG and ESR have decreased significantly (P<0.05). At the phylum level, the proportions of Actinobacteria, Firmicutes, Fusobacteria and Proteobacteria have reduced sharply, while the proportions of Bacteroidetes, Teneriquetes and Candidate-division-TM7 have increased significantly by treatment (all P<0.05). At the classification level, such treatment has caused a significant decrease in the proportions of Bacteroidaceae, Ruminococcaceae, Veillonellaceae, and Enterobacteriacea (all P<0.05), but a significant increase in the proportion of Lachnospiraceae (P<0.05). At the genus level, the treatment has significantly decreased the proportions of Bifidobacterium, Bacteroides, Escherichia-Shigella, Faecalibacterium and Prevotella (all P<0.05), but significantly increased the proportion of Clostridia (P<0.05), close to the levels of healthy subjects (P>0.05).Conclusions:There exists an imbalance of intestinal microecology in pSS patients, which can be improved through the treatment with YYHD. Besides, such treatment can also improve the disease activity and adjust the diversity of intestinal bacteria flora, the composition and the abundance of intestinal flora.  
        Keywords：primary Sjogren's syndrome;intestinal microecology;Yangyin Yiqi Huoxue Recipe;disease activity;16SrDNA metagenomic sequencing   
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      • Qi ZHOU,Dong-hua YU,Ning ZHANG,Shu-min LIU
        2019, 25(9): 663-670. DOI: 10.1007/s11655-016-2741-5
        Abstract：Objective:To investigate the mechanism of Chinese herbal medicine Dioscorea nipponica for the treatment of monosodium urate crystals-induced gouty arthritis (GA) in rats.Methods:Sixty male Wistar rats were divided into 6 groups: normal, model, indomethacin and three total saponin (900, 300 and 100 mg/kg) groups. The liver, kidney and serum levels of lysosomal enzymes, antioxidant capacities, and inflammatory factors were measured. In addition, the mRNA and protein levels of the NALP3 inflammasome components in the mononuclear cells of rats' peripheral blood were analyzed using real-time polymerase chain reaction and Western blotting methods, respectively.Results:Total saponins groups could reduce the activities of β-galactosidase, β-N acetyl glucosamine enzyme, β-glucuronidase, acid phosphatase, and malonaldehyde as well as the contents of TNF-α, IL-1β and IL-8 (all P<0.05). They could also increase the activities of glutathione peroxidase and total superoxide dismutase (both P<0.05). Further studies showed that total saponins groups of high, middle and low doses could all increase the mRNA and protein levels of caspase-1, adapter apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC) and NALP3 in the mononuclear cells of peripheral blood (all P<0.05).Conclusion:Dioscorea nipponica may treat GA by regulating lysosomal enzymes, antioxidant capacities and the NALP3 inflammasome.  
        Keywords：apoptosis-associated speck-like protein containing a caspase-recruitment domain;caspase-1;Chinese medicine;Dioscorea nipponica;NALP3   
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      • Qiang GENG,Fu WANG,Qiang HAN,Shao-feng CHEN,Bin OUYANG,Zhong LI,Yu ZHAO,Qing-he GAO,Guo-jin YU,Jun GUO
        2019, 25(9): 671-676. DOI: 10.1007/s11655-019-3203-7
        Abstract：Objective:To evaluate the effects of Xiaojin Pill (小金丸) in the treatment of Peyronie's disease (PD) in a rat model.Methods:Twenty-four male Sprague-Dawley rats were randomly divided into four groups with 6 in each: sham operation, PD model, vehicle control and Xiaojin Pill groups. The rats in the sham operation group received penile tunica albsginea (TA) injection with 50 μL vehicle, while the rats in the other 3 groups received 50 μL penile TA injection of 50 μg transforming growth factor (TGF)-β1. Forty-two days after the injection, rats in the vehicle control and Xiaojin Pill groups received 0.5 mL water and Xiaojin Pill solution (107 mg/kg of body weight), respectively by gavage for 28 days, while those in the sham operation and PD model groups did not receive any intervention. After intervention, the expressions of matrix metalloproteinase 2/9 (MMP2/9), nitric oxidesynthase (NOS), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured.Results:Rats in the PD model and vehicle control groups presented obvious fibrosis in corpus cavernosum (CC) and demonstrated a significantly increased expressions of MMP2 and MMP9 in the CC compared with the sham operation group (all P<0.01). In contrast, the expressions of MMP2 and MMP9 in the Xiaojin Pill group were significantly down-regulated (both P<0.01). In addition, the levels of NOS and MDA in CC were significantly increased while the activity of SOD was decreased in the PD model and vehicle control groups compared with the sham operation group (all P<0.01). After Xiaojin Pill treatment, the levels of MDA, NOS and SOD appeared to be corrected (all P<0.01).Conclusions:Xiaojin Pill could reduce fibrosis in the CC by decreasing the expressions of MMPs, NOS and MDA, and by increasing the activity of SOD. Therefore, Xiaojin Pill might be a therapeutic option for PD.  
        Keywords：antioxidant mechanism;Xiaojin Pill;Chinese medicine;Peyronie's disease;rats;matrix metalloproteinases   
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        Published：2021-08-27

        Acupuncture Research

      • Guang-wen WU,Jun CHEN,Yun-mei HUANG,Cai-bin PAN,Wen-lie CHEN,Shi-mao ZHANG,Wei LIN,Xian-xiang LIU,Ming-xia WU
        2019, 25(9): 677-683. DOI: 10.1007/s11655-018-2916-8
        Abstract：Objective:To illustrate the molecular mechanisms underlying the therapeutic effects of electroacupuncture (EA) on knee osteoarthritis (OA).Methods:Twenty-seven six-month-old New Zealand white rabbits were allocated into three groups in accordance with a random number table: normal group (no surgery-induced OA; without treatment), model group (surgery-induced OA; without treatment) and EA group [surgery-induced OA; received treatment with EA at acupoints Dubi (ST 35) and Neixiyan (EX-LE 5), 30 min twice a day]. After eight consecutive weeks of treatment, the histopathological alterations in cartilage were observed using optical microscopy and transmission electron microscopy, cartilage degeneration was evaluated by modified Mankin's score principles, the synovial fluid concentration of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and matrix metalloproteinase-3 (MMP-3) were evaluated by enzyme-linked immunosorbent assay, and the protein expression levels of IL-1β, IL-6, TNF-α, MMP-3, IκB kinase-β (IKK-β), nuclear factor of α light polypeptide gene enhancer in B-cells inhibitor α (IκB-α) and nuclear factor-κB (NF-κB) p65 were quantified by Western blot analysis.Results:EA treatment significantly improved cartilage structure arrangement and reduced cellular degeneration. The IL-1β, IL-6, TNF-α and MMP-3 of synovial fluid in the EA-treated group were significantly decreased compared with the model group (all P<0.01). Compared with the model group, the IL-1β, IL-6, TNF-α, MMP-3, IKK-β and NF-κB p65 protein expressions in cartilage of EA-treated group were significantly decreased (all P<0.01), whereas IκB-α expression was significantly up-regulated (P<0.01).Conclusion:EA treatment may delay cartilage degeneration by down-regulating inflammatory factors through NF-κB signaling pathway, which may, in part, explain its clinical efficacy in the treatment of knee OA.  
        Keywords：osteoarthritis;electroacupuncture;synovial fluid;cartilage;cytokines;nuclear factor-κB signaling pathway   
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        Clinical Experience

      • Ming-yue SUN,Yang MIAO,Min JIN,Yao-rong DONG,Shu-rong LIU,Mu-lan WANG,Rui GAO
        2019, 25(9): 684-690. DOI: 10.1007/s11655-019-3069-8
        Abstract：Objective:To investigate the effect and safety of Guanxinning Tablet (冠心宁片, GXN) for the treatment of stable angina pectoris patients with Xin (Heart)-blood stagnation syndrome (XBSS).Methods:One hundred and sixty stable angina pectoris patients with XBSS were randomly assigned to receive GXN (80 cases) or placebo (80 cases, Guanxinning simulation tablets, mainly composed of lactose), 4 tablets (0.38 g/tablet), thrice daily for 12 weeks. After treatment, an exercise stress test (treadmill protocol), Chinese medicine (CM) syndrome score, electrocardiogram (ECG), and nitroglycerin withdrawal rate were evaluated and compared in the patients between the two groups. Meanwhile, adverse events (AEs) were evaluated during the whole clinical trial.Results:Compared with the control group, the time extension of exercise duration in the GXN group increased 29.28±17.67 s after treatment (P>0.05); moreover, the change of exercise duration in the GXN group increased 63.10±96.96 s in subgroup analysis (P<0.05). The effective rates of angina pectoris, CM syndrome and ECG as well as nitroglycerin withdrawal rate were 81.33%, 90.67%, 45.76%, and 70.73%, respectively in the GXN group, which were all significantly higher than those in the control group (40.58%, 75.36%, 26.92%, 28.21%, respectively, P<0.05).Conclusion:GXN was a safe and effective treatment for stable angina pectoris patients with XBSS at a dose of 4 tablets, thrice daily.  
        Keywords：Guanxinning Tablet;coronary heart disease;stable angina pectoris;Xin (Heart)-blood stagnation syndrome;Chinese medicine   
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      • Decha Pinkaew,Kanokwan Kiattisin,Jiraporn Tocharus,Pichaya Jumnongprakhon,Pisittawoot Awoot
        2019, 25(9): 691-695. DOI: 10.1007/s11655-019-3202-8
        Abstract：Objective:To determine the changes in serum levels of inflammatory biomarkers and antioxidant levels among the knee osteoarthritis (OA) patients after treatment with Phyllanthus amarus (PP) by nanoparticle gel phonophoresis.Methods:This study was a randomized, double-blind, placebo-control, parallel-group, clinical trial involving 30 subjects with mild-to-moderate degree of knee OA. The patients were allocated to two groups using a computer-generated random numbers, and received conventional ultrasound therapy (control group, 15 cases) and PP (treatment group, 15 cases) once daily for 10 sessions. The pain was evaluated by visual analogue scale (VAS). Serum levels of tumor necrosis factor-α (TNF-α) were determined by enzyme-linked immunosorbnent assay (ELISA). Nitric oxide (NO) was determined by modified Griess reagent. The antioxidant effects, including superoxide dismutase (SOD) and total antioxidant capacity (TAC), were also measured by ELISA assay.Results:The VAS score was significantly decreased in the treatment group compared with the control group after treatment (P<0.01). The serum concentrations of TNF-α and NO were significantly reduced in the treatment group compared with the control group (P<0.01) after treatment. However, the serum concentrations of SOD and TAC in the treatment group were significantly higher after treatment compared with the control group (P<0.01).Conclusion:PP could alleviate knee pain and significantly reduce systemic antiinflammatory effects in knee OA patients.  
        Keywords：phonopheresis associated with nanoparticle gel from Phyllanthus amarus;osteoarthritis;proinflammatory cytokines;antioxidants;tumor necrosis factor-α;total antioxidant capacity   
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        Evidence-Based Integrative Medicine

      • Jing LUO,Wei-jiang SONG,Yuan XU,Guang-yao CHEN,Qi HU,Qing-wen TAO
        2019, 25(9): 696-703. DOI: 10.1007/s11655-019-3221-5
        Abstract：Objective:To summarize the evidence from systematic reviews (SRs) on the benefits and safety of Tripterygium glycosides (TG) and total glucosides of paeony (TGP), commonly used to treat rheumatoid arthritis (RA) in China, for patients with RA.Methods:SRs of randomized controlled trials (RCTs) on TG or TGP in treating RA were included, by searching 8 databases from their inception until December 2017. Two authors extracted data independently. We assessed the quality of SRs using AMSTAR and graded the quality of evidence according to the GRADE approach.Results:Eleven SRs containing an average of 7.6 RCTs, involving a total of 7,012 participants were included in this overview. On the basis of included SRs, TG and TGP could improve the following indexes for RA patients: American College of Rheumatology (ACR) 20 response rate, ACR50 response rate and ACR70 response rate, swollen joint count, tender joint count, erythrocyte sedimentation rate and C-reactive protein. Moreover, TGP could reduce incidence of hepatotoxicity. The most common adverse effects of TG were gastrointestinal discomfort and gonad toxicity, while for TGP was mild to moderate diarrhea. The overall quality of evidence for these findings ranged from "low" to "moderate".Conclusions:TG and TGP might be 2 potentially effective complementary and alternative drugs for patients with RA. Nevertheless, due to gonad toxicity, TG should only be considered in elderly patients or patients without reproductive needs. More evidence from high quality RCTs and SRs is warranted to support the use of TG and TGP for RA patients.  
        Keywords：rheumatoid arthritis;tripterygium glycosides;total glucosides of paeony;overview;systematic review   
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      • Susana Seca,Diana Miranda,Daniela Cardoso,Bernice Nogueira,Henry J. Greten,António Cabrita,Manuel Alves Rodrigues
        2019, 25(9): 704-709. DOI: 10.1007/s11655-018-2914-x
        Abstract：Objective:To identify and synthesize the most recent available evidence of effectiveness of acupuncture on pain, physical function and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA).Methods:A comprehensive search of 12 Western and Chinese databases was undertaken from their inception up to end of 2016. Randomized controlled trials (RCTs), concerning patients with RA treated with needle acupuncture, written in English, Portuguese, German or Chinese were included. Primary outcomes included pain, physical function and HRQoL. Secondary outcomes included morning stiffness, functional impairment, number of tender and swollen joints and serum concentrations of inflamatory markers. Methodological quality was assessed by three independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.Results:Twenty-two studies met the inclusion criteria. Of those, 9 studies were excluded after assessment of their methodological quality. The remaining 13 original RCTs included 974 patients. Ten of these studies published in China, showed favorable statistical significant effects of acupuncture in relieving symptoms of RA compared with controls.Conclusions:Evidence suggests that acupuncture interventions may have a positive effect in pain relief, physical function and HRQoL in RA patients. However, due to the heterogeneity and methodologic limitations of the studies included in this systematic review, evidence is not strong enough to produce a best practice guideline.  
        Keywords：acupuncture;rheumatoid arthritis;quality of life;pain;physical function;randomized clinical trial   
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        Academic Exploration

      • Ji WANG,Ruo-xi YU,Qi WANG
        2019, 25(9): 712-715. DOI: 10.1007/s11655-016-2671-2
        Abstract：Health medicine has been the direction of the development of medicine. However, the definition of health defined by Western medicine and traditional medicine cannot completely cover the full meaning of health. Therefore, we propose the new concept of health: health is a state of physical and mental harmony of different individuals in the life process with the environment, and good self-adaptive and regulation ability to natural and social environment. The new concept of health enriches the connotation of health defined by Western medicine and improves the understanding of health in the past, which provide the conceptual basis for further study on health medicine.  
        Keywords：health;concept;Western medicine;Chinese medicine   
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        Review

      • Yong-rong WU,Gao-yan KUANG,Fang-guo LU,Heng-xin WANG,Min LU,Qing ZHOU
        2019, 25(9): 716-720. DOI: 10.1007/s11655-019-3224-2
        Abstract：Chinese medicine (CM) has a good clinical effect on osteoarthritis (OA), but the mechanism is not very clear. Evidence-based medicine researches have shown that intestinal flora plays a role in the pathogenesis and succession of OA. Intestinal flora affects the efficacy of CM, and CM can affect the balance of intestinal flora. This paper focuses on the relationship between intestinal flora, intestinal microenvironment, brain-gut axis, metabolic immunity and OA, and preliminarily expound the significance of intestinal flora in the pathogenesis of OA and the mechanism of CM intervention. The above discussion will be of great significance in the prevention and treatment of OA by CM from the perspective of intestinal flora.  
        Keywords：osteoarthritis;intestinal flora;pathogenesis;treatment;mechanism of Chinese medicine   
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