OBJECTIVE: To analyze the differences in the needs of users and the value orientation of clinical practice guidelines (CPGs) by comparing the contents and formation methods of clinical questions in Chinese and Korean CPGs of acupuncture-moxibustion (Acup-Mox). METHODS: The full text of CPGs was systematically searched from the official websites of Chinese and Korean traditional medicine societies and Acup-Mox associations, with the topic "Acup-Mox for treating diseases" and the retrieval time up to September 28, 2022. Two researchers screened the CPGs independently, and extracted the guidelines' topics, content, quantity and formation methods of clinical questions. The quantitative data were collected by counting the frequency, and the qualitative data were classified and described by thematic analysis. RESULTS: A total of 29 guidelines were included in this study, including 20 Chinese guidelines (305 questions) and 9 Korean guidelines (223 questions). The differences lie in the aspects of content and diversity, and formation method. As for content and diversity, Chinese guidelines focused mainly on the questions related to treatment such as the operation of specific intervention (86, 28.2%), efficacy of intervention (78, 25.6%), and also involving questions in diagnosis, prevention, and prognosis. While the clinical questions in Korean guidelines were concentrated to efficacy of intervention (218, 97.8%). As for formation method, in Chinese guidelines, questions were usually collected directly from clinicians, and then determined and optimized by experts. In Korean guidelines, frequently used clinical Acup-Mox interventions would be screened first. Then the expert group would set up corresponding intervention control measures so as to form clinical questions related to treatment efficacy. CONCLUSIONS The differences reflect the different needs of clinical practitioners, and the different aims or concepts in developing Acup-Mox guidelines between China and South Korea. Chinese guidelines emphasized promoting operation protocols and techniques of Acup-Mox for practical use, while Korean guidelines emphasized promoting the frequently used clinical intervention therapies. It is speculated that the guidelines from these two countries would play different roles in guiding clinical operation and supporting medical decision. In terms of formation methods of clinical questions, it is suggested to attach importance to optimizing process in formatting clinical questions to improve the clinical applicability of CPGs of Acup-Mox.
Acupuncture ; Acupuncture Therapy/methods* ; Medicine, Chinese Traditional ; Moxibustion/methods* ; Republic of Korea ; Practice Guidelines as Topic

Objective: To evaluate the predictive value of the proportion of hibernating myocardium (HM) in total perfusion defect (TPD) on reverse left ventricle remodeling (RR) after coronary artery bypass graft (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) by ^99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with ¹⁸F-flurodeoxyglucose (FDG) gated myocardial imaging positron emission computed tomography (PET). Methods: Inpatients diagnosed with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2016 to January 2022 were prospectively recruited. MPI combined with ¹⁸F-FDG gated PET was performed before surgery for viability assessment and the patients received follow-up MPI and ¹⁸F-FDG gated PET at different stages (3-12 months) after surgery. Δ indicated changes (post-pre). Left ventricular end-systolic volume (ESV) reduced at least 10% was defined as RR, patients were divided into reverse remodeling (RR+) group and the non-reverse group (RR-). Binary logistic regression analysis was used to identify predictors of RR. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to assess the cut-off value for predicting RR. Additionally, we retrospectively enrolled inpatients with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2021 to January 2022 as the validation group, who underwent MPI and ¹⁸F-FDG gated PET before surgery. Echocardiography was performed before CABG and after CABG (3-12 months). In the validation group, the reliability of obtaining the cut-off value for the ROC curve was verified. Results: A total of 28 patients with HFrEF (26 males; age (56.9±8.7) years) were included in the prospective cohort. HM/TPD was significantly higher in the RR+ group than in the RR- group ((51.8%±17.9%) vs. (35.7%±13.9%), P=0.016). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of RR (Odds ratio=1.073, 95% Confidence interval: 1.005-1.145, P=0.035). ROC curve analysis revealed that HM/TPD=38.3% yielded the highest sensitivity, specificity, and accuracy (all 75%) for predicting RR and the AUC was 0.786 (P=0.011). Meanwhile, a total of 100 patients with HFrEF (90 males; age (59.7±9.6) years) were included in the validation group. In the validation group, HM/TPD=38.3% predicted RR in HFrEF patients after CABG with the highest sensitivity, specificity and accuracy (82%, 60% and 73% respectively). Compared with the HFrEF patients in the HM/TPD<38.3% group (n=36), RR and cardiac function improved more significantly in the HM/TPD≥38.3% group (n=64) (all P<0.05). Conclusions: Preoperative HM/TPD ratio is an independent factor for predicting RR in patients with HFrEF after CABG, and HM/TPD≥38.3% can accurately predict RR and the improvement of cardiac function after CABG.
Male ; Humans ; Middle Aged ; Aged ; Stroke Volume ; Heart Failure ; Fluorodeoxyglucose F18 ; Retrospective Studies ; Reproducibility of Results ; Prospective Studies ; Coronary Artery Bypass ; Ventricular Dysfunction, Left ; Tomography, Emission-Computed, Single-Photon ; Perfusion ; Myocardium

For local treatment of ulcerative colitis, a new azoreductase driven prodrug CDDO-AZO from bardoxolone methyl (CDDO-Me) and 5-aminosalicylate (5-ASA) was designed, synthesized and biologically evaluated. It is proposed that orally administrated CDDO-AZO is stable before reaching the colon, while it can also be triggered by the presence of azoreductase in the colon to fragment into CDDO-Me and 5-ASA, generating potent anti-colitis effects. Superior to olsalazine (OLS, a clinically used drug for ulcerative colitis) and CDDO-Me plus 5-ASA, CDDO-AZO significantly attenuated inflammatory colitis symptoms in DSS-induced chronic colitis mice, which suggested that CDDO-AZO may be a promising anti-ulcerative colitis agent.
Animals ; Colitis/drug therapy* ; Mesalamine/pharmacology* ; Mice ; Nitroreductases ; Oleanolic Acid/pharmacology* ; Prodrugs

Marsdeniae tenacissimae extract (MTE), commonly known as Xiao-Ai-Ping in China, is a traditional Chinese herb medicine capable of inhibiting proliferation and metastasis and boosting apoptosis in various cancer cells. However, little is known about the contribution of MTE towards tumor angiogenesis and the underlying mechanism. The present study aimed to evaluate the effects of MTE on the proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) and the molecular mechanism. 3-(4,5-dimethylthiazol-2-yl)-5(3-carboxymethoxyphenyl)-2-(4-sulfopheny)-2H-tetrazolium, inner salt (MTS) and PI-stained flow cytometry assays revealed that MTE dose-dependently reduced the proliferation of HUVECs by arresting cell cycle at S phase (P < 0.05). Annexin V-FITC/PI-stained flow cytometry confirmed that MTE (160 μL·L) enhanced the apoptosis of HUVECs significantly (P < 0.001). Real-time quantitative RT-PCR and Western blot analyses showed an increase in Bax expression and a sharply decline in Bcl-2 expression; caspase-3 was activated simultaneously in a dose-dependent manner (P < 0.05). Further study observed the dose-dependent down-regulation of vascular endothelial growth factor (VEGF) receptor-2 (VEGFR-2), P2Y6 receptor (P2Y6R), and chemokine (C-C motif) ligand 2 (CCL-2), along with the activation of PKC Δ and up-regulation of p53 in a dose-dependent manner in MTE-treated selected cells (P < 0.05). Collectively, the results from the present study suggested that MTE suppressed the proliferation by attenuating CCL-2-mediated VEGF/VEGFR2 interactions and promoted the apoptosis through PKCΔ-induced p53-dependent mitochondrial pathway in HUVECs, supporting that MTE may be developed as a potent anti-cancer medicine.
Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Proliferation ; drug effects ; Human Umbilical Vein Endothelial Cells ; cytology ; drug effects ; metabolism ; Humans ; Marsdenia ; chemistry ; Plant Extracts ; pharmacology ; Protein Kinase C ; genetics ; metabolism ; Signal Transduction ; drug effects ; Vascular Endothelial Growth Factor A ; genetics ; metabolism ; Vascular Endothelial Growth Factor Receptor-2 ; genetics ; metabolism

OBJECTIVETo explore the molecular mechanism of erythrocyte pyruvate kinase deficiency (PKD).

METHODSTargeted sequence capture and next-generation sequencing (NGS) were used to detect the regions of exon and exon-intron boundarie of PKLR gene in a clinical suspected PKD patient. The protein function of mutant gene was forecasted by the SIFT and PolyPhen-2 databank, after the mutation of PKLR gene in the patient was detected by the NGS technology, its genotype was confirmed by Sanger sequencing.

RESULTSThe patient was found to have peculiar double heterozygous mutations: 661 G>A (Asp221Asn) of exon 5 and 1528 C>T (Arg510Ter) of exon 10, resulting in amino acid substitution Asp221Asn and Arg510Ter, these mutations were also further confirmed by Sanger sequencing. The complex mutations were infrequent and each of them was able to cause diseases.

CONCLUSIONThe complex mutations of both 661 G>A and 1528 C>T of PKLR gene are the molecular mechanism of PKD. Simultaneous existance of above-mentioned complex mutations in PDK patient was never been previously reported at home and abroad.

Anemia, Hemolytic, Congenital Nonspherocytic ; genetics ; Exons ; Genotype ; High-Throughput Nucleotide Sequencing ; Humans ; Introns ; Mutation ; Pyruvate Kinase ; deficiency ; genetics ; Pyruvate Metabolism, Inborn Errors ; genetics

Cell Line ; Cell Proliferation ; drug effects ; Dose-Response Relationship, Drug ; Histone Chaperones ; metabolism ; Humans ; Liver ; cytology ; Protein Interaction Maps ; Solvents ; administration & dosage ; toxicity ; Transcription Factors ; metabolism ; Trichloroethylene ; administration & dosage ; toxicity

OBJECTIVETo evaluate the clinical efficacy and safety of treatment of chronic primary glomerulopathy (CPG) patients of Shen deficiency and dampness heat syndrome (SDDHS) by Yishen Qingli Granule (YQG) combined with low-dose Tripterygium Wilfordii multiglycoside Tablet (TWT).

METHODSTotally 231 CPG patients of SDDHS were enrolled in this study (including 60 patients from First Affiliated Hospital of Nanjing University of Chinese Medicine, 58 from First Affiliated Hospital of Nanjing Medical University, 46 from Xinqiao Hospital of Third Military Medical University, 35 from First Affiliated Hospital of Guangzhou University of Chinese Medicine, 14 from First Affiliated Hospital of Soochow University, and 18 from Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine). They were randomly assigned to the control group (116 cases) and the trial group (115 cases) according to block group method. There were 217 cases in the safety analysis set (109 cases in the trial group vs 108 cases in the control group), and 203 cases in the full analysis set (99 cases in the trial group vs 104 cases in the control group). All patients received basic treatment such as ACEI/ARB. Furthermore, YQG (consisting of raw astragalus 10 g, prepared Polygonum Multiflorum 10 g, Pyrrosia 10 g, 1.5 g each package, containing 10 g of crude drugs) was additionally given to patients in the trial group, each package, twice daily. The TWT (10 mg) was given, twice a day. The TWT dose was adjusted according to 24 h urinary total protein (UTP). The placebos of YQG and TWT were administered to those in the control group. The treatment course consisted of 24 weeks and the follow-up visit lasted for 24 weeks. The biochemical indices were observed before and after treatment including 24 h UTP, urine red cell count (U(RBC)), renal functions (BUN, SCr), blood routine test (WBC), and liver functions (SGPT, SGOT). Reverse reactions such as gastrointestinal discomfort, skin rash, and irregular menstruation were also observed.

RESULTSCompared with the control group, the total effective rate was better in the trial group (82.83% vs 61.54%, P < 0.01). Results of stratified comparison of UTP showed better efficacy in the trial group (0.8-3.0 g/24 h, P < 0.01). The UTP decline occurred in the trial group after 8 weeks of treatment, with stable action, showing statistical difference when compared with the control group (P < 0.01). In the trial group, U(RBC) level decreased after treatment but changed more significantly. But there was no statistical difference in the changes when compared with the control group (P > 0.05). After treatment, there were no statistical difference in safety indicators such as WBC, SGPT, and SGOT between the two groups after treatment (P > 0.05).

CONCLUSIONOn the basis of basic treatment such as ACEI/ARB, application of YQG combined with low-dose TWT had better effect in controlling proteinuria of CPG patients, and could help stabilizing their conditions with less adverse reactions.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Kidney Diseases ; diagnosis ; drug therapy ; Kidney Glomerulus ; pathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; methods ; Treatment Outcome ; Tripterygium

Objective To analyze the prevalence rate of diabetic nephropathy (DN) and the related factors on DN among type 2 diabetic patients.Methods A total number of 1758 type 2 diabetic patients who were hospitalized in the Beijing Hospital from 2003 to 2010 were analyzed retrospectively.Three groups were divided according to the rate of urinary albumin excretion (UAER).Patients whose UAER＜20 μg/min belonged to normal albuminuria (NA) group.The ones whose UAER from 20 to 200 μ g/min belonged to microalbuminuria (MA) group,and the others whose UAER≥200 μg/min belonged to large albuminuia (LA) group.The clinical characteristics were then compared.The related factors of DN were analyzed.Results (1)There were 1246 patients in NA group,408 patients in MA group,and 104 patients in LA group.The constituent ratio of nephropathy was 29.1％ (2) The ages of NA group,MA group and LA group were (59.87± 12.77,62.52± 12.74,64.44 ± 12.74) years old,respectively,with body mass index ( BMI ) as (24.90 ± 3.42,25.53 ± 4.00,25.53 ± 3.91 )kg/m2 respectively; duration of diabetes as (8.39 ± 7.12,10.77 ± 8.02,12.84 ± 7.97)years; systolic blood pressure (SBP) as (133.42 ± 18.19,142.72 ± 20.21,151.12 ± 21.91 )mm Hg;diastolic blood pressure as (78.75 ± 10.66,80.79 ±12.21,83.33 ±13.61 )mm Hg; fasting blood suger (FBS) as (8.25±3.43,9.02±3.72,9.22±4.62)mmol/L; glycated hemoglobin(HbAlc) as (8.88±2.10,9.34 ± 2.36,9.10 ± 2.36)％ ; uric acid (UA) as (288.04 ± 90.41,307.23 ± 96.96,374.28 ±105.47) mmol/L; triglyceride as (1.72 ± 1.51,2.06 ± 1.88,1.94 ± 1.42) mmol/L,high density lipoprotein cholesterol as ( 1.08 ± 0.30,1.02 ± 0.29,1.07 ± 0.28) mmol/L; fasting insulin as (9.24 ±9.02,11.24 ± 9.74,11.06 ± 9.29) μU/ml; fasting C peptide as (462.31 ± 289.94,510.02 ± 350.08,595.93 ± 445.86) pmol/L.There were significant differences between NA,MA and LA groups in all above items ( P ＜ 0.01 or P＜ 0.05 ).( 3 ) Logistic regression analysis showed that DN were related with duration of diabetes,BMI,SBP,HbAlc,FBS,UA (OR values were 1.041,1.055,1.028,1.116,1.100,1.004 respectively,P＜0.05 or P＜0.01 ).Conclusion It would be helpful to prevent and retard progression of DN that comprehensively controlling high blood glucose,hypertension,hyperuricemia and body weight of type 2 diabetic patients.

Objective To investigate the effect of nimesulide (NIM), a selective cyclooxygenase-2 (COX-2) inhibitor, on angiopoietins (Ang) gene expression of human glioma xenografts in nude mice and its significance. Methods Human SHG44 glioma cells were inoculated subcutaneously in 16 nude mice to establish xenograft models, and then these mouse models were randomly divided into NIM treatment group and control group. NIM (6 mg/kg) and saline were poured into the stomachs of the mice in each group, respectively, once daily for 35 d. The mRNA expressions of Ang-1 gene and Ang-2 gene in the xenografts were determined by RT-PCR. Microvessel density (MVD) in the xenografts was assessed by immunohistochemical technique. The tumor growth curve was drawn and the inhibition ratio of tumor growth was calculated. Results NIM could significantly inhibit the glioma xenografts growth with its inhibition rate reaching 42.03%. The mRNA expression of Ang-2 gene in NIM treatment group (0.2032±0.0185) was significantly lower than that in control group (0.6024±0.0289, P＜0.05), but that of Ang-1 gene showed no significant changes; therefore, the mRNA ratio of Ang-2/Ang-1 genes was decreased (0.5825±0.0621 vs. 1.5847±0.1948, P＜0.05). MVD in the xenografts of the NIM treatment group was significantly lower than that in the control group (P＜0.05). Conclusion NIM, by down-regulating the mRNA expression ofA ng-2 gene and changing the mRNA ratio of Ang-2/Ang-1 genes, can inhibit the tumor growth

To introduce the application of Stata software to heterogeneity test in meta-analysis.A data set was set up according to the example in the study,and the corresponding commands of the methods in Stata 9 software were applied to test the example.The methods used were Q-test and Ⅰ2statistic attached to the fixed effect model forest plot,H statistic and Galbraith plot.The existence of the heterogeneity among studies could he detected hy Q-test and H statistic and the degree of the heterogeneity could be detected by,Ⅰ2 statistic.The outliers which were the sources of the heterogeneity could be spotted from the Galbraith plot.Heterogeneity test in Meta-analysis can be completed by the four methods in Stata software simply and quickly.H and Ⅰ2 statistics are more robust,and the outliers of the heterogeneity can be clearly seen in the Galbraith plot among the four methods.