Most compounds in blood are blocked from flowing into brain by blood-brain barrier(BBB) to keep central nerve system normal, but this barrier will be open in different diseases with different mechanisms. As these mechanisms are understood more and more clearly, it will do help to protect blood-brain barrier and treat diseases which are correlative to blood-brain barrier. At the same time, it may also be helpful to let drugs entering central nerve system through BBB.

At present,intranasal delivery has entered clinical trial stage.In recent years,how to imroving the efficiency of intranasal delivery has been extensively investigated.This article briefly reviews some factors that impact the targeting of intranasal delivery and the drug concentration in the central nervous system.

OBJECTIVE: To test the reliability and validity of Health Scale of Traditional Chinese Medicine (HSTCM) by means of questionnaires. METHODS: A cross-sectional survey was conducted at Liwan Community of Guangzhou, Old People's Home in Guangzhou and Outpatient Department of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 652 Chinese individuals (over 18 years old) were assessed with the 88-item version of HSTCM and World Health Organization Quality of Life Measure-Abbreviated Version (WHOQOL-BREF), which were randomly delivered to them. Some socioeconomic characteristics were registered. RESULTS: A test-retest reliability (15-day interval) was found among the 76 persons who completed the questionnaires by themselves. Intra-class correlation coefficient (ICC) was 0.93. Associated 95% confidence interval (CI) was 0.89-0.96. Split-half reliability was 0.79. Inter-investigator reliability (0.93) was also good, and the ICC of HSTCM was 0.90 (95%CI 0.67-0.97). The correlation between HSTCM and WHOQOL-BREF was -0.66. The correlations of HSTCM and questionnaire deliver order, investigator, interview date and interview time were 0.06, -0.12, -0.17 and 0.20 respectively. The correlation between HSTCM and self-rated health (0.46) was greater than that between HSTCM and chronic illness (0.28). Divided by individuals with or without chronic illness, area under the ROC (receiver operator characteristic) curve for HSTCM was 0.67 (95%CI 0.63-0.71). CONCLUSION: It indicates that the HSTCM is conceptually valid with satisfactory psychometric properties and forms a basis for further applications in clinical research of traditional or integrative medicine.

Objective To evaluate the efficacy and safety ofGuipi Decoction vs. antidepressants for depression. Methods Articles about the randomized controlled trials (RCTs) ofGuipi Decoction for depression were searched in the databases of CNKI, VIP, Wanfang Data, CMB, Embase, PubMed, and Cochrane Library. Two researchers independently screened the articles, extracted the data, and evaluated the methodological quality. Meta-analyses were performed by using RevMan 5.2 software.Results A total of 9 RCTs articles involving 893 cases were included. Meta-analysis results suggested that as compared with antidepressants only,Guipi Decoction together with antidepressants was associated with a significantly greater reduction in HAMD scores (MD=-4.63, 95%CI [-5.95, -3.32];P<0.001). There was no significant difference in HAMD scores betweenGuipi Decoction used alone and antidepressants (MD=-0.30, 95%CI [-4.22, 3.62];P=0.88). As compared with antidepressants,Guipi Decoction together with antidepressants increased in the rates of total effective events (RR=1.26, 95%CI [1.14, 1.38];P<0.001). No serious adverse reactions were reported. Meta-analysis results suggested that the incidence of adverse reactions of Guipi Decoction(RR=0.48, 95%CI [0.40, 0.58];P<0.001) andGuipi Decoction together with antidepressants (RR=0.51, 95%CI [0.30, 0.85];P=0.010) were lower than that of antidepressants alone.Conclusion The present evidence suggests thatGuipi Decoction is effective and relatively safe for patients with depression. However, because the quality of included research was low, more large-scale RCTs with multicenter and high quality are needed for further verification.

Objective To assess the effectiveness of the Chinese herbal formula Tongxie Yaofang(TY) or its modified prescriptions in the management of irritable bowl syndrome(IBS).Methods A systematic review was carried out according to the Cochrane standards.A computerized literature search was carried out in main Chinese and English databases including CNKI,CBMdisc,Database of Chinese Doctorate Dissertation,Database of excellent Chinese Master Dissertation,MEDLINE and Cochrane Library.Studies were retrieved when they were randomized controlled trials(RCTs) whose interventions for IBS patients were TY or modified prescriptions of TY with placebos or conventional medicine as controls.Outcome measurement included the alleviation of main symptoms such as abdominal pain,diarrhea frequency,and(or) comprehensive effectiveness and quality of life(QOL).Meta-analysis was performed after evaluating the quality of included studies.Subgroup analysis was done between subgroups of diarrhea-predominant IBS and subtype-regardless IBS,and was also done between diarrhea-predominant IBS treated with TCM syndrome differentiation and that without TCM syndrome differentiation.Funnel plot analysis was used to analyze the publication bias.Results Forty-six studies met the inclusion criteria,and 4155 participants were included in the meta-analysis.The results showed that the effectiveness of TY or modified prescriptions of TY was better than that of conventional medicine or placebos[OR= 5.30,95%CI(4.38,6.41)].Subgroup analysis showed that the OR of TY or modified prescriptions of TY in the diarrhea-predominant groups[OR=5.61,95%CI(4.33,7.25)]was higher than that of subtype-regardless groups[OR=4.95,95%CI(3.74,6.55)],and OR of TY or modified prescriptions of TY in the studies of diarrhea-predominant IBS treated based on TCM syndrome differentiation [OR=6.50,95%CI(3.78,11.20)] was higher than that of the studies without TCM syndrome differentiation[OR=5.37,95%CI(4.01,7.19)],but the difference was insignificant.Funnel plot showed certain publication bias.Conclusion The effectiveness of TY or modified prescriptions of TY for IBS patients is better than that of western medicine and placebo.But their effectiveness for diarrhea-predominant IBS or with TCM syndrome differentiation was not proved to be better than those for other subtypes or without TCM syndrome differentiation.Biases may exist for overall quality of the studies is low;negative results in some high quality studies need further discussion.

Objective To obtain the effective characteristic information for the standardization of diagnosis of traditional Chinese medical(TCM) syndrome in rheumatoid arthritis(RA).Methods Fifty-four items of symptoms and signs in RA patients were input into the computer,and Mahalanobis distance discriminant analysis(DDA) was used for the selection of effective indexes.Results According to the weight value and the result of T test,17 items from 54 had the highest rate of discrimination accuracy,up to 96.5%.Conclusion The results of computerized pattern recognition for the syndrome diagnosis of RA are consistent with the clinical diagnosis,which indicates that computerized pattern recognition can be used for the standardization of syndrome diagnosis of RA.

[Objective] Systematic review was carried out in quality analysis of literature of Shuang Huanglian Injection (SHI) for acute respiratoiy infections ( ARI) . [Methods] Database was set up according to the principles of clinical epidemiology and evidence-based medicine and the evaluation scale for ARI. The data was managed by descriptive analysis and uniformity test. [Results] In 49 clinical reports, 42.16% adopted the randomized and controlled method but the quality was not so good; the criteria of inclusion and exclusion was absent or not standardized in most of the reports; blinded method was adopted scarcely; drop-out and missed cases were rarely mentioned while adverse effects were reported usually. [Conclusion] The design of clinical study of SHI for ARI has been improved in recent years but there is still a lot of inadequany.

Evaluation Studies as Topic ; Humans ; Medicine, Chinese Traditional ; Publishing ; standards ; Quality Control ; Randomized Controlled Trials as Topic ; standards

Objective To study the effect of intranasal nerve growth factor (NGF) on the expression of amyloid-β,peptide (Aβ) in the central nervous system in rats with traumatic brain injury (TBI).Methods Eighty rats were randomly divided into sham(n =26),control(n =27) and treatment group (n =27 ).They were subjected to the modified Feeney' s weight-drop model.The treatment group was treated with NGF administered by nasal route,and the control group was given phosphate-buffered saline (PBS).Beam walking and Morris water maze test were performed in the three groups.The concentration of Aβ40 and Aβ42 in the injured ipsilateral hippocampus was elevated by ELISA measurement.Immunohistochemistry was used to detect the amyloid precursor protein (APP) positive cells near the region of injury in the hippocampus in rats after TBI.Results NGF group traversed the beam significantly quicker (s) than control group ( 19.00 + 6.99 vs 27.33 ± 7.39 respectively,F2,15 =12.87,P =0.028 ).Morris water maze performance revealed that mean time of latency in the NGF group was significant shorter than vehicle group,and significant memory retention in NGF group as evidenced by a greater percentage of the 60 s allotted time spent in the target quadrant (45.82％ ± 11.15％ vs 33.99％ ± 3.46％,F2,15 =6.814,P=0.037),as well as the number crossing of the former site of the removed platform in NGF group was significant more than control group (8.60 ±2.73 vs 3.60 ±2.06,F2,15 =5.346,P =0.04).The Aβ42 level in control group was increased significantly higher than NGF group as indicated by ELISA measurements.While the Aβ40 level did not have similar shown.Immunohistochemical staining showed that APP level had significant differences among three groups ( F2,15 =8.672,P =0.003).The APP level in NGF group did not alter with control group.Conclusion Intranasal administration of NGF can regulate Aβ42 overproduction,improve the motor and cognitive function after brain injury in rats.

Objective To study the clinical,laboratory,imaging characteristics and surgical outcomes of Brucellar spondylitis.Methods The clinical,laboratory,imaging characteristics and surgical outcomes of 27 patients with Brucella spondylitis were analyzed in our department from September 2000 to December 2010.There were 18 males and 9 females,aged from 23 to 57 years(average,32.8 years ).There were 3 cases in cervical vertebra,8 cases in thoracolumbar vertebra,16 cases in lumbosacral vertebra respectively.Before admission,17 patients were misdiagnosed as tuberculosis,2 ones were as postoperative change of lumbar disc herniation.Eight patients underwent posterior debridement,autologous bone grafting and instrumentation,19 cases were treated with anterior debridement,autologous bone grafting and instrumentation.Streptomycin was placed in localized lesions for 24 patients,except for 3 cases whose streptomycin skin test positive.External fixation brace were used for 4 to 6 weeks,oral medication was used for a half month to 3 months.Clinical evaluation included clinical cure rate,pain visual analog scale (VAS) and the fusion rate.Results All of 27 patients were followed up for an average of 19.7 months (range,6 to 48 months).According to evaluation standard for Brucella spondylitis,24 patients were cured,3 patients got improvement.Three patients underwent the second operation owing to wound infection and sinus formation.Conclusion The pain of spine with intermittent fever,the imaging features as well as positive serum agglutination test can confirm the diagnosis of Brucellar spondylitis.Operation should be considered in patients with persistent pain and neurologic disorders as well as systemic symptoms.Instrumentation is effective and safe in the treatment of patients with spinal brucellosis following debridement,autogenous bone grafting,combined with antibiotic therapy.