OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

Objective:To investigate the mechanism by which formononetin combined with platelet-rich plasma (PRP) enhances the proliferation and differentiation of osteoblasts.Methods:Rat osteoblasts ROS17/2.8 were cultured in vitro and treated with formononetin (10, 20, 40 μmol/L) combined with PRP. Cells were also intervened with G15 (a G protein-coupled estrogen receptor inhibitor) and Super-TDU [a Yes-related protein (YAP) inhibitor]. Cell proliferation viability was detected using the cell counting kit-8 (CCK-8) assay; alkaline phosphatase (ALP) activity was measured using an ALP assay kit; protein expression of G protein-coupled estrogen receptor (GPER) and p-YAP was detected by Western blot; and YAP subcellular distribution was analyzed by fluorescence assay.Results:Formononetin (20 μmol/L) synergistically enhanced the PRP-induced proliferation and ALP activity of osteoblasts (all P<0.05). Compared with the control group, formononetin significantly up-regulated GPER protein expression and down-regulated p-YAP protein expression (all P<0.01), with the most pronounced effects observed at 20 μmol/L. Formononetin (20 μmol/L) induced nuclear accumulation of YAP protein in osteoblasts. Pretreatment with G15 or Super-TDU reversed the synergistic effect of formononetin on PRP, and both the cell proliferation rate and ALP activity were lower than those in the PRP+ formononetin group (all P<0.01). Conclusions:Formononetin enhances the PRP-induced proliferation and differentiation of osteoblasts through the GPER/YAP signaling pathway.

Objective:To investigate the mechanism by which formononetin combined with platelet-rich plasma (PRP) enhances the proliferation and differentiation of osteoblasts.Methods:Rat osteoblasts ROS17/2.8 were cultured in vitro and treated with formononetin (10, 20, 40 μmol/L) combined with PRP. Cells were also intervened with G15 (a G protein-coupled estrogen receptor inhibitor) and Super-TDU [a Yes-related protein (YAP) inhibitor]. Cell proliferation viability was detected using the cell counting kit-8 (CCK-8) assay; alkaline phosphatase (ALP) activity was measured using an ALP assay kit; protein expression of G protein-coupled estrogen receptor (GPER) and p-YAP was detected by Western blot; and YAP subcellular distribution was analyzed by fluorescence assay.Results:Formononetin (20 μmol/L) synergistically enhanced the PRP-induced proliferation and ALP activity of osteoblasts (all P<0.05). Compared with the control group, formononetin significantly up-regulated GPER protein expression and down-regulated p-YAP protein expression (all P<0.01), with the most pronounced effects observed at 20 μmol/L. Formononetin (20 μmol/L) induced nuclear accumulation of YAP protein in osteoblasts. Pretreatment with G15 or Super-TDU reversed the synergistic effect of formononetin on PRP, and both the cell proliferation rate and ALP activity were lower than those in the PRP+ formononetin group (all P<0.01). Conclusions:Formononetin enhances the PRP-induced proliferation and differentiation of osteoblasts through the GPER/YAP signaling pathway.

OBJECTIVE: Functional constipation (FC) is a common intestinal disease worldwide. Despite the presence of criteria such as Roman IV, there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches. This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients. METHODS: A systematic search of the PubMed, Cochrane Library, and China National Knowledge Infrastructure databases was performed from their inception to June 30th, 2022, collecting the current evidence about the efficacious integrative management for FC. We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process. RESULTS: We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts. This pathway includes a hierarchy of recommendations for every step of the clinical process, including clinical intake, diagnostic examination, recommended labs, diagnostic flowchart, and guidance for selection of therapeutic drugs. CONCLUSION This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine; it will help to provide high-quality medical services in Hong Kong for patients with FC. Please cite this article as: Wei DJ, Li HJ, Lyu ZP, Lyu AP, Bian ZX, Zhong LL. A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong, China. J Integr Med. 2023; 21(6): 550-560.
Humans ; Hong Kong ; Integrative Medicine ; Critical Pathways ; China ; Constipation/therapy*

OBJECTIVE: To investigate the effectiveness and safety of low concentration dithiothreitol (DTT) in removing the interference of monoclonal anti-CD38 on transfusion compatibility testing, and develop a reasonable clinical transfusion strategy. METHODS: The blood type, direct antiglobulin testing (DAT) and antibody screening were tested according to standard methods. Antibody screening cells and donor's red blood cells were treated by DTT 0.2, 0.1, 0.05, 0.02, 0.01 and 0.005 mol/L, and antibody screening and cross-matching of serums after monoclonal anti-CD38 treatment were performed by anti-human globulin card. RESULTS: The 0.01 mol/L DTT at 37℃ for 30 minutes could remove the effect of monoclonal anti-CD38 on antibody screening and cross-matching, meanwhile retain their effectiveness in detecting anti-K, anti-LW, anti-JMH, anti-Lu^b, anti-e, anti-Di^a and anti-Jk^a alloantibodies. All the 10 patients had no acute or delayed haemolytic transfusion reactions and their routine blood tests showed that the red blood cells transfusion was effective. CONCLUSION The 0.01 mol/L DTT is a safe and effective method for removing the interference of monoclonal anti-CD38 with transfusion compatibility testing, while retaining the ability to detect most alloantibodies.
Antibodies, Monoclonal/pharmacology* ; Blood Grouping and Crossmatching ; Blood Transfusion ; Dithiothreitol/pharmacology* ; Erythrocytes ; Humans ; Isoantibodies/pharmacology*

Objective::To investigate the anti-inflammation mechanism of Pien Tze Huang (PTH) via regulating microglia polarization. Method::The experiment was divided into five groups, Blank, M1[lipopolysaccharide (LPS) 100 μg·L^-1+ interferon-γ(IFN-γ) 10 μg·L^-1], M1-PTH group[LPS 100 μg·L^-1+ IFN-γ 10 μg·L^-1+ PTH 0.4 g·kg^-1], M2 group[interleukin-4 (IL-4) 20 μg·L^-1], and M2-PTH group[IL-4 20 μg·L^-1+ PTH 0.4 g·kg^-1]. The concentration of nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), and transforming growth factor-β₁(TGF-β₁) in the culture supernatant were measured by enzyme-linked immunosorbent assay (ELISA), the levels of inducible nitric oxide synthase(iNOS) and arginine-1 (Arg-1) mRNA were detected by real-time fluorescent quantitative polymerase chain reaction technique(Real-time PCR), and the expression levels of p-STAT1, p-STAT3, iNOS, p-STAT6, and Arg-1 were detected by Western blot. Result::The concentration of NO and TNF-α of the culture supernatant, the level of iNOS mRNA, as well as the level of p-STAT1, p-STAT3 and iNOS in M1 group, which were significantly increased(P<0.01) .Compared with blank group, but the concentration of NO and TNF-α were down-regulated(P<0.01), and iNOS mRNA(P<0.05), as well as the expression of iNOS, p-STAT1, and p-STAT3 was decreased (P<0.05, P<0.01) after the invention of PTH in M1-PTH group compared with M1 group. The concentration of IL-10 and TGF-β₁ in the culture supernatant, the mRNA level of Arg-1, as well as the levels of p-STAT6 and Arg-1 were significantly increased in M2 group when compared with Blank group, addition to the concentration of IL-10 and TGF-β₁ were up-regulated(P<0.05, P<0.01), and the expression of Arg-1 mRNA, the level of Arg-1, p-STAT6 were enhanced(P<0.05, P<0.01) in M2-PTH group compared with M2 group. Conclusion::PTH plays an anti-inflammatory role via regulating microglia polarization.