1.Evaluation of GRADE Clinical Research Evidence of Chinese Patent Medicine Combined with Western Medicine in Treatment of Hypertension with Dyslipidemia
Jiaheng WANG ; Yukun LI ; Liangyu CUI ; Yilan ZHENG ; Zhiwei ZHAO ; Cong REN ; Tianyue JING ; Tong YIN ; Liying WANG ; Xuejie HAN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(10):95-105
ObjectiveTo evaluate the effect of antihypertensive and lipid-regulating Chinese patent medicine combined with conventional Western medicine in the treatment of hypertension with dyslipidemia. To carry out the evidence synthesis of clinical research and provide evidence-based evidence support for clinical decision-making. MethodThe databases including China National Knowledge Infrastructure (CNKI),Wanfang Data Knowledge Service Platform (WF),VIP,SinoMed,Embase,PubMed,Web of Science (WOS),and the Cochrane Library were searched for randomized controlled trials (RCT) of all listed Chinese patent medicines in the treatment of hypertension with dyslipidemia from the establishment of the databases to April 15,2023. The literature was screened and extracted,and the risk of bias tool 2.0 (RoB2) was used to assess the quality and risk of bias of the methodology. Revman 5.4.1 software was used to analyze the outcome indicators. Grading of Recommendations Assessment,Development and Evaluation (GRADE) was applied to assess the quality of evidence formed by clinical research data. The inclusion and recommendation of Chinese patent medicines in the National Drug Catalogue for Basic Medical Insurance,Work-related Injury Insurance and Maternity Insurance (2022) and domestic guidelines and consensus were searched to form a bubble chart. ResultA total of 15 studies were included. The evaluation of the methodological quality of each study showed that the risk of bias stemmed from the lack of blinding and allocation concealment,and low sample size. The comprehensive analysis of clinical studies showed that Dengzhan Shengmai capsules combined with rosuvastatin and amlodipine besylate,Yindan Xinnaotong capsules combined with simvastatin and levamlodipine tablets,Xiaoshuan Tongluo capsules combined with nifedipine controlled release tablets and pravastatin sodium tablets,Xinshubao capsules combined with atorvastatin calcium tablets and irbesartan,Wenyading capsules combined with enalapril,and Jiangzhining tablets combined with conventional Western medicines were all superior to conventional Western medicines used in the control group in improving systolic blood pressure (SBP),diastolic blood pressure (DBP),cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C),and high density lipoprotein cholesterol (HDL-C). There was no significant difference in the incidence of adverse reactions between the two groups. The GRADE evaluation of the main outcome indicators showed that the evidence quality of SBP and incidence of adverse reactions was graded as B,that of DBP as C,and that of total TC,TG,LDL-C,and HDL-C as D. The evaluation of Chinese patent medicines covered by medical insurance and recommended by guidelines and consensus showed that Yindan Xinnaotong soft capsules,Dengzhan Shengmai capsules and Xiaoshuan Tongluo capsules belonged to class B drugs of medical insurance,and were recommended for 7,6 and 3 times in the guidelines and consensus,respectively. ConclusionCompared with simple medicine treatment,Chinese patent medicine combined with conventional Western medicine has more advantages in improving blood pressure and blood lipid,and shows higher safety. Among them,Yindan Xinnaotong soft capsules,Dengzhan Shengmai capsules and Xiaoshuan Tongluo capsules have stronger clinical applicability and economy. All the trials included in this article adhered to the principle of randomization and reported the outcome measures. However,the quality of evidence in related clinical studies was low. In terms of trial design,large-sample,multi-center,blinded randomized controlled trials based on the consolidated standards of reporting trials (CONSORT) statement are still needed for comprehensive trial designs and reporting,to further improve the GRADE quality evaluation and guideline formulation under the guidance of evidence-based medicine,so as to provide higher quality evidence-based research evidence for clinical decision-making.
2.GRADE Clinical Study Evidence Evaluation and Expert Consensus on Antihypertensive Chinese Patent Medicines Combined with Western Medicines for Treatment of Hypertension
Liangyu CUI ; Yukun LI ; Tianyue JING ; Yu WANG ; Cong REN ; Tong YIN ; Zhiwei ZHAO ; Jiaheng WANG ; Chenge SUN ; Dasheng LIU ; Zhizheng XING ; Xuejie HAN ; Liying WANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(10):106-115
ObjectiveTo evaluate the quality of research and evidence related to antihypertensive Chinese patent medicines combined with western medicines for the treatment of hypertension, synthesize and update the evidence, form expert consensus, and provide evidence for clinical decision-making. MethodThe databases of China National Knowledge Infrastructure (CNKI), WanFang Data Knowledge Service Platform (WanFang), Vip Chinese Science and Technology Journal Database (VIP), Chinese Biomedical Literature Service System (Sinomed), National Library of Medicine (PubMed), Cochrane Library, Web of Science, and US Clinical Trials Registry were searched for randomized controlled trials of antihypertensive Chinese medicine combined with western medicine for the treatment of hypertension from database construction to July 31, 2022. The quality of the literature was evaluated using the bias risk assessment tool in Cochrane Handbook 6.3. Evidence synthesis of main outcome indicators was performed using R software. The Grading of Recommendations Assessment, Development, and Evaluation profiler (GRADEprofiler) 3.6 was employed to evaluate the quality of evidence. Expert consensus was formed based on the Delphi method after two rounds of voting. Result64 pieces of literature were included, and the results of literature quality evaluation and risk of bias showed that 70.31% (45/64) of the studies indicated some risks, and 29.69% (19/64) indicated high risks. Compared with conventional western medicines, the combination of Chinese patent medicines with western medicines can significantly lower systolic pressure (SBP) and diastolic pressure (DBP), increase the effective rate of antihypertensive, reduce the incidence of adverse reactions, endothelin-1, and traditional Chinese medicine syndrome scores. Egger's test showed that Songling Xuemaikang capsules reduced SBP and DBP. Tianma Gouteng granules reduced SBP and DBP and increased the effective rate of antihypertensive, and Xinmaitong capsules reduced SBP and increased the effective rate of antihypertensive, without significant publication bias. Songling Xuemaikang capsules increased the effective rate of antihypertensive, and Xinmaitong capsules decreased DBP, with significant publication bias. The results of the GRADE evidence quality evaluation showed that most evidence was at grades B and C. Finally, four strong recommendations and 14 weak recommendations were formed. ConclusionCompared with conventional western medicines for the treatment of hypertension, antihypertensive Chinese patent medicines combined with western medicines have advantages in reducing blood pressure and improving drug use safety, but they are mostly weak recommendations in terms of efficacy, and more high-quality evidence is needed.
3.Clinical Evidence Mapping of Chinese Patent Medicines Combined with Western Medicine in Treatment of Hypertension
Yukun LI ; Liangyu CUI ; Zhiwei ZHAO ; Cong REN ; Tong YIN ; Yu WANG ; Liying WANG ; Xuejie HAN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(10):116-123
ObjectiveTo systematically collect, analyze, and evaluate the randomized controlled trials (RCT) of Chinese patent medicine combined with western medicine in the treatment of hypertension, map the evidence, and provide reference for the future clinical research and formulation of guidelines and policies. MethodThe relevant articles were retrieved from China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, PubMed, Embase, and Cochrane Library with the time interval from inception to December 31, 2022. The RCT of Chinese patent medicines combined with western medicine in the treatment of hypertension were included. The research characteristics and methodological quality were analyzed and evaluated. ResultA total of 330 RCTs of treating hypertension with Chinese patent medicines combined with Western medicine were included in this study, all of which were published in Chinese. These RCTs involved 88 Chinese patent medicines and 37 788 patients, and 46% of RCT had the sample size ≥100 patients. Eighty-seven percent of RCT showed the study period within 3 months. All the interventions in the RCTs were Chinese patent medicine + western medicine vs western medicine. Among the evaluation indicators, blood pressure, response rate, TCM syndrome score, endothelial cell function, and safety were mainly concerned. In terms of methodological quality, most articles did not mention the generation of random sequences, allocation concealment, or blinding method. The blinding evaluation of outcomes showed low risks of bias, and there was insufficient information to judge whether there was selective bias or other bias. ConclusionThere were many Chinese patent medicines used in combination with western medicine in the treatment of hypertension, and they were mainly taken orally. The existing RCT had problems such as small sample size, unclear clinical value positioning, imperfect design failing to reflect the value of Chinese patent medicines, unreasonable measurement indicators, and non-standard measurement methods. Future research should solve the above problems, improve the research quality, value, and authenticity, and enhance the reliability and extension of evidence.
4.Textual Research and Clinical Application of Chaihu Guizhi Ganjiangtang
Xuejie WANG ; Lyuyuan LIANG ; Jialei CAO ; Lan LIU ; Weixiao LI ; Yiping WANG ; Bingqi WEI ; Bingxiang MA ; Wenli SHI
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(12):136-146
Chaihu Guizhi Ganjiangtang with a definite clinical effect has been widely used and recorded since the Han Dynasty. As a classic prescription of Chaihu classic formula praised by doctors ofsuccessive generations, it has been included in the Ancient Classic Prescription Catalogue (Second Batch): Han Medicine published by the National Administration of Traditional Chinese Medicine in August 2023. We carried out a bibliometric study involved 34 ancient books of traditional Chinese medicine, with 37 records including the name and composition of the prescription. This paper summarizes the source name, composition, original medicinal plant, dose, preparation method, usage, ancient and modern indications, and clinical application of Chaihu Guizhi Ganjiangtang. The results of textual research show that Chaihu Guizhi Ganjiangtang is derived from the Treatise on Febrile Diseases (Shanghanlun) written by ZHANG Zhongjing in the Han dynasty, and the original plants of medicines in this prescription are basically the same in ancient and modern times. Most records about the doses in ancient books are consistent with those in the Treatise on Febrile Diseases (Shanghanlun). The efficacy of Chaihu Guizhi Ganjiangtang is to harmonize lesser yang and resolve water retention by warming. This prescription was used to treat a variety of diseases, especially those caused by disturbance of Qi movement in the greater Yang and lesser Yang. It is now mainly used to treat the diseases in the digestive system, respiratory system, dermatology, nervous system, etc., being effective for difficult and complicated diseases. Through the excavation and combing of the ancient records of Chaihu Guizhi Ganjiangtang, this paper clarifies the key information, providing a reference for the clinical application of classical prescriptions and the development of new drugs.
5.Design and Implementation of a Comprehensive Data Platform for Meteorological Sensitive Diseases
Huan ZHENG ; Qiang CHEN ; Rui ZHANG ; Yujie MENG ; Jia ZHAO ; Lizhu JIN ; Xuejie DU ; Songwang WANG
Journal of Medical Informatics 2024;45(6):79-84
Purpose/Significance To design a comprehensive data platform to meet the needs of collecting and sharing survey data on meteorological sensitive diseases,so as to enhance monitoring capabilities for meteorological sensitive diseases in China.Method/Process Through various methods such as data extraction,data exchange,data import and customized collection,disease data,meteoro-logical data,environmental data and diagnosis and treatment data are processed and integrated into the platform for unified management.Result/Conclusion This platform realizes the functions of data collection,aggregation,visualization display and data sharing,which can provide support for scientific researchers in various bases across the country to better manage and utilize meteorological sensitive disease survey data.
6.The Research Status and Thinking of Objectification of Diagnosis by Integrating Prior Knowledge and Information Technology
Chenge SUN ; Yukun LI ; Zhiwei ZHAO ; Linshuang WANG ; Liangyu CUI ; Tong YIN ; Liying WANG ; Xuejie HAN ; Dasheng LIU
World Science and Technology-Modernization of Traditional Chinese Medicine 2024;26(6):1654-1659
In order to solve the problem of strong subjectivity and difficulty in quantification,clinical objectification mainly adopts the techniques of image processing,computer vision and machine learning.The acquisition and processing of prior knowledge is a key link in the objectification of inspection,as well as an important elaboration of the quantification of subjective judgment and macro performance in objectification research.However,there is still a lack of in-depth summary and parametric processing of prior knowledge.Based on the analysis of the current research status of objectification of inspection,this paper uses data mining technology to summarize the experience of TCM inspection.Moreover,the observation information can be transformed into quantifiable digital features through natural language processing and representation learning.Meanwhile,the application of deep learning can realize automatic diagnosis and analysis of observation images to improve accuracy and efficiency,and promote the process of TCM modernization.
7.Effects of Different Frequencies of Electroacupuncture on the Degree of Atrophy of the Quadriceps Femoris in Rabbits with Anterior Cruciate Ligament Injury
Yongyuan HUANG ; Hong SU ; Pengyi ZHANG ; Yeteng WEI ; Zhaolin XU ; Chunhua FU ; Huijiao CHEN ; Xuejie YANG ; Jiaying LI ; Chenxi WANG
Chinese Journal of Information on Traditional Chinese Medicine 2024;31(6):88-94
Objective To observe the effects of different frequencies of electroacupuncture on the degree of atrophy of quadriceps femoris in rabbits with anterior cruciate ligament(ACL)injury model;To explore the possible mechanisms of electroacupuncture in treating ACL injury.Methods Totally 24 New Zealand rabbits were randomly divided into blank group,model group,low-frequency electroacupuncture group and high-frequency electroacupuncture group,with 6 rabbits in each group.Except for the blank group,ACL injury models were established in the other groups.On the 7th day after modeling,the low-frequency electroacupuncture group and the high-frequency electroacupuncture group performed electroacupuncture treatment(continuous wave,frequency of 2 Hz and 100 Hz respectively,and left the needle in place for 20 min)at"Xuehai"and"Liangqiu"of the operation side,and the remaining groups were only grasped and immobilized,for 21 days.The mass ratio of the quadriceps femoris was calculated,the histopathological morphology of the quadriceps femoris tissue of the rabbits in each group was observed by HE staining,the expressions of NO,iNOS in quadriceps femoris tissue were detected by ELISA,the content of ROS in quadriceps femoris tissue was detected by fluorescent probe,the protein expressions of PERK,ATF6,IRE1,MuRF1,MAFbx in quadriceps femoris tissue were detected by Western blot.Results Compared with the blank group,the quadriceps femoris muscle mass ratio of the model group rabbits was significantly reduced(P<0.01),with irregular arrangement of muscle cells,accompanied by swelling and atrophy,significant interstitial edema,and extensive inflammatory infiltration,the contents of NO,iNOS and ROS in quadriceps femoris tissue significantly increased(P<0.01),while the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly increased(P<0.01).Compared with the model group,the quadriceps femoris muscle mass ratio in the low-frequency and high-frequency electroacupuncture groups significantly increased(P<0.01),with regular arrangement of muscle cells,improved swelling and atrophy of cells,and reduced interstitial edema and inflammation,the contents of NO,iNOS and ROS in quadriceps femoris tissue were significantly reduced(P<0.01),and the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly decreased(P<0.01).Moreover,the low-frequency electroacupuncture group had better effects than the high-frequency electroacupuncture group(P<0.05).Conclusion Different frequencies of electroacupuncture intervention in ACL injury rabbits can better delay the degree of quadriceps femoris atrophy,and its mechanism may be related to reducing the expressions of oxidative metabolites NO,iNOS,ROS,and reducing the expressions of endoplasmic reticulum stress-related proteins PERK,ATF6,IRE1 in quadriceps fermoris,which in turn inhibit the expressions of quadriceps atrophy factors MuRF1,MAFbx,and delaying the degradation of quadriceps muscle proteins.The effect of low-frequency electroacupuncture is superior to the high-frequency electroacupuncture.
8.Analysis on the Acupoint Selection Law of Acupuncture and Moxibustion for the Treatment of Temporomandibular Joint Dysfunction Syndrome Based on Data Mining Technology
Yongyuan HUANG ; Huijiao CHEN ; Hong SU ; Pengyi ZHANG ; Jilang LI ; Yeteng WEI ; Jiaying LI ; Chenxi WANG ; Xuejie YANG
Chinese Journal of Information on Traditional Chinese Medicine 2024;31(12):63-69
Objective To analyze and summarize the acupoint selection law of acupuncture and moxibustion for the treatment of temporomandibular joint dysfunction syndrome(TMD)using data mining technology.Methods Clinical literature about acupuncture and moxibustion for the treatment of TMD was retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Embase and Cochrane Library from the establishment of the databases to March 1,2024.Excel 2021 was used to establish a prescription database of acupoints.SPSS Modeler 18.0 and SPSS Statistics 27.0 were used to analyze the frequency of use of acupoints,meridians,locations,specific acupoints,and the analysis of association rules,factor analysis,and clustering analysis.Results A total of 480 articles and 480 prescriptions were included in the study,containing 90 acupoints,with a total frequency of 2 290 times.The high-frequency acupoints were Xiaguan,Hegu,Jiache,Tinggong and Ashi point;the commonly used meridians were the stomach meridian,large intestine meridian,small intestine meridian,bile meridian,and triple-energizer meridian;the most frequently chosen acupoints were the Jiaohui acupoints,Yuan acupoints and Wushu acupoints;and mostly involved acupoints were located at the head and neck area,the upper limb area and the lower limb area.The association analysis showed that the top five combinations were"Xiaguan-Hegu","Xiaguan-Jiache","Xiaguan-Hegu-Jiache","Xiaguan-Tinggong","Xiaguan-Tinggong-Jiache";clustering analysis showed that five valid clusters were extracted;factor analysis extracted seven valid common factors.Conclusion The core acupoints of acupuncture and moxibustion for the treatment of TMD is Xiaguan-Hegu-Jiache-Tinggong,and mainly follows the principle of combining proximal and distal acupoints.
9.Feasibility analysis of dose calculation for nasopharyngeal carcinoma radiotherapy planning using MRI-only simulation
Xuejie XIE ; Guoliang ZHANG ; Siqi YUAN ; Yuxiang LIU ; Yunxiang WANG ; Bining YANG ; Ji ZHU ; Xinyuan CHEN ; Kuo MEN ; Jianrong DAI
Chinese Journal of Radiation Oncology 2024;33(5):446-453
Objective:To evaluate the feasibility of using MRI-only simulation images for dose calculation of both photon and proton radiotherapy for nasopharyngeal carcinoma cases.Methods:T 1-weighted MRI images and CT images of 100 patients with nasopharyngeal carcinoma treated with radiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2020 to December 2021 were retrospectively analyzed. MRI images were converted to generate pseudo-CT images by using deep learning network models. The training set, validation set and test set included 70 cases, 10 cases and 20 cases, respectively. Convolutional neural network (CNN) and cycle-consistent generative adversarial neural network (CycleGAN) were exploited. Quantitative assessment of image quality was conducted by using mean absolute error (MAE) and structural similarity (SSIM), etc. Dose assessment was performed by using 3D-gamma pass rate and dose-volume histogram (DVH). The quality of pseudo-CT images generated was statistically analyzed by Wilcoxon signed-rank test. Results:The MAE of the CNN and CycleGAN was (91.99±19.98) HU and (108.30±20.54) HU, and the SSIM was 0.97±0.01 and 0.96±0.01, respectively. In terms of dosimetry, the accuracy of pseudo-CT for photon dose calculation was higher than that of the proton plan. For CNN, the gamma pass rate (3 mm/3%) of the photon radiotherapy plan was 99.90%±0.13%. For CycleGAN, the value was 99.87%±0.34%. The gamma pass rates of proton radiotherapy plans were 98.65%±0.64% (CNN, 3 mm/3%) and 97.69%±0.86% (CycleGAN, 3 mm/3%). For DVH, the dose calculation accuracy in the photon plan of pseudo-CT was better than that of the proton plan.Conclusions:The deep learning-based model generated accurate pseudo-CT images from MR images. Most dosimetric differences were within clinically acceptable criteria for photon and proton radiotherapy, demonstrating the feasibility of an MRI-only workflow for radiotherapy of nasopharyngeal cancer. However, compared with the raw CT images, the error of the CT value in the nasal cavity of the pseudo-CT images was relatively large and special attention should be paid during clinical application.
10.Influence of donor and pancreatic characteristics on the success rate of islet isolation
Jiaqi ZOU ; Xingheng CAI ; Peng SUN ; Xuejie DING ; Shusen WANG
Chinese Journal of Endocrinology and Metabolism 2023;39(5):421-425
Objective:To explore the selection criteria of the donor for islet transplantation of Chinese people by analyzing the correlation between pancreas characteristics and success rate of islets isolation.Methods:Data from 113 cases of human islet isolation were collected. According to the result of islet isolation, the donors were divided into two groups, the success group(IEQ≥250 000, purification≥30%, and viability≥80%), and the failure group(IEQ<250 000, or purification<30%, or viability<80%). The modified Ricordi method was used to digest pancreas tissue, and the continuous density gradient method was performed to purify islets. The islets were identified by staining with the Dithizone(DTZ), the islets were analyzed for cell viability and purity.Results:The donor age in success group was significantly younger than failure group in the range of age eligible for this study( t=2.479, P=0.015). Pearson correlation showed that donor age was positively corelated with islet yield( r=-0.214, P=0.047). There was more fat on the pancreas surface in the successful islet isolation group( z=-2.007, P=0.045). The digestibility( t=2.133, P=0.035) and recovery rate( t=5.912, P=0.001) were elevated in success group. Conclusion:The pancreases from younger donors could obtain the higher-yielding islet, the pancreas with more surface fat or with higher weight was associated with islet isolation success in the scope covered by the inclusion criteria of this study.

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