Efficacy Evaluation of the Mahuang-Fuzi-Xixin Decoction in Combination with Shenmai Injection for Bradyarrhythmia Treatment: A Systematic Review and Meta-AnalysisRead the full article
Evidence-Based Complementary and Alternative Medicine seeks to apply scientific rigor to the study of complementary and alternative medicine, emphasizing on health outcome, while documenting biological mechanisms of action.
Chief Editor, Jian-Li Gao works as research professorship at the Zhejiang Chinese Medical University, China. Her research focuses on hypertension and oncology, as well as evidence-based use of Traditional Chinese Medicine in reducing the side effects of conventional cancer treatments.
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Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway
Background and Purpose. Electroacupuncture (EA) is effective on rheumatoid arthritis (RA), an autoimmune disease, but the mechanisms involved remain poorly understood. This study was designed to investigate the analgesic and anti-inflammatory effects of EA in a chronic inflammatory animal model of collagen-induced arthritis (CIA) and its underlying molecular mechanisms. Experimental Approach. For the male Sprague–Dawley (SD) rats were immunized with bovine type II collagen followed by a booster injection 7 days later. Two weeks after the first immunization, EA stimulation (2/100 Hz, 1 mA, lasting for 30 min/day) was delivered to Zusanli (ST36), and Sanyinjiao (SP6) or OxPAPC (TLR2/TLR4 inhibitor, 1.5 mg/kg) was injected by tail vein for 28 days. After intervention, the analgesic effect was evaluated from the aspect of pain responses including thermal withdrawal latency (TWL) and mechanical withdrawal thresholds (MWT). The anti-inflammatory effect was assessed by paw edema detection, histopathological analysis, and Meso Scale Discovery (MSD) testing of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6). The underlying molecular mechanism was analyzed through western blotting and double-immunofluorescence labeling. Results. EA intervention and OxPAPC injection could relieve mechanical allodynia and thermal hyperalgesia caused by CIA. Paw edema and pathological damage of synovium were significantly ameliorated after EA intervention and OxPAPC injection. Furthermore, EA intervention and OxPAPC injection markedly reduced the contents of serum TNF-α, IL-1β, and IL-6, as well as the protein expression levels of synovial TLR2, TLR4, MyD88, and NF-κB p-p65. In particular, the expression of TLR2 and TLR4 on synovial fibroblasts and macrophages in synovium was significantly reduced by EA intervention. Conclusions. Repeated EA stimulation at ST36 and SP6 can effectively relieve joint pain and synovial inflammation caused by RA in CIA rats. The analgesic and anti-inflammatory effect of EA may be closely related to the inhibition of innate immune responses driven by the TLR2/4-MyD88-NF-κB signaling pathway in the synovium.
Artesunate Alleviates Hyperoxia-Induced Lung Injury in Neonatal Mice by Inhibiting NLRP3 Inflammasome Activation
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease in preterm infants that may cause persistent lung injury. Artesunate exhibits excellent anti-inflammatory in lung injury caused by various factors. This study aimed to investigate the effect of the artesunate on hyperoxia-induced lung injury in neonatal mice and its mechanism. A BPD model of hyperoxic lung injury in neonatal mice was established after hyperoxia (75% oxygen) exposure for 14 days, and part of the mice received intraperitoneal injections of the artesunate. H&E staining was used to observe the pathology of lung tissue, and the degree of oxidative stress in the lung tissue was determined by commercial kits. The levels of inflammatory cytokines in the serum and lung tissues of neonatal mice were detected by an enzyme-linked immunosorbent assay. Immunohistochemical experiments were performed to further evaluate the expression of IL-1β. The real-time quantitative polymerase chain reaction was used to determine the mRNA level of the NLRP3 inflammasome. The western blot assay was used to measure the levels of NLRP3 inflammasome and NF-κB pathway-related proteins. Artesunate ameliorated weight loss and lung tissue injury in neonatal mice induced by hyperoxia. The level of malondialdehyde was decreased, while the activity of superoxide dismutase and the level of glutathione increased after artesunate treatment. Artesunate reduced the level of inflammation cytokines TNF-α, IL-6, and IL-1β in the serum and lung. Moreover, artesunate inhibited the mRNA expression and protein levels of NLRP3, ASC, and caspase-1, as well as the phosphorylation of the NF-κB and IκBα. Our findings suggest that artesunate treatment can attenuate hyperoxia-induced lung injury in BPD neonatal mice by inhibiting the activation of NLRP3 inflammasome and the phosphorylation of the NF-κB pathway.
The Efficacy and Safety of a Qiliqiangxin Capsule Combined with Sacubitril/Valsartan in the Treatment of Chronic Heart Failure: A Systematic Review and Meta-Analysis
Background. Qiliqiangxin (QLQX) capsules are a commonly used proprietary Chinese medicine for the adjuvant treatment of chronic heart failure (CHF) in China. In recent years, several randomized controlled trials (RCTs) have reported on the efficacy and safety of QLQX combined with sacubitril/valsartan for CHF. Objective. The purpose of this study was to systematically analyze the clinical efficacy and safety of QLQX combined with sacubitril/valsartan in the management of CHF and to provide clinicians as well as scientists with optimal evidence-based medical evidence. Methods. We searched RCTs to evaluate the efficacy and safety of QLQX combined with sacubitril/valsartan in the treatment of CHF in the Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, PubMed, Embase, and Cochrane Library databases from their inception until January 8, 2022. RCTs on QLQX in combination with sacubitril/valsartan for CHF were included. The outcome measures considered were total effective rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), 6-minute walking distance (6-MWD), and adverse events. The quality of the included RCTs was assessed thereafter using the Cochrane risk of bias tool. RevMan 5.3 software was used to conduct the meta-analysis. Results. The meta-analysis included 17 trials involving 1427 CHF patients. The results indicated that with sacubitril/valsartan administration combined with QLQX treatment, the total effective rate (relative risk (RR) = 1.24; 95% confidence interval (CI) (1.17, 1.31); ), LVEF (mean difference (MD) = 6.20; 95% CI (5.36, 7.05; )), and 6-MWD (MD = 55.87; 95% CI (40.66, 71.09); ) of CHF patients were significantly increased, and the LVEDD value of CHF patients was noted to be significantly reduced (MD = −3.98; 95% CI (−4.47, −3.48); ). Moreover, there was no increase in the number of adverse events during treatment (RR = 0.67; 95% CI (0.33, 1.34); ). Conclusions. This study indicated that in CHF patients, on the basis of sacubitril/valsartan treatment, combination with QLQX can potentially enhance the total effective rate, improve LVEF and 6-MWD, and reduce LVEDD values, with good safety. However, considering the poor quality of the included studies, a multicenter, randomized, double-blind controlled study is needed for further confirmation.
Efficacy of Fufang E’jiao Jiang in the Treatment of Patients with Qi and Blood Deficiency Syndrome: A Real-World Prospective Multicenter Study with a Patient Registry
Objective. This nationwide, multicenter prospective observational study with a patient registry was designed to evaluate the efficacy of Fufang E’jiao Jiang (FEJ) in Chinese patients with Qi and blood deficiency syndrome (QBDS). Methods. QBDS patients were consecutively recruited from 81 investigational sites in China from July, 2019, to December, 2020. Patients who met the eligibility criteria were enrolled in a prospective registry database. Baseline characteristics and changes in scores on the traditional Chinese medicine (TCM) symptom evaluation scale for Qi and blood deficiency, the clinical global impression (CGI) scale, the fatigue scale-14 (FS-14), and the Pittsburgh sleep quality index (PSQI) were analyzed to determine the clinical efficacy of FEJ. Results. A total of 3,203 patients were recruited. The average remission rate (i.e., the sum of the cure rate and improvement rate) of the 20 symptoms of QBDS was 92.49% after 4 weeks of FEJ treatment, which was higher than at baseline; the rate increased to 94.69% at 8 weeks. The CGI scale revealed that the number of total remissions at 4 and 8 weeks was 3,120 (97.41%) and 415 (100%), respectively. The total FS-14 scores decreased by 1.67 ± 4.11 () at 4 weeks and 1.72 ± 3.09 () at 8 weeks of treatment. The PSQI scores were 6.6 ± 4.7 and 6.52 ± 3.07 at 4 and 8 weeks, respectively, which were significantly lower than the baseline scores (; ). Both the subhealth fatigue (SF) and iron deficiency anemia (IDA) groups showed significantly improved clinical symptoms of QBDS (). Between-group comparisons revealed significantly greater improvements in FS-14 and PSQI scores in the SF group than in the IDA group (). A multivariate logistic regression analysis showed that disease course, FS-14 score at baseline, and four-week FEJ doses were independent risk factors for the degree of symptom relief in QBDS patients (). Conclusion. In real-world settings, FEJ has a promising effect in treating QBDS and can significantly improve the severity of its symptoms.
Clinical Promotion of Comfort Nursing Combined with Comprehensive Nursing in the Treatment of Severe Stroke Patients with Diabetes in ICU
Objective. To investigate the application value of comprehensive nursing combined with comfort nursing for severe stroke patients with diabetes in the intensive care unit (ICU), as well as its effect on the incidence of pressure ulcers and aspiration. Methods. Between March 2019 and March 2021, 123 severe stroke patients with diabetes who were treated at our hospital were randomly assigned to one of two groups: the control group (n = 61) or the study group (n = 62). The control group received normal care, but the research group received comprehensive nursing as well as comfort nursing. The two patient groups were compared in terms of the effects of the clinical application. Results. The two groups did not differ significantly in general data (). The shorter ICU monitoring and extubation times, the lower incidence of pressure ulcers, aspiration, and nosocomial infections, and higher self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores and a lower MOS 36-item short-form health survey (SF-36) score were all observed in the research group when compared to the control group (). Conclusion. For severe stroke patients with diabetes in the ICU, comprehensive nursing combined with comfort nursing has a promising effect, significantly, lowering the risk of pressure ulcers, aspiration, and nosocomial infections, accelerating physical recovery, enhancing mental state, and ensuring a better prognosis, deserving general clinical promotion.
Electroacupuncture Alleviates Diabetic Neuropathic Pain and Downregulates p-PKC and TRPV1 in Dorsal Root Ganglions and Spinal Cord Dorsal Horn
Diabetic neuropathic pain (DNP) is a common complication of diabetes. Streptozotocin (STZ)-induced changes of protein in dorsal root ganglion (DRG) and spinal cord dorsal horn (SCDH) are critical for DNP genesis. However, which proteins change remains elusive. Here, the DNP model was established by a single intraperitoneal injection of STZ, accompanied by increased fasting blood glucose (FBG), decreased body weight (BW), and decreased paw withdrawal latency (PWL). Proteins change in L4-L6 DRGs and SCDH of rats were detected. Western blot and immunofluorescence results showed that expression levels of phosphorylated protein kinase C (p-PKC), transient receptor potential vanilloid-1 (TRPV1), Substance P (SP) and calcitonin gene-related peptide (CGRP) in the DRG and the SCDH of rats were increased after STZ injection. A preliminary study from our previous study showed that 2 Hz electroacupuncture (EA) effectively alleviates DNP. However, the analgesic mechanism of EA needs further elucidation. Here, EA at the bilateral Zusanli (ST36) and KunLun (BL60) acupoints was applied for one week, and to investigate the effect on DNP. EA reversed thermal hyperalgesia in DNP rats and downregulated the expression of p-PKC, TRPV1, SP, and CGRP in DRG and SCDH.