Duloxetine for rehabilitation after total knee arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: The aim was to evaluate the efficacy and safety of duloxetine for postoperative recovery after total knee arthroplasty. METHODS: The following electronic databases were searched for eligible trials: PubMed, EMBASE, Web of Science, Cochrane Library, VIP, Wanfang Data, and China National Knowledge Infrastructure (CNKI). The search was performed from the inception dates to 10 August 2022. Data extraction and quality assessment were performed by two independent reviewers. Standard mean differences or mean differences with 95% CIs for pooled data were calculated. The primary outcomes were pain, physical function, and analgesic consumption. Secondary outcomes included range of motion (ROM) of the knee, depression, and mental health. RESULTS: This meta-analysis included 11 studies, reporting on a total of 1019 patients. Results of analyses indicated that duloxetine showed a statistically significant reduction in pain at rest at 3 days, 1 week, 2, and 6 weeks and pain on movement at 5 days, 1 week, 2, 4, 6, and 8 weeks. However, there was no statistical significance in pain at rest and on movement at 24 h, 12 weeks, 6 months, and 12 months. Additionally, duloxetine had a significant improvement in physical function, ROM of the knee at 6 weeks, and emotional function (depression and mental health). Moreover, the cumulative opioid consumption at 24 h in the duloxetine groups was lower than in the control groups. But there was no statistical significance for the cumulative opioid consumption over 7 days between the duloxetine groups and controls. CONCLUSIONS: In conclusion, duloxetine might reduce pain mainly over a time span of 3 days-8 weeks and lower cumulative opioid consumption within 24 h. In addition, it improved physical function, ROM of the knee with a time span of 1-6 weeks and emotional function (depression and mental health).

Immunoadsorption treatment for dilated cardiomyopathy: A PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: As one of the leading causes of heart failure, dilated cardiomyopathy (DCM) is characterized by dysfunctional muscle contraction and enlarged ventricular chamber. Patients with DCM have been shown to respond well to immunoadsorption (IA) therapies. However, the efficacy and safety of IA treatment for DCM patients remained to be evaluated. METHODS: This study was designed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis. We searched the databases such as Cochrane library, Cochrane Central Register of Controlled Trials, Embase, OVID, and Web of Science from January 1990 to March 20, 2020, and performed meta-analysis using Stata MP Version 13.0. RESULTS: We performed meta-analysis on 12 studies that included a total of 395 patients with DCM. Overall, IA treatment significantly improved the left ventricular ejection fraction (6.01, 95% confidence interval [CI] [4.84-7.19]), reduced the left ventricular end diastolic diameter (-3.62, 95% CI [-4.06 to -3.19]), reduced severity of symptoms according to the New York Heart Association (NYHA) functional classification (-1.37, 95% CI [-1.73 to -1.02]) as compared with the controls, but had no effect on values for safety parameters (1.13, 95% CI [0.58-2.19]). CONCLUSIONS: Results of this meta-analysis indicated that the IA treatment can improve the left ventricular ejection fraction, reduce left ventricular end diastolic diameter, and thus improve clinical outcome in DCM patients. However, further evidence are required to validate the relative safety of IA treatment. Multi-center, double blind studies should be conducted to elucidate the precise effect of IA treatment in DCM patients.

Mutation analysis of seven consanguineous Uyghur families with non-syndromic deafness.

OBJECTIVE: To investigate the genetic causes of consanguineous Uyghur families with nonsyndromic deafness. METHOD: Seven consanguineous Uyghur families with nonsyndromic deafness were recruited in this study and characterized for their audiometric phenotype. Mutation analysis of common deafness genes GJB2, SLC26A4 and MT-RNR1 was performed in all families by direct sequencing. RESULT: Bi-allelic mutations in SLC26A4, including p.N392Y/p.N392Y, p.S57X/p.S57X and p.Q413R/p.L676Q, were detected in three families as the pathogenic causes for the deafness. No mutations were identified in GJB2 and MT-RNR1. CONCLUSION: Mutations in SLC26A4 was the most common causes of the Uyghur consanguineous deaf families.

[Identification of Smilax glabra and its related species based on psbA-trnH sequence].

OBJECTIVE: To identify Smilax glabra and its related species using DNA barcoding technique and psbA-trnH sequence. METHODS: Total genomic DNA was isolated as template and the chloroplast gene psbA-trnH region was amplified by PCR technology and sequenced bidirectionally. The sequences and the related data were analyzed using the software CodonCode Aligner and MEGA 6.0; The intra- and inter-specific Kimura-2-Parameter(K2P) distances were calculated and the phylogenetic tree was constructed using the Neighbor-joining method. RESULTS: The maximum K2P genetic distance of the plants of Smilax glabra was lower than the minimum K2P genetic distance of its related species. In the cluster dendrogram, the plants of Smilax glabra from various sources showed the monophyletic and simultaneously distinguished from the closely relative species. CONCLUSION: psbA-trnH barcoding could be used to distinguish Smilax glabra and its related species effectively, and provide important molecular evidence for identification of original plant of Smilacis Glabrae Rhizoma and clinic safety in medicinal use.

[Fingerprint analysis of Glehniae Radix by TLC].

OBJECTIVE: To establish TLC fingerprint of Glehniae Radix for the identification and quality control of the drug. METHODS: 10 batches of Glehniae Radix commercial drugs collected from different gathering areas and 3 batches from Laiyang, Shandong were used as qualitative identification samples. Falcarindiol, scopoletin umbelliferone and isoimperatorin were used as the chemical reference substances. Double wavelength TLCS was performed with petroleum and ethyl acetate (4:1) as developer,detection wavelength at 300 nm and reference wavelength at 260 nm. RESULTS: TLC chromatogram of 13 samples had 8 well-resolved characteristic peaks, in which 4 peaks were falcarindiol, umbelliferone, scopoletin and isoimperatorin, respectively. CONCLUSION: The method is accurate and simple, and can be used for the quality control of Glehniae Radix.

Effects of xuesetong soft capsules on angiogenesis and VEGF mRNA expression in ischemic myocardium in rats with myocardial infarction.

OBJECTIVE: To observe the effects of Xuesetong Soft Capsules, Notoginseng total saponin) on angiogenesis and vascular endothelial growth factor (VEGF) mRNA expression in ischemic myocardium of rats with myocardial infarction. METHODS: The left coronary artery of rats was ligated to establish the animal model of acute myocardial infarction. Rats were randomly divided into Xuesetong Soft Capsule, Shexiangbaoxin Pill (positive control), model (negative control) and sham operation groups. After 6 weeks, microvessel count (MVC), microvessel density (MVD) and VEGF mRNA expression in ischemic myocardium were evaluated. RESULTS: MVC and MVD in the myocardial infarct border area in model, Shexiangbaoxin Pill and Xuesetong Soft Capsule groups significantly increased compared with those of the sham operation group (P < 0.05). MVC and MVD in the myocardial infarct border area in Xuesetong Soft Capsule and Shexiangbaoxin Pill groups significantly increased compared with those of the model group (P < 0.05). No significant differences between Xuesetong Soft Capsule and Shexiangbaoxin Pill groups were observed (P > 0.05). The model group showed significantly higher VEGF mRNA expression than that in the sham operation group (P < 0.05). Xuesetong Soft Capsule and Shexiangbaoxin Pill groups showed significantly higher VEGF mRNA expression than that of the model group (P < 0.05). No significant difference between Xuesetong Soft Capsule and the Shexiangbaoxin Pill groups was observed (P > 0.05). CONCLUSION: Xuesetong Soft Capsules promote angiogenesis in ischemic myocardium after myocardial infarction and the mechanism may be associated with VEGF mRNA expression.

Effects of lüfukang capsules on coronary artery ligation-induced arrhythmia in dogs.

OBJECTIVE: To observe the effects of Lüfukang Capsules on arrhythmia induced by ligation of coronary artery in dogs. METHODS: Thirty dogs were randomly divided into 5 groups, the model group administrated with equal volume of distilled water, the positive control group administrated with Wenxin Granules, and the small, medium and large dosage LFKC groups, 6 dogs in each group. Thirty minutes after medication, electrocardiogram was conducted and the time of arrhythmia occurrence, times of ventricular premature beat (VP), and incidence rates of ventricular tachycardia (VT) and ventricular fibrillation (VF) were recorded in the model dogs with arrhythmia induced by ligation of coronary artery. RESULTS: Compared with the model group, the occurrence time of arrhythmia induced by the coronary artery ligation in the medium and large LFKC groups was significantly delayed (20.45 +/- 9.10 and 19.92 +/- 3.78, respectively, both P < 0.05). The frequency of VP in the medium and large LFKC groups was also significantly decreased (8.17 +/- 6.62 and 3.83 +/- 2.79, respectively, both P < 0.01). CONCLUSION: LFKC has anti-arrhythmic effects for the experimental arrhythmia induced by the ligation of coronary artery in dogs.

[Study on establishing animal model of myocardial infarction of blood-stasis and Xin-qi deficiency syndrome or blood-stasis and Xin-yang deficiency syndrome type].

OBJECTIVE: To investigate the method for establishing animal model of integrative medical disease/ syndrome and its evaluation. METHODS: Rat myocardial (heart failure) model was established by anterio-descending coronary arterial ligation, and treated by nitric oxide synthase inhibitor 9-12 weeks after operation to induce hypertension and aggravate heart failure. The model rat was observed 12 weeks to collect the information of four-diagnosis, for visceral qi-blood and excess-deficiency syndrome differentiation in combining with the eight-principal syndrome differentiation according to the standard of deficiency syndrome and blood-stasis syndrom issued by Chinese Association of integrative medicine. RESULTS: After modeling, the model rats revealed ascended ST segment and abnormal Q-wave in ECG, with the visceral ratio, left ventricular area and myocardial collagen content significantly more than those in the sham-operative group (P < 0.01), showing a blood-stasis syndrome. Besides, Xin-qi deficiency syndrome, exhibiting as quickened heart rate, shortened swimming time and lowered cardiac function, appeared in the model rats (P < 0.01), which was aggravated in the late stage due to the increased blood pressure and deteriorated cardiac function, even revealed the manifestation of Yang-deficiency syndrome as low body temperature and polyuria. CONCLUSION: The basic thinking path of TCM animal disease/syndrome model establishment and evaluation should adopt the normative, mature and unified standard and methods formed in clinical and experimental study of integrative medicine.

[Comparative study on early application of the recipe for activating blood circulation and the recipe for supplementing qi for inhibiting left ventricular remodeling and apoptosis in rats with heart failure].

OBJECTIVE: To compare the characteristics of early application of the recipe for activating blood circulation and the recipe for supplementing qi for inhibiting left ventricular remodeling and apoptosis in rats with heart failure. METHOD: The left coronary artery occlusion was conducted to establish the rat model of heart failure after myocardial infarction. The model rats were randomly divided into 5 groups, including model group, activating blood circulation group (8 g x kg(-1)), supplementing qi group (8 g x kg(-1)), activating blood circulation plus supplementing qi group (16 g x kg(-1)), and captopril group (10.125 g x kg(-1)), and a sham operation group was set up as negative control group. The drugs were administrated on the second day after myocardial infarction with a therapeutic course of 4 weeks or 8 weeks. The heart function was detected by impedance method; Pathological staining and image analysis were used to determine the perimeter and the area of left ventricular cavity, and myocardial nuclei number and collagen content per unit area; Apoptosis percentage of the myocardial cell was detected by TUNEL and the content of Ang II in the cardiac muscle was measured by radioimmunoassay. RESULT: In comparison with the model group, the function of left ventricular contraction function improved, the area of left ventricular cavity diminished, and proliferation of collagen, content of Ang II and apoptosis percentage of the myocardial cell reduced in all of the treatment groups (P < 0.05 or P < 0.01). After treatment of 8 weeks, the activating blood circulation group was similar to the sham operation group in improvement of cardiac index, and decreases of the area of left ventricular cavity and the content of Ang II; Apoptosis percentage of the myocardial cell in the activating blood circulation group was significantly lower than that in the supplementing qi group. CONCLUSION: Both the recipes for activating blood circulation and for supplementing qi can inhibit left ventricular remodeling and myocardial apoptosis, and delay development of heart failure, with the best effect in the activating blood circulation group after treatment of 8 weeks.

Species differences in the in vitro metabolic activation of the hepatotoxic pyrrolizidine alkaloid clivorine.

Clivorine is a representative naturally occurring hepatotoxic otonecine-type pyrrolizidine alkaloid. Our previous study has demonstrated that clivorine induces liver damage via metabolic activation to form the reactive pyrrolic ester followed by covalent binding to liver tissue constituents. The present study investigated species differences in the in vitro metabolic activation of clivorine in the male rat and guinea pig of both sexes. In the male rat, the activation of clivorine to form the reactive pyrrolic ester was found as the only metabolic pathway. Moreover, the toxic tissue-bound pyrroles and four isolatable metabolites identified, namely DHR, 7-GSH-DHR, 7,9-diGSH-DHR, and clivoric acid, were all generated from further metabolism of this reactive intermediate. In the case of both sexes of guinea pig, the same activation was observed as the minor biotransformation, while an additional metabolic pathway, a direct hydrolysis of clivorine to form novel clivopic acid was identified as the predominant detoxification pathway. Furthermore, the formation rates for the toxic tissue-bound pyrroles and less toxic DHR were significantly slower and higher, respectively, compared with those in the male rat. In addition, the formation of the reactive pyrrolic ester was mediated by the CYP3A subfamily in both animals, while carboxylesterases might be responsible for the detoxification hydrolysis in guinea pig. The results suggest that the higher metabolic rates for detoxification hydrolyses and the lower formation rate for the toxic tissue-bound pyrroles play the key roles in guinea pig resistance to clivorine intoxication. Therefore, the male rat and guinea pig should be the suitable animal models for further studies of bioactivation and deactivation of otonecine-type PA, respectively.

[Comparative study on effect of recipe for activating blood circulation and replenishing Qi on left ventricular remodeling in rats with left heart failure after myocardial infarction].

OBJECTIVE: Comparative study to the effect of Chinese herbal medicine on left ventricular remodeling in rats with left heart failure after myocardial infarction (MI). METHODS: Rat's model of left heart failure after myocardial infarction was treated with injection for activating blood circulation (ABCI, consisted of R. Salviae miltiorrhizea; Rh. Ligusticum wallichii and F1. Carthamus tinctorius) and injection for replenishing Qi (RQI, consisted of R. Codonopsis Pilosulae and R. Astragalus membranaceus) respectively. The effect of treatment were evaluated by observing and comparing the changes of heart morphological structure, collagen element, heart weight/body weight ratio (HW/BW), left intraventricular area (LVA), ratio of ventricular wall thinning in MI area and myocardial nuclei number (MNN) per square area. RESULTS: In comparison with the model group, the reduction of collagen tissue around myocardial cells in living area of MI, HW/BW and LVA of ABCI and RQI group were lower, and MNN per square area was higher significantly (all P < 0.05). CONCLUSION: Both ABCI and RQI, though without positive myodynamia, showed certain inhibitory effect of left ventricular remodeling in rats with left heart failure after MI.