[Expert consensus on Tongsaimai Tablets/Capsules in treatment of peripheral vascular diseases in clinical practice].

Tongsaimai Tablets/Capsules are composed of Lonicerae Japonicae Flos, Angelicae Sinensis Radix, Achyranthis Bidentatae Radix, Codonopsis Radix, Dendrobii Caulis, Astragali Radix, Scrophulariae Radix, and Glycyrrhizae Radix et Rhizoma, and are effective in promoting blood circulation, removing blood stasis, supplementing Qi, and nourishing Yin. It is widely used in the treatment of peripheral vascular diseases. With 40 years of clinical application, it has accumulated substantial research data and application experience. Its good clinical efficacy and pharmacoeconomic benefits in improving the clinical symptoms of peripheral vascular diseases have been confirmed by relevant research. Meanwhile, this drug has also been recommended by many expert consensus, guidelines, and teaching materials, serving as one of the most commonly used Chinese patent medicines in clinical practice. To further improve the understanding of the drug among clinicians and properly guide its clinical medication, the China Association of Chinese Medicine took the lead and organized experts to jointly formulate this expert consensus. Based on the questionnaire survey of clinicians and the systematic review of research literature on Tongsaimai Tablets/Capsules with clinical problems in the PICO framework, the consensus, combined with expert experience, concludes recommendations or consensus suggestions by GRADE system with the optimal evidence available through the nominal group technique. This consensus defines the indications, usage, dosage, course of treatment, medication time, combined medication, and precautions of Tongsaimai Tablets/Capsules in the treatment of peripheral vascular diseases, and explains the safety of its clinical application. It is recommended for clinicians and pharmacists in the peripheral vascular department(vascular surgery), traditional Chinese medicine surgery(general surgery), and endocrinology department of hospitals at all levels in China.

A meta-analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients.

OBJECTIVE: To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients. METHODS: Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. RESULTS: A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies. Across the studies, the overall odds ratios (ORs) and 95% confidence intervals (CIs) of significant risk factors are ulcer reaching bone (OR, 11.796; 95% CI, 6.905-20.152), gangrene (OR, 6.487; 95% CI, 4.088-10.293), hindfoot position (OR, 3.913; 95% CI, 2.254-6.795), decreased ankle-brachial index (ABI) (OR, 2.522; 95% CI, 1.805-3.523), infection (OR, 2.516; 95% CI, 1.708-3.706), peripheral arterial disease (PAD) (OR, 2.114; 95% CI, 1.326-3.372). While there is no significant difference in the size of the ulcer, neuropathy, Charcot foot, osteomyelitis and intermittent claudication (OR, 1.15; 95% CI, 0.85-1.54). CONCLUSION: Factors among local characteristics of the foot associated with major amputation in patients with diabetic foot are the ulcer reaching bone, gangrene, hindfoot position, decreased ABI, infection, and PAD, a negative risk factor for the risk of amputation. Further studies are required to provide more details of foot local characteristics.

[Effect of Chinese drugs for benefiting-qi, activating-blood, dissolving-phlegm and removing-toxin combined with conventional treatment in preventing and treating post-operative vascular restenosis in patients with diabetic lower extremity arterial disease underwent percutaneous transluminal angioplasty].

OBJECTIVE: To verify the clinical efficacy of Chinese drugs for benefiting-qi, activating-blood, dissolving phlegm and removing-toxin (CDs) Combined with Conventional Treatment on post-operative vascular restenosis in patients with diabetic lower extremity arterial disease (DLEAD) underwent percutaneous transluminal angioplasty (PTA). METHODS: Fifty-six DLEAD patients underwent PTA of below-knee artery were assigned to the treatment group (32 patients) treated by basic therapy combined with CDs and the control group (24 patients) treated by basic therapy only. The changes in symptoms and signs, ankle/brachial index (ABI) and transcutaneous oxygen pressure (TCPO2) of affected limb, and blood flow (BF) in operated vessels checked with color Doppler examination were monitored and analyzed with SPSS software 16. 0. RESULTS: Overall effectiveness, including symptom score, ABI, TCPO2 and BF in patients after operation were all better in both groups significantly (P < 0.05), the improvements began to reveal in 3-6 months, and be stabilized in the treatment group, but declined gradually in the control group after then. So, the effective rate in the treatment group became significantly higher than that in the control group (75.00% vs. 41.67%, P < 0.01) at the end of the 6th month, meanwhile levels of ABI (0.65 +/- 0.12), TCPO2 (68.00 +/- 4.21 mm Hg), and BF (35.00 +/- 2.11 cm/s) in the former were better than those in the control group, respectively (0.44 +/- 0.12, 41.00 +/- 2.02 mm Hg and 21.00 +/- 1.85 cm/s, P < 0.05). CONCLUSION: CDs shows definite effect in post-PTA prevention of vascular restenosis in DLEAD patients.

[Treatment of lower limb ischemia with combination of traditional Chinese medicine and transplantation of autologous bone marrow mononuclear cells: a report of 23 cases].

OBJECTIVE: To evaluate the therapeutic effect of transplantation of autologous bone marrow mononuclear cells combined with traditional Chinese medicine for the treatment of limb ischemia. METHODS: Twenty-three patients with limb ischemia were treated. G-CSF was used to stimulate the bone marrow. The mononuclear cells were separated from the aspirated bone marrow fluid in the stem cell studio. The cell amount was above 1x10(9). The transplantation was performed by the way of intra-muscular multi-injection. Traditional Chinese medicine for replenishing qi to activate blood was prescribed from the first day after operation. The pain, poikilothermia, ulcer or necrosis and ankle/brachial index (ABI) of the ischemic limb were evaluated before and after the treatment. RESULTS: The pain score and poikilothermia score decreased one month after the transplantation, with distinct differences as compared with the scores before the treatment (P<0.05). The ABI increased gradually after the treatment, and one month after the treatment, it was 0.15 higher than that before the treatment. CONCLUSION: Transplantation of autologous bone marrow mononuclear cells combined with traditional Chinese medicine can decrease the symptoms and signs of severe lower limb ischemia effectively, and improve the circulation of the ischemic area.

[Effects of Astragalus membranaceus and Panax notoginseng on the transformation of bone marrow stem cells and proliferation of EPC in vitro].

OBJECTIVE: To investigate the effect and the possible mechanism underlying the promotional effect of Astragalus membranaceus and Panax notoginseng on the transformation of bone narrow stem cells and proliferation of EPC. METHOD: The marrow blood was collected in the patients with ischemia of lower limbs and BM-MNCs were separated and proliferated under different conditions. A. morphologic observation was performed and the ratio of CD34+ cells was measured. RESULT: The shuttle shaped cells lined up as bunches with several round cells scattered. The ratio of CD34+ cells was significantly increased in groups treated with medium (P < 0.01) and lower (P < 0.05) dosages of A. membranaceus and medium (P < 0.01) and high dosages (P < 0.01) of P. notoginseng respectively as compared with control group. CONCLUSION: A. membranaceus and P. notoginseng can promote the transformation and proliferation of EPC.