Traditional Chinese Medicine in Cancer Care: An Overview of 5834 Randomized Controlled Trials Published in Chinese.

BACKGROUND: Traditional Chinese medicine (TCM) is widely integrated into cancer care in China. An overview in 2011 identified 2384 randomized and non-randomized controlled trials (RCTs, non-RCTs) on TCM for cancer published in the Chinese literature. This article summarizes updated evidence of RCTs on TCM for cancer care. METHODS: We searched 4 main Chinese databases: China National Knowledge Infrastructure, Chinese Scientific Journal Database, SinoMed, and Wanfang. RCTs on TCM used in cancer care were analyzed in this bibliometric study. RESULTS: Of 5834 RCTs (477 157 cancer patients), only 62 RCTs were indexed in MEDLINE. The top 3 cancers treated were lung, stomach, and breast cancer. About 4752 RCTs (81.45%) tested TCM combined with conventional treatment, and 1082 RCTs (18.55%) used TCM alone for treating symptoms and side-effects. Herbal medicine was the most frequently used TCM modality (5087 RCTs; 87.20%). The most frequently reported outcome was symptom improvement (3712 RCTs; 63.63%) followed by quality of life (2725 RCTs; 46.71%), and biomarkers (2384 RCTs; 40.86%). The majority of RCTs (4051; 69.44%) concluded there were beneficial effects using either TCM alone or TCM plus conventional treatment compared with conventional treatment. CONCLUSION: Substantial randomized trials demonstrated different types/stages of cancer were treated by various TCM modalities, alone or in combination with conventional medicine. Further evaluation on the effects and safety of TCM modalities focusing on outcomes such as quality of life is required.

[Spatial autocorrelation analysis of land use and ecosystem service value in Maduo County, Qinghai Province, China at the grid scale]. / æ ¼ç½‘å°ºåº¦ä¸‹é’æµ·çŽ›å¤šåŽ¿åœŸåœ°åˆ©ç”¨åŠç”Ÿæ€ç³»ç»ŸæœåŠ¡ä»·å€¼ç©ºé—´è‡ªç›¸å ³åˆ†æž.

Research on the spatial quantitative evaluation of land use and ecosystem service value in the source region of the Yellow River is of great significance for ensuring the ecological security of the river basin. Taking Maduo County in the source region of the Yellow River as an example, based on a 3 km × 3 km grid unit, the spatial autocorrelation method was applied to construct an evaluation model of ecosystem service value. The spatial autocorrelation pattern characteristics of Maduo County in 2015 was quantitatively evaluated, and the spatial information of ecosystem service value was visually expressed. The results showed that, at the examined grid scale, the area of grasslands with different coverages was large, and water grid area accounted for 42.9% of the total grids and was mainly distributed in the northwest of Maduo County. The construction land showed a "line-like" distribution from northeast to southwest, while the unutilized land was more distributed in southwest and less in northeast. In space, different land use type grids interacted with each other, with positive correlation and cluster distribution. The values of global Moran I and local Moran I of water area was the largest, with strongest spatial aggregation and high local connectivity. The global Moran I and local Moran I values of the construction land were 0.293 and 0.127, respectively, with the weakest spatial autocorrelation and clustering characteristics in a small range. In 2015, ecosystem service value (ESV) of Maduo County was 93.887 billion yuan, the mean ESV across all the grids was 3.20×107 yuan, with a maximum of 19.96×107 yuan. The water distribution grid had high ESV. On the whole, the ESV distribution pattern in Maduo County had a significant spatial positive correlation, with clustered ESV grids. The ESV grids of different land use types generally showed high-high cluster and low-low cluster, with the spatial pattern of high-low cluster and low-high cluster being sporadic. We proposed several possible strategies of land space planning and use control. First, the water and unused land should adopt a "centralized continuum" protection mode that emphasize the value of ecological spillovers. Second, grasslands with different coverage levels should adopt a "group-type" eco-governance model of primary and secondary division and zoning management. Third, construction land should adopt a small-scale intensive development and utilization model in a "corridor " distribution pattern.

Factors influencing the quality of clinical trials on traditional Chinese medicine-Qualitative interviews with trial auditors, clinicians and academic researchers.

BACKGROUND: As clinical trials evaluating the efficacy of traditional Chinese medicine (TCM) therapies have increased, several empirical studies have shown that the quality of TCM trials is generally low in terms of risk of bias. This qualitative study aimed to investigate the factors influencing the quality of TCM clinical trials to provide strategic advice on trial quality improvement. METHODS: One focus group with clinical trial auditors (n = 4) and six in-depth semi-structured interviews with clinical research organization managers (n = 2), lecturers and researchers in TCM academic institutions (n = 2), a chief physician in a TCM oncology department and a PhD candidate specialized in non-pharmaceutical TCM interventions were conducted. The interviews were audio-recorded, transcribed verbatim and thematically analyzed. RESULTS: Factors that influenced the quality of TCM clinical trials emerged with the following 6 themes: trial design; trialists/participants; trial conducting; TCM specified problems; trial monitoring, and finally societal influences. The lack of expertise and time inputs of the trialists were repeatedly mentioned. Methodological difficulties experienced when conducting TCM trials including calculating sample size, analyzing the efficacy of TCM decoctions with multiple ingredients, blinding in trials investigating non-pharmaceutical TCM interventions were highlighted. Interviewees agreed that third-party monitoring can help improving trial quality and improve participant welfare, may accelerate recruiting processes and increase compliance; however more comprehensive regulations and funding requirements would be needed. CONCLUSIONS: This study identified real-life issues influencing the quality of TCM clinical trials from design to reporting. In addition to mandatory training for TCM trial designers and coordinators, more effective institutional oversight is required. Future studies should explore specific measures to address the methodological problems in TCM trials and explore how the quality of TCM trials can affect further evidence synthesis and clinical practice.

The effects of Chinese herbal medicines for treating diabetic foot ulcers: A systematic review of 49 randomized controlled trials.

OBJECTIVE: To assess the effects and associated risks of Chinese herbal medicine (CHM) for diabetic foot ulcer (DFU). METHODS: We systematically searched seven electronic databases for randomized controlled trials (RCTs) about Chinese herbal medicines for treating diabetic foot ulcers. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool. Data was synthesized using review manager (RevMan) 5.3. Meta-analysis was conducted if the data were available. A summary of finding table was generated by The GRADEpro Guideline Development Tool (GDT) online. RESULTS: Forty-nine RCTs, all conducted in China, involving 3646 participants were included. Most of the included trials had unclear or high risk of bias. Twenty-six trials could be pooled in five Meta-analyses, the remaining trials could not be pooled due to the obvious clinical heterogeneity. Only low evidence showed CHM therapy may have 42%-60.4% participants healed completely after treatment, approximately twice (RR 1.42-1.76) as much as the healed rates in conventional therapy (or plus hot water foot bath) group. Majority of the included trials reported benefit of CHM group on shortening healing time (4-23 days) and reducing ulcer wound size (at least 2 cm2). No serious adverse events were reported related to the medication in all trials. CONCLUSION: Weak evidence showed benefit of CHM as add-on treatment of conventional therapy on increasing number of ulcer heals in patients with DFU. That's about twice the healing rate of the conventional treatment (or plus hot water foot bath) group. With insufficient information, we could not draw confirmative conclusion on safety of CHM administration. These findings need to be tested in further large, rigorous trials.

Radioprotection of 4-hydroxy-3,5-dimethoxybenzaldehyde (VND3207) in culture cells is associated with minimizing DNA damage and activating Akt.

Vanillin is a naturally occurring compound and food-flavoring agent with antioxidant and antimutagenic activities. In present study, we explored the radioprotective effect of a novel vanillin derivative VND3207 (4-hydroxy-3,5-dimethoxybenzaldehyde). VND3207 has a much higher potential in scavenging hydroxyl radical and superoxide radical than vanillin as indicated in the ESR spin-trapping measurement, and it can effectively protect plasmid DNA against 10-50 Gy gamma-ray induced breaks in vitro at the concentrations as low as 10-20 microM. Using human lymphoblastoid AHH-1 cells and human fibroblastoid HFS cells, we demonstrated that VND3207 at 5-40 microM concentrations significantly attenuated the inhibition of proliferation and occurrence of apoptosis produced by 1-8 Gy gamma-irradiation. In the cultured cells, VND3207 significantly decreased the initial production and residual level of DNA double-strand breaks (DSBs) induced by 2 or 8 Gy irradiation. Treatment of VND3207 enhanced the level of DNA-PKcs protein, a critical component of DNA DSB repair pathway in the cells with or without gamma-irradiation. Consistently, the phosphorylation of Akt protein, a mediator of survival signal, as well as its substrate GSK3beta was concurrently increased by VND3207. Our results suggest that VND3207 has radioprotection effect through its capabilities as a powerful antioxidant, in minimizing DNA damage, and activating survival signal Akt pathway, and it may be of value in the development of radioprotective compounds.

Induction of apoptosis and autophagic cell death by the vanillin derivative 6-bromine-5-hydroxy-4-methoxybenzaldehyde is accompanied by the cleavage of DNA-PKcs and rapid destruction of c-Myc oncoprotein in HepG2 cells.

Autophagy is a regulated lysosomal pathway involving the bulk degradation of cytoplasmic contents, and is an emerging attractive therapeutic approach for treating cancers. In the present study, we demonstrates that bromovanin (6-bromine-5-hydroxy-4-methoxybenzaldehyde), a vanillin derivative, exhibits a potent antiproliferative effect on a broad spectrum of cancer cell lines, but it induces apoptosis with a large variation in extent on different cancer cell lines. Ultrastructural observation in transmission electron microscopy reveals that autophagy is another type of cell death induced by bromovanin in HepG2 cells. Treatment with bromovanin significantly increases cellular ROS level as well as elicits DNA double-strand breaks as indicated by comet assay and the increased phosphorylated H2AX. Cleavage and inactivation of DNA-PKcs induced by bromovanin is found to occur concurrently with a rapid destruction of c-Myc oncoprotein. These multiple effects of bromovanin, especially the induction of both apoptosis and autophagy, make it very appealing for the development as a novel anticancer drug.

Vanillin derivative 6-bromine-5-hydroxy-4-methoxybenzaldehyde-elicited apoptosis and G2/M arrest of Jurkat cells proceeds concurrently with DNA-PKcs cleavage and Akt inactivation.

Vanillin, a naturally occurring food component, has been reported to have anti-mutagenic and anti-metastatic potentials, and to inhibit DNA-PKcs activity. However, vanillin itself exhibits very weak antiproliferative activity. We explored the effects of bromovanin (6-bromine-5-hydroxy-4-methoxybenzaldehyde), a novel vanillin derivative, on survival and cell-cycle progression of human Jurkat leukemia cells. Treatment with >10 microM bromovanin significantly elicited apoptosis and G2/M arrest in Jurkat cells in a dose- and time-dependent manner. Bromovanin-induced DNA double-strand breaks (DSB) were demonstrated by means of comet assay as well as detection of phosphorylated H2AX, a sensitive indicator of DNA DSBs. Immuno-hybridization analysis revealed that the cleavage of procaspase-3 and DNA-PKcs occurred concurrently with bromovanin-induced apoptosis. Furthermore, phosphorylated Akt protein (Ser473), which is catalyzed by DNA-PKcs, as well as phosphorylated GSK3beta (a substrate of activated Akt), markedly decreased in bromovanin-treated Jurkat cells, suggesting that bromovanin leads to inactivation of Akt pathway via cleaving DNA-PKcs. These multiple effects, associated with the regimen of cancer therapeutic strategies, make bromovanin very appealing for future development as a novel anticancer drug.