World Health Organization survey on the level of integration of traditional Chinese medicine in Chinese health system rehabilitation services.

Background: To meet the growing global demand for rehabilitation services, the World Health Organization (WHO) launched Rehabilitation 2030. This study was commissioned by the WHO to investigate the integration degree of traditional Chinese medicine (TCM) in Chinese health system rehabilitation services and the demand for TCM rehabilitation in China. Methods: Twenty TCM rehabilitation experts and relevant government administrators were invited to complete the questionnaire between September 2019 and January 2022. The development of traditional, complementary, and integrative medicine (TCI) rehabilitation in China was assessed primarily based on six different health system components. Results: 26 policies, regulations, and national strategic plans related to TCI rehabilitation were issued by relevant government departments since 2002; notably, 14 policies related to TCI rehabilitation development were intensively introduced from 2016 to 2021. These policies cover the three main areas of financing, infrastructure development, and service delivery. The National Administration of Traditional Chinese Medicine's investment in TCM clinical capacity infrastructure and scientific research in 2019-2021 increased by 66% compared to 2010-2012, and the average number of TCM hospitals with rehabilitation departments in 2020 increased by 6.5% compared to 2018. The proportion of community health service centers providing TCM services in primary medical and health institutions has increased by 30.8% over the past 10 years. Conclusion: Long-term continuous policies, substantial financial investment, and expansion of the scope of TCI rehabilitation services in primary care institutions have effectively contributed to the rapid development of TCI rehabilitation. However, human resources and financing mechanisms for TCI rehabilitation need further improvement.

Standardization of Panax ginseng: Current Status of Global Trade, Demands, and Development.

Panax ginseng, as a kind of rare and valuable Chinese materia medica with the largest global trade volume, has been widely applied in many fields, such as medicine, food, health care, and production of daily chemical products. It is widely used in Asia, Europe, and America. However, its global trade and standardization present different features and an uneven development in different countries or regions. As the main country for its production and consumption, Panax ginseng in China is characterized by its large cultivation area and high total yield and is mainly sold as a raw material or primary processed product. By contrast, Panax ginseng produced in South Korea is mainly sold in manufactured products. Besides, European countries, as another consumption market of Panax ginseng, pay more attention to the research and development of its products. Although Panax ginseng has been widely recorded in various national pharmacopoeias and regional standards, the current standards of Panax ginseng differ in quantity, composition, and distribution, and the existing standards cannot be enough to meet the demands of its global trade. Based on the above issues, we systemically summarized and analyzed the status and features of Panax ginseng standardization and put forward suggestions on the development needs of international standardization of Panax ginseng to guarantee its quality and safety, regulate the order of its global trade, and resolve trade disputes, thereby promoting the high-quality development of the Panax ginseng industry.

Characterization and Comparison Analysis of WHO Monographs on Selected Medicinal Plants and ISO Standards of Chinese Materia Medica.

Medicinal plants or Chinese materia medica (CMM) are now attracting worldwide attention as they have increasingly prominent advantages over chemical drugs in disease treatment and healthcare. Since the 1990s, World Health Organization (WHO) and International Organization for Standardization established the Technical Committee of Traditional Chinese Medicine (ISO/TC 249) have carried out the development of quality standards on medicinal plants or CMMs respectively, and a considerable number of monographs and international standards have been published. Since the two international organizations adhere to different principles, the standards they develop naturally have different emphasis. Driven by market demand and international trade, ISO mainly takes quality, efficacy and safety into consideration when developing standards, while WHO pays more attention to clinical practice, quality control and medication guidance. Up to now, there is a lack of comparative analysis on the records, background, principles, basic content, and main requirements of quality standards on medicinal plants or CMMs respectively published by WHO and ISO. Therefore, based on international standards of CMM developed by ISO/TC 249 platform and WHO Monographs on Selected Medicinal Plants, this paper systematically compares the purposes, selected principles, standard-developing process, basic content, and main quality requirements to summarize their similarities and differences, and find their merits, aiming to serve as a reference to the development of international standards for CMMs that helps them go global.

Effects of an Isobutylene-Maleic Anhydride Copolymer on the Rheological Behavior and Early Hydration of Natural Hydraulic Lime.

Natural hydraulic lime (NHL) is a cementitious material widely used in the restoration of stone cultural relics and maintenance of historic buildings, the practical use of which is mainly hindered by its poor fluidity. Due to the multilayer (double-layer) adsorption that isobutylene-maleic anhydride (IBMA) has on the surface of NHL, the effects that IBMA copolymer have on the fluidity and hydration of NHL were thus investigated. Moreover, the yield stress and plastic viscosity of NHL pastes were found to be reduced significantly by the incorporation of IBMA. Combined with the effects of electrostatic repulsion and steric hindrance, the flocculated structures in NHL pastes were gradually dismantled, releasing the trapped water and leading to a significant enhancement in the fluidity of NHL. IBMA was found to postpone the early hydration of NHL. In particular, it showed that adding specific content of IBMA can significantly improve the early strength of NHL.

Graphene-Modified Co-B-P Catalysts for Hydrogen Generation from Sodium Borohydride Hydrolysis.

Sodium borohydride (NaBH4) is considered a good candidate for hydrogen generation from hydrolysis because of its high hydrogen storage capacity (10.8 wt%) and environmentally friendly hydrolysis products. However, due to its sluggish hydrogen generation (HG) rate in the water, it usually needs an efficient catalyst to enhance the HG rate. In this work, graphene oxide (GO)-modified Co-B-P catalysts were obtained using a chemical in situ reduction method. The structure and composition of the as-prepared catalysts were characterized, and the catalytic performance for NaBH4 hydrolysis was measured as well. The results show that the as-prepared catalyst with a GO content of 75 mg (Co-B-P/75rGO) exhibited an optimal catalytic efficiency with an HG rate of 12087.8 mL min-1 g-1 at 25 °C, far better than majority of the findings that have been reported. The catalyst had a good stability with 88.9% of the initial catalytic efficiency following 10 cycles. In addition, Co-, B-, and P-modified graphene showed a synergistic effect improving the kinetics and thermodynamics of NaBH4 hydrolysis with a lower activation energy of 28.64 kJ mol-1. These results reveal that the GO-modified Co-B-P catalyst has good potential for borohydride hydrolysis applications.

Bimetallic Pt-Ni Nanoparticles Confined in Porous Titanium Oxide Cage for Hydrogen Generation from NaBH4 Hydrolysis.

Sodium borohydride (NaBH4), with a high theoretical hydrogen content (10.8 wt%) and safe characteristics, has been widely employed to produce hydrogen based on hydrolysis reactions. In this work, a porous titanium oxide cage (PTOC) has been synthesized by a one-step hydrothermal method using NH2-MIL-125 as the template and L-alanine as the coordination agent. Due to the evenly distributed PtNi alloy particles with more catalytically active sites, and the synergistic effect between the PTOC and PtNi alloy particles, the PtNi/PTOC catalyst presents a high hydrogen generation rate (10,164.3 mL∙min-1∙g-1) and low activation energy (28.7 kJ∙mol-1). Furthermore, the robust porous structure of PTOC effectively suppresses the agglomeration issue; thus, the PtNi/PTOC catalyst retains 87.8% of the initial catalytic activity after eight cycles. These results indicate that the PtNi/PTOC catalyst has broad applications for the hydrolysis of borohydride.

An efficient differential sensing strategy for phenolic pollutants based on a nanozyme with polyphenol oxidase activity.

To realize the efficient differential sensing of phenolic pollutants in sewage, a novel sensing strategy was successfully developed based on a nanozyme (GMP-Cu) with polyphenol oxidase activity. Phenolic pollutants can be oxidized using GMP-Cu, and the oxidation products reacts subsequently with 4-aminoantipyrine to produce a quinone-imine compound. The absorption spectra of final quinone-imine products that resulted from different phenolic pollutants showed obvious differences, which were due to the interaction difference between GMP-Cu and phenolic pollutants, as well as the different molecular structures of the quinone-imine products from different phenolic pollutants. Based on the difference in the absorption spectra, a novel differential sensing strategy was developed. A genetic algorithm was used to select the characteristic wavelengths at different enzymatic reaction times. Hierarchical cluster analysis and PLS-DA algorithms were utilized for the discriminant sensing of seven representative phenolic pollutants, including hydroquinone, resorcinol, catechol, resorcinol, phenol, p-chlorophenol, and 2,4-dichlorophenol. A scientific wavelength selection algorithm and a recognition algorithm resulted in the successful identification of phenolic pollutants in sewage with a discriminant accuracy of 100%, and differentiation of the phenolic pollutants regardless of their concentration. These results indicated that a sensing strategy can be used as an effective tool for the efficient identification and differentiation of phenolic pollutants in sewage.

Microfluidic Preparation of Janus Microparticles With Temperature and pH Triggered Degradation Properties.

Based on the phase separation phenomenon in micro-droplets, polymer-lipid Janus particles were prepared on a microfluidic flow focusing chip. Phase separation of droplets was caused by solvent volatilization and Janus morphology was formed under the action of interfacial tension. Because phase change from solid to liquid of the lipid hemisphere could be triggered by physiological temperature, the lipid hemisphere could be used for rapid release of drugs. While the polymer we selected was pH sensitive that the polymer hemisphere could degrade under acidic conditions, making it possible to release drugs in a specific pH environment, such as tumor tissues. Janus particles with different structures were obtained by changing the experimental conditions. To widen the application range of the particles, fatty alcohol and fatty acid-based phase change materials were also employed to prepare the particles, such as 1-tetradecanol, 1-hexadecanol and lauric acid. The melting points of these substances are higher than the physiological temperature, which can be applied in fever triggered drug release or in thermotherapy. The introduction of poly (lactic-co-glycolic acid) enabled the formation of multicompartment particles with three distinct materials. With different degradation properties of each compartment, the particles generated in this work may find applications in programmed and sequential drug release triggered by multiple stimuli.

Development status and prospects of international standardization of medical devices of Traditional Chinese Medicine.

As Traditional Chinese Medicine (TCM) becomes widely used in many countries around the world, global demand for intelligent and modernized medical devices of TCM is increasing. Medical devices of TCM have played an important role in diagnosis and treatment of disease. Standardization on medical devices of TCM cannot only be beneficial to ensuring the life safety of patients, but also to enhancing the effectiveness of diagnosis and treatment. This paper includes (1) classification and trends in medical devices of TCM; (2) status review on international standardization of medical devices of TCM; (3) key technical factors in developing international standards for medical devices of TCM and (4) prospects for international standardization development of medical devices of TCM.

Key factors influencing the TCM nomenclature in international standards.

Amid the globalization of traditional Chinese medicine (TCM), the English translation of related texts is in full swing. Several representative international organizations in fields regarding standardization and healthcare, one after another, have published a series of international standards for TCM nomenclature. With these efforts, the internationalization of TCM has been dramatically advanced. When selecting parallel texts for reference, translators need to be aware of key factors influencing the English translation of TCM terms in international standards, including the distinctive characteristics of this discipline and relevant influences of international standard makers. In this way, proper standards and reasonable English expression can be chosen for specific terms, thus stimulating the effective use of TCM nomenclature with consensus.

Features and development trends in international standardization of Chinese materia medica in ISO/TC 249.

Chinese materia medica (CMM) is indispensable component of Traditional Chinese Medicine (TCM) therapy. With the widespread of TCM around the world, the quality control and safe use of CMM become a major concern. This paper introduces the role of ISO standards for industrial development and current development status of CMM standards in ISO/TC 249. Through the comparison of similarities and differences between CMM standards in ISO/TC 249 and pharmacopoeias of main stakeholders, this paper suggests strengthening standard formulation in the following areas to provide more appropriate documents to facilitate the international trade and promote the industrial development of CMM: (1) Develop standards to fill the blanks among the whole industry chain of CMM; (2) Develop standards for new forms of CMM and services; (3) Develop specification and grade standards for CMM with large quantity and high value.

KRAS, YWHAE, SP1 and MSRA as biomarkers in endometrial cancer.

BACKGROUND: We demonstrated that drinking hydrogen-rich water (HRW) inhibits endometrial tumor growth in our previous work. This research is to identify differentially expressed proteins (DEPs) between HRW and purified water groups in a xenograft mouse model of endometrial cancer (EC). METHODS: Samples were analyzed using tandem mass tags (TMTs) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS). DEPs were identified using bioinformatics to determine potential molecular functions and immunohistochemical (IHC) staining. RESULTS: In total, 11 DEPs were identified in the HRW group relative to the control. The up-regulated proteins included Gatad1, Ttyh3, Nek4, Dyrk2, and Gimap1, while the down-regulated proteins included SP1, Msl1, Plekha7, Dtwd2, MSRA, and KRAS. Gene Ontology (GO) annotations and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were associated with the binding region, biological regulation, endocrine resistance, estrogen signaling, choline metabolism in cancer and human cytomegalovirus infection. Furthermore, network analysis indicated that KRAS and MSRA interact with YWHAE. KRAS, YWHAE and SP1 were strongly expressed, while MSRA was weak expressed in atypical hyperplasia and EC tissue as well as in HRW group in xenograft tumor tissue. CONCLUSIONS: KRAS, YWHAE, SP1 and MSRA might be regarded as focused biomarkers to assess the prognosis of EC.

Discovery of chemical markers for improving the quality and safety control of Sinomenium acutum stem by the simultaneous determination of multiple alkaloids using UHPLC-QQQ-MS/MS.

Sinomenium acutum stem is a popular traditional Chinese medicine used to treat bone and joint diseases. Sinomenine is considered the only chemical marker for the quality control of S. acutum stem in mainstream pharmacopeias. However, higenamine in S. acutum stem is a novel stimulant that was banned by the World Anti-Doping Agency in 2017. Therefore, enhancing the quality and safety control of S. acutum stem to avoid potential safety risks is of utmost importance. In this study, a fast, sensitive, precise, and accurate method for the simultaneous determination of 11 alkaloids in S. acutum stem by ultrahigh-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UHPLC-QQQ-MS/MS) was established. This method successfully analyzed thirty-five batches of S. acutum stem samples. The average contents of sinomenine, magnoflorine, coclaurine, acutumine, higenamine, sinoacutine, palmatine, magnocurarine, columbamine, 8-oxypalmatine, and jatrorrhizine were 24.9 mg/g, 6.35 mg/g, 435 µg/g, 435 µg/g, 288 µg/g, 44.4 µg/g, 22.5 µg/g, 21.1 µg/g, 15.8 µg/g, 9.30 µg/g, and 8.75 µg/g, respectively. Multivariate analysis, including principal component analysis (PCA), orthogonal partial least square method-discriminant analysis (OPLS-DA), and hierarchical cluster analysis (HCA), were performed to characterize the importance and differences among these alkaloids in S. acutum stem samples. As a result, sinomenine, magnoflorine, coclaurine, acutumine, and higenamine are proposed as chemical markers for quality control. Higenamine and coclaurine are also recommended as chemical markers for safety control. This report provides five alkaloids that can be used as chemical markers for improving the quality and safety control of S. acutum stem. It also alerts athletes to avoid the risks associated with consuming S. acutum stem.

Analysis on the current quality standards of Chinese materia Medica used in COVID-19 prevention and treatment.

PURPOSE: Traditional Chinese medicine (TCM) has fully engaged and played an essential role in the prevention and treatment of Coronavirus Disease 2019 (COVID-19). This study compares relevant standards on high-frequent Chinese Materia Medicia (CMM) used in this pandemic aiming at reaching a global consensus and ensuring the use of Chinese medicines safely. METHODS: 141 representative Chinese formulas and Chinese Patent Medicines from the National Protocol and the most of Provincial Protocols for controlling COVID-19 in China have been collected to statistical analyze the composition and characteristics of CMM. Among them, the domestic and international standards of 47 varieties with the frequency usage over 10 times were selected to compare their quality requirements in the mainstream pharmacopoeias and international standards. RESULTS: The quality requirements of used CMM for fighting COVID-19 on the terms of overall quality control, marker compounds, and safety indicators showed different patterns in these mainstream pharmacopoeias and international standards. The uniformed and scientific quality standards of CMM were urgently needed to promote global acceptation and trade. CONCLUSIONS: These findings will provide evidence for building unified quality and safety standards that can adapt to the characteristics of CMM and promote international trade, and also will be stated that it is of the highest priority for ISO/TC 249 to formulate high-quality standards that consolidate international consensus to ensure quality and safety of the urgently needed CMM.

Discovery of chemical markers for identifying species, growth mode and production area of Astragali Radix by using ultra-high-performance liquid chromatography coupled to triple quadrupole mass spectrometry.

BACKGROUND: Astragali Radix (AR) is a well-known Chinese herbal medicine. The quality of AR can be affected by many factors such as species, growth mode and production area, but there are still no chemical markers to distinguish it. PURPOSE: To explore chemical markers for improving the quality assessment of AR and discover chemical markers for identifying species, growth mode and production area of AR. METHODS: A highly sensitive, efficient and accurate method based on ultra-high performance liquid chromatography coupled to triple quadrupole mass spectrometry (UHPLC-QQQ-MS/MS) for simultaneous quantitative determination of 14 major chemical components (five flavonoids and nine triterpene saponins) in 94 batches of AR from China, Republic of Korea and Germany was developed for the first time. To explore chemical markers and assess changes in the contents of 14 compounds in the 94 batches of AR samples from different regions, hierarchical clustering analysis (HCA) and principal component analysis (PCA) were performed. RESULTS: Astragaloside III was not only an important chemical marker for distinguishing two species of AR, i.e.: Astragalus mongholicus and A. membranaceus, but also a potential chemical marker for the classification of cultivated and semi-wild AR. In addition, in the batches of cultivated AR, the content of isoastragaloside II and cyclocephaloside II were greater in batches from the region of Shaanxi Province than that of other Provinces in China, but the content of calycosin-7-O-ß-D-glucoside and astragaloside IV, which are the quality control markers of AR required by the Chinese Pharmacopoeia, were higher than that of other Provinces in China. In addition, the content of calycosin-7-O-ß-D-glucoside, ononin, calycosin and astragaloside I could be used to identify samples of AR collected from China, Republic of Korea and Germany. CONCLUSION: This UHPLC-QQQ-MS/MS method could be applied to the quantitative evaluation of AR and could be an important and meaningful reference to develop chemical markers for quality control of AR.

Design Strategy for Porous Composites Aimed at Pressure Sensor Application.

Flexible and highly sensitive pressure sensors have versatile biomedical engineering applications for disease diagnosis and healthcare. The fabrication of such sensors based on porous structure composites usually requires complex, costly, and nonenvironmentally friendly procedures. As such, it is highly desired to develop facile, economical, and environment-friendly fabrication strategies for highly sensitive lightweight pressure sensors. Herein, a novel design strategy is reported to fabricate porous composite pressure sensors via a simple heat molding of conductive fillers and thermoplastic polyurethane (TPU) powders together with commercially available popcorn salts followed by water-assisted salt removal. The obtained TPU/carbon nanostructure (CNS) foam sensors have a linear resistance response up to 60% compressive strain with a gauge factor (GF ) of 1.5 and show reversible and reproducible piezoresistive properties due to the robust electrically conductive pathways formed on the foam struts. Such foam sensors can be potentially utilized for guiding squatting exercises and respiration rate monitoring in daily physical training.

Stretchable elastomer composites with segregated filler networks: effect of carbon nanofiller dimensionality.

Electrically conductive elastomer composites (CECs) have great potential in wearable and stretchable electronic applications. However, it is often challenging to trade off electrical conductivity and mechanical flexibility in melt-processed CECs for wearable electronic applications. Here, we develop CECs with high electrical conductivity and mechanical elasticity by controlling the segregated networks of carbon nanofillers formed at the elastomer interface. The carbon nanofiller dimensionality has a significant influence on the electrical and mechanical properties of thermoplastic polyurethane (TPU) composites. For instance, 3D branched carbon nanotubes (carbon nanostructures, CNSs) have a very low percolation threshold (Φ C = 0.01 wt%), which is about 8-10 times lower than that of 1D carbon nanotubes (CNTs) and 2D graphene nanosheets (GNSs). Besides, the TPU/CNS system has a higher electrical conductivity than other fillers at all filler contents (0.05-2 wt%). On the other hand, TPU/CNT systems can retain high elongation at break, whereas for the TPU/GNS systems elongation at break is severely deteriorated, especially at a high filler content. Different electrical and mechanical properties in the TPU-based CECs enable potential applications in flexible conductors/resistors and stretchable strain sensors, respectively.

Interface Design Strategy for the Fabrication of Highly Stretchable Strain Sensors.

Simultaneously achieving high piezoresistive sensitivity, stretchability, and good electrical conductivity in conductive elastomer composites (CECs) with carbon nanofillers is crucial for stretchable strain sensor and electrode applications. Here, we report a facile and environmentally friendly strategy to realize these three goals at once by using branched carbon nanotubes, also known as the carbon nanostructure (CNS). Inspired by the brick-wall structure, a robust segregated conductive network of a CNS is formed in the thermoplastic polyurethane (TPU) matrix at a very low filler fraction, which renders the composite very good electrical, mechanical, and piezoresistive properties. An extremely low percolation threshold of 0.06 wt %, currently the lowest for TPU-based CECs, is achieved via this strategy. Meanwhile, the electrical conductivity is up to 1 and 40 S/m for the composites with 0.7 and 4 wt % CNS, respectively. Tunable piezoresistive sensitivity dependent on CNS content is obtained, and the composite with 0.7 wt % filler has a gauge factor up to 6861 at strain ε = 660% (elongation at break is 950%). In addition, this strategy also renders the composites' attractive tensile modulus. The composite with 3 wt % CNS shows 450% improvement in Young's modulus versus neat TPU. This work introduces a facile strategy to fabricate highly stretchable strain sensors by designing CNS network structures, advancing understanding of the effects of polymer-filler interfaces on the mechanical and electrical property enhancements for polymer nanocomposites.

Functionalized alginate with liquid-like behaviors and its application in wet-spinning.

Alginate is a kind of marine-derived plant polysaccharide with useful properties including inherent flame-retardancy and biocompatibility, yet poor flowability and low processing efficiency induced by high viscosity impede its further industrial applications. In this study, PEG-substituted tertiary amines were adapted to functionalize alginate with different molecular weight via acid-base reaction to improve the flowability. Based on alginate with low molecular weight, alginate fluids exhibited excellent flowability at room temperature in the absence of solvent. For alginate with high molecular weight, gelatinous precipitated phase exhibited significant shear-thinning properties and higher solid content despite lack of solvent-free flowability, which was applied to wet-spinning. The alginate fibers exhibited increased tensile strength by 104% and elongation at break by 132% compared with conventional alginate fibers, and the spinning efficiency was significantly improved. The proposed strategy is expected to extend to highly efficient processing of other polysaccharides to obtain high-performance biomedical materials.

Chinese herb mix Tiáo-Geng-Tang possesses antiaging and antioxidative effects and upregulates expression of estrogen receptors alpha and beta in ovariectomized rats.

BACKGROUND: Herb mixtures are widely used as an alternative to hormonal therapy in China for treatment of the menopausal syndrome. However, composition of these herb mixtures are complex and their working mechanism is often unknown. This study investigated the effect of Tiáo-Geng-Tang (TG-decoction), a Chinese herbal mixture extract, in balancing female hormones, regulating expression of estrogen receptors (ERs), and preventing aging-related tissue damage. METHODS: Ovariectomized 5-month-old female rats were used to model menopause and treated with either TG-decoction or conjugated estrogen for 8 weeks. Estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured in serum and in the hypothalamus. Hypothalamic expression of estrogen receptor (ER) alpha and beta were studied by real-time PCR and western blotting. Total antioxidant capacity (T-AOC), oxidation indicator superoxide dismutase (SOD) activity and tissue damage parameter malondialdehyde (MDA) were measured using standard assays. Aging-related ultrastructural alterations in mitochondria were studied in all animals by transmission electron microscopy. RESULTS: TG-decoction-treatment elevated E2 and lowered FSH in serum of ovariectomized rats. The potency and efficacy of TG-decoction on the hypothalamus was generally weaker than that of conjugated estrogens. However, TG-decoction was superior in upregulating expression of ERα and ß. TG-decoction increased hypothalamic SOD and T-AOC levels and decreased MDAlevels and mitochondrial damage in hypothalamic neurons. CONCLUSIONS: TG-decoction balances female hormones similarly to conjugated estrogens but less effectively. However, it is superior in up regulating ERα and ß and exhibits antioxidative antiaging activities. Whilst it shares similar effects with estrogen, TG-decoction also seems to have distinctive and more complex functions and activities.