Coloclyster of Red Peony Root Granules Alleviates Moderately Severe Acute Pancreatitis: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial.

The red peony root derived from Paeonia lactiflora has been applied to treat human inflammatory diseases. To investigate its therapeutic potential in treating moderately severe acute pancreatitis (MSAP), which has been rarely studied, this study was designed as a double-blinded, placebo-controlled, randomized clinical trial. A total of 60 MSAP patients were enrolled and randomly divided into an experimental (n = 30) group and a control group (n = 30), who received a coloclyster of 15 g of red peony root or placebo granules dissolved in 150 mL of water, respectively. The patients' demographic and clinical characteristics were recorded. The results showed that the experimental group had a shorter remission time of fever (p < 0.05) and abdominal pain (p < 0.01) and faster resumption of self-defecation (p < 0.01) than did the control group. In addition, the coloclyster of red peony root decreased the modified Balthazar CT score as well as the serum interleukin-6 and tumor necrosis factor-alpha levels to a greater extent than did the placebo coloclyster (p < 0.05). The remission times for the normalization of white blood cells and percentage of neutrophils and lymphocytes in the experimental group were also significantly shorter than those in the control group (p < 0.05). In conclusion, a coloclyster of red peony root could help alleviate the clinical symptoms and shorten the course of MSAP by possibly attenuating systematic inflammation. This trial is registered with 14004664.

Corrigendum: A reduced lymphocyte ratio as an early marker for predicting acute pancreatitis.

This corrects the article DOI: 10.1038/srep44087.

A reduced lymphocyte ratio as an early marker for predicting acute pancreatitis.

The early diagnosis and severity grading for acute pancreatitis (AP) are difficult to determine because of the complexity and differences in disease process. To date, few studies have investigated the role of lymphocyte ratio (LR) in AP. Therefore, the objective of the present study was to investigate the prognostic value of LR as an indicator in AP, as well as determine an optimal cut-off value for the severity prediction. There were two hundred four patients involved in this study, ninety-two of whom had severe acute pancreatitis (SAP). The LR was analyzed on admission and correlated with severity, which was determined using the Atlanta classification. The optimal cut-off value for LR was generated using receiving operator characteristic (ROC) curves. The results showed that the LR in the SAP group decreased significantly compared to the mild acute pancreatitis (MAP) group (8.82 vs. 13.43). The optimal cut-off value obtained from ROC curves was 0.081, with a sensitivity of 80.4%, a specificity of 53.3%, a positive likelihood ratio of 1.722, and a negative likelihood ratio of 0.368. In conclusion, the LR is obviously related to the condition of AP patients and is valuable for the differential diagnosis of SAP in early stages of AP.

Hedyotis diffusa Willd extract inhibits HT-29 cell proliferation via cell cycle arrest.

Hedyotis diffusa Willd (HDW) has long been used as an important component in several Chinese medicine formulae to clinically treat various types of cancer, including colorectal cancer (CRC). Previously, we reported that HDW inhibits CRC growth via the induction of cancer cell apoptosis and the inhibition of tumor angiogenesis. In the present study, to further elucidate the mechanism of HDW-mediated antitumor activity, we investigated the effect of HDW ethanol extract (EEHDW) on the proliferation of HT-29 human colon carcinoma cells. We found that EEHDW reduced HT-29 cell viability and survival in a dose- and time-dependent manner. We also observed that EEHDW treatment blocked the cell cycle, preventing G1 to S progression, and reduced mRNA expression of pro-proliferative PCNA, Cyclin D1 and CDK4, but increased that of anti-proliferative p21. Our findings suggest that Hedyotis diffusa Willd may be an effective treatment for CRC via the suppression of cancer cell proliferation.

[Effects of ursolic acid on c-Cbl-associated protein expression in 3T3-L1 adipocytes with insulin resistance].

OBJECTIVE: To observe the effects of ursolic acid (UA) on insulin resistance and cell differentiation in 3T3-L1 adipocytes and to explore the mechanisms. METHODS: 3T3-L1 adipocytes were cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with glucose (25 mmol/L) and insulin (10(-6) mol/L) to induce insulin resistance. After culture, glucose consumption of the adipocytes was detected by glucose oxidase method and glucose uptake was detected by using tritium-marked glucose. Drug concentration for following test was determined through detecting the effects of different concentrations of UA on the activity of 3T3-L1 adipocytes with insulin resistance by methyl thiazolyl tetrazolium (MTT) staining. 3T3-L1 adipocytes with insulin resistance were cultured with DMEM, rosiglitazone, and low- and high-dose UA, and then, glucose uptake and differentiation of 3T3-L1 adipocytes were detected. Finally, real-time fluorescence quantitative polymerase chain reaction and Western blot methods were used to detect the effects of UA on expressions of adipocyte lipid binding protein (aP2), c-Cbl-associated protein (CAP) and matrix metalloproteinase-1 (MMP-1) in 3T3-L1 cells with insulin resistance. RESULTS: After dealing with high glucose/hyperinsulin for 24 h, insulin resistance was induced successfully in the 3T3-L1 adipocytes. The concentrations of UA were defined to be 4 to 20 µmol/L. Compared with the model group, the glucose uptake was significantly increased in the rosiglitazone group and groups treated with low- and high-dose UA (P<0.01). The differentiation levels of 3T3-L1 adipocytes in the UA groups were lower than those in the control group and the rosiglitazone group. Effects of UA on the expressions of aP2 and MMP-1 were not obvious, but UA could up-regulate expression of CAP both in mRNA and protein levels (P<0.01). CONCLUSION: Low- and high-dose UA can improve the glycometabolism and differentiation of 3T3-L1 adipocytes with insulin resistance by up-regulating the expression of CAP.

[Effects of ursolic acid in ameliorating insulin resistance in liver of KKAy mice via peroxisome proliferator-activated receptors α and γ].

OBJECTIVE: To explore the effects and mechanism of ursolic acid in improving hepatic insulin resistance in KKAy mice with spontaneous type 2 diabetes. METHODS: Thirty-five KKAy mice were divided into five groups according to the randomized block design, namely, control, rosiglitazone, fenofibrate, and high- and low-dose ursolic acid groups with seven mice in each group. C57BL/6J mice were used as the normal control group. At the end of the 4th week, free fatty acid (FFA), tumor necrosis factor-α (TNF-α) and adiponectin contents in serum were detected by enzyme-linked immunosorbent assay; the protein expressions of phosphoenolpyruvate carboxykinase (PEPCK), insulin receptor substrate-2 (IRS-2) and glucose transport factor-2 (GLUT-2) were detected by Western blot method; the mRNA expressions of PEPCK, IRS-2 and GLUT-2 were detected by real-time polymerase chain reaction; the expressions of peroxisome proliferator-activated receptor α (PPARα) and peroxisome proliferator-activated receptor γ (PPARγ) in liver tissue were detected by immunohistochemical method. RESULTS: After four weeks of intervention, the contents of FFA, TNF-α and adiponectin in serum of the high-dose ursolic acid group had changed, showing statistically significant difference compared to those of the control group (P<0.01); high dose of ursolic acid had depressant effect on the expressions of PEPCK protein and PEPCK mRNA (P<0.01); low dose of ursolic acid depressed the expression of PEPCK mRNA and induced phosphorylation of IRS-2 in the liver (P<0.05); both high and low dose of ursolic acid improved the expression of PPARα in the liver (P<0.01). CONCLUSION: The effects of ursolic acid in improving hepatic insulin resistance in KKAy mice with spontaneous type 2 diabetes may be closely related to affecting the contents of FFA, TNF-α and adiponectin, improving the expression of PPARα protein, regulating transcription of PEPCK protein and inducing phosphorylation of IRS-2.

Treatment of cholecystitis with Chinese herbal medicines: a systematic review of the literature.

AIM: To analyze the literature on the use of Chinese herbal medicines for the treatment of cholecystitis. METHODS: The literature on treatment of cholecystitis with traditional Chinese medicines (TCM) was analyzed based on the principles and methods described by evidence-based medicine (EBM). Eight databases including MEDLINE, EMbase, Cochrane Central (CCTR), four Chinese databases (China Biological Medicine Database, Chinese National Knowledge Infrastructure Database, Database of Chinese Science and Technology Periodicals, Database of Chinese Ministry of Science and Technology) and Chinese Clinical Registry Center, were searched. Full text articles or abstracts concerning TCM treatment of cholecystitis were selected, categorized according to study design, the strength of evidence, the first author's hospital type, and analyzed statistically. RESULTS: A search of the literature published from 1977 through 2009 yielded 1468 articles in Chinese and 9 in other languages; and 93.92% of the articles focused on clinical studies. No article was of level I evidence, and 9.26% were of level II evidence. The literature cited by Science Citation Index (SCI), MEDLINE and core Chinese medical journals accounted for 0.41%, 0.68% and 7.29%, respectively. Typically, the articles featured in case reports of illness, examined from the perspective of EBM, were weak in both quality and evidence level, which inconsistently conflicted with the fact that most of the papers were by authors from Level-3 hospitals, the highest possible level evaluated based on their comprehensive quality and academic authenticity in China. CONCLUSION: The published literature on TCM treatment of cholecystitis is of low quality and based on low evidence, and cognitive medicine may functions as a useful supplementary framework for the evaluation.

Hepatic iron stores are increased as assessed by magnetic resonance imaging in a Chinese population with altered glucose homeostasis.

BACKGROUND: Emerging scientific evidence has disclosed a correlation between iron metabolism and type 2 diabetes (T2D). OBJECTIVE: The objective of this study was to test the hypothesis that body iron stores are higher in a Chinese population with altered glucose homeostasis. DESIGN: Serum iron, ferritin, and soluble transferrin receptor concentrations were measured in 298 subjects, including 70 subjects with normal glucose tolerance (NGT group), 60 subjects with prediabetes (prediabetes group), and 168 subjects with T2D (T2D group). Hepatic iron stores in 88 subjects were assessed by using a magnetic resonance imaging (MRI) T2* gradient-recalled-echo technique. A general linear model ANOVA was performed for comparisons between groups after adjustment for age and BMI. Stepwise multiple linear regression analysis was used to identify factors associated with the MRI-estimated hepatic iron concentration (M-HIC). RESULTS: Mean (±SD) M-HIC and R2* values in the prediabetes and T2D groups were significantly higher than in the NGT group (M-HIC: 40.6 ± 8.6 and 39.3 ± 10.7 µmol/g compared with 27.8 ± 9.1 µmol/g; R2* values: 47.9 ± 11.9 and 47.3 ± 11.5 s(-1) compared with 34.9 ± 7.0 s(-1); all P < 0.01). No significant difference was shown in M-HIC and R2* values between prediabetes and T2D groups. The M-HIC independently contributed to 43.3% of the glycated hemoglobin variance after adjustment for main clinical indexes (P < 0.001). The proportions of subjects with mild hepatic iron overload in the NGT, prediabetes, and T2D groups were 12.5%, 70.6%, and 63.6%, respectively. CONCLUSIONS: To our knowledge, our findings provide novel evidence to support the hypothesis of a mild iron overload in patients with prediabetes and T2D. A cohort study concerned with the effect of the attenuation of excess iron on glucose metabolism in a prediabetic population is warranted.

[Effect of compound Chinese sour taste herbs on advanced glycation end products content and gene expression of their receptors in aorta of rats with type 2 diabetes mellitus].

OBJECTIVE: To investigate the possible mechanism of compound Chinese sour taste herbs (CS) in preventing and ameliorating diabetic macroangiopathy by analyzing the effects of CS on the deposition of advanced glycation end products (AGEs) and gene expression of receptor for advanced glycation end products (RAGE) in the aorta tissue of rats with type 2 diabetes mellitus (T2DM). METHODS: Rat model of T2DM was established by peritoneal injection of streptozotocin (STZ) and high caloric diet feeding. Experimental SD rats were divided into the normal group, the model group, the aminoguanidine (AG) group, and the CS group. At the end of the 8th and 12th week, the fasting blood glucose (FBG) was measured by glucose oxidase method; content of AGEs and collagen in aorta detected by fluorescent method and gene expression of RAGE in aorta determined by Real-time PCR method. RESULTS: FBG, AGEs and collagen contents and RAGE expression in aorta of model rats were all higher than those in the normal control group (P <0.05), while all these indices were lower in the CS group than in the model group (P<0.05). CONCLUSION: CS could realize the goal for preventing and ameliorating diabetic macroangiopathy by way of suppressing the production of AGEs and down-regulating the gene expression of RAGE in aorta of T2DM rats.

Prognostic analysis of transarterial chemoembolization combined with a traditional Chinese herbal medicine formula for treatment of unresectable hepatocellular carcinoma.

BACKGROUND: Transarterial chemoembolization (TACE) is the most widely used primary treatment for unresectable hepatocellular carcinoma (HCC) due to its survival benefit, though its clinical effect is still far from satisfactory. Jiedufang (JDF) granule preparation is a commonly used Chinese herbal medicine formula for HCC. The aim of this study was to evaluate the effect of combined therapy with TACE and JDF granule preparation in treatment of unresectable HCC on survival. METHODS: A retrospective study of TACE was performed in 165 patients with unresectable HCC who were admitted between January 2002 and December 2007 in Changhai Hospital, Shanghai, China. Of the 165 patients, 80 patients (study group) received combined therapy consisting of TACE and a long-term maintenance treatment with oral JDF granule preparation, and the remaining 85 patients (control group) received TACE alone. The survival rates of both groups were calculated by the Kaplan-Meier method. Factors possibly affecting survival were assessed by multivariate analysis in the Cox proportional hazard model, such as maximum tumor size, number of lesions, portal vein invasion, and etc. RESULTS: The median overall survival was 9.2 months (95% CI: 6.94 - 11.46) in the study group versus 5.87 months (95% CI: 4.21 - 7.52) in the control group. In the study group,survival rates of the 1-, 2- and 3-year follow-up were 41.2%, 18.4%, and 9.6%, respectively. Significant independent prognostic factors identified by the Cox regression analysis were as follows: serum hepatitis B surface antigen (HBsAg) (P = 0.014), maximum tumor size (P = 0.027), number of lesions (P < 0.001), portal vein invasion (P < 0.001), and the therapy model (P = 0.006). CONCLUSION: Combination therapy of TACE and JDF granule preparation may significantly prolong survival of patients with unresectable HCC.

The efficacy for unresectable hepatocellular carcinoma may be improved by transcatheter arterial chemoembolization in combination with a traditional Chinese herbal medicine formula: a retrospective study.

Transcatheter arterial chemoembolization (TACE) is the most widely used primary treatment for unresectable hepatocellular carcinoma (HCC) because of its survival benefit, although its clinical effect is still far from satisfactory. In China, there has been a long history of using traditional Chinese medicine in the treatment of liver cancer and other malignancies. In this study, the authors evaluated the effect of combined therapy with TACE and JDF granule preparation (a traditional Chinese herbal medicine formula) in the treatment of patients with unresectable HCC on survival. Clinical data, including baseline, performance status change, and survival time of 165 patients with unresectable HCC seen between January 2002 and December 2007 were retrospectively analyzed. Among the 165 patients, 80 patients (study group) received combined therapy consisting of TACE and a long-term maintenance treatment with oral JDF granule preparation, and 85 patients (control group) received TACE alone. The survival rate of both groups was calculated by the Kaplan-Meier method. Factors possibly affecting survival were assessed by multivariate analysis in the Cox proportional hazard model. The median overall survival was 9.2 months (95% confidence interval [95% CI], 6.94-1.46) in the study group versus 5.87 months (95% CI, 4.21-7.52) in the control group. In the study group (TACE + JDF), 1-year, 2-year, and 3-year survival rates were 41.2%, 18.4%, and 9.6%, respectively. The Cox regression analysis revealed the therapy model to be an independent predictor of patient prognosis. Current study data demonstrated that TACE combined with JDF granule preparation could improve the prognosis of patients. TACE combined with JDF granule preparation may prolong survival of patients with unresectable HCC.

[Red peony root decoction in treatment of severe acute pancreatitis: a randomized controlled trial].

OBJECTIVE: To compare the therapeutic effects of red peony root decoction, a compound traditional Chinese herbal medicine, and rhubarb in treating severe acute pancreatitis (SAP). METHODS: A total of 96 consecutive patients with objectively-graded SAP were randomly divided into treatment and control groups. There were 48 cases in each group. The patients in the treatment and control groups were assigned to receive red peony root decoction and rhubarb treatment 1-2 times a day via a gastric tube respectively. Comparisons in the time needed for the disappearance of abdominal tenderness, fever and abdominal distension were made between the two groups. The total days of using antibiotics, enzyme inhibitor, protease inhibitor, and nasojejunal feeding start, nasojejunal feeding, gastrointestinal decompression, fasting diet were also compared. And comparison also included hospital stays and hospitalization costs. RESULTS: The durations of abdominal tenderness, fever and abdominal distension in the treatment group were less than those in the control group (P<0.05). Compared with the control group, the time length for antibiotics (including anti-bacteria drug and antifungal agent) use, nasojejunal feeding start, nasojejunal feeding, gastrointestinal decompression, fasting diet, hospital stays and hospitalization costs were decreased in the treatment group (P<0.05). There were no significant differences between the two groups in enzyme inhibitor and protease inhibitor requirement, mortality and adverse reactions. CONCLUSION: Red peony root decoction is more effective than rhubarb alone for SAP patients.

[Study on the quantitative evaluation on the degree of TCM basic syndromes often encountered in patients with primary liver cancer].

OBJECTIVE: To establish a quantitative model for evaluating the degree of the TCM basic syndromes often encountered in patients with primary liver cancer (PLC). METHODS: Medical literatures concerning the clinical investigation and TCM syndrome of PLC were collected and analyzed adopting expert-composed symposium method, and the 100 millimeter scaling was applied in combining with scoring on degree of symptoms to establish a quantitative criterion for symptoms and signs degree classification in patients with PLC. Two models, i.e. the additive model and the additive-multiplicative model, were established by using comprehensive analytic hierarchy process (AHP) as the mathematical tool to estimate the weight of the criterion for evaluating basic syndromes in various layers by specialists. Then the two models were verified in clinical practice and the outcomes were compared with that fuzzy evaluated by specialists. RESULTS: Verification on 459 times/case of PLC showed that the coincidence rate between the outcomes derived from specialists with that from the additive model was 84.53 %, and with that from the additive-multificative model was 62.75 %, the difference between the two showed statistical significance (P<0.01). CONCLUSIONS: It could be decided that the additive model is the principle model suitable for quantitative evaluation on the degree of TCM basic syndromes in patients with PLC.

[Construction of a therapeutic effect evaluation system for patients with primary liver cancer based on syndrome differentiation in traditional Chinese medicine].

OBJECTIVE: To construct a system of therapeutic effect evaluation for patients with primary liver cancer according to the theory of syndrome differentiation in traditional Chinese medicine (TCM), and to examine its reliability. METHODS: Analytic hierarchy process and 100 mm surveyor's rod method were applied to obtain bottom layer and top level syndromes, which were used to construct the method of therapeutic effect evaluation, and its reliability was verified in clinical practice by comparing with some evaluation criteria in Western medicine, such as cancer severity scale; Karnofsky performance scale; Child-Pugh classification, cancer staging classification, and quality of life scale, etc. RESULTS: A system of therapeutic effect evaluation was constructed, and it could reflect the progress of tumor, changes of hepatic function and constitution. The evaluation scores acquired from the system were highly associated with the quality of life of the patients. CONCLUSION: The system of therapeutic effect evaluation can reflect the severity of disease and the characteristics of TCM treatment.

[Sustainable utilization of Radix Glycyrrhizae for protection of ecology environment and herbal resources].

Radix Glycyrrhizae is a commonly used herbal drug for traditional Chinese medicine in China, and it is also an important material for drug, food, chemical industry, and dye industry. Furthermore, in Northwest China, Radix Glycyrrhizae acts as a key plant for preventing desertification, which currently is the most serious environmental problem in China. This report concentrated on discussing the great potential value of Glycyrrhiza on ecosystem, introducing the principles of protection and sustainable utilization of Glycyrrhiza resource, offering the suitable methods of utilization, and suggesting how to carry out the research on the substitute drugs. To protect the ecosystem and herbal resource of Radix Glycyrrhizae, we should use this herb in a more reasonable way.

[Study of a qualitative diagnostic criterion for basic syndromes of traditional Chinese medicine in patients with primary liver cancer].

OBJECTIVE: To work out a qualitative diagnostic criterion for basic syndromes of traditional Chinese medicine in patients with primary liver cancer. METHODS: Based on the collection and analysis of related medical literature, clinical investigation, and experts' discussion, a preliminary qualitative diagnostic criterion for basic syndromes of traditional Chinese medicine in patients with primary liver cancer was formulated. Then it was used in clinic to be verified and revised repeatedly till it was improved to be a satisfied formal criterion. RESULTS: The basic syndromes listed in the qualitative diagnostic criterion for basic syndromes in patients with primary liver cancer consisted of two parts: excessive syndromes, including the syndromes of stagnation of qi, blood stasis, excess-heat and dampness, and deficient syndromes, including the syndromes of deficiency of qi, deficiency of blood, deficiency of yin and deficiency of yang. Each of the above syndromes could be diagnosed according to specific combination of its corresponding symptoms or signs. The clinical verification results showed that the total matching ratio was 73.92% between the diagnoses made according to the criterion and the diagnoses acquired from the experts' experience. CONCLUSIONS: The qualitative diagnostic criterion for basic syndromes of traditional Chinese medicine in patients with primary liver cancer is coincident with the experts' clinical practice. However, it needs to be further studied.

[Ginsenosides combined with dexamethasone in preventing and treating postembolization syndrome following transcatheter arterial chemoembolization: a randomized, controlled and double-blinded prospective trial].

OBJECTIVE: To observe the effect of ginsenosides (GS) and low dose glucocorticoid in preventing and treating the postembolization syndrome following transcatheter arterial chemoembolization (TACE). METHODS: Eighty patients with primary liver carcinoma were randomly divided into 4 double-blinded groups, with 20 patients in each group. Patients in groups A, B, C, D were treated with placebo, dexamethasone (Dex), GS, Dex and GS, respectively. The changes of clinical symptoms and laboratory tests after TACE were observed. RESULTS: Dex combined with GS markedly decreased the occurrence ratio and lasting time of the symptoms such as nausea, vomiting, fever and pain, and protected the function of liver as compared with the placebo (P<0.05). Single use of Dex or GS improved some symptoms as compared with the placebo, but it was not as good as the combination of Dex and GS. CONCLUSION: Dex combined with GS can effectively prevent and treat the postembolization syndrome following TACE.

[Discussion of some problems in studying relationship between sphygmo-diagram and syndrome types or diseases].

In contemporary studies of pulse and of the relationship between sphygmo-diagram and syndrome types or diseases, pulse instrument is usually applied to trace the sphygmo-diagram. A comparatively systemic theory about pulse diagnosis has been formed, and it promotes the pulse researching process. But the mechanism of pulse is complicated and the expressive information of pulse is diversity. So it is difficult to record the complicated information of pulse by applying the instrument. In addition, the simplicity in methods of tracing and analyzing sphygmo-diagram and the lack of criterion for syndrome differentiation make it difficult to study the relationship between the sphygmo-diagram and the syndrome types. It's important to lay stress on clinical applying, to promote communication among researchers, to unify the standards of pulse instrument and syndrome differentiation, and to reinforce the research on the relationship between sphygmo-diagram and the syndrome types. The government's support is also needed to promote multi-science cooperation at the same time.

[Treatment of intrahepatic cholestasis with integrated traditional Chinese and Western medicine].

Intrahepatic cholestasis results from the disturbance of the structure and function of bile secretory apparatus in hepatic cells. At present, the mechanism of the disease is still not clearly understood. The currently used Western medicine for liver-protective, cholagogic and immuno-suppressive treatment are not effective enough. According to the theory of traditional Chinese medicine, moisture, heat, stasis and toxin are the main factors of the etiology and pathogenesis of the jaundice in patients with intrahepatic cholestasis. Therefore, clearing away heat to drain dampness, cooling blood to remove toxin, activating blood to resolve stasis, soothing liver and invigorating spleen should be adopted in the treatment. In order to increase the therapeutic effects, rational application of traditional Chinese herbs combined with Western medicine should be emphasized in treating the disease under the doctrine of integration of syndrome differentiation and disease differentiation.