Effectiveness of Chinese Herbal Medicine as a Complementary Treatment for Neutropenia Prevention and Immunity Modulation During Chemotherapy in Patients With Breast Cancer: Protocol for a Real-World Pragmatic Clinical Trial.

BACKGROUND: In recent years, advancements in cancer treatment have enabled cancer cell inhibition, leading to improved patient outcomes. However, the side effects of chemotherapy, especially leukopenia, impact patients' ability to tolerate their treatments and affect their quality of life. Traditional Chinese medicine is thought to provide complementary cancer treatment to improve the quality of life and prolong survival time among patients with cancer. OBJECTIVE: This study aims to evaluate the effectiveness of Chinese herbal medicine (CHM) as a complementary treatment for neutropenia prevention and immunity modulation during chemotherapy in patients with breast cancer. METHODS: We will conduct a real-world pragmatic clinical trial to evaluate the effectiveness of CHM as a supplementary therapy to prevent neutropenia in patients with breast cancer undergoing chemotherapy. Patients will be classified into CHM or non-CHM groups based on whether they received CHM during chemotherapy. Using generalized estimating equations or repeated measures ANOVA, we will assess differences in white blood cell counts, absolute neutrophil counts, immune cells, and programmed cell death protein 1 (PD-1) expression levels between the 2 groups. RESULTS: This study was approved by the research ethics committee of Hualien Tzu Chi Hospital (IRB 110-168-A). The enrollment process began in September 2021 and will stop in December 2024. A total of 140 patients will be recruited. Data cleaning and analysis are expected to finish in the middle of 2025. CONCLUSIONS: Traditional Chinese medicine is the most commonly used complementary medicine, and it has been reported to significantly alleviate chemotherapy-related side effects. This study's findings may contribute to developing effective interventions targeting chemotherapy-related neutropenia among patients with breast cancer in clinical practice. TRIAL REGISTRATION: International Traditional Medicine Clinical Trial Registry ITMCTR2023000054; https://tinyurl.com/yc353hes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55662.

Application of Damage Control Surgery Combined with Seamless Integrated Rescue Mode in Emergency Treatment of Severe Thoracic and Abdominal Trauma.

Objective: To analyze the application effect of damage control surgery (DCS) combined with seamless integrated rescue mode in emergency treatment of severe thoracic and abdominal trauma. Methods: The clinical data of 90 patients with severe thoracic and abdominal trauma admitted to the emergency room of our hospital from September 2020 to September 2021 were selected for the retrospective analysis. According to the different treatment methods, they were divided into the experimental group (EG) and the control group (CG), with 45 cases in each group. The CG was treated with seamless integrated rescue mode, and the EG received the DCS combined with seamless integrated rescue mode. The mortality, complication rate, mixed venous oxygen saturation (SvO2), cardiac index (CI), central venous pressure (CVP), prothrombin time (PT), active partial thromboplastin time (APTT), the content of arterial blood lactate (ABL), C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-10 (IL-10) were compared between the two groups. Results: Compared with the CG, after intervention, the levels of SvO2, CI, CVP, APTT and IL-10 in the EG were signally higher (all P < .05), while the levels of PT, ABL, CRP and IL-6 in the EG were memorably lower (all P < .05), and the mortality and complication rate in the EG were notably lower (all P < .05). Conclusion: The application of DCS combined with seamless integrated rescue mode in emergency treatment of patients with severe thoracic and abdominal trauma can effectively reduce the mortality of patients, improve their coagulation dysfunction, decrease the level of inflammatory factors and reduce the occurrence of complications, with a positive significance for improving disease prognosis.

Simultaneous Determination of 147 Pesticide Residues in Traditional Chinese Medicines by GC-MS/MS.

Determination of pesticide residues remains a challenge in traditional Chinese medicines in which complex compounds may interfere with analysis signals. This study reports the development of a simple, effective, and high-throughput method combining gas chromatography-tandem mass spectrometry (GC-MS/MS) with either QuEChERS or solid phase extraction (SPE) to determine 147 pesticide residues in traditional Chinese medicines simultaneously. In SPE, the mixture of n-hexane and ethyl acetate (1:1, v/v) was selected to extract 147 pesticides in honeysuckle, and the extracted pesticides were determined by GC-MS/MS. The limits of detection for all pesticides were within 0.01-0.05 mg/kg. The recoveries were within 70-120% and the relative standard deviations were below 20% for over 90% pesticides. The coefficients of determination were up to 0.999 for the linearity between MS signals and different concentrations of pesticides (20-200 ng/mL). The analytical performance was confirmed in determining pesticide residues in dried tangerine peel. SPE achieved comparable recoveries for all pesticides compared to the QuEChERS method.

[Conversion of traditional Chinese medicine (TCM) into nanomedicine:application of theory of unification of medicines and excipients].

In recent years, the use of active substances as excipients or as substitutes for other excipients in the design of modern drug delivery systems has received widespread attention, which has promoted the development of the theory of unification of medicines and excipients in the design of traditional Chinese medicine(TCM) preparations. Adopting the theory of unification of medicines and excipients to design drug delivery systems can reduce the use of excipients and thus the cost of preparations, reduce drug toxicity, increase drug solubility and biocompatibility, enhance synergistic effect, and realize targeted delivery and simultaneous delivery of multiple components. However, the research on the application of this theory in the modern drug delivery system of TCM preparations is still insufficient, with few relevant articles. In addition, the TCM active substances that can be used as the excipients remain to be catalogued. In this paper, we review the types and applications of the drug delivery systems with TCM active substances as excipients and describe their common construction methods and mechanisms, aiming to provide references for the in-depth research on the modern drug delivery systems for TCM preparations.

[Application and problems analysis of traditional Chinese medicine volatile oil preparation technology based on ionic liquids].

Ionic liquids(ILs) are salts composed entirely of anions and cations in a liquid state at or near room temperature, which have a variety of good physicochemical properties such as low volatility and high stability. This paper mainly reviewed the research overview of ILs in the application of traditional Chinese medicine(TCM) volatile oil preparation technology. Firstly, it briefly introduced the application of TCM volatile oil preparation technology and composition classification and physicochemical properties of ILs, and then summarized the application of ILs in the extraction, separation, analysis, and preparation of TCM volatile oil. Finally, the problems and challenges of ILs in the application of TCM volatile oil were explained, and the application of ILs in TCM volatile oil in the future was prospected.

A comprehensive review of phosphorus recovery from wastewater by crystallization processes.

The presence of phosphorus (P) in discharged wastewater can lead to water pollution events and eutrophication. Given the increasing consumption of phosphate (PO43-) rocks, wastewater containing large quantities of P is deemed as a potential source of P recovery. Crystallization of P is an ideal way to recover P because of its simple design, ease of operation, high efficiency, and limited environmental impact. This paper provides a comprehensive review of P recovery by crystallization processes with respect to the mechanisms involved, operational parameters that influence the quality of the crystal, and available seed materials for inducing crystallization. Various operational parameters including pH, molar ratio of participating ions, mixing intensity, reactor type, and seeding conditions, were detailedly investigated. Different kinds of seeds were reviewed critically with regard to their principal properties, application, and long-term prospects. Crystallized products with a high P content can be used directly as slow-release fertilizers for agricultural production, and some test methods have been developed to determine their efficiency as a fertilizer and to evaluate their availability for plants. Further, the feasibility of P recovery by crystallization was evaluated in terms of economic benefits and environmental sustainability. This work serves as a basis for future research of P recovery by crystallization processes and responses to the increasingly stringent problems of eutrophication and the growing depletion of P resources.

Effects of calcium on the performance, bacterial population and microbial metabolism of a denitrifying phosphorus removal system.

A sequencing batch reactor was operated to study the effects of influent Ca2+ on the efficiency, bacterial population, and microbial metabolism of denitrifying phosphorus removal system. Results showed that high Ca2+ loading (≥80mg/L) significantly inhibited the performance of simultaneous nitrogen and phosphorus removal. The abundance of phosphorus removal-related organisms (Dechloromonas and Candidatus Accumulibacter) decreased with increasing Ca2+ concentration from 20 to 140mg/L, while the abundance of glycogen-accumulating organisms and other bacteria increased. Metabolomic analyses revealed that the metabolic profiles of microbial community were also affected by high influent Ca2+ concentrations. 3-Hydroxybutyrate, acetate, alanine, and glutamate were the main differentiated metabolites in the system. An accumulation of amino acids and a reduction of nucleotides and amines were important response to high Ca2+ loading. Long-term Ca2+ loading had a reversible effect on the denitrifying phosphorus removal system as it could revive after a 50-day recovery process.

Superwarfarin intoxication: hematuria is a major clinical manifestation.

Since superwarfarin is popular and readily available in stores, it may cause intoxication or overexposure, which can result in coagulopathy or abnormal bleeding in humans and, thus, is an important public health problem. We report our clinical experience with superwarfarin intoxication. Nine patients, including eight patients who had histories of ingesting superwarfarin, were studied. Of the patients, hematuria occurred in eight. Laboratory tests among the nine patients showed extremely prolonged prothrombin times and activated partial thromboplastin times, which could be corrected to normal by mixing 1:1 with normal pooled plasma; they also had very low functional levels of factor II, VII, IX, X, and proteins C and S, but normal functional levels of factors V, VIII, fibrinogen, and anti-thrombin III. Large doses of vitamin K1 were needed for 3 months or more to treat and correct the coagulopathy among the patients. The majority of the patients presented with gross hematuria, suggesting that hematuria is probably a major clinical manifestation of superwarfarin intoxication. Prolonged use of large doses of vitamin K1 is needed for the treatment of superwarfarin intoxication.

Honokiol: a potent chemotherapy candidate for human colorectal carcinoma.

AIM: To investigate the anticancer activity of honokiol on RKO, a human colorectal carcinoma cell line in vitro and in vivo, and to evaluate its possible use in clinic. METHODS: In vitro anticancer activity of honokiol was demonstrated by its induction of apoptosis in tumor cells. We analyzed cell proliferation with MTT assay, cell cycle with flow cytosmeter, DNA fragment with electrophoresis on agarose gels. To test the mechanism of honokiol-induced apoptosis, Western blotting was used to investigate the factors involved in this process. The pharmacokinetics study of honokiol was tested by high phase liquid chromatography. In in vivo study, Balb/c nude mice were incubated with RKO cells. Honokiol was injected intraperitoneally every other day into tumor bearing Balb/c nude mice. RESULTS: Our results showed that honokiol induced apoptosis of RKO cells in a time- and dose-dependent manner. At 5-10 microg/mL for 48 h, honokiol induced apoptosis through activating Caspase cascades. Pharmacokinetics study demonstrated that, honokiol could be absorbed quickly by intraperitoneal injection, and maintained in plasma for more than 10 h. In nude mice bearing RKO-incubated tumor, honokiol displayed anticancer activity by inhibiting tumor growth and prolonging the lifespan of tumor bearing mice. CONCLUSION: With its few toxicity to normal cells and potent anticancer activity in vitro and in vivo, honokiol might be a potential chemotherapy candidate in treating human colorectal carcinoma.