[Expert consensus on integrated traditional Chinese and western medicine diagnosis and treatment for osteoporotic fractures].

Osteoporotic fractures represent the most severe complications of osteoporosis,characterized by insidious onset,high mortality and disability rates,and a steadily increasing incidence,imposing a significant socioeconomic burden. Western medicine has advantages in diagnosis and surgical interventions,while traditional Chinese medicine excels in holistic management and the restoration of bodily equilibrium. The integration of both traditional Chinese medicine (TCM) and western medicine emerges as an effective therapeutic strategy for osteoporotic fractures. In order to propagate the concept of integrated diagnosis and treatment,foster the advancement of integrated medical techniques for osteoporotic fractures,and establish standardized and normative protocols for disease prevention,diagnosis,and treatment,a consensus expert group,led by Geriatric Branch of Chinese Geriatrics Society,the Young Osteoporosis Group of Orthopedics Branch of Chinese Medical Association,Osteoporosis Group of Orthopedics Branch of Chinese Physician Association,and Osteoporosis Professional Committee of the Shanghai Society of Integrated Traditional Chinese and Western Medicine,was established. This group engaged in deliberations and formulated the "Expert Consensus on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Osteoporotic Fractures" elucidating the concept of integrated medicine and offering recommendations in the domains of prevention,diagnosis,and treatment,with the aspiration of ameliorating the prognosis of osteoporotic fractures and enhancing the quality of life for these patients.

Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial.

BACKGROUND: As one of the most common musculoskeletal ailments, chronic nonspecific low-back pain (CNLBP) causes persistent disability and substantial medical expenses. Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising. Recent guidelines indicate a reduced role for medicines in the management of CNLBP. OBJECTIVE: The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm, compared to nonsteroidal anti-inflammatory drug (NSAID) with a capsaicin plaster, in the treatment of CNLBP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: We designed a prospective multicenter randomized clinical trial enrolling patients from January 1, 2022 to December 31, 2022. A total of 156 patients with CNLBP were randomized into two parallel groups. Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally. Patients in the test group were treated with cupping and scraping using a medical device and medicated balm. MAIN OUTCOME MEASURES: Primary outcome was pain recorded using the visual analogue scale (VAS). Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale (JOA) and the traditional Chinese medicine (TCM) syndrome integral scale (TCMS) as assessment tools. RESULTS: Between baseline and postintervention, all changes in outcome metric scales were statistically significant (P < 0.001). Compared to the control group, patients in the test group had a significantly greater treatment effect in all outcome variables, as indicated by lower VAS and TCMS scores and higher JOA scores, after the one-week intervention period (P < 0.001). Further, according to the findings of multivariate linear regression analysis, the participants' pain (VAS score) was related to their marital status, age, smoking habits and body mass index. No adverse reactions were reported for any participants in this trial. CONCLUSION: The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters, regarding to pain intensity, TCM symptoms and quality of life. The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects. TRIAL REGISTRATION: This study was registered at Chinese Clinical Trial Registry (ChiCTR2200055655). Please cite this article as: He JY, Tu XY, Yin ZF, Mu H, Luo MJ, Chen XY, Cai WB, Zhao X, Peng C, Fang FF, Lü C, Li B. Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial. J Integr Med. 2024; 22(1): 39-45.

Bibliometric Analysis of Research Trends on Manual Therapy for Low Back Pain Over Past 2 Decades.

Purpose: Low back pain (LBP) is a prevalent musculoskeletal disorder, and manual therapy (MT) is frequently employed as a non-pharmacological treatment for LBP. This study aims to explore the research hotspots and trends in MT for LBP. MT has gained widespread acceptance in clinical practice due to its proven safety and effectiveness. The study aims to analyze the developments in the field of MT for LBP over the past 23 years, including leading countries, institutions, authoritative authors, journals, keywords, and references. It endeavors to provide a comprehensive summary of the existing research foundation and to analyze the current cutting-edge research trends. Methods: Relevant articles between 2000 and 2023 were retrieved from the Web of Science Core Collection (WOSCC) database. We used the software VOSviewer and CiteSpace to perform the analysis and summarize current research hotspots and emerging trends. Results: Through screening, we included 1643 papers from 2000 to 2023. In general, the number of articles published each year showed an upward trend. The United States had the highest number of publications and citations. Canadian Memorial Chiropractic College was the most published research institution. The University of Pittsburgh in the United States had the most collaboration with other research institutions. Long, Cynthia R. was the active author. Journal of Manipulative and Physiological Therapeutics was the most prolific journal with 234 publications. Conclusion: This study provides an overview of the current status and trends of clinical studies on MT for LBP in the past 23 years using the visualization software, which may help researchers identify potential collaborators and collaborating institutions, hot topics, and new perspectives in research frontiers, while providing new clinical practice ideas for the treatment of LBP.

Analgesic Electrical Stimulation Combined with Wrist-Ankle Acupuncture Reduces the Cortical Response to Pain in Patients with Myofasciitis: A Randomized Clinical Trial.

OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS) based on wrist-ankle acupuncture has been shown to relieve pain levels in patients with myofascial pain syndrome (MPS). However, its efficacy is highly subjective. The purpose of this study was to evaluate the feasibility and effectiveness of TENS based on wrist-ankle acupuncture for pain management in patients with MPS from the perspective of cerebral cortex hemodynamics. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: We designed a double-blind, randomized, controlled clinical trial. Thirty-one male patients with MPS were randomly assigned to two parallel groups. The experimental group (n = 16) received TENS based on wrist-ankle acupuncture for analgesic treatment, while the control group (n = 15) did not. The pain was induced by mechanically pressurized at acupoint Jianjing. The multichannel functional near-infrared spectroscopy (fNIRS) equipment was utilized for measuring oxyhemoglobin (HbO) levels in the cerebral cortex during the tasks. RESULTS: After the intervention, visual analog scale (VAS), the activation degree and activation area of pain perception cortices were significantly reduced in the experimental group compared to the baseline values (P < .05). Particularly, Frontopolar Area (FPA), and Dorsolateral Prefrontal Cortex (DLPFC) are highly involved in the pain process and pain modulation. CONCLUSION: Compared to no intervention, TENS based on wrist-ankle acupuncture can be effective in relieving pain in patients with MPS in terms of cerebral cortical hemodynamics. However, further studies are necessary to quantify the analgesic effect in terms of cerebral hemodynamics and brain activation.

Serum metabonomics as a diagnostic approach for cancer-related fatigue.

In the present study, differences in metabolic pathways between patients with and without cancer-related fatigue (CRF) were examined to identify metabolic serum biomarkers of CRF. In this preliminary study, metabolic profiling was applied to analyze the serum samples from 14 patients with CRF and 11 non-CRF individuals (non-fatigue cancer survivors) by ultra-performance liquid chromatography coupled with mass spectrometry. Orthogonal partial least-squares discriminant analysis was adopted to evaluate the differences between the CRF and non-CRF groups. The CRF group was characterized by increases in phosphatidylethanolamine (PE; 18:0/0:0), LysoPE (0:0/20:4 and 0:0/16:0), lysophosphatidylcholine (LysoPC; 20:4, 22:4 and 16:0) and LysoPC/PC, phosphatidylserine (21:0/0:0), glycerophosphocholine and N-docosahexaenoyl γ-aminobutyric acid. Furthermore, decreases in anandamide, uric acid, dihydrouracil, LysoPE (0:0/22:5), 2,5,7,8-tetramethyl-2(2'-carboxyethyl)-6-hydroxychroman, 19(R)-hydroxy-prostaglandin F1α, N-(3α,12α-dihydroxy-5ß-cholan-24-oyl)-glycine, ketoleucine, indoxyl sulfate, α-N-phenylacetyl-L-glutamine and 1-linoleoyl-glycerophosphocholine were detected. These data indicate a possible disturbance in the metabolism of phospholipids and adjustments in the endocannabinoid system. The metabonomic approach may be helpful to determine the pathophysiological mechanisms of CRF and the identification of potential biomarkers for the accurate diagnosis of CRF. All clinical data were obtained from the 'Research on the efficacy of traditional Chinese medicine comprehensive intervention in cancer-related fatigue' (TCM-CRF) project. Medical Ethical Approval for TCM-CRF was approved by the Chinese Ethics Committee of Registering Clinical Trials. The approval number for the TCM-CRF study was ChiECRCT-2013038, and the TCM-CRF study was completed.

Core muscle functional strength training for reducing the risk of low back pain in military recruits: An open-label randomized controlled trial.

BACKGROUND: Core muscle functional strength training (CMFST) has been reported to reduce injuries to the lower extremity. However, no study has confirmed whether CMFST can reduce the risk of low back pain (LBP). OBJECTIVE: This study identified the effects of CMFST on the incidence of LBP in military recruits. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: We performed a prospective, open-label, randomized, controlled study in a population of young healthy male naval recruits from a Chinese basic combat training program. Participants were randomly assigned to either the core group or the control group. In additional to normal basic combat training, recruits in the core group underwent a CMFST program for 12 weeks, while recruits in the control group received no extra training. MAIN OUTCOME MEASURES: At the beginning of the study and at the 12th week, the number of participants with LBP was counted, and lumbar muscle endurance was measured. In addition, when participants complained of LBP, they were assessed using the visual analog scale (VAS) and Roland Morris Disability Questionnaire (RMDQ). RESULTS: A total of 588 participants were included in the final analysis (295 in the core group and 293 in the control group). The incidence of LBP in the control group was about twice that of the core group over the 12-week study (20.8% vs 10.8%, odds ratio: 2.161-2.159, P < 0.001). The core group had better lumbar muscle endurance at 12 weeks than the control group ([200.80 ± 92.98] s vs [147.00 ± 84.51] s, P < 0.01). There was no significant difference in VAS score between groups, but the core group had a significantly lower RMDQ score at week 12 than the control group (3.33 ± 0.58 vs 5.47 ± 4.41, P < 0.05). CONCLUSION: This study demonstrated that the CMFST effectively reduced the incidence of LBP, improved lumbar muscle endurance, and relieved the dysfunction of LBP during basic military training.

Pain modulation induced by electronic wrist-ankle acupuncture: A functional near-infrared spectroscopy study.

BACKGROUND: As a new technology, electronic wrist-ankle acupuncture (E-WAA) combines the advantages of wrist-ankle acupuncture and transcutaneous electrical nerve stimulation, but the analgesic effect and mechanism need to be clarified. The purpose of this study was to identify the pain modulation caused by E-WAA by evaluating the response of the prefrontal cortex (PFC) from the perspective of neurophysiology. METHODS: Fifty male volunteers (age 25.00 ± 1.05 years) with trapezius myofascial pain syndrome were randomly allocated into intervention group (E-WAA treatment) or sham control group at a 1:1 ratio. An outcome evaluation system was used to induce tenderness on the Jianjing point and record the pain value. A multichannel functional near-infrared spectroscope was used to detect the PFC activation during tenderness before and after treatment to demonstrate the neuromodulation mechanism. A general linear model and t-test (p < 0.05) were used to analyze the difference in the oxyhemoglobin (HbO) concentration and pain value. RESULTS: In the intervention group, the pain value of volunteers decreased significantly (p = 0.017) after E-WAA treatment, whereas there was no statistical difference (p = 0.082) in the sham group. Before treatment, the frontopolar (FP) and dorsolateral prefrontal cortex (DLPFC) were the activation areas of the PFC. The E-WAA treatment then suppressed the activation of the two areas. The HbO concentration of the FP and DLPFC changed from a sharp rise during tenderness to not changing with tenderness stimulation. CONCLUSION: The results demonstrated that the E-WAA have a great analgesic effect. The FP and DLPFC were relative to the analgesia neuromodulation induced by the E-WAA.

Efficacy of the acupressure wrist-ankle strap in mild insomnia patients with anxiety disorders: study protocol for a randomized controlled trial.

BACKGROUND: Insomnia is very common in current society, and patients are often accompanied by a certain degree of anxiety, depression, etc. Recent studies have found that the hypothalamic-pituitary-adrenal (HPA) axis excitement-inhibition state is an important indicator of sleep quality. Wrist-ankle acupuncture (WAA) is safe and effective for insomnia. Based on WAA theory, the acupressure wrist-ankle straps are portable WAA point compression straps that can treat diseases by automatically applying pressure to the treatment location and being operated by patients themselves. We design this trial to evaluate the clinical effect of the acupressure wrist-ankle strap in the treatment of mild insomnia patients with anxiety disorders. METHODS/DESIGN: This trial is a parallel-design, patients-assessor blinded, randomized, sham-controlled. In total, 114 patients diagnosed with mild insomnia and anxiety disorders will be randomly assigned into two groups, the acupressure wrist-ankle strap group or the non-acupressure wrist-ankle strap group; they will receive treatments for eight weeks with five sessions each week. Rating scales, sleep monitors, and laboratory tests will be used to observe the clinical effect. From the perspective of the circadian secretion of peripheral blood-related hormones in the hypothalamic-pituitary-adrenal (HPA) axis, the possible mechanism of acupressure wrist-ankle straps for treating insomnia is studied. DISCUSSION: The results of this study will confirm the efficacy of acupressure wrist-ankle strap in treating mild insomnia patients with anxiety disorder and whether its mechanism is related to the HPA axis. The acupressure wrist-ankle strap may become a pure physical, no side effect treatment of mild insomnia. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000039352 . Registered on 24 October 2020.

Aerobic exercise suppresses hepatocellular carcinoma by downregulating dynamin-related protein 1 through PI3K/AKT pathway.

OBJECTIVE: Exercise, as a common non-drug intervention, is one of several lifestyle choices known to reduce the risk of cancer. Mitochondrial division has been reported to play a key role in the occurrence and transformation of hepatocellular carcinoma (HCC). This study investigated whether exercise could regulate the occurrence and development of HCC through mitosis. METHODS: Bioinformatics technology was used to analyze the expression level of dynamin-related protein 1 (DRP1), a key protein of mitochondrial division. The effects of DRP1 and DRP1 inhibitor (mdivi-1) on the proliferation and migration of liver cancer cells BEL-7402 were observed using cell counting kit-8, plate colony formation, transwell cell migration, and scratch experiments. Enzyme-linked immunosorbent assay, Western blot and real-time polymerase chain reaction were used to detect the expression of DRP1 and its downstream phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway. A treadmill exercise intervention was tested in a nude mouse human liver cancer subcutaneous tumor model expressing different levels of DRP1. The size and weight of subcutaneous tumors in mice were detected before and after exercise. RESULTS: The expression of DRP1 in liver cancer tissues was significantly upregulated compared with normal liver tissues (P < 0.001). The proliferation rate and the migration of BEL-7402 cells in the DRP1 over-expression group were higher than that in the control group. The mdivi-1 group showed an inhibitory effect on the proliferation and migration of BEL-7402 cells at 50 µmol/L. Aerobic exercise was able to inhibit the expression of DRP1 and decrease the size and weight of subcutaneous tumors. Moreover, the expression of phosphorylated PI3K (p-PI3K) and phosphorylated AKT (p-AKT) decreased in the exercise group. However, exercise could not change p-PI3K and p-AKT levels after knocking down DRP1 or using mdivi-1 on subcutaneous tumor. CONCLUSION: Aerobic exercise can suppress the development of tumors partially by regulating DRP1 through PI3K/AKT pathway.

Rehabilitation of An Analgesic Bracelet Based on Wrist-Ankle Acupuncture in Patients with Rotator Cuff Injury: A Randomized Trial.

Objective: To evaluate the effect of transcutaneous electrical nerve stimulation (C-TENS) in the rehabilitation of rotator cuff injury. Methods: A total of 60 patients diagnosed with mild to moderate rotator cuff injury were randomly divided into the control group and test group. Both groups received conventional rehabilitation treatment including physical therapy, joint mobilization, interventional therapy, and family recovery training. The test group additionally received TENS treatment on the upper area 4 or 5 of the wrist, based on the wrist-ankle acupuncture (WAA) theory. The results of the visual analogue scale (VAS), shoulder range of motion (ROM), and Constant-Murley score (CMs) were collected before and after the 1st treatment and after the 5th treatment. The differences of those indicators between the two groups were analyzed statistically. Results: The VAS scores of measurement points after treatment were all improved compared with those at baseline. There was a significant difference between the two groups after the 1st and the 5th treatment (p < 0.05), and the improvements in the test group were better than those in the control group. The ROM of flexion, extension, abduction, adduction, internal rotation, and external rotation after the 1st treatment and 5th treatment in both groups were all improved compared with those at baseline. There was no significant difference between two groups. The CMs of the two groups after the 5th treatment were all improved compared with those at baseline. There was no significant difference between two groups. No adverse events occurred during the treatment. Conclusion: Electrical stimulation on the wrist combined with conventional rehabilitation is more effective in relieving pain than the conventional rehabilitation alone. Electrical stimulation on the wrist combined with conventional rehabilitation has no obvious effect in improving shoulder joint mobility and shoulder function.

Design and Implementation of an Intelligent Analgesic Bracelet Based on Wrist-ankle Acupuncture.

A flexible, multifunctional, and intelligent analgesic bracelet was proposed in this article to alleviate symptoms of pain. Based on the theory of wrist-ankle acupuncture in traditional Chinese medicine, transcutaneous electrical nerve stimulation is the technical basis of the method. A set of targeted circuit system capable of generating adjustable electrical stimulation signals to simulate filamentary acupuncture was designed. The system architecture includes a wireless communication module, a signal control module, a stimulus signal generation module, and a wearable, flexible bracelet. In addition, a pain assessment interface with a visual analog scale was designed to assess pain levels. Two comparative experiments were designed, involving a custom pain assessment scale and hand-held dolorimeter that were performed before and after wearing the bracelet to verify the analgesic effect of the bracelet. The results showed that the wrist-worn analgesic bracelet is significantly effective in alleviating pain in various parts of the human body.

Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: Dysmenorrhea seriously affects the ability of women to perform normal social activities and decreases their quality of life. Primary dysmenorrhea can be effectively treated with acupuncture. Based on the wrist-ankle acupuncture (WAA) theory, we designed a portable WAA point compression treatment strap that treats diseases by automatically applying pressure to acupuncture points. The proposed study aims to evaluate the immediate analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. METHODS: The study will be a randomized controlled trial conducted from May 1, 2019 to May 30, 2020 that includes 78 students from Shanghai University of Traditional Chinese Medicine who have primary dysmenorrhea and meet the eligibility criteria. Participants will be randomly divided into 2 groups in a 1:1 allocation ratio. The intervention group will use the acupressure wrist-ankle strap equipped with tip compression component parts on the internal side; the control group will use the nonacupressure wrist-ankle strap with the tip compression parts removed. All participants will be treated for 30 minutes on the 1st day of menstruation. The primary outcome is the pain intensity score measured by the visual analog scale. The secondary outcomes are the onset time of analgesia, the pain threshold at Yinlingquan (SP 9), skin temperature at Guanyuan (CV 4), and expectations and satisfaction of patients as investigated via the expectation and treatment credibility scale. DISCUSSION: This trial will be the 1st study to evaluate the analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. The quality of this study is ensured by the randomization, nonacupressure control, and blinded design. The results may provide evidence for a potential alternative treatment for primary dysmenorrhea and evidence-based proof of the analgesic effect of WAA.

Traditional Chinese Acupuncture for Poststroke Depression: A Single-Blind Double-Simulated Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness and possible side-effect of treating poststroke depression patients by traditional Chinese body acupuncture. DESIGN: Single-blind double-simulated randomized controlled trial. SETTING: Inpatient wards of neurology and rehabilitation departments. PARTICIPANTS: Sixty-eight (68) participants who met the criteria were randomly assigned into two groups, 34 cases (32 completed) into intervention group and 34 cases (33 completed) into control group. INTERVENTIONS: Body acupuncture (Shuigou GV 26, Neiguan PC 6, and Zusanli ST 36) and oral placebo were used in intervention group while fluoxetine and minimal nontraditional acupuncture (minimally active penetrating) were used in control group. Patients in both groups were treated separately once a day for 6 weeks. OUTCOME MEASURES: Outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), and side-effects were measured using the Side Effect Rating Scale (SERS) of Asberg and a self-designed needling adverse events scale. Clinical effects of both groups were statistically valued before treatment, week-2, week-6, and month-3. RESULTS: The total curative effects of both groups are similar (p > 0.05; evaluated in week-6 and month-3), while intervention group had an earlier onset time at week-2 (p < 0.05). The intervention group has fewer side-effects in week-2 (p < 0.05). CONCLUSIONS: Body acupuncture was effective in reducing stroke patients' depressive symptoms and had fewer side-effects. It should be considered as an option for neuropsychiatric sequelae of stroke.

Monoterpenoids from the whole herb of Veronicastrum axillare.

CONTEXT: Veronicastrum axillare (Sieb. et Zucc.) Yamazaki (Scrophulariaceae) embraces varieties of bioactivities such as anti-inflammatory, anti-pyresis and detoxification activity, while little is known of the phytochemical components of this medicinal plant. OBJECTIVE: To isolate and identify bioactive constituents from the whole herb of V. axillare. MATERIALS AND METHODS: Ethanol extract of the whole herb of V. axillare was subjected to successive column chromatography. Chemical structures of the compounds were elucidated by detailed spectroscopic analyses on the basis of NMR, IR and HR-MS data. RESULTS: A new monoterpenoid, axillacetal A (1) and a known analogue, tarumal (2), were isolated from the whole herb of V. axillare. The structure of tarumal (2) was also revised according to our NMR data. DISCUSSION AND CONCLUSION: This is the first report on the isolation and authentication of novel chemical constituents from V. axillare.

Reversal effect of bufalin on multidrug resistance in human hepatocellular carcinoma BEL-7402/5-FU cells.

Multidrug resistance (MDR) is a major obstacle to chemotherapy in patients with hepatocellular carcinoma (HCC). To overcome MDR and improve chemotherapeutic efficacy, novel reversal agents with higher efficacy and lower toxicity are urgently needed for HCC. The present study was designed to examine the potential reversal activity of bufalin, a toxic ligand isolated from the traditional Chinese medicine 'Chansu' and to elucidate the possible related mechanisms. A multidrug-resistant HCC cell line, BEL-7402/5-FU, was used as the cell model. The working concentration of bufalin as an effective reversal agent, and the cell viability in the reversal experiments were determined by MTT assay. The effects of bufalin at a non-cytotoxic dose on cell cycle distribution, apoptosis and drug efflux pump activity were measured by flow cytometry. Qualitative observation of apoptosis was also carried out by confocal microscopy. Furthermore, the effects of bufalin on the expression of potential genes involved in MDR of BEL-7402/5-FU cells, including thymidylate synthase (TS), P-glycoprotein (P-gp), multidrug resistance protein 1 (MRP1), B-cell lymphoma-extra large (Bcl-xL) and Bcl-2-associated X protein (Bax), were determined using real-time PCR and western blot analysis. The results showed that bufalin at a concentration of 1 nM enhanced the chemosensitivity of BEL-7402/5-FU cells to 5-FU with a reversal fold of 3.8 which was similar to that of 1 µM verapamil. Bufalin significantly arrested the cell cycle at the G0/G1 phase, induced apoptosis through an increase in the Bax/Bcl-xL ratio, inhibited drug efflux pump activity via downregulation of MRP1, and reduced the expression of TS in BEL-7402/5-FU cells. The present study revealed that bufalin effectively reversed MDR in BEL-7402/5-FU cells through multiple pathways. The combination of bufalin with cytotoxic drugs may serve as a promising strategy for the chemotherapy of HCC.

Reversal effect of bufalin on multidrug resistance in K562/VCR vincristine-resistant leukemia cell line.

OBJECTIVE: To probe insights into the reversal effect of bufalin on vincristine-acquired multidrug resistance (MDR) in human leukemia cell line K562/VCR. METHODS: Proliferative inhibition rate and the reversal index (RI) of bufalin were determined by Methyl thiazolyl tetrazolium assay. The uptake of Adriamycin (ADM) in K562/VCR cells, cell cycle and apoptosis rate were determined by flow cytometry (FCM). Cell morphologic changes were observed with Wright-Giemsa staining. The expression of P-glycoprotein (P-gp), multidrug-associated protein-1 (MRP1), Bcl-xL and Bax protein were measured by immunocytochemistry. RESULTS: The human leukemia multidrug resistant K562/VCR cells showed no cross-resistance to bufalin. The RIs of bufalin at concentrations of 0.0002, 0.001 and 0.005 µmol/L were 4.85, 6.94 and 14.77, respectively. Preincubation of 0.001 µmol/L bufalin for 2 h could increase intracellular ADM fluorescence intensity to 28.07% (P < 0.05) and down-regulate MRP1 expression simultaneously, but no remarkable effect was found on P-gp protein. Cell cycle analysis indicated increased apoptosis rate and apparent decreased G2/M phase proportion after treatment with bufalin. When exposed to 0.01 µmol/L bufalin, typical morphological changes of apoptosis could be observed. Down-regulation of Bcl-xL and up-regulation of Bax expression in K562/VCR cells could be detected by immunocytochemistry. CONCLUSION: Bufalin could partly reverse the MDR of K562/VCR cells, with a possible mechanism of down-regulating MRP1 expression and activating apoptosis pathway by altering Bcl-xL/Bax ratio.

MiR-181a contributes to bufalin-induced apoptosis in PC-3 prostate cancer cells.

BACKGROUND: Bufalin is a major active compound of cinobufacini, which comes from dried toad venom and has been used for treatments of various cancers in China for many years. A number of studies have demonstrated that bufalin can induce apoptosis in some cancers. However, effects and mechanism of bufalin on prostate cancer cells remain unknown. METHODS: Apoptosis assay was measured by the annexin-V/PI flow cytometric assay. Western blot was used to measure Caspase-3 and Bcl-2. qRT-PCR was used to measure the relative expression of miR-181a. RESULTS: Bufalin was found to induce the expression of miR-181a, a small non-coding RNA believed to induce apoptosis by repressing its target gene, BCL-2. In prostate cancer PC-3cell line, bufalin-induced apoptosis can be largely attenuated by a miR-181a inhibitor, which blocked bufalin-induced Bcl-2 reduction and caspase-3 activation. CONCLUSIONS: Our dataindicatedthat miR-181a mediates bufalin-induced apoptosis in PC-3 cells. Thus, we presented here a new pharmacological mechanism for bufalin in anti-tumor therapy.

[Traditional Chinese medicine constitution types in 127 elderly patients with insomnia: an investigation in communities of Yangpu District, Shanghai].

OBJECTIVE: To analyze the distribution of traditional Chinese medicine constitution types in elderly patients with insomnia. METHODS: The epidemiological data were collected from communities in the Yangpu District, Shanghai via a cross-sectional field survey. The elderly participants were enrolled by using the Pittsburgh Sleep Quality Index (PSQI) scale and the TCM Constitution Questionnaire. RESULTS: (1)The distribution of imbalanced constitutions between the elderly with insomnia and normal subjects showed statistical difference (P<0.01) and the elderly with insomnia tend to be of imbalanced constitutions. Among these unbalanced constitutions, deficient constitutions were more frequent than others in the elderly with insomnia, and yang-deficiency and qi-deficiency occurred mostly in unbalanced and simple constitutions. (2) Blood-stasis and qi-stagnation constitutions were more frequent in females than in males among the elderly with insomnia. Frequency of deficiency constitutions in the elderly increased as the age increases. (3) The frequency of composite constitutions was higher than that of simple constitutions in elderly patients with insomnia (74.8%), among which qi-deficiency was more likely to be composite with other constitutions. CONCLUSION: Identification and classification of traditional Chinese medicine constitution types will provide further information for devising projects with systematic intervention for insomnia management.

[Relieving pre-exam anxiety syndrome with wrist-ankle acupuncture: a randomized controlled trial].

BACKGROUND: Pre-exam anxiety syndrome is a common condition occurring in pre-exam students and directly affects their examination performance and physical state. Wrist-ankle acupuncture has significant therapeutic effects in treating mental disorders and may also relieve the symptoms of pre-exam anxiety syndrome. OBJECTIVE: To assess the therapeutic effect of wrist-ankle acupuncture on pre-exam anxiety syndrome. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: A total of 60 students who met the inclusion criteria of pre-exam anxiety syndrome were enrolled from a university in Shanghai and they were randomly divided into treatment group and control group. There were 30 cases in each group, and no case failed to follow-up. In the treatment group, wrist-ankle acupuncture was adopted to point upper 1 bilaterally (impression between flexor carpi ulnaris tendon and ulnar margin), and there was no requirement for Deqi (arrival of qi). In the control group, sham acupuncture was adopted. The treatment was applied 3 times totally in both groups one week before the exam, once every other day, each time with the needles retained for 30 min. MAIN OUTCOME MEASURES: The therapeutic effects were compared between two groups. Before and after 3 treatments, Sarason Test Anxiety Scale (TAS) and Expectation and Treatment Credibility Scale (ETCS) were measured and evaluated. RESULTS: The therapeutic effect experienced by the treatment group was better than that of the control group (P<0.05). There were no statistically significant differences in TAS and ETCS before treatment between the two groups. The scores of TAS after treatment in two groups were higher than those before treatment (P<0.05, P<0.01). There were statistical differences in TAS absolute difference and TAS relative difference between the two groups and the treatment group had better results (P<0.05, P<0.01). After treatment, patients in the treatment group had higher scores in ETCS than those in the control group (P<0.05, P<0.01). No adverse reaction was reported. CONCLUSION: Wrist-ankle acupuncture can relieve the symptoms of pre-exam anxiety syndrome significantly, and this therapy is highly safe.

[Relationships between constitutional types of traditional Chinese medicine and motion sickness in 145 ocean sailors].

OBJECTIVE: To investigate the relationships between constitutional types of traditional Chinese medicine (TCM) and motion sickness. METHODS: A survey of TCM constitutions in ocean sailors participating in a voyage was performed by using the TCM Constitution Questionnaire developed by Beijing University of Traditional Chinese Medicine, while the survey of motion sickness was operated by Graybiel's diagnostic criteria. The incidences of motion sickness among sailors with different types of constitutions were compared. RESULTS: Prior to the voyage, 50.3% of sailors exhibited a gentleness constitution, 14.5% were of dampness-heat constitution, 10.3% were of qi-stagnation constitution, whereas the percentages of qi-deficiency, yang-deficiency, yin-deficiency, blood-stasis and special diathesis constitutions were 6.2%, 7.6%, 6.2%, 4.1% and 0.7%, respectively. None exhibited a phlegm-dampness constitution. By the end of the 176-day voyage, the percentages of gentleness, dampness-heat, qi-depression, qi-deficiency, yang-deficiency, yin-deficiency, blood-stasis, special diathesis and phlegm-dampness constitutions were 33.8%, 13.8%, 13.1%, 11.0%, 6.9%, 9.7%, 4.1%, 0.7% and 6.9%, respectively. The incidence of motion sickness was 69.7% (101 sailors) during this voyage. The incidences of motion sickness among sailors with different types of constitutions before the voyage showed significant difference (P<0.001). The incidence of motion sickness was higher in the sailors with dampness-heat constitution than in those with gentleness constitution. CONCLUSION: Types of Chinese medical constitution can be related to susceptibility to motion sickness. Furthermore, ocean voyage may have an effect or influence on the type of Chinese medical constitution of sailors involved.