[Effect of traditional Chinese medicine treatment as maintenance therapy on regulating the serum concentration of sCTLA-4 in patients with advanced non-small-cell lung cancer and its relationship with prognosis].

Objective: To evaluate the effect of traditional Chinese medicine (TCM) treatment as maintenance therapy on regulating the serum concentration of soluble cytotoxic T lymphocyte associated antigen-4 (sCTLA-4) in patients with advanced non-small-cell lung cancer (NSCLC) and the relationship between sCTLA-4 and time to progression (TTP). Methods: This study was conducted as a prospective, randomized, controlled trial. 64 non-progressive patients who responded to initial therapy were randomized 1∶1 to the TCM arm (treated with cinobufacini injection, herbal decoction and Chinese acupoint application, n=32) or to the chemotherapy arm (n=32). Each cycle was 21 days. Cycles were repeated until disease progression, unacceptable toxicity, or until the patient requested therapy discontinuation.The serum concentration of sCTLA-4 was detected by enzyme linked immunosorbent assay (ELISA) in the 64 patients with advanced NSCLC before and after two cycles of maintenance treatment. Cox regression was used to analyze the relative ratio for the risk of disease progression. Results: After 2 cycles of maintenance TCM treatment, the serum concentration of sCTLA-4 in patients with advanced NSCLC was (12.77±2.37 pg/ml), significantly lower than that before treatment (40.30±10.75)(P=0.013). After 2 cycles of maintenance chemotherapy, the serum concentration of sCTLA-4 was higher than that before treatment, but was not significantly different (44.48±10.12 vs. 46.64±11.21 pg/ml, P=0.612). After 2 cycles of maintenance treatment, TCM treatment can significantly bring down the serum concentration of sCTLA-4 compared to chemotherapy (12.77±2.37 vs. 46.64±11.21 pg/ml, P=0.004). The multivariate analysis indicated that sCTLA-4 levels and treatment regimen were independent prognostic factors for TTP (P<0.05 for both). Conclusions: Regulating the serum concentration of sCTLA-4 may be one of the mechanisms of TCM maintenance treatment of NSCLC. Trial registration Chinese Clinical Trial Register, ChiCTR-TRC-10001017.

Hypothalamic expression of neuropeptide-Y in the New Zealand obese mouse.

OBJECTIVE: Increased levels of hypothalamic neuropeptide-Y (NPY) are thought to contribute to the manifestation of the obese phenotype. The aim of this study was to characterize the interactions between leptin, insulin and NPY in the pathogenesis of polygenic obesity. DESIGN AND METHODS: A polygenic obese animal model, the New Zealand obese mouse (NZO) and its age-matched control, was used to assess the hypothalamic mRNA expression of NPY, the insulin receptor (IR) and the leptin receptor (Ob-Rb), by semiquantitative polymerase chain reaction. Experiments were performed early (at eight weeks old) and late (at 40 weeks old) in the life of these animals. RESULTS: Serum glucose was significantly elevated in obese mice. Serum insulin levels were not different between obese and lean mice, whereas serum leptin levels were significantly elevated in obese mice and increased continuously during life [reaching extremely high values at 40 weeks (41.5+/-4.1 vs 3.4+/-0.25 ng/ml for obese and lean, respectively). The hypothalamic expression of NPY mRNA was significantly higher in NZO mice compared to controls at both eight weeks (2.3-fold) and 40 weeks (1.9-fold), respectively, whereas expression of IR and Ob-Rb remained unaffected. CONCLUSION: Increased hypothalamic expression of NPY due to leptin resistance, may be involved in the development of polygenic obesity. Unchanged Ob-Rb expression suggests that either a defective hypothalamic uptake or defects in Ob-Rb signalling underly this process.

Hospital management of acute ischemic stroke in China.

OBJECTIVE: Hospital management of acute ischemic stroke varies greatly within and between different countries. This study assesses the current practices and opinions of doctors in China routinely involved in the treatment of stroke, and compares them with those of British doctors. METHODS: Questionnaires about the usual management of acute ischemic stroke were sent to 247 Chinese hospitals (mostly urban) collaborating in an acute stroke trial, seeking responses from five doctors (one consultant, two registrars, and two house officers) in each. After one mailing, 1,095 doctors (89%) responded. RESULTS: Sixty-nine percent of the hospitals had computed tomography scanners, and 88% of the doctors in those hospitals reported that they would routinely scan acute stroke patients (78% usually within 24 hours of admission and 22% only later). Sixty-two percent of doctors reported average hospital stays of 2 to 4 weeks, whereas 36% reported longer average stays. Treatments reported to be used routinely within the first 48 hours of acute ischemic stroke included glycerol or mannitol (69% of doctors), Chinese herb products (66%), calcium antagonists (54%), and aspirin (53%); for each of these treatments, over 70% of all doctors believed it produced definite benefit. Reported routine use of dextran (44%), snake venom (32%), "photo-therapy" (22%), and steroids (19%) was also moderately common, and about half of all doctors believed each was beneficial. In contrast, routine use of thrombolytic agents (4%) or anticoagulants (1%) was uncommon. Only one third of the doctors reported active treatment of hypertension immediately after admission. CONCLUSIONS: Comparison with a similar survey in Britain showed reported use of most treatments for acute ischemic stroke was more extensive in China, but that within both countries there was wide variation. The substantial variations in clinical practice both within and between China, the United Kingdom and other countries reflect, at least in part, the substantial uncertainty about the effectiveness of many of the possible treatments for acute ischemic stroke. Large-scale randomized evidence is needed to confirm or refute the efficacy of these and newer treatments for acute stroke.

Effect of treatment with nimodipine in patients with mild and moderate essential hypertension.

This study shows that nimodipine significantly reduces levels of blood pressure in patients with mild and moderate essential hypertension. Hypotensive efficacy is less than with nifedipine, but side effects are light, and the drug is shown to reduce serum Na+ and cholesterol and there is regression of LVH (ECG).

Epidemiology of hypertension and cardiovascular disease--China experience.

Epidemiological studies show higher BP level, lipid level and higher prevalence of coronary atherosclerosis and stenosis, in north than in south China. Urban populations have higher prevalence of HT than rural, high altitude dwellers usually have lower prevalence. Genetic differences start to affect BP from early childhood, children from higher BP parents are found more salt sensitive. Higher Na and Na/K, lower protein and Ca in the north, are important dietary factors in explaining north-south difference. Low prevalence of high altitude dwellers is found to be related with low salt intake, less stress perhaps also hypoxia. CVD Community control program has started since 1969, from 1969-1989, eleven such programs have been established in Beijing covering a total population of 750,000. Encouraging results in reduction of CVD mortality and morbidity rates have been obtained. Primary prevention by restriction of Na and supplementation of calcium has been tried and found to be eligible preventive measures.

Calcium antagonists in prevention of hypertension and stroke in stroke-prone spontaneously hypertensive rats.

To investigate the effect of Calcium antagonists (Ca-An) with different tissue specificity in the development of hypertension and stroke in salt-loading SHRSP, three experiments were conducted. In experiment I (1), 50 8-week-old male SHRSP were divided into three groups and given nifedipine (NF, 32 mg/kg/day), menidipine (MN 32 mg/kg/day) and placebo (control group) respectively. In the control group 83.3% (15/18) died of stroke and 17 showed renal vascular sclerosis. Their average lifespan was 84 days. NF and MN significantly reduced systolic blood pressure (SBP), and no stroke of renal vascular sclerosis developed. In experiment I (2), 54 7-week-old male SHRSP were divided into three groups (18 in each group). They were treated with nimodipine (NM) 20 mg/kg/day, 2 mg/kg/day and placebo respectively. NM (20 mg/kg/day) markedly lowered SBP and postponed the onset of stroke. Only 11% died in 17 weeks. NM (2 mg/kg/day did not lower SBP but postpond the onset of stroke. In experiment II (1), 29 10-week-old female SHRSP were divided into three groups: Group A was given NF 32 mg/kg/day, group B was parathyroidectomized (PTX) and group C served as control. PTX group did not lower SBP but could postpone the onset of stroke. In experiment II (2), 33 male SHRSP were divided into three groups and ticated as described above in experiment II (1) (11 in each group). Seven weeks after the experiment, the brain blood flow of NF group was significantly greater (67.5%) than that of the control and PTX groups. In experiment III, 27 7-week-old male SHRSP were divided into three groups as described above in experiment I (2).(ABSTRACT TRUNCATED AT 250 WORDS)