Effect of Tai Chi vs Aerobic Exercise on Blood Pressure in Patients With Prehypertension: A Randomized Clinical Trial.

Importance: Prehypertension increases the risk of developing hypertension and other cardiovascular diseases. Early and effective intervention for patients with prehypertension is highly important. Objective: To assess the efficacy of Tai Chi vs aerobic exercise in patients with prehypertension. Design, Setting, and Participants: This prospective, single-blinded randomized clinical trial was conducted between July 25, 2019, and January 24, 2022, at 2 tertiary public hospitals in China. Participants included 342 adults aged 18 to 65 years with prehypertension, defined as systolic blood pressure (SBP) of 120 to 139 mm Hg and/or diastolic BP (DBP) of 80 to 89 mm Hg. Interventions: Participants were randomized in a 1:1 ratio to a Tai Chi group (n = 173) or an aerobic exercise group (n = 169). Both groups performed four 60-minute supervised sessions per week for 12 months. Main Outcomes and Measures: The primary outcome was SBP at 12 months obtained in the office setting. Secondary outcomes included SBP at 6 months and DBP at 6 and 12 months obtained in the office setting and 24-hour ambulatory BP at 12 months. Results: Of the 1189 patients screened, 342 (mean [SD] age, 49.3 [11.9] years; 166 men [48.5%] and 176 women [51.5%]) were randomized to 1 of 2 intervention groups: 173 to Tai Chi and 169 to aerobic exercise. At 12 months, the change in office SBP was significantly different between groups by -2.40 (95% CI, -4.39 to -0.41) mm Hg (P = .02), with a mean (SD) change of -7.01 (10.12) mm Hg in the Tai Chi group vs -4.61 (8.47) mm Hg in the aerobic exercise group. The analysis of office SBP at 6 months yielded similar results (-2.31 [95% CI, -3.94 to -0.67] mm Hg; P = .006). Additionally, 24-hour ambulatory SBP (-2.16 [95% CI, -3.84 to -0.47] mm Hg; P = .01) and nighttime ambulatory SBP (-4.08 [95% CI, -6.59 to -1.57] mm Hg; P = .002) were significantly reduced in the Tai Chi group compared with the aerobic exercise group. Conclusions and Relevance: In this study including patients with prehypertension, a 12-month Tai Chi intervention was more effective than aerobic exercise in reducing SBP. These findings suggest that Tai Chi may help promote the prevention of cardiovascular disease in populations with prehypertension. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR1900024368.

Comprehensive consideration of multiple determinants from evidence to recommendations in guidelines for most traditional Chinese medicine was suboptimal: a systematic review.

BACKGROUND: The overall comprehensive consideration of the factors influencing the recommendations in the traditional Chinese medicine (TCM) guidelines remains poorly studied. This study systematically evaluate the factors influencing recommendations formation in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) clinical practice guidelines (CPGs) and TCM CPGs. METHODS: This was a methodological review in which we searched six databases and multiple related websites. The GRADE CPGs were identified as the guidelines developed by the GRADE Working Group or the two Co-Chairs. For the TCM CPGs, we randomly selected guidelines that were published by the TCM or integrative medicine academic societies from China mainland (published by the TCM or integrative medicine academic societies of China mainland). Two reviewers independently screened and extracted data. We included CPGs published in 2018-2022. We extracted information on the influencing factors of evidence to recommendation and conducted the analyses using descriptive statistics and calculated the proportion of relevant items by IBM SPSS Statistics and Microsoft Excel to compare the differences between the GRADE CPGs and the TCM CPGs. RESULTS: Forty-five GRADE CPGs (including 912 recommendations) and 88 TCM CPGs (including 2452 recommendations) were included. TCM recommendations mainly considered the four key determinants of desirable anticipated effects, undesirable anticipated effects, balance between desirable and undesirable effects, certainty of evidence, with less than 20% of other dimensions. And TCM CPGs presented more strong recommendations (for or against) and inappropriate discordant recommendations than GRADE CPGs. GRADE CPGs were more comprehensive considered about the factors affecting the recommendations, and considered more than 70% of all factors in the evidence to recommendation. CONCLUSIONS: The TCM CPGs lack a comprehensive consideration of multiple influencing determinants from evidence to recommendations. In the future, the correct application of the GRADE approaches should be emphasized.

Association of magnesium sulfate use with mortality in critically ill patients with sepsis: a retrospective propensity score-matched cohort study.

BACKGROUND: Trials have demonstrated lower rates of acute kidney injury in critically ill patients receiving magnesium supplementation, but they have yielded conflicting results regarding mortality. METHODS: This is a retrospective cohort study based on the MIMIC-IV (Medical Information Mart in Intensive Care-IV) database. Adult critically ill patients with sepsis were included in the analysis. The exposure was magnesium sulfate use during ICU stay. The primary outcome was 28-day all-cause mortality. Propensity score matching (PSM) was conducted at a 1:1 ratio. Multivariable analyses were used to adjust for confounders. RESULTS: The pre-matched and propensity score-matched cohorts included 10 999 and 6052 patients, respectively. In the PSM analysis, 28-day all-cause mortality rate was 20.2% (611/3026) in the magnesium sulfate use group and 25.0% (757/3026) in the no use group. Magnesium sulfate use was associated with lower 28-day all-cause mortality (hazard ratio [HR], 0.70; 95% CI, 0.61-0.79; P<0.001). Lower mortality was observed regardless of baseline serum magnesium status: for hypomagnesaemia, HR, 0.64; 95% confidence interval (CI), 0.45-0.93; P=0.020; for normomagnesaemia, HR, 0.70; 95% CI, 0.61-0.80; P<0.001. Magnesium sulfate use was also associated with lower ICU mortality (odds ratio [OR], 0.52; 95% CI, 0.42-0.64; P<0.001), lower in-hospital mortality (OR, 0.65; 95% CI, 0.55-0.77; P<0.001), and renal replacement therapy (OR, 0.67; 95% CI, 0.52-0.87; P=0.002). A sensitivity analysis using the entire cohort also demonstrated lower 28-day all-cause mortality (HR, 0.62; 95% CI, 0.56-0.69; P<0.001). CONCLUSIONS: Magnesium sulfate use was associated with lower mortality in critically ill patients with sepsis. Prospective studies are needed to verify this finding.

Association of medicinal plant consumption with all-cause mortality and cognitive impairment in older adult: A large prospective cohort study.

BACKGROUND: Panax ginseng and other medicinal plants have long been believed to have beneficial effects on health, and there is substantial evidence supporting their mechanisms of action. However, the extent of the health benefits derived from consuming these medicinal plants lacks substantial evidence from large-scale longitudinal population studies. The purpose of this study was to analyze the effect of consuming these medicinal plants on all-cause mortality and cognitive impairment. METHODS: A population-based cohort study was conducted using the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which was established in 1998 and has been followed up till now. The main exposure was the frequency of eating medicinal plants, including Panax ginseng, Astragalus membranaceus, Lycium barbarum, Angelica sinensis, etc. According to the consumption patterns of medicinal plants, the participants were divided into three groups: frequent use, occasional use, and rarely or never use group. The participants were individually tracked to determine their mortality and cognitive impairment status during the period from 2008 to 2018. Cox proportional hazards regression and competing risk model were used to calculate the hazard ratio (HR) for the association between the use of medicinal plants and the all-cause mortality and cognitive impairment. RESULTS: Among 13,918 participants, the average age was 87.2 ± 11.3 years old, and 70.1% (9,754/13,918) of the participants died during follow-up. The proportion of those frequently using, occasionally using, and rarely using medicinal plants was 8.4%, 20.7%, and 70.8%, respectively. Compared with the rarely or never use group, the occasional and frequent use groups demonstrated significantly lower risks for all-cause mortality, with HR of 0.75 (95% CI: 0.71 - 0.79) and 0.53 (95% CI: 0.49 - 0.58), respectively. The protective effect of medicinal plants against all-cause mortality decreased with increasing age in the subgroup analysis. Additionally, frequent use of medicinal plants reduced the risk of cognitive impairment in the competing risk model (HR = 0.73, 95% CI: 0.60 - 0.87). However, there was no protective effect on cognitive function for those who occasional use medicinal plants. CONCLUSION: In elderly individuals, occasional and frequent use of medicinal plants was associated with reductions in risk of all-cause mortality, and frequent use of medicinal plants could reduce the risk of cognitive impairment.

Association of Drinking Herbal Tea with Activities of Daily Living among Elderly: A Latent Class Analysis.

The aim of this study was to explore whether drinking herbal tea and tea would positively benefit activities of daily living (ADL) in the elderly. We used data from the Chinese longitudinal healthy longevity survey (CLHLS) to explore the association. Drinking herbal tea and drinking tea were divided into three groups using latent class analysis (LCA): frequently, occasionally, and rarely. ADL disability was measured by the ADL score. Multivariate COX proportional hazards models with competing risks were used to explore the impact of drinking herbal tea and tea on ADL disability, statistically adjusted for a range of potential confounders. A total of 7441 participants (mean age 81.8 years) were included in this study. The proportions of frequently and occasionally drinking herbal tea were 12.0% and 25.7%, respectively. Additionally, 29.6% and 28.2% of participants reported drinking tea, respectively. Multivariate COX regression showed that compared with rarely drinking, frequently drinking herbal tea could effectively reduce the incidence of ADL disability (HR = 0.85, 95% CI = 0.77-0.93, p = 0.005), whereas tea drinking had a relatively weaker effect (HR = 0.92, 95% CI = 0.83-0.99, p = 0.040). Subgroup analysis found that frequently drinking herbal tea was more protective for males under 80 years old (HR = 0.74 and 0.79, respectively), while frequently drinking tea was somewhat protective for women (HR = 0.92). The results indicate that drinking herbal tea and tea may be associated with a lower incidence of ADL disability. However, the risks associated with using Chinese herb plants still deserve attention.

Effects of Tai Chi Chuan on Cognitive Function in Adults 60 Years or Older With Type 2 Diabetes and Mild Cognitive Impairment in China: A Randomized Clinical Trial.

Importance: Type 2 diabetes (T2D) is associated with the progression of cognitive dysfunction. Physical activity benefits cognition, but no evidence from randomized clinical trials has shown whether tai chi chuan has better long-term benefits than fitness walking in cognitive function for patients with T2D and mild cognitive impairment (MCI). Objective: To compare the effectiveness of tai chi chuan, a mind-body exercise, for improving cognitive function in older adults with T2D and MCI, with fitness walking. Design, Setting, and Participants: This randomized clinical trial was conducted between June 1, 2020, and February 28, 2022, at 4 sites in China. Participants included 328 adults (aged ≥60 years) with a clinical diagnosis of T2D and MCI. Interventions: Participants were randomized in a 1:1:1 ratio to a tai chi chuan group, a fitness walking group, or a control group. The tai chi chuan group received 24-form simplified tai chi chuan. The fitness walking group received fitness walking training. Both exercise groups took the training for 60 min/session, 3 times/wk, for 24 weeks in a supervised setting. All 3 groups were provided with a 30-minute diabetes self-management education session, once every 4 weeks for 24 weeks. The participants were followed up for 36 weeks. Main Outcomes and Measures: The primary outcome was the global cognitive function measured at 36 weeks by the Montreal Cognitive Assessment (MoCA). Secondary outcomes included MoCA at 24 weeks and other cognitive subdomain measures and blood metabolic indices at 24 and 36 weeks. Results: A total of 328 participants (mean [SD] age, 67.55 [5.02] years; mean [SD] T2D duration, 10.48 [6.81] years; 167 [50.9%] women) were randomized to the tai chi chuan group (n = 107), fitness walking group (n = 110), or control group (n = 111) and included in the intention-to-treat analysis. At 36 weeks, the tai chi chuan group showed improved MoCA scores compared with the fitness walking group (mean [SD], 24.67 [2.72] vs 23.84 [3.17]; between-group mean difference, 0.84 [95% CI, 0.02-1.66]; P = .046) in the intention-to-treat analysis. The per-protocol analysis data set and subgroup analysis at 36 weeks showed similar results. Based on the generalized linear models, the treatment effects were similar in each group after adjusting for self-reported dietary calories and physical activity. There were 37 nonserious adverse events (tai chi chuan group, 8; fitness walking group, 13; control group, 16) unrelated to the study with no statistically significant difference among the 3 groups (P = .26). Conclusions and Relevance: In this randomized clinical trial including older adults with T2D and MCI, tai chi chuan was more effective than fitness walking in improving global cognitive function. The findings support a long-term benefit, suggesting the potential clinical use of tai chi chuan as an exercise intervention to improve cognitive function for older adults with T2D and MCI. Trial Registration: ClinicalTrials.gov Identifier: NCT04416841.

Effects of tree canopy on psychological distress: A repeated cross-sectional study before and during the COVID-19 epidemic.

BACKGROUND: During the COVID-19 epidemic period, people showed a stronger connection to the environment within their communities. Although tree canopy in residential areas has been shown to positively affect psychological distress, it is not clear whether the COVID-19 epidemic played a role in this process. Elucidation of the relationship between tree canopy and the impact on psychological distress during the COVID-19 epidemic could provide valuable information as to the best methods to help individuals cope with urban mental stress events. METHODS: A total of 15 randomly selected residential areas of Beijing were enrolled in this repeated cross-sectional study. A total of 900 residents were included in the two-waves of the investigation (450 residents per wave) before and during the COVID-19 epidemic (i.e., May 2019 and May 2020). Psychological distress was estimated using the 12-question General Health Questionnaire (GHQ-12). Tree canopy coverage (TCC) was measured through visual interpretation based on the 2013 data sources (World View 2 satellite imagery of Beijing urban areas with a resolution of 0.5 m). The demographic characteristics, distance to the nearest surrounding green or blue space, residential area house price, household density, and construction year were also collected in this study. A multivariate logistic regression, relative risk due to interaction (RERI), and synergy index (SI) were used to explore the relationships among tree canopy, COVID-19, and psychological distress. RESULTS: The negative impact of the COVID-19 epidemic on mental health was significant, with the prevalence of psychological distress increased 7.84 times (aOR = 7.84, 95% CI = 4.67-13.95) during the COVID-19 epidemic period. Tree canopy coverage in the group without psychological distress was significantly higher than that of the psychologically distressed group (31.07 ± 11.38% vs. 27.87 ± 12.97%, P = 0.005). An increase in 1% of TCC, was related to a 5% decrease in the prevalence of psychological distress (aOR = 0.95, 95% CI = 0.93-0.98). An antagonism joint action between tree canopy and the COVID-19 epidemic existed (RERI = 1.09, 95% CI = 0.72-1.47; SI = 0.16, 95% CI = 0.05-0.52), and persisted enhancing only in medium (26.45%-33.21%) and above TCC level. Correlation of GHQ items and TCC significantly differed between the COVID-19 non-epidemic and epidemic periods, with the effects of tree canopy on GHQ-12 items covering topics, such as social function and depression, presumably absent because of epidemic limitations. CONCLUSIONS: This study indicates that the COVID-19 epidemic harmed mental health and verified the positive effects of residential tree canopy on psychological distress in Beijing. We suggest paying more attention to residents in areas of low TCC and dealing with psychological distress caused by public health stress events based on tree canopy strategies.

Risk factors associated with the severity of adverse drug reactions by Xiyanping injection: A propensity score-matched analysis.

ETHNOPHARMACOLOGICAL RELEVANCE: Xiyanping injection (XYP), extraction of Andrographis paniculate (Andrographis paniculata (Burm. f.) Nees, chuan xin lian), is a Chinese patent medicine approved to treat bronchitis in China. In 2017, safety incidents associated with treatment of XYP began to emerge throughout China. However, the risk factors of severity of adverse reactions by XYP remain uncertain. AIM OF THE STUDY: To determine risk factors for the severity of XYP-associated adverse drug reactions (ADRs). MATERIALS AND METHODS: We analyzed a total of 26,317 cases of ADRs linked to the use of XYP injection in the China National Adverse Drug Reaction Monitoring Information System from 2004 to 2017. Data were analyzed with respect to age, gender, ethnicity, previous ADRs, family history of ADRs, dosage specification, medication frequency specification, body weight, route of administration, herb-drug interactions (ribavirin, cefatriaxone, penicillin sodium, ambroxol hydrochloride, clindamycin, cefoxitin sodium, azithromycin, ceftazidime, amoxicillin sodium and clavulanate potassium, levofloxacin, cefazolin sodium pentahydrate, acyclovir) by univariate analysis and multivariate analysis. Propensity score matching was used to compare severity of (general or serious) ADRs. RESULTS: We included 24,911 cases of general ADRs and 1406 cases of serious ADRs. Univariate analysis identified age (p â€‹< â€‹0.001), body weight (p â€‹< â€‹0.001), route of administration (p â€‹= â€‹0.008), co-administration of XYP with ribavirin (p â€‹= â€‹0.031) as risk factors of severity of ADRs. Multivariate analysis identified XYP â€‹+ â€‹ribavirin combination (p â€‹= â€‹0.048) and age (p â€‹< â€‹0.001) as the independent risk factors. Upon propensity score matching, the variables were relatively balanced amongst the two groups of patients with general or severe ADRs, and the level of severity in patients who received treatment of XYP â€‹+ â€‹ribavirin increased (p â€‹= â€‹0.020). CONCLUSIONS: Age and co-administration of ribavirin may be potential risk factors for the severity of XYP-associated ADRs. This reminds us to pay more attention to the safety of elderly medication. Minimizing the herb-drug-interaction effects of XYP and ribavirin is a viable treatment target for healthcare professionals in managing serious ADRs amongst patients receiving XYP injection.

[Effect of tongxie yaofang on intestinal mast cells and cytokine expression of rats with visceral hypersensitivity].

OBJECTIVE: To observe the effect of Tongxie Yaofang (TY) on the number of mast cells (MCs) and the expression of cytokines in rats with visceral hypersensitivity, and to explore roles of TY in treating visceral hypersensitivity and its possible mechanism. METHODS: Totally 30 male adult Sprague Dawley (SD) rats were randomly divided into the blank control group, the model group, and the TY treatment group, 10 in each group. The irritable bowel syndrome (IBS) rat model was established by combining colorectal distention with restraint stress in the TY treatment group and the model group. The visceral hypersensitivity was assessed by abdominal withdrawal reflex (AWR). From the 2nd day of successful modeling, rats in the treatment group were admiministered with TY at the daily dose of 4 g/kg for 4 successive weeks. Equal volume of normal saline was given to rats in the model group for 4 successive weeks. No treatment was given to rats in the blank control group. Four weeks later the number of MCs was counted by using toluidine blue staining. The expression of interleukin-4 (IL-4) and interleukin-9 (IL-9) both in colonic mucosa and serum were measured by enzyme linked immunosorbent assay (ELISA), and the expression of protease-activated receptor type 2 (PAR-2) was detected by Western blot. RESULTS: Compared with the blank control group, the visceral sensitivity was significantly elevated, the number of MCs in the ileocecal junction increased, and the expression of IL-4, IL-9, and PAR-2 in serum and the colonic mucosa significantly increased (P < 0.05). Compared with the model group, the visceral sensitivity significantly decreased, the number of MCs reduced, and the expression of PAR-2 in the colonic mucosa significantly reduced (all P < 0.05), and the expression of IL-4 in colonic mucosa and IL-9 in serum were obviously reduced in the TY treatment group (P < 0.05). CONCLUSION: TY might improve the visceral hypersensitivity by acting on MCs related cytokines and reducing degranulation of MCs.