The Chinese herbal medicine Fufang Zhenzhu Tiaozhi protects against diabetic cardiomyopathy by alleviating cardiac lipotoxicity-induced oxidative stress and NLRP3-dependent inflammasome activation.

BACKGROUND: Fufang Zhenzhu Tiao Zhi (FTZ) formula is a Chinese herbal preparation used in the clinical treatment of disorders of glucolipid metabolism. Given its effective actions on the regulation of lipid dysfunction and its anti-inflammatory and antioxidative effects, we designed this study to investigate the cardioprotective effect and possible mechanism of FTZ in diabetic cardiomyopathy (DCM) mice. METHODS: FTZ was administered to diabetic mice by oral gavage daily at a dose of 1.2 g/kg or 2.4 g/kg bodyweight for 8 weeks. Doppler echocardiography, H&E, and WGA staining were used to evaluate cardiac function and structure in the mice. The levels of proinflammatory cytokines and lipids in serum were detected with corresponding commercial kits. Immunofluorescence staining and flow cytometry were used to detect oxidation damage and pyroptosis in myocardial cells. RT-PCR and western blotting were used to analyze the protein and mRNA expression levels of NLRP3 inflammasome-related genes. RESULTS: Our study indicated that FTZ improved cardiac function, attenuated heart hypertrophy, improved serum lipid and proinflammatory cytokine levels, and restrained oxidative stress and NLRP3 inflammasome-induced inflammatory activities in diabetic mouse hearts. The in vitro data suggested that FTZ suppressed intercellular lipid accumulation as well as palmitic acid (PA)-induced oxidative stress and NLRP3 inflammasome-dependent pyroptosis in cardiomyocytes. CONCLUSION: Our present findings indicate that FTZ inhibits DCM by inhibiting both oxidative stress and NLRP3 inflammasome activation induced by cardiac lipotoxicity.

[Effect of electroacupuncture on SIRT1/NF-κB signaling pathway in adipose tissue of obese rats].

OBJECTIVE: To explore the effect of electroacupuncture (EA) on insulin sensitivity, adipose tissue inflammatory reaction and silent information regulation factor 1(SIRT1)/nuclear factor kappa B (NF-κB) signaling pathway in obese rats. METHODS: A total of 100 SPF-grade Wistar male rats were collected. Thirteen rats of them were selected randomly as the normal group and fed with common forage, and the rest rats were fed with high-fat forage. Eight weeks later, 39 rats that met the obesity criteria were randomized into a model group, an EA group and a sham-EA group, 13 rats in each one. In each group, 3 rats were collected randomly and the hyperinsulinemic-euglycemic clamp was exerted to record glucose infusion rate (GIR) so as to determine insulin sensitivity. Afterwards, in the EA group, EA was applied to "Zusanli" (ST 36), "Fenglong" (ST 40), "Zhongwan" (CV 12) and "Guanyuan" (CV 4), stimulated with continuous wave, 2 Hz in frequency, 1 mA in current intensity, for 15 min. The treatment was given once every 2 days, 3 times a week, for 8 weeks totally. In the sham-EA group, the needles were inserted shallowly at the sites, 5 mm lateral to each of the acupoints stimulated in the EA group, and the electrodes were attached to the needle handles, but without electric stimulation exerted. The rest management was the same as the EA group. Before and after intervention, the body mass and the insulin sensitivity were measured. After intervention, the white adipose tissue was collected from the kidney in the rats. Western blot was adopted to detect the relative protein expressions of SIRT1, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and acetylated NF-κB (Ac-NFκB). The real-time fluorescence quantitative PCR was used to detect the mRNA expressions of SIRT1, IL-6 and TNF-α. The immunofluorescence double labeling method was applied to detect the co-expression of SIRT1 and Ac-NFκB in adipose tissue. RESULTS: After fed with high-fat forage for 8 weeks, the body mass was significantly increased and GIR decreased in the rats of the model group as compared with the normal group (P<0.01), suggesting that the model of obese rat with insulin resistance was successfully established. After 8-week intervention, compared with the model group, the body mass was reduced and GIR increased in the rats of the EA group (P<0.01). The differences were not significant statistically in comparison between the sham-EA group and the model group (P>0.05). Compared with the normal group, in the model group, the protein and mRNA expressions of SIRT1 in adipose tissue were decreased, and the protein expression of Ac-NFκB increased, the protein and mRNA expressions of IL-6 and TNF-α increased (P<0.05, P<0.01). Compared with the model group, in the EA group, the protein and mRNA expressions of SIRT1 in adipose tissue were increased significantly, the protein expression of Ac-NFκB decreased, and the protein and mRNA expressions of IL-6 and TNF-α significantly decreased (P<0.05, P<0.01). There was no significant difference in each index between the sham-EA group and the model group (P>0.05). The results of immunofluorescence double labeling showed that SIRT1 and Ac-NFκB were co-expressed in adipose tissue. CONCLUSION: Electroacupuncture significantly reduces the body mass, inflammatory reaction conditions of adipose tissue and improves insulin sensitivity in obese rats. Regarding the potential mechanism, after the activation of SIRT1/NF-κB signaling pathway by electroacupuncture, and down-regulates the transcription of downstream inflammatory factors.

Pathological pain processing in mouse models of multiple sclerosis and spinal cord injury: contribution of plasma membrane calcium ATPase 2 (PMCA2).

BACKGROUND: Neuropathic pain is often observed in individuals with multiple sclerosis (MS) and spinal cord injury (SCI) and is not adequately alleviated by current pharmacotherapies. A better understanding of underlying mechanisms could facilitate the discovery of novel targets for therapeutic interventions. We previously reported that decreased plasma membrane calcium ATPase 2 (PMCA2) expression in the dorsal horn (DH) of healthy PMCA2+/- mice is paralleled by increased sensitivity to evoked nociceptive pain. These studies suggested that PMCA2, a calcium extrusion pump expressed in spinal cord neurons, plays a role in pain mechanisms. However, the contribution of PMCA2 to neuropathic pain processing remains undefined. The present studies investigated the role of PMCA2 in neuropathic pain processing in the DH of wild-type mice affected by experimental autoimmune encephalomyelitis (EAE), an animal model of MS, and following SCI. METHODS: EAE was induced in female and male C57Bl/6N mice via inoculation with myelin oligodendrocyte glycoprotein fragment 35-55 (MOG35-55) emulsified in Complete Freund's Adjuvant (CFA). CFA-inoculated mice were used as controls. A severe SC contusion injury was induced at thoracic (T8) level in female C57Bl/6N mice. Pain was evaluated by the Hargreaves and von Frey filament tests. PMCA2 levels in the lumbar DH were analyzed by Western blotting. The effectors that decrease PMCA2 expression were identified in SC neuronal cultures. RESULTS: Increased pain in EAE and SCI was paralleled by a significant decrease in PMCA2 levels in the DH. In contrast, PMCA2 levels remained unaltered in the DH of mice with EAE that manifested motor deficits but not increased pain. Interleukin-1ß (IL-1ß), tumor necrosis factor α (TNFα), and IL-6 expression were robustly increased in the DH of mice with EAE manifesting pain, whereas these cytokines showed a modest increase or no change in mice with EAE in the absence of pain. Only IL-1ß decreased PMCA2 levels in pure SC neuronal cultures through direct actions. CONCLUSIONS: PMCA2 is a contributor to neuropathic pain mechanisms in the DH. A decrease in PMCA2 in DH neurons is paralleled by increased pain sensitivity, most likely through perturbations in calcium signaling. Interleukin-1ß is one of the effectors that downregulates PMCA2 by acting directly on neurons.

[Electroacupuncture reduces obesity by improving metabolism and up-regulating expression of hypothalamic Sirtuin 1 and proopiomelanocortin in obese rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on expression of hypothalamic sirtuin 1(SIRT1) and proopiomelanocortin (POMC), and body weight, food-intake, blood glucose, and blood lipid levels in obese rats, so as to explore its mechanisms underlying improvement of obesity. METHODS: Forty male Wistar rats were randomly divided into normal, model, EA, and sham EA groups (n＝10 rats in each group). The obesity model was established by feeding the rats with high fat diet. EA (2 Hz, 1 mA) was applied to "Zusanli" (ST36), "Zhongwan" (CV12), "Guanyuan" (CV4) and "Fenglong" (ST40) or sham acupoints (about 5 mm beside each acupoint, shallow needling) for 20 min, once every other day for 8 weeks. The rats' body weight and food-intake were recorded. The blood glucose (fasting plasma glucose: FPG, postprandial plasma glucose: PPG) and blood lipids (triglyceride: TG, total cholesterol: TC, non esterified fatty acid: NEFA) were assayed by using an automatic biochemical analyzer. The protein and mRNA expression levels of SIRT1 and POMC in the hypothalamus were detected by Western blot and quantitative real-time PCR, respectively. RESULTS: In comparison with the normal group, the body weight, food-intake, blood lipids, and PPG levels were significantly increased (P<0.05，P<0.01), and the expression levels of SIRT1 protein and mRNA in the hypothalamus were significantly doun-regulated in the model group (P<0.05). Following EA, the body weight, food-intake, blood lipids, and PPG levels were considerably down-regulated (P<0.01，P<0.05), and the expression levels of SIRT1 and POMC protein and mRNA in the hypothalamus were significantly up-regulated in the EA group rather than those in the sham EA and the model groups (P<0.05)．. CONCLUSION: EA can reduce the obese rats' body weight, food-intake, blood lipids and blood glucose, which may be associated with its effect in up-regulating the SIRT1 and POMC expression of hypothalamus.

Loss of Gut Microbiota Alters Immune System Composition and Cripples Postinfarction Cardiac Repair.

BACKGROUND: The impact of gut microbiota on the regulation of host physiology has recently garnered considerable attention, particularly in key areas such as the immune system and metabolism. These areas are also crucial for the pathophysiology of and repair after myocardial infarction (MI). However, the role of the gut microbiota in the context of MI remains to be fully elucidated. METHODS: To investigate the effects of gut microbiota on cardiac repair after MI, C57BL/6J mice were treated with antibiotics 7 days before MI to deplete mouse gut microbiota. Flow cytometry was applied to examine the changes in immune cell composition in the heart. 16S rDNA sequencing was conducted as a readout for changes in gut microbial composition. Short-chain fatty acid (SCFA) species altered after antibiotic treatment were identified by high-performance liquid chromatography. Fecal reconstitution, transplantation of monocytes, or dietary SCFA or Lactobacillus probiotic supplementation was conducted to evaluate the cardioprotective effects of microbiota on the mice after MI. RESULTS: Antibiotic-treated mice displayed drastic, dose-dependent mortality after MI. We observed an association between the gut microbiota depletion and significant reductions in the proportion of myeloid cells and SCFAs, more specifically acetate, butyrate, and propionate. Infiltration of CX3CR1+ monocytes to the peri-infarct zone after MI was also reduced, suggesting impairment of repair after MI. Accordingly, the physiological status and survival of mice were significantly improved after fecal reconstitution, transplantation of monocytes, or dietary SCFA supplementation. MI was associated with a reorganization of the gut microbial community such as a reduction in Lactobacillus. Supplementing antibiotic-treated mice with a Lactobacillus probiotic before MI restored myeloid cell proportions, yielded cardioprotective effects, and shifted the balance of SCFAs toward propionate. CONCLUSIONS: Gut microbiota-derived SCFAs play an important role in maintaining host immune composition and repair capacity after MI. This suggests that manipulation of these elements may provide opportunities to modulate pathological outcome after MI and indeed human health and disease as a whole.

Development of Pectin-Type B Gelatin Polyelectrolyte Complex for Curcumin Delivery in Anticancer Therapy.

Curcumin has been proven to be a potent agent in colon cancer treatment. However, its hydrophobicity and low oral bioavailability hampered its clinical application. These limitations could be improved through appropriate formulations such as using polyelectrolyte complexes (PECs). PECs were self-assembled with polycations and polyanions in polar solvents. In this study, a novel pectin-type B gelatin PEC was developed for use in curcumin formulation. At pH 4.0, natural polyanions pectin and polycations type B gelatin spontaneously formed PECs in ethanol/water solution, whereas under mimetic gastrointestinal tract (GI tract) conditions, at pH 2.0 and 8.0, pectin and type B gelatin were electrically neutralized, and the PECs swelled to allow payload release. After being transferred to pH 7.0 condition, as in the colon environment, PECs were internalized into colon carcinomas. Thus, pectin-type B gelatin PECs were successfully prepared, and their constituent ratio and drug-loading process were also optimized. The optimum particle size of the PECs was 264.0 ± 3.1 nm and they could swell as the zeta potential was altered at either pH 2.0 or 8.0. The optimum drug content and loading efficiency were 40% and 53%, respectively. At pH 2.0, curcumin was rapidly released from curcumin-loaded PECs, whereas at pH 8.0, curcumin-loaded PECs showed a sustained-release of curcumin. The bare PECs showed very low toxicity toward human normal cells, whereas curcumin-loaded PECs, after incubation at pH 2.0 for 2 h and at pH 8.0 for 4 h, induced cell cycle arrest and exhibited cytotoxic effect to HCT116 human colon cancer cells, even though these loaded PECs were pretreated with mimetic GI tract conditions. Our pectin-type B gelatin PECs were shown to be a promising oral formulation for curcumin delivery in anticancer therapy.

Acupuncture for Myofascial Pain Syndrome: A Network Meta-Analysis of 33 Randomized Controlled Trials.

BACKGROUND: Acupuncture techniques are commonly used as initial treatments for myofascial pain syndrome. OBJECTIVE: This study aimed to assess and compare the efficacy and safety of different techniques of acupuncture for myofascial pain syndrome. STUDY DESIGN: Network meta-analysis. SETTING: All selected studies were randomized controlled trials (RCTs). METHODS: The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, and Chinese Biomedical Literature Database were searched from their inceptions to February 2016. Only full texts of RCTs comparing acupuncture therapies with any other therapies or placebo-sham acupuncture were included. Two reviewers independently assessed eligibility and extracted data. The primary outcomes included pain intensity, PPT, and adverse events. Secondary outcome was physical function. RESULTS: Thirty-three trials with 1,692 patients were included. Patients were allocated to 22 kinds of interventions, of which dry needling and manual acupuncture was the most frequently investigated intervention. Compared with placebo-sham acupuncture, scraping combined with warming acupuncture and moxibustion was found to be more effective for decreasing pain intensity (standardized mean difference (SMD) = -3.6, 95% confidence interval (CI) ranging from -5.2 to -2.1); miniscalpel-needle was more effective for increasing the PPT (SMD = 2.2, 95% CI ranging from 1.2 to 3.1); trigger points injection with bupivacaine was associated with the highest risk of adverse event (odds ratio = 557.2, 95% CI ranging from 3.6 to 86867.3); and only EA showed a significant difference in the ROM (SMD = -4.4, 95% CI ranging from -7.5 to -1.3). LIMITATIONS: Lack of clarity concerning treatment periods, repetitive RCTs, and other valuable outcome measurements. The potential bias might affect the judgment of efficacy and safety. CONCLUSIONS: The existing evidence suggests that most acupuncture therapies, including acupuncture combined with other therapies, are effective in decreasing pain and in improving physical function, but additional investigation on the safety of these therapies is required.Key words: Myofascial pain syndrome, acupuncture, anesthesia, efficacy, safety, network meta-analysis, systematic review, randomized controlled trials.

The anti-hyperplasia, anti-oxidative and anti-inflammatory properties of Qing Ye Dan and swertiamarin in testosterone-induced benign prostatic hyperplasia in rats.

Qing Ye Dan (QYD) is the whole plant of Swertia mileensis and used in Chinese folk medicine for the treatment of prostatitis, benign prostatic hyperplasia (BPH) and so on. This study was to investigate the effects of QYD and its main component swertiamarin on BPH induced by testosterone in rats. The prostatic expressions of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), basic fibroblast growth factor (ßFGF) and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemistry assay. Prostatic levels of oxidative stress and inflammatory-related factors were also analyzed. Additionally, the prostatic expressions of androgen receptor (AR), estrogen receptor (ER)-α, ER-ß, hypoxia-inducible factor (HIF)-1α, B-cell CLL/lymphoma (Bcl)-2 and Bcl-2-associated X protein (Bax) were measured by western blot. The epithelial-mesenchymal transition (EMT) associated factors were evaluated by quantitative RT-PCR. It showed that QYD and swertiamarin ameliorated the testosterone-induced prostatic hyperplasia and collagen deposition, attenuated the over-expressions of HIF-1α, VEGF, EGF, ßFGF, PCNA, AR and ER-α, reduced the ratio of Bcl-2/Bax, enhanced the expression of ER-ß, inhibited the oxidative stress and local inflammation, as well as relieved prostatic EMT. It suggested that QYD and swertiamarin had prostatic protective potential against BPH.

Mesh fixation methods in open inguinal hernia repair: a protocol for network meta-analysis and trial sequential analysis of randomised controlled trials.

INTRODUCTION: Randomised clinical trials (RCTs) have been used to compare and evaluate different types of mesh fixation usually employed to repair open inguinal hernia. However, there is no consensus among surgeons on the best type of mesh fixation method to obtain optimal results. The choice often depends on surgeons' personal preference. This study aims to compare different types of mesh fixation methods to repair open inguinal hernias and their role in the incidences of chronic groin pain, risk of hernia recurrence, complications, operative time, length of hospital stay and postoperative pain, using Bayesian network meta-analysis and trial sequential analysis of RCTs. METHODS AND ANALYSIS: A systematic search will be performed using PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database (CBM) and Chinese Journal Full-text Database, to include RCTs of different mesh fixation methods (or fixation vs no fixation) during open inguinal hernia repair. The risk of bias in included RCTs will be evaluated according to the Cochrane Handbook V.5.1.0. Standard pairwise meta-analysis, trial sequential analysis and Bayesian network meta-analysis will be performed to compare the efficacy of different mesh fixation methods. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required since this study is a meta-analysis based on published studies. The results of this network meta-analysis and trial sequential analysis will be submitted to a peer-reviewed journal for publication. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD42015023758.

Ozone therapy for treating foot ulcers in people with diabetes.

BACKGROUND: It has been reported that ozone therapy might be helpful in treating foot ulcers in people with diabetes mellitus (DM). OBJECTIVES: To assess the effects of ozone therapy on the healing of foot ulcers in people with DM. SEARCH METHODS: In March 2015 we searched: The Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Science Citation Index, Chinese Biomedical Literature Database and The Chinese Clinical Registry. There were no restrictions based on language, date or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared ozone therapy with sham ozone therapy or any other interventions for foot ulcers in people with DM, irrespective of publication date or language. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened all retrieved citations, selected relevant citations and extracted data. Disagreements were resolved by discussion with a third reviewer. The methodological quality of included studies and the evidence level of outcomes were assessed using the Cochrane risk of bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach respectively. Data were expressed using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with their 95% confidence interval (95% CI). Review Manager (RevMan) software was used to analyse the data. MAIN RESULTS: Three studies (212 participants) were included in this review. The overall risk of bias was high for two trials and unclear for one.One trial (101 participants) compared ozone treatment with antibiotics for foot ulcers in people with DM. The study had a follow-up period of 20 days. This study showed that ozone treatment was associated with a greater reduction in ulcer area from baseline to the end of the study than treatment with antibiotics (MD -20.54 cm(2), 95% CI -20.61 to -20.47), and a shorter duration of hospitalisation (MD -8.00 days, 95% CI -14.17 to -1.83), but did not appear to affect the number of ulcers healed over 20 days (RR 1.10, 95% CI 0.87 to 1.40). No side effects were observed in either group.The other two trials (111 participants) compared ozone treatment plus usual care with usual care for foot ulcers in people with DM. The meta-analysis results did not show evidence of a difference between groups for the outcomes of reduction of ulcer area (MD -2.11 cm(2), 95% CI -5.29 to 1.07), the number of ulcers healed (RR 1.69, 95% CI 0.90 to 3.17), adverse events (RR 2.27, 95% CI 0.48 to 10.79), or amputation rate (RR 2.73, 95%CI 0.12, 64.42). AUTHORS' CONCLUSIONS: The available evidence was three small RCTs with unclear methodology, so we are unable to draw any firm conclusions regarding the effectiveness of ozone therapy for foot ulcers in people with DM.

Garlic in clinical practice: an evidence-based overview.

BACKGROUND AND OBJECTIVE: Garlic has been widely used in clinical practice, and there were many systematic reviews (SRs) describing its effects. But none reviewed the clinical utility comprehensively, so we aimed to evaluate its effects from every aspect of its effects. METHODS: We comprehensively searched medical electronic databases, asked the experts in this field, along with reference tracking, and manual searching. We included all kinds of SRs, including Cochrane SRs and non-Cochrane SRs. Two authors independently selected articles for relevant SRs, and extracted data of included SRs, resolved differences by consultation with a third reviewer. RESULTS: We described nine SRs about garlic. Available evidence showed that garlic can reduce blood pressure (BP) in hypertensive patients and patients with elevated systolic BP (SBP), but not in normotensive subjects. Evidence about the effects of garlic on lipid parameters was contentious, so we cannot make a decision whether garlic is effective enough for reducing total cholesterol (TC), triglycerides (TAG), and high-density lipoprotein (HDL). As evidence was very limited and insufficient, relations between garlic intake and reduced risks of all kinds of cancers, antiglycemic and antithrombotic effects of garlic, the effects of garlic on cardiovascular morbidity and mortality were unclear. Garlic as a preventative or treatment option for the common cold or peripheral arterial occlusive disease or pre-eclampsia and its complications could not be recommended, as only one relatively small trial evaluated the effects separately. CONCLUSIONS: Garlic might be effective in some areas of clinical practice, but the evidence levels were low, so further researches should be well designed using rigorous method to avoid potential biases.

Single-layer single-crystalline SnSe nanosheets.

Single-layer single-crystalline SnSe nanosheet with four-atomic thickness of ~1.0 nm and lateral size of ~300 nm is presented here by using a one-pot synthetic method. It is found that 1,10-phenanthroline plays an important role in determining the morphology of the SnSe product as three-dimensional SnSe nanoflowers are obtained in the absence of 1,10-phenanthroline while keeping other reaction parameters the same. The evolution process study discloses that single-crystalline nanosheets are obtained from the coalescence of the SnSe nucleus in an orientated attachment mechanism. Band gap determination and optoelectronic test based on hybrid films of SnSe and poly(3-hexylthiophene) indicate the great potential of the ultrathin SnSe nanosheets in photodector and photovoltaic, and so forth.