Emodin Inhibits Lipopolysaccharide-Induced Inflammation by Activating Autophagy in RAW 264.7 Cells.

OBJECTIVE: To investigate the effects of emodin on inflammation and autophagy in lipopolysaccharide (LPS)-induced RAW 264.7 macrophages and reveal its underlying mechanism. METHODS: 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay was conducted to find the appropriate dose for emodin. RAW264.7 cells pretreated with different concentrations (0-50 µmol/L) of emodin or vehicle for 2 h prior to exposure to LPS for 16 h. Cell morphology was examined and propidium iodide staining was used to examine cell cycle. Expressions of inflammation-related proteins [nuclear factor-kappaB (NF-κ B) and I-kappaB (I κ B)α] and autophagy-related proteins [light chain (LC)3, P62/sequestosome 1, mammalian target of rapamycin (mTOR), and p-mTOR] were examined using Western blot analysis. Expression of inflammation-related cytokines including tumor necrosis factor (TNF)-α, interleukin (IL)-1ß and IL-6 were detected by enzyme-linked immunosorbent assay. Autophagy was examined with LC3B fluorescence intensity and aggregation. The effect of emodin on autophagy was conducted with an autophagy inhibitor, 3-methyladenine (3-MA). RESULTS: The expression of NF-κ B in LPS-induced cells was significantly increased (P<0.01) and simultaneously I κ B α decreased compared with the normal cell (P<0.05). The expressions of TNF-α, IL-ß, and IL-6 proteins in the LPS-induced RAW264.7 cells were significantly higher than in the normal cell (P<0.05 or P<0.01). LPS increased the percentage of cells in the G0/G1 phase, which was recovered by emodin at different doses (12.5, 25, and 50µ mol/L, P<0.05 or P<0.01). The medium-dose (25 µ ml/L) emodin decreased the expressions of NF-κ B, P62 and p-mTOR (P<0.01) and increased I κ B α expression, LC3B II/I ratio as well as LC3B fluorescence intensity (P<0.05 or P<0.01). Meanwhile, the enhanced autophagic effects of emodin, such as the increment of LC3B II/ratio and the decrement of P62 expression, were suppressed by autophagy inhibitor 3-MA. CONCLUSION: Emodin could inhibit inflammation of mice RAW264.7 macrophages induced by LPS, possibly through activating autophagy.

Chinese medicine syndromes in congestive heart failure: A literature study and retrospective analysis of clinical cases.

OBJECTIVE: To discuss the characteristics of Chinese medicine (CM) syndrome factors and distribution of congestive heart failure (CHF), and provide a basis for the diagnosis criteria of essential syndromes. METHODS: Based on databases of China National Knowledge Infrastructure (CNKI, 1980-2012) and Chinese Journal of Chongqing VIP Database (1989-2012), the eligible studies in CHF and extracted factors associated with compound syndromes were analyzed. All the syndromes were classified into deficiency, excess, and deficiency-excess in complexity syndrome were classified. Compound syndromes were separated into syndrome factors including single, double, three or four factors, along with the frequency of occurrence. The relation of CHF syndromes with age, gender, primary disease, brain natriuretic peptide (BNP) and cardiac functional grade was studied in 1,451 CHF cases (between December 2010 and September 2012), and the clinical distribution of common CHF syndromes was summarized. RESULTS: The literature study involved 6,799 CHF cases in 66 literatures after screening. Of the different factors affecting CHF, qi deficiency was the most important one. In deficiency syndrome, Xin (Heart)-qi-deficiency was the most common single factor, and deficiency of both qi and yin was the most common double factor. The retrospective analysis involved 1,451 CHF cases (431 cases with test results of BNP). The xin blood stasis and obstruction and deficiency of both qi and yin syndrome were mostly seen in female patients, and phlegm-blocking-Xin-vessel and qi-deficiency-blood-stasis syndrome mostly in males. Xin-qi-deficiency and qi-deficiency-blood-stasis syndrome were mostly seen in patients aged 50-60 years. Patients aged over 60 years likely manifest deficiency of both qi and yin and Xin blood stasis and obstruction syndrome. The severity of syndrome is aggravated with increased BNP and cardiac functional grade. CONCLUSIONS: The essential syndromes of CHF include qi-deficiency-blood-stasis and deficiency of both qi and yin. The clinical distribution is linked to patients' age and gender. BNP and cardiac functional grade is closely related to CHF syndromes, which may indicate the severity of CM syndromes of CHF.

The application status of Chinese herbal medicine in military health service in China.

Military medicine has had a long history in China since the emergence of the war. Chinese medicine, especially Chinese herbs, was widely used in China as well as other Asian countries for the prevention and treatment of diseases in the military for hundreds of years. However, the use of Chinese medicine in military health service has never been well studied. In this article, we briefly summarize the application status of Chinese herbal medicine in military health service in China, putting particular emphasis on special military environment, in an attempt to build a bridge between Chinese medicine and military health service and promote the quality of health service for the military and maintain world peace.

How do systematic reviews of acupuncture for pain relief incorporate risk of bias assessments into the synthesis? A methodological study.

OBJECTIVE: By reviewing the assessment of internal validity in relevant systematic reviews (SRs), the aim of this study was to identify how critical appraisals of risk of bias (RoB) inform the synthesis of evidence in SRs of acupuncture for pain relief. METHODS: SRs were searched in Medline, EMBASE, and the Cochrane Database of SRs from their inception to 30 December 2014. Only SRs of acupuncture for pain relief were included. Basic information, types of RoB appraisal tool, whether or not there was domain-level assessment of RoB, whether or not the reviews ranked studies by RoB, plus whether or not (and, if so, how) RoB appraisal was incorporated into the synthesis were determined. RESULTS: A total of 91 SRs met the inclusion criteria and were included in the final analysis. Over half of the SRs (85, 64.8%) used standard tools, such as the Jadad quality score and the Cochrane RoB tool, followed by adapted tools (n=23, 25.3%). Of the 85 SRs that assessed RoB, 29 (34.1%) presented domain-level assessment and 71 SRs (83.5%) included ranking of the studies based on RoB assessment. Of these 71, 35 (49.4%) used a cut-off threshold score and 26 (36.6%) required all criteria sum-up. Of the 85 SRs that assessed RoB, 48 (56.5%) incorporated RoB appraisal into the data synthesis. CONCLUSIONS: Although most SRs of acupuncture for pain relief conducted some form of RoB assessment, nearly half of them failed to incorporate the RoB assessment into the synthesis.

Glutamine supplementation for critically ill adults.

BACKGROUND: Glutamine is a non-essential amino acid which is abundant in the healthy human body. There are studies reporting that plasma glutamine levels are reduced in patients with critical illness or following major surgery, suggesting that glutamine may be a conditionally essential amino acid in situations of extreme stress. In the past decade, several clinical trials examining the effects of glutamine supplementation in patients with critical illness or receiving surgery have been done, and the systematic review of this clinical evidence has suggested that glutamine supplementation may reduce infection and mortality rates in patients with critical illness. However, two recent large-scale randomized clinical trials did not find any beneficial effects of glutamine supplementation in patients with critical illness. OBJECTIVES: The objective of this review was to:1. assess the effects of glutamine supplementation in critically ill adults and in adults after major surgery on infection rate, mortality and other clinically relevant outcomes;2. investigate potential heterogeneity across different patient groups and different routes for providing nutrition. SEARCH METHODS: We searched the Cochrane Anaesthesia Review Group (CARG) Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 5); MEDLINE (1950 to May 2013); EMBASE (1980 to May 2013) and Web of Science (1945 to May 2013). SELECTION CRITERIA: We included controlled clinical trials with random or quasi-random allocation that examined glutamine supplementation versus no supplementation or placebo in adults with a critical illness or undergoing elective major surgery. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the relevant information from each included study using a standardized data extraction form. For infectious complications and mortality and morbidity outcomes we used risk ratio (RR) as the summary measure with the 95% confidence interval (CI). We calculated, where appropriate, the number needed to treat to benefit (NNTB) and the number needed to treat to harm (NNTH). We presented continuous data as the difference between means (MD) with the 95% CI. MAIN RESULTS: Our search identified 1999 titles, of which 53 trials (57 articles) fulfilled our inclusion criteria. The 53 included studies enrolled a total of 4671 participants with critical illness or undergoing elective major surgery. We analysed seven domains of potential risk of bias. In 10 studies the risk of bias was evaluated as low in all of the domains. Thirty-three trials (2303 patients) provided data on nosocomial infectious complications; pooling of these data suggested that glutamine supplementation reduced the infectious complications rate in adults with critical illness or undergoing elective major surgery (RR 0.79, 95% CI 0.71 to 0.87, P ＜ 0.00001, I² = 8%, moderate quality evidence). Thirty-six studies reported short-term (hospital or less than one month) mortality. The combined rate of mortality from these studies was not statistically different between the groups receiving glutamine supplement and those receiving no supplement (RR 0.89, 95% CI 0.78 to 1.02, P = 0.10, I² = 22%, low quality evidence). Eleven studies reported long-term (more than six months) mortality; meta-analysis of these studies (2277 participants) yielded a RR of 1.00 (95% CI 0.89 to 1.12, P = 0.94, I² = 30%, moderate quality evidence). Subgroup analysis of infectious complications and mortality outcomes did not find any statistically significant differences between the predefined groups. Hospital length of stay was reported in 36 studies. We found that the length of hospital stay was shorter in the intervention group than in the control group (MD -3.46 days, 95% CI -4.61 to -2.32, P < 0.0001, I² = 63%, low quality evidence). Slightly prolonged intensive care unit (ICU) stay was found in the glutamine supplemented group from 22 studies (2285 participants) (MD 0.18 days, 95% CI 0.07 to 0.29, P = 0.002, I² = 11%, moderate quality evidence). Days on mechanical ventilation (14 studies, 1297 participants) was found to be slightly shorter in the intervention group than in the control group (MD - 0.69 days, 95% CI -1.37 to -0.02, P = 0.04, I² = 18%, moderate quality evidence). There was no clear evidence of a difference between the groups for side effects and quality of life, however results were imprecise for serious adverse events and few studies reported on quality of life. Sensitivity analysis including only low risk of bias studies found that glutamine supplementation had beneficial effects in reducing the length of hospital stay (MD -2.9 days, 95% CI -5.3 to -0.5, P = 0.02, I² = 58%, eight studies) while there was no statistically significant difference between the groups for all of the other outcomes. AUTHORS' CONCLUSIONS: This review found moderate evidence that glutamine supplementation reduced the infection rate and days on mechanical ventilation, and low quality evidence that glutamine supplementation reduced length of hospital stay in critically ill or surgical patients. It seems to have little or no effect on the risk of mortality and length of ICU stay, however. The effects on the risk of serious side effects were imprecise. The strength of evidence in this review was impaired by a high risk of overall bias, suspected publication bias, and moderate to substantial heterogeneity within the included studies.

[Application and research of acupuncture in military].

Acupuncture has remarkable effects of pain relieving and functional restoration on injuries of soft tissue and joint due to military training. As more and more attention has been attached to the impact of psychological states and biorhythm disorder on the fighting ability of military staff, acupuncture has found its place in treating chronic fatigue, combat stress reaction, traumatic brain injury and post-traumatic stress disorder as well as regulating circadian rhythms. The therapeutic effect of acupuncture in military training-related physical damage and psychological trauma has already been proved by numerous clinical practices and researches. It is held that using acupuncture as an alternative could not only save medical resources, but also enhance the fighting ability of the army. However, the current clinical studies is facing the problem of limited sample size. Therefore, randomized controlled trials in large scale and multiple centers should be further carried out toward military staff, so as to provide more speaking evidences to the prevention and treatment of physical and psychological diseases.

[Chinese herbal medicine for side effects of transarterial chemoembolization in liver cancer patients: a systematic review and meta-analysis].

BACKGROUND: Primary liver cancer is one of the most commonly seen tumors in clinical practice. Due to the stealthiness and fast progress of liver cancer, only 20% of the patients may have chance to receive operation for radical therapy. Patients seldom get benefit from systematic chemotherapy and as a result, local chemotherapy methods such as transarterial chemoembolization (TACE) have become the mainstay in the treatment of liver cancer. Compared with systematic chemotherapy, TACE produces fewer side effects and most of such side effects are caused by postembolization syndrome manifested as nausea and vomiting, abdominal pain, fever, loss of appetite, etc. OBJECTIVE: In this systematic review, effects of Chinese herbal medicine (CHM) in relieving side effects caused by TACE in patients with liver cancer were evaluated and meta-analysis was conducted when possible. SEARCH STRATEGY: Literature search was conducted on August 23rd, 2011. The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE (Ovid SP), EMBASE (Ovid SP), and Science Citation Index Expanded, China National Knowledge Infrastructure Database, Chongqing VIP Database and Wanfang Data were searched with no time limits. INCLUSION CRITERIA: Randomized clinical trials (RCTs) of CHM for TACE-induced side effects in patients with primary liver cancer were eligible for this review, regardless of blinding, language, or publication status. DATA EXTRACTION AND ANALYSIS: Search results were screened to select the trials included in this review according to the inclusion criteria, and data were extracted from all the included RCTs by using a self-developed data extraction form. Assessment of risk of bias in included studies was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention (Version 5.0.2): Criteria for judging risk of bias in the "risk of bias" assessment tool. Dichotomous data were expressed as risk ratio with its 95% confidence interval (CI). Continuous outcomes were expressed as mean differences with 95% CI. If there was no significant heterogeneity, the results from the fixed-effect model were presented. If the heterogeneity was not substantial, the results from the random-effect model were presented. If the heterogeneity was substantial, a meta-analysis was not performed and a narrative, qualitative summary was performed instead. In the event of substantial clinical, methodological, or statistical heterogeneity, the trial components such as patients, diseases, interventions, comparisons, and outcomes in the included trials were reviewed to decide the reason for heterogeneity. RESULTS: A total of 47 RCTs were included in this review after screening the search results. Among them, 46 were in Chinese and 1 was in English; 43 were journal articles and 4 were academic dissertations; all the authors were from mainland China and all the trials were conducted in mainland China. The results of assessment of risk of bias showed that there was unclear or high risk of bias in most of the included RCTs and thus they were all with low quality. The results of systematic evaluation and meta-analysis showed that CHM was beneficial to patients with liver cancer in prolonging life expectancy, improving quality of life, reducing side effects of TACE such as nausea and vomiting, fever, liver pain, and bone marrow suppression, improving liver function indexes and immunological indexes, and enhancing objective curative effect on the tumor size. However, due to the substantial heterogeneity presented in most of the indexes, only descriptive analysis was conducted for these indexes. The results of the heterogeneity analysis showed that the causes of substantial heterogeneity may be due to the obvious difference in treatment protocol, components and dosage form of CHM, time for delivering drugs and course of treatment. CONCLUSION: CHM is effective in prolonging life expectancy, improving quality of life, and reducing side effects of TACE in the treatment of liver cancer. However, due to the undesirable quality of the included RCTs and the substantial heterogeneity, most of the outcome measure indexes were failed to be meta-analyzed, and thus the significance of this review for clinical practice was limited.

Scientific publications from mainland China, Taiwan, and Hong Kong in integrative and complementary medicine journals: a ten-year literature survey.

Practitioners and researchers from China, the largest user of complementary and alternative medicine (CAM), have been publishing an increasing number of scientific articles in world-famous CAM journals in recent years. However, the status of CAM research in the three major regions of China, the Mainland, Taiwan and Hong Kong has, until now, not been reported. In this study, we compared articles from these three regions published in international CAM journals from 2000 to 2009 using PubMed database and the Journal Citation Reports. The study results showed that the number of published articles from Mainland China increased significantly from 2000 to 2009, particularly since 2005. Meanwhile, the number of published articles from Taiwan also increased, whereas those from Hong Kong remained steady. Clinical trials and randomized controlled trials from Chinese authors both took a small percentage of the total. The impact factors of the journals in which these articles were published suggested similar academic levels whereas the average number of citation of articles from the Mainland was less than those from the other two regions. Journal of Ethnopharmacology, American Journal of Chinese Medicine, Journal of Alternative and Complementary Medicine and Evidence-based Complementary and Alternative Medicine were the most popular journals for Chinese authors.

[Does the utilization of traditional Chinese herbs threaten the biodiversity?].

In the view of the idea that the utilization of wild plants and animals in traditional Chinese medicine is destroying the biodiversity, this article discusses the relationship between traditional Chinese medicine and the biodiversity from a new point of view. The authors consider that reasonable utilization of the wildlife in traditional Chinese herbal medicine is beneficial to the protection of wildlife under proper management and guidance. However, there is still a long way to go to balance the relationship between the wildlife protection and exploration. In view of this, some propositions are put forward, including enforcing the relative laws and rules for herbal resources protection, carrying out the research work of the background data, formulating the standard for the classification of the rare and endangered species, accelerating the investigation of the substitute resources of extinctive wildlife for medical use, enforcing the citizens' consciousness of wildlife protection and developing the industrial and artificial cultivation of traditional Chinese herbal medicinal plants and animals.