Case report: Gitelman syndrome with diabetes: Confirmed by both hydrochlorothiazide test and genetic testing.

RATIONALE: Gitelman syndrome (GS) is an autosomal recessive tubulopathy caused by mutations of the SLC12A3 gene. It is characterized by hypokalemic metabolic alkalosis, hypomagnesemia and hypocalciuria. Hypokalemia, hypomagnesemia, and increased renin-angiotensin-aldosterone system (RAAS) activity can cause glucose metabolism dysfunction. The diagnosis of GS includes clinical diagnosis, genetic diagnosis and functional diagnosis. The gene diagnosis is the golden criterion while as functional diagnosis is of great value in differential diagnosis. The hydrochlorothiazide (HCT) test is helpful to distinguish GS from batter syndrome, but few cases have been reported to have HCT testing. PATIENT CONCERNS: A 51-year-old Chinese woman presented to emergency department because of intermittent fatigue for more than 10 years. DIAGNOSES: Laboratory test results showed hypokalemia, hypomagnesemia, hypocalciuria and metabolic alkalosis. The HCT test showed no response. Using next-generation and Sanger sequencing, we identified 2 heterozygous missense variants (c.533C > T:p.S178L and c.2582G > A:p.R861H) in the SLC12A3 gene. In addition, the patient was diagnosed with type 2 diabetes mellitus 7 years ago. Based on these findings, the patient was diagnosed with GS with type 2 diabetic mellitus (T2DM). INTERVENTIONS: She was given potassium and magnesium supplements, and dapagliflozin was used to control her blood glucose. OUTCOMES: After treatments, her fatigue symptoms were reduced, blood potassium and magnesium levels were increased, and blood glucose levels were well controlled. LESSONS: When GS is considered in patients with unexplained hypokalemia, the HCT test can be used for differential diagnosis, and genetic testing can be continued to confirm the diagnosis when conditions are available. GS patients often have abnormal glucose metabolism, which is mainly caused by hypokalemia, hypomagnesemia, and secondary activation of RAAS. When a patient is diagnosed with GS and type 2 diabetes, sodium-glucose cotransporter 2 inhibitors (SGLT2i) can be used to control the blood glucose level and assist in raising blood magnesium.

Removal of Cd from contaminated farmland soil by washing with residues of traditional Chinese herbal medicine extracts.

Soil washing is one of the effective methods for permanent removal of heavy metals from farmland soil, and selection of washing agents determines heavy metal removal efficiency. However, there is still a lack of cost-efficient and eco-friendly washing agents. In this study, three residues of traditional Chinese herbal medicine (RTCHM) extracts: residues of Prunus mume (Sieb.) Sieb. et Zucc. (RPM), residues of Schisandra chinensis (Turcz.) Baill. (RSC), and residues of Crataegus pinnatifida Bunge (RCP), were tested for their potential of Cd removal. The variations in amounts and compositions of dissolved organic carbon (DOC) and citric acid were responsible for the difference in Cd removal efficiencies of RTCHM extracts. Fourier-transform infrared spectrophotometer (FTIR) analysis showed that hydroxyl, carboxyl, and amine were the main functional groups of RTCHM extracts to chelate with heavy metals. The optimum conditions for RTCHM extracts were 100 g L-1 concentration, solid-liquid ratio 1:10, pH 2.50, and contact time of 1 h, and the highest Cd removal efficiencies of RPM, RSC, and RCP extracts reached 35%, 11%, and 15%, respectively. The ecological risk of Cd decreased significantly due to the decrease of exchangeable and reducible Cd fractions. RTCHM extracts washing alleviated soil alkalinity and had little effect on soil cation exchange capacity. Meanwhile, the concentrations of soil organic matter and nitrogen were enhanced significantly by RPM extracts and the activities of soil catalase and urease were also improved. Overall, among the tested extracts, RPM extracts was a much more feasible and environment-friendly washing agent for the remediation of Cd-contaminated farmland soil.

The effect and mechanism of traditional Chinese exercise for chronic low back pain in middle-aged and elderly patients: A systematic review.

Background: Increasing lines of evidence indicate that traditional Chinese exercise (TCE) has potential benefits in improving chronic low back pain (CLBP) symptoms. To assess the clinical efficacy of TCE in the treatment of CLBP, we performed a systematic review of existing randomized controlled trials (RCTs) of CLBP and summarized the neural mechanisms underlying TCE in the treatment of CLBP. Methods: A systematic search was conducted in four electronic databases: PubMed, Embase, the Cochrane Library, and EBSCO from January 1991 to March 2022. The quality of all included RCTs was evaluated by the Physiotherapy Evidence Database Scale (PEDro). The primary outcomes included pain severity and pain-related disability. Results: A total of 11 RCTs with 1,256 middle-aged and elderly patients with CLBP were included. The quality of all 11 included RCTs ranged from moderate to high according to PEDro. Results suggested that TCE could considerably reduce pain intensity in patients with CLBP. Overall, most studies did not find any difference in secondary outcomes (quality of life, depression, and sleep quality). Conclusion: The neurophysiological mechanism of TCE for treating CLBP could be linked to meditation and breathing, posture control, strength and flexibility training, and regulation of pain-related brain networks. Our systematic review showed that TCE appears to be effective in alleviating pain in patients with CLBP.

The combined impacts of selenium and phosphorus on the fate of arsenic in rice seedlings (Oryza sativa L.).

Although the single role of selenium (Se) or phosphorus (P) in regulating the As contamination of rice plants has been reported in some studies, the combined impacts of Se and P on the fate of As and the underlying mechanisms are poorly understood. To address this knowledge gap, the uptake, translocation, and biotransformation of As mediated by Se were investigated in rice (Oryza sativa L.) seedlings hydroponically cultured with P-normal and P-deficient conditions. The results showed Se addition stimulated the uptake of arsenite and arsenate by 15.6% and 30.7%, respectively in P-normal condition, and such effect was more profound in P-deficient condition with the value of 43.8% and 70.8%. However, regardless of Se addition, P-deficiency elevated the As uptake by 47.0%-92.1% for arsenate but had no obvious effects for arsenite. Accompanying with the As transfer factorShoot/Root reduced by 74.5%-80.2% and 71.1%-85.7%, Se addition decreased the shoot As content by 65.8%-69.7% and 59.6%-73.1%, respectively, in the arsenite- and arsenate-treated rice plants. Relative to the corresponding treatments of P-normal condition, P-deficiency reduced the As transfer factorShoot/Root by 38.9%-52.5% and thus decreasing the shoot As content by 35.2%-42.5% in the arsenite-treated plants; while the opposite impacts were observed in the arsenate-treated plants, in which the shoot As content was increased by 22.4%-83.7%. The analysis results of As species showed As(III) was dominant in both shoots (68.9%-75.1%) and roots (94.9%-97.2%), and neither Se addition nor P-deficiency had obvious impacts on the interconversion between As(III) and As(V). Our results demonstrate the regulating roles of Se in As accumulation mainly depend on P regimes and the specific rice tissues, but the effects of P-deficiency on the fate of As were influenced by the form of As added to the culture.

[Release rule of volatile components of moxa sticks with increase of temperature].

OBJECTIVE: To systematically investigate the changes rule of volatile oil and its main components released from moxa sticks under different headspace temperatures and combustion conditions, so as to guide the clinical rational selection of the temperature for moxa sticks. METHODS: Using the headspace gas chromatography-mass spectrometry (HS-GCMS) technique, the released gas from moxa sticks was collected at the headspace temperature (from room temperature [25 ℃] to 190 ℃) and during combustion. One mL of the gas was injected into 6890/5973N gas chromatography-mass spectrometry (GCMS). The release rates of volatile components of moxa sticks were calculated by total ion chromatography (TIC) and butanone internal standard method. The volatile components of moxa sticks were qualitatively analyzed by analyzing the mass spectra of each volatile component and matching the Nist 14 standard mass spectrometry library. By comparing and analyzing the peak intensity changes rule of 1,8-cineole and its main harmful components (benzene, toluene and phenol) under different headspace temperatures and combustion conditions, the optimal temperature for clinical use of moxa sticks was found. RESULTS: At room temperature and 50 ℃, the release rate of volatile components from moxa sticks was very low, and it showed a significant increase trend with the increase of temperature. When the headspace temperature was 190 ℃, the release rate of volatile components from moxa sticks reached 0.864 2%, which was 2 161 times as same as that at room temperature. After combustion, it dropped sharply to 0.027 9%, which was 96.8% lower than that at the headspace temperature of 190 ℃. When the headspace temperature was 125 ℃ and 150 ℃, the content of 1,8-cineole, a typical beneficial component in the volatile components of moxa sticks, was the highest. When the headspace temperature was higher than 150 ℃, its content showed a significant downward trend. Under combustion conditions, a large number of harmful substances, such as benzene, toluene and phenol, were detected. CONCLUSION: The combustion condition is not conducive to the efficient utilization of the volatile oil of moxa sticks. Temperature of 125-150 ℃ is the best for releasing the volatile components of moxa sticks, which is not only conducive to the release of the beneficial volatile components of moxa sticks, but also can greatly inhibit the production of harmful components.

X anthium Orientale subsp. Italicum (Moretti) Greuter: bioassay-guided isolation and its chemical basis of antitumor cytotoxicity.

Inspired by the allelopathetic effects of Xanthium orientale subsp. italicum (Moretti) Greuter, bioassay-guided isolation was employed to identify its antitumor constituents and clarify the chemical basis of its multitarget activity. Among four fractions of X.orientale extraction, TCM-fr and PE-fr were discovered to exhibit significant cytotoxicity aganist HepG two and A549 cells, which were further isolated by chromatographic methods to yield 16 compounds, including six active ones: xanthatin (1), xanthinosin (2), lupeol (6), oleanolic acid (9), betulinic acid (10) and emodin (12) with IC50 of 10 ∼ 120µM. The systematically study of antitumor constituents has firstly provided a chemical basis for the multitarget and synergistic anticancer activity of the genus Xanthium. The method presented could be utilized to guide the exploitation and promising utilization of X. orientale on cancer therapy.

Ganoderma lucidum Exerts an Anticancer Effect on Human Osteosarcoma Cells via Suppressing the Wnt/ß-Catenin Signaling Pathway.

Background: Current treatment of osteosarcoma is limited in part by side effects and low tolerability, problems generally avoided with traditional Chinese medicine. Ganoderma lucidum, a traditional Chinese medicine with antitumor effects, offers a potential alternative, but little is known about its molecular mechanisms in osteosarcoma cells. Objective: To investigate the effect of G lucidum on osteosarcoma cells and its mechanism. Methods: Osteosarcoma MG63 and U2-OS cells were treated with G lucidum, followed by assays for cell proliferation (Cell Counting Kit-8), colony formation, and apoptosis (Alexa Fluor 647-Annexin V/propidium iodide, flow cytometry). Migration and invasion of cells were assessed by wound healing and Transwell invasion assays, and the effect of G lucidum on Wnt/ß-catenin signal transduction was studied by real-time quantitative polymerase chain reaction, western blot, and dual-luciferase assay. Results:G lucidum inhibited the proliferation, migration, and invasion, and induced apoptosis of human osteosarcoma MG63 and U2-OS cells. Dual-luciferase assay showed that G lucidum suppressed the transcriptional activity of T-cell factor/lymphocyte enhancer factor in the Wnt/ß-catenin signaling pathway. Moreover, G lucidum blocked Wnt/ß-catenin signaling by inhibiting the Wnt co-receptor LRP5 and Wnt-related target genes, such as ß-catenin, cyclin D1, C-Myc, MMP-2, and MMP-9. At the same time, when Wnt/ß-catenin was inhibited, the expression of E-cadherin was upregulated. Conclusions: Our results suggest that G lucidum broadly suppresses osteosarcoma cell growth by inhibiting Wnt/ß-catenin signaling.

[Transcriptomics study on mechanism of Aconiti Lateralis Radix Praeparata in treatment of rats with acute heart failure].

In this study,transcriptomics technique was used to investigate the mechanism of action of Aconiti Lateralis Radix Praeparata on acute heart failure rats induced by propafenone hydrochloride.First,rats were randomly divided into normal group,model group and administration group(1.25,2.5,5 g·kg-1).A rat with acute heart failure was constructed by intravenous femoral administration of proparone hydrochloride.The changes of heart rate,+dp/dtmaxand-dp/dtmaxat 5,10,20,30 and 60 min were recorded.Then another group of rats were given the same drug delivery method.In another group of animals,serum TNF-α could be determined by ELISA with the same dosage method.High-throughput sequencing technology was used to detect all gene expression differences in cardiac tissue samples of rats with acute heart failure.Through functional annotation and enrichment analysis,gene expression signaling pathways of rats with acute heart failure and rats with post-administration heart failure were screened out.The results showed that heart rate and LV+dp/dtmaxand LV-dp/dtmaxwere significantly decreased in the model group(P<0.05),while heart rate and LV+dp/dtmax and LV-dp/dtmaxwere significantly increased in the drug group(P<0.05,P<0.01).Moreover,ANP,BNP and TNF-α in acute heart failure rats was significantly decreased in high-dose aconite decoction group(P<0.05).Transcriptomics analysis showed that the mechanism of action was mainly related to activation of PI3 K-AKT signaling pathway and Jak-STAT pathway.Compared with the model group,aconite decoction up-regulated the expression of phosphatidylinostol 3-kinase(PI3 K),lysophosphatidic acid(LAP3),Bcl-3 and STAT genes,and down-regulated the expression of integrin(ITGA),nuclear orphan receptor(Nur77) genes.It could be concluded that the mechanism of aconite in treating acute heart failure rats may be related to the regulation of the PI3 k-Akt/Jak-STAT pathway.

Transcriptomics study on mechanism of Aconiti Lateralis Radix Praeparata in treatment of rats with acute heart failure / 中国中药杂志

In this study,transcriptomics technique was used to investigate the mechanism of action of Aconiti Lateralis Radix Praeparata on acute heart failure rats induced by propafenone hydrochloride.First,rats were randomly divided into normal group,model group and administration group(1.25,2.5,5 g·kg-1).A rat with acute heart failure was constructed by intravenous femoral administration of proparone hydrochloride.The changes of heart rate,+dp/dtmaxand-dp/dtmaxat 5,10,20,30 and 60 min were recorded.Then another group of rats were given the same drug delivery method.In another group of animals,serum TNF-α could be determined by ELISA with the same dosage method.High-throughput sequencing technology was used to detect all gene expression differences in cardiac tissue samples of rats with acute heart failure.Through functional annotation and enrichment analysis,gene expression signaling pathways of rats with acute heart failure and rats with post-administration heart failure were screened out.The results showed that heart rate and LV+dp/dtmaxand LV-dp/dtmaxwere significantly decreased in the model group(P<0.05),while heart rate and LV+dp/dtmax and LV-dp/dtmaxwere significantly increased in the drug group(P<0.05,P<0.01).Moreover,ANP,BNP and TNF-α in acute heart failure rats was significantly decreased in high-dose aconite decoction group(P<0.05).Transcriptomics analysis showed that the mechanism of action was mainly related to activation of PI3 K-AKT signaling pathway and Jak-STAT pathway.Compared with the model group,aconite decoction up-regulated the expression of phosphatidylinostol 3-kinase(PI3 K),lysophosphatidic acid(LAP3),Bcl-3 and STAT genes,and down-regulated the expression of integrin(ITGA),nuclear orphan receptor(Nur77) genes.It could be concluded that the mechanism of aconite in treating acute heart failure rats may be related to the regulation of the PI3 k-Akt/Jak-STAT pathway.

Chinese Herbal Medicine for Vascular Dementia: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials.

BACKGROUND: Vascular dementia (VaD) is the second common form of dementia and Chinese herbal medicine (CHM) has been used for aging-related disorders for thousands of years. However, there is still a lack of scientific evidence using CHM for VaD. OBJECTIVE: To conduct a systematic review to assess the current evidence available for the effectiveness and safety of CHM for VaD. METHODS: Six databases were searched for high-quality randomized-controlled clinical trials that met the requirements of at least 4 of the 7 domains of the Cochrane risk of bias tool from their inception to February 2017. RevMan 5.3 was applied for data analysis. RESULTS: Forty studies with 42 comparisons and 3,572 individuals were included. The studies investigated the CHM versus placebo (n = 4), CHM versus western conventional treatment (WCT) (n = 36), and CHM plus WCT versus WCT (n = 2). Meta-analysis showed that CHM for VaD could improve Mini-Mental State Examination (MMSE), the Activities of Daily Living, Hasegawa's dementia scale, and clinical effective rate but had statistically similar effect based on Blessed Behavior Scale (BBS) outcome when compared with WCTs. When compared with placebo, CHMs were more beneficial in improving MMSE but showed no significant difference in BBS scores. CHM as adjuvant therapy exerted an additive anti-VaD benefit on MMSE scores. The participants of CHM group had fewer adverse events than that of the placebo group or WCT group. CONCLUSION: The findings of the present study support, at least to an extent, that CHM can be recommended for routine use for treatment of VaD.

Assessment of the embryotoxicity of four Chinese herbal extracts using the embryonic stem cell test.

Rhizoma Atractylodes macrocephala, Radix Isatidis, Coptis chinensis and Flos Genkwa are common herbal remedies used by pregnant woman in China. In this study, their potential embryotoxicity was assessed using the embryonic stem cell test (EST) and a prediction model. The potential embryotoxicity of the herbs was based on three endpoints: the concentrations of the compounds that inhibited the proliferation of 50% of embryonic stem cells (ESCs) (IC50ES), the concentrations that inhibited 50% of 3T3 cells (IC503T3), and the concentrations that inhibited the differentiation of 50% of ESCs (ID50ES). The results revealed that Rhizoma Atractylodes macrocephala and Radix Isatidis are non-embryotoxic compounds. Coptis chinensis extracts appeared to demonstrated weak embryotoxicity, and Flos Genkwa exhibited strong embryotoxicity. These results may be useful in guiding the clinical use of these herbs and in expanding the application of the EST to the field of traditional Chinese medicine.

Peri-operative use of sorafenib in liver transplantation: a time-to-event meta-analysis.

AIM: To evaluate whether the application of sorafenib during the peri-operative period of liver transplantation improves prognosis in liver cancer patients. METHODS: We searched PubMed, EMBASE and MEDLINE for eligible articles. A total of 4 studies were found that fulfilled the previously agreed-upon standards. We then performed a systematic review and meta-analysis on the enrolled trials that met the inclusion criteria. RESULTS: Out of the 104 studies identified in the database, 82 were not clinical experiments, and 18 did not fit the inclusion standards. Among the remaining 4 articles, only 1 was related to the preoperative use of sorafenib, whereas the other 3 were related to its postoperative use. As the heterogeneity among the 4 studies was high, with an I(2) of 86%, a randomized effect model was applied to pool the data. The application of sorafenib before liver transplantation had a hazard ratio (HR) of 3.29 with a 95% confidence interval (CI) of 0.33-32.56. The use of sorafenib after liver transplantation had an HR of 1.44 (95%CI: 0.27-7.71). The overall pooled HR was 1.68 (95%CI: 0.41-6.91). CONCLUSION: The results showed that the use of sorafenib during the peri-operative period of liver transplantation did not improve patient survival significantly. In fact, sorafenib could even lead to a worse prognosis, as its use may increase the hazard of poor survival.

[Significance of PLSCR1 in Matrine Induced Differentiation of ATRA Resistant APL Cells].

OBJECTIVE: To observe the expression of phospholipid scramblase 1 (PLSCR1) in matrine (MAT) induced differentiation of all-trans retinoic acid (ATRA) resistant acute promyelocytic leukemia (APL) cells, and to explore its correlation to cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signal pathway. METHODS: NB4 (an APL cell line sensitive to ATRA) and NB4-R1 (a resistant strain of ATRA) were observed as subjects in this study. Effects of combined treatment of 0.1 mmol/L MAT and 1 [mol/L ATRA on the differentiation of two cell lines were detected using nitroblue tetrazolium (NBT) reduction test and flow cytometry (CD11b). Expressions of PML/RARot and PLSCR1 protein/gene were detected using Western blot and Real-time fluorescence quantitative PCR assay. Meanwhile, H89, PKA antagonist, was used to observe cell differentiation antigen and changes of aforesaid proteins and genes. RESULTS: MAT combined ATRA could significantly elevate positive rates of NBT and CD11 b in NB4-R1 cells, and significantly down-regulate the expression of PML/RARapha-fusion protein/gene (P < 0.05, P < 0.01). ATRA used alone could obviously enhance the expression of PLSCRI in NB4 cells at protein and mRNA levels (P < 0.01). But the expression of PLSCR1 was up-regulated in NB4-R1 cells, but with statistical.difference only at the protein level (P <0. 01). In combination of MAT, PLSCR1 protein expression was further elevated in the two cell lines (P < 0.01). Besides, there was statistical difference in mRNA expressions in NB4-R1 cells (P < 0.05). All these actions could be reversed by treatment of 10 micromol/L H89 (P < 0.05, P < 0.01). CONCLUSION: MAT combined ATRA could significantly induce the differentiation of NB4-R1 cells, and inhibit the expression of PML/RARalpha fusion gene/protein, which might be associated with up-regulating PLSCR1 expression.

[A comparison study on cognitive function in patients with single subcortical lesion stroke of four different areas].

OBJECTIVE: Comparing the characteristics of cognitive impairment of patients with single subcortical lesion stroke of four different areas, we are to explore the cognitive function of the thalamus and basal ganglia and this is help for early identification of vascular cognitive impairment (VCI). METHODS: 63 patients with single subcortical lesion stroke (including 14 left thalamic stoke group, 17 left basal ganglia stroke group, 15 right thalamic stroke group, 17 right basal ganglia stroke group) and 34 healthy subjects participated in the current study, whose age, sex and education were matched. A comprehensive neuropsychological battery was used for evaluation. RESULTS: Compared to the normal control group, there was an overall decline of cognitive functions in patients with single subcortical lesion stroke in memory, attention/executive function, language, and visuospatial ability (P < 0.05). The scores of the left thalamic stroke group were worse than the other three stroke groups in language (BNT16.6 ± 2.6), auditory verbal learning test-immediate recall (12.8 ± 4.4), auditory verbal learning test-delayed recall (2.4 ± 2.3), listening recognition (19.1 ± 3.1), structure delayed recall (9.1 ± 4.7) and symbol digit modalities test-recall (0.9 ± 1.1) (P < 0.05). However, the left basal ganglia stroke group did better in tests manipulated by the right hand [including Trial making test (part A) score (75 ± 22), Trail making test (part B) score (204 ± 81), Clock drawing test (23.5 ± 4.6), Symbol digit modalities test (24 ± 9)] than other three stroke group, as good as the normal group (P < 0.05). CONCLUSIONS: Single subcortical stroke patients may have general, non-selective cognitive impairment. But, different stroke areas have their own characteristics. The scores of the left thalamic stroke group were worse than the other three stroke groups.

Static magnetic fields enhanced the potency of cisplatin on k562 cells.

PURPOSE: This study investigates whether 8.8 mT static magnetic fields (SMFs) can enhance the killing potency of cisplatin (DDP) on human leukemic cells (K562). METHODS: The cell proliferation, cell cycle distribution, DNA damage, and the change in cell surface ultrastructure after K562 cells were exposed to 8.8 mT SMFs with or without DDP were analyzed. RESULTS: The results show that SMFs enhanced the killing effect of DDP on K562 cells, reducing the efficient killing concentration of DDP on K562 cells from 20 to 10 microg/mL. Atomic force microscope observation showed that the cell surface ultrastructure was altered. The results of fluorescence-activated cell sorting analysis indicated that K562 cells treated with SMF plus DDP were arrested at the S phase. The SMF exposure induced DNA to become thicker than controls, and breakage of DNA occurred in the DDP group; however, DNA breakage was increased in the SMF + DDP group. CONCLUSIONS: The results show that SMFs enhanced the anticancer effect of DDP on K562 cells. The mechanism correlated with the DNA damage model. This study also shows the potentiality of SMFs as an adjunctive treatment method for chemotherapy.