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[Abstract]Objective:To evaluate the efficacy and safety of fermented cordyceps powder combined with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin Ⅱ receptor blocker (ARB) in the treatment of diabetic kidney disease (DKD). Method:The randomized controlled trials (RCTs) concerning the treatment of DKD with fermented cordyceps powder plus ACEI/ARB were retrieved from Pubmed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database on disc (CBMdisc), Wanfang Data Knowledge Service Platform, and Chongqing Weipu Database for Chinese Technical Periodicals (VIP). The quality of the included articles was evaluated by the Cochrane Collaboration's tool, followed by data analysis using RevMan 5.3. Result:A total of 48 RCTs were included, involving 4 562 cases. As revealed by Meta-analysis, the effective rate of fermented cordyceps powder combined with ACEI/ARB was higher than that of ACEI/ARB [risk ratio (RR)=1.20, 95% confidence interval (CI) (1.15,1.24), <italic>P</italic><0.000 01]. Moreover, such combination effectively reduced urinary albumin excretion rate [standardized mean difference (SMD)=-2.61,95%CI (-3.17,-2.05),<italic>P</italic><0.000 01],24-h proteinuria[SMD=-1.75,95%CI (-2.15,-1.35),<italic>P</italic><0.000 01], serum creatinine(Scr)[mean difference (MD)=-14.57,95%CI (-17.94,-11.21),<italic>P</italic><0.000 01], blood urea nitrogen(BUN)[MD=-1.05,95%CI (-1.29,-0.81),<italic>P</italic><0.000 01], cystatin C (Cys-C) [MD=-0.52,95%CI (-0.68,-0.36),<italic>P</italic><0.000 01], fasting blood glucose(FBG)[MD=-0.59,95%CI (-0.93,-0.25),<italic>P</italic>=0.000 6], hemoglobin A1c(HbA1c)[MD=-0.50,95%CI(-0.75,-0.24),<italic>P</italic>=0.000 1], tumor necrosis factor-<italic>α</italic>(TNF)-<italic>α </italic>[SMD=-1.68,95%CI (-2.21,-1.15),<italic>P</italic><0.000 01], C-reactive protein(CRP) [SMD=-1.35,95%CI (-1.77,-0.93),<italic>P</italic><0.000 01], and interleukin-6 (IL-6) [SMD=-1.52,95%CI (-1.98,-1.07),<italic>P</italic><0.000 01]. There was no significant difference in the incidence of adverse events between the two groups [RR=0.77,95%CI (0.49,1.21),<italic>P</italic>=0.25]. Conclusion:Fermented cordyceps powder combined with ACEI/ARB is more effective than ACEI/ARB in the treatment of DKD, which is worthy of clinical promotion and use. More multi-center RCTs with a large sample size are needed for verification.
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Aging is a gradual process during the loss of functions in cells,organs and tissues by time. The molecular mechanisms of aging-related theories include the classical ones such as telomere,oxygen radical and nonenzymatic glycosylation,as well as the newly proposed ones such as DNA methylation,mitochondrial DNA (mtDNA)and autophagy. The latest study showed the anti-aging effect of autophagy in hematopoietic stem cells. In recent years,based on the molecular regulative mechanisms of aging,a number of the promising anti-aging drugs have been found,including nicotinamide mononucleotide(NMN)and FOXO4-DRI,a peptide of anti-aging. In addition,there are many new discoveries in the field of plant extracts,in which,the extracts from Chinese herbal medicine(CHM),some single CHMs and the classical prescriptions of CHM,represented by curcumin and resveratrol,have the partial anti-aging effects by regulating the molecular mechanisms of aging both in vivo and in vitro. In brief,developing or exploring anti-aging drugs,especially the natural drugs,is one of the main development directions in the field of anti-aging research in the basis of the molecular regulative mechanisms of aging.
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The gut microbiota dysbiosis is one of the risk factors in the progression from the advanced chronic kidney disease(CKD)to uremia, characterized by the reduction of probiotics and the increase of opportunistic pathogens including urease-related microbes, endotoxin-related microbes and toxin-related microbes, which can produce uremic toxins. According to the core point of "the gut-kidney axis" theory and "the chronic kidney disease-colonic axis" concept, the gut microbiota dysbiosis aggravates renal damage by accumulating uremic toxins and inducing the systemic micro-inflammation. The preliminary clinical trials and animal experiments show that the probiotics biologicals from Lactobacillus acidophilus or Bifidobacterium, and the prebiotics including inulin and galactooligosaccharides, as well as lubiprostone and activated carbon adsorbents can be used for improving dysfunction of CKD patients with the gut microbiota dysbiosis via reducing uremic toxins and inhibiting the systemic micro-inflammation. But not only that, it is reported that, to some extent, a number of the single Chinese herbal medicine(CHM), the CHM prescriptions and the CHM extracts(emodin, etc.)with oral or enema administration can also regulate the gut microbiota dysbiosis, protect the intestinal epithelial barrier, reduce uremic toxins accumulation and delay CKD progression. Thereinto, Dahuang Gancao Decoction(the concentrated granule TJ-84), a classical CHM prescription of rhubarb, can ameliorate uremic toxins accumulation in the animal models with renal failure probably through targeting the gut-kidney axis triggered from gut microbiota, but not targeting the kidney. Based on these results, the interventional studies targeting the gut microbiota-related pathological factors such as tight junction proteins, helper T cells and regulatory T cells in the intestinal tract of the advanced CKD patients will become one of the key development directions in the future.
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To evaluate the safety and effectiveness of Shenbei Guchang capsules in treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions, an open, multicenter, controlled, phase Ⅳ clinical trial was conducted in the drug clinical trial centers of 16 domestic hospitals. 2 123 patients from June 10, 2011 to November 29, 2012 were enrolled in the trial. Drug clinical trial was approved by Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital Ethics Committee before implementation. Before the start of trial, subjects were selected according to the research scheme and inclusion criteria, then they would step into the 14 d study after signing Informed Consent Form. All subjects were treated according to the research scheme, evaluated the conditions and filled in CFR sheet, to provide the evaluation data and information on safety and efficacy of Shenbei Guchang capsules. Shenbei Guchang capsules were used to treat diarrhea type irritable bowel syndrome in widely used conditions (2 123 cases), and 2 029 cases of them entered FAS set, cure+markedly effective in 1 921 cases, with a comprehensive curative effect rate of 94.68%; 2 010 cases of them entered PPS set, cure+markedly effective in 1 906 cases, with a comprehensive curative effect rate of 94.83%. The primary symptoms of IBS were abdominal pain and diarrhea. After treatment, both abdominal pain and diarrhea were improved, with significant differences (P<0.000 1). There were significant differences in traditional Chinese medicine symptom scores on both post-treatment day 7 and day 14 as compared with the conditions before treatment (P<0.000 1). 35 cases of adverse events occurred during the trial with an incidence of 1.65%, including 12 cases of drug-related adverse events (adverse reaction) with an incidence of 0.57%, mainly manifested as nausea, abdominal distension and dry mouth, most of which would be spontaneously relieved without any measures. No serious adverse events occurred. The commercially available Shenbei Guchang capsules are proved safe and effective for the treatment of diarrhea type irritable bowel syndrome (yang deficiency of spleen and kidney) under widely used conditions (2 123 cases), and can be continued for clinical promotion and application.
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The applications accepted and approved by general program, young scientist fund and fund for less developed region of national natural science funds in the discipline of Chinese materia medica, NSFC in 2012 have been introduced. The research contents of the funded projects in the popular research areas have been summarized and the problems in the applications have been analyzed to give a reference to the scientists in the field of Chinese materia medica.