Chinese Medicine Combined with Adjuvant Chemotherapy for Improving Myelosuppression in Colorectal Cancer Patients: A Systematic Review and Network Meta-Analysis.

OBJECTIVE: To assess the effectiveness of Chinese herbal medicine (CHM) combined with adjuvant chemotherapy on myelosuppression for colorectal cancer (CRC) patients using network meta-analysis (NMA). METHODS: Literature searches in both international (PubMed, Embase, Web of Science, and Cochrane Library) and Chinese (China Science and Technology Journal Database, Wanfang Data, China National Knowledge Infrastructure) databases for relevant randomized controlled trials (RCTs) were conducted from inception until October 10, 2022. We included RCTs of patients who received CHM combined with chemotherapy, including FOLFOX, XELOX, FOLFIRI, and other relevant regimens in the CHM treatment group. The outcomes included the incidence of myelosuppression, leukopenia, hemoglobin reduction, and thrombocytopenia. Two reviewers independently screened the databases, extracted the data, and assessed the risk of bias and credibility of evidence. RevMan 5.4.1 software and STATA 14.0 were used to perform the NMA. RESULTS: A total of 31 RCTs were included, published from 2008 to 2021 in Chinese. Among these, 2,314 participants comparing the following 9 CHMs were identified: Shengbai Recipe (SBR), Bazhen Decoction (BZD), Jianpi Jiedu Recipe (JJR), Jianpi Recipe (JR), Compound Cantharis Capsule (CCC), Zaofan Pill (ZFP), Guilu Erxian Gel (GL), Buzhong Tiaogan Decoction (BZ), and Qiamagu Capsule (QM). The results of NMA found an indirect comparison. Based on the surface under the cumulative ranking curve (SUCRA), the ZFP+ chemotherapy group had the lowest incidence of myelosuppression, with an odds ratio (OR) of 0.08 [95% confidence interval (CI): 0.01, 0.76], whereas the GL+ chemotherapy group had the lowest incidence of leukopenia, hemoglobin reduction, and thrombocytopenia, with an OR of 5.25 (95% CI: 2.41, 11.43), 4.66 (95% CI: 2.23, 9.72), and 0.27 (95% CI: 0.13, 0.54), respectively. Moreover, BZD + chemotherapy could alleviate leukopenia, hemoglobin reduction, and thrombocytopenia (P<0.01). Pairwise comparison showed that there was no difference in the efficacy among the 8 CHMs+ chemotherapy group. The comparison and adjustment funnel plot indicated that small-study effect had no impact on these outcomes. CONCLUSIONS: This NMA provided evidence to support that patients with CRC benefit from receiving different combination of CHM chemotherapies. Among these, GL plus chemotherapy and BZD plus chemotherapy were the more effective for myelosuppression in patients; however, as the qualtiy of evidence is insufficient, further research is needed. (PROSPERO, No. CRD42022369025).

Effect of Jianpi Bushen Sequential Formula on Adjuvant Chemotherapy of Colon Cancer: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: The side effects of chemotherapy-induced nausea and vomiting (CINV) and myelosuppression reduce the cancer patients' adherence to chemotherapy. Many Chinese patients choose Chinese medicine (CM) during chemotherapy to reduce side effects; however, the evidence is lacking. The efficacy of a CM herbal treatment protocol, Jianpi Bushen Sequential Formula (, JBSF) will be evaluated on chemotherapy completion rate among patients with colon cancer. METHODS: A multi-center double-blind randomized controlled trial (RCT) will be conducted on 400 patients with colon cancer who will receive 8 cycles of adjuvant chemotherapy with oxaliplatin and capecitabine (CAPEOX). Patients will be randomized 1:1 to receive the JBSF or placebo formula. The primary outcome is the overall chemotherapy completion rate. The secondary outcomes include individual chemotherapy completion rate, 4-cycle completion rate of chemotherapy, time to treatment failure, relative dose intensity and treatment toxicity. Follow-up visits will be scheduled before every and after last chemotherapy. DISCUSSION: This study will provide evidence on whether JBSF can improve the chemotherapy completion rate and reduce side effects among patients with colon cancer. (Trial registration: ClinicalTrials.gov, No. NCT03716518).

Effectiveness of Herbal Medicine for Leukopenia/Neutropenia Induced by Chemotherapy in Adults with Colorectal Cancer: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the effectiveness of Chinese Herbal Medicine (CHM) on leukopenia/neutropenia induced by chemotherapy in adults with colorectal cancer (CRC). METHODS: Eight electronic databases were searched from their inception to June 2020. Randomized controlled trials with clarified sequence generation were qualified. Two reviewers independently conducted the screening and data extraction. Methodological quality was assessed using the Risk of Bias tool. RevMan 5.4 was applied to the meta-analysis. RESULTS: Twenty-seven studies involving 1867 participants were qualified, of which 26 were included in the quantitative synthesis. Meta-analysis showed that CHM significantly reduced the incidence of leukopenia induced by chemotherapy (RR = 0.69; 95% CI 0.59-0.82), as well as the grade 3/4 leukopenia (RR = 0.71; 95% CI 0.55-0.90). Meanwhile,CHM decreased the occurrence of neutropenia (RR = 0.52, 95% CI 0.35-0.77), especially for the grades 3/4 neutropenia (RR = 0.42, 95% CI 0.27-0.64). Twenty-six of the included studies focused on the adverse events related to CHM. CONCLUSION: CHM may relieve neutropenia/leukopenia induced by chemotherapy in adults with colorectal cancer.

[Impacts of Eichhornia crassipes (Mart.) Solms stress on the growth characteristics, microcystins and nutrients release of Microcystis aeruginosa].

Due to the large-scale application of Eichhornia crassipes (Mart.) Solms on the bioremediation of eutrophic lake in China, the influence of growth, physiological characteristics, microcystins production and release of M. aeruginosa by E. crassipes was investigated. Meanwhile, the release risk of nutrients from M. aeruginosa and the accumulation risk of microcystins in E. crassipe were explored through semi-continuous co-existence experiments. Our results indicated that M. aeruginosa was promoted by E. crassipes to undergo the cell death. Under the stress of E. crassipes, direct damage of phycocyanin and phycocyanin/allophycocyanin ratio in M. aeruginosa occurred, while the photosystem II-Hill reaction in M. aeruginosa was not interrupted. The PC/APC levels in the treatment of 10% and 20% water exchange rate were respectively decreased to 54.93% +/- 7.07% and 55.81% +/- 1.97% of the level in their relative controls after 8 days. Then, the final significant decrease of specific superoxide dismutase activity and the striking elevation of malondialdehyde content in M. aeruginosa could be the results of oxidative damage by E. crassipes. Algal malondialdehyde content in the treatment of 10% and 20% water exchange rate were respectively 2.95 +/- 0.074 and 2.22 +/- 0.086 times of the level in their relative controls on day 8. The release of nutrients from M. aeruginosa was accelerated because the decay and lysis of algal cells were promoted by E. crassipes. After 12-day co-existence experiments, the concentration of total dissolved nitrogen in water was brought back to the initial level and the release of total dissolved phosphorus was faster than nitrogen nutrients under the stress of E. crassipes. In addition, the microcystins production in M. aeruginosa was not stimulated and the extracellular microcystins were significantly eliminated by the influence of E. crassipes. The extracellular microcystins contents in the treatment of 10% and 20% water exchange rate were respectively decreased to 12.07 microg x L(-1) +/- 0.63 microg x L(-1) and 11.36 microg x L(-1) +/- 0.04 microg x L(-1) after 12 days. But the microcystins level in the whole plants of E. crassipes co-cultured with M. aeruginosa for 12 days was only about 5.95 ng x g(-1) +/- 0.76 ng x g(-1) FW. The increase of water exchange rate could reduce the damage of M. aeruginosa by E. crassipes, but had no significant effect on the microcystins elimination.

[Purification effects of large-area planting water hyacinth on water environment of Zhushan Bay, Lake Taihu].

Using water hyacinth and other fast-growing and high biomass of floating plants to purify polluted water has become an efficient and effective ecological restoration method at present. Effects of nutrients adsorption and water purification of planting water hyacinth on water quality in Zhushan Bay were studied. The results indicated that no anoxia was observed in water hyacinth planting areas because of wave disturbance and strong water exchange. Concentrations of TN and TP in water hyacinth planting areas were higher than that in the outside of stocking area (the content ranged 3.03-7.45 mg/L and 0.15-0.38 mg/L, respectively), and the content changes ranged 3.37-8.02 mg/L and 0.15-0.36 mg/L,respectively. The higher concentration of TN and TP in water indicated the water body was heavily polluted. Water hyacinth roots have a strong ability to adsorb suspended solids and algae cells, the concentration of Chl-a in stocking areas was higher than that in stocking fringe and outside, the maximum Chlorophyll in the stocking region in August was 177.01 mg/m3, and at the same time the concentrations in planting fringe and outside were 101.53 mg/m3 and 76.96 mg/m, respectively. Higher Chl-a content on water hyacinth roots indicated that water hyacinth had strong blocking effects on algae cells, and demonstrated it had a great purification effects on eutrophicated water, and it also provides a basis for the larger polluted water bodies purification in using water hyacinth.

[Environment effects of algae-caused black spots: driving effects on the N, P changes in the water-sediment interface].

The impact and driving effect of deposited algal cells in the water-sediment interface on the N, P changes were studied through continuous extracted pore water with home-made static experiment. Results showed that dissolved oxygen in water-sediment interface was depleted in 50 min after algal cells settled. Soon the dead algal cells formed the anoxia and strong reducing environment and the dead cells had a severe anaerobic mineralization in the water-sediment interface, also the water bodies had a intense black and stink phenomenon. PO4(-3) -P, NH4(+) -N concentration in water-sediment interface increased from the 2nd day after added the algal cells to the sediment interface, and its concentration was 4.00 mg/L and 39.45 mg/L, respectively. Its concentration was the 10 fold and 241 fold higher than that the control experiments at the same time (PO4(-3) -P, NH4(+) -N concentration in control experiments was 0.42 mg/L and 0.16 mg/L, respectively). Anaerobic mineralization of dead cells in sediment surface drove the nutrients diffusing upward the overlying water, added the nutrients concentration in water bodies, and it also supplied the nutrient materials for the algal blooms happened again.