Effectiveness and Safety of Acupoint Application of Guan Xin Su He Pill () for Patients with Chronic Stable Angina Pectoris: A Multi-Center, Randomized Controlled Trial.

OBJECTIVE: To assess the clinical effectiveness of acupoint application (AP) of Guan Xin Su He Pill (, GXSHP) for patients with chronic stable angina pectoris (CSAP). METHODS: This study was carried out in 3 local hospitals in Chengdu, China. After baseline evaluation, eligible patients were randomly assigned to the placebo application for acupoints (PAA) group or the herbal application for acupoints (HAA) group. Patients in the HAA group underwent AP with herbal powder, which was mainly GXSHP, and patients in the PAA group underwent AP with sham drugs. For each treatment session, unilateral acupoints including Neiguan (PC 6), Danzhong (RN 17), Xinshu (BL 15) and Jueyinshu (BL 14), were stimulated for both groups. AP was performed 3 times a week with a 2-day interval for 4 weeks. The primary outcome was the frequency of angina pectoris attacks per week, while the secondary outcomes included angina pain intensity measured by the Visual Analogue Scale (VAS), dose of rescue oral drugs (nitroglycerin), scores on the Seattle Angina Questionnaire (SAQ), Self-Rating Anxiety Scale scores (SAS) and Self-Rating Depression Scale scores (SDS). Clinical outcomes were measured at week 0, 4 and 8. The safety of AP of GXSHP treatment for CSAP were assessed. RESULTS: A total of 121 patients were enrolled. Baseline characteristics were comparable across the 2 groups. After treatment, the angina attack numbers in the HAA group were significantly reduced from 11.00 to 4.81 (P<0.05). While, for PAA group, the angina frequency was not significantly improved (baseline 10.55; post-treatment 11.05). The HAA group had significantly fewer angina attacks than the PAA group (P<0.05). Pain intensity measured by VAS in HAA group was significantly reduced from 4.06 to 3.02 (P<0.05). While, for PAA group, the VAS was significantly increased (baseline 3.62; post-treatment 3.96; P<0.05). Clinical outcomes showed better improvement after treatment in the HAA group than in the PAA group in terms of oral administration of rescue drugs, SAS, SDS and SAQ scores (P<0.05). The adverse events were also reported. CONCLUSION: AP of GXSHP is a safe and effective treatment for CSAP patients (Registration No. NCT02029118).

Photodynamic therapy as an alternative treatment in patients with invasive cutaneous SCC where surgery is not feasible: Single center experience.

The aim of this study was to demonstrate the efficacy of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) as an alternative treatment in cutaneous squamous cell carcinoma (cSCC) patients who are not fit for surgery. Thirty-three invasive cSCC patients who, for some reasons, cannot undergo surgery were enrolled in this study. All patients received plum blossom needle (PBN) pretreated ALA-PDT combined with topical application of 5% imiquimod cream. Two patients dropped the study because of severe pain and two patients discontinue treatment due to lack of response. Of 29 patients, who completed the treatment, 5 patients had complete response after 2-9 sessions of PDT and these patients had no recurrence till 18 months after treatment. Twenty-four patients achieved partial response and are satisfied with treatment outcome in terms of decreased symptoms and improved quality of life. PBN pretreated PDT in combination with topical imiquimod may be a viable treatment option for non resectable cSCC lesions.

Development of a Diagnostic Questionnaire for Damp Phlegm Pattern and Blood Stasis Pattern in Coronary Heart Disease Patients (CHD-DPBSPQ).

BACKGROUND: The aim was to develop a diagnostic questionnaire for damp phlegm pattern and blood stasis pattern in coronary heart disease patients (CHD-DPBSPQ). METHODS: The standard procedures of questionnaire development were carried out to develop and assess CHD-DPBSPQ. The patients were assessed using the CHD-DPBSPQ, CHD-DPPQ, and CHD-BSPQ. Four methods were used to select the items on the CHD-DPBSPQ in a pilot study based on data from a Guizhou tertiary grade A hospital. Cronbach's alpha and the split-half reliability, test-retest reliability, content validity, criterion validity, construct validity, and convergent validity were determined in a validation study using a nationwide sample. RESULTS: After item selection, the CHD-DPBSPQ contained 15 items in two domains: the phlegm domain (9 items) and the blood stasis domain (6 items). For the CHD-DPBSPQ, the alpha coefficient was 0.88, the split-half coefficient was 0.90, and the intraclass correlation coefficient was 0.83. The range of the item-level content validity index (I-CVI) was 0.71 to 1.0 and that of the scale-level content validity index/average (Scale-CVI/Ave) was 0.97. The domain scores on the CHD-DPBSPQ were in close relation to the scores on a questionnaire for damp phlegm pattern in coronary heart disease patients (CHD-DPPQ) and a questionnaire for blood stasis pattern in coronary heart disease patient (CHD-BSPQ) (P < 0.01). The root mean square error of approximation (RMSEA) was equal to 0.05 (90% CI: 0.044, 0.059). Convergent validity was demonstrated with a moderate correlation. CONCLUSION: The CHD-DPBSPQ is a reliable and valid instrument.

Comparison of 5-aminolevulinic acid photodynamic therapy and red light for treatment of photoaging.

OBJECTIVE: The aim of this pilot study was to compare the efficacy of ALA-PDT and red light alone in the treatment of photoaging. METHODS: A total of 14 adults with photoaging skin were recruited. ALA-PDT or red light alone was applied to the forearm extensor. Before and after treatment, the treated sites were examined by dermoscopy, the changes in straum corneum (SC) hydration, transepidermal water loss (TEWL), and the L*a*b* values were measured, and microscopic examination of collagens and elastins was performed. RESULTS: After ALA-PDT or red light illumination, the appearance of photoaging lesions improved, SC hydration increased and TEWL decreased. These changes in the ALA-PDT group were more obvious than those in the red light group. No significant change was noticed in the L*a*b* values in both groups. The signs of typical solar elastosis damage were improved in both groups. CONCLUSIONS: ALA-PDT showed better skin rejuvenation effect than red light alone.

[Comparison of the enhanced remineralization of initial enamel carious lesions treated with original and neutral Galla chinensis in vitro].

OBJECTIVE: To compare the effect of original and neutral Galla chinensis in promoting the remineralization of initial enamel carious lesions in vitro and to investigate the influence of Galla chinensis with different pH on the promoting effect. METHODS: Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then the lesions were exposed to a pH-cycling regime for 12 days. Each daily cycle included 4 × 1 min application of one of four treatments: distilled and deionized water (DDW), aqueous solutions of NaF, acidic or neutral aqueous solutions of Galla chinensis extract (GCE). Before and after pH-cycling, the surface topography of the enamel slabs was observed by atomic force microscopy (AFM), and the integrated mineral loss and lesion depth of all the specimens were analysed by transverse microradiography. RESULTS: AFM images revealed the surface topographical changes of GCE-treated enamel. The percentage change of integrated mineral loss (ΔIML%) of the samples of NaF group, DDW group, pH 3.8 GCE group and pH 7.0 GCE group was (-38 ± 14)%, (+43 ± 7)%, (-10 ± 4)% and (-11 ± 4)% respectively. The percentage of lesion depth (ΔLD%) of the samples of NaF group, DDW group, pH 3.8 GCE group and pH 7.0 GCE group was (-27.79 ± 3.51)%, (+21.13 ± 2.83)%, (-8.43 ± 3.32)% and (-9.20 ± 3.89)% respectively. There was no significant difference in ΔIML% and ΔLD% between pH 3.8 and pH 7.0 GCE-treated enamel. CONCLUSIONS: There is no significant difference in enhancement of remineralization of initial enamel carious lesions between the original and neutral Galla chinensis. Different pH Galla chinensis does not have obvious influence on remineralization. It is unnecessary to regulate the pH value of queous solution of Galla chinensis extract which acts as a anti-caries agent.

[Role of enamel organic matrix in the remineralization of initial demineralized enamel and artificial hydroxylapatite treated with Galla chinensis].

OBJECTIVE: To observe the remineralization of initial demineralized enamel and artificial hydroxylapatite treated with Galla chinensis in vitro, and to assess the effect of enamel organic matrix on the potential of Galla chinensis to promote the remineralization of initial enamel carious lesions, further to elucidate the mechanism of Galla chinensis in promoting the remineralization of initial enamel carious lesion. METHODS: Bovine sound enamel blocks, non-organic enamel blocks and artificial hydroxylapatite blocks were demineralized and exposed to a pH-cycling. During the pH-cycling, the specimens were randomly treated with 1 g/L NaF, 4 g/L Galla chinensis extract (GCE) or double deionized water (DDW). Surface microhardness of all the samples was measured before and after the pH-cycling, and percentage surface microhardness recovery (% SMHR) was calculated. The surface morphology was observed by scanning electron microscopy. RESULTS: A significant increase in microhardness (P < 0.05) with many irregular deposits and prominences on GCE treated regular enamel blocks were observed. No significant increase in that of the regular enamel treated with DDW, enamel disposed of its organic matrix or artificial hydroxylapatite treated with GCE were observed (P > 0.05). No obvious changes in the SEM images of regular enamel treated with DDW, enamel disposed of its organic matrix or artificial hydroxylapatite treated with GCE compared to those of them before pH-cycling. CONCLUSION: Galla chinensis enhances the remineralization of initial enamel carious lesions in vitro. The organic matrix of enamel was shown to play a substantial role in the observed mechanism.

Chemical and crystallographic study of remineralized surface on initial carious enamel treated with Galla chinensis.

To investigate the morphologic, chemical and crystallographic characters of remineralized surface on initial carious enamel treated with Galla chinensis, scanning electron microscopy equipped with energy dispersive analysis spectroscopy were used, and X-ray microdiffraction (microzone XRD) was used for the first time to analyze in situ the microzone crystallite of remineralized surface on carious enamel. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days of remineralization. Each daily cycle included 4x1 min applications with one of the three treatments: distilled and deionized water (DDW); 1 g/L NaF; 4 g/L G. chinensis extract (GCE). After the treatments, some rod-like deposits and many irregular prominences were found on GCE-treated enamel surface, and the intensities of Ca and P signals showed a tendency to increase; Ca:P ratio was significantly higher than that of DDW-treated enamel. X-ray microdiffraction showed hydroxyapatite was still the main component of GCE-treated enamel, and the crystallinity was increased, the crystal lattice changed gently with decreased lattice parameter a. These results indicated the potential of GCE in promoting the remineralization of initial enamel carious lesions, and supported the previous hypothesis about GCE mechanism. Combined with the anti-bacteria and demineralization inhibition properties of GCE, the natural G. chinensis may become one more promising agent for caries prevention.

Effects of Galla chinensis on the surface topography of initial enamel carious lesion: an atomic force microscopy study.

To investigate the effect of Galla chinensis on the surface topography of initial enamel carious lesion, atomic force microscope (AFM) was used, and it was a new AFM application in enamel de-/remineralization research. Bovine sound enamel slabs were demineralized to produce initial carious lesion in vitro. Then, the lesions were exposed to a pH-cycling regime for 12 days. Each daily cycle included 4x1 min applications with one of three treatments: negative control group: deionized water; positive control group: 1 g/L aqueous solutions of NaF; experimental group: 4 g/L aqueous solutions of G. chinensis extract (GCE). The surface topography and roughness were investigated on the enamel slabs before and after pH-cycling by AFM. 3D AFM images revealed the surface topographical changes of GCE-treated enamel. Significant difference existed before and after the pH-cycling among the groups. AFM offers a powerful tool for enamel de-/remineralization research. The surface roughness results provide the evidences to remineralization of carious lesion, and indicate the potential of G. chinensis in promoting the remineralization. G. chinensis may become one more promising agent for caries prevention.