Eicosapentaenoic acid supplementation modulates the osteoblast/osteoclast balance in inflammatory environments and protects against estrogen deficiency-induced bone loss in mice.

BACKGROUND: An imbalance of osteoblasts (OBs) and osteoclasts (OCs) in a chronic inflammatory microenvironment is an important pathological factor leading to osteoporosis. Eicosapentaenoic acid (EPA) has been shown to suppress inflammation in macrophages and adipocytes. However, the effect of EPA on OBs and OCs has yet to be fully elucidated. AIMS: We explored the roles of EPA in the differentiation of OBs and OCs, as well as the coupling between OBs and OCs in an inflammatory microenvironment. The effects of EPA on estrogen deficiency-induced osteoporosis were also evaluated. METHODS: Mouse bone marrow mesenchymal stem cells (mBMSCs) and mouse bone marrow-derived macrophages (mBMMs) were used for in vitro OBs and OCs differentiation. TNF-α was used to create an inflammatory microenvironment. We examined the effects of EPA on osteoblastogenesis in the absence or presence of TNF-α and collect OBs' culture medium as the conditioned medium (CM). Then we examined the effects of EPA and CM on RANKL-induced osteoclastogenesis. The in vivo effects of EPA were determined using an ovariectomized (OVX) mouse model treated with EPA or vehicle. RESULTS: High-dose EPA was shown to promote osteoblastogenesis in an inflammatory environment in vitro, as well as upregulate expression of OBs-specific proteins and genes. ARS and ALP staining also showed that high-dose EPA-treated groups restored mBMSCs' impaired osteogenic capacity caused by TNFa. Mechanistically, EPA suppressed the NF-κB pathway activated by TNF-α in mBMSCs and rescued TNF-α-mediated inhibition of osteoblastogenesis. EPA was also shown to inhibit expression of RANKL and decrease the RANKL/OPG ratio in OBs in an inflammatory environment. CM from TNF-α-stimulated OBs promoted osteoclastogenesis of mBMMs; EPA-treated CM prevented this. In the OVX mouse model, EPA supplementation prevented bone loss in an estrogen deficiency-induced inflammatory environment. CONCLUSIONS: EPA was demonstrated for the first time to restore mBMSCs' impaired osteogenic capacity caused by TNFa-induced inflammation and rescue the OBs/OCs balance via regulation of RANKL and OPG expression in OBs. EPA showed a remarkable ability to prevent bone loss in OVX mice, suggesting a potential application of EPA in postmenopausal osteoporosis.

The spatial variations of water quality and effects of water landscape in Baiyangdian Lake, North China.

Baiyangdian Lake (BYD), a large shallow lake in North China, has complex water landscape patterns that are underlies spatial variations in water quality. In this study, we collected 61 water samples from three water landscapes (reed littoral zones, fish ponds, and open water) and analyzed them for water quality parameters, such as dissolved organic carbon (DOC), total nitrogen (TN), and total phosphorus (TP). Water landscape distribution (determined using remote sensing imagery) was then used to assess correlations between water quality parameters and water landscape proportion in differently scaled buffer zones. There was substantial variation across all subareas, with TN and TP concentrations ranging from 0.90 to 4.10 mg/L and 0.06 to 0.18 mg/L, respectively, in class IV of water quality as a whole. Spatial variations in water quality were mainly caused by water landscape distribution and external nutrient inputs. There were negative correlations between DOC, TN, and TP concentrations and the area proportion of reed littoral zones in the 300 and 500 m buffers. In contrast, DOC, TN, and TP concentrations were significantly positively correlated with the area proportion of fish ponds in the 100 m buffer. Furthermore, compared with reed littoral zones, a lower ratio of nitrogen to phosphorus and a higher proportion of dissolved organic nitrogen and tyrosine-like proteins were found in fish ponds. These effects were mainly attributed to the development of internal sediment loadings due to nutrient exchange across the sediment-water interface. Therefore, dredging-based sediment removal from fish ponds should be considered to suppress internal phosphorus loading and accelerate recovery of the BYD ecosystem.

[Identification of Dredging Depths Based on Sediment Vertical Distribution Profiles of Total Nitrogen and Total Phosphorus and Their Adsorption-desorption Equilibria].

A dredging demonstration project in the Baiyangdian Lake included open waters and fishing ponds to reduce the internal release of nitrogen and phosphorus from bottom sediments. The dredging depth design was determined by both the sediment vertical distribution profile of total nitrogen and phosphorus, and the sediment adsorption-desorption equilibrium method. The determined dredging depths were very similar and coincident. The dredging depth for the demonstration area of open waters in Nanliuzhuang was identified as(50±10) cm; and the dredging depths for fishing ponds were(30±10) cm in both the Nanliuzhuang and Caiputai demonstration areas. The equilibrium nitrogen(NH4+-N) and phosphorus(SRP) concentrations at zero net sorption or desorption(ENC0 and EPC0) were significantly positively correlated with both exchangeable and total nitrogen and phosphorus in the sediments. The total nitrogen and phosphorus in the sediments were also used to predict the risk of their release from the bottom sediments to the overlying water column. The sediment layers with ENC0 and EPC0 values greater than the NH4+-N and SRP in the overlying water column indicated the sediments act as a source of dissolved nitrogen and phosphorus to the overlying water column in the Nanliuzhuang and Caiputai demonstration areas. Accordingly, the sediment layers with both total nitrogen concentrations greater than 750 mg·kg-1 and total phosphorus concentrations greater than 500 mg·kg-1 should be identified as dredging layers.

The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain.

Dissemination research is the study of distributing information and intervention materials to a specific clinical practice or public health audience. Acupuncture, a healthcare practice involving the stimulation of certain body points, often with thin needles, is considered an evidence-based treatment for low back pain (LBP), but is underutilized in the United States. Body: We will use the example of acupuncture for LBP to identify opportunities to leverage dissemination research to increase utilization of acupuncture. Deficits in the awareness or knowledge of acupuncture may limit its adoption by patients and other stakeholders. Thus, we summarize methods to gather data on stakeholder awareness and knowledge of acupuncture for LBP, i.e., audience research. Engaging multiple stakeholder audiences (e.g., health system leaders, primary care providers, patients), is needed to generate knowledge on promising dissemination strategies for each audience. Audience segmentation is important for identifying population subgroups for whom adoption of acupuncture may require a more intensive or tailored dissemination strategy. To illustrate potential audience 'segments', our research discussion focused on developing dissemination strategies by age (i.e., older adults - those age 65 years or older, and younger adults - those under age 65 ). This decision was prompted by Medicare's recent policy covering acupuncture for chronic LBP. We leverage current knowledge of barriers and facilitators of acupuncture use to discuss how further tailoring of dissemination strategies might optimize adoption of acupuncture in both groups of adults. Experimental study designs could then be used to compare the effectiveness of such strategies to increase awareness, knowledge, or adoption of acupuncture. Conclusions: Conducting dissemination research may improve awareness and knowledge of acupuncture, and ultimately the adoption of acupuncture in biomedical settings. We anticipate that the concepts highlighted in this manuscript will also be helpful for those disseminating information about other complementary and integrative health approaches.

Analysis of Movement-Based Mind-Body Interventions to Guide the Implementation of Osteoarthritis Exercise Programs: A Descriptive Review of Randomized Controlled Trials.

Background: Clear and complete reporting of the components of complex interventions is required in clinical trials to ensure that research can be reliably replicated and successfully translated into clinical practice. Movement-based mind-body exercises, such as Tai Chi, qigong, and Yoga (TQY), are considered complex interventions and recommended for individuals with osteoarthritis in the latest guidelines of the American College of Rheumatology. This review analyzes the intervention reporting of randomized controlled trials of TQY to guide the implementation in osteoarthritis exercise programs. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and EMBASE for TQY exercise trials in osteoarthritis between 2000 and 2020. Pairs of researchers independently screened the records, extracted study characteristics, and assessed 19 items on the Consensus on Exercise Reporting Template (CERT) checklist. For each of these items, the numbers of studies that clearly reported the item were calculated. We then identified the items in the studies that are key to delivering home-based exercises for further analysis. Results: We included 27 publications reporting 22 TQY interventions in the analysis. None of the studies reported sufficient details on all the 19 CERT items. The median completeness of reporting score was 11 and ranged from 6 to 15 of 19. The most frequently incompletely reported items (number reporting and percentage of studies) were "starting level rule" (n = 1, 5%) and "progression rule" (n = 1, 5%). Other incompletely reported items included "fidelity or adherence (planned)" (n = 9, 41%), "motivations" (n = 9, 41%), and "progression description" (n = 5, 23%). Conclusions: The content analysis highlights motivational strategies for long-term adherence to home-based exercises, which may help clinicians develop interventions for their patients. Details of TQY exercises interventions for osteoarthritis are incompletely reported in the included studies. The study suggests that improvements in content reporting are especially needed on items related to exercise intensity and program progression decisions, and motivational strategies in future implementation.

Equol Decreases Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Soy isoflavones may benefit some, but not all, menopausal women, and the ability of the women to produce equol may be the major determinant of effectiveness. We assessed the efficacy of soy isoflavones and equol for alleviating menopausal symptoms, especially vasomotor symptoms, in postmenopausal women who were equol producers and nonproducers by using systematic review and meta-analysis of randomized clinical trials (RCTs). We searched 12 English, Korean, and Chinese language scientific and medical databases. We selected all available RCTs that assessed the effect of equol, either equol itself or soy isoflavone in equol producers, on menopausal symptoms in peri- or postmenopausal women. The primary outcome was the effect on hot flashes. The severity of hot flashes was determined by the scores, and sensitivity and risk of bias analyses were conducted. Other outcomes of the review, but not meta-analysis, included depression and adverse events. Six studies (779 total subjects) met all criteria for the systematic review, 5 of those could be included in the meta-analysis (728 total subjects). Two studies included in the meta-analysis reported no statistically significant benefits of equol; the other three did report significant benefits of equol. Meta-analysis revealed a significant benefit of equol for lowering hot flash scores and revealed a generally low risk of bias. In conclusion, this study found that supplementing equol to equol nonproducers significantly lowered the incidence and/or severity of hot flashes in menopausal women.

[Clinical practice of integrative medicine in the United States and its development in primary care].

The field of integrative medicine (IM) has grown tremendously in the United States over last two decades, in terms of clinical practice, research, and education. Its growing popularity among patients has led to increased need for physicians with appropriate counseling skills and a knowledge base of the efficacy and safety of complementary and alternative medicine (CAM) therapies. Family medicine is the first specialty as a whole to embrace IM, which encounters similar ailing conditions and emphasizes similar core values-person centered, evidence based, proactive, and continuous in nature. As integrative family medicine emerges, family medicine educators have developed suggested curriculum guidelines and approved measurable competencies to implement the best of evidence-based CAM and principles of IM. There are currently over 40 family medicine residencies that officially advertise CAM/IM in their programs. Meanwhile, IM centers have also been developing their own primary care programs based on their unique characteristics. This physician-led IM workforce is similar to that of China's IM in the early 1960s. As the Chinese government embarks on repeating its efforts to educate more Western medicine trained physicians in Chinese medicine in primary care training programs, the process and insights related to implementation of their practice in the United States would provide useful food for thought.

Factors Affecting Definitions of and Approaches to Integrative Medicine: A Mixed Methods Study Examining China's Integrative Medicine Development.

Aim. This study identifies existing definitions and approaches among China's integrative medicine (IM) experts and examines relationships with key characteristics distinguishing individual experts. Methods. Snowball sampling was used to select 73 IM experts for semistructured interviews. In this mixed methods study, we first identified definitions and approaches through analyzing core statements. Four key factors, including age, education, practice type, and working environment, were then chosen to evaluate the associations with the definitions. Results. Four unique definitions were identified, including IM as a "new medicine" (D1), as a combination of western medicine (WM) and Chinese medicine (CM) (D2), as a modernization of CM (D3), and as a westernization of CM (D4). D4 was mostly supported by those working in WM organizations, while D3 was more prominent from individuals working in CM organizations (P = 0.00004). More than 64% clinicians had D2 while only 1 (5.9%) nonclinician had D2. Only 1 clinician (1.8%) had D4 while almost 30% nonclinicians had D4 (P = 0.0001). Among nonclinicians working in WM organizations, 83.3% of them had D4 (P = 0.001). Conclusion. Findings indicate that institutional structure and practice type are factors affecting IM approaches. These results carry implications for the ways in which western countries move forward with the definition and implementation of IM.

Effects of epigallocatechin gallate on the proliferation and apoptosis of the nasopharyngeal carcinoma cell line CNE2.

The present study explored the effects of epigallocatechin gallate (EGCG) on the cell cycle, proliferation and apoptosis of the nasopharyngeal carcinoma cell line CNE2 in vitro. The proliferation of CNE2 cells was detected using the cell counting kit-8 method. Cell cycle distribution and apoptosis were detected using flow cytometry. The human telomerase reverse transcriptase (hTERT) mRNA expression was determined using reverse transcription polymerase chain reactions. The protein expression of hTERT and Myc proto-oncogene protein (c-Myc) was observed using western blot analysis. EGCG inhibited the proliferation of CNE2 cells in a concentration-dependent manner (P<0.05) and blocked the cell cycle progression of the cells. In the low concentration (100 µg/ml) group, the cell cycle arrest showed a time-dependent manner. However, as the concentration increased and action time was prolonged, this time dependency became less marked. EGCG promoted the apoptosis of CNE2 cells in a time-dependent manner. In addition, EGCG downregulated the mRNA and protein expression of hTERT and downregulated the expression of c-Myc protein. Downregulation of the expression of hTERT and c-Myc was more evident in the high-dose group (200 µg/mL). In conclusion, EGCG has proliferation-inhibiting, cell cycle-blocking and apoptosis-promoting effects on CNE2 cells. EGCG may be developed into an auxiliary therapeutic agent for the treatment of nasopharyngeal carcinoma.

Longitudinal study of rural health workforce in five counties in China: research design and baseline description.

BACKGROUND: The village doctors have served rural residents for many decades in China, and their role in rural health system has been highly praised in the world; unfortunately, less attention has been paid to the health workforce during the ambitious healthcare reform in recent years. Therefore, we conducted a longitudinal study to explore the current situation and track the future evolution of the rural healthcare workforce. METHODS: The self-administered structured Village Clinic Questionnaire and Village Doctor Questionnaire, which were modified from the official questionnaires of the Ministry of Health, were constructed after three focus groups, in-depth interviews in Hebei Province, and a pilot survey in Sichuan Province. Using a stratified multistage cluster sampling process, we gathered baseline data for a longitudinal survey of village doctors, village clinics from Changshu County, Liyang County, Yongchuan District, Mianzhu County, and Jingning County in China in 2011. Well-trained interviewers and strict procedures were employed to ensure the quality of this survey. Descriptive and correlation analyses were performed with Stata 12.0. RESULTS: After four months of surveying, 1,982 Village Doctor Questionnaires were collected, and the response rate was 88.1%. There were 1,507 (76.0%) male and 475 (24.0%) female doctors, with an average age of 51.3 years. The majority of village doctors (58.5%) practiced both western medicine and Traditional Chinese Medicine, and 91.2% of the doctors received their education below college level. Their practice methods were not correlated with education level (P = 0.43), but closely related to the way they obtained their highest degree (that is, prior to starting work or as on-the-job training) (P < 0.01). The mean income of the village doctors was 1,817 (95% CI 1,733 to 1,900) RMB per month in 2011; only 757 (41.3%) doctors had pensions, and the self-reported expected pension was 1,965 RMB per month. CONCLUSIONS: Village doctors in rural China are facing critical challenges, including aging, gender imbalance, low education, and a lack of social protection. This study may be beneficial for making better policies for the development of the health workforce and China's healthcare reform.

Critical role for all-trans retinoic acid for optimal effector and effector memory CD8 T cell differentiation.

A plethora of work implicates important effects of the vitamin A derivative retinoic acid (RA) in myeloid differentiation, whereas fewer studies explore the role of RA in lymphoid cells. Most work on lymphoid cells has focused on the influence of RA on CD4 T cells. Little information about the role of RA in CD8 T cell differentiation is available, and even less on cell-intrinsic effects in the CD8 T cell. This study explores the role of RA in effector and memory differentiation in a cell-intrinsic manner in the context of vaccinia virus infection. We observed the loss of the short-lived effector cell phenotype (reduced KLRG1(+), T-bet(hi), granzyme B(hi)), accompanied by an enhanced memory precursor phenotype at the effector (increased CD127(hi), IL-2(+)) and contraction phases (increased CD127(hi), IL-2(+), eomesodermin(hi)) of the CD8 response in the absence of RA signaling. The lack of RA also increased the proportion of central memory CD8s. Collectively, these results introduce a new role for RA in CD8 T cell activation and differentiation. This new role may have significant implications for optimal vaccine design in which vitamin A supplementation is used to augment effector responses, but it may be to the detriment of the long-term central memory response.

[China is poised to build a better healthcare delivery system using the integrative health paradigm].

China and the United States share similar goals regarding their health care reform: expanding coverage, bending the curve of healthcare expenditure, and ensuring quality improvement and effectiveness of healthcare. Though many differences in the two health care systems exist, there are still many innovative strategies both countries can learn from each other. This paper first discusses two major problems in the America's health care system: an increasing aging population coupled with ineffective chronic disease management; and a failing primary care system. Next it discusses the role of integrative medicine in the United States health care reform. We also review some key strategies in China's health care reform, which we believe if these policies are implemented fully and effectively, China is poised to build a better healthcare delivery system using the integrative health paradigm.

Screening and identification of a novel B-cell neutralizing epitope from Helicobacter pylori UreB.

Urease plays a crucial role in the survival and pathogenesis of Helicobacter pylori (H. pylori), and antibody neutralizing the urease activity may be implicated for the protection against H. pylori infection. Previously, a neutralizing monoclonal antibody (MAb) 6E6 against UreB of H. pylori was developed. In this work, we try to identify the B-cell epitope recognized by neutralizing MAb 6E6. Following screening a series of truncated proteins of UreB, an epitope was primarily localized in the aa 200-230 of UreB. Subsequently, we screened the overlapping synthetic peptides covering the aa 200-230 and identified a novel B-cell epitope (U(211-225), IEAGAIGFKIHEDWG) that was recognized by specific MAb 6E6. The newly identified epitope may help understanding of the protective immunity against H. pylori and be implicated for vaccine development.

[Clinical study on Shen Shuai Fang in treating chronic renal failure].

OBJECTIVE: To explore the effect of Shen Shuai Fang in treating Chronic Renal Failure (CRF) of deficiency of spleen and kidney with turbid damp and blood stagnation symptom. METHODS: 125 patients with CRF of deficiency of spleen and kidney with turbid damp and blood stagnation symptom were randomly divided into two groups, 75 patients in treatment group were treated with Shen Shuai Fang adding western medicine and the other patients in control group were treated only with western medicine. We observed the effect and indexes change including renal function, Hb, proteinuria, lipid before and after treatment. RESULTS: After six months' treatment, the general effective rate in treatment group was 77.33%, which was higher than that in control group obviously (44.00%, P < 0.01). So treatment group was obviously better than control group on decreasing proteinuria, improving renal function, increasing Hb, ameliorating lipid metabolism (P < 0.05 or P < 0.01). CONCLUSION: Shen Shuai Fang is effective to treat CRF of deficiency of spleen and kidney with turbid damp and blood stagnation symptom.

[A clinical research of Naoxinqing tablet's effects on blood fat and viscosity].

OBJECTIVE: To investigate the effects on blood fat and viscosity of Naoxinqing tablet. METHODS: 66 patients of primary hyperlipoidemia were randomly divided into three groups. The first group was treated by Naoxinqing tablet, the second group was treated by Naoxinqing and combined with half dose Simvastatin, the third group was treated by full dose Simvastatin. Then the clinical effect, fasting plasma lipid, the index of blood viscosity and side effect of the three group' patients were compared after 8 weeks. RESULTS: The index of blood fat improved obviously after treatment of the three groups ( P < 0.05, P < 0. 01), group 2 and 3 were significantly superior to group 1 (P < 0.05), and no significance between group 2 and 3 (P > 0.05). CONCLUSIONS: The Naoxinqing tablet can improve the metabolism of blood fat, decrease blood viscosity obviously and treat hyperlipoidemia effectively with little side effect.

A difference frequency generation spectrometer and its detection of atmospheric N2O.

The paper reports the realization and characterization of a difference frequency generation spectrometer using periodically poled lithium niobate (PPLN) crystal. The pump and signal laser we used is a Ti:sapphire ring laser and a diode pumped monolithic Nd:YAG laser, respectively. The continuous wave (cw) infrared radiation from 2.8 to 4.8 microm has been generated. The idler radiation can be used to study fundamental absorption bands of molecules and trace gas detection. In this work, we report the detection of nitrous oxide (N(2)O) in atmosphere, the minimum detectable concentration of 10.9 ppbV was achieved using a Herriott cell with the optical path length of 100 m.

[Clinical study on Dan Shao Tang in treating diabetic nephropathy of deficiency of Yin with damp-heat symptom].

OBJECTIVE: To explore the effect of Dan Shao Tang (DST) in treating diabetic nephropathy (DN) of deficiency of Yin with damp-heat symptom. METHODS: The 72 patients with DN of deficieny of Yin with damp-heat symptom were randomly divided into two groups. Among them, the 42 patients in treatment group were treated with DST and western medicine and the 30 patients in control group were treated only with western medicine. Before and after treatment, the effect and indexes change including blood glucose, renal function, proteinuria, microproteins, lipid metabolism and hyperviscosity were observed. RESULTS: After three months treatment, the general effective rate in treatment group was 76.19%, which was markedly higher than that in control group (50.00%, P < 0.01). Moreover, treatment group was obviously better than control group on decreasing blood glucose proteinuria and microproteins, improving renal function, ameliorating lipuid metabolism and hyperviscosity (P < 0.01 or P < 0.05). CONCLUSION: DST is effective ton treatment on DN of deficiency of Yin with damp-heat symptom.