Structural, rheological and functional properties of ultrasonic treated xanthan gums.

Xanthan gum can improve the freeze-thaw stability of frozen foods. However, the high viscosity and long hydration time of xanthan gum limits its application. In this study, ultrasound was employed to reduce the viscosity of xanthan gum, and the effect of ultrasound on its physicochemical, structural, and rheological properties was investigated using High-performance size-exclusion chromatography (HPSEC), ion chromatograph, methylation analysis, 1H NMR, rheometer, etc.. The application of ultrasonic-treated xanthan gum was evaluated in frozen dough bread. Results showed that the molecular weight of xanthan gum was reduced significantly by ultrasonication (from 3.0 × 107 Da to 1.4 × 106 Da), and the monosaccharide compositions and linkage patterns of sugar residues were altered. Results revealed that ultrasonication treatment mainly broke the molecular backbone at a lower intensity, then mainly broke the side chains with increasing intensity, which significantly reduced the apparent viscosity and viscoelastic properties of xanthan gum. The results of specific volume and hardness showed that the bread containing low molecular weight xanthan gum was of better quality. Overall, this work offers a theoretical foundation for broadening the application of xanthan gum and improving its performance in frozen dough.

Diesel removal and recovery from heavily diesel-contaminated soil based on three-liquid-phase equilibria of diesel + 2-butyloxyethanol + water.

Diesel contamination poses a serious threat to ecosystem and human health. This study proposes a novel method for simultaneous diesel removal and recovery from heavily diesel-contaminated soil by washing based on three-liquid-phase equilibria of diesel+2-butoxyethanol+water. This work covers both theoretical-cum-experimental explorations. For this brand-new ternary three-liquid-phase system (TPS), Ternary-Gibbs and Fish-Shaped phase diagrams were constructed through the phase behavior investigation to provide theoretical support for diesel removal/recovery. As the experiment demonstrated, the removal efficiency was up to 87.5 % for the contaminated soil with diesel content of 226,723 mg/kg, and the recovery rate reached 73.8 %. In addition, the TPS could also be used continuously during the washing process while avoiding solution purification, and the detached diesel would automatically float into the top phase without complicated separation. The mechanism of diesel removal was determined as the surface "stripping" effect based on ultralow interfacial tension, and the enhanced process involved "stripping+dissolution". The treated soil contained almost negligible organic solvent residue and was therefore appropriate for plant cultivation. The recovered diesel exhibited less variation from commercial diesel in composition and properties, possessing a higher potential for reuse. Moreover, this study also provided key insights into the residual mechanisms of recalcitrant hydrocarbons in the soil.

Remediation of diesel-contaminated soil by alkoxyethanol aqueous two-phase system.

The increasing diesel pollution accidents pose a serious threat to the ecological environment and human health. Remediation of diesel-contaminated soil (DCS) has attracted widespread attention during the past few decades. This work proposed an approach for the remediation of DCS by alkoxyethanol aqueous two-phase extraction (ATPE), which was an application of this small molecule aqueous two-phase system (ATPS). In addition, the influence of temperature, stirring speed, stirring time, and solid-liquid ratio on the removal of diesel was explored respectively. The removal efficiency of diesel could reach more than 97.18% in 18 min. Meanwhile, ATPS had high reusability, and the removal efficiency remained above 85.17% in the reuse process. Alkoxyethanol ATPE could effectively remove diesel hydrocarbons with different carbon chain lengths and the remediation process hardly caused residual organic solvents on the soil surface according to the analysis of gas chromatography-mass spectrometry (GC-MS) and Fourier transforms infrared (FT-IR), which could be regarded as the distinct advantage compared to the traditional surfactant washing method and organic solvent extraction method. The study of soil physicochemical properties and wheat germination proved that the soil structure and properties changed little after ATPE remediation. And finally, the mechanism of alkoxyethanol ATPE was intensively discussed according to the remediation characteristic. This work provided an efficient method for the remediation of DCS and widened the application fields of alkoxyethanol ATPS as well.

Simultaneous removal of NOx and SO2 from simulated marine ship flue gas in a novel wet scrubbing system based on divided diaphragm seawater electrolysis technology: efficiency optimization and economic assessment.

This work constructed a divided diaphragm seawater electrolysis system with two tandem packed towers for the synergistic removal of NOx and SO2. The first tower was mainly used to oxidize NO and SO2 by AC (active chlorine), and the second tower was used to further absorb NOx. The factors affecting on NO removal, including ACC (active chlorine concentration), pH value, initial NO concentration and temperature in the oxidation tower were investigated. Moreover, the effect of different inlet gas concentrations and current values were explored. The results showed that with the increase of ACC, the NO and NOx removal efficiency increased rapidly, but when the ACC was higher than 500 mg/L [Cl2], the removal efficiency did not increase further in the oxidation tower. Low pH values in the oxidation tower were favorable for NO removal. NO removal efficiency reached a maximum at 40 °C. Higher NO and SO2 concentrations were favorable for NO removal. The decline of pH in the anode cell was not conducive to the storage of AC in the continuous electrolysis removal process. NOx and SO2 were almost completely removed after being scrubbed in the oxidation and absorption towers. The relationship between current and removal efficiency of NO and SO2 in the oxidation tower was also analyzed. Finally, the removal mechanism and the application prospects were discussed.

A composite adsorbent of ZnS nanoclusters grown in zeolite NaA synthesized from fly ash with a high mercury ion removal efficiency in solution.

In this study, the nanocomposite adsorbent (ZnS-zeolite NaA) was prepared by a simple ion-exchange method, which modified the zeolite NaA synthesized from fly ash. The removal efficiency, adsorption mechanism of mercury ions by ZnS-zeolite NaA and release of zinc ion into aqueous solution during the adsorption process were determined. The results showed that ZnS nanoclusters were introduced the supercages of zeolite by ion exchange to synthesize the ZnS-zeolite NaA with high removal capacity for Hg2+ in the initial pH 2-7 of solution. Determination of the adsorption kinetics and thermodynamic parameters, in combination with X-ray diffraction, X-ray photoelectron spectroscopy and transmission electron microscopy analyses, revealed that the Hg2+ adsorption by ZnS-zeolite NaA was Hg2+ complexed and ion exchanged with ZnS in the ZnS-zeolite NaA to form stable HgS, and then, the released Zn2+ was adsorbed by the zeolite, preventing Zn2+ pollution. The Hg2+ removal rate was greater than 99.90% with the coexistence of either Zn2+ or Cu2+, Cd2+ and Pb2+. After five repetitions, the Hg2+ removal rate by the ZnS-zeolite NaA was only slightly decreased by 2%. Therefore, ZnS-zeolite NaA synthesized using fly ash has potential for broad application as a Hg2+ adsorbent.

A novel method of pH-buffered NaClO2-NaCl system for NO removal from marine diesel engine.

Marine diesel engines produce a lot of exhaust gas (NO, SO2). Based on the situation that wet scrubbing methods have been already applied to ship desulfurization and seawater is easily accessible around the ships, this paper proposed a novel AOP (advanced oxidation process) of NaClO2 (sodium chlorite) with Cl- (abundant Cl- exist in seawater) to remove NO from the flue gases of marine engines. The buffer capacity of NaAC (sodium acetate), the effect of Cl- concentration, and Cl- promotion mechanism on NO removal were investigated. The result showed that the existence of NaAC in solution could inhibit the rapid decline of the solution pH. The addition of Cl- achieved a remarkable promotion to NO removal at lower NaClO2 concentration, which was due to the fast generation of ClO2 from the promotion decomposition of NaClO2 by Cl- in acidic condition. Then, the thermodynamic and dynamic mechanism of the generation of ClO2 was intensively analyzed. And the mechanism of NO removal was discussed finally.

How far do we still need to go? A survey on knowledge, attitudes, practice related to antimicrobial stewardship regulations among Chinese doctors in 2012 and 2016.

OBJECTIVES: To explore doctors' knowledge, willingness, concerns and the countermeasures to the most stringent antimicrobial stewardship regulations of China which implemented in August 2012. DESIGN: Cross-sectional survey. A pretested 32-point structured questionnaire was distributed to doctors by sending a web link via the mobile phone application WeChat through snowball sampling methods and email groups of medical academic societies. SETTING: China. PARTICIPANTS: Doctors. PRIMARY AND SECONDARY OUTCOME MEASURES: The questionnaire inquired about the doctors' experiences, knowledge, willingness, concerns and the countermeasures to the stewardship policies. RESULTS: Total of persons in the groups was 19 791, among them 1194 submitted the answers, within them, 807 were doctors. Doctors had a mean age of 39.0 years. The majority (78.9% in 2012, 89.1% in 2016) reported that they were willing or very willing to accept the regulations. Almost all respondents (93.2%) felt the stewardship regulations had the potential to adversely affect the prognosis of patients who would have been prescribed antimicrobials before they were implemented, and >65% (65.7% in 2012, 66.9% in 2016) of doctors were often or always concerned about the prognosis of these patients. In 2012, 32% of doctors prescribed restricted antimicrobials or suggested patient self-medication with restricted antimicrobials to address doctors' concerns, and this number decreased to 22.6% in 2016. Although compulsory antimicrobial stewardship training was frequent, less than half of respondents (46.8%) responded correctly to all three knowledge questions. CONCLUSION: Antimicrobial stewardship regulations had some positive effect on rational antimicrobial use. Willingness and practice of doctors towards the regulations improved from 2012 to 2016. Knowledge about rational antimicrobial use was still lacking. Doctors found ways of accessing restricted antibiotics to address their concerns about the prognosis of patients, which undermined the implementation of the stewardship regulations.

An Overview of the Randomized Placebo-Controlled Trials of Chinese Herbal Medicine Formula Granules.

OBJECTIVE: To summarize the characteristics and the outcomes of the Randomized Placebo-Controlled Trials of Chinese Herbal Medicine Granules manufactured by China Resources Sanjiu Pharmaceutical Co., Ltd. METHODS: Databases including China National Knowledge Infrastructure, VIP, Wanfang, PubMed, Cochrane Library, and clinicaltrials.gov were searched in March 2018 for relevant randomized controlled trials (RCTs). Two reviewers independently screened for and selected studies, extracted data, and checked data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. For the outcome, the characteristics of the study, the cure rate, the effectiveness rate, and advert events were described with a method of bibliometrics. Also, we performed meta-analysis only if there were ≥2 studies treated by the same intervention and evaluated by the same outcome. RESULTS: A total of 40 placebo-controlled RCTs treated for 17 diseases were included in our analysis involving 4,632 patients. 16 of 19 studies treated by CHM granules only showed positive result in patients with HBV, HCV, fever, depression, nonalcoholic fatty liver disease, AIDS, and asthma while negative result was shown in patients with migraine. 17 of 21 studies treated by combination therapy against conventional therapy showed positive result in patients with HBV, herpes simplex keratitis, COPD, liver cirrhotic ascites, Parkinson's disease, and diabetic peripheral neuropathy while negative result was shown in patients with myasthenia gravis, angina pectoris, and depression. The pooled result cannot demonstrate that the notifying kidney formula granules had the superior effect with placebo on the clearance of serum HBV DNA and HBeAg in HBV carriers with a RR (and the 95% CI) of 2.97 [0.74,11.91] and 1.99 [0.93,4.29], respectively. But, the CHM granules can reduce within-group HBV DNA levels by more than 2 lgIU/ml; the RR (and 95% CI) was 4.64 [2.89,7.45]. Qizhu granules had a significant effect on clearance of HCV RNA with a RR (and 95% CI) of 6.26 [2.16,18.16]. And, the heat-clearing and detoxifying formula granules were superior to placebo in resolution of cold symptom among patients with fever with a RR and 95% CI of 2.58 [1.40,4.74]. Based on the conventional therapy, the pooled result demonstrated that the Regulating liver formula granules were superior to placebo on the clearance of serum HBeAg in chronic hepatitis B patients with a RR (and the 95% CI) of 1.73 [1.30,2.31]. The EeChen decoction granules were superior to placebo in COPD patients with a RR (and the 95% CI) of 1.13 [1.06,1.22]. 28 of the 40 studies reported adverse events. There were 51 adverse events in CHM formula granules group or combination group (n=2,483) and 26 in control group (n=2,122) totally. Most of the adverse symptoms spontaneously resolved after completing the courses of treatment and the other adverse symptoms improved after symptomatic treatment. CONCLUSION: 16 of 19 studies treated by CHM granules only showed positive result in 7 diseases and negative result in 1 disease. 17 of 21 studies treated by combination therapy against conventional therapy showed positive result in 6 diseases and negative result in 3 diseases. However, both the absolute and relative effectiveness of CHM formula granules compared with placebo need to be considered clinically.

Sini powder () decoction alleviates mood disorder of insomnia by regulating cation-chloride cotransporters in hippocampus.

OBJECTIVE: To investigate the mechanism of Sini Powder () decoction (SND) in the treatment of insomnia. METHODS: The rats were randomly divided into four groups: control, model, SND-treated, and Estazolamtreated groups (n=15 in each group). Sleep deprivation (SD) rat model was established using the modifified multiple platform method for 14 h per day for 14 days, and the behavior of the rats were observed. Na-K-Cl-cotransporter (NKCC1) and K+/Cl- cotransporter (KCC2) in the hippocampus were tested by immunohistochemistry, real-time polymerase chain reaction, and western blot. RESULTS: SD rats displayed anxiety-like behavior, which was alleviated by SND. The protein expressions of NKCC1 and KCC2 in the hippocampus were signifificantly decreased in SD rats compared with those in control rats (P<0.05); these proteins were signifificantly increased by SND (P<0.05). The mRNA expression of KCC2 was signifificantly decreased in SD rats (0.62±0.35 vs. 2.29±0.56; P=0.044), while SND showed a tendency to increase the mRNA of KCC2 in SD rats (P>0.05). By contrast, the mRNA expression of NKCC1 was signifificantly increased in the hippocampus of SD rats (6.58±1.54 vs. 2.82±0.32; P=0.011), while SND decreased the mRNA expression of NKCC1 (6.58±1.54 vs. 2.79±0.81; P=0.016). CONCLUSIONS: Chinese medicine SND could alleviate mood disorder of SD rats by regulating cation-chloride cotransporters, such as NKCC1 and KCC2. These fifindings would have major implications in the mechanism of SND to relieve insomnia.

Chinese herbal medicine for Henoch-Schönlein purpura in children without renal damage: a systematic review of randomized controlled trials.

BACKGROUND: Henoch-Schönlein Purpura (HSP) is the most common necrotizing vasculitis affecting children. Traditional Chinese herbal medicine (CHM) was widely used. We aim to explore the evidence of effectiveness and safety of CHM for HSP in children without renal damage. METHODS: Randomized controlled trials (RCTs) comparing CHM with conventional medications were searched from five databases. Eligible data were pooled using random-effects model using RevMan 5.2 Subgroup analysis for different co-interventions and sensitivity analysis for reducing heterogeneity were implemented. GRADE approach was adopted. RESULTS: We included 15 trials with 1112HSP children (age 1-16 years old), disease duration one day to three months. The overall methodological quality of included trials is relatively low. Adjunctive oral CHM treatments reduced renal damage (6 trials, RR 0.47, 95%CI 0.31-0.72, I(2)=0%), and subsiding time (days) of purpura (5 trials, mean difference (MD) -3.60, 95%CI -4.21 to -2.99, I(2)=23%), joint pain (5 trials, MD -1.04, 95%CI -1.33 to -0.74, I(2)=1%) and abdomen pain (5 trials, MD -1.69, 95%CI -2.51 to -0.86, I(2)=74%). Subgroup and sensitivity analysis did not change the direction of results. No severe adverse events reported. CONCLUSIONS: Orally taken adjunctive CHM treatments are effective for children suffering HSP in terms of reducing renal damage and subsiding time of purpura, and could possibly reduce subsiding pain of joint and abdomen. No reliable conclusion regarding safety is possible based on the safety data retrieved. Further rigorous trials are warranted.

Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials.

BACKGROUND: There is no curative treatment for chronic fatigue syndrome (CFS). Traditional Chinese medicine (TCM) is widely used in the treatment of CFS in China. OBJECTIVE: To evaluate the effectiveness and safety of TCM for CFS. METHODS: The protocol of this review is registered at PROSPERO. We searched six main databases for randomized clinical trials (RCTs) on TCM for CFS from their inception to September 2013. The Cochrane risk of bias tool was used to assess the methodological quality. We used RevMan 5.1 to synthesize the results. RESULTS: 23 RCTs involving 1776 participants were identified. The risk of bias of the included studies was high. The types of TCM interventions varied, including Chinese herbal medicine, acupuncture, qigong, moxibustion, and acupoint application. The results of meta-analyses and several individual studies showed that TCM alone or in combination with other interventions significantly alleviated fatigue symptoms as measured by Chalder's fatigue scale, fatigue severity scale, fatigue assessment instrument by Joseph E. Schwartz, Bell's fatigue scale, and guiding principle of clinical research on new drugs of TCM for fatigue symptom. There was no enough evidence that TCM could improve the quality of life for CFS patients. The included studies did not report serious adverse events. CONCLUSIONS: TCM appears to be effective to alleviate the fatigue symptom for people with CFS. However, due to the high risk of bias of the included studies, larger, well-designed studies are needed to confirm the potential benefit in the future.

Physicochemical study of a metastable-state photoacid.

A photoacid that possesses a metastable acidic state induced by visible light is studied. Previous work showed that this photoacid can reversibly produce a large pH change capable of controlling chemical reactions, altering material properties, and killing bacteria. In this work, we studied the relaxation kinetics of the metastable acidic state in different solvents including water, ethanol, and DMSO. In all of these solvents, the kinetic data can be fitted well to a second-order rate equation, which indicates that protonation is involved in the rate-limiting step. The rate constants in water, ethanol, and DMSO are 73, 1.6, and 0.034 M(-1) s(-1), respectively. The slow relaxation in DMSO allowed us to fully characterize the structure of the metastable acidic state using proton NMR. We also measured the quantum yield of the photoreaction, which is as high as 0.37.

Chinese herbal medicine for diabetic peripheral neuropathy.

BACKGROUND: Chinese herbal medicine is frequently used for treating diabetic peripheral neuropathy in China. Many controlled trials have been undertaken to investigate its efficacy.This is an update of a Cochrane review that was first published in the year 2011. OBJECTIVES: To assess the beneficial effects and harms of Chinese herbal medicine for people with diabetic peripheral neuropathy. SEARCH METHODS: On 14 May 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register CENTRAL (2012, Issue 4 in The Cochrane Library), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), AMED (January 1985 to May 2012) and in October 2012, the Chinese Biomedical Database (CBM) (1979 to October 2012), Chinese National Knowledge Infrastructure Database (CNKI) (1979 to October 2012), and VIP Chinese Science and Technique Journals Database (1989 to October 2012). We searched for unpublished literature in the Chinese Conference Papers Database, and Chinese Dissertation Database (from inception to October 2012). There were no language or publication restrictions. SELECTION CRITERIA: We included randomised controlled trials of Chinese herbal medicine (with a minimum of four weeks treatment duration) for people with diabetic peripheral neuropathy compared with placebo, no intervention, or conventional interventions. Trials of herbal medicine plus a conventional drug versus the drug alone were also included. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and evaluated trial quality. We contacted study authors for additional information. MAIN RESULTS: Forty-nine randomised trials involving 3639 participants were included. All trials were conducted and published in China. Thirty-eight different herbal medicines were tested in these trials, including four single herbs (extracts from a single herb), eight traditional Chinese patent medicines, and 26 self concocted Chinese herbal compound prescriptions. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. The positive results described from the 49 studies of low quality are of questionable significance. There was inadequate reporting on adverse events in the included trials. Eighteen trials found no adverse events. Two trials reported adverse events: adverse events occurred in the control group in one trial, and in the other it was unclear in which group the adverse events occurred. 29 trials did not mention whether they monitored adverse events. Conclusions cannot be drawn from this review about the safety of herbal medicines, due to inadequate reporting. Most of the trials were of very low methodological quality and therefore the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating diabetic peripheral neuropathy should be made with caution. AUTHORS' CONCLUSIONS: Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for diabetic peripheral neuropathy. No well-designed, randomised, placebo controlled trial with objective outcome measures has been conducted.

Prospective registration, bias risk and outcome-reporting bias in randomised clinical trials of traditional Chinese medicine: an empirical methodological study.

BACKGROUND: Clinical trials on Traditional Chinese Medicine (TCM) should be registered in a publicly accessible international trial register and report on all outcomes. We systematically assessed and evaluated TCM trials in registries with their subsequent publications. OBJECTIVE: To describe the characteristics of TCM trials, estimate bias risk and outcome-reporting bias in clinical trials. DATA SOURCES AND STUDY SELECTION: Fifteen trial registries were searched from their inception to July 2012 to identify randomised trials on TCM including Chinese herbs, acupuncture and/or moxibustion, cupping, tuina, qigong, etc. DATA EXTRACTION: We extracted data including TCM specialty and treated disease/conditions from the registries and searched for subsequent publications in PubMed and Chinese databases. We compared information in the registries of completed trials with any publications focusing on study design, sample size, randomisation, bias risk including reporting bias from the register protocol. RESULTS: 1096 registered randomised trials were identified evaluating TCM, of which 505 were completed studies (46.1%). The most frequent conditions were pain (13.3%), musculoskeletal (11.7%), nervous (8.7%), digestive (7.1%), circulatory (6.5%), respiratory (6.3%), mental and behavioural disorders (6.2%) and cancer (6.0%). The trial register data identified parallel, phase II/III randomised trials with sample size estimations and blinding, but limited information about randomisation (sequence generation and allocation concealment). Comparing trial registration data of 115 completed trials (22.8%) with their subsequent 136 publications, inconsistencies were identified in one or more of the following: sample size (11%), outcome assessor blinding (37.5%), primary outcomes (29%) and safety (28%) reporting. CONCLUSIONS: Increasing numbers of clinical trials investigating a variety of TCM interventions have been registered in international trial registries. The study design of registered TCM trials has improved in estimating sample size, use of blinding and placebos. However, selective outcome reporting is widespread and similar to conventional medicine and therefore study conclusions should be interpreted with caution.

Chinese herbal medicine for gout: a systematic review of randomized clinical trials.

Patients with gout referring to Chinese herbal medicine are not rare in China, and a great number of clinical trials on herbal medicine have been published. However, there has not been a systematic review to summarize the evidence of Chinese herbal medicine for gout. The aim of this study is to evaluate the evidence for the effectiveness and safety of Chinese herbal medicine for gout. We searched for randomized clinical trials on Chinese herbal medicine for gout till December 2012. Cochrane risk of bias tool was used to assess the methodological quality. RevMan 5.2 was used to synthesize the results. We included 57 trials involving 4,527 gout patients. The quality of trials was generally poor. No trial reported health-related quality of life in patients. There is not enough evidence showing that herbal medicine was statistically more effective than conventional medications in pain relief [mean difference (MD), -0.03; 95% confidence interval (CI), -0.06, 0.00], but herbal medicine combined with conventional medicines may have better effectiveness (MD, -0.33; 95% CI, -0.59, -0.07). Trials that reported function limitation relief found herbal medicine more effective than conventional medications (MD, -0.23; 95% CI, -0.32, -0.15). There was no evidence showing that herbal medicine prevents gout recurrence better. Twenty-five out of 41 trials, involving 23 different herbal prescriptions, found statistical significance in lowering serum uric acid level, and the overall effect from Chinese herbal medicine in inflammation relief is better than conventional therapies in 19 trials with 17 different prescriptions. The current data show that herbal medicine leads to fewer side reactions compared to conventional therapies [risk ratio (RR), 0.11; 95% CI, 0.08 to 0.15]. Chinese herbal medicine may have clinical effectiveness for functional recovery in patients with gout, and lead to a safe control of serum uric acid level and inflammation severity. Due to low quality of trials, trials with higher methodological quality and less heterogeneity are needed in the future.

Traditional Chinese medicine in cancer care: a review of controlled clinical studies published in chinese.

BACKGROUND: Traditional Chinese medicine (TCM) has been widely applied for cancer care in China. There have been a large number of controlled clinical studies published in Chinese literature, yet no systematic searching and analysis has been done. This study summarizes the current evidence of controlled clinical studies of TCM for cancer. METHODS: We searched all the controlled clinical studies of TCM therapies for all kinds of cancers published in Chinese in four main Chinese electronic databases from their inception to November 2011. We bibliometrically analyzed the included studies and assessed the reporting quality. RESULTS: A total of 2964 reports (involving 253,434 cancer patients) including 2385 randomized controlled trials and 579 non-randomized controlled studies were included. The top seven cancer types treated were lung cancer, liver cancer, stomach cancer, breast cancer, esophagus cancer, colorectal cancer and nasopharyngeal cancer by both study numbers and case numbers. The majority of studies (72%) applied TCM therapy combined with conventional treatment, whilst fewer (28%) applied only TCM therapy in the experimental groups. Herbal medicine was the most frequently applied TCM therapy (2677 studies, 90.32%). The most frequently reported outcome was clinical symptom improvement (1667 studies, 56.24%) followed by biomarker indices (1270 studies, 42.85%), quality of life (1129 studies, 38.09%), chemo/radiotherapy induced side effects (1094 studies, 36.91%), tumor size (869 studies, 29.32%) and safety (547 studies, 18.45%). Completeness and adequacy of reporting appeared to improve with time. CONCLUSIONS: Data from controlled clinical studies of TCM therapies in cancer treatment is substantial, and different therapies are applied either as monotherapy or in combination with conventional medicine. Reporting of controlled clinical studies should be improved based on the CONSORT and TREND Statements in future. Further studies should address the most frequently used TCM therapy for common cancers and outcome measures should address survival, relapse/metastasis and quality of life.

Chinese Herbal Medicine in Treating Primary Sjögren's Syndrome: A Systematic Review of Randomized Trials.

Background. There is no curative treatment for primary Sjögren's syndrome (PSS). Chinese herbal medicine (CHM) is widely used in the treatment of PSS in China. Objective. To evaluate the effectiveness and safety of CHM for PSS. Methods. PubMed, Cochrane Library, China Knowledge Resource Integrated Database, Chinese Biomedical Database, Wanfang Data, and the Database for Chinese Technical Periodicals were searched for randomized controlled trials (RCTs) of CHM or CHM plus conventional medicine for PSS compared with placebo or conventional medicine. RevMan 5.0.17 was employed to conduct data analyses and assess homogeneity. Statistical models were chosen according to heterogeneity. Results. A total of 52 RCTs were included. The overall methodological quality of included trials was low. 49 trials reported response rates, of which 32 found significant improvements favoring CHM treatment against controls; 20 trials reported lacrimal function by Schirmer test scores, of which 16 trials reported a significant difference favoring CHM treatment. 21 trials reported salivary function by salivary flow rate, of which 10 reported significant favorable effects of CHM treatment. Other trials found no difference. The reported adverse effects of CHM included nausea, diarrhea, and other minor digestive symptoms, but more frequent adverse effects occurred in conventional medicine groups. Conclusions. Preliminary evidence from RCTs suggests the effect of CHM is promising for relieving symptoms, improving lacrimal and salivary function in PSS. However, the poor methodological quality of the included trials means that further well-designed, multicentered, larger trials are needed.

[Systematic review on methodology of randomized controlled trials of post-marketing Chinese patent drugs for treatment of type 2 diabetes].

BACKGROUND: Randomized controlled trial (RCT) is considered as the gold standard for the efficacy assessment of medicines. With the increasing number of Chinese patent drugs for treatment of type 2 diabetes, the methodology of post-marketing RCTs evaluating the efficacy and specific effect has become more important. OBJECTIVE: To investigate post-marketing Chinese patent drugs for treatment of type 2 diabetes, as well as the methodological quality of post-marketing RCTs. SEARCH STRATEGY: Literature was searched from the books of Newly Compiled Traditional Chinese Patent Medicine and Chinese Pharmacopeia, the websites of the State Food and Drug Administration and the Ministry of Human Resources and Social Security of the People's Republic of China, China National Knowledge Infrastructure Database, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biomedical Database (SinoMed) and Wanfang Data. The time period for searching ran from the commencement of each database to August 2011. INCLUSION CRITERIA: RCTs of post-marketing Chinese patent drugs for treatment of type 2 diabetes with intervention course no less than 3 months. DATA EXTRACTION AND ANALYSIS: Two authors independently evaluated the research quality of the RCTs by the checklist of risk bias assessment and the data collection forms based on the CONSORT Statement. Independent double data-extraction was performed. RESULTS: The authors identified a total of 149 Chinese patent drugs for treatment of type 2 diabetes. According to different indicative syndromes, the Chinese patent drugs can be divided into the following types, namely, yin deficiency and interior heat (n=48, 32%), dual deficiency of qi and yin (n=58, 39%) and dual deficiency of qi and yin combined with blood stasis (n=22, 15%). A total of 41 RCTs meeting the inclusion criteria were included. Neither multicenter RCTs nor endpoint outcome reports were found. Risk bias analysis showed that 81% of the included studies reported randomization for grouping without sequence generation, 98% of these studies did not report concealment of random numbers, 5% used placebo, 10% reported outcome attrition bias and no study employed the analysis of intention-to-treat and 98% reported the diagnostic criteria for type 2 diabetes. The participants mainly consisted of outpatients without complications (76%). The minimum and maximum sample size was 40 and 300 (106 ± 60), respectively. CONCLUSION: The inclusion and exclusion criteria and outcome measures did not match the purposes and contents of post-marketing research in the included studies. They also failed to reflect the basic principles of traditional Chinese medicine in the process of diagnosis and treatment. The demographic characteristics of the patients, the indications for medicine and the syndrome differentiation process were not reported sufficiently and transparently. In order to improve the post-marketing research and promote the rational use of Chinese patent drugs, it is recommended that phase IV clinical trials should establish clear research purpose as well as hypothesis first, and choose scientific and evidence-based study design and outcome measures. In addition, guidelines for implementation of post-marketing research should be developed.

Traditional Chinese medicine in cancer care: a review of case reports published in Chinese literature.

BACKGROUND: Traditional Chinese Medicine (TCM) is widely used for cancer treatment in China. Many support its use in treatment for cancer, yet scientific evidence for the effect of TCM needs to be established. MATERIAL AND METHODS: In this review case reports on cancer patients treated by TCM therapies are included. Search runs were conducted in 4 main Chinese databases till December 2009. RESULTS: A total of 716 reports involving 1,198 cancer patients were identified and summarized. Top 5 of the reported cancers treated with TCM were lung cancer (14.44%; 173 patients), leukemia (14.11%; 169 patients), stomach cancer (10.85%; 130 patients), liver cancer (10.18%; 122 patients) and esophageal cancer (7.35%; 88 patients). In the majority of cases (66.44%; 772) combined treatments of Chinese and conventional medicine were applied. The use of herbal medicine was highly prevalent (98.50%; 1,168 patients), and the typical administration was an individually tailored treatment according to the pattern differentiation of symptoms (74.21%; 889 patients); the use of acupuncture was relatively rare (1.8%; 22 patients). Symptom improvement was the most frequently reported outcome (84.72%; 1,015 patients). Only 15 studies (2.1%) were structurally reported. Detailed information on patients' demography, pathologically confirmed diagnosis and safety was given in 275 (22.95%), 692 (57.76%) and 10 (0.83%) reports, respectively. CONCLUSION: The amount of information from case reports of TCM therapies in cancer is rich and can be valuable for the preliminary evaluation of TCM and for the planning of further clinical trials in cancer treatment. However, the quality of the reports was generally poor and we recommend that case reports should be published in a structured manner.