Study of TCM Syndrome Identification Modes for Patients with Type 2 Diabetes Mellitus Based on Data Mining.

OBJECTIVE: To establish the diagnosis model for syndromes of type 2 diabetes mellitus (T2-DM) and explore symptoms, the pulse and tongue signs, and laboratory indexes related to syndromes of T2-DM. METHODS: A syndromatologic and laboratory investigation was conducted in 554 T2-DM patients with 58 symptoms, 14 tongue signs, 6 pulse signs, and 12 laboratory indexes. The clinical data on the syndrome were collected and analyzed by using logistic regression analysis, decision tree, and K-nearest neighbor to establish a diagnostic model for effectively distinguishing the typical syndromes in T2-DM patients. RESULTS: The most typical syndromes revealed in T2-DM were stomach heat flourishing (SHF) syndrome (261 patients, accounting for 47.1%) and Qi-Yin deficiency (QYD) syndrome (293 patients, 52.9%). According to the clinical data of the patients with these two syndromes, variables including 6 symptoms and signs, 2 pulse signs, 1 tongue sign, and 2 laboratory indicators were introduced into the logistic regression model. All of them were statistically significant. Then, a diagnostic model constructed by QUEST and CHAID algorithms of the decision tree for identifying the two syndromes was proved to have an accurate diagnostic rate of 85.2%. It was found that the following sign and symptoms were effective to differentiate these two syndromes: odor in the mouth, polyphagia, vulnerability to starvation, burning sensation in the stomach, fatigue, limb weakness, slippery and replete pulse, weak pulse, pink tongue, oral glucose tolerance test, and hemoglobin A1C. A classification model constructed by the K-nearest neighbor method to identify the two syndromes showed an accurate diagnostic rate of 88.3%. Three major statistically significant predictors included in the model were slippery and replete pulse, polyphagia, and weak pulse (P < 0.05). CONCLUSION: A model for distinguishing the two typical syndromes (SHF syndrome and QYD syndrome) in T2-DM patients was effectively established. This model could help to provide methodological support for the standardization of traditional Chinese medicine (TCM) syndrome differentiation methods.

The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Metformin is an important component of PCOS treatment. At present, the effect of metformin in overweight women with PCOS has not been evaluated. Therefore, we conducted a systematic review to assess the effects of metformin in overweight women with PCOS and to analyze the effects of metformin in overweight women with PCOS. METHODS: We searched the PubMed, Cochrane Library, Embase, CNKI, VIP, and Wanfang databases for studies published before March 2020. Randomized controlled trials were identified to study the effects of metformin in overweight women with PCOS. Data from studies including body mass index (BMI), waist circumference (WC), follicle-stimulating hormone (FSH), homeostasis model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), triglycerides (TG), fasting blood glucose (FBG), fasting insulin, testosterone, and androstenedione were pooled. Qualified trials were selected, and methodological quality was strictly assessed. Two reviewers chose the studies independently of each other. RESULTS: Twelve trials were included. The intervention group and the control group had significant differences in the changes in body mass index (BMI) (WMD = -1.25, 95% CI (-1.60, -0.91), p < 0.00001) and waist circumference (WC) (WMD = -1.41, 95% CI (-2.46, -0.37), p=0.008) after metformin. The comprehensive results show that, in all studies, overweight women with polycystic ovary syndrome treated with metformin had significantly improved endocrine and metabolic indicators, including testosterone, follicle-stimulating hormone, luteinizing hormone, and low-density lipoprotein cholesterol. However, metformin did not regulate the secretion indexes of fasting insulin, homeostasis model assessment of insulin resistance, sex hormone-binding globulin, high-density lipoprotein cholesterol, total cholesterol, triglycerides, fasting blood glucose, and androstenedione. CONCLUSIONS: Compared with control interventions, metformin appears to be an effective intervention for overweight women with PCOS.

Roles and possible mechanisms of autoantibodies against the angiotensin AT1 receptor in vascular calcification of rats.

The aim of this study was to investigate the effect of AT1-AAs on vascular calcification. Wistar rats were immunized with synthetic peptides corresponding to the second extracellular loop of AT1 receptor. The titer of AT1-AAs in rat serum, SBP, and HR were detected weekly. Histological analysis and biochemical parameters were measured 4 months after initial immunization. The level of osteopontin and osteocalcin was measured by Western blot analysis. The results showed that the titer of AT1-AAs, SBP, and HR were all increased significant 4 weeks after initial immunization. Compared with the control group, the contractile force of the aortic ring of the immunized group to phenylephrine was significantly higher, and relaxation function was significantly reduced. The ALP activity and protein levels of osteoporotin and osteocalcin were increased in the aortic tissue of the immunized group. Histological examination showed varying degrees of calcification within each cell layer with von Kossa staining in the immunized group. Losartan treatment not only significantly lowered SBP and HR to the similar level of the control group but inhibited the ALP activity and protein levels of osteoporotin and osteocalcin. Our study demonstrated that AT1-AAs contributed to the progression of vascular calcification, suggesting that AT1-AAs may play a vital role in the occurrence of cardiovascular disease in patients with severe hypertension.

Naoxuekang, Xinnaoshutong and Xuesaitong capsules for treating stroke: a protocol for a randomised controlled trial.

INTRODUCTION: After stroke, hemiplegia, dysphasia and facial paralysis can manifest during the convalescent period. Currently, no Chinese patent medicine (CPM) is previously reported to cure each of these symptoms primarily, and thus, there are no relevant instructions for the use of CPM. This study presents a new approach based on comparative effectiveness research to distinguish the curative effects of three CPMs that are often used in stroke convalescence to determine the ideal medicine for the treatment of each symptom. METHODS AND ANALYSIS: In this multicentre and double-blind clinical trial, stratified randomisation is used to group the patients according to their primary symptoms (hemiplegia, dysphasia and facial paralysis). Three strata will be enrolled, with 80 eligible participants included in each stratum. Each stratum will be randomly and equally divided into four groups, and each group will receive one of the following treatments: Naoxuekang, Xinnaoshutong (XNST), Xuesaitong (XST) or placebo. This study will include two stages: the initial treatment period (30 days) and a follow-up period (180 days). Three replicates for each data point will be completed during this trial. The first visit will occur on day 0 after enrolment, the second visit on day 30±2 and the third visit on day 210±5. The Delphi technique is adopted to achieve index weighting, which ensures that the evaluation outcome is patient oriented. The weighted index value will be computed as the final measurement index of the outcome. ETHICS AND DISSEMINATION: This study has been approved by the Medical Ethics Committee of Tianjin University of Traditional Chinese Medicine (registration number TJUTCM-EC20160007). The results will be offered for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-17010397). The date of registration was 11 January 2017.

Association between genetic variants and characteristic symptoms of type 2 diabetes: A matched case-control study.

OBJECTIVE: To examine the association of genetic variants with characteristic symptoms of type 2 diabetes mellitus (T2DM). METHODS: A matched case-control study was performed to investigate the association between common variants in four genes (CDKAL1, GLIS3, GRK5, and TCF7L2) and symptoms of T2DM. Symptoms were examined with questionnaire for 710 subjects. Genomic DNA was extracted from peripheral blood mononuclear cell by salting-out procedure. Genotyping was carried out by direct sequencing of the unpurified polymerase chain reaction products. RESULT: Most of the T2DM patients pressented characteristic symptoms, such as feeling weak in limbs (P =0.0057), hand tremor (P =0.0208), bradymasesis (P =0.0234), and polyuria (P =0.0051). Some of the T2DM patients shared characteristic symptoms, such as desire for cold drinks (P =0.0304), polyphagia (P =0.0051), and furred tongue (P =0.028). The impaired glucose regulation (IGR) cases took only one characteristic symptom of frequent micturition (P =0.0422). GLIS3 rs7034200 and GRK5 rs10886471 were significantly associated with increased T2DM risk (GLIS3 rs7034200 under dominant model: P=0.0307; GRK5 rs10886471 under recessive model: P=0.0092). However, only the rs10886471 polymorphism in GRK5 showed a significant effect on both differentiated symptoms and T2DM risk. The C-allele was involved in both dampness-heat encumbering Pi (Spleen) syndrome (P =0.047) and qi-yin deficiency syndrome (P =0.002) via increased GRK5 expression. CONCLUSIONS: Both T2DM and IGR exhibited its corresponding characteristic symptoms. The variants of GRK5 were involved with both qi-yin deficiency syndrome and dampness-heat encumbering Pi syndrome.