Chinese patent medicine combined with calcium channel blockers in the treatment of essential hypertension:a Bayes network meta-analysis and systematic review.

Backgroud: The co-administration of Chinese patent medicine with calcium channel blockers (CCBs) is a prevalent practice in China for treating essential hypertension (EH). However, robust evidence supporting the efficacy and safety of tailored combinations of different Chinese patent medicines with CCBs, according to individual patient conditions, is still limited. This study sought to elucidate the efficacy and safety of these combinations using a systematic review and network meta-analysis. Materials and methods: Relevant studies were sourced from established databases, incorporating randomized controlled trials published up to 1 February 2023. The ROB2 tool from the Cochrane Collaborative Network was employed to independently assess and cross-verify the quality of the included literature. A network meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 and PRISMA-Network Meta-Analyses (PRISMA-NMA) guidelines. A Bayesian network meta-analysis was utilized to gauge the efficacy and safety of distinct integrations of Chinese patent medicine and CCBs. Primary outcomes were interpreted using a paired fixed-effect meta-analysis. Publication bias was appraised through Egger's test and represented with funnel plots. All statistical analyses were executed within the R statistical framework. Results: Following rigorous selection, data extraction, and bias evaluation, 36 articles were incorporated. Tianma Gouteng Granule, when combined with CCBs, displayed superior efficacy in reducing systolic blood pressure (SBP). In terms of diastolic blood pressure (DBP) reduction, Songling Xuemaikang Capsule combined with CCBs emerged as the most effective. Regarding enhancement of antihypertensive effective rates, Qinggan Jiangya Capsule paired with CCBs demonstrated optimal results. For diminishing Traditional Chinese Medicine syndrome scores, the Qiangli Dingxuan Tablet and CCBs combination proved most beneficial. When aiming to reduce total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels, Tianma Gouteng Granule and CCBs showcased superior results. In contrast, the combination of Songling Xuemaikang Capsule and CCBs was more effective in reducing LDL-C, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6). Conclusion: This study underscores variability in outcomes from combining Chinese patent medicine and CCBs for hypertension, emphasizing the importance of personalized medicinal combinations, especially Tianma Gouteng Granule and Songling Xuemaikang Capsule. The results offer robust evidence to inform clinical guidelines for essential hypertention and significantly aid clinician in seleting appropriate Chinese patent medicines for treatment.

Elucidating the anti-hypertensive mechanisms of Uncaria rhynchophylla-Alisma plantago-aquatica L: an integrated network pharmacology, cluster analysis, and molecular docking approach.

Background: With the increasing global prevalence of hypertension, a condition that can severely affect multiple organs, there is a growing need for effective treatment options. Uncaria rhynchophylla-Alisma plantago-aquatica L. (UR-AP) is a traditional drug pair used for treating hypertension based on the liver-kidney synergy concept. However, the detailed molecular mechanisms underlying its efficacy remain unclear. Methods: This study utilized an integrative approach combining network pharmacology, cluster analysis, and molecular docking to uncover the bioactive components and targets of UR-AP in the treatment of hypertension. Initially, we extracted data from public databases to identify these components and targets. A Protein-Protein Interaction (PPI) network was constructed, followed by enrichment analysis to pinpoint the bioactive components, core targets, and pivotal pathways. Cluster analysis helped in identifying key sub-networks and hypothesizing primary targets. Furthermore, molecular docking was conducted to validate the interaction between the core targets and major bioactive components, thus confirming their potential efficacy in hypertension treatment. Results: Network pharmacological analysis identified 58 bioactive compounds in UR-AP, notably quercetin, kaempferol, beta-sitosterol (from Uncaria rhynchophylla), and Alisol B, alisol B 23-acetate (from Alisma plantago-aquatica L.), as pivotal bioactives. We pinpointed 143 targets common to both UR-AP and hypertension, highlighting MAPK1, IL6, AKT1, VEGFA, EGFR, and TP53 as central targets involved in key pathways like diastolic and endothelial function, anti-atherosclerosis, AGE-RAGE signaling, and calcium signaling. Cluster analysis emphasized IL6, TNF, AKT1, and VEGFA's roles in atherosclerosis and inflammation. Molecular docking confirmed strong interactions between these targets and UR-AP's main bioactives, underscoring their therapeutic potential. Conclusion: This research delineates UR-AP's pharmacological profile in hypertension treatment, linking traditional medicine with modern pharmacology. It highlights key bioactive components and their interactions with principal targets, suggesting UR-AP's potential as a novel therapeutic option for hypertension. The evidence from molecular docking studies supports these interactions, indicating the relevance of these components in affecting hypertension pathways. However, the study acknowledges its limitations, including the reliance on in silico analyses and the need for in vivo validation. These findings pave the way for future clinical research, aiming to integrate traditional medicine insights with contemporary scientific approaches for developing innovative hypertension therapies.

Diagnosis, Treatment, and Management for Chronic Coronary Syndrome: A Systematic Review of Clinical Practice Guidelines and Consensus Statements.

Objectives: Management of chronic coronary syndrome (CCS) encompasses a broad spectrum of practices, posing considerable complexity and variability. While guidelines have been established to augment the management quality of CCS, notable disparities persist across their recommendations. This study strives to scrutinize, compare, and reconcile these guideline recommendations pertaining to the diagnosis, treatment, and management of CCS patients. Our goal is to align these recommendations with contemporary clinical practices, thus laying a robust foundation for their pragmatic application in clinical settings. Methods: A comprehensive systematic search was conducted across multiple databases, including PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Chinese Biomedical Literature Service System, Chinese Science and Technology Periodical Database, and Chinese Biological Medicine Database. The timeframe for this search spanned from their inception up to May 30, 2022, aiming to collate all published guidelines relevant to CCS. Subsequently, two independent reviewers undertook the task of appraising the quality of these guidelines by utilizing the Appraisal of Guidelines for Research and Evaluation II instrument. Results: The search yielded a total of 10,699 citations. Following a thorough evaluation, fourteen clinical practice guidelines and four consensus statements, each offering specific recommendations for CCS, were selected. The quality of these guidelines showcased a broad spectrum of variation. The domain of "presentation clarity" received the highest accolades, while "applicability" languished at the lower end of the scoring spectrum. On average, the guidelines attained a quality score denoting sufficiency. Furthermore, recommendations across different guidelines for the diagnosis, treatment, and management of CCS displayed a striking level of divergence. Conclusion: The landscape of published CCS guidelines is marked by extensive variations in scope, quality, and recommendations. Hence, there is a compelling need for collaborative efforts amongst multidisciplinary professionals to forge comprehensive, higher-quality evidence-based guidelines; such a concerted approach is paramount to enhance treatment efficacy and health outcomes for patients grappling with CCS.

Promising Natural Medicines for the Treatment of High-Altitude Illness.

Li Li, Lin Lin, Bo Wen, Peng-cheng Zhao, Da-sheng Liu, Guo-ming Pang, Zi-rong Wang, Yong Tan, and Cheng Lu. Promising natural medicines for the treatment of high-altitude illness. High Alt Med Biol. 24:175-185, 2023.-High-altitude illness (HAI) is a dangerous disease characterized by oxidative stress, inflammatory damage and hemodynamic changes in the body that can lead to severe damage to the lungs, heart, and brain. Natural medicines are widely known for their multiple active ingredients and pharmacological effects, which may be important in the treatment of HAI. In this review, we outline the specific types of HAI and the underlying pathological mechanisms and summarize the currently documented natural medicines applied in the treatment of acute mountain sickness and high-altitude cerebral edema, high-altitude pulmonary edema, chronic mountain sickness, and high-altitude pulmonary hypertension. Their sources, types, and medicinal sites are summarized, and their active ingredients, pharmacological effects, related mechanisms, and potential toxicity are discussed. In conclusion, natural medicines, as an acceptable complementary and alternative strategy with fewer side effects and more long-term application, can provide a reference for developing more natural antialtitude sickness medicines in the future and have good application prospects in HAI treatment.

Direct mass spectrometry analysis of biological tissue for diagnosis of thyroid cancer using wooden-tip electrospray ionization.

Direct mass spectrometry (MS) analysis of human tissue at the molecular level could gain insight into biomarker discovery and disease diagnosis. Detecting metabolite profiles of tissue sample play an important role in understanding the pathological properties of disease development. Because the complex matrices in tissue samples, complicated and time-consuming sample preparation processes are usually required by conventional biological and clinical MS methods. Direct MS with ambient ionization technique is a new analytical strategy for direct sample analysis with little sample preparation, and has been proven to be a simple, rapid, and effective analytical tools for direct analysis of biological tissues. In this work, we applied a simple, low-cost, disposable wooden tip (WT) for loading tiny thyroid tissue, and then loading organic solvents to extract biomarkers under electrospray ionization (ESI) condition. Under such WT-ESI, the extract of thyroid was directly sprayed out from wooden tip to MS inlet. In this work, thyroid tissue from normal and cancer parts were analyzed by the established WT-ESI-MS, showing lipids were mainly detectable compounds in thyroid tissue. The MS data of lipids obtained from thyroid tissues were further analyzed with MS/MS experiment and multivariate variable analysis, and the biomarkers of thyroid cancer were also investigated.

An artificial anal sphincter based on a novel clamping mechanism: Design, analysis, and testing.

An artificial anal sphincter is a device to help patients with fecal incontinence rebuild the ability to control the excrement through the anus. In this article, an artificial anal sphincter based on a novel clamping mechanism (AASNCM) is proposed to improve the safety and reliability. The AASNCM, which is powered by a transcutaneous energy transfer system, consists of a novel clamping mechanism, a receiving coil and a control unit. According to design requirements, the novel clamping mechanism model was established. After that, its kinematics and dynamics were analyzed. The results of force tests on the prototype AASNCM show that the maximum values of clamping force and expanding force are 15.859 and 31.029 N, respectively. Comparing the experimental results with theoretical analysis, a good match can be concluded. Finally, in vitro experiments were conducted, and have verified the safety and reliability of the proposed AASNCM.

Potential secondary transmission of SARS-CoV-2 via wastewater.

The new coronavirus, SARS-CoV-2, has spread internationally and whilst the current focus of those dealing with the COVID-19 pandemic is understandably restricting its direct transmission, the potential for secondary transmission via wastewater should not be underestimated. The virus has been identified in human fecal and wastewater samples from different countries and potential cases of transmission via wastewater have been reported. Our recommendations for hospital wastewater treatment, municipal wastewater plants, sewage sludge, water reuse and aquatic environments are designed to reduce the risk of such transmission, and contribute to limiting the resurgence of COVID-19 as current restrictions are relaxed. A particular urgent recommendation focusses on supporting low-income countries in tackling the potential for secondary transmission via wastewater.

The Modelling, Analysis, and Experimental Validation of a Novel Micro-Robot for Diagnosis of Intestinal Diseases.

Intestinal-related diseases all around the world are increasing nowadays, and gradually become stubborn diseases threatening human health, and even lives. Diagnosis methods have attracted more and more attention. This article concerns a non-invasive way, a novel micro-robot, to diagnose intestinal diseases. This proposed micro-robot is a swallowable device, 14 mm in diameter, like a capsule. In order to make it possible for the micro-robot to move forward, backward, or anchor itself at a suspicious lesion point in the intestine with different lumen diameter sections, two key mechanisms have been proposed. One is an expanding mechanism with two-layer folded legs for anchoring. The designed expanding mechanism could realize a large variable diameter ratio, upwards of 3.43. In addition, a pair of specific annular gears instead of a traditional pinion drive is devised not only saving limited space, but also reducing energy loss. The other mechanism is a telescoping mechanism, possessing a self-locking lead screw nut system, which is used to obtain axial motion of the micro-robot. Then, the kinematics and dynamics of the micro-robot are analyzed. After that, the following experiments, including force tests and locomotion tests, are constructed. A good match is found between the theoretical results and the experimental data. Finally, in vitro experiments are performed with a prototype to verify the safety and reliability of the proposed micro-robot in porcine intestine.

[Design of Wearable Wireless Health Monitoring System and Status Recognition Algorithm].

A wearable wireless health monitoring system for drug addicts in compulsory rehabilitation centers was proposed. The system can continuously monitor multiple physiological parameters of drug addicts in real time, and issue early warning information when abnormal physiological parameters occur, so as to play the role of timely medical practice. In addition, this study proposes a convolutional neural network (CNN)model, which can evaluate the health status of drug addicts based on multiple physiological parameters. Experiments show that the model can be applied to the task of body state recognition in the open physiological parameter data set, and the recognition accuracy can reach up to 100% in a single physiological parameter data set; when the whole physiological data set is used, the recognition accuracy can reach 99.1%. The recognition accuracy exceeds the performance of the traditional pattern recognition method on this task, which verifies the superiority of the model.

Making Waves: Coronavirus detection, presence and persistence in the water environment: State of the art and knowledge needs for public health.

The main route of transmission of the human coronaviruses (HCoVs), and presumably also of the new pandemic SARS-CoV-2, is via droplets and close contacts, however their fecal elimination also suggests the possible spread via water. A scientific literature search was thus carried out to highlight the current state of the art and knowledge gaps regarding coronavirus in water. Since 1978 only 22 studies have met the inclusion criteria, and considered heterogeneous purposes, detection methods and types of water. In vitro experiments have addressed the recovery efficiency of analytical methods, survival in different types of water and the removal efficiency of water treatments. Field studies have monitored coronaviruses in surface waters, sewage, slurry, and biosolids. Overall, at the lab scale, HCoVs or surrogates can survive for several days at 4 °C, however their persistence is lower compared with non-enveloped viruses and is strongly influenced by temperature and organic or microbial pollution. HCoVs have rarely been detected in field investigations, however may be due to the low recovery efficiency of the analytical methods. The scarcity of information on HCoV in the environment suggests that research is needed to understand the fate of these viruses in the water cycle.

Cu accumulation, detoxification and tolerance in the red swamp crayfish Procambarus clarkii.

Copper is an essential metal but potentially toxic to aquatic animals at high levels. The present study investigated physiologically adaptive responses to waterborne Cu2+ exposure (0, 0.03, 0.30, 3.00 mg/L) in a representative species of crustaceans, the red swamp crayfish (Procambarus clarkii) for 7 d, followed by a 7-d depuration period. The tissue-specific distribution of Cu showed that crayfish hepatopancreas was the primary accumulating site among internal tissues. During Cu2+ exposure, crayfish repressed the expression level of Cu homeostasis genes (Ctr1, Atox1, copper-transporting ATPase 2, MTF-1/2, and MT) in hepatopancreas to inhibit intracellular Cu transporting. Cu2+-exposed crayfish increased activities of GPx and GST, GSH contents, and mRNA expression of antioxidative enzyme genes (Cu/Zn-sod, cat, gpx, gst) to cope with the Cu2+-induced oxidative stress which accompanied by an increased MDA content. Additionally, after a 7-d depuration, crayfish effectively eliminated excess Cu from hepatopancreas by up-regulating expression level of Cu homeostasis genes, and recovered from oxidative damage by enhancing antioxidative enzyme gene expression (Cu/Zn-sod, cat, gpx, gst) and consuming more GSH, which thereby caused a return of the MDA level to the control value. Overall, our study provided new insights into the regulatory mechanisms of cellular Cu homeostasis system and antioxidative system, contributing to Cu detoxification and tolerance ability exhibited by crayfish under Cu2+ stress and after withdrawal of Cu2+ stress.

RNA Sequencing Characterizes Transcriptomes Differences in Cold Response Between Northern and Southern Alternanthera philoxeroides and Highlight Adaptations Associated With Northward Expansion.

Alternanthera philoxeroides recently expanded its range northwards in China. It is unknown if the range expansion has a genetic and/or epigenetic basis, or merely an environmental basis due to a warming climate. To test these possibilities, we used an RNAseq approach with a common greenhouse design to examine gene expression in individuals from the northern edge and central portion of alligator weed range from China to determine if there were differences in their responses to cold temperatures. We hypothesized that if the recent range expansion was primarily environmental, we would observe few differences or only differences unrelated to low-temperature adaptations. We assembled over 75,000 genes of which over 65,000 had long open reading frames with similarity to sequences from arabidopsis. Differences in expression between northern and southern populations that were both exposed to low temperatures showed similar expression among genes in the C-REPEAT/DRE BINDING FACTOR (CBF) regulon. However, gene set and sub-network enrichment analysis indicated differences in the response of photosynthetic processes and oxidative stress responses were different between the two populations and we relate these differences to cold adaptation. The transcriptome differences in response to cold between the individuals from the two populations is consistent with adaptations potentiating or resulting from selection after expansion into colder environments and may indicate that genetic changes have accompanied the recent northward expansion of A. philoxeroides in China. However, we cannot rule out the possibility of epigenetic changes may have a role in this expansion.

Oxidative damage induced by copper in testis of the red swamp crayfish Procambarus clarkii and its underlying mechanisms.

Copper (Cu) is one of the most widespread environmental pollutants and is known to exert multiple toxic effects including reproductive toxicity. In this study, we investigated the toxic effect of Cu on reproduction of the red swamp crayfish (Procambarus clarkii), an economic crustacean species, by exposing adult male crayfish to 0.03 and 3.00 mg/L Cu2+ for 7 days. The results showed that Cu2+ exposure induced oxidative stress accompanied by elevated reactive oxygen species (ROS) and malondialdehyde (MDA) levels in testes, and resulted in decreased sperm quality and abnormal testicular structures with apoptotic germ cells and vacuolisation in Sertoli cells. To reveal the molecular mechanism of Cu2+-induced oxidative damage in crayfish testes, we sequenced, assembled and annotated the transcriptome for crayfish testes, using the Illumina sequencing approach. After the 3.00 mg/L Cu2+ treatment, 6745 genes with differentially expressed profile were identified, of which many genes were involved in cellular response to ROS based on Gene Ontology enrichment analysis. Further, KEGG analysis demonstrated that genes with up-regulated expression levels significantly enriched in mitochondria oxidative phosphorylation pathway, suggesting disturbed mitochondrial electron transport chain was probably a main source of Cu2+-induced ROS production in testes. This study represented the first use of transcriptome to investigate the toxic effect of Cu2+ on male crayfish reproduction, and the pathways identified underlying Cu2+ toxicity at molecular level provide a novel insight into the reproductive toxicity of Cu in crustaceans.

Appraisal of the Quality and Contents of Clinical Practice Guidelines for Hypertension Management in Chinese Medicine: A Systematic Review.

OBJECTIVE: To evaluate the quality and consistency of recommendations in the clinical practice guidelines (CPGs) for hypertension in Chinese medicine (CM). METHODS: CM CPGs were identified from 5 electronic databases and hand searches through related handbooks published from January 1990 to December 2013. Three reviewers independently appraised the CPGs based on the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument, and compared the CPGs' recommendations on CM syndrome pattern classification and treatment. RESULTS: Five CM CPGs for hypertension were included. The quality score of the evidence-based (EB) guideline was higher than those of the consensus-based with no explicit consideration of evidence-based (CB-EB) and the consensus-based (CB) guidelines. Three out of five patterns in the CPGs were recommended by the EB guideline. Tianma Gouteng Formula () in the EB guideline was recommended mostly for hypertension patients with pattern of ascendant hyperactivity of Gan (Liver)-yang and pattern of yin deficiency with yang hyperactivity in the CPGs. Acupuncture and massage were recommended for Grade I and Grade II hypertension with severe symptoms weakening the quality of life in the EB guideline. For Grade I and Grade II hypertension, CM could be used alone, while for Grade III hypertension, they should be used in combination with Western medicines. CONCLUSION: The quality of EB guideline was higher than those of CB and CB-EB CPGs in CM for hypertension and CM should be prescribed alone or combined with Western medicines based on the grade of hypertension.

Quantitation of ß-carboline and quercetin in alligator weed (Alternanthera philoxeroides (Mart.) Griseb.) by LC-MS/MS and evaluation of cardioprotective effects of the methanol extracts.

Plant invasion is one of the major threats to natural ecosystems. The alligator weed grows rapidly within a small span of time and is easily available all over the world. ß-Carboline and quercetin are considered as excellent bioactive components of the alligator weed. In our study LC-MS/MS methods were performed for the detection and determination of the bioactive constituents, ꞵ-carboline and quercetin in leaves, in multiple reaction monitoring (MRM) mode. The effects of methanol extract on cardiomyocyte apoptosis induced by doxorubicin using H9c2 cells were evaluated by MTT assay and Annexin V-FITC/PI staining assay. A sensitive and selective liquid chromatography tandem mass spectrometry was developed and validated for the determination of ꞵ-carboline and quercetin in this plant. According to in vitro cell evaluation experiments, methanol extracts significantly prevented cardiomyocyte apoptosis induced by doxorubicin.

Predicting Plant Invasions Following China's Water Diversion Project.

China's South to North Water Diversion (SNWD) project connects portions of the Yangtze River in the south to the Yellow River system in the north, overcoming biogeographic barriers to water movement. The diversion will supply potable water to over 110 million people and provide multiple other socioeconomic benefits. However, an inadvertent negative impact of this connection includes creation of conduits for species invasions. Alligator weed (Alternanthera philoxeroides), water hyacinth (Eichhornia crassipes), and water lettuce (Pistia stratiotes) are the only aquatic plant species on China's shortlists for special control. These species are mainly invasive in the Yangtze River basin. If these species are able to invade the SNWD and further spread via the SNWD, they have the potential to alter water supply, including water quantity and quality, as well as local ecology and agriculture, threatening the goals of the diversion. Understanding the full potential for these species to invade northern China is critical to early management decisions to avoid costly negative impacts. We used Maxent modeling to evaluate the probability that each of these species might become invasive in the receiving water regions. The models predict that all three species will be able to expand their ranges northward, with alligator weed and water hyacinth having the greatest potential for range expansion. These results suggest the need for prevention, monitoring, and management strategies for these species to reduce the risk and costs of impacts.

Locomotion enhancement of an inchworm-like capsule robot using long contact devices.

BACKGROUND: The inchworm-like capsule robot (CR), which consists of two anchoring mechanisms (AMs) and an extensor, is a promising device for exploring the human intestine. However, the slippery intestinal lumen can cause anchoring slippage and the visco-elastic intestine and mesentery can cause stroke loss, which both lower its locomotion performance. METHODS: This paper proposes a method for locomotion enhancement by optimizing the lengths of the contact devices that are installed at the tips of the AM. RESULTS: Theoretical analysis showed that a longer contact device was more beneficial to avoid slippage and reduce stroke loss, hence enhancing locomotion, which was then verified by ex vivo experiments. The 34.5 mm long contact devices enabled a locomotion efficiency of 54%, while it was only 21% when employing 5 mm long contact devices. CONCLUSIONS: The inchworm-like CR using long contact devices can enable a more efficient inspection of the intestine. Copyright © 2016 John Wiley & Sons, Ltd.