Change of Inflammatory Factors in Patients with Acute Coronary Syndrome / 中华医学杂志(英文版)

<p><b>Background</b>Acute coronary syndrome (ACS) is closely related to unstable plaques and secondary thrombosis. The inflammatory cells in plaques and their inflammatory products may be the cause for plaque instability and ruptures. The study aimed to disclose the changes of inflammatory factors including serum intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40), and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with ACS and its clinical significance.</p><p><b>Methods</b>A total of 120 patients with coronary heart disease (CHD) were categorized into 2 groups: 69 with ACS and 51 with stable angina pectoris (SAP); 20 patients with chest pain and normal angiography served as a control group. The 120 patients with CHD were categorized into single-vessel disease group, double-vessel disease group, and three-vessel disease group based on the number of coronary artery stenosis. The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score. They were further divided into mild CHD group with its Gensini score <26 (n = 36), moderate CHD group with its Gensini score being 26-54 (n = 48) and severe CHD group with its Gensini score >54 (n = 36). Serum levels of ICAM-1, YKL-40, and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay. Correlation between ICAM-1, YKL-40, Lp-PLA2, and Gensini score was analyzed.</p><p><b>Results</b>The levels of serum inflammatory factors ICAM-1, YKL-40, and Lp-PLA2 were significantly higher in the ACS group than those in control group and SAP group (all P < 0.05); and compared with control group, no significant difference was observed in terms of the serum ICAM-1, YKL-40, and Lp-PLA2 levels in the SAP group (P > 0.05).The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, single-vessel disease group, double-vessel disease group, and three-vessel disease group (all P > 0.05). The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, mild CHD group (Gensini score <26), moderate CHD group (Gensini score 26-54), and severe CHD group (Gensini score >54) (all P > 0.05). Nonparametric Spearman correlation analysis showed that the levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not correlated with the Gensini score in CHD patients (r = 0.093, r = -0.149, and r = -0.085, all P > 0.05; respectively).</p><p><b>Conclusions</b>The serum levels of ICAM-1, YKL-40, and Lp-PLA2 were correlated with different clinical types of CHD, but not well correlated the severity and extent of artery stenosis, suggesting that ICAM-1, YKL-40, and Lp-PLA2 might be involved in occurrence of instability of atherosclerotic plaque, and might reflect the severity of CHD mostly through reflecting the plaque stability.</p>

Clinical practice guidelines for the treatment of primary liver cancer with integrative traditional Chinese and Western medicine / 中西医结合学报

Traditional Chinese medicine (TCM) is an important part of the treatment of primary liver cancer (PLC) in China; however, the current instructions for the integrative use of traditional Chinese and Western medicine for PLC are mostly based on expert opinion. There is no evidence-based guideline for clinical practice in this field. Therefore, the Shanghai Association of Chinese Integrative Medicine has established a multidisciplinary working group to develop this guideline, which focuses on the most important questions about the use of TCM during PLC treatment. This guideline was developed following the methodological process recommended by the World Health Organization Handbook for Guideline Development. Two rounds of questionnaire survey were performed to identify clinical questions; published evidence was searched; the Grading of Recommendations Assessment, Development and Evaluation approach was used to evaluate the body of evidence; and recommendations were formulated by combining the quality of evidence, patient preferences and values, and other risk factors. The guideline was written based on the Reporting Items for Practice Guidelines in Healthcare tool. This guideline contains 10 recommendations related to 8 questions, including recommendations for early treatment by TCM after surgery, TCM combined with transcatheter arterial chemoembolization for advanced PLC, TCM drugs for external use, and acupuncture and moxibustion therapy.

Clinical observation of Shuanghuang Shengbai Granule () on prevention and treatment of myelosuppression caused by chemotherapy in cancer patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of Shuanghuang Shengbai Granule (, SSG), a traditional Chinese herbal medicine, on myelosuppression of cancer patients caused by chemotherapy.</p><p><b>METHODS</b>A total of 330 patients were randomly assigned to the treatment group (220 cases, analysed 209 cases) and the control group (110 cases, analysed 102 cases) with a 2:1 ratio by envelope method. The patients in the treatment group at the first day of chemotherapy started to take SSG for 14 days, while the patients in the control group took Leucogon Tablets. The changes of the blood routine, clinical symptoms and immune function in both groups were observed for safety and efficacy evaluation.</p><p><b>RESULTS</b>At the 7th day of chemotherapy, the white blood cells (WBCs) level in the treatment group was significantly higher than that in the control group (P<0.05). After treatment, the WBCs rate in the normal range accounted for 50.2% in the treatment group, the myelosuppression of WBCs and neutrophil were mainly grade I, while 8.1% and 5.7% of patients emerged grade III and grade IV myelosuppression, respectively. The incidence of myelosuppression of the treatment group was significantly lower than that of the control group (P<0.05). The total effective rate of Chinese medicine syndrome in the treatment group was significantly higher than that in the control group (84.2% vs. 72.5%, P<0.05). The immune cell levels in both groups were maintained in the normal range. Compared with that before treatment, the levels of CD3and CD4cells were significantly increased in the treatment group after treatment (P<0.05). The discrepancy of CD3and CD4cell activity before and after treatment in both groups were significantly different (P<0.05). No obvious adverse event occurred in both groups.</p><p><b>CONCLUSION</b>SSG had a protection effect on bone marrow suppression, and alleviated the clinical symptoms together with clinical safety.</p>

Relationship between two blood stasis syndromes and inflammatory factors in patients with acute coronary syndrome / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the relationship between inflammatory factors and two Chinese medicine (CM) syndrome types of qi stagnation and blood stasis (QSBS) and qi deficiency and blood stasis (QDBS) in patients with acute coronary syndrome (ACS).</p><p><b>METHODS</b>Sixty subjects with ACS, whose pathogenesis changes belongs to qi disturbance blood stasis syndrome, were divided into 2 groups: 30 in the QSBS group and 30 in the QDBS group. The comparative analysis on them was carried out through comparing general information, coronary angiography and inflammatory factors including intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40) and lipoprotein-associated phospholipase A2 (Lp-PLA2).</p><p><b>RESULTS</b>Compared with the QSBS group, Lp-PLA2 and YKL-40 levels in the QDBS group showed no-significant difference (P>0.05); ICAM-1 was significantly higher in the QDBS group than in the QSBS group in the pathological processes of qi disturbance and blood stasis syndrome of ACS (P<0.05).</p><p><b>CONCLUSIONS</b>Inflammatory factor ICAM-1 may be an objective basis for syndrome typing of QSBS and QDBS, which provides a research direction for standardization research of CM syndrome types.</p>

Randomized Comparison of the Crush Versus the Culotte Stenting for Coronary Artery Bifurcation Lesions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The crush and the culotte stenting were both reported to be effective for complex bifurcation lesion treatment. However, their comparative performance remains elusive.</p><p><b>METHODS</b>A total of 300 patients with coronary bifurcation lesions were randomly assigned to crush (n = 150) and culotte (n = 150) treatment. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 12 months including cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization. Index lesion restenosis at 12 months was a secondary endpoint. The surface integrals of time-averaged wall shear stress at bifurcation sites were also be quantified.</p><p><b>RESULTS</b>There were no significant differences in MACE rates between the two groups at 12-month follow-up: Crush 6.7%, culotte 5.3% (P = 0.48). The rates of index lesion restenosis were 12.7% versus 6.0% (P = 0.047) in the crush and the culotte groups, respectively. At 12-month follow-up, the surface integrals of time-averaged wall shear stress at bifurcation sites in the crush group were significantly lower than the culotte group ([5.01 ± 0.95] × 10-4 Newton and [6.08 ± 1.16] × 10-4 Newton, respectively; P = 0.003).</p><p><b>CONCLUSIONS</b>Both the crush and the culotte bifurcation stenting techniques showed satisfying clinical and angiographic results at 12-month follow-up. Bifurcation lesions treated with the culotte technique tended to have lower restenosis rates and more favorable flow patterns.</p>

Tumor microenvironment elicits primary resistance to afatinib through HGF secretion / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the effects of hepatocyte growth factor (HGF) derived from tumor microenvironment and/or afatinib on the growth of human lung adenocarcinoma H1975 cells and explore the potential mechanisms by which HGF induces primary resistance to afatinib.</p><p><b>METHODS</b>The effects of HGF, TGF-α and afatinib on the growth of H1975 cells were evaluated by MTT assay. The HGF concentrations of normal human fetal lung fibroblasts MRC-5 cells and human lung adenocarcinoma H1975 cells co-cultured or separately cultured were determined by ELISA assay. Western blot was used to detect the expressions of EGFR and Met signal pathway-related proteins and epithelial-mesenchymal transition (EMT) markers in H1975 cells treated with HGF and/or afatinib.</p><p><b>RESULTS</b>The MTT assay showed that H1975 cells were hyposensitive to afatinib in the presence of HGF. The ELISA assay showed that HGF production by H1975 cells was less than 0.1 ng/2.0×10(6) cells, but HGF production by MRC-5 cells was (151.37 ± 2.07)ng/2.0×10(6) cells incubated for 48 h. When H1975 cells and MRC-5 cells were co-cultured for 72 h, the concentration of HGF in the culture supernatant was (61.13 ± 16.21)ng/ml. In the presence of HGF, the expression of p-Met, p-Akt and p-ERK proteins in the H1975 cells was markedly up-regulated. afatinib inhibited p-EGFR, but did not affect the expression of p-Met, p-Akt and p-ERK proteins. In the presence of afatinib, HGF up-regulated the expression of vimentin and down-regulated the expression of E-cadherin.</p><p><b>CONCLUSIONS</b>HGF secreted by stromal cells in the tumor micro-environment may confer resistance to afatinib in H1975 cells by activation of the Met/PI3K/Akt and Met/MAPK/ERK signaling pathways, and is involved in the epithelial-mesenchymal transition process.</p>

Effect of bufalin combined gefitinib on lung cancer H1975 cells and its mechanisms research / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of bufalin combined Gefitinib on lung cancer H1975 cells, and to explore its potential mechanisms for anti-tumor.</p><p><b>METHODS</b>The cytostatic effects of bufalin (1 -100 nmol/L), gefitinib (0.1-20 micromol/L), and bufalin plus gefitinib on H1975 cells were evaluated by MTT assay. Their effects on apoptosis of H1975 cells were determined by flow cytometry (FCM). Their effects on expressions of epidermal growth factor receptor (EGFR) and Met signal pathway related proteins in H1975 cells were detected by Western blot.</p><p><b>RESULTS</b>Results of MTT assay showed that gefitinib over 5 micromol/L could inhibit H1975 cells. But combined therapy of bufalin and gefitinib could potently inhibit the growth of H1975 cells. Results of FCM showed the apoptotic rate was 61.64% +/- 5.61% in the bufalin plus gefitinib group, obviously higher than that of the bufalin group (18.34% +/- 3.42%) and the gefitinib group (7.32% +/- 1.08%), showing statistical difference (P < 0.01). Results of Western blot showed the protein expressions of p-EGFR, p-Met, p-Akt, and p-mTOR in H1975 cells could be markedly down-regulated by bufalin plus gefitinib.</p><p><b>CONCLUSIONS</b>Combination of bufalin and gefitinib potently inhibited the growth of H1975 cells, and induced cell apoptosis. The potential mechanism for anti-tumor might be involved in blocking EGFR-PI3k/Akt pathway.</p>

Objectified study on tongue images of patients with lung cancer of different syndromes / 中国结合医学杂志

<p><b>OBJECTIVE</b>To describe the characteristic of tongue images of patients with lung cancer of different Chinese medicine (CM) syndromes and to reveal the elemental rule on the changes of the tongue images.</p><p><b>METHODS</b>A total of 207 patients with lung cancer were divided into four syndrome groups according to the theory of CM: Fei and Shen deficiency syndrome (Group A, 72 cases), Pi deficiency and phlegm deficiency and phlegm) and Shen (deficiency and phlegm) deficiency syndrome (Group A, 72 cases), Pi (deficiency and phlegm) deficiency and phlegm dampness syndrome (Group B, 57 cases), phlegm-heat retention in Fei (Group C, 36 cases) and yin asthenia generating intrinsic heat syndrome (Group D, 42 cases). The tongue parameters were detected by tongue image digital analysis instrument, and the tongue images were described with qualitative, tongue color and quantitative analysis, respectively. The International Commission on Illumination (CIE) L·a·b (CIELAB) color model was used for the quantitative classification.</p><p><b>RESULTS</b>There was a significant statistical difference between different syndrome groups of lung cancer on tongue color, coating color, and thickness of tongue coating (P<0.01), and there was significant statistical difference between the four syndrome groups on Lab values of the tongue and coating (P<0.05). The correct identification rate of discriminant function on the raw data was 65.7%, including 72.2% for Group C, 69.4% for Group A, 69.0% for Group D and 54.4% for Group B.</p><p><b>CONCLUSIONS</b>A tongue image digital analysis instrument can objectively describe the tongue features of patients with different syndromes of lung cancer. The tongue diagnosis is very important to syndrome differentiation in CM. Tongue diagnosis should be combined with some important characteristics of syndromes in the future to establish a "combination of four examination methods, including inspection, auscultation, interrogation, and pulse-feeling and palpation" in the tongue diagnostic system.</p>

Clinical study on treatment of advanced non-small cell lung cancer with kangliu zengxiao decoction / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Kangliu Zengxiao Decoction (KLZX) in treating patients with advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>Sixty-one patients with confirmed diagnosis of NSCLC of IIIa-IV stage were randomly assigned to the treatment group (32 patients) and the control group (29 patients). Both groups were treated with two cycles of chemotherapy NP regimen, while KLZX was given to the treatment group additionally.</p><p><b>RESULTS</b>As compared with the control group, the improvements in the treatment group was better in terms of majority of clinical symptoms, median survival time, Karnofski score and body weight, also in increasing immune function, decreasing levels of tumor marks (CEA, VEGF, CYFRA21-1) and alleviating hemopoietic and digestive adverse reactions. But the two groups showed insignificant difference in reducing tumor size and stabilizing tumor foci.</p><p><b>CONCLUSION</b>Combined use of KLZX and chemotherapy has the toxicity reducing and effect enhancing action, is one of the effective approaches for treatment of advanced NSCLC.</p>

Effect of felyanning granule in antagonizing Lewis lung cancer cell proliferation through cell cycle G1/S checkpoint dominating signaling intervention / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Feiyanning Granule (FYN) on tumor growth and cell cycle distribution in mice with Lewis lung cancer, as well as its influence on G1/S cell cycle checkpoint dominating signaling RB-E2F1 bio-axis.</p><p><b>METHODS</b>Modeled C57BL/6 mice were randomly divided into 6 groups: the model group (A), the DDP treated group (B) peritoneally injected with cisplatin 0.1 mg on d1, d3 and d5 after modeling, and the 4 FYN treated groups (C-F), administered via gastrogavage with FYN Decoction, and FYN Granule in small-, median- and high- dose respectively for 14 days. The tumour inhibiting rate, tumour weight, and body weight of mice were observed after treatment; cell cycle distribution was detected by flow cytometry (FCM), RB-E2F1mRNA expressions in tumour tissue were analyzed by RT-PCR, and their protein expressions by Western blot.</p><p><b>RESULTS</b>Tumour weight in the 5 treated groups was lower than that in the model group (P < 0.05, P < 0.01). Body weight in group E was significantly higher than that in group A and B (P < 0.05, P < 0.01). FCM analysis showed the proportion of G0/G1 phase was higher in group E than in group A, B and C (P < 0.01), and cancer cell proliferation index (PI) in group E was lower than in group B (P < 0.05, P < 0.01). RT-PCR showed mRNA level of E2F1 was lower, but that of RB was significantly higher in group E than those in group A, B and C respectively (P < 0.01). Westem blot analysis showed the protein expression of E2F1 was lower in group E and B than that in group A (P < 0.05), while the protein expression of Rb in group E was higher than that in group A, B and C (P < 0.05).</p><p><b>CONCLUSION</b>The effect of FYN in inhibiting Lewis lung cancer growth was related to its intervention on cancer cell cycle distribution which blocks most tumor cells in G0/G1 phase. Moreover, FYN can reduce MDM2 expression, enhance P53 expression to influence cell cycle G1/S checkpoint dominating signaling, so as to achieve the effect of antagonizing lung cancer cell proliferation.</p>

Progress of studies on tumor stem cell and anti-cancer treatment by nourishing Shen essence and qi / 中国中西医结合杂志

The tumor stem cells (TSC) existing in the tumor plays a crucial role in carcinogenesis though very few in number. It is a special kind of stem cells with highly proliferative and self-regenerative cap ability to maintain its number stable and generate tumor. Therefore, the radical treatment of tumor should focus on TSC. TSC are derived from adult stem cells. According to TCM theory, normal stem cells belong to the category of Shen essence and qi, and patients suffering from malignant tumor always manifest as the syndrome of essence and qi deficiency, so nourishing Shen essence and qi should be of great importance for treatment of tumor.

Clinical study on treatment of advanced non-small-cell lung cancer with Chinese herbal medicine in different stages combined with chemotherapy / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of staged Chinese herbal medicinal therapy combined with chemotherapy in treating patients with non-small-cell lung cancer (NSCLC) of stage III or IV.</p><p><b>METHODS</b>Adopting prospective randomized controlled multi-centered method, the 116 patients enrolled were assigned to the treated group (n = 60) and the control group (n = 56). The control group was treated by chemotherapy alone, while the treated group treated by chemotherapy combined with Chinese herbal medicine, i.e. Kangliu Zengxiao Decoction (KLZX) was administered in the chemotherapy stage, followed with Feiyanning Decoction (FYN) in the stage after ending the chemotherapy. The survival time, Karnofsky score, main clinical symptoms and adverse reactions, etc. were observed.</p><p><b>RESULTS</b>The median survival time was 15.57 months in the treated group, which was higher than that in the control group (11.17 months, P< 0.01). The improvements in tumor related symptoms such as fatigue, dyspnea, etc. in the treated group were better than those in the control group (P <0.05). In addition, adverse reactions such as leucopenia, digestive reaction (such as nausea and vomiting) in the treated group were less than those in the control group (P <0.05).</p><p><b>CONCLUSION</b>Chinese herbal medicine combined with chemotherapy shows favorable effect in improving quality of life and prolonging survival time on patients with advanced NSCLC.</p>

Experimental research of Shuanghuang Shengbai granule on hematopoietic cells of leucopenia model mice / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the leukogenic function of Shuanghuang Shengbai (SHSB) granule and the related mechanisms.</p><p><b>METHOD</b>Mouse leukopenic models were induced by radiation. Mice were divided into normal control group, model control group, positive control group-Li kejun tablet group and three different dose (high, middle, low-dose) groups of SHSB granule. The peripheral hemogram, thymus index (TI), spleen index (SI), bone marrow nucleated cell (BMNC) and colony forming unit-spleen (CFU-S) were evaluated. The proliferation of bone marrow cells was determined. The in vitro cultured colony forming unit granulocyte macrophage (CFU-GM) was estimated. The index of CD34+ cell in BMNC were determined by flow cytometry. The ultra-micro structure of bone marrow were observed by electromicroscope.</p><p><b>RESULT</b>(1)SHSB rranule could increase the WBC of model mice; (2)SHSB granule could increase BMNC and promote the proliferation of bone marrow cell; (3)SHSB granule could increase CFU-S, CFU-GM and CD34+ cell index in BMNC of model mice significantly; (4)SHSB Granule could also protect the bone marrow hemotopoietic microenvironment from the harm of radiation; (5)SHSB granule could increase the SI of model mice, indicating the enhancement of immunological function.</p><p><b>CONCLUSION</b>SHSB granule has apparent leukogenic function. The mechanism may be related to enhancing the proliferation of hematopoietic cells and protecting the bone marrow hemotopoietic microenvironment.</p>

Effect of Shuanghuang Shengbai granule on radiotherapy or chemotherapy induced leukopenia in mice / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Shuanghuang Shengbai granule on mice leukopenia induced by ip cyclophosphamide (CTX) or radiation.</p><p><b>METHOD</b>Mice leukopenia models were induced by ip CTX or radiation, and then treated with Shuanghuang Shengbai granule per oral. The peripheral hemogram, thymus index, spleen index, bone marrow nucleated cell (BMNC) and colony forming unit-spleen (CFU-S) were detected. The bone marrow cell differentiation was examined. The pathological slices of bone marrow were observed.</p><p><b>RESULT</b>Shuanghuang Shengbai granule could increase the WBC, BMNC, CFU-S of model mice significantly; Shuanghuang Shengbai granule could make the granulocyte and erythrocyte index recovered to normal level and it could also protect the bone marrow hemotopoietic microenvironment from the harm of radiation.</p><p><b>CONCLUSION</b>Shuanghuang Shengbai granule has apparent leukogenic function.</p>