Reliable Evidence For Clinical Application Research Articles

Chinese Herbal Medicine Combined with Intravitreal Antivascular Growth Factor Agents in Treatment of Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis.

Retinal vein occlusion (RVO) is the second most common retinal vascular disease in the world after diabetic retinopathy. Moreover, macular edema (ME) is the main cause of visual impairment in RVO patients. Intravitreal injection of antivascular endothelial growth factor (VEGF) agents is recommended for RVO-ME. However, repeated injections severely limit their efficacy. Chinese herbal medicine (CHM) is widely used in RVO-ME as adjuvant therapy in China. The study aims to evaluate the efficacy and safety of anti-VEGF combined with CHM for RVO-ME and to provide reliable evidence for clinical application. Seven databases were searched without language or publication status restrictions. Randomized controlled trials (RCTs) comparing anti-VEGF combined with CHM (anti-VEGF + CHM) versus anti-VEGF in participants with RVO-ME were included in this study. The "risk of bias assessment tool" of the Cochrane Handbook was applied to assess the quality of included trials, and RevMan 5.3 software was used for data analysis. A total of 10 relevant trials with 743 patients were identified. The results showed that BCVA of the anti-VEGF + CHM group significantly improved at 3 months (P < 0.00001), 6 months (P=0.008), and 12 months (P=0.01), and CMT significantly reduced at 1 month (P=0.02), 2 months (P=0.0009), 3 months (P < 0.05), 6 months (P < 0.0001), and 12 months (P < 0.00001) compared with the anti-VEGF group alone. At the same time, the anti-VEGF + CHM group has a better performance in reducing the number of injections (P < 0.05) and improving the total effective rate (P < 0.0001). However, regarding adverse events, there was no statistical difference between the two groups (P=0.09). Our results provide promising evidence that anti-VEGF therapy combined with CHM may be more beneficial to patients than anti-VEGF therapy alone. However, because of the low quality and small sample size of the included studies, more rigorous and larger-scale trials were necessary to validate our results. Registration Number. CRD42021270262.

Imaging Study on Acupuncture Inhibiting Inflammation and Bone Destruction in Knee Osteoarthritis Induced by Monosodium Iodoacetate in Rat Model

ObjectiveWe aim to explore whether acupuncture inhibits inflammation and bone destruction in rat model monosodium iodoacetate (MIA)-induced knee osteoarthritis (KOA) by 18F-fluorodeoxyglucose (18F-FDG) small-animal positron emission tomography (PET) and micro-computed tomography (CT) imaging.MethodsKOA was induced in rats by intra-articular injection MIA (2 mg/50 μL) through the right knee of the rats. Forty male Sprague Dawley rats weighing 280 to 340 g (12 weeks old) were randomly divided into four groups including Control group, KOA group, KOA plus manual acupuncture group (KOA+MA), KOA plus sham acupuncture group (KOA+SA). The acupuncture treatment lasted for three weeks (one-day rest after six days of treatment). Paw withdrawal threshold test and open-field test were used to assess mechanical allodynia and locomotor activity respectively for once a week. Hematoxylin and eosin (H&E) staining was used to assess the damage of the cartilage, synovium and infrapatellar fat pad (IFP). 18F-FDG PET was performed to quantify joint inflammation. The influence on the subchondral bone in these rats was confirmed by micro-CT.ResultsMechanical hyperalgesia, joint inflammation, and obvious bone destruction were observed in the KOA group. H&E staining of the knee joint found that manual acupuncture played a protective effect in cartilage, synovium and IFP destruction. However, compared with KOA group, the results in sham acupuncture had no significant difference. After manual acupuncture treatment in KOA rats, inflammation was significantly suppressed shown by 18F-FDG PET imaging. Micro-CT analysis of the knee joint revealed that manual acupuncture protected bone by inhibiting osteophyte development and subchondral bone remodeling.ConclusionThe results of 18F-FDG PET and micro-CT showed that manual acupuncture inhibited inflammation and bone destruction, which provides reliable evidence for the effectiveness of acupuncture in hindering development of KOA, and provides reliable evidence for clinical application of acupuncture.

Xuesaitong oral preparation as adjuvant therapy for treating acute cerebral infarction: A systematic review and meta-analysis of randomized controlled trials

Ethnopharmacological relevanceCerebral infarction is the second leading cause of death and the third most common cause of disability. The use of anti-platelet aggregation drugs is prone to bleeding, liver and kidney damage, gastrointestinal reactions, and is not suitable for patients to take for a long time. Xuesaitong oral preparations (XSTOP), a traditional Chinese medicine formula, has shown therapeutic effect on treating cerebral infarction based on the clinical practice and pharmacological mechanism.Aim of the study: The study aims to evaluate the effectiveness and safety of XSTOP combined with conventional treatment (CT) in treatment of acute cerebral infarction (ACI), and to provide the reliable evidence for clinical application. Materials and methodsWe performed a literature search in Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, PubMed, EMBASE, Cochrane Library and Web of Science from their inceptions to August 2021. Systematic searches for randomized controlled trials (RCTs) of XSTOP in treatment of ACI. Odds ratio (OR) or mean difference (MD) with their 95% confidence interval was calculated between with and without XSTOP therapy. Cochrane risk of bias tool was used to evaluate the methodological quality of the included trials. ResultsEight RCTs involving 827 patients were included in this meta-analysis. By comparing XSTOP plus conventional treatment with conventional treatment alone, the meta-analysis gave the following results: (1) Total effective rate (OR = 4.53, 95% CI[2.85, 7.19], P < 0.0001); (2) National Institutes of Health Stroke Scale (NIHSS) score (MD = −3.22, 95% CI[-4.52, −1.92], P＜0.00001); (3) Plasma viscosity (PV) (MD = −0.74, 95%CI [-0.96, −0.51], P＜0.00001), hole blood high-cut viscosity (HBV) (MD = −0.63, 95%CI [-0.73, −0.53], P = 0.84), whole blood low-cut viscosity (LBV) (MD = −0.37, 95%CI [-0.56, −0.19], P = 0.96), fibrinogen (FIB) (MD = −23.78, 95%CI [-28.57, −18.99], P = 1.00), hematocrit (Hct) (MD = −2.76, 95%CI [-3.16, −2.36], P = 0.96); (4) China Stroke Scale (CSS) score (MD = −6.53, 95% CI[-9.07, −3.99], P＜0.00001); (5) No significant adverse reactions were reported; (6) The evidence was downgraded to “very low” quality, according to GRADE system. ConclusionXSTOP plus CT is conditional recommended to improve the total effective rate, NIHSS score, PV, CSS score, and no serious adverse reactions were noted. The GRADE assessment indicates that the overall certainty quality of evidence is very low. Further large-scale, well-designed and high-quality RCTs are needed to confirm the positive results. As all studies included were conducted in China. It is unclear if the findings of this meta-analysis could be generalized to other populations.

Efficacy and safety of Buyang Huanwu-Tang (Boyang Hwano-Tang) in patients with vascular dementia: A protocol of systematic review and meta analysis.

Background:Vascular dementia (VaD) is the second most common type of dementia; it has a significant impact on patients and exerts a great social and economic burden. However, there has been no comprehensive systematic review assessing the efficacy and safety of Buyang Huanwu-Tang (Boyang Hwano-Tang, BHT) for VaD. Therefore, this protocol was developed to conduct a comprehensive systematic review and meta-analysis to evaluate the effectiveness and safety of BHT in the treatment of VaD.Methods:We will perform a comprehensive electronic search including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, Research Information Service System, Korean Medical Database, KMbase, National Digital Science Library, China National Knowledge Infrastructure, Wanfang database, VIP database, Citation Information by NII, and other sources from their inception to November 25, 2020. This systematic review will include only randomized controlled clinical trials of BHT for VaD. The main outcomes will include the Mini-Mental State Examination, Montreal Cognitive Assessment, and Revised Hasegawa's Dementia Scale. Two researchers will independently conduct study selection, data extraction, and appraise the quality and risk of bias of the included studies. A meta-analysis will be conducted using Review Manager version 5.4. The evidence quality of each outcome will be appraised according to the Grades of Recommendation, Assessment, Development, and Evaluation.Results:This study will provide comprehensive understanding of the efficacy and safety of BHT for the treatment of VaD.Conclusions:The findings of this study will provide reliable evidence for clinical application and further study of BHT for VaD.Ethics and dissemination:Ethical approval is not required because individual patient data will not be included in this study. The study findings will be disseminated through conference presentations.OSF registration DOI:10.17605/OSF.IO/NDYGP

The Lethal Effects of Nicotinamide Combined With Nonfocused Ultrasound on Human Pulmonary Carcinoma Cell Line A549 in Suspension

Objective: To explore the lethal effects of nicotinamide combined with nonfocused ultrasound (NFU) on human pulmonary carcinoma A549 cell live in suspension and provide new evidence for killing the cancer cells in hydrothorax and hydroperitonia or malignant cells infiltrating in tissues. Patients and Methods: Six groups were set in our experiment: blank control group, NA group, NFU group in 0 C, NFU group in 37 C, NA-combined NFU group in 0 C, and NA-combined NFU group in 37 C. Instant and 24-hour survival rates of A549 cells treated by different methods were determined based on the trypan blue exclusive assay, growth rates were detected by MTT after 24 hours, capability of cell colony formation was detected by clone formation test, changes in construction and form of Climbing film cells could be observed under the light microscope after 24 hours, and the percentage changes of apoptosis and the distributional percentage of the cell cycle were analyzed with flow cytometry. Results: Instant and 24-hour survival rates, growth rates, and capability of cell colony formation of A549 cells decreased more obviously in NA-combined NFU group than those in the other four groups. On the contribution of NA-combined NFU, the number of karyokinesis decreased significantly, while karyopyknosis and nuclear fragmentation increased greatly. Flow cytometry showed that the apoptotic index in NA-combined NFU group was higher than that in the NA or NFU group alone, and the cell cycle was held up in G1 stage. Conclusion: Certain concentration of NA has enhancement property on NFU and can increase the irradiated effectiveness of focused ultrasound markedly, which can provide reliable evidence for clinical application of NA as an ultrasound sensitizer.