Western Drugs Research Articles

Inhibition of drug-metabolizing enzymes by Jingyin granules: implications of herb-drug interactions in antiviral therapy.

Jingyin granules, a marketed antiviral herbal medicine, have been recommended for treating H1N1 influenza A virus infection and Coronavirus disease 2019 (COVID-19) in China. To fight viral diseases in a more efficient way, Jingyin granules are frequently co-administered in clinical settings with a variety of therapeutic agents, including antiviral drugs, anti-inflammatory drugs, and other Western medicines. However, it is unclear whether Jingyin granules modulate the pharmacokinetics of Western drugs or trigger clinically significant herb–drug interactions. This study aims to assess the inhibitory potency of the herbal extract of Jingyin granules (HEJG) against human drug-metabolizing enzymes and to clarify whether HEJG can modulate the pharmacokinetic profiles of Western drug(s) in vivo. The results clearly demonstrated that HEJG dose-dependently inhibited human CES1A, CES2A, CYPs1A, 2A6, 2C8, 2C9, 2D6, and 2E1; this herbal medicine also time- and NADPH-dependently inhibited human CYP2C19 and CYP3A. In vivo tests showed that HEJG significantly increased the plasma exposure of lopinavir (a CYP3A-substrate drug) by 2.43-fold and strongly prolonged its half-life by 1.91-fold when HEJG (3 g/kg) was co-administered with lopinavir to rats. Further investigation revealed licochalcone A, licochalcone B, licochalcone C and echinatin in Radix Glycyrrhizae, as well as quercetin and kaempferol in Folium Llicis Purpureae, to be time-dependent CYP3A inhibitors. Collectively, our findings reveal that HEJG modulates the pharmacokinetics of CYP substrate-drug(s) by inactivating CYP3A, providing key information for both clinicians and patients to use herb–drug combinations for antiviral therapy in a scientific and reasonable way.

Clinical Analysis of Adverse Reaction Caused by Combined Use of Cephalosporins and Various Western Drugs

Clinical Analysis of Adverse Reaction Caused by Combined Use of Cephalosporins and Various Western Drugs

The Effects of Aspirin With Combined Compound Danshen Dropping Pills on Hemorheology and Blood Lipids in Middle-Aged and Elderly Patients With CHD: A Systematic Review and Meta-Analysis.

Background: Coronary heart disease (CHD) is one of the most common diseases in clinical cardiovascular practice, mainly afflicting the middle-aged and elderly. It will greatly affect elderly quality of life, and even affect their psychological and physical health. At present, CHD is treated with western drugs alone, but this can produce drug dependency. In recent years, Traditional Chinese Medicine (TCM) combine western drugs has been used as a complementary and alternative therapy, and its effectiveness and safety have been proven, attracting the attention of numerous researchers.Objective: Our study aimed to compare the efficacy of Aspirin with Combined Compound Danshen Dropping Pills had a superior effect on the treatment of Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD. Determine the effectiveness and safety of Aspirin with Combined Compound Danshen Dropping Pills in the treatment of CHD, and obtain high quality clinical evidence.Methods: Based on the PRISMA Statement, inclusion and exclusion criteria were formulated. Randomized controlled trials (RCTs) on the Effects of Aspirin with Combined Compound Danshen Dropping Pills on Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD were found following a search of 4 mainstream medical databases. RCTs found to meet the study's requirement were included; data information was then extracted, and the quality assessed using the Cochrane bias risk assessment tool. Through RevMan software, Meta analysis was carried out for overall TC, TG, HDL-C, LDL-C hematocrit, high shear viscosity, low shear viscosity, plasma viscosity, PAGM, and TXB2 effective rate. The relative risk (RR) and 95% confidence interval (95% CI) were calculated; heterogeneity was tested and its source found; publication bias was assessed through the Egger and Begg tests, and by means of funnel plots.Result: 22 RCTs were found, involving 1,987 cases. The results of the Meta analysis showed that, compared to drug therapy alone, Aspirin with Combined Compound Danshen Dropping Pills had a superior effect on the treatment of Hemorheology and Blood Lipids in Middle-aged and Elderly Patients with CHD. The meta analysis results show the effects on TC [MD = −0.91, 95% CI (−1.09, −0.73)], on TG [MD = −0.94, 95% CI (−1.22, −0.66)], on HDL-C [MD = 0.40, 95% CI (0.27, 0.53)], on LDL-C [MD = −0.99, 95% CI (−1.24, −0.74)], on hematocrit [MD = −2.69, 95% CI (−3.73, −1.65)], on high shear blood viscosity [MD = −1.11, 95% CI (−2.18, −0.05)], on low shear viscosity [MD = −0.79, 95% CI (−0.89, −0.68)], on plasma viscosity [MD = −0.26, 95% CI (−0.52, 0.01)], on PAMG [MD = −10.75, 95% CI (−16.84, −4.67)], and on TXB2 [MD = −11.84, 95% CI (−14.75, −8.92)]. The source of heterogeneity might be related to the state of patient, efficacy of drugs in the control group and difference in judgment criteria for efficacy. The Egger test and Begg test showed that publication bias did not occur in our study.Conclusions: The combination of compound dropping pill DSP with aspirin has some therapeutic effect on blood lipids and hemorheology in patients with CHD, ince some of the RCTs featured a very small sample size, the reliability and validity of our study's conclusion may have been affected as well; therefore, the explanation should be treated with some caution. In the future, a large number of higher-quality RCTs are still needed to confirm the results of our study.

Clinical Efficacy of Infantile Massage in the Treatment of Infant Functional Constipation: A Meta-Analysis.

Background: Functional constipation in children is a common disease that causes a psychological burden on infants and young children across the world. It will greatly affect infant quality of life in early childhood and even affect their psychological and physical health. At present, infant functional constipation is treated with western drugs alone, but this can produce drug dependency. In recent years, Traditional Chinese Medicine (TCM) infant massage has been used as a complementary and alternative therapy, and its effectiveness and safety have been proven, attracting the attention of numerous researchers.Objective: Our study aimed to compare the influence of infant massage intervention on defecation frequency and consistency, determine the effectiveness, and safety of infant massage in the treatment of infant functional constipation, and obtain high-quality clinical evidence.Methods: Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, inclusion, and exclusion criteria were formulated. Randomized controlled trials (RCTs) on TCM infant massage for the treatment of infant functional constipation were found following a search of four mainstream medical databases. RCTs found to meet the study's requirement were included; data information was then extracted, and the quality was assessed using the Cochrane bias risk assessment tool. Through RevMan software, a meta-analysis was carried out for overall effective rate, stool form, defecation frequency, defecation difficulty, and constipation symptom scoring index. The relative risk (RR) and 95% confidence interval (95% CI) were calculated, heterogeneity was tested and its source was found, and publication bias was assessed through the Egger's and Begg's tests and by means of funnel plots.Results: A total of 23 RCTs and 2,005 patients were included. The results of the meta-analysis showed that compared to drug therapy alone, TCM infant massage had a superior effect on the treatment of infant functional constipation. This difference was statistically significant (p < 0.05) and evaluated according to the overall effective rate (RR = 1.25; 95% CI = 1.17, 1.33), defecation frequency [mean difference (MD) = −0.72; 95% CI = −0.80, −0.65], and constipation symptom score (MD = −0.81; 95% CI = −1.20, −0.43), showing that TCM infant massage is indeed superior to drug therapy alone in the treatment of infant functional constipation. TCM infant massage was found to be equivalent to drug therapy alone in terms of the stool form score [−0.30 (−0.38, −0.22)] and the defecation difficulty score [−0.73 (−0.81, −0.65)], since the difference was not statistically significant (p > 0.05). The source of heterogeneity might be related to the state of patient, manipulation of the massages, efficacy of drugs in the control group, and difference in judgment criteria for efficacy. The Egger's test and Begg's test showed that publication bias did not occur in our study.Conclusion: TCM infant massage can increase defecation frequency and reduce the symptoms of constipation in children suffering from functional constipation; in addition, the clinical trial showed beneficial effects. Since some of the RCTs featured a very small sample size, the reliability and validity of our study's conclusion may have been affected as well; therefore, the explanation should be treated with some caution. In the future, a large number of higher-quality RCTs are still needed to confirm the results of our study.

Virtual screening by targeting proteolytic sites of furin and TMPRSS2 to propose potential compounds obstructing the entry of SARS-CoV-2 virus into human host cells

Background and aimThe year 2020 begins with the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that cause the disease COVID-19, and continue till today. As of March 23, 2021, the outbreak has infected 124,313,054 worldwide with a total death of 2,735,707. The use of traditional medicines as an adjuvant therapy with western drugs can lower the fatality rate due to the COVID-19. Therefore, in silico molecular docking study was performed to search potential phytochemicals and drugs that can block the entry of SARS-CoV-2 into host cells by inhibiting the proteolytic cleavage activity of furin and TMPRSS2. Experimental procedureThe protein-protein docking of the host proteases furin and TMPRSS2 was carried out with the virus spike (S) protein to examine the conformational details and residues involved in the complex formation. Subsequently, a library of 163 ligands containing phytochemicals and drugs was virtually screened to propose potential hits that can inhibit the proteolytic cleavage activity of furin and TMPRSS2. Results and conclusionThe phytochemicals like limonin, gedunin, eribulin, pedunculagin, limonin glycoside and betunilic acid bind at the active site of both furin and TMPRSS2. Limonin and gedunin found mainly in the citrus fruits and neem showed the highest binding energy at the active site of furin and TMPRSS2, respectively. The polyphenols found in green tea can also be useful in suppressing the furin activity. Among the drugs, the drug nafamostat may be more beneficial than the camostat in suppressing the activity of TMPRSS2.

Food-Medicine Interface and its Application in International Level, Comparative Jurisdictions and Sri Lankan Legal Context

There has been a growing interest in the Food-medicine interface due to its legal and commercial importance with the development of both food and medicine industries. Food and medicine--even though some foods have therapeutic (curative or preventive) properties--are two different entities, regulated by different legal regimes. Hence, the distinction between food and medicine is crucial in order to protect the interests of consumers. This study is a doctrinal review on the food-medicine interface at international level with particular reference to its application in the Sri Lankan context.&#x0D; There seems to be a lack of global policy consensus or coherent legal regime regarding the food-medicine interface, and the same is true for Sri Lanka. Both Western and Ayurveda drugs are registered with the competent authorities in Sri Lanka: The National Medicines Regulatory Authority and Ayurveda Department, respectively. To register a food as a drug, these authorities can use two criteria: 1. recognised medicinal properties and 2. therapeutic (curative or preventive) purpose of consumption. The registration of a food commodity by these two competent authorities can be taken as a criterion to identify them as medicines thus, to differentiate them in a legal sense from food per se. From a legal perspective, any food not registered by one of these two authorities--irrespective of their therapeutic (curative or preventive) benefits—is considered to be simply a food. This demarcation of the food-medicine interface could be used by industries for the purpose of marketing strategies and law enforcing officers for the purposes of law enforcement.

Effectiveness of Chinese herbal medicine combined with Western medicine on deferring dialysis initiation for nondialysis chronic kidney disease stage 5 patients: a multicenter prospective nonrandomized controlled study.

BackgroundIn clinical practice, Chinese herbal medicine (CHM) purportedly has beneficial therapeutic effects for chronic kidney disease (CKD), which include delaying disease progression and dialysis initiation. However, there is a lack of high-quality evidence-based results to support this. Therefore, this study aimed to evaluate the efficacy of CHM combined with Western medicine in the treatment of stage 5 CKD.MethodsThis was a prospective nonrandomized controlled study. Stage 5 CKD (nondialysis) patients were recruited form 29 AAA class hospitals across China from July 2014 to April 2019. According to doctors’ advice and the patients’ wishes, patients were assigned to the CHM group (Western medicine + CHM) and the non-CHM group (Western medicine). Patient demographic data, primary disease, blood pressure, Chinese and Western medical drugs, clinical test results, and time of dialysis initiation were collected during follow-up.ResultsA total of 908 patients were recruited in this study, and 814 patients were finally included for further analysis, including 747 patients in the CHM group and 67 patients in the non-CHM group. 482 patients in the CHM group and 52 patients in the non-CHM group initiated dialysis. The median time of initiating dialysis was 9 (7.90, 10.10) and 3 (0.98,5.02) months in the CHM group and non-CHM group, respectively. The multivariate Cox regression analysis showed that patients in the CHM group had a significantly lower risk of dialysis [adjusted hazard ratio (aHR): 0.38; 95% confidence interval (CI): 0.28, 0.53] compared to those in the non-CHM group. After 1:2 matching, the outcomes of 160 patients were analyzed. The multivariate Cox regression analysis showed that patients in the CHM group had a significantly lower risk of dialysis (aHR: 0.32; 95% CI: 0.21, 0.48) compared to patients in the non-CHM group. Also, the Kaplan-Meier analysis demonstrated that the cumulative incidence of dialysis in the CHM group was significantly lower than that in the non-CHM group (log-rank test, P<0.001) before and after matching.ConclusionsThis study suggest that the combination of CHM and Western medicine could effectively reduce the incidence of dialysis and delay the time of dialysis initiation in stage 5 CKD patients.

Systematic Review: Guideline-Based Approach for the Management of Asthma and Subtypes via Chinese Medicine

Background Asthma is a chronic condition that results in the inflammation and narrowing of airways, often clinically presenting as wheeze and shortness of breath. Little is known of the mechanisms of action (MOA) of herbs used to treat asthma. The aim of this study is to review existing data regarding known MOA of traditional Chinese medicine which will aid in the understanding of possible interactions between Western drugs and Chinese herbs as well as the standardization of management via a proposed guideline to improve patient safety and possible synergism in the long term. Methods We searched through 5 databases for commonly prescribed herbs and formulas for asthma and narrowed down the search to identify the underlying MOA of individual herbs that could specifically target asthma symptoms. We included studies that stated the MOA of individual herbs when used for treating symptoms of asthma, excluding them if they are described as part of a formula. Results A total of 26 herbs commonly prescribed for asthma with known mechanism of action were identified. Herbs used for asthma were found to have similar MOA as that for drugs. Based on existing GINA guidelines, a guideline is proposed which includes a total of 5 steps depending on the severity of asthma and the herbs' MOA. 16 formulas were subsequently identified for the management of asthma, which consist of 12 “stand-alone” and 4 “add-on” formulas. “Stand-alone” formulas used independently for asthma generally follow the GINA guidelines but do not proceed beyond step 3. These formulas consist mainly of beta-agonist and steroid-like effects. “Add-on” formulas added as adjunct to “stand-alone” formulas, however, mainly act on T helper cells or have steroid-like effects. Conclusion Through the understanding of MOA of herbs and their respective formulas, it will ensue greater patient safety and outcomes.

Retrospective evaluation of the curative effect of traditional Chinese medicine on dry eye disease.

Dry eye disease (DED) is a multifactorial illness with an increasingly high global prevalence and multiple risk factors that widely influences patients’ daily lives. It is essential to identify treatments with few or no side effects for patients with DED. We have reviewed studies published from 2001 to 2020 that investigated traditional Chinese medicine (TCM) and integrated Chinese and Western medicine for DED treatment. Current Chinese medicines used in DED therapy were categorized into four types, namely anti-oxidants, anti-inflammatory agents, hormone-like agents, and cell-repairing agents. Compound herbs, including Chi-Ju-Di-Huang-Wan and Qiming granule, can effectively alleviate dry eye symptoms. Moreover, patients with DED who were treated with Western medicine combined with TCM experienced significantly magnified therapeutic effects and reasonable costs of treatment. In conclusion, TCM can be a promising approach for treating DED, and combined treatment with TCM and Western drugs may represent a new strategy for improving the curative effect.

Literature based discovery of alternative TCM medicine for adverse reactions to depression drugs

BackgroundIn recent years, Traditional Chinese Medicine (TCM) and alternative medicine have been widely used along with western drugs as a complementary form of treatment. In this study, we first use the scientific literature to identify western drugs with obvious side effects. Then, we find TCM alternatives for these western drugs to ameliorate their side effects.ResultsWe used depression as a case study. To evaluate our method, we showed the relation between herb-ingredients-target-disease for representative alternative herbs of western drugs. Further, a protein-protein interaction network of western drugs and alternative herbs was produced, and we performed enrichment analysis of the targets of the active ingredients of the herbs and examined the enrichment of Gene Ontology terms for Biological Process, Cellular Component, and Molecular Function and KEGG Pathway levels, to show how these targets affect different levels of gene expression.ConclusionOur proposed method is able to select herbs that are highly relevant to the target indication (depression) and are able to treat the side effects caused by the target drug. The compounds from our selected alternative herbal medicines can therefore be complementary to the western drugs and ameliorate their side effects, which may help in the development of new drugs.

Analysis of clinical application characteristics of Xingnaojing Injection in treating cerebral hemorrhage in real world

To explore the population characteristics and clinical application characteristics of patients with cerebral hemorrhage treated with Xingnaojing Injection in real world. The model was established by Apriori algorithm, and the general information and medication information of 8 369 patients with cerebral hemorrhage treated with Xingnaojing Injection were analyzed by using Clementine 12.0 in the databases of information systems of 33 class Ⅲ grade A hospitals in China. The results showed that among the 8 369 patients with cerebral hemorrhage treated with Xingnaojing Injection, the median age was 59 years old. And the male to female ratio was about 1.74∶1. Most of them did manual labor(31.26%), and were hospitalized in winter(27.46%), especially during the Cold Dew(5.1%). The majority of the patients were in a stable condition(50.94%), and preferred neurosurgery department(48.82%). 29.03% of patients were hospitalized for 15-28 days, and 42.47% of patients spent 10 000-50 000 Yuan of hospitalization expenses. The single dose of Xingnaojing Injection was 10-20 mL at most(46.03%). And the course of medication was mostly 3 days or less(68.60%). Lidocain was the most frequently used Western medicine in drug combination(5.05%), and Huayu Tongmai Ji was the most frequently used traditional Chinese medicine in drug combination(10.73%). The most frequently used one type of traditional Chinese medicine combined with one type of Western medicine was Huayu Tongmai Ji + Dexamethasone(8.08%). The most frequently used two Western medicines in drug combination were Omeprazole + Dexamethasone(5.07%). Prilosec + Dexamethasone + Lidocaine(3.35%) were three Western drugs with the most frequent combination. When the dosage was 10-20 mL and the number of days of treatment was &gt; 15 days, the largest number of the patients was cured and improved(44.78%, 45.85%). The results showed that cerebral hemorrhage patients treated with Xingnaojing Injection were mostly middle-aged and elderly people, with more males than females. Brain hemorrhage often occurred in winter and spring. Xingnaojing Injectiont was often combined with glucocorticoids, proton pump inhibitors and cardiovascular drugs to prevent cerebral hemorrhage complications. The clinical medication met the guidelines for the treatment of cerebral hemorrhage. Some patients had over-treatment use, which can provide a reference for clinicians in treating cerebral hemorrhage.

Outpatient Prescriptions of Kampo Formulations in Japan.

Objective Kampo is a traditional Japanese medicine using formulae of natural agents. Although Kampo is widely practiced, information regarding the current prescriptions of Kampo formulations is lacking. The aim of the study was to describe the outpatient use of Kampo formulations in the current Japanese health insurance system. Methods From the JMDC Claims Database, we identified subscribers with outpatient prescriptions of Kampo extract formulations between April 2017 and March 2018. Prescription records were summarized at the individual level to describe the pattern of each formula's use, such as the frequency of prescription and the number of days within a year that were covered by the prescriptions. We also examined whether or not Kampo formulations were prescribed in combination with other drugs. Results Of the 4.5 million subscribers, 13.5% received prescriptions of Kampo extracts within 1 year, and 54% of Kampo users were women. The most commonly prescribed Kampo formulae included kakkonto, shoseiryuto, and maoto, which were used for the short term covering a median of 5 to 7 days. There were also several formulae that were prescribed for longer periods. The median numbers of days covered by kamishoyosan and keishibukuryogan were 60 and 56, respectively. Kampo formulations were used in combination with Western drugs in 85% of prescriptions. Conclusion Kampo formulations are commonly prescribed under the Japanese insurance system and are frequently used in combination with Western drugs. The pattern of prescriptions varied across different formulae.

Therapeutic Effect of Berberine on Insomnia Rats by ErbB Signaling Pathway.

BackgroundInsomnia seriously affects people’s health and quality of life. Short-term use of Western drugs may also be harmful. Traditional Chinese medicine has been widely used to treat diseases in world. Therefore, this paper aims to study the therapeutic effect of berberine based on the insomnious rat model.Material/MethodsThe insomnia rat model was established by intragastric administration of caffeine and parachlorophenylalanine (PCPA). Berberine and diazepam were used to treat the established insomnia rats. Then, the pathological changes of insomnia rats were detected. In addition, transcriptome sequencing and data analysis were carried out using rat hippocampus. The expression of key genes was verified by quantitative polymerase chain reaction and western blot.ResultsAfter 7 days of intragastric administration of berberine, the body weight, memory, and sleep quality of insomnia rats were significantly improved. The key roles of Erbb4, Erbb2, Ar, and Grin2a in berberine treatment were identified. Through the analysis of biological functions and signaling pathways, berberine was shown to play a salutary role through nervous system development and ErbB signaling pathway. Gene-set enrichment analysis (GSEA) results showed that berberine treatment affected more metabolic pathways. Compared with diazepam, berberine can play a faster role, and also improve the overall health level of insomnia rats.ConclusionsThese results suggest that berberine can alleviate insomnia in rats through a neuroprotective effect and improved metabolic level. Berberine has great potential in treatment of insomnia and might have better clinical significance.

Study on clinical characteristics of Danshen Chuanxiongqin Injection in treatment of cerebral infarction in real world

In this study, the clinical characteristics and drug combination rules of Danshen Chuanxiongqin Injection in the treatment of patients with cerebral infarction were analyzed. The inpatient information of 2 857 patients of cerebral infarction treated with Danshen Chuanxiongqin Injection in HIS database of 20 grade Ⅲ class A hospitals in China was collected, and a model was established by description analysis and Apriori algorithm, in order to explore the clinical characteristics and drug combination rules of Danshen Chuan-xiongqin Injection in the treatment of cerebral infarction. The results showed that among patients of cerebral infarction treated with Danshen Chuanxiongqin Injection, 1 727 patients were older than 65 years old, accounting for 69.61%, and 1 610 were males, accounting for 63.59%. Commonly used drugs included lipid-lowering agents, anticoagulant thrombolytic agents, antiplatelet agents, stimulants of brain metabolism, vasodilators and other Western drugs, as well as traditional Chinese medicines, such as blood-activating agents, heat-clearing agents and expectorant agents. The Western medicine with the highest use frequency in combination with Danshen Chuan-xiongqin Injection was aspirin enteric-coated tablets(1 528 cases, 53.48%). The traditional Chinese medicine with the highest use frequency in combination with Danshen Chuanxiongqin Injection was Xingnaojing Injection, with a total of 378 cases, accounting for 13.23%. Among them, the most commonly used Western drugs combined with Danshen Chuanxiongqin Injection were anticoagulant thrombolytic and antiplatelet drugs, with a usage rate as high as 83.48%. In order to further explore the drug combination rules of Danshen Chuanxiongqin Injection, the association analysis of drug combination in patients of cerebral infarction treated with Danshen Chuanxiongqin Injection was carried out. In clinical combination of two Western drugs, Atorvastatin Calcium Capsules+Cerebral Proteolytic Injection were the most common combination, with a support of 27.10%. In clinical combination with 3 Western drugs, Clopidogrel Bisulfate Tablets+Atorvastatin Calcium Capsules+Cerebral Proteolytic Injection were most commonly used, with a support of 15.90%. The results showed that the patients of cerebral infarction treated with Danshen Chuanxiongqin Injection were mainly elderly males, and often complicated with hypertension, coronary heart disease, diabetes and other basic diseases. The clinical application of Danshen Chuanxiongqin Injection was principally in line with the guidelines. In the treatment of cerebral infarction, it was often combined with Western medicine anticoagulant thrombolysis, antiplatelet drugs, traditional Chinese medicine blood-activating and stasis-dissolving prescription and other drugs with similar pharmacological effects, with an auxiliary therapeutic effect on patients of cerebral infarction complicated with other diseases, and can provide guidance for clinical medication.

Rapid bioluminescence assay for monitoring rat CES1 activity and its alteration by traditional Chinese medicines

In traditional Chinese medicine herbs (TCM), including Radix Salviae Miltiorrhizae (Danshen), Radix Puerariae Lobatae (Gegen), Radix Angelicae Sinensis (Danggui), and Rhizoma Chuanxiong (Chuanxiong) are widely used for the prevention and treatment of cardiovascular diseases and also often co-administered with Western drugs as a part of integrative medicine practice. Carboxylesterase 1 (CES1) plays a pivotal role in the metabolisms of pro-drugs. Since (S)-2-(2-(6-dimethylamino)-benzothiazole)-4,5-dihydro-thiazole-4-carboxylate (NLMe) has recently been identified by us as a selective CES1 bioluminescent sensor, we developed a rapid method using this substrate for the direct measurement of CES1 activity in rats. This bioluminescence assay was applied to determine CES1 activity in rat tissues after a two-week oral administration of each of the four herbs noted above. The results demonstrated the presence of CES1 enzyme in rat blood and all tested tissues with much higher enzyme activity in the blood, liver, kidney and heart than that in the small intestine, spleen, lung, pancreas, brain and stomach. In addition, the four herbs showed tissue-specific effects on rat CES1 expression. Based on the CES1 biodistribution and its changes after treatment in rats, the possibility that Danshen, Gegen and Danggui might alter CES1 activities in human blood and kidney should be considered. In summary, a selective and sensitive bioluminescence assay was developed to rapidly evaluate CES1 activity and the effects of orally administered TCMs in rats.

Clinical application of Xingnaojing Injection in treatment of 11 674 cases of cerebral infarction: a real world study

To analyzed the actual clinical application of Xingnaojing Injection in treating cerebral infarction in the real world, selected HIS(hospital information system) database of inpatients in 39 hospitals across the country, and conducted descriptive analysis and association rule analysis on the information of 11 674 patients with cerebral infarction using Xingnaojing Injection. The results showed that the average age of the patients was 69.69 years. TCM syndrome of phlegm stasis and collaterals stagnation was the most(37.56%), followed by wind-phlegm obstruction of collaterals(19.01%). Virtual syndrome accounted for 21.06%. Intravenous drip was the most important route of administration(96.50%). Iv infusion single dose of 10-20 mL(52.44%), other off-label doses accounted for a larger proportion(47.56%). Continuous use of the drug within 3 days(55.45%), 15-28 days accounted for 6.96%, &gt;28 days accounted for 0.89%. The top 10 Western drugs used in combination mainly include antihypertensive drugs, acid-suppressing drugs to protect stomach, drugs to improve brain circulation, drugs to protect brain nerves and drugs to fight infection. The top 10 of Chinese patent medicines are mainly activating blood circulation and removing stasis, clearing heat and clearing the surface, etc. According to the analysis of association rules, three types of clinical drug use modes for the combination of Chinese and Western medicine were obtained, mainly including the first type: Xingnaojing Injection+nifedipine(nifedipine, nifedipyridine, Lixinping)+levoflo-xacin+Huayu Tongmai agent. The second category: Xingnaojing Injection+omeprazole+edaravone+Huayu Tongmai agent; The third category: Xingnaojing Injection+ganglioside and ganglioside derivatives+edaravone+Huayu Tongmai agent. The results show that Xingnaojing Injection is not a standard drug in the treatment of cerebral infarction. At the same time, the combined use of drugs is mainly recommended by the guidelines and conventional treatment drugs, reflecting the clinical application of integrated traditional Chinese and Western medicine.

Apoptosis Exerts a Vital Role in the Treatment of Colitis-Associated Cancer by Herbal Medicine.

Colitis-associated cancer (CAC) is known as inflammatory bowel disease (IBD)-developed colorectal cancer, the pathogenesis of which involves the occurrence of apoptosis. Western drugs clinically applied to CAC are often single-targeted and exert many adverse reactions after long-term administration, so it is urgent to develop new drugs for the treatment of CAC. Herbal medicines commonly have multiple components with multiple targets, and most of them are low-toxicity. Some herbal medicines have been reported to ameliorate CAC through inducing apoptosis, but there is still a lack of systematic review. In this work, we reviewed articles published in Sci Finder, Web of Science, PubMed, Google Scholar, CNKI, and other databases in recent years by setting the keywords as apoptosis in combination with colitis-associated cancer. We summarized the herbal medicine extracts or their compounds that can prevent CAC by modulating apoptosis and analyzed the mechanism of action. The results show the following. (1) Herbal medicines regulate both the mitochondrial apoptosis pathway and death receptor apoptosis pathway. (2) Herbal medicines modulate the above two apoptotic pathways by affecting signal transductions of IL-6/STAT3, MAPK/NF-κ B, Oxidative stress, Non-canonical TGF-β1, WNT/β-catenin, and Cell cycle, thereby ameliorating CAC. We conclude that following. (1) Studies on the role of herbal medicine in regulating apoptosis through the Ras/Raf/ERK, WNT/β-catenin, and Cell cycle pathways have not yet been carried out in sufficient depth. (2) The active constituents of reported anti-CAC herbal medicine mainly include polyphenols, terpenoids, and saccharide. Also, we identified other herbal medicines with the constituents mentioned above as their main components, aiming to provide a reference for the clinical use of herbal medicine in the treatment of CAC. (3) New dosage forms can be utilized to elevate the targeting and reduce the toxicity of herbal medicine.

Clinical trial analysis of 2019-nCoV therapy registered in China.

So far, there is a lack of effective drugs for the new coronavirus pneumonia. With more and more patients diagnosed, China has carried out more than 100 clinical studies of new coronavirus infection, including antiviral drugs, antimalarial drugs, glucocorticoids, plasma therapy, virus vaccine, and other Western drugs, while Chinese medicine research accounted for half of the studies. Most of the trials were initiated by investigators and the study period would last for 1 to 11 months. The primary endpoints included symptom improvement and virus nucleic acid turning negative, but the optimal endpoint has not been determined. Although the final results of studies will take a long time to complete, the interim research data may provide some help for the current urgent demand for drug treatment. Compared with that of during SARS period in 2003, China has the stronger capability to carry out clinical trials of new drugs in emergency period.

COMPARATIVE ANALYSIS OF COVID-19 EPIDEMIC IN HUBEI PROVINCE AND REST PARTS OF MAINLAND CHINA

Background: China 's national-level anti-COVID-19 campaign has been going on for a month. With the development of the epidemic, it is found that COVID-19 severity in Hubei province (Hubei) is different from the rest of mainland China (Rest of China). It is necessary to compare the two areas, summarize experiences and lessons, analyze the epidemic trend and further point out the direction for the campaign. Methods: Prevent, quarantine and treat the disease according to The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Collect the numbers of total close contacts, daily observation cases, daily suspected cases, total conrmed cases, daily severe cases, total deaths from January 20 to February 19, input them into SPSS 25 and Microsoft ofce 2019 excel for data processing, statistical analysis and drawing. Findings: Total conrmed cases in Hubei account for 83.2% of the country. Daily suspected cases growth rates for both areas have become negative since February 9. Daily observation cases in Rest of China reached highest point on February 5 as opposed to February 13 in Hubei, and total close contacts growth rates for the last three days are declining steadily to 1.9% and 3.8% respectively. Total conrmed cases growth rate has hit the lowest levels in Rest of China at 0.34% by comparison with 0.57% in Hubei. Mean fatality rate and mean percentage of severe cases for the last three days in Rest of China are 0.67% and 5.83% in contrast to 3.12% and 18.2% in Hubei. There have been very signicant differences in fatality rate and percentage of severe cases existing in the two areas since January 23 and 24 respectively (P&lt;0.01). Interpretation: Hubei is the main epidemic area. COVID-19 has low fatality rate and high transmissibility. Cutting off the source of infection is pivotal in containing COVID-19 outbreak and has a guiding effect on prevention and control of pandemic worldwide. The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards has played an important role in helping medical staff across the country to ght the epidemic. Coordinating national medical resources to support disaster areas, making full use of the existing facilities to isolate and quarantine, providing timely and accurate treatment can reduce fatality rate. Further efforts are needed to develop highly effective Chinese medicines, western drugs and vaccines in order to eradicate the virus or prevent the epidemic from continuing.

Traditional Chinese Medicine as a Treatment for Rheumatoid Arthritis: From Empirical Practice to Evidence-Based Therapy

Abstract Rheumatoid arthritis (RA) is a common autoimmune condition with an elusive etiology. Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses. Traditional Chinese medicine (TCM) has long been used in China as a treatment for RA and is achieving ever-increasing acceptance worldwide. TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation; however, they remain a matter of empirical practice relying on TCM theories and doctors’ own experience, which places severe restrictions on worldwide TCM application. Nevertheless, TCM is a treasure trove for drug discovery, particularly as a treatment for complicated human conditions. The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide (As2O3) combination therapy as a treatment for acute promyelocytic leukemia (APL) are excellent examples of the great value of TCM. Regarding RA treatments, many Chinese medicinal herbs and their formulas, extracts, ingredients, and even single compounds have been used in clinical applications. Several Chinese proprietary medicines (CPMs) derived from TCM formulas or herbal bioactive components, such as the controlled-release ZhengQingFengTongNing (ZQFTN) Tablets, Tripterygium Glycoside Tablets, and Total Glucosides of Peony (TGP) Capsules, have been included in the National Health Insurance Directory of China, and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects. As TCM research has advanced, particularly in the use of multidisciplinary technologies, the scientific foundations and characteristics of the use of TCM to treat RA have been revealed, and the quality of TCM treatments have been increasingly enhanced. However, TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality, safety, and efficacy in order to support its application worldwide. Therefore, intensive basic and clinical studies on TCM are required. In particular, investigations that use cutting-edge technologies in analytical chemistry, biology, and biomedical sciences, and the development of randomized clinical trials (RCTs) and personalized pragmatic randomized controlled trials (PPRCTs) are necessary. Researchers should also collaborate to advance TCM from empirical practice to evidence-based therapy, thus consistently promoting TCM development and globalization in a vital, beneficial, and contributable manner.