Effect of electroacupuncture on ventricular structure and function in rats with myocardial ischemia-reperfusion injury

OBJECTIVES

To observe the effect of electroacupuncture (EA) on changes of ventricular structure and function in rats with myocardial ischemia-reperfusion injury (MIRI), so as to explore its potential mechanisms underlying improvement of ventricular remodeling after MIRI.

METHODS

Forty male SD rats were randomly divided into 4 groups：sham operation group, model group, EA group and medication (sacubactril valsartan, LCZ696) group, with 10 rats in each group. The MIRI model was established by ligation of the left anterior descending coronary artery and reperfusion. EA (2 Hz/100 Hz, 2 mA) was applied to bilateral "Neiguan" (PC6) for 20 min, once every other day for 21 d. Rats of the medication group received gavage of LCZ696 (60 mg·kg-1·d-1). After the intervention, echocardiography was used to detect the ejection fraction (EF) and fractional shortening (FS) of the left ventricle, and the contents of serum tumor necrosis factor-α(TNF-α), vascular cell adhesion molecule-1(VCAM-1) and intercellular cell adhesion molecule-1(ICAM-1) were assayed by enzyme-linked immunosorbent assay. The pathological changes of myocardial tissue were observed after HE staining. The Masson staining was used to evaluate the myocardial collagen deposition and myocardial fibrosis. The mRNA expression levels of collagen Ⅰ and Ⅲ and connective tissue growth factor (CTGF) in the myocardial tissue were detected by quantitative real-time PCR, and the expression levels of IL-1β and IL-18 were detected by Western blot.

RESULTS

In contrast to the sham operation group, the EF and FS levels of the left ventricle were ob-viously decreased (P<0.001), while the contents of serum TNF-α, VCAM-1 and ICAM-1, the proportion of myocardial fibrosis area, the mRNA expression levels of myocardial collagen Ⅰ, collagen Ⅲ and CTGF, the expression levels of IL-1β and IL-18 were significantly increased (P<0.001, P<0.000 1, P<0.05, P<0.01) in the model group. Compared with the model group, the EF and FS levels were remarkably increased (P<0.01), whereas the contents of serum TNF-α, VCAM-1 and ICAM-1, the proportion of myocardial fibrosis area, the mRNA expression levels of myocardial collagen Ⅰ, collagen Ⅲ and CTGF, and the expression levels of IL-1β and IL-18 were significantly down-regulated (P<0.001, P<0.01, P<0.05) in both the medication and EA groups. No significant differences were found between the EA and medication groups in all the indexes mentioned above.

CONCLUSIONS

EA can improve the left-ventricular fibrosis and function, delay or reverse ventricular remodeling in MIRI rats, which may be related to its functions in down-regulating myocardial inflammatory response and mRNA expression levels of myocardial collagen Ⅰ, collagen Ⅲ and CTGF.

[Lidong needling therapy combined with functional exercise in treatment of upper limb lymphedema after breast cancer surgery: a randomized controlled trial]

OBJECTIVE

To observe the clinical efficacy of lidong needling therapy (acupuncture technique combined with therapeutic movement of the body) on upper limb lymphedema after breast cancer surgery in combination with functional exercise.

METHODS

A total of 73 patients with postoperative lymphedema of breast cancer in the upper limbs were randomized into an observation group (36 cases) and a control group (37 cases). The routine nursing care and functional exercise were given in the control group, twice a day, for about 10-15 min each time, lasting 8 weeks. On the basis of the treatment as the control group, lidong needling therapy was applied to the acupionts on the affected upper limb, i.e. Jianyu (LI 15), Waiguan (TE 5), Hegu (LI 4) and ashi points (the most obvious swelling sites), as well as to bilateral Yinlingquan (SP 9) and Zusanli (ST 36), etc. The needles were retained for 30 min. While the needles retained, the patients were asked to move the affected shoulder to 90° by the sagittal anteflexion and keep it elevated. Simultaneously, the hand on the affected side was clenched and opened slowly and coordinately. Lidong needling therapy was delivered once every two days, three times weekly for 8 weeks. Before and after treatment, the difference of the circumference between the affected and healthy limbs, the score of visual analogue scale (VAS) for swelling and the score of disability of arm, shoulder and hand (DASH) were compared in the patients of the two groups. The clinical efficacy was evaluated.

RESULTS

After 2, 4, 6 and 8 weeks of treatment, except for the circumference of the area 10 cm below the cubitel crease in the control group, the differences in the circumferences of the rest parts between the affected and healthy limbs were reduced in comparison with those before treatment in the two groups (P<0.01, P<0.05). After 6 weeks of treatment, in the observation group, for the circumference at the level of hand between the thumb and the index finger and that of the wrist, the differences between the affected and healthy limbs was smaller compared with those in the control group (P<0.05). After 8 weeks of treatment, except for the areas 5 cm below and above the cubitel crease, the differences of circumferences between the affected and healthy limbs in the observation group were smaller than those in the control group in the rest parts (P<0.01, P<0.05). After 8 weeks of treatment, the swelling VAS scores were reduced when compared with those before treatment in the two groups (P<0.05), and the score in the observation group was lower than that in the control group (P<0.01). After 4 and 8 weeks of treatment, DASH scores were reduced in comparison with those before treatment in the two groups (P<0.01). The total effective rate of the observation group was 83.3% (30/36), which was higher than that of the control group (35.1%, 13/37, P<0.01).

CONCLUSION

Lidong needling therapy combined with the functional exercise obtains the satisfactory clinical effect on the upper limb lymphedema after breast cancer surgery. This treatment effectively relieves swelling and improves the upper limb function.

Electroacupuncture preconditioning protects against myocardial ischemia-reperfusion injury by modulating dynamic inflammatory response

Background

The protective effects of electroacupuncture (EA) preconditioning against myocardial ischemia-reperfusion injury (MIRI) have been reported. However, the underlying mechanism remains unclear. Recent research has indicated that the dynamic inflammatory response following MIRI plays an essential role in the progression of myocardial injury. This study aimed to investigate the myocardial protective effects of EA preconditioning on MIRI in rats and to explore the relevant mechanism from the perspective of dynamic inflammatory response.

Methods

A MIRI model was employed, and the rats were subjected to EA on Neiguan for four days prior to modeling. The myocardial protective effect of EA preconditioning was evaluated by echocardiography, Evans blue and triphenyltetrazolium chloride staining. Real-time polymerase chain reaction, Western blot, hematoxylin & eosin staining, and immunohistochemistry were utilized to detect the content of mitochondrial DNA, NOD receptor family protein 3 (NLRP3) inflammasome activation, neutrophil recruitment and macrophage infiltration in blood samples and myocardium below the ligation.

Results

We found that EA preconditioning could accelerate the recovery of left ventricle function after MIRI and reduce the myocardial infarction area, thereby protecting the myocardium against MIRI. Furthermore, EA preconditioning was observed to ameliorate mitochondrial impairment, reduce the level of plasma mitochondrial DNA, modulate NLRP3 inflammasome activation, attenuate neutrophil infiltration, and promote the polarization of M1 macrophages towards M2 macrophages in the myocardium after MIRI.

Conclusion

EA preconditioning could reduce plasma mtDNA, suppress overactivation of the NLRP3 inflammasome, facilitate the transition from the acute pro-inflammatory phase to the anti-inflammatory reparative phase after MIRI, and ultimately confer cardioprotective benefits.

[Technical recommendations for pragmatic randomized controlled trials of heat-sensitive moxibustion in community (Ⅱ): organization, implementation and follow-up visits]

Based on the community research experience of heat-sensitive moxibustion, this study explained technical recommendations for pragmatic randomized controlled trials (pRCTs) of heat-sensitive moxibustion in community from 7 aspects: selection of community research sites, ethical approval and registration, patient recruitment, training of standard operating procedures, ensuring patient compliance, quality control of follow-up visits and patient safety, which aimed to reduce the difficulty of research execution and improve the quality of pRCTs implementation and follow-up visits of heat-sensitive moxibustion.

[Effect of electroacupuncture preconditioning on expression of Gasdermin D, Caspase-1 and IL-1β in rats with myocardial ischemia reperfusion injury]

OBJECTIVE

To observe the effect of electroacupuncture(EA) preconditioning on expression of Caspase-1, Gasdermin D(GSDMD) and interleukin-1β(IL-1β) in myocardial tissue of myocardial ischemia reperfusion injury (MIRI) rats in order to explore its underlying mechanisms in resisting MIRI.

METHODS

Forty male rats were randomly divided into 4 groups: normal control (normal), sham operation (sham), MIRI model and EA groups. The MIRI model was established by ligation of the left anterior descending branch of the left coronary artery for 30 min and perfusion. EA (2 Hz/100 Hz, 1 mA) was applied to bilateral "Neiguan" (PC6) for 20 min, once a day for 3 consecutive days. The echocardiography was used to analyze the left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (LVEF, by using Teichholz formula) 4 h after modeling. The myocardial TTC staining was used to observe the proportion of the infarct area, and Western blot was used to detect the expression levels of GSDMD, Caspase-1, IL-1β proteins in the myocardium.

RESULTS

Compared with the normal group, the immunoactivity of GSDMD was increased in the sham group (P<0.05). Compared with the sham group, the LVEF was significantly decreased (P<0.000 1), while the myocardial infarction area, immunoactivity of GSDMD, and the expression levels of Caspase-1, GSDMD and IL-1β proteins were considerably increased in the model group (P<0.000 1, P<0.001). In comparison with the model group, the decreased ejection fraction and the increased myocardial infarction area, and Caspase-1, GSDMD and IL-1β expression were reversed in the EA group (P<0.001, P<0.000 1, P<0.01).

CONCLUSION

EA preconditioning may ameliorate myocardial injury in MIRI rats which may be associated with its function in down-regulating the expression of myocardial Caspase-1 protein to reduce cardiomyocyte pyroptosis.

[Technical recommendation for pragmatic randomized controlled trial of heat-sensitive moxibustion in community (Ⅰ): randomization with consideration of patient preference]

Heat-sensitive moxibustion is the appropriate technique of the external treatment in traditional Chinese medicine and it is widely used in community because of its "easy learning, simple operation and clear curative effect". Pragmatic randomized controlled trial is a main intervention design in the real world study, which provides a high-level evidence for the effectiveness assessment of heat-sensitive moxibustion in community management. Focusing on the key links of randomization, e.g. block randomization, stratified randomization, cluster randomization, sample size allocation, allocation concealment and blinding, the paper elaborates the advantages, disadvantages and technical details of two-stage randomization with consideration of patient preference in pragmatic randomized controlled trials of heat-sensitive moxibustion in community. It facilitates improving the quality of evidence, reproducibility and methodological homogeneity among different trials.

[Effect of electroacupuncture at "Neiguan" (PC 6) on cardiac function and inflammatory factors of acupoint area in rats with acute myocardial ischemia]

OBJECTIVE

To observe the effect of electroacupuncture (EA) at "Neiguan" (PC 6) on cardiac function and cardiomyocyte apoptosis in rats with acute myocardial ischemia (AMI), and to explore the correlation between myocardial protective effect of EA and inflammatory factors i.e. interleukin-1β (IL-1β) and interleukin-17 (IL-17) of "Neiguan" (PC 6) area.

METHODS

A total of 40 male SD rats with normal ultrasonic cardiogram were randomized into a sham-operation group, a sham-operation plus EA group, a model group and an EA group, 10 rats in each group. The AMI model was established by ligating the left anterior descending (LAD) branch of the coronary artery in the model group and the EA group, while the threading without ligating was adopted in the sham-operation group and the sham-operation plus EA group. In the sham-operation plus EA group and the EA group, EA at bilateral "Neiguan" (PC 6) was applied, with disperse-dense wave, 2 Hz/100 Hz in frequency and 2 mA in density, once a day, 20 min a time for 3 days. The cardiac ejection fraction (EF) and fractional shortening (FS) were measured by ultrasonic cardiogram to evaluate the cardiac function, the cardiomyocyte apoptosis was detected by TUNEL staining, the infiltration of inflammatory factors of "Neiguan" (PC 6) area was observed by H.E. staining, the expression of inflammatory factors IL-1β and IL-17 of "Neiguan" (PC 6) area was detected by immunofluorescence staining.

RESULTS

Compared with the sham-operation group, EF and FS were decreased (P<0.001), the average optical density of cardiomyocyte apoptosis was increased (P<0.001), the infiltration of inflammatory factors was obvious in skin dermis of "Neiguan" (PC 6) area in the model group; the positive expression of IL-1β and IL-17 of "Neiguan" (PC 6) area was increased in the model group and the sham-operation plus EA group (P<0.001, P<0.01). Compared with the model group, EF and FS were increased (P<0.01), the average optical density of cardiomyocyte apoptosis was decreased (P<0.01), the infiltration of inflammatory factors was aggravating in skin dermis of "Neiguan" (PC 6) area, and the positive expression of IL-1β and IL-17 of "Neiguan" (PC 6) area was increased in the EA group (P<0.001, P<0.01).

CONCLUSION

Electroacupuncture at "Neiguan" (PC 6) can improve the cardiac function and reduce the apoptosis of cardiomyocyte in rats with acute myocardial ischemia, its mechanism may be related to the regulation of the inflammatory factors of "Neiguan" (PC 6) area.

Electroacupuncture interventions alleviates myocardial ischemia reperfusion injury through regulating gut microbiota in rats

Electroacupuncture (EA) intervention has a remarkable cardioprotection against myocardial ischemia reperfusion injury (MIRI). Recently, it has been suggested that the gut microbiota plays an important role in regulating the progression and prognosis of MIRI. The purpose of this study was to illustrate the relationship between gut microbiota and cardioprotection of EA on MIRI. We conducted a MIRI model by ligating the left anterior descending coronary artery for 30 min followed by reperfusion in male Sprague Dawley rats, which then received 7 days of EA intervention. Echocardiography was employed to evaluate left ventricular function. Fecal samples were collected for microbial analysis by 16S rDNA high-throughput sequencing. Blood samples and myocardium were collected for inflammatory cytokine detection by enzyme linked immunosorbent assay (ELISA) and Western blot. Hematoxylin & eosin (HE) staining and immunofluorescence of ileum tissue were performed for intestinal damage evaluation. After 7 days of EA intervention, the left ventricular function was improved with significantly increased ejection fraction and fractional shortening. Furthermore, we found that EA intervention reversed the changed gut microbiota induced by MIRI, including Clostridiales, RF39, S24-7, Desulfovibrio, and Allobaculum, improved the impaired gut barrier, reduced the production and circulation of lipopolysaccharide (LPS), inhibited the level of interleukin 6 (IL-6) and interleukin 12 (IL-12) in periphery and decreased the expression of Toll like receptor 4 (TLR4) and IL-6 in myocardium. EA intervention could improve the impaired gut mucosal barrier and reduce the production and circulation of LPS after MIRI through regulating gut microbiota, thus inhibiting the circulation and myocardium inflammation and finally exerted the cardioprotective effect.

[Effect of electroacupuncture on expression of IL-23/IL-17 axis and TLR4 in infarcted tissue in rats with myocardial infarction]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on expression of interleukin (IL) -23/IL-17 axis and Toll-like receptor 4 (TLR4) in the infarcted tissue in rats with myocardial infarction (MI), and to explore the mechanism of EA on alleviating MI injury.

METHODS

Forty male SD rats were randomly divided into a sham-operation group, a sham-operation plus EA group, a model group and an EA group, 10 rats in each group. The MI models were established by ligation of left anterior descending coronary artery in the model group and EA group, while only threading was performed in the sham-operation group and sham-operation plus EA group. The rats in the sham-operation plus EA group and EA group were treated with EA at "Neiguan" (PC 6), disperse-dense wave, 2 Hz/100 Hz, 2 mA, once a day, 20 min each time, for 3 days. After the intervention, the ejection fraction (EF) was measured by echocardiography to evaluate the cardiac function; the infarct area was measured by TTC staining; the HE staining was used to observe the morphological changes of myocardial tissue; the levels of IL-23 and IL-17 in infarcted tissue were detected by ELISA; the protein expression of TLR4 in infarcted tissue was detected by Western blot.

RESULTS

Compared with the sham-operation group, the EF was decreased (P<0.01), the infarct area was increased (P<0.01), the myocardial fiber injury was obvious, accompanied by inflammatory cell infiltration, and the contents of IL-23, IL-17 and the expression of TLR4 in infarcted tissue were increased in the model group (P<0.01). Compared with the model group, the EF was increased (P<0.05), the infarct area was reduced (P<0.05), the myocardial fiber injury was significantly improved, the inflammatory cell infiltration was reduced, and the contents of IL-23, IL-17 and TLR4 expression in infarcted tissue were decreased in the EA group (P<0.05).

CONCLUSION

EA may alleviate the excessive inflammatory response after MI by inhibiting the expression of IL-23/IL-17 axis in MI rats, and TLR4 may be involved during the process.

Double Superconducting Dome and Triple Enhancement of T_{c} in the Kagome Superconductor CsV_{3}Sb_{5} under High Pressure

CsV_{3}Sb_{5} is a newly discovered Z_{2} topological kagome metal showing the coexistence of a charge-density-wave (CDW)-like order at T^{*}=94  K and superconductivity (SC) at T_{c}=2.5  K at ambient pressure. Here, we study the interplay between CDW and SC in CsV_{3}Sb_{5} via measurements of resistivity, dc and ac magnetic susceptibility under various pressures up to 6.6 GPa. We find that the CDW transition decreases with pressure and experience a subtle modification at P_{c1}≈0.6-0.9  GPa before it vanishes completely at P_{c2}≈2  GPa. Correspondingly, T_{c}(P) displays an unusual M-shaped double dome with two maxima around P_{c1} and P_{c2}, respectively, leading to a tripled enhancement of T_{c} to about 8 K at 2 GPa. The obtained temperature-pressure phase diagram resembles those of unconventional superconductors, illustrating an intimated competition between CDW-like order and SC. The competition is found to be particularly strong for the intermediate pressure range P_{c1}≤P≤P_{c2} as evidenced by the broad superconducting transition and reduced superconducting volume fraction. The modification of CDW order around P_{c1} has been discussed based on the band structure calculations. This work not only demonstrates the potential to raise T_{c} of the V-based kagome superconductors, but also offers more insights into the rich physics related to the electron correlations in this novel family of topological kagome metals.

[Effect of electroacupuncture pretreatment on transient receptor potential vanilloid 1(TRPV1)/calcitonin gene-related peptide(CGRP) signal and NF-κB p65 protein expression in rats with acute myocardial ischemia]

OBJECTIVE

To observe the effect of electroacupuncture(EA)pretreatment on transient receptor potential vanilloid 1(TRPV1)/calcitonin gene-related peptide(CGRP)signal and nuclear factor-κB p65 (NF-κB p65) protein expression in myocardial tissue of acute myocardial ischemic injury (AMI) rats, and to investigate the possible mechanism of electroacupuncture pretreatment against AMI.

METHODS

A total of 60 adult male SD rats were randomly divided into blank control, sham operation, model and EA pretreatment groups, 15 rats in each group. The acute myocardial ischemia model was established by ligating the left anterior descending (LAD)branch of the coronary artery in the model group and EA pretreatment group, while threading but no ligating at left anterior descending branch of the coronary artery was applied in the sham operation group. In the EA pretreatment group, bilateral "Neiguan"(PC6) acupoints were selected, with intensity of 2 mA and frequency of 2 Hz/100 Hz, for 20 min, once daily for 7 days before modeling. Electrocardiogram (ECG) was recorded by physiological signal acquisition system, and the ST segment potential offset values of standard Ⅱ lead were analyzed before surgery，30 min and 24 h after operation. The TTC staining was used to observe the percentage of myocardial infarction area. The HE staining was used to observe the pathological changes of myocardial tissue and the degree of inflammatory cell infiltration. And Western blot was used to detect TRPV1/CGRP signal and NF-κB p65 protein expression levels in myocardial tissue.

RESULTS

Compared with the sham operation group, the ECG-J point potential in the model group was significantly increased at 30 min and decreased at 24 h after operation (P<0.05), myocardial infarction area increased significantly (P<0.05), the myocardial fibers were obviously disordered, inflammatory cell infiltration was obvious, and the expressions of TRPV1，CGRP and NF-κB p65 proteins were all increased (P<0.05). Compared with the model group, the EA pretreatment group was decreased in the ECG-J point potential at 30 min after operation(P<0.05), significantly reduced in myocardial infarction area (P<0.05), improved in the morphology of myocardial fibers, reduced ininflammatory cell infiltration, and increased in the protein expressions of TRPV1 and CGRP in myocardium (P<0.05), significantly decreased in the protein expression of NF-κB p65 (P<0.05).

CONCLUSION

EA pretreatment may enhance TRPV1/CGRP signaling, down-regulate NF-κB p65 protein expression, reduce myocardial inflammatory response status, improve AMI injury, and reduce myocardial infarction area.

[Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children: a randomized controlled trial]

OBJECTIVE

To observe the clinical therapeutic effect of acupuncture at Sifeng (EX-UE 10) as adjuvant treatment for pneumonia of phlegm-heat blocking lung type in children.

METHODS

A total of 80 children with pneumonia of phlegm-heat blocking lung type were randomized into an observation group (40 cases, 1 case dropped off) and a control group (40 cases). In the control group, routine anti-infection and symptomatic and supportive treatment were given. On the basis of the treatment in the control group, acupuncture was applied at Sifeng (EX-UE 10) in the observation group, once every 2 days, 4 times were required. Before and after treatment, the score of clinical symptoms and signs and level of serum hypersensitive C-reactive protein (hs-CRP) were observed in the two groups. The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays were recorded, and the clinical therapeutic effect was evaluated in the two groups.

RESULTS

After treatment, the scores of clinical symptoms and signs and levels of serum hs-CRP were reduced in the two groups (P<0.01), and the changes of scores of fever, cough and lung moist rale, secondary symptom score, total score of clinical symptoms and signs and level of serum hs-CRP in the observation group were larger than those in the control group (P<0.05, P<0.01). The antifebrile time, lung moist rale disappearance time, duration of antibacterial drugs and hospital stays in the observation group were shorter than those in the control group (P<0.05). The total effective rate was 87.2% (34/39) in the observation group, which was superior to 65.0% (26/40) in the control group (P<0.05).

CONCLUSION

Acupuncture at Sifeng (EX-UE 10) as adjuvant treatment can relieve clinical symptoms, shorten duration of antibacterial drugs and hospital stays for children with pneumonia of phlegm-heat blocking lung type.

Proteomic and metabolomic characterization of cardiac tissue in acute myocardial ischemia injury rats

The pathological process and mechanism of myocardial ischemia (MI) is very complicated, and remains unclear. An integrated proteomic-metabolomics analysis was applied to comprehensively understand the pathological changes and mechanism of MI. Male Sprague-Dawley rats were randomly divided into a mock surgery (MS) group and an MI group. The MI model was made by ligating the left anterior descending coronary artery, twenty-four hours after which, echocardiography was employed to assess left ventricular (LV) function variables. Blood samples and left ventricular tissues were collected for ELISA, metabolomics and proteomics analysis. The results showed that LV function, including ejection fraction (EF) and fractional shortening (FS), was significantly reduced and the level of cTnT in the serum increased after MI. iTRAQ proteomics showed that a total of 169 proteins were altered including 52 and 117 proteins with increased and decreased expression, respectively, which were mainly involved in the following activities: complement and coagulation cascades, tight junction, regulation of actin cytoskeleton, MAPK signaling pathway, endocytosis, NOD-like receptor signaling pathway, as well as phagosome coupled with vitamin digestion and absorption. Altered metabolomic profiling of this transition was mostly enriched in pathways including ABC transporters, glycerophospholipid metabolism, protein digestion and absorption and aminoacyl-tRNA biosynthesis. The integrated metabolomics and proteomics analysis indicated that myocardial injury after MI is closely related to several metabolic pathways, especially energy metabolism, amino acid metabolism, vascular smooth muscle contraction, gap junction and neuroactive ligand-receptor interaction. These findings may contribute to understanding the mechanism of MI and have implication for new therapeutic targets.

[Molecular mechanisms of non-coding RNA regulating autophagy and interventional effects of Chinese herbal medicine]

Long non-coding RNAs(lncRNAs) and microRNAs(miRNAs),as members of the non-coding RNA family,play important roles in upstream processes that regulate autophagy in mammalian cells. LncRNA and miRNA participate in various phases of the process of autophagy,including initiation,vesicle nucleation,autophagosome maturation and autophagosome fusion. Some non-coding RNAs exert bidirectional regulatory functions in the process of autophagy,include the maternally expressed gene 3(MEG3),H19 and miR-21,whereas others either inhibit autophagy(including GAS5,miR-34 a and miR-30 a) or promote autophagy(including MALAT1,miR-152 and miR-24). The regulation of autophagy by non-coding RNAs has characteristics of conditionality,diversity and complexity. In recent years,researchers at home and abroad have constantly found that some extracts from the individual Chinese herbal medicine(CHM) such as ampelopsin,salvianolic acid B and paeonol,as well as the Chinese herbal compound named Eight Ingredients Decoction,can regulate autophagy by interacting with non-coding RNA in vitro and in vivo. The latest studies have shown that plant-derived small non-coding RNAs(sncRNAs) as one of the active ingredients of CHMs can directly enter the bloodstream and internal organs to regulate gene expressions in humans. In addition,it has been reported that rhein,hyperoside and mycelium of Cordyceps sinensis all can modulate autophagy in renal tubular epithelial cell via regulating the autophagy-related signaling pathways in vivo and in vitro to reduce renal damage and aging,which is likely mediated by the miR-34 a pathway. In summary,the understanding of molecular mechanisms underlying the regulation of autophagy by non-coding RNAs(such as lncRNAs and miRNAs) is essential and required to develop new strategies for the treatments and managements of tumors,immune diseases,metabolic diseases,neurodegenerative diseases and other common diseases and decipher pharmacologic actions of CHMs.

Effect of moxibustion preconditioning on autophagy-related proteins in rats with myocardial ischemia reperfusion injury

Background

Autophagy has increasingly been recognized as playing an essential role in the pathogenesis of myocardial ischemia reperfusion injury (MIRI). Moxibustion, a form of heat therapy commonly used in traditional Chinese medicine (TCM), has been shown to exhibit cardioprotective effects. However, whether the cardioprotective effect of moxibustion is related to the regulation of autophagy remains unknown. This study aimed to investigate the possible mechanism underlying the cardioprotective effect of moxibustion preconditioning at PC6 on MIRI by measuring the expressions of proteins involved in the regulation of autophagy.

Methods

Male Sprague-Dawley rats were randomly divided to receive moxibustion preconditioning or autophagy inhibitor 3-Methyladenine (3-MA) intervention. Then the MIRI model was established by ligating the left anterior descending (LAD) coronary artery for 30 minutes followed by reperfusion for 4 hours. After 4 hours of reperfusion, the myocardial infarction area was assessed using Evans blue and TTC staining, and cTnT and lactate dehydrogenase (LDH) levels in the serum were determined by ELISA. Hematoxylin and eosin (H&E) staining was performed for morphological evaluation of ventricular tissues. Expressions of autophagy components Beclin 1, Bcl-2, and Akt were assessed using quantitative real-time PCR, immunohistochemistry (IHC) and western blot.

Results

Moxibustion preconditioning significantly reduced the necrotic area and the levels of cTnT and LDH were similar to the 3-MA intervention, also attenuated morphological alterations were induced by MIRI. Simultaneously, the mRNA and protein expressions of Beclin 1 and Akt were up-regulated, while those of Bcl-2 were down-regulated by MIRI. Moxibustion preconditioning and 3-MA intervention reversed MIRI-induced changes in Beclin 1, Akt, and Bcl-2 expressions.

Conclusions

Moxibustion preconditioning at PC6 can attenuate myocardial injury for MIRI in a similar way to 3-MA intervention. This cardioprotective effect of moxibustion preconditioning may be mediated by modulating autophagy via regulation of Beclin 1, Bcl-2 and Akt.

Changes in the Serum Metabolome of Acute Myocardial Ischemia Rat Pretreatment with Electroacupuncture

Myocardial infarction (MI), the most common symptom is chest pain, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Electroacupuncture pretreatment (EP) is a recent observation which has been shown to induce ischemic tolerance like the ischemia preconditioning, suggesting that EP may be a promising preventive strategy for individual susceptibility to MI. This study investigated mechanisms that underlie the effect of EP on MI through the use of gas chromatography-mass spectrometry (GC-MS)-based metabolic profiling. Male Sprague-Dawley rats were randomly divided to receive or not receive three days of EP at PC6 (Neiguan). Then on the fourth day, each group was further divided to undergo mock surgery or MI, induced by ligation of the left anterior descending coronary artery. After 24h, the blood samples and hearts were collected for the follow-up research. The results showed that treatment by EP significantly reduced the levels of CK-MB, cTnT, AST, and MDH in serum and decreased myocardial infarction area. According to GC-MS-based serum metabolic profiling and analysis, a total of 636 characteristic peaks were identified, including 158 known and 478 unknown metabolites. MI caused comprehensive metabolic changes in glycolysis-related metabolites, malate-aspartate shuttle (MAS) metabolites, and purine metabolites with anti-oxidant functions, while EP reversed more than half of the differential metabolic changes, mainly affecting amino acid and energy metabolism, especially the glutamate metabolism and MAS. In a word, our findings suggest that EP exerts its cardioprotective effect on MI by regulating amino acid and energy metabolisms. Meanwhile, GC-MS-based metabolomics provided a powerful way to characterize the metabolic features of MI, with and without EP, and thereby improved our understanding of the effect and mechanisms of EP.

[Molecular regulative mechanisms of aging and interventional effects of Chinese herbal medicine]

Aging is a gradual process during the loss of functions in cells,organs and tissues by time. The molecular mechanisms of aging-related theories include the classical ones such as telomere,oxygen radical and nonenzymatic glycosylation,as well as the newly proposed ones such as DNA methylation,mitochondrial DNA （mtDNA）and autophagy. The latest study showed the anti-aging effect of autophagy in hematopoietic stem cells. In recent years,based on the molecular regulative mechanisms of aging,a number of the promising anti-aging drugs have been found,including nicotinamide mononucleotide（NMN）and FOXO4-DRI,a peptide of anti-aging. In addition,there are many new discoveries in the field of plant extracts,in which,the extracts from Chinese herbal medicine（CHM）,some single CHMs and the classical prescriptions of CHM,represented by curcumin and resveratrol,have the partial anti-aging effects by regulating the molecular mechanisms of aging both in vivo and in vitro. In brief,developing or exploring anti-aging drugs,especially the natural drugs,is one of the main development directions in the field of anti-aging research in the basis of the molecular regulative mechanisms of aging.

[Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China]

Objective: To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China. Methods: This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast, north, central, east, south, northwest and southwest). The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded. The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared. Results: During the study period, 6 480 patients were admitted for asthma exacerbation, accounting for 3.14% of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals. The ratio of asthmatic patients to total inpatients in the northeast area (5.61%) was highest, and the ratio in east area was lowest (1.97%). Statistical analysis showed that the difference among different areas was significant (P<0.000 1). In most areas, both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October). In the northeast area, east area and south area, the peaks in spring were more obvious, while in the north area and southwest area, the peaks in autumn were more obvious. In the northwest area the peaks occurred in winter (December-January) and summer (June-August), respectively. The differences in hospitalization due to asthma among different months were significant in the northeast, north, and southwest areas (P<0.005). Conclusion: The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China. In most areas, more asthmatic patients were admitted to hospitals in spring and autumn.

[Seasonal characteristics of patients hospitalized for asthma exacerbation in China]

Objective: To study the seasonal characteristics of patients hospitalized for asthma exacerbation in China. Methods: This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout mainland China during 2013-2014. The number of patients hospitalized for asthma exacerbation in each hospital was calculated, as well as the ratio of asthmatic patients to all the hospitalized patients. The analysis by month was conducted. The number and ratio of asthmatic patients in the northern and southern cities were calculated respectively. Results: During the study period, there were 6 480 patients hospitalized for asthma exacerbation, accounting for 3.14% (6 480/206 135) of all the hospitalized patients of the respiratory department in 29 hospitals. The analysis by month showed that the ratio of patients hospitalized for asthma exacerbation was highest in March (3.49%), then declined from April to June, then rose again from July, reaching a second peak at September (3.28%), and then declined again from October to December. The ratio of asthmatic patients in every month was higher in northern cities than in southern cities. Conclusions: The ratio of patients hospitalized for asthma exacerbation in China fluctuates with the changes of seasons, and March and September are the two peak months. Northern cities have a higher ratio of asthmatic patients than southern cities.

[Warning symptoms of asthma attack and asthma self-management: a national asthma control survey from China]

Objective: To investigate warning symptoms of asthma attack and evaluate asthma self-management status of asthma patients in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out from 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of frequency and warning symptoms of asthma attack, the time from warning symptoms to asthma attack, the impact of asthma attack and asthma self-management were collected from asthma patients of outpatient department. Results: Altogether 3 875 asthmatic outpatients were recruited. 78.1% (3 026/3 875) of the patients reported restriction of exercise and daily activities during asthma exacerbation. 82.5% (3 160/3 829) of the patients had warning symptoms before asthma attack, the most common warning symptoms were cough, chest tightness and shortness of breath. The median time from warning symptoms to asthma attack was 2 h, the mean time was 90 h. Only 4.4% (167/3 829) of the patients had definite confidence to control asthma when symptoms deteriorated. 76.7% (2 937/3 828) of the patients used medications to control asthma when asthma symptoms deteriorated. Medication choice: inhaled corticosteroid (ICS) + formoterol 45.8% (1 776/3 875), short-acting beta-agonist (SABA) 23.9% (927/3 875). Conclusions: Most asthma patients have warning symptoms before asthma attack, the most common symptoms are cough, chest tightness and shortness of breath. The proportion of patients conducting effective asthma self-management remains low.

[The level of asthma control in China from a national asthma control survey]

Objective: To assess the overall asthma control level in urban China. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out in 30 provinces in China (except Tibet). Asthmatic outpatients who met the inclusion criteria were recruited consecutively from 30 sub-centers from October 2015 to May 2016. Data of demographic characteristics, asthma control, asthma management, asthma exacerbations and self-management, and disease perception were collected by face-to-face interviews. Results: Totally 3 875 asthmatic outpatients were recruited. Asthma control level was assessed according to GINA 2015. The prevalence of asthma control was 28.5%(1 099/3 854). Among 10 cities, which were also involved in the asthma control survey in 2008, the level of asthma control improved from 28.7% in 2008 to 39.2%(533/1 361) in 2016. The rate of hospitalizations due to asthma exacerbations was 26.4%(1 017/3 858) and the rate of emergency visits was 22.4%(864/3 858). Among adult patients, 18.4%(568/3 092) of them had been absent from work while 63.6%(63/99) adolescent patients had been absent from school because of asthma attacks in the previous year. Conclusion: Although the level of asthma control in China is still far from ideal at present, the status has been improved in some cities. Poorly controlled asthma resulted in increase of hospitalizations, emergency department visits and work/school absences.

[A multi-center retrospective study of clinical characteristics and hospitalization costs of patients hospitalized for asthma exacerbation in China during 2013-2014]

Objective: To study the characteristics of patients hospitalized for asthma exacerbation in 29 teaching hospitals in China and to evaluate the hospitalization costs of these patients. Methods: This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during 2013-2014. Information about the demographic features, conditions before the admission, the outcome, the complications, and the costs was collected using the pre-designed case report form. The influencing factors of the hospitalization costs were analyzed. Results: 3 240 asthmatic patients (1 369 males and 1 871 females) were included and data were analyzed. There were 41.5% (1 346/3 240) patients who had a history of previous hospitalization or emergency department visits during the last year. Only 28.0% (907/3 240) patients had used asthma-controlling medications regularly before the admission. Seventy-three(2.3%) patients were admitted to ICU and used mechanical ventilation. Mortality among these patients hospitalized for asthma exacerbation was 0.25% (8/3 240). The median hospitalization costs was 9 045(6 431, 13 035) RMB. The costs of medications, examinations and treatment accounted for 52.1%, 27.6%, and 9.6% respectively. The costs of asthma medications accounted for only 22.7% of the total medication costs, while the costs of antibiotics accounted for 44.0%. The patients who were admitted to ICU, used mechanical ventilation, complicated with pneumonia, or had a history of hospitalization or emergency department visits during the last year due to asthma exacerbations tended to cost more. Conclusion: In this study, we demonstrated that only a minority of the patients had used asthma controllers regularly before the admissions with exacerbations. The in-hospital mortality of asthma patients in this study was much lower than that reported in other countries. The average cost of hospitalization was much higher than the yearly cost of maintenance therapy. Medication was the predominant component of the total hospitalization costs, and the costs of antibiotics made up the major part of the total medication costs.

[A retrospective study of the treatment of patients hospitalized for asthma exacerbation in China]

Objective: To study the treatment of patients hospitalized for asthma exacerbation in China. Methods: This was a retrospective study and involved patients hospitalized for asthma exacerbation in 29 hospitals throughout China during Jan 2013 to Dec 2014. Information of the demographic features, the severity of the exacerbation, the medicine prescribed during the hospitalization and the use of mechanical ventilation were collected and analyzed. Results: During the study period, there were 3 240 patients hospitalized for asthma exacerbation, and 1 369(42.3%) of them were males 1 871(57.7%)were females. Patients of mild, moderate, severe, and life-threatening exacerbation counted for 41.7%, 37.8%, 19.2% and 1.0%, respectively of the total patients. Of all the patients, 72.6% used bronchodilators by nebulizer, 70.8% used inhaled corticosteroids by nebulizer, 60.5% used intravenous corticosteroids, 17.3% used oral corticosteroids, and 80.5% used antibiotics. The percentages of patients using systemic corticosteroids and antibiotics were higher in patients with more severe exacerbation. In patients with mild exacerbation, there were 74.9% and 52.2% who used antibiotics and systemic corticosteroids, respectively. A total of 73 patients (2.3%) used mechanical ventilation, and 62 of them used noninvasive ventilation, 16 used invasive ventilation, and 5 used both. Conclusions: Nebulizer therapy has been accepted as the main administration route of medicine in the treatment of asthma exacerbation. A large amount of patients used antibiotics and systemic corticosteroids during hospitalization, indicating there may be some overuse of these medicines.

[Evaluation of asthma disease perception from China national asthma control survey]

Objective: In order to evaluate disease perception of asthma patients in urban China and provide evidence for further specific patient education. Methods: A multi-center, cross-sectional, questionnaire-based survey was carried out in 30 general hospitals dispersed in 30 provinces of mainland China (except for Tibet) during Oct 2015 to May 2016. Information of disease perception [Question 1: the disease nature of asthma; Question 2: medication choice of first-line in chronic asthma; Question 3: the occasion of using short-acting aerosols of receptor agonists; Question 4: perception of asthma treatment goal; Question 5: reason for not using peak flow meter (PFM)] were collected from asthma patients of outpatient department. These results were compared with the same type of survey results from 2007-2008. Results: Altogether 3 875 asthmatic outpatients were recruited. 69.0% (2 660/3 857) of the patients had right perception on the disease nature of asthma, 60.2% (2 321/3 857) of the patients considered inhaled corticosteroids (ICS)/inhaled corticosteroids plus long-acting beta2-agonists (ICS+ LABA) as daily-used first-line medication for chronic asthma. 85.7% (3 277/3 823) of the patients had right perception on the condition of using short-acting beta2-agonists (SABA). 75.4% (2 761/3 661) of the patients had right perception on asthma treatment goal. Only 10.1% (388/3 837) of the patients used PFM. Of the reasons for not using PFM, 65.2% (2 518/3 860) of the patients chose doctors never introduced. Among the 10 cities, which were also involved in the asthma control survey in 2007-2008, 71.1% (968/1 361) of the patients had right perception on the disease nature of asthma, 61.6% (839/1 362) of the patients considered ICS/ICS+ LABA as daily-used first-line medication for chronic asthma. 88.7% (1 207/1 361) of the patients had right perception on the condition of using SABA. 74.5% (1 013/1 360) of the patients had right perception on asthma treatment goal. 17.9% (244/1 360) of the patients used PFM. Of the reasons for not using PFM, 76.2% (931/1 221) of the patients chose doctors never introduced. Compared to the survey conducted in 2007-2008, the perception on disease nature and medication choice as daily-used first-line medication for chronic asthma significantly improved, the perception on occasion of using SABA and asthma treatment goal was comparable, while the rate of PFM usage showed no significant improvement. In reasons of not using PFM, doctors never introduced ranked the first. Conclusions: Compared to the similar survey conducted in 2007-2008, the overall status of disease perception of asthma patients has been improved in urban China, while the rate of PFM usage showed no significant improvement. Asthma education on asthma and asthma self-management should be further pushed forward.

[A retrospective study of the mortality and death-related risk factors of patients hospitalized for asthma exacerbation in Chinese urban areas]

Objective: To study the mortality and death-related risk factors of patients hospitalized for asthma exacerbation in Chinese urban areas. Methods: A retrospective study was carried out in 29 hospitals of 29 provinces throughout mainland China. Patients hospitalized for asthma exacerbation during 2013-2014 in each hospital were included. For each patient, information about demography, admission time, comorbidities, severity of diseases, intense care unit (ICU) admission, use of mechanical ventilation and the outcome was obtained. The mortality of patients hospitalized for asthma exacerbation was calculated, and the basic information and causes of death of the patients who died were summarized. The death-related risk factors and numbers of comorbidities were compared between the patients who survived and those who died during hospitalization. Results: A total of 3 240 patients (median age 57.0) were included and among them 8 patients (median age 68.5) died. The mortality of patients hospitalized for asthma exacerbation was 0.25%. All the patients who died were admitted during the winter and spring. One patient died of acute myocardial infarction, one of cardiac shock, one of tension pneumothorax, one of sudden death, one of respiratory failure and three of unknown causes. The average number of comorbidities of patients who died was 1.10, larger than that of patients who survived (0.83) (P>0.05). More patients had diabetes, coronary artery diseases and hypertension as comorbidities in the patients who died (2/8) than those who survived[7.6% (246/3 232), 7.6% (246/3 232), 22.6% (731/3 232), respectively](all P>0.05). Conclusions: The in-hospital mortality of patients hospitalized for asthma exacerbation of China in this study is low. The patients who died are much older, and with more comorbidities, and a higher percentage of comorbidities such as diabetes, coronary artery diseases, and hypertension.

[Progress of Research on Mechanisms of Moxibustion Intervention Underlying Improvement of Blood Circulation]

OBJECTIVE

Moxibustion is one of the commonly used therapy of traditional Chinese medicine by applying burning dried mugwort on particular acupoints of the body surface. In the present paper，we reviewed progress of researches about the mechanisms of moxibustion treatment undering imporvement of blood circulation in recent 15 years. Research results displayed that moxibustion can dilate blood vessels to increase blood flow and improve microcirculation, not only in the local superficial vessels of body, but also in the deep tissues as the brain, stomach and mesentery, kidney, heart, etc., as well as in the distal blood vessels. The vasodilator action of moxibustion stimulation is related to nerve regulation, endothelium derived relaxing factors and vasodilator mediator, etc. through 1) interaction of acetylcholine (Ach)/muscarinic receptor (MR) and noradrenaline (NE)/α- or β-receptor; 2) nitric oxide synthase (NOS)/NO/arachidonic acid/prostacyclin (PGI₂)/endothelium-derived hyperpolarizing factor (EDHF) pathway; 3) EDHF/TRPV 4/KCa channel, cytochrome P 450 oxidase/epoxyeicosatrienoicacid (EET); 4) EET/TRPV 4/big conductance calcium-activated potassium channel (BKCa); 5) sulfuretted hydrogen (H₂S)/ATP-sensitive potassium channel (K_ATP) or voltage-gated potassium channels (Kv 7); 6) NO/substance P (SP) or CGRP and adrenergic β 2 receptor(R)/TRPV 1/adenosin A 1 R and A 2 R/NK 1 R pathway; 7) PGI₂/adenylyl cyclase (cAMP)/PKA and vasoactive intestinal peptide (VIP), etc. in the vascular endothelium and smooth muscle. These research results may help us understand the effects and mechanisms of moxibustion in the treatment of different clinical conditions by improving microcirculation.

[Time-dependent Protective Effect of Electroacupuncture on Ischemic Myocardium and Changes of Myocardial Autophagy and Apoptosis Related Protein Expression in Rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) at different time-points on the injured myocar-dium and expression of myocardial Bax/Bcl-2 and Lc 3 Ⅱ/Ⅰ proteins in acute myocardial ischemia-reperfusion injury (MIRI) rats so as to explore its mechanisms underlying myocardial protective effect via reducing cardiomyocyte autophagy and apoptosis.

METHODS

A total of 66 adult SD rats were randomly divided into sham operation (sham), model, EA-R 0_min(R＝ reperfusion), EA-R 30_min, EA-R 60_min, and EA-R 120_min groups, with 6 rats being in the sham group and 12 rats being in each of the other 5 groups. The MIRI model was prepared by ligating the anterior descending branch (ADB) of the left coronary artery for 30 min followed by reperfusion for 4 h. In the sham group, the ADB was only threaded without ligation. EA was applied to bilateral "Neiguan" (PC 6) for 20 min at 0, 30, 60, and 120 min when reperfusion. Evans Blue-triphenyltetrazolium chloride (TTC) double staining was performed to determine the myocardial infarction area (MIA) and the ratio of the infarct size of the area at risk (IS/AAR). ELISA was performed to measure serum cardiac troponin 1 (cTn-Ⅰ) content, and Western blot was used to measure the expression of apoptosis-related proteins Bax and Bcl-2 and autophagy related proteins Lc 3 Ⅱ and Lc 3 Ⅰ in the left cardiac ventricle tissue.

RESULTS

Compared with the model group, the percentages of MIA in the EA-R 30_min, EA-R 60_min, and EA-R 120_min groups, and the IS/AAR in the EA-R 0_min, EA-R 30_min, EA-R 60_min and EA-R 120_min groups were significantly reduced (P<0.05, P<0.01). Comparison among the 4 EA groups showed that the percentages of MIA and the IS/AAR were considerably lower in the EA-R 30_min, EA-R 60_min, and EA-R 120_min groups than in the EA-R 0_min group (P<0.05, except IS/AAR in the EA-R 120_min group), but significantly higher in the EA-R 60_min and EA-R 120_min groups than in the EA-R 30_min group (P<0.05, P<0.01), suggesting a better therapeutic effect of EA intervention at 30 min of MIRI in improving MI. In comparison with the sham group, myocardial cTn-Ⅰ content and Bax/Bcl-2 and Lc 3 Ⅱ/Ⅰ levels in the model group were significantly increased (P<0.01). After EA intervention, the increased cTn-Ⅰ content and Bax/Bcl-2 and Lc 3 Ⅱ/Ⅰ levels in the EA-R 0_min, EA-R 30_min, EA-R 60_min, and EA-R 120_min groups were significantly reduced (P<0.05, P<0.01). The cTn-Ⅰ content was obviously lower at EA-R 30 _min, but markedly increased at EA-R 120_min than at EA-R 0_min (P<0.05). The expression of Bcl-2 was obviously higher at EA-R 30_min than at EA-R 0_min (P<0.05). No significant differences were found among the 4 EA intervention time-points in the levels of Bax/Bcl-2 and Lc 3 Ⅱ/Ⅰ (P>0.05).

CONCLUSION

EA intervention can reduce MIA in MIRI rats, which is possibly closely related to its effects in reducing apoptosis and autophagy. The best intervention time is at 30 min after MI reperfusion, but the difference of effects of EA at different time-points is independent of Bax/Bcl-2 and Lc 3 Ⅱ/Ⅰ expression.

[A multi-center study for the association between the perception and control of disease among asthmatic patients in Chinese urban areas]

Objective: To investigate the current perception of disease among asthmatic patients in Chinese urban areas, and to address its association with asthma control. Methods: This was a nationwide, multi-center, cross-sectional study covering 30 third-level, grade A hospitals in 30 provinces, municipalities and autonomous regions (not including Tibet) across Chinese mainland. The survey was carried out from October 2015 to May 2016. Asthmatic outpatients were selected to receive face-to-face questionnaire survey on asthma control including Asthma Control Test (ACT) score, classification of asthma control level[according to the Global Initiative for Asthma (GINA) 2015 classification system, as assessed by the physician completing the survey], perception of asthma (including question 1: nature of asthma as a disease; question 2: selection of first-line therapeutic agents to be regularly used daily for asthma; question 3: appropriate timing of the use of short-acting aerosols of β(2) receptor agonists; and question 4: therapeutic goals for asthma). Results: A total of 3 875 asthmatic outpatients were included; among them, 69.0% (2 660/3 857) were aware that asthma is "an airway inflammatory disorder resulting from the combined effects of heredity and environment" ; 60.2% (2 321/3 857) considered "inhaled glucocorticoids or their compound preparations" to be the first-line therapeutic agents to be regularly used daily for patients with persistent chronic asthma; 85.7% (3 277/3 823) considered it appropriate to use short-acting aerosols of β(2) receptor agonists "as needed in the event of disease aggravation or acute exacerbation" ; and 75.4% (2 761/3 661) were aware that asthma "can be adequately or completely controlled in the long term" . The ACT score[20 (16, 23) vs 19 (16, 22) points; Z=-3.928, P<0.001]and asthma control rate (29.92% vs 25.31%; χ(2)=8.616, P=0.003) were significantly higher, and the rate of uncontrolled asthma (19.92% vs 23.48%; χ(2)=6.267, P=0.012) was significantly lower among the 2 660 (69.0%) patients correctly answering question 1 than among the 1 197 (31.0%) patients giving incorrect answer. The ACT score[21 (17, 23) vs 19 (15, 22) points; Z=-9.190, P<0.001] and asthma control rate (32.66% vs 22.20%; χ(2)=49.614, P<0.001) were significantly higher, and the rate of uncontrolled asthma (18.40% vs 25.00%; χ(2)=24.267, P<0.001) was significantly lower among the 2 321 (60.2%) patient correctly answering question 2 than among the 1 536 (39.8%) patients giving incorrect answer. Conclusions: Compared to previous surveys, there has been improved perception of disease among asthmatic patients in Chinese urban areas. Correct perception of disease is favorable for improving asthma control level.

Efficacy and Safety of Acupuncture for Essential Hypertension: A Meta-Analysis

Background

The aim of this study was to assess the efficacy and safety of acupuncture therapy for patients with hypertension.

Material/Methods

We searched PubMed, Embase, the Cochrane Library, the Chinese Biomedical Literature Database, the Chinese National Knowledge Infrastructure, and the Wan-fang Data Database from inception through 29 April 2017. Randomized controlled trials investigating acupuncture therapy for hypertension were included. Review Manager 5.3 software was used for the data analysis.

Results

A total of 30 RCTs involving 2107 patients were included. The overall methodological quality of the included studies was low. Pooled results demonstrate that acupuncture plus anti-hypertensive drugs is better than anti-hypertensive drugs alone at reducing systolic and diastolic blood pressure (SBP and DBP). The same result was observed for pooled data from experiments that compared acupuncture plus medication to sham acupuncture plus medication at reducing SBP and DBP. However, studies reveal that using acupuncture alone or anti-hypertensive drugs alone do not differ in the effect on lowering blood pressure. Similarly, acupuncture alone also did not differ from sham acupuncture alone, and electroacupuncture versus anti-hypertensive drugs was not significantly different at reducing SBP and DBP.

Conclusions

Our systematic review indicates there is inadequate high quality evidence that acupuncture therapy is useful in treating hypertension, as the exact effect and safety of acupuncture therapy for hypertension is still unclear. Therefore, research with larger sample sizes and higher-quality RCTs is still needed.

[Effect of Moxibustion Preconditioning with Seed-sized Moxa Cones on Myocardial Infarction Size and Beclin 1 Expression in Myocardial Ischemia-reperfusion Injury Rats]

OBJECTIVE

To observe the effect of moxibustion (Moxi) preconditioning with seed-sized moxa cones on myocardial ischemia-reperfusion injury (MI/RI) at different stages, and to analyze the correlation between this effect and the expression of autophagy related protein Beclin 1.

METHODS

This study contains two parts: 1) changes of myocardial pathological injury and percentages of myocardial infarcted area at different time-points after modeling and Moxi intervention, and 2) effect of Moxi on contents of serum cardiac troponin T(cTnT) and expression of myocardial Bcl-2, Bax and Beclin 1 proteins. In the first part, 42 SD rats were randomly divided into model group, 1 day (d) Moxi group, 2 d Moxi group, 3 d Moxi group，4 d Moxi group, 5 d Moxi group and 7 d Moxi group. The model of MI/RI was established by ligating the left anterior descending coronary artery (LAD) for 30 min and reperfusion for 240 min. The electrocardiogram (ECG) of standard limb lead Ⅱ was monitored and the heart was taken 4 h after reperfusion for examining myocardial infarcted size with triphenyl tetrazolium chloride (TTC) staining. In the second part, 48 SD rats were randomized into sham-operation, model, moxibustion and autophagy inhibitor (3-MA) groups, with 12 rats in each group. The serum cTnT level was assayed and histopathological changes of the myocardial tissue below the ligation site were examined with HE staining, and the expression levels of Bcl-2, Bax and Beclin 1 proteins in the myocardial tissue below the LAD-ligated site were detected using Western blot.

RESULTS

Compared with the model group, the percentages of myocardial infarcted area were significantly decreased in the 4 d, 5 d and 7 d Moxi groups (P<0.05), but without significant differences among the 3 Moxi groups (P>0.05). The state of MI-induced breakage and disordered arrangement of myocardial fibers with interstitial edema and inflammatory cell infiltration at the MI stage in the Moxi group and at the reperfusion stage in the autophagy inhibitor group was relatively lighter. The levels of serum cTnT content and Bax/Bcl-2 and Beclin 1 protein expression at the MI and reperfusion stages were significantly higher in the model group than in the sham-operation group (P<0.01), and considerably lower in the Moxi and autophagy groups than in the model group (P<0.01). The serum cTnT content, ratio of Bax/Bcl-2 expression and Beclin 1 expression levels at the MI and reperfusion stages were significantly lower in the autophagy inhibitor group than in the Moxi group (P<0.05).

CONCLUSIONS

Moxibustion with seed-sized moxa cones at "Neiguan" (PC 6) can effectively alleviate myocardial ischemia in MI/RI rats, which is probably related to its effect in down-regulating Bax/Bcl-2 and Beclin 1 expression and in inhibiting autophagy.

[Progress of Acupuncture and Moxibustion Research on the Signal Transduction Pathways Involved in Cell Apoptosis in Myocardial Ischemia Reperfusion Injury]

Myocardial cell apoptosis is very common in the clinic, and is caused by myocardial ischemia reperfusion injury (MIRI). There are different degrees of cell apoptosis in MIRI. However, initiation of the signal transduction mechanism of myocardial cell apoptosis is unclear. The present research confirmed that acupuncture and moxibustion are effective interventions for cell apoptosis in MIRI through three approaches:the death receptor pathway, mitochondrial pathway and endoplasmic reticulum pathway. In this paper, the authors summarize the mechanism characteristics of acupuncture and moxibustion in MIRI cell apoptosis, and discuss the signal transduction pathways involved in the effects of acupuncture and moxibustion in MIRI cell apoptosis, in order to provide new ideas and evidence for the clinical application of acupuncture and moxibustion to prevent cell apoptosis in MIRI.

[The advantage of artery approach in lymph node sorting of rectal cancer]

Objective: To explore the technical advantages of artery approach in lymph node sortingofrectal cancer. Methods: Sixty patients with rectal cancer who treated in general surgery department of Henan provincial tumor hospitalfrom July 2015 to January 2016 were enrolled. Patientswere divided into two groupsrandomly.Lymph node sorting methods of control group andobservation group were the traditional method and the artery approach method respectively. The total number of lymph nodes, the average inspection number, the patients number of lymph nodes less than 12, the number of positive lymph nodes, the metastasis rate of the patients, the number of average diameter less than 5 mm, the number of the positive lymph nodes which average diameter less than 5 mm, the sorting time of lymph nodes, the total number of every stationand other indicators were collected and compared. Results: There wasa significant difference between the observation group and the control groupin the total number(553 vs 395, P<0.05), the number of positive ones(96 vs 54, P<0.05), average inspection number(18.43±5.93 vs 13.27±1.96, P=0.000), the sorting time (min) (14.1±2.5 vs 17.4±3.2, P=0.000), the average diameter less than 5 mm number(4.73±1.31 vs 1.23±1.14, P=0.000), the number of positive ones average diameter less than 5 mm(0.97±1.03 vs 0.20±0.55, P=0.010), the first(8.17±4.58 vs 5.07±1.96, P=0.000) and second station(6.57±1.87 vs 4.90±1.69, P=0.001)inspection number.The inspection number less than 12, the positive rate of lymph node, the metastatic rate of the patient and the inspection number of third station have no significant differences (all P≥0.05). Conclusion: Theartery approach method inrectal cancer lymph node inspectionhas many advantages such as simple operation, obtaining more lymph nodes and more accurate pathological staging.

[From Treatment of Stress Disease by Acupuncture to Correlation between Acupuncture and Stress]

Stress disease is a body functional disorder caused by harmful stimuli overwhelming the nonspecific adaptive capabilities. Numerous evidence proved the feasibility of acupuncture in treating stress diseases. This paper aims at exploring new perspective in the study on the underlying mechanism of acupuncture in the treatment of stress diseases. The discussion is conducted by summarizing the pathogenesis of stress diseases and mechanisms of its treatment with acupuncture, in exploring the related factors of acupuncture and stress response, and the correlation between the two from the regulatory pathway, medium, characteristics and manifestations.

[Grain-Moxibustion may Protect Myocardium by Reducing Oxidative Stress in Doxorubicin-induced Cardiomyopathy Rats]

OBJECTIVE

To observe the effectiveness of grain-moxibustion in resisting oxidative stress in doxorubicin (DOX)-induced cardiomyopathy rats.

METHODS

Sixty Sprague-Dawley (SD) rats were randomly divided into blank control group (blank group), cardiomyopathy model (model) group and grain-moxibustion (moxibustion) group, with 20 rats in each one. The cardiomyopathy model was established by intraperitoneal injection of DOX (0.5 mg/100 g), once a week for 4 weeks. Grain-moxibustion was applied to "Guanyuan" (CV 4) and "Juque" (CV 14) for 5 cones, once daily for 4 weeks except the Sundays. The rats' heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), left ventricular pressure maximum rising rate (+dp/dt_max), left ventricular pressure maximum decline rate (-dp/dt_max), left ventricular pressure change time (t-dp/dt_max) were detected to evaluate the cardiac function by using a physiological signal acquisition-analysis system. The pathological changes of the myocardium were observed by optical microscopy after H.E. staining. The activity of serum lactate dehydrogenase(LDH), creatine kinase(CK) and myocardial superoxide dismutase (SOD), and myocardial malondialdehyde (MDA) and serum cardiac troponin Ⅰ(cTnⅠ) contents were assayed by enzyme-linked immuno sorbent assay kit (ELISA).

RESULTS

Following modeling, the HR, LVSP, +dp/dt_max, -dp/dt_max, and myocardial SOD activity were significantly down-regulated (P<0.05, P<0.01), while the LVDP, t-dp/dt_max, serum LDH and CK activity and cTnⅠ content, as well as myocardial MDA content were considerably increased in comparison with the blank group (P<0.05, P<0.01). After moxibustion intervention, the decreased HR, LVSP, +dp/dt_max, -dp/dt_max, and myocardial SOD activity levels and the increased LVDP, t-dp/dt_max, serum LDH and CK activity and cTnⅠ content, as well as myocardial MDA content were remarkably suppressed in comparison with the model group (P<0.05, P<0.01).

CONCLUSIONS

Grain-moxibustion can significantly improve the left ventricular function, increase heart rate in cardiomyopathy rats, which may be associated with its effects in reducing myocardial oxidative stress damage by down-regulating the content of MDA and up-regulating SOD activity in the heart.

[Treatment of advanced Siewert type Ⅱ esophagogastric junction adenocarcinoma by thoracoabdominal radical gastrectomy and D2 lymphadenectomy]

OBJECTIVE

To investigate the advantages of thoracoabdominal radical gastrectomy for advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction.

METHODS

Clinical data of 86 patients with Siewert type Ⅱ adennocarcinoma of the esophagogastric junction who received surgical treatment at the Henan Provincial Tumor Hospital from January 2015 to January 2016 were retrospectively analyzed. Among them, 44 patients underwent abdominal operation (abdominal group), and 42 patients underwent thoracoabdominal radical gastrectomy (thoraco-abdominal group). The operation time, lymph node number, distance between the tumor and cutting edge, amount of intraoperational blood loss, postoperative pulmonary complications, and postoperative hospital stay in the two groups were compared.

RESULTS

Comparing the thoracoabdominal group with the abdominal group, the number of removed lymph nodes was 41.57±9.22 vs. 35.09±10.61 (P<0.01), the number of removed mediastinal lymph nodes was 6.38±1.50 vs. 3.52±1.42 (P<0.01), the distance between the tumor and cut edge was (5.62±0.73) cm vs. (3.30±0.85) cm (P<0.01), whereas the operation time, intraoperative blood loss, postoperative pulmonary complications, occurrence of anastomotic leakage and hospital stay were statistically not significantly different (P>0.05 for all).

CONCLUSIONS

For patients with advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction, radical gastrectomy through thoracoabdominal approach can resect a longer segment of the esophagus, dissect more mediastinal lymph nodes, and does not increase post-operative complications and extend hospital stay, thus, exhibits obvious advantages in the surgical treatment of Siewert Ⅱ adenocarcinoma of the esophagogastric junction.

[Progress of Researches on Protective Effect of Acupuncture and Moxibustion in Relieving Intracellular Calcium Overload of Cradiomyocytes]

Myocardial contraction and relaxation are regulated by increases and decreases of the intracellular cytoplasmic calcium (Ca²⁺) concentration. Intracellular calcium ion is also a ubiquitous second messenger, and its related signal transduction pathways involve a variety of physiological activities and pathological changes. It has been well documented that intracellular calcium overload is involved in myocardial cellular injury. In the present paper, the authors make a review about experimental researches on the underlying mechanisms of acupuncture and moxibustion in the prevention and treatment of ischemic myocardial injury from reducing calcium overload in recent 10 years. Results of recent studies indicate that acupuncture and moxibustion interventions have a cardioprotective effect by raising Ca²⁺-ATPase activity and nitric oxide content, lowering L-type voltage depen-dent calcium channel activity, and ameliorating calcium overload in ischemic cardiomyocytes mainly through cytomembrane, sarcoplasmic reticulum membrane and mitochondrial membrane pathways. However, the current studies on the mechanisms of acupuncture in the improvement of the ischemic myocardial injury are far unclear up to now and do not closely combine the clinical application.

[Progress of researches on prevention and treatment of sports fatigue with moxibustion therapy]

Sports fatigue belongs to the category of functional deficiency-syndrome according to the theory of traditional Chinese medicine. The moxibustion therapy has a long history and possesses a definite therapeutic effect in the prevention and treatment of sports fatigue. In the present paper, the authors reviewed development of researches on the effects of moxibustion intervention in the prevention and treatment of sports fatigue in recent 5 years. Results of researches showed that moxibustion intervention can 1) eliminate free radicals and reduce oxidative damage; 2) increase energy (glycogen) supply to delay the production of fatigue; 3) raise serum testosterone level (relieve exercise-induced neuroendocrine disorder) and reduce post-sports fatigue; 4) raise the anaerobic exercise ability, reduce the accumulation of metabolic products in the body and strengthen the endurance capacity of the skeletal muscle; and 5) improve ischemic cardiac function, and suppress cardiomyocyte apopotosis, etc. However, we should further strengthen our investigations on the moxibustion therapy in the ancient classical literature and sum up academic thoughts of different academic schools in the successive dynasties, put emphasis on the large sample randomized controlled clinical trails, establish united treatment standards, etc., and provide much evidence for effectively treating sports fatigue in the future.

STAT4 is a genetic risk factor for systemic sclerosis in a Chinese population

Systemic sclerosis (SSc) is an immune-mediated and complex genetic disease. An association of single-nucleotide polymorphisms (SNPs) in the STAT4 gene with SSc has been reported in European Caucasians, North Americans and Japanese. We undertook the current study to examine whether the STAT4 SNPs are also associated with susceptibility to SSc and SSc subsets in a Han Chinese population. A total of 453 Han Chinese patients with SSc and 534 healthy controls were examined in the study. The SNPs rs7574865, rs10168266 and rs3821236 of the STAT4 gene were examined with SNP TaqMan assays. The T-allele carriers of rs7574865 and rs10168266 were strongly associated with the presence of anti-topoisomerase I (ATA) and pulmonary fibrosis in SSc patients, as well as with diffuse cutaneous SSc (dcSSc). The presence of anti-centromere (ACA) and limited cutaneous SSc (lcSSc) did not show significant association with any of the examined SNPs. The results were consistent with previous reports in other ethnic populations in supporting the notion that polymorphisms of STAT4 may play an important role in susceptibility to SSc. It also revealed different genetic aspects of SSc subsets in a Han Chinese population.

Impact of MTHFR polymorphisms on methylation of MGMT in glioma patients from Northeast China with different folate levels

Hypomethylation of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter in glioma cells has been associated with temozolomide resistance. S-adenosylmethionine (SAM), which is produced during folate metabolism, is the main source of methyl groups during DNA methylation. As a key enzyme during folate metabolism, polymorphisms of 5,10-methylenetetrahydrofolate reductase (MTHFR) may regulate folate end-products. We investigated the effect of typical polymorphisms of MTHFR (C677T and A1298C) on MGMT methylation based on different serum folate levels in patients with glioma from Northeast China. A total of 275 patients with glioma and 329 without malignant tumors were tested. Serum folate concentration was assayed by using the electrochemiluminescence immunoassay. MTHFR polymorphisms were detected by Taqman-Fluorescence quantitative polymerase chain reaction (PCR). Methylation-specific PCR was used to assess MGMT methylation. The constituent ratio of glioma patients below the serum folate biological reference value was significantly higher than that of the control population (P < 0.001). In patients with oligodendroglioma and glioblastoma, heterozygotes for the A1298C mutation were found in higher frequency than homozygotes or wild types (oligodendroglioma, P < 0.001; glioblastoma, P < 0.01). When grouped by the median or biological reference value of serum folate, only homozygotes for C677T with low levels of folate were significantly associated with decreased methylation of MGMT (median, P < 0.001; biological reference value, P = 0.036). These data suggest that, in combination with a negative folate balance in glioma patients, T/T genotypes in MTHFR C677T may be associated with MGMT demethylation.

Therapeutic Effects of Qigong in Patients with COPD: A Randomized Controlled Trial

Objective

This study was conducted to compare the therapeutic effects of health qigong (HQG) with conventional pulmonary rehabilitation (PR) exercise among patients with chronic obstructive pulmonary disease (COPD).

Methods

A total of 132 patients with confirmed diagnosis of COPD but no serious comorbidities were randomly allocated to the HQG group (n = 51), PR group (n = 32), or medical treatment group (n = 35). The HQG group received 1 week of HQG training under the supervision of professional coaches, and were then encouraged to participate in a peer-led weekly practice group thrice a week, lasting 1 hour each time, for 6 months. The conventional PR group received the same amount of professional coaching on breathing and aerobic exercises, and peer-led walking or ball game groups. The medical treatment group only received health education on self-exercise. Baseline data were taken before randomization, and outcomes were ascertained at the 6-month follow-up by blinded assessors.

Results

Overall, 118 patients with complete data were recruited into the final analysis. Irrespective of disease stages, both HQG and PR groups showed improving trends across 6-minute walk test and quality of life scores, while the medical treatment group demonstrated either no improvements or some deteriorations. When comparing HQG with PR, HQG appeared to have better effects on decreasing the frequency of exacerbation for patients with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage I and maintaining a stable tumor necrosis factor-alpha level for patients of GOLD stage II.

Conclusion

This study solidifies the concept that both HQG and PR produce positive effects on subjective symptoms and functions among COPD patients, and also provided evidence that HQG can induce additional effects compared to conventional PR.

[Influence of acupuncture on the motor ability in training-induced fatigue mice]

OBJECTIVE

To observe the influence of acupuncture on the motor ability of training-induced fatigue mice so as to explore its mechanism underlying acupuncture-induced improvement of physical training fatigue.

METHODS

Sixty Kunming mice were divided into normal control, training model and acupuncture groups, with 20 mice in each. The training-fatigue model was established by forcing the mouse to swim in a water tank for 30 min/d in the 1st week, 60 min/d in the 2nd week, 90 min/d in the 3rd week and 120 min/d in the 4th and 5th weeks. "Guanyuan" (CV 4), and bilateral "Zusanli" (ST 36) and "Shenshu" (BL 23) were punctured with filiform needles, and with the needle twirled for about 30 s and retained for 5 min. Thetreatment was conducted once daily for 2 weeks. The duration of exhaustion training was recorded. Serum lactic acid (LA), lactate dehydrogenase (LDH) and creatine kinase (CK) contents were detected by LA oxidase method, immune-suppressive assay and enzyme-linked immunoassay, respectively.

RESULTS

Compared with the training-fatigue (model) group, the duration of the exhausted swimming of the acupuncture group was obviously longer (P < 0.05). In comparison with the control group, serum LA, LDH and CK contents were increased considerably in the model and acupuncture groups (P < 0.05, P < 0.01), while compared with the model group, serum LDH level of acupuncture group was increased significantly (P < 0.05), and serum CK level of acupuncture group decreased obviously (P < 0.05). No significant difference was found between the model and acupuncture groups in serum LA content (P > 0.05).

CONCLUSION

Acupuncture can effectively improve the motor ability of the training-fatigue mice, which may be closely relevant to its effects in upregulating LDH activity and reducing serum CK.

[Randomized controlled trials on the influence and mechanism of manipulation on delayed onset muscle soreness after eccentric exercise]

OBJECTIVE

To observe and compare the influence of pre- and post-exercise manipulation and natural recovery without any intervention on delayed onset muscle soreness (DOMS) after eccentric exercise and to explore the manipulation therapeutic mechanism on the metabolism of oxygen free radical (OFR).

METHODS

The study was carried on during Apr. to Jul. in 2008 at Nanjing University of TCM. The 30 healthy male students were divided into 3 groups randomly according to condition-equivalence principle including control group (C), pre-exercise manipulation group (A), post-exercise manipulation group (B). Before exercise, group A were intervened by manipulation for 30 minutes, which was followed by exercise 5 minutes later. While 30 minutes after exercise, group B accepted manipulation for 30 minutes and continued manipulation once a day for consecutive 3 days. Group C were not intervened by any approaches before or after exercise. The clinical manifestations, which include soreness intensity and lasting time, maximal isometric strength, arm girth, elbow range of motion, were evaluated at the 1st hour before exercise, immediately, 24th, 48th and 72th hours after exercise. Meanwhile, serum creatine kinase (CK), serum superoxide dismutase (SOD), serum malonaldehyde (MDA) were determined at the 1st hour before exercise, immediately, 24th and 48th hours after exercise.

RESULTS

Compared to group C, group A and B were manifested by significantly lower peak soreness (P < 0.01, P < 0.05), significantly better recovery of elbow flexing degree at the 72th hour after exercise (P < 0.05) and significantly lower rising range of serum CK at the 48th hour after exercise (P < 0.01). Comparing to group C, group A was manifested by significantly shorter lasting time of muscle soreness (P < 0.01) and significantly better recovery of maximal isometric strength of the 72th hour after exercise (P < 0.01). Compared to group C, group B was manifested by significantly better recovery of elbow extending degree at the 72 th hour after exercise (P < 0.01). There was no significant difference in the change of arm girth among the three groups. The level of Serum SOD, MDA and SOD/MDA at the 48th hour after exercise in group A and B were significantly different from those in group C (P < 0.01, P < 0.01, P < 0.05, P < 0.01).

CONCLUSION

Through improving the metabolism of OFR, pre-exercise and post-exercise manipulation can partially prevent and treat DOMS respectively. In addition, preventive effect by pre-exercise manipulation is better than curing effect by post-exercise manipulation, which proves the TCM thought, that is, prevention superior to treatment.

Sorafenib inhibits activation of human peripheral blood T cells by targeting LCK phosphorylation

Sorafenib, a novel drug for metastatic renal cancer, has broad-spectrum activity against multiple tyrosine kinases, including Raf-1, vascular endothelial growth factor receptor and platelet-derived growth factor receptor. However, little is known about its effects on the immune system. In this report, we examine the effects of sorafenib on the proliferation and activation of human peripheral blood T cells, as well as its effects on T-cell-mediated immune response in mice. At concentrations similar to those used in patients, sorafenib inhibited the proliferation of primary human T cells in vitro. At more than 10 microM, sorafenib caused an irrecoverable inhibition of proliferation, even after drug withdrawal. In addition, sorafenib induced T-cell apoptosis at concentrations higher than 10 muM. sorafenib also caused G(0)/G(1) phase arrest, inhibition of CD25 and CD69 expression, interleukin-2 production and LCK phosphorylation in the T cells; all of these effects exhibited dose and time dependence. When tested against contact dermatitis in mice, sorafenib significantly reduced the ear swelling induced by picryl chloride. These findings suggest that sorafenib may cause the loss of T-cell immune response by inducing apoptosis and targeting LCK. This could potentially lead to immunosuppression in patients with cancer.

Long-term exposure to gaseous formaldehyde promotes allergen-specific IgE-mediated immune responses in a murine model

It has long been questioned that whether exposure to formaldehyde in indoor environments may be a risk factor for developing allergen-specific IgE-mediated inflammatory responses, because there is limited clinical or experimental evidence that formaldehyde is involved in the cascade for IgE production. There is no known lower limit, below which there is no threat of serious allergic symptoms. The present study illustrates that the threshold limit of formaldehyde, 0.08 ppm (as defined by the World Health Organization), did not cause ovalbumin-specific IgE inflammatory immune responses, but higher than threshold concentrations of formaldehyde gas result in both enhanced allergen-specific IgE responses and NK (Natural Killer)-cell activity in peripheral blood cells in a murine model. Thus, formaldehyde gas may be involved in promoting allergic inflammatory effects in subjects primed with specific allergens by NK-cell activation. These results indicate that even threshold concentrations of formaldehyde gas may play a regulatory role for ‘systemic’ cell-mediated immune responses. The extensive use of adhesives for building materials has resulted in higher levels of indoor air pollutants. It is conceivable that increased time indoors may enhance pre-existing allergic symptoms by concomitant exposure to volatile organic compounds and formaldehyde. The affordable limit for formaldehyde might be much lower than currently established levels in indoor environments.

Association of ACE, ACE2 and UTS2 polymorphisms with essential hypertension in Han and Dongxiang populations from north-western China

To assess the significance of polymorphisms of the genes for angiotensin-converting enzyme (ACE), angiotensin-converting enzyme 2 (ACE2) and urotensin II (UTS2) as risk factors for essential hypertension in two populations from north-western China, we enrolled 198 patients with essential hypertension and 131 healthy controls from the Han population and 120 patients with essential hypertension and 102 healthy controls from the Dongxiang population. Polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism were used to analyse gene polymorphisms. The results provided evidence that genetic variants of UTS2 and ACE2 may play a role in the development of essential hypertension in these populations. Polymorphisms of ACE were not associated with essential hypertension in either population. This is the first report showing that the S89N single-nucleotide polymorphism of the UTS2 gene is associated with essential hypertension.

A survey of Japanese patients with Menkes disease from 1990 to 2003: incidence and early signs before typical symptomatic onset, pointing the way to earlier diagnosis

Menkes disease (MNK) is a lethal, X-linked recessive disorder of copper metabolism dominated by neurodegenerative symptoms and connective tissue disturbances. The incidence of MNK in Asia is not known. Most patients die by the age of 3 years if adequate treatment is not carried out. Early parenteral administration of copper can prevent the neurological disturbances and lead to a better outcome. In the present study, a survey on MNK in Japan was performed. There were in total 53 live-born Japanese patients with MNK collected from 1990 to 2003, including two females. The incidence of live-born MNK patients between 1992 and 2002 was 2.8 per million live births (95% confidence interval (CI): 1.8 to 3.7), 4.9 per million male live births (95% CI: 3.2 to 6.6). One-third of the patients were born before 37 weeks or weighing less than 2500 g. Seventeen per cent were born both before 37 gestational weeks and weighing less than 2500 g. These proportions were higher than those in Japanese live-birth babies according to a nationwide estimate. The hair on these Japanese patients appeared not only as white or grey but also brown and blond. We also found that many signs had been noted before the patient was brought to a hospital with typical symptoms. These signs may be a clue to early diagnosis of MNK.

Mutation spectrum and polymorphisms in ATP7B identified on direct sequencing of all exons in Chinese Han and Hui ethnic patients with Wilson's disease

Wilson's disease (WD), an autosomal recessive copper transport disorder, usually presents with symptoms involving the liver or central nervous system. The disease is caused by a large number of mutations in the ATP7B gene comprising 21 expressed exons. Some of the mutations appear to be population specific, whereas others are found in probands from a variety of different ethnic backgrounds. This paper presents the results of screening of the ATP7B gene by means of the direct sequencing of all exons in the gene in 39 Han and one Hui ethnic Chinese patients. Nineteen novel mutations were revealed along with nine others that have been previously described; 57.5% of the mutations were located in exons 8, 13, and 12. In particular, the Arg778Leu mutation in exon 8 was found in 55% of these Chinese patients in at least one allele. Five patients were homozygotes and 17 patients were heterozygotes for Arg778Leu. The detection rate on direct sequencing of the polymerase chain reaction products of all exons of the ATP7B gene in 40 unrelated patients was 83.8% of alleles. Seventeen polymorphisms were also identified in patients and healthy controls. We first reported the presence of ATP7B mutations in Chinese Hui ethnic patients and summarize our results here along with the previously reported findings. A significant correlation between genotype and phenotype was not found in 37 homozygotes and 52 heterozygotes for Arg778Leu.