Chinese herbal medicine Qinggongshoutao for the treatment of amnestic mild cognitive impairment: A 52-week randomized controlled trial

Introduction

This randomized, double-blind trial aimed to test effect of a Chinese herbal medicine, Qinggongshoutao (QGST) pill, on the cognition and progression of amnestic mild cognitive impairment (aMCI).

Methods

Patients with aMCI were randomly assigned to receive QGST, Ginkgo biloba extract, or placebo for 52 weeks. The primary outcome measures were progression to possible or probable Alzheimer's disease (AD) and change in Alzheimer's Disease Assessment Scale-cognitive subscale scores; secondary outcome measures included assessments for cognition and function.

Results

Total 350 patients were enrolled, possible or probable AD developed in 10. There were significant differences in the probability of progression to AD in the QGST group (1.15%) compared with placebo group (10%). There was significant difference in Alzheimer's Disease Assessment Scale-cognitive subscale scores in favor of QGST over the placebo group. Secondary outcome measure (Mini-Mental State Examination) also showed benefit in QGST at end point.

Discussion

In patients with aMCI, QGST showed lower AD progression rate than placebo at 8.85%, and may have benefit on global cognition.

FPR2 enhances colorectal cancer progression by promoting EMT process

Formyl peptide receptor-2 (FPR2) has been shown to promote various tumors, but its role in colorectal cancer (CRC) has not been clearly illuminated. The aim of this study was to investigate the effect of FPR2 interference on cell proliferation, migration, invasion, apoptosis, pro-angiogenesis of CRC cells, and also the mechanisms involved. Quantitative PCR assays were applied to assess the expression levels of FPR2 in CRC tissues. CRC cell line SW1116 was chosen to perform this study. We knocked down FPR2 gene by sh-RNA. Then, the cell proliferation was assayed by soft agar colony formation assay, the cell migration capacity was checked by wound healing assay, and cell invasion ability was detected by transwell assay. In addition, flow cytometric analysis was used to detect apoptosis, while endothelial tube formation assay was used to evaluate the effects of FPR2 on pro-angiogenesis in vitro. Tumorigenesis experiment in vivo was performed in nude mice. EMT-related proteins were studied by western blotting. Quantitative PCR demonstrated that FPR2 mRNA was highly expressed in the colorectal cancer tissues. SW1116 cells' capacities of proliferation, migration, invasion, anti-apoptosis and pro-angiogenesis were distinctly suppressed after silencing FPR2 in SW1116 by sh-RNA. Suppression FPR2 mRNA in SW1116 cells suppressed tumorigenicity in nude mice. The expression of proteins related to epithelial-mesenchymal transition (EMT) such as E-cadherin, N-cadherin, Snail, Slug and vimentin was changed after suppressing FPR2. In conclusion, our study demonstrated that FPR2 could promote CRC cells progression in vitro and in vivo that may relate to promoting EMT.

Three-dimensional printing of metals for biomedical applications

Three-dimensional (3D) printing technology has received great attention in the past decades in both academia and industry because of its advantages such as customized fabrication, low manufacturing cost, unprecedented capability for complex geometry, and short fabrication period. 3D printing of metals with controllable structures represents a state-of-the-art technology that enables the development of metallic implants for biomedical applications. This review discusses currently existing 3D printing techniques and their applications in developing metallic medical implants and devices. Perspective about the current challenges and future directions for development of this technology is also presented.

Comparison of intravenous lidocaine and dexmedetomidine infusion for prevention of postoperative catheter-related bladder discomfort: a randomized controlled trial

BACKGROUND

Catheter-related bladder discomfort (CRBD) frequently occurs during recovery in patients who undergo intra-operative urinary catheterization. We conducted this study to compare the effect of intravenous lidocaine and dexmedetomidine infusion for preventing CRBD.

METHODS

120 patients undergoing elective open abdominal hysterectomy or hysteromyomectomy requiring urinary bladder catheterization were randomly allocated into three groups of 40 each. Group L received a 2 mg/kg lidocaine bolus followed by infusion of 1.5 mg/kg/h; Group D received a 0.5 μg/kg dexmedetomidine bolus followed by infusion of 0.4 μg/kg/h; Group C received a bolus and infusion of normal saline of equivalent volume. The incidence and different severity (mild, moderate, and severe) of CRBD were assessed on arrival in the postanaesthesia care unit at 0, 1, 2, and 6 h postoperatively.

RESULTS

The incidence of CRBD was significantly lower in Group L and Group D compared with Group C at 0, 1, and 2 h. However, there was no significant difference among the three groups regarding the different severity of CRBD at all time points. The requirement of rescue tramadol for CRBD was lower in group L and group D than in group C. The incidence of sedation was significantly higher in Group D compared to Group L and Group C, though no difference in other adverse effects was observed.

CONCLUSIONS

Intravenous lidocaine and dexmedetomidine infusion reduced the incidence of CRBD as well as the additional tramadol requirement for CRBD, but had no effect on the different severity of CRBD.

TRIAL REGISTRATION

ChiCTR-INR-16009162 . Registered on 5 September 2016.

[Morphological classification of acute isolated pontine infarction and it's clinical relevance]

Objective: To investigate a diffusion weighted imaging (DWI)-based morphological classification for acute isolated pontine infarcts (AIPI) and to assess differences in clinical characteristics, risk factors and functional outcomes among the different morphologies. Methods: All participants from SMART cohort with DWI-proven AIPI were included and categorized into 3 groups: basilar artery branch disease (BABD) group, small artery disease (SAD) group and large-artery-occlusive disease (LAOD) group, according to lesion extent of the transverse axial plane and basilar artery atherosclerosis severity. The clinical characteristics, vascular risk factors and 6-month's functional outcome was analyzed among 3 groups. Results: Of the 1 129 patients enrolled, 175 had AIPI. BABD was the most frequent subtype of AIPI (46.3%), followed by SAD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD and BABD group than SAD group (P<0.001). In terms of risk factors, the percentage of hypertension was significant different among three groups (P<0.05). The average National Institute of Health stroke scale was 3.49 for SAD group, 5.93 for LAOD group, 5.97 for BABD group, and the differences were significant (P<0.001). The Poor outcome (mRS>2) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups. Conclusions: According to the morphological classification, BABD is the most frequent subtype of AIPI. The differences of the clinical characteristics and risk factors among three groups indicate that differences observed in morphology might have distinct pathophysiologic mechanisms. AIPI can be reliably classified based on morphology using clinical magnetic resonance images.

[Prevalence and risk factors of perivascular space in the population of Shunyi Study]

Objective: To investigate the prevalence on imaging, topographic distribution and risk factors of perivascular space (PVS) in community population. Methods: This study was based on the population of Shunyi Study in China from June 2013 to September 2016. One thousand two hundred and thirty-two stroke free participants older than 35 years, who completed cerebral MRI, were included. Cardiovascular risk factors were assessed by interview, physical examination and blood sample tests. PVS were evaluated on high-resolution 3-dimensional-T1WI, T2WI and FLAIR sequences. On T1WI, PVS were detected according to 3D imaging criteria. The number and anatomic location of large PVS (≥3 mm) were recorded. And severity of PVS was then semiquantitatively graded in both white matter (WM) and basal ganglia (BG). Associations between risk factors and PVS were analyzed by multinominal Logistic regression models and adjusted for age, gender and relevant confounders. Results: Perivascular spaces were observed in the BG or WM in every subject, aged (55±10) years and 37.3% male. Large PVS were detected in 19.0% (460/1 232) of participants. Severity of PVS was found to be strongly associated with age in both basal ganglia (severe versus mild: OR=1.81; 95%CI 1.45-2.27, P<0.01) and white matter (OR=1.39; 95%CI 1.13-1.71, P<0.01), and the proportion of subjects with hypercholesterolemia decreased with the severity of PVS in BG (OR=0.58, P=0.01) . The present of large PVS was found to be associated with age(present versus absent: OR=1.03, 95%CI 1.02-1.05, P<0.01) and ApoE ε4 carrier genotype(OR=1.53, 95%CI 1.01-2.23, P=0.04). Conclusions: Perivascular spaces are always detected in the BG or WM in elderly people, and large PVS are also prevalent in community-based population. The risk factors are different due to distribution and size, and may depend on anatomic or pathologic characteristics.

[The overview of the development of modern burn surgery in China]

Chinese modern burn surgery belongs to the western medicine system. From 1930s, the knowledge of modern burn surgery spread over China. Its development had experienced four stages: enlightening stage, exploratory stage, mature stage, and remodeling stage. Before the 1950s, medical personnel began to study those knowledges. The clinical treatment developed slowly and had little experience. From the 1950s to 1960s, Chinese burn surgery professionals made the painstaking exploration and accumulated rich clinical experiences. The success of severe burns treatment attracted worldwide attention. From the 1970s to the mid-1990s, as the regulations of burn diagnosis and treatment established in China, the clinical treatment developed widely. The world's leading therapeutic effects have achieved. The professional education system has been founded, and the professional societies have created. Those made medical personnel can access the scientific research achievement. Therefore, the leading talents emerged. Chinese modern burn surgery entered a mature stage. Since the late-1990s, Chinese modern burn surgery entered a remodeling stage. Besides increasing the cure rate and decrease disability rate of burn gradually, Chinese modern burn surgery need solve new problems such as that standardization of diagnosis and treatment sets up, the scope of diagnosis and treatment expands, professional training improves, etc.

The influence of GAPT extraction on synapse loss of APPswe/PS1dE9 transgenic mice via adjusting Bcl-2/Bax balance

Introduction

The degeneration of memory-focused synapses play important roles in Alzheimer's disease (AD) pathogenesis, while it is not well known how β amyloid interferes neuron apoptosis and how a herbal combination GAPT influence synapse loss and neuronal apoptosis pathways of APP/PS1 transgenic mice.

Methods

Three-month and six-month APPswe/PS1dE9 transgenic mice were used. Spatial and memory ability were measured by Morris Water Maze, Neuron and synapse number were assessed by electron microscope; Aβ, Bcl-2/Bax were determined by immunohistochemistry and western blot.

Results

APP/PS1 mice not only had increased Aβ accumulation, impaired memory performance, less synapse number, and much more necrosed neurons, but also had significant reduction in the Bcl-2/Bax ratio. However, GAPT and donepezil showed improved memory performance, less Aβ accumulation, increased neuron and synapse number, as well as restored balance of Bcl-2/Bax.

Discussion

GAPT may improve cognitive functions via both reducing Aβ deposition and restoring Bcl-2/Bax balance of neuron.

Efficacy and safety of Tianmabianchunzhigan in mild to moderate vascular dementia: Protocol of a randomized controlled IIa trial

BACKGROUND

Vascular dementia (VaD) is the 2nd most common subtype of dementia after Alzheimer disease. Currently, there are no medications approved for treating patients with VaD. Tianmabianchunzhigan (TMBCZG) tablet is an active ingredient extracted from Gastrodia that has been reported to improve memory and other cognition. And the TBMCZG has been approved clinical trial with patients with VaD by center for drug evaluation of China (CFDA). To evaluate the efficacy, safety, and tolerability of TMBCZG tablets in the treatment of mild to moderate VaD, we designed and reported the methodology for a 24-week, randomized, double-blind, parallel, placebo-controlled, multicenter trial.

METHODS

A total of 160 patients with mild to moderate VaD will be enrolled. After a 2-week run-in period, the eligible patients will be randomized to receive either TMBCZG high-dose group (TBMCZG 3 tablets, twice per day); TMBCZG middle-dose group (TMBCZG 2 tablets and placebo 1 tablet twice per day); TMBCZG low-dose group (TMBCZG 1 tablet and placebo 2 tablets, twice per day); placebo group (placebo 3 tablets, twice per day) for 24 weeks, with a follow-up 12 weeks after withdrawn drug treatment. The primary efficacy measurement will be the vascular dementia assessment scale-cognitive subscale and the Clinical Dementia Rating-Sum of the Boxes scale. The secondary efficacy measurements will include the mini mental state examination and activities of daily living. Adverse events will also be reported.

DISCUSSION

This randomized trial will be the 1st rigorous study on the efficacy and safety of TMBCZG tablets for treating cognitive symptoms in patients with VaD using a rational design.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03230071. Registered on July 26, 2017.

Removal of prometryn from hydroponic media using marsh pennywort (Hydrocotyle vulgaris L.)

The aquatic plant Hydrocotyle vulgaris was evaluated for its efficacy in removing prometryn from nutrient solution. Under optimized experimental conditions, up to 94.0% of the initial prometryn was removed from the hydroponic culture medium by H. vulgaris in 30 days. The concentration of prometryn decreased from the initial level of 0.55 ± 0.013 mg/L to 0.036 ± 0.001 mg/L at the end of the experimental period. The removal kinetics followed first-order kinetic equation (Ct = 0.4569e^-0.09t). Half-life (t_1/2) of prometryn was greatly shortened from 27.16 days (without plant) to 5.58 days (with H. vulgaris). Approximately 22% of the initial prometryn residue was found in H. vulgaris tissue, while 11.7% was degraded by the plant in 30 days. The metabolites of prometryn detected were 2,4-diamino-1,3,5-triazine (in the hydroponic culture medium) and 2,4,6-trihydroxy-1,3,5-triazine (in plant tissue) after 30 days. The results indicate that H. vulgaris can be used for phytoextraction of prometryn and could potentially be effective in removing other s-trazine pesticides from contaminated aquatic ecosystems.

Validation of a revised Mandarin Chinese language version of the Postoperative Quality of Recovery Scale

The aim of the study was to validate a revised Mandarin version of the Postoperative Quality of Recovery Scale (PostopQRS) and to apply the revised version in a Chinese population. In a prospective design, bilingual volunteers completed the scale at baseline, day one, day seven, and day 14 in both languages, with the order of language and parallel forms randomised. In addition, lung cancer patients undergoing open or video-assisted thoracoscopic surgery (VATS) completed the Mandarin version prior to surgery, day one, day three, day seven, day 14, one month, and three months postoperatively. Sixty-eight volunteers participated in the validation part of the study and in the clinical application, 93 lung cancer patients were included. The scores in the Mandarin version were equal to the English version in all domains at all timepoints including the word generation task, when the Mandarin morpheme was included in any part of the Mandarin word. However, Mandarin scores were lower in the word generation task if the morpheme was only included in the first part of the word. In addition, the Mandarin version was able to identify lower rates of overall recovery (<i>P</i> <0.01), nociceptive (<i>P</i> <0.01), emotive (<i>P</i> <0.01), and activities of daily living recovery (<i>P</i>=0.02) after open surgery compared to after VATS. The revised Mandarin version is equivalent to the English version for the cognitive domain, if morpheme substitution for the word generation task is allowed as any part of the word, and it is able to discriminate quality of recovery in Chinese patients.