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Li J, Wu H, Xing W, Li X, Han Z, Ji R, Deng Z, Jung M, Sun S, Chung BI, Cardenas A, Langston ME. Air pollution mixture associated with oxidative stress exacerbation and symptoms deterioration in allergic rhinitis patients: Evidence from a panel study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 930:172688. [PMID: 38663627 DOI: 10.1016/j.scitotenv.2024.172688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
With allergic rhinitis (AR) on the rise globally, there has been a growing focus on the role of environmental pollutants in the onset of AR. However, the potential mechanisms by how and which these pollutants exacerbate AR conditions remain unknown. This panel study of 49 patients diagnosed with AR over one year aimed to assess the individual and combined effects of short-term exposure to multiple ambient pollutants on oxidative stress, symptoms, and quality of life among patients with AR. All participants underwent four repeated assessments of health conditions and personal environmental exposures (PM2.5, O3, SO2, and NO2) over warm and cold seasons during 2017-2018. We evaluated two oxidative stress biomarkers (malondialdehyde [MDA], and superoxide dismutase [SOD]) via nasal lavage. We collected information on self-reported symptoms and quality of life using the Rhinitis Symptom Scale (SRS), the Visual Analog Scale (VAS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) through in-person interviews. Bayesian kernel machine regression (BKMR) was used to evaluate the joint effects of pollutant mixture and identify key contributors. The results revealed a significant association of the pollutant mixture when all four pollutants were at or above their median levels, with increased oxidative stress. This was evidenced by elevated MDA and reduced SOD. We found a joint detrimental effect of the pollutant mixture on AR symptoms with a strong association with increased SRS scores, but a non-significant positive association with VAS and RQLQ scores. PM2.5, O3, and SO2 presented as the potentially primary contributors to the adverse health effects associated with the pollutant mixture in Taiyuan city. Patients with AR exposed to short-term air pollutant mixture are more likely to have greater nasal symptoms and worse quality of life from increased oxidative stress and reduced antioxidant capacity. Further research is warranted to better elucidate the underlying mechanisms.
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Affiliation(s)
- Jinhui Li
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
| | - Haisheng Wu
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Weiwei Xing
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Zheshen Han
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Renyue Ji
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Zhengyi Deng
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Minji Jung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Shengzhi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Andres Cardenas
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Marvin E Langston
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Liu HL, Chen HF, Wu YD, Yan YJ, He XC, Li ZZ, Ruan Y, Wu GL. Xiaoqinglong decoction mitigates nasal inflammation and modulates gut microbiota in allergic rhinitis mice. Front Microbiol 2024; 15:1290985. [PMID: 38812686 PMCID: PMC11133530 DOI: 10.3389/fmicb.2024.1290985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Allergic rhinitis (AR) is a respiratory immune system disorder characterized by dysregulation of immune responses. Within the context of AR, gut microbiota and its metabolites have been identified as contributors to immune modulation. These microorganisms intricately connect the respiratory and gut immune systems, forming what is commonly referred to as the gut-lung axis. Xiaoqinglong Decoction (XQLD), a traditional Chinese herbal remedy, is widely utilized in traditional Chinese medicine for the clinical treatment of AR. In this study, it is hypothesized that the restoration of symbiotic microbiota balance within the gut-lung axis plays a pivotal role in supporting the superior long-term efficacy of XQLD in AR therapy. Therefore, the primary objective of this research is to investigate the impact of XQLD on the composition and functionality of the gut microbiota in a murine model of AR. Methods An ovalbumin-sensitized mouse model to simulate AR was utilized, the improvement of AR symptoms after medication was investigated, and high-throughput sequencing was employed to analyze the gut microbiota composition. Results XQLD exhibited substantial therapeutic effects in AR mice, notably characterized by a significant reduction in allergic inflammatory responses, considerable alleviation of nasal symptoms, and the restoration of normal nasal function. Additionally, following XQLD treatment, the disrupted gut microbiota in AR mice displayed a tendency toward restoration, showing significant differences compared to the Western medicine (loratadine) group. Discussion This results revealed that XQLD may enhance AR allergic inflammatory responses through the regulation of intestinal microbiota dysbiosis in mice, thus influencing the dynamics of the gut-lung axis. The proposal of this mechanism provides a foundation for future research in this area.
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Affiliation(s)
- Hao-Lan Liu
- School of Medicine, Jishou University, Jishou, China
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Institute of Otolaryngology, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Hui-Fang Chen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Institute of Otolaryngology, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
- Department of Medicine, Guangxi University of Science and Technology, Liuzhou, China
| | - Yun-Dang Wu
- National-Regional Joint Engineering Research Center for Soil Pollution Control and Remediation in South China, Guangzhou, China
- Guangdong Key Laboratory of Integrated Agro-environmental Pollution Control and Management, Institute of Eco-environmental and Soil Sciences, Guangdong Academy of Sciences, Guangzhou, China
| | - Ya-Jie Yan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Institute of Otolaryngology, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Xue-Cheng He
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Yan Ruan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Institute of Otolaryngology, Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Gan-Long Wu
- People’s Hospital of Jishou City, Jishou, China
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Lee SW, Woo SC, Lyu YR, Yang WK, Kim SH, Kim JH, Kim SY, Kang W, Jung IC, Kim T, Park YC. Efficacy and Safety of Bojungikgi-Tang for Persistent Allergic Rhinitis: A Randomized, Double-Blinded, Placebo-Controlled, Phase II Trial. Healthcare (Basel) 2024; 12:1017. [PMID: 38786427 PMCID: PMC11120927 DOI: 10.3390/healthcare12101017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Conventional treatments for allergic rhinitis (AR) exhibit insufficiency and long-term use-related side effects. Considering the reported anti-inflammatory and immunoregulatory effects of Bojungikgi-tang (BJIGT), we aimed to assess its efficacy on persistent AR (PAR). Patients with PAR were randomly assigned in a 1:1:1 ratio into high-dose BJIGT, standard-dose BJIGT, and placebo groups, followed by 1-week run-in and 4-week treatment periods. The primary outcome included the mean change in Total Nasal Symptom Score (TNSS), with secondary outcomes encompassing the Korean Allergic Rhinitis-Specific Quality of Life Questionnaire, biomarkers, overall assessment, TNSS by AR pattern identification, and the Sasang constitution. The mean TNSS change was more improved in the BJIGT group than in the placebo group; however, no statistically significant differences were observed. Additional interaction effect analysis revealed a statistically significant improvement in the high-dose BJIGT group compared with the placebo group from weeks 1-2 to weeks 3-4. Regarding secondary outcomes, the BJIGT group exhibited similar or improved results compared with the placebo group, showing no statistically significant differences. No serious adverse effects or clinically significant changes in safety assessments were observed. Given that this study validated clinical improvement and safety, it serves as potential groundwork for pertinent future studies.
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Affiliation(s)
- Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 34520, Republic of Korea; (S.W.L.); (S.-C.W.); (W.-K.Y.)
| | - Seong-Cheon Woo
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 34520, Republic of Korea; (S.W.L.); (S.-C.W.); (W.-K.Y.)
| | - Yee Ran Lyu
- Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Won-Kyung Yang
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 34520, Republic of Korea; (S.W.L.); (S.-C.W.); (W.-K.Y.)
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon 34520, Republic of Korea;
| | - Seung-Hyung Kim
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon 34520, Republic of Korea;
| | - Je Hyun Kim
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon 35235, Republic of Korea; (J.H.K.); (S.Y.K.); (I.C.J.)
| | - Si Yeon Kim
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon 35235, Republic of Korea; (J.H.K.); (S.Y.K.); (I.C.J.)
- Department of Statistics, Graduate School, Daejeon University, Daejeon 34520, Republic of Korea;
| | - Weechang Kang
- Department of Statistics, Graduate School, Daejeon University, Daejeon 34520, Republic of Korea;
| | - In Chul Jung
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon 35235, Republic of Korea; (J.H.K.); (S.Y.K.); (I.C.J.)
- Department of Neuropsychology, College of Korean Medicine, Daejeon University, Daejeon 34520, Republic of Korea
| | - Taesoo Kim
- Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 34520, Republic of Korea; (S.W.L.); (S.-C.W.); (W.-K.Y.)
- Institute of Traditional Medicine and Bioscience, Daejeon University, Daejeon 34520, Republic of Korea;
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon 35235, Republic of Korea; (J.H.K.); (S.Y.K.); (I.C.J.)
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Lee G, Jung BH, Lee T, Park JH, Kim HS, Kim H, Yang HO. Exploring the Metabolic Effects of a Herbal Remedy of Asarum sieboldii, Platycodon grandiflorum, and Cinnamomum cassia Extracts: Unraveling Its Therapeutic Potential as a Topical Application for Atopic Dermatitis Treatment. Antioxidants (Basel) 2024; 13:563. [PMID: 38790668 PMCID: PMC11117881 DOI: 10.3390/antiox13050563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Our previous study demonstrated that our novel herbal remedy, a mixture of Asarum sieboldii, Platycodon grandiflorum, and Cinnamomum Cassia extracts, exhibits a therapeutic effect in 1-chloro-2,4-dinitrobenzene (DNCB)-induced mice by inhibiting the Th-2 inflammatory response upon oral administration. It also ameliorated imbalances in lipid metabolism related to the skin barrier function in keratinocytes, indicating its potential as a topical agent. This study aims to further investigate the therapeutic effects and metabolic mechanisms of its topical application. The anti-atopic effect was evaluated using dermatitis scores, histopathological analysis, and immune cell factors in DNCB-induced mice. Metabolomic profiling of serum and lesional skin was conducted to elucidate the metabolic mechanisms. The topical application significantly reduced dermatitis scores, mast cell infiltration, and serum levels of immunoglobulin E (IgE), IFN-γ, interleukin (IL)-4, IL-17, and thymic stromal lymphopoietin (TSLP), demonstrating its effectiveness in treating atopic dermatitis (AD). Serum metabolomics revealed alterations in fatty acid metabolism related to the pro-inflammatory response. In lesional skin, metabolic markers associated with oxidative stress, immune regulation, and AD symptoms were restored. This study demonstrated its potential as a topical agent in suppressing Th-2 inflammatory responses and improving metabolic abnormalities related to AD symptoms, providing crucial insights for developing natural AD treatments.
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Affiliation(s)
- Gakyung Lee
- Department of Integrative Biological Sciences and Industry, Sejong University, Seoul 05006, Republic of Korea; (G.L.); (T.L.)
- Convergence Research Center for Natural Products, Sejong University, Seoul 05006, Republic of Korea
| | - Byung Hwa Jung
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology (KIST), Seoul 02792, Republic of Korea;
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology, Seoul 02792, Republic of Korea
| | - Taemin Lee
- Department of Integrative Biological Sciences and Industry, Sejong University, Seoul 05006, Republic of Korea; (G.L.); (T.L.)
- Convergence Research Center for Natural Products, Sejong University, Seoul 05006, Republic of Korea
| | - Jae Hyeon Park
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon 16419, Republic of Korea; (J.H.P.); (H.S.K.)
| | - Hyung Sik Kim
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon 16419, Republic of Korea; (J.H.P.); (H.S.K.)
| | - Hocheol Kim
- Department of Herbal Pharmacology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea;
| | - Hyun Ok Yang
- Department of Integrative Biological Sciences and Industry, Sejong University, Seoul 05006, Republic of Korea; (G.L.); (T.L.)
- Convergence Research Center for Natural Products, Sejong University, Seoul 05006, Republic of Korea
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Wang R, Wang Y, Yang Q, Liu J, Lu Z, Xu W, Zhu J, Liu H, He W, Yan Y, Ruan Y, Zhou M. Xiaoqinglong decoction improves allergic rhinitis by inhibiting NLRP3-mediated pyroptosis in BALB/C mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117490. [PMID: 38030025 DOI: 10.1016/j.jep.2023.117490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xiaoqinglong decoction (XQLD), first recorded in Shang Han Lun, is a traditional Chinese medicine prescribed for the treatment of allergic rhinitis (AR). XQLD alleviates the clinical symptoms of AR by inhibiting the occurrence of an inflammatory response, but the specific regulatory mechanism remains unclear. AIM OF THE STUDY NLRP3-mediated pyroptosis is closely related to AR pathogenesis. Hence, this study aimed to explore the potential role of NLRP3-mediated pyroptosis pathway in the AR-associated pharmacological mechanism of XQLD. MATERIALS AND METHODS BALB/C mice models of AR was established by using ovalbumin (OVA) and aluminum hydroxide sensitization. After intragastric administration of different dosages of XQLD, nasal allergic symptoms were observed. The expression of OVA-sIgE and Th2 inflammatory factors (IL-4, IL-5, and IL-13) in serum was detected by ELISA. The histopathological morphology and expression of inflammatory factors in nasal mucosa along with pyroptosis were investigated. Molecular docking was performed to analyze the binding of representative compounds of XQLD with NLRP3. Activation of the NLRP3 inflammasome was detected by immunofluorescence and western blotting. RESULTS XQLD significantly improved the nasal allergic symptoms of mice, reduced the degree of goblet cell proliferation, mast cell infiltration, and collagen fiber hyperplasia in nasal mucosa. Meanwhile, it could downregulate the expression of Th2 inflammatory factors (IL-4, IL-5, and IL-13) in serum and nasal mucosa. XQLD significantly reduced the number of GSDMD and TUNEL double-positive cells and IL-1β and IL-18 expression. Molecular docking confirmed that seven representative compounds of XQLD had good binding properties with NLRP3 and were able to inhibit the activation of the NLRP3 inflammasome. CONCLUSIONS The representative compounds of XQLD might inhibit pyroptosis in nasal mucosa mediated by the NLRP3 inflammasome to helping the recovery of AR, which provides a new modern pharmacological proof for XQLD to treat AR.
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Affiliation(s)
- Ruizhi Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Yongchun Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Qintai Yang
- Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510000, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510000, China.
| | - Jiaming Liu
- The Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Zesheng Lu
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Weizhen Xu
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Jinxiang Zhu
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - He Liu
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Weiping He
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou 510405, China.
| | - Yajie Yan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou 510405, China.
| | - Yan Ruan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou 510405, China.
| | - Min Zhou
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510000, China.
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Li X, Wu H, Xing W, Xia W, Jia P, Yuan K, Guo F, Ran J, Wang X, Ren Y, Dong L, Sun S, Xu D, Li J. Short-term association of fine particulate matter and its constituents with oxidative stress, symptoms and quality of life in patients with allergic rhinitis: A panel study. ENVIRONMENT INTERNATIONAL 2023; 182:108319. [PMID: 37980881 DOI: 10.1016/j.envint.2023.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/10/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Short-term exposure to fine particulate matter (PM2.5) and its specific constituents might exacerbate allergic rhinitis (AR) conditions. However, the evidence is still inconclusive. METHOD We conducted a panel study of 49 patients diagnosed with AR > 1 year prior to the study in Taiyuan, China, to investigate associations of individual exposure to PM2.5 and its constituents with oxidative parameters, symptoms, and quality of life among AR patients. All participants underwent repeated assessments of health and PM exposure at 4 time points in both the heating and nonheating seasons from June 2017 to January 2018. AR patients' oxidative parameters were assessed using nasal lavage, and their subjective symptoms and quality of life were determined through in-person interviews using a structured questionnaire. Short-term personal exposure to PM2.5 and its constituents was estimated using the time-microenvironment-activity pattern and data from the nearest air sampler, respectively. We applied mixed-effects regression models to estimate the short-term effects of PM2.5 and its constituents. RESULTS The results showed that exposure to PM2.5 and its constituents, including BaP, PAHs, SO42-, NH4+, V, Cr, Cu, As, Se, Cd, and Pb, was significantly associated with increased oxidative stress, as indicated by an increase in the malondialdehyde (MDA) index. Exposure to PM2.5 and its components (V, Mn, Fe, Zn, As, and Se) was associated with decreased antioxidant activity, as indicated by a decrease in the superoxide dismutase (SOD) index. Additionally, increased visual analog scale (VAS) and rhinoconjunctivitis quality of life questionnaire (RQLQ) scores indicated that exposure to PM2.5 and its constituents exacerbated inflammatory symptoms and affected quality of life in AR patients. CONCLUSION Exposure to PM2.5 and specific constituents, could exacerbate AR patients' inflammatory symptoms and adversely affect their quality of life in the heavily industrialized city of Taiyuan, China. These findings may have potential biological and policy implications.
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Affiliation(s)
- Xin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Haisheng Wu
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Weiwei Xing
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Wenrong Xia
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Pingping Jia
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kun Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Fang Guo
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jinjun Ran
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoling Wang
- Clinical Laboratory, Shanxi Academy of Traditional Chinese Medicine, Taiyuan, China
| | - Yanxin Ren
- Department of Head and Neck Surgery, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lina Dong
- Core Laboratory, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shengzhi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China.
| | - Donggang Xu
- Beijing Institute of Basic Medical Sciences, Beijing, China.
| | - Jinhui Li
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA.
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Woo SC, Lyu YR, Lee SW, Kwon OJ, Choi YE, Yang C, Park YC. Efficacy, Safety and Economic Evaluation of Wolbigachul-Tang for Chronic Cough Due to Upper Airway Cough Syndrome (UACS): A Study Protocol for Randomized, Double-Blind, Active-Comparator Controlled, Parallel, Exploratory Clinical Trial. Healthcare (Basel) 2023; 11:2733. [PMID: 37893807 PMCID: PMC10606134 DOI: 10.3390/healthcare11202733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Upper airway cough syndrome (UACS) is a common cause of chronic cough characterized by upper airway symptoms, including nasal discharge and throat discomfort. Empirical treatments for UASC-induced chronic cough, such as first-generation antihistamines, have been used; however, the long-term use of these medicines has adverse effects. Therefore, we evaluate the efficacy, safety, and economic feasibility of Wolbigachul-tang (WBGCT), an herbal medication for UASC-induced chronic cough. This is a randomized, double-blind, active-comparator-controlled, parallel, and exploratory clinical trial. Thirty patients with UASC-induced chronic cough will be recruited and randomly allocated to the WBGCT and control groups in a 1:1 allocation ratio. The investigational medicine will be administered three times per day for 2 weeks (3 g of WBGCT at a time). The primary outcome measure is the cough symptom score measured at screening, before starting the trial, and after 2 and 4 weeks. Secondary outcome measures include the cough visual analog scale, nasal discharge score, questionnaire of clinical symptoms of cough and sputum, Leicester cough questionnaire-Korean version, integrative medicine outcome scale, integrative medicine patient satisfaction scale, and 5-level EuroQol 5-dimensional questionnaire, which will be assessed before starting the trial and after 2 and 4 weeks. This study aims to investigate the efficacy, safety, and economic feasibility of WBGCT in the treatment of chronic cough. Therefore, the results of this trial provide evidence for the application of WBGCT in the treatment of UACS-induced chronic cough.
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Affiliation(s)
- Seong-Cheon Woo
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
| | - Yee Ran Lyu
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
| | - O-Jin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Young-Eun Choi
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.R.L.); (O.-J.K.)
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon 35235, Republic of Korea; (S.-C.W.); (S.W.L.)
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Zhang JJ, He XC, Zhou M, Liu QD, Xu WZ, Yan YJ, Ruan Y. Xiao-qing-long-tang ameliorates OVA-induced allergic rhinitis by inhibiting ILC2s through the IL-33/ST2 and JAK/STAT pathways. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 119:155012. [PMID: 37586158 DOI: 10.1016/j.phymed.2023.155012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a chronic inflammatory disease of the nasal mucosa that is mediated by immunoglobulin E (IgE). Xiao-qing-long-tang (XQLT) is a traditional Chinese medicine compound that is widely used to treat respiratory diseases such as AR. However, the underlying mechanism of the effect of XQLT on AR remains unclear. PURPOSE To elucidate the effect of XQLT on ovalbumin (OVA)-induced AR and the mechanisms of action. METHODS The therapeutic efficacy of XQLT was evaluated in a well-established OVA-induced AR mouse model. Nasal symptoms were analyzed, type 2 cytokines and OVA-sIgE levels were measured, nasal mucosa tissues were collected for histological analysis, and the changes of Group 2 innate lymphoid cells (ILC2s) and the IL-33/ST2 and JAK/STAT signaling pathways in the nasal mucosa were observed. RESULTS XQLT significantly alleviated the nasal symptoms and histological damage to the nasal mucosa in AR mice, and reduced the levels of type 2 cytokines and OVA-sIgE. In addition, after XQLT treatment, the numbers of ILC2s in the nasal mucosa of AR mice were reduced, and the mRNA levels of the transcription factors GATA3 and ROR-α were decreased. Moreover, IL-33/ST2 signaling pathway was inhibited. The costimulatory cytokine associated JAK/STAT signaling pathway was also inhibited in ILC2s. CONCLUSION Our study demonstrated that XQLT regulated ILC2s through the IL-33/ST2 and JAK/STAT pathways to ameliorate type 2 inflammation in OVA-induced AR. These findings suggest that XQLT might be used to treat AR.
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Affiliation(s)
- Jia-Jun Zhang
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Department of Otorhinolaryngology, the Second People's Hospital of Foshan, Affiliated Foshan Hospital of Southern Medical University, Foshan, Guangdong Province, 528099, China
| | - Xue-Cheng He
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Min Zhou
- Otorhinolaryngology Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Qin-Dong Liu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Wei-Zhen Xu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Ya-Jie Yan
- Otorhinolaryngology Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, 510405, China.
| | - Yan Ruan
- Otorhinolaryngology Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China; Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, 510405, China.
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9
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Son MJ, Kim S, Kim YE, Kim BY, Yeum CS, Lee JC, Cha JH, Kang S, Chang CH, Son S. Clinical effectiveness of decoction form of herbal medicine in primary care treatment of allergic rhinitis: A retrospective cohort study. Integr Med Res 2023; 12:100973. [PMID: 37637186 PMCID: PMC10448014 DOI: 10.1016/j.imr.2023.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background The decoction form of herbal medicine (D-HM) is mainly prescribed to patients with allergic rhinitis (AR) in Korean Medicine (KM) clinics in the Republic of Korea; however, it is difficult to conduct clinical trials of D-HM due to regulatory issues. This study investigated the clinical safety and effectiveness of D-HM combination therapy for the treatment of AR by analyzing the AR outpatient data from 17 KM clinics. Methods This retrospective cohort study included patients who visited KM clinics for AR treatment from January 1, 2021, to March 31, 2022. Cases were collated using structured case report forms and divided into the D-HM with KM usual care group (D-HM group) and the KM usual care group (UC group). Since D-HM therapy could not be randomly assigned to the study population, we used optimal propensity score (PS) matching to investigate the effectiveness and safety of D-HM combination therapy in the treatment of AR. Results Data from 228 patients were collected. After PS matching, 144 patients were finally analyzed. The total nasal symptom score (TNSS) and mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ) were significantly improved in the D-HM group compared with those in the UC group (TNSS: p=0.02; mini-RQLQ: p=0.04). Four patients in the D-HM group experienced minor adverse events that were mild and resolved within 15 days. Conclusions D-HM combination therapy may be beneficial in the management of symptoms and rhinitis-associated quality of life and potentially useful in clinical practice. However, randomized placebo-controlled clinical trials are required to confirm their effectiveness. Study registration This study has been registered at Clinical Research Information Service (KCT0007242).
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Affiliation(s)
- Mi Ju Son
- R&D Planning Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungha Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young-Eun Kim
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Bo-Young Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | | | - Jong Cheol Lee
- 365 Cha Korean Medicine Clinic, Yeosu, Republic of Korea
| | - Jae Hoon Cha
- 365 Cha Korean Medicine Clinic, Yeosu, Republic of Korea
| | - Soonsik Kang
- Moa Korean Medicine Clinic, Seoul, Republic of Korea
| | | | - Seokho Son
- I-Bone Korean Medicine Clinic, Asan, Republic of Korea
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10
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Yan Y, Zhang J, Liu H, Lin Z, Luo Q, Li Y, Ruan Y, Zhou S. Efficacy and safety of the Chinese herbal medicine Xiao-qing-long-tang for allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials. JOURNAL OF ETHNOPHARMACOLOGY 2022; 297:115169. [PMID: 35257842 DOI: 10.1016/j.jep.2022.115169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/05/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The classic Chinese herbal medicine formula Xiao-qing-long-tang (XQLT) is commonly recommended to manage allergic rhinitis (AR), but the treatment efficacy and safety of XQLT are uncertain. AIM OF THE STUDY This study aimed to evaluate the effectiveness and safety of XQLT in treating AR. MATERIALS AND METHODS Nine databases were searched from their inception to April 2021. Randomized controlled trials (RCTs) evaluating XQLT for AR were included. The methodological quality of the studies was assessed using the Cochrane risk-of-bias tool. A meta-analysis and a subgroup meta-analysis were conducted to evaluate the effectiveness of XQLT. RESULTS Twenty-four RCTs were included in this meta-analysis. XQLT was compared to both placebo and Western medicine (WM), and XQLT combined with WM was compared with WM alone. Meta-analyses were conducted for total nasal symptom scores (TNSS), four individual nasal symptom scores, quality of life (QoL), effective rate, and recurrence rate. The TNSS decreased after XQLT treatment and combination treatment (mean difference (MD): -0.79; 95% confidence interval (CI) [-1.20, -0.38], standardized mean difference (SMD): -1.42; 95% CI [-1.59, -1.24], and SMD: -1.84; 95% CI [-2.08, -1.60]). The two individual nasal symptom scores decreased after XQLT treatment and combination treatment; these nasal symptoms comprised rhinorrhea (SMD: -0.30; 95% CI [-0.58, -0.02] and SMD: -0.48; 95% CI [-0.70, -0.26]), and nasal obstruction (SMD: -0.54; 95% CI [-0.78, -0.30] and SMD: -0.54; 95% CI [-0.76, -0.32). XQLT and XQLT combined with WM achieved a better effective rate than WM (risk ratio (RR): 1.18; 95% CI [1.11, 1.25] and RR: 1.16; 95% CI [1.10, 1.23]) and a lower recurrence rate than WM (RR: 0.24; 95% CI [0.13, 0.43] and RR: 0.47; 95% CI [0.31, 0.72]). XQLT was well tolerated in patients being treated for AR. CONCLUSION Our results indicated that oral XQLT may alleviate the TNSS, rhinorrhea scores, and nasal obstruction scores of AR and is safe to use in clinical practice. However, more RCTs that follow rigorous methodologies and evaluate well-accepted outcome measures are required to evaluate the effectiveness of XQLT.
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Affiliation(s)
- Yajie Yan
- Otorhinolaryngology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Jiajun Zhang
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Haolan Liu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Ze Lin
- South China Agricultural University, Guangzhou, 510642, China.
| | - Qiulan Luo
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China; Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
| | - Yunying Li
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China; Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
| | - Yan Ruan
- Otorhinolaryngology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
| | - Shiqing Zhou
- Otorhinolaryngology Head and Neck Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China; Otorhinolaryngology Head and Neck Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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11
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Efficacy and Safety of Bojungikgi-Tang for Persistent Allergic Rhinitis: A Study Protocol for a Randomized, Double-Blind, Placebo-Controlled, Phase II Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4414192. [PMID: 35769160 PMCID: PMC9236759 DOI: 10.1155/2022/4414192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/22/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Background Allergic rhinitis (AR) is a common disease, and conventional medications are often insufficient for treatment. Bojungikgi-tang (BJIGT) is an herbal medicine widely used in traditional medicine and has anti-inflammatory and immunoregulatory effects. We hypothesize that BJIGT would improve nasal symptoms in patients with persistent AR (PAR). Methods This is a randomized, double-blind, placebo-controlled, phase II trial. A total of 105 patients, identified with perennial allergens, with a history of PAR and a mean total nasal symptom score (TNSS) ≥ 5 during the run-in period will be recruited from Daejeon Korean Medicine Hospital. Participants will be randomly assigned to a high-dose BJIGT group, standard-dose BJIGT group, or control group (placebo) in a 1 : 1 : 1 allocation ratio after a week run-in period. The treatment medication will be taken three times per day for 4 weeks. The primary outcome measure is the mean change in the TNSS before and after medication. The secondary outcome measures include the Korean Allergic Rhinitis-Specific Quality of Life Questionnaire, total IgE and eosinophil count, overall assessment of AR, pattern identification questionnaire for AR, and Sasang constitution. Discussion. The aim of this study is to investigate the efficacy and safety of BJIGT in the treatment of PAR and to determine the suitable dosage of BJIGT. Therefore, we planned a randomized, controlled, phase II trial of two different doses of BJIGT compared with placebo, and the results of this study are expected to provide evidence for the use of BJIGT as a treatment of PAR. Trial Registration. The National Clinical Trial Registry Clinical Research Information Service, CRIS, KCT0006616, https://cris.nih.go.kr/cris/search/detailSearch.do/20706.
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12
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Zhang T, Xu F, Ruhsam M, Feng L, Zhang M, Wang Z, Wang X. A nucleotide signature for the identification of Pinelliae Rhizoma (Banxia) and its products. Mol Biol Rep 2022; 49:7753-7763. [PMID: 35670929 PMCID: PMC9171473 DOI: 10.1007/s11033-022-07600-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022]
Abstract
Background Ensuring the authenticity of raw materials is a key step prior to producing Chinese patent medicines. Pinelliaternata (Thunb.) Breit. is the botanical origin of Pinelliae Rhizoma (Banxia), a traditional Chinese medicine used to treat cough, insomnia, nausea, inflammation, epilepsy, and so on. Unfortunately, authentic Pinelliae Rhizoma is often adulterated by morphologically indistinguishable plant material due to the insufficient regulatory procedures of processed medicinal plant products. Thus, it is important to develop a molecular assay based on species-specific nucleotide signatures and primers to efficiently distinguish authentic Pinelliae Rhizoma from its adulterants. Methods and results The ITS2 region of 67 Pinelliae Rhizoma and its common adulterants were sequenced. Eight single nucleotide polymorphisms within a 28–43 bp stretch of ITS2 were used to develop six primer pairs to amplify these species-specific regions. We assayed 56 Pinelliae Rhizoma products sold on the Chinese market, including medicinal slices, powder and Chinese patent medicines, which revealed that about 66% of products were adulterated. The most common adulterants were Pinelliapedatisecta (found in 57% of the assayed products), Arisaemaerubescens (9%), Typhoniumgiganteum (2%) and Typhoniumflagelliforme (2%). Conclusions A severe adulteration condition was revealed in the traditional medicine market. The species-specific nucleotide assays developed in this study can be applied to reliably identify Pinelliae Rhizoma and its adulterants, aiding in the authentication and quality control of processed products on the herbal market. Supplementary Information The online version contains supplementary material available at 10.1007/s11033-022-07600-0.
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Affiliation(s)
- Tianyi Zhang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Key Laboratory of Qiyao Resources and Anti-Tumor Activities, Shaanxi Administration of Traditional Chinese Medicine, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 10061, China
| | - Fusheng Xu
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Markus Ruhsam
- Royal Botanic Garden Edinburgh, Edinburgh, EH3 5LR, UK
| | - Li Feng
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China.,Key Laboratory of Qiyao Resources and Anti-Tumor Activities, Shaanxi Administration of Traditional Chinese Medicine, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 10061, China
| | - Miao Zhang
- Lixian Spring Pharmaceutical Co. Ltd., Longnan, 742200, China
| | - Zhengwei Wang
- Shanghai Chenshan Botanical Garden, Shanghai, 201602, China
| | - Xumei Wang
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, China. .,Key Laboratory of Qiyao Resources and Anti-Tumor Activities, Shaanxi Administration of Traditional Chinese Medicine, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 10061, China.
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13
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Li S, Wu W, Wang G, Zhang X, Guo Q, Wang B, Cao S, Yan M, Pan X, Xue T, Gong J, Duan X. Association between exposure to air pollution and risk of allergic rhinitis: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2022; 205:112472. [PMID: 34863689 DOI: 10.1016/j.envres.2021.112472] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is one of the most common allergic diseases in the world, and usually persists throughout the activity. Epidemiological studies have shown a positive association between air pollution and allergic rhinitis. However, we could not find any meta-analysis of the risk of air pollutants (PM2.5, PM10, NO2, SO2, O3 and CO) on the prevalence of AR in people of all ages. OBJECTIVES Carry out a meta-analysis on the results of recent studies (up to 2020) to present valid information about exposure to air pollution and risk of prevalence of AR. METHODS We systematically searched three databases for studies up to December 17, 2020, including air pollution and AR. Random effect models were conducted to estimate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Subgroup analysis, funnel plot, Egger's test, and the trim-and-fill method were also conducted. RESULTS Thirty-five studies across 12 countries, including a total of 453,470 participants, were included. The OR per 10 μg/m3 increase of pollutants was 1.13 (1.04-1.22) for PM10 and 1.12 (1.05-1.20) for PM2.5. The OR per 10 μg/m3 increment of gaseous pollutants were 1.13 (1.07-1.20) for NO2, 1.13 (1.04-1.22) for SO2 and 1.07 (1.01-1.12) for O3. No significant association was observed between CO and AR. Children or adolescents are more sensitive to air pollution than adults. The effects of PM10 and SO2 were significantly stronger in Europe than Asia. The effects of air pollutants were more significant and higher in developing countries than in developed countries, except for PM10. A significant difference of subgroup test was found between developed and developing countries of NO2. CONCLUSION This meta-analysis showed a positive association between air pollution and the prevalence of allergic rhinitis, and identified geographic area and economic level as the potential modifiers for the association.
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Affiliation(s)
- Sai Li
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Gang Wang
- Department of Otolaryngology-Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, China
| | - Xinyi Zhang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Qian Guo
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Beibei Wang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Suzhen Cao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Meilin Yan
- Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, 100871, China
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, 100871, China
| | - Tao Xue
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100871, China
| | - Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, 100871, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
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14
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Evaluation of shoseiryuto for seasonal allergic rhinitis, using an environmental challenge chamber. World Allergy Organ J 2022; 15:100636. [PMID: 35399817 PMCID: PMC8938619 DOI: 10.1016/j.waojou.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/03/2022] Open
Abstract
Background Methods Results Conclusions
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15
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Hung JH, Chen WC, Lin MC, Chuang HM, Wang JL, Fu PK, Lin CP, Huang ST. Associations of Chinese Herbal Medicine Use with the Risks of Acute Exacerbation and Mortality in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Retrospective Cohort Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:77-86. [PMID: 35085024 DOI: 10.1089/jicm.2021.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objectives: This study aimed to assess the correlation of exacerbation and the mortality rate in patients with chronic obstructive pulmonary disease (COPD) between biomedical treatments with or without Chinese herbal medicine (CHM) as an adjunct. Design: A total of 81,261 COPD patients were identified from the National Health Insurance Research Database in Taiwan between 2001 and 2012. After screening and matching, 3176 COPD patients were included in the study. Statistical analyses were performed to assess the differences in the baseline characteristics. The authors used the Cox proportional hazard regression analysis to calculate the risks of mortality and hospitalization due to acute exacerbation of COPD within 1 year between a CHM user cohort and non-CHM user cohort. The cumulative incidence of mortality in COPD patients with or without CHM treatment was calculated by the Kaplan-Meier method. Results: COPD patients in the CHM user cohort demonstrated a significantly lower risk of mortality (p < 0.001) and acute exacerbation (p < 0.05), compared with the non-CHM user cohort. In addition, the CHM users exhibited a reduced cumulative incidence of mortality compared with the non-CHM user cohort (p < 0.001). Xiao Qing Long Tang and Fritillariae thunbergii were the most common Chinese herbal formula and single Chinese herb prescribed for COPD patients. Conclusion: Combining CHM with biomedical treatment might reduce the risk of acute exacerbation and incidence of mortality in patients with COPD.
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Affiliation(s)
- Jui-Hung Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chieh Chen
- Department of Chinese Medicine, An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Mei Chuang
- Department of Chinese Medicine, An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Jiun-Long Wang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chun-Pang Lin
- Department of Chinese Medicine, An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Chinese Medicine, An-Nan Hospital, China Medical University, Tainan, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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16
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Chu H, Jang BH, Lee E, Moon S. Combined Korean medicine therapies in children with allergic rhinitis: A multi-center, observational explanatory registry trial: A study protocol. Medicine (Baltimore) 2021; 100:e28181. [PMID: 34941074 PMCID: PMC8701862 DOI: 10.1097/md.0000000000028181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) is the third most prevalent disease in early and middle adolescence in South Korea and one of the most common allergic diseases worldwide. Due to the ineffectiveness and frequent side effects of conventional medications for AR (such as antihistamines, corticosteroids) complementary and alternative medical (CAM) therapies have been in the spotlight. Although previous clinical trials conducted on AR with CAM showed efficacy and safety, these research results have limitations in that they did not estimate the effectiveness of combining multiple interventions. In this respect, this study aims to investigate the efficacy and safety of combined Korean medicine therapy by establishing an observational registry study at 13 Korean medical clinics that specialize in treating pediatric rhinitis. METHODS This is a prospective, observational, registry study of adolescent patients with AR. After screening, eligible subjects will be allocated to the registry. The patients will undergo a 4-week treatment and a 4-week post-treatment follow-up. The primary outcome will be the change in the average total nasal symptom score evaluated from baseline to the end of treatment. The secondary outcomes will include the numerical range scale, quality of life questionnaire in Korean children with AR, and the Pediatric Allergic Disease Quality of Life Questionnaire. KiFDA 3.0 will be measured for explanatory application on adolescents. Medical cost data and characteristics of patients such as weight, height, and sex will be collected by researchers. DISCUSSION This is the first multi-center observational registry study to compare combined Korean medicine treatment for AR. The results of this study will shed light on the effectiveness and safety of Korean medicine treatments for the treatment of patients with AR. TRIAL REGISTRATION KCT0006625 (2021.09.30)/IRB approval: Kyung-hee University Institutional Review Board (approval number: KHSIRB-21-358-1 [NA]).Trial Status: Protocol version 1.2(2021.09.16).
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Affiliation(s)
- Hongmin Chu
- Daecheong Public Health Subcenter, Daecheong-myeon, Ongjin-gun, Incheon, Republic of Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eunkoung Lee
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seunghwan Moon
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Zhu L, Wu Y, Lin C, Tang L, Yu B, Wan W, Xuan J, Du Y, Chen Z, Liang W. Dynamic Microbial Shifts and Signatures of Long-Term Remission in Allergic Rhinitis After an Herbal Formula Treatment. Front Immunol 2021; 12:774966. [PMID: 34745150 PMCID: PMC8569905 DOI: 10.3389/fimmu.2021.774966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
A mixed Chinese herbal formula, Xiao-Qing-Long-Decoction (XQLD), may contribute to sustained remission in allergic rhinitis (AR), but it is unknown which factors determine such long-term effect. Here, we aimed to identify bacterial signatures associated with sustained remission. To this end, samples from AR patients at four different times were analyzed to compare the dynamic bacterial community and structure shifts. Diversity indices Chao1 showed significant difference across different time (p<0.05), and the Kruskal-Wallis test identified that Dialister (OTU_31), Roseburia (OTU_36), Bacteroides (OTU_22), Bacteroides (OTU_2040), and Prevotella_9 (OTU_5) were the significant differential bacterial taxa (p<0.05). These distinctive genera were significantly associated with the change of AR clinical indices and the predicted functional pathways such as PPAR signaling pathway, peroxisome, and citrate cycle (TCA cycle) (p<0.05), indicating that they may be important bacterial signatures involving in the sustained remission in AR (p<0.05). Besides, lower Firmicutes/Bacteroidetes (F/B) ratio at 6 months follow-up may also contribute to the long-term remission of AR. No seriously adverse events and safety concerns were observed in this study. In conclusion, XQLD is a meaningful, long-term efficient and safe medication for AR treatment. The underlying mechanisms of sustained remission in AR after XQLD treatment may be associated with the dynamic alteration of featured gut bacteria taxa.
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Affiliation(s)
- Libing Zhu
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China.,Department of Traditional Chinese Medicine, Xiamen University Hospital, Xiamen, China
| | - Yuning Wu
- School of Mathematical Sciences, Xiamen University, Xiamen, China
| | - Chenglong Lin
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Lin Tang
- Department of Otorhinolaryngology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Bin Yu
- Department of Otorhinolaryngology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Wenrong Wan
- Internal Medicine Department of Traditional Chinese Medicine, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Jingxiu Xuan
- Laboratory of Rheumatology and Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yanling Du
- Department of Acupuncture and Tuina, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhangran Chen
- Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, China
| | - Wei Liang
- School of Mathematical Sciences, Xiamen University, Xiamen, China
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Chang HH, Chiang SY, Chen PC, Tsai CH, Yang RC, Tsai CL, Wu TH, Hsieh YW, Lin YC, Kuo YT, Chen KC, Chu HT. A system for reporting and evaluating adverse drug reactions of herbal medicine in Taiwan from 1998 to 2016. Sci Rep 2021; 11:21476. [PMID: 34728662 PMCID: PMC8564513 DOI: 10.1038/s41598-021-00704-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
The Taiwan Adverse Drug Reaction Reporting System for Herbal Medicine (TADRRS-HM) has systematically documented suspected adverse events from adverse drug reaction (ADR) reports from 1998 (prior to its formal establishment in 2001) and evaluates safety profiles of herbal medicines. This article describes findings from 2079 ADR reports filed between 1998 and 2016: 941 reports involved single herbs and 87 involved folk herbals; 842 were generated from clinical trials, while 209 ADR reports involving foods, health foods, dietary supplement foods and herbal cuisine were grouped as Other. Severity assessments using the Modified Hartwig and Siegel scale classified 72.4% of ADRs as mild, 17.4% as moderate and 6.5% as severe. System Organ Class classification of the ADRs identified gastrointestinal system disorders as the most common (33.4%), followed by skin and subcutaneous tissue disorders (21.2%). The TADRRS-HM records indicate that herbal medicines may cause a wide range of ADRs. Aconiti Radix, Xiao-Qing-Long-Tang, and Datura suaveolens were the most commonly reported single herb, herbal formula, and folk herbal, respectively. The data indicate that herbal medicines may cause a wide range of ADRs. This system will confer long-term benefits for the development of Taiwan’s herbal medicines adverse reaction database and facilitate epidemiological analysis.
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Affiliation(s)
- Hen-Hong Chang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, ROC. .,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Su-Yin Chiang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Han Tsai
- Division of Chinese Internal Medicine, Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Rong-Chi Yang
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiu-Lin Tsai
- Traditional Chinese Medicine Pharmacy, China Medical University Hospital, Taichung, Taiwan
| | - Tsung-Hsiu Wu
- Traditional Chinese Medicine Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Yow-Wen Hsieh
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.,School of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Yu-Chun Lin
- Department of Traditional Chinese Medicine, Chinese Medicine Department, China Medicine University Hospital, Taichung, Taiwan
| | - Yung-Te Kuo
- Traditional Chinese Medicine Pharmacy, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Chung Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Chinese Medicine Research Center, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, ROC
| | - Hsueh-Ting Chu
- Department of Computer Science and Information Engineering, College of Computer Science, Asia University, No. 500, Lioufeng Road, Wufeng, Taichung, 41354, Taiwan, ROC.
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Effects of Syo-seiryu-to and Its Constituent Crude Drugs on Phorbol Ester-Induced Up-Regulation of IL-33 and Histamine H1 Receptor mRNAs in Swiss 3T3 and HeLa Cells. ALLERGIES 2021. [DOI: 10.3390/allergies1030015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Syo-seiryu-to (SST) is a traditional herbal medicine that has been used clinically to treat allergic rhinitis (AR) in Japan. SST improves acute symptoms, such as sneezing and rhinorrhea, as well as chronic symptoms, such as nasal obstruction, in patients with AR. However, its therapeutic mechanisms remain unknown. We examined the effects of SST and eight constituent crude drugs on phorbol 12-myristate-13-acetate (PMA)-induced gene up-regulation of IL-33 and histamine H1 receptor (H1R), which are responsible for the pathogenesis of AR. We found that SST and its crude drugs, except for Pinellia tuber, significantly and dose-dependently suppressed PMA-induced both IL-33 and H1R mRNA up-regulation in vitro. The half-maximal inhibitory concentration values of the seven crude drugs to inhibit PMA-induced IL-33 mRNA up-regulation were correlated with those related to H1R mRNA up-regulation, suggesting that they act on a common signal molecule. These results suggest that SST improves nasal congestion that is induced by IL-33-related eosinophil infiltration and inhibits sneezing and rhinorrhea that are induced by H1R-mediated histamine signaling in the nasal mucosa of AR patients through its inhibition of a common molecule in the gene expression pathways of IL-33 and H1R. The results could explain the advantages of traditional herbal medicine, in which mixing various crude drugs not only acts on a common target to enhance its pharmacological action, similar to the effect of a high concentration of a single crude extract but also has the benefit of reducing the side effects of each crude drug.
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Herbal Medicines for Allergic Rhinitis: a Systematic Review and Meta-analysis. Curr Allergy Asthma Rep 2021; 21:25. [PMID: 33768322 DOI: 10.1007/s11882-021-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To assess the effects of herbal medicine (HM) therapy in various durations and analyze the effects of HM separately by mechanism of action in the treatment of allergic rhinitis (AR). RECENT FINDINGS Thirty-two studies were included (2,697 patients, mean age 34.6 years). For the ≤ 4 weeks of treatment duration, HM brought greater benefits over placebo in reduction of total nasal symptoms score (standardized mean difference (SMD) -0.68; 95% confidence interval (CI) -0.98, -0.38; p <0.01) and improvement in Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.53; 95% CI -0.81, -0.25; p <0.01). For the 4-12 weeks duration, total nasal symptoms score (SMD -0.22; 95%CI -0.4, -0.05; p =0.01) and Rhinoconjunctivitis Quality of Life Questionnaire score (SMD -0.48; 95% CI -0.89, -0.06; p =0.03) favored the HM. However, HM therapy for longer than 12 weeks was related to tachyphylaxis and showed no benefit over placebo in any outcomes. There was no difference between the HM and standard treatment on symptoms improvement. Anti-allergic effect, anti-inflammatory effect, anti-leukotriene effect, and anti-histaminic effect of HM were revealed. HM was safe and their adverse effects were comparable placebo. HM therapy is safe and provides better results than placebo in improving nasal symptoms and disease-specific quality of life in patients with AR. Its beneficial effects are demonstrated only in less than 12 weeks of treatment. TRIAL REGISTRATION PROSPERO ID: CRD42020168367.
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Zhu L, Xu F, Wan W, Yu B, Tang L, Yang Y, Du Y, Chen Z, Xu H. Gut microbial characteristics of adult patients with allergy rhinitis. Microb Cell Fact 2020; 19:171. [PMID: 32873292 PMCID: PMC7466420 DOI: 10.1186/s12934-020-01430-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/25/2020] [Indexed: 01/05/2023] Open
Abstract
Background Although recent studies have indicated that intestinal microbiota dweller are involved in the pathogenesis of allergy rhinitis (AR), the influence of gut microbiota on AR adult has not been fully elucidated yet. Hence, we carried out this study to uncover the distinctive bacterial taxa that differentiate allergy rhinitis patients from healthy individuals. Feces samples from thirty three AR patients and thirty one healthy individuals were analyzed by 16S rRNA gene sequencing. Results Results showed that the bacterial diversity in AR group was significantly higher than that of the non-AR group. Bacterial communities between AR and non-AR group were significantly differentiated as revealed by Principal coordinates analysis (PCoA) and the variation within non-AR were higher than that of the counterpart. Firmicutes, Fusobacteria, Actinobacteria, Cyanobacteria and Chloroflexi were the significantly differed phyla taxa and the top significantly distinguished bacterial genus included Prevotella_9, Phascolarctobacterium, Roseburia, Megamonas, Alistipes, Lachnoclostridium and Fusobacterium. The higher network complexity in AR group were dominated by taxa belonging to Firmicutes. The predicted function, alpha linolenic acid metabolism and bacterial invasion of epithelial cells pathway were higher in non-AR group while gonadotropin-releasing hormone (GnRH) signaling pathway, Fc γ-R mediated phagocytosis and endocytosis were higher in AR patients. Although the bacterial diversity between moderate and severe AR patients showed no significant difference, the significant correlation between featured genus and total nasal symptom score or rhinoconjunctivitis quality of life questionnaire, such as Butyricicoccus and Eisenbergiella, revealed the potential to intervene the AR status by means of gut microbiota. Conclusions In conclusion, patients with allergy rhinitis had distinguished gut microbiota characteritics in comparison with healthy controls. The results suggest that gut microbiota might play crucial roles in influencing the course and different symptoms of AR. Trial registration ChiCTR, ChiCTR1900028613. Registered 29 December 2019, https://www.chictr.org.cn/showproj.aspx?proj=47650.
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Affiliation(s)
- Libing Zhu
- Department of Traditional Chinese Medicine, School of Medicine, Xiamen University, Xiamen, China
| | - Feng Xu
- Internal Medicine Department of Traditional Chinese Medicine, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Wenrong Wan
- Internal Medicine Department of Traditional Chinese Medicine, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Bin Yu
- Department of Otorhinolaryngology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Lin Tang
- Department of Otorhinolaryngology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Yimin Yang
- Department of Pediatrics, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Yanling Du
- Department of Acupuncture and Tuina, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhangran Chen
- Department of Digestive Diseases, School of Medicine, Xiamen University, Xiamen, China. .,Department of Gastroenterology, Zhongshan Hospital, Xiamen University, Xiamen, China. .,Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, China.
| | - Hongzhi Xu
- Department of Digestive Diseases, School of Medicine, Xiamen University, Xiamen, China. .,Department of Gastroenterology, Zhongshan Hospital, Xiamen University, Xiamen, China. .,Institute for Microbial Ecology, School of Medicine, Xiamen University, Xiamen, China.
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