Chinese Medicine Injection Qingkailing for Treatment of Acute Ischemia Stroke: A Systematic Review of Randomized Controlled Trials

Qingkailing (QKL) injection was a famous traditional Chinese patent medicine, which was extensively used to treat the acute stages of cerebrovascular disease. The aim of this study was to assess the quantity, quality and overall strength of the evidence on QKL in the treatment of acute ischemic stroke. Methods. An extensive search was performed within MEDLINE, Cochrane, CNKI, Vip and Wan-Fang up to November 2011. Randomized controlled trails (RCTs) on QKL for treatment of acute stroke were collected, irrespective of languages. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards, and RevMan5 was used for data analysis. Results. 7 RCTs (545 patients) were included and the methodological quality was evaluated as generally low. The pooled results showed that QKL combined with conventional treatment was more effective in effect rate, and the score of MESSS and TNF-α level compared with conventional treatment alone, but there was no significant difference in mortality of two groups. Only one trial reported routine life status. There were four trials reported adverse events, and no obvious adverse event occurred in three trials while one reported adverse events described as eruption and dizziness

Sugarcane bagasse dietary fiber as an adjuvant therapy for stable chronic obstructive pulmonary disease: a four-center, randomized, double-blind, placebo-controlled study

AbstractObjectiveTo evaluate the efficacy and safety of sugarcane bagasse dietary fiber as an adjuvant therapy for improving quality of life in patients with stable chronic obstructive pulmonary disease (COPD).MethodsThis was a multicenter, randomized, double-blind, placebo-controlled trial. A total of 196 participants were randomized into a trial group (treated with 6 g/day sugarcane bagasse plus conventional treatment, n = 98) and a control group (treated with placebo plus conventional treatment, n = 98). All efficacy analyses were performed according to the intention-to-treat (ITT) principle. A per-protocol analysis set (PPS) was used to analyze the cases that completed the clinical trial with good compliance. The trial period was 30 days, with a 6-month follow-up. Pre- and post-treatment pulmonary symptom scores (cough, sputum, wheezing, and dyspnea) were recorded for both groups. The St. George's Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) dyspnea scale were assessed before treatment and at the end of the 6-month follow-up.ResultsThe ITT population was 178 and the PPS population was 166. Post-treatment pulmonary clinical symptoms and severity of dyspnea (mMRC and SGRQ evaluation) were significantly improved in both the trial group and the control group (ITT and PPS: P < 0.05). However, there was no statistical difference between the two groups in post-treatment pulmonary symptoms and mMRC. There was a greater reduction in the SGRQ subscales of activity, effect and total score in the trial group compared with the control group (ITT and PPS: P < 0.01). There was no statistical difference in pre- and post-treatment safety variables in either group.ConclusionSugarcane bagasse combined with conventional treatment improved quality of life in patients with stable COPD. Sugarcane bagasse appears to be a safe herbal medicine with potential for treating patients with stable COPD when taken orally as an adjuvant therapy

Refined Qingkailing Protects MCAO Mice from Endoplasmic Reticulum Stress-Induced Apoptosis with a Broad Time Window

In the current study, we are investigating effect of refined QKL on ischemia-reperfusion-induced brain injury in mice. Methods. Mice were employed to induce ischemia-reperfusion injury of brain by middle cerebral artery occlusion (MCAO). RQKL solution was administered with different doses (0, 1.5, 3, and 6 mL/kg body weight) at the same time of onset of ischemia, and with the dose of 1.5 mL/kg at different time points (0, 1.5, 3, 6, and 9 h after MCAO). Neurological function and brain infarction were examined and cell apoptosis and ROS at prefrontal cortex were evaluated 24 h after MCAO, and western blot and intracellular calcium were also researched, respectively. Results. RQKL of all doses can improve neurological function and decrease brain infarction, and it performed significant effect in 0, 1.5, 3, and 6 h groups. Moreover, RQKL was able to reduce apoptotic process by reduction of caspase-3 expression, or restraint of eIF2a phosphorylation and caspase-12 activation. It was also able to reduce ROS and modulate intracellular calcium in the brain. Conclusion. RQKL can prevent ischemic-induced brain injury with a time window of 6 h, and its mechanism might be related to suppress ER stress-mediated apoptotic signaling

A multicenter randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of rhubarb in treating acute exacerbation of chronic obstructive pulmonary disease of the syndrome type phlegm-heat obstructing the lungs

Objective: To observe the clinical efficacy and safety of oral administration of the traditional Chinese herb rhubarb to treat acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Method: This was a multicenter randomized double-blinded placebo controlled study that took place in 7 provinces of China that enrolled 244 patients (aged 18–80 years) who had acute exacerbation of COPD with the traditional Chinese syndrome pattern of phlegm-heat obstructing lung. Participants were divided into experimental and control groups. The experimental group received 4.5 g of rhubarb granules twice daily and the control group received placebo granules. Both groups also received conventional Western therapy consisting of oxygen therapy, an antibiotic, expectorant, and a bronchodilator. Treatment lasted 10 days. Symptom scores for cough, sputum volume and color, wheezing and chest tightness before treatment and on days 3, 5, 7, and 10 during the treatment were recorded. Lung function, arterial blood gas and levels of serum inflammatory factors, interleukin-4 (IL-4), interleukin-8 (IL-8), and interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α), before and after treatment were measured. Results: The sample size of the full analysis set (FAS) was 244 participants, and the sample size of per protocol set (PPS) was 235. Following 10 days' treatment, symptom scores of the experimental group were markedly lower than those of the placebo group (FAS: mean difference −1.67, 95% CI: –2.66 to −0.69, P = 0.001; PPS: mean difference −1.55, 95% CI: −2.56 to −0.54, P = 0.003). Lung function in the experimental group was significantly higher than in the placebo group (FEV1, FAS: mean difference 0.12, 95% CI: 0.06 to 0.18; P < 0.001; PPS: mean difference 0.12, 95% CI 0.05 to 0.18; P < 0.001. FVC: FAS: mean difference 0.16, 95% CI: 0.06 to 0.26; P = 0.002; PPS: mean difference 0.16, 95% CI 0.05 to 0.26; P = 0.003. FEV1%, FAS: mean difference 5.95, 95% CI: 3.36 to 8.53; P < 0.001; PPS: mean difference 5.92, 95% CI 3.28 to 8.56; P < 0.001.). PaO2, PaCO2, as well as serum inflammatory factors were also improved when compared to the placebo group. There were no significant differences in the incidence rate of adverse reaction between the two groups. Conclusions: Compared with placebo, rhubarb granules significantly reduced symptom scores, improved blood oxygen level, controlled systemic inflammatory response, without significant adverse effects. Thus, rhubarb may be a beneficial adjuvant method for treating the phlegm-heat obstructing the lung syndrome pattern of AECOPD

Baicalin’s Therapeutic Time Window of Neuroprotection during Transient Focal Cerebral Ischemia and Its Antioxidative Effects In Vitro and In Vivo

We investigated the effects of baicalin on an ischemia-reperfusion-induced brain injury model in rats and its antioxidative activities in vitro and in vivo. An ischemia-reperfusion injury of the brain via a middle cerebral artery occlusion (MCAO) was induced in rats. Baicalin was injected at different time points (0, 2, 4, and 6 h) after the MCAO was induced. Baicalin can improve neurological function and significantly decrease brain infarction within a time window of 4 h. Moreover, baicalin was able to reduce cell apoptosis and had the strong antioxidative effect of reducing reactive oxygen species production and malondialdehyde generation. In contrast, baicalin interfered with superoxide dismutase and nicotinamide adenine dinucleotide 2′-phosphate oxidase activities. Moreover, baicalin also exhibited strong neuroprotective effects against H2O2-mediated injury and improved the SOD activity of neurons. Furthermore, baicalin demonstrated good scavenging of hydroxyl radicals, superoxide anions, and DPPH radicals and exerted an additional effect of inhibiting xanthine oxidase. Baicalin showed beneficial effects against MCAO-induced injury within a 4 h time window, and its antioxidative effects both in vitro and in vivo may partly elucidate its mechanism of action

Effects of an immunosuppressive active component of Periplocae Cortex (Periploca sepium Bge.) on positive selection of thymocytes in vitro

Objective: To determine the effect of an immunosuppressive active component (periploside A) isolated from the stem bark of Periplocae Cortex (Periploca sepium Bge.), a Chinese medicinal herb used in the treatment of rheumatoid arthritis for centuries in China, on positive selection of thymocytes in vitro. Methods: Female C57BL/6 mice at 6 weeks of age were housed in specific pathogen-free conditions. Double-positive thymocytes from C57BL/6 mice were induced into positive selection in vitro with or without periploside A treatment. Cell viability and expression of CD69, CD4, and CD8 were analyzed by flow cytometry. Results: Flow cytometric examination of thymocyte populations revealed that the percentage of CD8+ single-positive thymocytes was decreased by periploside A upon differentiation induced by an anti-CD3 antibody. However, the percentage of CD4+ single-positive thymocytes was decreased by periploside A upon differentiation induced by phorbol 12-myristate 13-acetate/ionomycin. Expression of CD69 plays a major role in prohibiting differentiation of thymocytes. Treatment with periploside A decreased CD69 expression in thymocytes. Conclusion: These results demonstrate that periploside A influences positive selection of thymocytes in vitro. Keywords: Immunosuppressive active component, Positive selection, Thymocyte

The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang on the concentration of trace elements in the main organs of COPD rats

Objective: To test two theories from traditional Chinese medicine: “exterior–interior relationship between the lung and large intestine” and “treating from the intestine principle for lung disorders”. The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang (XBCQT) on the concentration of three trace elements – copper (Cu), zinc (Zn), and manganese (Mn) – was observed in the tissues of the lung, small intestine, large intestine, and stomach of rats suffering from chronic obstructive pulmonary disease (COPD). Methods: Thirty-five male Wistar rats were divided randomly and equally into five groups: control; model; Fei treatment (A); Chang treatment (B); and Fei–Chang treatment (C). A rat model of COPD was prepared by tracheal injection of lipopolysaccharide plus exposure to cigarette smoke. Treatments with medicinal herbs started day-22 of administration and exposure to cigarette smoke for 7 days. The control group and model group were administered physiologic (0.9%) saline solution via the stomach. After 7 days of intervention, the tissues of the lung, small intestine, large intestine, and stomach were removed. Inductively coupled plasma-atomic emission spectroscopy was used to detect the levels of Cu, Zn, and Mn in those tissues. Results: Compared with the control group, the Cu concentration in the tissues of the small intestine, large intestine, and stomach increased significantly in the model group (P < .05); the Mn concentration in the tissues of the lung, large intestine, and stomach increased significantly in the model group (P < .05); the Zn concentration in the tissues of the lung and large intestine decreased significantly in the model group (P < .05). In comparison of the model group: the Cu concentration in the tissues of the lung and large intestine decreased significantly in the B group (P < .05); the Mn concentration in the tissues of the lung, small intestine, and large intestine decreased significantly in the B group (P < .05); the Zn concentration in the tissues of the lung, small intestine, and large intestine increased significantly in the B group (P < .05). For the A group versus C group comparison, the Zn concentration in the tissues of the small intestine and stomach increased significantly in the latter (P < .05). Conclusion: This study showed that “treating from the intestine” using Xuan Bai Cheng Qi Tang and its modified formulae can regulate the concentration of trace elements in the main organs of COPD rats. This may be one of the mechanisms for intestine-based treatment for COPD

Effect of Xiaoqinglong decoction on mucus hypersecretion in the airways and cilia function in a murine model of asthma

Objective: Xiaoqinglong decoction (XQL) has been used in traditional Chinese medicine as a prescription for asthma treatment. We explored the effects of XQL on mucus hypersecretion and ciliophagy in the airways of mice in which asthma had been induced by ovalbumin (OVA). Methods: Thirty-six mice were sensitized by OVA injection (i.p.) on day-0 and day-14 and challenged with 1% OVA on day 18–22. Then, they were divided into three groups: model, carbocysteine and XQL. From day-15 to day-22, the XQL group was administered XQL (10 g/kg, p.o.) 1 hour before each aerosol challenge with OVA. To evaluate the effect of XQL on mucus hypersecretion, AB-PAS staining, measurement of serum levels of interleukin (IL)-13, bronchoalveolar lavage fluid (BALF) analyses, ciliophagy analyses, as well as co-expression of Light Chain 3 (LC3) and acetylated α-tubulin by immunofluorescence staining were undertaken. Results: Treatment with XQL (10 g/kg) attenuated mucus secretion in the airways, and reduced the positive areas of AB-PAS staining in histopathologic lung tissues (P < .05). IL-13 expression in serum (P < .01), OVA-induced inflammatory changes, and the number of white blood cells (P < .01) in BALF samples were also reduced. However, the effect on mucus secretion was less apparent in the carbocysteine group compared with the XQL group. XQL treatment also improved the cilia length and elicited a substantial reduction in ciliophagy and LC3 expression in the tracheal epithelium. Conclusion: XQL can attenuate cilia shortening, aid the clearance function of ciliated epithelial cells, and reduce mucus production in an OVA-induced asthma model in mice. XQL can inhibit mucus hypersecretion and could be a new type of pharmacotherapy