Chinese Journal of Integrative Medicine最新文献

Objective: To evaluate the efficacy and safety of Tongxinluo in improving medium- and long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) in a real-world setting.

Methods: This multicenter prospective cohort study enrolled STEMI patients from 122 certified chest pain centers in China. Participants were stratified into exposure (n=1,598) and non-exposure (n=1,600) groups based on Tongxinluo administration initiation before or within 24 h post-reperfusion. Both groups received percutaneous coronary intervention (PCI) or thrombolysis with guideline-based therapy. The primary endpoint was incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) at 12 months. Secondary endpoints included the incidence of severe STEMI complications at 30 days; MACCEs at 30 days and 6 months; composite endpoint events at 6 and 12 months; and all-cause mortality at 30 days, 6 months, and 12 months.

Results: A total of 3,198 patients were included in the primary analysis. The primary endpoint, MACCEs incidence at 12 months, was significantly lower in the exposure group [40 (2.5%) vs. 106 (6.6%)], driven by reductions in cardiac death and stroke. In the secondary endpoint analysis, early risk reduction was pronounced at 30 days [MACCEs: 19 (1.2%) vs. 64 (4.0%)] and 6 months [MACCEs: 33 (2.1%) vs. 90 (5.6%)]. The exposure group exhibited 92% lower 30-day STEMI complications [16 (1.0%) vs. 210 (13.1%)], including reductions in cardiogenic shock, acute heart failure, mechanical complications, and malignant arrhythmias. Composite endpoint risks decreased by 65% at 6 months [36 (2.3%) vs. 104 (6.5%)] and 66% at 12 months [43 (2.7%) vs. 127 (7.9%)], with significant heart failure readmission reductions and 89% lower severe bleeding risk. More surprisingly, the risk of all-cause death at 30 days, 6 months, and 1 year was reduced by 71%, 61% and 59% in the exposure group.

Conclusions: Adjunctive Tongxinluo therapy demonstrated significant improvement in 12-month cardiovascular outcomes with favorable safety profile, suggesting potential benefits of integrating traditional Chinese medicine with evidence-based STEMI management. (Registration No. ChiCTR100054466).

Objective: To investigate the anti-inflammatory effects and mechanisms of action of 4 steroidal alkaloids (ebeiedinone, imperialine, chuanbeinone, and peimisine) in Fritillaria.

Methods: This study established a lipopolysaccharide (LPS)-induced inflammatory model using mouse leukemia cells of monocyte macrophage (RAW 264.7) cells. The cell toxicity, nitric oxide (NO) release, expression levels of inflammatory factors, and expression levels of anti-inflammatory mechanism proteins and mRNA of ebeiedinone, imperialine, chuanbeinone, and peimisine on RAW 264.7 cells were detected by cell counting kit-8 (CCK8) assay, Griess assay, enzyme-linked immunosorbent assay, Western blot, and real-time quantitative PCR, respectively. An acute lung injury (ALI) rat model was established. Hematoxylin and eosin staining was used to observe the morphological and pathological characteristics of lung tissue in each group of rats. The expression levels of inflammatory factors and anti-inflammatory mechanism proteins and mRNA in the ALI rat model induced by the 2 alkaloids (ebeiedinone, peimisine) were detected.

Results: The 4 alkaloids reduced the release of NO, downregulated the expression of pro-inflammatory factors, regulated the expressions of the TIR domaincontaining adapter protein inducing interferon-beta (TRIF), myeloid differentiation factor 88 (MyD88), nuclear factor kappa-B (NF-κB), and mitogen-activated protein kinases (MAPKs) signaling pathways in LPS-induced RAW 264.7 cells, exerting an anti-inflammatory effect (P<0.05 or P<0.01). Ebeiedinone and peomisine improved pulmonary edema and inflammation levels, regulated the expressions of MyD88, NF-κB, and MAPKs signaling pathways in the ALI rat model, exerting anti-inflammatory effects (P<0.05 or P<0.01).

Conclusion: The 4 alkaloids of Fritillaria exert anti-inflammatory effects in vivo and in vitro through MyD88- and TRIF-dependent signaling pathways, thereby protecting rats from ALI.

Objective: To investigate the role of spinal manipulative therapy (SMT) in preventing progression and reducing the need for surgery in moderate-to-severe adolescent idiopathic scoliosis (AIS).

Methods: This randomized controlled clinical trial was conducted at the First Affiliated Hospital of Zhejiang Chinese Medical University between January 1, 2022, and December 31, 2023. Overall, 118 AIS patients were randomly divided into 2 groups by simple randomization: one receiving SMT combined with brace treatment (SMTB group, 59 participants), SMT was given twice weekly, brace was worn for 23 h per day) and the other receiving brace treatment alone (BA group, 59 participants, brace was worn for 23 h per day). The primary outcome measure was the success rate after 12-month treatment. The secondary outcomes related to scoliosis, including the Cobb angle, angle trunk rotation (ATR), and Scoliosis Research Society-22 (SRS-22) score were measured. All the above indicators were subjected to subgroup analysis based on the degree of scoliosis (moderate and severe). Adverse events were observed and recorded.

Results: Modified intention-to-treat analyses included 112 participants (SMTB group and BA group each had 56 participants, 101 girls and 11 boys; 15.11 ± 1.69 years). The success rate was significantly higher in the SMTB group [78.6% (44/56)] than in the BA group [51.8% (29/56), P<0.01]. Among the secondary outcomes, SMTB group was more effective than BA group in reducing the Cobb angle (difference, -3.93; 95% confidence interval [CI], -6.11 to -1.74, P<0.05); SMTB group showed a greater reduction in ATR compared to BA group (difference, -2.34; 95% CI, -3.46, -1.22, P<0.05) and demonstrated superior efficacy to BA in improving SRS-22 score (difference, 6.57; 95% CI, 4.55 to 8.59, P<0.05). Subgroup analysis showed that SMT had similar efficacy in the treatment of moderate and severe AIS. Safety analyses did not differ significantly between the two groups (P>0.05).

Conclusion: SMT appears to be safe and beneficial for moderate-to-severe AIS. (Trial registration No. NCT06648005).

Objective: To evaluate the efficacy of perioperative transcutaneous electrical acupoint stimulation (TEAS) for reducing postoperative abdominal pain in patients after endoscopic submucosal dissection (ESD) for early gastric and esophageal neoplasms.

Methods: A total of 129 patients undergoing ESD were assigned randomly to the TEAS group (64 cases) or the sham group (65 cases) using computer-generated random numbers and stratified by the surgical type (i.e., gastric or esophageal ESD). Patients in the TEAS group were treated bilaterally at the acupoints Hegu (LI 4), Neiguan (PC 6), Zusanli (ST 36), and Shangjuxu (ST 37), with the stimulation current frequency 2/100 Hz and intensity to the patient's maximum tolerance level. Patients in the sham group were treated at sham acupoints, and no electrical stimulation was given from the HANS stimulator. The TEAS and sham stimulations are both given from 30 min before ESD to the end of surgery. The primary outcome was the incidence of moderate-to-severe pain within 24 h. Secondary outcomes included the area under the curve (AUC) of Numeric Rating Scale (NRS) pain score from 1 to 48 h, morphine consumption after ESD, intraoperative hemodynamic parameters and postoperative nausea and vomiting (PONV).

Results: The incidence of moderate-to-severe pain within 24 h postoperative period was significantly decreased by TEAS [22 (37.9%) vs. 40 (64.5%), P=0.004]. Patients needing morphine were also reduced by TEAS treatment [19 (32.7%) vs. 40 (64.5%), P<0.01]. TEAS significantly decreased the proportion and incidence of PONV compared with the sham group (P=0.06). Intraoperative hemodynamic parameters, recovery of gastrointestinal function, postoperative adverse events were similar between the two groups. According to the results of multivariate logistic regression, TEAS treatment was a protective factor associated with reduced incidence of NRS scores ⩾4 (OR=0.227; 95% CI: 0.100 to 0.512; P<0.01), whereas patients undergoing gastric ESD had a much lower incidence of NRS scores ⩾ 4 than esophageal ESD (OR=0.287; 95% CI: 0.133 to 0.621; P=0.002).

Conclusions: TEAS can effectively reduce the incidence of moderate-to-severe pain in patients after ESD. TEAS demonstrates an morphine-sparing effect and reduces the occurrence of PONV. (Registration No. ChiCTR2100052837).