Tanreqing injection (TRQI) is a Chinese patent medicine. It is commonly used in the treatment of acute exacerbation of COPD in China. It substantially improves the partial pressure of oxygen (PaO2), ...partial pressure of carbon dioxide (PaCO2), and lung function in patients with COPD combined with respiratory failure (RF) and improves the total clinical effective rate.
Relevant randomized controlled trials (RCTs) on the treatment of COPD combined with RF with TRQI were collected through search of PubMed, Web of Science, Embase, Cochrane Library, CBM, VIP, Wanfang, and CNKI up to October 2, 022. Two investigators in this study independently evaluated the quality of the literature and utilized RevMan 5.4 software for analysis. In network pharmacology, TCMSP database, PubChem database, DisGeNet, Genecards, and other databases were searched to screen the chemical components and targets of TRQI and mapped with COPD-RF targets to obtain potential action targets, which were then analyzed using bioinformatics techniques to initially explore their effects.
A total of 18 RCTs containing 1485 patients, showed that TRQI combined with conventional treatment improved the total clinical efficiency of patients with COPD combined with RF compared with that of the conventional treatment group (RR = 1.33, 95% CI (1.25, 1.41), P < 0.01), PaCO2 SMD = −1.29, 95% CI (−1.41, −1.17), P < 0.00001, PaO2 SMD = 1.19, 95% CI (1.06, 1.31), P < 0.00001, pulmonary function SMD = 1.00, 95% CI (0.79, 1.21), P < 0.00001. Through network pharmacology analysis, 284 potential TRQI and 19 common targets were identified. TNF, TP53, SIRT1, SRC, CCND1, IL-10, NF-κB, MAPK14, STAT3, SMAD3 are core targets proteins. In addition, 56 related pathways of TRQI were identified, such as the TNF, MAPK, IL-17, NF-κB signaling pathways.
In conclusion, the efficacy of TRQI combined with conventional treatment for COPD combined with RF was higher than that of conventional treatment alone. These findings suggest that TRQI acts on COPD-RF through a multi-target, multi-component, and multi-pathway mechanism. Future studies may explore the active components of TRQI.
Background:
Tripterygium wilfordii Hook. F (TwHF), a Chinese herbal medicine used to treat CTD-ILD patients in China, has been previously found to have immunoinhibitory, antifibrotic and anti ...inflammatory effects. It has also shown good results in treating autoimmune and inflammatory diseases.
Objectives:
This systematic review and meta-analysis aims to evaluate the efficacy and safety of TwHF for CTD-ILD.
Methods:
A systematic search was performed on PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, Scopus, CNKI, Wanfang, VIP, and CBM databases up to May 2021. Randomized controlled trials (RCTs) comparing TwHF plus conventional therapy versus conventional therapy alone were included. We followed the PRISMA checklist, and applied Cochrane handbook 5.1.0 and RevMan 5.3 for data analysis and quality evaluation of the included studies.
Results:
Based on Cochrane handbook 5.1.0, nine RCTs consisting 650 patients met the inclusion/exclusion criteria and were selected for further analysis. The obtained data showed significant improvement in lung function with TwHF plus conventional treatment compared with conventional treatment (post-treatment FVC% (MD= 8.68, 95%Cl (5.10, 12.26),
p
< 0.00001), FEV1% (MD = 11.24, 95%Cl (6.87, 15.61),
p
< 0.00001), TLC% (MD = 5.28, 95%Cl (0.69, 9.87),
p
= 0.02), but no significant difference in the post-treatment DLCO% (MD = 4.40, 95%Cl (−2.29, 11.09),
p
= 0.20). Moreover, the data showed that TwHF combined with conventional treatment significantly reduced the HRCT integral of patients MD = -0.65, 95% (-1.01, -0.30),
p =
0.0003, the level of erythrocyte sedimentation rate (MD = −9.52, 95%Cl (−11.55, −7.49),
p
< 0.00001), c-reactive protein (CRP) (MD = −8.42, 95%Cl (−12.47, −4.38),
p
< 0.0001), and rheumatoid factor (MD = −25.48, 95%Cl (−29.36, −21.60),
p
< 0.00001). Compared to conventional therapy, TwHF combined with conventional therapy significantly improved clinical effects (RR = 1.33, 95%Cl (1.17, 1.51),
p
< 0.0001), in five trials with 354 patients. In terms of improvement of symptoms and signs, the TwHF group showed a more significant improvement than the conventional treatment group (Cough (MD = −0.96, 95%Cl (−1.43, −0.50),
p
< 0.0001), velcro rales (MD = −0.32, 95%Cl (−0.44, −0.20),
p
< 0.00001), shortness of breath (MD = −1.11, 95%Cl (−1.67, −0.56),
p
< 0.0001), but no statistical difference in dyspnea (MD = −0.66, 95%Cl (−1.35, 0.03),
p
= 0.06). There was no statistical significance in the incidence of adverse reactions.
Conclusion:
The performed meta-analysis indicated that TwHF combined with conventional treatment was more beneficial to patients for improving symptoms, lung function and laboratory indicators. As it included studies with relatively small sample size, the findings require confirmation by further rigorously well-designed RCTs.
The ginseng polysaccharide injection is a well-known traditional Chinese medicine often employed as a supplementary treatment for cancer. This treatment can not only alleviate the adverse effects ...caused by tumor radiotherapy and chemotherapy but also enhance the immune system of individuals diagnosed with lung cancer. It is important to acknowledge the efficacy of ginseng polysaccharide injection in the treatment of non-small cell lung cancer (NSCLC). However, these small-sample studies may have certain biases, and the underlying mechanisms of ginseng polysaccharides therapy for NSCLC are still unclear.
The present study involved a systematic review of the literature on randomized controlled trials (RCTs) focusing on using ginseng polysaccharide injection as a therapeutic approach for NSCLC. Seven databases were searched for eligible studies published before April 2023. Two researchers independently managed data extraction, risk of bias assessment, and data analyses using RevMan 5.3 software. In network pharmacology, we thoroughly searched the relevant literature on ginseng polysaccharides (GPs) and the PubChem database. This search aimed to identify the main active ingredients and targets associated with ginseng polysaccharides. Subsequently, we compared these targets with those of NSCLC and utilized bioinformatics techniques to analyze and explore their potential interactions.
A total of 11 RCTs involving 845 patients with NSCLC were included in the meta-analysis. The meta-analysis revealed that ginseng polysaccharide injection combined significantly improved the objective response rate RR = 1.45, 95% CI (1.26, 1.67), P < 0.00001. Furthermore, it was observed that ginseng polysaccharide injection increased the serum levels of CD4+ T-lymphocytes (CD4+ T) MD = 8.98, 95% CI (5.18, 12.78), P < 0.00001, and decreased the serum levels of CD8+ T-lymphocytes (CD8+ T) MD = −2.68, 95% CI (−4.66, −0.70), P = 0.008. Through network pharmacology analysis, a total of 211 target genes of GPs and 81 common targets were identified. GAPDH, EGFR, VEGFA, JUN, SRC, CASP3, STAT3, CCND1, HSP90AA1, and MMP9 were identified as the core target proteins. Additionally, KEGG enrichment analysis revealed 122 relevant signaling pathways, including Pathways in cancer, PD-L1 expression and PD-1 checkpoint pathway in cancer, and Proteoglycans in cancer.
Ginseng polysaccharide injection can improve the ORR of patients with NSCLC, increase the serum levels of CD4+ T, and decrease the serum levels of CD8+ T. The potential mechanism may be associated with the PD-1/PD-L1 signaling pathway.
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Cinobufacini is a Chinese medicinal preparation extracted from the traditional Chinese medicine toad skin and is commonly used clinically as an adjuvant treatment for malignant tumours.
To ...systematically evaluate the effects of Cinobufacini combined with a first-line platinum-based chemotherapy regimen in patients with non-small-cell lung cancer (NSCLC), especially in terms of immune function.
Eight electronic databases were searched for randomised controlled trials (RCTs) investigating Cinobufacini in conjunction with platinum-based chemotherapy for NSCLC (stage III-IV) published from 2012 to the present. GRADE Pro GDT was used to assess RCT quality and meta-analysis was performed mainly using Review Manager version 5.4, with the assistance of Stata version 16.0 (StataCorp LLC, College Station, TX, USA), and trial sequential analysis software.
A total of 35 studies were included. Meta-analysis revealed that the combination therapy group exhibited a better disease control rate (DCR) OR = 2.63, 95%CI (2.15, 3.21), P < 0.00001, with a higher one-year OR = 2.41,95% CI (1.75,3.33), P < 0.00001, and two-year OR = 2.28, 95% CI (1.56,3.33), P < 0.00001 survival rate, plus lower leukocyte toxicity OR = 0.40, 95%CI (0.33,0.49), P < 0.00001. For immune function, the combination of chemotherapy with Cinobufacini effectively increased the proportion of CD3+ SMD = 1.15, 95% CI (0.89,1.42), P < 0.00001, CD4+ SMD = 1.60, 95%CI (1.26,1.94), P < 0.00001 and the CD4+/CD8+ ratio SMD = 2.15, 95% CI (1.45,2.86), P < 0.00001 in peripheral blood.
The addition of Cinobufacini to platinum-based chemotherapies for advanced NSCLC significantly improved clinical efficacy, enhanced immune function, and reduced chemotherapeutic toxicity, irrespective of administration and treatment duration.
Objective: The objective of the study was to evaluate the clinical efficacy of kanglaite (KLT) injection combined with gefitinib versus gefitinib alone in the treatment of nonsmall cell lung cancer ...(NSCLC).
Methods: The randomized controlled trials involving NSCLC treatment with KLT injection combined with gefitinib versus gefitinib alone were searched on seven medical databases up to October 2016. Two reviewers independently assessed the methodological quality of the included studies. The RevMan 5.3 software was employed for data analysis.
Results: Seven randomized trials involving 554 patients met our criteria. Compared with gefitinib alone, KLT injection combined with gefitinib showed significant effects in increasing objective response rate (relative risk RR =1.38; 95% confidence interval CI, 1.09-1.75), improving the performance status (RR = 1.80; 95% CI: 1.34-2.42), raising the percentages of CD4+ cells (weighted mean difference WMD = 4.45; 95% CI: 2.61-6.28), natural killer cells (WMD = 4.43; 95% CI: 3.85-5.01), and ratio of CD4+/CD8+ (WMD = 0.08; 95% CI: 0.02-0.14), whereas the difference was not significant in gefitinib toxicity including rash (RR 0.90; 95% CI: 0.58-1.40, P = 0.65), diarrhea (RR 1.04; 95% CI: 0.66-1.64, P = 0.88), and liver injury (RR 1.00; 95% CI: 0.58-1.73, P = 1.00), CD3+ cells (WMD = 1.16; 95% CI: -2.64-4.97) and CD8+ cells (WMD = 6.78; 95% CI: -1.68-15.23).
Conclusion: Co-use of KLT injection and gefitinib may benefit the patients with NSCLC through enhancing the therapeutic effectiveness compared with gefitinib alone. To confirm these results, further rigorously designed trials are warranted.
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is an aggressive subtype of inflammatory myofibroblastic tumour which rarely affects the chest cavity. We, for the first time, report a case of ...mediastinal EIMS with the EML4‐ALK fusion. A young woman presented to our hospital with cough, chest tightness and shortness of breath. Computed tomography (CT) showed a mixed attenuation soft‐tissue mass in the right middle and upper mediastinum. Negative results were obtained from bronchoscopy forceps biopsy and endobronchial ultrasound‐guided transbronchial fine needle aspiration. CT‐guided percutaneous biopsy was finally performed. However, due to the rapidly progressed EIMS that compressed the trachea and right main bronchus, the patient died of respiratory failure 1 day before diagnosis. EIMS progresses rapidly, and an early diagnosis is important. For mediastinal EIMS, CT‐guided percutaneous biopsy may be useful. Next‐generation sequencing of blood may be instructive to EIMS patients who are intolerant to invasive biopsy.
Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a highly aggressive, recurrent, and metastatic subtype of inflammatory myofibroblastic tumour (IMT). Here, we for the first time reported a case of mediastinal EIMS with the EML4‐ALK fusion. Unfortunately, the patient died of respiratory failure due to the rapidly progressing EIMS that compressed the trachea and right main bronchus, 1 day before diagnosis.
The effects of body mass index (BMI) on mortality of sepsis remain unknown, since previous meta-analyses have reported conflicting results. Several observational studies published recently have ...provided new evidence. Thus, we performed this updated meta-analysis.
PubMed, Embase, Web of Science, and Cochran Library were searched for articles published before February 10, 2023. Observational studies that assessed the association of BMIs with mortality of sepsis patients aged > 18 years were selected. We excluded studies of which data were unavailable for quantitative synthesis. Odds ratios (OR) with 95% confidence interval (CI) were the effect measure, which were combined using fixed-effect or random-effect models. The Newcastle-Ottawa Scale was applied for quality assessment. Subgroups analyses were conducted according to potential confounders.
Fifteen studies (105,159 patients) were included in the overall analysis, which indicated that overweight and obese BMIs were associated with lower mortality (OR: 0.79, 95% CI 0.70-0.88 and OR: 0.74, 95% CI 0.67-0.82, respectively). The association was not significant in patients aged ≤ 50 years (OR: 0.89, 95% CI 0.68-1.14 and OR: 0.77, 95% CI 0.50-1.18, respectively). In addition, the relationship between morbidly obesity and mortality was not significant (OR: 0.91, 95% CI 0.62-1.32).
Overweight and obese BMIs (25.0-39.9 kg/m
) are associated with reduced mortality of patients with sepsis or septic shock, although such survival advantage was not found in all crowds. Trial registration The protocol of this study was registered in PROSPERO (registration number CRD42023399559).
Background. Radiotherapy has been widely used for non-small-cell lung cancer (NSCLC), while its low efficacy and high toxicity raise big concerns. Astragalus (as a monarch drug)-containing Chinese ...herbal prescriptions and radiotherapy were frequently coused for NSCLC in China; however, the effects were not systematically analyzed. Objective. To evaluate the benefits of Astragalus-containing Chinese herbal prescriptions combined with radiotherapy for NSCLC. Methods. The randomized controlled trials involving NSCLC treatment with Astragalus-containing Chinese herbal prescriptions combined with radiotherapy were searched. The Review Manager 5.1 software was employed for data analysis. Funnel plot and Egger’s test were applied to evaluate publication bias. Results. 29 eligible studies met our criteria. Of the studies, 8, 6, and 4 reported reduced risk of death at one year, two years, and three years, respectively. 26 studies revealed amended tumor response. Six studies showed improved Karnofsky performance status. Among the studies, 14 and 18 displayed a lowered white blood cells (WBC) toxicity and an ameliorated radiation pneumonia, respectively. Conclusion. Couse of Astragalus-containing Chinese herbal prescriptions and radiotherapy may benefit the patients with NSCLC via increasing the therapeutic effectiveness and reducing the toxicity of radiotherapy. To confirm the exact merits, further rigorously designed trials are warranted.
Platinum-based chemotherapy is one of the first line therapies for the advanced non-small cell lung cancer (NSCLC), even though its high toxicity and limited clinical effects cannot be neglected. ...Huisheng oral solution (HSOS) has been widely used as an adjuvant chemotherapy drug for NSCLC in China. To systematically analyze the therapeutic effects of the combination of HSOS and platinum-based chemotherapy, a comprehensive meta-analysis was performed.
This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of HSOS for NSCLC.
The randomized controlled trials (RCTs) were selected on seven medical databases up to June 2020, including advanced NSCLC treatment using HSOS plus platinum-based chemotherapy versus chemotherapy alone. We followed the PRISMA checklist in general, applying Cochrane handbook 5.1.0, GRADE Pro GDT, RevMan 5.3, Stata12.0, and TSA 0.9.5.10 Beta to evaluate the quality of the study and analyze the data.
Based on Cochrane handbook 5.1.0, 15 RCTs consisting 1165 patients met the criteria and were selected for further analysis. Compared to chemotherapy alone, the chemotherapy combined with HSOS significantly improved objective tumor response (ORR) RR = 1.38, 95% CI (1.19, 1.59),
< 0.0001, disease control rate (DCR) RR = 1.10, 95% CI (1.04, 1.16),
= 0.0006, and Karnofsky performance status (KPS) RR = 1.79, 95% CI (1.41, 2.26),
< 0.00001. However, there was no evidence of improvement in the 1-year survival rate RR = 1.37, 95% CI (0.98, 1.92),
= 0.07. In terms of the side effects, HSOS administered concurrently with chemotherapy resulted in a serial of substantial benefits: lower toxicity to white blood cell RR = 0.30, 95% CI (0.20, 0.43),
< 0.00001, lower platelet toxicity RR = 0.56, 95% CI (0.34, 0.92),
= 0.02, and reduced incidence of vomiting RR = 0.52, 95% CI (0.29, 0.92),
= 0.03.
The meta-analysis indicated that HSOS plus platinum-based chemotherapy was more beneficial for patients, as the therapy could synergize antitumor activity and could attenuate toxicity. The finding requires confirmation by further rigorously designed RCTs.
The study aims to evaluate the efficacy and safety of two Chinese herbal formulae for the treatment of stable COPD.
A multicenter, double-blind, double-dummy, and randomized controlled trial (RCT) ...was conducted. All groups were treated with additional conventional medicines. There were a 6-month treatment and a 12-month follow-up for 5 times. Primary outcomes included lung function test, exacerbation frequency, score of SGRQ. Second outcomes consisted of 6MWD, BODE index, psychological field score, inflammatory factors and cortisol.
A total of 331 patients were randomly divided into two active treatment groups (Bushen Yiqi (BY) granule group, n = 109; Bushen Fangchuan (BF) tablet group, n = 109) and a placebo group (n = 113). Finally 262 patients completed the study. BY granule & BF tablet increased the values of VC, FEV1 (%) and FEV1/FVC (%), compared with placebo. BY granule improved PEF. Both treatments reduced acute exacerbation frequency (P = 0.067), BODE index and psychological field score, while improved 6MWD. In terms of descent rang of SGRQ score, both treatments increased (P = 0.01). Both treatments decreased inflammatory cytokines, such as IL-8, and IL-17(P = 0.0219). BY granule obviously descended IL-17(P<0.05), IL-1β (P = 0.05), IL-6, compared with placebo. They improved the level of IL-10 and cortisol. BY granule raised cortisol (P = 0.07) and decreased TNF-α. Both treatments slightly descended TGF-β1. In terms of safety, subject compliance and drug combination, there were no differences (P>0.05) among three groups.
BY granule and BF tablet were positively effective for the treatment of COPD, and the former performed better in general.
Chinese Clinical Trial Register center ChiCTR-TRC-09000530.
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