Association of the immature platelet fraction with sepsis diagnosis and severity / 中华急诊医学杂志

Objective To explore the relationship between immature platelet fraction(IPF) with severity of sepsis and prognosis in patients with septic shock.Methods A total of 40 patients admitted to intensive care units of Tianjin First Central Hospital from June 2016 to June 2017 were enrolled.Of them,10 patients contracted non-sepsis infected,13 patietns with septic shock,and 17 patients with non-complicated sepsis.Ten healthy subjects were recruited as control groups from Tianjin Medical University.IPF and immature reticulocyte fraction (IRF) were detected,and SOFA and APACHE Ⅱ scores were calculated,and clinical findings of all groups were recorded.The differences in IPF and IRF between the groups were analyzed.The relationship between the IPF and SOFA score was studied,and the role of IPF in the diagnosis of septic shock was evaluated.Statistical methods include t test,MarmWhitney test,Spearman correlation analysis,and ROC procedure,and P＜0.05 was considered significant.Results Significantly higher IPF level was observed in patients with sepsis than that in patients with nonsepsis infection.(6.25 + 2.92) vs.(2.49 ± 1.03),P＜0.01.Significantly higher IPF level was observed in patients with septic shock than that in patients with non-complicated sepsis(4.71 ± 1.79) vs.(8.25 ± 2.94),P＜0.01.IPF correlated with sepsis severity scores (7.41 ± 3.51) vs.(4.5 ± 1.7),P=0.005;r=0.58,P=0.001.This study presented the highest diagnostic accuracy for the presence of sepsis by all studied clinical and laboratory parameters (AUC=0.78,P=0.01).Conclusion IPF levels could be used as a biomarker for diagnosis and severity of sepsis.

Research progress of acute cardiorenal syndrome / 中国中西医结合急救杂志

The heart and kidney damage is a clinical disease commonly seen, the 2 organs can interact with each other as cause and effect, leading to a series of clinical symptoms which is the cardiorenal syndrome (CRS). In 2008, according to the connection between the heart and kidney, the nephrologists Ronco, etc, completed the definition and classification of CRS, including type Ⅰ and type Ⅲ of CRS being acute cardiorenal syndrome (ACRS). ACRS refers to the fact that when the damage of heart or kidney dysfunction influences each other leading to a clinical syndrome caused by a sharp deterioration of cardiorenal function. At present, no definite diagnostic criteria for ACRS have yet been made. The pathogenesis of ACRS may be related to the renin-angiotensin-aldosterone system (RAAS), nitric oxide-reactive oxygen species (NO-ROS) system, inflammatory reaction, the excessive activation of sympathetic nervous system and so on. Clinically, about 50% of ACRS patients are accompanied by acute decompensated cardiorenal dysfunction or failure, that seriously impact on the patients' clinical prognosis and survival rate, so it is necessary to find an effective therapeutic regimen. At present, the treatments of ACRS have mainly the diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor inhibitor (ARB), β-receptor blocker, positive inotropic drugs, recombinant human erythropoietin, recombinant human brain natriuretic peptide, continuous blood purification (CBP) etc, and traditional Chinese medicine (TCM) also has a certain effect for improving the clinical symptoms of ACRS patients. Now the pathogenesis, diagnosis, and combined treatment of TCM and western medicine for treatment of ACRS are summarized.

Therapeutic effect of Lianggesan for treatment of patients with acute respiratory distress syndrome / 中国中西医结合急救杂志

Objective To observe the effect of prescription of traditional Chinese medicine (TCM) Lianggesan on clinical efficacy for treatment of patients with acute respiratory distress syndrome (ARDS). Methods Fifty-two patients consistent with the Berlin diagnostic criteria of ARDS admitted to the departments of intensive care unit (ICU) of Tianjin Hospital and of the First Tianjin Center Hospital from May 1, 2015 to April 30, 2016 were enrolled, and they were divided into a Chinese medicine group (24 cases) and a control group (28 cases) by lottery. The anti-infection, reduction of phlegm, mechanical ventilation and symptomatic support treatment were given to the two groups, additionally Chinese medicine group received TCM Lianggesan (particles) including ingredients: fructus forsythiae 30 g, radix scutellariae 10 g, fructus gardeniae 10 g, henon bamboo leaf 10 g, rhubarb 10 g, herba menthae 6 g, natrii sulfas 6 g, radix glycyrrhizae 15 g, adding water to punch the particles in 50 mL liquid, taken by nasal feeding or orally drinking, in the morning and in the evening, twice a day. Before and after treatment, the differences in levels of oxygenation index, tumor necrosis factor-α (TNF-α) and positive end expiratory pressure (PEEP) were compared between the two groups. Results After treatment, the oxygenation indexes of the two groups were significantly higher than those before treatment, the levels of TNF-α and PEEP of the two groups were significantly lower than those before treatment, and the degrees of changing in the Chinese medicine group were more significant than those of the control group [oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 267.45±38.67 vs. 235.26±30.62, TNF-α (mg/L):24.37±5.46 vs. 28.31±5.41, PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.58±1.61 vs. 5.93±1.61, all P < 0.05]. Conclusion TCM Lianggesan can effectively eliminate the inflammatory mediators of patients with ARDS, improve the respiratory function and promote the recovery of the disease.

The clinical efficacy of deep acupuncture atLianquan (CV23) combined with swallowing rehabilitation training on dysphagia after stroke / 国际中医中药杂志

Objective To evaluate the clinical effect of deep acupuncture at Lianquan (CV23) combined with swallowing rehabilitation training in the treatment of dysphagia after stroke.Methods A total of 84 patients with dysphagia after stroke who met the inclusion criteria were divided into 2 groups, 42 in each. The control group received swallowing rehabilitation training, and the observation group was treated with acupuncture therapy based on deep acupuncture atLianquan (CV23) combined with swallowing rehabilitation training. The VFSS score and clinical efficacy were compared between the 2 groups before and after treatment.Results The cure rate of observation group was 69.1% (29/42), the total effective rate 85.7% (36/42), while the control group were 42.86% (18/42) and 66.67% (28/42). The comparison of cure rate and total efficiency rate between the two group had statistically significant differences (χ2=5.845, 4.200,P=0.016, 0.040). After treatment, the VFSS score of the observation group was significantly higher than that of the control group (7.43 ± 2.27vs.4.31 ± 1.53;t=5.433, P<0.05). The recovery time of the 29 cured patients in the observation group was (12.0 ± 3.0) d, while the recovery time of the 18 cured patients in the control group was (17.8 ± 2.2) d. There was statistically significant difference between the 2 groups (t=7.094,P=0.001).Conclusions Deep acupuncture at Lianquan (CV23) combined with swallowing rehabilitation training can improve the swallowing function of patients with dysphagia after stroke, shorten the recovery time of swallowing function and improve the clinical efficacy.

The clinical curative effect of warming yang for diuresis of traditional Chinese medicine combined with blood purification for treatment of acute renocardiac syndrome / 中国中西医结合急救杂志

Objective To explore the effect of warming yang for diuresis method combined with blood purification on the clinical therapeutic effect of patients with acute renocardiac syndrome (ARCS).Methods Sixty ARCS patients admitted to the Department of Intensive Care Unit (ICU) of Affiliated Hospital of Tianjin Institute of Chinese Medicine from May 2013 to October 2016 were enrolled, they were divided into an observation group and a control group by random number table, 30 cases in each group, one case died of multiple organ failure due to aggravation of infection, thus the actual observation number was 29 patients in the control group. The continuous vein-vein hemofiltration (CVVH) was applied in the two groups, 6-13 hours each time, and according to the disease situation, the continuous ultrafiltration time was determined, generally about 3-7 days; the observation group was additionally treated with warming yang for diuresis oral herbal decoction, 1 dose daily, 2 times a day, once 100 mL orally taken. The changes of cardiac and renal function indexes, traditional Chinese medicine (TCM) syndrome score and clinical efficacy were observed before and after treatment in the two groups.Results After treatment, the heart and renal function indexes were significantly improved, serum creatinine (SCr), urea nitrogen (BUN), N-terminal pro-brain nitric peptide (NT-proBNP) were all significantly lower than those before treatment in both groups, glomerular filtration rate (GFR), urine output, left ventricular ejection fraction (LVEF), cardiac output index (CI) were all significantly higher than those before treatment in both group; 7 days after treatment, BUN was significantly lower in observation group than that in control group (mmol/L:10.38±1.02 vs. 13.68±2.67), GFR, urine output, CI were significantly higher in observation group than those in control group [GFR (mL/min): 62.02±4.47 vs. 52.95±1. 92, urine output (mL/24 h): 875.41±44.26 vs. 537.82±79.65, CI (L·min-1·m-2): 3.12±0.51 vs. 3.07±0.17, allP < 0.05]; the effective rate of TCM syndrome score and clinical efficacy were significantly higher in observation group than those in control group [total effective rate of TCM syndrome score: 80.0% (24/30) vs. 55.17% (16/29), total effective rate: 93.33% (28/30) vs. 72.41% (21/29), both P < 0.05].Conclusions The warming yang for diuresis TCM decoction intake combined with CVVH can improve the cardiac and renal functions and clinical symptoms, and increase urine output for patients with ARCS.

Acuuncture combined with swallowing training for post-stroke dysphagia: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy of deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training for post-stroke dysphagia.</p><p><b>METHODS</b>Sixty cases of post-stroke dys phagia were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the observation group, based on the regular acupuncture treatment, were treated with deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17), once a day, 30 min per treatment; also swallowing training was combined, twice a day, 20 min per treatment. Patients in the control group were treated with swallowing training. All the patients were treated with regular treatment of stroke. Six days of treatment were taken as one session, and totally 3 sessions were given with an interval of one day between sessions. The video fluoroscopic swallowing study (VFSS) dysphagia evaluation scale and Watian water swallow test (WWST) were evaluated before and after treatment also the clinical efficacy and the recovery time of two groups were compared.</p><p><b>RESULTS</b>After treatment, the VFSS score in the observation group was significantly superior to that in the control group (P < 0.01); the WWST in the observation group was significantly superior to that in the control group (P < 0.01). The cured rate was 70.0% (21/30) in the observation group, which was significantly superior to 43.3% (13/30) in the control group (P < 0.01); the total effective rate was 86.7% (26/30) in the observation group, which was significantly superior to 66.7% (20/30) in the control group (both P < 0.01). The clinical recovery time in the observation group was significantly shorter than that in the control group (P < 0.01).</p><p><b>CONCLUSION</b>Deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training could effectively improve post-stroke swallow function.</p>

Comparison of clinical efficacy between continuous renal replacement therapy and intermittent haemodialysis for the treatment of sepsis-induced acute kidney injury / 中华危重病急救医学

Objective To compare the clinical effects between continuous renal replacement therapy (CRRT) and intermittent haemodialysis (IHD) for the treatment of sepsis-induced acute kidney injury (AKI). Methods A prospective study was conducted. Seventy-three patients with sepsis-induced AKI admitted to the intensive care units (ICUs) of Tianjin Hospital and Tianjin First Center Hospital from January to December in 2014 were enrolled. They were randomly divided into two groups: CRRT group (n = 35) and IHD group (n = 38). Data were recorded for the patients in two groups before treatment, including acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mean arterial pressure (MAP), urine volume, and the levels of C-reactive protein (CRP) and serum creatinine (SCr) before and 1 week after treatment, the time of recovery of urine volume, the length of ICU stay, the duration of organ support, and the incidence of cardiovascular events. Results There was no statistically significant difference in APACHE Ⅱ scores (21.63±2.46 vs. 21.34±2.46), MAP [mmHg (1 mmHg = 0.133 kPa): 71.26±10.70 vs. 75.74±15.17], urine volume (mL: 404.00±79.13 vs. 438.97±87.17), CRP (mg/L: 100.94±14.73 vs. 95.17±27.03), and SCr (μmol/L: 394.02± 50.26 vs. 390.47±54.42) before treatment between CRRT group and IHD group (all P > 0.05). One week after treatment, compared to the IHD group, CRRT could dramatically reduce the levels of CRP (mg/L: 41.05±10.15 vs. 60.21±14.78, t = 6.401, P < 0.001), SCr (μmol/L: 185.97±65.48 vs. 232.02±71.93, t = 2.862, P = 0.006), urine output recovery time (days: 7.94±3.06 vs. 11.08±3.71, t = 3.923, P < 0.001), the length of ICU stay (days: 9.54±3.39 vs. 13.42±3.89, t = 4.521, P < 0.001), organ support time (days: 3.23±2.70 vs. 6.34±3.36, t = 4.343, P < 0.001), and the incidence of cardiovascular events [23.53% (8/35) vs. 39.47% (15/38), χ2 = 5.509, P = 0.025]. Conclusion Compared to IHD, CRRT can more efficiently help patients with sepsis-induced AKI in removing excessive water, metabolic waste, and lower the levels of pro-inflammatory cytokines, maintain homeostasis of the internal environment, lower the adverse effects on cardiovascular system, so that it significantly improve the prognosis of patients, shorten the time of organ support and the length of ICU stay.

Clinical observation on therapeutic effect of Xiaoqinglong decoction for supplementary treatment of patients with ventilator associated pneumonia / 中国中西医结合急救杂志

ObjectiveTo investigate the therapeutic effect of Xiaoqinglong decoction for supplementary treatment of patients with ventilator-associated pneumonia (VAP).Methods Thirty-three VAP patients with syndrome of traditional Chinese medicine (TCM) as interior retention of phlegm and exopathic cold admitted to Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine (TCM) from July 2011 to December 2014 were enrolled, and their historical data were retrospectively analyzed. According to the difference in treatment methods, the patients were divided into TCM treatment Xiaoqinglong decoction group (observation group, 18 cases) and general treatment group (control group, 15 cases). The patients in both groups were given conventional western medicine treatment, including anti-infection, phlegm elimination and cough relieve, protection of gastric mucosa and organ function, nutritional support, prevention of bedsore and thrombosis, etc. Additionally, the patients in TCM treatment group were given Xiaoqinglong decoction (drug composition: herba ephedrae 15 g, ramulus cinnamomi 15 g, herba asari 15 g, rhizoma zingiberis 15 g, chinese peony 15 g, rhizoma pinelliae 15 g, fructus schisandrae 15 g, radix glycyrrhizae preparata 10 g) for nasal feeding, once 150 mL, twice a day, once every 7 days. The changes in body temperature were observed before and 3 days and 7 days after treatment, and peripheral blood was collected for determination of white blood cell count (WBC) and C-reactive protein (CRP) level in the two groups. Comprehensive therapeutic effects of the patients in both groups were recorded.Results There were no significant differences in body temperature, WBC and CRP before treatment between the two groups. After treatment, the above parameters in both groups were significantly lower than those before treatment, and they showed a decrease tendency with time prolongation. The decrease in body temperature and WBC in observation group was more obvious than those of control group, and the comparisons showed statistical significant differences on 7 days after treatment [body temperature (℃): 36.5±0.6 vs. 37.0±0.8, WBC (×109/L):6.7±3.0 vs. 8.9±2.5, bothP 0.05). The total effective rate on the 7th day after treatment in observation group was higher than that of control group [83.3% (15/18) vs. 80.0% (12/15)], but no statistical significant difference was seen (P > 0.05).Conclusions The Xiaoqinglong decoction can reduce the inflammatory reaction of patients with VAP, and improve their symptoms.

Thrombocytopenia induced by lipopolysaccharide may be not related to coagulation and inflammatory response / 中华危重病急救医学

ObjectiveTo explore the relationship between thrombocytopenia (TCP) induced by lipopolysaccharide (LPS) and coagulation or inflammatory response in mouse.Methods Forty-eight C57BL/6 mice were divided into control group, low-dose, and high-dose LPS treatment groups by random number table method, and each group was subdivided into 4-hour and 24-hour subgroups randomly, with 8 mice in each subgroup. 0.5 mg/kg or 50 mg/kg LPS was injected intraperitoneally in low-dose or high-does group respectively, and equal amount of normal saline was injected in control group. Blood was collected from endocanthal vein at the specified time point, platelet count (PLT) was counted, and the levels of thrombin antithrombin complex (TAT), D-dimer, fibrinogen degradation product (FDP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme linked immunosorbent assay (ELISA).Results Compared with control group, PLT (×109/L) at 4 hours and 24 hours in low-dose and high-dose LPS groups was significantly decreased (4 hours: 660.65±180.48, 568.55±117.99 vs. 1 199.13±110.54; 24 hours:505.63±218.92, 256.33±72.86 vs. 1 229.13±1 189.37, allP< 0.05), and the changes were more obvious in high-dose LPS group compared with those of the low-dose LPS group (allP< 0.05). Factorial analysis showed that the changes in PLT were related with LPS dosage and time (F1 = 135.660,P1 = 0.000;F2 = 12.120,P2 = 0.001). It was also found that there was an interactive effect of the dose of LPS and time on PLT (F = 5.580,P = 0.007). Compared with control group, TAT, TNF-α, and IL-6 at 4 hours and 24 hours in low-dose and high-dose LPS groups were significantly decreased [TAT (ng/L) at 4 hours: 1.10±0.59, 0.22±0.13 vs. 3.47±1.73; 24 hours: 1.18±0.68, 0.39±0.29 vs. 3.19±1.27;TNF-α (nmol/L) at 4 hours: 87.35±12.29, 93.70±5.25 vs. 101.59±10.96, 24 hours: 81.94±8.26, 93.23±4.71 vs. 102.84±10.56; IL-6 (ng/L) at 4 hours: 81.78±7.82, 78.59±9.06 vs. 110.88±9.66, 24 hours: 76.03±9.85, 71.34±3.69 vs. 110.88±10.35, allP< 0.05]. TAT at 4 hours and 24 hours in high-dose LPS group was further decreased, and TNF-αat 24 hours was increased as compared with those of low-dose LPS group (allP< 0.05). TAT, TNF-α and IL-6 were influenced only by different dosage of LPS (TAT:F = 42.350,P = 0.000; TNF-α:F = 14.810,P = 0.000; IL-6:F =81.910,P = 0.000), not time (TAT:F = 0.002,P = 0.967; TNF-α:F = 0.342,P = 0.562; IL-6:F = 2.973,P = 0.092). Changes in TAT was not found to be related with the dose of LPS and its time of action, or levels of TNF-α and IL-6 (TAT:F = 0.236,P = 0.791; TNF-α:F = 0.572,P = 0.569; IL-6:F = 0.774,P = 0.468). The dosage of LPS and time of admission showed no influence on D-dimer (F1 = 2.448,P1 = 0.099;F2 = 0.024,P2 = 0.877). The effect of different doses of LPS and time of administration showed no influence on FDP (F1 = 0.106,P1 = 0.900;F2 = 0.013,P2 = 0.908), and no interactive effects were found (D- dimer:F = 0.002,P = 0.998; FDP:F = 0.582,P = 0.563).Conclusion LPS can induce TCP in mouse, but this effect may not related to the activation of coagulation system and excessive inflammatory response.

A study of apoptosis of murine platelet induced by lipopolysaccharide derived fromEscherichia coli in vitro / 中华危重病急救医学

ObjectiveTo observe whether lipopolysaccharide (LPS) derived fromEscherichia coli (E.coli) can induce apoptosis of murine platelets in vitro.Methods Washed platelet suspension was prepared and adjusted to the final concentration of 3×108/mL. According to the difference in stimulants, samples were divided into control group (non-calcium Tyrode buffer), thrombin-treated group (1 U/mL final concentration and non-calcium TB) and LPS in different concentrations treated groups (1, 10 and 100μg/mL final concentration respectively and non-calcium TB). To each specimental group corresponding stimulus was added and incubated 30 minutes at room temperature. Chemiluminescence was adopted to determine the concentration of adenosine triphosphate (ATP) and the activity of cysteinyl aspartate specific proteinase-3 (caspase-3). The percentage of Annexin V positive platelets was determined by flow cytometry to reflect the level of phosphatidylserine (PS) exposure. Mean channel fluorescence (MCF) of platelets was determined by flow cytometry for reflecting the level of mitochondrial inner transmembrane potential (ΔΨm) depolarization.Results Compared with control group, the ATP concentration in thrombin-treated group was decreased obviously [relative light unit (RLU): (5.46±0.14)×105 vs. (6.25±0.26)×105,P< 0.05], Annexin V positive ratio [(50.43±2.45)% vs. (1.58±0.25)%,P< 0.05] and caspase-3 activity [RLU: (26.92±1.60)×103 vs. (1.30±0.10) ×103,P< 0.05] were increased obviously, and platelets MCF was lowered significantly [(8.32±0.58)×104 vs. (13.05±1.10)×104,P< 0.05], suggesting an increase inΔΨm depolarization. After being treated with different concentrations of LPS, ATP concentration, Annexin V positive ratio and caspase-3 activity were increased obviously, platelet MCF was decreased obviously, suggestingΔΨm depolarization was increased in a concentration-dependent manner. Compared with control group, 1μg/mL LPS could increase Annexin V positive ratio [(10.45±1.08)% vs. (1.58±0.25)%,P< 0.05], elevate caspase-3 activity [RLU: (14.06±0.61)×103 vs. (1.30±0.10)×103,P< 0.05], and decrease MCF significantly [(9.48±0.50)×104 vs. (13.05±1.10)×104,P< 0.05]. The ATP concentration, Annexin V positive ratio and caspase-3 activity reached maximum levels after the treatment with 100μg/mL LPS, and they were higher obviously than those of the control group [ATP (RLU): (7.00±0.03)×105 vs. (6.25±0.26)×105, Annexin V positive ratio: (55.35±2.42)% vs. (1.58±0.25)%, casepase-3 (RLU): (32.00±3.75)×103 vs. (1.30± 0.10)×103, allP< 0.05], and platelets MCF reached trough levels, and they were obviously lower than those of the control group [(4.69±0.55)×104 vs. (13.05±1.10)×104,P< 0.05].ConclusionE.coli LPS can induce an increase in ATP, PS exposure,ΔΨm depolarization and activity increase of caspase-3 on mouse platelet in vitro, which indicate that LPS can induce apoptosis of platelets in a concentration-dependent manner.

A study on protective effects of epigallocatechin gallate on encephaledema following traumatic brain injury in rats / 中国中西医结合急救杂志

Objective To observe the inhibitory effect of epigallocatechin gallate (EGCG) on encephaledema following traumatic brain injury (TBI) in rats and its mechanism.Methods 200 Wistar rats were randomly divided into three groups: sham operation (n= 20), model (n= 90) and EGCG (n= 90) groups. The classic Feeney free fall drop method was used to establish the model of TBI. In EGCG group, intraperitoneal injection of EGCG in normal saline 100 mg/kg (10 mL/kg) was immediately given to the rats after model establishment, and in model group, equal amount of normal saline was administered with the same method, once 24 hours for 2 days in all the groups. At 24, 48, and 72 hours after the administration in various groups, the changes of water content, superoxide dismutase (SOD) activity and malondialdehyde (MDA) level in brain tissues were determined, cerebral vascular permeability was evaluated by evans blue (EB) content in the brain tissues, the changes of expressions of aquaporin-4 (AQP4) and glial fibrillary acidic protein (GFAP) in brain tissues were determined by immunohistochemical and Western Blot, and the cerebral histopathological changes were observed in various groups.Results Compared with sham operation group, the water content, the vascular permeability and MDA level in brain tissues were significantly higher, while the cerebral SOD activity was significant lower in the model group; the scores of cells with positive AQP4 and GFAP expressions (IHC score) were obviously increased at 24 hours and 72 hours after model establishment, and the levels of expressions of AQP4 and GFAPprotein [integral absorbance (IA) value] were markedly enhanced in model group than those in the sham operation group, the changes being more remarkable at 72 hours after model formation [water content in brain tissues: (89.71±0.94)% vs. (78.34±0.87)%, EB content (μg/g): 9.13±0.66 vs. 2.71±0.72, SOD activity (U/mg): 63.53±12.57 vs. 130.85±9.91, MDA (nmol/mg): 10.19±1.47 vs. 4.57±0.74, IHC score of AQP4: 8.81±1.75 vs. 2.76±0.82, IHC score of GFAP: 9.47±1.32 vs. 6.71±0.52, expression of AQP4 protein (IA value): 1.53±0.05 vs. 0.42±0.05, expression of GFAP protein (IA value): 1.45±0.05 vs. 0.62±0.04, allP < 0.01]. Compared with the model group, the cerebral water content, MDA, IHC scores and protein expressions of AQP4 and GFAP, and cerebral vascular permeability were significantly decreased, while the SOD activity was obviously increased in the EGCG group, and the changes being more significant at 72 hours after model establishment [water content of brain tissues: (86.59±0.89)%, EB content (μg/g): 7.82±0.32, SOD activity (U/mg): 107.58±10.87, MDA (nmol/mg): 5.61±1.64, IHC score of AQP4: 6.92±0.71, IHC score of GFAP: 6.71±0.52, expression of AQP4 protein (IA value): 1.14±0.06, expression of GFAP protein (IA value): 1.21±0.07, all P < 0.01]. Imunohistochemical assay showed: the cerebral contents of AQP4 and GFAP positive cells in the rats of EGCG group were decreased, and their color became lighter.Conclusion The inhibition of EGCG on encephaledema following TBI in rats is related to its effects of decreasing the cerebral vascular permeability, enhancing the level of SOD activity, depressing MDA level and the expressions of AQP4 and GFAP.

Effect of WS070117M1 on chronic obstructive pulmonary disease in mice and the underling mechanisms of anti-inflammation / 药学学报

The aim of this study is to investigate the anti-inflammatory effect of the adenosine derivative N6-(3-hydroxylaniline) adenosine (WS070117M1) on cigarette smoke plus LPS (lipopolysaccharide)-induced chronic obstructive pulmonary disease (COPD) in mice and its mechanism. COPD model was established by exposing male BALB/c mice to cigarette smoke and challenged with LPS inhalation. Supernatants of bronchoalveolar lavage fluid (BALF) were harvested and IL-1β, IL-6, IL-8 and TGF-β1 levels were measured by ELISA (enzyme-linked immunesorbent assay). The number of total white blood cells and neutrophils in bronchoalveolar lavage fluid was counted separately. Lung tissue was stained with Mayer 's hematoxylin and eosin for histopathologic examination. pAMPKa protein expression and distribution of lung tissue were analyzed by immunohistochemistry method. In vitro, levels of AMPKα phosphorylation in phorbol-12- myristate-13-acetate (PMA) differentiated THP-1 cells was detected by immunohistochemistry, IL-8 level in supernatants of cigarette smoke condensate stimulating PMA differentiated THP-1 cells was measured by ELISA. The results showed that WS070117M1 treatment significantly activated AMPKa in the lung tissue. It also resulted in down regulation of IL-1β, IL-6, IL-8 and TGF-β1 levels in bronchoalveolar lavage fluid and IL-8 level in cigarette smoke condensate stimulating PMA differentiated THP-1 cells. In addition, WS070117M1 could inhibit the recruitment of total white blood cells and neutrophils. These results suggest that WS070117M1 may alleviate the airway inflammation by activating AMPK in the lung tissue.

Epigallocatechin-3-Gallate (EGCG) Attenuates Traumatic Brain Injury by Inhibition of Edema Formation and Oxidative Stress

Traumatic brain injury (TBI) is a major cause of mortality and long-term disability, which can decrease quality of life. In spite of numerous studies suggesting that Epigallocatechin-3-gallate (EGCG) has been used as a therapeutic agent for a broad range of disorders, the effect of EGCG on TBI remains unknown. In this study, a weight drop model was established to evaluate the therapeutic potential of EGCG on TBI. Rats were administered with 100 mg/kg EGCG or PBS intraperitoneally. At different times following trauma, rats were sacrificed for analysis. It was found that EGCG (100 mg/kg, i.p.) treatment significantly reduced brain water content and vascular permeability at 12, 24, 48, 72 hour after TBI. Real-time PCR results revealed that EGCG inhibited TBI-induced IL-1beta and TNF-alpha mRNA expression. Importantly, CD68 mRNA expression decreasing in the brain suggested that EGCG inhibited microglia activation. Western blotting and immunohistochemistry results showed that administering of EGCG significantly inhibited the levels of aquaporin-4 (AQP4) and glial fibrillary acidic protein (GFAP) expression. TBI-induced oxidative stress was remarkably impaired by EGCG treatment, which elevated the activities of SOD and GSH-PX. Conversely, EGCG significantly reduced the contents of MDA after TBI. In addition, EGCG decreased TBI-induced NADPH oxidase activation through inhibition of p47phox translocation from cytoplasm to plasma membrane. These data demonstrate that EGCG treatment may be an effective therapeutic strategy for TBI and the underlying mechanism involves inhibition of oxidative stress.

Effect of Grape Seed Proanthocyanidin Extract on Ultrastructure Injury in Hippocampous and Cognition Impairment in Rats of Obstructive Sleep Apnea Hypoxia / 中国康复理论与实践

@#Objective To investigate the effect of grape seed proanthocyanidin extract (GSPE) on ultrastructure injury in hippocampous and cognition impairment in rat model of obstructive sleep apnea hypoxia. Methods 80 male Sprague-Dawley rats were randomly divided into control group, model group, high and low dose GSPE groups. The control group was exposed in air, while the model group was suffered from intermittent hypoxia conditions (50 ml/L, 8 h everyday, for 2 or 6 weeks), and the GSPE groups accepted GSPE 200 mg/kg or 100 mg/kg 2 weeks respectively before hypoxia. Pathology in hippocampal region was observed under electromicroscope. Malondialdehyde (MDA) contents and superoxide dismutase (SOD) activity were detected with colorimetry, and apoptotic cells were measured with TUNEL. The cognition function of rats was assessed with the Morris water maze (MWM). Results The ultrastructure in hippocampous was significantly injured,with the increase of MDA and decrease of SOD (P<0.001) in the model group. The apoptotic cells increased (P<0.001). The escaping latency prolonged (P<0.001) and the frequency of crossing the platform decreased (P<0.001) in MWM test in the model group. Compared with the model group, the GSPE groups decreased in MDA content, increased in SOD level, decreased in apoptotic cells and ultrastructure damages, shortened the escaping latency, and increased the frequency of crossing the platform (P<0.001), especially in the high dose group (P<0.05). Conclusion GSPE can relieve the damage of ultrastructure and improve cognition function after obstructive sleep apnea hypoxia in rats.

Analysis of Prognostic Risk Factors in Patients with Community Acquired Pneumonia Complicated with Acute Kidney Injury / 天津医药

Objective To explore clinical characteristics and prognostic risk factors in patients with community ac-quired pneumonia(CAP)complicated with acute kidney injury(AKI).Methods In total, 456 CAP patients were included based on the diagnostic guide.According to whether the patients were accompanied with AKI,the patients were divided in-to two groups(non-AKI group and AKI group). AKI group were further divided into risk group, injury group and failure group by RIFLE criteria using admission creatinine.Severity in CAP patients,clinical indexes and prognostic evaluation in-dexes were compared between different groups. Multiple factors were analyzed using Logistic regression model,survival analysis were examined by Kaplan-Meier, which analyzed the risk factors of poor prognosis in CAP patients and the role of RIFLE criteria in prognostic evaluation. Results Thirty percent(135)of the total 456 CAP patients were accompanied with AKI. Patients in AKI group were further divided into risked group (45.2%, 61 patients), injury group (17%, 23 pa-tients) and failure group (37.8%, 51 patients) according to the RIFLE diagnostic criteria using basal creatinine level. Among the 300 patients with PSI gradeⅠtoⅢ,23.3%(70)of patients developed AKI while among 156 patients who are with PSI gradeⅣor over, 65 patients (41.7%) developed AKI(P<0.01).The 30-day mortality of CAP patients accompanied with AKI were increased compared to Non-AKI group(Non-AKI:6.2%;Risk:14.8%;Injury:21.7%;Failure:45.1%).With de-teriorating in RIFLE criteria,the portion of patients who required mechanical ventilation, inotropic support(MV/IS)and re-nal replacement therapy(RRT)increased too. Logistic analysis revealed that AKI,age of 75 years or older and extra-renal or-gan failure were the risk factors of poor prognosis in patients with CAP. The rate of survivors was decreased in the CAP pa-tients accompanied with AKI compared with those who did not.Conclusion There is certain incidence of AKI to compli-cate CAP patients who will have a poor prognosis.RIFLE diagnostic criteria is a valuable tool to evaluate prognosis of CAP patients complicated with AKI.

Hpyerglycemic Effect of Arctiin in db/db Mice with Spontaneous Diabetes / 中国药师

Objective:To investigate the hpyerglycemic action of arctiin in db/db mice with spontaneous diabetes and the underly-ing mechanism. Methods:Totally 40 db/db mice were randomly divided into five groups: the model control group, arctiin group re-spectively with the dose of 75, 150, 300 mg·kg-1 , 300 mg·kg-1 metformin group. The age-matched db/m mice were selected as the normal control group. The mice were administered with corresponding drugs or solvent by gavage for 4 weeks. The oral glucose tol-erance test was carried out at the end of the 3rd week. After the 4-week treatment, all the mice were fasted overnight (12h), and then the body weight and fasting blood glucose ( FBG ) were determined. The concentration of insulin ( INS ) , glycated serum protein ( GSP) , triglyceride ( TG) , total cholesterol ( TC) and adiponection ( APN) were detected. Results:Arctiin could significantly lower the body weight and FBG, improve the glucose tolerance, decrease the serum concentration of INS, GSP, TG, TC and APN(P<0. 05 or 0. 01). Conclusion:Arctiin has benefit effects against glucose/lipid metabolism disorder and insulin resistance in db/db diabetic mice. The mechanism may be related to up-regulating the expression of adiponection.

Influence of dihydroxy-stilbene compound Vam3 on ATP-induced inflammatory response in macrophages and the underlying mechanisms / 中国药理学通报

Aim To investigate the effects of Vam3 on ATP-induced inflammatory response in macrophages and the underlying mechanisms. Methods LPS primed mouse peritoneal macrophages were stimulated with ATP,and IL-1βlevel in supernatants was meas-ured by ELISA.Activity of caspase 1 was measured u-sing caspase 1 activity assay kit.Reactive oxygen spe-cies (ROS )level was detected with fluorescent probe DCFH-DA.MTT assay was used to detect cell prolifer-ation,and intracellular Ca2+concentration was meas-ured using laser scanning confocal microscope.Results Extracellular ATP led to increase in IL-1βrelease, caspase 1 activity and ROS production.It also led to rapid increase in intracellular Ca2+concentration and induced cell death.These effects were inhibited by Vam3 .Conclusion Vam3 inhibits ATP-induced in-flammatory response in macrophages,which may sug-gest the blocking effect of Vam3 on caspase 1 ~IL-1βinflammatory signaling pathway in macrophages.

Advance in the research on P2X7 and inflammatory respiratory diseases / 药学学报

P2X7 is the most important subtype of the ATP receptors known so far. Recent investigations showed that the downstream signaling pathway of P2X7 is coupled with several key inflammatory molecules including IL-1beta and IL-18, this suggests P2X7 might have roles in the inflammatory diseases. Moreover, attenuation of P2X7 by selective antagonists in vitro and knockout mice in vivo reducing the inflammatory response indicated that P2X7 is a potential therapeutic target for inflammatory diseases. However, most previous studies on P2X7 were focused on nerve system diseases most, while its effects in inflammatory respiratory diseases, especially in asthma, chronic obstructive pulmonary disease (COPD) and lung cancer have been poorly investigated. In this paper, we reviewed the research progress on the structure, distribution, biological activities of P2X7 and its relationship with inflammatory respiratory diseases including asthma, COPD and lung cancer, along with the development of P2X7 antagonist as therapeutics.

Efficacy training for the recovery of memory and executive function after stroke / 中华物理医学与康复杂志

Objective To explore the influence of self-efficacy training on the memory and executive function of patients with ischemic stroke in the recovery stage.Methods A total of 80 cases were randomly divided into a self-efficacy training group and a control group,with 40 cases in each.The control group was given routine cognitive therapy,while the self-efficacy group was given cognitive interventions plus efficacy training.Before training and after training for 3 months,self-efficacy levels were examined using the general self-efficacy scale (GSES),memory and executive function were measured using the Behavioral Assessment of Dysexecutive Syndrome (BADS) and the Wechsler Memory Scale (WMS).Anxiety and depression were evaluated using the Self-rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS).Results Inter-group comparison showed no significant differences in terms of GSES or BADS scores before treatment between the control and self-efficacy groups.After training,the total GSES and BADS scores in both groups were significantly higher than before.Both the average GSES and BADS scores in the self-efficacy group were significantly higher than in the control group.There were similarly no significant differences in WMS scores before treatment,but after training the WMS results were significantly better in the self-efficacy training group than in the control group.After training,the SDS and SAS scores had improved to a significantly greater extent in the self-efficacy group than in the control group.Conclusion Self-efficacy training can facilitate the recovery of memory and promote executive function in patients with ischemic stroke.

Effect of grape seed proanthocyanidin on mitochondrial injury in hippocampus and cognition impairment in a rat model of obstructive sleep apnea hypoxia / 中华行为医学与脑科学杂志

Objective To investigate the effects of grape seed proanthocyanidin(GSPE) on mitochondrial injury in hippocampus and learning-memory impairment after obstructive sleep apnea hypoxia in rats.Methods Male SD rats(n=80) were randomly divided into control group,model group,low dose of GSPE treatment group and high dose of GSPE treatment group.Rats in control group were exposed in air,the model group were suffered from intermittent hypoxia conditions (50 ml/L,8-hour-intermittent hypoxia everyday,and the duration of experiment 2 and 6 weeks,respectively).Mitochondrion pathology in hippocampal region was observed using electron microscope;malondialdehyde (MDA) contents and superoxide dismutase activity were detected by colorimetry and apoptotic cells was measured by TUNEL method.The cognitive function of rats in each group was assessed with the Morris water maze (MWM).Results After hypoxia,mitochondrion was significantly injured.The MDA contents were increased(79.86 ± 2.52,88.26 ± 2.86) and SOD level decreased (70.67 ± 6.70,64.26 ± 7.86).The number of neural apoptotic cells was significantly enhanced (9.68 ± 0.79,15.9 ± 2.92).MWM test showed that the escaping latency was prolonged and the frequency of crossing the platform was decreased (P ＜ 0.05).Compared with that in the model group,low dose of GSPE decreased MDA contents (76.38 ± 1.96,82.16 ±2.02),increased SOD level(76.20 ± 6.86,70.58 ± 6.86),and decreased apoptotic cells (6.60 ± 0.69,9.54 ±1.36).MWM test showed that the escaping latency was shortened and the frequency of crossing the platform was increased in GSPE treatment groups(P ＜ 0.05).Compared with low dose of GSPE,high dose of GSPE decreased MDA contents increased SOD level and decreased apoptotic cells.MWM test showed that the escaping latency was shortened and the frequency of crossing the platform was increased (P＜ 0.05).Conclusion GSPE can attenuate mitochondrial injury and improve learning-memory function after obstructive sleep apnea hypoxia.