Effects of Nintedanib associated with Shenfu Injection on paraquat-induced lung injury in rats / 中华劳动卫生职业病杂志

Objective: To study the effects of Nintedanib associated with Shenfu Injection on lung injury induced by paraquat (PQ) intoxication. Methods: In September 2021, a total of 90 SD rats were divided into 5 groups in random, namely control group, PQ poisoning group, Shenfu Injection group, Nintedanib group and associated group, 18 rats in each group. Normal saline was given by gavage route to rats of control group, 20% PQ (80 mg/kg) was administered by gavage route to rats of other four groups. 6 hours after PQ gavage, Shenfu Injection group (12 ml/kg Shenfu Injection), Nintedanib group (60 mg/kg Nintedanib) and associated group (12 ml/kg Shenfu Injection and 60 mg/kg Nintedanib) were administered with medicine once a day. The levels of serum transforming growth factor beta1 (TGF-β1), interleukin-1 beta (IL-1β) were determined at 1, 3 and 7 d, respectively. The pathological changes of lung tissue, the ratio of wet weight and dry weight (W/D) of lung tissue, the levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in lung tissue were observed and determined after 7 d. Western blot was used to analyse the expression levels of fibroblast growth factor receptor 1 (FGFR1), platelet derivation growth factor receptor alpha (PDGFRα), vascular endothelial growth factor receptor 2 (VEGFR2) in lung tissue after 7 d. Results: The levels of TGF-β1, IL-1β in all poisoning groups went up first and then went down. The levels of TGF-β1, IL-1β in associated group at 1, 3, 7 d were lower than that of PQ poisoning group, Shenfu Injection group and Nintedanib group at the same point (P<0.05). Pathological changes of lung tissue under the light microscopes showed that the degrees of hemorrhage, effusion and infiltration of inflammatory cells inside the alveolar space of Shenfu Injection group, Nintedanib group and associated group were milder than that of PQ poisoning group, and the midest in associated group. Compared with control group, the W/D of lung tissue was higher, the level of MDA in lung tissue was higher, while the level of SOD was lower, the expressions of FGFR1, PDGFRα and VEGFR2 in lung tissue were higher in PQ poisoning group (P<0.05). Compared with PQ poisoning group, Shenfu Injection group and Nintedanib group, the W/D of lung tissue was lower, the level of MDA in lung tissue was lower, while the level of SOD was higher, the expressions of FGFR1, PDGFRα and VEGFR2 in lung tissue were lower in associated group (P<0.05) . Conclusion: Nintedanib associated with Shenfu Injection can relieve lung injury of rats induced by PQ, which may be related to Nintedanib associated with Shenfu Injection can inhibit the activation of TGF-β1 and the expressions of FGFR1, PDGFRα, VEGFR2 in lung tissue of rats.

Mechanism of chlorogenic acid reducing lipopolysaccharide-induced acute lung injury in mice by regulating miR-223/NLRP3 axis / 中南大学学报(医学版)

OBJECTIVES@#Chlorogenic acid has various physiological activities such as antibacterial, anti-inflammatory, and antiviral activities. Studies have shown that chlorogenic acid can alleviate the inflammatory response of mice with acute lung injury (ALI), but the specific mechanism is still unclear. This study aims to investigate whether chlorogenic acid attenuates lipopolysaccharide (LPS)-induced ALI in mice by regulating the microRNA-223 (miR-223)/nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) axis.@*METHODS@#SPF grade BALBc male mice were randomly divided into a control group, a model group, a chlorogenic acid group, a chlorogenic acid+miR-223 negative control (miR-223 NC) group, and a chlorogenic acid+miR-223 inhibitor (miR-223 antagomir) group, 10 mice in each group. Except the control group, the other groups were instilled with 4 mg/kg LPS through the airway to establish the ALI mouse model. After the modeling, the mice in the chlorogenic acid group were continuously given chlorogenic acid (100 mg/kg) by gavage for 7 d. The chlorogenic acid+miR-223 NC group and the chlorogenic acid+miR-223 antagomir group were given 100 mg/kg chlorogenic acid by gavage every day, and then were injected with 10 μL of miR-223 NC (0.5 nmol/μL) and miR-223 antagomir (0.5 nmol/μL) respectively for 7 consecutive days.The control group and the model group were replaced with normal saline. The lung tissues of mice were taken to measure the ratios of lung wet to dry weight (W/D). The bronchoalveolar lavage fluid of mice was collected to measure the levels of TNF-α, IL-6, and IL-1β by ELISA kit and to count the number of eosinophils (EOS), lymphocytes, neutrophils under light microscope. After HE staining, the pathological changes of lung tissues were observed and lung injury was scored. qRT-PCR method were used to determine the expression levels of miR-223 in lung tissues. Western blotting was used to determine the expression levels of NLRP3 protein in mouse lung tissues. Luciferase reporter assay was used to analyze the targeting relationship of miR-223 to NLRP3.@*RESULTS@#Compared with the control group, the lung W/D value, the lung injury score and the level of inflammatory factors in the bronchoalveolar lavage fluid were significantly increased in the model group (all P<0.05); the infiltration of inflammatory cells in the lung tissue was severe; the alveolar space was significantly increased; the alveolar wall was significantly thickened; the number of EOS, lymphocytes, and neutrophils in the bronchoalveolar lavage fluid was significantly increased (all P<0.05); the expression levels of miR-223 in lung tissue were significantly decreased (P<0.05); and the protein expression levels of NLRP3 were significantly increased (P<0.05). Compared with the model group, the W/D value of lungs, lung injury score, and levels of inflammatory factors in bronchoalveolar lavage fluid were significantly decreased in the chlorogenic acid group, the chlorogenic acid+miR-223 NC group, and the chlorogenic acid+miR-223 antagomir group (all P<0.05); lung tissues damage was alleviated; the numbers of EOS, lymphocytes, and neutrophils in bronchoalveolar lavage fluid were significantly decreased (all P<0.05); the expression levels of miR-223 in lung tissues were significantly increased (P<0.05); and the expression levels of NLRP3 protein were significantly decreased (P<0.05). Compared with the chlorogenic acid group, the lung W/D value, lung injury score, and inflammatory factor levels in the bronchoalveolar lavage fluid were significantly increased in the chlorogenic acid+miR-223 antagomir group (all P<0.05); lung tissue damage was aggravated; the number of EOS, lymphocytes and neutrophils in bronchoalveolar lavage fluid significantly increased (all P<0.05); the expression levels of miR-223 in lung tissues were significantly decreased (P<0.05); and the expression levels of NLRP3 protein were significantly increased (P<0.05). The results of luciferase reporter assay showed that miR-223 had a targeting relationship with NLRP3.@*CONCLUSIONS@#Chlorogenic acid may increase the level of miR-223, target the inhibition of NLRP3 expression, reduce LPS-induced inflammatory response in ALI mice, and alleviate pathological damage of lung tissues.

Simultaneous Determination of Pyrrolidine Alkaloids and Their Nitrogen Oxides in Farfarae Flos by UPLC-MS/MS / 中国实验方剂学杂志

<b>Objective::To establish an ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for the simultaneous determination of 15 pyrrolidine alkaloids (PAs) and their nitrogen oxides, and determine the content of the 15 PAs in the 15 batches of Farfarae Flos samples obtained from different sources, in order to understand the distribution status of these 15 PAs in Farfarae Flos from different sources, and provide relevant references for the safe and rational use of this medicinal materials. <b>Method::The method was achieved by Agilent Eclipse Plus C₁₈ column (3.0 mm×150 mm, 1.8 μm) using a mobile phase made up of 0.05%formic acid and 2.5 mmol·L^-1 ammonium formate in water (A)-0.05%formic acid and 2.5 mmol·L^-1 ammonium formate in methanol(B). The flow rate and the injection volume were 0.4 mL·min^-1 and 2 μL, respectively. The column temperature was 40 ℃. The instrument was Agilent 1290-6470 QQQ ultra high performance liquid chromatography-triple quaternary bar mass spectrometer. The components were detected in multiple reaction monitoring mode by mass spectrometry with ionizationmode of ESI⁺. The content of the components measured in the samples was calculated by using the external standard method, and the difference between samples was analyzed based on RSD of different components. <b>Result::The established method had a high sensitivity and good separation degree. The results of methodological investigation met the requirements. The results showed that all of the 15 batches of Farfarae Flos contained PAs and their nitrogen oxides. These PAs had almost the same types of structure. There were significant differences in the content and distribution of PAs in Farfarae Flos obtained from different sources. <b>Conclusion::In general, Farfarae Flos contains pyrrolidine alkaloids and their nitrogen oxides. Senkirkine with a significant hepatotoxicity is the main compound. The content determination of PAs will provide scientific fundaments for the safe and effective use of Farfarae Flos.

Effects of vascular endothelial growth factor combined with platelet-derived growth factor-bb on the angiogenic and proliferative abilities of bone marrow mesenchymal stem cells / 中国组织工程研究

BACKGROUND: Bone tissue engineering provides a new path to treat critical-sized bone defects. However, a stable osteogenesis and osseointegration can only be insured via formation of an intact vascular network, which can achieve satisfactory therapeutic effects. Thereafter, angiogenesis is a challenge and difficulty in bone tissue engineering. OBJECTIVE: To investigate the effect of combined application of vascular endothelial growth factor (VEGF) and platelet-derived growth factor-BB (PDGF-BB) on proliferation and angiogenesis of bone marrow mesenchymal stem cells. METHODS: Bone marrow mesenchymal stem cells from Sprague-Dawley rats were cultured and isolated in vitro, and interfered with different concentrations of VEGF (20, 40, 60, 80, 100, 120 μg/L) and PDGF-BB (20, 40, 60, 80, 100, 120 μg/L) in combination or 100 μg/L VEGF, and 100 μg/L PDGF-BB alone. The optimum concentration of promoting cell proliferation was detected by cell counting kit-8 assay. The expression levels of angiopoietin-1, hypoxia-inducible factor-1α, hepatocyte growth factor and insulin-like growth factor were detected by RT-PCR at 7 and 14 days after intervention. RESULTS AND CONCLUSION: (1) After growth factors were added, the cell proliferative ability was significantly improved, and combined application revealed better effect. The optimal concentration grou was 80 μg/L VEGF+80 μg/L PDGF-BB. (2) Both VEGF and PDGF-BB could promote the mRNA expression levels of angiopoietin-1, hypoxia-inducible factor-1α, hepatocyte growth factor and insulin-like growth factor, and the effect was more obvious in combined application. (3) The mRNA expression levels of hypoxia-inducible factor-1α and hepatocyte growth factor were significantly increased with time (P < 0.05). The mRNA expression levels of angiopoietin-1 and insulin-like growth factor were significantly decreased with time (P < 0.05). (4) In vitro experimental results suggest that VEGF and PDGF-BB at the concentration of 80 μg/L can consistently promote angiogenesis, and the effect of combined application is better than that of single application.

Effect of Shaoyaotang on Expressions of AP-1 and TNF-α in Colon of Rats with Hygrothermal Ulcerative Colitis / 中国实验方剂学杂志

Objective: To observe the effect of Shaoyaotang on mRNA and protein expressions of colon tissue activated protein-1 (AP-1) and tumor necrosis factor-α (TNF-α) of hot and humid-type intrinsic ulcerative colitis (UC) model in rats, in order to explore the mechanism of action of herbaceous peony decoction in the treatment of UC. Method: Totally 60 Wistar rats were randomly divided into blank group, model group, SASP group, and low, medium and high-dose Shaoyaotang groups. The damp-heat intrinsic UC rat model was replicated based on integrated disease and syndrome, namely, high-fat and high-sugar spicy food and immune complex method combined with 2,4,6-trinitrobenzene sulfolnic acid (TNBS) and ethanol complex method. After the successful modeling, low, medium and high-dose Shaoyaotang (6, 12, 24 g·kg-1) was given by gavage, and 1 g·kg-1 dose of salazol sulfadiazine was given to by gavage. The blank group was given constant volume normal saline for 21 d. Real-time fluorescence quantitative polymerase chain reaction(Real-time PCR) was used to detect mRNA expressions of AP-1 and TNF-α in colon tissues, and Western blot was used to detect protein expressions of AP-1 and TNF-α in colon tissues. Result: Compared with the blank group, relative mRNA and protein expressions of AP-1, TNF-α in the model group were significantly increased (Pα in the treatment groups were significantly decreased (PConclusion: Shaoyaotang can inhibit the expression of TNF-α and stimulate AP-1 protein expression in rats with damp-heat UC.

The comparison of robot-assisted laparoscopic and open pyelolithotomy in the management of nonstaghorn renal calculi larger than 2 cm / 复旦学报（医学版）

Objective To investigate the feasibility and safety of robot-assisted laparoscopic pyelolithotomy (RALPL) as the surgical management for nonstaghorn renal calculi larger than 2 cm. Methods Among the patients admitted to our hospital for nonstaghorn renal calculi larger than 2 cm between Jun. ,2013 and Jun. ,2017, a retrospective analysis was performed on the treatment outcome of patients undergoing RALPL (48 cases) and open pyelolithotomy (OPL) (44 cases). The initial stone-free rate, mean operating time, hemoglobin drop, off-bed activity time and hospital stay were compared between two groups. Results Compared with OPL group, RALPL group had a higher initial stone-free rate (91. 66% vs. 70.45%, P < 0.05), and had significant lesser hemoglobin drop, shorter operating time, off-bed activity time and hospital stay. There was no ClavienⅡ or above complications in RALPL group, but there were 2 cases of ClavienⅡcomplications in OPL group. Conclusions Transperitoneal approach RALPL has a better visual angle to observe renal pelvis and calyces, and can ensure a higher initial stone-free rate under the conditions of low intrarenal pelvic pressure and leaving renal parenchyma and vessels intact. RALPL is a minimally invasive, effective and safe treatment, and is an alternative indication for renal calculi larger than 2 cm (including renal pelvis stones with accompanying renal calyceal stones).

Use of double lumen microcatheter in interventional treatment of chronic total occlusion lesions at bifurcation / 中国介入心脏病学杂志

Objective To evaluate the efficacy and safety of double lumen microcatheters in chronic coronary artery total occlusion(CTO)lesions at bifurcation during percutaneous coronary intervention(PCI).Methods From October 2013 to March 2015,we retrospectively analysed the application of double lumen microcatheter with bifurcation CTO lesions and reviewed the patients' clinical features,coronary angiography,intervention operation success rate,complications rates and incidence of major adverse cardiac events(including all-cause death,nonfatal myocardial infarction and target vascular remodeling).Results Twenty-three CTO lesions at bifurcation were treated with double lumen microcatheters,stenting were performed in 21 lesions and 2 lesions only received PTCA due to small blood vessel size.The operation success rate was 100％.All the 11 right coronary lesions and 3 left coronary lesions were managed using single stenting technique.Double stenting strategy was used in 9 left coronary lesions including 4 cases with mini-crush technique,4 cases with modified culottes technique and one case with modified T technique.All double stenting procedures were completed by kissing balloon expansion.There was no major adverse cardiac event occured during and after operation.Conclusion Double lumen microcatheters are useful in PCI treatment of bifurcation CTO lesions.

Microbial Transformation of Gracillin by Penicillium Lilacinum ACCC 31890 / 中国药师

Objective: To study the biotransformation of gracillin by Penicillium lilacinumACC 31890,to isolate and to identify the structures of metabolites and investigate the pharmacological activities.Methods: The conversion products were isolated and purified by silica gel column chromatography and semi-preparative reversed phase liquid chromatography.Their structures were identified by MS and NMR, and the anti-inflammatory activity of the conversion products was investigated as well.Results: Three metabolites were isolated and purified, and identified as 5R-spirost-5-ene-3-ol-O-β-D-Glucopyranoside-(1→3)-β-D-glucopyranosyl (1), trillin (2) and diosgenin (3) with the conversion rate of 1%, 1% and 45%, respectively.In vitro study showed that the three products showed certain degrees of activity to inhibit the production of NO, IL-6 and MCP-1 in LPS-primed RAW264.7 macrophages.Moreover, the anti-inflammatory activity of the bioconversion products increased along with the hydrolyzation of carbohydrate chain.Diosgenin, the final product, showed the strongest anti-inflammatory activity among the three products.Conclusion: The biotransformation of gracillin by Penicillium lilacinum has a high productivity of diosgenin.The amount of glycosyls has notable influence on the anti-inflammatory activity of steroid sapoinin.

Effects of Compound Musk Injection Combined with Edaravone on Coagulation and Neurological Func-tion of Patients with Traumatic Brain Injury / 中国药房

OBJECTIVE:To investigate the effects and safety of Compound musk injection combined with edaravone on coag-ulation and neurological function of patients with traumatic brain injury. METHODS:A total of 84 patients with traumatic brain in-jury in our hospital during Apr. 2015 to Apr. 2016 were divided into observation group and control group,with 42 cases in each group. Control group was given Edaravone injection 30 mg+0.9% sodium chloride injection 100 mL,bid,ivgtt;observation group was additionally given Compound musk injection 20 mL+0.9% sodium chloride injection 250 mL,qd,ivgtt. Both groups were treated for 4 weeks. NIHSS score,GCS score,the levels of NSE,CRP,PT,APTT and D-dimer,GOS score,the occurrence of ADR were compared between 2 groups before and after treatment. RESULTS:After treatment,NIHSS score of 2 groups decreased significantly,compared to before treatment;the observation group was significantly lower than the control group,with statistical significance (P<0.05). GCS score of 2 groups increased significantly,compared to before treatment;and the observation group was significantly higher than the control group,with statistical significance(P<0.05). The serum levels of NSE,CRP,PT,APTT and D-dimer in 2 groups decreased significantly,compared to before treatment;and the observation group was significantly lower than the control group,with statistical significance(P<0.05). GOS score of observation group was significantly higher than that of control group,with statistical significance(P<0.05). No obvious adverse reaction was found in 2 groups during treatment. CON-CLUSIONS:Compound musk injection combined with edaravone can improve coagulation and neurological function of patients with traumatic brain injury,relieve traumatic brain injury and improve prognosis.

Endovascular treatment of ruptured aneurysms located at anterior communicating artery complex: a sixty-six cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex (ACoAC).</p><p><b>METHODS</b>The data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging (51±8) years. The Hunt-Hess grade at admission were 13 cases with grade Ⅰ, 36 cases with grade Ⅱ, 11 cases with grade Ⅲ, and 6 cases with grade Ⅳ. The most diameter of aneurysms sac: 14 cases less than or equal to 3 mm, 36 cases more than 3 mm but less than or equal to 7 mm, and 16 cases more than 7 mm. The height diameter/neck width ratio: 8 cases with absolute wide neck, 50 cases with relatively wide neck, and 8 cases with narrow neck. There were 28 cases underwent single micro-catheter embolization, 18 cases underwent double micro-catheters embolization, 14 cases underwent stent-assisted embolization and 6 cases underwent balloon-assisted embolization. The patients were followed up for 6 to 12 months and evaluated by modified Rankin score (mRS) and digital subtraction angiography (DSA). The ratio of total embolization, recurrence rate, and time from operation to reexamination of four groups managed by different endovascular treatment were compared by χ(2) test or F test.</p><p><b>RESULTS</b>Sixty cases were totally embolized, 3 cases subtotally embolized, 3 cases incompletely embolized. Mild hemiparalysis and aphasia occurred in 2 cases, and 1 case died of infarction induced by subarachnoid haemorrhage. The mRS at six months after operation were 0 in 31 cases, 1 in 22 cases, 2 in 8 cases, 3 in 2 cases, 4 in 2 cases, 6 in 1 case. All the included cases reexamined the DSA at averaging (7.5±1.0) month post-operatively and 4 cases recurred. There were not significant differences of the ratio of total embolization, recurrence rate, time from operation to reexamination among four groups (all P>0.05).</p><p><b>CONCLUSION</b>The endovascular treatment maybe an ideal management for ruptured ACoAC aneurysms.</p>

Comparison of the efficacy and safety of capecitabine or tegafur, gimeracil and oteracil potassium capsules combined with oxaliplatin chemotherapy regimens in the treatment of advanced gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the efficacy and safety of chemotherapy regimens oxaliplatin combined with capecitabine (CAPOX) or oxaliplatin combined with tegafur, gimeracil and oteracil potassium capsules (S-1)(SOX), and to investigate the value of expression of thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) proteins in tumor tissue for predicting the efficacy of CAPOX and SOX regimens in advanced gastric cancer patients.</p><p><b>METHODS</b>A total of 107 newly-diagnosed, stage Ⅲc/Ⅳ gastric cancer patients (no surgical indication, ECOG performance scores 0-2 and expected survival time ≥3 months) were recruited with 101 patients evaluated. The patients were randomly divided into two groups. One was study group in which the patients received CAPOX regimen. The other was control group received SOX regimen. Each patient received four cycles, at least two cycles chemotherapy every three weeks and followed up until death or lost. Tumor biopsies were obtained by gastroscopy for immunohistochemical examination of the expression of TP and DPD proteins before chemotherapy. Response rate (ORR), overall survival (OS) and time to tumor progression (TTP) of the patients were assessed.</p><p><b>RESULTS</b>The objective response rate (ORR) of the study and control groups was 49.0% (5/51) vs. 46.0% (23/50), respectively (P>0.05). The overall survival (OS) was 357.36±24.69 days in the study group and 349.87±22.63 days in the control group, and the time-to-progression (TTP) was 216.75±19.32 days in the study group and 220.54±18.47 days in the control group (P>0.05 for both). Stratified analysis showed that the ORR of TP-positive patients in the study group was significantly higher than that in the control group (72.0 % vs. 41.7 %, P=0.032). There was no significant difference in ORR between the TP-negative patients in the study and control groups (26.9% vs. 50.0%, P=0.087), while the ORR of DPD-positive patients in the control group was significantly higher than that of the study group (51.9% vs. 34.6%, P=0.046). There was no significant difference in the ORR between DPD-negative patients in the study and control groups (64.0% vs. 39.1%, P=0.084). The follow-up showed that the OS (378.42±22.56 days) and TTP (271.77±24.92 days) in the TP-positive patients of the study group were significantly longer than those of the control group (OS: 326.57±19.84 days, and TTP: 229.13±22.68 days)( P<0.05). The OS was 371.25±23.97 days and TTP was 264.66±21.36 days in the DPD-positive patients of control group, significantly longer than those of the study group (OS: 334.73±21.47days, and TTP: 208.58±20.70 days) (P<0.05). But there was no significant difference in the OS and TTP between the TP- and DPD-negative patients in the two groups (P>0.05). In respect of adverse events, both the rates of hematological and non-hematological toxicities were low and similar between the two groups (P>0.05), and well-tolerated by the patients.</p><p><b>CONCLUSIONS</b>Both CAPOX and SOX regimens are effective chemotherapeutic protocols in treatment of patients with advanced gastric cancer. The expression levels of TP and DPD in tumor tissue can be used as a predictive factor for the efficacy of capecitabine or tegafur, gimeracil and oteracil potassium capsules combined with oxaliplatin regimens. CAPOX chemotherapy regimen is more suitable for the TP-positive gastric cancer patients, and SOX regimen is more suitable for the DPS-positive gastric cancer patients.</p>

Vasorelaxant effects of procyanidins on pulmonary artery in vitro / 中国组织工程研究

BACKGROUND: Procyanidins is a kind of polyphenol compounds in regnum vegetable, which is composed of different quantities of catechin and epicatechin. Studies show that procyanidins plays a role on protecting vascular endothelium, scavenging free radicals, resisting platelet aggregation, and reducing capillary permeability. Thus, procyanidins has obviously functions of reducing blood pressure, anti-oxidant activity, anti-edema, preventing coronary heart disease and atherosclerosis. OBJECTIVE: To study the vasorelaxant effect of procyanidins on pulmonic rings and its mechanisms. METHODS: Rabbit thoracic pulmonary arteries were isolated. Pre-contracted with noradrenalin (1×10-6 mol/L) and their responses to different concentrations of procyanidins (0.625, 1.25, 2.5 mg/L) were investigated. After removal of the endothelium of pulmonary artery smooth muscle, the effects of different signaling pathway inhibitors on procyanidins-induced relaxation, including nitric oxide synthase inhibitor Nω-Nitro-L-arginine (1×10-4 mol/L), methylene blue (1×10-5 mol/L), prostaglandin synthase inhibitor indomethacin (1×10-5 mol/L) and blockage of the adrenergicβ-receptor propranolol (1×10-5 mol/L), were also assessed. RESULTS AND CONCLUSION: (1) Procyanidins did not change the resting tension of rabbit’s pulmonic rings, but caused an obvious dose-dependent relaxation in 1×10-6 mol/L noradrenalin-precontracted pulmonic rings (r=0.69, P < 0.001). (2) The relaxant effect of procyanidins was significantly reduced by removal of endothelium or by treatment with either Nω-Nitro-L-arginine or methylene blue, but not by treatment with prostaglandin synthase inhibitor or blockage of the adrenergic β-receptor. (3) Procyanidins (20 mg/L) dropped the dose-effect curves of noradrenalin, KCl and on pulmonic rings denuded endothelium. Moreover, affinity index of noradrenalin, KCl and CaCl2 decreased (P < 0.01). (4) Procyanidins also inhibited the vasoconstriction caused by noradrenalin in the first phase, but had no impact on the constriction induced by CaCl2 in the second phase. (5) Procyanidins has an endothelium-dependent vasorelaxation on isolated rabbit’s pulmonic rings, which is possibly mediated by nitric oxide/cyclic guanosine monophosphate pathways. Procyanidins blocked receptor-operated and voltage-dependent calcium channels to reduce intracel ular Ca2+, and induced vasorelaxation.

Prehospital Identification of Stroke Subtypes in Chinese Rural Areas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Differentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes.</p><p><b>METHODS</b>From 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.</p><p><b>RESULTS</b>Among the 1989 patients, 797, 689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure ≥180 mmHg, and age <65 years were more typical of ICH. For noncomatose stroke patients, Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%.</p><p><b>CONCLUSIONS</b>The model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.</p>

Comparison of outcomes in laparoscopic radical prostatectomy and open radical prostatectomy / 中华泌尿外科杂志

Objective To compare outcomes of laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP) performed in our hospital.Methods A non-randomized,retrospective comparative study was performed to analysis 302 prostate cancer patients from January 2011 to June 2014.One hundred and ten patients underwent LRP and 192 underwent ORP.There were no significant differences between the LRP and ORP groups with respect to patient age,body mass index,PSA level,Gleason Score,clinical T stage and transrectal ultrasonography prostate volume (P ＞ 0.05).The operating time,estimated blood loss,catheter retaining time,hospital stay time,positive surgical margin rate and urinary control rate were compared between the 2 groups.Results The median operative time of the ORP group and the LRP group was 95 min and 120 min,the difference between groups was significant (P ＜ 0.01).The median duration of hospitalization of the 2 groups was 9 d and 6 d,the difference between groups was significant (P＜0.01).ORP group and LRP group's estimated blood loss was 350 ml and 250 ml.Days of tube drainage were 3 d in both groups.Days of urinary catheterization drainage after surgery were 16 d and 15 d,respectively.Positive margin rate was 10.4％ and 12.7％.Urinary continence recovery rates at 3 month were 80.2％ and 70.8％.Urinary continence recovery rates at 6 month were 85.9％ and 87.3％.No significant difference was observed in the above index (P ＞ 0.05).Conclusions Compared with ORP,LRP has shorter hospital stay time and longer operating time.Both LRP and ORP have good outcomes in oncological control and function rehabilitation.Both of them are important procedures to treat localized prostate cancer.

Clinical experience in classification, diagnosis, and treatment for Wunderlich syndrome / 中华泌尿外科杂志

Objective To explore the clinical features, diagnosis and treatment of Wunderlich syndrome (WS).Methods Fifteen patients with WS were included from September 2008 to February 2014, and their clinical features, diagnosis and treatment were retrospectively reviewed.The most common clinical manifestations were flank or abdominal pain (15/15), hypovolemic shock (5/15), gross hematuria (4/15) and percussion pain on kidney region ( 15/15 ) .Laboratory tests showed anemia ( 9/15 ) and coagulation abnormalities (5/15).Five of 15 cases were critical patients with moderate to severe shock ( systolic blood pressure≤90 mmHg, 1 mmHg =0.133 kPa ) accompanied with severe anemia ( Hb <60 g/L ) and coagulation abnormalities.Results In the acute stage, the diagnostic ratios of ultrasonography and contrast enhanced CT for WS were 11/15 and 15/15, and cause determination ratios were 4/15 and 10/15, respectively.The latter was significantly higher than the former ( P <0.05 ) .Contrast enhanced MRI was performed in 5 cases, and the results were identical to those of CT.According to the causes made by emergent imaging, critical patients underwent emergent operations or renal arteriography plus selective arterial embolization, and the other patients underwent conservative management, emergency operations, or renal arteriography plus selective arterial embolization, respectively.The causes of WS included angiomyolipoma (8 cases), renal cell carcinoma (3 cases), metastatic tumor of lung cancer (1 case) and renal cyst (3 cases) in this study.The mean follow-up period was 34 months.One critical patient died, and all the other patients were cured or relieved.Conclusions WS has no specific clinical features.Contrast enhanced CT or MRI is the main approach for diagnosis and cause determination, which is superior to ultrasonography.Treatments for WS vary according to severity classification and imaging diagnosis.

Risk factors of benign anastomostic strictures after esophagectomy with cervical reconstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify the risk factors of benign cervical anastomotic strictures after esophagectomy.</p><p><b>METHODS</b>Clinical data of 946 esophageal cancer patients undergoing esophagectomy with cervical anastomosis between 2003 and 2012 were analyzed retrospectively. Benign stricture was defined as dysphagia for which endoscopic dilation of the anastomosis was needed. Histologically proven malignant stricture was not regarded as benign stricture. χ(2) test and logistic regression model were used for univariate and multivariate analysis respectively.</p><p><b>RESULTS</b>A total of 146 patients(16.5%) developed benign stricture during follow-up. Univariate analysis showed that the patients with cardiovascular disease (P=0.001), diabetes mellitus(P=0.041), gastric tube reconstruction(P=0.050), end-to-end anastomosis (P=0.013), or postoperative anastomotic leakage(P=0.008) had higher stricture rate. Multivariate analysis revealed that cardiovascular disease(P=0.004), gastric tube reconstruction (P=0.026), end-to-end anastomosis(P=0.043), and postoperative anastomotic leakage(P=0.001) were independently predictive factors for development of benign stricture.</p><p><b>CONCLUSIONS</b>The benign cervical stricture rate after esophagetomy with cervical gastric anastomosis is quite high. In order to prevent benign stricture formation, end-to-end anastomosis should be avoid. Blood pressure should be controlled for those with cardiovascular disease. Endoscopic dilation in an earlier stage postoperatively should be considered for those who develop anastomotic leakage.</p>

Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome

OBJECTIVE: To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder. METHODS: Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient. RESULTS: Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle). CONCLUSION: Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture.

Comparison of perioperative outcomes in robot-assisted partial nephrectomy and laparoscopic partial nephrectomy / 中华泌尿外科杂志

Objective To compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) with transperitoneal laparoscopic partial nephrectomy (LPN).Methods From July 2009 to March 2013,114 patients were treated in our hospital due to renal carcinoma,including RAPN in 45 patients and LPN in 69 patients.Their data were retrospectively reviewed.Clinical and pathological variables,R.E.N.A.L nephrometry score,operation time (OT),warm ischemia time (WIT),estimated blood loss (EBL),drainage volume,the length of hospitalization,estimated glomerular filtration rate (eGFR) outcomes,and complications were analyzed.Results There were no significant differences between the RAPN and LPN group with respect to patient age,sex,tumor laterality,size,R.E.N.A.L nephrometry score,the rate of hilar tumor and preoperative eGFR (P＞0.05).The median OT was shorter in the RAPN group than that in LPN group (165 min vs.196 min,P＜0.05).The median WIT was shorter in the RAPN than that in LPN group (21 min vs.25 min,P＜0.05).However,there were no significant differences in the postoperative eGFR and changing of eGFR within the 2 groups (P＞0.05).The rate of transfusion was similar between the RAPN (2/45) and LPN (4/69) group (P=0.72).There was also no significant difference in EBL (P=0.16).The drainage volume was also similar within two groups (167 ml vs.163 ml,P=0.81).The length of hospitalization was more favorable in the RAPN group (6.5 d vs.8.0 d,P=0.01).In RAPN group,27 cases were clear-cell carcinoma,5 cases were papillary cell carcinoma,2 cases were chromophobe cell carcinoma and 1 1 cases were angioleiomyolipoma.In LPN group,45 cases were clear-cell carcinoma,9 cases were papillary cell carcinoma,3 cases were chromophobe cell carcinoma and 12 cases were angioleiomyolipoma.There was no difference of pathological types between LPN and RAPN groups (P＞0.05).The rate of positive surgical margins was 0％ (0/45) in RAPN group and 1.4％ (1/69) in LPN group (P=0.69).The rates of complication requiring intervention (Clavien grade Ⅲ) were 2.2％ (1/45) and 2.9％ (2/69) in the RAPN and LPN group,respectively (P＞0.05).Median follow up was 12 (4-36) months in the RAPN and 13 (5-34) months in the LPN group.No local recurrence or metastasis occurred in two groups.Conclusions Early comparative outcomes suggest that RAPN has a significant benefit over the LPN in terms of OT,WIT and hospital stay.Meanwhile,it offers equivalent prognosis and postoperative renal function preservation compared with LPN.

Relationship between microalbuminuria and severity of acute ischemic stroke and outcomes / 国际脑血管病杂志

Objective To investigate the relationship between microalbuminuria (MAU) and the risk factor for acute ischemic stroke,the severity of the disease and outcomes.Methods A total of 156 consecutive patients with acute ischemic stroke were enrolled prospectively.They were randomly divided into either an MAU positive group (≥ 30 mg/g) or an MAU negative group (＜ 30 mg/g) according to urinary albumin/creatinine ratio (UACR).They were also randomly divided into either a good outcome group (0-2) or a poor outcome group (＞2) according to the modified Rankin scale (mRS) scores.The various demographic and clinical data were compared,and the poor outcome of acute ischemic stroke and the independent factors of positive MAU were analyzes.Results A total of 156 patients with acute ischemic stroke were enrolled,including 84 males and 72 female; aged 53 to 78 years (mean 65.4 ± 6.2); the time from onset to admission was 1.5 to 28 h; 94 patients had good outcomes,62 had poor outcomes,and no one died; MAU was positive in 76 patients and MAU was negative in 80 ones.Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 1.992,95％ confidence interval [CI] 1.108-2.374; P =0.015),complicated with diabetes (OR 2.497,95％ CI 1.177-5.298; P =0.017) and atrial fibrilhtion (OR 2.338,95％ CI 1.062-5.148; P =0.035),high serum homocysteine (Hcy) level (OR 2.541,95％ CI 1.073-6.02; P =0.047) and UACR (OR 2.130,95％ CI 1.396-3.017; P =0.001),MAU positive (OR 3.291,95％ CI 1.681-6.444; P =0.001),high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR 9.196,95％ CI 2.828-19.815; P＜ 0.001) were the independent risk factors for poor outcomes in patients with acute ischemic stroke.There were significant differences in the proportion of the patients complicated with diabetes (P =0.038) and fasting blood glucose level (P =0.025),serum Hey level (P =0.022),and carotid intima-media thickness (IMT) (P =0.019) between the MAU positive group and the MAU negative group.The proportion of anterior circulation infarction was lower (P =0.033),the rates of the baseline NIHSS score (P =0.003) and poor outcome were higher in the MAU positive group (P ＜ 0.001).Multivariate logistic regression analysis showed that increased diabetes (OR 2.237,95％ CI 1.036-4.829; P =0.040) and fasting blood glucose (OR 1.223,95％ CI 1.145-1.673; P =0.027),the increased Hey level (OR 2.542,95％ CI 1.047-6.612; P=0.025),carotid artery IMT (OR 1.295,95％ CI 1.106-1.362; P =0.023) and baseline NIHSS score (OR1.206,95％ CI 1.044-1.219; P =0.023) were correlated independently with the positive MAU in patients with acute ischemic stroke.Conclusions Positive MAU is one of the independent risk factors for poor outcomes of acute ischemic stroke,it is closely associated with some risk factors for acute ischemic stroke,and it has a significant impact on the severity of acute ischemic stroke and outcomes.

Manipulative reduction for lumbar intervertebral disc herniation: a controlled clinical trial / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of manipulative reduction on pain and clinical curative effect in patients with lumbar intervertebral disc herniation.</p><p><b>METHODS</b>Eleven thousands one hundred and twenty-eight patients with lumbar intervertebral disc herniation from our hospital were enrolled from November 1986 to June 2007. They were randomly divided into control group and treatment group. Patients of the control group received lumbar traction and various physiotherapies. Patients of the treatment group received manipulative reduction, besides the treatment in the control group. The treatment was performed once a day,ten times as a course. Curative effects were assessed three courses later. Pain was evaluated by visual analogue scale before and after the treatment.</p><p><b>RESULTS</b>No significant difference in the score of visual analogue scale was found before the treatment in the two groups (P > 0.05). As compared with the score before treatment,it was decreased by 4.73 points after treatment in the control group, and decreased by 6.37 points in the treatment group. The decrease was more significant in the treatment group than the control group (P < 0.01). The healing rate was 47.28% and total effective rate was 96.37% in the control group; The healing rate was 73.44% and total effective rate was 98.61% in the treatment group (P < 0.01).</p><p><b>CONCLUSION</b>Manipulative reduction for lumbar intervertebral disc herniation can remarkably relieve lumbar pain and improve clinical curative effect.</p>