Hedysari Radix Polysaccharide Regulates Apoptosis of Smooth Muscle Cells in Gastric Antrum of Rat Model of Diabetic Gastroparesis via IGF-1/PI3K/Akt Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the effects of Hedysari Radix polysaccharide on the apoptosis of gastric sinus smooth muscle cells and explore the underlying mechanism via the insulin-like growth factor-1 （IGF-1）/phosphatidylinositol 3-kinase （PI3K）/serine-threonine kinase （Akt） pathway in the rat model of diabetic gastroparesis （DGP）. MethodSixty-two Wistar male rats were randomized into a blank group （n=12） and a modelling group （n=50）. The rat model of DGP was established by small-dose multiple intraperitoneal injections of streptozotocin combined with an irregular high-fat and high-sugar diet for 4 weeks. The modeled rats were randomized into model group， mosapride citrate （1.35 mg·kg-1）， and high-， medium-， and low-dose （200， 100， and 50 mg·kg-1， respectively） Hedysari Radix polysaccharide groups. The rats were administrated with corresponding drugs by gavage， and those in the blank and model groups with equal volumes of pure water by gavage once a day for 8 consecutive weeks. The random blood glucose and body mass were measured every 2 weeks， and gastric emptying rate was calculated. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of smooth muscle in gastric antrum， and terminal deoxynucleoitidyl transferase-mediated nick-end labeling （TUNEL） was employed to detect the apoptosis of smooth muscle cells in the gastric antrum. The expression of IGF-1， phosphorylated （p）-PI3K， and p-Akt in the smooth muscle of gastric sinus tissue was detected by immunohistochemistry. Western blot was employed to determine the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax） in the smooth muscle of the gastric antrum. ResultCompared with the blank group， the model group showed elevated random blood glucose at all time points （P<0.01）， decreased body mass and gastric emptying rate （P<0.01）， increased apoptotic index of smooth muscle cells in the gastric antrum （P<0.01）， down-regulated protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated protein level of Bax （P<0.01）. Compared with the model group， the 8 weeks of drug administration lowered the random blood glucose， increased the body mass and gastric emptying rate （P<0.05， P<0.01）， decreased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， up-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and down-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the mosapride citrate group，the administration of low-dose Hedysari Radix polysaccharide for 6 and 8 weeks lowered the random blood glucose and decreased the body mass （P<0.05， P<0.01），low and medium-dose Hedysari Radix polysaccharide decreased the gastric emptying rate and the apoptotic index of smooth muscle cells in the astragaloside low-dose group decreased （P<0.05）. The protein levels of IGF-1，p-PI3K/PI3K，p-Akt/Akt and Bcl-2（low dose）were down-regulated and the protein level of Bax was up-regulated by low doses of Hedysari Radix polysaccharide （P<0.05， P<0.01）. Compared with high-dose Hedysari Radix polysaccharide， low-dose Hedysari Radix polysaccharide elevated random blood glucose and reduced body mass after 6 and 8 weeks of administration （P<0.05， P<0.01）， and the low and medium doses decreased the gastric emptying rate， increased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， down-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the medium-dose group，the low-dose group of Hedysari Radix polysaccharide had lower body mass，lower gastric emptying rate in rats，higher apoptotic index of smooth muscle cells in gastric sinus tissue after 6 and 8 weeks of administration （P<0.05， P<0.01）， and lower protein expression of IGF-1，p-PI3K/PI3K，p-Akt/Akt. ConclusionHedysari Radix polysaccharide protects the smooth muscle cells in gastric antrum against apoptotic injury and promotes gastric motility by activating the IGF-1/PI3K/Akt signaling pathway， as manifested by the up-regulated expression of IGF-1， p-PI3K， p-Akt， and Bcl-2 and down-regulated expression of Bax.

Effect of electroacupuncture combined with mosapride on gastric motility in diabetic gastroparesis rats / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis.@*METHODS@#Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected.@*RESULTS@#Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01).@*CONCLUSION@#Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.

Mechanism of Modified Taohe Chengqitang in Treating Diabetic Gastroparesis Based on Network Pharmacology / 中国实验方剂学杂志

<b>Objective::To study the mechanism of modified Taohe Chengqitang in preventing and treating diabetic gastroparesis by regulating relative genes and signaling pathways based on network pharmacology. <b>Method::Target genes of modified Taohe Chengqitang were obtained from Bioinformatics Analysis Tool for Molecular Mechanism of TCM (BATMAN-TCM) database, and target genes of diabetic gastroparesis were obtained from Comparative Toxicogenomics Database (CTD) database. The target genes of modified Taohe Chengqitang-diabetic gastroparesis intersection protein were obtained through the integration of two groups of genes. STRING was used to build the protein-protein interaction network and visualize the results. Cytospace software ClueGO, CluePedia plug-in were used for gene ontology (GO) analysis and enrichment analysis of KEGG pathway of modified Taohe Chengqitang-diabetic gastroparesis target genes intersection, and results were visualized. Finally, CTD database and literatures were used to obtain intersection genes in the treatment of diabetic gastroparesis. <b>Result::Among 621 target genes in modified Taohe Chengqitang, 25 were related to diabetic gastroparesis. By regulating expressions of MLNR, SST, PTGS1, HRH2, HTR3A, HTR4, HTR7, NOS3 and other intersection genes, Taohe Chengqitang could improve the gastrointestinal hormone levels, affected the combination of serotonin and its receptors, activated adenylate cyclase (AC), and induced cyclic adenosine monophosphate (cAMP) and protein kinase A (PKA), so as to activiate AC/cAMP/PKA signaling pathway, regulate Ca²⁺ /K⁺ channel, control ion balance, promote the adaptability of gastric smooth muscle, and contract gastric smooth muscle to regulate gastric volume. At the same time, gastric acid secretion was improved to protect gastric mucosa, which may help improve vasoconstriction and hemodynamics. <b>Conclusion::Based on the network pharmacology, modified Taohe Chengqitang has multiple mechanisms in the prevention and treatment of diabetic gastroparesis. This study explored relevant signaling pathways, advantages and research directions of modified Taohe Chengqitang in treatment of diabetic gastroparesis.

Effect of needling technique on diabetic gastroparesis and transmembrane protein 16A / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of needling technique (acupuncture for regulating spleen and stomach) on diabetic gastroparesis (DGP), and to explore its possible mechanism.@*METHODS@#A total of 128 patients with DGP were randomized into an observation group (64 cases, 4 cases dropped off) and a control group (64 cases, 4 cases dropped off). On the basis of intervention on controlling blood glucose by western medication, needling technique was adopted at Zhongwan (CV 12), Zusanli (ST 36), Yinlingquan (SP 9), Xuehai (SP 10), Sanyinjiao (SP 6), Diji (SP 8), etc. in the observation group, once a day. Mosapride citrate dispersible tablet 5 mg was given orally 3 times a day in the control group. The treatment was given 6 times a week in the both groups, and totally 4-week treatment was required. Before and after treatment, the DGP symptom score, serum content of transmembrane protein 16A (ANO1) were observed, and the clinical therapeutic effect and the safety were evaluated in the both groups.@*RESULTS@#After treatment, the each subitem score (belching, abdominal distension, inappetence, nausea and vomiting, epigastric pain, abnormal defecation) and the total score of DGP symptom were decreased in both groups (<0.05), the subitem scores of belching, abdominal distension, inappetence, nausea and vomiting and the total score in the observation group were lower than those in the control group (<0.05). After treatment, the serum contents of transmembrane protein 16A were reduced in both groups (<0.05), and that in the observation group was lower than the control group (<0.05). The total effective rate was 86.7% (52/60) in the observation group, which was superior to 70.0% (42/60) in the control group (<0.05). Subcutaneous hematoma occurred in 5 cases in the observation group, which was improved after cold compress without other particular intervention.@*CONCLUSION@#The therapeutic effect of needling technique on improving symptoms in patients with diabetic gastroparesis is superior to mosapride citrate dispersible tablet, its mechanism may be related to alleviating the damage of interstitial cells of Cajal (ICC).

Effect of Modified Chaiqin Wendantang on Blood Glucose Level and Gastrointestinal Dysfunction in Patients with Diabetic Gastroparesis / 中国实验方剂学杂志

Objective:To explore the effect of modified Chaiqin Wendantang on blood glucose level and gastrointestinal dysfunction in patients with diabetic gastroparesis (DGP) of weak spleen and stomach. Method:A total of 138 patients with DGP of weak spleen and stomach in Hainan Provincial Fourth People's Hospital from February 2017 to March 2019 were enrolled, and divided into two groups according to the random number table methods. Both groups received the routine treatment. In addition to this, study group received Chaiqin Wendantang, while control group received domperidone tablets. Traditional Chinese medicine (TCM) syndrome scores, blood glucose, gastrointestinal function, hemorheology index, gastric emptying function and gastric electrical activity, Pittsburgh Sleep Quality Index (PSQI) scale and clinical efficacy were compared. Result:After treatment, TCM symptom scores and total scores decreased (P<0.05), levels of fasting blood glucose (FBG), 2 hours postprandial blood glucose (2 h PBG), and glycated hemoglobin (HbA1c) decreased (P<0.05), serum motilin (MOT) and gastrin (GAS) levels increased (P<0.05), cholecystokinin (CCK) levels decreased (P<0.05), gastric emptying time shortened, frequency, amplitude and rhythm increased (P<0.05), PSQI score decreased (P<0.05), and whole blood viscosity (WBV) and fibrinogen (FIB) levels decreased (P<0.05), all of those changes were more obvious in study group than control group (P<0.05). The total effective rate in study group was higher than that in control group (P<0.05). During the treatment period, there were no obvious adverse reactions in study group, while there were 2 cases of transient dizziness and headache in control group, which were relieved after several seconds. The recurrence rate in study group was lower than that in control group (P<0.05). Conclusion:Modified Chaiqin Wendantang can effectively ameliorate the symptoms of gastric retention, improve sleep quality, control blood glucose levels, and improve hemodynamics for DGP of weak spleen and stomach patients. Besides, it can improve the gastrointestinal function by reducing serum CCK levels, so as to stimulate the secretion of MOT and GAS, increase gastric motility, shorten gastric emptying time, and promote the recovery of gastric electrical activity. With a high safety and low recurrence rate, it has clinical application value.

Banxia Xiexin Decoction () Treats Diabetic Gastroparesis through PLC-IP / 中国结合医学杂志

OBJECTIVE@#To test the effect of Banxia Xiexin Decoction (, BXD) on the contraction and relaxation of gastric smooth muscle (SM) in diabetic gastroparesis (DGP) model rats, and to explore the mechanism of BXD in the prevention and treatment of DGP through experiments of signal pathway both in vivo and in vitro.@*METHODS@#Sixty Sprague-Dawley rats were divided into 6 groups according to a random number table: control group, model group, high-, medium- and low-dose BXD groups (9.2, 4.6 and 1.8 g/(kg·d), respectively), and domperidone group (10 mg/(kg·d)), 10 rats per group. DGP model was established initially by a single intraperitoneal injection of streptozotocin (STZ), and was confirmed by recording gastric emptying, intestinal transport velocity and gastric myoelectric activity of rats after 2 months. Each group was treated with a corresponding drug for 4 weeks. The mRNA and protein expressions of phospholipase C (PLC), inositol triphosphate (IP@*RESULTS@#Compared with the model group, high- and medium-dose BXD and domperidone significantly increased the expressions of PLC, IP@*CONCLUSIONS@#Treatment with high- and medium-dose BXD significantly attenuated STZ-induced experimental DGP in rats. The therapeutic effect of BXD on DGP rats might be associated with the PLC-IP

Regulation and mechanism of Yiqijianpi compound on gastric motility of the rats with diabetic gastroparesis / 解放军医学杂志

Objective: To explore the potential mechanism of Yiqijianpi traditional Chinese medicine (TCM) compound treatment on gastric motility of diabetic gastroparesis (DGP) rats. Methods: Rats were treated with a single shot of STZ (tail vein injection) combined with high fat, high sugar, and irregular feeding methods for 4 weeks to induce DGP in these Rats. Then, they were randomized into the model group (normal saline 10 ml/kg), the mosapride group (mosapride 1.575 mg/kg), the high dose (5 g/kg), and the low dose TCM group (1.25 g/kg). In addition, normal rats were set as the control group (normal saline 10 ml/kg). Each group of rats was intragastrically administered once a day for 4 weeks according to the dose and treatment indicated above. The general conditions were recorded. The changes in weight, blood glucose, gastric emptying rate, and intestinal propulsion rate were monitored. ELISA was used to detect serum levels of gastrin (GAS), plasma motilin (MTL) and substance P (SP). Immunohistochemistry was used to detect the distribution and expression of tyrosine kinase (c-Kit) in the gastric antrum. The expression of stem cell factor (SCF) and tyrosine kinase (c-Kit) were detected by Western blotting. HE staining was used to observe pathological changes of the gastric antrum. Results: Compared with the control group, rats induced with GDP showed deteriorated disease progress, such as lower body weight (P<0.01) and higher blood glucose levels (P<0.01). Compared with the model group, rats that treated with different drugs showed improved parameters, such as increased body (P<0.05). In addition, lower blood glucose levels were detected in high/low-dose TCM group (P<0.05), with dramatic improvement in the high dose TCM group. The gastric emptying rate and small intestine propulsion rate of the model group were lower than those in the control group (P<0.01). The gastric emptying rate and small intestine propulsion rate in the high dose of TCM and the mosapride group were higher than those in the model group (P<0.05). Compared with the control group, the HE staining of the model group showed gastric glands of the gastric antrum were sparse and disorderly arranged with reduced numbers of blood vessels. Compared with the model group, those improved in each drug-administered group with the best-improved parameters detected in the high dose TCM group. The levels of serum GAS, plasma MTL and SP in the model group were lower than that in the control group (P<0.01). The levels of serum GAS and plasma MTL and SP in each drug-administered group were significantly higher than the model group (P<0.01). The expressions of SCF and c-Kit in gastric antrum of the model group were lower than those in the control group (P<0.01). The expression of SCF in gastric antrum of each drug-administered group was higher than that in the model group (P<0.05), among which high dose of TCM group changed most significantly (P<0.01). The expression of c-Kit in the mosapride group and the high dose of TCM group was higher than that in the model group (all P<0.05). Conclusion: Yiqijianpi compound can improve the gastric motility of DGP rats in a dose-dependent manner. It is likely that Yiqijianpi compound can promote the secretion of GAS, MTL, SP and other gastrointestinal hormones, and regulate the expression of SCF and c-Kit proteins in the gastric antrum.

Evaluation on therapeutic effect of needle warming moxibustion combined with Banxia-Xiexin decoction in diabetic gastroparesis / 国际中医中药杂志

Objective To investigate the effect of warm acupuncture combined with Banxia-Xiexin decoction on diabetic gastroparesis (DGP).Methods A total of 86 DGP patients who met the selected criteria were divided into two groups by random number table method.The control group was treated with warm acupuncture.The observation group added Banxia-Xiexin decoction on the basis of the control group.Both groups were treated for 4 weeks.The clinical efficacy of motilin (MTL),somatostatin (SS) and leptin (LP) were evaluated by ELISA.Results The total effective rate of the observation group was 97.7％ (42/43) and the control group was 88.4％ (38/43).The difference between the two groups was statistically significant (x2=9.492,P＜0.01).The post-treatment serum MTL (340.82 ± 51.32 ng/L vs.422.42 ± 64.51 ng/L,t=43.184) and LP (1.98 ± 0.24 ng/ml vs.2.78 ± 0.27 ng/ml,t=5.330) of the observation group were significantly lower than those of the control group (P＜0.01),while the serum SS (47.62 ± 7.48 ng/L vs.33.26 ± 5.09 ng/L,t=8.494) was significantly higher than that of the control group (P＜0.01).Conclusions The warm acupuncture combined with Banxia-Xiexin decoction can obviously relieve the clinical symptoms of DGP patients,reduce the level of leptin,and there is no obvious adverse reaction.

Effect of Different Stimulating Strength of Electroacupuncture on Gastrointestinal Motility and RhoA/ROCK Signaling in Gastric Antral Smooth Muscle in Diabetic Gastroparesis Rats / 针刺研究

OBJECTIVE: To observe the effect of different strength of electroacupuncture (EA) stimulation on gastrointestinal motility and Ras homolog gene family member (RhoA)/Rho associated coiled-coil forming protein kinase (ROCK) signaling in diabetic gastroparesis (DGP) rats, so as to reveal the underlying mechanisms of EA for improving DGP. METHODS: Sixty SD rats were randomly and equally divided into blank control, DGP model, weak EA, medium EA, and strong EA groups (n＝12 rats in each). The DGP model was established by intraperitoneal injection of streptozotocin (STZ, 55 mmol/kg, 2%) and high-sugar and high-fat fodder feeding for 8 weeks. EA (0.12, 0.24, 0.36 mA, 20 Hz/100 Hz) was applied to "Zusanli" (ST 36), "Sanyinjiao" (SP 6) and "Liangmen" (ST 21) for 20 min, once daily for 15 successive days. Blood glucose levels were measured weekly with blood glucose meter and blood glucose test paper. Fecal phenol red excretion method was used to display gastric emptying and small intestinal propulsion function. The expression of RhoA protein in the gastric antral smooth muscle tissue was detected by immunohistochemistry and Western blot (WB), separately, and that of ROCK, myosin phosphatase target subunit 1 (MYPT 1) and phosphorylated (p)-MYPT 1 proteins in gastric antrum detected by WB. RESULTS: Compared with the blank control group, the gastric emptying rate and small intestine propulsion rate of the model group were significantly decreased (P0.05). CONCLUSION: Electroacupuncture stimulation of ST 36-SP 6-ST 21 at 0.12, 0.24 and 0.36 mA can promote the gastrointestinal motility in DGP rats, which may be associated with its effects in enhancing RhoA/ROCK signaling in the gastric antral smooth muscle at different degrees.

Effects of Jinqi Zhizhu Decoction on Gastric Motility of GK Rats with Diabetic Gastroparesis / 中国中医药信息杂志

Objective To investigate the effects of Jinqi Zhizhu Decoction (JQZZD) on gastric motility of GK rats with diabetic gastroparesis (DGP); To discuss its mechanism of action. Methods 12 out of 80 male GK rats were randomly selected as normal group, and others were induced to be DGP model by irregular feeding with high sugar and high fat diet for 8 weeks. The model rats were randomly divided into model group, positive medicine group, JQZZD low-, medium-, and high-dose groups. All rats were given continuous intragastric administration for 12 weeks. The residual rate of pigment in stomach was detected and calculated. The concentration of DA, ACh and 5-HT in plasma were detected by ELISA. The morphological changes of gastric antrum were observed by HE staining. The ultrastructure of mucous layer of gastric antrum was observed by transmission electron microscope. The protein expressions of Rho A, ROCK1 and ROCK2 were detected by Western blot. Results Compared with normal group, the residual rate of pigment in model group increased, while DA, ACh and 5-HT, relative amount of protein expressions of Rho A, ROCK1 and ROCK2 decreased (P＜0.01). Compared with model group, the residual rate of pigment in positive medicine group and JQZZD high-dose group decreased, while DA, ACh and 5-HT, relative amount of protein expressions of Rho A, ROCK1 and ROCK2 increased (P＜0.05, P＜0.01), and morphological changes and ultrastructure of mucous layer obviously improved. There was no significant differences in the residual rate of pigment, DA content and protein expressions of Rho A, ROCK1 and ROCK2 between positive medicine group and JQZZD high-dose group (P＞0.05). Compared with JQZZD low-dose group, the residual rate of pigment in JQZZD high-dose group decreased, while DA, ACh and 5-HT, relative amount of protein expressions of Rho A, ROCK1 and ROCK2 increased (P＜0.05, P＜0.01). Conclusion JQZZD may improve gastric motility, promote gastric emptying, and improve and repair damage of mucous membrane in the gastric antrum. All of these may be related to regulating protein expressions of Rho A/ROCK signal pathway.

Effects of Electroacupuncture on Ultrastructure of Interstitial Cells of Cajal and Stem Cell Factor-kit Signal Pathway of Gastric Antrum in Diabetic Gastroparesis Rats / 针刺研究

OBJECTIVE: To observe the effects of electroacupuncture (EA) on gastrointestinal motility and the ultrastructure of interstitial cells of Cajal (ICC) and the expressions of c-kit receptor protein and stem cell factor (SCF) mRNA in diabetic gastroparesis (DGP) rats, so as to explore its mechanism. METHODS: Fifty SD rats were randomly divided into normal, model, acupoint, non-acupoint and metoclopramide groups (n＝10 rats/group). DGP model was established by intraperitoneal injection of streptozotocin (STZ, 2%), and raised with high-sugar high-fat diet irregularly. EA (sparse-dense, 10 Hz/50 Hz, 2 mA, 20 min) was applied at "Zusanli" (ST 36), "Liangmen" (ST 21) and "Sanyinjiao" (SP 6), and the corresponding non-acupoints of the 3 acupoints, daily for 15 days. The rats in metoclopramide group received intragastric administration of metoclopramide (1.7%, 1 mL/100 g) for 15 days, once a day. Blood sugar was determined with One Touch blood glucose test paper. The gastric emptying rate (GER) and the intestinal propulsion rate (IPR) were measured by intragastric phenol red. The ultrastructure of ICC was detected by transmission electron microscopy. The expression levels of c-kit receptor protein and SCF mRNA of gastric antrum were examined respectively by Western blot and RT-PCR. RESULTS: Compared with the normal group, the blood glucose significantly increased in the model group (P<0.01), while the GER, IRP and the expression level of SCF mRNA in the gastric antrum significantly decreased (P<0.01), and the ultrastructure of ICC appeared apoptosis-like changes. The blood glucose of the EA group was obviously decreased compared with that of the model group (P<0.05); the GER and IRP significantly increased(P<0.05, P<0.01); the expression level of SCF mRNA increased (P<0.01), the number of ICC increased and its ultrastructure was repaired. There was some relief on ICC ultrastructure in the acupoint group compared with that in the non-acupoint group; and SCF mRNA increased (P<0.05). There was no significant difference on c-kit receptor expression among all the modeling groups (P＞0.05). CONCLUSIONS: EA at ST 36, etc. can regulate the blood glucose and improve gastrointestinal emptying in DGP rats. The mechanism may be related to up-regulating SCF mRNA, repairing ICC ultrastructure, restoring the pacing function, and improving gastrointestinal motility.

Effect of Omeprazole Combined with Huoxue Huayu Tongluo Formula on the Efficacy and Relevant Indexes of Diabetic Gastroparesis Gastric Motility Disorder / 中国药房

OBJECTIVE:To explore the effects of omeprazole combined with Huxue huayu tongluo formula on the efficacy and relevant indexes of diabetic gastroparesis gastric motility disorder. METHODS:92 patients with diabetic gastroparesis gastric motili-ty disorder were randomly divided into observation group and control group. All patients were given diabetes dietary guidance and exercise guidance,and patients with combined metabolic disorders and hypertension were given lipid lowering,antihypertensive and other conventional treatment;based on it,control group was orally given 20 mg Omeprazole enteric-coated capsule,once a day;observation group was additionally given 300 ml Huxue huayu tongluo formula,150 ml once,twice a day. The treatment course for both groups was 14 d. Clinical efficacy,fasting blood glucose,glycated hemoglobin,whole blood viscosity level,moti-lin,gastrin,half gastric emptying time (GET1/2) before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was statistically significant(P0.05);after treatment,fasting blood glucose,glycated hemoglobin,whole blood viscosity level,motilin,gastrin and GET1/2 in 2 groups were significantly lower than before,and observa-tion group was lower than control group,the differences were statistically significant(P<0.05);and there were no adverse reac-tions during treatment. CONCLUSIONS:Based on the conventional treatment,the efficacy of omeprazole combined with Huxue huayu tongluo formula is superior to omeprazole alone for diabetic gastroparesis gastric motility disorder,it can significantly reduce blood glucose and improve hemodynamics,with similar safety.

Granisetron Transdermal System for Treatment of Symptoms of Gastroparesis: A Prescription Registry Study

BACKGROUND/AIMS: Serotonin receptor (eg, 5-HT₃) antagonists are used to treat nausea and vomiting from a variety of causes. Granisetron transdermal system (GTS) is an appealing delivery system for patients with gastroparesis. To assess if GTS improves nausea and vomiting and other gastroparesis symptoms in patients with gastroparesis. METHODS: Patients with gastroparesis and symptoms of nausea and vomiting refractory to conventional treatment were treated with GTS. Symptoms of gastroparesis were assessed using a modified Gastroparesis Cardinal Symptom Index (GCSI). Following 2 weeks of treatment, patients were asked to assess their symptoms and indicate their therapeutic response using the Clinical Patient Grading Assessment Scale (CPGAS) reporting if symptoms of nausea and vomiting improved on a scale: 0 = no change to +7 = completely better. RESULTS: Fifty-one patients received GTS by prescription: average age was 40 ± 17 years, 44 female, 11 diabetics, 23 ± 20% retention at 4 hours on gastric emptying scintigraphy. Thirty-nine of the 51 (76%) patients stated improvement with GTS. There was significant improvement in nausea and vomiting as assessed with CPGAS at 2 weeks (2.28 ± 2.53; P < 0.05). Symptoms of nausea and vomiting significantly improved. Other symptoms including postprandial fullness, loss of appetite, upper abdominal pain, and early satiety improved. Side effects reported included redness at the site of the patch in 7 patients, pruritus in 5, and constipation in 5. CONCLUSIONS: GTS was moderately effective in reducing nausea and/or vomiting in 76% of gastroparesis patients. In addition to nausea and vomiting, symptoms of postprandial fullness, loss of appetite, upper abdominal pain, and early satiety also improved.

Effects ofα-lipoic acid combined with motilin in treatment of patients with diabetic gastroparesis / 中华内分泌外科杂志

Objective To explore the curative effects and safety of α-lipoic acid combined with motilin in treatment of patients with diabetic gastroparesis and its influence on gastrointestinal dynamics and gastrointesti -nal hormone.Methods 108 patients with diabetic gastroparesis were included and they were divided into the ob -servation group and the control group according to the random indicator method , with 54 cases in each group .All patients were given routine hypoglycemic therapy .On this basis, patients in the control group were given motilin while patients in the observation group were given α-lipoic acid combined with motilin .After 14 days, the cura-tive effects, the rate of gastric emptying, oral-colonic transit time(OCTT), and gastrointestinal hormone including gastric dynamic element ( MTL ) and somatostatin ( SS ) , stomach gastrin-releasing ( GAS ) and adverse reactions during treatment were compared between the 2 groups.Results The total effective rate was 85.19% and 64.81% respectively in the observation group and the control group , and the difference had statistical significance (P0.05).Conclusions The cura-tive effects of α-lipoic acid combined with motilin in treatment of diabetic gastroparesis is distinct .Its mechanism may be related to improving gastrointestinal disorders , and adjusting gastrointestinal hormone .

Optimization of diabetic gastroparesis rat model by orthogonal design / 中草药

Objective: To optimize the preparation methods of diabetic gastroparesis rat model by orthogonal test. Methods: The diabetes gastroparesis rat model was duplicated with alloxan (ALX) by using four factors and three levels of orthogonal design. The fasting blood glucose, gastric emptying rate, and plasma motilin level were scored as evaluation indexes, and the influence of different factors on diabetic gastroparesis model rats was observed. Results: The effect of feed type on the diabetic gastroparesis rat model was not obvious, but the effects of modeling time and modeling agent ALX dose on diabetic gastroparesis rat model were decisive. The order of the importance was as follows: modeling time > dose of ALX > feed types. Conclusion: The optimized test method can effectively improve the diabetic gastroparesis rat model and provide a technical platform for the study on drug evaluation of diabetic gastroparesis.

Literature Study on Acupoint Selection Law in Diabetic Gastroparesis Treatment / 世界科学技术-中医药现代化

Diabetic gastroparesis (DGP) is one of the most common complications of diabetes. Acupuncture is an ef-fective treatment for DGP in recent years. Literatures on acupuncture therapy for DGP treatment were screened for the past 10 years. Statistical analysis was made on acupoints used in the literatures in order to find the most com-monly used acupoints and combinations. This article was aimed to explore and summarize the use of the acupuncture law for the better service of clinical practice.

The assessment of gastric emptying function of diabetic gastroparesis by gastroenteric contrastenhanced ultrasonography / 中国医师进修杂志

Objective To detect the changes of gastric emptying function by gastroenteric contrastenhanced ultrasonography and to offer the evidence for the diagnosis and treatment of diabetic gastroparesis.Methods The gastric emptying function was measured by gastroenteric contrast-enhanced ultrasonography in 35 cases of diabetic gastroparesis (DGP,DGP group) and 35 volunteers (control group).The gastric emptying rate(GER) and emptying time(ET) after taking orally gastroenteric ultrasound developer in DGP group were observed and compared with control group.Results The GER in DGP group was lower than that in control group [(27.05 ± 11.32)％ vs.(45.38 ± 15.08) ％] (P ＜ 0.05).The ET in DGP group was longer than that in control group[(102.43 ± 15.76) min vs.(75.31 ± 11.52) min] (P ＜ 0.05).Conclusions The method of gastroenteric contrast-enhanced ultrasonography is a simple,and repeatable imaging method,which can be used to make a real-time assessment on the gastric dynamic changes,but don't influence gastroenteric function and can provide a dependent and noninvasive examine means for clinical physician to test the gastric emptying function in DGP.

Bio-impedance gastric motility in patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To detect the gastric motility in patients with type 2 diabetes mellitus, and to explore the relationship between disorder of gastric motility in diabetes and the influential factors. Methods Sixty-five patients with type 2 diabetes mellitus and 30 health control subjects were collected. The gastric motility was tested with the signal processing device designed by Chongqing University of Posts and Telecommunications. The impedance and electrical signals were collected at the same time. Fasting blood glucose (FBG) was detected by oxidation enzyme method, while microcolumn method was adopted to test HbA1c. Results In the 65 patients with type 2 diabetes mellitus,the occurrence of abnormal gastric motility was 53.85% , they had several symptoms, such as abdominal distension, early satiety, and belching. The percentage of dominant frequency of impedance gastrogram in diabetes group was lower than that in the normal controls (P<0. 05 ). The percentage of dominant frequency of EGG in the abnormal HbA1c group( ≥6. 5% ) was significantly lower than that in the normal HbA1c group ( P<0. 01). The percentage of bradygastria in the elderly was higher than that in young and middle-aged subjects (P<0. 05), respectively. Disorder of gastric motility was not correlated with FBG and course of disease. Conclusions The incidence of disordered gastric motility is very high in patients with type 2 diabetes mellitus. Elderly patients and those with higher HbA1c are prone to suffer from disordered gastric motility. However, disorder in gastric motility is not correlated with FBG and duration of the illness.

Effects of Gastrin and Somatostatin in Diabetic Gastroparesis / 中国医科大学学报

Objective To investigate the changes of gastrin(GAS) and somatostatin(SS) in diabetic gastroparesis (DGP). Methods Totally 103 patients were divided into normal control group (n =17),simple gastroparesis(GP) group (n =30),simple diabetes mellitus(DM) group (n =23) and diabetes mellitus complicated with gastroparesis (DGP) group (n =33). Radioimmunity and RT-PCR were performed to detect the serum GAS and SS levels and the mRNA expression in the gastric mucosa tissue of 4 groups. Results There were significant differences in the serum levels and protein expression of GAS and SS between simple gastroparesis group,simple diabetes mellitus group, DGP group and the normal control group(P< 0.05). The differences between DGP group and normal control group was the most significant (P< 0.01), the differences between DGP group and the simple gastroparesis group or simple diabetes mellitus group were significant (P< 0.05). Contusion The increase of GAS and decrease of SS may play an important role in the occurrence and development of DGP.

Pyloric Injection of Botulinum Toxin for Treatment of Diabetic Gastroparesis: A Report of Four Cases / 대한소화기내시경학회지

Gastroparesis is a disorder of gastric motility that results in delayed gastric emptying. Up to 58% of patients with diabetes mellitus may have diabetic gastroparesis, a syndrome characterized by nausea, vomiting, early satiety, and bloating. The pathophysiology of this disorder is not completely understood, but it is believed to include fundic dysaccommodation, a decrease in gastroduodenal pressure gradient and antral hypomotility. In addition to antral and fundic dysfunction, patients with diabetes may typically have pyloric dysfunction or spasm. Treatment consists of a change in diet to small volume, frequent meals and the use of the prokinetic agents. This case report describes the four patients with severe diabetic gastroparesis whose symptoms persisted despite of dietary changes and the use of prokinetic agents in high doses. All of them were treated with pyloric injection of botulinum toxin and three had significant symptomatic and scintigraphic improvement.