Research progress on effective components，pharmacological mechanisms and clinical use of Polyporus umbellatus in diuresis-promotion and dampness-clearance / 中国药房

Polyporus umbellatus， as a traditional Chinese medicine for promoting diuresis and clearing dampness， mainly contains steroids and polysaccharides. It is usually used to treat diseases of urinary system. In this paper， the research progress of the effective components， pharmacological mechanisms and clinical use of P. umbellatus in diuresis-promotion and dampness- clearance is reviewed. Steroids such as ergosterone， peroxyergosterone， ergosta-7，22-dien-3-one and P. umbellatus polysaccharide PPS1， PPS2， PPS3， GUMP-1-1 and GUMP-1-2 promote diuresis and eliminate dampness through diuresis， renal protection， anti- inflammatory， bacteriostatic and immunomodulatory effects. Traditional Chinese medicine compound preparations such as P. umbellatus powder， P. umbellatus decoction， and Wuling powder have significant effects in treating urinary tract infections， lithiasis， renal edema and lesions， which providing reference for the further development and application of P. umbellatus.

Research Status of Zexietang / 中国实验方剂学杂志

Zexietang is derived from Jingui Yaolue （《金匮要略》）， which is composed of Alismatis Rhizoma and Atractylodis Macrocephalae Rhizoma， and has the effect of inducing diuresis and invigorating the spleen to produce water. Compared with western medicine in the treatment of related diseases， Zexietang can not only improve the curative effect， but also reduce the occurrence of adverse reactions， so as to achieve long-term stable administration. The authors sorted out and analyzed the chemical composition， pharmacological effect and clinical application of Zexietang in recent years. It was found that the main active components of Zexietang were alismol A and B， 23-acetyl-alismol B and C， atractylenolides （atractylenolide Ⅰ， Ⅱ， Ⅲ） and polysaccharides. Pharmacological experiments showed that they had diuretic， hypolipidemic， anti-inflammatory and others. And it can be used in the treatment of hypertension， hyperlipidemia， vertigo， cerebral vascular insufficiency and other diseases combined with other Chinese materia medica， and the curative effect is obvious. By summarizing the research status of Zexietang in recent years， its active components and pharmacological mechanism can be further clarified， which provides the basis for the clinical application of Zexietang and guides the direction of its further research.

The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review / O papel da diurese osmótica induzida por ureia na geração de hipernatremia no paciente crítico: relato de caso e revisão da literatura

Abstract Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

Resumo A hipernatremia é um distúrbio eletrolítico comum no ambiente de terapia intensiva, com uma prevalência que pode chegar a 25%. Está associada a maior tempo de internação hospitalar e é um fator de risco independente para a mortalidade. Este relato ilustra um caso de hipernatremia de origem multifatorial no ambiente de terapia intensiva. Destacaremos o papel da diurese osmótica por geração excessiva de ureia, uma causa de hipernatremia pouco conhecida e subdiagnosticada. Este cenário pode estar presente em pacientes em uso de elevadas doses de corticoides, com sangramento gastrointestinal, em uso de dietas e suplementos hiperproteicos e estado de hipercatabolismo, especialmente durante a fase de recuperação de injúria renal. A seguir, discutiremos uma abordagem clínica para o diagnóstico da hipernatremia secundária à diurese osmótica induzida por ureia, destacando a importância do conceito de clearance de água livre de eletrólitos nesse contexto.

Experience in Treatment of COVID-19 by Elimination of Pathogens Through Purgation and Diuresis / 中国实验方剂学杂志

Coronavirus disease-2019 (COVID-19) outbreaks were spreading rapidly around the world in early 2020. This disease is within the category of "damp epidemic" and "damp toxin epidemic" in traditional Chinese medicine, with lung and spleen as the lesion focuses, while dampness and toxin as especially prominent properties. Through clinical observation, we found that dampness would often transform into damp heat during the development and evolution of the disease, and the "triple energizer" treatment was an important therapeutic method, eliminating pathogens through purgation and diuresis: for those with damp-heat accumulation toxin diffused to the triple energizer, we could use Ganlu Xiaodudan as primary prescription, which can spread the upper part, smooth the middle part and infiltrate the lower part, so as to provide a way out for the pathogenic factors and regulate Qi movement. For those with damp-heat in Shaoyang channel, we could use Haoqin Qingdantang to clear heat and promote diuresis, harmonize Shaoyang, eliminate damp-heat and epidemic pathogenic factor. For those with pathogen hidden in membrane source dampness trapping and hidden heat, we could use Dayuanyin to eliminate pathogens between interior and exterior parts, and regulate Qi movement. At the same time we shared three typical cases treated in Wuhan, and conducted an in-depth analysis in this study. Clinically, the method of elimination of pathogens through purgation and diuresis is mainly used in the early and middle stage of this disease. When the disease is still located in Qi system, it also can be applied to mild, ordinary patients and severe patients that have accurate syndrome differentiation. In such cases, it can effectively improve symptoms, reduce pathogenic toxin, truncate and reverse the course of disease, give way to pathogen, and avoid disease aggravating.

Optimization of Processing Technology of Salt-processed Products of Plantaginis Semen Based on Response Surface Method and AHP-CRITIC Mixed Weighting Method and Investigation of Its Diuretic Effect / 中国实验方剂学杂志

Objective:To optimize the processing technology of salt-processed products of Plantaginis Semen with the specific process parameters, and verify the obtained processing technology by pharmacodynamic research, so as to provide experimental basis for the standardized production and quality control of this decoction pieces. Method:Taking composite score of appearance character score, dry extract yield and contents of three components (geniposidic acid, acteoside and isoacteoside) as index, the analytic hierarchy process (AHP)-criteria importance through intercrieria correlation (CRITIC) mixed weighting method was used to determine the weight coefficient of each index. Based on single factor tests, the response surface method was used to investigate the effects of frying time, frying temperature, salt amount and water amount on the processing technology of salt-processed products of Plantaginis Semen, and the processing technology was verified by diuretic experiment with furosemide tablets as the positive drug (administration dose of 0.01 g·kg-1). Result:The weight coefficients of geniposidic acid content, acteoside content, appearance character score, isoacteoside content and dry extract yield were 0.319, 0.193, 0.207, 0.273 and 0.008, respectively. The optimal process parameters were as following：fried at 150-180 ℃ for 10 min (obtained from the single factor tests), 100 g of Plantaginis Semen sprayed evenly with 2 g of salt (2 g of salt dissolved in 20 mL of water), and fried at 150-180 ℃ for 15 min. Compared with the blank group, both of the raw products group and the salt-processed products group could significantly increase the secretion of urine volume (P<0.01), but the excretion of Na+ in the urine of rats in the salt-processed products group was significantly higher than that in the raw products group (P<0.05). Conclusion:The optimized processing technology is simple and feasible, which can provide reference for standardizing the industrial production of salt-processed products of Plantaginis Semen. At the same time, combined with inherent quality and appearance of the salt-processed products, and verified by pharmacodynamic test, the obtained results are reasonable and reliable, which can be used for quality control of this decoction pieces.

Fluid balance in pediatric patients in prone position: a pragmatic study

SUMMARY OBJECTIVE: To verify the association between prone position, increased diuresis, and decreased cumulative fluid balance in critically ill pediatric patients who underwent mechanical ventilation (MV) for pulmonary causes and describe adverse events related to the use of the position. METHODS: This is a retrospective observational study. Patients aged between 1 month and 12 years who underwent MV for pulmonary causes, between January 2013 and December 2015, were selected and divided between those who were put on prone position (PG) and those who were not (CG) during the hospitalization at the Pediatric Intensive Care Unit (PICU). Data were analyzed longitudinally from D1 to D4. RESULTS: A total of 77 patients (PG = 37 and CG = 40) were analyzed. The general characteristics of both groups were similar. In the comparison between the groups, there was no increase in diuresis or decrease in cumulative fluid balance in the prone group. In the longitudinal analysis of D1 to D4, we saw that the PG presented higher diuresis (p = 0.034) and a lower cumulative fluid balance (p = 0.001) in D2. Regarding the use of diuretics, there was greater use of furosemide (P <0.001) and spironolactone (P = 0.04) in the PG. There was no increase in adverse events during the use of the prone position. CONCLUSION: The prone position was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients who underwent to MV for pulmonary causes.

RESUMO OBJETIVO: Verificar a associação entre posição prona, aumento da diurese e diminuição do balanço hídrico em pacientes pediátricos criticamente enfermos e submetidos à ventilação mecânica (VM) por causa pulmonar, além de descrever eventuais intercorrências relacionadas à aplicação dessa posição. MÉTODOS: Estudo observacional retrospectivo. Pacientes submetidos à VM por causa pulmonar, com idade entre 1 mês e 12 anos no período entre janeiro de 2013 e dezembro de 2015, foram selecionados e divididos entre os que receberam posição prona (GP) e os que não receberam (GC) durante a internação na Unidade de Terapia Intensiva Pediátrica (Utip). Os dados foram analisados longitudinalmente de D1 a D4. RESULTADOS: Foram analisados77 pacientes (GP=37 e GC=40). Em termos de características gerais, os grupos foram semelhantes entre si. Na comparação entre os grupos, não houve aumento da diurese ou diminuição do balanço hídrico cumulativo no grupo prona. Na análise longitudinal de D1 a D4, evidenciou-se que o GP apresentou maior diurese (p=0,034) e menor balanço hídrico cumulativo (p = 0,001) no D2. Com relação ao uso de diuréticos, houve maior uso de furosemida (P<0,001) e de espironolactona (P=0,04) no GP. Não houve aumento de eventos adversos durante a utilização da posição prona. CONCLUSÃO: A posição prona não demonstrou associação com aumento da diurese ou diminuição de balanço hídrico cumulativo em pacientes críticos pediátricos submetidos à VM por causa pulmonar.

Efeitos agudos da ingestão de bebidas energéticas sobre os paramêtros hidro-eletrolíticos durante exercício em esteira / Acute effects of energy drink intake on hydro-electrolytic parameters during the exercise on a treadmill

RESUMO O objetivo do estudo foi verificar se bebidas enegéticas com diferentes composições nutricionais afetam o balanço hidro-eletrolítico de corredores de resistência. Doze homens participaram desse estudo duplo cego e crossover randomizado, ingerindo 3mg.kg-1 de cafeína de bebida energética convencional e sugar free, e um placebo carboidratado e não cafeinado, 40 minutos antes de sessão de exercício em ambiente termoneutro. Em cada situação experimental, os avaliados realizaram exercício de corrida em esteira com duração de 60 minutos e intensidade constante entre 65 e 75% do VO2max, seguidos por um sprint correspondendo a 100% do VO2max até a exaustão. Foram avaliados o peso corporal (PC), desidratação absoluta e relativa, densidade da urina, taxa de sudorese e níveis de Na+, K+ e hematócrito. Durante o exercício os avaliados receberam somente água a cada 15 minutos. Foi verificada alteração nos níveis de densidade da urina antes e depois do exercício para todos os tratamentos (p<0,05). Não houve diferença significativa entre as bebidas nos níveis de Na+, K+ e hematócrito (p>0,05) mantendo-se dentro dos níveis de normalidade. Conclui-se que diferentes tipos de bebidas energéticas não afetam o balanço hidro-eletrolítico de corredores de resistência ao longo do exercício.

ABSTRACT This work compares the effects promoted by energy drinks with diferente nutricional compositions on the hydro-electrolytic balance of resistance runners. Twelve men participated in this double blinded, randomized crossover study, ingesting 3mg*Kg-1 of a conventional energy drink with caffeine or sugar-free, and a placebo 40-minutes before tests on thermoneutral environment. The duration of the session was 60 minutes with constant intensity between 65 and 75% of VO2max, followed by a sprint corresponding to 100% of VO2max until exhaustion. There were evaluated body weight (BW), absolute and relative dehydration, urine density, sweating rate and Na+, K+ and hematocrit levels. During the exercise, the participants drunk only water every 15 minutes. Changes in urine density levels were observed before and after exercise for all procedures (p <0.05). There was no significant difference on the levels of Na+, K+ and hematocrit between the drinks (p> 0.05), remaining within normal levels. It is concluded that different types of energy drinks do not affect the hydro-electrolytic balance of resistance runners during the exercise.

Sodium-glucose cotransporter-2 inhibition for the reduction of cardiovascular events in high-risk patients with diabetes mellitus

Patients with type 2 diabetes mellitus (T2DM) exhibit an increased risk for cardiovascular (CV) events. Hyperglycemia itself contributes to the pathogenesis of atherosclerosis and heart failure (HF) in these patients, but glucose-lowering strategies studied to date have had little or no impact on reducing CV risk, especially in patients with a long duration of T2DM and prevalent CV disease (CVD). Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the new class of glucose-lowering medications that increase urinary glucose excretion, thus improving glycemic control, independent of insulin. The recently published CV outcome trial, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients—Removing Excess Glucose (EMPA-REG OUTCOME), demonstrated that the SGLT2 inhibitor empagliflozin significantly reduced the combined CV end point of CV death, nonfatal myocardial infarction, and nonfatal stroke vs. placebo in a population of patients with T2DM and prevalent atherosclerotic CVD. In addition, and quite unexpectedly, empagliflozin significantly and robustly reduced the individual end points of CV death, overall mortality, and hospitalization for HF in this high-risk population. Several beneficial factors beyond glucose control, such as weight loss, lowering blood pressure, sodium depletion, renal hemodynamic effects, effects on myocardial energetics, and/or neurohormonal effects, have been seen with SGLT2 inhibition.

Presión intraabdominal y ventilación artificial mecánica. Hospital "Arnaldo Milián Castro". 2014-2015 / Intra-abdominal pressure and mechanical artificial ventilation. Arnaldo Milián Castro Hospital. 2014-2015

Introducción: La cavidad abdominal y la caja torácica se encuentran separadas por el diafragma, por lo que las variaciones en las presiones dentro de una, repercuten sobre las presiones de la otra. La hipertensión intraabdominal es hoy una entidad frecuente en el paciente crítico en el que constituye un factor de riesgo importante de complicaciones y mortalidad, ya que influye sobre órganos y sistemas. Objetivo: Relacionar la presión intraabdominal con presiones de la ventilación artificial mecánica y parámetros de la función respiratoria, cardiovascular y renal. Material y Métodos: Se realizó un estudio descriptivo y prospectivo de la presión intraabdominal en pacientes sometidos a ventilación mecánica, con enfermedades clínicas y quirúrgicas, en las Unidades de Cuidados Intensivos del Hospital Clínico Quirúrgico Arnaldo Milán Castro, durante el período comprendido entre enero 2014 hasta diciembre 2015. Resultados: Los pacientes clínicos con presiones de la vía aérea elevadas mostraron valores más altos de presión intraabdominal, y aquellos pacientes postquirúrgicos que cursaron con niveles altos de presión dentro del abdomen también presentaron los valores más elevados de presión pico y media registradas en el ventilador mecánico. Conclusiones: La tensión arterial media, el ritmo diurético y la saturación periférica de oxígeno disminuyeron, mientras que la presión venosa central, la presión parcial de dióxido de carbono en sangre y la creatinina aumentó ante los aumentos de la presión dentro del abdomen(AU)

Introduction: The abdominal cavity and the thoracic cage are separated by the diaphragm; therefore, the variations in the pressures within one of them have an effect on the pressures of the other. At present, intra-abdominal hypertension is a frequent entity in the critically ill patient, which constitutes an important risk factor for complications and mortality since it influences on different organs and systems. Objective: To relate intra-abdominal pressure with mechanical artificial ventilation pressures and parameters of respiratory, cardiovascular and renal function. Material and Methods: A descriptive prospective study of intra-abdominal pressure was conducted in patients undergoing mechanical ventilation with clinical and surgical diseases in the Intensive Care Units of the Arnaldo Milán Castro Hospital, during the period between January 2014 until December 2015. Results: Clinical patients with high values of airway pressures showed higher values of intra-abdominal pressure, and those post-surgical patients who presented with high levels of pressure inside the abdomen indicated the highest values of peak and average pressure recorded in the mechanical ventilator. Conclusions: Mean arterial pressure, diuretic rate and peripheral oxygen saturation decreased, whereas the central venous pressure, the partial pressure of carbon dioxide in blood, and creatinine increased due to raises in pressure within the abdomen(AU)

Efecto diurético de Cuphea glutinosa Cham. et Schltdl (Lythraceae) en ratas Wistar / Diuretic effect of Cuphea glutinosa Cham. et Schltdl (Lythraceae) in Wistar rats

Cuphea glutinosa (Lythraceae), popularmente conocida como "siete sangrías" o "sanguinaria", ha sido utilizada en las prácticas de medicina popular, especialmente como diurética e hipotensora. Actualmente, es comercializada en herboristerías de la República Argentina y consumida en forma de infusión en concentraciones no específicas. En este estudio se evaluó la diuresis producida en ratas Wistar, a partir de la administración de infusiones de diferentes concentraciones de planta entera de C. glutinosa. Se utilizaron tres concentraciones al 2,5 %; 5,0 % y 10,0 %, Furosemida (10 mg/kg peso vivo) como control positivo y solución salina (blanco) (NaCl 0,9 %) como control negativo, que fueron administradas oralmente. Se midieron los niveles de excreción urinaria de las ratas, mantenidas en jaulas metabólicas, en intervalos de 2 horas, durante 8 horas, y una última recolección a las 24 horas. La administración oral de infusión al 5 % incrementó significativamente la excreción urinaria a las 8 horas, comparada con el control positivo. Además se observó una tendencia a la diuresis con la administración de infusiones al 5 % y 10 % a las 4 horas. Durante la aplicación de los tratamientos no se observaron cambios en las condiciones físicas de los animales. Se requieren nuevos estudios para la determinación de la ruta farmacológica y la toxicidad de esta especie. (AU)

Research advances of material basis of multi-effect Astragali Radix / 中草药

Astragali Radix is a classic Chinese materia medica with multiple effects including replenishing qi, consolidating exterior, promoting pus and discharge tissue regeneration, inducing diuresis to alleviate edema and other effects. Modern scientific researches have confirmed that different forms of Astragali Radix (single drug and compound) exhibit various pharmacodynamic effects on different pathological diseases, and their material basis are not the same. This review summarized the researches on the material basis of multi-effect Astragali Radix and provided new ideas for the related studies of material basis of Astragali Radix and its formula.

Potential effect of Silybum marianum L. and Cistus ladaniferus L. extracts on urine volume, creatinine clearance and renal function

Objective:To investigate the diuretic and renal effects of Silybum marianum L. and Cistus ladaniferus L. in normal rats.Methods:Four groups of rats were used in each experiment. The first group received water, the second group received Cistus ladaniferus L. extract (100 mg/kg b.wt), the third group received Silybum marianum L. extract (100 mg/kg b.wt), and the fourth group received furosemide (10 mg/kg b.wt). Variables including urine volume, plasma and urine sodium, potassium and creatinine, and creatinine clearance were measured. Two experiments were conducted. A single dose of each intervention was used and the variables were measured during 24 h, and the interventions were given daily for a total of 8 d and the variables were measured during various intervals.Results:The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium (P<0.05). On the day 8 after daily administration, the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes (P<0.05), while furosemide caused hypokalemia. Both plant extracts significantly increased creatinine clearance (P<0.05).Conclusions:Silybum marianum L. and Cistus ladaniferus L. increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes. Silybum marianum L. is more potent than furosemide or Cistus ladaniferus L.

Efficacy and safety of toivaptan therapy for edema in patients with nephrotic syndrome / 中华肾脏病杂志

Objective To evaluate the efficacy and safety of tolvaptan therapy for edema in patients with nephrotic syndrome(NS).Methods Twelve patients with NS who had normal serum sodium and blood volume were enrolled.All of them were treated with oral tolvaptan of 15-30 mg per day for 7 days.The diuretic effects were observed and the adverse reactions including electrolyte disorders(especially hypernatremia),low blood volume,thromboembolic complications,and acute kidney injury were closely monitored.Results The average urine volume was significantly increased(F=5.792,P ＜ 0.001)and the body weight was significantly decreased(F=24.086,P ＜ 0.001)from the first day of tolvaptan therapy until the end of the treatment.The average serum sodium levels were significantly increased from the second day of tolvaptan therapy until the end of the treatment(F=2.790,P=0.012),but only 3 case-times(3.6％)among the total 84 case-times of serum sodium tests showed mild hypernatremia(the highest level 146.5 mmol/L)and all the hypernatremia returned back to normal after suspending tolvaptan for one day.There were no significant changes in the serum potassium levels(F=0.477,P=0.849)within the whole treatment course.There was also no significant difference of the blood volume between the level at the end of treatment and the baseline level[(74.3± 3.0)ml/kg vs(74.9±3.0)ml/kg,P=0.855].The thromboembolic complications and acute kidney injury both also did not take place.Conclusions As long as a rational and prudent treatment regimen is applied,tolvaptan has good diuretic effects and safety for treatment of edema in the NS patients with normal serum sodium and blood volume.

Delayed 18F-FDG PET/CT with oral small dosage diuretics in diagnosing urogenital cancers / 中国医学影像技术

Objective To investigate the value of delayed 18F-FDG PET/CT with oral intake small dosage diuretics for diagnosing urogenital cancers.Methods Patients with suspected urogenital system cancers were divided into routine dosage diuretic group (n=12) and small dosage diuretics group (n=35).All patients underwent whole-body PET/CT followed by delayed scanning after oral 40 mg or 20 mg Furosemide respectively.The urine maximum standard uptake value (SUVmax) and T/U (the ratio of urine and lesion SUVmax) before and after diuresis were compared respectively.Diagnostic efficacy for malignant urogenital system cancers of small dosage group was calculated.Results The urine SUVmax and T/U were statistically different between routine whole body and delayed scans in both groups (P＜0.05).SUVmax and T/U of routine and delayed scans had no statistical differences between the two groups (P＞0.05).In small dosage group,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of delayed imaging and routine imaging was 96.77％ (30/31)and 61.29％ (19/31),75.00％ (3/4) and 50.00％ (2/4),96.77％ (30/31) and 90.48％ (19/21),75.00％ (3/4)and 14.29％ (2/14),94.29％ (33/35) and 60.00％ (21/35),respectively.The sensitivity and accuracy were statistically different between routine and delayed imaging (P＜0.001).Conclusion Delayed PET/CT imaging with oral small dosage Furosemide has the same efficacy as PET/CT using routine dosage diuretics,which is useful for diagnosing urogenital cancers.

Therapeutic Effect of Heat-clearing and Diuresis-promoting Herbs Combined with Febuxostat for Chronic Gout / 广州中医药大学学报

Objective To investigate the clinical efficacy of heat-clearing and diuresis-promoting herbal formula Tongfeng Recipe in treating damp-turbidity-heat accumulation type of gout with tophus. Methods Sixty qualified patients were randomized into treatment group and control group, 30 cases in each group. The control group was given oral use of Febuxostat Tablets, and the treatment group was given Tongfeng Recipe combined with Febuxostat Tablets. After treatment for 6 months, we compared the changes of serum uric acid, the maximum diameter of the tophi, attack frequency of gout, scores of traditional Chinese medicine (TCM) syndromes, and adverse reaction in the two groups. Results (1) During the trial, 2 cases from the treatment group and 3 from the control group were lost to follow-up, and the final included case number of the treatment group and control group was 28, 27 respectively. (2) After treatment, the serum uric acid level in the two groups was decreased (P<0.01 compared with that before treatment), and the decrease in the treatment group was superior to that in the control group (P<0.05). (3) After treatment, the percentage of patients with serum uric acid less than 60mg/L in the treatment group and control group was 96.43％, 77.78％ respectively, the difference being significant(P<0.05).(4) After treatment, the maximum diameter of the tophi was reduced in the two groups(P<0.05 compared with that before treatment), and the decrease in the treatment group was superior to that in the control group (P<0.05). (5) After treatment, the scores of TCM syndromes in the two groups were markedly improved (P < 0.01 compared with those before treatment) , and the improvement in the treatment group was superior to that in the control group (P < 0.05). (6) During the treatment, acute attack of gout occurred in one case of the treatment group and in 7 cases of the control group, the difference being significant (P<0.05). The treatment group had 4 cases of diarrhea and one case of hepatic function injury, and the control group had 3 cases of diarrhea and one case of hepatic function injury , the difference being insignificant between the two groups (P > 0.05). Conclusion Heat-clearing and diuresis-promoting herbal formula Tongfeng Recipe exerts certain effect in treating damp-turbidity-heat accumulation type of gout with tophus, and the recipe is effective on decreasing serum uric acid, preventing the acute attack of gout induced by anti-uric acid treatment, and improving TCM syndromes.

Potential effect of Silybum marianum L. and Cistus ladaniferus L. extracts on urine volume, creatinine clearance and renal function

Objective: To investigate the diuretic and renal effects of Silybum marianum L. and Cistus ladaniferus L. in normal rats. Methods: Four groups of rats were used in each experiment. The first group received water, the second group received Cistus ladaniferus L. extract (100 mg/kg b.wt), the third group received Silybum marianum L. extract (100 mg/kg b.wt), and the fourth group received furosemide (10 mg/kg b.wt). Variables including urine volume, plasma and urine sodium, potassium and creatinine, and creatinine clearance were measured. Two experiments were conducted. A single dose of each intervention was used and the variables were measured during 24 h, and the interventions were given daily for a total of 8 d and the variables were measured during various intervals. Results: The single dose of each plant extract increased urine volume at all-time intervals and increased urine sodium and potassium excretion without affecting plasma sodium and potassium (P<0.05). On the day 8 after daily administration, the plant extracts induced a significant diuresis and natriuresis without affecting serum electrolytes (P<0.05), while furosemide caused hypokalemia. Both plant extracts significantly increased creatinine clearance (P<0.05). Conclusions: Silybum marianum L. and Cistus ladaniferus L. increase creatinine clearance and have a significant diuretic effect without affecting serum electrolytes. Silybum marianum L. is more potent than furosemide or Cistus ladaniferus L. http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=6;spage=393;epage=398;aulast=El;type=2.

Acute hypotensive and diuretic activities of Berberis vulgaris root bark aqueous extract in normal rats

The aim of this study is to investigate the effectiveness of intravenous administration of Berberis vulgaris root bark aqueous extract (BRBD) on the cardiovascular and renal functions of healthy normotensive rats. The different doses of BRBD 1, 10 and 20 mg/kg were administered intravenously (i.v) in normal rats. Blood pressure, diuretic activity and serum renal profile were analyzed. Intravenous injection of BRBD at the different doses of 1, 10 and 20 mg/kg showed a dose-dependent reduction in mean arterial blood pressure (P<0.001). At different doses of 1, 10 and 20 mg/kg, the hypotensive effect remained for more than one hour. Single dose administration of BRBD at doses of 10 and 20 mg/kg caused a significant increase in urine output (P<0.001) as compared to the control rats. Serum renal profile test (albumin, Urea, Uric Acid, creatinine and BUN) did not show any significant alteration. The authors conclude that the BRBD is a potent hypotensive and possesses diuretic potential

Efficacy of Benefiting Qi for Warming Yang and Activating Blood Circulation with Western Medicine for Inducing Diuresis in the Patients with Chronic Heart Failure and its Effect on the Expression of Circulating miRNAs / 中国药师

Objective:To observe the efficacy of benefiting Qi for warming Yang and activating blood circulation for inducing diu-resis method in the treatment of patients with chronic heart failure( CHF) and its effect on the expression of circulating miRNAs ( miR-423-5p, miR-210-3p). Methods:Totally 80 CHF patients were randomly divided into two groups,the control group with 40 patients was treated with the conventional anti-heart failure therapy, and the treatment group with 40 patients was treated with benefiting Qi for warming Yang and activating blood circulation for inducing diuresis decoction on the basis of the control group, and the treatment course was 2 weeks. The clinical efficacy and syndrome integral of traditional Chinese medicine ( TCM) were evaluated. Left ventricular ejec-tion fraction ( LVEF) and left ventricular end diastolic diameter( LVEDD) were measured by echocardiography;the plasma expression levels of circulating miRNAs(miR-423-5p, miR-210-3p) were measured by real-time PCR in the two groups before and after the treat-ment. The adverse drug reactions were observed as well. Results:The total clinical effective rate of the treatment group was significant-ly higher than that of the control group (87. 50% vs 65. 00%, P <0. 05); the syndrome integral of TCM, indices of LVEF and LVEDD and the expression of circulating miRNAs were improved in both groups(P<0. 05);the total clinical effective rate, syndrome integral of TCM, indices of LVEF and LVEDD and the expression of circulating miR-423-5p of the treatment group were better than those of the control group(P<0. 05); there was no significant difference in adverse drug reactions between the groups (P>0. 05). Conclusion:The benefiting Qi for warming Yang and activating blood circulation for inducing diuresis method can improve the clinical effects in the treatment of CHF, and improve the expression of circulating miRNAs.

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.

Clinical curative effect observation of different concentrations of hypertonic saline in patients with intracranial hypertension after traumatic brain injury / 天津医药

Objective To study the effects of different concentrations of hypertonic saline (HS) and 20%mannitol on decreasing intracranial pressure (ICP) in patients with moderate-sever traumatic brain injury (TBI). Methods A total of 60 patients were randomly assigned into 7.5%HS group, 3%HS group and 20%mannitol group, 20 patients in each group. All of patients were treated with conventional treatment according to the diagnostic and treatment practices of TBI. When ICP was above 20 mmHg for more than 5 minutes, patients were administered corresponding hypertonic dehydrator. The levels of ICP, mean arterial pressure (MAP), cerebral perfusion pressure (CPP), urine volume per hour and serum sodium were monitored continuously within 6 hours after the initiation of therapy. Results All agents could significantly decrease the ICP (P<0.05), but the onset time in 7.5%HS group was less than that of the other two groups (P<0.05), and the decreased magnitude of ICP and the effective time of decreasing ICP in 7.5%HS group were more than those of the other two groups (P < 0.05). Both 7.5%HS and 3%HS could increase MAP and CPP. There was no statistical difference in serum sodium between both groups , but the diuretic effect in both groups was worse than that of 20%mannitol group. Conclusion The rapidly infusion of 7.5%HS could significantly decrease the ICP, increase the MAP and CPP without obvious side-effect in patients with moderate-sever TBI, and which is a safe and effective therapy for intracranial hypertension after traumatic brain injury .