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The pathogenesis of metabolic syndrome （MS） includes insulin resistance （IR）， central obesity， chronic low-grade inflammation， oxidative stress， endoplasmic reticulum stress， elevated free fatty acid levels， intestinal flora imbalance， renin angiotensin system abnormality， and autophagy activity deficiency， etc. Most researchers believe that IR plays a central role in the pathogenesis of MS， and abdominal obesity is an important initial factor of MS. According to the incidence and clinical characteristics， MS is classified as "obesity" "pidan" " abdominal fullness " and other diseases. It is said that the pathogenesis of MS is related to the deficiency of spleen and kidney， the formation of phlegm， turbidity， blood stasis and other pathological products， which damage the body's functions of qi， blood， yin and yang. Traditional Chinese medicine （TCM） has unique advantages in treating MS based on the holistic view and syndrome differentiation concept. It has multi-level， multi-target and multi-channel treatment characteristics. It can intervene insulin signal transduction， regulate adipocyte factor secretion level， relieve oxidative stress and endoplasmic reticulum stress response， regulate intestinal flora and renin angiotensin system， reduce free fatty acid level and regulation Autophagy and other ways to improve chronic low-grade inflammation and IR status， and then comprehensive prevention and treatment of MS and its complications. However， the following problems still exist：lack of high-quality randomized controlled clinical research and large sample real-world research， clinical unified diagnosis and treatment standard has not yet formed， lack of genetic animal model in basic research， relatively single signal pathway and target of experimental research， and difficulty in timely formation of clinical transformation of scientific research achievements. Therefore， we should make full use of modern scientific and technological means to carry out systematic and standardized multicenter， large sample， high-quality randomized controlled trials or real-world research， we should prepare perfect animal models， focus on the crosstalk relationship between multiple related cell signaling pathways， and actively explore the potential relationship between signaling pathways and prescription compatibility， so as to actively promote basic scientific research achievements Clinical practice may be the key research direction in the prevention and treatment of MS in TCM.
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Metabolic syndrome (MS) is a pathological condition characterized by central obesity, insulin resistance, hypertension, and hyperlipidemia. With the increase of poor dietary habits and lifestyles in modern society, especially the poor living habits of sedentariness and less movement, the prevalence of MS has increased year by year. According to relevant data, the number of MS patients worldwide will reach about 2.568 billion by 2040, which will seriously endanger human life and health. Huanglian Wendantang, as a famous traditional Chinese medicine prescription for clearing away heat and drying dampness, regulating Qi and resolving phlegm, and benefiting the stomach and gall, has been proved to have significant pharmacological effects in lowering blood fat, reducing blood sugar and resisting inflammation by modern pharmacological studies, and widely used in the treatment of metabolic diseases, cardiovascular diseases and other systemic diseases. In recent years, a large number of studies have proved that Huanglian Wendantang has a significant effect on MS. In terms of clinical efficacy, it could significantly improve the pathological state of obesity, dyslipidemia, abnormal glucose metabolism and hypertension in MS patients. Meanwhile, it could also interfere with the inflammatory state, prethrombotic state, abnormal vascular regulation and other potential risk factors in the body, with a high safety and fewer side effects. In terms of experimental study, it could enhance the insulin sensitivity, and improve the insulin resistance of MS animal models and cell models through interventions in insulin signal transduction, inflammatory response, and antioxidant stress. By retrieving PubMed, CNKI, Weipu, Wanfang and other databases, the author summarized the study reports of Huanglian Wendantang on MS in recent years in three aspects: theoretical study, clinical efficacy study and experimental mechanism study, in the expectation of provide some scientific references for in-depth study of the mechanism of Huanglian Wendantang in treating MS and the development and clinical promotion of the prescription.
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Clinical data of patients underwent pancreaticoduodenectomy due to malignant ampullary tumors from January 2013 and December 2016 in our hospital with full access to medical records were collected,and 144 patients were enrolled in total.Surgical Apgar Score (SAS) was calculated based on the intraoperative lowest mean arterial pressure,lowest heart rate and blood loss.The patients were divided into 2 groups depending on whether postoperative delirium developed or not within 7 days after surgery.The receiver operating characteristic curve of SAS in predicting postoperative delirium was drawn.The area under the curve,optimal cut-off value and sensitivity and specificity were calculated.Thirty-six patients developed postoperative delirium,and the incidence was 25.0％.The area under the curve of SAS in predicting postoperative delirium was 0.86 (95％ confidence interval 0.79-0.91).The optimal cut-off value was 6 with a sensitivity of 86％ and a specificity of 83％.In conclusion,intraoperative SAS can predict the development of postoperative delirium in patients undergoing pancreaticoduodenectomy.
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Objective To analyze and verify the effects of different intervention on the gut microbiota of high fat diet(HFD) induced obese rats.Methods Totally 70 male Sprague-Dawley rats were enrolled in this test.After 4 weeks of HFD feeding,40 HFD induced obese rats were randomly divided into an obese control group (n=10),an aerobic exercise group(n=10),a polysaccharide lavage group(n=10),and an aerobic exercise combined with polysaccharide lavage group (n=10).The moderate intensity treadmill training,polysaccharide lavage and their combinations were conducted as their group names indicated.The gut microbiota was analyzed using the 16S rDNA sequencing before and after the intervention.Results Compared with the control group,the ratio of ruminococcacea and ruminococcaceae bromii increased significantly,while that of turicibacteraceae,bifidobacterium and turicibacter reduced significantly in HFD induced obese rats.Compared with the obese control group,aerobic exercise increased the ratio of bifidobacteriaceae,akkemansia,bifidobacterium,akkermansia mucinphila and prevetella copri significantly,but reduced that of helicobacteraceae and ruminococcaceae significantly.Compared with the obese control group,the polysaccharide lavage increased the ratio of bifidobacteriaceae and turicibacteraceae,bifidobacterium,together with allobaculum and turicibacter significantly,but reduces that of desulforibrionaceae,helicobacteraceae and ruminococcaceae,as well as ruminococcaceae bromii significantly.Compared with the obese control group,significant increase was observed in the ratio of bifidobacteriaceae,allobaculum and blautia in the aerobic exercise combined with polysaccharide lavage group.Conclusions The ratio of obesity related bacteria such as ruminococcus bromii increases significantly in the HFD induced obese rats.All of the three different interventions can optimize the gut microbiota composition of the HFD induce obese rats effectively by increasing the ratio of beneficial bacteria.However,they have significant differences on the ratio of different bateria.
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Objective To assess the impact of maximal fat oxidation intensity(FATmax) exercise on arterial stiffness in overweight/obesity young men.Method Thirty two overweight/obesity young men (BMI≥25 kg/m2) without the habit of doing exercises,were divided into an exercise group (n=16) and a control group (n=16) randomly.The exercise group completed a 12-week walk/run(FATmax intensity,3-5 times/week,40-60 min/time) intervention,while the control group maintained normal life style without regular exercise.The body composition,cardiopulmonary function (VO2max),C reactive proteins (CRP) and blood hemodynamic were measured,and the brachial-ankle pulse wave velocity(baPWV) was observed to assess the arterial stiffness before and after the 12-week intervention.Results Significant decrease was observed in the average weight,body mass index,body fat mass,body fat percentage,baPWV,CRP,platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) (P＜0.05),while significant increase was found in the average VO2max and HDL-C(P＜0.05) after the training.After the intervention,the change in baPWV(△) was positively associated with △ CRP(r=0.604),△ NLR(r=0.535) and △ WBC (white blood count) (r=0.406) (P＜0.05,n=32),but negatively correlated with △ VO2max (r=-0.660,P＜0.05,n=32).Conclusion FATmax intensity aerobic exercise is effective to downregulate the inflammation,and improve aerobic fitness and vascular function.However,the potential mechanism of arterial stiffness improvement following exercise needs further study.
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Objective To compare the efficacy and safety of Etomidate-Dexmedetomidine and Propofol-Dexmedetomidine sedation in patients undergoing endoscopic radiofrequency ablation of gastroesophageal relfux disease (GERD).Methods Sixty adult patients, scheduled for elective endoluminal radiofrequency ablation for GERD under sedation were prospectively randomized into Etomidate-Dexmedetomidine (Group-E,n = 30) or Propofol-Dexmedetomidine (Group-P,n = 30) group. A bolus of 0.2 μg/kg of intravenous Dexmedetomidine was followed by intermittent Etomidate or Propofol injection during the procedure in order to maintain a proper depth of sedation with a Ramsay sedation scores of 5~6. Heart rates, mean blood pressure, oxygen saturation, respiratory rates and Ramsay sedation scores were recorded before sedation (T0), at the beginning of the examination (T1), during radiofrequency energy delivery (T2), at the time of gastroscopy (T3) and at the end of therapy (T4). Inter-group differences in sedation proifles (duration, time to recovery, incidence of body movement, Ramsay sedation scores and satisfaction of patient and endoscopist) and cardio-respiratory responses (heart rate, mean arterial pressure, oxygen saturation) were determined during and after radiofrequency ablation.Results No difference was found for therapy duration, anesthesia time or the time to recovery between Group-P and Group-E. Patients receiving Propofol experienced more bradycardia (Ρ = 0.032) and had higher incidences of vasoactives used (Ρ = 0.002) compared with that receiving Etomidate. Oxygen saturation in T1 (Ρ = 0.023) and T2 (Ρ = 0.009) was lower in the Group-P. No significant difference was found for other indicators.Conclusion Etomidate-Dexmedetomidine sedation was superior to Propofol-Dexmedetomidine sedation for GERD radiofrequency therapy with more stable cardio-respiratory responses.
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Objective To evaluate the effect of remifentanil pretreatment on myoclonus after etomidate injection.Methods Sixty patients undergoing scheduled for intestinal endoscopy under general anesthesia were divided into remifentanil group and control group by random digits table method with 30 cases each.Before 0.3 mg/kg etomidate was given,the patients in remifentanil group and control group were pretreated with remifentanil 0.5 μ g/kg or amount of 0.9％ sodium chloride.Myoclonus was observed and recorded.Nausea,pruritis and apnea were observed after procedures.Results The incidence of myoclonus was 73.3％(22/30) in control group,mild in 11 cases,moderate in 10 cases and severe in 1 case.The incidence of myoclonus was 6.7％(2/30) in remifentanil group and mild in 2 cases.There was significant difference in the incidence of myoclonus between two groups (P ＜ 0.01).In control group,the ratio of myoclonus was 14/16 in males and 8/14 in females.In remifentanil group,male and female each had 1 case of myoclonus.There was no nausea,pruritis and apnea in remifentanil group.Conclusion Pretreatment with 0.5 μ g/kg remifentanil reduces myoclonus after etomidate injection,male patients are more associated with the incidence of myoclonus than female patients.
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<p><b>OBJECTIVE</b>To study the effect of blood activating water relieving method (BAWRM) on heart functions and serum levels of NT-proBNP in patients with heart failure with normal ejection fraction (HFNEF).</p><p><b>METHODS</b>Sixty-four HFNEF patients were admitted to our hospital during January 2011 to June 2012. They were randomly assigned to the treatment group (32 cases) and the control group (32 cases). Patients in the control group received routine Western medical treatment, while those in the treatment group additionally took Chinese medical recipes for activating blood circulation and relieving water retention. Changes of Chinese medical syndromes, E/E', serum NT-proBNP contents were observed between the two groups.</p><p><b>RESULTS</b>Compared with before treatment, their Chinese medical syndromes and E/E' were significantly improved, and serum NT-proBNP contents decreased in the two groups (P < 0.05). Compared with the control group, Chinese medical syndromes, E/E', serum NT-proBNP contents obviously decreased in the treatment group, showing statistical difference (P < 0.05).</p><p><b>CONCLUSION</b>BAWRM was an effective way to improve the diastolic function of HFNEF patients and lower the serum level of NT-proBNP with confirmative efficacy.</p>
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Cardíaca , Sangue , Tratamento Farmacológico , Medicina Tradicional Chinesa , Métodos , Peptídeo Natriurético Encefálico , Sangue , Fragmentos de Peptídeos , Sangue , Volume SistólicoRESUMO
Objective To investigate the effect of ropivacaine combined with dexanmethasone sprayed intratracheally in patients with resistant tubes and postoperative sore throat.Methods Eighty patients ASA Ⅰ-Ⅱ grade undergoing laparoscopic cholecystectomy were randomly divided into four groups by random digits tabel method,20 patients in each.2 ml of 0.75％ ropivacaine combined with 1 ml dexamethasone (group A) ; 2 ml of 0.75％ ropivacaine combined with 1 ml 0.9％ sodium (group B) ; 3 ml of 1％ tetracaine (group C); 3 ml of 0.9％ sodium (group D) were immediately intratracheal sprayed before intubation.The resistant tubes and degree of postoperative 24 h sore throat [by visual analog scale (VAS) scores],comfort [by Bruggrmann comfort scale (BCS) scores] and the incidence of sore throat were recorded.Results The resistant tubes appraised rate in group A,B and C was higher than that in group D [65.0％ (13/20),60.0％ (12/20),70.0％ (14/20) vs.5.0％ (1/20)] (P ＜ 0.05),but there was no significant difference among group A,B and C (P＞ 0.05).The incidence of sore throat at 24 h after surgery in group A,B and C was lower than that in group D [20.0％(4/20),25.0％ (5/20),25.0％ (5/20) vs.90.0％ (18/20)] (P ＜ 0.05),but there was no significant difference among group A,B and C (P＞ 0.05).The VAS and BCS scores in group A were better than those in group B,C and D [(0.52 ± 1.14) scores vs.(1.68 ± 1.42),(1.59 ± 1.33),(4.22 ± 1.95) scores,(2.80 ± 1.54) scores vs.(1.60 ± 1.19),(1.80 ± 1.20) and (0.45 ± 0.81) scores] (P ＜ 0.05),but there were no significant differences between group B and group C (P ＞ 0.05).Conclusion Ropivacaine combined with dexamethasone sprayedintratracheally can significantly increase the degree of postoperative resistant tubes,decrease the rate of sore throat after general anesthesia,and increase patient' s comfort.
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Objective To investigate the effect of dexmedetomidine on patients with pancreatic cancer treated by high intensity focused ultrasound (HIFU) under general anesthesia.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients with pancreatic cancer undergoing HIFU treatment,were divided into control group (group C) and dexmedetomidine group (group D) by random digits table method,each group with 60 cases.Dexmedetomidine was intravenously infused at 0.2 μ g/(kg· h) until the end of operation after a loading dose of 0.7 μg/kg over 15 min before induction of anesthesia in group D,while the equal volume of normal saline was infused in group C.Anesthesia was induced with intravenous injection of fentanyl 2-3 μg/kg and propofol 1.5-2.0 mg/kg and cisatracurium 0.2 mg/kg at 5 min after administration of the loading dose.Anesthesia was maintained with sevoflurane,remifentanil,propofol,cisatracurium.The propofol,remifentanil and sevoflurane consumption,the incidence of postoperative agitation,delirium,delayed recovery were recorded.Results The intraoperative heart rate in group D was significantly lower than that in group C (P ＜ 0.05).The propofol,remifentanil and sevoflurane consumption in group D were significantly shorter than those in group C [(341.4 ± 45.7) mg vs.(520.5 ± 50.8) mg,(1.7 ± 0.5) mg vs.(2.3 ± 0.8) mg,(11.6 ± 4.1) ml vs.(16.7 ± 3.8) ml,P ＜ 0.05].The incidence of postoperative agitation and delirium in group D were significantly lower than those in group C [6.7％(4/60) vs.21.7％(13/60),8.3％ (5/60) vs.26.7％ (16/60),P ＜ 0.05].There was no statistically significant difference in the incidence of delayed recovery between group D and group C [3.3％ (2/60) vs.1.7％ (1/60),P ＞ 0.05].Conclusions Dexmedetomidine given HIFU treatment of pancreatic cancer patients can reduce the amount of general anesthetic,reduce the incidence of postoperative agitation and delirium,intraoperative heart rate.
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Objective To study the effect of long-time carbon dioxide (CO2) pneumoperitoneum on QT dispersion (QTd) in elderly patients during Davinci robotassisted surgery.Methods Thirty elderly patients undergoing elective Davinci robot-assisted hepato-pancreato-biliary surgery with general anesthesia were enrolled in this study.Pneumoperitoneum was established at 12 mm Hg ( 1 mm Hg =0.13 3 k Pa).QTd was recorded before the induction of anesthesia; at 5,15,30,60,120,180 and 240 min after pneumoperitoneum.Results Compared with before anesthesia,mean arterial blood pressure (MAP) increased significantly at 15,30 min after pneumoperitoneum ( P＜0.05 ),and had no significant difference at 5,60,120,180,240min (P＞0.05 ).Heart rate (HR) increased significantly at 15,30 min after pneumoperitoneum (P＜0.05 ).End-tidal pressure of carbon dioxide (PETCO2) increased after pneumoperi-toneum,and had significant difference at 30,60,120,180,240 min after pneumoperitoneum (P＜0.05).In 30 patients,11 patients occurred arrhythmia including atrial extrasystole,premature ventricular beats,tachycardia.Compared with before anesthesia,QTd,corrected QTd (QTcd),QT interval,corrected QT interval (QTe) were significantly increased at 15,30,60 min after pneumoperitoneum (P＜0.05),but had on significant difference at 5,120,180,240 min after pneumoperitoneum (P＞0.05).Conclusion The effect of CO2 pneumoperitoneum on the autonomic nervous system for elderly patients might be important,as an imbalance in autonomic cardiac control might lead to serious consequences.
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Objective To observe and compare the efficacy and safety between propofol-remifentanil and propofol-fentanyl for anesthesia of artificial abortion.Methods 200 ASA I patients scheduled for painless artificial abortion were randomly divided into two groups.R group were given intravenous remifentanil 1.0μg/kg then propofol 1～1.5mg/kg(n=100);F group were given intravenous fentanyl 0.05mg then propofol 1～1.5mg/kg(n=100).Total propofol dosage,analgesic effect during intro-and post-operative,consciousness loss time,wake-up time and independenly leaving time were recorded.BP,HR,SpO2 and side effects such as nausea and vomiting were observed during intro-and post-operative.Results The dosage of propofol was less in group R than that in group F[(80.4±10.8)mg vs(110.1±13.6)mg,P＜0.01)];consciousness loss time,wake-up time and independenly leave hospital time were shorter in group R than that in group F(P＜0.05);SpO2 down range and rate were significandy higher in group R(P＜0.05);Incidence of nausea and somnolence in group R was obviously lesS than that in group F.Conclusion Artifical abortion can be preformed effectively and safely with propofol-remifentanil or propofol-fentanyl,but propofol-remifentanil especially fits for painless artificial abortion compared with propofol-fantanyl.
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Objective To invistigate molecular mechanism of the effect of aprotinin on platelets membrane glycoproyin during cardiopulmenary bypass Methods The venous blood of 20 healthy volunteers in the tubes containing 3 2% trisodium citrate or 5u/ml heparin,to evaluate the effect of aprotinin on the expressions of platelets membrane glycoprotein (GP) Ⅱb Ⅲa receptor and P seclectin with flow cytometric analysis Results Aprotinin at 50 200U/ml decreased the expression of activated GP Ⅱb Ⅲa complex in response to adenosine diphosphate or thrombin receptor activator peptide 6 in a dose dependent manner in both citrated and heparinized whole blood experiments (P
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Objective:To study the significance of QT dispersion(QTd) changes in electrocardiogram(ECG) after coronary artery bypass graft. Methods:Forty eight patients scheduled for elective coronary artery bypass graft were studied. The changes of QTd were monitored by 12 lead electrocardiogram system before surgery (as baseline values), at the end of surgery, and 1 4 d and 7 d after surgery.Results:The baseline values for QTd was (56.32?2.25) ms.QTd were significantly longer as compared to the baseline values ( P
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The aim of this study is to invistigate the effects of heparinization and the reversal of heparin activity with protamine on platelet function during extracorporeal cardiopulmonary bypass. The venous blood of 10 healthy volunteers was collected in tubes containing 3 2% trisodium citrate or 25??/ml heparin. The expression of P selectin (a secretion marker of platelets) and activated fibrinogen receptor GP Ⅱb Ⅲa (an aggregation marker of platelets) on normal platelets in response to the treatment with heparin and protamine in vitro were examined using whole blood flow cytometry. The results showed that heparin (5～50?g/ml) could increase adenosine diphosphate (ADP) induced expression of P selectin and GPⅡb Ⅲa in a dose dependent manner ( P