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Background: Endoscopy combined with biopsy-based histology is most commonly used in the surveillance of ulcerative colitis (UC). However, the endoscopic and histological results for assessing disease activity are often inconsistent. Aims: To investigate the consistency and correlation of endoscopic and histological scoring systems in assessing the disease activity in UC patients. Methods: A retrospective study was conducted in UC patients admitted from January 2014 to January 2020 at Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The clinical manifestations, endoscopic and histological findings were collected and analyzed, and the disease activity was examined endoscopically and histologically by Mayo Endoscopic Subscore and Simplified Geboes Score, respectively. Results: One hundred and forty-three UC patients were enrolled. Basal plasmacytosis is frequently seen in endoscopically active UC (OR=11.19, 95% CI: 4.80-26.09, P<0.001). Approximately half of the patients (53.7%) who achieved endoscopic remission still had inflammatory activity histologically. Kappa consistency test showed that the agreement between Mayo Endoscopic Subscore and Simplified Geboes Score for assessing disease activity was moderate (κ=0.4, P<0.001). By Spearman correlation coefficient analysis, a moderate correlation between the two scoring systems was identified (r
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Inflammatory bowel disease (IBD) is a chronic and recurrent inflammation of gastrointestinal tract caused by disorder of immune system. It includes Crohn's disease (CD) and ulcerative colitis (UC). Many factors such as environment and dysbiosis of gut microbiota can lead to IBD. TNF-α is generally considered as playing an important role in the development and progression of IBD. This article reviewed the role of TNF-α in the pathogenesis of IBD.
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Objective To systematically review the effect of Qingre Jiedu and Liangxue Sanyu method in patients with sepsis,and to discuss its effect in the treatment of sepsis.Methods The randomized controlled trials (RCTs) on the treatment of Qingre Jiedu and Liangxue Sanyu method for sepsis published on PubMed,Embase,Web of Science,CNKI and Wanfang database from the construction to December 31st,2017 were searched by electronical way.Conventional treatment measures for sepsis,such as fluid resuscitation,maintenance of hemodynamic stability,anti-infection,improvement of tissue perfusion,maintenance of organ function and nutritional support were used in the control group.While traditional Chinese medicine treatment based on Qingre Jiedu and Liangxue Sanyu method were applied in the experimental group besides the conventional treatment,including Chinese patent medicine or Chinese herbal medicine.The main outcome was 28-day mortality,and the second outcome was acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),coagulation function,inflammatory mediators,procalcitonin (PCT),lactic acid (Lac),and the length of intensive care unit (ICU) stay.Two researchers independently searched literatures,collected data and evaluated risk bias.The statistical analysis was completed by RevMan 5.3 and STATA 13.0 software.The funnel plot and Egger test were used to evaluate the potential publication bias of the main outcomes.Results A total of 20 RCTs were enrolled in this Meta-analysis,including 1 347 patients,with 667 patients in the control group and 680 patients in the experimental group.Comprehensive risk bias assessment showed that the risk bias of 11 RCT items was unknown,and the risk bias of 9 RCT items was high.Meta-analysis results showed that compared with the control group,the 28-day mortality of the experimental group was significantly lowered [relative risk (RR) =0.54,95％ confidence interval (95％CI) =0.45-0.65,P ＜ 0.00001],the 7-day APACHE Ⅱ score was significantly lowered [mean difference (MD) =-3.86,95％CI =-4.82 to-2.90,P ＜ 0.00001],the 7-day prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly shortened (PT:MD =-1.72,95％CI =-2.29 to-1.14,P ＜ 0.00001;APTT:MD =-4.36,95％CI =-5.81 to-2.91,P ＜ 0.000 01),the 7-day D-dimer was slightly improved (MD =-0.13,95％CI =-0.37-0.11,P =0.29),the 10-day interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly decreased (IL-6:MD =-40.33,95％CI =-59.55 to-21.11,P ＜ 0.000 1;TNF-α:MD =-7.26,95％CI =-11.31 to-3.21,P =0.000 4),the 7-day Lac was significantly declined (MD =-1.30,95％CI =-1.91 to-0.68,P ＜ 0.000 1),but no significance in PCT (MD =-1.57,95％CI =-3.25-0.11,P =0.07) or the length of ICU stay (MD =-4.02,95％CI =-8.60-0.56,P =0.09)was found.The results of publication bias assessment showed that 19 studies reported 28-day mortality were basically "funnel-shaped" distribution without potential publication bias (P =0.336).Conclusion The Meta-analysis showed that Qingre Jiedu and Liangxue Sanyu method may reduce the release of inflammatory mediators,improve the coagulation function,and reduce the 28-day mortality in patients with sepsis.
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Objective To investigate the effect of Qingfeihuayutongfu prescription on oxygenation and pulmonary fibrosis in patients with sepsis-associated acute respiratory distress syndrome (ARDS). Methods A prospective randomized controlled trial was performed. Patients with moderate to severe ARDS admitted to intensive care unit (ICU) of Affiliated Hospital of Nanjing University of Chinese Medicine from July 2015 to February 2017 were enrolled, and randomly divided into Qingfeihuayutongfu prescription group (observation group, 200 mL of Qingfeihuayutongfu prescription was given through nasal feeding on the first day after admission, one dose per day for 7 days) and placebo control group. Routine treatment of ARDS in both groups was the same. The oxygenation index (PaO2/FiO2), levels of serum procollagen Ⅲ (PC Ⅲ) and prolidase (PLD) were measured at 1, 3, 7, 14 and 28 days after treatment, duration of mechanical ventilation, the length of ICU stay and 60-day survival rate were recorded. Results A total of 32 patients with ARDS were selected, with 16 in each group, and their baseline data were balanced and comparable. As time went on, PaO2/FiO2in both groups was decreased gradually, and serum levels of PC Ⅲand PLD were increased gradually. Compared with placebo control group, PaO2/FiO2was significantly increased at 14 days and 28 days after treatment in observation group [mmHg (1 mmHg = 0.133 kPa): 185.81±65.07 vs. 137.19±55.72, 250.56±102.72 vs. 178.25±80.97, both P < 0.05], the levels of serum PC Ⅲ were significantly decreased at 14 days and 28 days after treatment (μmol/L: 197.13±26.61 vs. 240.81±45.27, 169.06±36.34 vs. 234.75±46.30, both P < 0.01), the levels of serum PLD was significantly decreased at 28 days after treatment (U/L: 1 166.31±304.84 vs. 1 468.81±387.65, P < 0.05), duration of mechanical ventilation (days: 18.20±5.20 vs. 23.38±7.57) and the length of ICU stay (days: 23.7±5.7 vs. 31.0±7.9 ) were significantly shortened (both P < 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference in the 60-day survival rate between the observation group and placebo control group [81.25% (13/16) vs. 68.75% (11/16), χ2= 0.667, P = 0.505]. Conclusion The Qingfeihuayutongfu prescription may improve oxygenation of ARDS patients, reduce the levels of serum PC Ⅲ and PLD, and inhibit pulmonary fibrosis, thus improve prognosis.
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Objective To investigate the value of bedside lung ultrasound B-line score in the diagnosis of acute heart failure (AHF). Methods A retrospectively analysis was conducted. The adult patients presenting with acute dyspnea in intensive care unit (ICU) of Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2016 to June 2017 were enrolled. An 8-zone lung ultrasound was performed and plasma B-type natriuretic peptide (BNP) level was tested in all patients. AHF was determined as the final diagnosis by two experienced ICU doctors according to the diagnostic criteria of AHF. Patients were divided into two groups: AHF group and non-AHF group. The levels of BNP and B-line score were compared between the two groups, and the diagnostic value of BNP and B-line score in AHF was evaluated. Results Fifty-six patients were included in this study, with 32 of men and 24 of women,and with an average age of 77.3±8.8. Thirty-six patients were diagnosed as AHF. The level of BNP and lung ultrasound B-line score in AHF group were higher than those in non-AHF group [BNP (ng/L): 1 640.4±1 078.4 vs. 236.9±124.9,B line score: 12.8±5.3 vs. 5.4±1.8, both 1 < 0.01]. There was a strong correlation between elevated BNP levels and an increased B-lines score (R2 = 0.712, 1 = 0.000). The receiver operating characteristic curve (ROC) showed that when the cut-off of lung ultrasound B-line score was 8.5, AHF could be discriminated from dyspnea caused by other diseases (sensitivity was 77.8%, specificity was 95%, positive likelihood ratio was 15.56, negative likelihood ratio was 0.23).The area under the ROC curve (AUC) of lung ultrasound B-line score was 0.917 [95% confidence interval (95%CI) =0.847-0.987, 1 = 0.000], slightly lower than that of plasma BNP [0.979 (95%CI = 0.951-1.008)]. Conclusion Lung ultrasound B-line score was highly specific, but moderately sensitive for identifying patients with AHF.
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Objective To confirm the effects of statin therapy on mortality of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods PubMed/Medline, Embase, Web of Science andCochrane Central Register of Controlled Trials were searched for articles using the terms acute lung injury, ALI,acute respiratory distress syndrome, ARDS, statin, simvastatin and rosuvastatin updated to November 17,2015. Randomized controlled trial (RCT) or observational cohort studies investigating the effects of statin therapy onmortality in patients with ALI or ARDS were all identified, without date or language restriction. The control group wasgiven conventional treatment, while the experimental group was treated with statins additionally. The primary outcomewas in-hospital mortality. Meanwhile, ventilator-free day, intensive care unit (ICU)-free day, ICU length of stay (LOS)and ICU mortality were also analyzed. RevMan 5.2 and STATA 13 software were used for systematic review and Metaanalysis, and funnel plot was used to analyze the publication bias. Results A total of five trials including threerandomized controlled trials and two observational studies were included. Among 1636 patients enrolled in the study,there were 739 patients in experimental group, and 897 in control group. It was shown by Meta analysis that there was nosignificant difference in in-hospital mortality between experimental group and control group [relative risk (RR) = 0.96,95% confidence interval (95%CI) = 0.79-1.15, P = 0.63]. The subgroup analysis based on RCT and cohort study, or thesubgroup analysis of different statins showed that there was no significant difference in in-hospital mortality betweenthe experimental group and the control group (both P > 0.05). There were no significant differences in ventilator-freedays [mean difference (MD) = 1.41, 95%CI = -0.32-3.13, P = 0.11], ICU-free days (MD = -0.23, 95%CI = -1.61-1.15,P = 0.75), ICU length of stay (MD = -1.03, 95%CI = -6.55-4.50, P = 0.72), or ICU mortality (RR = 0.88, 95%CI =0.68-1.14, P = 0.33) between the experimental group and the control group. It was shown by funnel plot that there was nopublication bias in in-hospital mortality. Conclusion The systematic review and meta-analysis suggests that statin may not be associated with a significant reduction in mortality, ventilator-free day, ICU-free day and ICU length of stayin patients with ALI/ARDS.
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Objective To observe the effect of Xijiaodihuang decoction on the release of inflammatory mediators and prognosis in elderly patients with sepsis.Methods A prospective randomized controlled study was conducted. Seventy-four patients with sepsis admitted to the Department of Geriatrics of Changshu Hospital of Traditional Chinese Medicine (TCM) Affiliated to Nanjing University of TCM from March 2015 to February 2017, and they were divided into a TCM treatment group and a control group randomly, 37 cases in each group, there were 2 patients transferred to other department during the period of study to continue treatment, 2 patients discharged automatically and 1 case transferred to other hospital in the TCM treatment group; and there were 3 patients transferred to other hospital, 1 patient discharged automatically, 1 patient dead in 7 days after entering the control group and 1 patient transferred to other department during the period of observation to continue treatment in the control group. Finally, 32 patients were in TCM treatment group and 31 patients in the control group, completing the study. All patients in the two groups received conventional treatment of sepsis, patients in the TCM treatment group took Xijiaodihuang decoction 100 mL concentrated [rhinoceros horn (replaced with buffalo horn) 30 g, rehmannia root 24 g, peony 12 g, tree peony bark 9 g] taken orally or by nasal feeding, and patients in the control group received the same amount of normal saline, the two groups were treated 1 time a day for consecutive 7 days to complete 1 therapeutic course, then the treatment efficacy was evaluated in the two groups. The differences of serum interleukins (IL-1β, IL-6), tumor necrosis factor-α (TNF-α), white blood cells (WBC), C-reaction protein (CRP), lactate levels between the two groups were compared before treatment and on the 3rd, 7th and 14th day after treatment, the incidence of staying in intensive care unit (ICU), time of staying in ICU and 28-day mortality were also observed. The 28-day survival rate between two groups was analyzed by Kaplan-Meier survival curve.Results After treatment in the two groups, the levels of IL-1β, IL-6 and TNF-α had a tendency of increase at first and then decrease. After treatment for 14 days, the IL-1β was significantly lower in the TCM treatment group than that of the control group (ng/L: 83.27±21.84 vs. 96.73±26.33), the levels of IL-6 and TNF-α in TCM treatment group were obviously lower than those in the control group since 7 days after treatment [IL-6 (ng/L): 48.27±24.13 vs. 62.15±24.34, TNF-α (μg/L): 1.41±0.31 vs. 1.96±0.29]. IL-6 and TNF-α were still lower than those in the control group until 14 days after treatment [IL-6 (ng/L): 29.25±18.57 vs. 56.24±23.61, TNF-α (μg/L) 1.35±0.28 vs. 1.83±0.22, allP 0.05). After treatment, the lactate in the control group was gradually decreased, while in the TCM treatment group, the lactate level after treatment presented a tendency firstly decreased and then elevated, and after treatment for 3 days in TCM treatment group, the level of lactate began markedly lower than that in the control group (mmol/L: 1.26±0.43 vs. 2.01±0.59,P < 0.05). The ICU hospitalization rate and ICU length of stay in the TCM treatment group were significantly lower than those in the control group [56.25% (18/32) vs. 83.87% (26/31), (10.2±5.4) days vs. (13.5±5.8) days], and the 28-day mortality was also obviously lower in TCM treatment group than that in control group [9.37% (3/32) vs. 29.03% (9/31)]. Kaplan-Meier survival curve analysis showed that the 28-day survival rate in TCM treatment group was significantly higher than that in control group (P = 0.045).Conclusion Xijiaodihuang decoction can reduce the levels of IL-1β, IL-6, TNF-α and lactate in serum, reduce the incidence of staying in ICU, decrease the time of staying in ICU and improve the prognosis of elderly patients with sepsis.
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Objective To observe the influence of Qingwen Baidu decoction (QBD) on serum procalcitonin (PCT) and C-reactive protein (CRP) levels in septic rats and study the mechanism of heat-clearing and detoxifying method for treatment of sepsis. Methods Fifty male Sprague-Dawley (SD) rats were randomly divided into control group (n=5), model group (n=25), and heat-clearing and detoxifying experimental group (experimental group, n=20). The septic model was reproduced by intra-peritoneal injection of lipopolysaccharide (LPS, 5 mg/kg). In control group, an equal volume of normal saline was given. After modeling for 2 hours, the heat-clearing and detoxifying experimental group received QBD the first time (composition of the decoction: Gypsum Fibrosum Recens 30 g, Rehmanniae Radix 10 g, Bubali Cornu 15 g, Coptidis Rhizoma 4 g, Gardeniae Fructus 5 g, Platycodonis Radix 5 g, Scutellariae Radix 5 g, Anemarrhenae Rhizoma 5 g, Paeoniae Radix Rubra 5 g, Scrophulariae Radix 5 g, Forsythiae Fructus 5 g, Glycyrrhizae Radix 5 g, Moutan Cortex 5 g, Lophatheri Herba 5 g) by gavage (0.01 mL/g); the rest administration time was 08:00 to 09:00, once a day. The rats in model group were given an equal volume of warm water by gavage. At different time points after modeling, the blood of 5 rats in control group, model group, and experimental group was collected from the abdominal aorta. The serum PCT and CRP levels were tested by the enzyme linked immunosorbent assay (ELISA), and the pathological changes in lung and intestinal tissue were observed under a light microscope. Results Compared with the control group, the PCT level of the model group after modeling for 2 hours was significantly increased (ng/L:332.32±22.85 vs. 70.46±3.18, P 0.05). The level of CRP in model group was lower than that of control group at 24 hours and 72 hours after modeling (μg/L:281.34±32.81, 237.84±41.42 vs. 350.09±56.67, P 0.05). The PCT level of experimental group was significantly lower than that of model group beginning from 48 hours after modeling (ng/L: 321.57±28.00 vs. 358.12±10.14, P < 0.05), and this situation continued until 72 hours after modeling (ng/L: 269.50±49.10 vs. 347.69±26.90, P <0.05). The CRP level of experimental group was significantly lower than that of model group beginning from 8 hours after modeling (μg/L:232.73±13.29 vs. 335.35±53.78, P<0.05), this statistical significant difference between the two groups persisted until 72 hours after modeling (μg/L:177.31±6.70 vs. 237.84±41.42, P<0.05). Compared to those in the model group, the lung tissue inflammatory cell infiltration, the intestinal mucosal inflammation and interstitial edema were milder in the experimental group. Conclusion Heat-clearing and detoxifying therapy can effectively reduce the serum PCT and CRP levels of septic rats induced by LPS, and it can alleviate the infiltration of inflammatory cells in lung tissues so as to play a role in protection of tissue organ.
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Objective To explore the relationship between job burnout and personality characteristics of prison police,and provide a basis for prevention and intervention of prison police burnout.Methods Using Maslach burnout inventory general survey(MBI-GS) and Catteii the sixteen factor questionnaire(16PF) to investigate 217 prison police in Beijing.Results The overall prevalence of burnout syndrome among prison police was 64.7％.The prevalence of emotional exhaustion(11.09±5.86),depersonalization(6.38±4.81) and diminished personal accomplishment(17.96± 2.07) was 46.5％,25.6％,33％ respectively.Compared with the national norm of 16PF,the 10 factors of warmth(t=-2.01,P=0.007),reasoning(t=9.22,P=0.000),dominance(t=6.46,P=0.000),liveliness(t=4.01,P=0.000),social boldness(t=-2.00,P=0.047),sensitivity(t=-7.80,P=0.000),abstractedness (t=-2.89,P=0.004),privateness (t=4.35,P=0.000),perfectionism(t=3.19,P=0.002) were significant differences.The emotional exhaustion was significantly related to emotional stability,dominance,liveliness,social boldness and tension.The depersonalization was significantly related to emotional stability,abstractedness and tension.The diminished personal accomplishment was significantly related to self-reliance.Conclusion Prison police burnout situation is more serious,and personality characteristics has a significant impact on job burnout.
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ObjectiveTo evaluate the protective effect of Xuebijing injection against renal injury in patients with sepsis, and to explore its possible mechanism.Methods A prospective randomized controlled trial (RCT) was conducted in which 62 severe patients with sepsis and septic shock admitted in Department of Critical Care Medicine of Jiangsu Province Traditional Chinese Medicine Hospital from June 2013 to December 2013 were randomly divided into control group and Xuebijing group, with 31 patients in each group. The patients in both groups received basic treatment for sepsis, and the patients in Xuebijing group were additionally given intravenous injection of Xuebijing 100 mL once a day for 7 days. In both groups, the changes in acute physiology and chronic health evaluationⅡ (APACHEⅡ) score were observed before treatment and 1, 3, 7 days after treatment, and the changes in the levels of interleukins (IL-6, IL-10), prothrombin time (PT), fibrinogen (Fib), activated partial thromboplastin time (APTT), serum creatinine (SCr), and Cystain C (Cys C) were determined before treatment and 1 day and 3 days after treatment.Results There was no statistically significant difference in APACHEⅡ score before treatment between two groups, however, the APACHEⅡ scores were significantly decreased in both groups 3 days and 7 days after treatment compared with those before treatment, and the degree of decrease in Xuebijing group was more obvious 7 days after treatment (13.61±7.62 vs. 16.34±8.70,P 0.05), while after treatment the degrees of improvement of above indexes in Xuebijing group were obviously superior to those in control group, especially 3 days after treatment[Cys C (mg/L):1.12±0.11 vs. 1.35±0.14, SCr (μmol/L): 115.0±31.0 vs. 135.0±24.0, IL-6 (ng/L): 54.27±28.79 vs. 73.35±31.01,PT (s): 13.50±0.11 vs. 15.71±0.11, APTT (s): 43.66±0.31 vs. 48.03±0.55, Fib (g/L): 1.91±0.51 vs. 1.51±0.52, P< 0.05 orP< 0.01].ConclusionXuebijing injection has certain renal protective effect in patients with sepsis, and its mechanism is possibly related to the regulation and improvement of uncontrolled inflammatory response and coagulation function in sepsis.
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Objective To observe the lung protective effect of Tongfu Xiefei method (TFXF) in rats with sepsis, and to discuss its possible mechanism.Methods Forty-two Sprague-Dawley (SD) rats were randomly divided into blank control group (n = 6), model group (n = 18) and TFXF group (n = 18). Sepsis model was reproduced by cecal ligation and puncture (CLP) in rats of model group and TFXF group. After the reproduction of sepsis model, rats in TFXF group received Tongfu Xiefei granules 0.01 mL/g by gavge, while those in model group were given equal dose of normal saline by the same way. The rats in blank control group received no treatment. At 3, 6, 12 hours after CLP, abdominal aorta blood was collected for blood gas analysis and inferior vena cava blood was collected for determination of the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Bronchoalveolar lavage fluid (BALF) was collected for measurement of concentrations of total protein (TP), total phospholipid (TPL), and desaturated phosphatidyl choline (DSPC). The ratio of wet/dry lung weight ratio (W/D) was measured, and malondialdehyde (MDA) and myeloperoxidase (MPO) in lung tissues were determined. The pathologic changes in their lungs were observed with light microscopy.Results Compared with those in blank control group, the levels of pH value, arterial oxygen partial pressure (PaO2), HCO3-, base excess (BE) were lowered, and partial pressure of carbon dioxide of arterial blood (PaCO2) was increased in model group. The serum concentrations of TNF-α and IL-6 were gradually increased after the reproduction of sepsis model. Compared with those in blank control group, the levels of TP, TPL, and DSPC/TPL in model group were decreased, while the levels of W/D, MDA and MPO were increased. Compared with those in model group, pH value was elevated in TFXF group at 3 hours (7.27±0.04 vs. 7.18±0.07,P < 0.05). PaO2 (mmHg, 1 mmHg = 0.133 kPa) was improved at 3, 6, 12 hours (3 hours: 128.00±16.05 vs. 106.78±10.73, 6 hours: 98.46±15.97 vs. 72.80±16.33, 12 hours: 90.70±9.31 vs. 74.28±12.19, allP < 0.05). The serum concentrations of TNF-α (ng/L) in TFXF group were significantly lower than those in model group at 12 hours (508.20±94.08 vs. 756.60±138.77,P < 0.05), and the serum concentrations of IL-6 (ng/L) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 687.80±35.00 vs. 849.40±148.28, 12 hours: 728.80±214.41 vs. 917.00±245.96, bothP < 0.05). Compared with those of model group, the levels of TP (g/L) in BALF in TFXF group were significantly decreased at 12 hours (1.01±0.23 vs. 1.60±0.47,P < 0.05), and the levels of TPL (mg/L) in TFXF group were significantly increased at 12 hours (86.40±11.33 vs. 62.40±16.33,P < 0.05). The levels of DSPC/TPL in TFXF group were significantly higher than those in model group at 6 hours and 12 hours (6 hours: 0.58±0.13 vs. 0.38±0.10, 12 hours: 0.45±0.13 vs. 0.24±0.07, bothP < 0.05). The levels of W/D in TFXF group were significantly higher than those in model group at 3 hours (3.84±0.25 vs. 2.99±0.50,P < 0.01), but lower than those in model group at 12 hours (3.21±0.53 vs. 4.89±1.14,P < 0.05). The levels of MDA (nmol/mg) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 4.04±2.58 vs. 8.89±2.61, 12 hours: 11.31±3.60 vs. 20.60±8.10, bothP < 0.05), while the levels of MPO (U/g) in TFXF group were lower than those in model group at 12 hours (4.79±0.66 vs. 7.22±1.76,P < 0.05). Compared with model group, the lungs in TFXF group showed less morphological changes under light microscopy, such as pulmonary edema, congestion, effusion and fibrosis.Conclusions The method of Tongfu Xiefei may improve hypoxemia and metabolic acidosis, alleviate lung edema and ameliorate pulmonary pathological changes in rat sepsis model. Tongfu Xiefei method shows a protective effect in sepsis by the way of reducing peroxidative damage, inhibiting the release of proinflammatory factors and abating degradation of lung surfactant.
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Objective To observe the effect of Sini decoction on inflammatory response and immune function in septic rats and to discuss its possible mechanism.Methods 66 Sprague-Dawley (SD) rats were randomly divided into normal control group (n=6),model group (n=30),and Sini decoction group (n=30).Septic model was reproduced by intraperitoneal injection of lipopolysaccharide (LPS,5 mg/kg).After the reproduction of sepsis,rats in Sini decoction group received Sini decoction (5 g/kg) by gavage,while those in model group were given equal dose of normal saline in the same way.Rats in normal control group did not receive any treatment.Blood was collected via eye sockets at 2,12,24,48,72 hours after LPS administration,then the rats were sacrificed.The concentrations of inflammatory mediators,such as interleukin (IL-1,IL-6,IL-10),tumor necrosis factor-α (TNF-α),and the expression level of monocyte human leukocyte antigen-DR (HLA-DR) were determined with enzyme linked immunosorbent assay (ELISA),and the pathological changes in intestinal mucosa were observed under electron microscope.Results The concentration of IL-1 (ng/L) at 2 hours in model group was gradually increased and peaked at 48 hours (4.07 ± 0.10),and then gradually decreased,while the IL-1 level in Sini decoction group peaked at 12 hours (2.98 ± 0.12) followed by a gradual decrease.IL-6 (ng/L) in model and Sini decoction groups peaked twice at 12 hours (91.39 ± 1.55,73.00 ± 2.38) and 48 hours (82.51 ± 1.49,64.68 ± 1.68) respectively.IL-10 (ng/L) in model group gradually decreased after peaking at 2 hours (86.66 ± 6.12),and that in Sini decoction decreased at 12 hours (71.61 ± 2.35) followed by an increasing tendency,and approached normal level at 48 hours (109.09 ±4.77 vs.124.01 ± 7.89,P＞0.05).TNF-α (ng/L) in model group was gradually increased and peaked at 48 hours (83.37 ±3.79),and that in Sini decoction peaked at 12 hours (48.52 ± 1.21),and decreased to normal level at 72 hours (18.59 ± 1.97 vs.15.50 ± 2.68,P＞0.05).During the course of the experiment,as compared with those of the model group,level of IL-1,IL-6,and TNF-α were significantly lower at all time points in Sini decoction group,and IL-10was significantly higher.The expression level of HLA-DR (μg/L) in model and Sini decoction groups peaked at 2 hours (4.86 ± 0.15,4.85 ± 0.17),and then gradually lowered.HLA-DR expression μg/L) at 48 hours and 72 hours in Sini decoction group was significantly lower than that in model group (48 hours:4.21 ± 0.12 vs.2.74 ± 0.16,72 hours:3.80 ± 0.09 vs.2.27 ± 0.12,both P＜0.01).Pathological study of intestinal mucosa showed that the intestinal mucosa were infiltrated significandy by inflammatory cells,and villi were damaged severely in both model group and Sini decoction group at 2 hours after LPS challenge.Infiltration of inflammatory cells in Sini decoction group was less intense after 12 hours,and the intestine villi repair was more obvious compared with model group.Conclusion Sini decoction could regulate systemic inflammatory response,and promote the repair of intestinal mucosa,the intestinal function and the immune status of septic rats.