Isolation of antifungal compound from Paeonia suffruticosa and its antifungal mechanism / 中国结合医学杂志

<p><b>OBJECTIVE</b>To isolate antifungal compound from Paeonia suffruticosa, and to find the antifungal mechanisms by observing the ultrastructural modifications of yeasts in growth phase produced by 1,2,3,4,6-penta-O-galloyl-beta-D-glucose (PGG).</p><p><b>METHODS</b>Peony (Paeonia suffruticosa) root bark (PRB) was separated by solvent extraction and purified by high performance liquid chromatography (HPLC) method using analytical and preparative reversed phase C18 column on the basis of bio-assay method. In order to investigate the antifungal mechanism of PGG, Yeasts were submitted to different concentrations [3 × minimum inhibition concentration (MIC), 0.3 × MIC] for 1 h under constant stirring at 30 °C, and transmission electron microscopy was performed.</p><p><b>RESULTS</b>Based on the antifungal activity of PRB on Candida glabrata CBS138, the antifungal compound were isolated in ethyl acetate layer of PRB and identified as PGG by mass spectrometry, 1H nuclear magnetic resonance (NMR) analyses, with molecular weight of 940 and molecular formular as C41H32O26. Transmission electron microscopy showed that PGG degraded the cell wall envelope.</p><p><b>CONCLUSION</b>The results suggest that PGG may be responsible for the antifungal activity of PRB by disrupting the structure of cell wall directly.</p>

Effect of Compound Qingre Granule on the Expression of Peripheral Blood Lymphocyte Subsets of Acute Virus Infection Patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe interventional effects of anti-viral therapy and Compound Qin-gre Granule (CQG) on host cellular immune functions of acute virus infection patients.</p><p><b>METHODS</b>Thirty acute virus infection patients were recruited to detect peripheral lymphocyte subsets. They were randomly assigned to two groups, the Western medicine treatment group (treated with anti-virus Western medicine) and the integrative medicine treatment group (treated with anti-virus Western medicine plus CQG). T-cell subsets were re-examined 7 days later. Changes between before and after treatment were observed. Effect on host cellular immune functions and efficacy were compared between the Western medicine treatment and the integrative medicine treatment.</p><p><b>RESULTS</b>Compared with the normal control group, the percentage of peripheral T cells increased, and the percentage of B/NK cells decreased in acute virus infection patients (P < 0.01). Meanwhile, in T cell subsets, the percentage of CD8+ T cells and CD8+ CD38+ T cells increased (P < 0.05, P < 0.01); and percentages of CD4+ T cells, CD4+ CD28 + T cells, and CD8+ CD28+ T cells decreased (P < 0.05, P < 0.01). After one-week treatment, percentages of CD4+ T cells, CD4+ CD28+ T cells, and CD8+ CD28+ T cells increased (P < 0.05, P < 0.01), while the percentage of CD8+ CD38+ T cells decreased (P < 0.01). More significantly, these changes were greater in the integrative medicine treatment group than in the Western medicine treatment group (P < 0.05).</p><p><b>CONCLUSIONS</b>Disarranged cellular immune functions existed in acute virus infection patients. CQG could significantly improve viral infection induced immunologic derangement and immunologic injury.</p>

Correlation between different Chinese medicine syndromes and changes in microcirculation in septic shock patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the correlation between different Chinese medicine (CM) syndromes and variations in microcirculation in septic shock patients.</p><p><b>METHODS</b>seventy Septic shock patients were divided into four groups: heat damaging qi-yin group (HDQY, 23 cases); yin exhaustion and yang collapse group (YEYC, 26 cases); excessive heat in Fu organ group (EHFO, 10 cases); and heat damaging nutrient-blood group (HDNB, 11 cases). Sublingual microcirculation parameters were observed by sidestream dark-field (SDF) imaging and scored by Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA), and parameters of microcirculation perfusion variations and prognoses were analyzed.</p><p><b>RESULTS</b>Compared with those with qi-yin heat damage, perfused vessel density (PVD) in other groups decreased dramatically (P<0.05), and APACHE II scores increased significantly (P<0.05). In addition, the recovery time was prolonged substantially (P<0.05), and the mixed venous oxygen saturation (SVO2) decreased (P<0.05). Blood lactic acid increased significantly (P<0.05), and the mixed SVO decreased (P<0.05), in the YEYC group. Compared with the thermal injury camp blood group, sublingual microcirculation parameter variations showed no obvious difference in the YEYC and EHFO groups (P>0.05). There were significant positive correlations between CM syndromes and APACHE II scoring in different groups (r=0.512, P<0.05). There were negative correlations between PVD and APACHE II scoring (r=-0.378, P=0.043), the proportion of perfused vessels (PPV) and APACHE II scoring (r=-0.472, P=0.008), as well as between the microvascular flow index (MFI) and APACHE II scoring (r=-0.424, P=0.023) in different patients.</p><p><b>CONCLUSION</b>Sublingual microcirculation may serve as a clinical diagnostic parameter of the patient condition, as well as being a prognostic indicator.</p>

Research on the relationship between thick greasy tongue fur formation and vascular endothelial cell permeability with the protein expression of zonula occludens-1 / 中国结合医学杂志

<p><b>OBJECTIVE</b>To determine the relationship of thick greasy tongue fur formation and permeability of vascular endothelial cells (ECs) with the protein expression of zonula occludens-1 (ZO-1).</p><p><b>METHODS</b>Sprague Dawley rats were randomly divided into a model group of severe acute pancreatitis (SAP) and a sham-operated (SO) group. The SAP rats were further divided into two subgroups on the basis of tongue-coating status: a thick greasy tongue fur group (SAP-TGF) and a normal tongue fur group (SAP-NF). Six rats were chosen randomly from every group mentioned above for an Evans blue assay 5 days after model establishment. For the histomorphology analysis, the expressions of ZO-1 protein and mRNA were studied by hematoxylin-eosin (H&E) staining, transmission electron microscope, Western blot, and Q-PCR using blood and tongue tissues, which were collected from 8 rats randomly chosen from each group.</p><p><b>RESULTS</b>The papillae density of the rat tongue surface and the caryocinesis frequency of the basal layer were significantly increased in the SAP-TGF group compared with the SO group (P<0.05). Evans blue levels in the tongue tissue of the SAP-TGF group were significantly higher than that of the SO and SAP-NF groups (P<0.05). Vascular ECs were wider and obviously fissured in the SAP-TGF group under transmission electron microscope observation. The protein and mRNA expression of ZO-1 in the SAP-TGF group were lower than those in the SAP-NF (P<0.05).</p><p><b>CONCLUSIONS</b>Reproductive activity enhancement of glossal epithelial cells was one of the main characteristics of thick greasy tongue fur formation. An increase in vasopermeability was closely associated with thick greasy tongue fur formation. Tight junction structural variation of vascular ECs might play an important role in the pathological and physiological process of thick greasy tongue fur formation.</p>

Inhibition of methicillin-resistant Staphylococcus aureus by the compound Qingre granules / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The infection rate of methicillin-resistant Staphylococcus aureus (MRSA) is increasing yearly due to the overprescription of antibiotics. Traditional Chinese compound medicines are less inclined to induce bacterial resistance in the clinical setting because of their multi-acting mechanisms. However, most current research is limited to bacteriostasis in vitro using single extracts or formulations. Plasma pharmacology is an in vitro method, using what is called "medicine serum". The aim of this study was to investigate whether the medicine serum of compound Qingre granules (QRKL) alone or in combination with antibiotics may treat MRSA infection in the clinic.</p><p><b>METHODS</b>An animal model of MRSA resistance was created by injecting rabbits with the standard strain of MRSA ATCC43300. Infected rabbits were treated with QRKL by intragastric administration. Sixty minutes after the last intragastric administration, serum was obtained from the rabbits by heart puncture to obtain what is termed "medicine serum". The minimum inhibitory concentration (MIC) of QRKL, medicine serum alone, or serum combined with antibiotics was assessed by agar dilution.</p><p><b>RESULTS</b>were compared with the growth of sixteen isolates of MRSA.</p><p><b>RESULTS</b>The MIC of QRKL to the standard strain ATCC43300 was 10.00 mg/ml. The MIC(90) of vancomycin was 1.00 microg/ml, which, when combined with QRKL, dropped to 0.50 microg/ml. The MIC(90) of cefuroxime alone was 512.00 microg/ml. This level also decreased to 256.00 microg/ml when combined with QRKL. The addition of QRKL thus significantly reduced the MIC of both cefuroxime and vancomycin compared with antibiotics alone (P < 0.01). The MIC(90) of vancomycin with medicine serum decreased to 0.50 microg/ml, and the MIC of vancomycin with medicine serum also descended compared with using vancomycin alone (P < 0.01).</p><p><b>CONCLUSIONS</b>The growth of MRSA can be inhibited by QRKL or medicine serum of QRKL in vitro. The addition of QRKL results in increased sensitivity of MRSA to vancomycin and this may provide a novel treatment for patients with MRSA infection.</p>

Effects of Tongfu Granule on intestinal dysfunction in patients with multiple organ dysfunction syndrome / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the mutual influences between intra-abdominal hypertension (IAH) and intestinal dysfunction, and to observe the efficacy of Tongfu Granule (TFG) in treating IAH of patients with multiorgan dysfunction syndrome (MODS).</p><p><b>METHODS</b>Adopting randomized, double-blinded, controlled method, 60 MODS patients hospitalized in authors' ICU wards from August 2007 to January 2008 were equally assigned to two groups: A and B, that is, the TFG group and the placebo group, all were treated by conventional treatment but different in the administration of TFG and placebo, respectively 1 bag, three times per day, for 7 days via oral intake or gastric infusion. On the 1st, 3rd and 7th day or before death, patients were monitored in terms of symptoms (abdominal distention, defecation, borborygmus, abdominal circumference, intra-abdominal pressure, and occult blood in stool), gastrointestinal function score, APACHE II score, and 28-day outcome. The blind outcome was shown up by specified tester by the end of the observation of 60 cases, A is the TFG group, B is the placebo group.</p><p><b>RESULTS</b>As compared with the placebo group, intestinal peristalsis and borborygmus were increased, the intra-abdominal pressure and circumference were decreased in the TFG group significantly, which could reduce the possibility of gastrointestinal hemorrhage. Moreover, the gastrointestinal function score and APACHE II score were improved and the 28-day mortality was reduced to a certain degree in the TFG group.</p><p><b>CONCLUSION</b>TFG could promote the recovering of gastrointestinal function and relieve the heightened intra-abdominal pressure in patients with MODS so as to improve patients' prognosis to some extents.</p>

A clinical study on the diagnostic criteria of multiple organ dysfunction syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To develop diagnostic criteria of multiple organ dysfunction syndrome (MODS) by a prospective and multi-center clinical investigation.</p><p><b>METHODS</b>The data of 1087 MODS cases obtained from ICU of 37 hospitals from March 2002 to January 2005 in 11 provinces in China were analyzed in order to derive the diagnostic criteria of MODS.</p><p><b>RESULTS</b>This MODS diagnostic criteria involved 7 organs. To diagnose MODS, the original cause of MODS should be identified, then there should be two or more organs showing signs of dysfunction. The criteria for organ dysfunction were as follows. (1) Cardiovascular system: SBP < 90 mm Hg (1 mm Hg = 0.133 kPa), MAP < 70 mm Hg, signs of shock, ventricular tachycardia, ventricular fibrillation, or myocardial infarction; (2) Respiratory system: oxygenation index < 300 mm Hg; (3) Nervous system: indifference, restlessness, lethargy, light coma, or deep coma, Glasgow score < or = 14; (4) Blood system: PLT < 100 x 10(9)/L; CT, APTT, and PT prolonged or shortened; positive plasma protamine paracoagulation; (5) Liver: TBIL > 20. 5 micromol/L, ALB < 28 g/L; (6) Kidney: Cr > 123.8 micromol/L, urinary volume < 500 ml/24 h; (7) Gastro-intestine: bowel sounds decreased or disappeared; retention in the stomach, or positive occult blood feces with dark stools or haematemesis; intraabdominal pressure (intravesical pressure) > or = 11 cm H2O (1 cm H2O = 0.098 kPa). Any organ function met with one of the above conditions was considered to have dysfunction.</p><p><b>CONCLUSIONS</b>This diagnostic criterion of multiple organ dysfunction syndrome has been developed by this research, but it needs to accumulate experience by clinical practice and to revise the diagnosis criteria.</p>

Tissue engineering of vascular graft from decellularized arterial matrix and mesenchymal stem cells / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the method of constructing small-diameter vascular grafts from xenogenic decellularized arterial matrices and mesenchymal stem cells (MSCs).</p><p><b>METHODS</b>Porcine iliac arteries were decellularized by detergent and trypsin treatment. Histology, mechanical strength and porosity experiments were performed to evaluate the properties of decellularized matrices. MSCs were isolated from bone marrow of dogs and expanded ex vivo. Decellularized matrices were seeded with MSCs and further cultured in a pulsatile bioreactor. Morphological features of the tissue engineered grafts were assayed by HE staining and scanning electron microscopy.</p><p><b>RESULTS</b>After cell extraction, absence of cellular components and preservation of extracellular matrix were verified. Mechanical strength of decellularized matrices was slightly reduced compared with native arteries. Porosity of decellularized matrices was 94.9%. Decellularized matrices were successfully seeded with MSCs, which grew to a near-confluent monolayer under flow conditions and MSCs were highly elongated and oriented to the flow direction.</p><p><b>CONCLUSION</b>Small-diameter vascular grafts can be constructed by seeding MSCs onto xenogenic decellularized arterial matrices and culturing in a pulsatile bioreactor.</p>

Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation.</p><p><b>METHODS</b>In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 (16 patients with 18 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 (16 patients with 17 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index (ABI), claudication, transcutaneous oxygen pressure (tcPO(2)) and angiography (15 limbs of 14 patients) were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.</p><p><b>RESULTS</b>Two patients died from heart failure. The improvement of rest pain was seen in 76.5% (13/17) of group 1 and 93.3% (14/15) of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% (8/18) in group 1 and 41.2% (7/17) in group 2. The value of tcPO(2) increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% (15/18) in group 1 and 94.1% (16/17) in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.</p><p><b>CONCLUSIONS</b>Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia, and the two approaches for the implantation, intra-muscular injection and intra-arterial injection, show similar results.</p>

Effect of Qishen Huoxue Granule in treating severe sepsis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the anti-inflammatory effect and the therapeutic efficacy of Qishen Huoxue Granule (QHG) in treating severe sepsis.</p><p><b>METHODS</b>One hundred and sixty-seven patients with severe sepsis were enrolled and randomly assigned to two groups, the 85 patients in the control group treated with conventional Western medicine and the 82 in the QHG group treated with conventional Western medicine plus QHG. Changes of tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), procalcitonin (PCT), Marshall score, APACHE II score, ICU stay time and 28-day mortality were monitored and compared.</p><p><b>RESULTS</b>Compared with the control group, IL-6 and TNF-alpha levels, the ICU stay time and 28-day mortality were significantly lower in the QHG group (all P < 0.05). During the QHG treatment, no severe adverse event was observed.</p><p><b>CONCLUSION</b>The integrative treatment could reduce the blood levels of IL-6 and TNF-alpha, shorten the ICU stay time and decrease the 28-day mortality of patients with sepsis, showing a favor therapeutic prospect.</p>

Effect of qishen huoxue granule combined with fluconazole on survival rate of mice with systemic C. albaicans infection / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Qishen Huoxue Granule (QHG) combined with Fluconazole on the survival rate of mice with systemic C. albaicans (CA) infection.</p><p><b>METHODS</b>Deep CA infection model mice, with normal and low immunity, were established separately by injecting standard strain of CA via caudal vein, and were divided into 4 groups at random, treated by gastrogavage with normal saline (Group A), QHG (Group B) Fluconazole (FCZ, Group C) and QHG + FCZ (Group D) respectively, and a blank group was set up with normal mice for control. The survival time and the total survival rate in 30 days in various groups were recorded.</p><p><b>RESULTS</b>For mice with normal immunity, the survival rate in Group D and C was 79% and 78% respectively, showing no difference between them (P > 0.05). But for those with low immunity, it was 36% and 7% respectively, and the survival rate significantly higher in Group D than in Group C (P < 0.05).</p><p><b>CONCLUSION</b>As compared with those treated with FCZ alone, QHG combined with FCZ can raise the survival rate of the immuno-suppressed mice with systemic CA infection.</p>

Liver injury and intervention of compound 912 liquid on it in rats with endotoxemia / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To investigate the liver injury in model rats with endotoxemia and to observe the protective effect of Compound 912 Liquid on it.</p><p><b>METHODS</b>Rats were randomly divided into three groups, the endotoxemia model group (EMG, injected by lipoplysaccharides (LPS) peritoneally), the intervention group (IG, treated with Compound 912 Liquid via gastrogavage 1 h before model establishing) and the normal control group (NCG). Blood samples of rats were taken at the time points of the 2nd, 4th, 8th, 12th, 48th, 72nd hour and the 7th day after modeling for measuring liver function, levels of plasmatic endotoxin, tumor necrosis factor alpha (TNF-alpha), interleukin-10 (IL-10). The pathological change of liver was observed using light microscope and electro-transmission microscope.</p><p><b>RESULTS</b>The peak concentration of endotoxin detected at 2 hour after modeling in the IG was significantly lower than that in the EMG (0.358 +/- 0.056 vs 0.685 +/- 0.030), but insignificant difference (P > 0.05) was shown between them in TNF-alpha level. The level of IL-10 continuously rose in IG after treatment, it was still higher than normal level until day 7 (49.096 +/- 4.076 vs 43.454 +/- 5.928, P < 0.05).</p><p><b>CONCLUSION</b>LPS can induce the increase of serum inflammatory cytokines and anti-inflammatory cytokines in rats to injure liver. Therefore, the inflammatory reaction indicated by LPS may be one of the mechanisms for liver injury. Preventive medication with Compound 912 Liquid showed a significant liver protective effect.</p>

Scoring system to measure the severity of the multiple organ dysfunction syndrome / 中国医学科学院学报

<p><b>OBJECTIVE</b>To develop a scoring system to measure the severity of the multiple organ dysfunction syndrome (MODS).</p><p><b>METHODS</b>The clinical data of patients with MODS were collected and analyzed prospectively. Seven indicators were screened out to assess the functions of seven organs. Each indicator was scored from 0 to 4 points, with the 0 point representing the normal organ function, and 1 point to 4 points representing the dysfuntion to failure of the organ. Acording to the index and points a severity scoring system were developed.</p><p><b>RESULTS</b>Seven indicators including the systolic pressure, oxygenation index, conscious state, peripheral blood platelet count, blood total bilirubin, and serum creatinine were used to represent the functions of seven organs. The seven organs included cardiovascular system, lung, brain, coagulative system, liver, kidney, and gastrointestinal tract. The severity scoring system were composed of seven indicators and their points. The total score was 24 points. The mortality increased along with the increase of the points (P<0.001).</p><p><b>CONCLUSION</b>This scoring system can be used to assess the severity of the MODS.</p>

Treatment of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore treatments of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine (ICWM), in order to elevate the curing rate as well as to lower the death rate.</p><p><b>METHODS</b>Based on conventional ways of Western medical treatments of 18 cases of severe post-kidney-transplant lung infection, such as putting the patients in single individual ward, antibiotics to prevent infection, respiratory machines, blood filtration, nutritional support, steroids, and maintaining electrolytes balance, we applied integrated Chinese medicinal treatments, like altering conventional prescription "pneumonia III", and conducted clinical observation of effectiveness, and indexes including white blood cell (WBC), neutrophilic granulocyte, blood urea nitrogen (BUN), blood creatinine (Cr), etc.</p><p><b>RESULTS</b>Of the 18 cases studied, 7 were already cured, 8 proved the treatment effective, 3 died. All clinical indexes had statistically significant changes compared with those of before treatment (P < 0.01).</p><p><b>CONCLUSION</b>ICWM can increase curing rate and lower death rate.</p>

Clinical study on treatment of severe acute respiratory syndrome by integrative Chinese and Western medicine / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the effect of integrative Chinese and western medicine (ICWM) in treating severe a cute respiratory syndrome (SARS).</p><p><b>METHODS</b>Sixty SARS patients were diagnosed and observed according to the universal standard, and divided into the ICWM group (n = 31, treated with ICWM) and the control group (n = 29, treated by conventional western medicine alone).</p><p><b>RESULTS</b>ICWM showed better effect than that of western medicine alone in improving clinical symptoms, promoting the absorption of inflammation in lung, increased oxygen saturation (P < 0.01) and decreased the dosage of corticoid used (P < 0.05).</p><p><b>CONCLUSION</b>The effect of ICWM is better than that of simple western medicine in treating SARS.</p>