Effect of Guizhitang on Atherosclerosis by Regulating Immune and Intestinal Flora / 中国实验方剂学杂志

Objective:To observe the effect of Guizhitang （GZT） on peripheral blood monocytes， intestinal flora and AS plaque formation of ApoE^-/- mice induced by Western diet （WD）. Method:In this study， 40 12-week-old homozygous female ApoE^-/- mice were randomly divided into chow diet （CD） group （ApoE^-/-+CD）， WD group （ApoE^-/-+WD）， GZT group （ApoE^-/-+WD+GZT， 7.83 g·kg^-1） and atorvastatin （Atr） group （ApoE^-/-+WD+Atr， 3.33 mg·kg^-1）. And 10 matched C57BL/6 mice were set as wild CD control group （C57BL/6+CD）. Except the CD group， the rest groups were given WD to induce models. Treatment groups were given Guizhitang or atorvastatin orally in addition to WD， while ApoE^-/-+CD and ApoE^-/-+WD model groups were treated with the same volume of double steam water at the same time. After 4 weeks of intervention， 5 mice in each group were selected to collect the eyeball blood samples. The levels of plasma lipids were detected by automatic biochemical analyzer， and the proportion of peripheral blood mononuclear cells and its subtypes， and the expression levels of surface receptors toll like receptor 4 （TLR4） and CD36 were detected by flow cytometry， the intestinal flora of mice was detected by 16S rDNA sequencing. The remaining 5 mice in each group were intervened for 12 weeks， and the aorta was taken to detect the formation of aortic plaque by oil red O staining. Result:After intervention for 4 week， compared with C57BL/6+CD group， the levels of plasma total cholesterol （TC） and low-density lipoprotein （LDL） levels in ApoE^-/-+CD and ApoE^-/-+WD groups were increased （<italic>P</italic><0.01）. ApoE^-/-+WD group showed increase in the proportion of monocytes， their inflammatory subtypes Ly6C^__， and TLR4 expression on monocyte surface in blood （<italic>P</italic><0.05）. ApoE^-/-+WD group induced the imbalance of intestinal flora， with increase of Firmicutes and decrease of Verrucomicrobia in ileum of ApoE^-/-mice. Compared with ApoE^-/-+WD group， there was no significant change in blood lipid level and monocyte proportion in ApoE^-/-+WD+GZT group， but with decrease in the proportion of Ly6C^__， increase in the proportion of anti-inflammatory subtype Ly6C^-， and decrease in the expression of TLR4 and CD36 on monocyte surface （P<0.05）. ApoE^-/-+WD+GZT group showed decrease of Firmicutes and increase of Bacteroidetes and Verrucomicrobia in ileum of ApoE^-/-mice. After 12 weeks of intervention， ApoE^-/-+WD group showed increase in the number and area of aortic plaques in ApoE^-/-mice. ApoE^-/-+WD+GZT group showed decrease of the area of aortic AS plaques. Conclusion:GZT can reduce the immune damage and imbalance of intestinal flora caused by WD， then inhibit the formation of AS plaque.

Sodium Tanshinone II A Sulfonate for Coronary Heart Disease: A Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To assess whether an adjunctive therapy of Sodium Tanshinone II A Sulfonate Injection (STS) is effective and safe in improving clinical outcomes in patients with coronary heart disease (CHD). METHODS: A literature search was conducted through PubMed, the Cochrane Library, Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2017. Randomized controlled trials (RCTs) comparing STS with placebo or no additional treatments on the basis of standard conventional medicine therapies were included. The outcomes were all-cause mortality, major acute cardiovascular events (MACEs), cardiac function and inflammatory factors. The risk of bias assessment according to the Cochrane Handbook was used to evaluate the methodological quality of the included trials. Revman 5.3 software was used for data analyses. RESULTS: A total of 22 RCTs involving 1,873 participants were included. All of the trials used STS as adjunctive treatment to standard conventional medicine therapy. Due to the poor quality of methodologies of most trials, only limited evidence showed that a combination of STS with percutaneous coronary intervention (PCI) or thrombolytic therapy (TT) might be more effective on reduction of all cause death rate than TT alone [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.07 to 0.87] or PCI alone (RR 0.42, 95% CI 0.04 to 4.36). The results of 6 trials comparing STS plus TT with TT alone showed that the addition of STS significantly reduced the incidence of cardiac shock (RR 0.35, 95% CI 0.14 to 0.86), heart failure (RR 0.41, 95% CI 0.20 to 0.83) and arrhythmia (RR 0.21, 95% CI 0.12 to 0.46). STS combined with TT also showed a superior effect on cardiac function and inflammatory factor. No severe adverse event was reported related to STS. CONCLUSIONS: As an adjunctive therapy, STS combined with standard conventional medicine seems to be more effective on all-cause mortality or MACEs than conventional medicine treatment alone with less side effects. However, we cannot make a firm conclusion due to low quality of inclusion trials. Well-designed trials with high methodological quality are needed to validate the effect of STS for CHD patients.

Acupuncture for Primary Insomnia: An Updated Systematic Review of Randomized Controlled Trials.

Introduction: Acupuncture as one of the alternative therapies for insomnia is widely used in Asia and increasingly employed in western countries. Objectives: To provide updated evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture for primary insomnia. Methods: A comprehensive literature search in 11 databases was conducted from January 2008 to October 2017. Two authors independently extracted data and assessed risk of bias independently. Statistical analysis was performed using RevMan 5.3 software. According to predefined protocol, we combined data in meta-analysis and performed trial sequential analysis when appropriate. Grading of Recommendations Assessment, Development, and Evaluation was also conducted to assess the quality of evidence. Results: A total of 73 RCTs involving 5533 participants were analyzed. The pooled results showed better effect from real acupuncture than no treatment (mean difference [MD] -5.58, 95% confidence interval [CI] -6.85 to -4.31, I2 = 0%, p < 0.00001, 2 trials, fixed effect model, 105 participants) on reducing Pittsburgh Sleep Quality Index (PSQI) scores with "very low quality" evidence. Acupuncture plus drugs showed better improvement than drugs alone on decreasing the PSQI total scores (MD -3.17, 95% CI -4.74 to -1.61, I2 = 72%, 4 trials, random-effects model (REM), p < 0.0001, 253 participants, low quality). Similar benefit favored acupuncture compared with no treatment (MD -8.46, 95% CI -9.59 to -7.33, I2 = 0%, p < 0.00001, 2 trials, 65 participants). Acupuncture showed more benefit than estazolam on PSQI (with enough statistical power). Athens Insomnia Scale (MD -1.64, 95% CI -2.40 to -0.89, I2 = 0%, p < 0.0001, 3 trials, fixed-effects model, 180 participants) or SPIEGEL (MD -2.86, 95% CI -3.54 to -2.18, p < 0.00001, I2 = 0%, 5 trials, fixed-effects model, 326 participants) with "very low-quality" evidence. Furthermore, low-quality evidence showed less adverse events from acupuncture than western medications (risk ratio 0.23, 95% CI 0.11-0.48, I2 = 56%, p < 0.0001, 11 trials, REM, 914 participants). Publication bias was likely present based on the PSQI total scores. Conclusions: The summary estimates indicate that acupuncture might result in improvement than no treatment on PSQI scores and appears safe. However, the quality of the evidence is varied from very low to low due to the potential risk of bias and inconsistency among included trials. Further large sample size and rigorously designed RCTs are still needed.

Research advances in validity of predictors for extubation outcome in children receiving invasive mechanical ventilation / 中国当代儿科杂志

The development of invasive mechanical ventilation technology provides effective respiratory support for critically ill children. However, respiratory support is not the end of treatment as the ultimate goal is successful extubation in children. At present, some evaluation indicators before extubation including rapid shallow breathing index, maximal inspiratory pressure, and work of breathing are of high clinical value in predicting adult extubation outcome, but their evidence of evidence-based medicine is not sufficient in the field of pediatric intensive care. This paper reviews the current research on the validity of predictors for extubation outcomes in children. It shows that there is still a lack of indicators with good sensitivity and specificity for assessment before extubation in children. The studies are still in a small-sample size and single-center stage. Therefore, how to optimize evaluation before extubation and improve the success rate of extubation is the direction of joint efforts of doctors in the pediatric intensive care unit and rehabilitation medicine department.

Choices of timing and mode of blood purification in the treatment of immune diseases of nervous system / 中国实用儿科杂志

The immune diseases of nervous system are a kind of nervous system diseases mediated by immune mechanism.High mortality and disability rates are its important characteristics. Early intervention and treatment can significantly improve the clinical outcomes of patients. At present, the main treatments for this kind of diseases include corticosteroid hormone, intravenous immunoglobulin(IVIG)and blood purification. Blood purification therapy has become the focus of current research because of its fast effect and other advantages.The main modes of blood purification therapy for this kind of diseases are plasma exchange and plasma immunoabsorption.Early application of blood purification therapy in patients with the acute attack and critical illness may lead to more significant clinical improvement. Therefore,blood purification may be an effective treatment for patients with the critical illness or when other medications are ineffective for the patients.

Research progress of natural marine product macrosphelides / 国际药学研究杂志

This paper summarizes the natural macroephelides,including the preparation of three key segments and the synthesis of 16-or 15-membered macrolactone skeleton by the ring-closing metathesis(RCM)strategy. It also summarizes the synthetic approaches to macrosphelide derivatives,including the common pharmaceutical chemistry methods,such as the ring size modification,the modification of lateral groups on the macro ring,and the combinatorial chemistry approach. Additionally,a brief introduction of structure-activity relationships is given for related compounds.

Protective effect and mechanism of ligustrazine combined with astragaloside IV on angiogenesis of human umbilical vein endothelial cells / 中草药

Objective: To study the protective effect and mechanism of ligustrazine combined with astragaloside IV on hypoxia injury of human umbilical vein endothelial cells (HUVECs). Methods: The model of hypoxia injury was established, and the cells for pharmacodynamics study were divided into five groups: control group, model group, ligustrazine group (80 μg/mL), astragaloside IV group (40 μg/mL), and compatibility of astragaloside IV and ligustrazine group. The effects of ligustrazine, astragaloside IV, and their compatibility on cell proliferation in each group after hypoxia injury were detected by MTT assay. Immunohistochemical method was used to observe the expression of proteins VEGF and Ang-II in HUVECs with hypoxia injury, and Western blotting was used to observe the expression of proteins VEGF and Ang-II. RT-PCR was used to observe the mRNA expression of VEGF and Ang-II. Results: Compared with those in the model group, cell viability of ligustrazine group, astragaloside IV group, and compatibility group significantly increased, and the best group was ligustrazine (80 μg/mL)+astragaloside IV (40 μg/mL) group. Ligustrazine (80 μg/mL)+astragaloside IV (40 μg/mL) group could up-regulate the protein expression levels of VEGF and Ang-II and the levels of VEGF and Ang-II mRNA. Conclusion: Ligustrazine combined with astragaloside IV may be targeted by increasing angiogenesis factor, and the expression of VEGF and Ang-II plays the role of promoting angiogenesis.

Effect of high frequency oscillatory ventilation on EVLW and lung capillary permeability of piglets with acute respiratory distress syndrome caused by pulmonary and extrapulmonary insults / 华中科技大学学报（医学）（英德文版）

The effect of high frequency oscillatory ventilation (HFOV) at early stage on hemodynamic parameters, extravascular lung water (EVLW), lung capillary permeability, CC16 and sICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome (ARDS) was explored. Central vein pressure (CVP) and pulse indicator continuous cardiac output (PiCCO) were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index (EVLWI), EVLW/intratroracic blood volume (ITBV) and pulmonary vascular permeability index (PVPI) were measured before and after modeling (T0 and T1), and T2 (1 h), T3 (2 h), T4 (3 h) and T5 (4 h) after HFOV. CC16 and sICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group (P<0.05). The EVLWI in ARDSp group was increased at T1 (P=0.008), and sustained continuously within 2 h (P=0.679, P=0.216), but decreased at T4 (P=0.007) and T5 (P=0.037). The EVLWI in ARDSexp group was also increased at T1 (P=0.003), but significantly decreased at T3 (P=0.002) and T4 (P=0.019). PVPI was increased after modeling in both two groups (P=0.004, P=0.012), but there was no significant change within 4 h (T5) under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI (P=0.13), ΔPVPI (P=0.28) and ΔEVLW/ITBV between the two groups (P=0.63). The significant decreases in both CC16 and sICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.

Effect of high frequency oscillatory ventilation on EVLW and lung capillary permeability of piglets with acute respiratory distress syndrome caused by pulmonary and extrapulmonary insults / 华中科技大学学报（医学）（英德文版）

The effect of high frequency oscillatory ventilation (HFOV) at early stage on hemodynamic parameters, extravascular lung water (EVLW), lung capillary permeability, CC16 and sICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome (ARDS) was explored. Central vein pressure (CVP) and pulse indicator continuous cardiac output (PiCCO) were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index (EVLWI), EVLW/intratroracic blood volume (ITBV) and pulmonary vascular permeability index (PVPI) were measured before and after modeling (T0 and T1), and T2 (1 h), T3 (2 h), T4 (3 h) and T5 (4 h) after HFOV. CC16 and sICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group (P<0.05). The EVLWI in ARDSp group was increased at T1 (P=0.008), and sustained continuously within 2 h (P=0.679, P=0.216), but decreased at T4 (P=0.007) and T5 (P=0.037). The EVLWI in ARDSexp group was also increased at T1 (P=0.003), but significantly decreased at T3 (P=0.002) and T4 (P=0.019). PVPI was increased after modeling in both two groups (P=0.004, P=0.012), but there was no significant change within 4 h (T5) under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI (P=0.13), ΔPVPI (P=0.28) and ΔEVLW/ITBV between the two groups (P=0.63). The significant decreases in both CC16 and sICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.