Autonomic nervous system mediates the cardiovascular effects of Rhodiola sacra radix in rats

ETHNOPHARMACOLOGICAL RELEVANCE: Rhodiola sacra (Crassulaceae) exhibits cardiovascular bioactivities and is used in Tibetan medicine for promoting circulation and preventing hypertension. However, the underlying mechanisms of its cardiovascular effects are poorly understood. AIM OF THE STUDY: The aim of this study was therefore to evaluate the cardiovascular activity of water-soluble fraction (WtF) and n-butanol-soluble fraction (BtF) of Rhodiola sacra radix and to explore its mechanism of action in propofol anesthetized Sprague-Dawley rats. MATERIALS AND METHODS: The changes of blood pressure, heart rate and cardiac contractility after systemic administration of the extracts (10-75mg/kg) were examined for at least 40min. Different antagonists were used to evaluate the mechanisms of cardiovascular effects of the extracts. RESULTS: Intravenous injection of the WtF (10, 25, 35, 50 or 75mg/kg) exhibited dose-dependent hypotension and increases in heart rate and cardiac contractility. In contrast, mild alterations in the same cardiovascular parameters were detected only at high dose (75mg/kg) BtF. The WtF-induced hypotensive, positive inotropic and chronotropic effects were significantly abolished by pretreatment with hexamethonium (30mg/kg, i.v.) or reserpine (5mg/kg, i.v.), whereas the hypotensive, but not the positive inotropic or chronotropic effect was potentiated by captopril (2.5mg/kg, i.v.). Pretreatment with methylatropine (1mg/kg, i.v.), on the other hand, reversed the positive inotropic and chronotropic but not the hypotensive effects of WtF. The WtF-induced cardiovascular responses were not affected in rats pretreated with N(G)-nitro-l-arginine methyl ester (20mg/kg, i.v.). CONCLUSIONS: We conclude that systemic administration of the WtF of Rhodiola sacra radix elicited a potent hypotensive effect that was mediated by the withdrawal of sympathetic vasomotor tone and interaction with the circulatory angiotensin system. The positive inotropic and chronotropic effects of WtF may result from a direct vagal inhibition on the heart.     

Mechanisms and significance of proteinuria

Summary: Glomerular permselectivity is determined by complex interactions of the glomerular basement membrane (GBM) and the endothelial and epithelial cells of the glomerular capillary wall. Proteinuria may result acutely from functional changes in filtration, and be quickly reversible. Chronic structural changes may also contribute to proteinuria in many disease settings by affecting the components of the glomerular capillary wall (GCW). Thus, glomerular epithelial cell abnormalities are prominent in both minimal change disease and focal segmental glomerulosclerosis, whereas altered GBM thickness and composition are major features in diabetic nephropathy and Alport syndrome. A multitude of pathologic stimuli appear to influence proteinuria, including the renin-angiotensin system and numerous other cytokines. Human and experimental data indicate a heterogeneity of mechanisms in different diseases manifesting proteinuria which are associated with a range of structural appearances from normal morphology to a severely damaged GCW. Current therapeutic trials in progressive human renal diseases have focused on the potential benefits of angiotensin converting enzyme inhibitor (ACEI). Encouraging results indicate amelioration of both functional and structural components of proteinuria, as well as a benefit on sclerosis, although the latter effect has so far only been documented in animal studies. Advances in molecular technologies may allow identification of more specific abnormalities in the GCW which underlie proteinuria. Further understanding of these abnormalities will direct future therapy at the specific defect in each disease setting.     

N-(4-乙氧羰基-4-取代丁酰基)-N-取代甘氨酸的合成

本文报道9个估计具有血管紧张素转化酶抑制活性的N-(4-乙氧羰基-4-取代丁酰基)-N-取代甘氨酸及其相应叔丁酯的合成和鉴定。药理初试结果,化合物Ⅶ₇和Ⅶ₉显示明显降压活性。     

血管紧张素转化酶抑制剂对风湿性心脏病换瓣术后患者血浆中s-ICAM-1、s-VCAM-1和vWF含量的影响

目的观察血管紧张素转化酶抑制剂（ACEI）：雅施达和卡托普利对风心病换瓣术后患者血浆中可溶性黏附分子含量及心功能的影响。方法风湿性心脏病患者90人，术前心功能（NYHA分级）Ⅲ～Ⅳ级，换瓣术后分为雅施达组（30人）、卡托普利组（30人）和对照组（30人），分别给予雅施达、卡托普利和安慰剂治疗。分别于术后4周、8周抽血测定血浆可溶性细胞间黏附分子-1（s—ICAM-1）、可溶性血管细胞间黏附分子-1（s—VCAM-1）和血管性血友病因子（vWF）含量并同时作心功能测定。结果给予雅施达和卡托普利治疗的风心病患者血浆中s—ICAM-1、s—VCAM-1和vWF浓度都低于对照组（P〈0．05），术后4周心功能恢复也好于对照组（P〈0．05），雅施达组和卡托普利组间差异无显著性（P〉0．05）。结论血管紧张素转化酶抑制剂能降低风心病术后患者血浆中可溶性黏附分子水平，尽早改善内皮功能和心肌功能，加强术后心脏功能的恢复，而与血管紧张素转化酶抑制剂（ACEI）的种类无明显相关。     

血清Hcy、ADMA、UA水平与ACEI类药物治疗高血压合并脑卒中的疗效关联分析

目的:探讨血清Hcy、ADMA、UA水平与ACEI类药物治疗高血压合并脑卒中的疗效的关联性.方法:收集2014年1月~2016年6月来我院就诊的高血压合并脑卒中患者164例,随机分为试验组和对照组,每组82例.两组患者根据高血压脑卒中的基本治疗原则统一给予常规对症治疗,试验组额外给予ACEI类药物赖诺普利治疗.同期收集来我院体检健康的志愿者82例,为健康组.观察两组患者治疗有效率,治疗前后后血清Hcy、ADMA和UA水平变化,并与健康组进行比较,进一步分析各组有效与无效患者血清水平差异.结果:试验组治疗有效率明显高于对照组,两组患者治疗前及对照组患者治疗后血清HCY、ADMA和UA水平均明显高于健康组,试验组患者治疗后上述血清水平明显低于对照组,两组中有效患者血清水平均低于无效患者,上述差异分别经t检验或卡方检验比较,差异均具有统计学意义.并针对上述血清水平与患者治疗效果进行logistics回归相关性分析,差异亦具有统计学意义,且各项分子最大似然估计值和OR值均<0.结论:血清Hcy、ADMA、UA水平与ACEI类药物治疗高血压合并脑卒中的疗效存在明显的相关性.     

舒张性心力衰竭临床诊治分析

目的：探讨舒张性心力衰竭的临床特点及诊治。方法：对2007年2月～2009年1月我院住院治疗的56例DHF患者的临床资料进行回顾性分析。结果：本组56例DHF患者经上述治疗后，症状完全消失、心功能I级以上49例（87．5％）；心功能I或Ⅱ级9例（16．1％）；5例（8．9％）合并右心衰竭和肾功能不全的患者的临床症状改善不明显，自动出院2例（3．6％），死亡1例（1．8％）。结论：患者存在心力衰竭的症状和体征，心脏超声示左心室舒张功能障碍，左心室射血分数≥50％，即可诊断为DHF；DHF的治疗以B受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）以及钙通道拮抗剂为主，同时针对基础疾病采取对症治疗措施。     

Long-term adherence to antihypertensive therapy: a survey in four primary care clinics

Background: Many hypertensive patients have suboptimal control of their blood pressure. One of the most common causes is poor adherence with treatment. Aim: To identify factors associated with poorer adherence to antihypertensive treatment. Methods: The study was conducted in four urban clinics of Clalit Health Services (Israel's largest Health management organization): 3799 patients aged > 20 years with hypertension in whom a new antihypertensive medicine was started in a 3-year period were included. Data included: age; gender; chronic diseases; type of antihypertensive medicine; and adherence with treatment. Reasons for non-adherence had been evaluated in a random sample of 453 of the medical records. Results: Of the patients, 2234/3799 (58.8%) stopped ≥ 1 medicine. Lower adherence was associated with female gender, new immigration, ischemic heart disease and being a non-diabetic. Adherence was related to the type of medicine. The highest rates of adherence were found with the use of angiotensin receptor blockers (59.1%) and selective β-blockers (59%), and the lowest with non-selective β-blockers (30.1%). There was no documentation of the reason to medicine cessation in 183/453 (40.4%) of the medical records. In 20.1% of cessations, the physician continued to prescribe the drug, despite the fact that the patient had stopped purchasing it. Common reasons for treatment cessation were side effects (15%) and lack of blood pressure control (5.5%). Conclusions: Adherence with antihypertensive treatment declines with time and is associated with the type of medicine, and sociodemographic and clinical backgrounds. Family physicians must increase their documentation and awareness to medicine adherence.     

血管紧张素转换酶抑制剂类降压药与咳嗽的临床分析

目的 :探讨使用血管紧张素转换酶抑制剂 (ACEI)类降压药后与病人出现咳嗽的临床联系。方法 :收集我院近 5年来门诊及病房使用ACEI类降压药的病人 6 1例 ,分析其与出现咳嗽症状的原因。结果 :咳嗽症状的出现并非全部由ACEI类降压药引起 ,部分是由其它原因引起。结论 :ACEI类降压药可引起难以耐受的咳嗽 ,但二者无必然的因果关系     

伍用转换酶抑制剂及螺内酯治疗充血性心力衰竭的临床观察

研究伍用转换酶抑制剂及螺内酯治疗充血心衰竭的临床效果。方法：在应用洋地黄，血管扩张剂及利尿剂的基础上，投予螺内酯４０－８０ｍｇ／ｄ，依那普利５－１０ｍｇ／ｄ，服药３周后复查血清钾，镁离子水平及二维心脏超声。结果：全部病例心衰症状改善，血钾，镁离子水平正常，左室舒张末期内径缩小，ＥＦ值增加。