The Effect of Xuefu Zhuyu Decoction(血府逐瘀汤) on in vitro Endothelial Progenitor Cell Tube Formation

<正>Objective:To observe the effect of Xuefu Zhuyu Decoction(血府逐瘀汤)-containing serum (XFZYD-CS) on endothelial progenitor cell(EPC) tube formation in vitro.Methods:Mononuclear cells from rat bone marrow were prepared in a Ficoll density gradient centrifuge.EPCs were separated by the differential attachment method,and observed with inverted microscope for the effect of XFZYD-CS on EPC tube formation. Results:After one day,EPCs exposed to the serum containing 5%,10%and 15%XFZYD-CS formed typical tubes or vessel networks.The tube formation time was two days ahead of the control group and the size of most tubes in the serum groups was smaller than in the control group.Conclusion:XFZYD-CS could induce EPC angiogenesis and hasten tube formation,especially in capillary vessels.The study provides experimental evidence for the plausibility of Xuefu Zhuyu Decoction in the treatment of ischemic diseases.     

Effect of Xuezhikang Capsule(血脂康胶囊)on Serum Tumor Necrosis Factor-αand Interleukin-6 in Patients with Nonalcoholic Fatty Liver Disease and Hyperlipidemia

<正>Objective:To evaluate the effect of Xuezhikang Capsule(血脂康胶囊) on the serum levels of inflammatory factors such as tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) in patients with nonalcoholic fatty liver disease(NAFLD) and hyperlipidemia,and to explore whether it has anti-inflammatory effect.Methods:A total of 84 patients were randomly assigned to two groups with stratified block randomization, the treatment group(42 cases) and the control group(42 cases).They were treated with Xuezhikang Capsule and polyene phosphatidylcholine capsule for twenty-four weeks,respectively.The changes in serum TNF-αand IL-6 were measured by enzyme linked immunosorbent assay before treatment and at the 12th and 24th week. Results:Compared with those before treatment,the serum levels of TNF-αand IL-6 significantly decreased in both groups after treatment(P0.01).There was no significant change between the two groups for the treatments at different time points(P0.05) and between the two groups for treatments at the same time points (P0.05).Conclusion:Xuezhikang Capsule can inhibit the serum inflammatory factor in patients with NAFLD and hyperlipidemia.     

Effect of chinese medicine therapy for strengthening-Pi and nourishing-shen in preventing lamivudine induced YMDD mutation and its immunologic mechanism

<正>Objective:To observe the effect of Chinese medicine therapy for strengthening-Pi(脾) and nourishing-Shen(肾,SPNS) in preventing lamivudine induced YMDD mutation and its immunological mechanism.Methods:One hundred and sixty chronic hepatitis B(CHB) patients with positive HBeAg were equally assigned to two groups at random:the observation group and the control group.Patients in the observation group were treated with lamivudine combined with SPNS,and those in the control group were treated with lamivudine only,with the treatment lasting for 52 weeks in total.Changes in indexes,including liver function,HbeAg,HBV-DNA,YMDD variation,CD_4,CD_4/CD_8 ratio,interferon-γ(IFN-γ),interleukin-4(IL-4), blood routine,renal function,as well as any adverse reactions that occurred in patients,were observed at different time points.Results:The ALT,AST recovery rate and HBV-DNA negatively inversing rate at the 24th week,the 36th week and the 52nd week were all higher(P0.05);meanwhile,the YMDD mutation rate at the 36th week and the 52nd week was lower(P0.05) in the observation group than in the control group.The posttreatment levels of CD_4,CD_4/CD_8 ratio,IFN-γ,and IL-4 as well as the pre-post treatment difference of these indexes in the observation group were significantly different from those in the control group(P0.05).Conclusion: Chinese medicine SPNS therapy can significantly reduce the YMDD variation of HBV,and the mechanism may be related to its regulation of the CD_4 level,CD_4/CD_8 ratio and Th1/Th2 balance.     

The effects of Valsalva maneuver on venipuncture pain in children: comparison to EMLA® (lidocaine–prilocaine cream)

Background

Venipuncture is one of the most painful events for children in hospitals. Valsalva maneuver (VM) decreases the incidence and severity of pain on venipuncture pain in adults. This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic (EMLA^®) cream for venipuncture pain in children.

Method

In this study, we evaluated the effect of VM on venipuncture pain in children. 60 patients scheduled for elective surgery were randomly divided into three groups. In Group V, children were punctured during VM. In Group E, EMLA^® 5 % cream and in Group C (control group) vaseline was applied on the non-dominant hand 60 min before the venipuncture. Patients made a pain assessment using visual analog score (VAS). Mean arterial pressure (MAP), heart rate (HR), and SpO₂ measurements were obtained during the venous cannulation.

Results

Respectively, the VAS was 2.15 ± 1.95 for Group V and 1.00 ± 0.79 for Group E and 2.55 ± 2.74 for Group C. A significant reduction in the severity of pain was observed in Group E. The difference being statistically significant (p < 0.05), the VAS of Group V was higher than Group E but lower than Group C (p > 0.05).

Conclusions

On the basis of data from this study, the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA^®.     

Evaluating hyperglycaemia in the hospitalised patient: towards an improved system for classification and treatment

Background

Hyperglycaemia is common amongst hospitalised patients. Some of this is due to pre-existing diabetes (either previously diagnosed or not), but a proportion is due to stress hyperglycaemia, a transient state of high blood sugars related to the underlying illness.

Aims

We aimed to estimate the prevalence of hyperglycaemia in an Irish hospital setting, including an assessment of what contribution is made by cases of stress hyperglycaemia.

Methods

Over a 9-day period, all bedside glucometer-measured point of care blood glucoses performed in medical and surgical wards in University Hospital Galway were examined. Medical case notes and our diabetes computerised database were analysed to identify individuals with pre-existing diabetes. Glycosylated haemoglobin (HbA_1c) was measured on the remainder of patients, to differentiate between pre-existing diabetes (HbA_1c ≥ 48 mmol/mol) and stress hyperglycaemia (HbA_1c < 48 mmol/mol).

Results

A total of 1,637 glucose readings were performed on 262 in-patients, of which 164 (63 %) were in the hyperglycaemic range. Of the 126 eligible for study inclusion, 92 (73 %) had pre-existing diabetes and 11 (9 %) had previously undiagnosed diabetes. The remaining 20 patients (16 %) had stress hyperglycaemia.

Conclusions

We report a high prevalence of hyperglycaemia (including stress hyperglycaemia) in an in-patient cohort in whom testing was undertaken at the discretion of the treating physician. Our data illustrate the utility of HbA_1c measurement in this setting to help differentiate between pre-existing diabetes and stress hyperglycaemia. Much work remains to be done on how to best identify and treat in-patient hyperglycaemia.     

Effects of sildenafil treatment on patients with Peyronie’s disease and erectile dysfunction

Introduction

It has been shown on experimental rat models that type 5-phosphodiesterase isoenzyme (PDE₅) inhibitors have anti-fibrotic effects for Peyronie’s disease (PD); however, this issue has not been addressed clinically. The aim of this study was to document the effects of PDE₅ inhibitors used for erectile dysfunction (ED) seen in PD patients on the main course of the PD clinically.

Methods

A total of 39 PD patients with ED were divided into two groups. Patients in Group 1 (n = 18) served as controls and received 400 IU vitamin E per day. Those in Group 2 (n = 21) received 50 mg sildenafil per day for 12 weeks. Penile plaque volume was assessed by palpation and by duplex ultrasound. Erectile capacity, penile deformity and plaque characteristics were assessed by the International Index of Erectile Function questionnaire form (IIEF-5) and penile duplex ultrasound.

Results

Statistically significant improvement in all parameters was observed within both groups except for IIEF score in Group 1 when compared with the initial values. Significant reduction in plaques and pain were observed in 7 (33.3 %) and 14 (66.6 %) patients in Group 2 and 6 (33.3 %) and 9 patients (42.8 %) in Group 1, respectively. At the end of the therapy, improvement in IIEF score and reduction in pain were statistically significant in Group 2 compared with Group 1 (p = 0.028 and p = 0.045, respectively).

Conclusion

We conclude that continuous administration of oral PDE₅ inhibitors may be a candidate for medical treatment of PD; however, more controlled studies are needed.     

Accuracy of implant placement with a computer-aided fabricated surgical template with guided parallel pins: A pilot study

Background

A precise positioning for dental implant placement is important for further prosthesis fabrication and maintenance. Computer-aided surgery has been developed to transfer digitally planned implant positioning to the patient over the past decades. This study aimed to evaluate the accuracy of a computer-aided laboratory-fabricated surgical template. A further objective was to compare the accuracy between in vivo and in vitro groups.

Ginger (zingiber officinale) might improve female fertility: A rat model

Background

Ginger (Zingiber officinale) is a well known and extensively used antioxidant in traditional remedies. In this study, we aimed to investigate the effects of ginger powder on ovarian folliculogenesis and implantation in rats.

Pretreatment of Shaoyao Gancao Decoction (芍药甘草汤) Alters Pharmacokinetics of Intravenous Paclitaxel in Rats

Objective:To investigate the effect of Shaoyao Gancao Decoction(芍药甘草汤,SGD) on the pharmacokinetics of intravenously administered paclitaxel in rats.Methods:Paclitaxel was intravenously administered to rats(3 mg/kg) with or without the concomitant administration of SGD(752 mg/kg,a single day or 14 consecutive days pretreatment).The paclitaxel in the serum was quantified using a simple and rapid ultra performance liquid chromatography(UPLC) method for the pharmacokinetic study.The pharmacokinetic parameters were calculated via a non-compartment model using the computer program DAS 2.0.Results:The pharmacokinetic parameters of paclitaxel were significantly altered in response to 14 consecutive days of pretreatment with SGD.The area under the curve(AUC_(0-t),from 4 820 ± 197 to 4 205 ± 186 ng·mL~(-1)·h~(-1))and AUC_(0-∞)(from 5 237 ±280 to 4 514 ± 210 ng·mL~(-1)·h~(-1)) significantly decreased in response to the 14-day pretreatment with SGD.The values of V_(dss)(L/kg) were 10.74 ±1.08 and 9.35 ±0.49,those of CL(L/kg) were0.67 ±0.03 and 0.57 ±0.03 and the t_(1/2)(h) values were 11.17 ±0.84 and 11.32 ±0.93,respectively,for the14-day SGD pretreatment and intravenous paclitaxel alone.The AUC_(0-t) and AUC_(0-∞) values decreased by13%and 14%(P0.01),respectively.The area under the curve decreased significantly(P0.01),and the total clearance increased by 1.2-fold(P0.01),after 14 consecutive days of pretreatment with SGD.A single-day pretreatment with SGD did not significantly affect the pharmacokinetic parameters of paclitaxel.Conclusions:SGD administration for 14 consecutive days increased the metabolism of paclitaxel,while a 1-day pretreatment had little effect.The results would contribute important information to the study on interaction between Chinese medicines and chemotherapy and also help to utilize SGD better in the adjunctive therapy of cancer patients.     

Comparison of IS6110 and ‘short fragment’ devR (Rv3133c) gene targets with phenotypic methods for diagnosis of Mycobacterium tuberculosis

Background

Tuberculosis (TB), declared a global emergency in 1993 by the WHO, remains a worldwide public health problem. Rapid diagnosis is required for treatment and prevention. This study compares genotypic methods using two gene targets [IS6110 and ''short fragment'' devR (Rv3133c)] with phenotypic methods [Lowenstein Jensen (LJ) and BACTEC 460] for the diagnosis of TB while using Ziehl Neelsen (ZN) staining as the gold standard.

Methods

56 clinical TB samples from a tertiary care apex center along with 50 healthy control samples, excluding samples from patients already on ATT were processed by routine USP methodology. Smears were graded by ZN stain. Solid media (LJ) and liquid media (BACTEC 460) were used along with IS6110 and ''short fragment'' devR (Rv3133c) specific gene amplification and comparatively analyzed.

Results

50/56 samples were positive by phenotypic methods, 53 by IS6110 and 45 by devR (Rv3133c) amplification. 38 samples were positive by both phenotypic and genotypic methods. IS6110 detected six and devR (Rv3133c) detected five phenotypically negative samples. Both IS6110 and devR (Rv3133c) were positive in 42 samples. 11 devR (Rv3133c) negative samples were positive by IS6110 and three IS6110 negative samples were positive by ''short fragment'' devR (Rv3133c). Compared to phenotypic methods, the sensitivity, specificity, positive and negative predictive values of IS6110 was 94%, 89.29%, 88.68% and 94.34% while that of devR (Rv3133c) was 80%, 91.07%, 88.89% and 83.61% respectively.

Conclusion

Simultaneous use of both phenotypic and genotypic methods increases the yield of positive results.     

Contamination of blood pressure cuffs by methicillin-resistant Staphylococcus aureus and preventive measures

Background

Although blood pressure cuffs are commonly used and shared in medical facilities, their routine disinfection is performed infrequently.

Aims

We investigated the contamination of blood pressure cuffs by methicillin-resistant Staphylococcus aureus (MRSA).

Methods

The MRSA level on the inner side (the surface in contact with patients’ skin) of blood pressure cuffs used in the wards and outpatient clinics of a university hospital (733 beds) was determined using the gauze and swab wiping methods.

Results

Using the gauze wiping method (n = 35), the MRSA contamination rate was 31.4 %, and the MRSA contamination level was 1,702.6 ± 9,996.1 (0–58, 320) colony-forming units (cfu)/cuff. No MRSA was detected on blood pressure cuffs after washing (n = 30) or wiping with 80 vol% ethanol (n = 18).

Conclusions

Blood pressure cuffs are frequently contaminated by MRSA.     

Evaluation of the need for endoscopy to identify low-risk patients presenting with an acute upper gastrointestinal bleed suitable for early discharge

Aims

To audit the safety of differing protocol‐driven early‐discharge policies, from two sites, for low‐risk acute upper gastrointestinal (GI) bleeding and determine if default early (<24 h) in‐patient endoscopy is necessary.

Methods

All patients with low‐risk acute upper GI bleeding presenting to two separate hospital sites in Leeds from August 2002 to March 2005 were identified. Both hospitals operate nurse‐led process‐driven protocols for discharge within 24 h, but only one includes default endoscopy. Relevant information was obtained from patients'' notes, patient administration systems, discharge letters and endoscopy records.

Results

120 patients were admitted to site A and 74 to site B. Median length of stay on the clinical decisions unit was 12.6 h at site A and 9.4 h at site B (p = 0.045). Oesophagogastroduodenoscopy was performed on 89/120 (74%) patients at site A compared with only 7/74 (9%) at site B (p<0.001). Six of 120 (5%) patients from site A were admitted to hospital for further observation compared with 6/74 (8%) from site B (p = 0.38). Of the remaining patients, all were discharged within 24 h, and 8/114 (7%) at site A vs 17/68 (25%) at site B were given hospital clinic follow‐up (p<0.001). None of the 194 patients had further bleeding or complications within 30 days.

Conclusions

Patients admitted with a low‐risk acute upper GI bleeding can be managed safely by a nurse‐led process‐driven protocol, based on readily available clinical and laboratory variables, with early discharge <24 h. Avoiding in‐patient endoscopy appears to be safe but at the price of greater clinic follow‐up.     

Evaluation of peripheral blood NK cell subsets and cytokines in unexplained recurrent miscarriage

Background

Recurrent miscarriage is considered as one of the main problems in women's reproductive health. The aim of the present study was to evaluate the natural killer cells (NK cells) and cytokines in unexplained recurrent miscarriage and fertile women.

Intravenous administration of metoclopramide by 2?min bolus vs 15?min infusion: does it affect the improvement of headache while reducing the side effects?

Objective

To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache.

Material and methods

All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication''s efficacy and side effects.

Results

A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups.

Conclusion

Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache.     

Immunomodulators for multiple sclerosis may ameliorate spinal bone loss

Background

The effect of immunomodulator therapy (IMT) for multiple sclerosis (MS) on bone turnover is unknown.

Aim

The aim of this study was to assess bone turnover in MS patients on IMT.

Methods

MS patients (n = 29) on maintenance IMT had repeat measurement of bone mineral density (BMD) after a 4.0 ± 0.4 years; bone turnover markers (BTM) were measured at the time of repeat BMD.

Results

BMD was unchanged at the spine but declined at the hip. BTMs, both resorption and formation, were reduced compared to normative range that may indicate an anti-resorptive action of IMT. Significant negative correlations were noted between BTMs and changes in BMD at spine but not hip.

Conclusion

These observations suggest that IMT may have a beneficial effect on spinal bone by an antiresorptive action. A prospective study of the effect of IMT on BMD and bone turnover is warranted.     

Low impedance nature of 12 acupoints on the limbs,and the unexpected dependence on limb angle

OBJECTIVE

To better understand the working mechanism of acupuncture, we investigated the skin electrical impedance distribution around acupoints, and the impedance changes at 12 original acupoints bilaterally after bending the limbs.

The impact of abdominal aortic aneurysm surgery on intensive care unit resources in an Irish tertiary centre

Background

The potential impact of surgical service reconfiguration on intensive care unit (ICU) resources needs to be assessed.

Aims

To determine the resources required to provide post-operative ICU care to patients undergoing open abdominal aortic aneurysm (AAA) repair or endovascular aneurysm repair (EVAR) at a specialist centre in the HSE South area

Methods

For 198 patients, we calculated: (1) ICU bed-days; (2) organ support required; and (3) monetary cost of ICU care.

Results

In total, 82.8 % (101/122) of patients undergoing open AAA repair required post-operative ICU care (52 emergency and 49 elective). Emergency cases required more ICU bed-days (median 4.2 vs. 1.9, p < 0.0005) and were more likely to require ventilation (odds ratio, OR 11.7, p < 0.0001), inotropes (OR 3.1, p = 0.01) or enteral nutrition (OR 23.3, p < 0.0001). Mean cost per patient was €3,956 for elective cases and €16,419 for emergency cases. No patient required ICU admission after EVAR (n = 76).

Conclusions

Open AAA surgery places significant demands on ICU resources. The planned reconfiguration of surgical services in Ireland must provide for parallel investment in ICU facilities and expertise.     

Ethnic variations in the management of patients with acute stroke

Background

There is increasing interest in the management of stroke in ethnic minorities but few studies have considered this issue. This study investigated if differences in acute stroke management exist between a white European and Bangladeshi populations living in London, England.

Methods

All stroke surviving patients discharged over a five year period in a major London teaching hospital based in an ethnically diverse area of inner city London were recruited. Cerebrovascular risk factors, their management, and investigation for acute stroke syndromes were recorded and comparison between white and Bangladeshi cohorts was made. Categorical data were analysed using Fisher''s exact test.

Results

Measurement of cholesterol concentrations are undertaken less often in those from a Bangladeshi background (25%) compared with white Europeans (76%) (p<0.0001). Statin therapy tends to be given less often to Bangladeshis. However, neuroimaging (p<0.05) and echocardiography (p<0.0001) is performed more often in Bangladeshis compared with white Europeans.

Conclusion

There are variations in the management of acute stroke because of ethnicity and these variations could have substantial consequences on secondary rates of cerebrovascular and cardiovascular disease. Whether the reasons for this disparity are attributable to inequity or iniquity of care need to be further investigated perhaps along with the development of ethnicity specific protocols. Overall the management of stroke and its risk factors in either racial group remains lamentable.     

Zhang Ji-zhi (张继志)—A pioneer of integrated mental health

ＰｒｏｆｅｓｓｏｒＺＨＡＮＧＪｉ ｚｈｉ,ｗｈｏｗａｓｂｏｒｎｉｎＷｅｉｆａｎｇＣｉｔｙ,ＳｈａｎｄｏｎｇＰｒｏｖｉｎｃｅ,ｗａｓｇｒａｄｕａｔｅｄｆｒｏｍＳｈａｎｄｏｎｇＵｎｉｖｅｒｓｉ ｔｙ,ＳｃｈｏｏｌｏｆＭｅｄｉｃｉｎｅｉｎ195 2．ＨｅｔｏｏｋｆｕｒｔｈｅｒｔｒａｉｎｉｎｇｉｎＴｒａｄｉｔｉｏｎａｌＣｈｉｎｅｓｅＭｅｄｉｃｉｎｅＣｌａｓｓ（ｏｎｌｅａｖｅ）ａｎｄｇｒａｄｕａｔｅｄｉｎ 1976．ＨｅｈａｄｓｅｒｖｅｄｓｕｃｃｅｓｓｉｖｅｌｙａｓｄｉｒｅｃｔｏｒｆｏｒＤｅｐａｒｔｍｅｎｔｏｆＰｓｙ…