Rhubarb-based Chinese herbal formulae for hepatic encephalopathy: a systematic review and Meta-analysis

Objective

To evaluate the effectiveness and safety of rhubarb-based Chinese herbal formulae (RCHF), which are widely used to treat hepatic encephalopathy (HE) in China.

大黄对老年Ⅱ型糖尿病尿蛋白排泄率的影响

目的 :观察大黄对老年Ⅱ型糖尿病尿白蛋白排泄率的改变。方法 :94例年龄≥ 60岁的NID DM患者伴微量白蛋白尿 ,分为三组 ,分别应用captopril、大黄及两药联合治疗 ,比较治疗前、治疗 2W和4W尿白蛋白排泄率。结果 :应用captopril 2W即发挥降低UAER作用 ( 95.1± 9.8比 82 .7± 8.8,P <0 .0 5) ,大黄治疗 2W对UAER无明显改变 ,4W与captopril效果相似 ( 72 .3± 9.6比 73.3± 9.2 ,P >0 .0 0 1 ) ,两药联合应用效果最佳 ( 4 2 .3± 1 1 .6,P <0 .0 0 1 )。结论 :大黄有降低老年NIDDM患者尿白蛋白排泄的作用 ,与aptopril联用效果最好。     

大黄游离蒽醌的制备与纯化

从中药大黄中提取总蒽醌（结合和游离２类）,经水解后用水化学试剂或大孔树脂制备总游离蒽醌（含大黄素、大黄酸、芦荟大黄素、大黄酚和大黄素甲醚）,进一步纯化得大黄酸和大黄素。     

藏边大黄的化学成分研究

目的研究藏边大黄的化学成分。方法用硅胶、聚酰胺柱色谱分离结合重结晶方法进行分离纯化。用MS、1H-NMR、13C-NMR谱学方法结合化学方法确定化合物的结构。结果从藏边大黄干燥根与根茎的乙醇提取物中分得18个化合物,鉴定了其中16个化合物的结构,分别为大黄酚(1)、大黄素甲醚(2)、β-谷甾醇(3)、大黄素(4)、芦荟大黄素(5)、波叶素(6)、胡萝卜苷(7)、d-儿茶素(8)、反式-3,5,3′,4′-四羟基茋(9)、反式-3,5,3′,4′-四羟基茋-4′-O-β-D-吡喃葡萄糖苷(10)、反式-3,5,3′,4′-四羟基茋-4′-O-β-D-(6″-O-p-香豆酰)-吡喃葡萄糖苷(11)、大黄酚-8-O-β-D-吡喃葡萄糖苷(12)、大黄素甲醚-1和8-O-β-D-吡喃葡萄糖苷(13a和13b)、大黄素-8-O-β-D-吡喃葡萄糖苷(14)、蔗糖(15)。同时得到一种大黄酸类似物,因量少未得到最终的结构确定。结论化合物11为一新化合物,命名为波叶苷(rheoside),化合物13a和13b系首次从该植物中分得。     

Potential ex vivo immunomodulatory effects of San-Huang-Xie-Xin-Tang and its component herbs on mice and humans

Aim of the study

San-Huang-Xie-Xin-Tang (SHXXT), an important Chinese medicine formula, contains Rhei Rhizoma (RR), Scutellariae Radix (SR) and Coptidis Rhizoma (CR). RR and SR are abundant in anthraquinone and flavonoid polyphenols. Pharmacokinetic study of SHXXT indicated that glucuronides were the predominant forms of polyphenols in rats.

Materials and methods

As an extension of pharmacokinetic study, the serum metabolites of SHXXT, RR, SR and CR were prepared from rats and quantitated, then the immunomodulation effects were examined by culturing these serum metabolites with murine and human immune cells.

Results

The results indicated that the inhibitions on nitric oxide (NO) and cytokine production from mitogen-activated peritoneal macrophages by the serum metabolites of SHXXT, RR, SR and CR were through reducing the protein expression of inducible NO synthase (iNOS) and the IC₅₀ were 0.8%, 1.5%, 3.0% and 0.8% of their blood concentrations, respectively. In addition, the serum metabolites of SHXXT, RR, SR and CR significantly decreased the ratios of interferon-gamma (IFN-γ) to interleukin (IL)-4 in mitogen-stimulated mice spleen cells and human peripheral blood mononuclear cells (PBMCs). Moreover, the serum metabolites of SHXXT and SR significantly arrested the mitogen-stimulated mice spleen cells at G2/M stage.

Conclusions

In conclusion, the serum metabolites of SHXXT and the component herbs exerted promising modulation activities on the immune functions and the cell cycle distribution of mice and human immune cells. We suggest that SHXXT is a promising remedy for immunomodulation through Th1/Th2 regulation.     

大黄醇提液抗乙肝病毒作用

目的研究评价大黄醇提液的抗乙肝病毒作用。方法体内实验采用先天感染鸭乙肝模型,检测血清DHBV—DNA动态变化,体外实验采用2、2．15细胞为模型,检测用药后对细胞培养上清中HBsAg和HBeAg的抑制作用。结果在体内抗乙肝病毒实验中,大黄醇提液20g／kg和10g／kg剂量组于给药5d(T5)、10d(T10)和停药3d(P3)时体内均有显著抑制DHBV-DNA的作用。体外实验显示：大黄醇提液对2．2、15细胞分泌HBsAg的治疗指数为16、96,对分泌HBeAg的治疗指数为12．06。结论大黄醇提液在体内外实验中均具有明显的抗乙肝病毒作用。     

When and How to Treat Agitation in Alzheimer's Disease Dementia With Citalopram and Escitalopram

Agitation is a common neuropsychiatric symptom (NPS) in the early and middle stages of Alzheimer's disease (AD) dementia, which is difficult to treat and causes much distress. The U.S. Food and Drug Administration (U.S. FDA) issued black box warnings against the use of antipsychotics in dementia in 2005 and 2008 due to the increased risk of morbidity and mortality, resulting in the reduction in antipsychotic use for treating dementia-related NPS and spurring the quest for safer and more effective pharmacological options. The data favoring the use of citalopram for treating agitation in AD dementia is particularly compelling, and this may be a class effect for all selective serotonin reuptake inhibitors. However, concerns about the cardiac side-effects of citalopram have limited its widespread use for this indication. In this article, available efficacy and safety data for the use of citalopram and escitalopram in treating agitation in AD dementia is reviewed, using a composite case to illustrate key points. Practical recommendations are made to facilitate the use of these medications in routine clinical practice, risk mitigation strategies are discussed and salient issues for future clinical research are emphasized.     

Response of the popliteal artery to treadmill exercise and stress positioning in patients with and without exertional lower extremity symptoms

ObjectiveFunctionally limiting exertional lower extremity pain and neurologic symptoms are commonly encountered in military and civilian settings. Exertional muscle compression of the popliteal artery (PA) and tibial nerve in the proximal calf (the “popliteal outlet”) can be associated with these symptoms but is rarely investigated as a cause. Exertional ankle-brachial index (EABI) and dynamic PA ultrasound imaging may be suitable to screen for this syndrome of “functional” popliteal entrapment, but neither has been rigorously studied. Our objective was to characterize the response of the PA to lower extremity exertion and dynamic ankle positioning in symptomatic and asymptomatic limbs.MethodsLimbs characterized as symptomatic (n = 29) or asymptomatic (n = 61) had duplex ultrasound PA diameter and peak systolic velocity measurements with the ankle neutral and maximally plantar flexed. EABIs were obtained at rest and 1 minute and 5 minutes after walking (5 minutes, 3 mph, 10-degree incline) and running (5 minutes, 6 mph, 0-degree incline). Significance was set at P ≤ .05. Data are expressed as mean ± standard error of the mean.ResultsPlantar flexion resulted in PA occlusion and changes in diameter and peak systolic velocity in symptomatic (three occluded, ?2.4 ± 0.34 mm, +49 cm/s) and asymptomatic (six occluded, ?1.6 ± 0.21 mm, +65 cm/s) limbs. The difference in percentage change was significant between groups only for diameter change. EABIs in both groups were similar at rest, decreased with running and walking at 1 minute, and were not fully recovered by 5 minutes. Symptomatic limbs had a greater decrease in ABI than did asymptomatic limbs with both running and walking. The decrease was greatest at 1 minute after running and significantly more pronounced in symptomatic (?0.18) than in asymptomatic (?0.02) limbs.ConclusionsEABI decrease at 1 minute after running and PA diameter decrease with dynamic ankle plantar flexion are significantly greater in limbs with than without exertional lower extremity symptoms. These noninvasive measurements may be valuable in the workup of such symptoms. PA and tibial nerve compression at the popliteal outlet may be a more frequent cause of functionally limiting exertional lower extremity pain and neurologic symptoms than previously recognized.     

Weight loss and co-morbidity resolution between different races and ethnicities after gastric bypass

BackgroundSeveral studies have demonstrated that minorities and Hispanic ethnicities have disproportionally greater burden of morbid obesity in the United States. However, the majority of bariatric procedures are performed in the non-Hispanic white population.ObjectivesThe objective of this study was to investigate the weight loss and remission of obesity-related co-morbidities based on race and ethnicity.SettingThe Longitudinal Assessment of Bariatric Surgery prospective, multicenter, observational study was used to collect patients from 10 different health centers across the United States.MethodsRetrospective analysis of a prospective, multicenter, observational study over a 5-year follow-up.ResultsAll patients who underwent primary gastric bypass and provided racial/ethnic information were included in the study (n = 1695). Regardless of race or ethnicity, total weight loss was maintained over a 5-year follow-up, which included 87% of the original cohort. However, whites had on average 1.94% higher adjusted total weight loss compared with blacks (P < .0001). After adjusting for confounders there were no significant differences in resolution of co-morbidities, including diabetes.ConclusionAll patients regardless of race or ethnicity have significant and sustained total weight loss and resolution of co-morbidities after gastric bypass at 5-year follow-up.