OBJECTIVETo observe the clinical effect of TCM treatment for dissolving phlegm and dispelling stasis (DP-DS) on acute cerebral infarction (ACI) and its influences on plasma protein C and S and soluble thrombomodulin (TM).

METHODSOne hundred and twenty-two patients were randomly assigned to two groups, the treated group (62 cases) and the control group (60 cases). They were all treated with the conventional treatment, and DP-DS treatment was given to the treated group additionally. The treatment course was 14 days. The changes in scores of TCM syndrome and neurofunction impairment (NIHSS), levels of plasma protein C (PC), protein S (PS) and TM before and after treatment in the two groups were observed.

RESULTSThe total effective rate of TCM syndrome in the treated group was higher than that in the control group (P= 0.00). After treatment, NIHSS in the two groups was significantly different (P=0.00), and the score in the treated group was superior to that in the control group (P = 0.00). NIHSS score and levels of PC and PS were improved in both groups (P = 0.024, 0.028), and the improvement of PC in the treated group was superior to that in the control group respectively (P = 0.049). But no significant change of TM was shown after treatment.

CONCLUSIONTCM DP-DS treatment shows significant effect in improving TCM syndrome and neurofunction impairment of the patients with acute cerebral infarction, and raise the levels of PC and PS.

Aged ; Cerebral Infarction ; blood ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Phytotherapy ; Protein C ; metabolism ; Thrombomodulin ; blood

BACKGROUNDSepsis induced acute lung injury (ALI) as a common syndrome in clinical practice has a high mortality. Recombinant human activated protein C (APC) can significantly reduce the mortality of patients with severe sepsis. Several studies have implicated that APC may be protective in ALI.

METHODSTwenty-one rabbits were operatively prepared and randomly divided into sham, control, or APC groups (n = 7 in each group). After a tracheotomy had been performed, ALI was produced in the control and APC groups by infusion of Escherichia coli endotoxin 100 microg/kg per hour intravenously for 1 hour. The sham group received only the vehicle, infusion of 20 ml of 0.9% saline. The rabbits were studied under anesthesia for 6 hours and were ventilated with 40% oxygen. Bovine APC (25 microg x kg(-1) x h(-1)) was intravenously administered. The infusion was initiated half an hour post-injury and lasted for 4 hours. The animals were resuscitated with Ringer's lactate solution.

RESULTSIn comparison with nontreatment in the control group, the infusion of APC significantly reduced the increase of thrombomodulin level (TM; control group was (0.68 +/- 0.06) ng/ml, vs APC group of (0.62 +/- 0.07) ng/ml at 6 hours, P < 0.05), and significantly attenuated the fall in protein S (PS; control group was (2.32 +/- 0.03) microg/ml at 2 hours, (2.24 +/- 0.06) microg/ml at 4 hours and (2.21 +/- 0.09) microg/ml at 6 hours, vs APC group (2.46 +/- 0.04) microg/ml at 2 hours, (2.40 +/- 0.05) microg/ml at 4 hours and (2.39 +/- 0.07) microg/ml at 6 hours, P < 0.01). In addition, APC limited the increase in plasminogen activator inhibitor-1 (PAI-1) both in plasma (control group was (0.68 +/- 0.12) ng/ml at 1 hour, (0.84 +/- 0.06) ng/ml at 2 hours, (0.87 +/- 0.08) ng/ml at 4 hours and (0.91 +/- 0.05) ng/ml at 6 hours, vs APC group (0.42 +/- 0.16) ng/ml at 1 hour, (0.43 +/- 0.04) ng/ml at 2 hours, (0.45 +/- 0.09) ng/ml at 4 hours and (0.45 +/- 0.14) ng/ml at 6 hours, P < 0.01) and in bronchoalveolar lavage fluid (at 6 hours: sham, (1.05 +/- 0.05) ng/ml; control, (1.13 +/- 0.06) ng/ml; APC, (1.06 +/- 0.06) ng/ml; P < 0.05). However, APC failed to prevent the decrease in PaO(2)/FiO(2) ratio. APC-treated rabbits showed no significant difference in platelet count and antithrombin but exhibited less D-dimer production than did the controls. Moreover, APC limited the histopathological score of lung injury (2.6 +/- 0.8 in control, vs 1.4 +/- 0.6 in APC group, P < 0.01).

CONCLUSIONAnti-coagulation and pro-fibrinolysis activity may be two of the possible mechanisms by which activated protein C attenuated endotoxin-induced ALI.

Acute Lung Injury ; blood ; chemically induced ; Animals ; Antithrombin III ; metabolism ; Blood Coagulation ; drug effects ; Blood Pressure ; drug effects ; Endotoxins ; pharmacology ; Fibrinolysis ; drug effects ; Male ; Plasminogen Activator Inhibitor 1 ; blood ; Protein C ; pharmacology ; Protein S ; metabolism ; Rabbits ; Random Allocation ; Thrombomodulin ; blood

OBJECTIVETo explore the mechanism of Chinese medicinal therapy for nourishing blood and softening Gan in treating senile pruritus through observing the impact of Guishen Zhiyang Recipe (GZR) on serum levels of stem cell factor (SCF) and dynorphin (DYN) in patients suffered from the disease of blood-deficiency and Gan-hyperactive syndrome type (BDGH).

METHODSSixty patients with senile pruritus were equally randomized into two groups, the patients in the treated group (33 cases) were treated by GZR, and those in the control group (28 cases) were treated by Fuyang Granule, all for 8 weeks. Changes of symptoms and skin lesions as well as blood levels of SCF and DYN were observed before and after treatment.

RESULTSThree patients were rejected from the treated group. Twenty patients in the treated group were cured after treatment, the cure rate being 66.7%, which was significantly higher than that in the control group (10 patients, 35.7%, P < 0.05). Levels of SCF and DYN in the treated group significantly lowered after treatment (all P < 0.01), and were lower than those in the control group (P < 0.05 and P < 0.01, respectively).

CONCLUSIONGZR shows favorite effect in treating senile pruritus of BDGH type and it may be achieved by regulating SCF and DYN levels to improve the pruritus associated inflammatory media.

Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Dynorphins ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Pruritus ; drug therapy ; metabolism ; Stem Cell Factor ; metabolism ; Syndrome

Objective To establish a model of chronic periodontitis(CP) accompanied with chronic obstructive pulmonary disease (COPD) in SD rats and investigate the relationship between chronic periodontitis and COPD. Methods Equal gender SD rats were randomly divided into 4 groups, A: control group, B: CP group, C: COPD group, D: COPD with CP group (n = 10, respectively). Each group was subjected to its predesigned intervention to establish a specific disease model. After 10 weeks, animals were sacrificed. The level of alveolar bone loss, lung function measurement, and the histopathological changes of periodontal and lung tissues were examined. The serum tumor necrosis factor (TNF)-α level was detected by enzymelinked immunoabsorbent assay kits. Results Bleeding index (BI) levels of group A and C were (0.25±0.04) and (1.30 ±0.25),respectively. Attachment loss was (0.43 ±0.02) and (0.51 ±0. 02) mm. BI levels in group B and D were significantly higher than those in group A and C. Forced expiratory volume in 0. 2 second to forced vital capital ratio(FEV0.2/FVC) values in group B, C and D were significantly lower than that in group A. Pulmonary function were worse in group D than that in group C(P＜0. 05). The levels of serum TNF-α, a sensitive indicator of both diseases, were increased in all test groups compared with the control, and increased most in group D. Conclusions The chronic periodontitis and chronic obstructive pulmonary disease model was established in SD rat. The chronic periodontitis may be a risk factor for promoting and inducing COPD.

OBJECTIVETo identify the risk factors of deep venous thrombosis (DVT) in hospitalized patients with acute stroke, under a perspective case-control study.

METHODS488 cases with stroke, identified by CT or MRI and admitted to the department of neurology and neurosurgery in Beijing Chaoyang Hospital between December 2001 and December 2002 were consecutively studied. There were 328 male and 160 female patients (95.5% Hans) with a mean age of 65 +/- 11 years, ranging 22 - 93 years. The procedure of study would include: (1) General condition, possible risk factors, symptoms of DVT physical check-up to every eligible patient on first day of admission but the plasma concentrations of D-dimer (ELISA), thrombomodulin, antithrombin-III and blood routine examination were measured on the next morning. (2) The ultrasonography (US) was used for detecting both lower extremities at 7 - 10 days after the onset of stroke, and D-dimer and AT-III tests were repeated on the same or next day that the US was taken. (3) The ultrasound examination was repeated after a week in patients with high suspicion of DVT. (4) The therapy of stroke was recorded before the end of the study. Data of stoke patients with DVT was compared with those without DVT to identify the DVT risk factors. The effect of each variable on DVT was assessed by logistic regression analysis.

RESULTSThe prevalence of DVT was 21.7% among the patients. In multivariate analysis, age >/= 65 years old (OR = 1.655, 95% CI: 1.005 - 2.725), being male (OR = 1.993, 95% CI: 1.221 - 3.253), bedridden (OR = 3.275, 95% CI: 1.653 - 6.486) and DVT assessment scores >/= 2 (OR = 5.019, 95% CI: 2.685 - 9.381) were independently associated with DVT in all the stroke patients. Being male (OR = 2.828, 95% CI: 1.242 - 6.438), white blood cell count > 10.0 x 10(9)/L (OR = 2.032, 95% CI: 0.897 - 4.602) and DVT assessment scores >/= 2 (OR = 8.809, 95% CI: 3.081 - 25.188) were the independent risk factors of DVT in hemorrhagic stroke group. Age >/= 65 years old (OR = 2.167, 95% CI: 1.072 - 4.381), bedridden (OR = 3.008, 95% CI: 1.435 - 6.307) and DVT assessment scores >/= 2 (OR = 2.600, 95% CI: 1.077 - 6.278) were the independent risk factors of DVT in ischemic stroke group.

CONCLUSIONPatients hospitalized with acute stroke were under high risk of DVT. Data suggested that old age, female, bedridden and high DVT assessment scores >/= 2 were independent risk factors for DVT in acute stroke patients that called for supervision and prophylaxis on DVT.

Aged ; Case-Control Studies ; China ; epidemiology ; Female ; Hospitalization ; Humans ; Leg ; blood supply ; Male ; Prevalence ; Prospective Studies ; Risk Factors ; Stroke ; complications ; Venous Thrombosis ; epidemiology ; etiology

OBJECTIVETo evaluate the effects of simvastatin combined with omega-3 fatty acids on high sensitive C-reactive protein (HsCRP), lipidemia, and fibrinolysis in coronary heart disease (CHD) and CHD risk equivalent patients with mixed dyslipidemia.

METHODSA randomized, double-blind placebo controlled and parallel group trial was conducted. Patients with CHD and CHD risk equivalents with mixed dyslipidemia were treated with 10 or 20 mg simvastatin for 6-12 weeks. Following with the treatment of patients whose low-density lipoprotein cholesterol (LDL-ch) reaching goal level (< 100 mg/dL) or close to the goal (< 130 mg/dL), while triglyceride (TG) > or = 200 mg/dL and < 500 mg/dL, was combined with omega-3 fatty acids (3 g/d) or a placebo for 2 months. The effects of the treatment on HsCRP, total cholesterol (TC), LDL-ch, high-density lipoprotein cholesterol (HDL-ch), TG, lipoprotein (a) [LP (a)], apolipoprotein A1 (apoA1), apolipoprotein B (apoB), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (tPA) were investigated. Forty patients finished the study with each group consisting of twenty patients.

RESULTS(1) There were significant reductions of HsCRP, TG, TC, and TC/HDL-ch, which decreased by 2.16 +/- 2.77 mg/L (38.5%), 94.0 +/- 65.4 mg/dL (31.1%), 13.3 +/- 22.3 mg/dL (6.3%), 0.78 +/- 1.60 respectively in the omega-3 fatty acids group (P < 0.01, < 0.001, < 0.05, < 0.05) compared to the baseline. HsCRP and triglyceride reduction were more significant in omega-3 fatty acids group compared to the placebo group (P = 0.021 and 0.011 respectively). (2) In the omega-3 fatty acids group, the values and percentage of TG reduction had a significantly positive relation with HsCRP reduction (r = 0.51 and 0.45, P = 0.021 and 0.047 respectively).

CONCLUSIONIn CHD and CHD risk equivalent patients with mixed dyslipidemia, dyslipidemia's therapeutic effect using simvastatin and omega-3 fatty acids may result from not only the combination of lipid adjustment, but also enhancement of their own nonlipid influences.

Aged ; C-Reactive Protein ; metabolism ; Coronary Disease ; blood ; Double-Blind Method ; Drug Therapy, Combination ; Fatty Acids, Omega-3 ; therapeutic use ; Fibrinolysis ; drug effects ; Humans ; Hypolipidemic Agents ; therapeutic use ; Lipids ; blood ; Male ; Middle Aged ; Simvastatin ; therapeutic use ; Triglycerides ; blood

BACKGROUNDPeripheral skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) may be due to the disease per se or as a result of concomitant confounding factors. Although the mechanistic basis for this functional impairment is uncertain, oxidative stress may play a role. The purpose of this study was to investigate whether local oxidative stress is associated with the reduced peripheral skeletal muscle performance in rats with emphysema.

METHODSIn situ mechanical properties of gastrocnemius were measured in Sprague-Dawley rats 5 months after intratracheal instillation of either elastase (EMP, n = 10) or normal saline (CON, n = 10). Lipofuscin inclusions, myocyte apoptosis and antioxidant enzyme activities were examined in the gastrocnemius muscle.

RESULTSLipofuscin inclusions were significantly higher in the gastrocnemius muscle of EMP compared with CON (3.2 + or - 0.4 vs. 1.7 + or - 0.4, P < 0.01). The activities of antioxidant enzymes were significantly increased in muscle homogenates of EMP as compared to CON. No significant differences were found in myocyte apoptosis between EMP and CON (1.2 + or - 0.9 vs. 1.0 + or - 0.8, P > 0.05). EMP decreased the fatigue endurance of gastrocnemius muscle (half-time to fatigue recovery: (150.0 + or - 55.4) seconds vs. (55.2 + or - 29.3) seconds, P < 0.01) and had no effect on maximal tetanic force ((467.4 + or - 36.6) g vs. (493.2 + or - 30.5) g, P > 0.05). A significantly positive correlation was found between the level of lipofuscin inclusions and the half-time to fatigue recovery of gastrocnemius muscle in EMP (r = 0.664, P < 0.05).

CONCLUSIONLocal oxidative stress may have important functional consequences for peripheral skeletal muscle in rats with EMP.

Animals ; Catalase ; metabolism ; Emphysema ; metabolism ; pathology ; physiopathology ; In Vitro Techniques ; Male ; Muscle, Skeletal ; metabolism ; pathology ; physiopathology ; Oxidative Stress ; physiology ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; metabolism

OBJECTIVETo determine the prevalence of beta-fibrinogen gene -455G/A, -148C/T polymorphisms in Chinese Han population and to investigate whether they were associated with pulmonary thromboembolism (PTE).

METHODSThe subjects consisted of 101 patients with PTE and 101 healthy controls matched with age and sex, from the same geographic area. All patients were diagnosed by high probability of lung ventilation/perfusion scan and/or multi-slice CT pulmonary angiography as well as medical history and clinical manifestations. Genome DNA was extracted from whole blood using KI-phenol-chloroform. Genotypes and allele frequencies of fibrinogen beta gene -455G/A, -148C/T polymorphisms were examined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Restriction enzyme HaeIII and HindIII digestion were used for detecting -455G/A, -148C/T polymorphisms respectively.

RESULTSRegarding fibrinogen beta gene -455G/A and -148C/, the allele frequencies G and A of fibrinogen beta -455 in the controls were 0.931, 0.069 while C and T of -148 were 0.777, 0.223 respectively, which were in good agreement with Hardy-Weinberg equilibrium. There was significant difference of -455G/A genotype frequencies distribution of AA, GA, GG between cases and in controls respectively, but no significant difference was found in the -148C/T polymorphisms. The frequencies of mutation allele -455A were 0.193, 0.169 in cases and in controls with P < 0.05 but there was no statistically significant difference of -148T allele. The presence of A allele of fibrinogen beta -455 was found to be a greater risk factor in cases than in controls. The odds ratio (OR) of GA and GA + AA were 3.723 (1.786 - 7.759), 3.749 (1.842 - 7.630), respectively. When compared with GG genotype, the P value was 0.0001.

CONCLUSIONThere was a complete linkage disequilibrium between fibrinogen beta -148C/T and -455G/A found. The frequencies of -455A, alleles in PTE disease were apparently higher than that of healthy adults but there was no difference in -148T alleles.

Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; China ; Fibrinogen ; genetics ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Humans ; Linkage Disequilibrium ; Odds Ratio ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Pulmonary Embolism ; genetics ; Risk Factors

OBJECTIVETo investigate the relationship between vascular endothelial dysfunction and serum homocysteine (HCY) level in patients with coronary lesions.

METHODSSerum HCY, serum nitric oxide (NO), plasma endothelin-1 (ET-1), and circulation endothelial cell (CEC) were measured in 76 patients who received coronary angiography. Fifty-four patients with a stenosis of 50% or more at least in one coronary atery were as coronary artery disease (CAD) group. Other 22 cases with no recognizable plaque and/or stenosis were as control group. HCY level was detected using an enzyme immunoassay kit. NO concentration was measured using a nitrate reductase kit. Radio-immunoassay was applied to analyse the ET-1 level, and CEC was measured by flow cytometry.

RESULTSThe levels of HCY, ET-1, and CEC in patients with coronary lesions were significantly increased in comparison with control group (P < 0.01), while NO level in CAD group was significantly lower compared with that in control (P < 0.01). Using a multivariate stepwise regression analysis, HCY level had a positive correlation with ET-1 level (r = 0.420, P < 0.05) and CECs number (r = 0.423, P < 0.05); and had a negative correlation with NO/ET-1 (r = -0.403, P < 0.05). But there was no significant correlation between HCY and NO levels.

CONCLUSIONSHCY might lead to endothelial cell injury, which would provide a plausible mechanism for the relationship between hyperhomocysteinemia and development of coronary artery disease. HCY can be considered as a predictor for preliminary or active coronary lesion.

Aged ; Biomarkers ; blood ; Cell Count ; Coronary Artery Disease ; blood ; pathology ; Endothelial Cells ; pathology ; Endothelin-1 ; blood ; Female ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Nitric Oxide ; blood

BACKGROUNDThe body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index was shown at predicting the risk of death, exacerbation and disease severity among patients with COPD, but few studies verified relationship between BODE index and health related quality of life (HRQoL) among Chinese COPD patients. The objective of this study was to evaluate the relationship between BODE index and HRQoL in cross-sectional and longitudinal association analyses.

METHODSA multi-center prospective cohort study was initially conducted in 491 stable COPD patients in Beijing, China. Health status (HRQoL) was assessed by St. George's Respiratory Questionnaire (SGRQ); the BODE index was calculated for each patient; dyspnea was assessed using the 5-grade Medical Research Council dyspnea scale. Other measurements included socio-demographic, body mass index (BMI), lung function test and 6-minute-walk test (6MWT). Patients were then followed monthly for 12 months.

RESULTSOnly 450 patients completed the 1-year follow up and were enrolled in our present analyses. Mean age was (65.2 +/- 10.6) years, men 309 (68.7%). The BODE index was categorized into 4 subgroups: 0 - 2, 3 - 4, 5 - 6 and 7 - 10. At baseline BODE index was gradually increased with baseline total SGRQ and SGRQ subscales (P trend < 0.001). For individual components of BODE index, with the decrease of airflow limitation, and 6MWD, and with the increase of Medical Research Council (MRC) dyspnea grade, total SGRQ and SGRQ subscales were increased correspondingly, P trend < 0.05, respectively. Similar association patterns were found between baseline BODE index and its individual components and mean SGRQ scores at the end of 1-year follow up. By multiple linear regression analyses, baseline BODE index was not only significantly associated with SGRQ score at baseline but also with SGRQ score at the end of 1-year follow up after adjustment for age, male, current smoking, betas being 0.434 and 0.378, respectively.

CONCLUSIONSBODE index is associated with SGRQ score cross-sectionally and longitudinally among stable COPD patients. BODE index might have potential to be used as a sensitive tool to assess the status of quality of life and to monitor disease progression among stable COPD patients.

Aged ; Body Mass Index ; Cross-Sectional Studies ; Dyspnea ; pathology ; physiopathology ; Exercise Tolerance ; physiology ; Female ; Humans ; Linear Models ; Longitudinal Studies ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; pathology ; physiopathology ; Quality of Life ; Respiratory Function Tests ; Smoking ; Surveys and Questionnaires