[Objective] To evaluate the effect of Bushen Yixin Tablet (BYT) on blood pressure (BP) and hemorrheology in rats with hypertension. [Methods] Rat models of hypertension were established by constricting either of the bilateral renal arteries with one clip. Sixty rats were randomly allocated to high - dose BYT group (Group A), low - dose BYT group (Group B), nitrendipine (Group C) and normal saline group (Group D) . Ten rats served as mimic group (Group E) . BP of tail artery was examined in various groups and after a 4 - week treatment, whole blood viscosity and indexes of erythrocyte aggregation (EA) and erythrocyte deformation (ED) were detected. [Results] BP was increased, high- , middle - and low - shear whole blood viscosity and EA index were elevated and ED index was decreased in model rats as compared with those of the normal. After treatment, BP and whole blood viscosity were reduced and ED index was increased in Group A, Group B and Group C, and EA index in Group A was lowered as compared with those in Group D (P

Objective To evaluate the teaching method of three-stage learning(STL) in ICU's ventilation education.Methods 18 ICU interns and transferred doctors were taught with STL method in ventilation education.The teaching effect was evaluated.Results Doctors with STL method got better effect.Conclusion STL method is practical and suitable for ventilation teaching in ICU.

ObjectiveTo evaluate the clinical efficacy and safety of astragalus injection on the immune function in patients with senile sepsis.Methods Sixty patients with old age sepsis in Critical Care Medicine Department of Guangdong Provincial Traditional Chinese Medicine Hospital were enrolled and randomly assigned into control and treatment groups according to the table of random numbers, 30 cases in each group. According to 2012 sepsis guidelines for treatment, including antibacterial drug, mechanical ventilation, visceral function support, etc., the therapy was given to the control group; besides the treatment in the control group, intravenous drip of 60 mL astragalus injection(10 mL per ampoule) in 250 mL 0.9% normal saline was additionally given in the treatment group, once a day for 7 days. Before and after treatment, the immunological indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, duration of mechanical ventilation and time of stay in intensive care unit(ICU), 28-day mortality and adverse drug reactions were compared between the two groups.Results Before treatment, there were no statistically significant differences in CD3+, CD3+CD4+, CD3+CD8+ and T helper cells /T suppressor cells(Th/Ts)levels between the two groups(allP>0.05), while CD3-NK+ of the control group was significantly higher than that in the treatment group〔(10.47±6.22)% vs. (6.26±4.13)%,P<0.05〕. After treatment in treatment group, CD3+, CD3+CD4+ and CD3-NK+ were increased, CD3+CD8+,Th/Ts were decreased compared with those before treatment; in the control group after treatment, CD3+,CD3+CD8+ and CD3-NK+ were decreased and CD3+CD4+ and Th/Ts increased compared with those before treatment. In the comparisons between the treatment group and control group after treatment, the differences in CD3+, CD3+CD4+ and CD3+CD8+ had statistical significance〔CD3+:(30.30±17.17)% vs.(41.91±22.29)%, CD3+CD4+:(31.54±13.24)% vs.(40.08±15.28)%, CD3+CD8+:(14.25±8.10)% vs.(9.52±9.33)%,allP<0.05〕; while the differences in Th/Ts and CD3-NK+ had no statistical significance(bothP>0.05). After treatment in the treatment group, IgG was increased compared with that in the control group〔IgG(g/L): 13.07±5.43 vs. 10.10±3.96,P<
0.05〕. The differences in IgA, IgM, complement(C3,C4) and total serum complement activity(CH50) in the comparisons between the two groups had no statistical significance after treatment(allP>0.05). The differences in APACHEⅡ score(13.83±6.18 vs. 15.90±7.48), SOFA score(7.38±4.66 vs. 6.89±4.19), time of stay in ICU(day: 11.63±5.13 vs. 13.62±8.08), invasive ventilation time(hour: 155.44±119.68 vs. 224.08±174.15) and noninvasive ventilation time(hour: 55.55±42.24 vs. 98.57±43.17) had no statistical significance in comparisons between the treatment group and control group after treatment(allP>0.05). The difference in 28-day mortality had no statistical significance in comparison between the treatment group and control group〔16.7%(5/30) vs. 20.0%(6/30),P>0.05〕. In 60 cases, there were 2 patients with adverse drug reaction, one diarrhea and another little rashes, the rest of the patients did not appear any drug side effect.ConclusionAstragalus injection combined with conventional western medicine therapy possibly has certain effect on adjustment of disturbance of immunologic functions in old patients with sepsis, and its therapeutic safety is well.

Acute myocardial infarction (AMI) is one of the most common cardiovascular diseases. The clinical pathway is the therapeutic program for disease-specific treatment and its implementation may reduce both the duration and cost of the hospital stay. This study aims to construct and evaluate the efficacy of clinical pathways (CPs) based on integrated traditional Chinese and Western medicine for patients with AMI.

Objective To observe hemodynamic characteristics and the correlation with syndrome types of traditional Chinese medicine (TCM) in patients with septic shock, so as to direct the treatment based on syndrome differentiation. Methods A prospective observation was conducted. Sixty-eight patients with septic shock admitted to the Department of Critical Care Medicine of Dade Road General Hospital of Guangdong Hospital of TCM from January 2013 to July 2015 were enrolled. Pulse indicating continuous cardiac output (PiCCO) was used to monitor the hemodynamic changes, including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), maximum rate of the increase in pressure (dPmax) and systemic vascular resistance index (SVRI), for assessment of hemodynamics. According to the CI, the patients were divided into two groups , i.e. high CI group (CI ≥ 50.0 mL·s-1·m-2, n = 34) and low CI group (CI < 50.0 mL·s-1·m-2, n = 34), and the clinical and hemodynamic characteristics of two groups were investigated. The TCM differentiation was conducted with four syndromes and four methods, and the hemodynamic characteristics of different syndrome types were investigated, the correlation between the TCM syndrome factors and hemodynamic parameters was analyzed. The patients were divided into survival group and death group, and clinical parameters and hemodynamic characteristics were compared between two groups. Results The acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and blood glucose of low CI group were higher than those of high CI group [APACHEⅡ score: 24.4±7.2 vs. 19.8±7.4, t = -2.279, P = 0.023; blood glucose (mmol/L): 9.7 (7.7, 14.6) vs. 6.7 (5.6, 10.0), Z = -2.257, P = 0.024], CI and GEDVI were lowered [CI (mL·s-1·m-2): 36.7±8.3 vs. 68.4±16.7, t = 10.285, P = 0.000; GEDVI (mL/m2): 689.0 (566.0, 883.8) vs. 838.5 (692.8, 1 247.3), Z = -2.711, P = 0.007], while SVRI was increased [kPa·s·L-1·m-2: 248.7 (202.1, 324.5) vs. 143.4 (102.7, 171.4), Z = -5.336, P = 0.000]. Accompanied symptoms were found to occur more commonly in septic shock patients, and the most common syndrome elements were Qi deficiency syndrome (n = 45), blood stasis syndrome (n = 40), heat-toxin syndrome (n = 37), Fushi syndrome (n = 24) and Yin deficiency syndrome (n = 10), respectively. There was no significant difference in hemodynamic parameters among patients with five types of syndrome (all P > 0.05). However, only the CI of those with Qi deficiency syndrome was significantly lower than that of heat-toxin syndrome (mL·s-1·m-2: 48.3±18.3 vs. 53.3±21.7, P < 0.05). While the results after removing the effect of accompanied symptoms showed that CI of Qi deficiency syndrome was significantly lower than that of non-Qi deficiency syndrome (mL·s-1·m-2: 48.3±18.3 vs. 61.7±21.7, t = -2.783, P = 0.007), CI of heat-toxin syndrome was significantly higher than that of non-heat-toxin syndrome (mL·s-1·m-2: 58.3±21.7 vs. 48.3±16.7, t = 2.133, P = 0.037), EVLWI of blood stasis syndrome was significantly lower than that of non-blood stasis syndrome [mL/kg: 10.0 (7.0, 15.1) vs. 14.9 (8.5, 26.8), Z = -2.075, P = 0.038]. Compared with survival group (n = 38), APACHEⅡ score in death group (n = 30) was increased (25.8±8.4 vs. 19.1±5.4, t = -3.940, P = 0.000), the proportion of continuous renal replacement therapy (CRRT) was increased [60.0% (18/30) vs. 31.6% (12/38), χ2 = 5.493, P = 0.019], HR was increased (bpm: 118.5±20.5 vs. 98.1±19.9, t = -4.157, P = 0.000), and the proportion of Qi deficiency syndrome was increased [86.7% (26/30) vs. 50.0% (19/38), χ2 = 10.070, P = 0.002]. Conclusions Patients with sepsis shock may be divided into high-output and low-resistance & low-output and high-resistance groups according to hemodynamics, with respective hemodynamic characteristics. Hemodynamic performance differed among different syndrome types, and there was a certain relationship. Hemodynamic monitoring with PiCCO was a useful supplement of TCM, which was good for the evidence-based medicine.

ObjectiveTo investigate the effects of Xuebijing injection on hemodynamics, cardiac function, and endothelial function in patients with severe sepsis in order to study the therapeutic effect of Xuebijing in the treatment of severe sepsis.Methods A prospective randomized controlled trial was conducted. Sixty-six severe sepsis patients admitted to the Department of Critical Care Medicine of Guangdong Hospital of Traditional Chinese Medicine from March 2013 to February 2014 were enrolled. The patients were divided into control group (n = 31) and Xuebijing group (n= 35). The patients in both groups were treated according to 2012 international guidelines for management of severe sepsis and septic shock, and the patients in Xuebijing group received Xuebijing injection of 50 mL (added with 100 mL of 0.9% sodium chloride injection) twice a day for 5 days, and those in control group received instead 150 mL of 0.9% sodium chloride injection for 5 days. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and dosage of vasoactive drugs before and 1 day and 5 days after treatment were determined for hemodynamics assessment. Blood lactic acid (Lac), central venous oxygen saturation (ScvO2), and difference in arterial-venous blood carbon dioxide pressure (Pv-aCO2) were determined for microcirculation assessment. The left ventricular ejection fraction (LVEF), cardiac output (CO), left ventricular end diastolic diameter (LVEDD), the ratio of blood flow of mitral orifice between rapid filling period and atrial systole period (E/A), and B-type natriuretic peptide (BNP) were determined for cardiac function assessment. Vascular endothelial growth factor (VEGF) and soluble receptor (sFLT-1) were assessed for endothelial function assessment. The relationship among the indexes of the hemodynamics, microcirculation, cardiac function, and endothelial function was analyzed with Pearson related-analysis.Results After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg =0.133 kPa): 74.9±10.7 vs. 70.2±6.6,P< 0.05], the dosage of NE was decreased [μg·kg-1·min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80),P< 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129,P< 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2),P< 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5,P> 0.05), and sFLT-1 was significantly decreased (ng/L:245.7±86.2 vs. 295.1±95.1,P< 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r= -0.569,P= 0.000;r= -0.341,P= 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (r= 0.749,P= 0.000;r= 0.645,P= 0.000).Conclusions In patients with severe sepsis, there are hemodynamics disorders and effect in microcirculation perfusion. Xuebijing injection can improve hemodynamics and cardiac function in the patients with severe sepsis, and the mechanism may be related to the improvement of endothelial function.

Objective To explore the effect and application of the clinical teaching method of stage-separated to targeted management in the comprehensive ICU. Methods ICU rotation learning plans were developed for 113 probationers and rotating physicians,who were given the training of stage-separated to targeted teaching. The program was divided into three stages based on corresponding teaching objective and comprehensive examination and assessment with combination the dynamic and static evaluation were carried out to three parts. Results The probationers and rotating physicians had significant improvement in the familiarity and mastery of ICU specialist knowledge and skills through the systematic training. Conclusion Such training program can effectively improve the ICU specialized quality and comprehensive ability of the probationers and rotating physicians and bring about better clinical teaching effect.

[ ABSTRACT] AIM:To develop the cell model of polymer/liquid crystal and to study the effect of their elasticity on the adhesion of rat bone marrow mesenchymal stem cells (rBM-MSCs).METHODS: Using the method of solvent e-vaporation induced phase separation, the cell model of polymer/liquid crystal was constructed.The surface morphology and phase separation structure were determined by polarized optical microscopy ( POM) , scanning electron microscopy ( SEM) and small angle X-ray scattering ( SAXS ) .rBM-MSCs were separated and expanded by adherent culture.The surface markers of rBM-MSCs were detected by flow cytometry.The cells were induced to osteogenic differentiation and adipogenic differentiation for 2 weeks.After 3 passages, the cells were divided into 4 groups, including total PU control group, 10%membrane group, 30%membrane group and 50%membrane group.The cells were then incubated with rhodamine phalloi-din for cytoskeleton staining and were observed under the confocal laser scanning microscope after cultured for 24 h.RE-SULTS:The cell model of polymer/liquid crystal was constructed successfully using the method of solvent evaporation in-duced phase separation.Flow cytometry results showed that the rBM-MSCs positively expressed CD29, CD44 and CD90, and negatively expressed CD34 and CD45.After stained with alizarin red S and oil red O, the calcium nodule and lipid droplets in rBM-MSCs were observed obviously.The cytoskeleton staining result indicated that the area in total PU control group, 10%membrane group and 30%membrane group were greater, and the actin microfilaments were also clearer than
that in 50%membrane group.CONCLUSION:The cell model with suitable content of liquid crystal made a contribution to the rBM-MSCs’ adhesion, but too much liquid crystal inhibits cell adhesion.

Objective To investigate the effect of calcitonin gene-related peptide (CGRP) on angiogenesis of human umbilical vein endothelial cells (HUVECs).Methods The HUVECs were collected from human umbilical core,and the expression of the CGRP receptor-1 was identified though immunofluorescence.After HUVECs were treated with CGRP,the angiogenesis was detected through tube formation experiment.The secretion of vascular endothelial growth factor (VEGF) was detected through ELISA method.The mRNA expression of VEGF,VEGF receptor-1 (FLT1),VEGF receptor-2 (KDR) and CGRP receptor-1 were detected through quantitative PCR (Q-PCR) at 3,7,10 days after culturing.Western blot method was used to detect the protein expression of FLT1 and KDR in HUVECs.Results Immunofluorescence result showed CGRP receptor-1 expressed in HUVECs.CGRP could significantly promote angiogenesis and increase VEGF secretion in direct manner.The Q-PCR results showed that the mRNA expression level of CGRP receptor-1 was significantly higher in CGRP groups than that in control group,especially at 10 days.Compared to the control group,the mRNA and protein expression level of FLT1 and KDR were statistically higher in CGRP groups at different time.Conclusion CGRP can significantly promote angiogenesis of HUVECs in vitro,which may be because it can promote VEGF secretion and expression of FLT1 and KDR in HUVECs.Meanwhile,the increase of CGRP receptor-1 expression also can promote angiogenesis of HUVECs.

Objective To observe the effect of Xinmailong injection on microcirculation in patients with septic shock,so as to understand the application effect and value of Xinmailong injection in patients with septic shock.Methods A total of 82 patients with septic shock treated in the intensive care unit of our hospital were selected as the research objects and randomly divided into two groups.41 patients in the control group were treated with conventional septic shock cluster therapy,and 41 patients in the treatment group were treated with Xinmailong injection on the basis of cluster therapy in the control group.Then hemodynamic parameters(HR,CVP,CO,MAP,SVR),hemorheology(whole blood reducing viscosity,hematocrit,fibrinogen,platelet aggregation rate),microcirculation perfusion indexes(oxygenation index,blood lactate level,SCVO2,Pcv-aCO2)and 28-day survival rate were detected and compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in hemodynamic parameters,blood rheology and microcirculation perfusion indexes between the two groups(P>0.05).After treatment,the above test results of the two groups were signifi-cantly improved,and the test results of the treatment group were significantly better than those of the control group,and the 28-day survival rate was also better than that of the control group.The differences were statistically significant(P<0.05).Conclusion Xinmailong injection can significantly improve the hemodynamic parameters,blood rheology and microcirculation perfusion indexes,and improve the 28-day survival rate of patients with sepsis.It has a positive clinical effect in the treatment of septic shock patients.