OBJECTIVETo compare the therapeutic effect of Astragalus and Angelica Mixture (AAM) on treating CKD patients according to different CKD primary diseases, staging and TCM syndromes.

METHODSA multicentre, open-label, and self control clinical design was used, and thirty-two patients in line with inclusive criteria were recruited. Based on maintaining their previous basic CKD treatment, patients additionally took AAM (Astragalus and Angelica each 30 g), once a day, three months consisted of one therapeutic course. Serum creatinine (SCr), estimated glomerular filtration rate (eG- FR), 24 h urinary total protein (UTP), plasma albumin (ALB), hemoglobin (Hb), and changes of TCM syndrome factor integrals were compared before treatment, at the end of month 1, 2, and 3. The differences in the aforesaid indices were compared between CKD patients with different CKD primary diseases (chronic glomerulonephritis, chronic renal tubulointerstitial disease, hypertensive renal damage), different CKD stages (CKD 3 and CKD 4), and patients of qi-blood deficiency syndrome (QBDS) and non-QBDS.

RESULTSAAM could improve 78.12% (25/32) patients' renal function. Compared with before treatment, SCr decreased (12.08% +/- 10.11%), eGFR increased (21.14% +/- 18.55%), and ALB increased (2.76% +/- 1.97%) at the end of 3-month treatment (all P < 0.05). As for TCM syndrome factor integrals, compared with before treatment, the integrals for qi deficiency syndrome, blood deficiency syndrome, and yin deficiency syndrome decreased, while the integrals for dampness heat syndrome and turbid-toxin syndrome increased (all P < 0.05). There was no obvious difference in all indices except the integral for hypertensive renal damage patients of yin deficiency syndrome (P > 0.05). The SCr decreasing percent was 19.82% +/- 8.30% for patients of non-QBDS and 5.24% +/- 10.75% for patients of QBDS. The latter was higher with statistical difference (P < 0.05). As for TCM syndrome factor integrals, the integral differences of qi deficiency and blood deficiency were obviously higher in patients of QBDS, when compared with patients of non-QBDS (P < 0.05).

CONCLUSIONAAM could improve the renal function of CKD patients, elevate their ALB levels, and ameliorate associated qi deficiency syndrome, blood deficiency syndrome, and yin deficiency syndrome, especially for CKD patients of QBDS.

Adolescent ; Adult ; Aged ; Angelica ; Astragalus Plant ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Renal Insufficiency, Chronic ; drug therapy ; Treatment Outcome ; Yin Deficiency ; drug therapy ; Young Adult

BACKGROUNDDisequilibrium of Th1/Th2 is known as an important cause of allergic asthma with a biased Th2 type response. It has been shown that lipopolysaccharide (LPS) administration during post-sensitization modified the inflammation of asthma via upregulating the Th1 response that decrease the Th2 immunity. We would like to know if, during pre-sensitization, the elevated Th1 response is necessary for LPS exposure to modify the asthmatic response.

METHODSDuring pre- or post-sensitization, 40 microg LPS were intraperitoneal injected (i.p.) to asthmatic mice sensitized and challenged by Dermatophagoides farinae (D. farinea). Inflammation was assessed by examining bronchoalveolar lavage fluid (BALF) for the number and identity of cells and by cytokine titers measured by ELISA. Semi-quantified RT-PCR was used to evaluate the level of Toll-like receptor 4 (TLR4) mRNA in dendritic cells (DCs) from bone marrow (BMDCs).

RESULTSThese investigations demonstrated that LPS exposure during pre-sensitization inhibited the Th2 cytokine and inflammatory infiltration, the same as with LPS exposure during post-sensitization in allergic asthma mice. Contrary to post-sensitization LPS exposure, the Th1 cytokines were not upregulated by pre-sensitization with LPS. Finally, the study failed to show any significant difference between TLR4 mRNA expressed in BMDCs with the two times of LPS exposure.

CONCLUSIONSOur data suggest that elevated Th1 immunity is not required for the modification of the Th2 response induced by LPS exposure during pre-sensitization in asthmatic mice and that pre-sensitization differs from post-sensitization. Immune modulation with treatment is independent of TLR4 expression in BMDCs. This study implicates a potential way to protect from allergic disease and an inflammatory response.

Animals ; Asthma ; chemically induced ; immunology ; Bronchoalveolar Lavage Fluid ; immunology ; Cytokines ; immunology ; metabolism ; Dendritic Cells ; immunology ; Dermatophagoides farinae ; immunology ; Female ; Lipopolysaccharides ; immunology ; Mice ; Mice, Inbred BALB C ; Reverse Transcriptase Polymerase Chain Reaction ; Th1 Cells ; immunology ; Th2 Cells ; immunology ; Toll-Like Receptor 4 ; genetics

OBJECTIVETo investigate the effect of intralipid on protein consumption in severe burned patients. METHODS; Sixty-seven nonoperative patients with severe burns were divided into Intralipid treatment group and non-intralipid treatment group (control group), and the former was treated with 20% intralipid (500 ml once a day) from postburn day 4 for 10 consecutive days. Venous blood samples were collected from these patients for testing total protein, albumin, total cholesterol and triglyceride on postburn days 1, 7 and 14, respectively.

RESULTSThe levels of total protein, albumin, total cholesterol and triglyceride were within normal range on postburn day 1 in both groups, and only the albumin level was lowered in the groups on day 7 but at comparable magnitudes (32+/-4.83 vs 31+/-5.04 g/L, P<0.05). In contrast, the levels of total protein, albumin, total cholesterol and triglyceride were below the normal range on postburn day 14 in both groups, but intralipid treatment group showed more albumin loss than the control group (28+/-6.46 vs 23+/-7.03 g/L, P<0.01).

CONCLUSIONIntralipid (20%) provides good energy source to ameliorate albumin loss in severe burned patients.

Adolescent ; Adult ; Burns ; metabolism ; therapy ; Fat Emulsions, Intravenous ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Serum Albumin ; metabolism

OBJECTIVETo determine the adequate timing of antibiotics application in severely burned patients by observing the dynamic changes of amikacin in blister fluid during early postburn stage.

METHODSTwenty patients in early stage of sever burns were divided into 4 groups (n=5) according to the timing of amikacin administration, namely at 3-4 h (group A), 10 h (group B, 20 h (group C), and 30 h (group D) postburn. Amikacin was administered intravenously via a single dose of 400 mg within 30 min, and at the time points of 0.25 to 7 h after completion of the infusion, the blister fluid was collected from each patient for determination of amikacin concentration with fluorescence polarization immunoassay.

RESULTSFifteen minutes after intravenous administration, amikacin could be detected in the blister fluid, reaching the highest level at 1-2 h after administration followed by gradual declination. In group B, blister fluid amikacin concentration reached 4.96+1.60 microg/ml 15 min after administration, and at the subsequent time points until 4 h, amikacin concentration was significantly higher in groups A and B than in groups C and D (P<0.05). Amikacin concentration in the blister fluid in group D was not sufficient for effective antibacterial therapy.

CONCLUSIONAmikacin administration in the early postburn stage may ensure higher amikacin concentration in the blister fluid and wound exudate. Better antibacterial effect can be expected when amikacin is applied within the initial 10 h postburn.

Adult ; Amikacin ; administration & dosage ; analysis ; Anti-Bacterial Agents ; administration & dosage ; analysis ; Blister ; drug therapy ; pathology ; Burns ; drug therapy ; pathology ; Exudates and Transudates ; chemistry ; Female ; Humans ; Infusions, Intravenous ; Male ; Young Adult

OBJECTIVETo investigate the changes of pharmacokinetic parameters of amikacin in the subeschar tissue fluid (STF) in the early stage of severe burns.

METHODSAmikacin concentration in the STF of 10 severely burned patients were determined by fluorescence polarization immunoassay (FPIA) at different time points after intravenous amikacin infusion of the initial dose of 400 mg given within 60 min. The pharmacokinetic parameters of amikacin were measured using 3P97 program and statistically analyzed with SPSS10.0 software.

RESULTS AND CONCLUSIONAfter the initial dose of 400 mg of amikacin, the STF concentration-time curves of amikacin were fitted in two compartment model. The pharmacokinetic parameters of amikacin in the STF were: t(1/2alpha)=(4.35-/+1.66) h, t(1/2beta)= (80.04-/+9.52) h, Vc= (13.17-/+1.32) L, AUC= (1802.49-/+285.68) microg. h.ml(-1), and CLs= (0.2272-/+0.0383) L. h(-1), demonstrating significantly lower clearance and longer elimination half life of amikacin in the STF following amikacin administration in early stage of severe burns. Elimination half-life of amikacin in the STF in severely burned patients was 28.20-44.78 times longer than that in the serum of normal volunteers, and the effective inhibitory concentration of amikacin could maintain for at least 24 h, suggesting antibiotic retention in the third space after early and short-term use of potent antibiotics and formation of antibiotic barrier in the STF, which may help prevent bacterial infection of the wound.

Adult ; Amikacin ; administration & dosage ; pharmacokinetics ; therapeutic use ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; therapeutic use ; Burns ; drug therapy ; metabolism ; Extracellular Space ; metabolism ; Exudates and Transudates ; metabolism ; Female ; Humans ; Infusions, Intravenous ; Male ; Skin ; drug effects ; metabolism ; pathology

OBJECTIVETo investigate the concentration and pharmacokinetics changes of amikacin in the serum and blister fluid in severe burn patients at early stage.

METHODSTwenty severe burn patients during early postburn stage were divided into four groups with five patients in each group. Each patient was given a single dose of 400 mg amikacin in 30 minutes during 3-4 postburn hour (PBH) in A group, at 10 PBH in B group, at 20 PBH in C group, and at 30 PBH in D group. The concentration of amikacin in blister fluid was examined at 0.25, 0.5 min and 1, 2, 3, 4, 5, 6, 7 h after treatment by fluorescence polarization immunoassay, meanwhile, the venous blood of 9 patients among them was also collected to determine the concentration of amikacin at the same time points. Pharmacokinetics parameters of model were produced by program 3P97.

RESULTSAmong all groups, the concentration of amikacin in blister fluid in A group increased quickest and maintained longest, that of B group ranked second. The amikacin concentration of blister fluid in A, B groups were obviously higher than those in C, D groups at each time point (P <0.05 orP < 0.01), especially at 1PBH (12.53 +/- 1.76, 9.52 +/- 1.51 microg/mL vs 4.65 +/- 0.77, 3.10 +/- 0.41 microg/ml, P < 0.01). The serum concentration of amikacin in 9 patients were decreasing along with elapse of time. The amikacin concentration-time curves in blister fluid and serum were best fit in two compartment models. Compared with that in normal value, t1/2beta of amikacin from burn patient was shortened in serum and prolonged in blister fluid.

CONCLUSIONEarly administration of amikacin in burn patients (within 10 PBH) may form an effective and continuous antibiotics barrier around the wound to prevent bacterial infection.

Adult ; Amikacin ; pharmacokinetics ; therapeutic use ; Burns ; blood ; drug therapy ; Female ; Humans ; Male ; Serum ; chemistry

OBJECTIVETo investigate the changes in pharmacokinetic parameters of vancomycin in the subeschar tissue fluid (STF) at early post-burn stage in patients with severe burns.

METHODSTen patients with severe burns were enrolled in the study and received intravenous injection of 500 mg vancomycin at an even rate within 60 mins 1 to 2 hours after admission. A total of 0.5 ml STF was collected each time and the concentration of vancomycin in the STF was determined by fluorescence polarization immunoassay (FPIA) method at 1, 2, 4, 8, 24, 48, 96, 144, 192, 240 post-burn hours (PBH). Pharmacokinetic parameters of vancomycin were produced by program 3P97 and statistically analyzed by program package SPSS10. 0.

RESULTSThe STF concentration-time curves of vancomycin were best fit in two compartment model. Pharmacokinetic parameters of vancomycin in the STF were: t1/2alpha = (3.7 +/- 2.6) h, t1/2beta = (92 +/- 12)h, Vc = (26 +/- 6)L, AUC = (1279 +/- 256) microg x h x ml(-1), CLs = (0.40 +/- 0.08) L/h.

CONCLUSIONWhen vancomycin is used early after severe burns, the drug can be retained in the third space, and the concentration of the drug can be maintained for over 24hrs, and it is beneficial to form an antibiotic barrier around the wound to prevent an invasive bacterial infection to the burn wound.

Adult ; Burns ; drug therapy ; metabolism ; Exudates and Transudates ; chemistry ; metabolism ; Female ; Humans ; Male ; Vancomycin ; pharmacokinetics ; therapeutic use

BACKGROUNDBranch retinal vein occlusion (BRVO) is a common retinal vascular disorder of the elderly and both intravitreal triamcinolone acetonide (TA) and intravitreal bevacizumab were reported to be effective. The purpose of this study was to compare intravitreal bevacizumab with intravitreal TA for the treatment of macular edema resulting from BRVO.

METHODSThe retrospectively comparative interventional study included a bevacizumab group of 34 BRVO patients (1.25 mg bevacizumab) and a TA group of 34 BRVO patients (4.0 mg TA), and the two groups were matched by baseline best corrected visual acuity (BCVA). Examinations were designed to be carried out at 1 day, 3 days, 1 month, 2 months, 3 months, 6 months and 1 year after each injection. The mean follow-up was (148.43 +/- 130.56) days. Main outcome parameters were BCVA and morphometric measurements of the macula obtained by optical coherence tomography.

RESULTSIn all follow-ups, the mean changes of BCVA (LogMAR) between two groups were not significantly different (P > 0.10). Similarly, the rates of patients who got BCVA improvement > or = 2 lines or lost BCVA > or = 2 lines were not significantly different, either (P > 0.10). In both groups, compared with baseline, the mean central macular thickness (CMT) got reduction from 4 weeks to 1 year after initial injection, however, which lost statistical significance at 6-month follow-up in TA group (P = 0.25) and lost significance at 3-month and 6-month follow-up in bevacizumab group (P = 0.07, 0.21). The mean CMT between two groups differed at 3-month follow-up (P < 0.01), while almost kept parallel in other follow-ups (all P > 0.40). In TA group, retinal pigment epithelium tear occurred in 1 eye at 8 weeks after initial injection and 12 eyes (35.3%) got intraocular pressure > 21 mmHg. In bevacizumab group, no severe complications were observed.

CONCLUSIONFor BRVO, intravitreal bevacizumab versus intravitreal TA causes a similar increase in visual acuity and reduction of macular edema (except 3-month follow-up) with minor complications during 1 year.

Adult ; Aged ; Antibodies, Monoclonal ; administration & dosage ; adverse effects ; Antibodies, Monoclonal, Humanized ; Bevacizumab ; Female ; Follow-Up Studies ; Humans ; Macular Edema ; drug therapy ; pathology ; Male ; Middle Aged ; Retinal Vein Occlusion ; complications ; Retrospective Studies ; Triamcinolone Acetonide ; administration & dosage ; adverse effects ; Visual Acuity ; Vitreous Body

Objective To investigate clinical manifestation of unspecified functional bowel disorder (UFBD), the features of coexistence with functional gastrointestinal disorder (FGID) and its relationship with psychological factors and sleep disturbance in the Chinese Army servicemen.Methodsc FGIDs were diagnosed based on the RomeⅢ Modular Questionnaire. The subjects were 189 servicemen with UFBD (UFBD group) and 372 without FGID (control group). All subjects completed symptom checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results'Have to rush to the toilet when having a desire to defecate' was the most frequent symptom of UFBD (93.7%). More than one half of UFBD patients had the symptom 'a feeling of incomplete emptying as bowel movements' or 'straining during bowel movements'. Twenty-eight percent of UFBD subjects had combined FGID (namely cFGID). Among them, the most frequent was proctalgia fugax (7.9%), followed by cyclic vomiting syndrome (6.3%), functional fecal incontinence (6.3%), functional dyspepsia (4.8%) and belching (4.8%). The UFBD group scored significantly higher than the control group in the global severity index (GSI) and in all SCL-90 subscales (P<0.05). The scores of the four domains (sleep quality, sleep latency , sleep disturbance and daytime function disorder), total PSQI score and proportion of poor sleeping quality were significantly higher in the UFBD group than in the control group (P<0.05). The subjects scored significantly higher in combined FGID group than in UFBD group in GSI and in all of SCL-90 subscales, except for phobic anxiety subscales (P<0.05). However, there was no significant difference in each domain, total PSQI and proportion of poor sleeping quality between the cFGID group and UFBD group (P>0.05).ConclusionPathogenesis of UFBD may be closely correlated with psychiatric and psychological factors and sleep disturbance. cFGID are associated with an increased severity of psychopathological features.

Aim Kadsuraheteroclita ( Roxb ) Craib ( Schizandraceae) is a medicinal plant termed Xuetong in Chinese Tujia ethnomedicine. Xuetong possesses therapeutic effects of, in the terms of Chinese medical theories, reinforcing vital energy, promoting blood cir-culation, expelling wind-evil, and removing damp-e-vil, and has been long used for the prevention and treatment of rheumatic and arthritic diseases, especial-ly in the southern China. The HPLC analysis has iden-tified that the ethanol extract of Xuetong contains large-ly biologically active lignans and triterpenoids. Our previous studies have shown that KHS exhibits very fa-vorable safety profile and potent anti-inflammatory and analgesic activities. In the present study, we investiga-ted anti-arthritic effects and the possible mechanisms of Xuetongon adjuvant-induced arthritis ( AIA ) in rats. Methods AIA was established in male Sprague-Daw-ley ( SD ) rats as described previously, and animals were daily treated by gavage with Xuetong ethanol ex-tract ( 1. 0 g · kg-1 ) or vehicle ( 0. 3% CMC-Na ) throughout the 30-day experiment. The incidence and severity of arthritis were evaluated using clinical pa-rameters. On day 30, bone destruction of the arthritic joints was assessed by computed tomography( CT) and histopathological analyses. The serum levels of pro-in-flammatory cytokines TNF-α, IL-1β, and IL-6 were measured by ELISA. Results Treatment with 1. 0 g/kg Xuetong significantly inhibited the onset and pro-gression of AIA. The vehicle-treated rats all developed severe arthritis, while the incidence of AIA in the Xue-tong-treated rats was as low as 55%( P=0. 035 ) . The Xuetong -treated rats exhibited 1. 8 to 2. 3 fold reduc-tion of paw swelling, and gained 10 to 20% more body weight than the vehicle-treated AIA rats throughout the experiment. CT and histopathological examinations re-vealed that Xuetong markedly protected AIA rats from cartilage and bone destruction of joints. Moreover, the serum levels of TNF-α, IL-1β, and IL-6 were signifi-cantly decreased in the Xuetong-treated rats than the vehicle-treated AIA rats. Conclusions These data strongly support the clinical use of Xuetong for rheu-matic and arthritic diseases, and suggest that Xuetong is a valuable candidate for further investigation to be a new anti-arthritic drug with favorable safety profile.