Objective To observe the lung protective effect of Tongfu Xiefei method (TFXF) in rats with sepsis, and to discuss its possible mechanism.Methods Forty-two Sprague-Dawley (SD) rats were randomly divided into blank control group (n = 6), model group (n = 18) and TFXF group (n = 18). Sepsis model was reproduced by cecal ligation and puncture (CLP) in rats of model group and TFXF group. After the reproduction of sepsis model, rats in TFXF group received Tongfu Xiefei granules 0.01 mL/g by gavge, while those in model group were given equal dose of normal saline by the same way. The rats in blank control group received no treatment. At 3, 6, 12 hours after CLP, abdominal aorta blood was collected for blood gas analysis and inferior vena cava blood was collected for determination of the concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Bronchoalveolar lavage fluid (BALF) was collected for measurement of concentrations of total protein (TP), total phospholipid (TPL), and desaturated phosphatidyl choline (DSPC). The ratio of wet/dry lung weight ratio (W/D) was measured, and malondialdehyde (MDA) and myeloperoxidase (MPO) in lung tissues were determined. The pathologic changes in their lungs were observed with light microscopy.Results Compared with those in blank control group, the levels of pH value, arterial oxygen partial pressure (PaO2), HCO3-, base excess (BE) were lowered, and partial pressure of carbon dioxide of arterial blood (PaCO2) was increased in model group. The serum concentrations of TNF-α and IL-6 were gradually increased after the reproduction of sepsis model. Compared with those in blank control group, the levels of TP, TPL, and DSPC/TPL in model group were decreased, while the levels of W/D, MDA and MPO were increased. Compared with those in model group, pH value was elevated in TFXF group at 3 hours (7.27±0.04 vs. 7.18±0.07,P < 0.05). PaO2 (mmHg, 1 mmHg = 0.133 kPa) was improved at 3, 6, 12 hours (3 hours: 128.00±16.05 vs. 106.78±10.73, 6 hours: 98.46±15.97 vs. 72.80±16.33, 12 hours: 90.70±9.31 vs. 74.28±12.19, allP < 0.05). The serum concentrations of TNF-α (ng/L) in TFXF group were significantly lower than those in model group at 12 hours (508.20±94.08 vs. 756.60±138.77,P < 0.05), and the serum concentrations of IL-6 (ng/L) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 687.80±35.00 vs. 849.40±148.28, 12 hours: 728.80±214.41 vs. 917.00±245.96, bothP < 0.05). Compared with those of model group, the levels of TP (g/L) in BALF in TFXF group were significantly decreased at 12 hours (1.01±0.23 vs. 1.60±0.47,P < 0.05), and the levels of TPL (mg/L) in TFXF group were significantly increased at 12 hours (86.40±11.33 vs. 62.40±16.33,P < 0.05). The levels of DSPC/TPL in TFXF group were significantly higher than those in model group at 6 hours and 12 hours (6 hours: 0.58±0.13 vs. 0.38±0.10, 12 hours: 0.45±0.13 vs. 0.24±0.07, bothP < 0.05). The levels of W/D in TFXF group were significantly higher than those in model group at 3 hours (3.84±0.25 vs. 2.99±0.50,P < 0.01), but lower than those in model group at 12 hours (3.21±0.53 vs. 4.89±1.14,P < 0.05). The levels of MDA (nmol/mg) in TFXF group were significantly lower than those in model group at 6 hours and 12 hours (6 hours: 4.04±2.58 vs. 8.89±2.61, 12 hours: 11.31±3.60 vs. 20.60±8.10, bothP < 0.05), while the levels of MPO (U/g) in TFXF group were lower than those in model group at 12 hours (4.79±0.66 vs. 7.22±1.76,P < 0.05). Compared with model group, the lungs in TFXF group showed less morphological changes under light microscopy, such as pulmonary edema, congestion, effusion and fibrosis.Conclusions The method of Tongfu Xiefei may improve hypoxemia and metabolic acidosis, alleviate lung edema and ameliorate pulmonary pathological changes in rat sepsis model. Tongfu Xiefei method shows a protective effect in sepsis by the way of reducing peroxidative damage, inhibiting the release of proinflammatory factors and abating degradation of lung surfactant.

Objective:To investigate the roles of donor alveolar maerophages and the recipient circulating neutrophils in early-stage reperfusion injury of lung allograft,and to study the interaction between the 2 kinds of cells.Methods:Twenty pairs of size-and weight-matched adult mongrel dogs were randomly assigned to 4 groups:C(control),D(leukocyte-depleted blood reperfusion),M(maerophage inhibition)and DM(leukocyte-depleted plus macropbage inhibition).The 20 cases of left lung transplantations were performed by the same surgeon.All procedures were identical,except that the donors in Group M and DM received the macrophage inhibitor gadolinium chloride(14 mg/kg)intravenously 24 h before operation,and that the recipients in Group D and DM underwent initial 10 min reperfusion with leukocyte-depleted blood collected from donors'inferior vena cava. All lung allografts were reperfused for 2 h.Results:Compared with Group D and C,macrophage inhibition ameliorated PO_2/FiO_2 and mean pulmonary arterial pressure(mPAP)consistently after 30 min reperfusion in Group M and DM;the parameters of lung reperfusion injury(malonaldehyde activity,wet/dry ratio)at 120 min after reperfusion were also significantly improved(P

Objective: To investigate the effect of rhubarb on gastrointestinal blood perfusion in critical illness and hemorrhagic shocked rats.Methods: Clinical Study: Sixty-four septic patients, who suffered from stress ulcer, were treated with rhubarb at a dose of 25 mg/kg. Twenty-five non-septic patients were taken as control. The gastrointestinal perfusion was evaluated by intramural pH (pHi). Animal study: SD rats were anesthetized with intraperitoneal sodium pentobarbital at a dose of 20 mg/kg. Blood-letting were performed in the animals. Blood pressure reduced to 5.32 kPa and maintained for 120 mins. They were resuscitated at the end of shock by reinfusing all of the shed blood. The rats were randomly divided into four groups: Normal control, shock group, therapeutic group (shocked rats were treated with 50 mg/kg rhubarb at the end of shock) and rhubarb group (normal rats were treated with rhubarb). Laser Doppler was applied to estimate the gastrointestinal blood perfusion. Results: Clinical Study: The gastrointestinal pHi in septic patients was much lower than that in the control, whereas rhubarb could obviously elevate gastrointestinal pHi (P<0.001). In addition, rhubarb also had good effect on gastric hemorrhage caused by stress ulcer. Animal Study: Although the shocked rats were resuscitated completely, their gastrointestinal blood perfusion was much lower than that in the control. Rhubarb could significantly improve the blood perfusion in gastrointestinal mucosa and mesentery (P<0.01). Furthermore, rhubarb also increase the gastrointestinal perfusion in normal rats. Conclusion: Rhubarb could improve gastrointestinal blood perfusion in critical illness and shocked rats.

Objective To confirm the effects of statin therapy on mortality of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods PubMed/Medline, Embase, Web of Science andCochrane Central Register of Controlled Trials were searched for articles using the terms acute lung injury, ALI,acute respiratory distress syndrome, ARDS, statin, simvastatin and rosuvastatin updated to November 17,2015. Randomized controlled trial (RCT) or observational cohort studies investigating the effects of statin therapy onmortality in patients with ALI or ARDS were all identified, without date or language restriction. The control group wasgiven conventional treatment, while the experimental group was treated with statins additionally. The primary outcomewas in-hospital mortality. Meanwhile, ventilator-free day, intensive care unit (ICU)-free day, ICU length of stay (LOS)and ICU mortality were also analyzed. RevMan 5.2 and STATA 13 software were used for systematic review and Metaanalysis, and funnel plot was used to analyze the publication bias. Results A total of five trials including threerandomized controlled trials and two observational studies were included. Among 1636 patients enrolled in the study,there were 739 patients in experimental group, and 897 in control group. It was shown by Meta analysis that there was nosignificant difference in in-hospital mortality between experimental group and control group [relative risk (RR) = 0.96,95% confidence interval (95%CI) = 0.79-1.15, P = 0.63]. The subgroup analysis based on RCT and cohort study, or thesubgroup analysis of different statins showed that there was no significant difference in in-hospital mortality betweenthe experimental group and the control group (both P > 0.05). There were no significant differences in ventilator-freedays [mean difference (MD) = 1.41, 95%CI = -0.32-3.13, P = 0.11], ICU-free days (MD = -0.23, 95%CI = -1.61-1.15,P = 0.75), ICU length of stay (MD = -1.03, 95%CI = -6.55-4.50, P = 0.72), or ICU mortality (RR = 0.88, 95%CI =0.68-1.14, P = 0.33) between the experimental group and the control group. It was shown by funnel plot that there was nopublication bias in in-hospital mortality. Conclusion The systematic review and meta-analysis suggests that statin may not be associated with a significant reduction in mortality, ventilator-free day, ICU-free day and ICU length of stayin patients with ALI/ARDS.

This study was aimed to observe effect of pomegranate leaf tannin and ellagic acid on primary rat adipocyte differentiation and lipid metabolism-related factor expression. Primary rat preadipocyte was in vitro cultured to observe the effect of pomegranate leaf tannin and ellagic acid on lipid fat cells as well as mRNA expression of its related factor. The results showed that pomegranate leaf tannin and ellagic acid had obvious inhibition effect on fat formation in fat cells. It had certain inhibition effect on activities of lipoprotein lipase (LPL) and glucose-3-phosphate dehydrogenase (GPDH). It promoted fat decomposition and reduced intracellular lipid content. It upregulated PPARγ and fatty acid-binding protein (aP2). It downregulated obese (ob) gene level. It was concluded that pomegranate leaf tannin can inhibit fat generation of fat cells and promote fat metabolism. Ellagic acid was its main active ingredient, which had the same effect as pomegranate leaf tannin.

Objective To explore the impacts of natural ovulation cycles and stimulation cycles on the outcome of intrauterine insemination (IUI) in order to improve the clinical effects of IUI. Methods 176 women received 384 stimulation cycles. According to different ovulation stimulation protocols , the women were divided into six groups including natural cycle (NC) group, clomiphene citrate (CC) group, letrozole (LE) group;human menopausal gonadotrophin (HMG ) group, CC + HMG group, and LE + HMG group. The pregnancy rate between nature cycles and ovarian hyperstimulation cycles was compared. Results The pregnancy rate was 9.33%in the nature cycle group and 13.27% in the stimulation cycle group, with a significant difference (P < 0.05);and it dif not differ significantly among the stimulation cycle groups (P > 0.05). Conclusions Use of ovulation-induction medications is one of the important factors affecting the pregnancy rate of intrauterine insemination. There are no differences in the outcome of IUI among different ovulation stimulation protocols.

ObjectiveTo compare the effects of different surgical approaches on SiewertⅡ (esophageal invasion ≤3 cm) adenocarcinoma of esophagogastric junction.MethodsThis retrospective study included 251 cases of Siewert Ⅱ adenocarcinoma of esophagogastric junction undergoing D2 or D2 + total gastrectomy by transabdominal approach ( TA group, 128 cases) or left thoracoabdominal approach ( LTA group, 123 cases).Operation time,blood loss, extent of esophageal resection, number of lymph nodes dissected,morbidity, mortality and the survival rate were a analyzed between the two groups.ResultsThe 3,5-year overall survival rates were 62. 5％, 39.0％ ( TA group) and 54. 9％, 31.9％ ( LTA group),respectively (P ＞ 0. 05). Length of esophageal resection in the LTA group were slightly longer than that in the TA group (5. 6 ± 1.1) cm vs. (5.4 ± 1.1 ) cm (P ＜0. 05), the positive surgical margin between two groups were not statistically different[1.6％ ( LTA group) vs. 3. 1％ ( TA group), ( P ＞ 0. 05 )]. The mean number of removed lymph node were not significantly different between two groups[23.4 ± 8.7 ( TA group) vs. 23.7 ± 8.4 ( LTA group)], ( P ＞ 0. 05 ). The operation time (227 ± 24) min, blood loss (270 ± 78)ml, and perioperative morbidity( 13.3％ ) and mortality( 1.6％ ) in TA group was significantly better than the LTA group[(261 ±32) min, (342 ±59)ml, 26.8％, 6.5％](P＜0.05).ConclusionsFor Siewert Ⅱ adenocarcinoma at esophagogastric junction (esophageal invasion ≤3 cm) ,total gastrectomy with D2 or D2 + lymph node dissection through the transabdominal approach could achieve curative purposes, with a low morbidity and mortality rate.

Objective To observe the effect of Xijiaodihuang decoction on the release of inflammatory mediators and prognosis in elderly patients with sepsis.Methods A prospective randomized controlled study was conducted. Seventy-four patients with sepsis admitted to the Department of Geriatrics of Changshu Hospital of Traditional Chinese Medicine (TCM) Affiliated to Nanjing University of TCM from March 2015 to February 2017, and they were divided into a TCM treatment group and a control group randomly, 37 cases in each group, there were 2 patients transferred to other department during the period of study to continue treatment, 2 patients discharged automatically and 1 case transferred to other hospital in the TCM treatment group; and there were 3 patients transferred to other hospital, 1 patient discharged automatically, 1 patient dead in 7 days after entering the control group and 1 patient transferred to other department during the period of observation to continue treatment in the control group. Finally, 32 patients were in TCM treatment group and 31 patients in the control group, completing the study. All patients in the two groups received conventional treatment of sepsis, patients in the TCM treatment group took Xijiaodihuang decoction 100 mL concentrated [rhinoceros horn (replaced with buffalo horn) 30 g, rehmannia root 24 g, peony 12 g, tree peony bark 9 g] taken orally or by nasal feeding, and patients in the control group received the same amount of normal saline, the two groups were treated 1 time a day for consecutive 7 days to complete 1 therapeutic course, then the treatment efficacy was evaluated in the two groups. The differences of serum interleukins (IL-1β, IL-6), tumor necrosis factor-α (TNF-α), white blood cells (WBC), C-reaction protein (CRP), lactate levels between the two groups were compared before treatment and on the 3rd, 7th and 14th day after treatment, the incidence of staying in intensive care unit (ICU), time of staying in ICU and 28-day mortality were also observed. The 28-day survival rate between two groups was analyzed by Kaplan-Meier survival curve.Results After treatment in the two groups, the levels of IL-1β, IL-6 and TNF-α had a tendency of increase at first and then decrease. After treatment for 14 days, the IL-1β was significantly lower in the TCM treatment group than that of the control group (ng/L: 83.27±21.84 vs. 96.73±26.33), the levels of IL-6 and TNF-α in TCM treatment group were obviously lower than those in the control group since 7 days after treatment [IL-6 (ng/L): 48.27±24.13 vs. 62.15±24.34, TNF-α (μg/L): 1.41±0.31 vs. 1.96±0.29]. IL-6 and TNF-α were still lower than those in the control group until 14 days after treatment [IL-6 (ng/L): 29.25±18.57 vs. 56.24±23.61, TNF-α (μg/L) 1.35±0.28 vs. 1.83±0.22, allP < 0.05]. There was no significant difference in WBC and CRP between the two groups before and after treatment (bothP > 0.05). After treatment, the lactate in the control group was gradually decreased, while in the TCM treatment group, the lactate level after treatment presented a tendency firstly decreased and then elevated, and after treatment for 3 days in TCM treatment group, the level of lactate began markedly lower than that in the control group (mmol/L: 1.26±0.43 vs. 2.01±0.59,P < 0.05). The ICU hospitalization rate and ICU length of stay in the TCM treatment group were significantly lower than those in the control group [56.25% (18/32) vs. 83.87% (26/31), (10.2±5.4) days vs. (13.5±5.8) days], and the 28-day mortality was also obviously lower in TCM treatment group than that in control group [9.37% (3/32) vs. 29.03% (9/31)]. Kaplan-Meier survival curve analysis showed that the 28-day survival rate in TCM treatment group was significantly higher than that in control group (P = 0.045).Conclusion Xijiaodihuang decoction can reduce the levels of IL-1β, IL-6, TNF-α and lactate in serum, reduce the incidence of staying in ICU, decrease the time of staying in ICU and improve the prognosis of elderly patients with sepsis.

0.1),and there were significant differences in the other groups[F(H)=33.57,F(I)=133.6,F(HI)=69.75 Pa

OBJECTIVE:To investigate the therapeutic efficacy of edaravone combined with citicoline sodium on acute cere-bral infarction and its effects on the levels of oxidative stress and inflammatory factors. METHODS:108 patients with acute cere-bral infarction were randomly divided into edaravone group(single group)and edaravone+citicoline sodium group(drug combina-tion group),with 54 cases in each group. Based on routine treatment,single group was given Edaravone injection 30 mg added in-to 100 ml 0.9% Sodium chloride injection intravenously,bid,used up within 30 min each time;drug combination group was addi-tionally given Citicoline sodium injection 0.5 g added into 250 ml 0.9% Sodium chloride injection intravenously,qd,on the basis of single group. Treatment course of 2 groups lasted for 2 weeks. NIHSS,HDS,Barthel index,oxidant stress indicator and inflam-matory factors were compared between 2 groups before and after treatment. RESULTS:After treatment,the effective rate of NI-HSS in drug combination group was 81.48%,which was significantly higher than single group(53.70%),with statistical signifi-cance (χ2=9.511,P=0.002). HDS score and Barthel index of 2 groups were significantly increased after treatment,especially in drug combination group,with statistical significance(P<0.05). Compared with before treatment,contents of MDA and ET-1 in 2 groups were decreased significantly,while SOD activity and NO content were increased significantly;the inflammatory cytokines IL-6,IL-8,IL-12 and IL-16,TNF-α were all decreased gradually,with statistical significance (P<0.05);the improvement of each indicator in drug combination group was more significant than single group,with statistical significance(P<0.05). CONCLU-SIONS:Edaravone combined with citicoline sodium show good therapeutic efficacy in the treatment of acute cerebral infarction, can decrease the levels of oxidative stress and inflammation and promote the recovery of the neurological function and the daily liv-ing ability.