Objective To evaluate the physiological variables,which precisely and reliably reflected the effect of emergency fluid therapy for severely traumatized patients, in order to set up the ultimate criteria of optimal goal in fluid resuscitation. Method A total of 149 patients with severe trauma were given fluid resuscitation and were stratified into 3 groups with different severities of trauma as per ISS (injury severity score) and APACHE Ⅱ . Of all patients, heart rate (HR), systolic blood pressure (SBP), oxygen saturation of arterial blood (SaO2), blood gas analysis, arterial blood lactate (ABL), oxygen saturation of central venous blood (SCVO2) or oxygen saturation of mixed venous blood (SVC2), urine output, base excess (BE) and oxygenation index (OI = PaO2/FiO2) were measured and calculated. These variables were compared between groups to find out the significant differences and the relationship to response time to fluid therapy as well as complications and outcomes. Results Within 24 hours of fluid resuscitation, 127 patients reached the therapeutic goal in respect of systemic hemodynamics improved including the variables of SBP, HR and urine output, and the optimal goal of fluid therapy in 112 patients was estimated with cellular oxygen available found in the levels of ABL, BE and OI measured. These two sets of criteria (clinical signs vs laboratory findings) for determining the therapeutic goal showed significant difference in length of time taken for reaching the goal of treatment ( P < 0.05). There were significant differences in APACHE Ⅱ scores between those reaching the therapeutic goal within 24 hours and those taking longer time over 24 hours reaching the therapeutic goal or the death (P < 0.01). The duration of persistence in abnormal systemic hemody-namics and laboratory findings was longer in patients with complications or injured to death than that in survivors (P <0.05 -0.01). Conclusions In addition to the stability of vital signs, tissue perfusion and cellular oxy-genation should be taken as ultimate criteria of successful fluid resuscitation for severely traumatized patients judged by means of measuring the ABL, BE and OI variables.

Objective To observe the changes in cytokines, oxygen free radicals, acidulous production in serum and to investigate the effectiveness of monitoring metabolism of cells and the method for evaluating cell injury in patients with severe trauma. Method The detailed data of 117 patients rescued and managed carefully from May 2005 to February 2007 were assessed and stratified with ISS and APACHE Ⅱ , and the serum levels of arterial blood lactate(ABL) ,base deficit(BD) ,superoxide(SOD) ,lipid peroxide(LPO) ,TNF-α and IL-6 were measured in real-time according to the condition of the patient. Results The monitoring biomarkers obviously changed with injury severity which endangered the situation of patients after trauma (P < 0.05) , especially in the patients with ischemia , hypoxia, shock, iniection, SIRS, and MODS (P < 0.01). The persistence of extremely elevated levels of biomarkers meant the organ failure and fatality of patients after trauma, and there was a obvious differece between those cases and cases without elevation of biomarkers ( P < 0.01). Conclusions The outcome of patients after trauma is closely correlated with injury severity,infection and MODS,and the levels of biomarkers including ABL, SOD, IPO, TNF-a and IL-6 are useful indicators of outcome measure.

OBJECTIVEIn order to explore the relationship between the active components and the functional links of Chinese herbs, the effect of Xuesaitong capsule, a preparation made of multi-component Panax notoginseng saponins (PNS) on platelet activating molecule expression and aggregation in patients with blood hyperviscosity syndrome (BHS) was observed, with aspirin (ASP) as a control.

METHODSOne hundred and twenty patients with BHS were divided, adopting randomized, double-blinded and double simulated principle into 2 groups, the PNS group and the ASP group, 60 in each group. Changes of the TCM clinical syndrome, platelet adhesion and aggregation, endothelin (ET), prostacyclin, thromboxane, CD62P and CD41 before treatment and after 28 days treatment were observed.

RESULTSComparison between the therapeutic effects of the two groups on TCM clinical syndrome showed that the total effective rate in the PNS group was 86.67% and that in the ASP group 56.67%, showing significant difference (P < 0.05). Compared with before treatment, after treatment, levels of platelet adhesion and aggregation, endothelin, prostacyclin and thromboxane were significantly different in both groups (P < 0.05 or P < 0.01); levels of CD62P and CD41 in the PNS group were also significantly different, but the difference was insignificant in the ASP group; no significant difference was shown in both groups in levels of triglyceride, total cholesterol and very low density lipoprotein-cholesterol.

CONCLUSIONPNS may inhibit activation of platelet through multiple components and multiple pathways, which is different from that of ASP, only through inhibition on arachidonic acid metabolism to suppress platelet aggregation. PNS has effects of decreasing platelet superficial activation, inhibiting platelet adhesion and aggregation, preventing thrombosis and improving microcirculation, and its therapeutic effect on clinical syndrome is better than that of ASP.

Aged ; Blood Viscosity ; Female ; Hematologic Diseases ; blood ; drug therapy ; Hemorheology ; Humans ; Male ; Middle Aged ; Panax ; chemistry ; Platelet Activating Factor ; metabolism ; Platelet Activation ; drug effects ; Platelet Aggregation ; drug effects ; Saponins ; therapeutic use ; Syndrome

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.

OBJECTIVETo observe the effects of refined Xuefu Capsule (RXC) in patients with arteriosclerosis obliterans (ASO) after femoral-popliteal bypass (FPB).

METHODSThirty-eight ASO patients with 41 limbs underwent FPB were randomly assigned to two groups: the control group (18 cases with 20 operated limbs) and the RXC group (20 cases with 21 operated limbs). All patients received long-term anticoagulant treatment with Warfarin, and RXC was given to the RXC group additionally for 3 months. Changes of clinical symptoms, blood coagulating function, as well as the condition of vascular patency and ankle arm index (AAI) were assessed 6 and 12 months after operation.

RESULTSClinical symptoms were improved in all the patients after operation. One year after operation, incidence of intermittent claudication and amputation rate in the RXC group was 20% and 5 %, being lower than the respective rate (56% and 17%) in the control group (P < 0.05); the patency rate was 86% in the RXC group, being higher than that in the control group (65%, P<0.05). Six and 12 months after operation, AAI was 0.73 +/- 0.24 and 0.69 +/- 0.19 respectively in the RXC group, being significantly higher than that in the control group (0.45 +/- 0.17 and 0.41 +/- 0.23, P < 0.05) at the corresponding time points.

CONCLUSIONRXC could obviously increase the patency rate 12 months after FPB, improve the clinical symptoms and alleviate the symptom of limb ischemia in ASO patients.

Aged ; Aged, 80 and over ; Arteriosclerosis Obliterans ; drug therapy ; physiopathology ; surgery ; Blood Vessel Prosthesis Implantation ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Femoral Artery ; surgery ; Graft Occlusion, Vascular ; prevention & control ; Humans ; Male ; Middle Aged ; Phytotherapy ; Popliteal Artery ; surgery ; Vascular Patency ; drug effects

OBJECTIVETo investigate the regularity of traditional Chinese compound prescription by observing the clinical effect of the compatibility and dismantlement of Xuefu Zhuyu decoction on blood stasis and stagnation of qi syndrome of angina.

METHOD123 outpatients were randomly divided into Xuefu Zhuyu group(XF), Jingzhi Xuefu Zhuyu group(JZ), Yaodui group(YD) and placebo group and treated.

RESULTThe array of angina effect and blood stasis and qi stagnation of syndrome effect was XF group, JZ group, YD group, placebo group( P < 0.01). The levels of blood viscosity, platelet adhesiveness, RED transfigure were significantly different before and after treatment in XF group (P < 0.05). The levels of blood viscosity, platelet adhesiveness were significant different before and after treatment in JZ group ( P < 0.05). The levels of blood plasma viscosity, platelet adhesiveness were significantly different before and after treatment in YD group ( P < 0.05). The levels of platelet adhesiveness, RED transfigure were significantly different before and after treatment in placebo group (P < 0.05). There are no difference among levels of blood lipoprotein and ET of four groups ( P > 0.05). Significant difference was found among four groups in increase of NO and t-PA and decrease of IL-6 (P < 0.05).

CONCLUSIONThe clinical effect and indexes amelioration are correlated to the combination of prescription and the corresponding degree of prescription to syndrome. There are same material foundation in the series of Xuefu Zhuyu dismantle decoction, but the function degree and targets are different with the change of herbs. The method of conjugating disease and syndromes, and prescription to syndromes are a practical pattern to expound the relationship between disease and syndrome.

Aged ; Angina Pectoris ; blood ; drug therapy ; Blood Viscosity ; drug effects ; Double-Blind Method ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; therapeutic use ; Female ; Hematocrit ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Nitric Oxide ; blood ; Plants, Medicinal ; chemistry ; Platelet Adhesiveness ; drug effects ; Tissue Plasminogen Activator ; blood

OBJECTIVETo explore the effects of Tongxinluo capsule (TXL) on the atherosclerosis obliterans (ASO) in iliofemoral artery of rabbits.

METHODRabbits were randomly divided into 7 groups: sham, model, TXL (0.8, 0.4, 0.2 g x kg(-1)), Tongsaimai tablet (0.8 g x kg(-1)) and Laishike (0.002 g x kg(-1)). The animal model of ASO was established with a combined method of mechanical trauma, immunologic injury and high fat fodder feeding. Rabbits were administrated the drugs 8 weeks after surgery. The levels of TC, TG, HDL-C and LDL-C in serum were determined at the time points below: pre-experiment (0 week), pre-drug administration (8 weeks post-surgery), 4 weeks after drug administration (12 weeks post-surgery), 8 weeks after drug administration (16 weeks post-surgery), 12 weeks after drug administration (20 weeks post-surgery). Meanwhile, the behavioral study was performed, the distal skin temperature of the injured hind limb detected. The histopathological changes in iliofemoral artery were examined after opacification.

RESULTThe levels of TC, TG, LDL-C, VLDL-C and TC/HDL-C were decreased significantly in serum of ASO rabbits. The severity of lameness in the injured hind limb was improved. The distal skin temperature was increased. The thickness and the ratio of intima area of the iliofemoral artery of the injured hind limb were decreased, while the stenosis extent was improved.

CONCLUSIONTXL might be beneficial to modulate blood lipid, as well as the prevention and treatment for ASO.

Animals ; Arteriosclerosis Obliterans ; blood ; pathology ; prevention & control ; Arthropods ; chemistry ; Behavior, Animal ; drug effects ; Capsules ; Cholesterol ; blood ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Femoral Artery ; drug effects ; pathology ; Iliac Artery ; drug effects ; pathology ; Male ; Materia Medica ; administration & dosage ; isolation & purification ; pharmacology ; Plants, Medicinal ; chemistry ; Rabbits ; Random Allocation ; Triglycerides ; blood ; Tunica Intima ; drug effects ; pathology

OBJECTIVE： To study the effects of Dengzhan shengmai capsules combined with isosorbide mononitrate on serum TIMP-1 and MMP-9 levels， blood lipid level and cardiac function in patients with unstable angina pectoris （UAP）. METHODS： Totally 198 UAP patients admitted to our hospital from Apr. 2016 to Apr. 2019 were selected， and divided into observation group （n＝102） and control group （n＝96） according to therapy plan. Control group received Isosorbide mononitrate tablets 40 mg， qd， orally； observation group additionally received Dengzhan shengmai capsules， 2 capsules per time， tid， orally， on the basis of control group. Both groups received treatment for consecutive 4 weeks. The clinical efficacy， serum levels of MMP-9 and TIMP-1， blood lipid indexes [low density lipoprotein cholesterol （LDL-C）， high density lipoprotein cholesterol （HDL-C）， triglyceride （TG）， total cholesterol （TC）]， cardiac function indexes [end-diastolic volume （EDV）， left ventricular ejection fraction （LVEF）， end-systolic volume （ESV）] and ADR were compared between 2 groups. RESULTS： The total response rate of observation group was significantly higher than control group （91.18％ vs. 70.83％， P＜0.05）. Before treatment， there was no statistical significance in the levels of ESV， MMP-9， TIMP-1， TC， LDL-C， TG， HDL-C， EDV and LVEF between 2 groups （P＞0.05）. After treatment， the levels of MMP-9， TC， LDL-C， TG， ESV and EDV in 2 groups were decreased significantly in both groups， and the observation group was significantly lower than the control group （P＜0.05）； meanwhile， the levels of TIMP-1， HDL-C and LVEF in 2 groups were increased significantly， and the observation group was significantly higher than control group （P＜0.05）. There was no statistical significance in the incidence of total ADR in 2 groups （P＞0.05）. CONCLUSIONS： Dengzhan shengmai capsules combined with isosorbide mononitrate show good clinical efficacy for UAP， which can effectively reduce serum MMP-9 level and increase serum TIMP-1 level， reduce blood lipid levels， as well as improve cardiac function for UAP patients， with good safety.

Many studies have linked cigarette smoke (CS) exposure and tuberculosis (TB) infection and disease although much fewer have studied second-hand smoke (SHS) exposure. Our goal is to review the epidemiologic link between SHS and TB as well as to summarize the effects SHS and direct CS on various immune cells relevant for TB. PubMed searches were performed using the key words “tuberculosis” with “cigarette,”“tobacco,” or “second-hand smoke.” The bibliography of relevant papers were examined for additional relevant publications. Relatively few studies associate SHS exposure with TB infection and active disease. Both SHS and direct CS can alter various components of host immunity resulting in increased vulnerability to TB. While the epidemiologic link of these 2 health maladies is robust, more definitive, mechanistic studies are required to prove that SHS and direct CS actually cause increased susceptibility to TB.
Mycobacterium tuberculosis ; Smoke* ; Smoking ; Tobacco Products ; Tobacco Smoke Pollution ; Tuberculosis*

Objective:To observe the effect of total flavonoids from Epimedii Folium （TEF） on the angiogenesis of ischemic myocardium in rats after acute myocardial infarction （AMI） and discuss its molecular biological mechanism of attenuating myocardial ischemia and improving cardiac function. Method:AMI in rats was induced through the ligation of left anterior descending coronary artery. All male SD rats were randomized into sham-operated group， model group， diltiazem group （10 mg·kg^-1·d^-1）， and TEF low-dose and high-dose groups （100 and 200 mg·kg^-1·d^-1）， with 8 rats in each group. After modeling， rats in the diltiazem group and TEF groups were given corresponding doses of diltiazem and TEF， respectively， and those in the model group and sham-operated group received normal saline of equivalent volume， once a day for 7 days. After the administration， VisualSonics Vevo2100 imaging system was used to detect the cardiac structure and function and hematoxylin-eosin （HE） staining to observe the histomorphological changes in myocardial ischemic area. Immunohistochemistry was employed to analyze the expression of CD31 and α-smooth muscle actin （α-SMA） in ischemic myocardium and Western blot to detect the expression of vascular endothelial growth factor-receptor 2 （VEGF-R2） and phosphorylation of protein kinase B （Akt） in ischemic myocardium. Real-time PCR was applied to quantify the mRNA levels of vascular endothelial growth factor （VEGF） and basic fibroblast growth factor （bFGF）. Result:Compared with the sham-operated group， the model group demonstrated significant increase in left ventricular systolic diameter （LVIDs）， left ventricular internal diameter at end-diastole （LVIDd）， left ventricular end-systolic volume （LVEVs）， and left ventricular end-diastolic volume （LVEVd）， significant decrease in End-systolic thickness of left ventricular anterior wall （LVAWs）， end-diastolic thickness of left ventricle anterior wall （LVAWd）， end systolic thickness of left ventricular posterior wall （LVPWs）， stroke volume （SV）， ejection fraction （EF）， fractional shortening （FS）， and cardiac output （CO）， obvious pathological changes in the ischemic myocardium， and plummet of the expression of CD31 and α-SMA （P<0.01）， Akt phosphorylation level， protein level of VEGF-R2， and mRNA levels of VEGF and bFGF （P<0.05， P<0.01）. High-dose TEF significantly alleviated the pathological changes of ischemic myocardium as compared with the model group. Moreover， TEF high-dose group showed significantly lower levels of LVIDs， LVIDd， LVEVs， and LVEVd， significantly higher levels of LVAWs， LVAWd， LVPWs， SV， EF， FS， and CO， higher expression of CD31 and α-SMA （P<0.05， P<0.01）， and higher levels of VEGF-R2 protein， phosphorylated Akt， and VEGF and bFGF mRNA than the model group （P<0.05， P<0.01）. Conclusion:TEF can effectively improve myocardial perfusion in peri-myocardial infarction area and attenuate ventricular remodeling and heart failure after AMI by up-regulating the expression of bFGF， VEGF， and VEGF-R2 in ischemic myocardium following AMI and activating phosphatidylinositol 3-kinases （PI3K）/Akt/VEGF signaling transduction pathway which can promote angiogenesis in ischemic myocardium.