The identification of the specific cause in every patient has important clinical implications, because ischemic stroke is an etiologically heterogeneous disease. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification can be used to define the etiology of stroke. However, TOAST classification can not be completed timely on admission of patients with acute stroke, which has impacted early guidance of clinical treatment. This article reviews the biological markers of early differential-diagnostic significance of the TOAST classification.

Traditional medicine (herb medicine) began to prevail again over last two decades, and it is about 70% of the world population taking herb medicine as supplement or alternative medicine according to a recent survey. The consumption of herb medicine increased exponentially in Canada, Australia and Europe during last 10 years. Since concomitant administration of herbal and western medicine has become a trend, it requires paying close attention to the problem. Herb-drug interactions have been extensively investigated worldwide, and there is an increasing concern about the clinical herb-drug interaction. In this review we introduced the current progress in the herb-drug interactions including evidence-based clinical studies and establishment of levels of evidence for herb-drug interaction; and in the related mechanisms including the induction and inhibition of metabolic enzymes, inhibition and induction of transport and efflux proteins, alteration of gastrointestinal functions, and alteration in renal elimination. We also analyzed both the achievements and the challenges faced in the concomitant administration of traditional Chinese medicine and western medicine.
ATP-Binding Cassette, Sub-Family B, Member 1 ; metabolism ; Biological Transport ; drug effects ; Cytochrome P-450 Enzyme System ; metabolism ; Drugs, Chinese Herbal ; isolation & purification ; pharmacokinetics ; pharmacology ; Evidence-Based Medicine ; methods ; Gastrointestinal Tract ; drug effects ; Herb-Drug Interactions ; Humans ; Kidney ; drug effects ; Medicine, Chinese Traditional ; Pharmacokinetics ; Phytotherapy ; Plants, Medicinal ; chemistry

AIMTo observe the effect of adenosine A, receptor antagonist on synaptic transmission in the dentate gyrus of hippocampus and its relations with NMDA receptor.

METHODSUsing electrophysiological technique to record the long-term potentiation (LTP), the relation between selective adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) and NMDA receptor agonist/antagonist, in both basic synaptic transmission and 200 Hz high-frequency stimulation (HFS) induced LTP of the dentate gyrus of hippocampus in anesthetized rats, was studied.

RESULTSDPCPX (6 mg x L(-1), 5 microL, icv) or NMDA (0.2 mg x L(-1), 5 microL, icv) was shown not to affect the synaptic transmission in the dentate gyrus in rats. DPCPX was found not to affect the keeping of LTP induced by HFS after icv NMDA. But the basic synaptic transmission and the magnitude of LTP induced by HFS in the dentate gyrus after icv NMDA could be enhanced significantly by icv DPCPX in advance. DPCPX could not affect the magnitude of LTP inhibited by AP5 (0.5 mg x L(-1), 5 microL) NMDA receptor antagonist, but the inhibitory effect of AP5 on LTP could be antagonized by icv DPCPX in advance.

CONCLUSIONThe selective adenosine A1 receptor antagonist DPCPX could not affect the synaptic transmission in the dentate gyrus of hippocampus, but could significantly enhance the effect of NMDA receptor in both basic synaptic transmission and HFS induced LTP in the dentate gyrus of hippocampus in anesthetized rats.

2-Amino-5-phosphonovalerate ; pharmacology ; Adenosine A1 Receptor Antagonists ; Animals ; Dentate Gyrus ; drug effects ; physiology ; Long-Term Potentiation ; drug effects ; Male ; N-Methylaspartate ; pharmacology ; Rats ; Rats, Wistar ; Receptors, N-Methyl-D-Aspartate ; antagonists & inhibitors ; Synaptic Transmission ; drug effects ; Xanthines ; pharmacology

This study is to observe the difference in pharmacological characteristics between circular smooth muscles of rat isolated gastric body and gastric fundus, and to investigate the effects of nucleoside and nucleotide on circular smooth muscle of the rat gastric body and the involved receptors. Circular muscle strips of the rat gastric body and gastric fundus were prepared, and contractile responses to agonists were investigated with a technique of drug-receptor interaction in functional system. There was no significant difference between the circular muscle strips of the gastric body and gastric fundus in the responses to KCl, and no difference in EC50 values of contractile responses for 5-HT and His between the two kinds of preparations (P > 0.05). However, Emax values of contractile responses to 5-HT and His [(0.81 +/- 0.26) and (0.88 +/- 0.27) g] in gastric body were significantly smaller than those in gastric fundus [(2.67 +/- 0.61) and (1.90 +/- 0.68) g, P < 0.01], and EC50 value of CCh produced contractile response [(0.45 +/- 0.15) micromol x L(-1)] in gastric body was significantly higher than that in gastric fundus [(0.20 +/- 0.09) micromol x L(-1), P < 0.01]. In precontracted circular muscle strips of the gastric body, ATP (0.1-3000 micromol x L(-1)) produced only a contractile response concentration-dependently, but the same concentration of ATP induced a biphasic response (relaxation followed by a contraction) in precontracted circular muscle strips of the gastric fundus. ATP, UTP, ADP, 2-MeSATP and alpha,beta-MeATP produced contractile responses concentration-dependently in circular muscle strips of the rat gastric body. The EC50 value for 2-MeSATP [(7.2 +/- 5.2) nmol x L(-1)] was about 500 times lower than that for Ach [(3.47 +/- 1.20) micromol x L(-1)]. The rank order of potency for the contraction was 2-MeSATP>ADP>ATP=UTP>alpha,beta-MeATP>adenosine. The contractile responses to ATP and UTP were not significantly affected by phentolamine, propranolol, atropine or tetrodotoxin. In conclusion, there is a significant difference in pharmacological characteristics between the circular smooth muscles of the rat gastric body and gastric fundus and nucleotides might be important mediators responsible for the contraction via a specific P2Y receptor in circular smooth muscle of the rat gastric body.
Adenosine ; pharmacology ; Adenosine Diphosphate ; pharmacology ; Adenosine Triphosphate ; analogs & derivatives ; pharmacology ; Animals ; Gastric Fundus ; drug effects ; physiology ; Male ; Muscle Contraction ; drug effects ; Muscle, Smooth ; drug effects ; physiology ; Purinergic P2 Receptor Agonists ; Rats ; Rats, Wistar ; Receptors, Purinergic P2 ; drug effects ; Stomach ; drug effects ; physiology ; Thionucleotides ; pharmacology ; Uridine Triphosphate ; pharmacology

AIMTo study the effect of blocking adenosine A1 receptors on learning and memory and the relation with cholinergic and aminoacidergic nerve.

METHODSUsing step through test, spectrophotometry and HPLC method, the effect of selective adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX, 0.3, 0.15, 0.075, 0.03, 0.015 microgram, icv) on memory impairment by scopolamine (Scop, 3 mg.kg-1 i.p.) or 2-amino-5-phosphonovaleric (AP5, 2.5 ng, icv), acetylcholinesterase (AChE) activity and aminoacid level in brain of mice was studied.

RESULTSDPCPX was shown to significantly improve scopolamine-induced memory impairment, but not AP5-induced. The activity of AChE in mouse brain was significantly inhibited by large doses of DPCPX in vitro and in vivo test. DPCPX(0.3 microgram, icv) was shown to significantly increase the content of glutamate and aspartic acid in brain of mice. DPCPX (0.3, 0.15 microgram, icv) significantly decrease GABA and increase Glu/GABA in brain of mice.

CONCLUSIONThe selective adenosine A1 receptor antagonist DPCPX was shown to significantly improve scopolamine but not AP5-induced memory impairment. Large doses of DPCPX was shown to influence the AChE activity and the changes in aminoacid level in brain, especially increase Glu/GABA.

2-Amino-5-phosphonovalerate ; metabolism ; Acetylcholine ; metabolism ; Adenosine A1 Receptor Antagonists ; Animals ; Brain ; drug effects ; metabolism ; Female ; Glutamic Acid ; metabolism ; Learning ; drug effects ; Male ; Mice ; Random Allocation ; Scopolamine Hydrobromide ; Xanthines ; pharmacology ; gamma-Aminobutyric Acid ; metabolism

To learn about the economic studies on traditional Chinese medicines in domestic literatures, in order to analyze the current economic assessment of traditional Chinese medicines and explore the existing problems. Efforts were made to search CNKI, VIP, Wanfang database and CBM by computer and include all literatures about economic assessment of traditional Chinese medicines published on professional domestic journals in the systematic assessment and quality evaluation. Finally, 50 articles were included in the study, and the systematic assessment and quality evaluation were made for them in terms of titles, year, authors' identity, expense source, disease type, study perspective, study design type, study target, study target source, time limit, cost calculation, effect indicator, analytical technique and sensitivity analysis. The finally quality score was 0.74, which is very low. The results of the study showed insufficient studies on economics of traditional Chinese medicines, short study duration and simple evaluation methods, which will be solved through unremitting efforts in the future.
Costs and Cost Analysis ; Databases, Factual ; economics ; Drug Therapy ; economics ; Drugs, Chinese Herbal ; economics ; therapeutic use ; Evaluation Studies as Topic ; Medicine, Chinese Traditional ; economics ; Publications ; economics

OBJECTIVETo evaluate that the effect of formula of removing both phlegm and blood stasis in improving cardiac function of Chinese mini-swine with coronary heart disease of phlegm-stasis cementation syndrome.

METHODTotally 36 Chinese mini-swine were randomly divided to six groups: the normal control group, the model group, the Danlou tablet group, and Tanyu Tonzhi Fang(TYTZ) groups with doses of 2. 0, 1. 0 and 0. 5 g kg-1, with six in each group. Except for the normal control group, all of other groups were fed with high-fat diet for 2 weeks. Interventional balloons are adopted to injure their left anterior descending artery endothelium. After the operation, they were fed with high-fat diet for 8 weeks to prepare the coronary heart disease model of phlegm-stasis cementation syndrome. After the operation, they were administered with drugs for 8 weeks. The changes in the myocardial ischemia were observed. The changes in the cardiac function and structure were detected by cardiac ultrasound and noninvasive hemodynamic method.

RESULTCompared with the normal control group, the model group showed significant increase in myocardial ischemia and SVR and obvious decrease in CO, SV and LCW in noninvasive hemodynamic parameters (P <0.05 or P <0.01). The ultrasonic cardiogram indicated notable decrease in IVSd, LVPWs, EF and FS, and remarkable increase in LVIDs (P<0. 05 orP<0.01). Compared with the model group, TYTZ could reduce the myocardial ischemia, strengthen cardiac function, and improve the abnormal cardiac structure and function induced by ischemia (P <0. 05 or P <0. 01).

CONCLUSIONTYTZ shows a significant effect in improving cardiac function of Chinese mini-swine with coronary heart disease of phlegm-stasis cementation syndrome. The clinical cardiac function detection method could be adopted to correctly evaluate the changes in the post-myocardial ischemia cardiac function, and narrow the gap between clinical application and basic experimental studies.

Animals ; Coronary Circulation ; Coronary Disease ; diagnostic imaging ; metabolism ; physiopathology ; therapy ; Heart ; physiopathology ; Hemodynamics ; Medicine, Chinese Traditional ; methods ; Mucus ; metabolism ; Swine ; Swine, Miniature ; Ultrasonography

OBJECTIVETo establish a revered-phase HPLC method for the study of pharmacokinetics of loganin and morroniside in Cornus officinalis injectionin mice after a single oral and intravenous administrations.

METHODThe Diamonsil C18 column (4.6 mm x 250 mm, 5 microns) was used as the analytical column and the mobile phase consisted of acetonitrile-methanol-0.2% formic acid (12:8:80) with the flow rate at 1.0 mL.min-1. The UV detection was set at 237 nm.

RESULTThe calibration curves of loganin and morroniside were linear in the range from 0.38 to 68.25 mg.L-1(r = 0.9999), and from 0.66 to 117.22 mg.L-1(r = 0.9999), respectively. The lowest determination concentrations of loganin and morroniside were 0.10 and 0.16 mg.L-1, respectively. The recoveries and relative standard deviations of loganin were 99.6% (2.0%), 102.0% (1.0%), 87.9% (7.2%), and those of morroniside were 99.2% (2.5%), 104.1% (1.2%), 92.7% (4.2%), respectively. The relative standard deviations of within-day and between-day precision for the method were all less than 6.8%. After a single intravenous administration of Cornus officinalis injection to mice, the mean plasma concentration-time courses were found to fit a two-compartment open model, the main pharmacokinetic parameters of loganin were as follows: T1/2(alpha), T1/2(beta), K21, K12, K10, V(c), AUC, CL were 3.2 min, 25.1 min, 5.997 h-1, 4.981 h-1, 3.564 h-1, 0.551 L.kg-1, 13.59 mg.L-1.h, 1.965 L.kg-1.h-1, respectively and those of morroniside were 3.6 min, 21.5 min, 5.926 h-1, 3.833 h-1, 3.797 h-1, 0.647 L.kg-1, 27.15 mg.L-1.h, 2.457 L.kg-1.h-1, respectively.

CONCLUSIONIt is the first time to establish the revered-phase HPLC method to determine concentrations of loganin and morroniside in plasma and to obtain their pharmacokinetic parameters and characteristics.

Administration, Oral ; Animals ; Area Under Curve ; Chromatography, High Pressure Liquid ; Cornus ; chemistry ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacokinetics ; Female ; Injections, Intravenous ; Iridoids ; blood ; Male ; Mice ; Plants, Medicinal ; chemistry

OBJECTIVETo sum up the clinical experience in the management of benign prostatic hyperplasia (BPH) with the prostate weighing over 80 ml by transurethral resection of the prostate (TURP) combined with 2 μm continuous-wave laser vaporesection (LVR).

METHODSWe retrospectively analyzed the clinical effects of TURP combined with 2 μm LVR in the treatment of 46 cases of BPH with the prostate volume > 80 ml.

RESULTSAll the operations were successfully accomplished. The operation time and intraoperative blood loss were (112.0 ± 20.0) min (range 86-176 min) and (77.9 ± 25.9) ml (range 50-200 ml), respectively. The catheters were withdrawn at 7 days after surgery. Transient urinary incontinence occurred in 6 cases and secondary hemorrhage was found in 2 postoperatively. Six-month follow-up revealed no urethral stricture or other complications. Compared with the baseline, the international prostate symptom score (IPSS) was significantly decreased at 6 months after operation (26.3 ± 1.8 vs 11.6 ± 1.7, P <0.05), and so were the quality of life (QOL) score (5.3 ± 0.7 vs 1.3 ± 1.1, P <0.05) and post-void residual urine (PVR) ([115.5 ± 55.6] ml vs [19.9 ± 11.6] ml, P <0.05). However, the maximum urinary flow rate (Qmax) was remarkably increased from (4.1 ± 2.6) ml/s to (16.2 ± 1.7) ml/s (P <0.05).

CONCLUSIONTURP combined with 2 μm LVR is safe and effective for the treatment of BPH with the prostate volume >80 ml.

Aged ; Blood Loss, Surgical ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Organ Size ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urethral Stricture ; Urinary Incontinence ; etiology ; Urinary Retention

The aim of this study is to investigate the effect of isosorbide-5-mononitrate (ISMN) on the electric field stimulation induced sympathetic purinergic vasoconstriction of the rabbit saphenous arterial rings. Isometric vasoconstrictive responses to electric field stimulation and to exogenous noradrenaline and adenosine triphosphate were recorded. We found that the vasoconstrictive responses to electric field stimulation (15 V, 1 ms pulse duration, 2 - 16 Hz) were frequency-dependant in the rabbit saphenous arterial rings, and abolished by tetrodotoxin (0.1 micromol x L(-1)). The alpha1-adrenoceptor antagonist prazosin (1 micromol x L(-1)) did not affect the vascular responses to the electric field stimulation (2 -8 Hz). After a combination treatment with both alpha,beta-meATP (3 micromol x L(-1), desensitizing P2X1 receptors) and prazosin (1 micromol x L(-1)), the vasoconstrictive responses to electric field stimulation were abolished. When the arterial preparation was treated with ISMN (one preparation was exposed to only one concentration of ISMN), ISMN at 0.1 mmol x L(-1) significantly inhibited the vasoconstriction induced by electric stimulation at 8 Hz, 0.3 and 1.0 mmol x L(-1) significantly inhibited the vasoconstrictive responses to electric stimulation at 2 - 16 Hz. The highest concentration of ISMN (1.0 mmol x L(-1)) reduced the vasoconstrictive responses by 46% (2 Hz), 47% (4 Hz), 34% (8 Hz) and 22% (16 Hz), separately. ISMN (0.3 and 1.0 mmol x L(-1)) did not affect the vascular responses to exogenous noradrenaline (0.01-100 micromol x L(-1)) and adenosine triphosphate (1 mmol x L(-1)). It is reasonable to suggest that ISMN inhibits the purinergic vasoconstriction induced by sympathetic nerve stimulation via a prejunctional mechanism.
Adenosine Triphosphate ; analogs & derivatives ; pharmacology ; Adrenergic alpha-Antagonists ; pharmacology ; Animals ; Arteries ; drug effects ; Delayed-Action Preparations ; Electric Stimulation ; Isosorbide Dinitrate ; administration & dosage ; analogs & derivatives ; pharmacology ; Male ; Norepinephrine ; pharmacology ; Prazosin ; pharmacology ; Purinergic P2 Receptor Agonists ; Rabbits ; Receptors, Purinergic P2X ; Vasoconstriction ; drug effects