ObjectiveTo determine the optimal dose of Dachengqi Decoction （大承气汤， DCQD） for the treatment of acute intestinal obstruction （AIO） through a randomized， double-blind， dosage parallel controlled， multi-center clinical trial， and to providee evidence support for the reasonable dosage of DCQD in clinical practice. MethodsBased on the commonly used clinical dose of DCQD， three different groups were set up， including low-dose group which used Dahuang （Radix et Rhizoma Rhei） 12 g， Houpo （Cortex Magnoliae Officinalis） 9 g， Zhishi （Fructus Aurantii Immaturus） 9 g， and Mangxiao （Natrii Sulfas） 4.5 g， medium-dose group using Dahuang 36 g， Houpo 27 g， Zhishi 27 g， Mangxiao 13.5 g， and high-dose group using Dahuang 60 g， Houp0 45 g， Zhishi 45 g and Mangxiao 22.5 g. Initially， 149 AIO patients with Yangming （阳明） bowel excess syndrome were randomly assigned to three groups using a stratified randomization method， and both the patients and the doctors were blinded. In addition to conventional western medicine treatment， each group was given 12 bags of granules made from the raw herbs of DCQD at different doses， taken orally or injected through a gastric catheter once every 6 hours， 3 bags each time， for 3 consecutive days. After treatment， the indicators of the three groups of patients with primary AIO and non-primary AIO were evaluated respectively， and the full analysis set （FAS） and per-protocol set （PPS） were used for analysis. The primary outcomes were the time to recover voluntary bowel movements and voluntary flatulence. The secondary outcomes were the ideal rate of spontaneous defecation and the ideal rate of spontaneous flatus. The occurrence of adverse events during the study was recorded and analyzed using the safety analysis set （SS）. ResultsA total of 91 patients with primary AIO and 58 patients with non-primary AIO were included in the FAS and SS analysis， while 80 primary AIO patients and 56 non-primary AIO patients were included in the PPS analysis. Both FAS and PPS analysis showed significant differences in the time to recover voluntary bowel movements and voluntary flatulence among primary AIO patients in different dose groups of DCQD （P＜0.01）， and the high- and medium-dose groups assumed less time than the low-dose group （P＜0.05）. There was no statistically significant difference in the ideal rate of spontaneous defecation and spontaneous flatus among the three groups （P＞0.05）. And consistent results were seen in the non-primary AIO patients among the three groups. Five adverse events occurred in primary AIO patients （3 in the low-dose group， 1 in the medium-dose group， and 1 in the high-dose group）， mainly manifested as abdominal distension and abdominal pain， and there was no statistically significant difference in the incidence of adverse events （P＞0.05）. No adverse events occurred in patients with non-primary AIO. ConclusionDCQD， as an effective treatment for patients with AIO， is commonly used at a medium dose for patients with primary AIO and at a high dose for patients with non-primary AIO. The therapeutic advantage is mainly reflected in the shorter time to recover spontaneous defecation and spontaneous flatulence and the improvement of intestinal function.

Objective: To compare the clinical effects among single-incision laparoscopic appendectomy(SILA), laparoscopic appendectomy(LA)and open appendectomy(OA)in the treatment of elderly patients with acute appendicitis. Methods: A total of 98 consecutive elderly patients undergoing appendectomy in our hospital from November 2014 to December 2016 were retrospectively selected.Among them, 31 patients underwent SILA, 35 underwent LA and 32 underwent OA.The operation time, the first exhaust time after operation, length of hospital stay, Numerical Rating Scale(NRS)pain score, wound infection rate and incidence of postoperative complications were compared between the three groups. Results: The postoperative venting time and length of hospital stay were shorter, NRS was less, wound infection rate and incidence of postoperative complications were lower in the SILA and LA groups than in the OA group[(21.5±5.2) h, (22.1±5.4) h vs.(24.8±5.8) h, (4.5±1.3) d, (4.8±1.4) d vs.(9.4±1.5) d, (3.7±0.5), (4.1±0.7) vs. (6.3±0.9), 0%, 0% vs. 12.5%, 9.7% or 3/31, 14.3% or 5/35 vs. 43.8% or 14/32, respectively, P<0.05), while the operative time was less in the LA and OA groups than in the SILA group(45.4±10.5) min, (48.6±1.4) min vs.(73.2±12.3)min, P<0.05). The incision NRS pain score was lower in the SILA group than in the LA and OA groups(3.7±0.5 in SILA vs.4.1±0.7 in LA vs. 6.3±0.9 in OA, P<0.05). Conclusions LA has advantages of less trauma, less pain, quicker recovery, fewer complications and beautiful incisions.SILA has less pain than LA, but needs longer operative time.SILA is worthy of promotion in the treatment of acute appendicitis especially in the elderly, but still needs further improvement.

Integrated traditional Chinese and Western medicine therapy for pancreatitis has been used since the 1960s.According to the clinical manifestations and traditional Chinese medicine (TCM) syndrome differentiation of pancreatitis,pancreatitis was named true heart pain with cold limbs caused by spleen disease.Syndrome differentiation of acute pancreatitis and treatment with modified Dachaihu decoction achieved good clinical effects.After the 1990s,the research focus of pancreatitis research was shifted to severe acute pancreatitis (SAP).The clinical course of SAP was divided into three phases,and different therapeutic regimens were given.Clinical studies achieved good therapeutic effects in terms of cure rate and fatality rate.After 2000,integrated traditional Chinese and Western medicine therapy for chronic pancreatitis has been promoted systemically,and the cooperation between traditional Chinese medicine,endoscopic techniques,and operative treatment helps to significantly improve pain control,nutritional status,and incidence of complications.

Objective To observe the effects of mesenteric lymph drainage on acute lung injury and expression of p38 mitogen activated protein kinase (p38MAPK) signal pathway in rats with bowel repletion pattern. Methods Thirty male Wistar rats were randomly divided into three groups according to random number table method, namely sham operation group (sham group), bowel repletion model group (model group) and mesenteric lymph drainage group (drainage group), 10 rats in each group. The rat model of bowel repletion was established by ischemia/reperfusion (I/R) method, firstly 1 hour occlusion of superior mesenteric artery (SMA) to induce ischemia followed by reperfusion for 2 hours. In the rats of drainage group, the drainage of mesenteric lymph duct began at the end of model establishment and persisted for 3 hours. In the rats of sham group, the SMA and mesenteric lymph ducts were exposed with blunt dissection, and then they were immediately placed back into the abdominal cavity. After 3 hours of mesenteric lymph drainage, the lung and ileum tissues of rats in each group were harvested for evaluation of pathohistological changes and for the determination and comparison of myeloperoxidase (MPO) activity changes; the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF) were detected by enzyme linked immunosorbent assay (ELISA), and the expressions of Toll-like receptor 4 (TLR4) mRNA and p38MAPK mRNA in the lung tissues were measured by fluorescence quantitative polymerase chain reaction (PCR).Results Under the light microscope, the pulmonary capillaries markedly dilated and congested, the interstitium width of lung increased with a large amount of inflammatory cells infiltration, the intestinal mucosal layer becoming thinner with detachment of intestinal villi and a large amount of inflammatory cells infiltration were detected in rats of model group. Compared with those in sham group, the levels of TNF-α and IL-6 in BALF, the MPO activity of lung and ileum tissues, and the expressions of TLR4 mRNA and p38MAPK mRNA in the lung tissues were significantly increased in model group.Compared with those in model group, the pathohistological damages in lung and ileum tissues were ameliorated, the levels of TNF-α and IL-6 in BALF, the MPO activity of lung and intestinal tissues and the expressions of TLR4 mRNA and p38MAPK mRNA in the lung tissues were lower in the rats of drainage group [TNF-α in BALF (ng/L): 858.55±27.16 vs. 1 680.58±105.62; IL-6 in BALF (ng/L): 0 vs. 484.71±5.43; MPO activity of lung (U/g): 0.95±0.13 vs. 1.36±0.11; MPO activity of ileum tissues (U/g): 0.75±0.13 vs. 1.30±0.16; TLR4 mRNA: 0.21±0.11 vs. 0.69±0.13, p38MAPK mRNA: 0.21±0.13 vs. 0.47±0.09; allP < 0.05].Conclusion Mesenteric lymph drainage can alleviate acute lung injury in rats with bowel repletion, and its mechanism may be related to the reduction of the expressions of TLR4 mRNA and p38MAPK mRNA and the release of TNF-α and IL-6 in lung tissues.

Objective:To study the effect of different dose of persicae semen extract extract(PSE) to barrier function of the intestinal mucous membrane and immunologic function in acute pancreatitis rats.Methods:A total of 48 rats were divided into model control group,low dose,medial dose and high dose PSE groups,and there were 12 rats in each group.Another 12 rats were Sham-operation group.After anesthesia recovery,rats in low dose,medial dose and high dose PSE groups respectively received PSE 0.12 g/kg,0.248 g/kg and 0.36 g/kg,and rats in Sham-operation group and model control group receive isovolumetric distilled water,once per 6 h,4 times in 24 hours.All rats were anesthetized by 10%chloral hydrate after in 24th hour after dosing.Thorax and enterocoelia were opened; 5 ml of blood were respectively drawed to EDTA-anticoagulation tube and un-anticoagulation tube from aorta abdominalis.CD4+, CD8+and Treg cells were determined by direct fluorescent-labelded flow cytometry.IgA, IgG and IgM were determined by immunoturbidimetry.Serum amylase was determined by EPS-G7 substrate,D-lactic acid was determined by enzymology, and serum diamine oxidase was determined by active ration of colorimetry method.Pathological examination of small intestine mucous membrane tissue was taken after HE staining.sIgA in small intestine was determined by radioimmunoassay.mRNA of TLR4 and NF-κBp65 in small intestine tissue was determined by RT-PCR.Results:(1) Serum amylase,D-lactic acid and diamine oxidase in medial dose and high dose PSE groups were significantly decreased ( P<0.01 ) , and sIgA in small intestine was significantly increased ( P<0.01).These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(2) CD4+and CD4+/CD8+in medial dose and high dose PSE groups were significantly increased(P<0.01),and CD8+,Treg cells were significantly decreased(P<0.01) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(3) IgA,IgG and IgM in medial dose and high dose PSE groups were significantly decreased(P<0.01) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups(P<0.01).(4) Small intestine mucous membrane tissue in Sham-operation group was not damaged significantly,but that in model control group was damaged significantly.Small intestine mucous membrane tissue in low dose PSE group was similar to that in model control group,and damage in medial dose and high dose PSE groups was decreased significantly.( 5 ) mRNA of TLR4 and NF-κBp65 in small intestine tissue in medial dose and high dose PSE groups were significantly increased ( P<0.01 ) compared with those in low dose PSE group.These indicators were significantly different in medial dose and high dose PSE groups ( P<0.01 ).Conclusion: PSE has protective effect to barrier function of the intestinal mucous membrane,and significantly improve the immunologic function.

OBJECTIVETo investigate the effect of mesenteric lymph drainage on intestinal barrier function in severe intraperitoneal infection (SII).

METHODSThirty healthy male Wistar rats were randomly divided into 3 groups(model group, drainage group and control group). SII model rats were prepared by injecting E.coli intraperitoneally. Rats in drainage group rats underwent mesentery lymphatic duct ligation and drainage 2 hours after model induction, and those in control group received equal amount of 10% BaSO4 nutrient broth injection intraperitonerally. Six hours after model induction, rats were sacrificed. The intestinal samples were collected for pathology analysis and content of DAO and concentration of TNF-α, IL-6. Content of D-lactate in blood plasma was detected.

RESULTSUnder light microscopy, ileum mucosa tissue structure of model group was disordered. Under transmission electron microscopy, intestinal mucosal epithelial cells of model group swelled obviously, close connection was destructed, and early apoptosis cells occurred. After mesentery lymph drainage, intestinal mucosa tissue structure was improved obviously, endoplasmic reticulum and mitochondria of epithelium swelled mildly. The contents of intestinal tissue DAO in drainage group, model group and control group were (5.9±0.4) U/L, (3.0±0.1) U/L and (18.3±2.1) U/L respectively. There was significant difference among groups (P<0.05). Compared with control group [(45.4±37.9) μg/L], the plasma content of D-lactate in model group [(256.0±177.2) μg/L] increased significantly (P<0.05). The plasma content of D-lactate in drainage group [(136.9±21.5) μg/L] was not significantly different compared with model group (P>0.05), but was significantly higher compared to control group (P<0.05). Compared with control group, model group had significantly higher levels of TNF-α [(3431.3±23.9) ng/L vs. (2730.0±408.7) ng/L] and IL-6 [(86.3±1.6) ng/L vs. (30.2±0.9) ng/L] (P<0.05), while the TNF-α was (2653.2±324.1) ng/L, and the IL-6 was (50.9±0.7) ng/L in drainage group, which were significantly lower compared with model group (P<0.05).

CONCLUSIONMesenteric lymph drainage can obviously improve intestinal barrier function in severe intraperitoneal infection and may play a protective role in intestinal mucosa.

Animals ; Drainage ; Interleukin-6 ; Intestinal Mucosa ; physiology ; Lymph Nodes ; Male ; Mesentery ; Peritoneal Diseases ; therapy ; Rats ; Rats, Wistar ; Tumor Necrosis Factor-alpha

Objective To investigate the components of mesenteric lymph of the rats with severe intraperitoneal infection,and inquire into the effect of intestinal lymphatic pathway in severe intraperitoneal infection.Methods Twenty-four male Wistar rats were randomly divided into two groups according to random number table method,namely model group and sham group with 12 rats in each group.The rat model of severe intraperitoneal infection was reproduced by injecting artificial gastric juice and E.coli intraperitoneally.Mesenteric lymph in both groups was collected 4 hours after the reproduction of the model,and white blood cells were counted and classified.The levels of endotoxin,alkaline phosphatase (AKP),lactate dehydrogenase (LDH),creatine kinase (CK),glutamine transferase (GST),protein and cytokines of mesenteric lymph were determined.Results Compared with the sham group,there was an increase in the neutrophil ratio in mesenteric lymph (0.167 ± 0.004 vs.0.610 ± 0.006,t=33.520,P＜0.001),however the percentage of both macrophages (0.009 ± 0.001 vs.0.020 ± 0.004,t=-6.677,P＜0.001) and lymphocytes (0.824 ± 0.005 vs.0.921 ± 0.004,t=-31.471,P＜0.001) was decreased in model group.Compared with sham group,the levels ofendotoxin (kEU/L:0.346 ±0.022 vs.0.186 ±0.001,t=18.103,P＜0.001),AKP [U (king unit):13.97 ± 5.55 vs.3.76 ± 0.18,t=4.503,P=0.006],LDH (U/L:2 827.45 ± 1 940.32 vs.712.68 ± 14.09,t=2.670,P=0.044),CK (kU/L:2.19 ± 1.21 vs.0.70 ± 0.01,t=3.035,P=0.029),GST (kU/L:12.33 ± 6.53 vs.1.36 ± 0.39,t=4.105,P=0.009) were all significantly elevated.The concentration of protein (g/L:4.40 ± 0.48 vs.2.84 ± 0.16,t=6.882,P=0.001),tumor necrosis factor-α [TNF-α (ng/L):499.39 ±76.36 vs.180.90 ± 70.98,t=7.483,P＜0.001],interleukin-6 [IL-6 (μg/L):13.74 ± 0.78 vs.-0.07 ± 0.07,t=52.972,P＜0.001],intercellular adhesion molecule-1 [ICAM-1 (ng/L):2 754.19 ±221.48 vs.1 362.85 ±393.43,t=6.891,P＜0.001] and monocyte chemo-attractant protein-1 [MCP-1 (μg/L):28.23 ± 1.77 vs.24.87 ± 1.15,t=3.561,P=0.007] and high mobility group protein-1 [HMGB-1 (ng/L):1 392.78 ± 572.42 vs.564.17 ± 21.32,t=3.543,P=0.016] in mesenteric lymph in model group were significantly higher than those in sham group.Conclusion Intestinal lymphatic pathway maybe the early pathway for the production of remote organ injury caused by severe intraperitoneal infection.

Objective To observe the effects of Qingfei Chengqi decoction on lung tissue cell apoptosis and its associated protein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)of lung tissues in rats with severe intra-peritoneal infection(SII). Methods Thirty male Wistar rats were randomly divided into three groups:sham operation group,model group and traditional Chinese medicine(TCM)group(each n=10). Simulating clinical pathophysiological process of digestive tract perforation,the rat model of SII was reproduced by injecting E. coli intraperitoneally. The TCM group was treated by gavage with Qingfei Chengqi decoction one day in advance of the study,3 times per day,once 2 mL. The same amount of nutrient broth which contained 10%barium sulfate(BaSO4) to replace the bacteria solution was injected into the sham operation group. Six hours after model establishment,all rats were killed and lung tissues were harvested for pathohistological evaluation and for the determination of apoptosis rate with TdT-mediated dUTP nick-end labeling(TUNEL)method,of Bax,Bcl-2 protein expression with Western Blot method,and of the level of TNF-α,IL-6 with enzyme-linked immunosorbent assay(ELISA)method,and the pathological changes of lung tissues were observed under the light and electron microscopes. Results Compared with sham operation group,the apoptosis rate〔(12.7±5.4)%vs. 0〕,the expression of Bax protein〔absorbance(A)value:8 416.89±875.16 vs. 6 654.09±1 130.18〕,the level of TNF-α(ng/L:3 132.56±457.96 vs. 1 948.55±269.32), the level of IL-6(ng/L:75.14±1.63 vs. 31.17±0.81)of lung tissues were significantly increased(all P<0.05), meanwhile Bcl-2 protein expression decreased observably(A value:7 490.59±200.34 vs. 12 289.02±535.93,P<0.05)in model group induced by SII. After treatment with TCM,apoptosis rate〔(7.9±0.3)%〕,the expression of Bax protein(A value:7 619.50±999.30),the level of TNF-α(ng/L:3 114.34±454.32)and IL-6(ng/L:52.46±0.96) of lung tissues were decreased and Bcl-2 protein expression(A value:11 155.07±1 018.87)increased(all P<0.05) compared with model group. General observation:the color of lung tissues was uniform in sham operation group;the lung tissues of model group swelled obviously,and parts of lung tissues had patches of ecchymosis and hemorrhage. The light microscope showed:the pulmonary vessels,the alveolar interstitium,alveolar epithelium and lobular interstitium of sham operation group were all normal,while in the model group,the pulmonary interstitium was edematous and hemorrhagic,and in the alveolar cavities there was infiltration of inflammatory cells. Under the electron microscope, the lung tissue type Ⅱ alveolar epithelial cells of model group were increased,and they had morphological changes in various degrees,such as cell shrinkage and change becoming round,and cell nucleus presenting irregular in shape. After treatment with TCM,the above pathological changes were all alleviated compared with those in the model group. Conclusions Qingfei Chengqi decoction can ameliorate the SII leading to acute lung injury,and reduce the cell apoptosis rate of lung tissues in SII rats. Its mechanism may be related to the intervention of above TCM which can lower the levels of inflammatory media and elevate the protein expression of Bcl-2.

Objective To observe the level of hypoxia-inducible factor-1 alpha (HIF-1α) and its downstream target gene cyclooxygenase-2 (COX-2) in LPS-treated intestinal epithelial cells,and to explore the possible intervention targets of Rheum emodin.Methods Human intestinal epithelial cells were cultured in vitro treated with LPS to establish the experimental model.The protein level trends of HIF-1α and COX-2 were measured by Western blot in LPS dose-dependent and time-dependent manners.The protein level trends of HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 were measured in LPS plus various concentrations of Rheum emodin treated groups.The expression of HIF-1α mRNA were detected by PCR after cells treated with LPS or LPS plus Rheum emodin,respectively.The effect of Rheum emodin on the proliferation of intestinal epithelial cells was measured by MTT assay in each group.Data were analyzed with ANOVA,and P ＜0.05 was considered significant.Results LPS induced the protein level of HIF-1α in a dose-dependent and a time-dependent manners.With increasing concentrations of LPS,the protein level of HIF-1α increased to the peak when cells were treated with LPS at 10-30mg/mL,and then gradually decreased (P ＜0.05).Firstly the protein level of HIF-1α reached the peak at 0.5 h after treatment,and then decreased to the lowest level at 4 h,and finally returned to a high level (P＜0.05).The protein level trend of COX-2 went a similar way to that of HIF-1α (P ＜0.05).Rheum emodin inhibited the protein levels of LPS-induced HIF-1α,COX-2,Phospho-IκB-α and Phospho-NF-κB p65 with a significant dose-effect relationship (P ＜ 0.05).The PCR showed Rheum emodin inhibited LPS-induced increasing expression of HIF-1α mRNA.MTT assay showed different concentrations of Rheum emodin (0 μmol/L,20 μmol/L,40 μmol/L,60 μmol/L,80 μmol/L) had no significant effect on cell proliferation (0.95 ± 0.02,0.89 ± 0.03,0.88 ± 0.04,0.91 ± 0.03,0.83 ± 0.03,P ＞ 0.05).Although Rheum emodin produced biological effect at this concentration range,and it had no toxicity to intestinal cells.Conclusions LPS induces HIF-1α/COX-2 signaling pathway in a time-dependent and a dose-dependent manners in intestinal epithelial cells.Rheum emodin blocks the hypoxia pathway of LPS/HIF-1α/COX-2 and the inflammatory pathway of LPS/IκB-α/NF-κB/COX-2,which may play a protective effect on intestinal epithelial cells.

Objective To probe the differences in clinicopathological features between benign and malignant polypoid lesions of the gallbladder.Methods In this study,1396 PLG cases diagnosed by postoperative pathology between 2007.1 to 2009.12 were enrolled.Cases were divided into three groups according to the pathological classification:1339 cases of benign proliferative diseases ;42 cases of adenoma,15 cases of malignant disease.Comparing the clinical characteristics of the three groups,we screened out the risk factors for malignant transitions.Results Age (F =8.090,P =0.000),size of polyp (F =102.61,P =0.000),single vs multiple lesions (x2 =214.25,P =0.000),concurrent inflammation (x2 =9.362,P =0.009),and stones (x2 =34.022,P =0.000) were significantly different between the three groups.Conclusions Size of polyps over 0.8 cm,age over 60 years,single polyp,accompanied by stones and inflammation were the risk factors for malignancy in gallbladder polypoid lesions.