1.Finite element model establishment and stress analysis of lumbar-sacral intervertebral disc in ankylosing spondylitis
Zhijie KANG ; Zhenhua CAO ; Yangyang XU ; Yunfeng ZHANG ; Feng JIN ; Baoke SU ; Lidong WANG ; Ling TONG ; Qinghua LIU ; Yuan FANG ; Lirong SHA ; Liang LIANG ; Mengmeng LI ; Yifei DU ; Lin LIN ; Haiyan WANG ; Xiaohe LI ; Zhijun LI
Chinese Journal of Tissue Engineering Research 2024;28(6):840-846
BACKGROUND:Ankylosing spondylitis is a chronic inflammatory disease with chronic rheumatic immunity.Soft tissue ossification and fusion and spinal stiffness can cause biomechanical changes. OBJECTIVE:To reconstruct the lumbar-sacral intervertebral disc in ankylosing spondylitis patients with lumbar kyphosis by finite element analysis,and to study the range of motion of each segment of T11-S1 and the biomechanical characteristics of annulus fibrosus and nucleus pulposus. METHODS:The imaging data were obtained from an ankylosing spondylitis patient with lumbar kyphosis.The original CT image data of continuously scanned spine were imported into Mimics 21.0 in DICOM format,and T11-S1 was reconstructed respectively.The established model was imported into 3-Matic software in the format of"Stl"to reconstruct the intervertebral disc,and the fibrous intervertebral disc model was obtained.The improved model was further imported into Hypermesh software,and the vertebra,nucleus pulposus,annulus fibrosus and ligament were mesh-divided.After the material properties were given,the model was imported into ABAQUS software to observe the range of motion of each vertebral body in seven different working conditions of T11-S1,and analyze the biomechanical characteristics of each segment of annulus fibrosus and nucleus pulposus. RESULTS AND CONCLUSION:(1)The range of motion of L1 vertebrae was higher than that of other vertebrae under six different working conditions:extension,forward flexion,rotation(left and right),and lateral flexion(left and right).The maximum range of motion was 2.18° during L1 vertebral flexion,and the minimum range of motion was 0.12° during L5 vertebral extension.(2)The annular fiber flexion at L2-L3 segments was greater than the extension(P<0.05),and the annular fiber flexion at L3-L4 and L4-L5 segments was less than the extension(P<0.05).The left rotation of L1-L2 annular fibers was greater than the right rotation(P<0.05).The left flexion of the annulus was greater than the right flexion in L1-L2,L2-L3,L3-L4,L4-L5 and L5-S1 segments(P<0.05).(3)The nucleus pulposus stresses of T11-L12,L1-L2,L2-L3,L3-L4 and L4-L5 segments in forward flexion were greater than in extension(P<0.05).The left rotation of T12-L1 and L3-L4 segments was smaller than the right rotation(P<0.05),and that of T11-T12,L1-L2,and L2-L3 segments was larger than the right rotation(P<0.05).The left flexion was larger than the right flexion in the T11-S1 segment.(4)It is concluded that in ankylosing spondylitis patients with lumbar kyphosis,the minimum range of motion of the vertebral body is located at the L5 vertebral body in extension.To prevent fractures,it is recommended to avoid exercise in the extension position.During the onset of lumbar kyphosis in patients with ankylosing spondylitis,the maximum stress of the annulus fibrosus and nucleus pulposus is located in the L1-L2 segment,which is fixed and will not alter with the change of body position.The late surgical treatment and correction of deformity should focus on releasing the pressure of the annulus fibrosus and nucleus pulposus in this segment to avoid the rupture of the annulus fibrosus and the injury of the nucleus pulposus.
2.Developing a family meeting centered on dying patients and creating a guidebook: a field study based on hospice centers in tertiary hospitals
Mengmeng WANG ; Yuan QIN ; Peng YUE
Chinese Journal of Practical Nursing 2024;40(28):2172-2179
Objective:To observe family meetings in hospice care centers of tertiary hospitals and to clarify the experience and methods of patient-centered communication.Methods:From Agust 2020 to January 2021, the field research was conducted in the hospice wards of Beijing Haidian Hospital for 6 months. Audio, video, and verbatim transcripts were collected from palliative care family meetings by purposive sampling method. Family meeting transcripts were analyzed by a content analysis approach.Results:A total of 25 family meeting recordings and transcripts and 21 case observation data were collected. There were 10 males and 15 females, aged 39-90 years old. Three themes and nine sub-themes were identified to summarize family meetings: patient-centered foundational support and key measures -- preparation for family meeting (environmental preparation, information preparation); patient centered communication implementation path--how the family meeting was conducted (structured communication, professional communication, patient-centered communication); patient-centered communication effectiveness--outcomes after the family meeting (directly facing the current situation, clarifying choices, reducing regrets, feeling humanistic). A family meeting instruction manual had been developed.Conclusions:The patient-centered family meeting for terminal patients is an important platform for tertiary hospitals to achieve systematic communication among medical workers, patients, and their families. Through the family meeting, medical workers, patients, and their families can share information, with patients and their families feeling supported by a multidisciplinary team and humanistic care. The family meeting guidebook is anticipated to enhance the organizational and communication skills of healthcare professionals in facilitating family meetings.
3.Correlation between CT-based arterial radiomics score and the neo-adjuvant treatment response of pancreatic cancer
Mengmeng ZHU ; Yun BIAN ; Chengwei CHEN ; Jian ZHOU ; Na LI ; Yifei GUO ; Ying LI ; Xiaohan YUAN ; Jieyu YU ; Jianping LU
Chinese Journal of Pancreatology 2024;24(3):190-197
Objective:To identify the relationship between the CT arterial radiomics score and the treatment response to neoadjuvant therapy for pancreatic cancer.Methods:The clinical data of 243 pancreatic cancer patients who received surgical resection after neo-adjuvant therapy in the First Affiliated Hospital of Naval Medical University from March 2017 to March 2023 were retrospectively analyzed. Based on the tumor regression grade (TRG), the patients were divided into good response group (TRG 0-1, n=30) and non-good response group (TRG 2-3, n=213). The clinical, radiological and pathological features were compared between two groups. Fully-automated segmentation tool was used for segmenting the arterial CT scan of pancreatic tumor before and after treatment. Python package was applied to extract the radiomics features of tumors after segmentation and the extracted features were reduced and chosen using the least absolute shrinkage and selection operator (Lasso) logistic regression algorithm. Lasso logistic regression formula was applied to calculate the arterial radiomics score. Univariate and multivariate logistic regression models were used to analyze the association between arterial radiomics score and treatment response to neoadjucant therapy. Receiver operating-characteristics (ROC) curve was drawn and area under curve (AUC), specificity, sensitivity and accuracy for evaluating the treatment response were calculated. The clinical usefulness of arterial radiomics score for diagnosing the response of neoadjuvant treatment for pancreatic cancer were determined by decision curve analysis (DCA) . Results:A total of 330 arterial radiomics CT features were obtained, and 9-selected arterial phase features associated with treatment response were determined after being reduced by the Lasso logistic regression algorithm. Univariate analysis showed that the arterial radiomics score, three-dimensional diameter after neoadjuvant therapy, pancreatic contour, T stage, N stage, Peri-pancreatic nerve invasion, lymph-vascular space invasion (LVSI) and invasion of duodenum were all associated with treatment response (all P value <0.05). Multivariate logistic regression analyses confirmed that arterial radiomics score was obviously associated with the neoadjuvant treatment response ( P<0.001). At the cut-off value of 1.93, AUC of the arterial radiomics score for diagnosing neoadjuvant treatment response was 0.92, and the specificity, sensitivity and accuracy was 86.7%, 84.5% and 84.8%. DCA demonstrated that when the percentage for predicting the treatment response by using the arterial radiomics score was >0.2, the patients could benefit from the application of arterial radiomics score for evaluating neoadjuvant therapy response. Conclusions:The arterial radiomics score was strongly correlated with the neoadjuvant treatment response of pancreatic cancer, and can accurately predict neoadjuant treatment efficacy.
4.Quantitative susceptibility mapping assessment of iron deposition in gray matter nuclei and the correlation with cognitive function in cerebral small vessel disease
Mengmeng FENG ; Yuan WANG ; Xiaoyi LIU ; Senhao ZHANG ; Fan YU ; Jie LU
Chinese Journal of Cerebrovascular Diseases 2024;21(9):595-602
Objective To evaluate iron deposition in gray matter nuclei in patients with cerebral small vessel disease(CSVD)based on quantitative susceptibility mapping(QSM)and to analyze its correlation with cognitive function.Methods Patients with CSVD attending the outpatient clinic in the Department of Neurology at Xuanwu Hospital of Capital Medical University from December 2016 to November 2022,and healthy controls recruited from previous studies in the Department of Radiology and Nuclear Medicine at Xuanwu Hospital of Capital Medical University from September 2022 to November 2022 were retrospectively consecutively collected.Baseline data of CSVD patients and healthy controls was collected and compared,including age,sex,past history(hypertension,diabetes,hyperlipidemia),smoking history,alcohol consumption history and Montreal cognitive assessment(MoCA)scale score.MRI of all CSVD patients and healthy controls were collected,including three-dimensional T1 weighted imaging,QSM,T2 weighted imaging,and fluid attenuated inversion recovery(FLAIR)sequence imaging.According to the MRI-related imaging features and CSVD total burden score,the patients were divided into mild CSVD(CSVD-m)group and severe CSVD(CSVD-s)group,and healthy controls were the control group.QSM was used to obtain the susceptibility values of gray matter nuclei for all CSVD patients and controls.One-way covariance analysis and Bonferroni correction were used to compare the gray matter nuclei susceptibility values among the three groups.Spearman correlation analysis was performed between susceptibility values of gray matter nuclei with statistically significant differences in susceptibility values and cognitive function.Results A total of 61 cases of CSVD patients were included,including 29 cases in the CSVD-s group and 32 cases in the CSVD-m group;32 healthy controls were included in the control group.(1)There was no statistically significant difference in age,sex,hypertension,diabetes,hyperlipidemia,smoking,and alcohol consumption between the CSVD-s group,CSVD-m group and control group(all P>0.05).The MoCA scale scores of the CSVD-s group and CSVD-m group were lower than those of the control group(25.0[22.5,27.5]points,27.0[25.0,29.0]points than 28.0[27.0,29.0]points,H=15.006,P<0.01).The difference in the imaging features distribution of cerebral microbleeds,white matter hyperintensity,and perivascular space among the CSVD-s group and the CSVD-m group was statistically significant(all P<0.05).(2)The differences in susceptibility values of the left putamen(F=4.790),pallidus(F=12.896),hippocampus(F=3.904)and the right putamen(F=36.278),pallidus(F=39.449),caudate nucleus(F=6.797),and thalamus(F=6.525)were statistically significant among the three groups(all P<0.05).After Bonferroni correction,the susceptibility values of the left putamen and pallidus and the right putamen,pallidus,caudate nucleus,and thalamus in the CSVD-s group were higher than those of the control group(all P<0.05);the susceptibility values of the left pallidus and the right pallidus,putamen,and thalamus in the CSVD-m group were higher than those of the control group(all P<0.01),and the left hippocampus was lower than that of the control group(P=0.045).(3)The susceptibility values of the bilateral putamen were significantly negatively correlated with MoCA scale score(left putamen:rs=-0.316,P=0.015;right putamen:rs=-0.316,P=0.014).Conclusion Abnormal iron metabolism occurs in gray matter nuclei of CSVD patients,and iron deposition in the putamen correlate with cognitive dysfunction.
5.Effect and mechanism of Glabridin on cognitive impairment from MPTP to Parkinson's disease in mice
Yan ZHAO ; Mengmeng SU ; Lan DU ; Yuan YAO ; Runxiu ZHU
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2024;31(2):178-183
Objective To investigate the improving effect and mechanism of the traditional Chinese herbal medicine Glabridin(GLA)on cognitive impairment in Parkinson's disease(PD)mice induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP),and its protective effect on the cerebral cortex and hippocampus through affecting the extracellular regulated protein kinases(ERK)signaling pathway involved in the regulation of neural plasticity.Methods A total of 120 C57BL//6N mice were randomly divided into control group,model group,GLA control group and MPTP+GLA low,medium and high-dose groups,with 20 mice in each group.The mouse PD model was established by intraperitoneal injection of MPTP 20 mg/kg,and the control group was injected with the same dose of normal saline.The GLA control group was given 50 mg/kg GLA by gavage;the MPTP+GLA low,medium and high dose groups were given 20,30 and 50 mg/kg GLA by gavage 1 hour after each MPTP administration,once a day for 7 consecutive days.The learning and memory abilities of the mice in each group and the pathological changes of hippocampal tissue were observed,as well as the changes in the contents of tumor necrosis factor-α(TNF-α),interleukin-18(IL-18),malondialdehyde(MDA),superoxide dismutase(SOD),tyrosine hydroxylase(TH)and protein expression levels of phosphorylated-ERK 1/2(p-ERK1/2)in the cerebral cortex.Results Compared with the control group,the levels of MDA and TNF-α,IL-18 in the cerebral cortex of the model group were significantly increased[MDA(nmol/mg):4.68±0.51 vs.2.05±0.22,TNF-α(μg/L):116.87±15.65 vs.48.52±7.83,IL-18(μg/L):57.52±6.89 vs.24.26±1.89,all P<0.05],while the activity of SOD was significantly decreased(U/mg:77.84±7.84 vs.130.89±18.56,P<0.05).Compared with the model group,the contents of TNF-α,IL-18,and MDA in each MPTP+GLA group were significantly decreased,while the activity of SOD was significantly increased(all P<0.05),and the change in the high-dose MPTP+GLA group was more obvious.The learning and memory ability of the high-dose MPTP+GLA group was significantly improved,the number of neurons in the hippocampus tissue decreased,the neurodegeneration was improved,and the glial cell proliferation was reduced.The results of immunohistochemistry showed that compared with the model group,the loss of TH positive cells in the high-dose MPTP+GLA group was significantly reduced[absorbance(A value):cerebral cortex was 39.14±3.25 vs.23.14±3.1,hippocampus was 72.14±4.25 vs.52.16±3.32,both P<0.05],and the expression of p-ERK1/2 positive cells was significantly inhibited(A value:cerebral cortex was 63.91±3.55 vs.88.35±6.41,hippocampus was 73.36±3.52 vs.93.25±6.73,both P<0.05).Western blotting showed that compared with the model group,the protein expression level of cerebral cortex and hippocampus TH in the high-dose MPTP+GLA group was significantly increased(gray value:cerebral cortex was 0.71±0.09 vs.0.53±0.06,hippocampus was 0.68±0.06 vs.0.45±0.03,both P<0.05),and the protein expression level of p-ERK1/2 was significantly inhibited(gray value:cerebral cortex was 0.76±0.10 vs.0.96±0.08,hippocampus was 0.74±0.06 vs.0.96±0.12,both P<0.05).Conclusions The traditional Chinese medicine GLA can improve the learning and memory ability of MPTP-induced PD mice,as well as prevent and treat MPTP-induced neuronal damage and glial cell proliferation.The ERK signaling pathway is associated with neural damage in PD brain tissue.GLA protects the learning and memory ability of MPTP-induced PD mice by inhibiting the ERK signaling pathway.
6.Association between MPV,PDW,PCT and Cardiac Function in Patients with Pulmonary Hypertension
Yan QIU ; Yinli WANG ; Mengmeng YANG ; Liangmin GUO ; Longhui YUAN
Journal of Kunming Medical University 2023;44(12):121-126
Objective To study the association between mean platelet volume(MPV),platelet distribution width(PDW)and procalcitonin(PCT)and cardiac function in patients with pulmonary hypertension(PH)and their diagnostic value on heart failure.Methods 103 patients with PH(PH group)in the 3rd People's Hospital of Chengdu from October 2021 to October 2022 and 103 healthy subjects with physical examination(control group)were selected as study subjects.Fasting peripheral venous blood was collected on the 1st day of admission and MPV,PDW and PCT were detected.The left ventricular ejection fraction(LVEF)was measured and the cardiac function was evaluated by New York Heart Association(NYHA)grading criteria.The patients with PH were divided into failure group and non-failure group according to the diagnosis results of heart failure.The relations of MPV,PDW and PCT with cardiac function in patients with PH and the diagnostic value on heart failure were analyzed.Results The levels of MPV,PDW,and PCT were all higher in the experimental group compared to the control group,while the LVEF was lower,and these differences were statistically significant(P<0.05);as the NYHA classification increased,the levels of MPV,PDW,and PCT showed an increasing trend,while LVEF showed a decreasing trend,and the differences between the groups were statistically significant(P<0.05);in the heart failure group n = 65,the levels of MPV,PDW,and PCT were higher compared to the non-heart failure group n = 38,while LVEF was lower,and these differences were statistically significant(P<0.05).The levels of MPV,PDW,and PCT werr signifi-cantly positively correlated with NYHA functional classification and LVEF(P<0.05).The levels of MPV,PDW,and PCT had good reference value for the diagnosis of heart failure in PH patients,with AUC values of 0.816,0.897,and 0.825 respectively,and the combined diagnostic AUC is 0.952,which wass statistically different from the application of the three indicators alone(P<0.05).Conclusion RDW,PDW and PCT are closely related to cardiac function in patients with PH,and can provide reference information for diagnosis and treatment of heart failure in patients with PH.
7.Differentiating pancreatic adenosquamous carcinoma from pancreatic ductal adenocarcinoma by CT radiomic and deep learning features
Qi LI ; Jian ZHOU ; Xu FANG ; Jieyu YU ; Mengmeng ZHU ; Xiaohan YUAN ; Ying LI ; Yifei GUO ; Jun WANG ; Shiyue CHEN ; Yun BIAN ; Chenwei SHAO
Chinese Journal of Pancreatology 2023;23(3):171-179
Objective:To develop and validate the models based on mixed enhanced computed tomography (CT) radiomics and deep learning features, and evaluate the efficacy for differentiating pancreatic adenosquamous carcinoma (PASC) from pancreatic ductal adenocarcinoma (PDAC) before surgery.Methods:The clinical data of 201 patients with surgically resected and histopathologically confirmed PASC (PASC group) and 332 patients with surgically resected histopathologically confirmed PDAC (PDAC group) who underwent enhanced CT within 1 month before surgery in the First Affiliated Hospital of Naval Medical University from January 2011 to December 2020 were retrospectively collected. The patients were chronologically divided into a training set (treated between January 2011 and January 2018, 156 patients with PASC and 241 patients with PDAC) and a validation set (treated between February 2018 and December 2020, 45 patients with PASC and 91 patients with PDAC) according to the international consensus on the predictive model. The nnU-Net model was used for pancreatic tumor automatic segmentation, the clinical and CT images were evaluated, and radiomics features and deep learning features during portal vein phase were extracted; then the features were dimensionally reduced and screened. Binary logistic analysis was performed to develop the clinical, radiomics and deep learning models in the training set. The models' performances were determined by area under the ROC curve (AUC), sensitivity, specificity, accuracy, and decision curve analysis (DCA).Results:Significant differences were observed in tumor size, ring-enhancement, upstream pancreatic parenchymal atrophy and cystic degeneration of tumor both in PASC and PDAC group in the training and validation set (all P value <0.05). The multivariable logistic regression analysis showed the tumor size, ring-enhancement, dilation of the common bile duct and upstream pancreatic parenchymal atrophy were associated with PASC significantly in the clinical model. The ring-enhancement, dilation of the common bile duct, upstream pancreatic parenchymal atrophy and radiomics score were associated with PASC significantly in the radiomics model. The ring-enhancement, upstream pancreatic parenchymal atrophy and deep learning score were associated with PASC significantly in the deep learning model. The diagnostic efficacy of the deep learning model was highest, and the AUC, sensitivity, specificity, and accuracy of the deep learning model was 0.86 (95% CI 0.82-0.90), 75.00%, 84.23%, and 80.60% and those of clinical and radiomics models were 0.81 (95% CI 0.76-0.85), 62.18%, 85.89%, 76.57% and 0.84 (95% CI 0.80-0.88), 73.08%, 82.16%, 78.59% in the training set. In the validation set, the area AUC, sensitivity, specificity, and accuracy of deep learning model were 0.78 (95% CI 0.67-0.84), 68.89%, 78.02% and 75.00%, those of clinical and radiomics were 0.72 (95% CI 0.63-0.81), 77.78%, 59.34%, 65.44% and 0.75 (95% CI 0.66-0.84), 86.67%, 56.04%, 66.18%. The DCA in the training and validation sets showed that if the threshold probabilities were >0.05 and >0.1, respectively, using the deep learning model to distinguish PASC from PDAC was more beneficial for the patients than the treat-all-patients as having PDAC scheme or the treat-all-patients as having PASC scheme. Conclusions:The deep learning model based on CT automatic image segmentation of pancreatic neoplasm could effectively differentiate PASC from PDAC, and provide a new non-invasive method for confirming PASC before surgery.
8.Exploration and application of flipped classroom model in theory teaching of psychiatry: with the teaching of "anxiety disorder" as an example
Yuan WANG ; Miao PENG ; Yinglin HUANG ; Jie QIN ; Mengmeng ZHOU ; Qian GAO ; Qi SHI
Chinese Journal of Medical Education Research 2023;22(4):524-527
Objective:To investigate the effect of flipped classroom model in the theory teaching of psychiatry for medical undergraduates.Methods:A total of 121 students from grade 2014 were randomly divided into observation group and control group. The observation group was given flipped classroom teaching and the control group was given traditional teaching. In order to evaluate the teaching effect of flipped classroom, the students in the observation group were evaluated by comparing the test scores of the two groups in class and using the self-made questionnaire. SPSS 18.0 was used to conduct t-test. Results:The results showed that the average score of the observation group was significantly higher than that of the control group ( P < 0.05). The results of teaching effect showed that there were 60 students in the observation group, among which 96.7% (58 students) believed that flipped classroom teaching was beneficial to promoting pre-class preview, improving teamwork ability, autonomous learning ability and teacher-student communication; 95.0% (57 students) thought they were satisfied with flipped classroom teaching, which was conducive to linking theory with practice; 93.3% (56 students) thought that they could arouse their interest in learning, improve their attention, and improve their ability to analyze and solve problems; 90.0% (54 students) thought flipped classroom was superior to traditional classroom and helpful to their future study; 86.7% (52 students) did not think their study burden was increased. Conclusion:The flipped classroom model can stimulate students' interest and attention, and promote the combination of independent learning and interactive learning, which has a better effect than the traditional teaching model in the theory teaching of psychiatry and is easily accepted by students. Therefore, it holds promise for application.
9.Roles of m6A modification in neurological diseases.
Yuan ZHANG ; Si ZHANG ; Mengmeng SHI ; Menglin LI ; Jiayu ZENG ; Jie HE
Journal of Central South University(Medical Sciences) 2022;47(1):109-115
N6-methyladenosine (m6A) methylation modification is one of the most common epigenetic modifications for eukaryotic mRNA. Under the catalytic regulation of relevant enzymes, m6A participates in the body's pathophysiological processes via mediating RNA transcription, splicing, translation, and decay. In the past, we mainly focused on the regulation of m6A in tumors such as hematological tumors, cervical cancer, breast cancer. In recent years, it has been found that m6A is enriched in mRNAs of neurogenesis, cell cycle, and neuron differentiation. Its regulation in the nervous system is gradually being recognized. When the level of m6A modification and the expression levels of relevant enzyme proteins are changed, it will cause neurological dysfunction and participate in the occurrence and conversion of neurological diseases. Recent studies have found that the m6A modification and its associated enzymes were involved in major depressive disorder, Parkinson's disease, Alzheimer's disease, Fragile X syndrome, amyotrophic lateral sclerosis, and traumatic brain injury, and they also play a key role in the development of neurological diseases and many other neurological diseases. This paper mainly reviewed the recent progress of m6A modification-related enzymes, focusing on the impact of m6A modification and related enzyme-mediated regulation of gene expression on the central nervous system diseases, so as to provide potential targets for the prevention of neurological diseases.
Adenosine/metabolism*
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Depressive Disorder, Major
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Epigenesis, Genetic
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Humans
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Methylation
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RNA, Messenger/metabolism*
10.Ascending, Descending, Floating and Sinking Properties of Descurainiae Semen Lepidii Semen Based on Pulmonary Edema Model
Mengmeng WANG ; Yingying KE ; Wangyang MI ; Zengfu SHAN ; Peipei YUAN ; Weisheng FENG ; Xiaoke ZHENG
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(15):42-52
ObjectiveThe pulmonary edema (PE) model where the disease was located in the viscera was established according to the treatment principle that patients with the disease location inside should be treated with descending and sinking medicine, combined with changes in the disease tendency, to verify the scientificity of descending and sinking properties of Descurainiae Semen Lepidii Semen (SD), and to preliminarily elucidate the scientific connotation of descending, ascending, floating and sinking of Chinese medicine. MethodSixty male SD rats were randomly divided into normal control group, model group (20 mg·kg-1), positive drug group (dexamethasone, 0.075 mg·kg-1) and SD low (1.167 g·kg-1), medium (2.334 g·kg-1)and high (4.668 g·kg-1) dose groups. The PE model was established by intrapleural injection of 1% carrageenan (2 mL·kg-1). The evaluation indexes (lung autopsy, amount of pleural effusion, number of white blood cells, lung wet/dry weight ratio, lung water content and lung permeability) were tested to determine the optimal dose of SD decoction for intervention of PE. The relevant indexes of the five major systems (central nervous system, respiratory system, circulatory system, digestive system and urinary system) closely related to the body's Qi movement were detected and changes in the disease tendency in PE rats were analyzed, to determine the descending, ascending, floating and sinking properties of SD. In addition, histopathological changes were investigated by hematoxylin-eosin (HE) staining, and types and numbers of inflammatory cells and mediators were detected to preliminarily explore the mechanism of SD in improving PE. ResultCompared with the conditions in the normal control group, the amount of pleural effusion, number of white blood cells in pleural effusion, lung wet/dry weight ratio, lung water content and lung permeability were increased (P<0.01) in the model group, where the rats presented cough, dyspnea, shortness of breath and arched back, and a small number of them had wet nose and bubble liquid in nostrils. In the autopsy of the rats in the model group, the lungs were enlarged or accompanied by congestion and plenty of pink bubble liquid appeared at the trachea. Compared with the conditions in the model group, SD reduced the amount of pleural effusion, number of white blood cells in pleural effusion, lung coefficient, lung wet/dry weight ratio and lung water content (P<0.01), and improved pulmonary edema symptoms such as damage, inflammation and infiltration around the lumen, thickening of the trachea, and accumulation of edema fluid, and the SD medium dose group had the best effect on the treatment of PE. In terms of respiratory system, compared with the normal control group, the model group had reduced latent time of cough and asthma (P<0.05, P<0.01) and elevated number of cough and wheezing (P<0.01). The three SD groups had increased latent time of cough and asthma and decreased number of cough and wheezing (P<0.01). In terms of urinary system, compared with the normal control group, the model group presented decreased urine volume. The SD low, medium and high dose groups had increased urine volume (P<0.05, P<0.01), but they had no effect on perspiration. In terms of digestive system, compared with the conditions in the normal control group, the gastric residual rate and gastrin (GT) level were increased (P<0.05, P<0.01), and the gastric emptying rate and small intestine transit rate were decreased (P<0.01). The SD low dose group had elevated small intestine transit rate (P<0.01), and the SD high and medium groups had enhanced gastric emptying rate and small intestine transit rate (P<0.01), reduced gastric residual rate, lowered GT level to promote gastrointestinal movement and transportation (P<0.01), and increased motilin (MTL) level to promote gastric emptying in rats (P<0.05, P<0.01). In terms of circulatory system, compared with the normal control group, the model group displayed reduced left ventricular ejection fraction (LVEF), left ventricular short axis shortening rate (LVFS) and cardiac output (CO) (P<0.01), and elevated tendency of heart rate, systolic blood pressure (SBP, P<0.01) and diastolic blood pressure (DBP, P<0.05). Compared with the model group, the SD low dose group increased LVEF and decreased DBP (P<0.05), while the SD medium dose group increased LVEF, LVFS, CO and SBP (P<0.01) and decreased DBP (P<0.05), and the SD high dose group increased LVFS (P<0.01) and decreased SBP (P<0.01) and DBP (P<0.05). In terms of central nervous system, compared with the conditions in the normal control group, the standing times dropped in the model group (P<0.01). SD reduced the movement distance, movement time, standing times and activity time in the center of the open field, and increased the rest time and activity time at the edge of the open field (P<0.05, P<0.01). Moreover, compared with the normal control group, the model group had serious inflammatory infiltration around the lung lumen, thickened trachea with accumulated edema fluid, seriously damaged lung tissue, increased number of white blood cells and percentage of neutrophils in blood (P<0.01), elevated percentage of monocytes, interleukin-4 (IL-4), immunoglobulin E (IgE) level and reactive oxygen species (ROS) level in lung tissue (P<0.05,P<0.01), and decreased IFN-γ in alveolar lavage fluid (P<0.01). Compared with the model group, SD decreased the number of white blood cells, neutrophil accumulation, pulmonary congestion and interstitial edema, IFN-γ and IL-4 levels in alveolar lavage fluid and ROS level in lung tissue, and increased IgE level (P<0.05, P<0.01). ConclusionSD had a significant improvement effect on PE model where the disease was located in the viscera. It could regulate the excretion of water by purgation, regulate Qi movement and expel Qi stagnation by descending and sinking lung Qi, and promote purification and descent of lung qi to make Qi movement downward. This indicated SD had the descending and sinking properties. The medium dose of SD decoction exerted the best effect, and its mechanism of action might be through regulating the neutrophil inflammatory response.

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