Discovery of effective combination from Renshen-Fuzi herbal pair against heart failure by spectrum-effect relationship analysis and zebrafish models.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional herbal pair Ginseng Radix et Rhizoma (roots and rhizomes of Panax ginseng C.A. Mey, Renshen in Chinese) and Aconiti Lateralis Radix Praeparata (lateral roots of Aconitum carmichaelii Debeaux, Fuzi in Chinese), composition of two traditional Chinese medicinal herbs, has been widely used in traditional Chinese medicine formula, in which Shenfu decoction has been used clinically in China for the treatment of heart failure at present. AIM OF THE STUDY: Although the ginsenosides and aconite alkaloids have been proven as the essential bioactive components in Renshen-Fuzi herbal pair, the exact composition of effective components to combat heart failure are still unclear. Therefore, spectrum-effect relationship analysis was performed to reveal its effective combination for anti-heart failure effect. MATERIALS AND METHODS: Firstly, the chemical constituents of Renshen-Fuzi herbal pair were identified using ultra high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UHPLC-QTOF MS). The 39 major compounds in Renshen-Fuzi with five different compatibility ratios were simultaneously quantified using ultra high-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UHPLC-QQQ MS/MS). Subsequently, zebrafish models induced by verapamil hydrochloride were constructed and four heart failure-related indexes were selected for pharmacodynamic evaluation of Renshen-Fuzi. To analyze the spectrum-effect relationships, partial least squares regression (PLSR) models were established among the contents of 39 compounds in Renshen-Fuzi with each pharmacodynamic index. According to the contribution of each compound to the whole efficacy, 12 compounds were finally screened out as the effective combination. RESULTS: A total of 157 chemical compounds of Renshen-Fuzi herbal pair were identified, in which 39 components were simultaneously determined. The pharmacological effects indicated that Renshen-Fuzi with 1:2 ratio exhibited the best effect based on zebrafish model, which could improve cardiac output and blood flow velocity and inhibit pericardial enlargement and venous blood stasis significantly. A combination of 9 ginsenosides and 3 aconite alkaloids based on a component-efficacy modeling by PLSR was screened, and exerted approximately equivalent pharmacological effects compared with Renshen-Fuzi herbal pair. CONCLUSIONS: Our findings elucidated the effective combination of Renshen-Fuzi herbal pair that has been used in clinic for the treatment of heart failure, which could also promote the pharmacological research and quality control of their formula such as Shenfu decoction.

Value of Intrauterine Autologous Platelet-Rich Plasma Therapy on Endometrial Receptivity: A Literature Review.

Endometrial receptivity is an important factor that influences embryo implantation. Thus, it is important to identify an applicable approach to improve endometrial receptivity in women undergoing assisted reproductive technology. Recently, growing evidence has indicated that intrauterine platelet-rich plasma (PRP) infusion is an effective method to obtain a satisfactory reproductive outcome by increasing endometrial thickness and improving endometrial receptivity. Therefore, the present review aims to outline the possible mechanisms of PRP on endometrial receptivity and summarize the present literature on the effects of PRP therapy in improving endometrial receptivity.

Successful treatment with danhong injection for hepatic veno-occlusive disease.

Hepatic veno-occlusive disease (HVOD) is a clinical syndrome characterized as hepatomegaly, ascites, jaundice and elevation of hepatic enzymes as an outcome from fibrous obliteration of small centrilobular hepatic venules. It is recognized as a rare but life-threatening complication of organ transplantation, tumor eradication chemotherapy and is associated with haematopoietic stem cell transplantation (SCT). Recent researches report that ingestion of plants which contain pyrrolizidine alkaloids (PAs) is associated with the onset of HVOD with unclear pathogenesis. Nowadays, there is no effective therapeutic strategy for HVOD besides supportive care using diuretics or albumin. In our case, a 42-year-old woman administered a concoction of Chinese traditional medicine supposed to contain PAs, was found to develop HVOD confirmed by liver biopsy. A therapeutic strategy was developed using Danhong injection, accompanied with supportive care, and obtained a favorable response manifesting as regression of symptoms and decline of hepatic enzymes. Danhong injection, a Chinese medical product exerting a milder anticoagulation and antithrombotic effect, is beneficial to HVOD probably by promoting microcirculation, ameliorating liver function and inhibiting hepatic fibrosis.

The role of postoperative colonoscopic surveillance after radical surgery for colorectal cancer: a prospective, randomized clinical study.

BACKGROUND: Although colonoscopy plays an important role in postoperative surveillance of patients with colorectal cancer, the optimum protocol for colonoscopic surveillance has not been established. OBJECTIVE: Our purpose was to compare the efficacy of 2 different colonoscopic surveillance strategies in terms of both survival and recurrence resectability. DESIGN: Prospective, randomized, controlled trial. SETTING: A teaching hospital in Sun Yat-sen University. PATIENTS: Three hundred twenty-six consecutive patients undergoing radical surgery for colorectal cancer. INTERVENTION: In the intensive colonoscopic surveillance group (ICS group, n = 165), colonoscopy was performed at 3-month intervals for 1 year, at 6-month intervals for the next 2 years, and once a year thereafter. In the routine colonoscopic surveillance group (RCS group, n = 161), colonoscopy was performed at 6 months, 30 months, and 60 months postoperatively. MAIN OUTCOME MEASUREMENTS AND RESULTS: The 5-year survival rate was 77% in the ICS group and 73% in the RCS group (P > .05). Postoperative colorectal cancer was detected in 13 patients (8.1%) in the ICS group and in 18 patients (11.4%) in the RCS group. In the ICS group, there were more asymptomatic postoperative colorectal cancers (P = .04), more patients had reoperation with curative intent (P = .048), and the probability of survival after postoperative colorectal cancer was higher (P = .03). LIMITATION: Lack of detailed characterization of metachronous colorectal adenomas in these patients. CONCLUSIONS: Although the patients in the ICS group had more curative operations for postoperative colorectal cancer and survived significantly longer, ICS itself did not improve overall survival.

Diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography for biliary complications after liver transplantation: report of 12 cases.

OBJECTIVE: To evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications after liver transplantation. METHOD: ERCP was performed via electronic duodenoscopy in 12 patients suspected of having biliary complications such as obstructive jaundice after orthotopic liver transplantation. RESULTS: ERCP displayed common bile duct stenosis or obstruction in 9 cases (including 2 cases with also calculi), common bile duct calculi in 2 cases (including 1 complicated by bile duct dilation) and intrahepatic bile duct thinning in the donor liver in 1 case. Balloon dilation of the common bile duct, calculus removal and metal stent placement in the common bile duct was performed in one case. Calculus removal by Oddi sphincterotomy was carried out in 3 cases. Nasobiliary catheter placement was performed in 2 cases. CONCLUSION: ERCP may serve as the primary modality for diagnosing and treating biliary complications after orthotopic liver transplantation with good safety and effectiveness in most cases.

Recurrent genetic alterations in 26 colorectal carcinomas and 21 adenomas from Chinese patients.

Colorectal cancer (CRC) is one of the most common malignancies worldwide. The incidence of CRC in the Chinese population has increased dramatically during the last two decades; however, nonrandom chromosomal alterations in Chinese patients have not been described. In the present study, comparative genomic hybridization (CGH) was applied to detect recurrent chromosome alterations in 26 primary colorectal carcinomas and 21 colorectal adenomas from Chinese patients. In CRC, several recurrent chromosomal changes were found, including gains of 8q (14/26 cases, 54%), 20q (54%), 3q (50%), 13q (50%), 5p (46%), 7p (42%), 7q (42%), and 12p (38%) and losses of 18q (65%) and 17p (42%). From comparison with previous CGH studies, the frequent gains of 3q and 12p might be distinctive occurrences in Chinese patients. The distribution of frequently found chromosomal alterations in different locations was studied. The gain of 20q was more frequently found in colon cancer (P<0.01) and the gain of 12p was more frequently found in rectal cancer. Chromosomal alterations were found in 19/21 of adenomas; the most frequent chromosomal alteration was the loss of 18q (9/21 cases, 43%). These recurrent alterations provide several starting points for the isolation of candidate oncogenes and tumor suppressor genes.

[A study of diagnosis of primary biliary reflux gastritis].

OBJECTIVE: To study the diadynamic method of primary bile reflux gastritis. METHODS: Endoscopy, histologic examination, symptom analysis and 24-hour gastritic bilirubin monitoring with Bilitec 2000 were performed in 20 healthy subjects (HS) and 42 patients with symptoms of abdominal pain, abdominal distention, nausea and bile vomiting. RESULTS: The total fraction time of bile reflux was higher in 42 patents than in 20 HS [(17.68 +/- 17.89)% vs. (2.92 +/- 2.39)%, P < 0.01]. 23 (55%) of 42 patients showed pathologic duodenogastric reflux (DGR). The incidence of pathologic DGR detected by Bilitec2000 in bile dyed mucous lake, antral mucosal erosion, bile dyed mucous lake accompanied with erosion and bile dyed mucous lake accompanied with middle-hyperemia of antral mucosae found in endoscopy were 86%, 88%, 8/8 and 85% respectively. The diagnosis of bile reflux gastritis (BRG) could be established if the patients with bile dyed mucous lake accompanied with erosion and/or middle-hyperemia of antral mucosae were found to be pathologic DGR. With this criterion, 11 patients were BRG in 42 patients in this study. The active inflammation of antral mucosae in the patients with BRG that without Helicobacter pylori (Hp) infection was more severe than that in the patients with physiologic DGR that without Hp infection significantly (P < 0.05). The symptoms of abdominal distention, nausea and bile vomiting in the patients with BRG were more severe significantly than those in the patients with physiologic DGR respectively (P < 0.05). CONCLUSIONS: Final diagnosis of BRG can be made for the integrity stomach if the patients with bile dyed mucous lake accompanied with erosion and/or middle-hyperemia of antral mucosae were found to be pathologic DGR by Bilitec 2000.

Inhibition of the interleukin-23/interleukin-17 pathway by anti-interleukin-23p19 monoclonal antibody attenuates 2,4,6-trinitrobenzene sulfonic acid-induced Crohn's disease in rats.

The interleukin (IL)-23/IL-17 pathway is considered to be important in the pathogenesis of Crohn's disease (CD). The present study aimed to evaluate the effects of targeting the IL­23/IL­17 pathway using the anti-IL-23p19 monoclonal antibody (mAb) on 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced CD rats. A total of 60 Sprague-Dawley rats were randomly divided into a control group, model group and an anti-IL-23p19 mAb treatment group (administered intramuscularly every week at a dose of 1 ml/mg). Disease activity index (DAI), colon macroscopic damage index (CMDI) and tissue damage index (TDI) were then evaluated. The mRNA expression of IL-23p19, p40 (IL-23/12), retinoic acid-related orphan receptor-γt (ROR­Î³t) and IL­17 in colonic tissues were detected by reverse transcription­polymerase chain reaction and levels of serum IL-23p19, p40, ROR-γt and IL-17 were measured using an enzyme­linked immunosorbent assay. Anti­IL­23p19 mAb was found to effectively attenuate colonic inflammation demonstrated by reduced DAI, CMDI and TDI scores, improvement in pathological evaluation and downregulation of expression levels of IL­23p19, p40 (IL-23/12), ROR-γt and the downstream proinflammatory cytokine, IL-17. Anti-IL-23p19 mAb attenuated TNBS-induced CD in model rats. The possible underlying mechanisms may be associated with inhibition of the IL-23/IL-17 pathway by inhibiting the expression of IL­23p19 and downregulating the downstream proinflammatory cytokine IL­17. Targeting the IL-23/IL-17 pathway may be a relevant and realistic therapeutic approach for the development of additive and alternative treatments to the biologics currently available in the treatment of CD.

[Establishment and maintenance of the way of enteral nutrition support].

Enteral nutrition is the preferred way of clinical nutrition support, especially in critical ill patients. Establishment and maintenance of an appropriate way should be considered to ensure the safety and effectiveness of enteral nutrition support.

Development of a real-time PCR method for the detection of bacterial colonization in rat models of severe acute pancreatitis.

BACKGROUND: Techniques for the fast and accurate detection of bacterial infection are critical for early diagnosis, prevention and treatment of bacterial translocation in clinical severe acute pancreatitis (SAP). In this study, the availability of a real-time PCR method in detection of bacterial colonization in SAP rat models was investigated. METHODS: Samples of blood, mesenteric lymph nodes (MLN), pancreas and liver from 24 specific pathogen-free rats (8 in a control group, 16 in a SAP group) were detected for bacterial infection rates both by agar plate culture and a real-time PCR method, and the results were made contrast. RESULTS: Bacterial infection rates of the blood, MLN, pancreas and liver in the SAP group and the control group by the two different methods were almost the same, which were 5/16, 12/16, 15/16, 12/16 in the SAP group compared with 0/8, 1/8, 0/8, 0/8 in the control group by agar plate culture, while 5/16, 10/16, 13/16, 12/16 and 0/8, 1/8, 0/8, 0/8 respectively by a real-time PCR method. Bacterial number was estimated by real-time PCR, which showed that in the same mass of tissues, the pancreas contained more bacteria than the other three kinds of organs in SAP rats (P < 0.01), that may be due to the edema, necrosis and hemorrhage existing in the pancreas, making it easier for bacteria to invade and breed. CONCLUSION: Fast and accurate detection of bacterial translocation in SAP rat models could be carried out by a real-time PCR procedure.

A simple taurocholate-induced model of severe acute pancreatitis in rats.

AIM: To investigate gut barrier damage and intestinal bacteria translocation in severe acute pancreatitis (SAP), a simple rat model of SAP was induced and studied. METHODS: Pancreatitis was induced by uniformly distributed injection of 3.8% Na taurocholate (1 mL/kg) beneath the pancreatic capsule. Rats in the control group were injected with normal saline in the identical location. RESULTS: Serum amylase, plasma endotoxin, intestinal permeability, and pancreatitis pathology scores were all markedly higher in the pancreatitis group than in the control group (P < 0.01). The bacterial infection rate was significantly higher in the SAP group than in the control group (P < 0.01), observed in parallel by both bacterial culture and real-time polymerase chain reaction. Acute damage of the pancreas was observed histologically in SAP rats, showing interstitial edema, leukocyte infiltration, acinar cell necrosis and hemorrhage. The microstructure of the intestinal mucosa of SAP rats appeared to be destroyed with loose, shortened microvilli and rupture of the intercellular junction, as shown by electron microscopy. CONCLUSION: Significant gut barrier damage and intestinal bacterial translocation were definitely observed with few potential study confounders in this SAP rat model, suggesting that it may be an appropriate animal model for study of gut barrier damage and bacterial translocation in SAP.

Colorectal neoplasia in Asia: a multicenter colonoscopy survey in symptomatic patients.

BACKGROUND: The incidence of colorectal cancer is rising rapidly in some Asian countries. OBJECTIVE: To determine the prevalence and the distribution of colorectal neoplasm in Asian populations. DESIGN: A multicenter colonoscopy survey. PATIENTS: Between July 2004 and April 2005, consecutive symptomatic patients undergoing colonoscopic examinations in 10 different Asian countries. SETTING: The location and the histologic features of all colonic neoplasms were recorded. Advanced neoplasm was defined as adenoma larger than 10 mm in size, with >25% villous features or with high-grade dysplasia or invasive carcinoma. MAIN OUTCOME MEASUREMENTS: The prevalence and the distribution of colorectal neoplasm and advanced neoplasm. RESULTS: A total of 5464 eligible patients underwent colonoscopy. Advanced neoplasm was found in 512 patients (9.4%). Factors associated with the presence of advanced neoplasm in this symptomatic Asian population included male sex (relative risk [RR] 1.52, 95% confidence interval [CI] 1.26-1.84), older age (RR 1.05, 95% CI 1.04-1.06), and ethnicity (P = .001). Advanced proximal neoplasm was detected in 136 patients (2.5%); 83 (61.0%) of the patients had normal distal colon. The RR of proximal advanced neoplasm was 2.5, 95% CI 1.7-3.7 in those with any adenoma in the distal colon compared with those with normal distal colon. LIMITATIONS: Possible underrepresentation of some ethnic groups because of uneven ethnic group distribution and the lack of population-based registry. CONCLUSIONS: This was the first multicenter colonoscopy survey that examined the characteristics of colorectal neoplasm in Asia. The results will have important implications on the planning for future colorectal cancer screening in this region.