Role of inflammatory factors in diabetic ulcers and prospects of traditional Chinese medicine intervention / 中国组织工程研究

BACKGROUND:Diabetic ulcers are a common complication of diabetes mellitus,which is manifested as foot ulcers complicated with infection,long treatment cycle,high disability rate and mortality rate,and brings a heavy burden to patients and social care. OBJECTIVE:To review the mechanism of action and the latest treatment progress of traditional Chinese medicine(TCM)in the treatment of diabetic ulcers,and to provide a basis for further theoretical research and clinical application. METHODS:CNKI,WanFang Database and PubMed database were searched for relevant literature using the keywords of"diabetic ulcer,medicinal herb,inflammation,interleukin-1β,interleukin-6,tumor necrosis factor,hypersensitive C-reactive protein,γ-interferon,interleukin-4,interleukin-10"in Chinese and English,respectively.The relevant literature in recent years was searched,and finally 75 articles were included for review. RESULTS AND CONCLUSION:The high glucose environment of the body will increase the level of pro-inflammatory cytokines,so that diabetic ulcer wounds are in a state of chronic inflammatory response for a long time,and difficult to heal or even not heal.TCM has summed up a lot of experience in the long-term struggle with diabetic ulcer.At present,TCM divides diabetic ulcers into four syndrome types:dampness and heat poison syndrome,blood and blood stasis obstruction pattern,heat poison injury Yin pattern,and Qi and blood deficiency syndrome,as well as representative prescriptions for treatment.According to their clinical characteristics,diabetic ulcers can be also divided into three stages:primary,middle and late stages.Different treatment methods are proposed:"clear method,""warm and clear combined use"and"maintenance method."Under the guidance of dialectical typing and staging of TCM,TCM monomers,extracts and compounds inhibit the inflammatory response and promote the healing of diabetic ulcers by down-regulating the expression of pro-inflammatory factors and/or up-regulating the expression of anti-inflammatory factors.Compared with modern medicine,TCM has significant advantages in the treatment of diabetic ulcers.There are many TCM monomers,extracts and compounds for the treatment of diabetic ulcers,such as angelica,curcumin,improved Chonghe ointment,Sanhuang blood exhaustion prescription and sore-ulcer I.formula,etc.It has been found that TCM for the treatment of diabetic ulcers is mainly heat-clearing and detoxifying,invigorating blood circulation and removing blood stasis,and amassing sores and muscle-building drugs,and the frequency of use,treatment scope and therapeutic effect of TCM compounds are obviously better than those of TCM monomers and extracts.Among them,the most commonly used are the Sanhuang blood exhaustion prescription and the sore-ulcer I as well as prescription for the treatment of damp heat toxicity syndrome and Zizhu ointment for the treatment of non-ischemic diabetic ulcers.However,there are also some shortcomings in the treatment of diabetic ulcers with TCM.First,there are few clinical syndrome studies on diabetic ulcers.Secondly,there are a wide variety of TCM monomers,extracts and compounds for the treatment of diabetic ulcers,and the relevant research is insufficiently in-depth.Finally,the research on the mechanism underlying TCM treatment of diabetic ulcers is still in the preliminary exploration stage,and the mechanism of action still needs to be further explored.In the future,it is necessary to strengthen the research on the pharmacology of TCM and the clinical syndrome of diabetic ulcers,analyze the potential targets and related signaling pathways of TCM in the treatment of diabetic ulcers,give full play to the therapeutic advantages of TCM with multiple targets,multiple pathways,multiple levels and multiple systems,and develop TCM with significant efficacy,active ingredients and clear targets.

Perfluorooctanoic acid-induced lipid metabolism disorder in SD rat liver and its effect on the expression of fatty acid metabolism-related proteins / 中南大学学报(医学版)

OBJECTIVES@#Perfluorooctanoic acid (PFOA) can cause lipid metabolism disorders in animal body and affect the lipolysis and synthesis of fatty acids. Peroxisome proliferators-activated receptor (PPAR) plays an extremely important role in this process. This study aims to explore the effects of PFOA on liver lipid metabolism disorders in Sprague Dewley (SD) rats and the expression of PPAR.@*METHODS@#A total of 40 male SD rats were randomly divided into 4 groups (n=10 in each group): a control group (ddH2O), a low-dose PFOA group [PFOA 1.25 mg/(kg·d)], a middle-dose PFOA group [PFOA 5.00 mg/(kg·d)], and a high-dose PFOA group [PFOA 20.00 mg/(kg·d)]. The rats were fed with normal diet, and PFOA exposure were performed by oral gavage for 14 days, and the rats were observed, weighted and recorded every day during the exposure. After the exposure, the blood was collected, and the livers were quickly stripped after the rats were killed. Part of the liver tissues were fixed in 4% paraformaldehyde for periodic acid-schiff (PAS) staining; the contents of HDLC, LDLC, TG, TC in serum and liver tissues, as well as the activities of their related enzymes were assayed; The expression levels of cyclic adenosine monophosphate-response element binding protein (Cbp), general control of amino acid synthesis 5-like 2 (Gcn5L2), peroxidation peroxisome proliferation factor activated receptor γ (PPAR), silent information regulator 1 (Sirt1) and human retinoid X receptor alpha 2 (Rxrα2) ) were detected by Western blotting.@*RESULTS@#After 14 days of PFOA exposure, the PAS staining positive particles in the cytoplasm and nucleus of SD rats in the medium and high dose groups were significantly reduced compared with the control group. The serum levels of LDLC and TC in the low-dose and middle-dose groups were significantly reduced compared with the control group (all P<0.05), while the high-dose group showed an increasing tendency, without siginificant difference (P>0.05), there was no significant difference in HDLC and TG (both P>0.05). The activities of alkaline phosphatase (AKP) and alanine aminotransferase (ALT) were increased significantly (both P<0.05) compared with control group; the ratio of ALT/aspartate aminotransferase (AST) in the high-dose group was increased significantly (P<0.05), there was no significant difference in LDH and TG (both P>0.05); the HDLC content in the liver tissues in the high-dose group was significantly reduced, compared with the control group (P<0.05); the TC contents in the liver tissues in the low, medium and high-dose groups were significantly increased (all P<0.05), there was no significant difference in LDLC and TG (both P>0.05); the AKP activity in the livers in the medium and high-dose groups was significantly increased (both P<0.05), there was no siginificant difference in LDH, ALT, and the ratio of ALT/AST (all P>0.05); the protein expression levels of Ppar γ, Cbp and Rxrα2 in the liver in the high dose groups were significantly down-regulated compared with the control group (all P<0.05), while the protein expression levels of Sirt1 were significantly up-regulated (all P<0.05).@*CONCLUSIONS@#PFOA exposure can cause lipid metabolism disorder and glycogen reduction in SD rat livers, which may be related to the activation of Sirt1 and inhibition of Ppar γ expression, leading to affecting the normal metabolism of fatty acids and promoting glycolysis.

Treatment of clavicle fractures with closed reduction and titanium elastic nail fixation under precise guidance of intraoperative ultrasound / 中华创伤骨科杂志

Objective:To evaluate the precise guidance of intraoperative ultrasound for closed reduction and fixation with intramedullary titanium elastic nail (TEN) in the treatment of clavicle fractures.Methods:The data of 40 patients with fresh clavicle fracture were retrospectively analyzed who had undergone closed reduction and TEN fixation under precise guidance of intraoperative ultrasound at Department of Emergency Trauma, Shandong Wendeng Osteopathic Hospital from January 2017 to March 2019. They were 25 males and 15 females, aged from 25 to 68 years (average, 52.1 years), with 27 cases on the left side and 13 on the right. Reduction and fixation of the fracture was monitored during operation to avoid iatrogenic injuries to the subclavian brachial plexus nerve, subclavian artery and vein and thoracic cavity. The Neer scoring was used at the last follow-up to assess shoulder joint function and complications were recorded.Results:Closed reduction and TEN fixation was completed uneventfully in all the 40 patients under precise guidance of intraoperative ultrasound. The operation time ranged from 20 to 56 min, averaging 36 min; the blood loss from 10 to 35 mL, averaging 22 mL. No injury occurred to the subclavian brachial plexus, subclavian artery or vein, or thoracic cavity. The 40 patients were followed up for 4 to 6 months (average, 4.8 months). All fractures achieved bony union, with no displacement or breakage of internal fixation, or fracture malunion. At the last follow-up, the shoulder joint function was good, with Neer scores ranging from 85 to 95 points (average, 93.1 points).Conclusion:The precise guidance of intraoperative ultrasound improves surgical accuracy and safety, making the closed reduction and TEN fixation a safe and minimally invasive treatment for clavicle fractures.

Immediate and long-term curative effect and safety assessment of laparoscopic surgery treated for advanced gastric cancer / 中国现代普通外科进展

Objective:To analyse immediate and long-term curative effect and safety assessment of Laparoscopic surgery treated for advanced gastric cancer.80 cases with advanced gastric cancer treated in our hospital from August 2012 to August 2014 were selected.All the patients divided into laparoscopic operation group and laparotomy group according to the different operation method,40 cases in each group,compared surgical characteristics index,incidence of postoperative complications,the median follow-up period,disease-free survival and overall survival of the two groups of patients.The operative time was extended and intraoperatve blood soss decreased,Postoperative exhaust time for the first time and postoperative analgesic use time and post operation hospitalization duration were shortened when the laparoscopic group compared compared to laparotomy group,laparoscopic group compared(P＞0.05).The incidence rate of fever,infection,reflux gastritis,intestinal obstruction,gastric emptying dysfunction,other complications of the two groups had no obvious difference(P＞0.05).The median follow-up period,disease-free survival and overall survival of the two groups had no obvious difference (P＞0.05).The laparoscopic surgery for advanced gastric cancer can receive obviously clinical advantages and high security,it is worth promoting.