Nutrition therapy in critically ill patients with severe acute pancreatitis.

A significant proportion of patients (10%-20%) with acute pancreatitis develop severe acute pancreatitis characterized by pancreatic necrosis, systemic inflammation, and organ failure, commonly requiring intensive care unit (ICU) admission. In this specific population, nutrition therapy is more challenging than that in the general ICU population, primarily because of inevitable gastrointestinal involvement by pancreatic inflammation. In this review, we discussed several key aspects of nutrition therapy in this population, including key pathophysiology that may impede nutrition therapy, the timing and implementation of enteral nutrition and parenteral nutrition, the importance of specific nutrient supplements, and the long-term outcomes that may be addressed by nutrition therapy.

[A single arm clinical study of 86 patients with common type of coronavirus disease 2019 treated by integrated traditional Chinese and Western medicine: multicenter case observation from 7 designated hospitals in Henan Province].

OBJECTIVE: To evaluate the clinical effect of integrated traditional Chinese and Western medicine on common type of coronavirus disease 2019 (COVID-19) in Henan Province. METHODS: A prospective single arm clinical study was performed. Patients with common type of COVID-19 admitted to seven designated hospitals for COVID-19 in Henan Province from January 25th to February 26th, 2020 were enrolled, and treated with integrated traditional Chinese and Western medicine. The negative transformation of 2019 novel coronavirus (2019-nCoV) nucleic acid, disease outcome, hospital stay, clinical symptoms and signs scores, and chest imaging performance were observed. RESULTS: Totally 86 cases were included in the analysis, including 48 males (55.8%), aged 43.5 (35.0, 53.3) years old, 24 patients (27.9%) with previous medical history. Fifty-eight patients were primarily diagnosed COVID-19 and 28 patients were transferred. The 2019-nCoV nucleic acid of 86 cases (100%) turned negative, and the median time of turning negative was 10 (7, 14) days. Eighty-six cases (100%) were discharged from hospital, and none turned into the severe type; the average length of hospital stay was (13.8±5.6) days. The scores of fever, cough, chest tightness, shortness of breath, and fatigue decreased with the treatment time, and the scores of 7 days and 14 days after treatment were significantly lower than those before treatment [fever (points): 0 (0, 0), 0 (0, 0) vs. 1 (0, 1); cough (points): 1 (0, 1), 0 (0, 1) vs. 1 (0, 2); chest tightness (points): 0 (0, 0), 0 (0, 0) vs. 0 (0, 1); shortness of breath (points): 0 (0, 0), 0 (0, 0) vs. 0 (0, 1); fatigue (points): 0 (0, 1), 0 (0, 1) vs. 1 (0, 1); all P < 0.05]. The improvement rate of X ray and CT image was 42.9% (12/28) and 81.0% (64/79), respectively. CONCLUSIONS: The treatment with integrated traditional Chinese and Western medicine has good curative effect on common type of COVID-19 in 7 designated hospitals of Henan Province. It can improve the clinical symptoms, promote the absorption of pulmonary inflammation, and to some extent control the progress of disease and shorten the time of turning negative of virus nucleic acid and hospital stay.

[A multi-center, double-blind, placebo-controlled, randomized trial for effect of Longxue Tongluo capsule in treatment of patients of atherosclerotic thrombotic cerebral infarction with blood-stasis syndrome in convalescence].

To evaluate the effectiveness and safety of Longxue Tongluo capsule on patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, a double-blind, randomized controlled, multi-center clinical trial was conducted. A total of 160 eligible patients were randomly divided into treatment group and control group, with 80 patients in each group, and all of them were orally given Troxerutin pill(three pills each time, three times daily). Longxue Tongluo capsule was applied in the treatment group, while placebo was applied in the control group(two capsules each time, three times daily) for 4 weeks. Main outcomes were measured by ITT analysis. The neurological function deficits scale showed a decrease of 5.17±2.60 in the treatment group, while 4.31±2.31 in the control group, with significant differences between the two groups(P<0.05); the reduction rate in the treatment group (37.2±15.8)% was significantly higher than that in the control group (29.9±15.3)%(P<0.05). In terms of the comprehensive curative effect by ITT, the effective rates in the treatment and control group were 31.6% and 13.5%, respectively(P<0.05). With respect to the efficacy of traditional Chinese medicine syndrome by ITT, the total effective rate of the treatment group was significantly higher than the control group 88.2% vs 68.9%, P<0.05. Three cases of adverse events occurred in this study, including 1 case of diarrhea in treatment group and 2 cases of skin itch and upper respiratory infection in control group. In conclusion, Longxue Tongluo capsule is effective and safe in the treatment of patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, and can effectively alleviate the patients' nerve function defect degree and invalidism, with a good effect on blood stasis syndrome.

A multi-center, double-blind, placebo-controlled, randomized trial for effect of Longxue Tongluo capsule in treatment of patients of atherosclerotic thrombotic cerebral infarction with blood-stasis syndrome in convalescence / 中国中药杂志

To evaluate the effectiveness and safety of Longxue Tongluo capsule on patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, a double-blind, randomized controlled, multi-center clinical trial was conducted. A total of 160 eligible patients were randomly divided into treatment group and control group, with 80 patients in each group, and all of them were orally given Troxerutin pill(three pills each time, three times daily). Longxue Tongluo capsule was applied in the treatment group, while placebo was applied in the control group(two capsules each time, three times daily) for 4 weeks. Main outcomes were measured by ITT analysis. The neurological function deficits scale showed a decrease of 5.17±2.60 in the treatment group, while 4.31±2.31 in the control group, with significant differences between the two groups(P<0.05); the reduction rate in the treatment group (37.2±15.8)% was significantly higher than that in the control group (29.9±15.3)%(P<0.05). In terms of the comprehensive curative effect by ITT, the effective rates in the treatment and control group were 31.6% and 13.5%, respectively(P<0.05). With respect to the efficacy of traditional Chinese medicine syndrome by ITT, the total effective rate of the treatment group was significantly higher than the control group 88.2% vs 68.9%, P<0.05. Three cases of adverse events occurred in this study, including 1 case of diarrhea in treatment group and 2 cases of skin itch and upper respiratory infection in control group. In conclusion, Longxue Tongluo capsule is effective and safe in the treatment of patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, and can effectively alleviate the patients' nerve function defect degree and invalidism, with a good effect on blood stasis syndrome.

Effects of ginsenoside Rg-1 on the proliferation and osteogenic differentiation of human periodontal ligament stem cells.

OBJECTIVE: To evaluate the effects of ginsenoside Rg-1 on the proliferation and osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) and to explore the possible application on the alveolar bone regeneration. METHODS: To determine the optimum concentration, the effects of ginsenoside Rg-1 ranging from 10 to 100 µmol/L were evaluated by 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide, alkaline phosphatase activity and calcium deposition. Expressions of runt-related transcription factor 2, collagen alpha-2(I) chain, osteopontin, osteocalcin protein were examined using real-time polymerase chain reaction. RESULTS: Compared with the control group, a certain concentration (10 µmol/L) of the Rg-1 solution significantly enhanced the proliferation and osteogenic differentiation of hPDLSCs (P<0.05). However, concentrations that exceeds 100 µmol/L led to cytotoxicity whereas concentrations below 10 nmol/L showed no significant effect as compared with the control. CONCLUSION: Ginsenoside Rg-1 can enhance the proliferation and osteogenic differentiation of hPDLSCs at an optimal concentration of 10 µmol/L.

[Effect of electroacupuncture on cerebral PKC isozyme expression levels in cerebral ischemia-reperfusion rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) of "Dingzhongxian" (MS 5) and "Dingpangxian" (MS 8) on the expression of cerebral protein kinase C (PKC) isozymes in local cerebral ischemia reperfusion injury (CI/RI) rats so as to explore its underlying mechanism in protecting ischemic brain tissue. METHODS: Seventy-two Wistar rats were randomized into normal control (n = 8), CI/RI model (model, n = 32), and EA (n = 32) groups. The later two groups were further divided into 4, 12, 24 and 72 h subgroups, respectively, with 8 rats in each. CI/RI model was established by occlusion of the middle cerebral artery under anesthesia and reperfusion for 4, 12, 24 and 72 h, respectively. EA (1 mA, 2 Hz/15 Hz) was applied to "Dingzhongxian" (MS5) and "Dingpangxian" (MS8) for 10 min every time, and once again every 12 h after modeling. The expression of PKCgamma and PKCdelta in the ischemic cortex tissue was detected using immunohistochemistry. TdT-mediated dUTP Nick-End Labeling was used to detect neuronal apoptosis of the local ischemic cerebral cortex. RESULTS: In comparison with the normal group, the expression levels of cerebral PKCgamma and PKCdelta proteins as well as the number of the apoptotic neurons at time-points of 4, 12, 24 and 72 h after modeling were increased apparently in the model group (P < 0.01); while compared with the model group, cerebral PKCgamma and PKCdelta protein expressions and the apoptotic neuronal number were decreased considerably in the EA group (P < 0.01, P < 0.05). No significant differences were found among the 4 time-points in the expression levels of PKCgamma and PKCdelta and apoptotic neuronal number in the model group and EA group (P > 0.05). CONCLUSION: EA intervention can effectively down-regulate expressions of cerebral PKCgamma, PKCdelta proteins and apoptotic neuronal number in cerebral ischemia rats, which may contribute to its effect in protecting the ischemic cerebral tissue.

Acupuncture intervention in ischemic stroke: a randomized controlled prospective study.

Stroke is one of the most common causes of death and few pharmacological therapies show benefits in ischemic stroke. In this study, 290 patients aged 40-75 years old with first onset of acute ischemic stroke (more than 24 hours but within 14 days) were treated with standard treatments, and then were randomly allocated into an intervention group (treated with resuscitating acupuncture) and a control group (treated using sham-acupoints). Primary outcome measures included Barthel Index (BI), relapse and death up to six months. For the 290 patients in both groups, one case in the intervention group died, and two cases in the control group died from the disease (p = 0.558). Six patients of the 144 cases in the intervention group had relapse, whereas 34 of 143 patients had relapse in the control group (p < 0.001). The mean values for BI at six months were 70.25 ± 20.37 and 57.43 ± 19.61 for the two groups, respectively (p < 0.01). Acupuncture resulted in a significant difference between the two groups for the National Institute of Health Stroke Scale (NIHSS), not at two weeks (7.03 ± 3.201 vs. 8.13 ± 3.634; p = 0.067), but at four weeks (4.15 ± 2.032 vs. 6.35 ± 3.131, p < 0.01). The Chinese Stroke Scale (CSS) at four weeks showed more improvement in the intervention group than that in the control group (9.40 ± 4.51 vs. 13.09 ± 5.80, p < 0.001). Stroke Specific Quality of Life Scale (SS-QOL) at six months was higher in the intervention group (166.63 ± 45.70) than the control group (143.60 ± 50.24; p < 0.01). The results of this clinical trial showed a clinically relevant decrease of relapse in patients treated with resuscitating acupuncture intervention by the end of six months, compared with needling at the sham-acupoints. The resuscitating acupuncture intervention could also improve self-care ability and quality of life, evaluated with BI, NIHSS, CSS, Oxford Handicap Scale (OHS), and SS-QOL.

[Multi-central controlled study on acupuncture for treatment of cerebral infarction in restoration stage].

OBJECTIVE: To probe into long-term therapeutic effect and safety of Xingnao Kaiqiao acupuncture for treatment of cerebral infarction in restoration stage. METHODS: Two hundred and thirty-four cases of cerebral infarction in restoration stage were randomly assigned to a Xingnao group and a routine group. The Xingnao group (n=116) were treated by Xingnao Kaiqiao acupuncture (once each day, for 4 weeks) and routine treatment of western medicine, and the routine group (n=118) were treated with routine acupuncture and the routine treatment of western medicine. They were followed-up for 6 months. The main indexes living, treatment and recurrence at the end of the following survey and the secondary indexes assessment of nervous functions at the end of the following survey, and the incidence rate of bad events in acupuncture were observed. RESULTS: The death rate was 0.86% and the continuing treatment rate was 36.21% in the Xingnao group, and 1.69% and 36.44% in the routine group, with no significant difference between the two groups (both P>0.05) at the following-up of 6 months; the Xingnao group in decreasing recurrent rate and improving nervous function was better than the routine group (P<0.01); no severe adverse response was found in the 2 groups. CONCLUSION: Xingnao Kaiqiao acupuncture is safe and it is superior to routine acupuncture in long-term therapeutic effect, decreasing recurrence rate, improving nervous function.

Multi-central controlled study on acupuncture for treatment of cerebral infarction in restoration stage / 中国针灸

<p><b>OBJECTIVE</b>To probe into long-term therapeutic effect and safety of Xingnao Kaiqiao acupuncture for treatment of cerebral infarction in restoration stage.</p><p><b>METHODS</b>Two hundred and thirty-four cases of cerebral infarction in restoration stage were randomly assigned to a Xingnao group and a routine group. The Xingnao group (n=116) were treated by Xingnao Kaiqiao acupuncture (once each day, for 4 weeks) and routine treatment of western medicine, and the routine group (n=118) were treated with routine acupuncture and the routine treatment of western medicine. They were followed-up for 6 months. The main indexes living, treatment and recurrence at the end of the following survey and the secondary indexes assessment of nervous functions at the end of the following survey, and the incidence rate of bad events in acupuncture were observed.</p><p><b>RESULTS</b>The death rate was 0.86% and the continuing treatment rate was 36.21% in the Xingnao group, and 1.69% and 36.44% in the routine group, with no significant difference between the two groups (both P>0.05) at the following-up of 6 months; the Xingnao group in decreasing recurrent rate and improving nervous function was better than the routine group (P<0.01); no severe adverse response was found in the 2 groups.</p><p><b>CONCLUSION</b>Xingnao Kaiqiao acupuncture is safe and it is superior to routine acupuncture in long-term therapeutic effect, decreasing recurrence rate, improving nervous function.</p>

[The duration and amount of fire (huo hou) in drug processing].

The unique connotations for the special terms such as slow fire (wen huo), strong fire (wu huo), moderate fire (wen wu huo), ma tong fire, husk fire (kang huo), reed fire (lu di huo), mulberry fire (sang cai huo) and charcoal fire (tan huo) are investigated. There are many practical examples of these terms in related literature. The drug process is related to the alchemy in Taoism. The methods of fire control in drug processing are mostly from the literature on Alchemy (dan jing). The expression of these special terms and their connotations are different in various literature, because of their different traditions.

[Comparative studies on purgative potency among three spieces of certified rhubarb].

OBJECTIVE: To investigate the difference and causes of purgative activity in three species of certified rhubarb, so as to lay steady foundations of further research on assessing purgative activity impersonally by using measurable indexes. METHOD: The potencies of three species were comparied with purgative ED, of mice as quantitative index which were calculated, and activities of Na+ K + -ATP ase in mouse colonic epithelial cell membrane were also investigated . The related purgative contents (conjunct and free rhein, chrysophanol, chrysophanic acid, sennoside A) were detected by HPLC and contents (total anthraquinones, anthraglucosennin; conjunct and free anthraquinones) were detected by UV. RESULT: There were different purgative activities among three spieces of certified rhubarb. Each purgative ED, of mice was Rheum tanguticum ( ED50 = 0. 37 g x kg (-1)) , R. officinale ( ED50 = 0. 99 g x kg(-1) ) and R. palrnatum from Gansu (ED50 = 1. 83 g x kg(-1)) , the ratio of potency of those was 4. 94: 1. 85: 1. In the meanwhile, the difference of the inhibitory effect on Na+ -K + -ATP ase in mouse colonic epithelial cell membrane and relative purgative components also existed in the three species of certified rhubarb. CONCLUSION: It disclosed that there was notable diference of purgative activity and components among three spieces of certified Rhubarb, which probably resulted in the ultimate diference in clinical prescription and the production of Chinese patent medicines.

Comparative studies on purgative potency among three spieces of certified rhubarb / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the difference and causes of purgative activity in three species of certified rhubarb, so as to lay steady foundations of further research on assessing purgative activity impersonally by using measurable indexes.</p><p><b>METHOD</b>The potencies of three species were comparied with purgative ED, of mice as quantitative index which were calculated, and activities of Na+ K + -ATP ase in mouse colonic epithelial cell membrane were also investigated . The related purgative contents (conjunct and free rhein, chrysophanol, chrysophanic acid, sennoside A) were detected by HPLC and contents (total anthraquinones, anthraglucosennin; conjunct and free anthraquinones) were detected by UV.</p><p><b>RESULT</b>There were different purgative activities among three spieces of certified rhubarb. Each purgative ED, of mice was Rheum tanguticum ( ED50 = 0. 37 g x kg (-1)) , R. officinale ( ED50 = 0. 99 g x kg(-1) ) and R. palrnatum from Gansu (ED50 = 1. 83 g x kg(-1)) , the ratio of potency of those was 4. 94: 1. 85: 1. In the meanwhile, the difference of the inhibitory effect on Na+ -K + -ATP ase in mouse colonic epithelial cell membrane and relative purgative components also existed in the three species of certified rhubarb.</p><p><b>CONCLUSION</b>It disclosed that there was notable diference of purgative activity and components among three spieces of certified Rhubarb, which probably resulted in the ultimate diference in clinical prescription and the production of Chinese patent medicines.</p>