[Current practice patterns of preoperative bowel preparation in elective colorectal surgery: a nation-wide survey of Chinese surgeons].

Objective: To understand the current practice of preoperative bowel preparation in elective colorectal surgery in China. Methods: A cross-sectional questionnaire survey was conducted through wechat. The content of the questionnaire survey included professional title of the participants, the hospital class, dietary preparation and protocol, oral laxatives and specific types, oral antibiotics, gastric intubation, and mechanical enema before elective colorectal surgery. A stratified analysis based on hospital class was conducted to understand their current practice of preoperative bowel preparation in elective colorectal surgery. Result: A total of 600 questionnaires were issued, and 516 (86.00%) questionnaires of participants from different hospitals, engaged in colorectal surgery or general surgeons were recovered, of which 366 were from tertiary hospitals (70.93%) and 150 from secondary hospitals (29.07%). For diet preparation, the proportions of right hemicolic, left hemicolic and rectal surgery were 81.59% (421/516), 84.88% (438/516) and 84.88% (438/516) respectively. The average time of preoperative dietary preparation was 2.03 days. The study showed that 85.85% (443/516) of surgeons chose oral laxatives for bowel preparation in all colorectal surgery, while only 4.26% (22/516) of surgeons did not choose oral laxatives. For mechanical enema, the proportions of right hemicolic, left hemicolic and rectal surgery were 19.19% (99/516), 30.04% (155/516) and 32.75% (169/516) respectively. Preoperative oral antibiotics was used by 34.69% (179/516) of the respondents. 94.38% (487/516) of participants were satisfied with bowel preparation, and 55.43% (286/516) of participants believed that preoperative bowel preparation was well tolerated. In terms of preoperative oral laxatives, there was no statistically significant difference between different levels of hospitals [secondary hospitals vs. tertiary hospitals: 90.00% (135/150) vs. 84.15% (308/366), χ(2)=2.995, P=0.084]. Compared with the tertiary hospitals, the surgeons in the secondary hospitals accounted for higher proportions in diet preparation [87.33% (131/150) vs. 76.78% (281/366), χ(2)=7.369, P=0.007], gastric intubation [54.00% (81/150) vs. 36.33% (133/366), χ(2)=13.672, P<0.001], preoperative oral antibiotics [58.67% (88/150) vs. 24.86% (91/366), χ(2)=12.259, P<0.001] and enema [28.67% (43/150) vs. 15.30% (56/366), χ(2)=53.661, P<0.001]. Conclusion: Although the preoperative bowel preparation practice in elective colorectal surgery for most of surgeons in China is basically the same as the current international protocol, the proportions of mechanical enema and gastric intubation before surgery are still relatively high.

Tea polyphenols benefit vascular function.

Tea, the most popular beverage worldwide, is consumed in three basic forms; green tea, black tea and oolong tea. Tea contains over 4,000 chemicals some of which are bioactive. In recent years there has been a mounting interest in understanding the cardiovascular and metabolic benefits of polyphenolic flavonoids in tea, which can be used as a supplement among patients. Diverse cardioprotective effects of consuming tea or tea polyphenols have been described on pathological conditions, e. g. hypertension, atherosclerosis, diabetics, hypercholesterolemia, obesity, and are attributed to antioxidative, anti-thrombogenic, anti-inflammatory, hypotensive and hypocholesterolemic properties of tea polyphenols. This review focuses on cardiovascular benefits of tea polyphenols based on in vitro and in vivo studies on experimental animal models and on studies of human subjects in four areas: (1) vasorelaxant effect; (2) protective effect against endothelial dysfunction; (3) antioxidant effect and (4) hypolipidemic effect. We will briefly discuss the effects of tea on atherosclerosis and hypertension.

Cardiovascular actions of berberine.

Berberine, is an alkaloid from Hydrastis canadensis L., Chinese herb Huanglian, and many other plants. It is widely used in traditional Chinese medicine as an antimicrobial in the treatment of dysentery and infectious diarrhea. This manuscript describes cardiovascular effects of berberine and its derivatives, tetrahydroberberine and 8-oxoberberine. Berberine has positive inotropic, negative chronotropic, antiarrhythmic, and vasodilator properties. Both derivatives of berberine have antiarrhythmic activity. Some cardiovascular effects of berberine and its derivatives are attributed to the blockade of K+ channels (delayed rectifier and K(ATP)) and stimulation of Na+ -Ca(2+) exchanger. Berberine has been shown to prolong the duration of ventricular action potential. Its vasodilator activity has been attributed to multiple cellular mechanisms. The cardiovascular effects of berberine suggest its possible clinical usefulness in the treatment of arrhythmias and/or heart failure.

Potentiating effects on contractions by purified baicalin and baicalein in the rat mesenteric artery.

The effects of purified baicalin and baicalein from the traditional Chinese herb, Huangqin, on contractions induced by phenylephrine, U46619, and high extracellular K+ were investigated in isolated rat mesenteric arteries. Both baicalin (1-100 microM) and baicalein (1-50 microM) potentiated the contractile response to phenylephrine in a concentration-related manner. Both flavonoids (10 microM) also enhanced the U46619- or 40 mM K+-induced contractions. Baicalein (100-300 microM) reduced the phenylephrine-induced tone. Prazosin at 1 microM did not affect U46619-induced contraction in the absence and presence of baicalein or baicalin. Neither baicalin (1-100 microM) nor baicalein (1-100 microM) affected the basal tension. Removal of the functional endothelium abolished the potentiating effects of baicalin and baicalein in arteries preconstricted by both constrictors. Pretreatment of endothelium-intact rings with 100 microM N(G)-nitro-L-arginine also potentiated phenylephrine- or U46619-induced contraction but completely inhibited the effects of baicalin and baicalein. Pretreatment with 1 mM L-arginine reversed the enhancing effect of baicalin but not of baicalein on phenylephrine-evoked contraction. Pretreatment with 10 microM baicalin or 10 microM baicalein significantly reduced the endothelium-dependent relaxation induced by acetylcholine or ionomycin. These results indicate that both baicalin and baicalein potentiated the evoked contractile response, likely through inhibition of nitric oxide formation and/or release in the endothelium.

Inhibitory effects of purified green tea epicatechins on contraction and proliferation of arterial smooth muscle cells.

AIM: The present study was aimed to examine the vasorelaxant and antiproliferative responses to purified green tea epicatechin mixture, (-)epicatechin and (-)epigallocatechin gallate on rat arterial smooth muscle cells. METHODS: Changes in isometric force were measured by Grass force transducer and effects on cell proliferation were evaluated using [3H]thymidine incorporation assay. RESULTS: Epicatechin mixture, (-)epicatechin and (-)epigallocatechin gallate, which we isolated and purified from jasmine green tea, concentration-dependently, reduced the contractile response to phenylephrine in rat isolated aortic rings with (-)epigallocatechin gallate being more effective. These three agents also inhibited [3H]thymidine incorporation into DNA in cultured rat aortic smooth muscle cells in a concentration-dependent manner. CONCLUSION: The purified epicatechin derivatives from jasmine green tea relaxed the isolated rat arteries preconstricted by phenylephrine and inhibited aortic smooth muscle cell proliferation.

Involvement of endothelium/nitric oxide in vasorelaxation induced by purified green tea (-)epicatechin.

The present study investigated the involvement of endothelial nitric oxide in relaxation induced by purified green tea (-)epicatechin in rat isolated mesenteric arteries. (-)Epicatechin caused both endothelium-dependent and -independent relaxation. NG-Nitro-L-arginine methyl ester (L-NAME, 100 microM) and methylene blue (10 microM) significantly attenuated (-)epicatechin-induced relaxation in endothelium-intact tissues. L-Arginine (1 mM) partially antagonized the effect of L-NAME. (-)Epicatechin-induced relaxation was inhibited by Rp-guanosine 3',5'-cyclic monophosphothioate triethylamine. In contrast, indomethacin and glibenclamide had no effect. (-)Epicatechin (100 microM) significantly increased the tissue content of cyclic GMP and NG-nitro-L-arginine (100 microM) or removal of the endothelium abolished this increase. (-)Epicatechin (100 microM) induced an increase in intracellular Ca2+ levels in cultured human umbilical vein endothelial cells. Iberiotoxin at 100 nM attenuated (-)epicatechin-induced relaxation in endothelium-intact arteries and this effect was absent in the presence of 100 microM L-NAME. In summary, (-)epicatechin-induced endothelium-dependent relaxation is primarily mediated by nitric oxide and partially through nitric oxide-dependent activation of iberiotoxin-sensitive K+ channels. In addition, there may be a causal link between increased Ca2+ levels and nitric oxide release in response to (-)epicatechin.