Ameliorative effects of the traditional Chinese medicine formula Qing-Mai-Yin on arteriosclerosis obliterans in a rabbit model.

CONTEXT: Qing-Mai-Yin (QMY) is a clinically used herbal formula for treating arteriosclerosis obliterans (ASO). OBJECTIVE: To evaluate the chemical constituents and effects of QMY on ASO rabbit model. MATERIALS AND METHODS: Forty-eight New Zealand rabbits were divided into six groups (n = 8): normal (normal rabbits treated with 0.5% CMC-Na), vehicle (ASO rabbits treated with 0.5% CMC-Na), positive (simvastatin, 1.53 mg/kg), and QMY treatment (300, 600, and 1200 mg/kg). ASO rabbit model was prepared by high fatty feeding, roundly shortening artery, and bovine serum albumin immune injury. QMY (300, 600 and 1200 mg/kg) was orally administered for 8 weeks. The effects and possible mechanisms of QMY on ASO rabbits were evaluated by pathological examination, biochemical assays, and immunohistochemical assays. The compositions of QMY were analysed using HPLC-Q-TOF-MS/MS analysis. RESULTS: Compared to the vehicle rabbit, QMY treatment suppressed plaque formation and intima thickness in aorta, and decreased intima thickness, whereas increased lumen area of femoral artery. Additionally, QMY treatment decreased TC, TG and LDL, decreased CRP and ET, and increased NO and 6-K-PGF1α in serum. Furthermore, the potential mechanisms studied revealed that QMY treatment could suppress expression of TNF-α, IL-6, ICAM-1 and NF-κB in endothelial tissues, and increase IκB. In addition, HPLC analysis showed QMY had abundant anthraquinones, stilbenes, and flavonoids. CONCLUSION: QMY has ameliorative effects on ASO rabbit, and the potential mechanisms are correlated to reducing inflammation and down-regulating NF-κB. Our study provides a scientific basis for the future application and investigation of QMY.

[Taohong Siwu Decoction regulated functions of endothelial cells and treated arteriosclerosis obliterans: an experimental study].

OBJECTIVE: To discuss the effect of Taohong Siwu Decoction (TSD) in regulating functions of endothelial cells and treating arteriosclerosis obliterans (ASO). METHODS: The ASO model was prepared by using high-fat diet plus intimal injury. They were randomly divided into the model group (n = 10), the normal control group (n = 9), the low dose TSD group (group A, n = 12), the middle dose TSD group (group B, n = 10), and the high dose TSD group (group C, n = 9). Eight weeks after modeling, the limb blood perfusion was observed using laser Doppler flowmetry. The arterial morphology was observed using light microscope and transmission electron microscope. The number of circulating endothelial cells (CECs) was determined using Percoll density gradient centrifugation method. Serum levels of TNF-alpha, IL-1, ET-1, and NO were detected using double antibody sandwich assay of enzyme linked immunosorbent assay (ELISA). RESULTS: The ASO rat model was successfully established. Blood lipids levels significantly increased, the blood perfusion of left hind limbs significantly decreased, the number of CECs in the peripheral blood significantly increased, the arterial lumen was irregularly narrowed, the ultra-structure of vessel walls was damaged, serum levels of TNF-alpha, IL-1, and ET-1 significantly increased, and the serum level of NO significantly decreased in the model group, showing statistical difference when compared with the normal control group (P < 0.01). Compared with the model group, significant improvement in the aforesaid indices was shown in group B and C (P < 0.05, P < 0.01). CONCLUSIONS: The injury and abnormal functions of endothelial cells is an important pathological process of ASO. As an effective recipe for treating ASO, TSD could protect vascular endothelial cells and improve the secretion function of vascular endothelial cells.

[Effectiveness of pentoxifylline and of bio-electromagnetic therapy in lower limb obliterative arterial disease]. / A pentoxifillin és a bioelektromágnes-regulációs kezelés hatása alsó végtagi obliteratív veroérbetegségben.

INTRODUCTION: There are limited therapeutic options to improve microcirculation. AIM: The question of the study was to investigate any potential beneficial effect of bio-electro-magnetic-regulation therapy on microcirculation in patients suffering from obliterative peripheral arterial disease including the circulation of lower extremities, as well as intermittent claudication. METHOD: Thirty patients suffering from obliterative peripheral arterial disease (Fontaine IIa and IIb) were recruited. The first step of the study was to determine the pain free and maximal walking distance with a treadmill unit. After the placebo period patients received 8 and 20 minutes bio-electro-magnetic-regulation treatment 16 times. After the treatment the pain free and maximal walking distance were measured again. In the second stage of the study the patients were treated by pentoxifylline infusions. RESULTS: Bio-electro-magnetic-regulation treatment increased the pain free period by 57.4% (p = 0.005) and the maximal walking distance by 36.6% (p = 0.042). The two forms of therapy together increased the pain free and maximal walking distance by 81.9% and by 84.0%, respectively. The combined therapy was very effective in contrast to placebo and bio-electro-magnetic-regulation treatment (p = 0.000373 and p = 0.00741, respectively). CONCLUSIONS: The bio-electro-magnetic-regulation therapy mainly affected the microvessels and pentoxifylline therapy rather had beneficial effects on hemorheology. The clinical effectiveness of combined therapy was good or excellent in 70% of patients.

[Integrated traditional Chinese and Western medicine versus Western medicine in treatment of arteriosclerosis obliterans: a systematic review of randomized controlled trials].

BACKGROUND: The conventional therapy for arteriosclerosis obliterans (ASO) is Western medicine. However, it has some adverse effects and does not respond to some patients, and it is also very expensive. OBJECTIVE: To evaluate the efficacy of integrated traditional Chinese (TCM) and Western medicine (WM) in treatment of ASO. SEARCH STRATEGY: Electronic and manual searches were conducted and the searches ended on May 20, 2009. INCLUSION CRITERIA: We included randomized controlled trials (RCT) evaluating integrated TCM and WM (as treatment group) versus WM used alone (as control group), and no language limits were set. DATA EXTRACTION AND ANALYSIS: Selection of trials for inclusion, assessment for methodological quality, data extraction and data syntheses were conducted according to protocol of a Cochrane systematic review by the authors. RESULTS: Thirteen RCT were included, which encompassed a total of 968 patients. The results showed that all of the 13 included trials did not report mortality rate of ASO. The studies displayed that the amputation rate in the treatment group was lower than that in the control group, but there was no statistical significance. Ten studies adopted inefficiency analysis and 2 of them showed that the ineffective rate in the treatment group was lower than that in the control group, and the relative risk (RR) and 95% CI were 0.36 [0.13, 0.99]. We performed descriptive analysis on other 8 studies; analyses of secondary outcomes such as intermittent claudication, ankle brachial index, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) showed that integrated TCM and WM therapy was more effective than WM treatment alone; one study showed that WM was better than integrated TCM and WM therapy in decreasing the content of fibrinogen. All of the included trials did not report any critical adverse reactions occurred in the treatment group. CONCLUSION: The current evidence shows that integrated TCM and WM therapy is safe and effective in treating ASO, and tends to reduce amputation rate, improve intermittent claudication, decrease the levels of fibrinogen, HDL and LDL, and increase ankle brachial index, without obvious adverse reactions. Due to the low methodological quality of trials included, more prospective, multicenter, large-scale, high-quality RCTs are needed.

[Treatment of lower extremity diabetic atherosclerotic obliterans with shuxuetong injection].

OBJECTIVE: To observe the effect and safety of Shuxuetong Injection (SXT) in treating patients with type 2 diabetes mellitus accompanying lower extremity atherosclerotic obliterans. METHODS: The selected patients were assigned by randomized digital table to the treated group (180 cases treated with SXT) and the control group (80 cases treated with alprostadil). The clinical efficacy was assessed after 4 weeks of treatment, and the inner diameters and blood flow of the superficial femoral artery, the posterior tibial artery and the foot dorsal artery were measured and compared before and after treatment using Doppler's ultrasonography. RESULTS: The total effective rate in the treated group was 94.4% (170/180), better than that in the control group, 85.0% (68/80, P < 0.01). Ultrasonic examination showed that the inner diameter and the blood flow of all the arteries measured in the treated groups increased after treatment (P < 0.01), with the increase superior to those in the control group (P < 0.05). No adverse reaction was found during the treatment. CONCLUSION: SXT has the effect of activating blood circulation, dissolving stasis and dredging collaterals, it could reduce or eliminate the formation of thrombi, being effective and safe when applied in clinical practice for the treatment of lower extremity diabetic atherosclerotic obliterans.

[Effects of Refined Xuefu Capsule on vascular patency rate after femoral-popliteal bypass].

OBJECTIVE: To observe the effects of refined Xuefu Capsule (RXC) in patients with arteriosclerosis obliterans (ASO) after femoral-popliteal bypass (FPB). METHODS: Thirty-eight ASO patients with 41 limbs underwent FPB were randomly assigned to two groups: the control group (18 cases with 20 operated limbs) and the RXC group (20 cases with 21 operated limbs). All patients received long-term anticoagulant treatment with Warfarin, and RXC was given to the RXC group additionally for 3 months. Changes of clinical symptoms, blood coagulating function, as well as the condition of vascular patency and ankle arm index (AAI) were assessed 6 and 12 months after operation. RESULTS: Clinical symptoms were improved in all the patients after operation. One year after operation, incidence of intermittent claudication and amputation rate in the RXC group was 20% and 5 %, being lower than the respective rate (56% and 17%) in the control group (P < 0.05); the patency rate was 86% in the RXC group, being higher than that in the control group (65%, P<0.05). Six and 12 months after operation, AAI was 0.73 +/- 0.24 and 0.69 +/- 0.19 respectively in the RXC group, being significantly higher than that in the control group (0.45 +/- 0.17 and 0.41 +/- 0.23, P < 0.05) at the corresponding time points. CONCLUSION: RXC could obviously increase the patency rate 12 months after FPB, improve the clinical symptoms and alleviate the symptom of limb ischemia in ASO patients.

[Immunological disorders and correction of them in surgical patients with atherosclerosis obliterance].

Atherosclerosis obliterance and critical lower limb ischemia lead to immunodeficiency and disbalance of T- and B- components of immune system. Surgical treatment doesn't eliminate but in a number of cases aggravates immune disorders. Immunocorrection stimulates anti-infectious protection. Indications to different variants of immunocorrection are formulated.

[Antioxidant and metabolic therapy of lower limb chronic obliterative arterial disease].

Metabolic therapy is one of several therapeutic strategies that can be used in patients with lower limb chronic obliterative arterial disease (COAD). Tanakan (EGb76) has demonstrated high efficiency and safety in 9 controlled clinical trials and author's clinical series in patients with lower limb COAD. Improvement with significant increase of pain-free walking distance and beneficial safety profile was observed in all cases. Tanakan (EGb76) is highly effective conventional therapeutic agent for memory and attention disorders, dizziness and balance disturbances in adults and elderly patients. Given a common concomitance of these disorders and lower limb COAD, Tanakan can be recommended as a drug of choice for treatment of chronic obliterative arteriopathy.

The effects of Chinese medicines on micro-circulation of nail folds and blood flow velocity of limbs in the patients with arteriosclerotic obliteration.

The effects of Chinese medicines on micro-circulation and blood flow velocity in arteries of the lower limbs were observed in 33 patients with arteriosclerotic obliteration (ASO). The results showed that the integral values of micro-circulation after treatment were obviously higher than those before treatment (P < 0.05 or P < 0.01). Blood flow velocity in arteries of the lower limbs determined with the color Doppler ultrasound detecting method after treatment were also obviously higher than those before treatment (P < 0.05 or P < 0.01). In this series of 33 ASO patients, the markedly effective rate was 36.36%, and the total effective rate was 63.64%. The observation indicates that the recipe prescribed according to the principle of supplementing qi and activating blood circulation can effectively improve micro-circulation in ASO patients, and accelerate blood flow in arteries of the lower limbs.

[Low-intensive laser irradiation in combined treatment of lower limbs atherosclerotic lesions]. / Nizkointensivnoe lazernoe izluchenie v kompleksnom lechenii obliteriruiushchego ateroskleroza nizhnikh konechnostei.

Seventy-one subjects entered this study. The control group consisted of 12 healthy subjects, the comparative group included 15 patients who received standard therapy of vascular diseases but without physiotherapy. The study group consisted of 44 patients whose treatment was supplemented with laser irradiation. Angiography, ultrasonic dopplerography, laser flowmetry, oxygenometry were applied for control of treatment efficacy. Regional ischemia was evaluated with detection of pO2 of foot. LT increased oxygenation of foot soft tissues in patients with low primary pO2 and decreased in ones with higher. As a result the number of patients with low pO2 (0 < pO2 < 20) decreased from 13.7 to 4.5%, with middle pO2 (20 < pO2 < 40) increased from 27.3 to 50.0%, with high pO2 (pO2 = 40) decreased from 59.0 to 45.5%. Redistribution in favor of 20 < pO2 < 40 is regarded as normalizing effect of LT. It is concluded that LT increases oxygenation of foot soft tissues in patients with low primary pO2 and decreased in ones with higher.

[Effect of sodium ferulate on leucocyte spontaneous activation and surface adhesion molecule expression in arteriosclerosis obliterans patients].

OBJECTIVE: To explore the effect of sodium ferulate (SF) on leucocyte spontaneous activation rate (LSAR) and the surface expression of adhesion molecule (SEAM) in patients with arteriosclerosis obliterans (ASO). METHODS: Forty-two patients with ASO were treated by SF, LSAR and SEAM in them were determined qualitatively before and after SF treatment, as well as in 36 healthy subjects for control. RESULTS: Therapeutic effect of SF in the treated 42 patients was short-term cured in 17 cases (40.5%), markedly effective in 21 (50%), effective in 2 (4.8%), ineffective in 2(4.8%), and the total effective rate being 95.2%. LSAR and SEAM in ASO patients before treatment was 14.84 +/- 7.54% and 47.94 +/- 13.48% respectively, which was obviously higher than 4.96 +/- 2.04% and 24.12 +/- 9.35% in healthy subjects (P < 0.01) respectively, but markedly reduced to 8.19 +/- 4.09% and 28.63 +/- 7.91% after SF treatment (P < 0.01). CONCLUSION: SF could not only obviously lower both LSAR and SEAM but also exert a good therapeutic effect on patients with ASO.

[Effect of ligustrazine injection on vascular endothelial cell of the patients with arteriosclerosis obliterans].

OBJECTIVE: To study the effect of ligustrazine injection (LI) on vascular endothelial cell of the patients with arteriosclerosis obliterans (ASO) and explore the new pathway of investigating effective vascular protective agents in Chinese medicinal herbs. METHODS: Forty-six patients with ASO in the LI group treated by LI were observed, their circulating endothelial cells (CEC) were detected quantitatively before and after treatment. The results were compared with the CEC of 53 cases of healthy persons (control group) in the same period. RESULTS: In the LI group, the immediate cure rate was 45.7% (21 cases), markedly effective rate 36.9% (17 cases) and the effective rate 17.4% (8 cases). The CEC of patients before treatment was 4.39 +/- 1.76/0.9 microliter, which was significantly higher than that of the healthy persons (1.53 +/- 0.42/0.9 microliter). It could be reduced after treatment, along with the improvement of symptoms and signs, to 2.43 +/- 0.87/0.9 microliter, P < 0.01. CONCLUSION: LI in treating ASO not only displays extraordinary effect, but also has good effect in curing the damage of endothelial cells.

[Clinical study on treatment of atherosclerosis obliterans by integrated traditional Chinese and Western medicine].

OBJECTIVE: To investigate the mechanism in treating atherosclerosis obliterans (ASO) with integrated traditional Chinese and western medicine (TCM-WM). METHODS: The changes in level of vasoactive factors, such as endothelin (ET), nitric oxide (NO), apoprotein and the iconographic changes in angiography before and after treatment were observed in 40 patients of ASO. RESULTS: All patients had high levels of plasma ET and low level of NO, abnormal metabolism apoproteins, and showed the signs of trunk artery obstruction and marked decrease of collateral circulation in affected limb. After treatment, the plasma ET, NO and apoprotein levels recovered to normal range in 30 markedly effective cases, as compared with those before treatment, the difference was significant (P < 0.01) and their collateral circulation in the affected limb significantly increased, showing obvious improvement of peripheral circulation. CONCLUSION: The therapeutic mechanism of TCM-WM in treating ASO might be related with its effects on vascular endothelium, lipid metabolism adjustment, collateral circulation establishment and microcirculation improvement.

[Observation on effect of integrated Chinese and Western medicine in treating patients with peripheral atherosclerosis obliterans].

OBJECTIVE: To observe the therapeutic effect of integrated traditional Chinese and western medicine (TCM-WM) and its influence on plasma endothelin-1 (ET-1), nitric oxide (NO) and apoproteins. METHODS: Ninety patients of peripheral atherosclerosis obliterans (ASO) were divided into three groups randomly and treated with Salvia injection (SI), prostaglandin E1(PGE1) and SI + PGE1 respectively. The clinical manifestation of patients was observed dynamically, plasma level of ET-1, NO and apoprotein were tested before and after treatment by radioimmunoassay, Griss method, immuno-transmission method and enzyme method. RESULTS: The cure rate of the SI, PGE1 and TCM-WM group was 26.67%, 33.33% and 46.67% respectively, the effective rate of them was 26.67%, 40.00% and 43.33% respectively. The therapeutic effect of the TCM-WM group was better than that of the SI and PGE1 group, P < 0.01. The plasma level of ET-1, NO and apoprotein was positively correlated with the stage altering of ASO, it was normalized gradually when ASO was alleviating effectively. CONCLUSION: The TCM-WM therapy has good clinical effect in treating ASO. To observe the change of ET-1, NO and apoprotein level before and after treatment dynamically is helpful to judge the severity, progress of disease and effect of treatment, and has high clinical significance.

[Clinical study on treatment of arteriosclerosis obliterans using huangqi tongmai decoction].

OBJECTIVE: To test and verify the effects of Huangqi Tongmai Decoction (HQTMI) regulating blood lipid in treating arteriosclerosis obliterans (ASO). METHODS: Thirty-two cases of ASO was treated with HQTMD for two months. The drug was in water decoction, oral taken. RESULTS: Compared with the blood lipid level before treatment, the high density lipoprotein of cholesterol (HDL-C) was increased, the low density lipoprotein of cholesterol (LDL-C), atherogenic index (AI) was decreased (P < 0.01). The serum total cholesterol (TC), triglyceride (TG), very low density lipoprotein of cholesterol (VLDL), apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB100) were all changed (P < 0.05). apoA1/apoB100 ratio increased. CONCLUSION: HQTMD could regulate blood lipid. This method was effective in treating ASO.

[Arteriosclerosis obliterans and ozone therapy. Its administration by different routes]. / Ateroesclerosis obliterante y ozonoterapia. Administración por diferentes vías.

We report 72 non-diabetic patients with obliterant atherosclerosis, stadium II, (intermittent claudication). The medium age of these patients was 62 +/- 4.5 years old. They were randomly included into four groups. Three were treated with Ozone: one of them by endovenous way, other intramuscular way, and the last one by rectal way; meanwhile, in the fourth group the patients were submitted to conventional medical treatment (control group). In the three ozone-groups there weren't differences when they were compared between then. But there was a significant improvement in comparison with the control group. The claudication distance in the treadmill increased to the 2.5 km/hour. Ankle/arm pressure rates hadn't significant differences, this corroborates the ozone action on the microcirculation. The least uncomfortable, the more harmless and the more economic way was the rectal way.

[The effects of ticlopidine and nifedipine on platelet aggregation in patients with obliterating arteriopathy of the lower limbs]. / Efectos de la ticlopidina y el nifedipino sobre la agregación plaquetaria en pacientes con arteriopatía obliterante de miembros inferiores (AOMI).

This paper evaluates the antiaggregant action of ticlopidine and nifedipine in patients with obliterate arteriopathy in inferior limbs of arteriosclerotic etiology (OAIL). They were established 4 study groups: control, with health volunteers without treatment (N = 10); patients treated with placebo (n = 11); patients treated with 500 mg/day of ticlopidine (n = 12) and treated with 30 mg/day of nifedipine (n = 12). The last 3 groups the treatment duration was 30 days. It was studied the platelet aggregatory activity against ADP and collagen, before drug administration and at 15 and 30 days post-treatment. Our results suggest that: Platelet aggregation is increased in patients with AOMI compared with that observed in the control group. Ticlopidine inhibits platelet aggregation induced by ADP, but not that induced by collagen. Nifedipine doesn't produce any effect on platelet aggregation.