[Characteristics and influencing factors of early pain in patients after total knee arthroplasty].

OBJECTIVE: To investigate the current status of early pain in patients after total knee arthroplasty under enhanced recovery mode and analyze the influencing factors. METHODS: In the study, 142 patients with total knee arthroplasty of a hospital in Beijing were investigated by convenient sampling. Visual analog scale (VAS) was used to describe the degree of pain (including resting pain and activity pain) within 3 days after operation, and the nature and location of pain and satisfaction with the analgesic effect of the patients were recorded. The influencing factors included age, gender, place of residence, education level, body mass index (BMI), years of pain, chronic medical history, surgical history, surgical duration, whether to indwell a drainage tube, type of carer, severity of the disease, sleep quality, anxiety, depression, and preoperative pain level. The investigation tools of influencing factors were the general information questionnaire of patients, pain assessment questionnaire, Pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Firstly, single factor analysis was carried out on the included influencing factors, and then multiple stepwise regression analysis was carried out on the statistically significant variables to clarify the main influencing factors of early pain in patients after total knee arthroplasty. RESULTS: The peak pain of the patient occurred at night on the first postoperative day and in the afternoon on the second postoperative day, with resting pain scores of (2.5±1.2) and (2.7±1.1), and activity pain scores of (3.8±1.5) and (4.0±1.6); the most common pain site was posterior knee pain (68, 47.9%), followed by anterior knee combined with posterior knee pain (32, 22.5%), anterior knee pain (27, 19.1%), anterior knee combined with medial knee pain (10, 7.0%), and anterior knee combined with lateral knee pain (5, 3.5%); the nature of pain was mostly composed of soreness combined with swelling pain (58, 40.8%), while the rest included simple soreness (26, 18. 3%), simple swelling pain (24, 16.9%), hot burning pain (10, 7.0%), pricking pain (9, 6.3%), spasmodic traction pain (5, 3.5%), tearing pain (4, 2.8%), knife cutting pain (3, 2.2%), and stabbing pain combined with soreness (3, 2.2%); the patients who were satisfied and very satisfied with the analgesic effect were 114 (80.3%). The results of univariate analysis showed that there were significant differences in sleep quality, disease severity, types of care-givers and depression score (P<0.05). The results of multiple stepwise regression analysis showed that the main factors affecting the patients' early postoperative pain were preoperative sleep quality, depression, the Knee Society score and the type of care (P=0.002). CONCLUSION: Most patients under enhanced recovery after surgery are satisfied with the effect of pain control after operation. Medical staff can carry out predictive intervention in patients' sleep quality, depression to reduce the patients' early postoperative pain. At the same time, the research results suggest that choosing family members to accompany the patients can effectively improve the patients' early postoperative pain experience.

The anti-diabetic effect of eight Lagerstroemia speciosa leaf extracts based on the contents of ellagitannins and ellagic acid derivatives.

Previously, we have reported the opposite effects of compounds isolated from Lagerstroemia speciosa leaves on a glucose transport (GLUT4) assay. Ellagitannins from L. speciosa activated GLUT4, while ellagic acid derivatives showed an inhibitory effect. As part of our continuing research on anti-diabetic nutritional supplements, we herein compared the anti-diabetic effects of several extracts (LE1-8) from leaves of L. speciosa using different manufacturing processes based on the contents of ellagitannins and ellagic acid derivatives. Their anti-diabetic effects were evaluated through glucose uptake and adipocyte differentiation in 3T3-L1 cells in vitro as well as alloxan induced diabetic mice in vivo. These extracts were given to mice by gavage at doses of 0.25, 1.0, and 4.0 g per kg body weight once a day for 21 consecutive days. Results showed that LE1 (1.0 g kg-1), LE3 (1.0 or 4.0 g kg-1), LE4 (1.0 or 4.0 g kg-1), LE5 (0.25 or 1.0 or 4.0 g kg-1) and LE7 (1.0 or 4.0 g kg-1) showed significant anti-diabetic effects in alloxan-induced diabetic mice as indicated by the decreased levels of fasting blood glucose, body weight, serum biomarkers, tissue weight and body fat, and increased final insulin levels. LE8 (1.0 g kg-1) showed a moderate anti-diabetic effect as illustrated by the reduced fasting blood glucose level while LE2 and LE6 showed slight effects in alloxan-induced diabetic mice. The potential correlation of the content of ellagitannins, ellagic acid derivatives, and corosolic acid with the anti-diabetic activity was discussed.

Molecular Weight Determination of Aloe Polysaccharides Using Size Exclusion Chromatography Coupled with Multi-Angle Laser Light Scattering and Refractive Index Detectors.

Background: Size exclusion chromatography (SEC)/refractive index (RI) were used to determine molecular weight (MW) and molecular weight distributions (MWD) of polysaccharides. In aloe product research and quality control, commercially available pullulan and dextran are most commonly employed as calibration standards. Significant difference in the MW and MWD were found in literature when different methods were used. Objectives: This study was to investigate the traditional methods and more recent technologies used to determine the MW and MWD of Aloe vera polysaccharides. Methods: In this study, multi-angle laser light scattering (MALS) detection was studied on three polysaccharides, 1, 2, and 3, that were isolated and purified from A. vera leaf. The chemical structures of 1-3 were characterized as 1, 4-ß-linked glucomannans by monosaccharide composition and glycosidic linkage analysis. Absolute MW and root-mean-square radius were determined by MALS on the isolated aloe polysaccharides. The conditions to obtain reliable results from MALS measurement were examined. Results: MALS analysis demonstrates that the 1, 4-ß-linked glucomannan adopt the conformation of random coils or hard spheres in the analytical environment of a 0.1 M NaCl solution. Non-size exclusion effects and interactions between polysaccharide molecules were also observed in some aloe polysaccharides in the current analysis. The weight-average MW obtained by MALS measurement for 1, 2, and 3 are 55, 129, and 962 kDa, respectively. Comparing the results with SEC/RI calibrated by pullulan and dextran standards, marked differences in the MWD are found. Both overestimated the MW of 1 and 2 by factors of 4.4 and 4.2, and 2.4 and 1.6, when using dextran and pullulan calibration, respectively. Using pullulan calibration underestimated the MW of 3 by a factor of 3.1, but a similar result was obtained from dextran calibration compared to MALS measurement. The two isolated aloe polysaccharides were employed to be broad calibration standards or to be combined with narrow polydispersity pullulan calibration standards. Several aloe samples were tested using the different calibration curves, and the determined MWs were compared with the results obtained by MALS measurement. Conclusions: The results clearly indicated that until true polysaccharide standards become available MW and MWD's will be simply relative to the standards employed and the technologies used.

Chemical Investigation of Major Constituents in Aloe vera Leaves and Several Commercial Aloe Juice Powders.

Background: There are a substantial number of papers in the scientific literature reporting on the chemical composition of the Aloe vera plant. None of these investigations are truly comprehensive nor address the differences in composition that occur through processing variations in fresh leaves and commercially available product forms. Objectives: This work was to analytically examine a range of these forms and compile the findings. Methods: Fresh A. vera leaves and a number of commercial aloe juice powders were investigated for their major chemical constituents. Samples included fresh leaves from China and Mexico, plus commercial powders from different manufacturers made from different plant parts and/or manufacturing processes. The test results include moisture, ash, fiber, protein, lipids, minerals, organic acids, free sugars, and polysaccharides. The analytical methods employed comprise inductively coupled plasma-optical emission spectroscopy for minerals, high-performance anion-exchange chromatography equipped with pulsed amperometric detection for free sugars, HPLC for organic acids, and size exclusion chromatography (SEC)-multi-angle laser light scattering (MALS)-differential refractive index (dRI) for polysaccharide analyses. The absolute MW and MW distribution were determined using MALS measurement. Results: The major constituents of A. vera fresh leaf are fibers, proteins, organic acids, minerals, monosaccharides, and polysaccharides, which accounted for 85-95% of the total composition determined. In the commercial powdered aloe juice samples, four major components-organic acids, minerals, monosaccharides, and polysaccharides-accounted for 78-84% of the total composition. Apart from the four major components, products manufactured by ethanol precipitation contained high amounts of fiber and protein, while the free sugars were removed. In ethanol-precipitated products, the polysaccharide MW was less affected by manufacturing conditions and the concentration of aloe polysaccharides was higher than in products made in the nonethanol manufacturing processes. The overall chemical profiles were found to be consistent, except for the MW and content of polysaccharides in the commercial aloe samples analyzed, which were largely dependent on the types of manufacturing processes employed. Conclusions: This present study provides a comprehensive investigation of the major chemical composition of A. vera leaf and commercially derived products. The use of the SEC combined with MALS and differential RI detectors has proved to be an improved tool for the accurate determination of polysaccharide MW and contents of the various commercially available A. vera products in this study.

[Comparative and correlational studies on contents of stilbenes in different portions of mulberry].

OBJECTIVE: To compare the contents of stilbenes in different parts and axial root bark of mulberry, and study their correlation. METHOD: The contents of 3 major stilbenes, mulberroside A, oxyresveratrol, and resveratrol in different parts of mulberry were determined by HPLC. The correlation and regression analysis between the contents of stilbenes in the different parts and axial root bark was carried out. RESULT: The contents of stilbenes in most different parts of mulberry showed significant correlation. Between the contents of stilbenes in the different parts and axial root bark, oxyresveratrol showed significant correlation among all different parts, resveratrol showed significant correlation except in spinal cord of annual branch, mulberroside A showed significant correlation between bark of annual branch, lateral root and axial root bark. The results of the correlation and regression analysis indicated that the contents of mulberroside A, oxyresveratrol, resveratrol in different parts and axial root bark were significant positively correlated. CONCLUSION: The contents of stilbenes are significant correlation distributed in different parts and axial root bark of mulberry. The contents of stilbenes in different parts could be used to estimate the content of the axial root bark. The result could be useful for breeding and preserving excellent germplasm at the system breed process for mulberry of rich in stilbenes.

Active compounds from Lagerstroemia speciosa, insulin-like glucose uptake-stimulatory/inhibitory and adipocyte differentiation-inhibitory activities in 3T3-L1 cells.

Seven ellagitannins, lagerstroemin (1), flosin B (2), stachyurin (3), casuarinin (4), casuariin (5), epipunicacortein A (6), and 2, 3-(S)-hexahydroxydiphenoyl-alpha/beta-D-glucose (7), together with one ellagic acid sulfate, 3-O-methyl-ellagic acid 4'-sulfate (8), ellagic acid (9), and four methyl ellagic acid derivatives, 3-O-methylellagic acid (10), 3,3'-di-O-methylellagic acid (11), 3,4,3'-tri-O-methylellagic acid (12), and 3,4,8,9,10-pentahydroxydibenzo[b,d]pyran-6-one (13), were identified by the bioassay-directed isolation from the leaves of Lagerstroemia speciosa (L.) Pers. The chemical structures of these components were established on the basis of one- and two-dimensional NMR and high-resolution mass spectroscopic analyses. Other known compounds, including corosolic acid, gallic acid, 4-hydroxybenzoic acid, 3-O-methylprotocatechuic acid, caffeic acid, p-coumaric acid, kaempferol, quercetin, and isoquercitrin, were also isolated from the same plant. The obtained ellagitannins exhibited strong activities in both stimulating insulin-like glucose uptake (1-5 and 7) and inhibiting adipocyte differentiation (1 and 4) in 3T3-L1 cells. Meanwhile, ellagic acid derivatives (10-13) showed an inhibitory effect on glucose transport assay. This study is the first to report an inhibitory effect for methyl ellagic acid derivatives.

Cimicifuga species identification by high performance liquid chromatography-photodiode array/mass spectrometric/evaporative light scattering detection for quality control of black cohosh products.

Black cohosh has become one of the most important herbal products in the US dietary supplements market. It is manufactured from roots and rhizomes of Cimicifuga racemosa (Ranunculaceae). Botanical identification of the raw starting material is a key step in the quality control of black cohosh preparations. The present report summarizes a fingerprinting approach based on high performance liquid chromatography-photodiode array/mass spectrometric/evaporative light scattering detection (HPLC-PDA/MS/ELSD) that has been developed and validated using a total of 10 Cimicifuga species. These include three North American species, Cimicifuga racemosa, Cimicifuga americana, Cimicifuga rubifolia, and seven Asian species, Cimicifuga acerina, Cimicifuga biternat, Cimicifuga dahurica, Cimicifuga heracleifolia, Cimicifuga japonica, Cimicifuga foetida, and Cimicifuga simplex. The chemotaxonomic distinctiveness of the HPLC fingerprints allows identification of all 10 Cimicifuga species. The triterpene glycoside cimigenol-3-O-arabinoside (3), cimifugin (12), and cimifugin-3-O-glucoside (18) were determined to be suitable species-specific markers for the distinction of C. racemosa from the other Cimicifuga species. In addition to identification, the fingerprint method provided insight into chemical interconversion processes occurring between the diverse triterpene glycosides contained in black cohosh. The reported method has proven its usefulness in the botanical standardization and quality control of black cohosh products.

New unusual iridoids from the leaves of noni (Morinda citrifolia L.) show inhibitory effect on ultraviolet B-induced transcriptional activator protein-1 (AP-1) activity.

A novel iridoid dimer in whose structure the two iridoid units are connected by a rare ether group, together with two new unusual iridoids showing significant inhibition of UVB-induced Activator Protein-1 (AP-1) activity in cell cultures, have been isolated from the leaves of noni (Morinda citrifolia L.). Their structures were determined on the basis of detailed high-field 1D and 2D spectral analysis. Their inhibitory effect on UVB-induced transcriptional Activator Protein-1 (AP-1) activity are also discussed.

Analysis of antioxidative phenolic compounds in artichoke (Cynara scolymus L.).

Artichoke leaf is an herbal medicine known for a long time. A systematic antioxidant activity-directed fractionation procedure was used to purify antioxidative components from the aqueous methanol extractions of artichoke heads and leaves in this study. Seven active polyphenolic compounds were purified from artichoke, and structural elucidation of each was achieved using MS and NMR. Two of these compounds, apigenin-7-rutinoside and narirutin, were found to be unique to artichoke heads, this represents the first report of these compounds in the edible portion of this plant. The contents of these antioxidants and total phenols in dried artichoke samples from leaves and immature and mature heads of three varieties, Imperial Star, Green Globe, and Violet, were then analyzed and compared by colorimetric and validated HPLC methods. Significant differences by variety and plant organ were observed.