Association of severity and sex with vasoactive substance and sexual hormone level in patients with vascular dementia in the type of kidney asthenia and blood stasis syndrome

BACKGROUND: Kidney asthenia is the basic cause of the development of vascular dementia (VD). Kidney asthenia lasting for a long time will result in blood stasis. Also, the cause of VD may have relationships with endothelin (ET), nitric oxide (NO), homocysteine (HCY), estrogen (E2), and testosterone (T). OBJECTIVE: To observed clinical curative effect of the kidney tonic, pancreas tonic, and blood tonic with promoting blood circulation components in treating kidney asthenia with blood stasis syndrome of VD. DESIGN: Case controlled study. SETTING: Geriatric Institute of Integrated Medicine, Fujian College of Traditional Chinese Medicine. PARTICIPANTS: A total of 70 patients, including 39 males and 31 females aged 60-80 years, were selected from Department of Neurology, Pingshan Hospital from May 2000 to September 2002. Diagnostic criteria were used for probable VD of the American Psychiatric Association. Diagnostic and Statistical of Manual of Mental Disorder, 4th ed (DSM-Ⅳ), 1994 revised, mini-mental state examination (MMSE), and criteria of kidney asthenia with blood stasis with mixed weak and sthenia syndrome of Guidelines of Clinical Research of New Chinese Medicine in Treating Dementia. According to score of kidney asthenia with blood stasis syndrome, they were classified to three groups: mild (n =22), moderate (n =33) and severe (n =15). All of them with complete chest X-Ray, ECG, blood chemistry and other related examinations, exclusive of cardiovascular, liver, kidney diseases, homeopathy and psychiatry diseases. And hereby we also select 30 normal people as the comparing group, having no substantial diseases in heart, brain, kidney, liver, lung and other main organic systems after medical examination. Of this group, 11 were males and 19 were females, ranging from 62 years old to 78 years old. There were no obvious differences between the above two groups in sex, age, and education level after statistical analysis. All patients observed in Pingxi Hospital, Fuzhou, from May 2000 to September 2002. METHODS: ① According to the diagnoses standard of blood stasis syndrome: 0-89: The increase in score indicated that blood stasis syndrome was getting serious. ② According to MMSE: All the test samples were evaluated, those with scores of 0-30, in which the non-educated ≤ 17, primary school ≤ 20, above middle school ≤ 24 were categorized. ③ Testing all sample's ET, E2 and T by using radioimmunoassay, the RIA kits were provided by Scientific and Technological Development Center of General Hospital of PLA. ④ Testing the level of NO by using colorimetic method. ⑤ Testing the level of HCY by using Enzyme-linked Immunoassay. ⑥ Meanwhile, analyzing the blood stasis score by comparing with every standard. The differences of data were compared by using t test and F test. MAIN OUTCOME MEASURES: ① Blood plasma ET, blood serum NO, HCY, E2 and T. ② The analyzing results obtained from comparing score of blood stasis with every indicators. RESULTS: The result analysis was including of both the 70 patients of VD with kidney asthenia and blood stasis and compared group consist of 30 healthy people. ① ET, NO, HCY and ET/NO: The levels of ET, HCY and ET/NO were increasing with pathography, while the levels of ET, NO, HCY and ET/NO were decreasing with the pathography, and the difference in statistics was significant (P < 0.01). ② The level of E2 and T: The levels of both E2, T and E2/T for male VD patients were (67.72±12.18) pg/L and (351.58±155.02) ng/L, 0.24±0.12 respectively, which were higher than the compared group [(53.96±16.13) pg/L, (471.83±143.99) ng/L, 0.12±0.00, P < 0.05]. The level of E2 in the female VD patients was lower than the compared group [(34.23±10.99), (44.81±14.65) pg/L, P < 0.05]. ③ The relationship between the score of blood stasis and each indicators: The levels of ET, ET/NO and HCY had significant positive relationship with blood stasis mark (r = 0.352, 0.754, 0.347, P < 0.05-0.01), obvious negative relationship with NO (r =-0.528, P < 0.01) and no clear relationship with female E2/T and male E2/T (r = -0.210, 0.04, P > 0.05). CONCLUSION: ① The levels of ET, HCY and ET/NO are increasing with pathography, while the level of NO is decreasing, which may be the evidence that the possibility of VD pathography may have relationship with the indicators above. ② The level of E2 increase in male's VD patients, and decrease in male's. And the decrease of the female may have relationship with the VD.

The effect of continuous Jue tone intervention on blood pressure and vasoactive substances in hypertensive rats with a liver-fire hyperactivity pattern

Objective:Jue tone is a kind of sound,using 3-mi as the main tone,and is melodious,profound,makes people feel comfortable and pleasant.This study aimed to explore the probable mechanism of Jue tone to reduce blood pressure(BP)in hypertensive rats with a liver-fire hyperactivity pattern by observing changes in BP as well as physiochemical indexes in plasma.Methods:Sixteen male spontaneous hypertensive rats(SHR)with a liver-fire hyperactivity pattern were randomly divided into a control group and a Jue tone group.The rats in the Jue tone group were treated with Jue tone(55e65 dB,played by the five elements of music rhythm instrument,a kind of physiotherapy regimen music played by Shen Wu)once a day for 4 weeks.The BP levels in each group were measured twice a week,on Monday and Friday.The levels of angiotensin II(Ang-II),thromboxane B2(TXB2),endothelin-1(ET-1),calcitonin gene-related peptide(cGRP),norepinephrine(NE),cortisol(CORT),and 5-hydroxytryptamine(5-HT).in plasma were detected by enzyme-linked immunosorbent assay after 4 weeks of intervention.Results:BP and the levels of TXB2 and ET-1 in the plasma of the treatment group were significantly lower than those of the control group,while the level of cGRP was significantly higher.Conclusion:Jue tone can reduce the BP of hypertensive rats with a liver-fire hyperactivity pattern.The mechanism may correlate with a reduction in TXB2 and ET-1 and an increase in cGRP with the reduction of reactive oxygen species(ROS).

Explore the direct and/or the synergistic antihypertensive effects of wind-dispelling herbs involving Fangfeng and Baizhi on hypertensive rats with liver-yang hyperactivity based on vasoactive substances

Objective： To explore the direct and/or the enhancing antihypertensive effects of wind-dispelling herbs involvingFangfeng （Saposhnikoviae Radix） and Baizhi （Angelicae dahuricae Radix） using liver-yang hyperactivity renalhypertension rat. Methods： Model rats with hyperactivity of liver-yang hyperactivity were prepared using male SD rats.Once successful, the rats were randomly divided into groups and given medicine by gavage for 4 weeks. Blood wascollected from the abdominal aorta to prepare serum. Serum nitric oxide （NO） concentration was determined bychemical colorimetry. The contents of ET, TXB2 and 6-K-PGF1a were determined by enzyme linked immunosorbentassay （ELISA）. Results： Compared with the control model group, the blood pressure, serum ET and TXB2 of rats in thewind dispelling medicine group was not significantly reduced, while those of rats in captopril group, Tianma GoutengDecoction I group （TGD group） decreased significantly （P 〈0.05 for both）. Interestingly, the blood pressure, serum ETand TXB2 of rats in the combination group （wind dispelling medicine ＆ TGD） decreased significantly compared withboth wind dispelling medicine group and TGD group. Meanwhile, the levels of serum NO and 6- K-PGF1a in thecombination group was much higher than those in the wind dispelling medicine group or TGD group （P 〈0.05 for both）.However, the levels of serum NO and 6- K-PGF1a in the wind dispelling medicine group was not significantly increasedcompared with the model group. Conclusion： There is no direct pressure lowering effects of wind dispelling medicinealone, while wind dispelling medicine could potentiates the antihypertensive effects of Tianma Gouteng Decoction I.Besides, the synergistic effects may be related to decreased ET and TXB2 levels and the increased NO and 6- K-PGF1alevels.

The Changes of Vasoactive Substances Originated Endotheiium in Patients with Unstable Angina Pectoris Treated by Improved Thrombolytic Therapy

Objectives To analyze the changes of vasoactive substances originated from endo- theiium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mech- anisms of the drug to treat unstable angina pectoris. Methods 120 patients with unstable angina pectoris who were not well responsed to common medication were studied. Their ECG stress tests were abnormal and there were ischemic changes in Holter. Urokinase 300,000 U was added in 100 ml normal saline and in- jected within 30 min once a day for 3 days. 300 mg as- pirin was administrated a day before and during uroki- nase applications. Before and after urokinase treat- ments , endothelin-1 , plasma tissue plasminogen activa- tor and its inhibitor-lwere determined. Results Compared with pretreatments, after treatments, the ac- tivities of tissue plasminogen activator increased, endo- thelin-1 and the inhibitor-1 decreased. The changes were significant. Conclusions Modified thrombolytic therapy can regulate the vasoactive substances origina- ted endotheiium in patients with unstable angina pecto- ris . The major substances include endothelin-1, plasma tissue plasminogen activator and inhibitor-1. This mechanism may suggest that urokinase can treat coro- nary heart disease effectively.

Cardiopulmonary,complications in chronic liver disease

Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular and pulmonary hemodynamic changes. A vasodilatatory state and a hyperdynamic circulation affecting the cardiac and pulmonary functions dominate the circulation. The recently defined cirrhotic cardiomyopathy may affect systolic and diastolic functions, and imply electromechanical abnormalities. In addition, the baroreceptor function and regulation of the circulatory homoeostasis is impaired. Pulmonary dysfunction involves diffusing abnormalities with the development of the hepatopulmonary syndrome and portopulmonary hypertension in some patients. Recent research has focused on the assertion that the hemodynamic and neurohumoral dysregulation are of major importance for the development of the cardiovascular and pulmonary complications in cirrhosis. This aspect is important to take into account in the management of these patients.

Clinical research on navel application of Shehuang Paste combined with Chinese herbal colon dialysis in treatment of refractory cirrhotic ascites complicated with azotemia

AIM: To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia. METHODS: Seventy-five cases of refractory cirrhotic ascites complicated with azotemia were randomly divided into 3 groups: comprehensive treatment (n = 29), simple treatment (n = 24), and control (n = 22). The basic treatment methods were the same in all groups, including liver protecting medicines, diuretics and supportive drugs. The control group underwent only the basic treatment. Shehuang Paste (SHP) was applied to the navels of the two treatment groups once a day for 30 d. Colon dialysis with Chinese herbs was administered to the comprehensive treatment group once every two days. Before and after treatment, we measured abdominal circumference, BUN, Cr, serum Na+, urine Na+/K+, liver function, endotoxin content, NO, and ET-1. Color Doppler ultrasonography was conducted to measure the portal vein blood flow. RESULTS: The total effective rate for ascites was 72.4% in the comprehensive treatment group, 45.8% in the simple treatment, contrasting with 18.2% in the controls. Between the two treatment groups and the controls, there were significant differences in the effective rates (P < 0.01, and P < 0.05). There was also a significant difference (P < 0.05) between the two treatment groups. Measurements of Cr and BUN showed higher values for the treatment groups, with the comprehensive better than the simple group (P < 0.05). Sera Na, urineNa/K were different, P < 0.01 between pre- and post- treatment in the comprehensive group, and P < 0.05 in the simple group. The treatment groups’ endotoxin content was also significantly reduced (P < 0.01, and P < 0.05), with the comprehensive group better than the simple group (P < 0.05). Portal vein blood flow and NO content significantly reduced (P < 0.05), as did ET-1 content (P < 0.01). There were no significant changes in the control group (P > 0.05). The comprehensive treatment group’s pre- and post-treatment portal vein and splenic vein blood flows showed a positive correlation to NO, ET-1 and endotoxin contents.CONCLUSION: When treating refractory cirrhotic ascites complicated with azotemia, Shehuang Paste combined with Chinese herbal dialysis is better than Shehuang Paste alone for ascites resolution, azotemia, and endotoxin elimination. However, both methods on their own were also effective for reducing portal and splenic vein blood flow, and lowering the contents of NO, ET-1 in the two treatment groups.

Comparative effect of electroacupuncture and moxibustion on the expression of substance P and vasoactive intestinal peptide in patients with irritable bowel syndrome

OBJECTIVE: To compare the impacts of electroacupuncture(EA) and moxibustion(Mox) on the primary gastrointestinal symptoms and the expressions of colonic mucosa-associated neuropeptide substance P(SP) and vasoactive intestinal peptide(VIP)in patients with either diarrhea-predominant or constipation-predominant irritable bowel syndrome(IBS-D and IBS-C,respectively).METHODS: Eighty-five IBS patients were randomly allocated to the EA and Mox groups. Zusanli(ST 36)and Shangjuxu(ST 37) were selected as acupoints for electroacupuncture or warm moxibustion treatment once a day for 14 consecutive days. Before and after the treatment sessions,a Visual Analog Pain Scale and the Bristol Stool Form Scale were used to evaluate gastrointestinal symptoms. There were four dropout cases,leaving 81 participants(41 with IBS-D and 40 with IBS-C) who volunteered to undergo colonoscopy before and after the treatment sessions. During colonoscopy,sigmoid mucosa were collected to detect SP and VIP expression using immunohistochemistry assay.RESULTS: Both EA and Mox treatments were effective at relieving abdominal pain in IBS-D and IBS-C patients. However,Mox was more effective at reducing diarrhea in IBS-D patients,whereas EA was more effective at improving constipation in IBS-C patients. EA and Mox treatments both down-regulated the abnormally increased SP and VIP expression in the colonic mucosa,with no significant difference shown between the two treatments.CONCLUSION: Both EA and Mox treatments are effective at ameliorating gastrointestinal symptoms by reducing SP and VIP expression in the colonic mucosa of IBS patients.

Ameliorating Effect and Potential Mechanism of Camellia Oil on Constipated Mice

Constipation is a global epidemic. To evaluate the ameliorating effect of camellia oil on constipation,two slowtransit costive mice models were established by water deprivation or sucralfate gavage. Administration of camellia oil（ 4. 0 and 8. 0 mL/kg/day） significantly shortened the defecation time,increased defecation mass and fecal water content,with efficacies comparable to that of hemp seed oil. Intestinal propulsion test showed that camellia oil significantly enhanced the propelling rates of the charcoal powder in the intestine. Meanwhile,camellia oil also significantly decreased the serum levels of nitric oxide（ NO）,nitric oxide synthase（ NOS） and vasoactive intestinal peptide（ VIP） and increased serum substance P in costive animals. These results suggested that camellia oil can largely relieve slowtransit constipation and enhance the gastrointestinal motility through modulation of serum gastrointestinal motility key factors such as NO,NOS and VIP and substance P.

Effects of Shehuang Paste (麝黄膏) on Hemodynamics, Endotoxin, Nitric Oxide and Endothelin-1 in Patients with Refractory Cirrhotic Ascites

Objective： To explore the influence of Shehuang Paste （麝黄膏, SHP） to the hemodynamics, endotoxin, nitric oxide （NO）, and endothelin-1 （ET-1） in patients with refractory cirrhotic ascites. Methods： Fifty-nine cases of refractory cirrhotic ascites were randomly assigned to two groups, 32 cases in the treatment group and 27 cases in the control group. The basic treatment was the same for both groups, including liver protecting medicines, diuretics and supportive drugs, but SHP navel sticking was applied for the treatment group additionally once a day. A course of one month of treatment was applied and the general efficacy on ascites was observed by the end of the therapeutic course. Before and after the treatment, examinations by limulus lysate chromogenic test was conducted to measure plasma endotoxin content; colorimetry to measure plasma content of NO indirectly, radioimmunoassay to measure plasma ET-1 content; and color Doppler ultrasonography to measure the blood flow of portal vein and splenic vein. The relationship between the blood flow of portal vein and splenic vein and endotoxin, NO and ET-1 in the treatment group was analyzed as well. Results： The total effective rate on ascites was 84.4% in the treatment group, and 48. 1% in the control group, with significant difference shown between them （P〈0.01）. In the treatment group the blood flow of portal vein and splenic vein, contents of endotoxin, NO and ET-1 all got significantly reduced after treatment （ P〈0.05 or P〈0.01）; while these indexes in the control group were not significantly changed （P〉0.05）. Moreover, it was found that in the treatment group, the blood flow of portal vein and splenic vein had a positive correlation to the levels of NO, ET-1, and endotoxin, either before or after treatment. Conclusion： Application of SHP navel sticking could clearly reduce the blood flow of portal vein and splenic vein, and lower the content of endotoxin, NO and ET-1. The blood flow of portal vein and splenic vein in the treatment group showed a positive correlation with the contents of endotoxin, NO and ET-1.