Successful laparoscopic management for cholecystoenteric fistula

AIM: Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula (CF) is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy.

METHODS: During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial Hospital-Taipei were retrospectively reviewed.

RESULTS: The study comprised two male and two female patients with ages ranging from 36 to 74 years (median: 53.5 years). All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography. One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d (median, 8 d).

CONCLUSION: CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.

Evaluating microcirculation by pulsatile laser Doppler signal

Laser Doppler flowmetry (LDF) is a popular method for monitoring the microcirculation, but it does not provide absolute measurements. Instead, the mean flux response or energy distribution in the frequency domain is generally compared before and after stimulus. Using the heartbeat as a trigger, we investigated whether the relation between pressure and flux can be used to discriminate different microcirculatory conditions. We propose the following three pulsatile indices for evaluating the microcirculation condition from the normalized pressure and flux segment with a synchronized-averaging method: peak delay time (PDT), pressure rise time and flux rise time (FRT). The abdominal aortic blood pressure and renal cortex flux (RCF) signals were measured in spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY). The mean value of the RCF did not differ between SHR and WKY. However, the PDT was longer in SHR (87.14 +/- 5.54 ms, mean +/- SD) than in WKY (76.92 +/- 2.62 ms; p < 0.001). The FRT was also longer in SHR (66.56 +/- 1.98 ms) than in WKY (58.02 +/- 1.77 ms; p < 0.001). We propose that a new dimension for comparing the LDF signals, which the results from the present study show, can be used to discriminate RCF signals that cannot be discriminated using traditional methods.

Population structure of wild bananas, Musa balbisiana, in China determined by SSR fingerprinting and cpDNA PCR-RFLP

Both demographic history and dispersal mechanisms influence the apportionment of genetic diversity among plant populations across geographical regions. In this study, phylogeography and population structure of wild banana, Musa balbisiana, one of the progenitors of cultivated bananas and plantains in China were investigated by an analysis of genetic diversity of simple sequence repeat (SSR) fingerprint markers and cpDNA PCR-RFLP. A chloroplast DNA (cpDNA) genealogy of 21 haplotypes identified two major clades, which correspond to two geographical regions separated by the Beijiang and Xijiang rivers, suggesting a history of vicariance. Significant genetic differentiation was detected among populations with cpDNA markers, a result consistent with limited seed dispersal in wild banana mediated by foraging of rodents. Nuclear SSR data also revealed significant geographical structuring in banana populations. In western China, however, there was no detected phylogeograpahical pattern, possibly due to frequent pollen flow via fruit bats. In contrast, populations east of the Beijiang River and the population of Hainan Island, where long-range soaring pollinators are absent, are genetically distinct. Colonization-extinction processes may have influenced the evolution of Musa populations, which have a metapopulation structure and are connected by migrating individuals. Effective gene flow via pollen, estimated from the nuclear SSR data, is 3.65 times greater than gene flow via seed, estimated from cpDNA data. Chloroplast and nuclear DNAs provide different insights into phylogeographical patterns of wild banana populations and, taken together, can inform conservation practices.

Effects of whole-body mechanical stimulation at double the heart rate on the blood pressure waveform in rats

The effects of mechanical stimulation on hemodynamics, such as due to mechanotransduction in vascular endothelial cells, have been widely discussed recently. We previously proposed a resonance model in which the arterial system is treated as a pressure-transmitting system, and suggested that the application of external mechanical stimulation with frequencies near the heart rate (HR) or harmonics thereof can be sensed by the arterial system and induce hemodynamic changes. In this study, we monitored the effects of external mechanical stimulation at a frequency of double the HR on BPW (blood pressure waveform), HRV (HR variability) and BPHV (blood-pressure-harmonics variability) in rats. A motor beating a waterbed mattress was used to generate pressure variations of 0.5 mmHg to apply onto the rats. The experiments were performed on three groups of rats with different beating frequencies: (A) double the HR, (B) 5% deviation from double the HR and (C) 1.5 times the HR. The experimental procedure was a 15 min control period followed by application of the mechanical stimulation for 15 min and further recording for 15 min (OFF period). During the OFF period, the amplitude of the second harmonic in the BPW significantly increased by >5% in group A with decreased HRV and BPHV. The second harmonic increased less in group B, and decreased in group C. The increase in the second-harmonic amplitude in group A may be due to the filtering properties of the renal arterial structure. This mechanism could be used to improve the local blood supply into the kidneys, and hence provide a new treatment modality for some important diseases, such as renal hypertension or nephrosis.

Validation of fermentation processes

The ability to prepare consistent biopharmaceutical products depends extensively on possession of banked and characterized cell substrates and on development of production processes which can be validated. While the attributes that define cell characterization have been extensively detailed by ICH and the regulatory agencies in the past decade, little has been specified regarding process validation for biological processes. The extent to which validation concepts can be applied to biological processes varies depending on the nature of the process, the nature of the product, and the level of knowledge regarding the relationship between process parameters and product quality. Expectations concerning the rigour of the validation programme should be adjusted accordingly. There is no single approach that is appropriate for all processes and products. At a minimum, there should be an attempt to define which process parameters are critical, and to focus the attention of validation efforts on these parameters.

Influencing the heart rate of rats with weak external mechanical stimulation

The ventricular-arterial coupling is assumed to minimize the expenditure of cardiac energy. From the conjecture of the resonance theory, the arterial system transmits pressure waves and resonates with the heartbeat, therefore, the arterial system is similar to a mechanical resonator. Theoretically, the heart rate can be paced with weak external mechanical stimulation and corresponding blood pressure changes can be observed. A waterbed was activated to generate 0.5-mmHg pressure vibrations as a stimulus and the rate was set to deviate 5% from the control heart rate. Among 13 studies on seven rats, the linear regression between X (stimulation frequency--control heart rate) and Y (actual changes of the heart rate) is Y = 0.992X = 0.062 (Hz) with a correlation coefficient of 0.97 (Y = X implies complete steering). The intercorrelation coefficient between the change in mean blood pressure and the heart rate was 0.79. The study showed that this weak mechanical stimulation influences the heart rate, and the blood pressure changes according to the heart rate. Cardiovascular optimization and the resonance theory may explain the way one may regulate the heart rate and the blood pressure of humans noninvasively in the future.

Crystallization and preliminary crystallographic studies of a ribosomal protein L30e from the hyperthermophilic archaeonThermococcus celer

Ribosomal protein L30e from the hyperthermophilic archaeon Thermococcus celer is a good model for the study of the thermostability of proteins. It has been overexpressed, purified and crystallized using the hanging-drop vapour-diffusion method using PEG 8000 as precipitant at 290 K. The crystal belongs to the hexagonal space group P6(1)/P6(5), with unit-cell parameters a = b = 48.32, c = 86.42 A. The asymmetric unit contains a single molecule of L30e, with a corresponding crystal volume per protein mass (V(M)) of 2.68 A(3) Da(-1) and a solvent content of 54%. A complete data set diffracting to 1.96 A resolution was collected from a single crystal at 100 K.

Structure of the C-terminal sterile alpha-motif (SAM) domain of human p73 alpha

p73 is a homologue of the tumour suppressor p53 and contains all three functional domains of p53. The alpha-splice variant of p73 (p73 alpha) contains near its C-terminus an additional structural domain known as the sterile alpha-motif (SAM) that is probably responsible for regulating p53-like functions of p73. Here, the 2.54 A resolution crystal structure of this protein domain is reported. The crystal structure and the published solution structure have the same five-helix bundle fold that is characteristic of all SAM-domain structures, with an overall r.m.s.d. of 1.5 A for main-chain atoms. The hydrophobic core residues are well conserved, yet some large local differences are observed. The crystal structure reveals a dimeric organization, with the interface residues forming a mini four-helix bundle. However, analysis of solvation free energies and the surface area buried upon dimer formation indicated that this arrangement is more likely to be an effect of crystal packing rather than reflecting a physiological state. This is consistent with the solution structure being a monomer. The p73 alpha SAM domain also contains several interesting structural features: a Cys-X-X-Cys motif, a 3(10)-helix and a loop that have elevated B factors, and short tight inter-helical loops including two beta-turns; these elements are probably important in the normal function of this domain.

[Studies of FISH and karyotype of Gossypium barbadense]

Based on the fluorescent in situ hybridization (FISH) of somatic chromosome of Gossypium barbadense with the probe of genomic DNA (gDNA) of Gossypium arboreum, two sets of chromosomes were easily distinguished by signals hybridized or not. The FISH directly proved that G. barbadense originated from two different diploid species, but was not in concordance with the former point that every chromosome of A sub-genome of tetraploid species was bigger than that of other sub-genome (D genome). The karyotype formula of G. barbadense based on its FISH was 2n = 4x = 52 = 38 m + 14sm(6sat). There were three pairs of satellite chromosomes which were all sm types. Their satellites located in short arms but originated differently from their chromosomes of sub-genome. Fragment translocations occured in the long arms of homologous chromosomes of number 5, 6 and 9 of A sub-genome. It was suggested that the translated fragments come from D sub-genome. The fragments are fairly large with the relative lengths of 19.21%, 17.69% and 12.88% of their whole chromosomes, respectively. At least five pairs of chromosomes in D sub-genome show some hybridized signals of gDNA probe of G. arboreum in their centromere regions, which indicated that there would be chromatin introgressions from A sub-genome.

Influence of spleen meridian herbs on the harmonic spectrum of the arterial pulse

Pulse analysis is a powerful method in Chinese medicine. We suggest that the effect of herbal medicine is to redistribute the blood to organs and meridians. In this report, by injecting extracts into rats and then analyzing the blood pressure wave measured at the caudate arteries, we studied eight important spleen meridian related herbs: They were Semen Lablab, Fructus Amomi Globosi, Rhizoma Atractylodis Macrocephalae, Rhizoma Atractylodis, Tuber Pinelliae, Radix Codonopsitis, Pericarpium Aurantii and Rhizoma Polygonati. All eight herbs increased the intensity of the 3rd harmonic (C3) of the pressure pulse which is correlated to the spleen and spleen meridian, as described in traditional Chinese medical literature. All of them also increased the 2nd harmonic (which is correlated to the kidney and the kidney meridian) as well as decreased the heart load (DC term of pressure wave, C0). Tuber Pinelliae, Radix Codonopsitis, Pericarpium Aurantii and Rhizoma Polygonati decreased the 1st harmonic (correlated to the liver meridian) significantly, while Rhizoma Atractylodis Macrocephalae only decreased C1 slightly. Except for Semen Lablab, all the others decreased the intensity of the 5th (stomach meridian) and the 7th harmonics. The effects of kidney herbs: Cortex Eucommiae and Radix Achyranthis were also shown for comparison.

Interaction between HIV type 1 glycoprotein 120 and CXCR4 coreceptor involves a highly conserved arginine residue in hypervariable region 3

Several seven-transmembrane chemokine receptors are known to function as entry coreceptors for human immunodeficiency virus type 1. CCR5 and CXCR4 are the major coreceptors for non-syncytium-inducing (NSI) and syncytium-inducing (SI) viruses, respectively. During the natural course of infection, the emergence of variants with a phenotypic transition from NSI to SI and rapid disease progression is associated with expanded coreceptor usage to CXCR4. Characteristic amino acids at several positions in the hypervariable region 3 (V3) of gp120 have been linked to CXCR4 utilization. Previously, we reported that a highly conserved arginine residue of V3 played an important role in CCR5 utilization. In this study, the possible involvement of the same arginine residue in CXCR4 utilization was investigated. Amino acid substitutions introduced to this arginine on R5X4 viruses were found to have a significant effect on their utilization of CXCR4. These results, taken together with those reported previously, suggest that this highly conserved arginine may contribute to the functional convergence of chemokine coreceptor utilization by human immunodeficiency viruses and may represent a unique target for future antiviral design.

Quantitative competitive reverse transcription-PCR for quantification of dengue virus RNA

A quantitative competitive reverse transcription-PCR assay was developed to quantify dengue virus RNA in this study. The main features include a primer pair targeting a highly conserved region in the capsid and the addition of competing RNA that contains an internal deletion to provide a stringent internal control for quantification. It can be utilized to quantify RNA isolated from the four dengue virus serotypes but not RNA isolated from other flaviviruses, including Japanese encephalitis virus and hepatitis C virus, both prevalent in Asia. It can also be used to quantify dengue virus RNA isolated from the plasma of infected individuals. The sensitivity of the assay was estimated to be 10 to 50 copies of RNA per reaction, and twofold differences in virus titer are distinguishable. This assay is a convenient, sensitive, and accurate method for quantification and can be used to further understanding of the pathogenesis of dengue virus infection.

Molecular biology of human immunodeficiency virus type 1

Since the discovery of human immunodeficiency virus (HIV) as the etiologic agent of acquired immune deficiency syndrome (AIDS) more than a decade ago, tremendous progress has been made in various aspects of this virus and its interplay with the host immune system. The advent of potent combination therapy has made it possible to achieve effective and durable control of HIV-1 replication in vivo, yet the persistence of the latent reservoirs pose a new challenge. The recent identifications of several cellular proteins interacting with different viral gene products have not only shed new insights into our understanding of the HIV-1 and the host cell biology, but also provided the bases for developing novel strategies to block HIV-1 replication. It is from this perspective that we review the current understanding of the molecular mechanisms governing the HIV-1 life cycle.

Determination of human immunodeficiency virus type 1 subtypes in Taiwan by vpu gene analysis

The genetic diversity of human immunodeficiency virus (HIV) type 1 (HIV-1) has been characterized mainly by analysis of the env and gag genes. Information on the vpu genes in the HIV sequence database is very limited. In the present study, the nucleotide sequences of the vpu genes were analyzed, and the genetic subtypes determined by analysis of the vpu gene were compared with those previously determined by analysis of the gag and env genes. The vpu genes were amplified by nested PCR of proviral DNA extracted from 363 HIV-1-infected individuals and were sequenced directly by use of the PCR products. HIV-1 subtypes were determined by sequence alignment and phylogenetic analysis with reference strains. The strains in all except one of the samples analyzed could be classified as subtype A, B, C, E, or G. The vpu subtype of one strain could not be determined. Of the strains analyzed, genetic subtypes of 247 (68.0%) were also determined by analysis of the env or gag gene. The genetic subtypes determined by vpu gene analysis were, in general, consistent with those determined by gag and/or env gene analysis except for those for two AG recombinant strains. All the strains that clustered with a Thailand subtype E strain in the vpu phylogenetic analyses were subtype E by env gene analysis and subtype A by gag gene analysis. In summary, our genetic typing revealed that subtype B strains, which constituted 73.8% of all strains analyzed, were most prevalent in Taiwan. While subtype E strains constituted about one-quarter of the viruses, they were prevalent at a higher proportion in the group infected by heterosexual transmission. Genetic analysis of vpu may provide an alternate method for determination of HIV-1 subtypes for most of the strains, excluding those in which intersubtype recombination has occurred.

Crystallization and preliminary crystallographic studies of a SAM domain at the C-terminus of human p73alpha

p73 is a recently discovered homologue of the tumour suppressor p53 and contains all three functional domains of p53. The alpha-splice variant of p73 (p73alpha) contains an additional structural domain near its C--terminus that has sequence homology with the sterile alpha-motif (SAM) domain. This domain is considered to be responsible for mediating protein-protein interactions. Pyramidal crystals of human p73alpha SAM domain were obtained by the hanging-drop vapour-diffusion method with ammonium dihydrogen orthophosphate as the precipitant. The crystals diffract to 2.54 A resolution and belong to the tetragonal space group P4(1)2(1)2, with unit-cell parameters a = b = 32.02, c = 133.84 A. The structure was solved by molecular replacement using the NMR structure of the same protein as the search model.

Effect of length on the fundamental resonance frequency of arterial models having radial dilatation

The pressure wave moving along an elastic artery filled with blood was examined as a moving Windkessel having a natural oscillation angular frequency nu 0 and a damping coefficient b. The radial directional motion for an element of the wall segment and the adherent fluid was considered. This equation was solved with conditions at both ends of an artery of length L. An external impulse force was applied at one end and a static pressure Po at the other. Analytic solution allowed only certain oscillation modes of resonance frequencies fn, where fn2 = a + cnL-2 with [formula: see text] and V infinity is the high frequency phase velocity. The relationship between f0 and L was examined experimentally for tubes constructed of latex, rubber, or dissected aorta. The effect of raising the static pressure P0 or increasing the tension in the tube was consistent with the prediction. The hypertension that accompanies an augmentation in arterial wall and the association between the heart rate and the mean blood pressure were discussed.

Hypervariable region 3 residues of HIV type 1 gp120 involved in CCR5 coreceptor utilization: therapeutic and prophylactic implications

Crystallographic characterization of a ternary complex containing a monomeric gp120 core, parts of CD4, and a mAb, revealed a region that bridges the inner and outer domains of gp120. In a related genetic study, several residues conserved among primate lentiviruses were found to play important roles in CC-chemokine receptor 5 (CCR5) coreceptor utilization, and all but one were mapped to the bridging domain. To reconcile this finding with previous reports that the hypervariable region 3 (V3) of gp120 plays an important role in chemokine coreceptor utilization, elucidating the roles of various V3 residues in this critical part of the HIV type 1 (HIV-1) life cycle is essential. Alanine-scanning mutagenesis was carried out to identify V3 residues critical for CCR5 utilization. Our findings demonstrated that several residues in V3 were critical to CCR5 utilization. Furthermore, these residues included not only those conserved across HIV-1 subtypes, but also those that varied among HIV-1 subtypes. Although the highly conserved V3 residues may represent unique targets for antiviral designs, the involvement of variable residues raises the possibility that antigenic variation in the coreceptor binding domain could further complicate HIV-1 vaccine design.

Stability and folding of the tumour suppressor protein p16

The tumour suppressor p16 is a member of the INK4 family of inhibi tors of the cyclin D-dependent kinases, CDK4 and CDK6, that are involved in the key growth control pathway of the eukaryotic cell cycle. The 156 amino acid residue protein is composed of four ankyrin repeats (a helix-turn-helix motif) that stack linearly as two four-helix bundles resulting in a non-globular, elongated molecule. The thermodynamic and kinetic properties of the folding of p16 are unusual. The protein has a very low free energy of unfolding, Delta GH-2O/D-N, of 3.1 kcal mol-1 at 25 degreesC. The rate-determining transition state of folding/unfolding is very compact (89% as compact as the native state). The other unusual feature is the very rapid rate of unfolding in the absence of denaturant of 0.8 s-1 at 25 degreesC. Thus, p16 has both thermodynamic and kinetic instability. These features may be essential for the regulatory function of the INK4 proteins and of other ankyrin-repeat-containing proteins that mediate a wide range of protein-protein interactions. The mechanisms of inactivation of p16 by eight cancer-associated mutations were dissected using a systematic method designed to probe the integrity of the secondary structure and the global fold. The structure and folding of p16 appear to be highly vulnerable to single point mutations, probably as a result of the protein's low stability. This vulnerability provides one explanation for the striking frequency of p16 mutations in tumours and in immortalised cell lines.

Role of the CCR5 delta 32 allele in resistance to HIV-1 infection in west Africa

OBJECTIVE

To determine the frequency of the mutant CCR5 delta 32 allele in high-risk HIV-seronegative Africans as compared with the general African population, and to assess its in vitro protective efficacy against HIV-1 infection.

STUDY DESIGN

In the homozygous form, the CCR5 delta 32 allele confers resistance to macrophage-tropic (M-tropic) strains of HIV-1. Assuming that genetic characteristics favoring HIV resistance would prevail in a high-risk HIV-seronegative population, we examined the CCR5 genotypes of female commercial sex workers (CSWs) from Dakar, Senegal, who have remained uninfected for an elongated period.

METHODS

The CCR5 genetic profile of study participants was determined by polymerase chain reaction (PCR) amplification of genomic DNA followed by sequencing. Peripheral blood mononuclear cells (PBMCs) were infected with different strains of HIV-1 and monitored by p24 enzyme-linked immunosorbent assay (ELISA).

RESULTS

We confirmed the presence of two CCR5wt/delta 32 genotypes among 139 individuals (1.44%). PBMCs from these 2 heterozygous individuals were also found to be less susceptible to in vitro infection by an M-tropic HIV-1 primary isolate.

CONCLUSIONS

Evidence was found of an increased prevalence of the CCR5wt/delta 32 genotype in a high-risk HIV-seronegative cohort in West Africa. Furthermore, reduced susceptibility to HIV-1 infection among heterozygous individuals supports a role for 32-bp CCR5 deletion in HIV-1 resistance.

Liu-wei-dihuang: a study by pulse analysis

Pulse analysis method was used in studying the traditional Chinese formula Liu-Wei-Dihuang as well as five of its main components (Rehmannia glutinosa, Cornus officinalis, Paeonia Suffruticosa, Poria cocos and Alisma plantogo-aquatica var oriental). Based on our recently developed resonance theory, we tried to elucidate the mechanism and mutual reactions of these meridian related herbs. Hot water herbal extracts were injected intraperitoneally into rats and the pressure pulse spectrum at the caudate artery was measured. The results of this study indicated that Liu-Wei-Dihuang mildly increased blood flow to meridians with lower resonance frequency: namely the liver C1, the kidney C2 and the spleen C3; but decreased blood flow to the higher resonance frequency organs and meridians: the lung C4, the stomach C5, the gall bladder C6, and the bladder C7. It also decreased the heart load C0. All of the five herb components increased blood flow to the kidney C2 and the spleen C3; but their effects on the high frequency organs varied. Alisma plantogo-aquatica var. oriental decreased the C0, C5, C6, C7; Poria cocos decreased C1, C4, C5, C6; Rehmannia glutinosa, Paeonia Suffruticosa decreased C0, C4, C5, C6, C7; Cornus officinalis increased C4 but decreased C0, C5, C6, C7.

CCR5 coreceptor utilization involves a highly conserved arginine residue of HIV type 1 gp120

The seven-transmembrane CCR5 was recently found to double as a coreceptor for a genetically diverse family of human and nonhuman primate lentiviruses. Paradoxically, the main region of the envelope protein believed to be involved in CCR5 utilization was mapped to hypervariable region 3, or V3, of the envelope glycoprotein gp120. In this study, we addressed the question of whether functional convergence in CCR5 utilization is mediated by certain V3 residues that are highly conserved among HIV type 1 (HIV-1), HIV type 2, and simian immunodeficiency virus. Site-directed mutagenesis carried out on three such V3 residues revealed that the Arg-298 of HIV-1 gp120 has an important role in CCR5 utilization. In contrast, no effect was observed for the other residues we tested. The inability of Arg-298 mutants to use CCR5 was not attributed to global alteration of gp120 conformation. Neither the expression, processing, and incorporation of mutant envelope proteins into virions, nor CD4 binding were significantly affected by the mutations. This interpretation is further supported by the finding that alanine substitutions of five residues immediately adjacent to the arginine residue had no effect on CCR5 utilization. Taken together, our data strongly suggests that the highly conserved Arg-298 residue identified in the V3 of HIV-1 has a significant role in CCR5 utilization, and may represent an unusually conserved target for future anti-viral designs.

Pulse spectrum study on the effect of sie-zie-tang and Radix aconiti

Extracts of the traditional Chinese formula Sie-Zie-Tang as well as one of its main components, Radix Aconiti were injected into rats intraperitoneally to observe pressure wave spectrum changes at the caudate artery. We found that Radix Aconiti decreased the C0 (DC term of the pulse), C5 and C6 (the harmonic proportions of the 5th and the 6th harmonic), but increased C2 and C3 (the harmonic proportions of the second and the third harmonic) significantly. For Sie-Zie-Tang, the increases of C2, C3, and C4 were accompanied by the decreasing of C0. The decreases of C5, C6 were small and not significant. The additional ingredients in the formula reduce toxic side effects (arrhythmia or heart failure caused by faster and stronger heart beat) due to Radix Aconiti. For human subjects, low dose Sie-Zie-Tang tends to normalize the Fourier components of the pressure wave. Orally taking the formula elevates the harmonic proportion of the harmonic that is lower than normal, but suppresses the higher one. Our results provides a possible mechanism for heart meridian related herbs. It strengthens heart beats, and normalizes energy distribution to different meridians. The study on Sie-Zie-Tang reveals another formula construction to reduce toxic side effects.