Effect of constituents from Fructus Aurantii Immaturus and Radix Paeoniae Alba on gastrointestinal movement

Fructus Aurantii Immaturus and Radix Paeoniae Alba Powder (FPP) is a popular Chinese herbal prescription. The combination of Fructus Aurantii Immaturus and Radix Paeoniae Alba has been used to treat gastrointestinal disorders for hundreds of years. To our interest, this combination shows a bilateral effect on gastrointestinal peristalsis. Our present study was focused on the bilateral role of this combination on the gastrointestinal tract. The effective constituents and mechanisms were explored. Six monomer constituents from Radix Paeoniae Alba and Fructus Aurantii Immaturus were screened by intestinal transit assay. The bilateral roles of three effective constituents were authenticated by gastric emptying assay, and the combination of three constituents showed a bilateral effect. Then, the mediating receptors and the role of NO and NF- kappaB p65 were examined to determine the mechanism involved. The overall results suggest that the major effective constituents of this combination are synephrine, hesperidin and paeoniflorin. Synephrine inhibits the gastrointestinal movement, while hesperidin stimulates it. Paeoniflorin shows different effects on intestinal and gastric activity. The effect of synephrine relies on the alpha-adrenergic receptor, and the effect of hesperidin is mediated via the H1 histamine receptor. The regulation of hesperidin and synephrine on NF- kappaB p65 translocation and NO production through the alpha-receptor and the H1 receptor, respectively, is involved in the bilateral effect of the Fructus Aurantii Immaturus-Radix Paeoniae Alba combination.

Infrapopliteal arterial bypass for limb salvage: increased patency and utilization of the saphenous vein used "in situ"

A prospective study of "in situ" saphenous vein has been made to determine its patency and utilization when used for arterial bypass distal to the popliteal artery. The valvular obstructions to arterial flow were removed by the method of valve incision developed by the authors. Of 316 consecutive "in situ" bypass procedures, 133 attempts were made to complete the procedure to the infrapopliteal level for limb salvage. One hundred and twenty-four of these were completed, to 43 peroneal, 40 posterior tibial, 25 anterior tibial, and 16 tibioperoneal arteries. At the level of its distal transection, the saphenous veins had diameters of 3.5 to 2.5 mm in 58 cases (45%). Only 7% of these procedures could not be completed without resorting to the use of excised vein segments. There were seven occlusions within 30 days (94% immediate patency rate). Cumulative patency rates by life-table analysis at 1, 2, and 3 years were 87%, 82%, and 72%, respectively. Neither the vein diameter nor the location of the distal anastomosis had any effect on these patency rates. In spite of the immediate failure rate of 15% to 30%, reversed autogenous saphenous vein is the present material of choice for infrapopliteal bypass. However, when the generally accepted minimum diameter of 4 mm is applied, at least 25% of these veins may not meet this criterion. These data show that the "in situ" method allows for both increased bypass patency and utilization of saphenous vein by permitting the consistent use of increased bypass patency and utilization of saphenous vein by permitting the consistent use of veins of 3.5 mm diameter or less. The summation of these improved utilization and patency rates has resulted in a greater number of functioning bypasses when compared to the present experience with reversed saphenous vein and/or nonautogenous substitutes in current use.