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Objective:To analyze the mechanism of Danpi-Chishao in treatment of sepsis based on network pharmacology.Methods:The corresponding targets of Danpi-Chishao and sepsis were carried out through TCMSP database, OMIM database and Genecards database. Cystoscope 3.8.2 software was used to construct the " Chinese medicine-active components-target-disease" network diagram. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out by DAVID database. Weisheng cloud platform was used to draw bubble map.Results:A total of 36 effective components of Danpi-Chishao was obtained, mainly including quercetin, kaempferol, baicalin, β-sitosterol, stigmasterol, paeoniflorin and so on. There were 96 potential common key targets between Danpi-Chishao and sepsis, such as prostaglandin-endoperoxide synthase 2 (PTGS2), transcription factor p65 (RELA), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit gamma (PIK3CG), B-cell lymphoma 2 (BCL-2)-associated X (BAX), BCL-2, Caspase-3 (CASP3) with a degree value>4.9. The result of protein-protein interaction (PPI) network analysis showed that there were 10 important target proteins, including alpha serine/threonine-protein kinase (AKT1), interleukin-6 (IL-6), tumor necrosis factor (TNF), interleukin-1β (IL-1β), vascular endothelial growth factor A (VEGFA), cellular tumor antigen p53 (TP53), matrix metalloproteinase-9 (MMP9), CASP3, PTGS2, C-C motif chemokine ligand 2 (CCL2). The pathways obtained by GO and KEGG enrichment analysis included atherosclerosis pathway, advanced glycation end products (AGE)-receptor for advanced glycation end products (RAGE) signal pathway, cancer pathway, tumor necrosis factor signal pathway, hypoxia-inducible factor (HIF) signal pathway, IL-17 signal pathway and other pathway.Conclusions:The mechanism of the intervention effect of Danpi-Chishao on sepsis may be that the active components such as quercetin, kaempferol, paeoniflorin act on target proteins such as PTGS2, RELA, PIK3CG, BAX, BCL2, CASP3, and through TNF-related signal pathway, HIF-1 signal pathway, IL-17 signal pathway, etc. Nonetheless, the conclusion needs further experimental verification.
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Objective:To evaluate the value of age-adjusted Charlson comorbidity index (aCCI) in the clinical prognosis of sepsis and septic shock in the elderly, and to further explore the role of aCCI in evaluating the timing of Shenfu injection in elderly patients with septic shock.Methods:Clinical data of elderly patients with sepsis and septic shock in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1, 2019 to January 1, 2022 were retrospectively analyzed. With the median aCCI score of all samples as the cutoff value, the patients were divided into the low aCCI score group and high aCCI score group. The prognosis of elderly patients with septic shock and the application timing of Shenfu injection with aCCI score and sequential organ failure assessment (SOFA) were compared.Results:A total of 61 patients were included, including 31 patients in the high aCCI score group. The proportion of septic shock in elderly sepsis patients was lower in the low aCCI score group ( P < 0.05). The aCCI score (95% CI: 1.229-2.615; P< 0.01) was more valuable than SOFA score (95% CI: 1.035-1.607; P< 0.05) in predicting septic shock in elderly patients with sepsis. The 28-day survival rate in the low aCCI score group was higher than that in the high aCCI score group ( P < 0.05). Both the SOFA score (95% CI: 1.010-1.364) and the aCCI score (95% CI: 1.072-10.501) were independent factors affecting the 28-day survival rate. The use of Shenfu injection was associated with 28-day survival outcome in elderly patients with septic shock (95% CI: 0.012-0.788; P < 0.05). Conclusions:aCCI score is more effective than SOFA score in assessing the risk of shock in elderly patients with septic shock, and has a certain predictive value for the survival and prognosis of elderly patients with sepsis. Shenfu injection may be beneficial to the survival and prognosis of elderly patients with septic shock, but it needs to be further verified by large-scale prospective studies.
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Objective:Animal models of sepsis are mainly established by cecal ligation and puncture which causes mixed bacterial infections in the abdominal cavity. However in internal clinic, sepsis is more common to be caused by respiratory bacterial infections. Therefore, it is necessary to establish animal models of sepsis caused by lung Infection.Methods:According to the concentration of Staphylococcus aureus (S. aureus) suspension and Pseudomonas aeruginosa (P. aeruginosa) suspension, Sprague Dawley (SD) rats were equally divided into 10 groups, including S-Cont group, S-0.75 group, S-1.5 group, S-3 group, S-6 group and P-Cont group, P-1 group, P-2 group, P-4 group, P-8 group. Rats in the control group were treated with normal saline nasal drip. Rats in each experimental group were infected by nasal dripping bacterial suspension with 0.75×10 8 CFU/ml, 1.5×10 8 CFU/ml, 3×10 8 CFU/ml, 6×10 8 CFU/ml of S. aureus suspension or 1×10 8 CFU/ml, 2×10 8 CFU/ml, 4×10 8 CFU/ml, 8×10 8CFU/ml P. aeruginosa suspension. Our study detected the body temperature (T), blood pressure (BP), heart rate (HR) of rats in each group before and after infection, as well as blood lactic acid (Lac) and procalcitonin (PCT) level after infection. The lung infections of rats in each group were observed by hematoxylin-eosin (HE) staining. Results:The blood pressure(BP) of S-1.5 group, S-3 group, S-6 group and P-8 group was lower than before infection (all P<0.05). The Lac and PCT of each S. aureus experimental group were higher than that of the S-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration ( P<0.05), except for the S-3 and S-6 group ( P>0.05). The Lac and PCT of each P. aeruginosa experimental group were higher than that of the P-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration (all P<0.05), except for the Lac in the P-4 group and P-8 group ( P>0.05). HE staining showed that different degrees of inflammatory infiltration can be seen in the lungs of the experimental rats in each group. Conclusions:Infection of rats by nasal dripping with 3×10 8 CFU/ml of S. aureus suspension or 4×10 8 CFU/ml of P. aeruginosa suspension could establish relatively stable rat sepsis model induced by lung bacterial infection, of which the former could also establish a relatively stable septic shock model.
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Objective:To compare the efficacy of conventional Western medicine alone and acupuncture combined with acupoint application in treating intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis.Methods:A retrospective analysis was performed on 111 elderly patients with mechanical ventilation for sepsis admitted to the emergency department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to June 2021. They were divided into two groups according to the time of admission: Western medicine treatment group alone (patients from January 2019 to December 2019, n=47) and acupuncture combined with acupoint application group (patients from January 2020 to June 2021, n=64). Acupuncture combined with acupoint application group was treated with acupuncture combined with acupoint application on the basis of conventional Western medicine. The intestinal dysfunction score, abdominal circumference and mortality after 4 weeks were compared between the two groups. Results:The abdominal circumference and intestinal dysfunction score in acupuncture combined with acupoint application group were significantly lower than those before treatment [(100.56±9.34)cm vs (106.25±9.74)cm; (0.92±0.72)point vs (2.31±0.69)point, all P< 0.05], while there was no significant difference in the above indexes before and after treatment in the Western medicine treatment group (all P>0.05). The abdominal circumference, intestinal dysfunction score and mortality after 4 weeks in the acupuncture combined with acupoint application group were significantly lower than those in the Western medicine treatment group [(100.56±9.34)cm vs (108.09±10.52)cm; (0.92±0.72)point vs (2.43±0.62)point; (29.7%, 19/64) vs (48.9%, 23/47), all P<0.05]. Conclusions:The curative effect of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with sepsis in emergency is better than that of routine treatment of Western medicine alone. The gastrointestinal function and prognosis of patients have been significantly improved, which is worthy of clinical promotion.
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Objective:To compare the effect of metaraminol and norepinephrine (NA) on elderly patients with septic shock.Methods:In this multicenter prospective cohort study elderly patients with septic shock were divided into the metaraminol group ( n=100) and NA group ( n=100). The 28-day survival and average hospital stay, the hemodynamics and renal function of the patients were observed. Results:The average hospital stay in the metaraminol group was lower than that in the NA group ( P < 0.05). Blood pressure, heart rate, arterial lactate, B-type natriuretic peptide, left ventricular ejection fraction and 28-day survival had no significant differences between the two groups (all P > 0.05). The average urine output at day 3 and 7 after the administration of vasopressor in the metaraminol group were higher than those in the NA group (all P< 0.05), blood urea nitrogen at day 3, 7 and 14 after the administration of vasopressor in the metaraminol group were lower than those in the NA group (all P < 0.05), and the creatinine at day 3, 7 and 14 after the administration of vasopressor and the rate of renal replacement therapy in the metaraminol group were lower than those in the NA group (all P < 0.05). Conclusions:Metaraminol has similar effect to norepinephrine in improving 28-day survival and hemodynamics of elderly patients with septic shock, but is superior to norepinephrine in reducing the average hospital stay and protecting renal function.
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Chronic intermittent hypoxia ( CIH ) caused by ob-structive sleep apnea hypopnea syndrome( OSAHS) is an impor-tant factor causing or aggravating many kinds of cardiovascular and cerebrovascular diseases. Establishing a rational animal model for intermittent hypoxia is an essential method to study the CIH related cardiovascular diseases. Recently, researchers have tended to simulate intermittent hypoxia condition by controlling the oxygen concentration of the environmental air around the ani-mals. In the paper, we summarize and compare the methods of making intermittent hypoxia animal model in recent literature, from aspects of experimental animals, gas control apparatus, gas species and concentration, intermittent hypoxia treatment time, and anoxic cycle mode.