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Objective To explore the synergism efficacy and mechanism of Warm Purgative and Strengthening Spleen (WPSS) therapy combined with antibiotics in the treatment of sepsis. Methods Thirty-two SPF Spargue-Dawley (SD) rats were used to replicate the rat sepsis model by cecum ligation perforation (CLP) method and equally divided into model control (MC) group, ceftriaxone group, Chinese herbal medicine (CHM) group and ceftriaxone +CHM group. Eight SD rats underwent sham surgery were used as a sham operation (Sham) group. Rats in Sham and MC groups were administered with 0.9% normal saline (NS) by intraperitoneal injection and gavage. Rats in CHM group were administered with modified Dahuang Fuzi Decoction (DFD, 8 mg/kg) by gavage + 0.9% NS by intraperitoneal injection, Bid. Rats in ceftriaxone group were administered with 0.9% NS by gavage and ceftriaxone (120 mg/kg) by intraperitoneal injection, Bid. Rats in ceftriaxone + CHM group were administered with modified DFD (8 mg/kg) by gavage and ceftriaxone (120 mg/kg) intraperitoneal injection, Bid. The drugs were given for 2 days. The mortality of rats in each group was observed after treatment. The intestinal flora changes and intestinal permeability [intestinal mucosa injury index (IMII), intestinal mucosa secretory immunoglobulin (sIgA), serum D-lactic acid, diamine oxidase (DAO) and sIgA] were detected. Meanwhile, the levels of serum inflammation indexes [lipopolysaccharide (LPS), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)] were detected. Results ① Mortality: ceftriaxone+CHM group (25.0%) < CHM group (37.5%) and ceftriaxone group (37.5%) < MC group (50.0%), the differences between groups were statistically significant (all P < 0.05). ② 16S rDNA sequencing analysis: the ratio of Bacteroidetesin in MC group was lower than that in the Sham group [(24.36±7.15)% vs. (45.20±6.05)%], and the ratio of Proteobacteria in MC group was higher than that in Sham group [(10.03±7.55)% vs. (0.41±0.21)%]. The diversity of intestinal flora in ceftriaxone group was significantly lower than that in Sham and CHM groups (404.60±17.09 vs. 470.80±16.97, 469.20±14.59), the differences between groups were statistically significant (all P < 0.05). The principal component analysis (PCA) suggested that the composition of CHM group was closer to that of Sham group, which indicated that WPSS therapy could reduce intestinal flora disorders in rats with sepsis. ③The pathological changes of intestinal mucosa: light microscope showed the intestinal mucosa of Sham group was intact; the intestinal mucosa became thinner, and local inflammatory cells had infiltration in MC group. The thickness of intestinal mucosa in CHM, ceftriaxone and CHM+ceftriaxone groups was slightly thicker, and the infiltration of local inflammatory cells was less than that in MC group. The thickness of intestinal mucosa in CHM group and ceftriaxone+CHM group was slightly thicker than that in the ceftriaxone group, and the arrangement was more regular than that in MC group and ceftriaxone group.④Intestinal mucosa permeability and inflammatory state: IMII, D-lactic acid, DAO, LPS, TNF-α and IL-6 of rats in MC group were higher than those of rats in Sham group [IMII: 4.37±0.56 vs. 0.26±0.29, D-lactic acid (mg/L):12.35±0.83 vs. 7.30±1.29, DAO (kU/L): 2.16±0.43 vs. 0.32±0.06, LPS (kU/L): 0.663±0.012 vs. 0.095±0.003, TNF-α (μg/L): 251.03±82.69 vs. 52.15±6.25, IL-6 (μg/L): 160.50±4.77 vs. 54.30±3.36], while sIgA in MC group was lower than that in Sham group (mg/L: 11.57±0.17 vs. 26.76±1.99). IMII, D-lactic acid, DAO, LPS, TNF-α and IL-6 of rats in CHM, ceftriaxone and CHM+ ceftriaxone groups were significantly lower than those of rats in MC group, while sIgA in CHM, ceftriaxone and CHM+ceftriaxone groups were significantly higher than that of rats in MC group. The change of CHM+ceftriaxone group was more significant than those of CHM group and ceftriaxone group [IMII:1.78±0.23 vs. 1.96±0.62, 3.39±0.43, D-lactic acid (mg/L): 8.56±0.37 vs. 9.62±0.57,11.42±0.39, DAO (kU/L):1.14±0.12 vs. 1.72±0.24, 2.01±0.32, sIgA (mg/L): 25.34±1.49 vs. 23.99±7.85, 17.46±1.20, LPS (kU/L):0.302±0.007 vs. 0.387±0.004, 0.715±0.013, TNF-α (μg/L): 57.10±3.98 vs. 101.49±21.49, 141.91±20.20, IL-6 (μg/L): 93.71±2.39 vs. 87.12±7.31, 104.27±1.84]. Conclusion WPSS therapy may improve the efficacy of antibiotics in the treatment of sepsis by regulating the intestinal flora and reducing the intestinal mucosa permeability and inflammation level.
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ObjectiveTo evaluate the effect of Rhubarb associated preparations (rhubarb or prescriptions of traditional Chinese medicine including rhubarb) on sepsis patients with acute gastrointestinal dysfunction (AGI).Methods The retrieval of databases from libraries including PubMed, Medline, Cochrane Central Register of Controlled Trials, CNKI, CBMdisc, Wan Fang Database, VIP database were searched to identify randomized controlled trials (RCTs) about Rhubarb associated preparations for treatment of sepsis patients with AGI from the foundation of the various databases to March 2016. And in the mean time, the references of the studies accepted were also retrieved. The retrieving and screening of literatures were performed independently by two researchers, the methodological quality and data extraction of the enrolled literatures were assessed by Jadad scale, and Cochrane Collaboration 5.3 software was used to perform Meta analyses to observe the effects of rhubarb associated preparations on gastrointestinal function score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality in sepsis patients with AGI; the bias of published literatures was evaluated by funnel plot.Results ① Finally, 16 studies involving 1 171 patients (610 in rhubarb preparation group and 561 in the control group) were identified and enrolled. 12 studies had a Jadad score ≥ 3 and 4 studies < 3. The random method was used in classification of groups in all the studies in which the intergroup baseline data being comparable was clearly indicated. The blind method was applied in 5 contained RCTs.② The results of Meta-analyses showed that rhubarb associated preparation could improve gastrointestinal function score [mean difference (MD) = -0.52, 95% confidence interval (95%CI) = -0.55 to -0.48, P < 0.000 01], reduce the APACHEⅡ score (MD = -3.66, 95%CI = -5.00 to -2.33,P < 0.000 01) and 28-day mortality [odds ratio (OR) = 0.46, 95%CI = 0.30 to 0.71,P < 0.000 01] compared with those in the control group, the differences being statistically significant. No publication bias was seen in 16 literatures containing RCTs from the funnel plot.Conclusions Compared with the control group, the rhubarb associated preparations combined with conventional theraph can significantly improve the gastrointestinal function score, reduce APACHE Ⅱ score and 28-day mortality of sepsis patients with AGI, which suggests the rhubarb associated preparations have better efficacy. In addition, the result of sensitivity analysis has not substantially changed the results of Meta-analysis.
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Objective To analyze the positive rate of specific distribution characteristics in Rh blood group antibody,analyze the clinical significance of Rh blood group antibody and rules.Methods The micro column gel anti globulin technique was used to screen and identify irregular red blood cell antibodies,for patients with Rh blood group antibody,monoclonal anti-D,anti-C,anti-c, anti-E,anti-e were used to identify Rh blood group antigen to confirm the accuracy of detection.The antibody titer,Ig-type and 37℃ reactive were used to determine its clinical significance.Through asking pregnancy history,history of blood transfusion,under-standing whether the same specificity of the antibody in maternal plasma if the patient was newborn,the causes of antibody were an-alyzed.Results In 109 000 patients,Rh blood group antibodies were detected in 96 cases,the positive rate was 0.088%,which has a history of pregnancy in 68 cases,5 cases had history of blood transfusion,both pregnancy history and history of blood transfusion in 6 cases,1 7 cases of neonatal maternally derived antibody.Antibody specificity:65 cases of anti-E(67.710%),12 cases of anti-cE (12.500%),8 cases of anti-D (8.330%),7 cases of anti-c(7.291%),2 cases of anti-C (2.083%),2 cases of anti-e(2.083%).96 cases of Rh blood group antibodies were IgG or IgG+IgM class,37 ℃ reaction could be with the corresponding antigen of red blood cell,antibody titer between 4-2 048.Conclusion Anti-D detection rate shows a trend of gradually decreasing.In Rh blood group antibody detection,anti-E and anti-cE account for an absolute majority.Alloimmune caused by pregnancies and blood transfusion is the main reason of Rh blood group antibody production from Rh blood group antibody.Neonatal maternal passive getisa Rh-HDN is the main pathogenic antibody.
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@#This paper points out the importance of intravenous thrombolysis with recombinant tissue plasminogen activator(r-tPA)according to the international guidelines in acute ischemic stroke.Some practical problems,such as the lower rate of thrombolysis for ischemic stroke,the price of r-tPA being too expensive to clinical using,the dosage of r-tPA in Chinese being not clear,the curative effect being not so good,and traditional Chinese medicine (TCM) applied in intravenous thrombolysis,and so on,should be further discussed.