Efficacy and Safety of Tigecycline for Patients with Hospital-Acquired Pneumonia.

BACKGROUND: Tigecycline is an antibiotic agent with a broad spectrum, which has an antibacterial effect against many multidrug-resistant organisms. However, its clinical efficacy in the treatment of hospital-acquired pneumonia (HAP) is disputed. MATERIALS AND METHODS: In this report, a systematic review and meta-analysis were conducted to evaluate the efficacy and safety of tigecycline for the treatment of HAP. The primary outcome was the rate of clinical cure, and the secondary outcomes were mortality and adverse events (AEs). RESULTS: Four trials involving 1,234 patients were included. The standard-dose tigecycline and comparator groups did not differ significantly in their rates of clinical cure. However, high-dose tigecycline was more effective than standard-dose tigecycline or the comparators for the treatment of HAP. There was no significant difference in mortality between the standard-dose or high-dose regimen and the comparators. Although the safety profile of standard-dose tigecycline was similar to the comparators, the high-dose regimen exhibited more AEs compared with the other groups. CONCLUSION: High-dose tigecycline is efficient for the treatment of HAP but is associated with more AEs.

Inhaled antibiotics in non-cystic fibrosis bronchiectasis: A meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of inhaled antibiotics for the treatment of non-cystic fibrosis bronchiectasis (NCFB). METHODS: Pubmed, Cochrane library, Embase, Elsevier, OVID, Springerlink, Web of knowledge and NEJM were searched for randomized controlled trials (RCTs) on inhaled antibiotics in treatment of NCFB from inception until April 2015. Meta-analysis was conducted to assess the efficacy and safety of inhaled antibiotics in the treatment of NCFB. RESULTS: Twelve RCTs involving 1154 participants were included. They showed that inhaled antibiotics were more effective in reduction of sputum bacterial density, eradication of P. aeruginosa, prolonged time to exacerbation and reduction of new pathogens emergence with no significant difference in adverse events compared with control groups. However, we did not find significant benefits of inhaled antibiotics in reducing the risk of acute exacerbation, improving health-related quality of life and reduction of P. aeruginosa resistance. Moreover, inhaled antibiotics exerted a statistically significant reduction in FEV1%. CONCLUSIONS: Inhaled antibiotics may be an alternative pathway to inhibit airway inflammation with no more adverse events in patients with NCFB.

Efficacy of Hepatoprotective Agents With or Without Antiviral Drugs on Liver Function and Fibrosis in Patients With Hepatitis B: A Meta-Analysis.

CONTEXT: To systematically evaluate the effects of hepatoprotective agents, when delivered either alone or in combination with other antiviral or non-antiviral drugs in patients with hepatitis B and hepatic fibrosis. OBJECTIVES: The current randomized controlled clinical trials aimed to evaluate the efficacy of combinations of antiviral and non-antiviral hepatoprotective agents on indexes of liver function and liver fibrosis in patients with hepatitis B. DATA SOURCES: Published literatures in Chinese and English on hepatoprotective treatment strategies for chronic hepatitis B and liver fibrosis were searched in three databases and randomized controlled clinical trials were selected. STUDY SELECTION: Data were extracted according to a variety of inclusion and exclusion criteria. Meta-analysis was employed to analyze the data. RESULTS: A total of 22 randomized controlled trials encompassing 1,714 cases were considered in the meta-analysis. The obtained results indicated that the combination of antiviral drug and hepatoprotective agent was better than antiviral drug alone to improve liver function. Similarly, regarding liver fibrosis, using two different hepatoprotective agents was better than using one agent. The normalization rates of Aminotransferase (ALT) and total Bilirubin (TBil) were improved 25.7% by two hepatoprotective agents compared to the single agent. Acetylcysteine was superior to ursodeoxycholic acid or silibinin to reduce ALT. Ursodeoxycholic acid was superior to acetylcysteine or silibinin to reduce TBIL. CONCLUSIONS: Hepatoprotective agents combined with antiviral drugs can significantly improve liver function and liver fibrosis parameters in patients with hepatitis B.

Thrombolytic effects of a combined therapy with targeted microbubbles and ultrasound in a 6 h cerebral thrombosis rabbit model.

Our previous study has shown that P1 polypeptide-loaded microbubbles (clot-targeted microbubbles, TMB) are effective for thrombolysis and recanalization in a 0.5 h cerebral thrombosis rabbit model when combined with low-frequency ultrasound (LFUS, 0.8 MHz). However, the thrombolytic effects of TMB combined with LFUS are still unclear in a 6 h cerebral thrombosis rabbit model, which closely resembles human embolic stroke. Aiming to extend the 3 h therapeutic window limitation of thrombolytic drugs, a 6 h cerebral thrombosis model of common carotid artery (CCA) occlusion was induced in rabbits, and thrombolysis using TMB by intra-arterial (IA) and intravenous (IV) application combined with LFUS was then compared to untargeted microbubbles (UTMB) and recombinant tissue plasminogen activator (rt-PA). The patency score and thrombolysis in brain ischemia (TIBI) in IA TMB combined with LFUS (IA TMB/LFUS) were significantly higher compared to the IA normal saline control with LFUS (IA SC/LFUS) (both P < 0.05) and IA UTMB plus LFUS (IA UTMB/LFUS) (both P < 0.05), respectively. The recanalization rate in the IA TMB/LFUS group (66.67%) was significantly higher compared to the IA SC/LFUS group (12.50%, P < 0.05). The patency score, TIBI and recanalization rate of IA TMB/LFUS were higher than in the IV TMB/LFUS group, but there was no significant difference between the two groups, which was similar to the infarction ratio. TMB/LFUS is an effective and safe therapy for thrombolysis in a 6 h cerebral thrombosis rabbit model, and the IA TMB/LFUS group was slightly better than the IV TMB/LFUS group.

Anticoagulant, anti-aggregation and antithrombotic effects of a novel hexapeptide.

OBJECTIVES: Hexapeptide is a novel synthetic oligopeptide with a structure similar to that of eptifibatide. This study was designed to investigate the anticoagulant, anti-aggregation, disaggregation and anti-thrombogenesis effects of hexapeptide. METHODS: The effects of antiplatelet aggregation induced by adenosine diphosphate (ADP), arachidonic acid (AA) and thrombin, and the effect of disaggregation of platelet aggregation induced by ADP were determined. The anticoagulation indexes were determined by different kits. KEY FINDINGS: Hexapeptide 1 × 10(-5) -1 × 10(-4) m could significantly prolong rabbit blood clotting time, thrombin time, prothrombin time and activated partial thromboplastin enzyme time, and reduce the length, wet weight, dry weight and the index of thrombus in a concentration-dependent manner. Hexapeptide 1 × 10(-4) m decreased platelet adhesion rate by 40.2%. The platelet aggregation inhibition of hexapeptide in dogs and humans was more obvious than in rabbits and rats. The aggregation inhibition rate of 1 × 10(-5) m hexapeptide in dogs, rabbits, rats and humans induced by ADP was 93.9 ± 1.3%, 66.2 ± 1.4%, 76.1 ± 3.2% and 99.8 ± 0.2%, respectively; the 50% inhibitory concentration (IC50) of hexapeptide was 7.24 × 10(-8), 3.24 × 10(-6), 6.61 × 10(-6) and 8.91 × 10(-8) m, respectively. For the aggregation inhibition rate of hexapeptide in dogs, rabbits and humans induced by AA, the IC50 was 1.29 × 10(-9), 1.32 × 10(-6) and 9.33 × 10(-8) m, respectively; the IC50 of aggregation inhibition rates induced by thrombin was 2.88 × 10(-6), >1 × 10(-5) and 4.17 × 10(-6) m, respectively. The disaggregation rate of 1 × 10(-4) m hexapeptide in dog induced by ADP was 68.8 ± 7.4%. CONCLUSIONS: Hexapeptide has anticoagulant, antiplatelet aggregation, disaggregation and antithrombotic effects in vitro.

Montmorillonite adsorbs uric acid and increases the excretion of uric acid from the intestinal tract in mice.

OBJECTIVES: The aim was to evaluate the adsorbing effect of montmorillonite on uric acid, promoting diffusion of uric acid from blood to intestine, preventing absorption of uric acid in intestine and reducing uric acid level in serum. METHODS: The adsorbing effect of montmorillonite on uric acid was observed in vitro. The intestine and blood vessel of rats were circularly perfused with intestinal perfusate and vascular perfusate, respectively. A model of hyperuricaemia in mice was prepared by intraperitoneal injection of hypoxanthine and potassium oteracil. The concentration of uric acid was determined by the method of urate oxidase and peroxide enzyme. KEY FINDINGS: The results showed that different concentrations of montmorillonite could adsorb uric acid in a concentration-dependent manner. The adsorbing effect was fast. The adsorptive rate was high in acid solution and was low in alkaline solution. When blood vessels were circularly perfused by vascular perfusate containing uric acid, the concentration of uric acid in vascular perfusate was decreased and the concentration of uric acid in intestinal perfusate was increased, suggesting that uric acid in blood vessels diffused into the intestine. When the intestine was perfused with intestinal perfusate containing uric acid, the uric acid concentration in vascular perfusate was increased, but the uric acid concentration of intestinal perfusate was decreased, suggesting that uric acid was absorbed in the intestine. The uric acid concentrations of intestinal perfusate and vascular perfusate in montmorillonite 0.5 and 1.0 g/kg groups were lower than the control group. Concentrations of uric acid in serum and urine in the montmorillonite 1 and 2 g/kg groups were lower compared with mice in the hyperuricaemic group. CONCLUSIONS: The results suggested that montmorillonite adsorbed uric acid and promoted diffusion of uric acid from blood vessels to intestine, prevented absorption of uric acid in intestine and decreased uric acid level in serum.

[Effect of montmorillonite on diffussion of urea between blood and intestine and on absorption of intestine in rats].

OBJECTIVE: To study the effect of montmorillonite on promoting diffussion of urea from blood vessel to intestine and preventing absorption of urea in intestine. METHODS: Rat intestine tract and blood vessel were perfusated circularly with intestinal tract perfusate and blood vessel perfusate with or without urea 1 g/L, respectively. The concentration of urea in perfusates was measured by urease and glutamic dehydrogenase coupling method. RESULTS: The blood vessel was circularly perfusated with vascular perfusate containing urea and intestinal tract was circularly perfusated with intestinal perfusate without urea. The concentration of urea in vascular perfusate decreased gradually, and the concentration of urea in intestine perfusate increased slowly. When montmorillonite was added into the intestinal tract, the urea concentration in both intestinal tract perfusate and the vascular perfusate in montmorillonite 0.5 g/kg and 1.0 g/kg groups were significantly lower than that of control group (P < 0.05). The blood vessel was circularly perfusated with vascular perfusate without urea and intestinal tract was circularly perfusated with perfusate containing urea, the concentration of urea in intestine perfusate decreased little by little, and the concentration of urea in vascular perfusate increased slowly. After montmorillonite was administrated into the intestinal tract, the urea concentrations in both the vascular perfusate and intestinal tract perfusate in montmorillonite 0.5 g/kg and 1.0 g/kg were obviously lower than that of control group (P < 0.05). CONCLUSION: Montmorillonite promotes the diffusion of urea from blood vessel to intestine, and inhibits the absorption of urea in intestine.

Montmorillonite adsorbs creatinine and accelerates creatinine excretion from the intestine.

OBJECTIVES: This study aims to evaluate the sorption by montmorillonite of creatinine and the accelerating effect of montmorillonite on creatinine excretion from the intestine. METHODS: The sorption of montmorillonite was observed in vitro. Also, rat intestinal tract and blood vessels were perfused circularly with perfusate with or without creatinine, respectively, to study the promotion of creatinine diffusion from the blood vessel to the intestine and the inhibition of creatinine absorption in the intestinal tract. The effect of decreasing the serum concentration of creatinine was studied in an acute hypercreatininaemia mouse model. The concentration of creatinine was determined by the basic picric acid method. KEY FINDINGS: Montmorillonite adsorbed creatinine markedly in the simulated intestinal solution in a concentration-dependent manner. The sorption-time curve of montmorillonite with creatinine showed that the sorption was fast. The adsorption rate reached a maximum in 10 min. The pH of the solution influenced the sorption, the rate of which was higher at a low pH than at a high pH. Creatinine could diffuse from the blood vessel to the intestine and was reabsorbed in the intestine. Montmorillonite promoted the diffusion and inhibited the absorption. Montmorillonite decreased the serum creatinine level of hypercreatininaemia mice prepared by injecting creatinine intraperitoneally. CONCLUSIONS: Montmorillonite adsorbs creatinine and accelerates its excretion from the intestine.

[Studies on the methods of extract and determination of total tannins and gallic acids of the root of Euphorbia hylonoma].

OBJECTIVE: To determine total tannins and gallic acid of the root of Euphorbia hyloomla. METHODS: With the gallic acid as reference, tannins and gallic acid of the root of Euphorbia hylonoma were determined by ultraviolet spectrophtometer and high performance liquid chromatography, respectively. RESULTS: The content of tannins of the root of Euphorbia hylonoma were determined by different extract methods, including extracted by water, 70% alcohol, acetone on supersound, the determination data were 4.375%, 7.240%, 3.958%, respectively. When used recirculation method by water, 70% alcohol, acetone, the determination data were the determination data are 3.773%, 2.503%, 1.59%, respectively. The content of gallic acid of the root was 0.047%. CONCLUSION: Content of total tannins by alcohol super sound is the highest comparing with other extract methods, this method can used in extract of total Tannins of the root of Euphorbia hylonoma.