Why anticoagulant studies on sepsis fail frequently --- start with SCARLET / 中华创伤杂志(英文版)

The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin (SCARLET) trial has many defects, and thus cannot be the terminator of recombinant thrombomodulin (rTM). On the contrary, it provides sufficient evidence for further research. Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies, it is most important for new studies to grasp the following two points: (1) The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation; (2) Heparin should not be used in combination with the investigated drugs. Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism. In fact, the combination of heparin can mask the true efficacy of the investigated drug. Due to the complexity of sepsis treatment and the limitations of clinical studies, the results of all treatment studies should be repeatedly verified, rather than be determined at one stroke. Some research conclusions contrary to disease physiology, pharmacology and clinical practice may be deceptive, and should be cautious rather than be simply accepted. On the other hand, the dissenting voices in the "consensus" scene are often well discussed by the authors and should be highly valued.

The severe COVID-19: A sepsis induced by viral infection? And its immunomodulatory therapy / 中华创伤杂志(英文版)

COVID-19 is known for its magical infectivity, fast transmission and high death toll based on the large number of infected people. From the perspective of the clinical manifestation, autopsy examination and pathophysiology, the essence of COVID-19 should be viewed as a sepsis induced by viral infection, and has the essential characteristics as sepsis induced by other pathogens. Therefore, in addition to etiological and supportive treatment, immunomodulatory therapy is also appropriate to severe COVID-19. Although there is still a lack of consensus on immunotherapy for sepsis so far, relatively rich experiences have been accumulated in the past decades, which will help us in the treatment of severe COVID-19. This article will elaborate immunotherapy of sepsis, though it may not be consistent.

[Assay of Tetramethylpyrazine in Szechwan Lovage Rhizome and Cnidium Rhizome by HPLC-DAD-MS].

OBJECTIVE: To quantity the amount of tetramethylpyrazine in Szechwan Lovage Rhizome (Chuanxiong, the rhizome of Ligusticum chuanxiong Hort., CX) and Cnidium Rhizome(Japanese Chuanxiong, the rhizome of Cnidium officinale Makino, JCX) for quality assessment. METHODS: An HPLC-DAD-MS technique was employed to detect tetramethylpyrazine in 27 CX and 10 JCX samples. Tetramethylpyrazine was separated on a Waters Symmetry C,, column (250 mm x 4. 6 mm, 5 µm). The mobile phase was methanol-acetonitrile-water(27: 1: 72) at a flow rate of 1. 0 mL/min. The column temperature was 35 °C. DAD detection wavelength was 280 nm, while electrospray ionization detector was set at positive mode to collect MS spectrum. RESULTS: In the total of 37 herb samples, 11 samples were found to contain tetramethylpyrazine with the mean amount of 2. 19 µg/g(n = 11). 6 of 27 CX samples and 5 of 10 JCX sample were found the existence of tetramethylpyrazine with the amount of 0. 60 - 11. 75 µg and 0. 61 - 3. 05 µg/g,respectively. The correlation was not found between tetramethylpyrazine and the cultivation area, morphological character, processing or storage method for CX and JCX samples. It was possible that tetramethylpyrazine resulted from the microbes in soil. CONCLUSION: The developed method is accurate to quantify tetramethylpyrazine in CX and JCX herbs. Both the two herbs indeed contain tetramethylpyrazine, but it is not suitable to be a chemical marker to assess the quality of CX and JCX owing to low content.