Zhiwei Fan

The effect of Chinese herbal medicine on non-biliogenic severe acute pancreatitis: a systematic review and meta-analysis.

ETHNOPHARMACOLOGICAL RELEVANCE More and more clinicians and researchers have realized that clinical trials are necessary to define clinical efficacy effect. Even though the number has been substantially growing for the past years, the finished and reported trials are limited. Nevertheless, those documented trials are important and precious, and comprehensive evaluation and analysis of them are warranted at current stage. Our goal was to evaluate the effect of Chinese herbal medicine (CHM) on non-biliogenic severe acute pancreatitis (SAP) by conducting a systematic review and meta-analysis of prospective randomized controlled studies. METHODS Relevant studies were identified by PubMed, Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure Databases (CNKI), and Wanfang database up to 2014.Reference lists of retrieved articles were also reviewed. Two reviewers independently assessed studies for inclusion and extracted data. The main outcome data of trials were analyzed by using RevMan5.2. Odds ratio (OR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. Either a fixed or a random-effect model was used to evaluate the effect of CHM on non-biliogenic SAP. RESULTS Twenty two prospective randomized controlled studies involving 1388 participants were included in the meta-analysis. CHM was tested to be more effective than reference group: Mortality [OR: 0.43, 95% CI (0.29, 0.64)], overall efficiency [OR: 4.0, 95% CI (2.72, 5.89)], operability [OR: 0.313, 95% CI (0.21, 0.46)], rate of complications [OR: 0.37, 95% CI (0.27, 0.50)], Length of hospitalization [MD: -9.70, 95% CI (-12.88, -6.51)] compared with reference group. CONCLUSIONS No serious adverse events were reported. This meta-analysis provides evidence suggesting that CHM seems to be an effective and safe treatment for people with non-biliogenic severe acute pancreatitis (SAP). However, the poor methodological quality of most of the trials means that we may be unable to reach a definitive conclusion. Hence, the effect of CHM in the treatment of non-biliogenic SAP warrants rigorously designed, multicentre, large-scale trials with higher quality worldwide.

Effects of pyruvate-enriched peritoneal dialysis solution on intestinal barrier in peritoneal resuscitation from hemorrhagic shock in rats

BACKGROUND To investigate protective effects of pyruvate-enriched peritoneal dialysis solution (P-PDS), compared with lactate-PDS (L-PDS), on the intestinal mucosal barrier in peritoneal resuscitation (PR) from severe hemorrhagic shock (HS) in rats. MATERIALS AND METHODS Fifty male SD rats were randomly divided into five groups (n = 10): group sham, group control (HS without fluid resuscitation), group intravenous resuscitation (IVR) (HS with IVR only), group L-PDS (HS with i.v. infusion plus PR with L-PDS), and group P-PDS (HS with i.v. infusion plus PR with P-PDS). HS was induced by hemorrhage with mean arterial pressure 40 mm Hg for 60 min. In three groups with fluid rehydration, IVR included shed blood and dl-lactate Ringer solution equal to two times the volume of shed blood during 60 min; in two groups with PR, 20 mL of L-PDS, or P-PDS were infused when i.v. infusion started after HS into the peritoneal cavity in 20 min, respectively. Blood samples were taken for determinations of pH, base excess, PaCO2, PaO2, and D-LA 60 min post fluid resuscitation. After rats were sacrificed, a segment of intestine was harvested for the detection of expressions of intestinal barrier proteins: zonula occludens-1 (ZO-1) and phosphorylated vasodilator-stimulated phosphoprotein (p-VASP) by Western blot and immunohistochemistry. Intestinal morphologic alterations were also observed. RESULTS Blood pH, base excess, and PaO2 were higher, whereas PaCO2 and D-LA were lower in group P-PDS than in other three HS groups (P < 0.05 and P < 0.01, respectively). Severe acidosis was nearly corrected in group P-PDS. Intestinal barrier proteins ZO-1 and p-VASP were significantly preserved in group P-PDS than in group L-PDS (P < 0.05) although they were improved in group L-PDS in comparison with other two HS groups (P < 0.05 or P < 0.01). Expressions of barrier proteins by Western blotting in group P-PDS were reversed to normal. The score of intestinal epithelial damage index was reduced in group L-PDS, compared with other two HS groups (P < 0.05), however, it was significantly lower in group P-PDS than in group L-PDS (P < 0.05). CONCLUSIONS Pyruvate was superior to lactate in PDS in the correction of severe acidosis with PR. P-PDS was more preservative of expressions of intestinal ZO-1 and p-VASP and mucosal barrier function, compared with L-PDS in PR from severe HS in rats.

Sepsis-induced impairment of neutrophil chemotaxis on a microfluidic chip

This study aimed to design a microfluidic chip to measure neutrophil chemotaxis, which is a convenient assay to assess the severity and prognosis of sepsis, and to study the mechanisms involved in the variation of neutrophil chemotaxis. Neutrophil chemotaxis was investigated in this microfluidic device by measuring the migration speed of neutrophils following the LPS concentration gradient stimulus. Neutrophils of 32 sepsis patients were divided into three groups according to the seriousness of physician-diagnosed sepsis, and 12 healthy individuals served as controls. Statistical significance was set at an alpha value of P<0.05. Neutrophil chemotaxis was significantly decreased following the seriousness of sepsis. By contrast, in septic neutrophils, the expression of TLR2 was significantly increased, whereas the expression of CXCR2 was significantly decreased. Neutrophil chemotaxis in sepsis was significantly reduced as compared to healthy individuals. We speculated that impaired neutrophil chemotaxis in sepsis was probably mediated by the TLR2-CXCR2 pathway.

Dai Huang Fu Zi Tang could ameliorate intestinal injury in a rat model of hemorrhagic shock by regulating intestinal blood flow and intestinal expression of p-VASP and ZO-1

BackgroundDai Huang Fu Zi Tang (DHFZT), an oriental herbal formula, has long been used clinically in treatment of intestinal obstruction, acute pancreatitis, cholecystalgia and chronic diarrhea for thousands of years. Recent studies have demonstrated that DHFZT can reduce intestinal pathological injury and the concentration of enterogenous endotoxin in an animal model. But the underlying mechanism has not been fully elucidated.MethodsSD male rats in adult were used to model HS and treated with DHFZT. The serum concentration of endotoxin were analyzed by dynamic turbidimetric method. In addition, the blood flow of small intestine were measured using laser speckle technique. Phosphorylated vasodilator-stimulated phosphoprotein (p-VASP) and zonula occludens (ZO)-1 protein, intestinal fatty acid binding protein (IFABP) were measured by Western Blotting, RT-PCR, ELISA respectively.ResultsPresent study showed that DHFZT markedly elevated the blood flow of small intestine, protected the intestinal barrier function by up-regulating the expression of ZO-1 protein and down-regulating expression of p-VASP, and notely decreased serum concentration of IFABP and endotoxin in HS.ConclusionsThese results reveal that DHFZT improves intestinal blood flow, protects the intestinal barrier function, and ameliorates intestinal endotoxaemia in rats with HS.

Efficacy of Chinese Herbal Medicine as an Adjunctive Therapy on in-Hospital Mortality in Patients with Acute Kidney Injury: A Systematic Review and Meta-Analysis

Objective. We aimed to systematically assess the efficacy of Chinese herbal medicine (CHM) as an adjunctive therapy on in-hospital mortality in patients with acute kidney injury (AKI). Methods. We did a systematic review of articles published in any language up until Jun 23, 2015, by searching PubMed, Embase, the Cochrane Library, CBM, and CNKI. We included all RCTs that compared outcomes of patients with AKI taking CHM plus Western treatment (WT) with those taking WT alone. We applied Cochrane risk-of-bias tool to assess the methodological quality of the included trials. Results. Of 832 citations, 15 studies involving 966 patients met inclusion criteria. The methodological quality was assessed with unclear risk of bias. In the primary outcome of meta-analysis, pooled outcome of in-hospital mortality showed that patients randomly assigned to CHM treatment group were associated with low risk of in-hospital mortality compared with those randomly assigned to WT alone (RR = 0.41; 95% CI = 0.24 to 0.71; P = 0.001). Conclusions. CHM as an adjunctive therapy is associated with a decreased risk of in-hospital mortality compared with WT in patients with AKI. Further studies with high quality and large sample size are needed to verify our conclusions.

Circulating miRNAs as biomarkers for severe acute pancreatitis associated with acute lung injury

AIM To identify circulating micro (mi)RNAs as biological markers for prediction of severe acute pancreatitis (SAP) with acute lung injury (ALI). METHODS Twenty-four serum samples were respectively collected and classified as SAP associated with ALI and SAP without ALI, and the miRNA expression profiles were determined by microarray analysis. These miRNAs were validated by quantitative reverse transcription-polymerase chain reaction, and their putative targets were predicted by the online software TargetScan, miRanda and PicTar database. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (commonly known as KEGG) were used to predict their possible functions and pathways involved. RESULTS We investigated 287 miRNAs based on microarray data analysis. Twelve miRNAs were differentially expressed in the patients with SAP with ALI and those with SAP without ALI. Hsa-miR-1260b, 762, 22-3p, 23b and 23a were differently up-regulated and hsa-miR-550a*, 324-5p, 484, 331-3p, 140-3p, 342-3p and 150 were differently down-regulated in patients with SAP with ALI compared to those with SAP without ALI. In addition, 85 putative target genes of the significantly dysregulated miRNAs were found by TargetScan, miRanda and PicTar. Finally, GO and pathway network analysis showed that they were mainly enriched in signal transduction, metabolic processes, cytoplasm and cell membranes. CONCLUSION This is the first study to identify 12 circulating miRNAs in patients with SAP with ALI, which may be biomarkers for prediction of ALI after SAP.

Dai-Huang-Fu-Zi-Tang Alleviates Intestinal Injury Associated with Severe Acute Pancreatitis by Regulating Mitochondrial Permeability Transition Pore of Intestinal Mucosa Epithelial Cells

Objective The aim of the present study was to examine whether Dai-Huang-Fu-Zi-Tang (DHFZT) could regulate mitochondrial permeability transition pore (MPTP) of intestinal mucosa epithelial cells for alleviating intestinal injury associated with severe acute pancreatitis (SAP). Methods A total of 72 Sprague-Dawley rats were randomly divided into 3 groups (sham group, SAP group, and DHFZT group, n = 24 per group). The rats in each group were divided into 4 subgroups (n = 6 per subgroup) accordingly at 1, 3, 6, and 12 h after the operation. The contents of serum amylase, D-lactic acid, diamine oxidase activity, and degree of MPTP were measured by dry chemical method and enzyme-linked immunosorbent assay. The change of mitochondria of intestinal epithelial cells was observed by transmission electron microscopy. Results The present study showed that DHFZT inhibited the openness of MPTP at 3, 6, and 12 h after the operation. Meanwhile, it reduced the contents of serum D-lactic acid and activity of diamine oxidase activity and also drastically relieved histopathological manifestations and epithelial cells injury of intestine. Conclusion DHFZT alleviates intestinal injury associated SAP via reducing the openness of MPTP. In addition, DHFZT could also decrease the content of serum diamine oxidase activity and D-lactic acid after SAP.

UHPLC‐MS/MS determination and pharmacokinetic study of plantamajoside in rat plasma after oral administration of single plantamajoside and Plantago asiatica extract

A sensitive and reliable ultra-high performance liquid chromatography coupled with tandem quadrupole mass spectrometry (UHPLC-MS/MS) method was developed for quantitation of plantamajoside in rat plasma. First, this study compared the pharmacokinetic properties of plantamajoside after oral administration of Plantago asiatica extract and pure plantamajoside in rat plasma with approximately the same dosage of 8.98 mg/kg. Second, chromatographic separation was performed on an Acquity HSS C18 column (50 × 2.1 mm, p.d.1.7 μm) with isocratic elution using methanol-water (80:20, v/v) as mobile phase at a flow rate of 0.25 mL/min. The calibration curves were linear over the range of 0.1-100 ng/mL for plantamajoside. At different time points (0, 0.083, 0.167, 0.25, 0.5, 0.75, 1, 2, 3, 4, 5, 6 and 8 h) after administration, the concentrations of plantamajoside in plasma were measured and the main pharmacokinetic parameters were estimated. The study indicates that the pharmacokinetics of plantamajoside in rat plasma have significant differences between two groups.

Effect of Combination of Chinese Herbal Medicine versus Western Medicine on Mortality in Patients after Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Introduction. Although Chinese herbal medicine (CHM) treatment combined with conventional western therapy has been widely used and reported in many clinical trials in China, there is uncertainty about the efficacy of this combination in the treatment of patients after cardiopulmonary resuscitation (CPR). This systematic review aimed to assess whether the risk of mortality has decreased comparing the combination of CHM treatment with conventional western therapy. Methods. To identify relevant studies, the literature search was conducted in Medline, Embase, the Cochrane Library, CBM, CNKI, VIP, and Wanfang database. We included all randomized controlled trials (RCTs) that compared outcomes of patients after CPR taking combination of CHM treatment with those taking just conventional western therapy. Results. This meta-analysis showed that patients randomly assigned to combined CHM treatment group had a statistically significant 23% reduction in mortality compared with those randomly assigned to conventional western therapy group (RR: 0.77; 95% CI: 0.70–0.84). Conclusions. This meta-analysis provides evidence suggesting that a combined CHM therapy is associated with a decreased risk of mortality compared with conventional western therapy in patients after CPR. Further studies are needed to provide more evidence to prove or refute our conclusion and identify reasons for the reduction of mortality.