Analysis on the Clinical Effect of Shenling Baizhu San Combined with Routine Treatment on Bacterial Pneumonia in Children

[Objectives]To explore the effect of Shenling Baizhu San combined with routine treatment on the clinical efficacy,gastrointestinal function protection,inflammatory response and immune function of children with bacterial pneumonia.[Methods]From July 2017 to January 2018,80 children with bacterial pneumonia were randomly selected and divided into observation group and control group with 40 cases in each group.The control group was treated with conventional Western medicine,while the observation group was treated with Shenling Baizhu San on the basis of conventional treatment,with a period of 10 d.Then,we compared the clinical efficacy,incidence of gastrointestinal symptoms,WBC,CRP,CD4+and CD8+levels between the two groups.[Results]The clinical efficacy of the observation group was better than that of the control group(P<0.05).After treatment,the levels of WBC and CRP in the two groups decreased,especially in the observation group(P<0.05).After treatment,the level of CD4+in both groups increased significantly,while the level of CD8+decreased significantly,and the level of CD4+in the observation group was significantly higher than that in the control group after treatment.The incidence of gastrointestinal symptoms in the observation group was significantly lower than that in the control group(P<0.01).[Conclusions]Shenling Baizhu San can obviously improve the clinical effect of bacterial pneumonia in children and has the protective effect of gastrointestinal tract,and its mechanism may be related to its anti-inflammatory and immunomodulatory effects.

Application of 16s rDNA Sequencing in the Analysis of Pathogenic Bacteria in Sputum of Severe Bacterial Pneumonia

Objective: 120 patients with severe pneumonia who were kept in the comprehensive ICU of our hospital in 2018 were selected, and 16s rDNA sequencing was performed to analyze the composition of pathogenic bacteria in the sputum of severe pneumonia. Methods: The sputum samples of patients with severe bacterial pneumonia were collected, and the diversity of pathogens in the samples was analyzed by polymerase chain reaction (PCR) amplification and high-throughput sequencing (16s rDNA PCR-DGGE). Results: Sequence showed that sputum samples contained a relatively large number of species, and there were many species that were not detected by sequencing. The dominant bacteria were Streptococcus, Sphingomonas, Corynebacterium, Denatobacteria, Aquobacteria, Acinetobacteria, Prevotella, Klebsiella, Pseudomonas, etc. Conclusion: Bacteria caused by sputum of severe bacterial pneumonia are complex and diverse, which provides new methods and ideas for individualized treatment of patients with severe pneumonia.

Mechanisms of Shufeng Jiedu Capsule in treating bacterial pneumonia based on network pharmacology and experimental verification

Objective: The aim of this study was to investigate the underlying mechanism of Shufeng Jiedu Capsule(SFJD) for treating bacterial pneumonia(BP) in vivo based on network pharmacology and experimental verification study.Methods: Network pharmacology was used to screen the active compounds and target genes of SFJD.Then, the multi drug resistance-Pseudomonas aeruginosa(MDR-PA) mice lethal model and MDR-PA pneumonia model were established to evaluate the therapeutic effects and underlying mechanisms of SFJD.Western blot and ELISA were used to determinate the protein expression level of the IL-17 signaling pathway and JAK/STAT signaling pathway.Results: After screening, 172 potential components of SFJD were generated, based on which we constructed an SFJD-component-target-BP interaction network. The Gene ontology(GO) and Kyoto encyclopedia of genes and genomes(KEGG) enrichment revealed that SFJD could regulate the IL-17 signaling pathway and Janus kinase/signal transducer and activator of transcription(JAK/STAT) signaling pathway.Molecular docking showed that the potential target proteins had good combinations with the main active components. SFJD significantly reduced the mortality and prolonged survival days in lethal models. The lung index and pathological changes in the lung were also significantly decreased. SFJD could significantly decrease the expression of interleukin-17A(IL-17A), TNF receptor associated factor 6(TRAF6),phospho-inhibitor of nuclear factor-kappa B(p-IκB)/inhibitor of NF-κB(IκB), phospho-NF-κB p65(pNF-κB p65), phospho-protein kinase B(p-AKT)/AKT, phospho-signal transducer and activator of transcription 3(p-STAT3)/STAT3, phospho-signal transducer and activator of transcription 1(p-STAT1)/STAT1, and the protein level of interleukin-6(IL-6), tumor necrosis factor a(TNF-a), and IL-1β.Conclusion: Combined with network pharmacology and in vivo study, it was found that SFJD exerted its therapeutic effects on BP by inhibiting the IL-17 pathway and JAK/STAT signaling pathway. This study provides new evidence for SFJD in treatment of BP.

High-performance lung-targeted bio-responsive platform for severe colistin-resistant bacterial pneumonia therapy

Polymyxins are the last line of defense against multidrug-resistant(MDR)Gram-negative bacterial infections.However,this last resort has been threatened by the emergence of superbugs carrying the mobile colistin resistance gene-1(mcr-1).Given the high concentration of matrix metalloproteinase 3(MMP-3)in bacterial pneumonia,limited plasma accumulation of colistin(CST)in the lung,and potential toxicity of ionic silver(Ag+),we designed a feasible clinical transformation platform,an MMP-3 high-performance lung-targeted bio-responsive delivery system,which we named“CST&Ag@CNMS”.This system exhibited excellent lung-targeting ability(>80%in lungs),MMP-3 bio-responsive release property(95%release on demand),and synergistic bactericidal activity in vitro(2-4-fold minimum inhibitory concentration reduction).In the mcr-1+CST-resistant murine pneumonia model,treatment with CST&Ag@CNMS improved survival rates(70%vs.20%),reduced bacteria burden(2-3 log colony-forming unit[CFU]/g tissue),and considerably mitigated inflammatory response.In this study,CST&Ag@CNMS performed better than the combination of free CST and AgNO3.We also demonstrated the superior biosafety and biodegradability of CST&Ag@CNMS both in vitro and in vivo.These findings indicate the clinical translational potential of CST&Ag@CNMS for the treatment of lung infections caused by CST-resistant bacteria carrying mcr-1.

Aberrant Th2 inflammation drives dysfunction of alveolar macrophages and susceptibility to bacterial pneumonia

The ubiquitin ligase,Itch,is required to prevent autoinflammatory disease in mice and humans.Itch-deficient mice develop lethal pulmonary inflammation characterized by the production of Th2 cytokines(for example,interleukin-4(IL-4));however,the contribution of Itch to immune defense against respiratory pathogens has not been determined.We found that Itch-deficient mice were highly susceptible to intranasal infection with the respiratory pathogen Klebsiella pneumoniae.Infected Itch-deficient mice exhibited increased immune cell infiltration,cytokine levels and bacterial burden in the respiratory tract compared with control mice.However,numbers of resident alveolar macrophages were reduced in the lungs from Itch-deficient mice both before and after infection.High levels of Th2 cytokines in the respiratory tract correlated with deceased alveolar macrophages,and genetic ablation of IL-4 restored alveolar macrophages and host defense to K.pneumoniae in Itch-deficient mice,suggesting that loss of alveolar macrophages occurred as a consequence of Th2 inflammation.Adoptive transfer of Itch−/−CD4+T cells into Rag−/−mice was sufficient to drive reduction in numbers of Itch-replete alveolar macrophages.Finally,we found that Stat6 signaling downstream of the IL-4 receptor directly reduced fitness of alveolar macrophages when these cells were exposed to the Itch−/−inflamed respiratory tract.These data suggest that Th2 inflammation directly impairs alveolar macrophage fitness in Itch−/−mice,and elucidate a previously unappreciated link between Th2 cells,alveolar macrophages and susceptibility to bacterial infection.

Necrotizing Pneumonia and Conservative Treatment: A Case Report and Review of the Literature

We present a case of necrotizing pneumonia in an 87-year-old man without severe respiratory instability. Clinical suspicion arose due to the need for supplementary oxygen and persistent fever during treatment for community-acquired pneumonia. The diagnosis was confirmed by chest computed tomography. Although necrotizing pneumonia typically requires major surgical intervention upon diagnosis, we chose conservative management with antimicrobials and chest drainage alone. The patient experienced significant improvement and resolution of pneumonia with conservative management.

Application of 16S rDNA Sequencing Technology in the Analysis of Pathogenic Bacteria in Sputum of Severe Pneumonia

The diagnosis of pathogenic bacteria in severe pneumonia is difficult and the prognosis is poor. Its outcome is closely related to bacterial pathogenicity and the timeliness and pertinence of antibiotic treatment. Therefore, early diagnosis is of great significance to the prognosis of patients. Sputum examination and culture is the gold standard for the diagnosis of pathogens of severe pneumonia. However, due to the long time of bacterial culture, the early use of antibiotics, the change of bacteria species, mixed infection and other problems, the results of bacterial culture in sputum are often false negative. With the continuous application of new molecular biology techniques in clinical detection, the classification of bacteria and microorganisms has deepened from the identification of phenotypic characteristics to the classification of gene characteristics. Sequencing analysis with 16S rDNA sequencing technology has the characteristics of high sequencing flux, large amount of data obtained, short cycle, and can more comprehensively reflect the species composition of microbial community, real species distribution and abundance information. In this paper, 16S rDNA sequencing technology was used to analyze the bacterial population composition in the sputum of severe pneumonia, and to explore a new method of etiological diagnosis.

Pandemic and modern medicine:Time to recognize and correct previous misconceptions

A sudden increase in the number of viral pneumonias with the onset of the COVID-19 pandemic revealed defects in the provision of medical care for acute pneumonia in the lungs.Localization of the inflammatory process and its functional consequences indicate the identity of all forms of acute pneumonia,regardless of the etiology,and the need to develop treatment principles based on the pathogenesis of the disease.

Pulmonary Bacterial Infection and Liver Cirrhosis: Current Status and Treatment

Liver cirrhosis has a higher incidence rate and mortality when complicated with bacterial infections.Concomitant bacterial infections,especially bacterial pneumonia,increase the susceptibility of cirrhotic patients to decompensation,with a higher likelihood of mortality.Bacterial pneu-monia is often overlooked in patients with liver cirrhosis,although it can impact the clinical progress and outcomes.Untimely diagnosis and inappropriate antibiotic treatments are associated with poor prognosis and increased mortality.Current understanding of mechanisms and appropriate antibiotic treatments for cirrhosis-related bacterial pneumonia remain inadequate.Herein,we reviewed the epidemiology,clinical characteristics and treatment of pulmonary bacterial infections in cirrhotic patients to provide suggestions for clinical practice.

Bacterial Resistance in Clinical Isolates of Klebsiella Pneumoniae

Ninety-four percent of 336 strains Klebsiellapneumoniae were resistant to ampicillin，while less than 10％were resistant to cefotaxine and ceftazidine.Among all theaminoglycosides tested,amikacin had the strongest activity on K.

Assessment of polymerase chain reaction and serology for detection of chlamydia pneumoniae in patients with acute respiratory tract infection

OBJECTIVE: To study Chlamydia pneumoniae (C. pneumoniae) infection in 110 patients with respiratory tract infection admitted to our hospital from January to December 1995 in Nanjing. METHODS: Sputum and throat swab specimens were taken and C. pneumoniae DNA was detected by using polymerase chain reaction (PCR) with the HM-1-HR-1 primer pair. At the same time, serum samples were taken and immunoglobulin G and M (IgG and IgM) fractions of antibodies to C. pneumoniae were studied by microimmunofluorescence test. RESULTS: Prevalence of specific IgG was 70% in patients with respiratory tract infection. Seventeen patients (15.5%) were serologically diagnosed as having recent C. pneumoniae infections and 12 patients (10.9%) had positive PCR in sputum and/or swab specimens. The total positive rate was 22.7% (25/110) detected by PCR combined with serological tests. Acute infection of C. pneumoniae was common in patients with asthma (57.1%), pneumonia (35.0%), COPD (25.9%) and bronchitis (25.0%). Clinical features between C. pneumoniae infection and non-C. pneumonia infection showed no significant differences. CONCLUSIONS: Chlamydia pneumoniae is an important pathogen that causes infection of the human respiratory tract and attention should be drawn to this special illness.

Xuebijing injection,a Chinese patent medicine,against severe pneumonia:Current research progress and future perspectives

Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.