Effect of early fluid resuscitation combined with low dose cyclophosphamide on intestinal barrier function in severe sepsis rats.

To investigate the effect of early fluid resuscitation on intestinal microecology in rats with severe sepsis. The severe sepsis model used was mainly cecal ligation perforation (CLP) model. Male SD rats were randomly divided into five groups: sham, CLP, CLP + normal saline (NS), CLP + cyclophosphamide (CTX), and CLP + NS + CTX. (1) The levels of IL-6, IL-10, and TNF-α in peripheral blood were measured by ELISA. (2) The expression of occludin/ß-action in colonic tissue of mice was examined by Western Blot. (3) The intestinal permeability was measured by FD70 detection. (4) The length of the chorionic membrane was measured by colon histopathological staining. (5) The intestinal epithelial cell apoptosis was measured with the apoptosis index. (1) The rat model of severe sepsis was successfully replicated, and the 7-day survival rate of sepsis mice in each group was analyzed. (2) The expression level of splenic junction protein and the pathological damage in colonic tissue of the severe sepsis mice was significantly different between sham, CLP, CTX, NS, and NS + CTX (P < 0.05). The expression of tight junction protein in the NS + CTX mice was the highest, and the pathological damage was the smallest. (3) The colonic tissue apoptosis and intestinal permeability in the severe sepsis mice were compared with those of the colon tissues (P < 0.05). (4) The expression levels of IL-6, IL-10, and TNF-α in peripheral blood were significantly increased after severe sepsis (P < 0.01). The expression of IL-6 and TNF-alpha in each treatment group decreased (P < 0.05), while the expression of IL-10 in NS + CTX group increased significantly (P < 0.01). (1) We successfully replicated the rat model of severe sepsis. (2) Early fluid intervention and cyclophosphamide treatment can significantly improve the 7-day survival rate of the sepsis mice. (3) The fluid resuscitation and cyclophosphamide can delay intestinal damage to the intestinal tract barrier function and play a protective role.

Comparison of mono- and combination antibiotic therapy for the treatment of Pseudomonas aeruginosa bacteraemia: A cumulative meta-analysis of cohort studies.

It is currently unknown whether antibiotic monotherapy or combination therapy is a more effective treatment for patients with Pseudomonas aeruginosa bacteraemia. The present study consists of a systematic review and meta-analysis of cohort studies in associated studies. The treatment options of monotherapy and combination therapy have been compared, to determine which is more effective against P. aeruginosa bacteraemia. Several electronic bibliographic databases were systematically searched and clinical studies that compared combination therapy with monotherapy for P. aeruginosa bacteraemia were identified. Dersimonian and Laird's random-effects models were used to generate summary estimates of the effects and to assess their association according to different patient characteristics and research quality standards. A total of 17 studies were selected, 3 of which were prospective while the remaining 14 were retrospective. The studies involved a total of 2,504 patients. Significant differences between combination therapy and monotherapy treatment were not found when the data were combined (odds ratio (OR)=0.81, 95% confidence interval (CI)=0.61-1.08; P=0.035). The results demonstrated strength in a number of stratification and sensitivity analyses. The variables used included study type, treatment quality score and survival rate of subgroup analysis. To conduct cumulative meta-analysis, the number of years and samples were calculated. The OR value and 95% CI were stable and demonstrated good change trend. According to the size of the sample order following accumulation, OR values and 95% CI (0.89, 0.76-1.04) exhibited a narrow range. Neither combination therapy or monotherapy exhibited significant effects on the mortality of patients with P. aeruginosa bacteraemia. Future research is required and should include large, well-designed prospective cohorts, and grouped clinical studies.