Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis: The EXIT-SEP Randomized Clinical Trial.

Importance: Previous research has suggested that Xuebijing injection (XBJ), an herbal-based intravenous preparation, may reduce mortality among patients with sepsis. Objective: To determine the effect of XBJ vs placebo on 28-day mortality among patients with sepsis. Design, Setting, and Participants: The Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP) trial was a multicenter, randomized double-blind, placebo-controlled trial conducted in intensive care units at 45 sites and included 1817 randomized patients with sepsis (sepsis 3.0) present for less than 48 hours. Patients aged 18 to 75 years with a Sequential Organ Failure Assessment score of 2 to 13 were enrolled. The study was conducted from October 2017 to June 2019. The final date of follow-up was July 26, 2019. Data analysis was performed from January 2020 to August 2022. Interventions: The patients were randomized to receive either intravenous infusion of XBJ (100 mL, n = 911) or volume-matched saline placebo (n = 906) every 12 hours for 5 days. Main Outcomes and Measures: The primary outcome was 28-day mortality. Results: Among the 1817 patients who were randomized (mean [SD] age, 56.5 [13.5] years; 1199 [66.0%] men), 1760 (96.9%) completed the trial. In these patients, the 28-day mortality rate was significantly different between the placebo group and the XBJ group (230 of 882 patients [26.1%] vs 165 of 878 patients [18.8%], respectively; P < .001). The absolute risk difference was 7.3 (95% CI, 3.4-11.2) percentage points. The incidence of adverse events was 222 of 878 patients (25.3%) in the placebo group and 200 of 872 patients (22.9%) in the XBJ group. Conclusions and Relevance: In this randomized clinical trial among patients with sepsis, the administration of XBJ reduced 28-day mortality compared with placebo. Trial Registration: ClinicalTrials.gov Identifier: NCT03238742.

Cistanches alleviates sevoflurane-induced cognitive dysfunction by regulating PPAR-γ-dependent antioxidant and anti-inflammatory in rats.

This study aimed to investigate the protective effects and underlying mechanisms of cistanche on sevoflurane-induced aged cognitive dysfunction rat model. Aged (24 months) male SD rats were randomly assigned to four groups: control group, sevoflurane group, control + cistanche and sevoflurane + cistanche group. Subsequently, inflammatory cytokine levels were measured by ELISA, and the cognitive dysfunction of rats was evaluated by water maze test, open-field test and the fear conditioning test. Three days following anaesthesia, the rats were killed and hippocampus was harvested for the analysis of relative biomolecules. The oxidative stress level was indicated as nitrite and MDA concentration, along with the SOD and CAT activity. Finally, PPAR-γ antagonist was used to explore the mechanism of cistanche in vivo. The results showed that after inhaling the sevoflurane, 24- but not 3-month-old male SD rats developed obvious cognitive impairments in the behaviour test 3 days after anaesthesia. Intraperitoneal injection of cistanche at the dose of 50 mg/kg for 3 consecutive days before anaesthesia alleviated the sevoflurane-induced elevation of neuroinflammation levels and significantly attenuated the hippocampus-dependent memory impairments in 24-month-old rats. Cistanche also reduced the oxidative stress by decreasing nitrite and MDA while increasing the SOD and CAT activity. Moreover, such treatment also inhibited the activation of microglia. In addition, we demonstrated that PPAR-γ inhibition conversely alleviated cistanche-induced protective effect. Taken together, we demonstrated that cistanche can exert antioxidant, anti-inflammatory, anti-apoptosis and anti-activation of microglia effects on the development of sevoflurane-induced cognitive dysfunction by activating PPAR-γ signalling.

[Phosphate adsorption characteristics on the desert particulates of inflow Yellow River].

Adsorption behaviors of phosphate on the desert particulates of inflow Yellow River were investigated in natural water (river water and sea water) and the experimental data was fitted by both the improved Langmuir and Freundlich isotherm adsorption models. The results show that (1) With more clear physical meaning and more reasonable fitting parameters, the improved Langmuir isotherm adsorption model is much better for describing phosphate adsorption on the desert particulates than the improved Freundlich isotherm adsorption model; (2) The maximum phosphorus (P) adsorption capacity Qmac is in the range of 41.322-357.143 mg x kg(-1), which is the biggest in Y2 (Juyanhai Lake particulates). There is remarkable positive correlation between Qmax and organic matter of the particulates (Y1-Y5); (3) Except for Y1 (Badain Jaran Desert particulates), the EPC0 (zero equilibrium P concentration) of the particulates are higher than the concentration of P in corresponding water. The EPC0 of P adsorption on Y1 in Yellow River is lower than P concentration in corresponding water (0.010 mg x L(-1) < 0.053 mg x L(-1)), while the EPC0 of P adsorption on Y1 in Bohai Sea water is higher than the P concentration in their corresponding water (0.109 mg x L(-1) > 0.074 mg x L(-1)), which shows that Y1 adsorbs P from the water of the Yellow River, then it releases its NAP (native adsorbed exchangeable phosphorus) into Bohai Seawater. However, in the process of the P exchange between other desert particulates and their corresponding water, only desorption phenomenon were observed, which means all other desert particulates release P to their corresponding water; (4) The adsorption isotherms of phosphate on the desert particulates of inflow Yellow River are cross-axis-type with over 0.00, a new cross-axis-type adsorption-desorption model, which provide a better explanation for adsorption characteristics of P and for the dual role of natural particulates.