Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study.

BACKGROUND: Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China. METHODS: A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed. RESULTS: 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid. CONCLUSIONS: Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.

Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners.

Qigong is a gentle exercise that promotes health and well-being. This study evaluated the acute physiological and psychological effects of one session of qigong exercise in older practitioners. A total of 45 participants (mean age, 65.14 years) were recruited. Meridian electrical conductance, State-Trait Anxiety Inventory (STAI), heart rate variability (HRV), and Short Form 36 (SF-36) were evaluated and compared before and after one session of qigong exercise. The results revealed that the electrical conductance of all meridians, except spleen and bladder meridians, increased significantly (p < 0.05). Compared with baseline values, upper to lower body ratio and sympathetic/vagal index were significantly improved and closer to 1 (p = 0.011 and p = 0.007, resp.). STAI-S and STAI-T scores decreased significantly (p < 0.001 and p = 0.001, resp.). The RR interval of HRV decreased significantly (p = 0.035), a significant positive correlation was observed between kidney meridian electrical conductance and SF-36 physical scores (r = 0.74, p = 0.018), and a positive correlation was observed between pericardium meridian electrical conductance and SF-36 mental scores (r = 0.50, p = 0.06). In conclusion, one session of qigong exercise increased meridian electrical conductance, reduced anxiety, and improved body and autonomic nervous system balance. These findings provide scientific evidence for acute physiological and psychological effects of qigong exercise in older practitioners.

Comparison of the effects of carbamyl-beta-methylcholine chloride administered by intravenous, intramuscular and intra-acupuncture point injections.

OBJECTIVE: To compare the effects of carbamyl-beta-methylcholine chloride (CMCC) administered by intra-acupuncture point injection (IAI), intramuscular injection (IMI), and intravenous injection (IVI), and to analyze the mechanisms. METHODS: In the IAI group, CMCC was injected into the Zusanli acupoint (ST 36) immediately after 30-min stimulation by electro-acupuncture (EA) at the acupoints, and into the femoral vein and skeletal muscle in IVI and IMI groups, respectively. Intra-gastric pressure was detected. The plasma concentration of CMCC was measured at various times. RESULTS: The gastric effect of CMCC in the IVI group was enhanced and attenuated more rapidly than in the other groups. In the IAI group, this effect was significantly stronger than that in the IMI group at 2 min and 15 min, but not significantly different between the two groups at 5 min and 30 min. Plasma concentration of CMCC in the IAI group was similar to that in the IVI group at 2 min, but higher than that in the IMI group. The concentration in the IAI group was higher than that in the IV group and similar to that in the IMI group at 5, 15 and 30 min, indicating rapid increase and slower reduction of the plasma concentration of the drug in the IAI group. There was a positive correlation between the plasma concentration of CMCC and intragastric pressure in all groups. CONCLUSION: The effect of IAI with CMCC was stronger than that of IMI and longer-lasting than that of IVI, which correlated with the blood concentration of CMCC.

[Considerations about study on mechanisms of acupuncture underlying efficacy-enhancement and toxicity-attenuation of digitalis drugs for heart failure].

Digitalis glycosides, a group of cardiotonic agents for heart failure, have been used for a long time, but may often trigger arrhythmias as a result of digitalis intoxication. It is of great significance in finding a method to reduce their toxicity and improve clinical curative effects simultaneously in the application of digitalis glycosides. It has been well documented that acupuncture has good therapeutic effects in improving cardiac function and inhibiting arrhythmia induced by myocardial ischemia. Acupuncture combined with chemotherapeutics can reduce the adverse effects of chemotherapeutics. Accordingly, acupuncture combined with digitalis is likely to reduce the side effects of digitalis by regulating intracellular Ca2+, improving the function of Ca(2+)-ATPase in the sarcoplasmic reticulum, increasing calcium sensitivity of cardiac troponin, etc. These considerations may provide a novel clue for treatment of heart failure by joint administration of acupuncture and drugs.

[A reinforcement of acupuncture on the cardiac effect of dobatamine: exhibition of acupoint's functional specificity].

OBJECTIVE: To investigate the functional specificity of acupoint by means of acupoint injection of Dobutamine Hydrochloride (DH). METHODS: Male SD rats were randomized into normal control (NC), EA-Neiguan (PC6) + acupoint injection (AI, EA-PC 6 + AI), EA-Zusanli (ST 36) + AI (EA-ST 36 + AI), and EA-intramuscular injection site (IMIS) + intramuscular injection (EA-IMIS+ IMI) groups,with 8 rats being in each group. EA (2 Hz/15 Hz, 3 mA) was applied to bilateral "Neiguan" (PC 6), "Zusanli "(ST 36) and muscular-injection site for 10 min. DH (a beta1-adrenoceptor agonist) solution (100 microg/kg) was injected intramuscularly into the gluteus maximus after termination of EA intervention. The left ventricular systolic pressure (LVSP), heart rate (HR) and + dp/dt max were recorded before and 2, 5, 15 and 30 min after injection of DH. RESULTS: The values of LVSP, HR and + dp/dt max in EA-PC 6 + AI group were significantly higher than those in NC, EA-ST 36 + AI, and EA-IMIS + IMI groups (P < 0.01) 2 and 5 minutes after EA plus acupoint injection of DH. No significant differences were found between EA-ST 36 + AI and EA-IMIS+ IMI groups in LVSP, HR and +dp/dt max (P > 0.05). After injection of DH for 30 minutes, the values of LVSP, HR and + dp/dt max in EA-PC 6 + AI group were still significantly higher than those in NC group (P < 0.01). CONCLUSION: EA-PC 6+ AI DH is significantly superior to EA-ST 36 + AI DH and EA-IMIS+ IMI DH in producing a stronger cardiac excitatory effect and a longer post-effect, showing a relative specificity of the acupoint in upregulating cardiac functional activities.

[Discussion on the novel clues for studying the underlying mechanisms of acupuncture-induced potentiation of the curative effect of medicines].

Acupuncture combined with drugs has been widely used in the treatment of various clinical conditions and can produce a stronger or more beneficial curative effect than either separate acupuncture or chemical drug does. However, the mechanisms underlying the additive or synergetic effects of acupuncture plus drugs are not well understood so far. Based on careful review and analysis of the literature accumulated, the authors proposed several aspects possibly involving the additive or synergetic effects produced by acupuncture plus drugs. For instance, acupuncture stimulation at acupoints may influence the drug concentration in blood and/or in target organ and the bioavailability of the drug via modulating the drug absorption, distribution and metabolism in the body. In addition, the curative effect of drug may also be strengthened by acupuncture stimulation via altering the signaling pathways of the targeted specific receptors and via potentiating the resultant responsiveness or sensitivity of the cells in the target organ in responding to the drugs administered. The ideas mentioned above may raise the novel clues for further studying the mechanisms underlying acupuncture-produced increase of the curative effects of medicines.

[On the scientific foundation that the tissue structure of acupoints can decide and affect specificity of acupoints-organs effects].

Specificity of acupoints is one of the basic theories of the acupuncture and moxibustion sciences and is a very important basis to guide the clinical treatment of acupuncture and moxibustion. However, the scientific foundation of specificity of acupoints is still unclear, which has greatly restricted to the clinical effect improvement of acupuncture and moxibustion and has influenced to academic status of acupuncture and moxibustion sciences both in China and abroad. In this paper, the recent related researches are reviewed and then the key effects and mechanism that the tissue structure of acupoints can decide and affect specificity of acupoints-organs effects are analyzed and explored. It is held that acupuncture at the different tissue structure of the different depth in the different or the same acupoints will cause changes of varying qualities or degrees of visceral function because of stimulation of the different receptors in the different tissues followed by excitation of varying afferent nerve fibers.

[Review on the mechanism of joint application of acupuncture therapy and medication in clinical practice].

Acupuncture therapy combined with medication has been widely used in clinic practice in China and proved to be effective in the, treatment of many disorders. The authors of the present paper review researches on the underlying mechanism of joint application of acupuncture therapy and medication in recent decade from (1) neural regulation, (2) endocrine regulation, and (3) immunological regulation. After comprehensive analysis, the authors think that the mechanism underlying the enhanced clinical efficacy of acupuncture therapy combined with drugs may be closely associated with the following factors: (1) acupuncture stimulation of acupoints leads to changes of the drug concentration in the blood and/or in the target organ and, (2) the reactivity or sensitivity of the target organ tissues to the specifically effective drug elements is enhanced.

[Effect of combined application of deproteinised calf serum injection and acupuncture on cerebral ischemia in rats].

OBJECTIVE: To study the efficacy of combined application of deproteinised calf serum injection (DCSI) and acupuncture in treating cerebral ischemia (CI) in rats. METHODS: Ninety Wistar rats were randomly divided into control, CI model, Acupunct (acupuncture), DCSI, Acupunct + DCSI groups, with 18 cases in each group. CI model was duplicated by middle cerebral artery occlusion (MCAO). DCSI (80 mg/kg) was given via the rat's tail vein, once daily for 7 days. Acupuncture was applied to "Baihui" (GV 20), "Shuigou" (GV 26), "Neiguan" (PC 6), "Hegu" (LI 4), "Taichong" (LR 3) and "Zusanli" (ST 36), once daily for 7 days. The neurological deficit score (NDS), cerebral infarct volume (CIV), water and lactic acid (LA) contents in cerebral tissues were measured. RESULTS: In comparison with control group, NDS, CIV, cerebral water content and LA in model group increased significantly (P<0.05); while compared with model group, NDS, CIV, cerebral water content and LA in Acupunct, DCSI and Acupunct + DCSI groups decreased significantly (P<0.05). Comparison among DCSI group, Acupunct group and DCSI + Acupunct group showed that NDS, CIV, cerebral water and LA contents of Acupunct + DCSI group were significantly lower than those of the former two groups (P<0.05). No significant differences were found between DCSI and Acupunct groups in the above-mentioned 4 indexes (P>0.05). CONCLUSION: Combined application of DCSI and acupuncture has a definite effect in improving cerebral ischemia and is superior to that of simple acupuncture or DCSI alone.

[Effects of electroacupuncture pretreatment on ischemic arrhythmia and intracellular calcium oscillation in single cardiocyte isolated from rats with myocardial ischemia and reperfusion].

OBJECTIVE: To observe the inhibitory effects of acupuncture pretreatment on arrhythmia and intracellular calcium ([Ca2+]i) oscillation in single cardiocyte in rats subjected to myocardial ischemia-reperfusion (MIR). METHODS: Male SD rats were evenly randomized into normal control (NC), MIR and electroacupuncture (EA) groups. MIR was performed by ligation (30 min) and reperfusion (10 min) of the left anterior descending coronary artery in vivo in rats or in the isolated and perfused rat heart subjected to a 40 min global ischemia followed by a 10 min reperfusion. EA pretreatment was applied to bilateral "Neiguan" (PC 6) for 30 min once a day in 3 consecutive days. Arrhythmic score was calculated according to Curtis's and Walker's method, and the count of [Ca2+]i oscillation was measured by using InCytPm 2 intracellular ion detecting system. RESULTS: Both the arrhythmic score and the count of [Ca2+]i oscillation in MIR group were considerably higher than those in NC group (P<0.05). While compared with MIR group, the arrhythmia score and the count of [Ca2+]i oscillation in EA group were decreased significantly (P<0.05). CONCLUSION: Pretreatment of EA can effectively resist MIR-induced arrhythmia and intracellular calcium oscillation in the rat.