Association of Trauma Severity with Antibody Seroconversion in Heparin-Induced Thrombocytopenia: A Multicenter, Prospective Observational Study

BACKground: Heparin administration can induce the production of anti-platelet factor 4 (PF4)/heparin antibodies with platelet-activating properties, causing heparin-induced thrombocytopenia (HIT). Previous studies have suggested that trauma severity influences HIT immune responses, but their relationship has not been fully explained. This study aimed to clarify this association by multicenter prospective observational study.methods: Trauma patients who met the criteria of age ≥18 years and Injury Severity Scores (ISS) ≥ 9 from March 2018 to February 2019 were included. Patients who did not receive any heparin and those who received it as flushes or for treatment were also included. A total of 184 patients were divided into three groups based on trauma severity (mild (9 ≤ ISS ≤ 15), moderate (16 ≤ ISS ≤ 24), severe (25 ≤ ISS)), and were compared by the seroconversion time and rate, as well as the disappearance rate of antibodies on day 30. RESULTS: Overall, the seroconversion rates of anti-PF4/heparin IgG and HIT antibodies by washed platelet activation assay were 26.6% and 16.3%, respectively. There was a significant difference in the seroconversion rates of anti-PF4/heparin IgG (p = 0.016) and HIT antibodies (p = 0.046) among the groups. Seroconversion rates in both assays increased with increasing trauma severity. The time required to achieve seroconversion was similar (between 5 and 10 days of trauma onset) regardless of heparin administration. Anti-PF4/heparin IgG and HIT antibodies were no longer detected on day 30 in 28.6% and 60.9% of seroconverted patients, respectively.Conclusions: Development of HIT antibodies was observed commonly in severely injured trauma patients. HIT antibody development may related to trauma severity, with high disappearance rate on day 30. HIT should be considered as a differential diagnosis in patients with thrombocytopenia or thromboembolism between 5 and 10 days after trauma.

Chinese Patent Medicine as Adjuvant for Mild-to-Moderate Active Ulcerative Colitis: A Network Meta-Analysis of Randomized Controlled Trials

Objective. To evaluate the effectiveness and safety of Chinese patent medicine for mild-to-moderate active ulcerative colitis (UC) using network meta-analysis (NMA). Methods. We systematically searched PubMed, Cochrane library, Embase, Sino-Med, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journal Database (VIP) databases to October, 2020. We included randomized controlled trials (RCTs) on Chinese patent medicine for mild-to-moderate active UC. The main analysis was complemented by network subanalyses and standard pairwise comparisons. Statistical heterogeneity, inconsistencies, and ranking probability were also evaluated. Results. The databases search identified 3222 citations, of which 33 RCTs involving 2971 patients met the inclusion criteria. A total of 15 Chinese patent medicines were analyzed. The overall quality of the included studies was low. Pairwise meta-analysis showed that Chinese patent medicine was superior to Mesalazine in improving disappearances of clinical symptoms, recurrence rate, and Mayo score. Based on decreases in adverse events, results from NMA showed that Xilei powder plus Mesalazine was more effective than other drugs. Other NMA results indicated that Danshen freeze-dried powder plus Mesalazine (RR: 0.13; 95% CI, 0.02–0.78) and Kangfuxin lotion plus Mesalazine (RR: 0.24; 95% CI, 0.07–0.57) were superior to Mesalazine in decreasing recurrence rate. Another NMA result indicated that Kangfuxin lotion plus Mesalazine (RR: 0.00; 95% CI, 0.00–0.02) and Zhi Kang capsule plus Mesalazine (RR: 0.00; 95% CI, 0.00–0.02) were superior to Mesalazine in increasing the disappearance of tenesmus. Conclusion. In the probability sorting, Xilei powder combined with Mesalazine ranked first for having the fewest adverse events, Maintaining Intestines Antidiarrheal Pills combined with Mesalazine ranked first for having the lowest recurrence rate, Xilei powder combined with Mesalazine ranked first for improving disappearance rate of mucopurulent bloody stool/abdominal pain, and Kangfuxin lotion combined with Mesalazine ranked first for improving the disappearance rate of diarrhea/tenesmus. However, there is a lack of direct comparisons among Chinese patent medicines for UC. More multiarm RCTs are needed in the future to provide direct comparative evidence.

Efficacy of Integrated Traditional Chinese and Western Medicine for Treating COVID-19: A Systematic Review and Meta-Analysis of RCTs

Background: Integrated Chinese and Western medicine (integrated medicine) is routinely used in the treatment of coronavirus disease 2019 (COVID-19) in China. In this study, we undertook a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the efficacy of integrated medicine therapy for patients with COVID-19.Methods: In this meta-analysis, we searched PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), and Wanfang databases from inception to April 12, 2021, to identify RCTs of integrated medicine in the treatment of COVID-19. The quality of RCTs was assessed by the Cochrane risk of bias tool. RevMan v5.3 and Stata software packages were used for statistical analysis.Results: Nineteen RCTs involving 1,853 patients met our inclusion criteria. Compared with patients treated by conventional Western medicine (CWM), patients treated by integrated medicine have a higher overall effective rate [RR = 1.17, 95% CI: (1.10, 1.26), p < 0.00001], fever disappearance rate [RR = 1.25, 95% CI: (1.04, 1.50), p = 0.02], fatigue disappearance rate [RR = 1.28, 95% CI: (1.00, 1.63), p = 0.05], and chest CT improvement rate [RR = 1.24, 95% CI: (1.14, 1.34), p < 00001]. Beneficial effects of the integrated medicine therapy were also seen in C-reactive protein (CRP) level [WMD = −4.14, 95% CI: (−6.38, −1.91), p = 0.0003] and white blood cell (WBC) count [WMD = 0.35, 95% CI: (0.11, 0.58), p = 0.004]. Subgroup analyses showed that, when the treatment time is <2 weeks, the effect of integrated medicine treatment is more obvious in improving the overall effective rate, clinical symptoms (fever, fatigue, and cough), the CRP level, and WBC count compared with that of the CWM treatment. For patients with severe and non-severe COVID-19, integrated medicine is more effective in improving fever and cough symptoms and WBC count than using CWM alone.Conclusion: The results of the current meta-analysis suggested that the integrated medicine can improve the clinical symptoms, chest CT and infection indicators of COVID-19 patients. Even if the treatment time is <2 weeks, the effect of integrated medicine in improving symptoms is more obvious compared with the treatment of CWM. However, the results should be interpreted cautiously due to the heterogeneity among the studies.

Efficacy and Safety of Traditional Chinese Medicine (Lianhua Qingwen) for Coronavirus Disease 2019: a Systematic Review and Meta-analysis

Background: The coronavirus disease 2019(COVID-19) had become an epidemic and spread across the world, lead to severe respiratory failure and death. Traditional Chinese Medicine(TCM), Such as Lianhua Qingwen has been widely used in the prevention and treatment of COVID-19, This systematic review and meta-analysis will assess the effects of traditional Chinese herbal medicine(Lianhua Qingwen) in COVID-19 pneumonia from the randomized controlled trials(RCTs) and case control studies(CCSs).Method: we search the literatures in databases inculding PubMed, Embase, Web of science, Cochrane Library, Wanfang, Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database (CBM) and China National Knowledge Infrastructure(CNKI), setting the date from December 1, 2019, to June 1, 2021, Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale were used to assess the quality of randomized controlled trials. All analyses were conducted by Stata 14.0.Results: nine studies with 1163 patients(616males) were included, six were RCTs, three are CCSs. Compared with patients treated by western medicine alone, patients treated by Lianhua Qingwen combined with western medicine have a higher overall effective rate[RR=1.20, 95%CI1.20(1.11, 1.31), P=0.000], cardinal symptom disappearance rate[disappearance rate of fever: OR:3.64, 95%CI(1.57, 8.47), P=0.001;disappearance rate of cough: OR:1.97, 95%CI(1.45, 2.68), P=0.001; disappearance rate of fatigue: OR:2.55, 95%CI(1.09, 5.99), P=0.032] and CT recovery rate[RR:1.25, 95%CI(1.13,1.38), P=0.000], reduce the rate of the progress into severe diseases of COVID-19 patients[RR:0.43, 95%CI(0.30, 0.62), P=0.000], with more shorter duration of fever[WMD=-1.07，95%CI(-1.77, -0.37), P=0.003], The including studies described that Lianhua Qingwen did not increase the adverse drug reactions.Conclusion: Lianhua Qingwen may have advantages in improving the clinical effective rate and cardinal symptom disappearance rate. Besides, it also had an excellent effect on the improvement of the chest CT and the proportion reducing of progress into severe clinical disease, which could be used as an effective therapy for COVID-19.

Orchid Extinction over the Last 150 Years in the Czech Republic

Understanding temporal changes in the distribution and abundance of various species is one of the key goals of conservation biology. During recent decades, the abundance and distribution of many species of plants and animals have declined dramatically, mainly because of habitat loss and fragmentation. The purpose of this study is to analyze the rate of extinction of orchids at various sites in different 20-year time intervals over the last 150 years, determined according to changes in society. Using the dataset of the orchid records of the Nature Conservation Agency of the Czech Republic, we determined the disappearance rate of orchids from sites using a grid of 1 × 1 km. We found that the vast majority of orchids disappeared from many of their historical localities in all time intervals analyzed. The number of sites suitable for Czech orchids declined by 8–92%, depending on the species. The most threatened orchid species in the Czech Republic are Spiranthes spiralis, Anacamptis palustris, Epipogium aphyllum and Goodyera repens. This all seems to be closely related with changes in agricultural practices in the open as well as in forest habitats. Preserving suitable orchid habitats seems to be the key for keeping Czech orchid flora alive.

Integrated Lianhua-Qingwen and Western Medicine Versus Western Medicine-Only Therapies Against COVID-19: A Systematic Review and Meta-Analysis

Background Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome, has resulted in a global outbreak. Objective To systematically review the therapeutic reports on COVID-19 treated with integrated herbal medicine “Lianhua-Qingwen”and Western medicine to evaluate the efficacy and safety of the treatment. Methods PubMed, Embase, Web of Science, CNKI, CBM and other databases were searched to locate the clinical trials of integrated Lianhua-Qingwen and Western medicine treatment for COVID-19. The herbal medicine Lianhua-Qingwen reported in the treatments is in the form of capsules or granules. Two researchers of our team independently carried out data extraction and quality assessment of the collected literature according to the Cochrane systematic review methodology, calculated combined relative risk (RR) or weighted mean difference (MD)/standardized mean difference (SMD) . Results This meta-analysis included 13 studies collected, a total of 1182 cases of patients with common type COVID-19. Comparison of integrated Lianhua-Qingwen and Western medicine treatment with conventional Western medicine treatment found that the effective combined RR value was 1.18 (95% CI: 1.09, 1.27; I2 = 37%), and the RR value of CT image improvement rate was 1.12 (95% CI: 1.03, 1.23; I2 = 38%). The rate of progressing to critical cases decreased by 50% (RR: 0.50; 95% CI: 0.35, 0.73; I2 = 0%); the RR value of the fever disappearance rate was 1.43 (95% CI: 1.24, 1.65; I2 = 0%); the RR value of the cough disappearance rate was 1.97 (95% CI: 1.45, 2.68; I2 = 0%); the RR value of the rate of recovery from fatigue was 1.51 (95% CI: 1.15, 2.03; I2 = 0%). Compared with conventional Western medicine treatment, the integrated therapy shortened the duration of fever by 1.33 days (95% CI: -1.92, -0.73; I2 = 5%). The number of adverse reactions decreased by 49% (RR = 0.51; 95% CI: 0.14, 1.82; I2 = 76%). Conclusion Therapy of integrated Lianhua-Qingwen and Western medicine treatment is more effective for the treatment of patients with common type COVID-19, more effective in CT improvement rate, and more effective in reducing the rate of progressing to critical cases significantly and with fewer adverse reactions.

Ruminal kinetics and degradability of energetic feedstuffs used in diets for ruminants

This study aimed to evaluate energetic feedstuffs regarding chemical composition, in situ ruminal degradability of dry matter (DMD), ruminal kinetics and ruminal disappearance rate of dry matter. Seven feedstuffs (treatments) were evaluated: ground corn, ground oat, ground barley, wheat bran, soybean hull, malt root and corn germ, in a completely randomized design of four repetitions each. Two bovines ruminally cannulated were used for incubation, wherein each treatment was subjected to seven periods of exposure to the rumen (0, 3, 6, 9, 12, 18 and 24 hours). Among the evaluated feedstuffs, soybean hull had the highest neutral detergent fiber (NDF) content (68.91%) and the lowest DMD at 24 h (64.91%). Ground barley and ground corn contained the lowest content of soluble fraction (SF) (26.34 and 28.7%, respectively), among which ground barley had the highest DMD at 24 h (90.48%) and therefore showed the highest rumen disappearance rate (2.50%.h-1) by combining both parameters, while the ground oat presented the highest SF (47.75%) and the lowest rumen disappearance rate (1.09%.h-1).