Galla Chinensis, a Traditional Chinese Medicine: Comprehensive review of botany, traditional uses, chemical composition, pharmacology and toxicology

ETHNOPHARMACOLOGICAL RELEVANCE

Galla chinensis (GC), a traditional Chinese medicine (TCM), has a wide range of pharmacological properties which have been widely used for more than 1400 years. Based on shape, GC is divided into two groups: jiaobei and dubei. It is a bitter, sour, cold and astringent substance which is usually used for treating diarrhea, constipation, bleeding, cough, vomiting, sweating, hemorrhoids, and anal and uterine prolapse. It is distributed in Japan, North Korea, and all parts of China.

AIM OF STUDY

This study was aimed at carrying out a comprehensive overview of the current status of research on Galla chinensis (GC) for better understanding of it characteristics, while providing a clear direction for future studies. It has aroused the interest of researchers, leading to development of medicinal value, expansion of its application, and provision of wider and more effective drug choices. This study was focused on the traditional uses, botany, chemical composition, pharmacology and toxicology of GC. Finally, the study focused on possible future research directions for GC.

MATERIALS AND METHODS

A comprehensive analysis was done based on academic papers, pharmaceutical monographs, ancient medicinal works, and drug standards of China. This review used Galla and Galla chinensis as keywords for retrieval of information on GC from online databases such as PubMed, Elsevier, CNKI, Web of Science, Google Scholar, SCI hub, and Baidu academic.

RESULTS

It was found that the chemical constituents of GC included tannins, phenolic acid, amino acids and fatty acid, with polyphenol compounds (especially tannins and gallic acid) as the distinct components. In vitro and in vivo studies revealed that GC exerted numerous biological effects such as anti-caries, antibacterial, antiviral, anticancer, and antioxidant effects. The therapeutic effect of GC was attributed mainly to the biological properties of its bioactive components.

CONCLUSIONS

GC is an important TCM which has potential benefit in the treatment of a variety of diseases. However, the relationship amongst the structure and biological activity of GC and its components, mechanism of action, toxicity, pharmacokinetics and target organs need to be further studied. Quality control and quality assurance programs for GC need to be further developed. There is need to study the dynamics associated with the accumulation of chemical compounds in GC as well as the original plants and aphid that form GC.

Prevalence and antimicrobial resistance of Mycoplasmas and Chlamydiae in patients with genital tract infections in Shanghai, China

The infections of Mycoplasmas and Chlamydiae are still severe in patients with genital tract diseases and antimicrobial resistance for these organisms has been changing in recent years. In this study, we reported the prevalence status of Ureaplasma urealyticum, Mycoplasma hominis and Chlamydia trachomatis in 965 patients with genital tract infection in Shanghai from January 2011 to December 2014 and analyzed the antimicrobial resistance of U. urealyticum and M. hominis to 12 kinds of antimicrobial drugs by using commercial kits and SPSS13.0 software. Here, we found the infection of U. urealyticum was the most frequent among these three organisms. The total infection rate for containing any organisms of them was 49.5%, and it has been increasing in recent 4 years. Positive rate in female (53.3%) was higher than male's (34.8%), and the high risk population was 20-39 years old (56.7%). Besides, U. urealyticum and M. hominis displayed relative lower resistance rates to minocycline, doxycycline, josamycin and gatifloxacin (6.5%, 7.2%, 13.5% and 8.6%, respectively). However, for erythromycin, roxithromycin, thiamphenicol and clindamycin, the resistance rates were relatively high (41.9%, 47.2%, 62.3% and 74.9%, respectively). U. urealyticum and M. hominis displayed a declined trend of the antimicrobial resistance to 12 kinds of drugs detected in this study. In total, these preliminary data showed the prevalence of Mycoplasmas and Chlamydiae in patients and the antimicrobial resistance status of Mycoplasmas, which has use for reference on both prevention and treatment of diseases caused by them.

Male infertility: a public health issue caused by sexually transmitted pathogens

Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.

The resistance analysis of Ureaplasma urealyticum and Mycoplasma hominis in female reproductive tract specimens

The aim of this study was to analyze the drug resistance of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) in female reproductive track from 2007 to 2011 in Hangzhou. Antibiotics sensitivity test in Mycoplasma, which was isolated in clinics from 2007 to 2011 were analyzed retrospectively. The detection of Mycoplasma during 2007-2011 was 20,146 (54.37 %), of which the single infection rate of Uu was 42.08 %, of Mh 1.26 %, and of Uu+Mh was 11.02 %. The drug resistance rate of Uu was increased significantly in ofloxacin in 2007 (41.80 %), 2008 (45.94 %), 2009 (46.07 %), 2010 (50.36 %), and 2011 (53.22 %) (P < 0.05). The resistance rate to ciprofloxacin was significantly increased in 2007 (67.15 %), 2008 (67.44 %), 2009 (73.00 %), 2010 (75.28 %), and 2011 (75.28 %) (P < 0.05). Exceptionally, the resistance rates of the other antibiotics were low. The drug resistance rate of Uu was significantly increased with quinolones at increasing tendency. It is necessary to monitor the local drug resistance rate of Uu regularly to provide reasonable guidelines in clinics.

Mycoplasma genitalium: prevalence in men presenting with urethritis to a South Australian public sexual health clinic

BACKGROUND/AIM

This study aimed to determine the prevalence of Mycoplasma genitalium infection among male patients with dysuria and/or urethral discharge. An analysis of the clinical, demographic and microbiological factors associated with M. genitalium infection was also conducted.

METHOD

From May 2007 to June 2011, men presenting to the clinic with self-reported symptoms of dysuria and/or urethral discharge were identified and underwent urethral swab, which was microscopically assessed for objective non-gonococcal urethritis. A first-void urine sample was tested for Chlamydia trachomatis and Neisseria gonorrhoeae using the Aptima Combo-2 assay. A portion of the urine sample was sent for polymerase chain reaction analysis for M. genitalium.

RESULTS

One thousand, one hundred and eighty-two men with dysuria and/or urethral discharge were tested for M. genitalium. Of those, 96 men (8.1%) were positive for M. genitalium. Men identifying as solely MSM (men who have sex with men) constituted 16.3% (n = 193) of the sample. Their infection rate was 3.1% (n = 6). The infection rate for heterosexual and bisexual men was 9.1%. For all men, the M. genitalium co-infection rate was 14.6% (n = 14) with C. trachomatis and 3.1% (n = 3) with N. gonorrhoeae. Factors associated with M. genitalium infection were analysed by univariate analysis. We determined that five investigated predictors were significantly associated with M. genitalium infection, urethral discharge, non-gonococcal urethritis on Gram stain of urethral smears, identification as heterosexual or bisexual, and absence of co-infection with C. trachomatis or N. gonorrhoeae.

CONCLUSION

In Adelaide, M. genitalium is an important sexually transmitted infection among men with dysuria and/or urethral discharge, and is primarily an infection of heterosexual and bisexual men.

In vitro antimicrobial profile of Ureaplasma urealyticum from genital tract of childbearing-aged women in Northern and Southern Italy

Ureaplasma urealyticum is an opportunistic pathogen during pregnancy and in newborns. Other clinical problems related to U. urealyticum infections are: no susceptibility to cell wall-active drugs, limits of antibiotic treatment in pregnancy, and spread of antimicrobial resistance. In addition, the results of antimicrobial susceptibility against U. urealyticum from various countries are few and controversial. The antimicrobial susceptibility of U. urealyticum, isolated from cervical swabs and collected from outpatient childbearing-aged women in Italy from 2009 to 2012, was performed against fluoroquinolones, macrolides, streptogramin and tetracyclines, using an available biochemical commercial kit and a specific solid culture medium, to improve the therapeutic management of these pathogenic agents. Ureaplasma urealyticum was detected in 49.4% of samples, but significant bacterial load was revealed in 29.8%. In vitro tetracyclines showed the best activity against U. urealyticum, followed by streptogramin, macrolides, and fluoroquinolones.

Ureaplasma urealyticum is associated with nongonococcal urethritis among men with fewer lifetime sexual partners: a case-control study

BACKGROUND

Ureaplasmas have been inconsistently associated with nongonococcal urethritis (NGU). We evaluated the association of the newly differentiated species Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) with NGU using 2 separate control groups.

METHODS

Case patients were men who attended a sexually transmitted disease (STD) clinic in Seattle, Washington, during the period 2007-2009 with NGU (defined as visible urethral discharge and/or ≥5 polymorphonuclear neutrophils per high-powered field; n = 329). Control subjects were STD clinic attendees (n = 191) and emergency department (ED) attendees (n = 193) without NGU. Polymerase chain reaction assays detected UU and UP in ureaplasma culture-positive urine. Multivariable logistic regression was used to assess the associations of UU and UP with NGU.

RESULTS

UU was only marginally associated with NGU in aggregate multivariable analyses, irrespective of control group (adjusted odds ratio [aOR](STD-control), 1.6 [95% confidence interval {CI}, 0.9-2.8]; aOR(ED-control), 1.7 [95% CI, 0.97-3.0]). This association was significantly stronger when analyses were restricted to men with fewer lifetime sex partners (<10 vaginal partners: aOR(STD-control), 2.9 [95% CI, 1.2-6.7]; aOR(ED-control), 3.2 [95% CI, 1.3-7.6]; <5 vaginal partners: aOR(STD-control), 6.2 [95% CI, 1.8-21.0]; aOR(ED-control), 5.2 [95% CI, 1.3-20.2]). UP was not positively associated with NGU overall or among subgroups.

CONCLUSIONS

The absence of an association of UU with NGU among men with more lifetime sex partners suggests that adaptive immunity may attenuate the clinical manifestation of UU infection. Similar relationships were not observed with UP, which suggests that it is not a urethral pathogen.

A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium

Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.