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OuYang X, Yang CY, Xiu WL, Hu YH, Mei SS, Lin Q. Oropharyngeal administration of colostrum for preventing necrotizing enterocolitis and late-onset sepsis in preterm infants with gestational age ≤ 32 weeks: a pilot single-center randomized controlled trial. Int Breastfeed J 2021; 16:59. [PMID: 34419090 PMCID: PMC8379587 DOI: 10.1186/s13006-021-00408-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Oropharyngeal administration of colostrum (OAC) may provide immunoprotective and anti-inflammatory effects that potentially reduce the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis and improve short-term outcomes. Our objective was to evaluate the role of OAC in the early prevention of NEC and late-onset sepsis in preterm infants with gestational age (GA) ≤ 32 weeks. Methods A pilot, single-center, 1:1 parallel randomized controlled trial was conducted in a 40-bed tertiary neonatal intensive care unit (NICU) in China from 1 January 2019 to 30 September 2020. Preterm infants were randomly divided into two groups with GA ≤ 32 weeks. The OAC group included preterm infants who received 0.4 ml of maternal colostrum via the oropharyngeal route every 3 h for 10 days beginning within the first 48 h after birth, and the control group included preterm infants who received normal saline instead. Data from the two groups were collected and compared. Results A total of 127 infants in the OAC group and 125 infants in the control group were enrolled. The incidence of NEC (Bell stage 2 or 3) and late-onset sepsis were lower in the OAC group [2.36% vs. 10.40%, relative risk (RR) 0.23 (95% confidence interval (CI) 0.07, 0.78), adjusted RR 0.23 (95% CI 0.06, 0.84); 4.72% vs. 13.60%, RR 0.35 (95% CI 0.14, 0.85), adjusted RR 0.36 (95% CI 0.14, 0.95)]. In addition, the incidence of proven sepsis and intraventricular hemorrhage (IVH) (stage 3 or 4) were lower in the OAC group [2.36% vs. 8.80%, RR 0.27 (95% CI 0.08, 0.94); 1.57% vs. 7.20%, RR 0.22 (95% CI 0.05, 0.99)], and the time to achieve full enteral feeding was shorter (23.13 ± 9.45 days vs. 28.50 ± 14.80 days). No adverse reactions were observed in either group. Conclusions Oropharyngeal administration of colostrum is a safe and simple NICU procedure that may yield a potential effect in decreasing the incidences of NEC, late-onset sepsis, and severe IVH and shorten the time to achieve full enteral feeding in preterm infants with GA ≤ 32 weeks. Trial registration Chinese Clinical Trial Registry, ChiCTR1900023697, Registered 8 June 2019, retrospectively registered.
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Affiliation(s)
- Xia OuYang
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Chang-Yi Yang
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Wen-Long Xiu
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China.
| | - Yan-Hua Hu
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Su-Su Mei
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China
| | - Qin Lin
- Department of Neonatology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, China
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Abstract
Glucagon-like peptide-1 (GLP-1) receptor agonists are efficacious glucose-lowering medications with salient benefits for body weight and cardiovascular events. This class of medications is now recommended as the top priority for patients with established cardiovascular disease or indicators of high risk. Until the advent of oral semaglutide, however, GLP-1 receptor agonists were available only in the form of subcutaneous injections. Aversion to needles, discomfort with self-injection, or skin problems at the injection site are commonly voiced problems in people with diabetes, and thus, attempts for non-invasive delivery strategies have continued. Herein, we review the evolution of GLP-1 therapy from its discovery and the development of currently approved drugs to the unprecedented endeavor to administer GLP-1 receptor agonists via the oral route. We focus on the pharmacokinetic and pharmacodynamic properties of the recently approved oral GLP-1 receptor agonist, oral semaglutide. Small molecule oral GLP-1 receptor agonists are currently in development, and we introduce how these chemicals have addressed the challenge posed by interactions with the large extracellular ligand binding domain of the GLP-1 receptor. We specifically discuss the structure and pharmacological properties of TT-OAD2, LY3502970, and PF-06882961, and envision an era where more patients could benefit from oral GLP-1 receptor agonist therapy.
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Affiliation(s)
- Hun Jee Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Cattrall JWS, Asín-Prieto E, Freeman J, Trocóniz IF, Kirby A. A pharmacokinetic-pharmacodynamic assessment of oral antibiotics for pyelonephritis. Eur J Clin Microbiol Infect Dis 2019; 38:2311-2321. [PMID: 31494827 PMCID: PMC6858297 DOI: 10.1007/s10096-019-03679-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022]
Abstract
Antibiotic resistance to oral antibiotics recommended for pyelonephritis is increasing. The objective was to determine if there is a pharmacological basis to consider alternative treatments/novel dosing regimens for the oral treatment of pyelonephritis. A systematic review identified pharmacokinetic models of suitable quality for a selection of antibiotics with activity against Escherichia coli. MIC data was obtained for a population of E. coli isolates derived from patients with pyelonephritis. Pharmacokinetic/pharmacodynamic (PK/PD) simulations determined probability of target attainment (PTA) and cumulative fraction response (CFR) values for sub-populations of the E. coli population at varying doses. There are limited high-quality models available for the agents investigated. Pharmacokinetic models of sufficient quality for simulation were identified for amoxicillin, amoxicillin-clavulanic acid, cephalexin, ciprofloxacin, and fosfomycin trometamol. These antibiotics were predicted to have PTAs ≥ 0.85 at or below standard doses for the tested E. coli population including cephalexin 1500 mg 8 hourly for 22% of the population (MIC ≤ 4 mg/L) and ciprofloxacin 100 mg 12 hourly for 71% of the population (MIC ≤ 0.06 mg/L). For EUCAST-susceptible E. coli isolates, doses achieving CFRs ≥ 0.9 included amoxicillin 2500 mg 8 hourly, cephalexin 4000 mg 6 hourly, ciprofloxacin 200 mg 12 hourly, and 3000 mg of fosfomycin 24 hourly. Limitations in the PK data support carrying out additional PK studies in populations of interest. Oral antibiotics including amoxicillin, amoxicillin-clavulanic acid, and cephalexin have potential to be effective for a proportion of patients with pyelonephritis. Ciprofloxacin may be effective at lower doses than currently prescribed.
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Affiliation(s)
| | - E Asín-Prieto
- Pharmacometrics & Systems Pharmacology Research Unit, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - J Freeman
- University of Leeds, Leeds, LS2 9JT, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - I F Trocóniz
- Pharmacometrics & Systems Pharmacology Research Unit, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - A Kirby
- University of Leeds, Leeds, LS2 9JT, UK. .,Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. .,Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK.
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Yi Y, Zhao Y, Li C, Zhang Y, Bin Y, Yuan Y, Pan C, Wang L, Liang A. Potential chronic liver toxicity in rats orally administered an ethanol extract of Huangqin (Radix Scutellariae Baicalensis). J TRADIT CHIN MED 2018; 38:242-256. [PMID: 32186063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate on the cytotoxicity and penetration enhancement effect of essential oils (EOs) from warming the interior medicinals (WIM) from Traditional Chinese Medicine (TCM). METHODS EOs were extracted from WIM of Bichengqie (Litseae Fructus), Dingxiang (Flos Syzygii Aromatici), Huajiao (Pericarpium Zanthoxyli Bungeani), and Xiaohuixiang (Fructus Foeniculi) with warm nature, and Ganjiang (Rhizoma Zingiberis), Gaoliangjiang (Rhizoma Alpiniae Officinari), Rougui (Cortex Cinnamomi Cassiae), and Wuzhuyu (Fructus Evodiae Rutaecarpae) with hot nature, respectively. Their chemical compositions were analyzed by gas chromatography-mass spectrometry (GC-MS). The cytotoxicity of the extracted eight EOs on HaCaT cells was measured and compared. Moreover, analyses of cell cycle and cell apoptosis were performed to investigate the cytotoxic mechanism. The transdermal penetration enhancement effects of the extracted eight EOs on ibuprofen were further compared by the modified Franz diffusion cell method. RESULTS The most abundant constituents in the extracted eight EOs were determined to be monoterpenes, especially oxygen-containing monoterpenes. The HaCaT cell cytotoxicity of EOs from WIM with hot nature were significantly (P = 0.020) higher than that with warm nature. Both ginger oil and zanthoxylum oil significantly induced G0/G1 phase arrestment in HaCaT cell cycle. For ginger oil from WIM with hot nature and zanthoxylum oil from WIM with warm nature, the main mechanisms of the cytotoxicity were found to be the induction of cellular necrosis and the cellular apoptosis, respectively. Furthermore, most of the tested EOs showed remarkable penetration enhancement activity on ibuprofen. However, no statistical significance (P = 0.18) was found between penetration enhancement activity of EOs from WIM with warm nature and EOs from WIM with hot nature. CONCLUSION With the enhanced penetration activity, the extracted EOs from the WIM demonstrated their significant effect of the cytotoxicity on the skin cells.
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Affiliation(s)
- Yan Yi
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yong Zhao
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Chunying Li
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yushi Zhang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yang Bin
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yalan Yuan
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Chen Pan
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Lianmei Wang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Aihua Liang
- Key Laboratory of Beijing for Identification and Safety Evaluation of Chinese Medicine, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
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Zimmer J, Niemann D, Seltmann K, Fischer L, Christiansen H, Frontini R, Kiess W, Neininger MP, Bertsche A, Bertsche T. Managing of oral medicines in paediatric oncology: can a handbook and a pharmaceutical counselling intervention for patients and their parents prevent knowledge deficits? A pilot study. Eur J Hosp Pharm 2015; 23:100-105. [PMID: 31156825 DOI: 10.1136/ejhpharm-2015-000716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 11/04/2022] Open
Abstract
Objectives To assess knowledge deficits of patients/parents and prevention strategies. Methods After receiving ethics approval, we performed a controlled, quasi-randomised, prospective intervention study. We enrolled patients/parents involved in managing oral medicines in three groups: control (routine care only), handbook intervention and pharmaceutical counselling intervention group. At baseline and after the interventions, we assessed patients'/parents' knowledge deficits (incorrect or missing answers) by questionnaire. Results We enrolled 64 patients/parents. At baseline, knowledge deficits among the groups were similar: 17% in controls, 22% in the handbook group and 24% in the pharmaceutical counselling group. After the intervention, knowledge deficits decreased to 13% in the handbook group and to 8% in the pharmaceutical counselling group (NS; p=0.003 compared with controls, respectively). For controls, knowledge deficits remained almost unchanged (19%). Results for the pharmaceutical counselling group showed a strong correlation between baseline knowledge deficits and the extent of the deficit decrease after the intervention (τ=-0.74; p<0.001), whereas no significant correlation was found in the control or handbook group. Conclusions In paediatric oncology, patients'/parents' knowledge of managing oral medicines was improved. Pharmaceutical counselling substantially reduced high knowledge deficits but no significant improvement was seen with the handbook approach. Pharmaceutical counselling should be offered to patients/parents with high knowledge deficits to reduce errors in managing medicines and increase safety.
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Affiliation(s)
- Janine Zimmer
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany.,Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Leipzig, Germany
| | - Dorothee Niemann
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Kirsten Seltmann
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Lars Fischer
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany.,Department of Paediatric Oncology, Haematology and Haemostaseology, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Holger Christiansen
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany.,Department of Paediatric Oncology, Haematology and Haemostaseology, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Roberto Frontini
- Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany
| | - Martina P Neininger
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
| | - Astrid Bertsche
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Leipzig, Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Leipzig, Germany
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