Add-on effects of Chinese herbal medicine external application (FZHFZY) to topical urea for mild-to-moderate psoriasis vulgaris: Protocol for a double-blinded randomized controlled pilot trial embedded with a qualitative study.

Psoriasis vulgaris is a chronic dermatological disease with a high global prevalence. It significantly reduces patients' quality of life and is associated with a substantial economic burden. Conventional therapies for mild-to-moderate psoriasis are often associated with insufficient long-term symptomatic relief and side effects. Chinese herbal medicine (CHM) is commonly used for psoriasis management. A CHM formula, namely Fu zheng he fu zhi yang (FZHFZY), has shown promising treatment effects in clinical practice when used as a bath therapy. However, its efficacy and safety has not been evaluated by a rigorous randomized controlled trial (RCT). Therefore, we designed a double-blinded pilot RCT embedded with a qualitative study on CHM formula FZHFZY plus topical urea for mild-to-moderate psoriasis vulgaris to advance the evidence development and practice of CHM external application for psoriasis. This will be a mixed-method design consisting of a pilot RCT and a qualitative study. The pilot RCT is a two-arm, parallel, placebo-controlled, double-blinded trial. Sixty eligible participants will be randomized at a 1:1 ratio to receive eight weeks' treatment of either FZHFZY plus 10% urea cream, or placebo plus 10% urea cream, with 12-week follow-up visits after the treatment phase. The CHM or placebo will be administered externally as a bath therapy. Outcome measures include trial feasibility, efficacy and safety. The primary efficacy outcome will be Psoriasis Area Severity Index (PASI). Secondary efficacy outcomes include Physician Global Assessment, PASI-75, PASI-50, Body Surface Area, Dermatology Life Quality Index, Skindex-16, itch visual analogue scale and relapse. The qualitative study will be conducted to collect participants' feedback on CHM external application and their experience with the pilot RCT. This study will advance the evidence-based clinical practice of using CHM for psoriasis vulgaris and then to support translation of findings into clinical practice in the future. Trial registration number: ChiCTR2200064092.

Effect of Chinese herbal medicine injections for treatment of psoriasis vulgaris: a systematic review and meta-analysis.

Background: Psoriasis vulgaris (PV) is a longstanding, inflammatory, immune-responsive skin condition. Chinese herbal medicine injections (CHMIs) have been utilized for treating PV in Asian countries. This study aims to conduct a thorough systematic review and meta-analysis to comprehensively appraise the efficacy of CHMIs in treating PV. Methods: Seven databases were searched for randomized controlled trials that evaluated the effect of CHMIs in treating PV, ranging from 2004 to June 2022. The meta-analysis was undertaken based on outcome measures, treatment options, and treatment durations using Review Manager 5.4. The primary outcome measure of this study was a 60% or higher reduction in the Psoriasis Area and Severity Index score (PASI 60). A descriptive analysis was performed for the assessment of adverse events. Results: This systematic review incorporated 33 studies, comprising 3,059 participants. The main findings indicated significant differences based on the PASI 60 (RR = 1.30, 95% CI: 1.24 to 1.37, Z = 10.72, p < 0.00001), PASI 30 (RR = 1.25, 95% CI: 1.13 to 1.38, Z = 4.48, p < 0.00001), and PASI 20 (RR = 1.28, 95% CI: 1.13 to 1.45, Z = 3.82, p = 0.0001) outcome measures. Evaluating the treatment options, CHMIs in combination with monotherapies like narrowband ultraviolet B (NB-UVB) and the acitretin capsule (AC) showed a greater reduction in PASI 60 (RR = 1.33, 95% CI: 1.25 to 1.43, Z = 8.32, p < 0.00001). In terms of treatment duration, no significant difference was observed when the duration extended beyond 56 days. Furthermore, the results suggested that CHMIs might reduce the incidence of adverse events in the treatment of PV. Conclusion: This systematic review revealed preliminary clinical evidence supporting the use of CHMIs for treating PV, considering outcome measures, treatment options, and treatment durations. However, due to the low methodological quality and limited sample size of the included studies, there is an urgent need for high-quality, multi-center and larger-scale studies of CHMIs for PV to provide robust evidence for their clinical application. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=326531], identifier [CRD42022326531].

Microbial population changes and metabolic shift of candidatus accumulibacter under low temperature and limiting polyphosphate.

This study explored the microbial population dynamics of Accumulibacter (Acc) at low temperature and metabolic shift to limiting polyphosphate (Poly-P) in enhanced biological phosphorus removal (EBPR) system. The Accumulibacter-enriched EBPR systems, fed with acetate (HAc) and propionate (HPr) at 10 ± 1 °C respectively, were operated for 60 days in two identical SBR reactors (SBR-1 and SBR-2). The phosphorus removal performance in two systems was stable at 10 ± 1 °C, while the microbial community structure changed. Compared with the population structure in seed sludge, Accumulibacter clades reduced in the HAc system, while Acc I increased significantly in the HPr system. Low temperature was beneficial to the formation of granular sludge in the EBPR system, and the sludge granulation in the HAc system was more homogeneous than that in the HPr system. Accumulibacter in the HPr system can get ATP through glycogen accumulating metabolism (GAM) under limiting Poly-P condition at 10 ± 1 °C, while that in the HAc system cannot. This work suggests that poly-P levels can affect the metabolic pathway of Accumulibacter in EBPR systems under low temperature.

Stability of pure oxygen aeration-activated sludge system under non-steady food-to-microorganism ratio conditions during petrochemical wastewater treatment.

This study investigates the stability of a pure oxygen aeration-activated sludge system for petrochemical wastewater treatment under high organic concentration and non-steady food-to-microorganism (F/M) ratio conditions. Sludge settling characteristics maintained relatively stable conditions with an F/M ratio variation from 0.15 ± 0.04 to 0.33 ± 0.07 kg COD/kg MLSS⋅d, while the excess F/M ratio (0.44 ± 0.16 kg COD/kg MLSS⋅d) resulted in deterioration of the organic removal and sludge-water separation performances. Loosely bound extracellular polymeric substances (EPS) showed more significant effect on sludge settleability than the tightly bound EPS. The genus Hydrogenophaga was related to organic removal performance, while Zoogloea and Chitinophaga were related to the effluent quality of suspended solids. The excess F/M ratio also caused an increase in Zoogloea and Chitinophaga, whereas the toxicity of petrochemical wastewater resulted in decreased abundance of Hydrogenophaga. These changes caused deterioration of the organic removal and sludge-water separation performances.

Chinese Medicine for Psoriasis Vulgaris Based on Syndrome Pattern: A Network Pharmacological Study.

BACKGROUND: The long-term use of conventional therapy for psoriasis vulgaris remains a challenge due to limited or no patient response and severe side effects. Complementary and alternative treatments such as traditional Chinese medicine (TCM) are widely used in East Asia. TCM treatment is based on individual syndrome types. Three TCM formulae, Compound Qingdai Pills (F1), Yujin Yinxie Tablets (F2), and Xiaoyin Tablets (F3), are used for blood heat, blood stasis, and blood dryness type of psoriasis vulgaris, respectively. OBJECTIVES: To explore the mechanism of three TCM formulae for three syndrome types of psoriasis vulgaris. METHODS: The compounds of the three TCM formulae were retrieved from the Psoriasis Database of Traditional Chinese Medicine (PDTCM). Their molecular properties of absorption, distribution, metabolism, excretion and toxicity (ADME/T), and drug-likeness were compared by analyzing the distribution of compounds in the chemical space. The cellular targets of the compounds were predicted by molecular docking. By constructing the compound-target network and analyzing network centrality, key targets and compounds for each formula were screened. Three syndrome types of psoriasis vulgaris related pathways and biological processes (BPs) were enriched by the Database for Annotation, Visualization, and Integrated Discovery (DAVID) v6.8. RESULTS: The compounds of the three formulae exhibited structural diversity, good drug-like properties, and ADME/T properties. A total of 72, 97 and 85 targets were found to have interactions with compounds of F1, F2, and F3, respectively. The three formulae were all related to 53 targets, 8 pathways, 9 biological processes, and 10 molecular functions (MFs). In addition, each formula had unique targets and regulated different pathways and BPs. CONCLUSION: The three TCM formulae exhibited common mechanisms to some extent. The differences at molecular and systems levels may contribute to their unique applications in individualized treatment.

[Effects of Long-term Poly-P Deficiency on the Metabolic Properties of Accumulibacter in AO-SBR System].

To investigate the changes in microbial community structure and metabolic properties of Accumulibacter under long-term Poly-P deficiency, an activated sludge enriched with Accumulibacter was inoculated into two SBR reactors, where sodium acetate and sodium propionate were used separately as organic carbon sources. The two reactors were operated for 60 days with an influent PO43--P concentration of 2.5 mg·L-1. The phosphorus removal performance, sludge production, and changes in the microbial community structure of the systems were analyzed. The results indicated that both SBR systems showed good performance of phosphorus and organic matter removal. However, microorganisms in both systems showed glycogen-accumulating metabolism properties under long-term Poly-P deficiency. In the unfavorable environment of long-term Poly-P deficiency, Accumulibacter Ⅰ maintained a high abundance (40%±7%) in the propionate SBR system, indicating that Accumulibacter Ⅰ had higher metabolic activity and its metabolic properties could be independent of Poly-P for survival under Poly-P deficiency for a long period. In comparison, propionate is more conducive to Accumulibacter adaptation to lower phosphorus loads, and Accumulibacter Ⅰ is more competitive than Accumulibacter Ⅱ under lower phosphorus loads.

Diurnal Regulation of Cellular Processes in the Cyanobacterium Synechocystis sp. Strain PCC 6803: Insights from Transcriptomic, Fluxomic, and Physiological Analyses.

UNLABELLED: Synechocystis sp. strain PCC 6803 is the most widely studied model cyanobacterium, with a well-developed omics level knowledgebase. Like the lifestyles of other cyanobacteria, that of Synechocystis PCC 6803 is tuned to diurnal changes in light intensity. In this study, we analyzed the expression patterns of all of the genes of this cyanobacterium over two consecutive diurnal periods. Using stringent criteria, we determined that the transcript levels of nearly 40% of the genes in Synechocystis PCC 6803 show robust diurnal oscillating behavior, with a majority of the transcripts being upregulated during the early light period. Such transcripts corresponded to a wide array of cellular processes, such as light harvesting, photosynthetic light and dark reactions, and central carbon metabolism. In contrast, transcripts of membrane transporters for transition metals involved in the photosynthetic electron transport chain (e.g., iron, manganese, and copper) were significantly upregulated during the late dark period. Thus, the pattern of global gene expression led to the development of two distinct transcriptional networks of coregulated oscillatory genes. These networks help describe how Synechocystis PCC 6803 regulates its metabolism toward the end of the dark period in anticipation of efficient photosynthesis during the early light period. Furthermore, in silico flux prediction of important cellular processes and experimental measurements of cellular ATP, NADP(H), and glycogen levels showed how this diurnal behavior influences its metabolic characteristics. In particular, NADPH/NADP(+) showed a strong correlation with the majority of the genes whose expression peaks in the light. We conclude that this ratio is a key endogenous determinant of the diurnal behavior of this cyanobacterium. IMPORTANCE: Cyanobacteria are photosynthetic microbes that use energy from sunlight and CO2 as feedstock. Certain cyanobacterial strains are amenable to facile genetic manipulation, thus enabling synthetic biology and metabolic engineering applications. Such strains are being developed as a chassis for the sustainable production of food, feed, and fuel. To this end, a holistic knowledge of cyanobacterial physiology and its correlation with gene expression patterns under the diurnal cycle is warranted. In this report, a genomewide transcriptional analysis of Synechocystis PCC 6803, the most widely studied model cyanobacterium, sheds light on the global coordination of cellular processes during diurnal periods. Furthermore, we found that, in addition to light, the redox level of NADP(H) is an important endogenous regulator of diurnal entrainment of Synechocystis PCC 6803.

Efficacy of combining oral Chinese herbal medicine and NB-UVB in treating psoriasis vulgaris: a systematic review and meta-analysis.

BACKGROUND: The combination of a Chinese herbal medicine (CHM) bath and narrowband ultraviolet B (NB-UVB) improved the efficacy of NB-UVB treatment of psoriasis vulgaris, but bath therapy is inconvenient. Oral CHM plus NB-UVB has been tested in clinical practice. This study aims to evaluate whether adding oral CHM could be beneficial for NB-UVB therapy by a systematic review and meta-analysis. METHODS: Nine English and Chinese databases were searched from their inception to April 2014. Randomized controlled trials (RCTs) comparing the combination of orally administered CHM and NB-UVB with that of CHM placebo and NB-UVB or NB-UVB alone for treating psoriasis vulgaris and reporting Psoriasis Area Severity Index (PASI) outcomes were included. A systematic review, meta-analysis, risk of bias assessment and the GRADE assessment were conducted in accordance with Cochrane Collaboration methodology to assess the evidence for efficacy outcome. Data were analyzed in RevMan5.2. RESULTS: Eighteen eligible RCTs (n = 1416) were included for systematic review, and 17 (n = 1342) of them were included in meta-analysis. Risk of bias in terms of blinding was high and so was in publication bias. Quality of evidence was low according the GRADE assessment. PASI-60 or above [risk ratio (RR) = 1.35, 95 % confidence interval (CI) 1.26-1.45, I(2) = 5 %, number needed to treat = 4.27] and PASI-90 or above (RR = 1.71, 95 % CI 1.45-2.01, I(2) = 0 %, number needed to treat = 5.92) were higher in the intervention group. The combination treatment conferred a 24 % benefit of PASI-60 or above (83 vs 59 %, RR = 1.35, 95 % CI 1.26-1.45, P < 0.01). The incidence of NB-UVB-induced adverse events was lower in the intervention group (95/464 vs 123/428, RR = 0.66, 95 % CI 0.46-0.96, P < 0.01). Mild gastrointestinal reactions (2.87 %) and liver function impairments (0.68 %) were reported in the intervention group. No serious adverse events were reported. CONCLUSION: The orally administrated CHM combined with NB-UVB in treating psoriasis vulgaris showed improved efficacy but quality of evidence was low.

Chronic Supplementation of Curcumin Enhances the Efficacy of Antidepressants in Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Pilot Study.

Major depressive disorder is a devastating mental illness leading to a lifetime prevalence of higher than 16% on individuals. The treatment delay and inevitable adverse effects are major limitations of current depression interventions. Emerging evidence indicates that curcumin produced significant antidepressant properties in depression in both rodents and humans without adverse effects. Therefore, it is necessary to further clarify the antidepressant actions of curcumin and the underlying mechanism in depressed patients. A total of 108 male adults aged between 31 and 59 years were systematically recruited in Tianjin Anding Hospital. Subjects were administered the Chinese version of 17-item Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale that measures different scores of depressive symptoms. The subjects were asked to take 2 capsules containing either 1000 mg of curcumin or placebo soybean powder daily for 6 weeks on the basis of their current antidepressant medications. The plasma levels of interleukin 1ß, tumor necrosis factor α, brain-derived neurotrophic factor, and salivary cortisol were measured by enzyme-linked immunosorbent assay before and after curcumin or placebo treatment during the 6-week procedure. Chronic supplementation with curcumin produced significant antidepressant behavioral response in depressed patients by reduction of 17-item Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale scores. Furthermore, curcumin decreases inflammatory cytokines interleukin 1ß and tumor necrosis factor α level, increases plasma brain-derived neurotrophic factor levels, and decreases salivary cortisol concentrations compared with placebo group. These findings indicate the potential benefits of further implications of supplementary administration of curcumin to reverse the development of depression and enhance the outcome of antidepressants treatment in major depressive disorder.

Acupuncture therapies for psoriasis vulgaris: a systematic review of randomized controlled trials.

The purpose of this review was to evaluate the efficacy and safety of acupuncture therapies in the treatment of psoriasis vulgaris. Embase, CENTRAL, PubMed, AMED, CINAHL, CNKI, CQVIP, CBM, and Wanfang databases were searched from inceptions to May 2013 for prospective randomized controlled trials evaluating acupuncture therapies for psoriasis vulgaris. No language limitations were applied. Studies were assessed using the Cochrane risk of bias tool. The primary outcome was Psoriasis Area Severity Index (PASI) score. Six studies (involving 522 participants) met the eligibility criteria for this review, and 5 were included in quantitative analysis. Due to the diversity of interventions, comparators and reported outcomes, meta-analysis was not possible. Results from single studies produced conflicting results for the outcomes PASI reduction, lesion reduction (non-PASI), PASI score, and relapse rate. There is some evidence of benefit of acupuncture therapies for the treatment of psoriasis vulgaris. However, the conclusions are limited by the small number of included trials and conflicting results from single studies. More research is needed to clarify the effect of acupuncture therapies for psoriasis vulgaris.

Antihypertensive effects of extract from Picrasma quassiodes (D. Don) Benn. in spontaneously hypertensive rats.

UNLABELLED: ETHNOPHARMACOLOGICA RELEVANCE: Picrasma quassiodes (D. Don) Benn. (PQB) is a widely used herbal medicine used for gastroenteritis, snakebite, infection and hypertension in China. The aim of the study was to investigate the possible antihypertensive mechanisms on spontaneously hypertensive rats (SHR) of the extract from Picrasma quassiodes (D. Don) Benn. MATERIALS AND METHODS: In the in vivo study, extract from Picrasma quassiodes (D. Don) Benn. at the dose of 50, 100, 200mg/kg and captopril (12.5mg/kg) were administrated to different group of SHR rats by gavage for six consecutive weeks after the blood pressures were firstly measured. At the end of the study, rats serum nitric oxide (NO) was measured by the nitrate reductase method; superoxide dismutase (SOD) and malondialdehyde (MDA) activities were measured by the colorimetric method; the expression of aorta endothelial nitric oxide synthase (eNOS) was measured by immunohistochemical analysis. RESULTS: The results showed that the oral administration of PQB could lower the systolic blood pressure (SBP) of SHR rats. In addition, the serum level of NO in SHR treated with PQB (100 and 200mg/kg) was increased dramatically (P<0.05, P<0.01), but administration with captopril had no significant effect. The expression of aorta eNOS was markedly increased when treated with PQB. The serum SOD levels were increased with treatment of PQB (100 and 200mg/kg; P<0.05, P<0.01). All the effects of these parameters were comparable to that of the SHR control group. CONCLUSIONS: Our results disclosed that PQB is effective to lower blood pressure of SHR, its antihypertensive effect is probably associated with lowering oxidative stress by reducing SOD activity, preserving endothelial function and increasing the expression of eNOS to regulate NO and directly relax artery.

Disease-syndrome combination clinical study of psoriasis: present status, advantages, and prospects.

Psoriasis is an immune-abnormal, chronic, proliferative skin disease determined by polygenic inheritance and induced by a number of environmental factors. It causes worldwide concern because of its high-prevalence, harmful and incurable characteristics. Over the years, Chinese medicine (CM) treatment of psoriasis has accumulated a wealth of clinical experience. Disease-syndrome combination, which achieves more satisfactory clinical effect, is the basis to highlight the special CM advantages in treating psoriasis. In this paper, we review the advantages of treating psoriasis with the combination of disease and syndrome, analyze the prospects of research on treating psoriasis combining disease with syndrome. We also make a point that there are several key points for the clinical research of combination of disease and syndrome. It can be expected that carrying out clinical research on the combination of disease and syndrome will help improve the clinical efficacy of medical treatment of psoriasis, which will be the main direction of research in the future.