Chinese Medicine as Supporting Therapy for Psoriasis: Past, Present, and Future.

Psoriasis is a chronic skin disease and an important health concern. Western medicine and therapies are the main treatment strategies for psoriasis vulgaris (PV); however, the overall prognosis of patients with PV is still poor. Therefore, PV prevention is especially crucial. Chinese medicine (CM) has a long history of treating psoriasis, and it has unique wisdom in different cognitive angles and treatment modes from modern medicine. In this review, we first summarized the herbs and ancient CM formulas that have therapeutic effects on PV. Second, the research status and obstacles to the current development of CM in modern medicine were reviewed. Finally, the future of CM in the context of precision medicine and integrated medicine was discussed. After a detailed reading of the abundant literature, we believe that CM, through thousands of years of continuous development and clinical practice, has achieved high effectiveness and safety for PV treatment, despite its surrounding controversy. Moreover, precise analyses and systematic research methods have provided new approaches for the modernization of CM in the future. The treatment of PV with CM is worth popularizing, and we hope it can benefit more patients.

Knockdown of CD146 promotes endothelial-to-mesenchymal transition via Wnt/ß-catenin pathway.

PURPOSE: Cardiac fibrosis is characterized by the excessive deposition of extracellular matrix (ECM) proteins and leads to the maladaptive changes in myocardium. Endothelial cells (ECs) undergoing mesenchymal transition contributes to the occurrence and development of cardiac fibrosis. CD146 is an adhesion molecule highly expressed in ECs. The present study was performed to explore the role of CD146 in modulating endothelial to mesenchymal transition (EndMT). METHODS: C57BL/6 mice were subjected to subcutaneous implantation of osmotic minipump infused with angiotensin II (Ang Ⅱ). Adenovirus carrying CD146 short hairpin RNA (shRNA) or CD146 encoding sequence were infected into cultured human umbilical vein endothelial cells (HUVECs) followed by stimulation with Ang II or transforming growth factor-ß1 (TGF-ß1). Differentially expressed genes were revealed by RNA-sequencing (RNA-Seq) analysis. Gene expression was measured by quantitative real-time PCR, and protein expression and distribution were determined by Western blot and immunofluorescence staining, respectively. RESULTS: CD146 was predominantly expressed by ECs in normal mouse hearts. CD146 was upregulated in ECs but not fibroblasts and myocytes in hearts of Ang II-infused mice and in HUVECs stimulated with Ang Ⅱ. RNA-Seq analysis revealed the differentially expressed genes related to EndMT and Wnt/ß-catenin signaling pathway. CD146 knockdown and overexpression facilitated and attenuated, respectively, EndMT induced by Ang II or TGF-ß1. CD146 knockdown upregulated Wnt pathway-related genes including Wnt4, LEF1, HNF4A, FOXA1, SOX6, and CCND3, and increased the protein level and nuclear translocation of ß-catenin. CONCLUSIONS: Knockdown of CD146 exerts promotional effects on EndMT via activating Wnt/ß-catenin pathway and the upregulation of CD146 might play a protective role against EndMT and cardiac fibrosis.

Safety, pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy Chinese volunteers.

PURPOSE: The aim of the present study was to evaluate the safety, pharmacokinetic (PK) and pharmacodynamic (PD) properties of remimazolam besylate following single ascending dose (SAD) and continuous infusion in healthy Chinese volunteers. METHODS: This was a randomized phase I study conducted in two parts. Part I was a double-blind, placebo- and midazolam-controlled, SAD study among healthy Chinese participants with a remimazolam dose of 0.025-0.4 mg/kg. Part II was an open-label, midazolam-controlled, continuous infusion study. Bispectral index (BIS) monitoring and Modified Observers Assessment of Alertness and Sedation (MOAA/S) score assessment were used to assess the PD properties. RESULTS: The half-life range of remimazolam was from 34.1 ± 8.1 to 59.8 ± 20.5 min in the SAD study. The sedation function was initially observed at the dose of 0.05 mg/kg remimazolam. Doses of ≥ 0.075 mg/kg exerted a peak sedation effect within 1-2 min after injection, resulting in a deeper and more rapid sedation. In the 2 h continuous infusion, remimazolam showed a deeper sedation and more rapid recovery than midazolam. For general anesthesia, an induction dosage of 0.2 mg/kg/min and a maintenance dosage of 1 mg/kg/h can achieve a satisfactory efficacy effect. CONCLUSIONS: Remimazolam was safe and well tolerated in healthy Chinese participants. Based on the phase I clinical study, we suggest that remimazolam besylate demonstrates greater sedation and quicker recovery from sedation than midazolam.

Enhanced denitrification by nano ɑ-Fe2O3 induced self-assembled hybrid biofilm on particle electrodes of three-dimensional biofilm electrode reactors.

Three-dimensional biofilm electrode reactors (3D-BERs) represent a novel technology for wastewater denitrification. Formation of mature electroactive biofilm on particle electrodes is crucial to realize successful denitrification in 3D-BERs. However, long start-up time and low electroactivity of the biofilm formed on particle electrodes limit the further application of 3D-BERs in wastewater treatment. In this work, self-assembled hybrid biofilms (SAHB) was cultivated on granular activate carbon particle electrodes of the 3D-BER by assembling nano ɑ-Fe2O3 into the biofilm. ɑ-Fe2O3 was selected due to its high affinity to bacterial outer-membrane cytochromes, an important mediator for microbial electron transfer. SAHB formed on particle electrodes were characterized and the denitrification performance of 3D-BERs was also investigated. Results indicate that nano ɑ-Fe2O3 plays positive roles in the start-up of 3D-BER, which captures more microbes into SAHB and constructs thick biofilm on particle electrodes. Special microorganisms with denitrification function related with genera of Hydrogenophaga and Opitutus are distinctively enriched in SAHB. Nano ɑ-Fe2O3 induced SAHB exhibit superior denitrification performance compared to natural biofilm. The average denitrification rate increases from 0.62 mg total nitrogen/L/h for natural biofilm to 1.73 mg total nitrogen/L/h for SAHB, mainly ascribed to accelerated nitrites reduction. Our work provides new technical solution to enhance nitrates removal in 3D-BERs and brings deep insights into application of bio-electrochemical system in wastewater treatment.

Insights into the interactions between triclosan (TCS) and extracellular polymeric substance (EPS) of activated sludge.

Triclosan (TCS) contaminant has aroused wide concerns due to the high risk of converting into toxic dioxin in aquatic environments. During the wastewater treatment process, considerable amounts of TCS are accumulated in activated sludge but the mechanisms are still unclear. Especially, roles of extracellular polymeric substances (EPS), the main components of activated sludge, in TCS removal have never been addressed. In this work, the binding properties of loosely-bound EPS (LB-EPS) and tightly-bound EPS (TB-EPS) of activated sludge to TCS are investigated by fluorescence quenching approach. The influences of aquatic conditions including solution pH, ionic strength and temperature on the interactions between EPS and TCS are explored. Possible interaction mechanisms are discussed as well as the corresponding environmental implication. Results indicate that binding processes of EPS to TCS are exothermic mainly driven by the enthalpy changes. The proteins components in EPS dominate the interactions between EPS and TCS by hydrogen bond and hydrophobic interaction. The binding strength could be improved under the condition of weak alkaline and relative high ionic strength. Generally, LB-EPS exhibit stronger binding ability to TCS than TB-EPS under neutral environment, playing more crucial roles in the binding process. This work highlights the important contributions of EPS to TCS removal, that is beneficial to comprehensively understand the migration of TCS in activated sludge system.

Multiple response optimization for high efficiency energy saving treatment of rhodamine B wastewater in a three-dimensional electrochemical reactor.

The removal of high-concentration rhodamine B (RhB) wastewater was investigated in a three-dimensional electrochemical reactor (3DER) packed with granular activated carbon (GAC) particle electrodes. Response surface methodology (RSM) coupled with grey relational analysis (GRA) was used to evaluate the effects of voltage, initial pH, aeration rate and NaCl dosage on RhB removal and energy consumption of the 3DER. The optimal conditions were determined as voltage 7.25 V, pH 5.99, aeration rate 151.13 mL/min, and NaCl concentration 0.11 mol/L. After 30 min electrolysis, COD removal rate could arrive at 60.13% with an extremely low energy consumption of 6.22 kWh/kg COD. The voltage and NaCl were demonstrated to be the most significant factors affecting the COD removal and energy consumption of 3DER. The intermediates generated during the treatment process were identified and the possible degradation pathway of RhB was proposed. It is worth noting that 3DER also showed an excellent performance in total nitrogen (TN) removal under the optimal condition. The activated chlorine generated from chloride had great contributions to eliminate carbon and nitrogen of RhB wastewater. The treatment effluent had a good biodegradability, which was suitable for subsequent biological treatment.

Bioactive terpenoids from Silybum marianum and their suppression on NO release in LPS-induced BV-2 cells and interaction with iNOS.

Three new (1-3) and one known (4) bioactive terpenoids were isolated from the seeds of Silybum marianum based on the investigation to get new NO inhibitors. Their structures were determined by extensive NMR (1D and 2D NMR) and MS spectroscopic data, and the absolute configurations were identified by experimental and calculated ECD spectra. The NO inhibitory activities in murine microglial BV-2 cells and interactions with iNOS protein by molecular docking were evaluated for all compounds. The results showed that these compounds had potent NO inhibitory effects.

Acquired latent tuberculosis infection in psoriasis patients treated with etanercept in the People's Republic of China.

BACKGROUND: TNF-α plays a key role in host defense against mycobacterial infection, and patients receiving TNF-α blocker treatment have increased susceptibility to tuberculosis disease. In the People's Republic of China, an intermediate tuberculosis-burden country, the latent tuberculosis infection (LTBI) risk in patients with psoriasis who are treated with etanercept, the safest kind of TNF-α blocker, is unknown. OBJECTIVES: This study reports the LTBI risk in patients with psoriasis after etanercept treatment and aims to answer the question of how often rescreening for LTBI should be done in order to reduce active tuberculosis infection of patients and further reduce the incidence of active tuberculosis disease. PATIENTS AND METHODS: This retrospective review evaluated patients with moderate-to-severe chronic plaque psoriasis between 2009 and 2013. All patients were excluded tuberculosis infection and received etanercept 25 mg twice weekly, then the patients were checked for LTBI 3 months after etanercept treatment to observe the incidence of LTBI and assess the need for rescreening for LTBI every 3 months. RESULTS: We retrospectively analyzed 192 patients with psoriasis with moderate-to-severe chronic plaque whose tuberculin skin test and chest X-rays were negative and who received etanercept 25 mg twice weekly. Eighteen of them were excluded because they received less than 3 months of etanercept therapy. After treatment with etanercept, four patients were found to have LTBI. CONCLUSION: In this study, the incidence of LTBI after 3 months was four in 192 (2.1%), which is higher than the annual incidence of LTBI in the People's Republic of China (0.72%), so LTBI could be expected to occur within 3 months in psoriasis patients on etanercept. Periodic screening for LTBI in the therapy course, as well as before initiating treatment, is necessary in those patients who use a TNF-α blocker. We recommend rescreening for LTBI every 3 months.

In vitro enzymatic degradation of poly (glycerol sebacate)-based materials.

Enzymatic degradation is a major feature of polyester implants in vivo. An in vitro experimental protocol that can simulate and predict the in vivo enzymatic degradation kinetics of implants is of importance not only to our understanding of the scientific issue, but also to the well-being of animals. In this study, we explored the enzymatic degradation of PGS-based materials in vitro, in tissue culture medium or a buffer solution at the pH optima and under static or cyclic mechanical-loading conditions, in the presence of defined concentrations of an esterase. Surprisingly, it was found that the in vitro enzymatic degradation rates of the PGS-based materials were higher in the tissue culture medium than in the buffered solution at the optimum pH 8. The in vitro enzymatic degradation rate of PGS-based biomaterials crosslinked at 125°C for 2 days was approximately 0.6-0.9 mm/month in tissue culture medium, which falls within the range of in vivo degradation rates (0.2-1.5mm/month) of PGS crosslinked at similar conditions. Enzymatic degradation was also further enhanced in relation to mechanical deformation. Hence, in vitro enzymatic degradation of PGS materials conducted in tissue culture medium under appropriate enzymatic conditions can quantitatively capture the features of in vivo degradation of PGS-based materials and can be used to indicate effective strategies for tuning the degradation rates of this material system prior to animal model testing.

[A comparison of remifentanil versus sufentanil with target-controlled infusion in combined inhalation anesthesia for surgical patients: effects on hemodynamics and postoperative recovery].

OBJECTIVE: To compare the effect of remifentanil versus sufentanil with target-controlled infusion in combination with inhalation anesthesia for surgical patients on the parameters of hemodynamics and postoperative recovery. METHODS: Forty ASA I-II patients aged 18 - 65 years old with BMI (body mass index) < 30, undergoing colectomy or pedical screw interfix were enrolled. Upon the approval of institutional Ethics Committee, they were randomized to receive remifentanil or sufentanil at a target plasma concentration of 3 ng/ml and 0.3 ng/ml respectively in combination of inhalated anesthesia at 0.9 MAC (minimal alveolar concentration). The infusion of remifentanil was discontinued at the end of surgery while the infusion of sufentanil at 40 - 60 minutes before the end of surgery. The arterial blood pressure (ABP), heart rate (HR), electrocardiogram (ECG) and pulse blood oxygen saturation during anesthesia were monitored. The time between the termination of anesthetic use and recovery of spontaneous breathing and extubation were observed. And the incidence of postoperative pain and respiratory depression were recorded. RESULTS: As compared with the baseline values, BP and HR decreased significantly in both groups. BP was similar in both groups whereas HR was lower in Group R than that in Group S at post-induction, post-intubation, incision, the end of surgery and extubation (P < 0.05). The time from termination of anesthesia to recovery of spontaneous breathing was 1.8 ± 1.4 min in Group R. And it was significantly shorter than that in Group S (2.9 ± 1.5 min) (P < 0.05). The time from termination of anesthetic use to extubation was 6.8 ± 3.9 min in Group R. And it was also significantly shorter than that in Group S (9.1 ± 2.8 min) (P < 0.05). Seven patients experienced postoperative pain with visual analogue scale (VAS) > 4. And morphine was used for rescue analgesia in recovery room. CONCLUSION: When combined with inhalation anesthesia, the effects on hemodynamics are similar between the patients receiving the target-controlled infusions of remifentanil and sufentanil. Remifentanil offers a shorter time to recovery of spontaneous breathing and tracheal extubation.

[Effects of metoprolol on perioperative cardiovascular events in patients with risk or at high risk for coronary artery disease undergoing non-cardiac surgery].

OBJECTIVE: To assess the effects of metoprolol on perioperative cardiovascular events in patients with risk or at high risk for coronary artery disease (CAD) who were to undergo non-cardiac surgery. METHODS: 102 patients with definite CAD or at high risk for CAD who were to undergo selective non-cardiac surgery were randomized to 2 equal groups: Group A (blank control group) and Group B given metoprolol orally or intravenously from 2 h before surgery to 30 days after surgery. The dosage of metoprolol was adjusted according to the blood pressure and heart rate. The changes of peri-operative heart rate (HR), level of creatine kinase (CK)-MB, cardiac events such as unstable angina pectoris (UAP) and myocardial infarction (MI), death, and stroke were recorded. RESULTS: The HR values, intra-operative and 6 h, 1 d, and 2 d after operation of Group B were all significantly lower than those of Group A (all P < 0.05). One patient from each group had MI. One case of death and two cases of strokes occurred in Group A. The occurrence rate of at least one cardiovascular event were 9.8% in Group A (5/51) and 2.0% in Group B (1/51) without significant difference between these 2 groups (P > 0.05). CONCLUSIONS: Metoprolol reduces the incidence of postoperative severe cardiovascular episodes in patients with risk of or at high risk for CAD undergoing non-cardiac surgery.

[Effect of target-controlled infusion sufentanil in different doses combined with nitrogen monoxide inhalation on hemodynamics and postoperative recovery].

OBJECTIVE: To investigate the effect of target-controlled infusion sufentanil in different doses combined with inhalation anesthesia at 0.9 minimum alveolar concentration (MAC) on the intraoperative hemodynamics and postoperative recovery of spontaneous breathing. METHODS: Sixty patients aged 18-65, weighing 45-80 kg, undergoing colectomy or pedical screw intermix were randomized into 3 groups: Groups S3, S4, and S5 to receive sufentanil at the fixed target plasma concentrations of 0.3, 0.4, and 0.5 ng/ml respectively in combination of nitrogen monoxide inhalation at 0.9 MAC. The arterial blood pressure (ABP), heart rate (HR), electrocardiogram (ECG), and pulse blood oxygen saturation during anesthesia were monitored, the time between the termination of anesthetic use and recovery of spontaneous breathing and extubation were observed, and the use of vasoactive drug and other intravenous anesthetics were recorded. RESULTS: The BP and HR were nearly stable during the anesthesia in three groups. The values of time from termination of anesthesia to recovery of spontaneous breathing of Groups S2, S3, and S5 were (3.3 +/- 2.0) min, (2.8-2.5) min, and (6.1-3.4) min) respectively without significant differences among them. The time from termination of anesthetic use to extubation of Group S5 was 14.6 +/- 10.9 min, significantly longer than those of Groups S3 and S4: [(9.6 +/- 8.0) and (9.4 +/- 6.4) min, both P < 0.05]. CONCLUSION: When the concentration of inhalation anesthetic is at 0.9 MAC, the target plasma sufentanil concentration of 0.3 ng/ml is adequate in anesthesia. If sufentanil infusion was terminated 50 min before the end of surgery, the patients can recover safely and quickly.