Performance of the PRISM I, PIM2, PELOD-2 and PRISM IV scoring systems in western China: a multicenter prospective study.

BACKGROUND: The aim of this study was to evaluate the performance of the four scoring tools in predicting mortality in pediatric intensive care units (PICUs) in western China. METHODS: This was a multicenter, prospective, cohort study conducted in six PICUs in western China. The performances of the scoring systems were evaluated based on both discrimination and calibration. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC) for each model. Calibration was measured across defined groups based on mortality risk using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: A total of 2034 patients were included in this study, of whom 127 (6.2%) died. For the entire cohort, AUCs for Pediatric Risk of Mortality Score (PRISM) I, Pediatric Index of Mortality 2 (PIM2), Pediatric Logistic Organ Dysfunction Score-2 (PELOD-2) and PRISM IV were 0.88 [95% confidence interval (CI) 0.85-0.92], 0.84 (95% CI 0.80-0.88), 0.80 (95% CI 0.75-0.85), and 0.91 (95% CI 0.88-0.94), respectively. The Hosmer-Lemeshow goodness-of-fit Chi-square value was 12.71 (P = 0.12) for PRISM I, 4.70 (P = 0.79) for PIM2, 205.98 (P < 0.001) for PELOD-2, and 7.50 (P = 0.48) for PRISM IV [degree of freedom (df) = 8]. The standardized mortality ratios obtained with the PRISM I, PIM2, PELOD-2, and PRISM IV models were 0.87 (95% CI, 0.75-1.01), 0.97 (95% CI, 0.85-1.12), 1.74 (95% CI, 1.58-1.92), and 1.05 (95% CI, 0.92-1.21), respectively. CONCLUSIONS: PRISM IV performed best and can be used as a prediction tool in PICUs in Western China. However, PRISM IV needs to be further validated in NICUs.

[Effect of Xinfeng Capsule on Pulmonary Function, Thi/Th2 Cells, and Regulatory T Cells of Adjuvant Arthritis Rats].

Objective To observe the effects of Xinfeng Capsule (XFC) at different doses on lung function, Thl/Th2 cells, regulatory T cells (Treg) in adjuvant arthritis (AA) rats. Methods Totally 84 rats were randomly divided into 5 groups, i.e., the normal control group (NC) , the model group (M) , the methotrexate (MTX) group, the Tripterygium Glycosides Table (TGT) group, the low dose XFC (XFC- L) group, the medium dose XFC (XFC-M) group, the high dose XFC (XFC-H) group, 12 in each group. Freund's complete adjuvant (FCA; 0. 1 mL) was intradermally injected to all rats except those in the NC group from right rear paw to induce inflammation. Medication was started from the 19th day after inflam- mation. Normal saline was administered to rats in the NC group and the M group. Rats in the rest groups were correspondingly administered with MTX, TGT, XFC, respectively. Changes of each index were ob- served in all groups. Results (1) Compared with the NC group, rat paw swelling degree (E) , arthritis index (AI) , lung index (LI) , average expiratory flow in 1 second (FEV1/FVC%) , alveolitis integral, TNF- α, Th1/Th2 cells, transforming growth factor-ß1 ( TGF-ß1 ) expression significantly increased in the M group (P <0. 01) ; forced vital capacity (FVC) , peak expiratory flow 25% of vital capacity (FEF25), peak expiratory flow 50% of vital capacity (FEF50), peak expiratory flow 75% of vital capacity (FEF75), the maximum mid-expiratory flow (MMF) , peak expiratory flow (PEF) , CD4 ⁺Treg, CD4⁺CD25 ⁺Treg, IL-10, and Foxp3 expression significantly decreased in the M group (P <0. 01). (2) Compared with the M group, body weight, FVC, FEF25, FEF50, FEF75, MMF, PEF, IL-10, Treg, and Foxp3 expression increased in all treatment groups; E, Al, LI, FEV1/FVC%, TNF-α, Th1/Th2 cells, and TGF-ß1 expression decreased in all treatment groups (P <0. 05, P <0. 01). (3) Compared with the XFC-M group, LI, alveolitis integral, TNF- α, Th1/Th2 cells, and TGF-ß1 increased; FVC, FEF25, FEF50, FEF75, IL-10, CD4⁺Treg, CD4⁺CD25⁺ Treg, and Foxp3 decreased in other treatment groups (P <0. 05, P <0. 01). Conclusions AA rats had local swollen paws and decreased lung function. XFC could significantly improve paw swelling and Al of AA rats, and improve lung function. It could reduce inflammatory reaction and immune complexes on tis- sue and organ damage, improve joint and pulmonary symptoms possibly through promoting expressions of IL-10, CD4⁺Treg, CD4⁺CD25⁺Treg, and Foxp3, and inhibiting TNF-α,Th1/Th2 cells, and TGF-ß1 ex- pression.

[Effect of triptolide on expressions of Notch receptors and ligands in rats with adjuvant- induced arthritis and reduced pulmonary function].

OBJECTIVE: To investigate the effects of triptolide on Notch receptor and ligand expressions in rats with adjuvant-induced arthritis (AA). METHODS: Forty rats were randomly divided into normal control (NC) group, model (MC) group, methotrexate group and triptolide groups. Rat models of AA were established by an intradermal injection of 0.1 mL Freund's complete adjuvant into the right paw. Twelve days after the injection, the rats were treated with corresponding drugs for 30 days; the rats in NC group and MC group were given saline only. Paw edema volume (E), arthritis index (AI), pulmonary function, histomorphologies, and Notch receptor/ ligand expression in the lung tissue were analyzed after the treatments. RESULTS: Compared with the NC group, E, AI, Notch3, Notch4, and Delta1 expressions in the lung tissues significantly increased while pulmonary function and pulmonary expressions of Notch1, Jagged1, and Jagged2 significantly decreased the model rats (P<0.01). Compared with the MC group, triptolide-treated rats showed significantly improved pulmonary functions, increased expressions of Notch1, Jagged1, and Jagged2 and decreased expressions of Notch3, Notch4, and Delta1 in the lungs (P<0.05, P<0.01); the therapeutic effect of triptolide was better than that of methotrexate. CONCLUSION: Triptolide can reduce inflammatory reaction and immune complex deposition to improve joint and pulmonary symptoms in rats with AA possibly by up-regulating the expressions of Notch3, Notch4, and Delta1 and down-regulating the expressions of Jagged1, Jagged2, and Notch1.

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis: study protocol of a multicenter randomized controlled trial.

BACKGROUND: Rheumatoid arthritis (RA), as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN: This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1:1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo (imitation leflunomide). The control group will receive leflunomide and an herbal placebo (imitation Xinfeng Capsule). The American College of Rheumatology (ACR) Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate (ACR20), which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION: The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION: This trial has been registered in ClinicalTrials.gov. The identifier is NCT01774877.

Effect of tripterygium glycosides on pulmonary function in adjuvant arthritis rats.

BACKGROUND: Tripterygium is a Chinese herb with immunosuppressive effects and an established history of use in the treatment of rheumatoid arthritis. Previous studies demonstrated that tripterygium glycosides (TPG) alleviated Freund's complete adjuvant (FCA)-induced arthritis. Simultaneously, it has also been observed to impact the adjuvant arthritis (AA) associated with lung injury. In this study, we have investigated whether traditional Chinese medicine could attenuate lung injury induced by AA by observing the effects of TPG on the degree swelling, arthritis index (AI), lung index (LI), pulmonary function, cytokines, and the expression of regulatory T cells (Treg) and Foxp3 in AA rats. METHODS: A total of 48 rats were separated into four groups: normal control (NC), model control (MC), methotrexate (MTX), and TPG groups (12 in each). Except for the rats of NC group, those in the others groups were intracutaneously injected in the right hind limb with 0.1 ml of FCA. The NC and MC groups were treated with physiological saline, and the MTX and TPG groups were treated with MTX and TPG, respectively. Thirty days after administration, the changes in swelling degree, AI, LI, pulmonary function, Treg levels, the ultrastructure of the lung tissue, and the expression of Foxp3 in the lung tissue were observed. RESULTS: Compared with NC group, the level of swelling degree, AI, LI, 1 second average expiratory flow (FEV1/FVC %), the alveolar inflammation integration, tumor necrosis factor alpha (TNF-α), and endothelium-1 (ET-1) in the MC group had significantly increased (p < 0.01). However, the level of forced vital capacity (FVC), 25% vital capacity of the peak expiratory flow (FEF25), 50% vital capacity of the peak expiratory flow (FEF50), 75% vital capacity of the peak expiratory flow (FEF75), maximum mid-expiratory flow (MMF), peak expiratory flow (PEF), interleukin-10 (IL-10), CD4(+) CD25(+) Treg, and Foxp3 had significantly decreased (p < 0.01). LI, the alveolitis score, and ET-1 were found to decrease with TPG treatment. However, the levels of FVC, FEF25, FEF50, FEF75, MMF, PEF, IL-10 in serum, and CD4(+) CD25(+) Treg in peripheral blood had increased. The expressions of Foxp3 protein and mRNA in the lung tissue had also increased in the TPG group. Compared with the MTX group, the pulmonary function had enhanced, the structure of alveolar type II cells had improved, and the expression of the IL-10, Treg, and Foxp3 had elevated. However, the TNF-α and ET-1 levels had reduced as compared to the MTX group. CONCLUSION: The level of paw swelling and AI in the AA rats can be inhibited by TPG. The inflammatory response in lung tissue had also decreased, although there was significant improvement in the pulmonary function. The mechanism that would explain this observation is probably associated with the upregulation of the expression of IL-10, Treg, and Foxp3 and downregulation of the expression of TNF-α and ET-1.

[Xinfeng Capsule improves cardiopulmonary function of knee osteoarthritis rats by BTLA-HVEM signaling pathway to induce Treg immune tolerance].

AIM: To observe the effects of Xinfeng Capsule (XFC) on cardiopulmonary function of knee osteoarthritis (KOA) rats and explore its molecular mechanism. METHODS: Forty rats were randomly divided into normal control (NC) group, model control (MC) group, glucosamine control (GS) group and XFC group, 10 in each group. All rats were induced to KOA by injected papain and L-Cys into the right knee joint except NC group. Fourteen days after modeling, NC and MC groups were given normal saline (0.01 g/kg), GS and XFC groups were given glucosamine (0.098 g/kg) and XFC suspension (0.375 g/kg), respectively. Cardiac and pulmonary function were detected by ultrasonography and animal spirometry, respectively. B and T lymphocyte attenuator (BTLA), herpesvirus entry mediator (HVEM), interleukin (IL)-17, IL-4, transforming growth factor-beta (TGF-ß1) were detected by ELISA; CD4(+);CD25(+);Treg and CD4(+); CD25(+);Foxp3(+); Treg were detected by flow cytometry. RESULTS: Compared with NC group, body mass, levels of early diastolic peak flow velocity (E), early diastolic peak flow velocity/atrial peak flow velocity (E/A), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), 25% forced expiratory flow (FEF25), 50% forced expiratory flow (FEF50), 75% forced expiratory flow (FEF75), maximal mid-expiratory flow (MMF), peak expiratory flow (PEF), expressions of BTLA, HVEM, IL-4, CD4(+);CD25(+);Treg and CD4(+);CD25(+);Foxp3(+); Treg significantly decreased, and TGF-ß1, IL-17 significantly increased in MC group (P<0.01 or P<0.05). Compared with MC group, weight, levels of E, E/A, FEV1, FEF50, FEF75, PEF, BTLA, HVEM, IL-4, CD4(+);CD25(+);Treg and CD4(+);CD25(+);Foxp3(+); Treg significantly increased, and Mankin score, cardiacindex (CI), lung index (LI), TGF-ß1, IL-17 significantly decreased in GS and XFC groups (P<0.01 or P<0.05); Compared with GS group, weight and Treg were significantly elevated in XFC group (P<0.01 or P<0.05). CONCLUSION: XFC can decrease Mankin scores of cartilage and improve cardiopulmonary function of KOA rats. Its mechanism may be enhancing BTLA-HVEM negative co-stimulatory signals, inducing Treg immune tolerance, up-regulating IL-4, down-regulating IL-17, TGF-ß1, then to inhibit abnormal inflammatory immune response.

Ternary liquid-liquid equilibria measurement for epoxidized soybean oil + acetic acid + water.

Liquid-liquid equilibria (LLE) data were measured for ternary system epoxidized soybean oil (ESO) + acetic acid + water at 313.15, 323.15 and 333.15 K, respectively. The consistency of the measured LLE data was tested, using Othmer-Tobias correlation and root-mean-square deviation (sigma) in mass fraction of water in the lower phase and average value of the absolute difference (AAD) between experimental mass fraction of epoxidized soybean oil in the upper phase and that calculated using Othmer-Tobias correlation.

[Quality standard of stewed rhizoma polygonati with yellow wine].

OBJECTIVE: To improve the quality standard of stewed Rhizoma Polygonati with yellow wine. METHODS: On the basis of Chinese Pharmacopoeia 2010, some items were added, which included assay of reducing sugars, water-soluble extracts, acid insoluble ash content and 5-hydroxymethylfurfural. RESULTS: Reducing sugars was no less than 34.0%, water-soluble extracts no less than 19.0%, acid insoluble ash content no more than 0.2%, 5-hydroxymethylfurfural no more than 0.02%. CONCLUSION: The quality standard of stewed Rhizoma Polygonati with yellow wine is improved on the basis of Chinese Pharmacopoeia.

[Influential factors of Hardy-Weinberg equilibrium on the study of association between gene polymorphism and disease].

OBJECTIVE: According to the data collected from gastric cancer families comparative study, the influence factors of Hardy-Weinberg (H-W) equilibrium in the association studies of gene polymorphism and disease were analyzed to reveal the reasons that affecting the equilibrium deviation in the group. METHODS: Varieties of risk genotype for gastric cancer were analyzed and detected with H-W equilibrium, genetic linkage disequilibrium analysis and Cochran-Armitage trend test. RESULTS: (1) Significant deviations from H-W equilibrium were observed in IL-1B-31, IL-1B-511, IL-1RN and TNF-A-308 of the cases and controls (P < 0.01). MIF-173 tended to be equilibrium in the population. (2) Deviations from expectations of phenotypes combination probability were observed in two-site H-W chi(2) tests (P < 0.01). (3) The Cochran-Armitage trend test showed that distribution of IL-1B-511 and IL-1RN were significantly different (P < 0.05), suggesting that population stratification might have existed in the group. CONCLUSIONS: (1) Affected by frequency-dependent selection, under the combination of linkage disequilibrium, mutations and interaction, genotype frequency of IL-1B-31, IL-1B-511, IL-1RN and TNF-A-308 showed deviation from H-W equilibrium in population. (2) Two-site genetic equilibrium test model seemed better to reflect the differences of phenotypic combination fitness. (3) Population stratification was another factor to express the deviation from H-W equilibrium.

[Determination of 5-hydroxymethyl furfuraldehyde in different processed products of polygonatum].

OBJECTIVE: By finding the changing regularity of 5-Hydroxymethyl furfuraldehyde (5-HMF) content in Polygonatum for different time, this provides basis for the technology of processing Polygonatum and quality standards of its prepared pieces. METHODS: The testing solution was acquired by ultrasonic extraction, HPLC was used to determine the contents. The chromatographic conditions: Agilent HC-C18 column (5 microm, 250 mm x 4.6 mm). The mobile phase: methanol-water (15:85) at the flow rate of 1 ml/min. The determination wave length was 284 nm. RESULTS: All kinds of processed Polygonatum had 5-Hydroxymethyl furfuraldethyde in different degrees, contents in Polygonatum kept relatively stable before 30 hours, but contents rose rapidly after 30 hours, contents decreased as continuing heating. CONCLUSION: The result can provide useful references to quality control and standard porcessing condition of Polygonatum.

[Therapeutic effects of Tiaozhong Granule on esophagus mucous membrane in rats with mixed reflux esophagitis and the mechanisms].

OBJECTIVE: To explore the mechanism of Tiaozhong Granule (TZG), a compound traditional Chinese herbal medicine, in treating rats with mixed reflux esophagitis. METHODS: Fifty-eight SD rats were randomly divided into untreated group (n=12), sham-operated group (n=10), TZG-treated group (n=12), Banxia Xiexin Decoction (BXXXD)-treated group (n=12) and cisapride-treated group (n=12). Mixed reflux esophagitis was induced by esophago-duodenum end-to-side anastomosis. Four weeks later, the rats were orally administered twice daily for 12 days. Pathological changes of esophagus mucous membrane were observed by using HE staining. The expressions of proliferating cell nuclear antigen (PCNA) and p53 in the esophagus tissue were detected by immunohistochemical SABC method. Spectrophotometric method was used to detect the content of malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in serum. RESULTS: Compared with the untreated group, pathological changes of esophagus mucous membrane were relieved in different degrees in TZG-treated group, BXXXD-treated group and cisapride-treated group. Content of MDA and expressions of PCNA and p53 were obviously decreased in the three treated groups (P<0.01), and the activities of SOD and GSH-Px were significantly increased in the three treated groups (P<0.05, P<0.01). TZG had better effects than cisapride in decreasing the content of MDA and increasing the activities of SOD and GSH-Px (P<0.05). TZG was better in aspect of reducing the expressions of PCNA and p53 than BXXXD and cisapride tablets (P<0.05). CONCLUSION: Tiaozhong Granule can treat mixed reflux esophagitis in rats, and its action mechanisms may be associated with decreasing the expressions of PCNA and p53 in esophagus mucous membrane, reducing the content of MDA and increasing the activities of SOD and GSH-Px in serum.