Processing methods and the underlying detoxification mechanisms for toxic medicinal materials used by ethnic minorities in China: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Various toxic medicinal materials have been used by different ethnic minorities in China for thousands of years because of their extraordinary pharmacological activities. However, the improper use and complex toxicity-efficacy relationship could cause poisoning and even death. Therefore, the study of toxicity-attenuating methods and mechanisms is necessary. AIM OF THE STUDY: This review aims to summarize commonly used toxic ethnomedicines and their processing methods as well as the underlying mechanisms to potentially reduce toxicity and even enhance or preserve efficacy. Prospective for possible future investigations is also discussed. MATERIALS AND METHODS: Processing methods and mechanisms are investigated mainly through literature review. RESULTS: Processing methods with heating (boiling, stir frying, and steaming, etc.) and without heating (soaking) are usually used by Chinese ethnic minorities to attenuate the toxicity of ethnomedicines. Wheat bran, vinegar, wine, and herbal decoction are commonly used processing excipients. The mechanisms of detoxification by processing can be briefly summarized into three major categories: (1) direct elimination of impurities or reduction of toxic constituents' contents of ethnomedicines by cutting, washing, soaking or frosting; (2) chemical structure transformation of toxic constituents, such as alkaloids, glycosides, toxic proteins, animal toxicants, and mineral components, during heating and/or soaking; and (3) biological synergism or antagonism effects between the chemical constituents of processing excipients and ethnomedicines in vivo, to reduce toxicity and protect target organs. CONCLUSION: Toxic ethnomedicines have long been used in China, and detoxification by processing is the prerequisite for their safe clinical application. However, understanding on the special processing methods and detoxification mechanisms of ethnomedicines in China remains insufficient. Investigations on quality control of toxic ethnomedicines, as well as evaluation of processing methods and studies of the corresponding mechanisms should be further strengthened for safe and effective clinical application.

Predicting major adverse cardiac events based on multi-parameter coronary computed tomography angiography.

OBJECTIVE: To build a nomogram model to improve the prediction of major adverse cardiac events (MACE) using multi-parameter coronary computed tomography angiography (CCTA). METHODS: All patients underwent CCTA. Those who developed MACE 90 days later but within 2 years between January 2008 and December 2018 were retrospectively enrolled as MACE group, while those without MACE were 1:1 propensity score matched in the control group. CCTA stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from computed tomography angiography (FFRct) were analyzed and compared between the two groups. The independent risk factors for predicting MACE were obtained through univariate and multivariate regression analysis, after which multi-parameter models were built to predict MACE. Finally, the nomogram for predicting MACE was created using the independent risk factors from multivariate regression analysis. RESULTS: A total of 483 vessels in 260 patients were successfully analyzed. The combination of CCTA stenosis, plaque qualitative-quantitative characteristics, and FFRct (AUC = 0.922, P < 0.001) showed a higher predictive value compared to CCTA stenosis alone, FFRct alone, plaque qualitative-quantitative characteristics alone, CCTA stenosis combined with plaque qualitative-quantitative characteristics, and CCTA stenosis combined with FFRct (all P < 0.001). Independent risk factors were CCTA stenosis ≥50%, low attenuation plaque, positive remodeling, napkin ring sign, lipid plaque volume proportion, and FFRct. Subsequently, a nomogram was created using these independent risk factors. CONCLUSIONS: The multi-parameter CCTA model has improved performance in predicting MACE. Nomogram for predicting MACE, which includes these factors, represents a practical and easy-to-use method in the clinical setting.

A predictive nomogram for intracerebral hematoma expansion based on non-contrast computed tomography and clinical features.

PURPOSE: To develop and validate a new nomogram utilizing non-contrast computed tomography (NCCT) signs and clinical factors for predicting hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: HE was defined as > 6 mL or 33% increase in baseline hematoma volume. Multivariable logistic regression analysis was performed to identify the predictors of HE. The discriminatory performance of the proposed model was evaluated via receiver operation characteristic (ROC) analysis, and the predictive accuracy was assessed by a calibration curve. The nomogram was established by R programming language. The decision curve analysis and clinical impact curve were drawn according to the related risk factors. RESULTS: A total of 506 patients with spontaneous ICH were recruited in the development cohort, and 103 patients were registered as the external validation cohort. Among the development cohort, 132 (26.09%) experienced HE. Glasgow coma scale (GCS) (P < 0.001), neutrophil to lymphocyte ratio (NLR) (P < 0.001), blend sign (P < 0.001), swirl sign (P < 0.001), and hypodensities (P = 0.003) were significant predictors of HE, by which were used to establish the nomogram. The model demonstrated good performance with high area under the curve both in the development (AUC = 0.908; 95% confidence interval, 0.880-0.936) and the external validation (AUC = 0.844; 95% confidence interval, 0.760-0.908) cohort. The calibration curve illustrated a high accuracy for HE prediction. CONCLUSION: The nomogram derived from NCCT markers and clinical factors outperformed the NCCT signs-only model in predicting HE for patients with ICH, thus providing an effective and noninvasive tool for the risk stratification of HE.

[Study on regularity of Tibetan medicine in treatment of gZav-Grib disease (apoplexy sequelae) based on HIS clinical medical records].

This research is launched to look for the medication rules and characteristics of Tibetan medicine in the treatment of gZav-Grib( apoplexy sequelae). HIS records of gZav-Grib patients were selected from the Tibetan Hospital of Tibet Autonomous Region and Tibetan Hospital of the city of Naqu. SPSS Modeler,Gephi and other data mining and visualization software were used to study the actual law of drug use in the treatment of gZav-Grib in Tibetan medicine. Finally,479 cases of gZav-Grib patients in Tibetan medicine were included. Their average age is 63 and average hospital stay was 32 days. In total,82 Tibetan medicine prescriptions were used for treating gZav-Grib. The frequency in the front is Twenty-flavor Chenxiang Pills( 338 times),Ruyi Zhenbao Pills( 322 times),and Seventy-flavor Zhenzhu Pills( 315 times). According to the regularity of Tebitan medicine,they were applied in different time periods including the early morning,morning,noon,and evening,for example,in the early morning: Seventy-flavor Zhenzhu Pills,morning: Ruyi Zhenbao Pills,noon: Eighteen-flavor Dujuan Pills,evening: Twenty-flavor Chenxiang Pills. In the clinical joint,18 groups were found in the 10% support and 70% confidence. There are two prescriptions confidence more than 80% which nature focus on Gan,Ruan,Xi,Liang,Dun,Han,Wen. gZav-Grib of Tibetan medicine can be divided into two types: r Lung-Grib type and k Hrag-Grib type,in which the medicine of r Lung-Grib type takes Seventy-flavor Zhenzhu Pills as the core prescription,while the medicine of k Hrag-Grib type takes Ruyi Zhenbao Pills as the core prescription. It is found that the treatment of gZav-Grib by Tibetan medicine is mainly dominated by the treatment idea about " Therapeutic r Lung and blood,Consideration of venous diseases". Treatment functions is promoting the circulation of Qi,clearing blood heat and getting rid of bad blood,achieving the purpose of treating both principal secondary aspect of gZav-Grib. The research methods based on the HIS can't only optimize the Tibetan treating gZav-Grib sequela treatment plan and rule of medication,but also provide the scientific basis for Tibetan medicine treat gZav-Grib.

Metabolic Discrimination of Different Rhodiola Species Using 1H-NMR and GEP Combinational Chemometrics.

Rhodiola is widely consumed in traditional folk medicine and nutraceuticals. To establish a procedure for the hydrogen (1H)-NMR spectroscopic fingerprinting of secondary metabolites from three different Rhodiola species, the variation among three Rhodiola species were studied using 1H-NMR metabolomics combined with multivariate data analysis. Gene expression programming (GEP) was used to generate a formula to distinguish Rhodiola crenulata from two other Rhodiola species. Finally, HPLC was used to demonstrate the results. Same metabolites were compared by quantitative 1H-NMR (qNMR). Three Rhodiola species were clearly discriminated by 1H-NMR fingerprinting involved 22 nuclear magnetic signals of chemical constituents. y = d166 × 2 + C1 + d56 + d236 - d128 × C2 can be used to distinguish R. crenulata from two other Rhodiola species by GEP. The gallic acid concentration in R. crenulata was significantly higher than in the other. Rhodiola species as was the level of salidroside. R. crenulata also exhibited substantially higher levels of α-glucose. The fatty acid level in Rhodiola kirilowii was lower than the other species. These findings demonstrated that 1H-NMR fingerprinting combined with principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), hierarchical cluster analysis (HCA) and GEP can be used to distinguish different Rhodiola species and these methods were applicable and effective approaches for metabolic analysis, species differentiation, and quality assessment. In addition, gallic acid, salidroside, α-D-glucose, glycine, alanine, caffeic acid and tyrosol and are the discriminators.

[Analysis on medication regularity and action mechanism of Tibetan medicine in treatment of spleen and stomach diseases based on data mining and integrated pharmacology].

To explore the medication regularity of Tibetan medicine in the treatment of spleen and stomach diseases, analyze the potential drug targets and interactions of the prescriptions, and reveal the mechanism of Tibetan medicine in the treatment of spleen and stomach diseases. The prescriptions in Tibetan medicine for treatment of spleen and stomach diseases were collected, and Traditional Chinese Medicine Inheritance Support System (TCMISS) was used to analyze the association rules between the herbs and discover the core herbs and new prescriptions. The integrated pharmacology platform V1.0 software was used to construct "herb-compound-target" network and investigate the interactions between various herbs and related pathways of Tibetan medicine Wuwei Shiliu powder in the treatment of spleen and stomach diseases. Among the 216 prescriptions of Tibetan medicine in the treatment of spleen and stomach diseases, pomegranate seed was used at a highest frequency (118 times), followed by white cardamom (107 times) and comatose (107 times). 12 new prescriptions were evolved by using the association rules (support>=34%, confidence>=0.85). 5 242 related drug targets and 20 related pathways were obtained from classic formula Wuwei Shiliu Powder (FDR<0.01). It was proposed that Tibetan medicine treatment for spleen and stomach diseases was mainly based on proliferation of "stomach fire" and the main drugs were for regulating Qi-flowing for strengthening spleen. The mechanism may be associated with regulation of digestive juice secretion, proton pump, mitochondria, regulation of intestinal digestion and immunity, the body's immunity to microorganisms function and other multiple targets and pathways to achieve the joint intervention.