***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background / Aims : Multi-glycoside from Tripterygium wilfordii Hook f. ( GTW ) is used for treatment of progressive glomerulonephritis ( GN ) in China . We have previously reported the beneficial effects of GTW on acute GN induced by an anti-Thy-1.1 monoclonal antibody ( mAb ) . In the present study , the effect and potential mechanisms of GTW on the chronic irreversible model of GN were investigated . Methods : Progressive GN was induced in rats by two intravenous injections of anti-Thy-1.1 mAb 1 - 22 - 3 . Daily oral administration of GTW was started before the second injection of mAb until the day of sacrifice . Ten rats were r and omly divided into a control ( vehicle-treated ) and a GTW-treated group , and sacrificed on day 45 after the first injection of mAb 1 - 22 - 3 . Proteinuria was determined on days 0 , 1 , 3 , 5 , 7 , 10 , 14 , 20 , 25 , 30 , 35 , 40 , and 45 . Blood biochemical parameters , morphological changes of mesangium , glomerular infiltration of macrophage and T lymphocyte , and glomerular mRNA expression of cytokines ( TGF-β , IL-2 , and IFN-γ ) were examined from the sample s taken at terminal sacrifice . Results : GTW treatment significantly ameliorated proteinuria , renal function , prolonged mesangial lesions and inflammatory cell accumulation in glomerulus . In addition , it significantly reduced the glomerular mRNA expression for TGF-β , IL-2 , and IFN-γ . Conclusion : GTW  ameliorates prolonged glomerular lesions presumably through suppression of cytokine production ( TGF-β , IL-2 , and IFN-γ ) . GTW could be an effective therapeutic agent for treatment of chronic renal diseases BACKGROUND In a proportion of adults with steroid-resistant nephrotic syndrome ( SRNS ) , intravenous cyclophosphamide therapy fails . Tacrolimus may be a promising alternative to cyclophosphamide for such patients . STUDY DESIGN Prospect i ve observational study . SETTING & PARTICIPANTS 19 adults with SRNS ( 6 with minimal change nephropathy , 8 with focal segmental glomerulosclerosis [ FSGS ] , and 5 with mesangioproliferative glomerulonephritis ) that did not respond to intravenous cyclophosphamide therapy were studied from January 2003 to September 2006 .  Oral tacrolimus was administered ( target trough levels , 5 to 10 ng/mL ) for 24 weeks , then reduced doses were given ( target trough level , 3 to 6 ng/mL ) for another 24 weeks . FACTORS Histopathologic types : minimal change nephropathy ( n = 6 ) , FSGS ( n = 8) , and mesangioproliferative glomerulonephritis ( n = 5 ) . OUTCOMES MEASUREMENTS outcome variables included complete remission ( decrease in daily proteinuria to protein < or = 0.3 g/d ) , partial remission ( decrease in daily proteinuria to protein < 3.5 g/d but > 0.3 g/d ) , relapse ( increase in daily proteinuria to protein > or = 3.5 g/d in patients who had partial or complete remission ) , change in kidney function , and tacrolimus dosing and serum levels . RESULTS 17 patients completed at least 24 weeks of tacrolimus therapy .  Complete remission was achieved in 11 patients ( 64.7 % ) , and partial remission was achieved in 3 ( 17.6 % ) . Complete or partial remission was achieved in 5 of 5 patients with minimal change nephropathy , 4 of 7 patients with FSGS , and 5 of 5 patients with mesangioproliferative glomerulonephritis . Primary resistance to tacrolimus was seen in 3 patients ( 17.6 % ) , all with FSGS . Mean times to achieve partial and complete remission were 5.6 + /- 1.4 and 8.0 + /- 5.1 weeks , respectively . In patients who achieved complete or partial remission , 35.7 % experienced relapse during follow-up ( mean , 37.6 + /- 13.4 months ) . Two patients had doubling of serum creatinine levels , both with FSGS . LIMITATIONS Observational study . CONCLUSIONS Tacrolimus rapidly and effectively induced remission of SRNS in Chinese adults with disease refractory to treatment with intravenous cyclophosphamide . Treatment may be less effective in patients with FSGS Context In Chinese medicine , extracts of Tripterygium wilfordii Hook F ( TwHF , known as lei gong teng or thunder god vine ) are used to treat autoimmune and inflammatory conditions . Small clinical trials suggest that TwHF may benefit patients with rheumatoid arthritis . Contribution This trial compared TwHF extract with sulfasalazine in 121 patients with active rheumatoid arthritis who could continue oral prednisone and nonsteroidal anti-inflammatory drugs but not disease-modifying antirheumatic drugs .  Among patients who continued treatment for 24 weeks , achievement of 20 % improvement in American College of Rheumatology criteria was greater with TwHF than with sulfasalazine .  Adverse event rates were similar . Caution Only 62 % and 41 % of patients continued TwHF and sulfasalazine treatment , respectively , and provided 24 weeks of data . The Editors Rheumatoid arthritis is characterized by chronic inflammation of the joint lining ( synovial membrane ) ( 1 ) , which causes pain and swelling of diarthrodial joints . Over time , uncontrolled disease results in progressive joint damage , disability , and increased mortality ( 2 ) . The evolving underst and ing of the immune mechanisms that perpetuate the inflammatory response has led to effective targeted therapies , including inhibitors of inflammatory cytokines ( tumor necrosis factor , interleukin-1 , and interleukin-6 ) , modulators of activation of CD4 + T cells and dendritic cells , and agents that deplete B cells ( 3 , 4 ) . Despite the clinical efficacy of these therapies , many patients have no clinical ly meaningful response or discontinue treatment because of adverse events . Furthermore , the limited availability of effective biologics in developing countries , the need for parenteral administration of the biologics , and the relatively high cost all restrict access to these therapies in many patients with rheumatoid arthritis around the world ( 5 ) . In traditional Chinese medicine , extracts of the roots of the medicinal vine Tripterygium wilfordii Hook F ( TwHF ) ( known in China as lei gong teng or thunder god vine ) have shown therapeutic promise in treating autoimmune and inflammatory conditions as well as cancer ( 68 ) . More recently , different extracts of TwHF have been used in Chinese allopathic medicine for the treatment of autoimmune and inflammatory diseases , and small controlled trials reported good responses with TwHF extracts in patients with cadaveric kidney transplants ( 9 , 10 ) and Crohn disease ( 11 ) . Of the approximately 380 metabolites isolated from the plant , 95 % are terpenoids ( 12 , 13 ) . Three diterpenoidstriptolide , tripdiolide , and triptonide (13)are the most abundant and account for the immunosuppressive and anti-inflammatory effects observed with the root extracts in both in vitro and in vivo studies ( 6 ) . In 2 previous single-center trials of patients with rheumatoid arthritis , the extract was st and ardized by the content of triptolide and tripdiolide ( 14 ) . This made it possible to use optimal doses identified in an open-label trial ( 15 ) for the design of a subsequent small placebo-controlled study ( 16 ) . Although the number of patients was small , the apparent clinical impact and experimental results indicating potent inhibition of the expression of proinflammatory genes both in vitro and in vivo in animal models ( 1721 ) provided the rationale for our multicenter , double-blind , active comparator trial of a st and ardized TwHF extract in patients with active rheumatoid arthritis . Methods Design Overview This r and omized , controlled , 24-week study was conducted between March 2004 and October 2005 . All participants provided written informed consent to enter the trial , and the institutional review boards at the participating sites approved the protocol . All investigators and outcome assessors were blinded to group assignment of the patients . Our objective was to determine whether therapy with TwHF extract , 180 mg/d , was statistically significantly better than therapy with sulfasalazine , 2 g/d , over 24 weeks in patients with rheumatoid arthritis by using st and ard outcome measures . Setting and Participants Our study was conducted at 11 U.S. centers : 2 academic centers ( National Institutes of Health , Bethesda , Maryl and , and University of Texas , Dallas , Texas ) and 9 rheumatology subspecialty clinics ( 1 each in Dallas and Austin , Texas ; Tampa and Fort Lauderdale , Florida ; Arlington , Virginia ; Duncanville , Pennsylvania ; Wheaton and Greenbelt , Maryl and ; and Lansing , Michigan ) . Eligible patients had to be at least 18 years of age and have established rheumatoid arthritis , defined by the American College of Rheumatology ( ACR ) classification criteria ( 22 ) as rheumatoid arthritis lasting longer than 6 months . Eligible patients had active disease , defined as 6 or more painful and swollen joints , a visual analogue scale score for pain of at least 3 ( on a scale of 1 to 10 , with 1 being mild ) , and a C-reactive protein ( CRP ) level of 57.14 nmol/L or greater ( 0.6 mg/dL ) or an erythrocyte sedimentation rate ( ESR ) greater than 25 mm/h . Patients who were taking any disease-modifying antirheumatic drug at screening underwent a 28-day washout period . The use of oral prednisone , at stable doses up to 7.5 mg/d , and nonsteroidal anti-inflammatory drugs were allowed as long as the dose was not changed for 28 days before r and omization and the patient agreed to continue to take the medication during the study . Table 1 lists baseline patient characteristics . Table 1 . Patient Characteristics at Baseline R and omization and Interventions We used a computer-generated , pseudo-r and om code ( with r and om , permuted blocks ) to assign patients to treatment groups across all centers . We assigned eligible patients at a 1:1 ratio to receive either TwHF extract , 180 mg/d , or sulfasalazine , 2 g/d . In the event of gastrointestinal intolerance , the protocol allowed for temporary dose reduction of 50 % . As described elsewhere ( 15 , 16 ) , the triptolide and tripdiolide content of the ethanol and ethylacetate extract ( measured by high-performance liquid chromatography [ 22 ] ) was used to st and ardize the drug preparation for this study . On the basis of data on in vitro activity and in vivo toxicity , 30 mg of TwHF extract were formulated per capsule . Our study was conducted under the U.S Food and Drug Administrationapproved Investigational New Drug application 39191 . Outcomes and Measurements Patients were evaluated clinical ly and by laboratory measures at baseline , 2 weeks , and every 4 weeks for a total of 24 weeks . A rheumatologist or trained staff member masked to treatment allocation assessed the patients . Serum or plasma specimens were obtained from the patients at baseline , 4 weeks , and 24 weeks and stored at 80C until analysis . Radiographs of h and s and feet were obtained at baseline and 24 weeks or at study discontinuation . The primary end point was a 20 % improvement at 24 weeks , as defined by ACR criteria ( ACR 20 ) ( 23 ) . To meet criteria , a patient must have 20 % or greater improvement in both tender and swollen joints ( 68 tender and 66 swollen joints were assessed ) and 20 % or greater improvement in 3 or more of the following : the physician 's or patient 's assessment of global health status , the patient 's assessment of pain on a visual analogue scale , the patient 's assessment of function ( using a modified version of the Health Assessment Question naire [ HAQ ] ) , and the serum CRP level . Secondary end points included the efficacy of TwHF in achieving ACR 50 and ACR 70 responses at 24 weeks , the improvement in the European League Against Rheumatism Disease Activity Score 28 ( DAS 28 ) measure , and a change in the Sharpvan der Heijde score of the h and and foot radiographs ( 24 ) . Radiographs were obtained at baseline and at the end of the study and were scored by 2 independent readers who were blinded to the r and omization schedule and the radiograph sequence . Drug adherence was assessed by using a daily diary and by pill counts . Body weight , blood pressure , and serum glucose level were measured at each visit . Laboratory assessment s included ESR ( Westergren method ) ; high-sensitivity CRP with normal levels up to 38.1 nmol/L ( 0.4 mg/dL ) , which was analyzed in a central laboratory ; and interleukin-6 levels , which were 
    Output:
    
TwHF may have an add-on effect on remission in patients with primary NS .
There was insufficient evidence to assess if TwHF was as effective as prednisone or CPA .