New Research Offers Potential To Protect Patients From Liver Injury After Abdomen Surgery

Many patients worldwide are going to receive major abdomen surgery or intestine transplantation every year and expect to be afflicted with liver injury afterwards. The finding of a research group headed by Professor Han Jing-Yan in China and reported in January 7, 2008 of the World Journal of Gastroenterology (volume 14, issue 1) may prove good news for them.



The study by Han Jing-Yan et al discovered Ginsenosaide Rb1 (R1) is able to prevent hepatic microcirculatory disturbance and subsequent liver injury in mice induced by intestine ischemia and reperfusion (I/R). R1 is one of the major effective ingredients of Panax notoginseng (PN), a traditional Chinese herb medicine frequently included in various compound Chinese medicines for treatment of liver injury and numerous other diseases in China and other Asian countries.



In 2005, Dr. Han was working on the effect and underlying mechanism of cardiotonic pills (CP) in cooperation with Prof. Toshifumi Hibi and Dr Yoshinori Horie in the Department of Internal Medicine, School of Medicine, Keio University, Japan. They revealed the beneficial effect of CP for improving gut I/R induced liver injury (Horie Y, Han JY, Mori S, Konishi M, Kajihara M, Kaneko T, Yamagishi Y, Kato S, Ishii H, Toshifumi Hibi. Herbal cardiotonic pills prevent gut ischemia/reperfusion-induced hepatic microvascular dysfunction in rats fed ethanol chronically. World J Gastroenterol 2005; 11(4): 511-515). However, CP is a compound Chinese medicine preparation that contains PN, and salvia miltiorrhiza and Borneol additionally. It was not clear at that time which one among the three ingredients is actually responsible for this action. The present report of Dr. Han's group shows R1, one of the major compounds of PN, protects against the gut I/R induced liver injury impressively.



In this study, the animal model is established by ligation of the superior mesenteric artery (SMA) in C57/BL mice for 15 min followed by 30 min reperfusion. The researchers apply several techniques to address the issue concerned. First, they take advantage of an inverted intravital microscope assisted by a 3CCD color camera and high speed video camera and laser confocal microscope. This enables a dynamic examination of the hepatic microcirculatory parameters under investigation in mouse subjected to gut I/R and observes the gut I/R imposed impairment in vascular diameter, red blood cell velocity, sinusoid perfusion and leukocyte rolling and adhesion is obviously alleviated or completely abolished by pretreatment with R1.



Secondly, immunofluorescent staining is used to examine the endothelial adhesion molecules E-selectin and ICAM-1. Finally, blood is collected for detecting the expression of adhesion molecules in leukocyte and the activity of hepatic enzymes, including LDH, ALT, and AST, and the concentration of pro-inflammatory mediators such as TNF-?│??, IL-6 and monocyte chemotactic protein-1 (MCP-1). After careful evaluation, the researchers concluded R1 prevents I/R-induced hepatic microcirculation disturbance and hepatocyte injury by inhibition of leukocyte rolling and adhesion, through depressing the expression of E-selectin in endothelium and CD18 in neutrophils. This result is of significance not only for better understanding the mechanism of the effect of PN and PN containing preparations, but also for R1 to be used to prevent liver injury originated from gut I/R.

Media Opportunity: Herbal Medicine Awareness Week 23-30 May 2008, UK

Herbal Medicine Awareness Week is being held 23rd to 30th May 2008. The National Institute of Medical Herbalists is arranging for journalists to attend free consultations at their local qualified medical herbalist.


The consultation will look at the journalist's health from a holistic perspective as well as advising on any specific issues.


Photo opportunites will be available in most cases.


More about herbal medicine can be found on the NIMH site: nimh.uk


A Mintel report in August 2007 on Complementary medicine found that 32% of the population had tried herbal medicine. There is tremendous public interest in the subject and I am sure it would be of value to your readers.


National Institute of Medical Herbalists

In Treatment Of Hot Flushes Acupuncture Not Found To Be Effective

Acupuncture cannot be shown to have any positive effect on hot flushes during the menopause. This is the conclusion of a systematic review of literature by three groups in Daejon, Busan (South Korea) and Exeter (UK), published in the current edition of the peer-reviewed journal Climacteric.



Many women are concerned by the unfavourable publicity given to HRT use, but still have to deal with the symptoms which can occur during and after the menopause. A significant minority of women look for alternatives to HRT to deal with these symptoms. Often these alternatives are untested, and it can be impossible to balance the risks and benefits of these treatments against the risks and benefits of conventional treatments or the discomfort of untreated menopause.



The researchers reviewed studies on the use of acupuncture for the relief of hot flushes during the menopause. They identified 106 studies in total, which they eventually narrowed down to the six most relevant to the study. These six studies were randomised controlled trials (RCTs), which included testing the effects of real acupuncture against the effect of sham acupuncture. Only one RCT reported favorable effect of acupuncture on the frequency and severity of hot flush after 4 weeks follow-up, while the other five RCTs demonstrated no such effects.



Researchers caution that the quality of good studies is not great, and that because of this the use of acupuncture cannot be completely ruled out. However, the available literature indicates that acupuncture does not seem to be effective in the treatment of menopausal hot flushes.



Lead researcher, Dr Myeong Soo Lee (Korea Institute of Oriental Medicine, South Korea) said



Although the availability of good Randomised Controlled Trials is too small to draw any firm conclusion, in general the evidence from sham-controlled RCTs for the effects of acupuncture for treating menopausal hot flush is not convincing. We would always recommend that women wanting relief from menopausal symptoms consult their clinician before undertaking any course of treatment.



Commenting, Dr David Sturdee (President of the International Menopause Society) said: There's no doubt that many women need relief from the symptoms associated with the menopause. They need to make sure that the treatment they choose works, and is right for them. I would always recommend that a woman consult her clinician before starting any treatment.


Notes:


This press release is based on the following paper: Acupuncture for treating menopausal hot flushes: a systematic review. It is published in the journal Climacteric (Lee MS, Shin B-C, Ernst E., Climacteric 2009;12:1625-25, February 2009). Climacteric is the journal of the International Menopause Society.



Conflict of Interest: none reported



Source of funding: M. S. Lee was supported by the Acupuncture, Moxibustion and Meridian Research Project of Korea Institute of Oriental Medicine.



ABSTRACT



Acupuncture for treating menopausal hot flushes: a systematic review



M S. Lee, B.-C. Shin* and E. Ernst?? 



Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; *Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, Pusan National University, Pusan, South Korea; ?? Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK



Objective: To assess the effectiveness of acupuncture as a treatment option for menopausal hot flushes.



Design: We have searched the literature using 17 databases from inception to May 2008, without language restrictions. We included randomized, clinical trials (RCTs) of acupuncture versus sham acupuncture. Their methodological quality was assessed using the modified Jadad score.



Results: In total, six RCTs could be included. Four RCTs compared the effects of acupuncture with needle acupuncture on non-acupuncture points. All of these trials failed to show specific effects on menopausal hot flush frequency, severity or index. One RCT found no effects of acupuncture on hot flush frequency and severity compared with penetrating sham acupuncture on acupuncture points that are not relevant for the treatment of hot flushes. The remaining RCT tested acupuncture against nonpenetrating acupuncture on non-acupuncture points. Its results suggested favorable effects of acupuncture on menopausal hot flush severity. However, this study was too small to generate reliable findings.



Conclusion: Sham-controlled RCTs fail to show specific effects of acupuncture for control of menopausal hot flushes. More rigorous research seems warranted.

Linking Breast Cancer Patients With Alternative Therapies

Biological-based therapies such as diet supplements and vitamins are the most popular complementary and alternative medicines for women recovering from breast cancer, according to a Michigan State University researcher working to create a support intervention for women in treatment for the disease.



Gwen Wyatt of MSU's College of Nursing, in research published in the current edition of Nursing Research, analyzed which CAM therapies - such as massage, supplements and reflexology - are used the most and why. She looked at the five major categories of therapies: biological, mind-body, manipulative and body, energy and alternative medical systems.



"Quality of life is a research priority for the National Institutes of Health as it pertains to breast cancer," Wyatt said. "Patients link symptoms to quality of life; if you have to live with breast cancer, then let's have the highest quality of life we can during the process and make it as humane as possible."



She found that 57 percent of women are using CAM therapies, and the sicker a woman is the more likely she is to use multiple therapies. Besides biological-based therapies, the next most popular were mind-body therapies using audiotapes, video and music therapy. More than 200 women were part of the study.



"The more popular therapies selected might be rationalized by women viewing these categories as more closely aligned with their health care provider's recommendations," Wyatt said.



She is using the results of the study, which was funded by the U.S. Department of Defense, to help women identify which therapies will be most effective for them. CAM therapies have gained widespread use in the past decade; Wyatt is currently funded by the NIH with a $3.1 million grant to study the effects of reflexology - a specialized foot therapy that applies firm pressure to certain parts of the sole of the foot - on symptom management and quality of life for women with breast cancer.



Among her other findings:
The therapies with the highest mean spending (acupuncture and therapeutic touch at $45) were used by very few women, while vitamins, massage and homeopathy had an average total spending of $19.78 to $38.54 and were frequently used.


Women without at least some college education were less likely to use CAM therapies.


Employed women were more likely to use different types of therapies.


Women reported greater use of therapies that required fewer sessions.

With research findings in hand, Wyatt is working with Darcy Greene from the College of Communications Arts and Sciences and Alla Sikorskii from the Department of Statistics and Probability to create a decision support intervention for women newly diagnosed with breast cancer and those recovering from surgery. It will include a DVD and booklet, outlining therapies and their safety and effectiveness.



"Women are using these therapies, but they have little education about safety and efficacy," Wyatt said. "One report indicates up to 80 percent of women diagnosed with breast cancer are using CAM therapies."



"They could really benefit from information on how to make a wise decision and choose the best therapies."



That project is funded by two grants, one through the MSU College of Nursing Research Center and another via the Ohio State University Nursing Research Center.

FDA Warns Consumers To Stop Using Soladek Vitamin Solution

The U.S. Food and Drug Administration is warning consumers to stop using Soladek, a vitamin-solution product marketed by Indo Pharma, S.A., of the Dominican Republic, because the product may contain dangerously high levels of vitamins A and D.


Soladek is marketed with claims that the product treats "hypo and avitaminosis, rickets, growth, dentition, lactation, fractures, infection, convalescence, protection and regeneration of certain epithelium (bronchial, glandular, ocular, cutaneous), corticotherapy, aging and pregnancy." The product is sold in a box labeled in Spanish and containing a vial of the solution.


FDA recently received information that tested samples of Soladek contained levels of vitamin A and vitamin D that were many times the recommended daily allowances for these vitamins. Intake of excessively high levels of these vitamins poses a risk to human health.


The FDA also received seven reports of serious health problems occurring in consumers using the product. The problems include decreased renal function, elevated levels of calcium in the blood, fatigue, heart arrhythmia, vomiting, and diarrhea. Symptoms of vitamin D toxicity include weakness, fatigue, headache, nausea, vomiting, diarrhea, changes in mental status, increased blood pressure, abnormal heart rate or rhythm, kidney damage, and coma.


Symptoms of vitamin A toxicity include anemia, anorexia, alopecia, joint pain, bone weakness, bulging eyes, liver abnormalities, and birth defects.


Consumers who are in possession of Soladek should stop using the product immediately. Any consumers who have been using Soladek and are experiencing any of the above symptoms should see a doctor immediately.


Soladek cannot currently be marketed legally in the United States because U.S. law prohibits the sale of products claiming to treat disease conditions without review and approval by the FDA. However, the reports of adverse events and other information leads the FDA to conclude that Soladek may be available illegally in the country; therefore, the agency is issuing this warning.


Health care professionals and consumers should report adverse events or other problems with regulated products to the FDA's MedWatch Adverse Event Reporting program online, by regular mail, or fax.


- Online here.1

- Regular Mail: Use FDA postage paid form 3500 and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787

- Fax: 800-FDA-0178

GOsC Responds To Positive Audit Of Complaints Handling, UK

The General Osteopathic Council (GOsC) welcomes the positive results of an audit of its complaints handling process by the independent statutory body overseeing the work of all healthcare regulators - the Council for Healthcare Regulatory Excellence (CHRE).


In September 2010 the CHRE conducted an audit of the way the GOsC handled complaints against osteopaths which had been formally closed, and not referred to a full hearing from March - August 2010.


The overall aim of the CHRE's audit, conducted across all UK healthcare regulators, is to seek assurance that the regulators' decisions protect patients and the public, maintaining confidence in the reputation of the professions and the system of regulation.


Along with examples of strengths in case handling by the GOsC, the CHRE's audit found that:


- cases reviewed and closed by the GOsC were reasonable and the reasons given were clear and comprehensive,


- the GOsC's complaints handling systems helped to deliver high-quality decisions communicated to parties in a professional way, and


- the GOsC has a well managed system of casework with no evidence of significant risks to patients or to the maintenance of public confidence.


GOsC Head of Regulation, Velia Soames, said: "We welcome the findings of the CHRE's audit that our systems and processes for dealing with the initial stages of a complaint are robust."

Balance, Not Bias Provided By Complementary Medicines Training

Complementary and alternative medicines (CAM) training for students in the health professions improves their ability to provide balanced, evidence-based advice to patients.



Dr Evelin Tiralongo, a lecturer in Griffith University's School of Pharmacy, has found CAM education integrated into the pharmacy curriculum rationalised rather than marginalised students' attitudes.



"A survey and interviews of more than 100 pharmacy students in second, third and fourth years at Griffith found that students with a more positive attitude to CAM at the start of their degree changed to a more careful assessment of CAM therapy, whereas students with a more negative attitude at first, realised that some CAM therapies are based on significant evidence," she said.



"We found that CAM education encouraged students to look for evidence of effectiveness, evaluate that evidence, and then make informed decisions in the best interests of their patients," she said.



Overall 96 per cent of pharmacy students believed they need to be equipped to advise patients about CAM and 90 percent said it should therefore be a core part of their education.



Dr Tiralongo said CAM education should be integrated into the core teaching curricula for pharmacy, nursing and medical students around the country.



"Health professionals have a responsibility to understand CAM, given that more than half of the population already use herbal medicines, vitamins and minerals, and therapies such as acupuncture."



"Our National Medicines Policy for example covers prescription and non-prescription medicines as well as complementary medicines."



"Given pharmacists' ethical and legal responsibility to counsel patients on medicines they supply, we need to ensure graduates have a reasonable knowledge of CAM and the ability to finding the best options for patient care."



Dr Tiralongo's research interests include the clinical efficacy of CAM and the pharmacological potential of medicinal plants and macrofungi.