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Aim: Receiving a diagnosis of brain stem death poses significant challenges for families. While much research focuses on organ donation in the context of brain stem death, there is a notable dearth of studies examining the experiences of families themselves. The aim of this review is to explore the experiences of families facing brain stem death. Design: Systematic review. Method: A narrative synthesis was conducted, drawing on 11 studies that employed both qualitative and quantitative methodologies. The search encompassed four electronic databases: AHMED (Allied and Complementary Medicine), Emcare (1995-present), MEDLINE (Ovid), and APA PsycInfo (Ovid). Due to the limited research on this topic, no restrictions were placed on the publication dates. Results: The synthesis revealed five main themes: The Unexpected Prognosis, Coming to Terms with Brain Stem Death—Grieving Process, Observing Brain Stem Death Testing, The Impact of Staff on Families' Experience, and The Lasting Impact. Conclusion: The review underscores the pervasive lack of understanding among families regarding the diagnosis and process of brain stem death, as well as the short- and long-term distress it can engender. There is a clear imperative to establish national or international protocols for brain stem death, ensuring more effective and consistent support for affected families. [ABSTRACT FROM AUTHOR]

Objectives: This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. Evidence acquisition: Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1–18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. Results: 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. Conclusion: The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. [ABSTRACT FROM AUTHOR]

This paper reviews the medical (salutogenic) effect of interventions that aim to improve quality of life. Review of studies where the global quality of life in chronically ill patients was improved independently of subjective and objective factors (like physical and mental health, yearly income, education, social network, self-esteem, sexual ability and problems or work). The methods used were subtypes of integrative medicine (non-drug CAM) like mind body medicine, body psychotherapy, clinical holistic medicine, consciousness-based medicine and sexology. In about 20 papers on QOL as medicine, in cancer, coronary heart disease, chronic pain, mental illness, sexual dysfunction, low self-esteem, low working ability and poor QOL, the most successful intervention strategy seems to be to create a maternal, infantile bonding induced by a combination of conversation therapy and bodywork. The papers examined the treatments of over 2,000 chronically ill or dysfunctional patients and more than 20 different types of health problems . Global QOL measured by SEQOL, QOL5, QOL1, self-rated physical health, self-rated mental health, self-rated sexual functioning, anorgasmia, genital pain, self-rated working ability, self-rated relation to self, well-being, life-satisfaction, happiness, fulfillment of needs, experience of temporal and spatial domains, expression of life's potentials, and objective functioning. We found 'QOL as medicine' able in the treatment of physical disorders and illnesses including chronic pain (Number Needed to Treat (NNT) = 1-3, Number Needed to Harm (NNH) > 500), in mental illness (NNT = 1-3, NNH > 500), in sexual dysfunctions (NNT = 1-2, NNH > 1,000), self-rated low working ability (NNT = 2, NNH > 500), and self-rated low QOL (NNT = 2, NNH > 2,000). We found that QOL improving interventions helped or cured 30-90% of the patients, typically within one year, independent of the type of health problem. 'QOL as medicine' seems to be able in improving chronic mental, somatic and sexual health issues without side effects. [ABSTRACT FROM AUTHOR]

Background: Despite the recognised high prevalence of migraines among bank employees, yet their healthcare utilisation patterns and the economic burden of migraines remain underexplored. Aim: To examine migraine-related healthcare utilisation among bank employees in China, and to estimate the economic burden of migraines. Methods: A cross-sectional survey was conducted in Guizhou province, China between May and October 2022. The HARDSHIP questionnaire was used to identify migraine-positive individuals and enquire about their healthcare utilisation and productivity losses. A probabilistic decision-analytic model with a micro-costing approach was used to estimate the economic burden from the perspectives of the healthcare system, employers, and society. All costs were expressed in 2022 United States dollars. One-way and probabilistic sensitivity analyses were performed. Results: Nearly half of individuals with migraines reported not seeking medical care. Only 21.8% reported seeking outpatient consultations, 52.5% reported taking medicines, and 27.1% reported using complementary therapies. Chronic migraine patients had significantly higher healthcare utilisation than episodic migraine patients. Among individuals with a monthly migraine frequency of 15 days or more, 63.6% took inappropriate treatments by excessively using acute medications. Migraines in the banking sector in Guizhou cost the healthcare system a median of $7,578.0 thousand (25th to 75th percentile $4,509.2–$16,434.9 thousand) per year, employers $89,750.3 thousand (25th to 75th percentile $53,211.6–$151,162.2 thousand), and society $108,850.3 thousand (25th to 75th percentile $67,370.1–$181,048.6 thousand). The median societal cost per patient-year is $3,078.1. Migraine prevalence and productivity losses were identified as key cost drivers. Conclusions: The study points to the need to raise awareness of migraines across all stakeholders and to improve the organisation of the migraine care system. A substantial economic burden of migraines on the healthcare system, employers, and society at large was highlighted. These cost estimates offer evidence-based benchmarks for assessing economic savings from improved migraine management, and can also draw the attention of Chinese policymakers to prioritise migraine policies within the banking and other office-based occupations. [ABSTRACT FROM AUTHOR]

Background: Chronic migraine is a disabling condition that impacts multiple aspects of migraineurs' lives. Although pharmacological treatments can help to treat the pain associated with migraine headache, chronic migraineurs often experience side-effects of pharmacological treatments. Those experiences may contribute to the observed growth in complementary and alternative medicine (CAM) use among migraineurs. Relatively little is known about the patterns of CAM treatment and the characteristics of chronic migraineurs. Therefore, the purpose of the present study is to investigate the characteristics of chronic migraineurs who use CAM treatment and the relationship among satisfaction with current CAM use, negative life impact, migraine outcomes, and psychiatric comorbidities among chronic migraineurs. Methods: 2907 participants were recruited from a well-known online migraine headache resource. All participants were US adults aged 18 years or older. Migraineurs are referred to this website through various routes (e.g., referral from healthcare providers, internet search, obtaining information from research papers, personal invitation from other users, and information shared on social media etc.). Participants completed a 30-min self-report-survey in the spring of 2014. Results: Almost half of the participants reported that they are currently using more than three different CAM treatments even though the majority of the participants reported neutral or dissatisfied with their current CAM treatment. Chronic migraineurs who use CAM treatments were more likely to experience prolonged or frequent migraine headaches (p = .018, η = .0021), and experience greater negative life impact from their headaches (p = .000, η = .0172) compared to non-CAM users. CAM treatment satisfaction was inversely related to the number of psychiatric comorbidities, frequency of migraines, and number of migraine symptoms (p's < .05). However, CAM treatment satisfaction was more strongly correlated with migraine outcomes than psychiatric comorbidities. Conclusions: Chronic migraineurs often pursue multiple CAM treatments in spite of low levels of satisfaction with those treatments. Patients who experience relief from traditional treatments are less likely to seek the out additional CAM treatments. Thus it is often the sicker migraine patients who use CAM. More attention is needed to consider migraine treatment resistance, and psychological factors in planning the treatment of chronic migraineurs as those factors may play an important role in treatment choices by patients. [ABSTRACT FROM AUTHOR]

Background: Physiotherapy education and practice have country-specific peculiarities which may limit globalization in health care. This study aimed to characterize physiotherapy practice and treatment preferences, educational qualifications, and research in Nigeria, with a view of providing vital information for transnational integration and collaboration. Methods: A cross-sectional survey of 104 Nigerian physiotherapists was conducted. The Physical Therapy Practice Questionnaire and a self-developed proforma were used as survey tools. Results: The mean age of respondents was 33.5 ± 9.4 years. About two-fifth of all respondents (39.4%) had an MSc and mostly practice as clinicians (51.0%) in teaching hospitals (34.6%). The respondents were mostly involved in general practice (50.0%), with a caseload of 1–10 patients per day (67.3%). Soft tissue mobilization (83%), proprioceptive neuromuscular facilitation (76%), breathing exercises (77%), and transcutaneous electrical neuromuscular stimulation (83%) were commonly used. Respondents were familiar databases and evidence-based resources (81.2%) and mostly utilize PubMed (73.3%). Regular case conferences with professional colleagues (47.6%) and treatment planning of between 11 and 30 min (40.6%) were common. Educators spend 1–3 h planning educational work (91.8%). Clinical decision-making is mostly based on professional experience, while journals are the primary resource for educational information. Conclusion: Physiotherapy practice in Nigeria is degree based and requires registration board's licensure. Practitioners deal with a high caseload and utilize a wide range of techniques and modalities and have tendencies to utilize personal experience and research in making clinical decisions. The parity in education and practice with advanced climes inadvertently gives physiotherapy practice in Nigeria a global purview. [ABSTRACT FROM AUTHOR]

The authors discuss the multiple testing, selection issues, and the analysis of mortality rates in their article. They say that their results do not show that patients registered to general practitioner-complementary and alternative medicine (GP-CAM) have higher mortality rates. They add that the text and the title of their paper show that they do not claim to have found a formal evidence of cost-effectiveness.

The article discusses studies on chronic pain selected by the members of the Society of General Internal Medicine. It says that the papers were chosen for their potential to change generalist care of patients with chronic pain. The articles include one on the assessment of pain intensity and interference, a randomized trial on optimized antidepressant therapy and pain self-management to improve pain and depression outcomes, and one on the trends in opioid use in patients with non-cancer pain.

Objective: Traditional Chinese Medicine (TCM) provides an alternative method for achieving and maintaining good health. Due to the increasing prevalence of TCM and the large volume of TCM data accumulated though thousands of years, there is an urgent need to efficiently and effectively explore this information and its hidden rules with knowledge discovery in database (KDD) techniques. This paper describes the design and development of a knowledge discovery system for TCM as well as the newly proposed KDD techniques integrated in this system. Methods: A novel Knowledge dIscovery System for TCM (KISTCM) is developed by incorporating several data mining techniques, primarily including a medicine dependency relationship discovery algorithm, an efficacy dimension reduction algorithm based on neural networks, a method for exploring the relationships between formulae and syndromes using gene expression programming (GEP), and an approach for discovering the properties in terms of nature, taste and meridian based on the herbal dosage by employing the effect degree function to calculate the effect of each property. Results: Representative experimental cases are used to evaluate the system performance. Encouraging results are obtained, including rules previously unknown to algorithm designers and experiment runners. Experiments demonstrate that KISTCM has powerful knowledge discovery and data analysis capabilities, and is a useful tool for discovering the underlying rules in formulae. Our proposed techniques successfully discover hidden knowledge from TCM data, which is a new direction in knowledge discovery. From TCM experts’ perspective, the accuracy of data analysis for KISTCM is an improvement, and these results compare favorably to other existing TCM data mining techniques. The system could be expected to be useful in the practice of TCM, e.g., assisting TCM physicians in prescribing formulae or automatically distinguishing between minister and assistant herbs in a formula. [ABSTRACT FROM AUTHOR]

Phosphodiesterase type-5 (PDE-5) inhibitors are well tolerated and efficacious treatments for male erectile dysfunction that currently rank among the best-selling drugs worldwide. Since their introduction 10 years ago, there have been a number of reports of patients developing, within hours of PDE-5 inhibitor use, permanent visual loss due to nonarteritic anterior ischemic optic neuropathy (NAION), a common optic neuropathy that results from ischemia of the optic nerve head. In some of the cases, visual loss recurred upon rechallenge with the drug. However, as the bulk of the evidence suggesting a relationship between PDE-5 inhibitor use and NAION comes from case reports and small series, it is difficult to ascertain if a cause–effect relationship truly exists. In this paper, following a review of the transient visual side effects of PDE-5 inhibitors and NAION, we discuss the evidence for and against NAION occurring as a complication of PDE-5 inhibitor use.International Journal of Impotence Research (2008) 20, 537–543; doi:10.1038/ijir.2008.25; published online 5 June 2008 [ABSTRACT FROM AUTHOR]

Although mainstream allopatic medicine is the dominant model in Iran, many other kinds of healing are currently also being used. This paper aims to describe some aspects of prayer healing in Iran. This study has been carried out using participatory observation and in-depth interviews with fourteen healers who worked in Tehran. Also one hundred and seventy patients who referred to healing centers were interviewed through random sampling. The findings are summarized in terms of a description of some personal characteristic of healers, the methods of healing, healer–patient communication patterns and, finally, some consequences of visiting a prayer healer. The findings indicate that, despite the increasing growth in scientific medicine, traditional healing is still alive. It is a cultural way of coping with health problems. This essay also makes several suggestion for future research. [ABSTRACT FROM AUTHOR]

The article offers information on the article by P. Kooreman and E. W. Baars which explores the cost-effectiveness of complementary and alternative medicine (CAM) in comparison with conventional medicine. It mentions that the authors asserts that the patients registered to CAM-general practitioner (GP) have lower mortality rates and health-care costs. It notes that Kooreman and Baars failed to communicate their research without misinterpretation.

Introduction: Left atrial appendage (LAA) closure has become of major interest for patients with atrial fibrillation intolerant to oral anticoagulation therapy (OAC). Patients with a contraindication to both OAC and antiplatelet therapy are not eligible for percutaneous LAA closure. We aimed to find an alternative treatment for these specific patients. Methods: From March 2014 until December 2015 five patients were referred for percutaneous LAA closure. Alternative treatment was necessary due to an absolute contraindication to OAC and antiplatelet therapy ( n = 4) or after previous failed percutaneous device implantation ( n = 1). A stand-alone full thoracoscopic closure of the LAA using the Atriclip PRO device (AtriCure Inc., Dayton, OH, USA) was performed under guidance of transoesophageal echocardiography (TEE). After three months all patients underwent a computed tomography scan. Mean follow-up was 7.2 months [range 4.5-9.8 months]. Results: All procedures were achieved without the occurrence of complications. Complete LAA closure was obtained in all patients without any residual flow confirmed by TEE. Postoperative computed tomography confirmed persisting adequate clip positioning with complete LAA closure and absence of intracardial thrombi. During follow-up no thromboembolic events occurred. Conclusion: For atrial fibrillation patients with an absolute contraindication to OAC and antiplatelet therapy a stand-alone, minimally invasive thoracoscopic closure of the LAA is a safe and feasible alternative treatment. This might be a solution to avoid serious bleeding complications while eliminating the thromboembolic risk originating from the LAA in patients who are not eligible for percutaneous LAA closure. [ABSTRACT FROM AUTHOR]

Background: Atherosclerosis is arteries' thickening and stiffening condition manifested due to plaque formation by oxidized-LDL of abundant and deranged lipid metabolism. Traditionally, Melastoma malabathricum Linn (MM) leaves are used for anti-diabetics, abdominal problems, and high blood pressure. The current experiment unveils the potency of ethanol, acetone, and water MM extracts as antibacterial agents and alternative medicine during hyperlipidemic conditions. Methods: A high cholesterol diet (HCD-2500 mg/kg) was provided with regular feeds for 3 weeks to induce hyperlipidemic mice. Afterward, comparing weight with Group-A (normal control), the hyperlipidemic mice were classified into five groups: Group-B (hyperlipidemic control), Group-C (MFA-500 mg/kg), Group-D (MSE-250 mg/kg), Group-E (MSE-500 mg/kg), and Group-F (ATOVAT-20 mg/kg). And the dosages were given orally for 28 days according to their body weight. Fasting blood was collected at the end of treatment, and serum was taken to test lipid profiling and liver enzymes. Results: The body mass had waxed significantly (P < 0.001) in all the groups compared with Group-A. Subsequently, orally administered different doses where group-D and group-E demonstrated magnificent anti-hyperlipidemic potency (P < 0.001) compared with group-B. During treatment, rapid upward body mass was tardy in group-E (P < 0.001). However, the liver enzyme expression such as AST, ALT, and ALP was elevated (P < 0.001) in Group-F, they were significantly lessened (P < 0.001, P < 0.01) in Groups-C, D, and E, which indicates these extracts have significant anti-liver damaging potency. Alongside the antibacterial activity of MSE-1500 μg/disc, it exhibited the greatest (16.50 mm) zone of inhibition against Shigella dysenteriae. Conclusion: However, in our current experiment, depending on the derived data, we can elicit that the Melastoma malabathricum shoot ethanolic (MSE) extract is a potential resource for developing alternative medicine to manage the hyperlipidemic condition. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is frequently associated with microvascular complications such as retinopathy, nephropathy, and peripheral neuropathy. Neurotrophic keratopathy occurs in response to a neuropathy of the ophthalmic division of the trigeminal nerve. Rarely has diabetic neurotrophic keratopathy been described. This paper discusses the ophthalmic histories of three patients who presented with diabetic neurotrophic keratopathy. In one patient the corneal ulceration was the sole presenting feature of his diabetes. We discuss the need for increased vigilance in the ophthalmic community for suspecting diabetes in patients with unexplained corneal epithelial disease.Eye (2006) 20, 837–839. doi:10.1038/sj.eye.6702053; published online 7 October 2005 [ABSTRACT FROM AUTHOR]

Background: Acupuncture has become a more popular complementary and alternative medicine worldwide. As pneumothorax is a rare acupuncture-related adverse event (AE), it is thought to be under-recognized by acupuncturists and emergency physicians, and the public is often not aware of this potential AE resulting in delayed hospital presentation. Methods: This is a case series of acupuncture-related pneumothoraces diagnosed in an emergency department (ED) in Singapore. Data was collected retrospectively from patients' notes and prospectively from the patients over the phone. Case presentations: Between 2017 and 2021, 4 out of 474 (0.84%) pneumothoraces were acupuncture related. Three of these patients consented to participate in this study. One patient developed bilateral pneumothoraces. All 3 patients claimed that they were not informed by the acupuncturists of potential serious AEs prior to acupuncture treatments and that they were not aware that such AE could occur. All 3 patients had reported their symptoms of chest pain and/or breathlessness to their acupuncturists post-treatment, but they were not advised to seek urgent medical attention. When the 3 patients had informed their acupuncturists about their diagnosis of pneumothorax, 2 of the acupuncturists did not seem to be aware of this acupuncture-related AE. Discussion: When pneumothorax manifests, there is a potential need for an invasive procedure and continuous monitoring as it may devolve into a life-threatening condition with cardiovascular compromise. Early medical recognition and attention are needed to ensure optimal patient outcomes. In the appropriate population cohort, a history of prior acupuncture treatments should be included as part of history-taking assessment in patients presenting with chest pain and/or breathlessness. Conclusion: Emergency physicians should be vigilant of this potentially serious and life-threatening complication for anyone presenting with chest discomfort and/or breathlessness after recently undergoing acupuncture to ensure earlier diagnosis, management, and better patient outcome. [ABSTRACT FROM AUTHOR]

Men with prostate cancer are reported as commonly using complementary and alternative medicine (CAM) but surveys have not recently been subjected to a rigorous systematic review incorporating quality assessment. Six electronic databases were searched using pre-defined terms. Detailed information was extracted systematically from each relevant article. Study reporting quality was assessed using a quality assessment tool, which demonstrated acceptable inter-rater reliability and produces a percentage score. In all, 42 studies are reviewed. All were published in English between 1999 and 2009; 60% were conducted in the United States. The reporting quality was mixed (median score=66%, range 23-94%). Significant heterogeneity precluded formal meta-analysis. In all, 39 studies covering 11 736 men reported overall prevalence of CAM use; this ranged from 8 to 90% (median=30%). In all, 10 studies reported prevalence of CAM use specifically for cancer care; this ranged from 8 to 50% (median=30%). Some evidence suggested CAM use is more common in men with higher education/incomes and more severe disease. The prevalence of CAM use among men with prostate cancer varies greatly across studies. Future studies should use standardised and validated data collection techniques to reduce bias and enhance comparability. [ABSTRACT FROM AUTHOR]

Background: Theobroma cacao Linn. husks are considered agricultural wastes, but studies show that they exhibit natural compounds that may be used in alternative medicine. Hence, this study was conducted to determine the antidiabetic, anti-inflammatory, and cytotoxic potential of T. cacao husk aqueous extracts (TCE). Results: A significantly higher glucose dialysis retardation index (GDRI) was shown by 10% TCE than the rest of the concentrations (1%, 3%, 5%, 7%) (P<0.05), and its activity is comparable with 5% Metformin (positive control) after 30 min, 60 min, 120 min and 180 min of incubation. The 7% TCE also showed significantly higher GDRI than the 5%, 3%, and 1% concentrations (P<0.05), and its activity is comparable with 5% Metformin after 60 min and 180 min of incubation. Moreover, 10% TCE exhibited a significantly higher glucose uptake percentage than the rest of the samples (P<0.05) and has activity comparable with 5% Metformin. The anti-inflammatory assay showed a significantly higher inhibition rate of 10% TCE than the rest of the concentrations (P<0.05), and its activity is comparable with 5% Diclofenac (positive control). The cytotoxicity assay showed that the percentage mortality of brine shrimps after 24 h of exposure to the different TCE samples is less than 50%. Conclusion: This study concludes that T. cacao husk aqueous extract has potential antidiabetic and anti-inflammatory properties without being toxic to cells. [ABSTRACT FROM AUTHOR]

Background: Blood cleansing, purification, detoxification or strengthening is an ancient folkloric East African practice without any validated scientific underpinnings. This study was undertaken to retrieve ethnobotanical information and reported bioactivities of plants claimed to be blood purifiers, cleansers, detoxifiers and tonics in Eastern Africa and correlate their claimed use with scientific studies to find out whether there is any justification for their use in this ancient practice. Method: An elaborate review was performed in electronic databases (PubMed, Science Direct, Scopus, Springer Link, Wiley Online Library, Taylor & Francis Online, SciFinder, Google Scholar, Web of Science) and the Google search engine to retrieve information on ethnomedicinal plants used in East Africa in blood purification, detoxification, cleansing or strengthening and their investigated bioactivities related to their use in this traditional practice. Results: The search retrieved 74 plant species from 45 families distributed among 66 genera with some documented bioactivities, though, with little correlation with their traditional utilization in blood purification, cleansing, detoxification and strengthening. Some justification of the link between blood purification, cleansing, detoxification and strengthening and the use of the plants as antiplatelet aggregation, vasorelaxant, bronchodilatory, antihyperlipidaemic, cardioprotective, antiatherosclerotic and immunomodulatory agents were evident, but majorly antimicrobial activity has been investigated in most species. Thus, only 15 (20.2%) of the plant species (Allium sativum, Moringa oleifera, Olea capensis, Clausena anisata, Centella asiatica, Nasturtium officinale, Solanum nigrum, Withania somnifera, Rubus apetalus, Delonix elata, Persia americana, Aloe vera, Azadirachta indica, Echinacea angustifolia and Dioscorea bulbifera) could be directly correlated with studies pertaining to blood health. Conclusion: Medicinal plants used in blood purification, cleansing, detoxification and strengthening in East Africa play a holistic role in rejuvenation of overall human health. Few studies have examined their bioactivities pertaining to blood health. Thus, bioactivities and pharmacological activities (such as blood thinning, hypolipemic, cardioprotective, immunomodulatory, tonic and renoprotective properties) and phytochemicals of the claimed plants warrant further research as these could lead to discovery of chemical scaffolds of lead compounds that can be used in modern blood purification. [ABSTRACT FROM AUTHOR]

Highlights: A system that NO-loaded metal–organic frameworks encapsulated in PCL/Gel aligned coaxial scaffold is successfully constructed. The system enables to release NO slowly (1.67 nM h−1) and stably in a long period (15 d) without a burst release in the initial 48 h. The scaffold can promote the regeneration of the injured tendon with maturer collagen fibers and better mechanical properties by angiogenesis. Tendon regeneration is still a great challenge due to its avascular structure and low self-renewal capability. The nitric oxide (NO) therapy emerges as a promising treatment for inducing the regeneration of injured tendon by angiogenesis. Here, in this study, a system that NO-loaded metal–organic frameworks (MOFs) encapsulated in polycaprolactone (PCL)/gelatin (Gel) aligned coaxial scaffolds (NMPGA) is designed and prepared for tendon repair. In this system, NO is able to be released in vitro at a slow and stable average speed of 1.67 nM h−1 as long as 15 d without a burst release stage in the initial 48 h. Furthermore, NMPGA can not only improve the tubular formation capability of endothelial cells in vitro but also obviously increase the blood perfusion near the injured tendon in vivo, leading to accelerating the maturity of collagen and recovery of biomechanical strength of the regenerated tendon tissue. As a NO-loaded MOFs therapeutic system, NMPGA can promote tendon regeneration in a shorter healing period with better biomechanical properties in comparison with control group by angiogenesis. Therefore, this study not only provides a promising scaffold for tendon regeneration, but also paves a new way to develop a NO-based therapy for biomedical application in the future. [ABSTRACT FROM AUTHOR]

Detection of patients with esophageal squamous cell carcinoma (ESCC) who do not benefit from standard chemoradiation (CRT) is an important medical need. Radiomics using 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a promising approach. In this retrospective study of 184 patients with locally advanced ESCC. 152 patients from one center were grouped into a training cohort (n = 100) and an internal validation cohort (n = 52). External validation was performed with 32 patients treated at a second center. Primary endpoint was disease-free survival (DFS), secondary endpoints were overall survival (OS) and local control (LC). FDG-PET radiomics features were selected by Lasso-Cox regression analyses and a separate radiomics signature was calculated for each endpoint. In the training cohort radiomics signatures containing up to four PET derived features were able to identify non-responders in regard of all endpoints (DFS p < 0.001, LC p = 0.003, OS p = 0.001). After successful internal validation of the cutoff values generated by the training cohort for DFS (p = 0.025) and OS (p = 0.002), external validation using these cutoffs was successful for DFS (p = 0.002) but not for the other investigated endpoints. These results suggest that pre-treatment FDG-PET features may be useful to detect patients who do not respond to CRT and could benefit from alternative treatment. [ABSTRACT FROM AUTHOR]

Therapeutic drug monitoring is used in the clinical setting in the optimisation of dosages to overcome inter-patient pharmacokinetic variability, increasing efficacy whilst reducing toxicity. Imatinib is a tyrosine kinase inhibitor, displaying large variations in plasma concentrations that impact therapeutic success. As a result, imatinib has been the focus in the development of innovative techniques, aimed at its quantification in plasma. Liquid chromatography coupled with tandem mass spectrometry is currently the gold standard; however, cost and availability of the equipment limit its wider application in clinical settings. Recent advances in the field have shown Raman spectroscopy and electrochemistry to be key techniques for the development of promising analytical tools. This article reviews the latest advances towards less costly, more portable solutions that can be used at the point of care. [ABSTRACT FROM AUTHOR]

This study demonstrates the development and application of a novel workflow for designing and fabricating orthoses, using a combination of 3D scanning and 3D printing technologies. The workflow is applied to a clinically relevant translational case study in a patient with a neurological disorder and complex clinical needs. All traditional and commercial approaches to helping the patient's cervical instability and resulting 'head-drop' had previously failed, with associated progressive deterioration in the patient's clinical state and posture. The workflow was developed to design and fabricate a bespoke device for this patient with no viable alternative therapy. The workflow was developed to generate 3D printable geometry from obtained 3D scan data. The workflow includes algorithms to relax geometry, distribute material efficiently and for variational cutting of orthosis padding material. The 3D patient scan was validated against actual measurements to ensure accuracy of measurements. A total of four prototypes were produced with each iteration being improved based on patient and clinical feedback. There was a progressive improvement in subjective feedback through each iteration at sites of discomfort and overall comfort score. There was a marked improvement in the patient's posture with correction at the cervical and lumbar spine with the 3D-printed padded collar being worn for 4 hour periods. This study has implications for the rapid production of personalised orthoses which can help reduce patient waiting time, improve patient compliance, reduce pain and reduce further deterioration. The workflow could form the basis for an integrated process, whereby a single hospital visit results in a bespoke orthosis optimised and personalised for each patient. [ABSTRACT FROM AUTHOR]

Cryoablation has been used for the treatment of various sorts of solid visceral tumors, but few are reported on gastric tumor via endoscope, in terms of accurate control of ablation site, freezing depth and effective temperature. Thus, we developed a novel device, which could perform accurate cryoablation on the stomach via endoscope. This study aimed to evaluate the efficacy and safety of the device on porcine stomach. Results showed that the novel device could provide direct view of the operation space, allowing accurate and safe ablation of the stomach. Three minutes cryoablation caused a transmural, 1 cm radius gastric lesion. On serosal side, the temperature dropped to −64.2 °C, −34.1 °C, 26.1 °C at the center, 1 cm and 2 cm from center, respectively. Histopathology revealed acute ruptured cells with damaged glands in mucosa, partial disruption in muscularis propria and serosal slight exudation. Three months later, scar formed with complete recovery of gastric structure. No active bleeding or perforation of stomach, nor injury or adhesion of adjacent organs was observed. This endoscopic cryoablation device allowed safe, full-thickness cryoablation with effective temperature, which may provide an alternative treatment for gastric tumor. [ABSTRACT FROM AUTHOR]

The article offers several research papers related to biotechnology. One paper highlights the therapeutic effects of Block cohosh, a plant native to the eastern U.S., for menopausal symptoms among native Americans. Another paper provides insights into mutations that ensemble transmission of avian H5N1 influenza virus between humans and the effectiveness of mammalian immune responses to such variants that serves as key to preparing for the possibility of a pandemic. The third paper describes an alternative to antisense oligonucleotides in depressing microRNA targets.

Objectives: Non-pharmacological treatment options for common conditions such as chronic pain, anxiety, and depression are being given increased consideration in healthcare, especially given the recent emphasis to address the opioid crisis. One set of non-pharmacological treatment options are evidence-based complementary and integrative health (CIH) approaches, such as yoga, acupuncture, and meditation. The Veterans Health Administration (VHA), the nation's largest healthcare system, has been at the forefront of implementing CIH approaches, given their patients' high prevalence of pain, anxiety, and depression. We aimed to conduct the first national survey of veterans' interest in and use of CIH approaches.Methods: Using a large national convenience sample of veterans who regularly use the VHA, we conducted the first national survey of veterans' interest in, frequency of and reasons for use of, and satisfaction with 26 CIH approaches (n = 3346, 37% response rate) in July 2017.Results: In the past year, 52% used any CIH approach, with 44% using massage therapy, 37% using chiropractic, 34% using mindfulness, 24% using other meditation, and 25% using yoga. For nine CIH approaches, pain and stress reduction/relaxation were the two most frequent reasons veterans gave for using them. Overall, 84% said they were interested in trying/learning more about at least one CIH approach, with about half being interested in six individual CIH approaches (e.g., massage therapy, chiropractic, acupuncture, acupressure, reflexology, and progressive relaxation). Veterans appeared to be much more likely to use each CIH approach outside the VHA vs. within the VHA.Conclusions: Veterans report relatively high past-year use of CIH approaches and many more report interest in CIH approaches. To address this gap between patients' level of interest in and use of CIH approaches, primary care providers might want to discuss evidence-based CIH options to their patients for relevant health conditions, given most CIH approaches are safe. [ABSTRACT FROM AUTHOR]

Introduction: We review the literature evaluating certolizumab in psoriasis and report our experience of treatment outcomes in a joint dermatology and rheumatology clinic. Methods: Patients with concomitant psoriatic arthritis (PsA) and psoriasis who had been commenced on certolizumab were included within our retrospective review. Data was collected for patient demographics, Patient Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and previous treatments. The literature was systematically searched using Pubmed and Scopus. Results: Very recent results from the CIMPASI-1 and CIMPASI-2 studies have demonstrated the high efficacy of certolizumab in the treatment of psoriasis at both week 16 and 48. Pooled results from these studies showed a PASI75 at week 16 and week 48 of 82% and 83.6% respectively, in the certolizumab 400 mg group. In our cohort of eight patients (two female; six male; median age 49 and mean PASI of 20.8) all had failed at least two systemic non-biologic agents. Objective improvements were observed in seven patients, with five achieving PASI90 and two demonstrating either PASI75 or PASI50. Conclusion: Certolizumab is efficacious in both psoriasis and PsA, including in patients who are biologic failures, and could be considered as an alternative treatment modality. [ABSTRACT FROM AUTHOR]

The application of natural products to treat various diseases, such as cancer, has been an important area of research for many years. Several phytochemicals have demonstrated anticarcinogenic activity to prevent or reduce the progression of cancer by modulating various cellular mechanisms. However, poor bioavailability has hindered clinical success and the incorporation of these drugs into efficient drug delivery systems would be beneficial. For lung cancer, local delivery via the pulmonary route would also be more effective. In this article, recent in vitro scientific literature on phenolic compounds with anticancer activity towards lung cancer cell lines is reviewed and nanoparticulate delivery is mentioned as a possible solution to the problem of bioavailability. The first part of the review will explore the different classes of natural phenolic compounds and discuss recent reports on their activity on lung cancer cells. Then, the problem of the poor bioavailability of phenolic compounds will be explored, followed by a summary of recent advances in improving the efficacy of these phenolic compounds using nanoparticulate drug delivery systems. [ABSTRACT FROM AUTHOR]

A collaborative think tank involving panellists from immuno-oncology networks, clinical/translational investigators and the pharmaceutical industry was held in Siena, Italy, in October 2017 to discuss the evolving immune-oncology landscape, identify selected key challenges, and provide a perspective on the next steps required in the translation of current research and knowledge to clinical reality. While there is a trend of combining new agents (e.g., co-stimulator agonists) with a PD-1/PD-L1 treatment backbone, use of alternative combination therapy approaches should also be considered. While the rapid evolution in systems biology provides a deeper understanding of tumor and tumor microenvironment heterogeneity, there remains the need to identify and define genuinely predictive biomarkers to guide treatment and patient selection. Cross-specialty and cross-sector collaboration, along with a broader collective data-sharing approach are key to optimizing immuno-oncology therapy in clinical practice. Continued support of younger research-clinicians is essential for future success in clinical, translational and basic science investigations. [ABSTRACT FROM AUTHOR]

Background: Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored.Objective: To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain.Study Design: Prospective cohort study using propensity score-matched controls.Participants: Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months.Main Measures: Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care.Key Results: Both groups' (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. (severity - 0.10 (95% CI - 0.30, 0.10), interference - 0.07 (- 0.31, 0.16), bothersomeness - 0.1 (- 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group ($1996 [SD = 3874] vs $1086 [SD = 1212], p = .034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072).Conclusions: We found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense. [ABSTRACT FROM AUTHOR]

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A formula granule is a traditional Chinese medicine preparation made from the decoction of a single herbal medicinal. Because of the flexibility for combination and the convenience for utilization, formula granules are becoming popular in clinical applications. However, the efficacy and safety of commercial formula granules often suffer from the improper addition of carbohydrate excipients. Therefore, the detection of carbohydrate excipients is indispensable for the quality control of formula granules. FTIR spectroscopy has been used for the detection of carbohydrate excipients in formula granules. But the overlapped absorption signals limit the sensitivity and specificity of detection. Besides, a large number of multivariate calibration models are needed for quantitative determination. To overcome the above disadvantages, this research utilizes FTIR microspectroscopy for the model-free and universal detection of carbohydrate excipients in formula granules. Using ATR-FTIR imaging, excipient particles and herbal extract particles in formula granules can be measured individually, which resolves the absorption signals of excipients and herbal extract spatially and thus improves the sensitivity and specificity of detection. The content of excipients can be estimated directly from the number of excipient particles, which is robust to the variations of herb extracts and free of calibration models. The case study of Gardeniae Fructus formula granules shows the potential of FTIR microspectroscopy in the direct and rapid detection of carbohydrate excipients in formula granules. [ABSTRACT FROM AUTHOR]

Tea tree oil distilled from Melaleuca alternifolia has widespread use in the cosmetic industry as an antimicrobial as well as for other functions in topical products. Concerns were first raised by the European Commission's Scientific Committee on Consumer Products in 2004 about the level of the potentially carcinogenic phenylpropanoid compound methyl eugenol in tea tree oil. Limits on oil content in different types of cosmetic products were set based on a reported upper level of 0.9% methyl eugenol in the oil. A previous publication indicated that these levels were based on oil from a Melaleuca species not used in the commercial production of oil. Even the highest recorded levels in Melaleuca alternifolia, the overwhelmingly most common species used, were ∼15 times less than this, meaning that more oil could be safely used in the products. The current study, including details on methodology and reproducibility, extends that work across a suite of 57 plantation-sourced oils from a range of geographical locations and production years, as well as many Australian and international commercial oils. Lower levels of methyl eugenol in oils of known provenance were confirmed, with a recorded range of 160-552 ppm and a mean of 337 ppm. Analysis of variance showed methyl eugenol levels in Australian plantation oils to be correlated to the geographical region but not to the year of production. Average methyl eugenol levels in commercial oils were significantly lower, and these samples were divided into an authentic group and a group that were suspected of being adulterated based on an independent test. Authentic commercial oils had similar levels of methyl eugenol to Australian provenance material, whilst the oils classed as suspect had significantly lower levels. [ABSTRACT FROM AUTHOR]

Flooding causes significant public health issues. The Mekong Delta has been considered the region to be the most vulnerable to flooding in Vietnam. This study assessed the spatial vulnerability of the health impacts of flooding in the Mekong Delta region, Vietnam. This study applied a vulnerability assessment framework which was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity. The indicators for each dimension were derived from the relevant literature, consultations with experts, and data availability. An analytic hierarchy process (AHP) and a principal component analysis (PCA) were used to determine the weight of indicators. Vulnerability indexes (VIs) were then computed for each province. A total of 29 indicators (sensitivity index, 14; adaptive capacity index, 13; and exposure index, 2) were employed to evaluate the vulnerability to the health impacts of flooding at a provincial level. The results of AHP revealed that the highest VIs were found in the Dong Thap and An Giang provinces (VI, 1.948 and 1.574, respectively). VIs were distributed with higher indexes in upstream provinces close to a river than in coastal provinces. PCA generated three components from the 29 indicators, and the VIs computed from the PCA method are in substantial agreement with the AHP method (ICC = 0.71, p < 0.05). The vulnerability to the health impacts of flooding varies from province to province in the Mekong Delta region in Vietnam. Individual plans for health preparedness and adaption to flooding should be developed for each province in the Mekong Delta region. [ABSTRACT FROM AUTHOR]

For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (⩽10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients. [ABSTRACT FROM AUTHOR]

Although Traditional Chinese Medicine (TCM) preparations have long history with successful applications, the scientific and systematic quality assessment of TCM preparations mainly focuses on chemical constituents and is far from comprehensive. There are currently only few primitive studies on assessment of biological ingredients in TCM preparations. Here, we have proposed a method, M-TCM, for biological assessment of the quality of TCM preparations based on high-throughput sequencing and metagenomic analysis. We have tested this method on Liuwei Dihuang Wan (LDW), a TCM whose ingredients have been well-defined. Our results have shown that firstly, this method could determine the biological ingredients of LDW preparations. Secondly, the quality and stability of LDW varies significantly among different manufacturers. Thirdly, the overall quality of LDW samples is significantly affected by their biological contaminations. This novel strategy has the potential to achieve comprehensive ingredient profiling of TCM preparations. [ABSTRACT FROM AUTHOR]

The National Center for Health Statistics estimates that more than 100,000 Americans receive chelation each year, although far fewer than 1 % of these cases are managed by medical toxicologists. Unfortunately, fatalities have been reported after inappropriate chelation use. There are currently 11 FDA-approved chelators available by prescription although chelation products may also be obtained through compounding pharmacies and directly over the internet. Promotion of chelation training is prominent on some alternative and complementary medicine websites. [ABSTRACT FROM AUTHOR]

Complementary medicine advocates the use of a multifactorial approach to address the varied aspects of hypertension. The aim of this study was to compare the blood pressure (BP) effect and medication use of a novel Comprehensive Approach to Lowering Measured Blood Pressure (CALM-BP), based on complementary medicine principles, with the standard recommended Dietary Approach to Stop Hypertension (DASH). A total of 113 patients treated with antihypertensive drugs were randomly assigned to either CALM-BP treatment (consisting of rice diet, walks, yoga, relaxation and stress management) or to a DASH+exercise control group (consisting of DASH and walks). Ambulatory 24-h and home BP were monitored over a 16-week programme, followed by 6 months of maintenance period. Medications were reduced if systolic BP dropped below 110 mm Hg accompanied by symptoms. In addition to BP reduction, medications were reduced because of symptomatic hypotension in 70.7% of the CALM-BP group compared with 32.7% in the DASH group, P<0.0001. After 6 months, medication status was not altered in the majority of individuals. Significant reductions in body mass index, cholesterol and improved quality-of-life scores were observed only in the CALM-BP group. Lifestyle and diet modifications based on complementary medicine principles are highly effective with respect to BP control, medication use and cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Turning to faith in God or a higher spiritual power is a common way of coping with life-threatening disease such as cancer. Little, however, is known about religious faith among cancer patients in secular societies. The present study aimed at exploring the prevalence of religious faith among Danish breast cancer patients and at identifying whether socio-demographic, pre-cancer health status, clinical, and health behavior characteristics, including their use of complementary and alternative medicine (CAM), were associated with their degree of faith. Information on faith in God or a higher spiritual power and use of CAM was provided by a nationwide sample of 3,128 recurrence-free Danish women who had received surgery for early-stage breast cancer 15-16 months earlier. Socio-demographic, clinical, and health status variables were obtained from national longitudinal registries, and health behaviors had been assessed at 3-4 months post-surgery. Of the women, 47.3% reported a high degree of faith (unambiguous believers), 35.9% some degree of faith (ambiguous believers), while the remaining 16.8% were non-believers. Unambiguous believers were more likely than ambiguous believers to experience their faith as having a positive impact on their disease and their disease-related quality-of-life. When compared to non-believers, unambiguous believers were also older, had poorer physical function, and were more frequent users of CAM, and more inclined to believe that their use of CAM would have a beneficial influence on their cancer. Disease- and treatment-related variables were unrelated to faith. While overall religious faith appears equally prevalent among Danish and US breast cancer patients, the majority of Danish breast cancer patients experienced ambiguous faith, whereas the majority of US patients have been found to express unambiguous faith. Our results suggest that future studies may benefit from exploring the role of faith for health behaviors, adherence to conventional treatment, and impact upon quality of life. [ABSTRACT FROM AUTHOR]

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or 'allopathic' (disease as 'other' or 'outsider') practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such 'world medicine' as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice. [ABSTRACT FROM AUTHOR]