Analysis of Herbal Medicine Prescriptions for Patients in An Academic Korean Medical Hospital: A Cross Sectional Study of Electronic Medical Records (2010-2013) / 中国结合医学杂志

<p><b>OBJECTIVE</b>To obtain fundamental information for the standardization of herbal medicine in Korea.</p><p><b>METHODS</b>We analyzed the herbal medicine prescription data of patients at the Pusan National University Korean Medicine Hospital from March 2010 to February 2013. We used the Dongui-Bogam (Dong Yi Bao Jian) to classify prescribed herbal medicines.</p><p><b>RESULTS</b>The study revealed that the most frequently prescribed herbal medicine was 'Liuwei Dihuang Pill (LWDHP, )' which was used for invigorating 'Shen (Kidndy)-yin'. 'LWDHP' was most frequently prescribed to male patients aged 50-59, 60-69, 70-79 and 80-89 years, and 'Xionggui Tiaoxue Decoction (XGTXD, )' was most frequently prescribed to female patients aged 30-39 and 40-49 years. According to the International Classification of Diseases (ICD) codes, 'Diseases of the musculoskeletal system and connective tissue' showed the highest prevalence. 'LWDHP' and 'XGTXD' was the most frequently prescribed in categories 5 and 3, respectively. Based on the percentage of prescriptions for each sex, 'Ziyin Jianghuo Decoction ()' was prescribed to mainly male patients, and 'XGTXD' with 'Guima Geban Decoction ()' were prescribed to mainly female patients.</p><p><b>CONCLUSION</b>This study analysis successfully determined the frequency of a variety of herbal medicines, and many restorative herbal medicines were identified and frequently administered.</p>

Electrical stimulation of auricular acupressure for dry eye: A randomized controlled-clinical trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of electrical stimulation (ES) of auricular acupressure on reducing the ocular symptoms and signs before and after treatment for dry eye.</p><p><b>METHODS</b>The inclusion criteria were the tear film break-up time (TFBUT) below 5 s and a Schirmer test-I below 5 mm in dry eyes with ocular symptoms for at least 6 months. Subjects were randomized into a treatment group (50 cases) with continuous low frequency ES under auricular acupressure at acupoints and a no ES under auricular acupressure (no-ES, control group, 50 cases) on the same acupoints. Auricular acupressure were stimulated with ES at 4 master points of both ears, which were performed twice a week for 4 weeks at each point for 30 s. The ocular symptoms, the TFBUT, and Schirmer test-I were evaluated before and after this procedure.</p><p><b>RESULTS</b>There were significantly better scores in TFBUT (P=0.032), the Schirmer test-I (P=0.044) and ocular symptoms (P=0.029) at 3 months post-treatment in the treatment group than in the control group. The total effective rate in the treatment group was accomplished in 41 (82%) of the 50 cases of dry eye.</p><p><b>CONCLUSIONS</b>Auricular acupressure with ES at auricular acupoint improves ocular symptoms and signs of dry eye for a period of at least 3 months.</p>

Syndrome pattern and its application in parallel randomized controlled trials / 中国结合医学杂志

Syndrome pattern (SP) is a core concept of Chinese medicine (CM) and is used to diagnose and treat patients based on an overall analysis of symptoms and signs. This study aimed to systematically review randomized controlled trials (RCTs) using the SP concept and to demonstrate how the SP concept could be applied to the study design of parallel RCTs, considering a gold standard of clinical research. After conducting a brief systematic review by way of a PubMed search, we analyzed how the SP concept was applied to the design of RCT in a CM herbal medicine trial. We then formulated possible research questions, applied the SP concept to answer the research questions, and suggested possible RCT designs to be used for conducting future trials. Fourteen RCTs were included in our systematic review, and three key points of the SP concept were formulated for the design of parallel RCTs: the time point of SP diagnosis between before and after randomization; the relationship between the international classification of diseases (ICD) and SP for the inclusion of target population; and the proper diagnostic method of SP. In this study, we formulated three possible research questions and then suggested perspectives for five possible RCT models arrived at using SP concepts. Future trials applying SP concept to RCTs should overcome the shortcomings of past SP trials, moving CM forward from experience-based to evidence-based medicine.

Scalp acupuncture for Parkinson's disease: a systematic review of randomized controlled trials / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of scalp acupuncture (SA), a modern acupuncture technique specialized to neurological disorders, in managing motor function and symptoms for Parkinson's disease (PD) patients.</p><p><b>METHODS</b>Two independent reviewers extracted data from all of the randomized clinical trials (RCTs) that assessed the efficacy of SA for PD compared with conventional therapies (CTs). Sixteen electronic databases were searched. The risk of bias was appraised with the Cochrane Collaboration tool, and the reporting of the included studies was evaluated by the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist and the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines.</p><p><b>RESULTS</b>In total, 4 RCTs met the inclusion criteria. As assessed by the Unified PD Rating Scale (UPDRS), 2 RCTs showed that SA combined with CTs proved superior to CTs alone [60 cases; weighted mean difference, -3.94; 95% confidence interval (CI), -6.05 to -1.84, P=0.01; I(2) =0%]. Based on the Webster scale, however, 3 RCTs showed no superior effect of SA when combined with CTs with high heterogeneity (154 cases; risk ratio, 1.29; 95% CI, 0.79 to 2.12, P=0.30; I(2) =84%). The Cochrane risk of bias, adherence to the CONSORT and the STRICTA checklist showed that the quality of all the included RCTs was generally low.</p><p><b>CONCLUSIONS</b>The result of our systematic review and meta-analysis suggested that the effectiveness of SA for PD is promising, however, the evidence is not convincing. A sham-controlled RCT design that adheres to the CONSORT and STRICTA guidelines to overcome methodological weakness and that includes a large sample size is strongly recommended to confirm the precise effect of SA on PD.</p>

Red ginseng for type 2 diabetes mellitus: a systematic review of randomized controlled trials / 中国结合医学杂志

<p><b>OBJECTIVE</b>Red ginseng (RG, Panax ginseng C.A. Meyer) is one of the widely used herbs for treating type 2 diabetes mellitus (DM). However, no systematic review of the effectiveness of RG for type 2 DM is available. This systematic review aimed to evaluate the current evidence for the effectiveness of RG in patients with type 2 DM.</p><p><b>METHODS</b>Electronic searches of 14 electronic databases were conducted without language restrictions. All randomized clinical trials (RCTs) with RG as a treatment for type 2 DM were considered for inclusion. Their methodological quality was assessed using the Cochrane criteria.</p><p><b>RESULTS</b>Four RCTs met our inclusion criteria. Their methodological quality was variable. Three of the RCTs compared the effectiveness of RG with placebo. The meta-analysis of these data failed to favor RG over placebo for fasting plasma glucose (FPG) [n =76, weighted mean difference (WMD): -0.43 mmol/L; 95% confidence interval (CI): -1.16 to 0.30, =0.25] and fasting plasma insulin (FPI) (n =76, WMD: -8.43 pmol/L; 95% CI: -19.54 to 2.68, P =0.14) for 12 weeks of treatment. One RCT compared the effects of RG with no treatment. The results did not suggest favorable effects of RG on FPG, hemoglobin A(1c) (HbA(1c)) or 2-h blood glucose after a meal (PP2h).</p><p><b>CONCLUSIONS</b>The evidence for the effectiveness of RG in controlling glucose in type 2 DM is not convincing. Few included studies with various treatment regimens prohibit definitive conclusions. More rigorous studies are needed to clarify the effects of RG on this condition.</p>

Randomized clinical trials on Eastern-Western integrative medicine for health care in Korean literature: a systematic review / 中国结合医学杂志

<p><b>OBJECTIVE</b>To summarize and critically evaluate the evidence for and against the effectiveness of Eastern-Western integrative medicine (EWIM) for health care compared to Eastern medicine (EM) or Western medicine (WM) alone.</p><p><b>METHODS</b>Systematic searches were conducted on five Korean medical databases. Manual searches were also conducted through nine major Korean medical journals. Prospective randomized clinical trials (RCTs) were included if EWIM was tested for any type of conditions compared to EM or WM.</p><p><b>RESULTS</b>There were one hundred forty-one possibly relevant studies were identified, and seven RCTs were included. The risk of bias was high in most studies. The EWIM methods were compared with EM or WM in patients with pain conditions in four studies. These studies showed favorable effects of EWIM on pain reduction in patients with shoulder pain and chronic headache compared with EM, while the other RCTs failed to do so in traffic injury patients. Two studies tested EWIM in patients with Bell's palsy compared with EM and found acute functional improvement. An RCT comparing EWIM with WM in patients with acne showed a significant difference.</p><p><b>CONCLUSION</b>The results of our systematic review suggest that there is limited evidence for the superiority of EWIM over EM or WM in the treatment of pain and acute symptom improvement in patients with Bell's palsy. The evidence from our analysis was limited from the low number of RCTs included and the high risk of bias. Future RCTs appear to be warranted.</p>

Moxibustion for managing type 2 diabetes mellitus: a systematic review / 中国结合医学杂志

<p><b>OBJECTIVE</b>Moxibustion is currently used for treating diabetes mellitus (DM) as a non-drug intervention in East Asian countries. This systematic review aims to evaluate the effectiveness of moxibustion for managing the symptoms of type 2 DM patients.</p><p><b>METHODS</b>We searched MEDLINE, AMED, EMBASE, CINAHL, The Cochrane Library, six Korean databases, and four Chinese databases. Risk of bias was used for evaluating the quality of the included studies.</p><p><b>RESULTS</b>A total of 5 studies met the inclusion criteria for this review. All of the included studies had high risks of bias. One randomized clinical trial (RCT) compared the effectiveness of one-time moxibustion use with oral administration of glibenclimide and showed the significant effects of moxibustion on glycemic control. Another RCT tested the effectiveness of moxibustion plus conventional treatment, and the moxibustion group reported significant improvement in fasting and postprandial blood glucose levels compared with the conventional treatment group. Two RCTs compared the effectiveness of moxibustion versus acupuncture or moxibustion plus acupuncture, and the combined treatment showed the most favorable effects on the control of blood glucose, urine glucose, and glycocylated hemoglobin A(1c) (HbA(1c)). One uncontrolled observational study showed favorable effects of moxibustion on the response rate.</p><p><b>CONCLUSIONS</b>It is difficult to conclude that moxibustion is an effective intervention for the control of type 2 DM due to the scarcity of trials and the low methodological quality of included studies. Further rigorous RCTs may be necessary to evaluate the effectiveness of moxibustion for type 2 DM.</p>

Inadvertent discogram during transforaminal epidural injection in patients with lumbar disc herniation: A report of 2 cases / 대한마취과학회지

The transforaminal epidural injection (TFEI) has been preferred in many cases because it can deliver the injected dose of medication closer to the nerve root and better facilitate ventral epidural flow compared to other methods. However, in patients with deformities not demonstrated on fluoroscopic imaging, the needle may enter unwanted locations. We treated two cases of intradiscal injection of contrast dye, during the TFEI, in patients with lumbar disc herniation.

Anesthetic Management of Tracheal Reconstruction Surgery with Laryngeal Mask Airway: A case report / 대한마취과학회지

Ventilatory management of tracheal reconstruction surgery may require sophisticated anesthetic techniques. Most airway problems that occurred during the tracheal surgery can be prevented by passing an endotracheal tube of small size through the tracheal narrowing or locating a normal endotracheal tube just above the stenotic lesion. However, in case of high tracheal stenosis sited near the vocal cord, it is difficult to manage airway using a cuffed endotracheal tube because of high possibility of injury of the vocal cord, shallow placement of the tube and inability to apply positive pressure ventilation. The laryngeal mask airway has been used as an efficient ventilatory device in this situation. We report one case of high tracheal stenosis requiring end to end anastomosis, where airway management was successful without any complications using the proseal laryngeal mask airway (PLMA).

Herba houttuyniae extract induces apoptotic death of human promyelocytic leukemia cells via caspase activation accompanied by dissipation of mitochondrial membrane potential and cytochrome c release

Herba houttuyniae has been used as a constituent of herval medicine prescriptions for the treatment of inflammation, cancer, and other diseases. In the present study, we investigated the cellular effects of herba houttuyniae extract (HHE) and the signal pathways of HHE-induced apoptosis in HL-60 human promyelocytic leukemia cell line. HHE treatment caused apoptosis of cells as evidenced by discontinuous fragmentation of DNA, the loss of mitochondrial membrane potential, release of mitochondrial cytochrome c into the cytosol, activation of procaspase-9 and caspase-3, and proteolytic cleavage of poly(ADP-ribose) polymerase. Pretreatment of Ac-DEVD-CHO, caspase-3 specific inhibitor, or cyclosporin A, a mitochondrial permeability transition inhibitor, completely abolished HHE-induced DNA fragmentation. Together, these results suggest that HHE possibly causes mitochondrial damage leading to cytochrome c release into cytosol and activation of caspases resulting in PARP cleavage and execution of apoptotic cell death in HL-60 cells.

Does Bispectral Index Monitoring Detect the Sedative Effect of Epidural Anesthesia? / 대한마취과학회지

BACKGROUND: Epidural anesthesia has been shown to a have direct sedative effect and to markedly reduce the amount of hypnotic agents required for sedation. A Bispectral Index (BIS) is a useful monitor of the level of sedation and loss of consciousness for several anesthetics including propofol. In this study, we investigated whether BIS monitoring could detect the sedative effect of epidural anesthesia during propofol induction. METHODS: Twenty patients scheduled for elective lower abdominal surgery were included. A Target controlled infusion (target effect concentration 5micro gram/ml, induction time 3 min) of propofol was administered to the patients with or without epidural anesthesia (2% lidocaine 15 ml) at the L2-3 level. The OAA/S scale and BIS were evaluated 20 min after epidural injection. Hypnotic requirements of propofol were determined using loss of eye opening in response to verbal command as an endpoint. At the time of induction of hypnosis, the target concentration, target effect concentration and BIS were recorded. RESULTS: Epidural lidocaine significantly decreased the hypnotic dose of propofol (1.0 +/- 0.2 micro gram/ml vs. 1.3 +/- 0.1 micro gram/ml; P = 0.0008), hypnotic calculated concentration (3.3 +/- 0.6 micro gram/ml vs. 4.1 +/- 0.3 micro gram/ml; P = 0.0007), and the hypnotic effect concentration (0.7 +/- 0.3micro gram/ml vs. 1.1 +/- 0.1 micro gram/ml; P = 0.0007). In the patients with epidural anesthesia, the OAA/S scale was decreased without a change of the BIS after epidural anesthesia and BIS recorded at the time of induction of hypnosis was much higher in patients with epidural anesthesia than in patients without epidural anesthesia (92.7 +/- 2.2 vs. 85.5 +/- 6.2; P = 0.0029) CONCLUSIONS: Epidural anesthesia induced a sedative effect without a change of the BIS and then induced the hypnosis with lesser dose of propofol. At the time of hypnosis, a higher BIS was noticed with epidural anestheia. These results concluded that BIS monitoring could not detect the sedative effect induced with epidural anesthesia.