Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis.

Background: The use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence. Methods: The PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature. Results: This study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use. Conclusion: The study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs.

Novel polymorphisms and genetic studies of the shadow of prion protein gene (SPRN) in pheasants.

Background: Prion diseases in mammals are caused by the structural conversion of the natural prion protein (PrPC) to a pathogenic isoform, the "scrapie form of prion protein (PrPSc)." Several studies reported that the shadow of prion protein (Sho), encoded by the shadow of prion protein gene (SPRN), is involved in prion disease development by accelerating the conformational conversion of PrPC to PrPSc. Until now, genetic polymorphisms of the SPRN gene and the protein structure of Sho related to fragility to prion disease have not been investigated in pheasants, which are a species of poultry. Methods: Here, we identified the SPRN gene sequence by polymerase chain reaction (PCR) and compared the SPRN gene and Sho protein sequences among various prion disease-susceptible and -resistant species to identify the distinctive genetic features of pheasant Sho using Clustal Omega. In addition, we investigated genetic polymorphisms of the SPRN gene in pheasants and analyzed genotype, allele, and haplotype frequencies, as well as linkage disequilibrium among the genetic polymorphisms. Furthermore, we used in silico programs, namely Mutpred2, MUpro and AMYCO, to investigate the effect of non-synonymous single nucleotide polymorphisms (SNPs). Finally, the predicted secondary and tertiary structures of Sho proteins from various species were analyzed by Alphafold2. Results: In the present study, we reported pheasant SPRN gene sequences for the first time and identified a total of 14 novel SNPs, including 7 non-synonymous and 4 synonymous SNPs. In addition, the pheasant Sho protein sequence showed 100% identity with the chicken Sho protein sequence. Furthermore, amino acid substitutions were predicted to affect the hydrogen bond distribution in the 3D structure of the pheasant Sho protein. Conclusion: To the best of our knowledge, this is the first report of the genetic and structural features of the pheasant SPRN gene.

Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis.

INTRODUCTION: Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures. METHODS: A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators. RESULTS: This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes. CONCLUSION: Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.

Assessing the safety and use of medicinal herbs during pregnancy: a cross-sectional study in São Paulo, Brazil.

Background: Despite the lack of evidence supporting the safety and clinical efficacy of herbal medicine (HM), its use among pregnant women continues to increase. Given the high prevalence of contraindicated herbs among the pregnant population in Brazil, it is crucial to examine the use of HM and evaluate its safety based on the current scientific literature to ensure that women are using HM appropriately. Methods: A cross-sectional study was conducted from October 2022 to January 2023 at a public teaching hospital in São Paulo, Brazil. A total of 333 postpartum women in the postnatal wards and postnatal clinic were interviewed using a semi-structured questionnaire. The survey instrument consisted of 51 items covering the use of HM during pregnancy, sociodemographic and health-related characteristics, COVID-19 experiences, and pregnancy outcomes. For data analysis, chi-square and multivariate logistic regression were conducted using SPSS ver. 26.0. Results: Approximately 20% of respondents reported using HM during their most recent pregnancy, with a higher use observed among women from ethnic minority groups and those with prior HM experience. Among the 20 medicinal herbs identified, 40% were found to be contraindicated or recommended for use with caution during pregnancy. However, only half of the women discussed their HM use with obstetric care providers. Conclusion: This study emphasizes the continued public health concern regarding the use of contraindicated or potentially harmful HM among pregnant women in Brazil, highlighting the need for sustained efforts to reduce the risk of inappropriate HM use. By updating antenatal care guidelines based on the latest scientific evidence, healthcare providers can make informed clinical decisions and effectively monitor pregnant women's HM use, ultimately promoting safer and more effective healthcare practices.

Panoramic dental tomosynthesis imaging by use of CBCT projection data.

Dental CBCT and panoramic images are important imaging modalities used in dental diagnosis and treatment planning. In order to acquire a panoramic image without an additional panoramic scan, in this study, we proposed a method of reconstructing a panoramic image by extracting panoramic projection data from dental CBCT projection data. After specifying the patient's dental arch from the patient's CBCT image, panoramic projection data are extracted from the CBCT projection data along the appropriate panoramic scan trajectory that fits the dental arch. A total of 40 clinical human datasets and one head phantom dataset were used to test the proposed method. The clinical human dataset used in this study includes cases in which it is difficult to reconstruct panoramic images from CBCT images, such as data with severe metal artifacts or data without teeth. As a result of applying the panoramic image reconstruction method proposed in this study, we were able to successfully acquire panoramic images from the CBCT projection data of various patients. The proposed method acquires a universally applicable panoramic image that is less affected by CBCT image quality and metal artifacts by extracting panoramic projection data from dental CBCT data and reconstructing a panoramic image.

Traditional and complementary medicine use among cancer patients in Nepal: a cross-sectional survey.

BACKGROUND: Traditional and complementary medicine (T&CM) is commonly used in South Asian countries such as Nepal. There are various causes and contributing factors for patients with cancer to consider using T&CM. However, little is known about the use of T&CM among the cancer population in this region. METHODS: The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from two National hospitals in Kathmandu, Nepal. The survey instrument comprised 30 questions, including variables on demographics, use of T&CM, and perceived level of disease severity, and cancer treatment. Chi-square test and logistic regression were used for data analysis using SPSS ver. 23.0. RESULTS: Of 908 participants, 31.6% used one or more modalities of T&CM after a cancer diagnosis. The most commonly used T&CM was Ayurveda (46.5%), followed by yoga (32.4%). About 46% of T&CM users discussed their use with their doctors. The main source of information on T&CM was their family members and relatives (55.7%). Cancer type (head and neck cancer OR: 2.30, CI: 1.23-4.29; abdominal cancer OR: 2.69, CI: 1.47-4.95; lung cancer OR: 5.88, CI: 2.69-12.89), cancer stage (Stage I OR: 1.92¸CI: 1.14-3.25; Stage II OR: 1.76, CI: 1.06-2.94), and the patients' self-rated disease severity (high perceived severity OR: 1.50, CI: 1.05-2.16) were strong predictors of T&CM use. CONCLUSION: This study underlined that despite the widespread use of T&CM among cancer patients in Nepal, most patients obtained information on T&CM from informal sources and did not disclose their use to physicians. To ensure the safe use of T&CM modalities, physicians should integrate questions on T&CM use into routine patient assessments in order to facilitate active communication and improve the quality of care.

Keratinocytes-Derived Reactive Oxygen Species Play an Active Role to Induce Type 2 Inflammation of the Skin: A Pathogenic Role of Reactive Oxygen Species at the Early Phase of Atopic Dermatitis.

BACKGROUND: Atopic dermatitis (AD) is characterized by chronic, relapsing skin inflammation (eczema) with itchy sensation. Keratinocytes, which are located at the outermost part of our body, are supposed to play important roles at the early phase of type 2 inflammation including AD pathogenesis. OBJECTIVE: The purpose of this study was to evaluate whether keratinocytes-derived reactive oxygen species (ROS) could be produced by the allergens or non-allergens, and the keratinocytes-derived ROS could modulate a set of biomarkers for type 2 inflammation of the skin. METHODS: Normal human epidermal keratinocytes (NHEKs) were treated with an allergen of house dust mites (HDM) or a non-allergen of compound 48/80 (C48/80). Then, biomarkers for type 2 inflammation of the skin including those for neurogenic inflammation were checked by reverse transcriptase-polymerase chain reaction and western immunoblot experiments. RESULTS: HDM or C48/80 was found to upregulate expression levels of our tested biomarkers, including type 2 T helper-driving pathway (KLK5, PAR2, and NFκB), epithelial-cell-derived cytokines (thymic stromal lymphopoietin, interleukin [IL]-25, IL-33), and neurogenic inflammation (NGF, CGRP). The HDM- or C-48/80-induced expression levels of the biomarkers could be blocked by an antioxidant treatment with 5 mM N-acetyl-cysteine. In contrast, pro-oxidant treatment with 1 mM H2O2 could upregulate expression levels of the tested biomarkers in NHEKs. CONCLUSION: Our results reveal that keratinocytes-derived ROS, irrespective to their origins from allergens or non-allergens, have a potential to induce type 2 inflammation of AD skin.

Galuteolin, identified in the extract of thymus quinquecostatus flowers, is involved in inhibiting melanin biosynthesis in B16/F10 melanoma cells.

To enhance the skin whitening effect, tyrosinase activity and melanin biosynthesis needs to be suppressed in the skin. To achieve this goal, we examined the extract of Thymus quinquecostatus flowers, and identified a functional ingredient, galuteolin. Galuteolin effectively inhibited melanin biosynthesis in B16/F10 cells, partially suppressing tyrosinase activity. Therefore, this study suggests that galuteolin can be used as a cosmetic ingredient for skin whitening.

Effects of Patient-Directed Interactive Music Therapy on Sleep Quality in Postoperative Elderly Patients: A Randomized-Controlled Trial.

PURPOSE: This study aimed to investigate the effects of patient-directed interactive music on saliva melatonin levels and sleep quality among postoperative elderly patients in the intensive care unit (ICU). PATIENTS AND METHODS: A total of 133 elderly patients were randomized into three groups: interactive music therapy (IMT), passive listening (PL), and the control group. The control group (n = 45) received routine medical care, while IMT and PL groups received music therapy on ICU day 1. The IMT group received up to 20 mins of interactive music sessions, including relaxation techniques. The PL group received only pre-selected relaxing music-listening for 30 mins. Saliva melatonin and cortisol levels were measured three times at 11 p.m. (preoperative, operation day, and postoperative day [POD] 1). The Richards-Campbell Sleep Questionnaire (RCSQ) and Quality of Recovery-40 questionnaire (QoR40) were administered on the preoperative day, as well as PODs 1 and 2. RESULTS: The RCSQ showed a significant improvement in the IMT group compared to the control group on POD2 (71.50 vs 56.89, p=0.012), but the QoR40 did not show any difference between groups. The quality control of the saliva sample was not available due to the immediate postoperative patient's condition, resulting in a higher dropout rate. Saliva melatonin levels on POD 1 were elevated in the IMT group compared to the control group (1.45 vs 0.04, p=0.0068). The cortisol level did not show a significant difference between groups. CONCLUSION: Single IMT intervention improved subjectively assessed short-term sleep quality in postoperative elderly patients. It is difficult to conclude whether music therapy intervention affects the level of melatonin and cortisol. TRIAL REGISTRATION: The study was registered at ClinicalTrials.Gov (number NCT03156205).

An additional tilted-scan-based CT metal-artifact-reduction method for radiation therapy planning.

PURPOSE: As computed tomography (CT) imaging is the most commonly used modality for treatment planning in radiation therapy, metal artifacts in the planning CT images may complicate the target delineation and reduce the dose calculation accuracy. Although current CT scanners do provide certain correction steps, it is a common understanding that there is not a universal solution yet to the metal artifact reduction (MAR) in general. Particularly noting the importance of MAR for radiation treatment planning, we propose a novel MAR method in this work that recruits an additional tilted CT scan and synthesizes nearly metal-artifact-free CT images. METHODS: The proposed method is based on the facts that the most pronounced metal artifacts in CT images show up along the x-ray beam direction traversing multiple metallic objects and that a tilted CT scan can provide complementary information free of such metal artifacts in the earlier scan. Although the tilted CT scan would contain its own metal artifacts in the images, the artifacts may manifest in a different fashion leaving a chance to concatenate the two CT images with the metal artifacts much suppressed. We developed an image processing technique that uses the structural similarity (SSIM) for suppressing the metal artifacts. On top of the additional scan, we proposed to use an existing MAR method for each scan if necessary to further suppress the metal artifacts. RESULTS: The proposed method was validated by a simulation study using the pelvic region of an XCAT numerical phantom and also by an experimental study using the head part of the Rando phantom. The proposed method was found to effectively reduce the metal artifacts. Quantitative analyses revealed that the proposed method reduced the mean absolute percentages of the error by up to 86% and 89% in the simulation and experimental studies, respectively. CONCLUSIONS: It was confirmed that the proposed method, using complementary information acquired from an additional tilted CT scan, can provide nearly metal-artifact-free images for the treatment planning.

Ethanol Extract of Peanut Sprout Exhibits a Potent Anti-Inflammatory Activity in Both an Oxazolone-Induced Contact Dermatitis Mouse Model and Compound 48/80-Treated HaCaT Cells.

BACKGROUND: We developed an ethanol extract of peanut sprouts (EPS), a peanut sprout-derived natural product, which contains a high level of trans-resveratrol (176.75 µg/ml) and was shown to have potent antioxidant activity. OBJECTIVE: We evaluated the potential anti-inflammatory activity of EPS by measuring its antioxidant potential in skin. METHODS: The anti-inflammatory activity of EPS was tested using two models of skin inflammation: oxazolone (OX)-induced contact dermatitis in mice and compound 48/80-treated HaCaT cells. As biomarkers of skin inflammation, cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) levels were measured. RESULTS: OX-induced contact dermatitis was suppressed markedly in mice that were treated with an ointment containing 5% EPS as evidenced by a decrease in the extent of scaling and thickening (p<0.05) and supported by a histological study. COX-2 (messenger RNA [mRNA] and protein) and NGF (mRNA) levels, which were upregulated in the skin of OX-treated mice, were suppressed markedly in the skin of OX+EPS-treated mice. Consistent with this, compound 48/80-induced expression of COX-2 (mRNA and protein) and NGF (mRNA) in HaCaT cells were suppressed by EPS treatment in a dose-dependent manner. As an inhibitor of NF-κB, IκB protein levels were dose-dependently upregulated by EPS. Fluorescence-activated cell sorting (FACS) analysis revealed that EPS scavenged compound 48/80-induced reactive oxygen species (ROS) in HaCaT cells. CONCLUSION: EPS exerts a potent anti-inflammatory activity via its anti-oxidant activity in both mouse skin and compound 48/80-treated HaCaT cells in vitro. Compound 48/80-treated HaCaT cells are a useful new in vitro model of skin inflammation.

Methyl-ß-cyclodextrin up-regulates collagen I expression in chronologically-aged skin via its anti-caveolin-1 activity.

Caveolin-1 (Cav-1) is one of the key molecules to modulate collagen metabolism in the skin. This study aimed to unravel the relationship between Cav-1 and collagen levels in the aged skin, and also to evaluate a new role of anti-Cav-1 agent as a collagen-modulating agent. A negative correlation between Cav-1 and collagen I (COL I) was detected in chronologically aged skin of humans and mice, which was further confirmed by Cav-1 knock-down or knock-out experiments. Next, we tested whether methyl-ß-cyclodextrin (MßCD) as a chemical Cav-1 inhibitor could be developed as a collagen-modulating agent in the skin. Testing different conditions of MßCD injection via the intra-dermal route revealed that 2.5% MßCD administered twice per week for two months showed a potent COL I-up-regulating activity, leading to the increase of skin thickness (P < 0.05) without adverse reactions such as skin fibrosis. In human dermal fibroblasts, MßCD treatment induced up-regulated COL I and down-regulated Cav-1, supporting the results of mouse experiments. Collectively, MßCD has a COL I-enhancing activity in chronologically-aged skin, where Cav-1 acts as a brake in COL I expression, suggesting its potential role for an anti-aging agent.

Ethanol extract of peanut sprout induces Nrf2 activation and expression of antioxidant and detoxifying enzymes in human dermal fibroblasts: implication for its protection against UVB-irradiated oxidative stress.

A peanut sprout is known to contain a significant level of resveratrol, which was reported to have beneficial effects in our body due to its antioxidant activities. The purpose of this study was to evaluate the cytoprotective activity of ethanol extract of peanut sprout (EPS) from ultraviolet B (UVB)-induced oxidative stress in human dermal fibroblasts (HDF). EPS was revealed to contain 54.2 µg g(-1) of trans-resveratrol. The DCF-DA-positive reactive oxygen species level was increased by 50 mJ cm(-2) of UVB irradiation (2150 ± 450% of nonirradiated control), which was markedly suppressed by EPS treatment (180 ± 42% of control). Annexin V-positive apoptotic cell death induced by UVB irradiation (16.4 ± 4.5%) was also significantly inhibited by EPS treatment (6.7 ± 2.5%). EPS induced up-regulation and nuclear translocation of Nrf2, a transcription factor for antioxidant and detoxifying enzymes, in HDF as a dose-dependent manner. UVB irradiation up-regulated Nrf2-dependent enzymes of heme oxygenase-1, NAD(P)H:quinine oxidoreductase-1 and glutathione-S-transferase pi, and they were further stimulated by EPS treatment. Taken together, EPS is an efficient cytoprotective agent against UVB-induced oxidative stress by activation of Nrf2 and upregulation of Nrf2-relating antioxidant and detoxifying enzymes in HDF.