Ayurveda & Complementary Systems

of Medicine

(Acupuncture, Alternative Medicine, Aromatherapy, Ayurveda, Complementary Medicine, Herbal Medicine, Homeopathy, Hypnotherapy, Magnetotherapy, Reflexology, Siddha & Traditional Medicine)

Abstract

January 2003

Acupuncture:

6381. Altshuler LH, Maher JH. Acupuncture: a physician's primer, Part I. J Okla State Med Assoc. 2002 Aug;95(8):527-33. Review.

Acupuncture is one of the alternative therapies that is quickly gaining popularity and acceptance among both patients and doctors. The NIH has supported its use for many conditions, alone or as adjunctive therapy to conventional methods. Research has now demonstrated several physiological mechanisms to explain acupuncture's benefits. However, there are many different schools of acupuncture, and methodology and techniques vary widely, all contributi ng to the success or failure of acupuncture treatment. With proper use, acupuncture can be an effective treatment for a variety of medical conditions, but used incorrectly, it can be a waste of time and resources.

6382. Beinfield H. Tribulations and trials: acupuncture study designs affect outcome. Altern Ther Health Med. 2002 Jul-Aug;8(4):40-3. No abstract.

6383. Ernst E. Re: Does acupuncture have additional value to standard poststroke motor rehabilitation? Stroke. 2002 Jul;33(7):1744; discussion 1744. No abstract.

Alternative Medicine / Complementary Medicine:

6384. Aragon D, Farris C, Byers JF. The effects of harp music in vascular and thoracic surgical patients. Altern Ther Health Med. 2002 Sep-Oct;8(5):52-4, 56-60.

CONTEXT: Music has been used in the acute clinical care setting as an adjunct to current treatment modalities. Previous studies have indicated that some types of music may benefit patients by reducing pain and anxiety, and may have an effect on physiological measures. OBJECTIVE: To evaluate the scientific foundation for the implementation of a complementary therapy, harp playing. The research questions for this pilot study were: Does live harp playing have an effect on patient perception of anxiety, pain, and satisfaction? Does live harp playing produce statistically and clinically significant differences in physiological measures of heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation? DESIGN: A prospective, quasiexperimental, repeated measures design was used with a convenience sampling. SETTING: Orlando Regional Medical Center, Orlando Fla. PATIENTS: Subjects wer eligible for the study if they were postoperative and admitted to a hard-wired-bedside-monitored room of the Vascular Thoracic Unit within the 3 days of the study period. INTERVENTION: A singl e20-minute live harp playing session. MAIN OUTCOME MEASURES: Visual analog scales (VAS) were used to measure patient anxiety and pain. Patient satisfaction was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor. METHODS: Visual analog scales (VAS) were completed just before harp playing, 20 minutes after harp playing was started, and 10 minutes after completion. Patient satisfaction with the experience was measured with a 4-item questionnaire. Physiological measures (heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation) were recorded from the bedside monitor at baseline (5 minutes before study setup), at zero, 5, 10, 15, and 20 minutes after harp playing began, and at 5 and 10 minutes after harp playing stopped. RESULTS: Seventeen patients were used in this study, with a retrospective power of .91. Results indicate that listening to live harp music has a positive effect on patient perception of anxiety (P=.000), pain (P=.000) and satisfaction. Live harp playing also produced statistically significant differences in physiological measures of systolic blood pressure (P=.046), and oxygen saturation (P=.011). Although all values over time trended downward, the changes of other variables were not adequate to achieve statistical or clinical significance. CONCLUSION: Subjects in this study experienced decreased pain and anxiety with the harp intervention, and slight reductions in physiologic variable values. It is not possible in this study to determine if the results were due to the harp music, the presence of the harpist and data collector, or both. Future research is recommended using a control group and comparison of live versus recorded harp music with a wider variety of diagnoses and procedures.

6385. Astin JA. Complementary and alternative medicine and the need for evidence-based criticism. Acad Med. 2002 Sep;77(9):864-8; discussion 869-75. No abstract.

6386. Baldwin C. Early menopause & self-care. AWHONN Lifelines. 2002 Aug-Sep;6(4):376, 373-8. No abstract.

6387. Barlow SE, Trowbridge FL, Klish WJ, Dietz WH. Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics. 2002 Jul;110(1 Pt 2):229-35.

OBJECTIVE: The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices. STUDY DESIGN: A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics. RESULTS: A total of 940 providers responded (response rate: 19%-33%). The majority recommended "changes in eating patterns" and "limitations of specific foods." Half or more used "low-fat diet" and "modest calorie restriction" in adolescents. Less than 15% used "very low-calorie diet." Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified. CONCLUSIONS: The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.

6388. Bauer-Wu SM. Psychoneuroimmunology. Part II: Mind-body interventions. Clin J Oncol Nurs. 2002 Jul-Aug;6(4):243-6. Review.

PNI provides the scientific foundation of several integrative therapies. PNI interventions or mind-body therapies can be categorized into four general mechanisms: sensory, cognitive, expressive, and physical. Some therapies are used in combination, and others incorporate more than one mechanism. Although PNI is limited as a purely biomedical framework, it is a valuable frame of reference because it supports the use of many integrative therapies for patients with cancer.

6389. Bielory L. 'Complementary and alternative medicine' population based studies: a growing focus on allergy and asthma. Allergy. 2002 Aug;57(8):655-8. Review. No abstract.

6390. Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth AM. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopath Assoc. 2002 Jul;102(7):371-5; discussion 375.

In this pilot study, the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma. The research followed a pretest-posttest crossover design wherein each subject served as her own control. Blinded examiners recorded respiratory excursion, peak expiratory flow rates, and subjective measures of asthma symptoms. Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures. Changes in peak expiratory flow rates and asthma symptoms were not statistically significant.

6391. Brokaw JJ, Tunnicliff G, Raess BU, Saxon DW. The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors. Acad Med. 2002 Sep;77(9):876-81.

PURPOSE: The number of U.S. medical schools offering courses in complementary and alternative medicine (CAM) has risen sharply in recent years. This study gauged the current state of CAM instruction by gathering details about the specific topics being taught and the objectives behind the instruction. METHOD: Data were collected from questionnaires mailed to 123 CAM course directors at 74 U.S. medical schools. RESULTS: Questionnaires were returned by 73 course directors at 53 schools. The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). The amounts of instructional time devoted to individual CAM topics varied widely, but most received about two contact hours. The "typical" CAM course was sponsored by a clinical department as an elective, was most likely to be taught in the first or fourth year of medical school, and had fewer than 20 contact hours of instruction. Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribes of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness. CONCLUSION: A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.

6392. Bruce JC. Marrying modern health practices and technology with traditional practices: issues for the African continent. Int Nurs Rev. 2002 Sep;49(3):161-7.

One of the main sessions at the 2001 22nd Quadrennial Congress of the International Council of Nurses in Denmark explored the harnessing of modern health technologies for contemporary health care. The session theme of 'marrying the old and the new' is particularly important in societies where modern medicine and technology coexist with traditional approaches to health care; in this instance, its coexistence with traditional medicine in African societies. This coexistence has not been easy for many African countries. For some, overt exclusion from health care systems through prohibitive legislation has become the order of the day for traditional practitioners. On the other hand, there has been an increasing interest in traditional practices among modern health practitioners and a willingness to collaborate. Similarly, traditional practitioners are slowly beginning to incorporate aspects of modern medicine into their practice; notably the use of science and technology. This report describes the interface of modern medicine and technologies with traditional approaches to health care. Benefits and concerns raised by genetic, information, solar and environmental technologies at this interface, are discussed. Selected traditions and the challenges these bring to the practice arena, research, education and policy, are presented together with suggestions to reconcile old and new.

6393. Chiradejnant A, Latimer J, Maher CG. Forces applied during manual therapy to patients with low back pain. J Manipulative Physiol Ther. 2002 Jul-Aug;25(6):362-9.

BACKGROUND: To date, there is little information available regarding the forces used during mobilization treatment of patients with low back pain (LBP). OBJECTIVE: This study measured such forces and investigated whether the force characteristics could be predicted on the basis of physical therapist and patient characteristics. SUBJECTS: Ten physical therapists applied a central posteroanterior (PA) mobilization treatment to 80 patients with LBP, providing data on treatment of 123 lumbar levels. METHODS: Physical therapists were required to treat their patients while the patients lay on an instrumented couch. This couch has been shown to be highly accurate in its measurement of force in 3 directions (error <2%) and has demonstrated high test-retest reliability (ICC [2, 1], 99% CI = 0.99-1.00). The forces applied by the physical therapists were recorded over a 10-second period. Data on the characteristics of the physical therapists and patients were collected by means of questionnaires. RESULTS: The force used by physical therapists related not only to patient characteristics but also to physical therapist characteristics. Interestingly, current pain intensity and nature of symptoms did not affect the forces used. The overall patterns of the force characteristics were generally consistent with previous studies performed in asymptomatic subjects. However, the magnitude of the force applied and the frequency of each grade used in the present study are relatively higher than in earlier studies. CONCLUSION: These preliminary data provide some useful quantitative information about the forces used during mobilization treatment of patients with LBP. Also, the force characteristics described here may provide useful data for both teaching and research in manual therapy.

6394. Contestabile MT, Recupero SM, Palladino D, De Stefanis M, Abdolrahimzadeh S, Suppressa F, Balacco Gabrieli C. A new method of biofeedback in the management of low vision. Eye. 2002 Jul;16(4):472-80.

Twenty-eight patients with low vision were enrolled into the study. A preliminary study was carried out on 18 eyes of 13 patients with low vision who underwent visual rehabilitation with a new instrument for biofeedback (BF) applied to vision; improved biofeedback integrated system (Ibis). Successively, eight patients (16 eyes) with bilateral low vision were subjected to biofeedback in one eye. The experimental and control eye were evaluated separately. Then a placebo training was developed on seven patients (12 eyes). Visual acuity, colour vision, automated perimetry, contrast sensitivity and flash VEP were evaluated. A brief review of the literature and the possible mechanisms behind the results are discussed.

6395. Couper RT. Complementary therapies and children. J Paediatr Child Health. 2002 Aug;38(4):339-40. No abstract.

6396. Cunningham E. Do cranberries aid in the treatment of urinary tract infections? J Am Diet Assoc. 2002 Aug;102(8):1118. No abstract.

6397. Day AS. Use of complementary and alternative therapies and probiotic agents by children attending gastroenterology outpatient clinics. J Paediatr Child Health. 2002 Aug;38(4):343-6.

OBJECTIVES: Complementary and alternative medicines (CAM) and probiotic therapies appear to be increasingly accepted and used. This questionnaire-based study aimed to ascertain the frequency of use and the acceptance of these therapies by children attending outpatient gastroenterology clinics. METHODS: Parents accompanying children to their appointments were asked to complete a questionnaire in order to determine usage of probiotic and alternative therapies. Questions also ascertained relevant background information and parental acceptance of alternative therapies. RESULTS: Ninety-two questionnaires were completed. The ages of the children varied from 6 months to 16 years (mean +/- SD; 6.5 +/- 4.3 years) and they had been prescribed an average of 1.7 +/- 1.3 (range 0-6) conventional medications. Thirty-three children (35.9%) were taking CAM and 98.6% of parents answered that they would be prepared to administer CAM to their child. Symptomatic improvements were attributed to CAM by the parents of 24 out of 33 children given these therapies. In addition, probiotic therapies were utilized by 23.8% of children, and 93.0% of parents would administer probiotic agents if recommended for their child's condition. CONCLUSION: Complementary and alternative medicines and probiotic therapies are used frequently by children attending gastroenterology clinics and are accepted widely by their parents.

6398. DiGianni LM, Garber JE, Winer EP. Complementary and alternative medicine use among women with breast cancer. J Clin Oncol. 2002 Sep 15;20(18 Suppl):34S-8S. Review.

Complementary and alternative medicine (CAM) use has increased in recent years, with at least 42% of individuals in the United States using some form of CAM in 1997. CAM includes a variety of modalities, ranging from nutritionally based interventions to behavioral techniques. This article reviews the status of CAM use among women with breast cancer. Patients are increasingly incorporating CAM into cancer prevention and treatment regimens. The prevalence of CAM use by breast cancer patients varies; however, it is typically higher than among individuals in the general population. Commonly used CAMs among women with breast cancer include nutritional/dietary supplements, relaxation strategies, and various types of social support groups. Apart from psychosocial interventions, little scientific evidence exists regarding the efficacy of CAM use for breast cancer patients. A common theme seen in many studies is that CAM use in women with breast cancer is highly correlated with increased psychosocial distress.

6399. Eisenberg L. Complementary and alternative medicine: what is its role? Harv Rev Psychiatry. 2002 Jul-Aug;10(4):221-30. Review.

Complementary and alternative medicine (CAM) remedies vary greatly in safety and effectiveness. Then why is their use increasing at a time when evidence for the effectiveness of "orthodox" treatments is greater than ever before? Dazzled by technology, physicians dismiss "nonspecific" treatment effects as mere "placebo" and ignore the effects of caring. Over half of patients with anxiety or depression consult CAM practitioners in any given year. The popularity of CAM attests to its responsiveness to patients' search for more than procedurally oriented care. It reflects biomedicine's failure to give patients the time they need to tell their story and to explain the nature of problems they face, and its failure to provide sufficient information to allow patients their choice among therapeutic alternatives. Effective CAM practices should be incorporated into care, whether treatments are provided by biomedical or CAM practitioners.

6400. Ernst E, Schmidt K. 'Alternative' cancer cures via the Internet? Br J Cancer. 2002 Aug 27;87(5):479-80. No abstract.

6401. Foley CL, Bott SR, Arya M, Kirby RS. Benign prostatic hyperplasia: solutions to an ageing problem. Hosp Med. 2002 Aug;63(8):460-4. Review.

As the population ages, the demand for treatment of the symptoms of benign prostatic hyperplasia has never been higher. Equally the choice of treatments has never been greater. This review considers the medical and surgical options.

6402. Gaudet TW, Snyderman R. Integrative medicine and the search for the best practice of medicine. Acad Med. 2002 Sep;77(9):861-3. No abstract.

6403. Greenfield S. Mind, brain and consciousness. Br J Psychiatry. 2002 Aug;181:91-3. No abstract.

6404. Hansen G. The role of massage in the care of the critically ill. Nurs N Z. 2002 Aug;8(7):14-6. Review. No abstract.

6405. Holden C. Alternative medicine. NIH trial to test chelation therapy. Science. 2002 Aug 16;297(5584):1109. No abstract.

6406. Kaberi-Otarod J, Conetta R, Kundo KK, Farkash A. Ischemic stroke in a user of thermadrene: a case study in alternative medicine. Clin Pharmacol Ther. 2002 Sep;72(3):343-6.

A case of a young user of Thermadrene (SportPharma USA, Inc, Concord, Calif), an herbal remedy for weight loss, was studied. We believe that Thermadrene can cause serious complications such as ischemic stroke. Because these remedies are available over the counter and are not regulated by the Food and Drug Administration or similar organizations, there is a need for critical scrutiny of their content and side effects, as is performed for other pharmaceuticals.

6407. Kennedy JE, Abbott RA, Rosenberg BS. Changes in spirituality and well-being in a retreat program for cardiac patients. Altern Ther Health Med. 2002 Jul-Aug;8(4):64-6, 68-70, 72-3.

CONTEXT: Many epidemiological studies indicate that spirituality or religion are positively correlated with health measures, but research is needed on interventions that change spirituality to verify that it actually affects health and to justify suggestions that changes in spiritual practices or beliefs may have health benefits. However, it is not clear that health interventions can influence spirituality or which techniques are effective. OBJECTIVE: To evaluate whether participation in a retreat program for cardiac patients and their partners resulted in changes in spirituality and whether changes in spirituality were related to changes in well-being meaning in life, anger, and confidence in handling problems. DESIGN: Participants filled out questionnaires before and after participating in the retreat. SETTING: Retreats were sponsored by the Health Promotion and Wellness Program, University of Wisconsin-Stevens Point, and were held in a remote training center. PARTICIPANTS: Notices were sent to cardiac rehabilitation programs and directly to heart patients, resulting in the enrollment of 72 first-time participants. INTERVENTION: The 2.5-day educational retreats included discussion and opportunities to experience healthy lifestyle options. Exercise, nutrition, stress management techniques, communication skills that enhance social support, and spiritual principles of healing were incorporated. Experiential practices included yoga, meditation, visualization, and prayer. RESULTS: Of the participants, 78% reported increased spirituality after the retreat. Changes in spirituality were positively associated with increased well-being meaning in life, confidence in handling problems, and decreased tendency to become angry. CONCLUSIONS: Programs that explore spirituality in a health context can result in increased spirituality that is associated with increased well-being and related measures. Many patients and their families want to integrate the spiritual and health dimensions of their lives. Further work is needed to develop healthcare settings that can support this integration.

6408. Lamberg L. Mind-body medicine explored at APA meeting. JAMA. 2002 Jul 24-31;288(4):435-9. No abstract.

6409. Lawson KL, Horneffer KJ. Roots and wings: a pilot of a mind-body-spirit program. J Holist Nurs. 2002 Sep;20(3):250-63.

The overwhelming supply and demand for holistic health information and services suggest the need for integrative medical centers to offer experientially based educational programs. Seventeen individuals participated in a pilot of a 12-week multidisciplinary program titled Roots and Wings. Self-reported pre- and postmeasures were completed by 11 participants and indicated promising outcomes across the dimensions of physical, emotional, and spiritual health. Participants had a statistically significant decrease in physical and psychological symptoms and an increase in daily spiritual experiences. Statistically significant positive changes were also found for psychological attitudes and health locus of control in addition to indicators of behavior, satisfaction and attitudes relevant to the goals of Roots and Wings. The content of the program and the implications of these findings for nurse educators are discussed.

6410. Lodi G, Sardella A, Bez C, Demarosi F, Carrassi A. Systematic review of randomized trials for the treatment of oral leukoplakia. J Dent Educ. 2002 Aug;66(8):896-902. Review.

Oral leukoplakia is a relatively common oral lesion that, in a varying proportion of cases, undergoes malignant transformation. The aim of this review was to assess the effectiveness of treatments for leukoplakia. Randomized controlled trials (RCTs) enrolling patients with a diagnosis of oral leukoplakia were identified by searching biomedical databases, hand-searching relevant oral medicine journals, and contacting oral medicine experts through a European mailing list. The methodological quality of included studies was assessed on the basis of the method of allocation concealment, blindness of the study, and loss of participants. Data were analyzed by calculating relative risk. Malignant transformation of leukoplakia, demonstrated by histopathological examination, was the main outcome considered. Secondary outcomes included clinical resolution of the lesion and variation in dysplasia severity. Six RCTs were included in the review. Vitamin A and retinoids were tested in four RCTs; the other agents tested were bleomycin, mixed tea, and beta carotene. Malignant transformation was recorded in just two studies: none of the treatments tested showed a benefit when compared with placebo. Treatment with beta carotene and vitamin A or retinoids was associated with better rates of clinical remission, compared with placebo or absence of treatment. Whenever reported, a high rate of relapse was a common finding. Side effects of variable severity were often described; however, interventions were well accepted by patients since drop-out rates were similar between treatment and control groups. It is noteworthy that the possible effectiveness of surgical interventions, including laser therapy and cryotherapy, has apparently never been studied by means of an RCT. To date, in conclusion, there is no evidence of effective treatment in preventing malignant transformation of leukoplakia. Treatments may be effective in the resolution of lesion; however, relapses and adverse effects are common.

6411. Maizes V, Schneider C, Bell I, Weil A. Integrative medical education: development and implementation of a comprehensive curriculum at the University of Arizona. Acad Med. 2002 Sep;77(9):851-60. Review.

Dissatisfaction with the U.S. health care system is increasing despite impressive technologic advances. This dissatisfaction is one factor that has led patients to seek out complementary and alternative medicine (CAM) and led medical schools to start teaching CAM. This paper focuses on the University of Arizona's approach to developing and implementing a comprehensive curriculum in integrative medicine. Integrative medicine is defined much more broadly than CAM. It is healing-oriented medicine that reemphasizes the relationship between patient and physician, and integrates the best of complementary and alternative medicine with the best of conventional medicine. Since its inception in 1996, the Program in Integrative Medicine (PIM) has grown to include a two-year residential fellowship that educates four fellows each year, a distance learning associate fellowship that educates 50 physicians each year, medical student and resident rotations, continuing medical and professional education, an NIH-supported research department, and an active outreach program to acilitate the international development of integrative medicine. The paper describes the PIM curriculum, educational programs, clinical education, goals, and results. Future strategies for assessing competency and credentialing professionals are suggested.

6412. Mills PJ, Farag NH, Newton RP, Parry BL. Effects of a traditional herbal supplement on anxiety in patients with generalized anxiety disorder. J Clin Psychopharmacol. 2002 Aug;22(4):443-4. No abstract.

6413. Newton KM, Buist DS, Keenan NL, Anderson LA, LaCroix AZ. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol. 2002 Jul;100(1):18-25.

OBJECTIVE: To describe self-reported prevalence of the use of alternative therapies for menopause symptoms and subject characteristics associated with their use. METHODS: A telephone survey of 886 women aged 45-65 years (87.2% response rate) was conducted at Group Health Cooperative in Washington state. Women were asked about eight alternative therapies and their use for menopause symptoms. RESULTS: The proportion of women who used each therapy was 76.1% for any therapy, 43.1% for stress management, 37.0% for over-the-counter alternative remedies, 31.6% for chiropractic, 29.5% for massage therapy, 22.9% for dietary soy, 10.4% for acupuncture, 9.4% for naturopath or homeopath, and 4.6% for herbalists. The proportion of women who used it to manage menopause symptoms was 22.1% for any therapy, 9.1% for stress management, 13.1% for over-the-counter alternative remedies, 0.9% for chiropractic, 2.6% for massage therapy, 7.4% for dietary soy, 0.6% for acupuncture, 2.0% for naturopath or homeopath, and 1.2% for herbalists. Among women who used these therapies, 89-100% found them to be somewhat or very helpful. A history of breast cancer was associated with a six-fold increase in use of dietary soy for menopause symptoms (odds ratio 6.23, 95% confidence limits 2.54, 15.28). Current users of hormone replacement therapy were half as likely to use alternative remedies or providers (odds ratio 0.48, 95% confidence limits 0.29, 0.77) as were never users. Sleep disturbances were associated with a four-fold increase in the use of body work, a three-fold increase in the use of stress management, and more than doubled the use of dietary soy products to manage menopause symptoms. CONCLUSION: The use of alternative therapies for menopause symptoms is common, and women who use them generally find them to be beneficial. Physicians should routinely ascertain perimenopausal women's use of alternative therapies.

6414. Pal SK. Use of alternative cancer medicine in India. Lancet Oncol. 2002 Jul;3(7):394-5. No abstract.

6415. Pizzorno JE Jr. Survey of naturopathic physicians: implications and recommendations. Altern Ther Health Med. 2002 Jul-Aug;8(4):38-9. No abstract.

6416. Raguram R, Venkateswaran A, Ramakrishna J, Weiss MG. Traditional community resources for mental health: a report of temple healing from India. BMJ. 2002 Jul 6;325(7354):38-40. No abstract.

6417. Schafer T, Riehle A, Wichmann HE, Ring J. Alternative medicine in allergies - prevalence, patterns of use, and costs. Allergy. 2002 Aug;57(8):694-700.

BACKGROUND: There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies. METHODS: A population-based nested case-control study was conducted in 2000-01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM. RESULTS: 26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p=0.004) and better educated (school education > 8 year vs<or= 8 year; odds ratio (OR) 2.17, 1.28-3.67) and was mostly motivated by the assumption of few side-effects (78.3%), by a wish to try everything (71.7%), and by unsatisfying results from conventional therapy (66.3%). Users also had more experience with conventional therapy than nonusers (94.6% vs 63.6%; OR 10.10, 4.00-25.72). Four procedures accounted for almost the entire usage: homeopathy (35.3%), autologous blood injection (28.1%), acupuncture (16.6%), and bioresonance (10.0%). The AM were mostly promoted (40.2%) and provided (60.9%) by medical doctors, and produced median costs for single and entire treatment of 4 (15-205) and 205 (15-1278) euros. Reimbursement from insurance companies was received by 52.3%, in full (37.8%) or partial (14.5%). Most subjects (55.4%) admitted that they would pay more (median 153 euros) for the achieved result. Users scored the efficacy of conventional therapy significantly lower (p<0.001) than nonusers, and assessed the results of AM as very good (28.6%) or rather good (53.8%). CONCLUSIONS: AM is used widely for allergies by the general population and is associated with considerable costs. This has implications for the health care system and health policy.

6418. Schneider J. Hospitals get alternative. Acupuncture, massage, and even herbs pop up in mainstream medical settings. US News World Rep. 2002 Jul 22;133(3):68, 70. No abstract.

6419. Standish LJ, Greene K, Greenlee H, Kim JG, Grosshans C. Complementary and alternative medical treatment of breast cancer: a survey of licensed North American naturopathic physicians. Altern Ther Health Med. 2002 Sep-Oct;8(5):68-70; 72-5.

CONTEXT: Complementary and alternative medicine (CAM) use is on the rise in the United States, especially for breast cancer patients. Many CAM therapies are delivered by licensed naturopathic physicians using individualized treatment plans. OBJECTIVE: To describe naturopathic treatment for women with breast cancer. DESIGN: Cross-sectional mail survey in 2 parts: screening form and 13-page survey. SETTING: Bastyr University Cancer Research Center, Kenmore, Wash. PARTICIPANTS: All licensed naturopathic physicians in the United States and Canada (N=1,356) received screening forms; 642 (47%) completed the form. Of the respondents, 333 (52%) were eligible, and 161 completed the survey (48%). MAIN OUTCOME MEASURES: Demographics of naturopathic physicians, development of treatment plans, CAM therapies used, perceived efficacy of therapeutic interventions. RESULTS: Of those respondents screened, 497 (77%) had provided naturopathic care to women with breast cancer, and 402 (63%) had treated women with breast cancer in the previous 12 months. Naturopaths who were women were more likely than men to treat breast cancer (P < or = .004). Of the survey respondents, 104 (65%) practiced in the United States, and 57 (35%) practiced in Canada; 107 (66.5%) were women, and 54 (33.5%) were men. To develop naturopathic treatment plans, naturopathic physicians most often considered the stage of cancer, the patient's emotional constitution, and the conventional therapies used. To monitor patients clinically, 64% of the naturopathic physicians used diagnostic imaging, 57% considered the patient's quality of life, and 51% used physical examinations. The most common general CAM therapies used were dietary counseling (94%), botanical medicines (88%), antioxidants (84%), and supplemental nutrition (84%). The most common specific treatments were vitamin C (39%), coenzyme Q-10 (34%), and Hoxsey formula (29%).

6420. Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psychiatry. 2002 Jul-Aug;24(4):238-48.

Increasing numbers of women with breast cancer are seeking alternatives to standard group support in coping with their illness. This study examines outcomes for 181 women with breast cancer randomized to either a 12-week standard group support or a 12-week complementary and alternative medicine (CAM) support intervention. Participants in the CAM group were taught the use of meditation, affirmation, imagery and ritual. The standard group combined cognitive-behavioral approaches with group sharing and support. Both interventions were found to be associated with improved quality of life (CAM, P=0.008; Standard, P=0.006), decreased depression (CAM, P=0.004; Standard, P=0.02), decreased anxiety (CAM, P=0.0003; Standard, P=0.02) and increased "spiritual well-being" (CAM, P=002; Standard, P=0.003). Only the CAM group showed increases in measures of Spiritual Integration (P=0.001) which were also significant between groups (P=0.003). The Standard group was associated with decreased confusion (P=0.01) and decreased helplessness/hopelessness (P=0.01), while the CAM group was associated with decreased avoidance (P=0.01). None of these latter changes were significant between groups. At baseline, very high correlations were noted between measures of quality of life, mood, and spiritual integration. At the end of the intervention, the CAM group showed higher satisfaction (P=0.006) and fewer dropouts (P=0.006) compared to the standard group. Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit (r=-.39, P=0.001). No baseline factors predicted better outcomes in the Standard group. In summary, the study found equivalence on most psychosocial outcomes between the two interventions.

6421. Vogelzang JL. Using special foods and supplements as alternative cancer treatments. Home Healthc Nurse. 2002 Jul;20(7):431-3. No abstract.

Aromatherapy:

6422. Ballard CG, O'Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry 2002 Jul;63(7):553-8

BACKGROUND: Behavioral and psychological symptoms in dementia are frequent and are a major management problem, especially for patients with severe cognitive impairment. Preliminary reports have indicated positive effects of aromatherapy using select essential oils, but there are no adequately powered placebo-controlled trials. We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia. METHOD: Seventy-two people residing in National Health Service (U.K.) care facilities who had clinically significant agitation in the context of severe dementia were randomly assigned to aromatherapy with Melissa essential oil (N = 36) or placebo (sunflower oil) (N = 36). The active treatment or placebo oil was combined with a base lotion and applied to patients' faces and arms twice a day by caregiving staff. Changes in clinically significant agitation (Cohen-Mansfield Agitation Inventory [CMAI]) and quality of life indices (percentage of time spent socially withdrawn and percentage of time engaged in constructive activities, measured with Dementia Care Mapping) were compared between the 2 groups over a 4-week period of treatment. RESULTS: Seventy-one patients completed the trial. No significant side effects were observed. Sixty percent (21/35) of the active treatment group and 14% (5/36) of the placebo-treated group experienced a 30% reduction of CMAI score, with an overall improvement in agitation (mean reduction in CMAI score) of 35% in patients receiving Melissa balm essential oil and 11% in those treated with placebo (Mann-Whitney U test; Z = 4.1, p < .0001). Quality of life indices also improved significantly more in people receiving essential balm oil (Mann-Whitney U test; percentage of time spent socially withdrawn: Z = 2.6, p =.005; percentage of time engaged in constructive activities: Z = 3.5, p = .001). CONCLUSION: The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinically significant agitation in people with severe dementia, with additional benefits for key quality of life parameters, indicates the need for further controlled trials.

Ayurveda

6423. Ahuja D; Ahuja N; Kumar. Breast fed babies are the best fed babies Antiseptic. 2002 Jul; 99(7): 260.

ABSTRACT: Breast feeding continues to have practical and psychological advantages. Human milk is most appropriate for the human infant. The composition of human milk is unique and adopted to the demand of growing offspring. It provides specific nutritional support to meet the rapid growth of the newborn. It provides the essential nutrients such as protein, fat, carbohydrates, minerals and vitamins

6424. Goel RK; Sairam K. Anti-ulcer drugs from indigenous sources with emphasis on musa sapientum, tamarabhasma, asparagus racemosus and zingiber officinale Indian Journal of Pharmacology. 2002 Apr; 34(2): 100-10.

ABSTRACT: Sula, Parinamasula and Amlapitta are clinical entities recognized by ayurveda, akin to peptic ulcer and functional dyspepsia. Many indigenous drugs have been advocated in ayurveda for treatment of dyspepsia. Our laboratory has been engaged in screening of various indigenous herbal and metallic drugs for their potential use in peptic ulcer diseases , taking lead from Ayurveda and have reported anti-ulcer and ulcer-healing properties of Tectona grandis (lapachol), Rhamnus procumbens (kaempferol), Rhamnus triquerta (emodin), Withania somnifera (acylsteryl glycoside), Shilajit (fulvic acid and carboxymethoxybiphenyl), Datura fastuosa (withafastuosin E), Fluggea microcarpa and Aegle marmelos (pyrano-and iso-coumarins) etc., along with their mechanism of action. The present article includes the detailed exploration of ulcer protective and healing effects of unripe plantain banana, tambrabhasma and Asparagus racemosus on various models of experimental gastroduodenal ulceration and patients with peptic ulcer. Their effects on mucin secretion, mucosal cell shedding, cell proliferation, anti-oxidant activity, glycoproteins, and PG synthesis have been reported. Clinical trials of these drugs for evaluating their potential ulcer healing effects in peptic ulcer patients have been done. Their potential ulcer protective effects both, experimental and clinical seemed to be due to their predominant effects on various mucosal defensive factors rather than on the offensive acid-pepsin secretion. Thus, the above herbal/herbo-mineral drugs do have potential usefulness for treatment of peptic ulcer diseases.

6425. Herron RE, Fagan JB. Lipophil-mediated reduction of toxicants in humans: an evaluation of an ayurvedic detoxification procedure. Altern Ther Health Med. 2002 Sep-Oct;8(5):40-51.

CONTEXT: Lipophilic toxicants have been associated with hormone disruption, immune system suppression, reproductive disorders, several types of cancer, and other diseases. Due to environmental persistence and bioaccumulation, body burdens of certain toxicants, such as dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs), appear to be a health risk despite the toxicants' having been banned for decades. OBJECTIVE: To determine whether a safe, standardized, Ayurvedic detoxification procedure can mobilize lipid-soluble toxicants and stimulate their excretion. DESIGN: Cross-sectional and longitudinal evaluations. SETTING: Southeastern Iowa. PARTICIPANTS: In the cross-sectional study, 48 participants who had undertaken lipophil-mediated detoxification were compared with 40 control subjects. In the prospective, longitudinal evaluation, serum levels were measured in 15 subjects before and after they underwent the detoxification procedure. These 15 subjects served as their own controls. INTERVENTION(S): Ayurvedic lipophil-mediated detoxification procedure. MAIN OUTCOME MEASURE: Gas chromatographic analysis of 17 serum toxicant levels (9 PCB congeners and 8 pesticides or metabolites) on a lipid-adjusted and wet-weight basis (ng/g) as parts per billion. RESULTS: In the cross-sectional study, gas chromatographic analysis of 9 PCB congeners and 8 pesticides revealed that serum PCB levels were significantly lower in the detoxification subjects than in controls. Trans-nonachlor (TNC), p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE), oxychlordane, and hexachlorobenzene (HCB) levels were also markedly lower in the detoxification group. All subjects had undetectable levels of p,p'-DDT, lindane, and a-hexachlorocyclohexane (a-HCH). Beta-hexachlorocyclohexane (beta-HCH) levels were significantly higher in detoxification subjects than in controls. In the longitudinal evaluation, after treatment, mean levels of PCBs (46%) and beta-HCH (58%) declined significantly in the subjects. CONCLUSIONS: The higher beta-HCH levels in the subjects in the longitudinal study appear to be an anomaly related to diet. The results of the 2 studies generally suggest that lipophil-mediated detoxification may be effective in reducing body burdens of fat-soluble toxicants. As numerous people worldwide are at risk from high body burdens of such lipid-soluble agents, further studies to evaluate this procedure appear warranted.

6426. Irvine KN, Warber SL. Greening healthcare: practicing as if the natural environment really mattered. Altern Ther Health Med. 2002 Sep-Oct;8(5):76-83. Review.

OBJECTIVE: The natural world's role in human well-being is an essential, yet often forgotten, aspect of healthcare. Of particular importance are the benefits one can derive through interaction with natural environments. While health is an obvious goal of allopathic medicine, many healthcare settings are neither nurturing nor healing. Reincorporating the natural world into the design of settings in which medicine is practiced is one way to complement conventional healing modalities and move healthcare toward being more "green." This article discusses the breadth of existing knowledge available on the positive aspects of interaction with nature and provides a comprehensive theoretical perspective for future research. DATA SOURCES: Computerized searches were conducted using MEDLINE, PsycINFO, the Social and Scientific Science Indices, Dissertation Abstracts, Lexus-Nexus, the University of Michigan library, and the Internet. Searches were conducted from June 2001 through March 2002. STUDY SELECTION: Keywords used included health, well-being stress, attention, nature, garden, landscape, restorative, and healing. The literature, published between 1960 and 2001, came from various disciplines, including medicine, public health, nursing psychology, natural resources, history, and landscape architecture. Four components of well-being were used as a framework for literature selection: physical psychological-emotional social, and spiritual. DATA EXTRACTION: Articles were qualitatively reviewed to extract theories, hypotheses, and experimental evidence. DATA SYNTHESIS: Interaction with nature positively affects multiple dimensions of human health. Physiological effects of stress on the autonomic nervous system are lessened. Psychologically, deficits in attention can be restored or minimized, and people report feeling greater satisfaction with a variety of aspects of life. The presence of the natural world promotes social health by encouraging positive social interaction and lessening the frequency of aggressive behavior. Spiritual well-being is enhanced through the experience of greater interconnectedness, which occurs when interacting with the natural world. CONCLUSIONS: The literature reviewed provides evidence to support the intuitive belief that interaction with the natural world is a vital part of biopsychosocial-spiritual well-being. Incorporating the natural world into healthcare could provide health benefits and improve the design of healthcare facilities. Applied more broadly to society, this knowledge may change the way we approach public health, guard and manage natural resources, and design environments for human use.

6427. Keating A, Chez RA. Ginger syrup as an antiemetic in early pregnancy. Altern Ther Health Med. 2002 Sep-Oct;8(5):89-91.

CONTEXT: Ginger (Zingiber officinale) has been used to ameliorate symptoms of nausea. A beverage containing ginger in a syrup may be easier to consume than a capsule or solid food. OBJECTIVE: To determine if ginger syrup mixed in water is an effective remedy for the relief of nausea and vomiting in the first trimester of pregnancy. DESIGN: Double-blind, placebo-controlled, randomized clinical trial. SETTING: Subjects were enrolled from the University of South Florida department of obstetrics and gynecology private practice office. PATIENTS: 26 subjects in the first trimester of pregnancy. INTERVENTION: Subjects ingested 1 tablespoon of commercially prepared study syrup (or placebo) in 4 to 8 ounces of hot or cold water 4 times daily. MAIN OUTCOME MEASURES: Duration and severity of nausea and vomiting over a 2-week period measured on a 10-point scale. RESULTS: After 9 days, 10 of the 13 (77%) subjects receiving ginger had at least a 4-point improvement on the nausea scale. Only 2 of the 10 (20%) remaining subjects in the placebo group had the same improvement. Conversely, no woman in the ginger group, but 7 (70%) of the women in the placebo group, had a 2-point or less improvement on the nausea scale. Eight of the 12 (67%) women in the ginger group who were vomiting daily at the beginning of the treatment stopped vomiting by day 6. Only 2 of the 10 (20%) women in the placebo group who were vomiting stopped by day 6. CONCLUSION: The ingestion of 1 g of ginger in syrup in a divided dose daily may be useful in some patients experiencing nausea and vomiting in the first trimester of pregnancy.

Herbal Medicine:

6428. Brokaw JJ, Tunnicliff G, Raess BU, Saxon DW. The teaching of complementary and alternative medicine in U.S. medical schools: a survey of course directors. Acad Med. 2002 Sep;77(9):876-81.

6429. Cheng TO. Interaction of herbal drugs with digoxin. J Am Coll Cardiol. 2002 Aug 21;40(4):838-9. No abstract.

6430. Davidson J. Botanical medicines for anxiety: do they have a place? Curr Psychiatry Rep. 2002 Aug;4(4):245-6. No abstract.

6431. Downey RP. Healing with flower essences. Beginnings. 2002 Jul-Aug;22(4):11-2. No abstract.

6432. Farooqi A H A, Fatima S, Sharma S, Sushil Kumar. Recent trends in the development of herbal formulations from medicinal plants for common use. J medicinal Aromatic PI Sci 2000/01; 22/23 (4A & 1A), 597-601.

Medicinal plants like Xanthoxylum armatum, Pistacia lentiscus, Zingiber officinale, Quercus infectoria, etc that are used in different tooth powders, have been reported. Dentifrices, containing glycosides of eugenol, raspberry ketone, isoeugenol and capsacin, etc., have been developed for different tooth ailments. Inspect repellents and slow burning insecticidal incenses and synergistic insecticides containing essential oils, pyrethrun and Azadirachtaindica extracts have also been formulated for cockroaches, mosquitoes, ants and for animals like rats and dogs, cosmetics containing glycyrrhizic acid have significantly improved depression and stress after menopause. Anti-aging skin cosmetics based on glycyrrhizic acid and polyalcohols have been patented. Soe health-foods and neutraceuticals have been developed using medicinal plants like Aloe vera. Antidiabetic formulations containing fenugreek, Syzygium cumini, Azadarachita indica, bitter gourd, etc. have been patented. A number of research groups are currently actively engaged, worldwide, at various research centres, in improving and developing such formulations. CIMAP too has contributed to the field by way of the development and patenting of a range of insect repellents, skin ointments/creams, dental hygiene products, pain balms, pesticides and antidiabetic formulations.

6433. Goel RK; Sairam K. Anti-ulcer drugs from indigenous sources with emphasis on musa sapientum, tamarabhasma, asparagus racemosus and zingiber officinale Indian Journal of Pharmacology. 2002 Apr; 34(2): 100-10

6434. Kanjilal P B, Singh R S, Bordoloi S. Effect of planting density and time of planting of growth and herb yield of Wedelia calendulacea, a traditional medicinal plant. J medicinal Aromatic PI Sci 2000/01; 22/23 (4A & 1A), 370-2.

Field trial was conducted at Regional Research Laboratory, Jorhat, Assam, during 1997-99 on Wedelia calendulacea (Family: Asteraceae), a traditional medicinal plant, in order to study the effect of planting density and time of plantation on yield of herbs under the agro-climatic condition of Jorhat, Assam. The highest fresh and dry herb yields in respect of (10.7 t/ha and 3.5 t/ha respectively) were obtained with 60 x 60 cm spacing. No definite trend was observed in respect of the effect of planting time on growth and herb yield. However, the best overall growth, viz., plant height, number of branches / plant, number of sucker plant, leaf area/m² and herb yield, was exhibited if planting was done in the month of May.

6435. Kasera P K, Shukla J K, Jai Prakash, Saharan P, Chawan D D. Biology, conservation and mediculture of important medicinal plants from Indian thar desert. J medicinal Aromatic PI Sci 2000/01; 22/23(4A & 1A), 432-43.

Air layering experiments on Commiphora wightii have revealed that guggul solution (500 and 1000 ppm) to be more suitable for initiation of roots and increasing the length of roots and survival rate under field conditions than other treatments. Soil mixture made up of sand: clay: FYM (1:1:1) gave good height and aboveground biomass of this plant. Seeds sown during 20-30 June gave maximum emergence of seedlings. Conc. H₂SO₄ (25 min) and mechanical scarification helped in breaking the hard seed coat dormancy of Evolvulus alsinoides. Plants treated with NPK, FYM, hexameal and their combinations showed better growth performance over control under field conditions. Freshly harvested seeds of Leptademia reticulata showed 93.33% germination under control conditions, while cent percent germination was observed in seeds pretreated with 50% H₂SO₄ for 2 min, soaked for 24 h in tap water and in hot water (55-60⁰C) for 2 and 5 min. The survival percentage of air layered twigs treated with Ceradik was high as compared to control under field confitions.

6436. Mehmood Z, Mohammad F, Ahmed I, Ahmad S. Herbal formulations based on Indian medicinal plants. J medicinal Aromatic PI Sci 2000/01, 22/23 (4A & 1A), 522-7.

Antimicrobial potential of some Indian medicinal plants and their formulations has been studied. Twenty – five different formulations based on five alcoholic extracts were tested against several pathogenic microorganisms. Ten formulations showed higher potency compared their constituents. They showed good synergistic activity, leading to significant reduction in the MIC values of the formulations. All the 10 formulations which showed higher potency than their individual constituents were also tested for their cytotoxicity using sheep erythrocytes and found to be non-toxic.

6437. Natarajan D, John Britto S, Selvaraj R, Arockiasamy DI. Effect of extracts of two medicinal plants on some phytopathogenic fungi. Geobios, Jodhpur. 2001; 28(4), 223-4.

Abstract: Efficacy of extracts from Coleus aromaticus (leaf) and Curcuma domestica (rhizome) when tested against Alternaria solani and Fusarium oxysporum f. sp. coriandri showed a slow but significant inhibition of growth in C. aromatics, whereas in C. domestica, a sudden decrease in growth of the fungi was noticed.

6438. Sharma S S, Gill K, Malik M S, Malik O P. Insecticidal, antifeedant and growth inhibitory activities of essential oils of some medicinal plants. J medicinal Aromatic PI Sci 2000/01; 22/23(4A & 1A), 373-7.

Insecticidal, antifeedant and growth inhibitory activities of essential oils of Callistemon lanceolatus, Cymbopogon winterianus, Eucalyptus sp., Lantana camara, Nerium oleander, Ocimum basilicum, Ocimum sanctum and Vitex negundo were studied against third instar larvae of Spodoptera litura. Under no choice assay, no feeding was observed at all the concentrations in the case of Ocimum sanctum and at 10 percent concentration in Callistemon lanceolatus, Cymbopogon winterianus and Ocimum basilicum. Under choice assay treatment, Ocimum sanctum and Ocimum basilicum showed 100 per cent activity. Twenty percent larval mortality was also recorded in Ocimum sanctum at 10 per cent concentration after 48 h of exposure. Reduced feeding resulted in significant losses in weights of larvae and pupae. The larval period increased, whereas the adult emergence was reduced.

6439. Singh BL, Singh DV, Verma RK, Gupta MM, Jain DC, Sushil Kumar. Simultaneous determination of antimalarial artemisinin, dihydroartemisinin and arteenther using reversed phase high performance liquid chromatography. J Indian chem. Soc 2001; 78(9): 489-91.

Abstract: Simple and rapid reverse phase HPLC method using photodiode array detection has been developed for simultaneous quantitation of a-arteether (3a), b-arteether, its chemical precursor artemisinin and intermediate a-dihydroartemisinin (DHA) and b-dihydroartemisinin. The method is capableof separating two isomeric forms of DHA (a,b), arteether (a,b) artemisinin in a single run. The method is suitable for monitoring the reaction product in the preparation of arteether using artemisinin via dihydroartemisinin.

6440. Vaidya R R, Dhumal K N. Physiological investigation in Microstylis versicolor – a rare medicinal plant of Mahabaleshwar. J. medicinal Aromatics PI Sci 2000/01; 22/23 (4A & 1A), 314-15. No abstract.

6441. Verma S, Sharma R K, Srivastava D. Seed germination, viability and invigoration studies in medicinal plants of commercial value. J medicinal Aromatic PI Sci 2000/01; 22/23(4A & 1A), 426-8.

Poor seed germination was recorded in Glycyrrhiza glabra, Psoralea corilifolia, Rauvolfia serpentina, Chlorophytum borivilianum. Dormancy breaking treatments were found effective in Glycyrrhiza recording 88% germination on treatment with concentrated H₂SO₄ and Psoralea recording 90% germination on deep scratching of seed coat with a coarse sand paper. Assessment of seed viability through Tetrazolium test confirmed presence of viable embryos (>80%) in Chlorophytum. Frequent unstained (46.6%) and partially stained (41.3%) embryos recorded in Rauvolifa seeds confirmed presence of non viable embryos resulting in poor germination. Invigoration studies in Withania somnifera seeds pretreated with 100 ppm Gibberellic acid resulted in vigorous growth of seedlings in January under laboratory conditions.

Homeopathy:

6442. Suramanian P, Sunil Kumar. Standardization and quality control in homeopathic medicinal plants. J medicinal Aromatic PI Sci 2000/01; 22/23 (4A & 1A), 628-32.

Standardization of medicinal plants used in homeopathy would ensure uniformity and use of modern scientific method would rationalize their use and promote their wider acceptance. This is particularly important since only infinintensimal doses of active ingredients are used for manufacturing Homeopathic drugs, which makes it generally impossible to exercise analytical control over finished products. Hence, the quality of medicine in homeopathic system can be guaranted only through proper processing of the raw materials contained in them by implementing a quality control system.

Reflexology:

6443. Remington R. Calming music and hand massage with agitated elderly. Nurs Res 2002 Sep-Oct;51(5):317-23

BACKGROUND: Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care. OBJECTIVE: To examine whether modifying environmental stimuli by the use of calming music and hand massage affects agitated behavior in persons with dementia. METHOD: A four group, repeated measures experimental design was used to test the effect of a 10-minute exposure to either calming music, hand massage, or calming music and hand massage simultaneously, or no intervention (control) on the frequency and type of agitated behaviors in nursing home residents with dementia (N = 68). A modified version of the Cohen-Mansfield Agitation Inventory was used to record agitated behaviors. RESULTS: Each of the experimental interventions reduced agitation more than no intervention. The benefit was sustained and increased up to one hour following the intervention (F = 6.47, p<.01). The increase in benefit over time was similar for each intervention group. When types of agitated behaviors were examined separately, none of the interventions significantly reduced physically aggressive behaviors (F = 1.93, p=.09), while physically nonaggressive behaviors decreased during each of the interventions (F = 3.78, p< 01). No additive benefit resulted from simultaneous exposure to calming music and hand massage. At one hour following any intervention, verbally agitated behavior decreased more than no interventin. CONCLUSION: Calming music and hand massage alter the immediate environment of agitated nursing home residents to a calm structured surrounding, offsetting disturbing stimuli, but no additive benefit was found by combining interventions simultaneously.

Traditional Medicine:

6444. Lee R, Balick MJ. Micronesian massage and massage oils: ancient practice and contemporary medical therapy. Altern Ther Health Med. 2002 Sep-Oct;8(5):107-10. No abstract.

6445. Shoskes DA. Phytotherapy and other alternative forms of care for the patient with prostatitis. Curr Urol Rep. 2002 Aug;3(4):330-4.

Chronic prostatitis is a very common and poorly understood condition with significant impact on quality of life. Given the lack of proven efficacy of conventional therapies such as antibiotics, it is not surprising that patients have turned with increasing frequency to phytotherapy and other alternative treatments. Although alternative therapies are plentiful, few have been subjected to scientific scrutiny and prospective controlled clinical trials. This review discusses therapies commonly used by patients with prostatitis and focuses in detail on those with published data. These treatments include zinc, cernitin pollen extract (bee pollen), quercetin, saw palmetto (Serenoa repens), and acupuncture. Complementary therapies may indeed have much to offer patients, particularly those with chronic degenerative conditions in which allopathic therapies have proven less successful. Alternative therapies, however, require the same scientific criteria for validation and acceptance as do conventional medical therapies.

Yoga:

6446. Khare KC; Rai S Study of lipid profile in post myocardial infarction subjects following yogic life style intervention Indian Practitioner. 2002 Jun; 55(6): 369-73

ABSTRACT: Fifty cases of post myocardial infarction and twenty controls were studied over a period of twenty four weeks. All cases were male patients. Yogic life style intervention included low fat diet, five support asanas and half an hour of pranayama and meditation which were grouped under a stress management technique. There was significant reduction in total cholesterol and LDL cholesterol, whereas increase in HDL cholesterol was also noted. In control group, these changes were insignificant. Hence, it is concluded that yogic life style intervention is beneficial in the management of dyslipidaemia in post myocardial infarction subject.

6447. Yadav R K, Das S. Effect of yogic practice on pulmonary functions in young females. Indian J Physiol Pharmac 2001; 46(4), 493-6. No abstract.

April 2003

6960. Allais G, De Lorenzo C, Quirico PE, Airola G, Tolardo G, Mana O, Benedetto C. Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache. 2002 Oct;42(9):855-61.

OBJECTIVES: In a randomized controlled trial extending over 6 months, we evaluated the effectiveness of acupuncture versus flunarizine in the prophylactic treatment of migraine without aura. METHODS: One hundred sixty women with migraines were randomly assigned to acupuncture treatment (group A, n = 80) or to an oral therapy with flunarizine (group F, n = 80). In group A, acupuncture was carried out in weekly sessions for the first 2 months and then once a month for the next 4 months. The same acupoints were used at each treatment: LR3 Taichong, SP6 Sanyinjiao, ST36 Zusanli, CV12 Zhongwan, LI4 Hegu, PC6 Neiguan, GB20 Fengchi, GB14 Yangbai, EX-HN5 Taiyang, GV20 Baihui. In group F, 10 mg flunarizine were given daily for the first 2 months and then for 20 days per month for the next 4 months. RESULTS: The frequency of attacks and use of symptomatic drugs significantly decreased during treatment in both groups. The number of attacks after 2 and 4 months of therapy was significantly lower in group A than in group F, and analgesic consumption was significantly lower in group A at 2 months of treatment. At 6 months no such differences existed between the two treatment groups. Pain intensity was significantly reduced only by acupuncture treatment. Side effects were significantly less frequent in group A. CONCLUSIONS: Acupuncture proved to be adequate for migraine prophylaxis. Relative to flunarizine, acupuncture treatment exhibited greater effectiveness in the first months of therapy and superior tolerability.

6961. Alraek T, Soedal LI, Fagerheim SU, Digranes A, Baerheim A. Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. Am J Public Health. 2002 Oct;92(10):1609-11. No abstract

6962. Fee E, Brown TM, Lazarus J, Theerman P. Exploring acupuncture: ancient ideas, modern techniques. Am J Public Health. 2002 Oct;92(10):1592-3. No abstract

6963. Kemper KJ, Highfield ES, McLellan M, Ott MJ, Dvorkin L, Whelan JS. Pediatric faculty development in integrative medicine. Altern Ther Health Med. 2002 Nov-Dec;8(6):70-3.

As more patients use complementary and alternative medical (CAM) therapies, faculty may be asked to teach trainees about topics requiring faculty development training. Our purpose in this study was to evaluate qualitatively and quantitatively a new faculty development program covering 4 key areas of CAM: herbs and dietary supplements, mind-body therapies, massage, and acupuncture. Faculty members (N = 6) volunteered for the program and were included in the study if they completed at least 3 of the 6 scheduled sessions. For each session, participants completed a pretest evaluating their knowledge and confidence about the topic, then they received background reading and focused discussion questions. Each session was a case-based, experiential seminar led by an expert in the content area. Participants completed post-session questionnaires measuring knowledge, confidence, and communication practices at the end of each session and at the end of the series of seminars. They also were asked for feedback and suggestions for the following year. All participants strongly agreed that they gained important knowledge; scores on tests about herbs increased from 62% at baseline to 84% at completion, and scores on knowledge of acupuncture increased from 60% before the session to 98% after. All participants strongly agreed that their confidence in talking with patients, colleagues, and trainees improved; on average, confidence scores improved an average of 1.8 out of a total of 5 possible points for all topics. Participants more frequently asked patients about their use of herbs (from 50% at baseline to 75% at the end) and increased the percentage of training encounters in which they discussed CAM with trainees or colleagues from 10% to 25%. We concluded that faculty development in integrative medicine is feasible and results in qualitative and quantitative improvements in knowledge, confidence, and clinical and teaching behaviors.

6964. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med. 2002 Nov 19;137(10):805-13.

BACKGROUND: Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies. PURPOSE: To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research. DATA SOURCES: Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM ), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch. STUDY SELECTION: 29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies. DATA EXTRACTION: Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results. DATA SYNTHESIS: Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes. CONCLUSIONS: Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.

6965. Parthasarathy S. Acupuncture – an analgesic supplement in post appendicectomy pain .Indian J Anaesth 2001,45(4),267-9. (ISA 015377, Vol 38 No15 ,1 Aug 2002)

6966. Sze FK, Wong E, Or KK, Lau J, Woo J. Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials. Stroke. 2002 Nov;33(11):2604-19.

BACKGROUND AND PURPOSE: Acupuncture may be a promising treatment for poststroke paralysis. We conducted a meta-analysis, assessing the efficacy of acupuncture with and without stroke rehabilitation. METHODS: We identified randomized trials comparing acupuncture with no acupuncture within 6 months of stroke by searching MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical literature databases. Two reviewers independently extracted data on study characteristics, patient characteristics, and impairment and disability outcomes. The outcome measures were internationally recognized or nationally approved. The fixed- and random-effects models were used to combine effect size and odds ratio across studies. RESULTS: Fourteen trials with 1213 patients met all the inclusion criteria. For the comparison of acupuncture with no acupuncture in addition to stroke rehabilitation, the pooled random-effects estimates of the change in motor impairment and disability were 0.06 (95% CI, -0.12 to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity in disability measures (P=0.05, chi(2) test). For the comparison of real with sham acupuncture, the pooled random-effects estimate of the change in disability was 0.07 (95% CI, -0.34 to 0.48). For the comparison of acupuncture with no acupuncture without stroke rehabilitation, the pooled random-effects estimate of the change in motor impairment was 0.46 (95% CI, -0.20 to 1.12), and the pooled random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2), with no statistically significant heterogeneity (P=0.97 and P=0.12, respectively, chi(2) test), but the study quality was poor. CONCLUSIONS: This meta-analysis suggests that with stroke rehabilitation, acupuncture has no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. The efficacy of acupuncture without stroke rehabilitation remains uncertain, mainly because of the poor quality of such studies.

Alternative / Complementary Medicine:

6967. Agarwal C, Singh RP, Agarwal R. Grape seed extract induces apoptotic death of human prostate carcinoma DU145 cells via caspases activation accompanied by dissipation of mitochondrial membrane potential and cytochrome c release. Carcinogenesis. 2002 Nov;23(11):1869-76.

Grape seed extract (GSE), rich in the bioflavonoids commonly known as procyanidins, is one of the most commonly consumed dietary supplements in the United States because of its several health benefits. Epidemiological studies show that many prostate cancer (PCA) patients use herbal extracts as dietary supplements in addition to their prescription drugs. Accordingly, in recent years, we have focused our attention on assessing the efficacy of GSE against PCA. Our studies showed that GSE inhibits growth and induces apoptotic death of human PCA cells in culture and in nude mice. Here, we performed detailed studies to define the molecular mechanism of GSE-induced apoptosis in advanced human PCA DU145 cells. GSE treatment of cells at various doses (50-200 micro g/ml) for 12-72 h resulted in a moderate to strong apoptotic death in a dose- and time-dependent manner. In the studies assessing the apoptotic-signaling pathway induced by GSE, we observed an increase in cleaved fragments of caspases 3, 7 and 9 as well as PARP in GSE-treated cells after 48 and 72 h of treatment. Pre-treatment of cells with general caspases inhibitor, z-Val-Ala-Asp(OMe)-FMK or caspase 3-like proteases inhibitor [z-Asp(OMe)-Glu(OMe)-Val-Asp(OMe)-FMK], almost completely (approximately 90%) inhibited the GSE-induced apoptotic cell death. In a later case, GSE-induced caspase-3 activity was completely inhibited. Selective caspase 9 inhibitor [z-Leu-Glu(OMe)-His-Asp(OMe)-FMK] showed only partial inhibition of GSE-induced apoptosis whereas GSE-induced protease activity of caspase 9 was completely inhibited. Upstream of caspase cascade, GSE showed disappearance of mitochondrial membrane potential and an increase in cytochrome c release in cytosol. Together, these results suggest that GSE possibly causes mitochondrial damage leading to cytochrome c release in cytosol and activation of caspases resulting in PARP cleavage and execution of apoptotic death of human PCA DU145 cells. Furthermore, GSE-caused caspase 3-mediated apoptosis also involves other pathway(s) including caspase 9 activation.

6968. Amro B, Aburjai T, Al-Khalil S. Antioxidative and radical scavenging effects of olive cake extract. Fitoterapia. 2002 Oct;73(6):456-61.

The antioxidative activity of different butanol extract fractions of olive cake was investigated. Four fractions showed marked antioxidative activity in comparison with BHT. Fractions tested also showed good hydrogen donating abilities, indicating that they had effective activities as radical scavengers. Coumaric, ferulic, cinnamic acids and oleuropein were isolated. Copyright 2002 Elsevier Science B.V.

6969. Anjum A, Ekramul Haque M, Mukhlesur Rahman M, Sarker SD. Antibacterial compounds from the flowers of Alangium salviifolium. Fitoterapia. 2002 Oct;73(6):526-8.

1-Methyl-1H-pyrimidine-2,4-dione and 3-O-beta-D-glucopyranosyl-(24beta)-ethylcholesta-5,22,25-triene, isolated from the flowers of Alangium salviifolium, showed remarkable antibacterial activities against a number of Gram-positive and Gram-negative bacterial species. Copyright 2002 Elsevier Science B.V.

6970. Arai S. Global view on functional foods: Asian perspectives. Br J Nutr. 2002 Nov;88 Suppl 2:S139-43.

There is an old Chinese thought meaning that medicine and food are isogenic. In Japan, a national research project started to endorse the thought scientifically, with the birth of functional foods that are now known to function to reduce the risk of life-style related diseases. The science gave rise to a national policy in which some functional foods were legally approved in terms of Foods for Specified Health Use. China has also constructed a unique system for approving some functional foods. This paper pinpoints a recent trend of functional foods characteristic to Asia, with special reference to relevant topics in Japan.

6971. Barak V, Birkenfeld S, Halperin T, Kalickman I. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002 Nov;4(11 Suppl):919-22.

BACKGROUND: Some herbal remedies are sold as food additives and are believed to have immune-enhancing properties. OBJECTIVES: To study the effect of five herbal remedies--Sambucol Black Elderberry Extract, Sambucol Active Defense Formula and Sambucol for Kids (with known antiviral properties), Protec and Chizukit N (containing propolis and Echinacea, claimed to be immune enhancers)--on the production of cytokines, one of the main components of the immune system. METHODS: The production of four inflammatory cytokines (interleukin-1 beta, tumor necrosis factor alpha, and IL-6 and IL-8) and one anti-inflammatory cytokine (IL-10) was tested using blood-derived monocytes from 12 healthy donors. RESULTS: The Sambucol preparations increased the production of five cytokines (1.3-6.2 fold) compared to the control. Protec induced only a moderate production of IL-8 (1.6 fold) and IL-10 (2.3 fold) while Chizukit N caused only a moderate increase in IL-10 production (1.4 fold). Both Protec and Chizukit N caused moderate decreases in IL-1 beta, TNF alpha and IL-6 production. Lipopolysaccharide, a known activator of monocytes, induced the highest levels of cytokine production (3.6-10.7 fold). CONCLUSIONS: The three Sambucol formulations activate the healthy immune system by increasing inflammatory and anti-inflammatory cytokines production, while the effect of Protec and Chizukit N is much less. Sambucol could therefore have immunostimulatory properties when administered to patients suffering from influenza (as shown before), or immunodepressed cancer or AIDS patients who are receiving chemotherapy or other treatments.

6972. Baser KH, Demirci B, Demirci F, Kocak S, Akinci C, Malyer H, Guleryuz G. Composition and antimicrobial activity of the essential oil of Achillea multifida. Planta Med. 2002 Oct;68(10):941-3.

The composition of the water-distilled essential oil of Achillea multifida (DC.) Boiss. (Compositae) was analysed by GC and GC/MS. Fifty-eight compounds were identified representing 93.9 % of the total oil. alpha-Thujone (60.9 %), beta-thujone (9.1 %), sabinene (4.1 %) and camphor (3.7 %) were characterised as the main constituents. The essential oil was tested for its antimicrobial activity using a micro-dilution assay resulting in the inhibition (MIC: 62.5-250 microg/ml) of human pathogenic bacteria and yeast.

6973. Berman SM, Naliboff BD, Chang L, Fitzgerald L, Antolin T, Camplone A, Mayer EA. Enhanced preattentive central nervous system reactivity in irritable bowel syndrome. Am J Gastroenterol. 2002 Nov;97(11):2791-7.

OBJECTIVE: Irritable bowel syndrome (IBS) is a common functional disorder characterized by enhanced perceptual sensitivity and hypervigilance toward afferent signals from the viscera. We hypothesize that the increased responsiveness of IBS patients is a generalized phenomenon applying to stimuli other than visceral and attempt to demonstrate increased responsiveness to sounds as measured by the P1 scalp potential. METHODS: Event-related potentials were recorded from IBS patients and control subjects in an auditory task requiring detection of rare pitch targets in a designated ear. Visual words served as targets in an additional block. RESULTS: Compared to control subjects, IBS patients displayed a robust increase in the amplitude of the P1 scalp potential elicited by both attended and unattended sounds. CONCLUSIONS: Enhanced P1 indicates preattentive central nervous system dishabituation in response to repeated sounds. A generalized preattentive increase in central nervous system reactivity may be a feature that IBS shares with several anxiety disorders that frequently co-occur in these patients.

6974. Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity and diabetes. Am J Clin Nutr. 2002 Dec;76(6):1191-201. Review.

Evidence is emerging that dietary phytoestrogens play a beneficial role in obesity and diabetes. Nutritional intervention studies performed in animals and humans suggest that the ingestion of soy protein associated with isoflavones and flaxseed rich in lignans improves glucose control and insulin resistance. In animal models of obesity and diabetes, soy protein has been shown to reduce serum insulin and insulin resistance. In studies of human subjects with or without diabetes, soy protein also appears to moderate hyperglycemia and reduce body weight, hyperlipidemia, and hyperinsulinemia, supporting its beneficial effects on obesity and diabetes. However, most of these clinical trials were relatively short and involved a small number of patients. Furthermore, it is not clear whether the beneficial effects of soy protein and flaxseed are due to isoflavones (daidzein and genistein), lignans (matairesinol and secoisolariciresinol), or some other component. Isoflavones and lignans appear to act through various mechanisms that modulate pancreatic insulin secretion or through antioxidative actions. They may also act via estrogen receptor-mediated mechanisms. Some of these actions have been shown in vitro, but the relevance of these studies to in vivo disease is not known. The diversity of cellular actions of isoflavones and lignans supports their possible beneficial effects on various chronic diseases. Further investigations are needed to evaluate the long-term effects of phytoestrogens on obesity and diabetes mellitus and their associated possible complications.

6975. Biswas R, Paul A, Shetty KJ. A yoga teacher with persistent reflux symptoms. Int J Clin Pract. 2002 Nov;56(9):723. No abstract

6976. Blank MB, Mahmood M, Fox JC, Guterbock T. Alternative mental health services: the role of the black church in the South. Am J Public Health. 2002 Oct;92(10):1668-72.

OBJECTIVES: This study determined the extent to which churches in the South were providing mental health and social services to congregations and had established linkages with formal systems of care. METHODS: A computer-assisted telephone interview (CATI) survey was conducted with pastors from 269 Southern churches. RESULTS: Black churches reported providing many more services than did White churches, regardless of urban or rural location. Few links between churches and formal provider systems were found, irrespective of the location--urban or rural--or racial composition of the churches. CONCLUSIONS: Results are discussed in terms of the potential for linking faith communities and formal systems of care, given the centrality of the Black church in historical context.

6977. Bodeker G, Kronenberg F. A public health agenda for traditional, complementary, and alternative medicine. Am J Public Heaalth. 2002 Oct;92(10):1582-91.

Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public's awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally.

6978. Bonham MJ, Galkin A, Montgomery B, Stahl WL, Agus D, Nelson PS. Effects of the herbal extract PC-SPES on microtubule dynamics and paclitaxel-mediated prostate tumor growth inhibition. J Natl Cancer Inst. 2002 Nov 6;94(21):1641-7.

BACKGROUND: PC-SPES is a botanical preparation shown to have efficacy in patients with androgen-dependent and androgen-independent prostate carcinoma. Several herbal constituents in PC-SPES inhibit tumor growth through cell cycle arrest and apoptosis, although the mechanisms of these activities are poorly defined. We sought to identify PC-SPES-induced changes in gene expression, specifically in those genes encoding cytoskeletal proteins that could be associated with PC-SPES-induced cytoxicity. METHODS: LNCaP prostate carcinoma cells were treated with PC-SPES, and changes in gene expression were determined by complementary DNA (cDNA) microarray hybridization and northern blot analyses. PC-SPES and paclitaxel, a microtubule-stabilizing drug, effects on microtubules were assessed by immunofluorescence of treated cells and by in vitro tubulin polymerization assays. In vivo effects of PC-SPES and paclitaxel were assessed using CWR22R androgen-independent prostate cancer xenografts. All statistical tests were two-sided. RESULTS: PC-SPES treatment of LNCaP cells for 24 hours altered the expression of 17 cytoskeletal genes. mRNA levels of alpha-tubulin decreased sevenfold. Although paclitaxel stabilized and PC-SPES treatment disrupted microtubule architecture in LNCaP cells, the combination of both agents had an intermediate effect. PC-SPES inhibited tubulin polymerization in vitro, even in the presence of paclitaxel. Compared with tumors in control mice (mean tumor volume = 2983 mm(3), 95% confidence interval [CI] = 2380 to 3586 mm(3)), tumors were statistically significantly smaller in mice that received PC-SPES (mean tumor volume = 2018 mm(3), 95% CI = 1450 to 2568 mm(3); P =.028), paclitaxel (mean tumor volume = 1340 mm(3), 95% CI = 697 to 1983 mm(3); P<.001), or the combination of PC-SPES and paclitaxel (mean tumor volume = 1955 mm(3), 95% CI = 1260 to 2650 mm(3); P =.034). CONCLUSION: PC-SPES may interfere with microtubule polymerization. This activity has implications for the clinical management of patients with advanced prostate cancer who may be taking PC-SPES concurrently with microtubule-modulating chemotherapeutic agents, such as paclitaxel.

6979. Bratton RL, Montero DP, Adams KS, Novas MA, McKay TC, Hall LJ, Foust JG, Mueller MB, O'Brien PC, Atkinson EJ, Maurer MS. Effect of "ionized" wrist bracelets on musculoskeletal pain: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc. 2002 Nov;77(11):1164-8.

OBJECTIVE: To assess objectively the perceived benefits of wearing an "ionized" wrist bracelet to treat muscle or joint pain. SUBJECTS AND METHODS: This study was performed at the Mayo Clinic in Jacksonville, Fla, in 2000 and 2001. In a randomized, double-blind design, 305 participants wore an ionized bracelet and 305 wore a placebo bracelet for 4 weeks. For each location where pain was present at baseline, participants rated the intensity of pain. Follow-up ratings were made after 1, 3, 7, 14, 21, and 28 days of wearing the bracelet. Two primary end points were defined for evaluating efficacy. The first was the change at 4-week follow-up (day 28) in the pain score at the location with the highest baseline value (maximum pain score). The second was the change at 4-week follow-up in the sum of the pain scores for all locations. RESULTS: Analysis of the data showed significant improvement in pain scores in both groups, but no differences were observed between the group wearing the placebo bracelet and the group wearing the ionized bracelet. CONCLUSION: The finding that subjective improvement in pain scores was equivalent with ionized and placebo bracelet use questions the benefit of using an ionized bracelet. New treatments in alternative medical therapy must be shown to be effective through vigorous, unbiased, objective testing before physicians acknowledge potential benefits or recommend these treatments to patients.

6980. Burge SK, Albright TL. Use of complementary and alternative medicine among family practice patients in south Texas. Am J Public Health. 2002 Oct;92(10):1614-6. No abstract.

6981. Conforti F, Statti GA, Tundis R, Menichini F, Houghton P. Antioxidant activity of methanolic extract of Hypericum triquetrifolium Turra aerial part. Fitoterapia. 2002 Oct;73(6):479-83.

The antioxidant activity of the methanol extract of Hypericum triquetrifolium Turra (Hypericaceae) aerial part and of flavonoids isolated therein, I3,II8-biapigenin, quercetin-3-O-galactoside, kaempferol-3-O-glycoside, (-)-epicatechin and hypericin, was evaluated. The IC(50) resulted between 0.062 and 1 mg/ml. Copyright 2002 Elsevier Science B.V.

6982. Curtis P, McDermott J, Gaylord S, Mann D, Norton SK, Motyka T, Tresolini C. Preparing complementary and alternative practitioners to teach learners in conventional health professions. Altern Ther Health Med. 2002 Nov-Dec;8(6):54-9.

Federal funding is supporting complementary and alternative medicine (CAM) educational programming in health-professions schools in the United States. CAM practitioners from a wide range of disciplines are now being invited to participate as instructors or content experts in this effort. The challenge is to promote effective and consistent teaching methods around appropriate content. This article describes the development of a series of 4 workshops intended to enhance the teaching skills of 9 complementary medicine practitioners participating in an educational project at the University of North Carolina. Key issues addressed in the workshops included the interface between CAM and conventional medicine, a better understanding of the nature of conventional medical practice, styles and strategies in teaching complementary medicine, and building skills in accessing information from databases.

6983. Daniels C. The last taboo. It's not sex. It's not drinking. It's stress--and it's soaring. Fortune. 2002 Oct 28;146(8):136-8, 140, 142 passim. No abstract.

6984. Danz H, Stoyanova S, Thomet OA, Simon HU, Dannhardt G, Ulbrich H, Hamburger M. Inhibitory activity of tryptanthrin on prostaglandin and leukotriene synthesis. Planta Med. 2002 Oct;68(10):875-80.

The indolo[2,1- b]quinazoline alkaloid tryptanthrin has previously been identified as the cyclooxygenase-2 (COX-2) inhibitory principle in the extract ZE550 prepared from the medicinal plant Isatis tinctoria (Brassicaceae). We here investigated the potential inhibitory activity of tryptanthrin and ZE550 on COX-2, COX-1 in cellular and cell-free systems. A certain degree of selectivity towards COX-2 was observed when COX-1-dependent formation of thromboxane B(2) (TxB(2)) in HEL cells and COX-2-dependent formation of 6-ketoprostaglandin F(1alpha) (6-keto-PGF(1alpha)) in Mono Mac 6 and RAW 264.7 cells were compared. Preferential inhibition of COX-2 by two orders of magnitude was found in phorbol myristate acetate (PMA) activated bovine aortic coronary endothelial cells (BAECs). Assays with purified COX isoenzymes from sheep confirmed the high selectivity towards COX-2. The leukotriene B(4) (LTB(4)) release from calcium ionophore-stimulated human granulocytes (neutrophils) was used as a model to determine 5-lipoxygenase (5-LOX) activity. Tryptanthrin and the extract ZE550 inhibited LTB(4) release in a dose dependent manner and with a potency comparable to that of the clinically used 5-LOX inhibitor zileuton.

6985. De Smet PA. Herbal remedies. N Engl J Med. 2002 Dec 19;347(25):2046-56. Review. No Abstract

6986. de Visser R, Grierson J. Use of alternative therapies by people living with HIV/AIDS in Australia. AIDS Care. 2002 Oct;14(5):599-606.

Few studies of use of complementary and alternative medicine (CAM) among people living with HIV/AIDS (PLWHA) have been conducted since combination antiretroviral (ARV) drug therapy became widespread. In the context of changing ARV treatment options, it is important to consider the prevalence and correlates of use of CAM. In this study, a sample of 924 Australian PLWHA completed a self-administered survey that included questions on use of CAM. Half (55%) of the respondents reported using CAM. Most PLWHA did not choose CAM as an alternative to ARV drugs, but use CAM to complement ARV drugs. Use of CAM was not related to measures of progression of HIV/AIDS disease. In contrast, CAM use was related to characteristics of the ways respondents live with HIV/AIDS, and their attitudes toward treatment. The popularity of CAM among PLWHA highlights a need to ensure that PLWHA can make informed choices about CAM use.

6987. Dell'Orfano S. The meaning of spiritual care in a pediatric setting. J Pediatr Nurs. 2002 Oct;17(5):380-5.

In the previous issue of the Journal of Pediatric Nursing, one type of evidence-based practice (EBP) format was provided for potential nurse scholars who utilize the EBP process [MacPhee, M. (2002). Journal of Pediatric Nursing, 17(4);313-20]. There are, however, many potential formats to present evidence-based clinical practice innovations. I am eager to work with nurses who have been involved in promoting evidence-based nursing practice. The Journal of Pediatric Nursing will use this column as a forum for sharing evidence-based clinical practice innovations, such as case studies, clinical teaching exemplars, and interdisciplinary programs highlighting collaborative practice among nurses and other health care professionals. Please contact me at maura80521@yahoo.com for editorial advice and assistance. The following article is a clinical contribution from a nurse on the Neurosurgery-Rehabilitation Unit of The Children's Hospital, Denver. This evidence-based clinical project evolved from a nurse's recognition of the importance of spiritual care for families of children with serious brain injuries. It is an example of how an EBP formula can facilitate change and innovation. Start with a clinical problem; get help; look to the literature for best research evidence; look to other clinical sources for best practice ideas; evaluate what you have; and make a decision to maintain the status quo, gather more data, or change practice. This clinical project is an example of the collaborative, interdisciplinary nature of EBP, and it is also an example of the collaborative work among differently skilled nurses. In this instance, a clinically based nurse identified a practice problem and recruited a nurse researcher to help design, analyze, and evaluate the findings from an interview study. The results are being implemented via nursing leadership to change practice. Copyright 2002, Elsevier Science (USA). All rights reserved.

6988. Desai PP, Ng JB, Bryant SG. Care of children and families in the CICU: A focus on their developmental, psychosocial, and spiritual needs. Crit Care Nurs Q. 2002 Nov;25(3):88-97. Review.

The staff of Patient and Family Support Services oversees the developmental, psychosocial, and spiritual care of the child in the cardiac intensive care unit. Staff collaborate with medical team members, as well as the patient's family, to promote holistic care. This article describes the roles and responsibilities of the child life specialist, the social worker, and the chaplain and identifies discipline-specific assessment techniques and interventions. The article highlights identified needs of children and their families, offering tools and interventions health care clinicians can use in the cardiac intensive care unit.

6989. deVere White RW, Hackman RM, Soares SE, Beckett LA, Sun B. Effects of a mushroom mycelium extract on the treatment of prostate cancer. Urology. 2002 Oct;60(4):640-4.

OBJECTIVES: To determine whether supplemental amounts of a polysaccharide/oligosaccharide complex obtained from a shiitake mushroom extract (SME) would lower the prostate-specific antigen (PSA) level in patients with prostate cancer. METHODS: A total of 62 men (mean age 73.2 years, range 53.6 to 85.5) with histologically proven prostate cancer who had two consecutive elevated PSA readings were accrued to the study during a 3-month period. This was an open-label study in which the patients received oral administration of capsules containing SME given three times daily for 6 months. The endpoint for the trial was the lowering of the PSA levels. RESULTS: Of the 62 men enrolled in the study, 61 were assessable. At 4 months, 1 patient withdrew because of unrelated surgery and 7 withdrew because of disease progression; none had responded with a decrease of greater than 50% in the PSA level. By 6 months, a total of 23 patients had progression and none had responded. Thirty-eight patients had stable PSA levels after 6 months. Although not the primary endpoint of the study, in other studies these patients could have been included as responders. When the patients' rates of PSA rise before study entry were analyzed, 4 (7%) had stabilized disease while taking SME. Thus, the final results for our study patients were 0 with a complete response, 0 with a partial response, 4 (7%) with stable disease, and 23 of 61 with progression while taking SME. CONCLUSIONS: SME alone is ineffective in the treatment of clinical prostate cancer.

6990. Dimsdale JE, Mills PJ. An unanticipated effect of meditation on cardiovascular pharmacology and physiology. Am J Cardiol. 2002 Oct 15;90(8):908-9. No Abstract

6991. Ernst E. Stevens' cure for tuberculosis. J R Soc Med. 2002 Nov;95(11):575. No Abstract

6992. Fee E, Brown TM, Lazarus J, Theerman P. Exploring acupuncture: ancient ideas, modern techniques. Am J Public Health. 2002 Oct;92(10):1592-3. No Abstract

6993. Fink DJ. Chiropractic. Ann Intern Med. 2002 Oct 15;137(8):701-2; author reply 701-2. No Abstract

6994. Fink S. International efforts spotlight traditional, complementary, and alternative medicine. Am J Public Health. 2002 Nov;92(11):1734-9.

Affordable, available, and ever more popular at home and abroad, "alternative" healers are finally getting positive attention from Western practitioners. This rapprochement has enormous implications for public health worldwide.

6995. Freedman RR. A woman attempting to discontinue hormone therapy. JAMA. 2002 Nov 13;288(18):2264; author reply 2264-5. No Abstract

6996. Gallagher EB, Wadsworth AL, Stratton TD. Religion, spirituality, and mental health. J Nerv Ment Dis. 2002 Oct;190(10):697-704. No Abstract

6997. Ginandes C. Extended, strategic therapy for recalcitrant mind/body healing: an integrative model. Am J Clin Hypn. 2002 Oct;45(2):91-102.

The development of the power therapies, behavioral medicine, and short term interventions have reported such success even with trauma cases that it is relevant to question the justification for lengthy psychotherapy. Yet some patients with complex mind/body conditions impervious to medical treatment/hypnosis may require extended, multi-modal, integrative therapy. This paper details a single complex case of paruresis as a prototype for illustrating a holographic treatment model for recalcitrant conditions: Component features of the proposed model presented include: 1) the sequential utilization of hypnobehavioral and analytic approaches; 2) uncovering work providing access to the somatic ego state associated with the illness condition; 3) the extended treatment time frame required for deep psycho-physiological change; and 4) the stages of counter-transference expectably evoked by such patients (e.g. urgency, exuberant optimism, frustration, discouragement), and the transformation of such reactions to achieve maximum therapeutic efficacy.

6998. Gold PW, Charney DS. Diseases of the mind and brain: depression: a disease of the mind, brain, and body. Am J Psychiatry. 2002 Nov;159(11):1826. No Abstract

6999. Gorman C, Park A. The new science of headaches. Time. 2002 Oct 7;160(15):76-82. No Abstract

7000. Greendale GA, McDivit A, Carpenter A, Seeger L, Huang MH. Yoga for women with hyperkyphosis: results of a pilot study. Am J Public Health. 2002 Oct;92(10):1611-4. No Abstract

7001. Horn WL. The magic of music. J Psychosoc Nurs Ment Health Serv. 2002 Dec;40(12):8. No Abstract

7002. Hsing AW, Chokkalingam AP, Gao YT, Madigan MP, Deng J, Gridley G, Fraumeni JF Jr. Allium vegetables and risk of prostate cancer: a population-based study. J Natl Cancer Inst. 2002 Nov 6;94(21):1648-51.

Epidemiologic and laboratory studies suggest that allium vegetables and garlic constituents have antitumor effects. In a population-based, case-control study conducted in Shanghai, China, we investigated the association between intake of allium vegetables, including garlic, scallions, onions, chives, and leeks, and the risk of prostate cancer. We administered in-person interviews and collected information on 122 food items from 238 case subjects with incident, histologically confirmed prostate cancer and from 471 male population control subjects. Men in the highest of three intake categories of total allium vegetables (>10.0 g/day) had a statistically significantly lower risk (odds ratio [OR] = 0.51, 95% confidence interval [CI] = 0.34 to 0.76; P(trend)<.001) of prostate cancer than those in the lowest category (<2.2 g/day). Similar comparisons between categories showed reductions in risk for men in the highest intake categories for garlic (OR = 0.47, 95% CI = 0.31 to 0.71; P(trend)<.001) and scallions (OR = 0.30, 95% CI = 0.18 to 0.51; P(trend)<.001). The reduced risk of prostate cancer associated with allium vegetables was independent of body size, intake of other foods, and total calorie intake and was more pronounced for men with localized than with advanced prostate cancer.

7003. Jacobs BP, Dennehy C, Ramirez G, Sapp J, Lawrence VA. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med. 2002 Oct 15;113(6):506-15.

PURPOSE: Milk thistle, an herbal compound, is the dietary supplement taken most frequently by patients with chronic liver disease. We performed a systematic review of the literature to determine the efficacy and safety of this herb for the treatment of liver disease. METHODS: We searched English and non-English reports through July 1999 using thirteen databases and reference lists, and contacting manufacturers and technical experts. Reviewers independently screened all reports to identify randomized placebo-controlled trials that evaluated milk thistle for the treatment of liver disease. Outcomes of primary interest included mortality, histological findings on liver biopsy specimens, serum aminotransferase and albumin levels, and prothrombin times. RESULTS: Fourteen trials met inclusion criteria. Four trials reported outcomes for mortality among 433 participants. The overall summary odds ratio for mortality in the milk thistle group compared with placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.5; P = 0.6). Three trials assessed histology on liver biopsy; study quality was inversely associated with the likelihood of histological benefit for milk thistle compared with placebo. There were no differences in serum alanine aminotransferase, aspartate aminotransferase, or albumin levels, or prothrombin times, among participants assigned to milk thistle compared with those assigned to placebo. The only statistically significant difference was a greater reduction in alanine aminotransferase levels among patients with chronic liver disease assigned to milk thistle (-9 IU/L, 95% CI: -18 to -1 IU/L; P = 0.05), but this reduction was of negligible clinical importance and no longer statistically significant after limiting analyses to studies of longer duration or of higher quality. The frequency of adverse effects was low and, in clinical trials, indistinguishable from placebo. CONCLUSION: Treatment with milk thistle appears to be safe and well tolerated. We found no reduction in mortality, in improvements in histology at liver biopsy, or in biochemical markers of liver function among patients with chronic liver disease. Data are too limited to exclude a substantial benefit or harm of milk thistle on mortality, and also to support recommending this herbal compound for the treatment of liver disease.

7004. Juteau F, Masotti V, Bessiere JM, Dherbomez M, Viano J. Antibacterial and antioxidant activities of Artemisia annua essential oil. Fitoterapia. 2002 Oct;73(6):532-5.

The essential oil of Artemisia annua aerial parts, consisting of camphor (44%), germacrene D (16%), trans-pinocarveol (11%), beta-selinene (9%), beta-caryophyllene (9%) and artemisia ketone (3%), was screened for its antimicrobial activity. The essential oil remarkably inhibited the growth of tested Gram-positive bacteria Enterococcus hirae and both tested fungi. This oil has shown an antioxidant activity equivalent to 18% of the reference compound (alpha-tocopherol). Copyright 2002 Elsevier Science B.V.

7005. Kalantri SP. Temple healing. Healing temples may breed superstitions. BMJ. 2002 Oct 26;325(7370):968; author reply 968. No Abstract

7006. Kemper KJ, Highfield ES, McLellan M, Ott MJ, Dvorkin L, Whelan JS. Pediatric faculty development in integrative medicine. Altern Ther Health Med. 2002 Nov-Dec;8(6):70-3.

7007. Kerr C. Curry ingredient protects skin against radiation. Lancet Oncol. 2002 Dec;3(12):713. No Abstract

7008. Lee SI, Khang YH, Lee MS, Kang W. Knowledge of, attitudes toward, and experience of complementary and alternative medicine in Western medicine- and oriental medicine-trained physicians in Korea. Am J Public Health. 2002 Dec;92(12):1994-2000.

OBJECTIVES: We compared knowledge of, attitudes toward, and experience with complementary and alternative medicine (CAM) among Western medicine-trained doctors (WMDs) and Oriental medicine-trained doctors (OMDs). METHODS: In Korea, 502 WMDs and 500 OMDs were interviewed with a structured questionnaire. RESULTS: OMDs held more favorable attitudes toward CAM than did WMDs. OMDs possessed a deeper understanding of and greater experience with CAM. OMDs more readily endorsed health beliefs congruent with CAM. CONCLUSIONS: In the future, CAM can be more readily used by OMDs than by WMDs. Because evidence for the effectiveness of CAM remains sparse, more research is needed for the prudent use of CAM in Korea. An education and training system for potential CAM providers remains to be developed.

7009. Lipe AW. Beyond therapy: music, spirituality, and health in human experience: a review of literature. J Music Ther. 2002 Fall;39(3):209-40. Review.

In the current healthcare environment, there is a growing interest in the relationship between spirituality and health. The connections between music and both medicine and religious experience are well-established, but little is known about how the musical and spiritual aspects of human experience work together to influence well-being. A review of the healthcare literature from 1973-2000 identified 52 published reports on the topic of music, spirituality, and health. The majority of the papers were narrative descriptions or case studies, and appear within a variety of clinical contexts. Fifty-two percent of the authors were credentialed music therapists. Examination of the literature indicated that many papers used terms and concepts associated with both spirituality and health interchangeably, which might lend support to the basic interconnectedness of these two aspects of being. The function of music across the literature was explored, and a transformational model of music experience derived from the literature is proposed. Based on the findings of the review, several conclusions about the future role of music in spirituality and health are drawn, and recommendations for further research are offered.

7010. Marcus DM. Integrative medicine is a trojan horse. Arch Intern Med. 2002 Nov 11;162(20):2381-3; author reply 2383. No Abstract

7011. McFarland B, Bigelow D, Zani B, Newsom J, Kaplan M. Complementary and alternative medicine use in Canada and the United States. Am J Public Health. 2002 Oct;92(10):1616-8. No Abstract

7012. Mercer SW, Hasegawa H, Reilly D, Bikker AP. Length of consultations. Time and stress are limiting holistic care in Scotland. BMJ. 2002 Nov 23;325(7374):1241. No Abstract

7013. Milner JA. Functional foods and health: a US perspective. Br J Nutr. 2002 Nov;88 Suppl 2:S151-8. Review.

Linkages between diet habits and the quality of life continue to surface on numerous fronts. Collectively these epidemiological, pre-clinical and clinical studies provide rather compelling evidence that numerous essential and non-essential dietary components are capable of influencing growth, development and performance and disease prevention. Scientific discoveries and widespread interest in the potential medicinal benefits of foods and food components have fostered a variety of content, health and structure-function claims. Unfortunately, defining the ideal diet is complicated by the numerous and diverse components that may influence biological processes. Inconsistencies in the literature may reflect the multi-factorial nature of these processes and the specificity that individual dietary constituents have in modifying genetic and epigenetic events. New and emerging genomic and proteonomic approaches and technologies offer exciting opportunities for identifying molecular targets for dietary components and thus determining mechanisms by which they influence the quality of life. All cells have unique 'signatures' that are characterized by active and inactive genes and cellular products. It is plausible that bridging knowledge about unique cellular characteristics with molecular targets for nutrients can be used to develop strategies to optimize nutrition and minimize disease risk.

7014. Mitaine-Offer AC, Hornebeck W, Sauvain M, Zeches-Hanrot M. Triterpenes and phytosterols as human leucocyte elastase inhibitors. Planta Med. 2002 Oct;68(10):930-2.

Ten triterpenes and phytosterols beta-amyrin, lupeol, lupeol acetate, ursolic acid, friedelin, canophyllol, 29-hydroxy-friedelan-3-one, beta sitosterol, 3- O-beta- D-glucopyranosyl-beta-sitosterol, 3-O-(6'-O-palmitoyl)-beta-D-glucopyranosyl-beta-sitosterol, were evaluated as potential inhibitors of human leucocyte elastase (HLE). In this series, lupeol, ursolic acid and canophyllol showed marked HLE inhibitory activity with IC(50) values at 1.9 microM, 4.4 microM, and 2.5 microM, respectively. It appeared that HLE inhibition depended on the presence and the orientation of two reactive groups in the tested molecules, distant from 10-12 A, reacting with Arg-217 in S(4) -S(5) subsites of the extended substrate-binding domain of HLE, and S(3), respectively.

7015. Oberbaum M, Schlesinger M. "Scientifying" herbal medicine. Isr Med Assoc J. 2002 Nov;4(11 Suppl):944-6. Review. No Abstract

7016. O'Connor TS, McCarroll-Butler P, Meakes E, Davis A, Jadad A. Review of quantity and types of spirituality research in three health care databases (1962-1999): implications for the health care ministry. J Pastoral Care Counsel. 2002 Fall;56(3):227-32.

Using computer technology to identify the term "spiritual," these researchers present results of the 2306 citations and compare five criteria discovered with research reported in four pastoral counseling journals. The authors note the limitations of such a search and the possible implications of the findings for health care ministry.

7017. Oh H, Ko EK, Jun JY, Oh MH, Park SU, Kang KH, Lee HS, Kim YC. Hepatoprotective and free radical scavenging activities of prenylflavonoids, coumarin, and stilbene from Morus alba. Planta Med. 2002 Oct;68(10):932-4.

Chemical investigation of the EtOH extract of Morus alba L. (Moraceae), as guided by free radical scavenging activity, furnished 5,7 dihydroxycoumarin 7-methyl ether (1), two prenylflavones, cudraflavone B (2) and cudraflavone C (3), and oxyresveratrol (4). Compounds 1 and 4 showed superoxide scavenging effects with the IC(50) values of 19.1 +/- 3.6 and 3.81 +/- 0.5 microM, respectively. Compound 4 exhibited a DPPH free radical scavenging effect (IC(50) = 23.4 +/- 1.5 microM). Compounds 2 and 4 showed hepatoprotective effects with EC(50) values of 10.3 +/- 0.42 and 32.3 +/- 2.62 micro, respectively, on tacrine-induced cytotoxicity in human liver-derived Hep G2 cells.

7018. Palsson OS, Whitehead WE. The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders. Gastroenterology. 2002 Dec;123(6):2132-5. Review. No Abstract

7019. Pelletier KR. Kenneth R. Pelletier, PhD, MD(hc) mindbody medicine. Interview by Alternative Therapies. Altern Ther Health Med. 2002 Nov-Dec;8(6):90-9. No Abstract

7020. Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002 Oct;92(10):1657-61.

OBJECTIVES: The effect of massage therapy on chronic nonmigraine headache was investigated. METHODS: Chronic tension headache sufferers received structured massage therapy treatment directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures. RESULTS: Compared with baseline values, headache frequency was significantly reduced within the first week of the massage protocol. The reduction of headache frequency continued for the remainder of the study (P =.009). The duration of headaches tended to decrease during the massage treatment period (P =.058). Headache intensity was unaffected by massage (P =.19). CONCLUSIONS: The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.

7021. Rafter JJ. Scientific basis of biomarkers and benefits of functional foods for reduction of disease risk: cancer. Br J Nutr. 2002 Nov;88 Suppl 2:S219-24. Review.

One of the most promising areas for the development of functional foods lies in modification of the activity of the gastrointestinal tract by use of probiotics, prebiotics and synbiotics. While a myriad of healthful effects have been attributed to the probiotic lactic acid bacteria, perhaps the most controversial remains that of anticancer activity. However, it must be emphasised that, to date, there is no direct experimental evidence for cancer suppression in man as a result of consumption of lactic cultures in fermented or unfermented dairy products, although there is a wealth of indirect evidence, based largely on laboratory studies. Presently, there are a large number of biomarkers available for assessing colon cancer risk in dietary intervention studies, which are validated to varying degrees. These include colonic mucosal markers, faecal water markers and immunological markers. Overwhelming evidence from epidemiological, in vivo, in vitro and clinical trial data indicates that a plant-based diet can reduce the risk of chronic disease, particularly cancer. It is now clear that there are components in a plant-based diet other than traditional nutrients that can reduce cancer risk. More than a dozen classes of these biologically active plant chemicals, now known as 'phytochemicals', have been identified. Although the vast number of naturally occurring health-enhancing substances appear to be of plant origin, there are a number of physiologically active components in animal products (such as the probiotics referred to above) that deserve attention for their potential role in cancer prevention.

7022. Reznik M, Ozuah PO, Franco K, Cohen R, Motlow F. Use of complementary therapy by adolescents with asthma. Arch Pediatr Adolesc Med. 2002 Oct;156(10):1042-4.

BACKGROUND: About 40% of adult Americans use complementary or alternative medicine (CAM) for health problems. OBJECTIVE: To determine the prevalence of reported use of CAM in a population of urban adolescents with asthma. DESIGN/METHODS: We used a multistaged, stratified sample approach at an inner-city high school. An asthma screening survey was administered to 3800 registered students, aged 13 to 18 years. We identified a subset of 200 respondents who answered yes to each of the following questions: (1) Does your physician think that you have asthma? (2) Do your parents think that you have asthma? (3) Do you think that you have asthma? A self-completion questionnaire was administered to a sample drawn from this cohort. Differences in proportion were tested by chi( 2) analyses. RESULTS: Of the 160 participants, 63% were female, 68% were Hispanic, 26% were African American, 33% had weekly symptoms, and 14% had daily symptoms. Overall, 80% of participants reported using CAM for asthma. The most commonly reported CAM included rubs (74%), herbal teas (39%), prayer (37%), massage (36%), and Jarabe 7 syrup (24%). Subjects with daily or weekly symptoms were more likely to use CAM for each episode of asthma (72% vs 51%; P =.005). The 61% of subjects who had a family member who used CAM were more likely to use CAM again (84% vs 39%; P<.001). Of the respondents, 59% reported that CAM was effective. Subjects who perceived CAM to be effective were more likely to use it again (96% vs 22%; P<.001). CONCLUSIONS: Most adolescents with asthma in this study used CAM. The prevalence of CAM use in this study population was twice the national average for adults.

7023. Saw SM, Gazzard G, Au Eong KG, Tan DT. Myopia: attempts to arrest progression. Br J Ophthalmol. 2002 Nov;86(11):1306-11. Review.

Previous studies have evaluated the efficacy of several interventions to decrease the progression of myopia. These include devices that alter the perception of the visual environment and pharmacological treatments. There is no conclusive evidence thus far that alteration of the pattern of spectacle wear, bifocals, ocular hypotensives, or contact lenses retards the progression of myopia. Several randomised clinical trials have demonstrated that the rate of progression of myopia is lower in children given atropine eye drops than those given placebo. However, atropine is associated with short term side effects such as photophobia and possible long term adverse events including light induced retinal damage and cataract formation. Other more selective antimuscarinic agents such as pirenzipine are presently being evaluated. Further well conducted randomised clinical trials with large sample sizes and adequate follow up designed to evaluate treatments to retard the progression of myopia should be conducted, since the identification of an effective intervention may have a greater public health impact on the burden and morbidity from myopia than the few treatments currently available.

7024. Shermer M. Mesmerized by magnetism. An 18th-century investigation into mesmerism shows us how to think about 21st-century therapeutic magnets. Sci Am. 2002 Nov;287(5):41. No Abstract

7025. Shuval JT, Mizrachi N, Smetannikov E. Entering the well-guarded fortress: alternative practitioners in hospital settings. Soc Sci Med. 2002 Nov;55(10):1745-55.

There is a growing evidence that alternative health care practitioners and physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level, the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense, the issues involved concern processes of accommodation and social change.Data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem during 2000. Nineteen persons were interviewed including 10 alternative practitioners working in a variety of fields and nine biomedical practitioners who worked with them (six physicians and three nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered.The findings suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no way accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. There is a division of labour expressed by focusing on the biomedical practitioners on the diagnosis and treatment of specific disease entities, while the alternative practitioners work in the illness context, concentrating of feelings and affective states involving the alleviation of pain, suffering and efforts to improve the quality of life.

7026. Singh V, Sinha HV, Gupta R. Barriers in the management of asthma and attitudes towards complementary medicine. Respir Med. 2002 Oct;96(10):835-40.

BACKGROUND: Undertreatment is said to be an important problem for those with asthma. Misconceptions regarding the nature and treatment of asthma may contribute to this. This study was planned to evaluate the perception of those with asthma about various aspects of their condition. METHODS: A total of 1012 patients with asthma volunteered to complete the questionnaire. Questions included those regarding severity, nature, regularity of use of medicine and attitudes towards trying complementary medicine. Forced expiratory volume in 1 s (FEV1) was measured to assess the severity of airway obstruction. RESULTS: Only 9% of patients took treatment for asthma according to the advice of the doctor. The remainder reported stopping treatment when they became free of symptoms or were able to tolerate their symptoms. A majority of the patients had moderately severe airway obstruction as determined by spirometer and reported being unable to assess the severity of their disease with only 11.9% reporting that they could perceive the warning symptoms of an acute attack. Seventy-nine percent of the patients had used complementary medicine. Home remedies, such as tea, hot water, walking, ginger and turmeric, were perceived to provide relief in asthma. CONCLUSION: Patients with asthma have many barriers in the way of optimal treatment. These include a failure to recognize warning symptoms, belief in a permanent cure; not continuing treatment for as long as needed; and, an inclination to seek complimentary medicines.

7027. Thomet OA, Simon HU. Petasins in the treatment of allergic diseases: results of preclinical and clinical studies. Int Arch Allergy Immunol. 2002 Oct;129(2):108-12. Review.

Plant extracts are causing an increased interest in the treatment of many chronic diseases, including asthma and other allergic diseases. Several laboratories characterized petasins (petasin, isopetasin, and neopetasin) isolated from extracts of butterbur (Petasites hybridus) as pharmacologically active components, which inhibit leukotriene synthesis in leukocytes. The molecular mechanisms by which petasins abrogate inflammatory effector cell functions have, at least partially, been identified. In vitro studies revealed that petasins may have several intracellular targets and this may depend on the stereoisomer used. In an open clinical trial in patients suffering from allergic rhinitis, a reduction of leukotriene and histamine levels in nasal fluids was associated with the butterbur extract administration. To better evaluate the clinical value in this particular allergic disease, the clinical efficacy of the drug was compared with an established antihistamine treatment scheme in a double-blind study; no significant difference was observed between the two treatment groups. In this article, we critically review recently published work and summarize the current stage in the pharmacological characterization of butterbur extracts. Copyright 2002 S. Karger AG, Basel

7028. Tuffs A. Three out of four Germans have used complementary or natural remedies. BMJ. 2002 Nov 2;325(7371):990. No Abstract

7029. Wang CC, Huang YJ, Chen LG, Lee LT, Yang LL. Inducible nitric oxide synthase inhibitors of Chinese herbs III. Rheum palmatum. Planta Med. 2002 Oct;68(10):869-74.

In this paper, the effects of bioactive compounds of Rheum palmatum L. on the inhibition of NO production from RAW 264.7 cells were explored. Seven main anthraquinone derivatives were isolated from the root of R. palmatum, and of these, emodin and rhein significantly inhibited nitrite production from lipopolysaccharide (LPS)-activated RAW 264.7 cells. The IC(50) values for inhibition of nitrite production by emodin and rhein were 60.7 and 67.3 microM, respectively. After iNOS enzyme activity was stimulated by LPS for 12 h, treatment with emodin or rhein at 20 microg/ml for 18 h did not significantly inhibit NO production. The data show that the inhibitory activity of emodin and rhein is not due to direct inhibition of iNOS enzyme activity. However, expression of iNOS and the COX-2 protein was inhibited by emodin in LPS-activated RAW 264.7 cells, and PGE(2) production was reduced. Rhein also inhibited LPS-induced iNOS protein expression, but not COX-2 or PGE(2) production. On the other hand, inhibition effects on NO production from RAW 264.7 cells were enhanced and cytotoxic effects decreased by co-treatment with emodin and rhein. In conclusion, emodin and rhein are major iNOS inhibitors of R. palmatum and may possibly serve as bioactive substances for anti-inflammation effects.

7030. Yeh GY, Eisenberg DM, Davis RB, Phillips RS. Use of complementary and alternative medicine among persons with diabetes mellitus: results of a national survey. Am J Public Health. 2002 Oct;92(10):1648-52.

OBJECTIVES: This study sought to characterize the use of complementary and alternative medicine (CAM) among persons with diabetes mellitus residing in the United States. METHODS: Data from a 1997-1998 national survey (n = 2055) on CAM use were examined. RESULTS: Ninety-five respondents reported having diabetes, of whom 57% reported CAM use in the past year; fewer respondents (35%) reported use specifically for diabetes. Therapies used for diabetes included solitary prayer/spiritual practices (28%), herbal remedies (7%), commercial diets (6%), and folk remedies (3%). Excluding solitary prayer, only 20% of respondents used CAM to treat diabetes. CONCLUSIONS: The prevalence of CAM therapy use among persons with diabetes is comparable to that among the general population. Use of CAM therapies specifically to treat diabetes, however, is much less common.

Aromatherapy:

7031. Dunwoody L, Smyth A, Davidson R. Cancer patients' experiences and evaluations of aromatherapy massage in palliative care. Int J Palliat Nurs 2002 Oct;8(10):497-504

Many patients suffering from cancer make use of complementary therapies, with aromatherapy being a popular choice. Quantitative studies, using questionnaire data, have shown that aromatherapy may reduce psychological distress and enhance symptom control in cancer patients. However, little is known about the personal meanings patients associate with the therapy. This study explored the patients' experiences of aromatherapy using of a focus group interview. Eight themes emerged from the analysis, six of which have been acknowledged to some extent by previous authors: de-stressing effects of aromatherapy, the counselling role of the aromatherapist, aromatherapy as a reward, patient empowerment, communication through touch, and negative aspects of the service. Two apparently new themes emerged concerned with security of context (where the aromatherapy took place) and preconceived perceptions of the value of aromatherapy as a treatment of cancer patients. The implications of the findings are discussed in relation to the perceived role of counselling, collaborative practice and training in complementary therapies.

7032. Louis M, Kowalski SD. Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Am J Hosp Palliat Care 2002 Nov-Dec;19(6):381-6

This study measured the responses of 17 cancer hospice patients to humidified essential lavender oil aromatherapy. Vital signs as well as levels of pain, anxiety, depression, and sense of well-being were measured (using 11-point verbal analogs). Each subject was measured on three different days before and after a 60-minute session consisting of (1) no treatment (control); (2) water humidification (control); or (3) 3-percent lavender aromatherapy. Results reflected a positive, yet small, change in blood pressure and pulse, pain, anxiety, depression, and sense of well-being after both the humidified water treatment and the lavender treatment. Following the control session (no treatment), there was also slight improvement in vital signs, depression, and sense of well-being, but not in pain or anxiety levels.

Ayurveda:

7033. Emami Limited . Process for preparing ayurvedic tonic cum restorative preparation for given sufficient energy to body and having booster, reflaxant, digestive and restorative properties .India 187339. (ISA 018622, Vol 38 No18 ,16 Sept 2002)

7034. Gautam H R. Set your body clock for good health.kisan wld 2001,28(9),47(9). (ISA 016141, Vol 38 No16 ,16 Aug. 2002)

7035. Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med 2002 Nov 19;137(10):805-13.

7036. Muzaffer Alam, Jaya N, Saraswathy VN, Venugopal TN, Tewari NS. Hypoglycaemic action of some ayurvedic medicines. Aryavaidyan. 2002 Aug-Oct; XVI(1): 45-50.

Herbal Medicine:

7037. Barak V, Birkenfeld S, Halperin T, Kalickman I. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002 Nov;4(11 Suppl):919-22.

7038. Danz H, Stoyanova S, Thomet OA, Simon HU, Dannhardt G, Ulbrich H, Hamburger M. Inhibitory activity of tryptanthrin on prostaglandin and leukotriene synthesis. Planta Med. 2002 Oct;68(10):875-80.

7039. De Smet PA. Herbal remedies. N Engl J Med. 2002 Dec 19;347(25):2046-56. Review. No abstract.

7040. Ganguly M , Manna A Chandra G, Ghosh D Ghosh L.K. Gupta B.K. Andrographis paniculata : a promising herbal plant. Indian J Pharm Education 2001,35(2),63-4. (ISA 014375, Vol 38 No14 ,16 July 2002)

7041. McCulloch M, Broffman M, Gao J, Colford JM Jr. Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials. Am J Public Health. 2002 Oct;92(10):1619-28.

OBJECTIVES: This meta-analysis was conducted to examine the effectiveness of Chinese herbal medicine (either alone or with interferon alfa) in treating chronic hepatitis B. METHODS: We searched the TCMLARS, AMED, CISCOM, EMBASE, MEDLINE, and Cochrane Collaboration databases and then hand-searched the articles' bibliographies. RESULTS: Chinese herbal medicine significantly increased seroreversion of HBsAg and was equivalent to interferon alfa in seroreversion of HBeAg and hepatitis B virus (HBV) DNA; Chinese herbal medicine combined with interferon alfa significantly increased seroreversion of HBsAg, HBeAg, and HBV DNA. The Chinese herbal medicine active component bufotoxin combined with interferon alfa significantly increased HBeAg and HBV DNA seroreversion. The Chinese herbal medicine active component kurorinone was equivalent to interferon alfa in seroreversion of HBeAg and HBV DNA. CONCLUSIONS: Although the quality of existing studies was poor, these data suggest that further trials of Chinese Herbal Medicine and interferon in chronic hepatitis B infection are justified.

7042. Natarajan D, Lavarasan RI, Chandra babu S, Sahib Thambi Refai MAC, Thameemul – Ansari LH. Antimicrobial studies on methanol extract of Benincasa hispida cogn. Fruit. Ancient Science of Life. 2003 Jan; XXII(3): 98-100.

7043. Satish Nayak, Singhai AK. Antimicrobial activity of the roots of cocculus hirsutus. Ancient Science of Life. 2003 Jan; XXII(3): 101-105.

7044. Singh OP, Das B, Padhi MM, Tewari NS. Common herbs used in different skin disorders as described in Ayurvedic classics. Ancient Science of Life. 2003 Jan; XXII(3): 88-94.

Homeopathy:

7045. Fleisher MA, McCarter DF. Homeopathy or isopathy? J Fam Pract 2002 Nov;51(11):984, 986. No abstract.

Hypnotherapy:

7046. Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology 2002 Dec;123(6):1778-85

BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.

Naturopathy:

7047. Steyer TE, Freed GL, Lantz PM. Medicaid reimbursement for alternative therapies. Altern Ther Health Med 2002 Nov-Dec;8(6):84-8

CONTEXT: A growing number of complementary and alternative therapies are eligible for reimbursement by third party payers in the United States. No studies have examined current trends in the use of public funds for the payment of complementary and alternative medicine (CAM). OBJECTIVE: To determine the reimbursement polices of state Medicaid programs for CAM. DESIGN: Cross-sectional study. PARTICIPANTS: 46 state Medicaid reimbursement specialists. INTERVENTION: Telephone survey. RESULTS: Of the 46 states participating in the study, 36 Medicaid programs (78.3%) provide coverage for at least 1 alternative therapy. The most commonly reimbursed therapies are chiropractic by 33 programs (71.7%), biofeedback by 10 programs (21.7%), acupuncture by 7 programs (15.2%), and hypnotherapy and naturopathy by 5 programs each (10.8%). CONCLUSIONS: Many Medicaid programs are paying for the use of CAM. Further research is needed to determine if Medicaid recipients are aware of these reimbursement policies and the extent to which recipients are using CAM for their healthcare.

Reflexology:

7048. Mantle F. The role of alternative medicine in treating postnatal depression. Complement Ther Nurs Midwifery. 2002 Nov;8(4):197-203. Review.

Postnatal depression is a serious and debilitating condition. Due to the perceived stigma of mental illness, the incidence of it is underreported and many mothers refuse psychiatric help either assuming postnatal depression to be normal or because of the potential consequences of having a psychiatric history. Community practitioners who are in contact with new mothers may welcome additional interventions which can enhance the supportive care they give to these women. This article discusses the evidence for a number of these interventions which mothers may find more acceptable than orthodox treatment. The aim of this article is to highlight the possible role of a number of complementary and alternative medicines as adjuncts or alternative treatments for postnatal depression. The interventions discussed in this article include Ayurvedic medicine, herbalism, homeopathy, aromatherapy, massage, hypnosis and traditional Chinese medicine (TCM). With the exception of TCM and Ayurvedic medicine, these interventions have been supported by the House of Lord's Select Committee on Science and Technology (2000) as having an evidence base. Ayurvedic medicine and TCM have been included in this article however, because a number of clients may be using them as their main system of health care—thereby validating the need for information regarding their efficacy. This article is not exhaustive, nor a licence to practice, but is intended as a resource for practitioners with a sound understanding of postnatal depression and conventional treatments whose clients may reject these approaches and be looking for alternative interventions. The final choice of treatment should be the result of discussion between the health visitor and the client and will depend on considerations such as availability, cost and acceptability of the intervention--this article does not, therefore, suggest a 'best option' approach. In addition, it does not address the professional and legal responsibilities of practitioners since these have been well reviewed by Darley (1995), Mantle (1997), Knape (1998) and Rankin-Box (2001).

7049. Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002 Oct;92(10):1657-61.

7050. Stuttard P. Working in partnership to develop evidence-based practice within the massage profession. Complement Ther Nurs Midwifery. 2002 Nov;8(4):185-90.

In view of changing policy and recommendation for complementary medicine, the moves towards regulatory mechanisms and an evidence base for practice, there is a need to establish the extent to which this is happening within professions and identify away forward that will benefit the individuals and organisations involved. This paper outlines the views and opinions of professional masseurs at the Northern Institute of Massage in the North of England and discusses how such a professional organisation for massage can work in partnership with Higher Education to develop a stronger evidence base for practice. The study concludes that a significant number of practitioners of the Northern Institute are aware of the need for an evidence base for practice but need to be supported in finding, reading and applying research findings to their practice. A partnership between professional organisations for massage and higher education can benefit both parties and help to facilitate change for the future.

Traditional Medicine:

7051. Baumann B, Bohnenstengel F, Siegmund D, Wajant H, Weber C, Herr I, Debatin KM, Proksch P, Wirth T. Rocaglamide derivatives are potent inhibitors of NF-kappa B activation in T-cells. J Biol Chem. 2002 Nov 22;277(47):44791-800.

Crude extracts from different Aglaia species are used as anti inflammatory remedies in the traditional medicine of several countries from Southeast Asia. Because NF-kappaB transcription factors represent key regulators of genes involved in immune and inflammatory responses, we supposed that the anti-inflammatory effects of Aglaia extracts are mediated by the inhibition of NF-kappaB activity. Purified compounds of Aglaia species, namely 1H-cyclopenta[b]benzofuran lignans of the rocaglamide type as well as one aglain congener were tested for their ability to inhibit NF-kappaB activity. We show that a group of rocaglamides represent highly potent and specific inhibitors of tumor necrosis factor-alpha (TNFalpha) and phorbol 12-myristate 13-acetate (PMA)-induced NF-kappaB-dependent reporter gene activity in Jurkat T cells with IC(50) values in the nanomolar range. Some derivatives are less effective, and others are completely inactive. Rocaglamides are able to suppress the PMA-induced expression of NF-kappaB target genes and sensitize leukemic T cells to apoptosis induced by TNFalpha, cisplatin, and gamma-irradiation. The suppression of NF-kappaB activation correlated with the inhibition of induced IkappaB(alpha) degradation and IkappaB(alpha) kinase activation. The level of interference was determined and found to be localized upstream of the IkappaB kinase complex but downstream of the TNF receptor-associated protein 2. Our data suggest that rocaglamide derivatives could serve as lead structures in the development of anti-inflammatory and tumoricidal drugs.

7052. Bodeker G, Kronenberg F. A public health agenda for traditional, complementary, and alternative medicine. Am J Public Health. 2002 Oct;92(10):1582-91.

Yoga:

7053. Biswas R, Paul A, Shetty KJ. A yoga teacher with persistent reflux symptoms. Int J Clin Pract 2002 Nov;56(9):723 No abstract.

7054. Greendale GA, McDivit A, Carpenter A, Seeger L, Huang MH. Yoga for women with hyperkyphosis: results of a pilot study. Am J Public Health 2002 Oct;92(10):1611-4 No Abstract

7055. Sahay BK. Role of exercise and yoga in diabetes millitus. JIMSA 2000 ,13(2),154-9. (ISA 013477, Vol 38 No13 ,1 July 2002)

Yunani

7056. Siddiqui MMH, Hakkim MH. Effect of majoon dabid-ward-al-ward and sharbat buzoori motadil in yarqan-e-suddi (obstructive jaundice). Aryavaidyan. 2002 Aug-Oct; XVI(1): 30-35.

July 2003

Acupuncture:

7565. Crane R. Acupuncture and smoking cessation: pinning down the claims. Am J Public Health. 2003 Feb;93(2):187. No abstract.

7566. Fassoulaki A, Paraskeva A, Patris K, Pourgiezi T, Kostopanagiotou G. Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers. Anesth Analg. 2003 Mar;96(3):885-90.

We investigated the effect of pressure application on the acupuncture point

"extra 1" and on a control point on the bispectral index (BIS) values and on stress in 25 volunteers. In each volunteer, pressure was applied on the extra 1 point for 10 min and on a control point for 5 min on different days and in a randomized manner. The BIS value was recorded before applying pressure on the extra 1 point, during pressure application every 30 s for 10 min, and after pressure release. Regarding the control point, BIS values were recorded for 5 instead of 10 min during pressure application because acupressure on that point was associated with an unpleasant feeling. Each volunteer was asked to score stress before and after pressure application from 0 to 10. The BIS values were significantly reduced 2.5, 5, 7.5, and 10 min during pressure application on the extra 1 point (P < 0.001 for each comparison, respectively) and returned to the baseline values after pressure release. Pressure application on the control point decreased BIS values (P < 0.01 and P < 0.05 at 2.5 and 5 min, respectively). However, these values were maintained close to 90% and were significantly higher than those obtained during pressure on the extra 1 point (P < 0.001 and P < 0.001 for the 2.5- and 5-min comparisons). The verbal sedation score values obtained after pressure application on the extra 1 point were also lower when compared with the values obtained after pressure application on the control point (P < 0.001). IMPLICATIONS: This crossover study investigated the effect of pressure application on the acupuncture "extra 1" point in healthy volunteers. Acupressure applied for 10 min on the extra 1 point significantly reduced the BIS values and the verbal stress score when compared with acupressure applied on a control point.

7567. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci. 2003 Jan;26(1):17-22. Review. No abstract.

7568. Melchart D, Thormaehlen J, Hager S, Liao J, Linde K, Weidenhammer W. Acupuncture versus placebo versus sumatriptan for early treatment of migraine attacks: a randomized controlled trial. J Intern Med. 2003 Feb;253(2):181-8.

OBJECTIVES: To investigate whether acupuncture is superior to placebo and equivalent to sumatriptan for the early treatment of an acute migraine attack. DESIGN: Randomized, partly double-blind (sumatriptan versus placebo) trial. SETTING: Two hospitals in Germany (one specialized in traditional Chinese medicine and one in the treatment of headache). SUBJECTS: A total of 179 migraineurs experiencing the first symptoms of a developing migraine attack. INTERVENTIONS: Traditional Chinese acupuncture, sumatriptan (6 mg subcutaneously) or placebo injection. MAIN OUTCOME MEASURE: Number of patients in whom a full migraine attack (defined as severe migraine headache) within 48 h was prevented. In patients who developed a migraine attack in spite of early treatment, acupuncture and sumatriptan were applied a second time, whilst patients initially randomized to placebo received sumatriptan. RESULTS: A full migraine attack was prevented in 21 of 60 (35%) patients receiving acupuncture, 21 of 58 (36%) patients receiving sumatriptan and 11 of 61 (18%) patients receiving placebo (relative risk of having a full attack 0.79 (95% CI, 0.64-0.99) for acupuncture versus placebo, and 0.78 (95% CI, 0.62-0.98) for sumatriptan versus placebo). Response to the second intervention in patients who developed a full attack was better with sumatriptan (17/31 patients who received sumatriptan twice and 37/46 patients who had had placebo first) than with acupuncture (4/31). The number of patients reporting side-effects was 14 in the acupuncture group, 23 in the sumatriptan group and 10 in the placebo group. CONCLUSIONS: In this trial acupuncture and sumatriptan were more effective than a placebo injection in the early treatment of an acute migraine attack. When an attack could not be prevented, sumatriptan was more effective than acupuncture at relieving headache.

Ayurveda:

7569. Auddy B, Ferreira M, Blasina F, Lafon L, Arredondo F, Dajas F, Tripathi PC, Seal T, Mukherjee B. Screening of antioxidant activity of three Indian medicinal plants, traditionally used for the management of neurodegenerative diseases. J Ethnopharmacol 2003 Feb;84(2-3):131-8

A number of Indian medicinal plants have been used for thousands of years in the traditional system of medicine (Ayurveda). Amongst these are plants used for the management of neurodegenerative diseases such as Parkinson's, Alzheimer's, loss of memory, degeneration of nerves and other neuronal disorders by the Ayurvedic practitioners. Though the etiology of neurodegenerative diseases remains enigmatic, there is evidence, which indicates that defective energy metabolism, excitotoxicity and oxidative damage may be crucial factors (Ann. Neurol. 38 (3)(1995) 357). The part of the Ayurvedic system that provides an approach to prevention and treatment of degenerative diseases is known as Rasayana, and plants used for this purpose are classed as rejuvenators. This group of plants generally possesses strong antioxidant activity (Pharmacol. Biochem. Behav. 43 (1992) 1175), but only a few have been investigated in detail. In the present study, three such rasayana plants were tested for the first time for their toxicity and free radical scavenging activity both in vitro and ex vivo. All the three plant infusions (up to 1 mg/ml) showed no toxic effects on the viability of PC12 cell line as judged by MTT-test. Both ethanolic extracts and water infusions of the plants were tested for their antioxidant activity in the 2,2'-azinobis-3-ethyl-benzothiazoline-6-sulfonic acid (ABTS*(+)) radical cation decolorization assay; inhibition of lipid peroxidation by plant infusions was carried out using spontaneous lipid peroxidation of rat brain homogenate, and IC50 values were determined. The results from the ABTS assay showed that the ethanolic extract of Sida cordifolia was found to be most potent (IC50 16.07 microg/ml), followed by Evolvulus alsinoides (IC50 33.39 microg/ml) and Cynodon dactylon (IC50 78.62 microg/ml). The relative antioxidant capacity for the water infusions was observed in the following order: E. alsinoides (IC50 172.25 microg/ml)>C. dactylon (IC50 273.64 microg/ml)>S. cordifolia (IC50 342.82 microg/ml). The results of water infusions of the plants on lipid peroxidation were as follows: E. alsinoides (IC50 89.23 microg/ml)>S. cordifolia) (IC50 126.78 microg/ml)>C. dactylon (IC50 608.31 microg/ml). Copyright 2002 Elsevier Science Ireland Ltd.

7570. Falkenbach A, Oberguggenberger R. Ayurveda in ankylosing spondylitis and low back pain. Ann Rheum Dis 2003 Mar;62(3):276-7 No abstract.

Herbal Medicine:

7571. Agrawala SK; Chatterjee S; Misra SK Immune-potentiation activity of a polyherbal formulation "IMMU-21" (Research name) Phytomedica. 2001; 2(1 & 2): 1-22. No abstract.

7572. Auddy B, Ferreira M, Blasina F, Lafon L, Arredondo F, Dajas F, Tripathi PC, Seal T, Mukherjee B. Screening of antioxidant activity of three Indian medicinal plants, traditionally used for the management of neurodegenerative diseases. J Ethnopharmacol. 2003 Feb;84(2-3):131-8.

A number of Indian medicinal plants have been used for thousands of years in the traditional system of medicine (Ayurveda). Amongst these are plants used for the management of neurodegenerative diseases such as Parkinson's, Alzheimer's, loss of memory, degeneration of nerves and other neuronal disorders by the Ayurvedic practitioners. Though the etiology of neurodegenerative diseases remains enigmatic, there is evidence, which indicates that defective energy metabolism, excitotoxicity and oxidative damage may be crucial factors (Ann. Neurol. 38 (3) (1995) 357). The part of the Ayurvedic system that provides an approach to prevention and treatment of degenerative diseases is known as Rasayana, and plants used for this purpose are classed as rejuvenators. This group of plants generally possesses strong antioxidant activity (Pharmacol. Biochem. Behav. 43 (1992) 1175), but only a few have been investigated in detail. In the present study, three such rasayana plants were tested for the first time for their toxicity and free radical scavenging activity both in vitro and ex vivo. All the three plant infusions (up to 1 mg/ml) showed no toxic effects on the viability of PC12 cell line as judged by MTT-test. Both ethanolic extracts and water infusions of the plants were tested for their antioxidant activity in the 2,2'-azinobis-3-ethyl-benzothiazoline-6-sulfonic acid (ABTS*(+)) radical cation decolorization assay; inhibition of lipid peroxidation by plant infusions was carried out using spontaneous lipid peroxidation of rat brain homogenate, and IC50 values were determined. The results from the ABTS assay showed that the ethanolic extract of Sida cordifolia was found to be most potent (IC50 16.07 microg/ml), followed by Evolvulus alsinoides (IC50 33.39 microg/ml) and Cynodon dactylon (IC50 78.62 microg/ml). The relative antioxidant capacity for the water infusions was observed in the following order: E. alsinoides (IC50 172.25 microg/ml)>C. dactylon (IC50 273.64 microg/ml)>S. cordifolia (IC50 342.82 microg/ml). The results of water infusions of the plants on lipid peroxidation were as follows: E. alsinoides (IC50 89.23 microg/ml)>S. cordifolia) (IC50 126.78 microg/ml)>C. dactylon (IC50 608.31 microg/ml). Copyright 2002 Elsevier Science Ireland Ltd.

7573. Babu MR; Rao RVK; Annapurna A; Babu DRK. Immunostimulant profile of a polyherbal formulation rv08 Indian Journal of Pharmacology. 2001 Dec; 33(6): 454-5 No abstract.

7574. Blumenthal M. Ginger as an antiemetic during pregnancy. Altern Ther Health Med. 2003 Jan-Feb;9(1):19-21; author reply 19-21. No abstract.

7575. Chatterjee S. Effect of immu-21, a herbal formulation on granulocyte-macrophage colony stimulating factors, macrophage maturation and splenic plaque forming cells in experimental animals Indian Journal of Pharmacology. 2001 Dec; 33(6): 442-4.

ABSTRACT: Objective: To investigate the mechanism of immunostimulating action of Immu-21. Method: Swiss albino mice were treated with Immu-21 at various doses (25,50,100 mg/kg, orally) for 15 and 30 days. Granulocyte-Macrophage Colony Stimulating Factors (GM-CSF) was estimated in the serum of the experimental animals. Numbers of esterase positive cells in the bone marrow were counted. Plaque forming cells in spleen of the experimental mice were estimated following sheep RBC challenge. Results: Immu-21 significantly enhanced the GM-CSF activity, number of esterase positive bone marrow cells and plaque forming cells of spleen in experimental animals. The immunostimulatory effect of Immu-21 is dose- dependent. Conclusion: The present study suggests that Immu-21 modulates macrophage maturation and function. Stimulation of plaque forming cell production from spleen by this product helps in stimulating humoral arm of immunity in experimental animals.

7576. Chatterjee S; Agrawala SK. Mast cell stabilizing and lipoxygenase inhibitory activity of AAC 400: a herbal antiasthmatic formulation Phytomedica. 2001; 2(1 & 2): 63-8

ABSTRACT: AAC-400 is a polyherbal formulation reported to be effective against asthma and other allergic respiratory disorders. Present study was made to confirm the mechanism of its action in experimental models. AAC-400 reduced the time of sustained contraction of airway smooth muscles (from 110 minutes to 50 minutes) in response to compound 48/80 challenge. This indicates a possible inhibitory effect on tissue lipoxygenase activity and generation of leukotrienes. Inhibition of Compound 48/80 induced rat paw oedema by AAC-400 could be due to its ability to interfere in the release and/or synthesis of mediators of allergy. Further, the protection against Compound 48/80 induced mortality in rats by AAC- 400 is indicative of its mast cell stabilising effect. It was also found that ACC-400 showed significant inhibition of enzyme lipoxydase (showing the effect on lipoxygenase activity from 100 percent in control to only 7.26 percent in AAC-400 treated), indicating its ability to inhibit the synthesis of leukotrienes. Inhibition of lipoxygenase enzyme and thus synthesis of leukotrienes by AAC-400 leads to a break in the vicious cycle of allergy which appears to be one of the mechanisms of its antiallergic activity. Based on these findings, it appears that the usefulness of AAC-400 in bronchial asthma could be primarily due to its ability to inhibit the synthesis of leukotrienes and also by stabilisation of mast cell membrane.

7577. Chauhan SK; Singh BP. Determination of pistacienoic acids in pistacia integerrima stewart ex brand's by HPTLC and HPLC Indian Journal of Pharmaceutical Sciences. 2002 Jul-Aug; 64(4): 403-5.

ABSTRACT: Simple and reproducible HPTLC and HPLC methods for the determination of pistacienoic acids in Pistacia integerrima were developed and are described. The HPTLC method involves separation of components by TLC on precoated Slice gel 60 F254 plate with a solvent system of chloroform: methanol (95:05) and detection at 220 nm in absorbance mode. The senstivity of HPTLC method was found to be 1.0 miu g and the linearity was observed in the range of 1.0 miu g to 8.0 miu g. The HPLC method involves separation of pistacienoic acids using mobile phase comprising of acetonitrile:water:phosphoric acid (80:20:1) and scanning the chromatogram at 220 nm using a photodiode array detector. The response was linear in the range of 1.25 miu g to 10.0 miu g to 10.0 miu g. The proposed methods being precise and sensitive can be used for detection, monitoring and quantification of pistacienoic acids in P. integerrima.

7578. Chauhan SK; Singh BP; Tuago A; Agrawal S. Accelerated stability studies of a polyherbal preparation (Eumil) capsule. Indian Journal of Pharmaceutical Sciences. 2000 May-Jun.; 62(3): 181-4

ABSTRACT: The stability of Eumil capsule by exposing it to elevated conditions of temperature at 45 Degree and at 40 Degree with 75 Percent relative humidity was studied. The samples were periodically analysed upto six months for their organoleptic characteristics, assay of active plant ingredients and the HPTLC finger printing and their peak area analysis, which were found to be stable/consistent during the period of study. The change in quantifiable components was within 90 Percent of the initial amount, indicating the stability of product for more than three years at room temperature.

7579. Das SN; Singh Y; Agrawala SK. Some Pharmacological and toxicological studies on herbal anti-arthritic product art 400. Phytomedica. 2001; 2(1 & 2): 85-8

ABSTRACT: `Art-400' a poly herbal product is recommended to control the degenerative process in articular cartilage and provide relief from pain and inflammation, in Arthritic conditions. During pharmacological and toxicological studies in laboratory animals, `ART-400' did not show any effect on respiration of anaesthetised rabbits, however, slight fall of arterial blood pressure in anaesthetised dogs was observed. A positive inotropic action without negative or positive chronotropic action was seen in amphibian heart after pretreatment with ART-400. Further, `ART-400' did not modify the action of acetylcholine on isolated ileum of rats, however, per se effect of `ART-400' was having slight relaxation of ileum. The ulcerogenic studies indicated that `ART-400' does not cause any kind of irritation or ulcers in stomach of albino mice.

7580. Das SN; Singh Y; Agrawala SK; Mathur AK. Effect of nefroliv on ischaemia-reperfused renal damage in rats Phytomedica. 2001; 2(1 & 2): 37-40

ABSTRACT: Nefroliv oral administration at the dose of 25 and 50 mg/kg body wt. for 6 consecutive days exhibited reno-protective action against renal damage in rats where injury was induced by ischaemia- reperfusion of kidneys. Both the doses of nefroliv were equally effective in controlling rise in Blood Urea Nitrogen (BUN) after 6 days of oral administration compared to non-treated groups of rats. There was also a significantly lower level of serum creatinine in Nefroliv treated groups as compared to control. Higher dose of Nefroliv (50 mg/kg) was more effective than lower dose (25 mg/kg). Hyperkalaemia was detected in control rats while there was no hyperkalaemia in rats who received Nefroliv.

7581. Diallo D, Paulsen BS, Liljeback TH, Michaelsen TE. The malian medicinal plant Trichilia emetica; studies on polysaccharides with complement fixing ability. J Ethnopharmacol. 2003 Feb;84(2-3):279-87.

Trichilia emetica is a tree or bush that has many different traditional uses in Mali, amongst others the leaves have been used as a woundhealing remedy. As polysaccharides have been isolated from other plants that have a long tradition as woundhealing remedies, it was of interest to study the polysaccharides of T. emetica as well. The polysaccharides were extracted at 50 and 100 degrees C, and the polymeric material was separated into neutral and acidic polymers by anion exchange chromatography. The complement fixation ability of the different fractions was determined. The Acidic fraction 4 of the 100 degrees C extract was the most active, but most of the other fractions were also quite active. Structural studies showed that the most active fraction was a pectin of the rhamnogalacturonan type 1 with side chains of the arabinogalactan type II. Removal of terminal arabinofuranosides lead to a drop of the activity indicating that this structural unit may be involved in the bioactive site of the molecule. Copyright 2002 Elsevier Science Ireland Ltd.

7582. Edmonds SE, Montgomery JC. Reversible ovarian failure induced by a Chinese herbal medicine: lei gong teng. BJOG. 2003 Jan;110(1):77-8. No abstract.

7583. Fabio A, Corona A, Forte E, Quaglio P. Inhibitory activity of spices and essential oils on psychrotrophic bacteria. New Microbiol. 2003 Jan;26(1):115-20.

This study was designed to evaluate "in vitro" the inhibitory effects of spices and essential oils on the growth of psycrotrophic food-borne bacteria: Aeromonas hydrophila, Listeria monocytogenes and Yersinia enterocolitica. The sensitivity to nine spices and their oils (chilli, cinnamon, cloves, ginger, nutmeg, oregano, rosemary, sage, thyme) was studied. Antibacterial activity was evaluated on liquid and solid medium. Spices: 1% concentration of each spice was added separately to Triptic Soy Broth and then inoculated to contain 10(8)/ml sorganism and held to 4 degrees C for 7 days. Populations of test organism were determined on Triptic Soy Agar. Oils: Inhibition of growth was tested by using the paper disc agar diffusion method (at 35, 20 and 4 degrees C) and measuring their inhibition zone. MIC was determined by the broth microdilution method. Some culinary spices produce antibacterial activity: inhibition of growth ranged from complete (cinnamon and cloves against A. hydrophila) to no inhibition. Antibacterial inhibition zone ranged from 8 mm to 45 mm: thyme essential oil showed the greatest inhibition against A. hydrophila.

7584. Ghosal S. Free radicals, oxidative stress and antioxidant defence Phytomedica. 2000 Mar; 1(1 & 2): 1-8.

ABSTRACT: Oxidative stresses of modern age and daily use of oxygen in aerobic organisms cause high production of free radicals of different chemistry and biology which give rise to various diseases and disorders. When body's in-built system of anti-oxidant enzymes e.g. SOD, CAT and GPX are not able to combat unbridled production of free radicals the use of antioxidants of natural origin provides immense benefits. The scientific studies conducted on some herbs e.g. Withania somnifera, Emblica officinalis, Ocimum sanctum, Bacopa moniera and herbomineral shilajit confirm their antioxidant defenses and mechanisms of action in lipophilic and hydrophilic phases, with more potent effect than synthetic Vit. C & E combination and other known chemical antioxidants.

7585. Goel RK; Sairam K. Anti-ulcer drugs from indigenous sources with emphasis on musa sapientum, tamarabhasma, asparagus racemosus and zingiber officinale Indian Journal of Pharmacology. 2002 Apr; 34(2): 100-10.

7586. Gomes A; Dasgupta SC Antihistaminic and antianaphylactic property of polyherbal immunomodulator pulmoflex Phytomedica. 2000 Mar; 1(1 & 2): 9-13

ABSTRACT: Therapeutic application of herbs against various pathophysiological condition is well known and several herbs and herbal formulations have been mentioned in Indian Ayurvedic literature. PulmoFlex is a polyherbal formulation of ten standardised herbal extracts, manufactured by Indian Herbs, Saharanpur, India. This product is claimed to provide long lasting relief in allergic disorders through its immunomodulatory, mast cell stabilizing, antiallergic and bronchodilator actions. The present study was designed to explore the antihistaminic and antianaphylactic property of PulmoFlex in experimental animals. In in-vitro studies, PulmoFlex significantly inhibited compound 48/80 induced mast cell degranulation. PulmoFlex significantly protected histamine aerosol induced collapse in guineapig and compound 48/80 induced histamine release from guineapig chopped lung preparation. PulmoFlex also exhibited significant protection in passive foot anaphylaxis and passive cutaneous anaphylaxis in albino mice. Bovine serum albumin induced anaphylactic shock in male albino mice was also antagonised by PulmoFlex.

7587. Howes MJ, Perry NS, Houghton PJ. Plants with traditional uses and activities, relevant to the management of Alzheimer's disease and other cognitive disorders. Phytother Res. 2003 Jan;17(1):1-18. Review.

In traditional practices of medicine, numerous plants have been used to treat cognitive disorders, including neurodegenerative diseases such as Alzheimer's disease (AD) and other memory related disorders. An ethnopharmacological approach has provided leads to identifying potential new drugs from plant sources, including those for memory disorders. There are numerous drugs available in Western medicine that have been directly isolated from plants, or are derived from templates of compounds from plant sources. For example, some alkaloids from plant sources have been investigated for their potential in AD therapy, and are now in clinical use (e.g. galantamine from Galanthus nivalis L. is used in the United Kingdom). Various other plant species have shown favourable effects in AD, or pharmacological activities indicating the potential for use in AD therapy. This article reviews some of the plants and their active constituents that have been used in traditional medicine, including Ayurvedic, Chinese, European and Japanese medicine, for their reputed cognitive-enhancing and antidementia effects. Plants and their constituents with pharmacological activities that may be relevant to the treatment of cognitive disorders, including enhancement of cholinergic function in the central nervous system, anti-cholinesterase (anti-ChE), antiinflammatory, antioxidant and oestrogenic effects, are discussed. Copyright 2003 John Wiley & Sons, Ltd.

7588. Kaur M; Chandola HM. Clinical study on the role of dazzle in the management of rheumatoid arthritis. Antiseptic. 2001 Jun; 98(6): 210-3.

ABSTRACT: Rheumatoid arthritis is the most rampant chronic inflammatory disease of the joints and affects approximately 3 percent of the population. The disease has worldwide distribution, claiming the maximum loss of human working hours. It continues to pose a challenge to the physicians due to its chronicity and crippling character. An ayurvedic preparation named Dazzle capsule, formulated with the extract of the herbs, is claimed to be effective in rheumatoid arthritis. This study was carried out to evaluate its role in the management of rheumatoid arthritis (Amavata).

7589. Mary N K, Shylesh B S, Babu B H, Padikkala J. Antioxidant and hypolipidaemic activity of a herbal formulation – Liposem. Indian J expl Biol 2002, 40(8), 901-40(04).

ISA 22881 Vol 38, No. 22, 16 Nov 2002.

7590. Mathur AK Jain AK; Vikas Kumar; Das SN; Agarwala SK. Clinical trial of herbal nathaem in healthy human volunteers Antiseptic. 2002 Nov; 99(11): 420-2.

ABSTRACT: NatHaem is a herbo-mineral formulation of Indian herbs, Saharanpur for the treatment and prevention of iron deficiency anaemia. A clinical study was conducted in healthy human volunteers to assess the safety and tolerability profile of this products. Body weight, pulse rate, blood pressure, haemogram, urine examination and routine biochemistry parameters were recorded before and after administration of NatHaem Syrup/Capsules administration improved body iron stores in all the volunteers under trial, proving the beneficial effects of NatHaem on iron metabolism and assimilation. Kidney and liver functions were well maintained in all cases showing the high safety and tolerability profile of NatHaem.

7591. Mathur AK. Multicentre clinical evaluation of "eazmov plus" a polyherbal formulation in arthritic patients JK Practitioner. 2000 Apr-Jun; 7(2): 149-52.

ABSTRACT: A multicentre Clinical Observation and Monitoring Project (COMP) was carried out in 60 patients of Arthritis comprising Osteoarthritis (OA), Rheumatoid arthritis (RA) and Non-specific Arthritis (NSA), ranging in age from 32 to 70 years. This trial was designed as a prospective observational study to monitor the safety and efficacy profile of "EazMov Plus" a polyherbal formulation for treatment of Arthritis. It involved 10 physicians from different parts of Northern India who recruited arthritic patients and no maximum limit of patients per physician. Thus this COMP ensured the use of the product in "Real Life Situation", as seen in day to day clinical practice. The Clinical profile of all patients was carefully recorded in a clinical examination form at the beginning of treatment and "EazMov Plus" Capsules were given in dose of 1 capsule twice a day after meals for 3 weeks. Clinical signs were again recorded at the end of week 1, 2 and 3 respectively on a scale as absent, mild, moderate and severe. Patient compliance, the presence of side effects, and overall response to treatment were carefully observed and noted. Significant reduction in the severity of symptoms as compared to the baseline was seen, with improvement in joint mobility and reduction of stiffness. The incidence of drug related adverse events was minimal 3 percent and did not require discontinuation of treatment. It would be interesting to compare the results of this real life COMP with a double blind activedrug/placebo controlled trial in a monitored clinical environment.

7592. Oza MI A Clinical evaluation of ovarin syrup-an ayurvedic preparation in 110 patients suffering from irregular menstruation cycle, dysfunctional uterine bleeding & associated symptoms Antiseptic. 2003 Jan; 100(1): 23-5.

ABSTRACT: Menstrual disorders are the commonest problems observed and the treatment is mainly by Hormone Replacement Therapy, but tolerance ratio in Hormone Replacement Therapy is not satisfactory and is not well tolerated and safe in some cases. After doing the research works on different herbs in different formulation, Ban Labs formulated non-hormonal, herbo-mineral uterine tonic with the nature of Ovarin syrup through the extensive experimental trial. To further confirm the efficacy and the safety a clinical trial was conducted.

7593. Padmalatha K; Venkataraman BV; Roopa R. Antianaphylactic effect of DLH-3041 (Polyherbal formulation) on rat mesenteric mast cell degranulation Indian Journal of Pharmacology. 2002 Apr; 34(2): 119-22

ABSTRACT: Objective: To study the antianaphylactic effect of DLH-3041 (polyherbal formulation) on the rat mesenteric mast cells. Methods: The study was carried out on the rat mesenteries sensitized with sheep serum to induce mast cell degranulation. Mesenteries pretreated with prednisolone, disodium cromoglycate, DLH-3041 were analysed for the mast cell degranulation during the anaphylactic reactions. Results: Treatment with DLH-3041 showed beneficial effect on degranulation of actively (P0.005) and passively (P0.05-0.005) sensitized mesenteric mast cells. The protective effect was comparable with that of prednisolone and disodium cromoglycate and was also observed after one week of withdrawal of the compound. Conclusion: Antianaphylactic activity of DLH-3041 may be possibly due to the membrane stabilizing potential, suppression of antibody production and inhibition of antigen induced histamine release.

7594. Pathak K P, Ghanchi F D, Zacharias S J. Dilemma of tuberculosis. Gujarat med J 2002, 59(1), 71-2.

ISA 22891Vol 38, No. 22, 16 Nov 2002.

7595. Sahoo N; Behura NC; Mishra J Effects of Immu-21 on certain blood biochemicals, milk, colostrum, body weight gain and livability in goats Phytomedica. 2001; 2(1 & 2): 69-76.

ABSTRACT: Study was undertaken to evaluate the efficacy of immu-21 (a herbal immunomodulator manufactured by M/s Indian Herbs) in goats. Twenty-four healthy pregnant Black Bengal goats in the last month of the pregnancy were randomly divided into two equal groups (Group I and II). The Immu-21 at the dose rate of 15 mg/kg body weight daily was given orally to does of Group I for about one month before the expected date of kidding. All the kids delivered from both the groups were subsequently divided into equal numbers (Group IA, IIA and IIB) consisting of six kids each. Kids of Group IA and IIA were given Immu-21 at the same dose rate for first 10 days of every month till 6 months of age. Haemato-biochemical values such as Hb, PCV, Glucose, Total protein, Albumin, Globulin, creatinine, cholesterol, Urea, GOT, GPT, LDH, ALP and Immunoglobulin were recorded both pre and post kidding in does and during 1st, 3rd and 6th month of age in kids. Milk yield and its composition (protein, ash, SNF, fat lactose and lactoglobulin) were recoded at 15 days interval upto 60 days. Besides, body weight of kids were recorded from birth upto 270 days of age at an interval of 15 days. Significantly higher birth weight, increased concentration of protein in blood and immunoglobulin in colostrum and absence of kid mortality were recorded in the pregnant does and kids supplemented with immu-21. Thus administration of Immu- 21 during later part of pregnancy as well as to the kids during growth period would be considered much more beneficial than either stage alone.

7596. Udupa V; Kulkarni KS; Rafiq Md; Gopumadhavan S; Venkataranganna MV; Mitra SK Effect of HD-03 on levels of various enzymes in paracetamol induced liver damage in rats. Indian Journal of Pharmacology. 2000 Dec.; 32(6): 361-4

ABSTRACT: Objective: To review the evidence for a role of HD-03, a polyherbal formulation in regulating the sodium pump in hepatic injury induced by paracetamol. Methods: Alterations in sodium pump was induced by chronic administration of paracetamol at the dose of 500 and 1000 mg/kg, b. wt. for 28 days. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), liver glutathione, glycogen and Na+/-K+/-ATPase activity estimation and histology of liver were studied in rats. Results: Chronic administration of paracetamol for 4 weeks to rats produced dose dependent increase in ALT, AST and reduction in liver Na+/-K+/-ATPase activity, glycogen and glutathione levels, indicating the hepatocellular damage. Histological evaluation supported this change with evidence of swelling, hydropic degeneration and necrosis of the hepatocytes. These changes were reversed with simultaneous administration of paracetamol and HD-03 at 750 mg/kg, for 28 days. Conclusion: Reversal of Na+/-K+/-ATPase, glycogen, glutathione levels and restricted hepatic damage in HD-03 treated animals confirms the hepatoprotective effect of HD-03. Thus, Na+/-K+/-ATPase may be considered as a marker to evaluate the hepatoprotective effects of various herbs.

7597. Vastrad CS; Pakkanavar RV. Clinical evaluation of PIL - 28, a herbal formulation in the management of hemorrhoids. Antiseptic. 2002 Sep; 99(9): 343-4.

ABSTRACT: Fifty patients of either sex aged between 22 and 63 years entered in the study for the evaluation of safety and efficacy of PIL-28. PIL -28 is a formulation of herbs and minerals designed for the management of hemorrhoids. In the group that entered the study, 31 had external hemorrhoids 10 had internal hemorrhoids and 9 of the patients had both internal as well as external hemorrhoids. The patients were given PIL-28 at a dose of 1 table, twice daily for 6 weeks. At the end of the 6 weeks treatment, the patients were evaluated for efficacy and tolerability of PIL-28 tablets. The results revealed that response to PIL 28 was very good in 56.25 percent of patients and good in 37.50 percent of the patients, showing a marked improvement in general health along with a gross reduction of associated symptoms. There were no side effects observed during the treatment and follow-up period.

7598. Yang CH, Hsieh LL, Tsai CW, Chiou FS, Chou SL, Hsu BD, Pai CY. Evaluation of the DNA stability of forensic markers used in betel-quid chewers' oral swab samples and oral cancerous specimens: implications for forensic application. J Forensic Sci. 2003 Jan;48(1):88-92.

Chewed betel-quid (BQ) residues are often considered vital biological evidence at crime scenes, since the human DNA extracted from the residues is actually from buccal epithelial cells and can be associated with suspects. BQ-chewing is also a risk factor for oral diseases and/or cancers. Archived medical oral-specimens can be used to identify specific individuals under adverse conditions, although STR markers are known to be unstable in various tumor tissues. This study evaluates the DNA stability of forensic marker systems in BQ-chewers' oral epithelial cells, and in archived clinical specimens of oral cancer patients. The genotypes of oral and paired peripheral blood samples in 200 subjects were compared, using the commercialized typing systems of HLA-DQA1, PM (including LDLR, GYPA, HBGG, D7S8, and GC loci), and AmpFlSTR markers (including 9 STR loci and the Amelogenin gene). The 100 healthy BQ-chewers had consistent oral swab and paired blood sample genotypes analyzed withboth DQA1/PM and STR marker systems. In the 100 oral cancer patients, one discordant result at D7S8 was found in the 600DQA1/PM-marker loci, and 25 allelic alterations with expansion or contraction were detected in the 900 STR loci. The findings herein suggest that when cancerous specimens were tested, the HLA-DQA1/PM system with point polymorphism appears more reliable than the STR system with length polymorphism. Our results also indicate that healthy BQ-chewers' oral cotton swabs containing buccal epithelial cells are useful for forensic purposes using the HLA-DQA1, PM, and STR marker systems.

7599. Yeh SF, Gupta M, Sarma DN, Mitra SK. Downregulation of hepatitis B surface antigen expression in human hepatocellular carcinoma cell lines by HD-03, a polyherbal formulation. Phytother Res. 2003 Jan;17(1):89-91.

Hepatitis B virus is associated with chronic or acute liver diseases and with hepatocellular carcinoma. In the present study, we examined the activity of HD-03, a polyherbal formulation, on two hepatitis B surface antigen (HBsAg) expressing human hepatocellular carcinoma cell lines, PLC/PRF/5 and HepG2/A2. We observed that HD-03 downregulates HBsAg expression from these cell lines. Our studies have also shown that this effect is neither due to cytotoxicity on the cell lines nor due to blockade of the release of the antigen from the cells nor due to binding of the substance with the antigen. The possible mode of its antiviral activity is explained. Copyright 2003 John Wiley & Sons, Ltd.

Homeopathy:

7600. Crump SC, Oxley M. Society of Homeopaths does not advise against vaccination. BMJ. 2003 Jan 18;326(7381):164. No abstract.

7601. Hobbs B. Homeopathy: a potent alternative. J Fam Plann Reprod Health Care. 2003 Jan;29(1):6-7. No abstract.

7602. Jonas WB, Kaptchuk TJ, Linde K. A critical overview of homeopathy. Ann Intern Med. 2003 Mar 4;138(5):393-9. Review.

Homeopathy is a 200-year-old therapeutic system that uses small doses of various substances to stimulate autoregulatory and self-healing processes. Homeopathy selects substances by matching a patient's symptoms with symptoms produced by these substances in healthy individuals. Medicines are prepared by serial dilution and shaking, which proponents claim imprints information into water. Although many conventional physicians find such notions implausible, homeopathy had a prominent place in 19th-century health care and has recently undergone a worldwide revival. In the United States, patients who seek homeopathic care are more affluent and younger and more often seek treatment for subjective symptoms than those who seek conventional care. Homeopathic remedies were allowed by the 1939 Pure Food and Drug Act and are available over the counter. Some data—both from randomized, controlled trials and laboratory research--show effects from homeopathic remedies that contradict the contemporary rational basis of medicine. Three independent systematic reviews of placebo-controlled trials on homeopathy reported that its effects seem to be more than placebo, and one review found its effects consistent with placebo. There is also evidence from randomized, controlled trials that homeopathy may be effective for the treatment of influenza, allergies, postoperative ileus, and childhood diarrhea. Evidence suggests that homeopathy is ineffective for migraine, delayed-onset muscle soreness, and influenza prevention. There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles, but it should not be substituted for proven therapies.

7603. Jones A. Homeopathic treatment for premenstrual symptoms. J Fam Plann Reprod Health Care. 2003 Jan;29(1):25-8.

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are well-documented disorders causing significant morbidity in the female population. Treatments prescribed do not necessarily reflect proven clinical effectiveness. A recent systematic review from the Exeter Department of Complementary Medicine failed to endorse complementary therapies as a whole for treatment of PMS. However, a recent randomised controlled trial of homeopathic treatment for PMS confirms the clinical experience of homeopathic physicians that homeopathy is helpful in PMS.

7604. McCarney R, Warner J, Fisher P, Van Haselen R. Homeopathy for dementia. Cochrane Database Syst Rev. 2003;(1):CD003803. Review.

BACKGROUND: Dementia is a common illness in older people and has major implications for individuals with the disease, their carers and society. A meta-analysis of population based studies in Europe found the prevalence of dementia in individuals over 65 to be 6.4%. Homeopathy (also spelt "homoeopathy") is a popular form of "complementary" or "alternative" treatment. Some studies have found evidence for efficacy of homeopathic treatment for some conditions, but any mechanism of action of the ultra molecular dilutions used in homeopathy is not comprehensible in terms of current scientific concepts. OBJECTIVES: To evaluate the effectiveness and safety profile of homeopathically prepared medications used in treating dementia, as established by randomized controlled trials. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 May 2024 using the terms alum*, homeop*, "nat sulph" and "natrum sulphate". This Register contains records from all major medical databases. In addition the reviewers searched CISCOM, AMED and Hom-Inform. Leading homeopathic researchers, practitioners and manufacturers were also contacted. SELECTION CRITERIA: All types of randomized controlled trials with a sample size of more than 20 were considered. DATA COLLECTION AND ANALYSIS: The database searches resulted in one trial being identified. After examining the abstract, a paper copy was obtained and independently assessed for inclusion by RM and JW. MAIN RESULTS: There were no studies that fulfilled the criteria for inclusion and no data to present. REVIEWER'S CONCLUSIONS: In view of the absence of evidence it is not possible to comment on the use of homeopathy in treating dementia. The extent of homeopathic prescribing for people with dementia is not clear and so it is difficult to comment on the importance of conducting trials in this area.

Naturopathy:

7605. Runowicz CD. Alternative cancer therapies can be dangerous. "Natural" and "herbal" are not synonymous with "safe". Health News. 2003 Feb;9(2):1-2. No abstract.

Reflexology:

7606. Hanley J, Stirling P, Brown C. Randomised controlled trial of therapeutic massage in the management of stress. Br J Gen Pract. 2003 Jan;53(486):20-5.

BACKGROUND: Many patients presenting in general practice are suffering from stress. Approaches using complementary therapeies are gaining popularity but have not been systematically evaluated. AIM: To compare the effect of six sessions of therapeutic massage with the use of a relaxation tape on stress, as measured by The General Health Questionnaire (GHQ-30). DESIGN OF STUDY: Randomised controlled trial. SETTING: A stress reduction clinic in general practice. METHOD: There were three treatment groups. Patients in the first group received six sessions of therapeutic massage, which was carried out by a nurse trained in this technique. Patients in the second group were given six sessions using a relaxation tape in the surgery and those in the third group were given a relaxation tape to use at home. The main outcome measures were: the GHQ-30, the Adapted Well Being Index (AWBI); a sleep scale; general practitioner (GP) sconsultations for any reason in the six weeks before treatment, during treatment, and the six weeks following treatment; and patient satisfaction. RESULTS: Sixty-nine patients completed the treatment. There were significant improvements across all four outcome measures and all three treatment groups. Following treatment the majority of patients felt far less emotional disturbance, were sleeping better, and consulting their GP less. CONCLUSION: Despite very strong patient preference for therapeutic massage, it did not show any benefits over either a relaxation tape used in the surgery or a relaxation tape used at home.

7607. Hehir B. Head cases: an examination of craniosacral therapy. RCM Midwives J. 2003 Jan;6(1):38-40. Review. No abstract.

7608. Hilbert JE, Sforzo GA, Swensen T. The effects of massage on delayed onset muscle soreness. Br J Sports Med. 2003 Feb;37(1):72-5.

OBJECTIVES: The purpose of this study was to investigate the physiological and psychological effects of massage on delayed onset muscle soreness (DOMS). METHODS: Eighteen volunteers were randomly assigned to either a massage or control group. DOMS was induced with six sets of eight maximal eccentric contractions of the right hamstring, which were followed 2 h later by 20 min of massage or sham massage (control). Peak torque and mood were assessed at 2, 6, 24, and 48 h postexercise. Range of motion (ROM) and intensity and unpleasantness of soreness were assessed at 6, 24, and 48 h postexercise. Neutrophil count was assessed at 6 and 24 h postexercise. RESULTS: A two factor ANOVA (treatment v time) with repeated measures on the second factor showed no significant treatment differences for peak torque, ROM, neutrophils, unpleasantness of soreness, and mood (p > 0.05). The intensity of soreness, however, was significantly lower in the massage group relative to the control group at 48 h postexercise (p < 0.05). CONCLUSIONS: Massage administered 2 h after exercise induced muscle injury did not improve hamstring function but did reduce the intensity of soreness 48 h after muscle insult.

7609. Ryle A. Supporting individuals with disabling multiple sclerosis. J R Soc Med. 2003 Feb;96(2):104. No abstract.

7610. Smith MC, Reeder F, Daniel L, Baramee J, Hagman J. Outcomes of touch therapies during bone marrow transplant. Altern Ther Health Med. 2003 Jan-Feb;9(1):40-9.

CONTEXT: The integration of complementary modalities into mainstream healthcare is gaining increasing emphasis. It is important, therefore, to document the effects of these interventions on patient outcomes. OBJECTIVE: To investigate the effects of Therapeutic Touch and massage therapy on the outcomes of engraftment time, complications, and perceived benefits of therapy during bone marrow transplant. DESIGN: Randomized clinical trial. PARTICIPANTS/SETTING: Subjects were adult patients on the bone marrow transplant unit of a large urban tertiary care center. INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups: Therapeutic Touch (TT), massage therapy (MT), and a control group called the friendly visit (FV). Subjects (N = 88) were stratified by type of transplant (allogeneic or autologous). Twenty-seven subjects received MT; 31 received TT; and 30 received FV. Nurses with expertise in the 2 touch therapies administered them. The interventions of MT, TT, and FV were administered according to standarized protocols every third day beginning the day chemotherapy began until discharge from the program. OUTCOME MEASURES: Time for engraftment, complications, and patient perceptions of benefits of therapy were the main outcome measures. Analysis of variance and analysis of covariance were used to determine significant differences among the 3 groups with respect to time of engraftment. RESULTS: A significantly lower score for central nervous system or neurological complications was noted for subjects who received MT comppared with the control group; however, no differences were found among the 3 groups with respect to the other 10 complication categories or in the total mean score for complications. Patients' perception of the benefits of therapy (total score) was significantly higher for those who received MT compared with the FV control group. The mean scores on the comfort subscale were significantly higher for patients receiving both MT and TT compared with the FV control group. CONCLUSIONS: Massage therapy may be effective in altering the psychological and neurological complications associated with chemotherapy during bone marrow transplant. Both massage and Therapeutic Touch provide comfort to patients undergoing this challenging process.

Traditional Medicine:

7611. Auddy B, Ferreira M, Blasina F, Lafon L, Arredondo F, Dajas F, Tripathi PC, Seal T, Mukherjee B. Screening of antioxidant activity of three Indian medicinal plants, traditionally used for the management of neurodegenerative diseases. J Ethnopharmacol. 2003 Feb;84(2-3):131-8.

A number of Indian medicinal plants have been used for thousands of years in the traditional system of medicine (Ayurveda). Amongst these are plants used for the management of neurodegenerative diseases such as Parkinson's, Alzheimer's, loss of memory, degeneration of nerves and other neuronal disorders by the Ayurvedic practitioners. Though the etiology of neurodegenerative diseases remains enigmatic, there is evidence, which indicates that defective energy metabolism, excitotoxicity and oxidative damage may be crucial factors (Ann. Neurol. 38 (3) (1995) 357). The part of the Ayurvedic system that provides an approach to prevention and treatment of degenerative diseases is known as Rasayana, and plants used for this purpose are classed as rejuvenators. This group of plants generally possesses strong antioxidant activity (Pharmacol. Biochem. Behav. 43 (1992) 1175), but only a few have been investigated in detail. In the present study, three such rasayana plants were tested for the first time for their toxicity and free radical scavenging activity both in vitro and ex vivo. All the three plant infusions (up to 1 mg/ml) showed no toxic effects on the viability of PC12 cell line as judged by MTT-test. Both ethanolic extracts and water infusions of the plants were tested for their antioxidant activity in the 2,2'-azinobis-3-ethyl-benzothiazoline-6-sulfonic acid (ABTS*(+)) radical cation decolorization assay; inhibition of lipid peroxidation by plant infusions was carried out using spontaneous lipid peroxidation of rat brain homogenate, and IC50 values were determined. The results from the ABTS assay showed that the ethanolic extract of Sida cordifolia was found to be most potent (IC50 16.07 microg/ml), followed by Evolvulus alsinoides (IC50 33.39 microg/ml) and Cynodon dactylon (IC50 78.62 microg/ml). The relative antioxidant capacity for the water infusions was observed in the following order: E. alsinoides (IC50 172.25 microg/ml)>C. dactylon (IC50 273.64 microg/ml)>S. cordifolia (IC50 342.82 microg/ml). The results of water infusions of the plants on lipid peroxidation were as follows: E. alsinoides (IC50 89.23 microg/ml)>S. cordifolia) (IC50 126.78 microg/ml)>C. dactylon (IC50 608.31 microg/ml). Copyright 2002 Elsevier Science Ireland Ltd.

7612. Falkenbach A, Oberguggenberger R. Ayurveda in ankylosing spondylitis and low back pain. Ann Rheum Dis. 2003 Mar;62(3):276-7. No abstract.

7613. Harris JJ, Shao J, Sugarman J. Disclosure of cancer diagnosis and prognosis in Northern Tanzania. Soc Sci Med. 2003 Mar;56(5):905-13.

Whether to tell patients with cancer about their diagnoses and prognoses is a matter of great debate. While many argue the importance of giving this information to facilitate informed decision-making, others argue that this same information can extinguish hope. Although there is some evidence that disclosure of this information is now commonplace in many Northern and Western settings, there are very few data about this issue from resource-poor nations describing physicians' decision-making regarding whether to disclose this information. Using a combination of ethnographic and other qualitative methods including participant observation, semi-structured interviews, informal interviews, and a review of key documents in Northern Tanzania, we map some of the salient issues in this setting. Like their colleagues in many other parts of the world, Tanzanian physicians often withhold diagnostic and prognostic information from patients. In addition, however, to the cultural arguments often used to justify this practice, issues of treatment availability and patient poverty also influenced the physicians' disclosure practices. Expatriate and Tanzanian physicians practicing in Northern Tanzania often had different approaches to informing patients of their diagnoses and prognoses. Some Tanzanian physicians advocated the use of a "roundabout" approach to disclosure, arguing that it was more reflective of the normal mode of discourse in Tanzania than the more direct approach advocated by many of their expatriate colleagues. Expatriate physicians and some of their Tanzanian colleagues felt that such an indirect approach often left patients confused, or indeed, uninformed.

7614. Im DS. Linking Chinese medicine and G-protein-coupled receptors. Trends Pharmacol Sci. 2003 Jan;24(1):2-4. Review.

Following the purification of the immunosuppressant ISP-1 from a Chinese medicine, Japanese scientists have developed a more potent immune modulator, FTY720, that induces T-cell homing. FTY720, a promising immunosuppressant for use in patients with tissue transplants and autoimmune diseases, is currently in clinical trials. Two recent studies have elucidated that the mechanism of action of FTY720 is via a subset of G-protein-coupled receptors for the lysophospholipid mediator sphingosine-1-phosphate.

7615. Jain A, Basal E. Inhibition of Propionibacterium acnes-induced mediators of inflammation by Indian herbs. Phytomedicine. 2003 Jan;10(1):34-8.

Propionibacterium acnes, an anaerobic pathogen, plays an important role in the pathogenesis of acne by inducing certain inflammatory mediators. These mediators include reactive oxygen species (ROS) and pro-inflammatory cytokines. In the present study, ROS, interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) were used as the major criteria for the evaluation of anti-inflammatory activity. To prove the anti-inflammatory effects of herbs, polymorphonuclear leukocytes (PMNL) and monocytes were treated with culture supernatant of P. acnes in the presence or absence of herbs. It was found that Rubia cordifolia, Curcuma longa, Hemidesmus indicus, and Azadirachta indica caused a statistically significant suppression of ROS from PMNL. Sphaeranthus indicus caused a smaller, still significant suppression of ROS. Aloe vera had no effect on ROS production. In the case of proinflammatory cytokine-induced monocytes, maximum suppression was shown by Azadirachta indica and Sphaeranthus indicus, followed by Hemidesmus indicus, Rubia cordifolia, and Curcuma longa. Aloe vera showed insignificant inhibitory activity. Thus, these herbs shows anti-inflammatory activity by suppressing the capacity of P. acnes-induced ROS and pro-inflammatory cytokines, the two important inflammatory mediators in acne pathogenesis.

7616. Jing-Ping OY, Baohua W, Yongming L, Lei W, Jingwei Y. Effect of angelica on the expressional changes of cytokines in endothelial cells induced by hyperlipidemic serum. Biorheology. 2003;40(1-3):395-9.

The aim of this article was to examine the protective effect of Chinese traditional medicine angelica on human umbilical vein endothelial cells (HUVECs, ECV304) from injury induced by hyperlipidemic serum (HLS) and to study the underlying mechanism. Spectrophotometer and immunocytochemical methods were used to detect the content of nitric oxide (NO) in suspension and expression of intercellular adhesion molecule-1 (ICAM-1), transforming growth factor beta1 (TGFbeta1), basic fibroblast growth factor (bFGF) on the cell surface, respectively. After incubated with 50 microl/ml HLS for 24 hours, expression of ICAM-1 and bFGF in ECs was significantly increased, while expression of TGFbeta1 and the release of NO from ECs were significantly decreased. All these effect of HLS on ECs can be reversed by angelica significantly. The above effect of angelica may be related to its anti-atherosclerotic action. Our findings provided experimental basement for the clinical application of angelica to prevent the development of atherosclerosis.

7617. Wartenberg M, Budde P, De Marees M, Grunheck F, Tsang SY, Huang Y, Chen ZY, Hescheler J, Sauer H. Inhibition of tumor-induced angiogenesis and matrix-metalloproteinase expression in confrontation cultures of embryoid bodies and tumor spheroids by plant ingredients used in traditional chinese medicine. Lab Invest. 2003 Jan;83(1):87-98.

Tumor-induced angiogenesis is a prerequisite for excessive tumor growth. Blood vessels invade the tumor tissue after degradation of the extracellular matrix scaffold by matrix metalloproteinases (MMPs). Inhibition of MMPs has been therefore suggested to be a useful tool to abolish neoangiogenesis of solid tumors. In the present study, antioxidative plant ingredients used in traditional Chinese medicine were investigated for their capacity to down-regulate MMP expression and to inhibit angiogenesis in embryonic stem cell-derived embryoid bodies and tumor-induced angiogenesis in confrontation cultures consisting of embryoid bodies and multicellular DU-145 prostate tumor spheroids. Embryoid bodies transiently expressed MMP-1, MMP-2, and MMP-9 during the time of differentiation of capillary-like structures. In confrontation cultures, MMP expression was increased compared with control tumor spheroids and embryoid bodies cultivated separately. The increased expression of MMPs in confrontation cultures was a result of elevated levels of reactive oxygen species (ROS) upon confrontation culture and was totally abolished in the presence of the free radical scavenger vitamin E. Incubation of embryoid bodies with baicalein, epicatechin, berberine, and acteoside, which are herbal ingredients used in traditional Chinese medicine, significantly inhibited angiogenesis in embryoid bodies and decreased intracellular ROS levels. Tumor-induced angiogenesis in confrontation cultures was totally abolished in the presence of the free radical scavenger vitamin E. Because herbal ingredients down-regulated MMP expression, we conclude that ROS generated during confrontation culture induce the expression of MMPs that are necessary for endothelial cell invasion into the tumor tissue.

7618. Yen PK. Maintaining cognitive function with diet. Geriatr Nurs. 2003 Jan-Feb;24(1):62-3. No abstract.

7619. Zhong L, Chen F, Han J, Shao N, Ouyang R. Effects of red orpiment on cell morphology and expression of PML mRNA and protein in NB4 and HL-60 cells. Chin Med J (Engl). 2003 Jan;116(1):148-50.

OBJECTIVE: To investigate the effects of red orpiment on cell morphology, expression of promyelocytic leukemia (PML) mRNA and its protein localization in NB4 and HL-60 cell lines. METHODS: Cell morphology was assayed by Wright's staining and fluorescence staining, while PML mRNA expression was determined by RT-PCR. PML protein localization by evaluated by immunofluorescence staining. RESULTS: The typical apoptosis was found in NB4 and HL-60 cells after treatment with red orpiment. The fusion protein was no longer observed in NB4 cells, PML protein was relocated, and then degraded. In HL-60 cells, PML protein underwent a similar progress. The expression of promyelocytic leukemia (PML) mRNA was not changed in the treated cells. CONCLUSION: Red orpiment inhibits the proliferation of leukemia cells by inducing them to undergo apoptosis.

Yoga:

7620. O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;(1):CD003219

BACKGROUND: Non-surgical treatment for carpal tunnel syndrome is frequently offered to those with mild to moderate symptoms. The effectiveness and duration of benefit from non-surgical treatment for carpal tunnel syndrome remain unknown. OBJECTIVES: To evaluate the effectiveness of non-surgical treatment (other than steroid injection) for carpal tunnel syndrome versus a placebo or other non-surgical, control interventions in improving clinical outcome. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group specialised register (searched March 2002), MEDLINE (searched January 1966 to February 7 2001), EMBASE (searched January 1980 to March 2002), CINAHL (searched January 1983 to December 2001), AMED (searched 1984 to January 2002), Current Contents (January 1993 to March 2002), PEDro and reference lists of articles. SELECTION CRITERIA: Randomised or quasi-randomised studies in any language of participants with the diagnosis of carpal tunnel syndrome who had not previously undergone surgical release. We considered all non-surgical treatments apart from local steroid injection. The primary outcome measure was improvement in clinical symptoms after at least three months following the end of treatment. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included. Two reviewers independently extracted data. Studies were rated for their overall quality. Relative risks and weighted mean differences with 95% confidence intervals were calculated for the primary and secondary outcomes in each trial. Results of clinically and statistically homogeneous trials were pooled to provide estimates of the efficacy of non-surgical treatments. MAIN RESULTS: Twenty-one trials involving 884 people were included. A hand brace significantly improved symptoms after four weeks (weighted mean difference (WMD) -1.07; 95% confidence interval (CI) -1.29 to -0.85) and function (WMD -0.55; 95% CI -0.82 to -0.28). In an analysis of pooled data from two trials (63 participants) ultrasound treatment for two weeks was not significantly beneficial. However one trial showed significant symptom improvement after seven weeks of ultrasound (WMD -0.99; 95% CI -1.77 to - 0.21) which was maintained at six months (WMD -1.86; 95% CI -2.67 to -1.05). Four trials involving 193 people examined various oral medications (steroids, diuretics, nonsteroidal anti-inflammatory drugs) versus placebo. Compared to placebo, pooled data for two-week oral steroid treatment demonstrated a significant improvement in symptoms (WMD -7.23; 95% CI -10.31 to -4.14). One trial also showed improvement after four weeks (WMD -10.8; 95% CI -15.26 to -6.34). Compared to placebo, diuretics or nonsteroidal anti-inflammatory drugs did not demonstrate significant benefit. In two trials involving 50 people, vitamin B6 did not significantly improve overall symptoms. In one trial involving 51 people yoga significantly reduced pain after eight weeks (WMD -1.40; 95% CI -2.73 to -0.07) compared with wrist splinting. In one trial involving 21 people carpal bone mobilisation significantly improved symptoms after three weeks (WMD -1.43; 95% CI -2.19 to -0.67) compared to no treatment. In one trial involving 50 people with diabetes, steroid and insulin injections significantly improved symptoms over eight weeks compared with steroid and placebo injections. Two trials involving 105 people compared ergonomic keyboards versus control and demonstrated equivocal results for pain and function. Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo or control. REVIEWER'S CONCLUSIONS: Current evidence shows significant short-term benefit from oral steroids, splinting, ultrasound, yoga and carpal bone mobilisation. Other non-surgical treatments do not produce significant benefit. More trials are needed to compare treatments and ascertain the duration of benefit.

7621. Patki RA; Makwana JJ; Karmarkar G; Wadikar SS LTMMC, Sion Hospital, Mumbai, India Effect of regular yogic practice on autonomic functions. Indian Practitioner. 2003 Jan; 56(1): 9-11

ABSTRACT: To study the effect of Yoga on status of autonomic nervous system functions, the present study was carried out on 30 nonhypertensive individuals at Ganesh Mandir, Kurla. The parameters selected were resting pulse rate and blood pressure. It was observed that after the Yoga training there was a fall in the level of resting pulse rate and blood pressure. The results were statistically significant. Yoga helps to decrease the activity of the sympathetic nervous system.

7622. Raman PG; Tripathi S. Role of yoga in diabetes mellitus Antiseptic. 2003 Feb; 100(2): 63-6.

ABSTRACT: Diabetes mellitus is a disease which has plagued man for centuries, though its incidence at present especially in the more developed countries of the world is higher than it has ever been in past. The reason for his is that, through technological achievements, stress and affluence have become increasingly widespread and people have tended to avoid strenuous physical exercise and to overeat. Thus, the recent flourishing of diabetes can be considered to be a side effect of 20th century technological age.

Alternative / Complementary Medicine:

7623. Agadi S. Iatrogenic Cushing's syndrome: a different story. Lancet. 2003 Mar 22;361(9362):1059. No abstract.

7624. Akbay P, Basaran AA, Undeger U, Basaran N. In vitro immunomodulatory activity of flavonoid glycosides from Urtica dioica L. Phytother Res. 2003 Jan;17(1):34-7.

The major compounds isolated from the methanolic extract of the aerial parts of Urtica dioica L. were determined as quercetin-3-O-rutinoside (1).

kaempherol-3-O-rutinoside (2). and isorhamnetin-3-O-glucoside (3). By chromatographic, chemical (acidic hydrolysis) and spectral (UV, IR, (1)H-NMR, (13)C-NMR) methods. Their immunomodulatory activities were studied in vitro by chemotaxis (Boyden Migration Chamber) and intracellular killing activity (NBT reduction) tests. Compounds 1, 2, 3 and the total flavonoid fraction were determined to have significant chemotactic effects in 4, 8, 16 microg doses. According to the results of the NBT reduction test, all flavonoid glycosides showed high intracellular killing activity. The results of both assays confirmed the immunostimulatory activity of the flavonoid fraction and the isolated flavonoid glycosides on neutrophils suggesting that they could possibly be useful for treating patients suffering from neutrophil function deficiency and chronic granulomatous diseases. Copyright -Copyright 2003 John Wiley & Sons, Ltd

7625. Akhondzadeh S, Kashani L, Fotouhi A, Jarvandi S, Mobaseri M, Moin M, Khani M, Jamshidi AH, Baghalian K, Taghizadeh M. Comparison of Lavandula angustifolia Mill. tincture and imipramine in the treatment of mild to moderate depression: a double-blind, randomized trial. Prog Neuropsychopharmacol Biol Psychiatry. 2003 Feb;27(1):123-7.

Depression is a major health problem and is not only underrecognized and undertreated but is associated with significant morbidity and mortality. Lavandula angustifolia Mill. (Lamiacae) is used to treat depression. Many medicinal plant textbooks refer to this indication, whereas there is no evidence-based document. Our objective was to compare the efficacy of tincture of L. angustifolia with imipramine in the treatment of mild to moderatev depression and to evaluate the possible adjuvant effect of this tincture in a 4 week double-blind, randomized trial. Forty-five adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, for major depression based on the structured clinical interview for DSM IV participated in the trial. Patients have a baseline Hamilton Rating Scale for Depression score of at least 18. In this double-blind, single-center trial, patients were randomly assigned to receive lavandula tincture (1:5 in 50% alcohol ) 60 drops/day plus placebo tablet (Group A), tablet imipramine 100 mg/day plus placebo drop (Group B) and tablet imipramine 100 mg/day plus lavandula tincture 60 drops/day (Group C) for a 4-week study. In this small preliminary double-blind and randomized trial, lavandula tincture at this concentration was found to be less effective than imipramine in the treatment of mild to moderate depression (F=13.16, df=1, P=.001). In the imipramine group, anticholinergic effects such as dry mouth and urinary retention were observed more often that was predictable, whereas headache was observed more in the lavandula tincture group. A combination of imipramine and lavandula tincture was more effective than imipramine alone (F=20.83, df=1, P<.0001). As this study indicates, one of the advantages of this combination is a better and earlier improvement. The main overall finding from this study is that lavandula tincture may be of therapeutic benefit in the management of mild to moderate depression as adjuvant therapy. A large-scale trial is justified.

7626. Almerud S, Petersson K. Music therapy--a complementary treatment for mechanically ventilated intensive care patients. Intensive Crit Care Nurs. 2003 Feb;19(1):21-30.

The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients' experiences of the music therapy. In the study both quantitative and qualitative measurements were applied. Twenty patients were included using consecutive selection. It became apparent that the patients remembered very little of their time in ICU. The analysis of the quantitative data showed a significant fall in systolic and diastolic blood pressure during the music therapy session and a corresponding rise after cessation of treatment. All changes were found to be statistically significant. The conclusion was that intensive care nursing staff can beneficially apply music therapy as a non-pharmacological intervention.

7627. Anand Kumar BH; Sachidanand YN. Herbal formulation in the treatment of different types of dermatitis Indian Practitioner. 2001 Aug; 54(8): 571-5

ABSTRACT: A polyherbal formulation, Purim, which has anti-inflammatory and immunomodulatory properties and is a chealating agent for various toxins in the blood, has been advocated to treat various skin disorders. Purim therapy was effective in treating various types of dermatitis in this open clinical trial. Fifty two patients were treated with Purim for 1 month, out of which forty nine completed the study. These patients had various diseases such as lichen planus, psoriasis, chronic lichen simplex, chronic eczema, contact dermatitis, etc. The patients were dispensed Purim tablets at a dose of 2 tablets twice a day and were assessed every week for 1 month. It was observed that the symptom score reduced at the end of 2 weeks onwards. At the end of the study, the symptom score for psoriasis reduced from 16.15 plus minus 0.93 to 7.61 plus minus 1.13, chronic lichen simplex from 22.44 plus minus 1.9 to 16.22 plus minus 1.57, chronic eczema from 20.63 plus minus 2.15 to 10.13 plus minus 1.24, chronic lichen planus from 26.14 plus minus 3.38 to 15.29 plus minus 2.95, contact dermatitis from 27.75 plus minus 3.94 to 15.00 plus minus 4.37 and in other skin diseases from 18.56 plus minus 2.30 to 8.66 plus minus 1.51. Purim was effective in reducing most of the symptoms considerably in all these chronic cases. (The Ind. Pract. 2001;54(8):571-575)

7628. Atkinson HG. Are acupressure wrist bands helpful for motion sickness? Health News. 2003 Jan;9(1):12. No abstract.

7629. Bagchi D, Sen CK, Ray SD, Das DK, Bagchi M, Preuss HG, Vinson JA. Molecular mechanisms of cardioprotection by a novel grape seed proanthocyanidin extract. Mutat Res. 2003 Feb-Mar;523-524:87-97. Review.

Free radicals and oxidative stress play a crucial role in the pathophysiology of a broad spectrum of cardiovascular diseases including congestive heart failure, valvular heart disease, cardiomyopathy, hypertrophy, atherosclerosis and ischemic heart disease. We have demonstrated that IH636 grape seed proanthocyanidin extract (GSPE) provides superior antioxidant efficacy as compared to Vitamins C, E and beta-carotene. A series of studies were conducted using GSPE to demonstrate its cardioprotective ability in animals and humans. GSPE supplementation improved cardiac functional assessment including post-ischemic left ventricular function, reduced myocardial infarct size, reduced ventricular fibrillation (VF) and tachycardia, decreased the amount of reactive oxygen species (ROS) as detected by ESR spectroscopy and reduced malondialdehyde (MDA) formation in the heart perfusate. Cardiomyocyte apoptosis detected by terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) staining. In concert, the proapoptotic signals mediated by JNK-l and c-fos proteins were also reduced suggesting that the novel cardioprotective properties of GSPE may be at least partially attributed to its ability to block anti-death signaling mediated through the proapoptotic transcription factors and genes such as JNK-1 and c-JUN. In a separate study, GSPE pretreatment significantly inhibited doxorubicin-induced cardiotoxicity as demonstrated by reduced serum creatine kinase (CK) activity, DNA damage and histopathological changes in the cardiac tissue of mice. Concentration-dependent efficacy of GSPE was also assessed in a hamster atherosclerosis model. Approximately 49 and 63% reduction in foam cells, a biomarker of early stage atherosclerosis, were observed following supplementation of 50 and 100 mg GSPE/kg body weight, respectively. A human clinical trial was conducted on hypercholesterolemic subjects. GSPE supplementation significantly reduced oxidized LDL, a biomarker of cardiovascular diseases. Finally, a cDNA microarray study demonstratedsignificant inhibition of inducible endothelial CD36 expression, a novel cardioregulatory gene, by GSPE. These results demonstrate that GSPE may serve as a potential therapeutic tool in promoting cardiovascular health via a number of novel mechanisms. Copyright 2003 Elsevier Science B.V.

7630. Bennett MP, Zeller JM, Rosenberg L, McCann J. The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med. 2003 Mar-Apr;9(2):38-45.

CONTEXT: A recent survey of rural Midwestern cancer patients revealed that humor was one of the most frequently used complementary therapies. Psychoneuroimmunology research suggests that, in addition to its stablished psychological benefits, humor may have physiological effects on immune functioning. OBJECTIVE: To determine the effect of laughter on self-reported stress and natural killer cell activity. DESIGN: Randomized, pre-post test with comparison group. SETTING: Indiana State University Sycamore Nursing Center, which is a nurse-managed community health clinic in a mid-sized, Midwestern city. PARTICIPANTS: 33 healthy adult women. INTERVENTION: Experimental subjects viewed a humorous video while subjects in the distraction control group viewed a tourism video. MAIN OUTCOME MEASURES: Self-reported stress and arousal (Stress Arousal Check List), mirthful laughter (Humor Response Scale), and immune function (chromium release natural killer [NK] cell cytotoxicity assay). RESULTS: Stress decreased for subjects in the humor group, compared with those in the distraction group (U32 = 215.5; P = .004). Amount of mirthful laughter correlated with postintervention stress measures for persons in the humor group (r16 = -.655; P = .004). Subjects who scored greater than 25 on the humor response scale had increased immune function postintervention (t16 = 2.52 P = .037) and compared with the remaining participants (t32 = 32.1; P = .04). Humor response scale scores correlated with changes in NK cell activity (r16 = .744; P = 001). CONCLUSION: Laughter may reduce stress and improve NK cell activity. As low NK cell activity is linked to decreased disease resistance and increased morbidity in persons with cancer and HIV disease, laughter may be a useful cognitive-behavioral intervention.

7631. Bhardwaj M, Macer DR. Policy and ethical issues in applying medical biotechnology in developing countries. Med Sci Monit. 2003 Feb;9(2):RA49-54. Review.

A brief review of some of the key issues in policy relating to the ethical issues raised by medical biotechnology in developing countries is presented, using India as an example. A series of some key issues is discussed, including information obtained from interviewing Indian government policy makers. Some of the issues discussed include: Economic and social incentives to encourage biotechnology; Health policy and ethics review; Patents on drugs; Medical genetics; Relationship to traditional medical practices; Positive public attitudes to biotechnology; Limited public participation; Infrastructural hurdles; Indian progress in stem cell research; and dilemmas of expensive technologies. The results show that although the needs of developing countries are different to those of rich countries, government policy utilizing guidelines and ethics committees has evolved as mechanisms to aid ethical health care delivery in India. In all countries there may be some of these concerns that are raised here, however, the integration of traditional medicine and advanced medical technology, and access to medical services by people in need, are particularly important challenges in developing countries. Better public involvement in policy making will require education and infrastructural organization as well as mutual willingness on the part of policy makers and

citizens.

7632. Buckle J. Aromatherapy for health professionals. Beginnings. 2003 Jan-Feb;23(1):6-7. No abstract.

7633. Chen QH, Wang FP. Further studies on the synthesis of 7,17-seco norditerpenoid alkaloids. J Asian Nat Prod Res. 2003 Mar;5(1):43-8.

Following the report on the synthesis of the 7,17-seco compounds [Wang, F.P., Yang, J.S., Chen, Q.H., Yu, L. and Li, B.G. (2000), Chem. Pharm. Bull. 48, 1912-1916], further studies on the reaction optimization for cleavage of the C(7),C(17) bond led to the 7,17-seco norditerpenoid alkaloids (e.g. 4, 9) in nearly 90% yield.

7634. Chrubasik S, Model A, Black A, Pollak S. A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology (Oxford). 2003 Jan;42(1):141-8.

OBJECTIVE: This randomized, double-dummy, double-blind pilot study of acutely exacerbated low back pain was aimed to inform a definitive comparison between Doloteffin, a proprietary extract of Harpagophytum, and rofecoxib, a selective inhibitor of cyclo-oxygenase-2 (COX-2). METHODS: Forty-four patients (phyto-anti-inflammatory drug-PAID-group) received a daily dose of Doloteffin containing, inter alia, 60 mg of harpagoside for 6 weeks and 44 (non-steroidal anti-inflammatory drug-NSAID-group) received 12.5 mg/day of rofecoxib. All were allowed rescue medication of up to 400 mg/day of tramadol. Several outcome measures were examined at various intervals to obtain estimates of effect size and variability that might be used to decide the most suitable principal outcome measure and corresponding numbers required for a definitive study. RESULTS: Forty-three PAID and 36 NSAID patients completed the study. Ten PAID and 5 NSAID patients reported no pain without rescue medication for at least 5 days of the 6th week of treatment. Eighteen PAID and 12 NSAID patients had more than a 50% reduction in the week's average of their pain scores between the 1st and 6^th weeks. The mean percentage decrease from baseline in the pain component of the Arhus Index was 23 (S.D. 52) in PAID and 26 (S.D. 43) in NSAID. The corresponding measures for the overall Arhus Index were 11 (31) and 16 (24) and, for the Health Assessment Questionnaire, 7 (8) and 6 (7). Tramadol was used by 21 PAID patients and 13 NSAID patients. Fourteen patients in each group experienced 39 adverse effects, of which 28 (13 in PAID) were judged to some degree attributable to the study medications. CONCLUSION: Though no significant intergroup differences were demonstrable, large numbers will be needed to show equivalence.

7635. Dai JG, Guo HZ, Ye M, Zhu WH, Zhang DY, Hu Q, Han J, Zheng JH, Guo DA. Biotransformation of 4(20),11-taxadienes by cell suspension cultures of Platycodon grandiflorum. J Asian Nat Prod Res. 2003 Mar;5(1):5-10.

Platycodon grandiflorum cell suspension cultures were employed to biotransform the taxane diterpenoids 2alpha,5alpha,10beta,14beta-tetraacetoxy-4(20),11-taxadiene (1) and 9alpha-hydroxy-2alpha,5alpha,10beta,14beta-tetraacetoxy-4(20),11-taxadiene (2). One product, 10beta-hydroxy-2alpha,5alpha,14beta-triacetoxy-4(20),11-taxadiene (3) was obtained from 1 and two products, 9alpha,10beta-dihydroxy-2alpha,5alpha,14beta-triacetoxy-4(20),11-taxadiene (4) and 10beta-hydroxy-2alpha,5alpha,9alpha,14beta-tetraacetoxy-4(20),11-taxadiene (5) were obtained from 2 incubated with Platycodon cultured cells respectively, among which 5 is characterized as a new taxoid compound. The effects of the addition stage for 1 and 2 on the biotransformation were investigated and the results revealed that: (1) the optimal addition stage for 1 was in the early logarithmic phase (6th day) of the cell growth period, in which 78% of 1 was converted and the yield for 3 reached 75%; (2) the optimal addition stage for 2 was on the mid-logarithmic phase (12th day) of the cell growth period, in which 25.3% of 2 was converted and the yields for 4 and 5 reached 18.9 and 14.5%, respectively.

7636. Devine EC. Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncol Nurs Forum. 2003 Jan-Feb;30(1):75-89.

PURPOSE/OBJECTIVES: To determine the effect of psychoeducational interventions on pain in adults with cancer. DATA SOURCES: 25 intervention studies published from 1978-2001. DATA SYNTHESIS: When analyzed across all studies, a statistically significant, beneficial effect on pain was found. However, threats to validity were present in some studies. The most serious of these involved a lack of random assignment to treatment condition and a floor effect on pain. When limited to the studies with the best methodologic quality, the effect on pain continued to be statistically significant. Effect on pain by type of treatment was examined and found to be somewhat variable and limited by the small number of studies testing each type of treatment. CONCLUSIONS: Methodologic quality was variable. Reasonably strong evidence exists for relaxation-based cognitive-behavioral interventions, education about analgesic usage, and supportive counseling. Minimal data were available about the relative effectiveness of different types of psychoeducational interventions because few studies included within-study contrasts of different experimental interventions and usual care was not well documented. IMPLICATIONS FOR NURSING: Psychoeducational interventions are not a substitute for analgesics, but they may serve as adjuvant therapy. Assessment and clinical judgment are critical. The intervention must be acceptable to patients and not too burdensome for patients in pain to use.

7637. Drisko JA, Chapman J, Hunter VJ. The use of antioxidant therapies during chemotherapy. Gynecol Oncol. 2003 Mar;88(3):434-9. Review.

OBJECTIVE: At the present time, many cancer patients combine some form of complementary and alternative medicine therapies with their conventional therapies. The most common choice of these therapies is the use of antioxidants. RESULTS: A review of four common antioxidants is undertaken, which includes vitamin E (mixed tocopherols and tocotrienols), beta-carotene (natural mixed carotenoids), vitamin C (ascorbic acid), and vitamin A (retinoic acid). Antioxidants act as electron acceptors as well as therapeutic biologic response modifiers. Despite the fact that chemotherapy-induced formation of free radicals is well-demonstrated, chemotherapy-induced cytotoxicity in general does not seem to depend on formation of reactive oxygen species. CONCLUSIONS: Currently, evidence is growing that antioxidants may provide some benefit when combined with certain types of chemotherapy. Because of the potential for positive benefits, a randomized controlled trial evaluating the safety and efficacy of adding antioxidants to chemotherapy in newly diagnosed ovarian cancer is

underway at the University of Kansas Medical Center.

7638. Edwards-Jones V, Greenwood JE. What's new in burn microbiology? James Laing Memorial Prize Essay 2000. Burns. 2003 Feb;29(1):15-24. Review.

A variety of factors contribute to the development of infection in burned patients. The role of wound management procedures, risk factors associated with infection, typical bacterial pathogens and associated exotoxins, current problems with antibiotic resistance, wound sampling and rare complications of infection are described. The use of new novel treatments that are currently being developed, such as cell signalling molecules and the increasing use of natural antimicrobial agents, for example honey, papaya fruit and tea-tree oil are discussed. The impact of new methods for earlier detection of infectious agents that could change future practices in burn care is also described.

7639. Eger E, Sterzer P, Russ MO, Giraud AL, Kleinschmidt A. A supramodal number representation in human intraparietal cortex. Neuron. 2003 Feb 20;37(4):719-25.

The triple-code theory of numerical processing postulates an abstract-semantic "number sense." Neuropsychology points to intraparietal cortex as a potential substrate, but previous functional neuroimaging studies did not dissociate the representation of numerical magnitude from task-driven effects on intraparietal activation. In an event-related fMRI study, we presented numbers, letters, and colors in the visual and auditory modality, asking subjects to respond to target items within each category. In the absence of explicit magnitude processing, numbers compared with letters and colors across modalities activated a bilateral region in the horizontal intraparietal sulcus. This stimulus-driven number-specific intraparietal response supports the idea of a supramodal number representation that is automatically accessed by presentation of numbers and may code magnitude information.

7640. Farriol M, Segovia-Silvestre T, Venereo Y, Orta X. Antioxidant effect of polyamines on erythrocyte cell membrane lipoperoxidation after free-radical damage. Phytother Res. 2003 Jan;17(1):44-7.

This in vitro study determined the effect of three doses each (100, 500 and 1000 microm) of putrescine, spermidine and spermine on malondialdehyde (MDA) release in red blood cells (RBCs) from healthy individuals after hydrogen peroxide stimulation (10 mM). Twenty-two volunteers, 9 males and 13 females, aged 41.5 +/- 16.4 years, were studied. MDA was measured by thiobarbituric reaction (TBARs) and the results were calculated using epsilon = 1.56 x 10(5). The analysis of variance (ANOVA) demonstrated a statistically significant overall decrease in MDA release in the polyamine-exposed cells (p < 0.0001) when compared with unexposed cells. Individual analysis of each polyamine separately showed a 52% decrease in MDA release with added spermine and a 39.5% decrease with added spermidine (p < 0.001). No evaluable effect was found for putrescine. There was no correlation between the effect produced and the three doses of spermidine or spermine added, indicating a non dose-dependent action. Copyright 2003 John Wiley & Sons, Ltd.

7641. Feinberg AW. Are there any studies showing whether ginkgo biloba is effective for tinnitus (ringing in the ears)? Health News. 2003 Jan;9(1):12. No abstract.

7642. Foulds R. Holistic medicine Health Administrator. 1996 Jul & 1997 Dec; 7 & 8(1 & 2): 130. No abstract.

7643. Gearon CJ. Women's health. The whole woman. Hosp Health Netw. 2003 Jan;77(1):18. No abstract.

7644. Gopal MG; Farahana B. Effectiveness of herbal medications in the treatment of acne vulgaris - a pilot study. Indian Practitioner. 2001 Oct; 54(10): 723-7.

ABSTRACT: A clinical trial was conducted in patients with grade II and III acne vulgaris. Seventy six patients aged between 16 and 24 years were included in the trial. They were advised to apply locally a herbal medication known as Clarina cream and simultaneously to take herbal Purim tablets at a dose of 2 tablets twice a day for a month. Results showed that patients with grade II acne had an excellent response in 56.25 percent and good response in 43.75 percent. Patients with grade III acne had an excellent response in 38.30 percent and good response in 56.66 percent and moderate response in 5 percent. These results show that Purim tablets and Clarina cream can be a useful combination treatment in patients with grade II and grade III acne vulgaris. There were no serious adverse reactions in any of these patients.

7645. Hazra J; Srikanth N; Chopra KK. Holistic approach to the management of diabetes mellitus with classical and folk plant drugs Health Administrator. 1996 Jul & 1997 Dec; 7 & 8(1 & 2): 131-7. No abstract.

7646. Henderson JW, Donatelle RJ. The relationship between cancer locus of control and complementary and alternative medicine use by women diagnosed with breast cancer. Psychooncology. 2003 Jan-Feb;12(1):59-67.

Research has shown that perceptions of control influence health-related behavior and outcomes. This study explored the influence of the control constructs in the context of the theory of cognitive adaptation to the use of complementary and alternative medicine (CAM) among 551 women diagnosed with breast cancer in Portland, Oregon. The majority of these women had high perceptions of cancer control and used one or more types of CAM therapy. Multinomial logistical regression indicated that higher perceptions of control over the course and cause of cancer significantly predicted CAM use. The model combining sociodemographic variables (age, education and type of health insurance) and control variables explained more variation (R(2)=0.23) in predicting CAM use than the model with only sociodemographic variables (R(2)=0.14), indicating that perceptions of control over the cause and the course of cancer had an independent significant influence. It was concluded that the assessment of control constructs from the theory of cognitive adaptation is useful for studying CAM use among women diagnosed with breast cancer and that understanding the meanings that lie behind the decisions to use these therapies are essential for health care providers who are promoting the health and well-being of their patients. Copyright 2003 John Wiley & Sons, Ltd.

7647. Hensick J. Build the excitement when they're young. Mich Nurse. 2003 Feb;76(2):18-9. No abstract.

7648. Hill EL, Frith U. Understanding autism: insights from mind and brain. Philos Trans R Soc Lond B Biol Sci. 2003 Feb 28;358(1430):281-9. Review.

Autism is a developmental disorder characterized by impaired social interaction and communication as well as repetitive behaviours and restricted interests. The consequences of this disorder for everyday life adaptation are extremely variable. The general public is now more aware of the high prevalence of this lifelong disorder, with ca. 0.6% of the population being affected. However, the signs and symptoms of autism are still puzzling. Since a biological basis of autism was accepted, approaches from developmental cognitive neuroscience have been applied to further our understanding of the autism spectrum. The study of the behavioural and underlying cognitive deficits in autism has advanced ahead of the study of the underlying brain abnormalities and of the putative genetic mechanisms. However, advances in these fields are expected as methodological difficulties are overcome. In this paper, recent developments in the field of autism are outlined. In particular, we review the findings of the three main neuro-cognitive theories of autism: theory-of-mind deficit, weak central coherence and executive dysfunction.

7649. Jonas WB, Crawford CC. Science and spiritual healing: a critical review of spiritual healing, "energy" medicine, and intentionality. Altern Ther Health Med. 2003 Mar-Apr;9(2):56-61. No abstract.

7650. Kayser J, Fong R, Tenke CE, Bruder GE. Event-related brain potentials during auditory and visual word recognition memory tasks. Brain Res Cogn Brain Res. 2003 Mar;16(1):11-25.

Event-related brain potentials (ERPs) recorded during presentation of a series of words or pictures show enhanced positivity between 300 and 800 ms after presentation of repeated items. However, little attention has been directed to the characterization of this ERP recognition memory effect using auditory stimuli. The present study directly compared the ERP 'old/new effect' for words presented in the visual and auditory modalities. Nose-referenced ERPs were recorded from 30 electrode sites while participants (N=16) were engaged in visual and auditory continuous word recognition memory tasks. Spatially and temporally overlapping ERP components were identified and measured by covariance-based principal components analysis. The expected old/new effect was observed in both modalities, with a comparable time course peaking at 560 ms, but having a more anterior scalp topography for visual items. This suggests a common cognitive process (i.e. successful retrieval of information from memory) associated with separable neural generators in each modality. Despite this temporal synchronization, the old/new effect overlapped ERP components having distinct scalp topographies (N2) or peak latencies (P3) for each modality. The positive-going old/new effect was preceded by an earlier negativity peaking at 370 ms that was greater across modalities for old than new words, likely reflecting semantic processing aspects of word recognition memory. A late (beyond 900 ms), broadly-distributed negativity was also greater for old than new words, prolonged for auditory items, and may represent activity of a post-retrieval process.

7651. Lal M, H Mann C, Callender R, Radley S. Does cesarean delivery prevent anal incontinence? Obstet Gynecol. 2003 Feb;101(2):305-12.

OBJECTIVE: To compare the incidence and severity of anal incontinence in primiparas after cesarean delivery versus spontaneous vaginal delivery. METHODS: A total of 184 primiparas who delivered by cesarean (104 emergency, 80 elective) and 100 who delivered vaginally were interviewed 10 +/- 2 months postpartum. A comprehensive bowel function questionnaire was completed. Bowel-specific questions included bowel habits, laxative use, urgency, flatus, urge and passive incontinence, soiling, and pad use, before and during pregnancy and postpartum. Obstetric details were confirmed from obstetric records. RESULTS: Anal incontinence was first present in nine (5%) mothers after cesarean delivery and eight (8%) after vaginal delivery (relative risk 0.611, 95% confidence interval 0.25, 1.53). Severe symptoms necessitating pad use affected two (3%) mothers after elective cesarean and one (1%) after vaginal delivery. Two (3%) mothers after elective cesarean, one (1%) after emergency cesarean, and two (2%) after vaginal delivery had at least two symptoms. Anal incontinence followed prelabor emergency cesarean in two mothers. Of the 22 mothers who sustained a second-degree tear, five (23%) had new anal incontinence compared with only one (3%) of 40 mothers with an intact perineum (Fisher exact test value = 9.697, P =.014). CONCLUSION: Because severe anal incontinence followed elective and prelabor emergency cesarean, it seems that pregnancy itself can lead to pelvic floor disorders. A high incidence of anal incontinence is associated with a second-degree tear. Measures to detect and reduce postpartum anal incontinence should target all pregnant women and mothers, even after prelabor cesarean delivery.

7652. Lemonick MD. The power of mood. Time. 2003 Jan 20;161(3):64-9. No abstract.

7653. Lemonick MD. Your mind your body. Time. 2003 Jan 20;161(3):62-3. No abstract.

7654. Li XH, Shen DD, Li N, Yu SS. Bioactive triterpenoids from Symplocos chinensis. J Asian Nat Prod Res. 2003 Mar;5(1):49-56.

A new triterpenoid, 2beta,3beta,19alpha,24-tetrahydroxy-23-norurs-12-en-28-oic acid (4), together with three known triterpenoids 3-oxo-19alpha,23,24-trihydroxyurs-12-en-28-oic acid (1), 2alpha,3beta,19alpha,23-tetrahydroxyurs-12-en-28-oic acid (2), 2alpha,3alpha,19alpha,23-tetrahydroxyurs-12-en-28-oic acid (3), was isolated from the roots of Symplocos chinensis. The new triterpenoid shows significant cytotoxic activity against B16 and BGC-823 cells.

7655. Loft M, McWilliam C, Ward-Griffin C. Patient empowerment after total hip and knee replacement. Orthop Nurs. 2003 Jan-Feb;22(1):42-7.

PURPOSE: This research was designed to gain an enhanced understanding of empowerment within in-home care relationships after hospital discharge of elderly patients who had undergone total hip or total knee replacement. METHOD: An interpretive phenomenology method was used. SAMPLE: Nine participants were interviewed on audiotape, guided by a semistructured interview guide. Five themes emerged centering on a strong desire to maintain independence. Overall, participants experienced disempowered relationships with professional in-home care providers and a more equitable empowered relationship with nonprofessional care providers. CONCLUSION: Disempowered relationships with professional personnel were not identified as a dissatisfier to most participants. Rather, patients expressed deference to the traditional expert model of healthcare. Further investigation is needed to understand the effect of empowerment on client satisfaction and clinical outcomes.

7656. Longtin R. The pomegranate: nature's power fruit? J Natl Cancer Inst. 2003 Mar 5;95(5):346-8. No abstract.

7657. Majumdar R; Bagade A; Phadke MA. Seizure control and pattern of behaviour in children with simple febrile convulsions-effect of mentat syrup. Indian Practitioner. 2001 Oct; 54(10): 729-32.

ABSTRACT: The aim of this placebo-controlled clinical study was to assess the efficacy of a herbal formulation, Mental syrup, in children suffering from febrile convulsions. Fifty children with a history of febrile convulsion were included in the study. They were divided into two groups of 25 each. Mentat syrup or an identical placebo was given to each group. During the 6 month trial period episodes of febrile convulsions and behavioural pattern were recorded. At the end of the study it was observed that 36 percent of the children on Mentat syrup had a febrile episode, but did not suffer from convulsions. However all the children in the placebo group who were febrile had episodes of convulsions. Children, on Mentat syrup showed improved behavioural pattern compared to the placebo group. Thus, it can be concluded that mentat syrup can be a useful drug in the treatment of febrile convulsions.

7658. McCarney R, Warner J, Fisher P, Van Haselen R. Homeopathy for dementia. Cochrane Database Syst Rev. 2003;(1):CD003803. Review.

7659. McConkey B. Adrenal corticosteroids in Chinese herbal remedies. QJM. 2003 Jan;96(1):81-2. No abstract.

7660. McDonald JJ, Teder-Salejarvi WA, Di Russo F, Hillyard SA. Neural substrates of perceptual enhancement by cross-modal spatial attention. J Cogn Neurosci. 2003 Jan 1;15(1):10-9.

Orienting attention involuntarily to the location of a sudden sound improves perception of subsequent visual stimuli that appear nearby. The neural substrates of this cross-modal attention effect were investigated by recording event-related potentials to the visual stimuli using a dense electrode array and localizing their brain sources through inverse dipole modeling. A spatially nonpredictive auditory precue modulated visual-evoked neural activity first in the superior temporal cortex at 120-140 msec and then in the ventral occipital cortex of the fusiform gyrus 15-25 msec later. This spatio-temporal sequence of brain activity suggests that enhanced visual perception produced by the cross-modal orienting of spatial attention results from neural feedback from the multimodal superior temporal cortex to the visual cortex of the ventral processing stream.

7661. McGuire H, Hawton K. Interventions for vaginismus. Cochrane Database Syst Rev. 2003;(1):CD001760. Review.

BACKGROUND: Vaginismus is involuntary vaginal muscle contraction which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitization, have been considered in uncontrolled studies. OBJECTIVES: The aim of this review is to determine the clinical effectiveness of treatments for vaginismus and also to examine the role of partner participation in the effectiveness of the treatment. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register (Issue 3, 2000), the Cochrane Controlled Trials Register (Cochrane Library, Issue 2, 2002), MEDLINE (1966 to Nov 2002), EMBASE (1980 to Nov 2002), PsycINFO (1967 to Nov 2002) and CINAHL (1982 to Nov 2002) were searched. The Journal of Sex Research (1974 to 1999), Sexual & Marital Therapy (1986 to 1999), Sexual Dysfunction (1998 to 1999) and the Journal of Sex and Marital Therapy (1974 to 1999) were handsearched. Reference lists and conference abstracts were searched. Experts in the field were contacted regarding unpublished material. SELECTION CRITERIA: Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control. DATA COLLECTION AND ANALYSIS: The reviewers extracted data which were verified with the trial investigator. MAIN RESULTS: Two controlled trials were identified although data were only available from one trial. The second trial compared two forms of systematic desensitization and reported no discernible differences between them. REVIEWER'S CONCLUSIONS: In spite of encouraging results reported from uncontrolled series of patients there is very limited evidence from controlled trials concerning the effectiveness treatments for vaginismus. Further trials are need to compare therapies with waiting list control and with other therapies.

7662. McNeal S. A character in search of character: Narcissistic Personality Disorder and Ego State Therapy. Am J Clin Hypn. 2003 Jan;45(3):233-43.

The individual diagnosed with Narcissistic Personality Disorder presents with grandiosity, extreme self-involvement, and lack of interest in and empathy for others. This paper reviews current theories concerning the development and treatment of Narcissistic Personality Disorder, and introduces the use of Ego State Therapy for its treatment. The ego state model of treatment will be described and demonstrated with case material. Initially ego states that reveal the grandiosity will be accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge. With further treatment, transformation and maturation of the ego states occur, reflecting the changes in internal structure and dynamics as well as improvement in external interpersonal relationships. Issues concerning Ego State Therapy as utilized with personality disorders will be discussed and contrasted with more traditional methods of treatment.

7663. Mellor JM. Resolving arthritis, allergies, & immune compromising disorders with the JMT technique. Beginnings. 2003 Jan-Feb;23(1):10-1. No abstract.

7664. Mok E, Wong KY. Effects of music on patient anxiety. AORN J. 2003 Feb;77(2):396-7, 401-6, 409-10.

Undergoing surgery with local anesthesia is stressful because patients often are aware of their surroundings. This study investigated music as a method of reducing patients' anxiety during minor surgery with local anesthesia. For this study, researchers assessed the effectiveness of music as a relaxation modality by measuring patients' vital signs and self-reported anxiety before and after surgery. Study results indicate that patients who listened to their choice of music during surgery experienced significantly lower anxiety levels, heart rates, and blood pressure than patients who did not listen to music.

7665. Moritz CH, Rogers BP, Meyerand ME. Power spectrum ranked independent component analysis of a periodic fMRI complex motor paradigm. Hum Brain Mapp. 2003 Feb;18(2):111-22.

Independent component analysis (ICA) has been demonstrated to be an effective data-driven method for analyzing fMRI data. However, a method for objective differentiation of task-related components from those that are artifactually non-relevant is needed. We propose a method of constant-cycle (periodic) fMRI task paradigm combined with ranking of spatial ICA components by the magnitude contribution of their temporal aspects to the fundamental task frequency. Power spectrum ranking shares some similarity to correlation with an a priori hemodynamic response, but without a need to presume an exact timing or duration of the fMRI response. When applied to a complex motor task paradigm with auditory cues, multiple task-related activations are successfully identified and separated from artifactual components. These activations include sensorimotor, auditory, and superior parietal areas. Comparisons of task-related component time courses indicate the temporal relationship of fMRI responses in functionally involved regions. Results indicate the sensitivity of ICA to short-duration hemodynamics, and the efficacy of a power spectrum ranking method for identification of task-related components. Copyright 2002 Wiley-Liss, Inc.

7666. Nenadic I, Gaser C, Volz HP, Rammsayer T, Hager F, Sauer H. Processing of temporal information and the basal ganglia: new evidence from fMRI. Exp Brain Res. 2003 Jan;148(2):238-46.

Temporal information processing is a fundamental brain function, which might include central timekeeping mechanisms independent of sensory modality. Psychopharmacological and patient studies suggest a crucial role of the basal ganglia in time estimation. In this study, functional magnetic resonance imaging (fMRI) was applied in 15 healthy right-handed male subjects performing an auditory time estimation task (duration discrimination of tone pairs in the range of 1,000-1,400 ms) and frequency discriminations (tone pairs differing in pitch, around 1,000 Hz) as an active control task. Task difficulty was constantly modulated by an adaptive algorithm (weighted up-down method) reacting on individual performance. Time estimation (vs rest condition) elicited a distinct pattern of cerebral activity, including the right medial and both left and right dorsolateral prefrontal cortices (DLPFC), thalamus, basal ganglia (caudate nucleus and putamen), left anterior cingulate cortex, and superior temporal auditory areas. Most activations showed lateralisation to the right hemisphere and were similar in the frequency discrimination task. Comparing time and frequency tasks, we isolated activation in the right putamen restricted to time estimation only. This result supports the notion of central processing of temporal information associated with basal ganglia activity. Temporal information processing in the brain might thus be a distributed process of interaction between modality-dependent sensory cortical function, the putamen (with a timing-specific function), and additional prefrontal cortical systems related to attention and memory. Further investigations are needed to delineate the differential contributions of the striatum and other areas to timing.

7667. Ng JK, Parnianpour M, Richardson CA, Kippers V. Effect of fatigue on torque output and electromyographic measures of trunk muscles during isometric axial rotation. Arch Phys Med Rehabil. 2003 Mar;84(3):374-81.

OBJECTIVES: To examine the changes in torque output resulting from fatigue, as well as changes in electromyographic measures of trunk muscles during isometric axial rotation and to compare these changes between directions of axial rotation. DESIGN: Subjects performed fatiguing right and left isometric axial rotation of the trunk at 80% of maximum voluntary contraction while standing upright. SETTING: A rehabilitation center. PARTICIPANTS: Twenty-three men with no history of back pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Surface electromyographic signals were recorded from 6 trunk muscles bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were also measured. RESULTS: During the fatiguing axial rotation contraction, coupling torques of both sagittal and coronal planes were slightly decreased and no difference was found between directions of axial rotation. Decreasing median frequency and an increase in electromyographic amplitude were also found in trunk muscles with different degrees of changes in individual muscles. There were significant differences (P<.05) between right and left axial rotation exertions in median frequency slope of external oblique, internal oblique, latissimus dorsi, and iliocostalis lumborum muscles, but no such difference was found in median frequency slope of rectus abdominis and multifidus muscles. This could be attributed to different functional roles among the muscles. Similar differences (P<.05) between right and left axial rotation in median frequency slope were also detected in the electromyographic amplitude slope of the trunk muscles. Coefficient of variation of the torque output and electromyographic activation in most of the trunk muscles increased during the fatigue process. CONCLUSION: The changing coupling torque, different fatigue rate, and activation changes of trunk muscles, as well as the increase in variability during fatiguing axial rotation exertion, could affect the internal loading and stability of the spine; this needs to be further quantified in future studies. Copyright 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

7668. Pahwa S. Matter of faith Health Administrator. 1996 Jul & 1997 Dec; 7 & 8(1 & 2): 169-71. No abstract.

7669. Pizzuti A, Flex E, Di Bonaventura C, Dottorini T, Egeo G, Manfredi M, Dallapiccola B, Giallonardo AT. Epilepsy with auditory features: a LGI1 gene mutation suggests a loss-of-function mechanism. Ann Neurol. 2003 Mar;53(3):396-9.

Autosomal dominant partial epilepsy with auditory features (ADPEAF) is a genetically heterogeneous disorder. Some patients exhibit mutations in the leucine-rich glioma inactivated (LGI1) gene. In an ADPEAF family, a novel mutation in the Lgi1 signal peptide is predicted to interfere with the protein cell sorting, resulting in altered processing. This finding suggests a loss-of-function mechanism for LGI1 gene mutations causing ADPEAF even if other mechanisms cannot be ruled out.

7670. Polo MD, Escera C, Yago E, Alho K, Gual A, Grau C. Electrophysiological evidence of abnormal activation of the cerebral network of involuntary attention in alcoholism. Clin Neurophysiol. 2003 Jan;114(1):134-46.

OBJECTIVE: Increased distractibility is a common impairment in alcoholism, but objective evidence has remained elusive. Here, a task designed to investigate with event-related brain potentials (ERPs) the neural mechanism underlying distraction was used to show abnormal involuntary orienting of attention in chronic alcoholism. METHODS: Fifteen alcoholics and 17 matched healthy controls were instructed to ignore auditory stimuli while concentrating in the discrimination of immediately following visual stimuli. The auditory sequences contained repetitive standard tones occasionally replaced by deviant tones of slightly higher frequency, or by complex novel sounds. RESULTS: Deviant tones and novel sounds distracted visual performance, i.e. increased reaction time to visual stimuli, similarly in patients and controls. Compared to controls, however, alcoholics showed ERP abnormalities, i.e. enhanced P3a amplitudes over the left frontal region, and a positive posterior deflection instead of the frontally distributed reorienting negativity (RON). CONCLUSIONS: The enhanced P3a to novelty and subsequent positive wave instead of RON in alcoholics suggests encoding into working memory of task-irrelevant auditory events and provides neurophysiological markers of impaired involuntary attention mechanisms in chronic alcoholism.

7671. Polyakov A, Pratt H. The cumulative effect of high click rate on monaural and binaural processing in the human auditory brainstem. Clin Neurophysiol. 2003 Feb;114(2):366-75.

OBJECTIVE: The objective of the present study was to compare the effects of high stimulus rate and click position in the train on monaurally and binaurally evoked activities in the human auditory brainstem and suggest their possible physiological mechanism. METHODS: Auditory brainstem evoked potentials (ABEPs) were recorded from 15 normally and symmetrically hearing adults from 3 channels, in response to 50dB nHL, alternating polarity clicks, presented at a rate of 21/s as well as separately to each click in a train of 10 with an interstimulus interval of 11ms. Click trains were presented at a rate of 5.13/s. The binaural interaction components (BICs) of ABEPs were derived by subtracting the response to binaural clicks from the algebraic sum of monaural responses. Single, centrally located equivalent dipoles were estimated as concise measures of the surface-summated activity of ABEPs and BICs generators. RESULTS: A significant effect of click position in the train on equivalent dipole latency of ABEP component V and on equivalent dipole magnitude of III were found. Latency was prolonged and amplitude was increased the later the click's position in the train. A significant effect of click position in the train on equivalent dipole latencies of all components of BICs was found. Latencies were prolonged if the click's position occurred later in the train, with most of the latency shift achieved by the third click in the train for the first major BIC and by the seventh click for other BIC components. No significant effects on equivalent dipole magnitudes of BICs were found. No significant effect of click position in the train on orientation of any of the equivalent dipoles of ABEP or BIC was found. CONCLUSIONS: The progressive prolongation of latency of ABEP and BIC components with advancing position in the train may be attributed to cumulatively decreased synaptic efficacy at high stimulus rates, resulting in prolonged synaptic delays along the auditory pathway. The paradoxic enhancement of ABEP dipole III magnitude with advancing click position in the train may reflect higher sensitivity of inhibitory brainstem neurons to increased stimulus rate, resulting in disinhibition. The absence of significant effects on BIC dipole magnitudes may reflect the amplifying effect of divergence in the ascending auditory pathway, as has been observed for the monaurally evoked ABEP components from the upper pons.

7672. Porchezhian E, Dobriyal RM. An overview on the advances of Gymnema sylvestre: chemistry, pharmacology and patents. Pharmazie. 2003 Jan;58(1):5-12. Review.

Chemistry and pharmacology of Gymnema sylvestre is reviewed relying on research papers and patent literature. Extracts of this plant are widely used in Australian, Japananese, Vietnamese and Indian folk medicine. Gymnema preparations have a profound action on the modulation of taste, particularly suppressing sweet taste sensations. It is used in the treatment of diabetes mellitus and in food additives against obesity and caries. Anti-allergic, antiviral, lipid lowering and other effects are also reported. From a technological point of view, muchefforts have been made to mask the biter taste of Gymnema preparations.

7673. Quaranta L, Bettelli S, Uva MG, Semeraro F, Turano R, Gandolfo E. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology. 2003 Feb;110(2):359-62; discussion 362-4.

OBJECTIVE: To evaluate the effect of Ginkgo biloba extract (GBE) on preexisting visual field damage in patients with normal tension glaucoma (NTG). DESIGN: Prospective, randomized, placebo-controlled, double-masked cross-over trial. PARTICIPANTS: Twenty-seven patients with bilateral visual field damage resulting from NTG. INTERVENTION: Patients received 40 mg GBE, administered orally, three times daily for 4 weeks, followed by a wash-out period of 8 weeks, then 4 weeks of placebo treatment (identical capsules filled with 40 mg fructose). Other patients underwent the same regimen, but took the placebo first and the GBE last. Visual field tests, performed at baseline and at the end of each phase of the study, were evaluated for changes. MAIN OUTCOME MEASURES: Change in visual field and any ocular or systemic complications. RESULTS: After GBE treatment, a significant improvement in visual fields indices was recorded: mean deviation (MD) at baseline versus MD after GBE treatment, 11.40 +/- 3.27 dB versus 8.78 +/- 2.56 dB (t = 8.86, P = 0.0001, chi-square test); corrected pattern standard deviation (CPSD) at baseline versus CPSD after GBE treatment, 10.93 +/- 2.12 dB versus 8.13 +/- 2.12 dB (t = 9.89, P = 0.0001, chi-square test). No significant changes were found in intraocular pressure, blood pressure, or heart rate after placebo or GBE treatment. Any ocular and systemic side effects were recorded for the duration of the trial. CONCLUSIONS: Ginkgo biloba extract administration appears to improve preexisting visual field damage in some patients with NTG.

7674. Ramakrishnan S. Role for alternative system of medicine : our experience. JIRA. 1994 Oct-Dec; 2(4): 63-5. No abstract.

7675. Ranjan; Mishra DN. India Evaluation of the efficacy of V-Gel in vaginitis and cervicitis Indian Practitioner. 2001 Sep; 54(9): 645-9.

ABSTRACT: An open clinical trial was conducted in twenty six women suffering from vaginitis and cervicitis. After confirming the clinical and microbiological diagnosis, all the females were given V-Gel, which was recommended to be applied typically on the vagina and cervix, twice daily for 15 days. The soreness of cervix, pruritus, inflammation of vulva, vaginal discharge was significantly reduced within two weeks of drug treatment. Foul odour of the vaginal discharge disappeared significantly. Majority of patients showed microbiological cure after treatment with V-Gel. Eighty three percent of patients had partial relief within one week and 60 percent patients had complete relief at two weeks. Thus, V-Gel was found to be clinically effective formulation for the treatment of vaginitis and cervicitis. (The Ind. Pract. 2001; 54(9):645-649)

7676. Reed KS. Grief is more than tears. Nurs Sci Q. 2003 Jan;16(1):77-81. Review.

Much has been written in the professional and popular literature about grief. The multiplicity of sources for information about the phenomenon often leads to confusion regarding terminology and process. In addition, assessment and intervention methods show the phenomenon as unidimensional despite evidence to the contrary. Because nursing routinely deals with grief, it is important that a framework be developed to help understand the process and guide appropriate interventions. The Neuman systems model is particularly well suited as a framework because concepts found in the model are similar to descriptions of the concept of grief. An analysis of the grief concept using the Neuman model is presented, with perinatal grief presented as an example.

7677. Rosburg T. Left hemispheric dipole locations of the neuromagnetic mismatch negativity to frequency, intensity and duration deviants. Brain Res Cogn Brain Res. 2003 Mar;16(1):83-90.

The aim of the current study was to differentiate the sources of neuromagnetic mismatch negativity (MMNm) to deviants of different features. For this purpose, the MMNm of twenty-one healthy subjects (seven males) were recorded left-hemispherically. Subjects were stimulated monaurally in an oddball paradigm with standard tones of 1000 Hz and three different kinds of mismatch tones (frequency, duration and intensity deviants). Data analysis revealed mean MMNm dipole locations anterior, inferior and more medial than the N100m dipoles. The mean difference between the N100m and MMNm dipoles was in the range of up to 6 mm in one dimension. The dipole locations of all three kinds of deviants differed significantly from each other. The MMNm dipoles of both frequency and duration deviants were found to be significantly inferior to the corresponding source of intensity deviants, while the MMNm dipoles of duration and frequency deviants significantly differed in anterior-posterior direction. This differentiation between sources emphasizes the importance of feature analysis in MMN(m) generation.

7678. Sayal SK; Banerjee S; Das AL; Gupta CM; Doiphade VV; Gogte RB; Uppal SS. Role of ayurvedic drugs in treatment of HIV infection [Letter] Medical Journal Armed Forces India. 1998 Oct; 54(4): 374 No abstract.

7679. Schmehr R. Enhancing the treatment of HIV/AIDS with Reiki training and treatment. Altern Ther Health Med. 2003 Mar-Apr;9(2):120, 118. No abstract.

7680. Shallow H. Should cord pH be performed routinely after normal birth? RCM Midwives J. 2003 Jan;6(1):28-31.

Care of women in labour and how we monitor the wellbeing of baby remains a contentious issue. The National Institute for Clinical Excellence (NICE) guidance informs us that for low risk women intermittent auscultation is the method of choice. It also informs us that cord pH sampling should be performed in those cases where there has been fetal blood sampling in labour, caesarean section, or instrumental delivery. It does not say that all babies should have their acid base or pH determined after birth (NICE, 2001: 29). Nevertheless, in the hospital where the author practiced until July 2002 it remains hospital 'policy' to perform cord sampling on all babies. The net result influenced how midwives practiced, in that many midwives felt unable in the main to go against Trust policy. It became even more difficult to encourage midwives to practise intermittent auscultation as they felt the new policy made them more fearful of not using the cardiotocograph. Even when midwives protested and put forward their case, they were forced by fear of blame and litigation to practise defensively and not in the best interests of women. Midwives made their concerns known, but the practice continues and the issues remain largely unresolved. This paper is an account not only of the impact of cord pH sampling on well babies, but also of the unequal status of midwifery in relation to medical dominance that still persists in the NHS today.

7681. Shankar A. Strychnus nuxvomica consumption a changing trend in rural poisoning Antiseptic. 2003 Feb; 100(2): 69-72.

ABSTRACT: Strychnous nuxvomica (Kuchia) commonly used for killing dogs and rodents and purified form as therapeutics, now being quite in vogue for suicide among rurals. Strychnus nuxvomica presents as tetanus, not caused by the toxin of Clostridium tetani, but due to active ingredient Pseudotetanus syndrome.

7682. Sridevi K; Rao KPV; Rao K PV. Yoga practice and menstrual distress. Journal of Indian Academy of Applied Psychology. 1996 Jan-Jul; 22(1-2): 47-53.

ABSTRACT: Menstrual distress refers to the charaacteristic nagative symptomatology experienced by women over the course of the menstrual cycle. Physiological and psychological treatment measures such as exercise and progressive relaxation are used in the treatment of menstrual disorders. As yoga encompasses the methods for relaxing the minds as well as the body, an attempt has been made in the present study to investigate the effectiveness of certain yogic practices in relieving menstrual problems. Two comparable groups of unmarried women (N is equal to 40) of age range 20 to 24 years were assessed for the number of reported menstrual symptoms with a Menstrual Distress Questionnaire. One group underwent yoga training which involved a regular practice of certain asanas and transcendental meditation (TM) for a period of 10 months, whereas the other group which served as a control had no such training. The results revealed that the yoga trained group obtained significantly lower scores on the subscales of MDQ compared to the control group in both the premenstrual and also menstrual periods. This indicates that the distressing physiological and psychological changes occurring in both the menstrual phases can be successfully reduced with the help of yogic methods.

7683. Takechi M, Doi K, Wakayama Y. Biological activities of synthetic saponins and cardiac glycosides. Phytother Res. 2003 Jan;17(1):83-5.

Comparisons of the biological activities of diosgenyl (DIO) beta-D-xylopyranosyl- (1 --> 2)-alpha-D-glucopyranoside (2DXalpha) and beta-D-glucopyranosyl- (1 --> 3)-beta-D-glucopyranoside (3GLbeta) or methyl glycyrrhetinate (GAM) 2DXalpha and 3GLbeta with those of the other DIO- or GAM-glycosides confirmed our assumption that both haemolytic and antifungal activities of DIO-glycosides (steroid saponins) generally parallel each other, while almost all haemolytic GAM-glycosides (triterpenoid saponins) have no antifungal activity. By comparisons of digitoxigenyl (DIG) 2DXalpha, beta-D-xylopyranosyl- (1 --> 2)-beta-D-glucopyranoside (2DXbeta) and 3Glbeta with the other DIG-glycosides, the previous supposition on DIG-diglycosides (cardiac diglycosides) has been developed into the assumption that those having a (1 --> 4), (1 --> 3) or (1 --> 2)beta sugar linkage show stronger anti-ATPase and antiviral activities than those with a (1 --> 6) or (1 --> 2)alpha linkage. Copyright 2003 John Wiley & Sons, Ltd.

7684. Van Wijk R, Van Wijk EP. The search for a biosensor as a witness of a human laying on of hands ritual. Altern Ther Health Med. 2003 Mar-Apr;9(2):48-55.

CONTEXT: Intentional healing by laying on of hands is a popular complementary therapy. Previous studies of this therapy have been focused on the influence of laying on of hands with focused intention on the patient or on a biological model that took the place of the patient. OBJECTIVE: Exploring the line of thinking that the consciousness-mediated act of healing during a healer-patient ritual changes a consciousness field that could be detected in another living non-human organism that was present only as a witness and was not the object of any directed intention. DESIGN: A comparison of a biosensor's behavior during healer-patient ritual treatments that were alternated by non-healing periods. SETTING AND PARTICIPANTS: An automatic device for measurement of ultra-weak emission of photons from algae was placed at the location of a healer during a series of experiments consisting of 36 healing sessions with human patients. Neither healer nor patients were aware of the type of measurements that took place. MAIN OUTCOME MEASURES: The number and periodicity of photon counts. RESULTS: Primary data analysis showed that the photon count distributions show some remarkable alterations during the ritual of healer-patient sessions. The data further suggest that during healing a shift in cyclical components of photon emission occurs. CONCLUSIONS: The significance of the experiment lies in the possibility to enter the discussion on a quantitative basis with respect to the relevance of the patient-healer relationship in intentional healing.

7685. Wang S, Chen RY, Yu SS, Yu DQ. Uvamalols D-G: novel polyoxygenated seco-cyclohexenes from the roots of Uvaria macrophylla. J Asian Nat Prod Res. 2003 Mar;5(1):17-23. No abstract.

7686. Wartenberg M, Budde P, De Marees M, Grunheck F, Tsang SY, Huang Y, Chen ZY, Hescheler J, Sauer H. Inhibition of tumor-induced angiogenesis and matrix-metalloproteinase expression in confrontation cultures of embryoid bodies and tumor spheroids by plant ingredients used in traditional chinese medicine. Lab Invest. 2003 Jan;83(1):87-98.

7687. Weber DO Mainstreaming of alternative medicine Health Administrator. 1996 Jul & 1997 Dec; 7 & 8(1 & 2): 26-40 No abstract.

7688. Weil A. Mother nature's little helpers. Time. 2003 Jan 20;161(3):70-1. No abstract.

7689. Zappa SB, Cassileth BR. Complementary approaches to palliative oncological care. J Nurs Care Qual. 2003 Jan-Mar;18(1):22-6.

The popularity of complementary and alternative medicine (CAM) has increased tremendously in recent years. Thus, it is imperative to distinguish between alternative therapies that can be dangerous and complementary therapies that are primarily palliative and augment conventional treatment. Memorial Sloan-Kettering Cancer Center's Integrative Medicine Service offers complementary therapies to patients in an attempt to improve quality of life and provide symptom management. In addition to clinical services, it also provides education to health care professionals and the public and performs clinical and laboratory research on complementary modalities and the antitumor properties of botanicals. If CAM is to be accepted by mainstream medicine, research must be done usingstandard research methodologies.

7690. Zhong L, Chen F, Han J, Shao N, Ouyang R. Effects of red orpiment on cell morphology and expression of PML mRNA and protein in NB4 and HL-60 cells. Chin Med J (Engl). 2003 Jan;116(1):148-50.

October 2003

Acupuncture:

8214. Berman BM. Integrative approaches to pain management: how to get the best of both worlds. BMJ. 2003 Jun 14;326(7402):1320-1. No abstract.

8215. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003 Jun 3;138(11):898-906. Review.

BACKGROUND: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. PURPOSE: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. STUDY SELECTION: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or spinal manipulation for nonspecific back pain and RCTs published since the reviews were conducted. DATA EXTRACTION: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). DATA SYNTHESIS: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating spinal manipulation for acute and chronic back pain reported that spinal manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. CONCLUSIONS: Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy.

8216. Cymet TC. A practical approach to fibromyalgia. J Natl Med Assoc. 2003 Apr;95(4):278-85. Review.

Fibromyalgia is the name given to a collection of symptoms with no clear physiologic cause, The constellation of symptoms are clearly recognizable as a distinct pathologic entity. The diagnosis is made through clinical observations made by the examiner. Differential diagnosis must include other somatic syndromes as well as disease entities like hepatitis, hypothyroidism, diabetes mellitus, electrolyte imbalance, multiple sclerosis, and cancer. Diagnostic criteria are given as guidelines for the diagnosis, not as absolute requirements. Treatment of this condition remains individualized and relies heavily on having a therapeutic relationship with a provider. Treatment of this syndrome needs to be looked at as an ongoing process. Goal oriented treatment aimed at maintaining specific functions can be directed at helping a patient get restorative sleep, alleviating the somatic pains that ail the patient, keeping a person productive, regulating schedules or through goal oriented agreements made with the patient. Since this syndrome is chronic and may effect all areas of a persons functioning the family and social support system of the person being treated need to be evaluated. Patients often seek alternative medical treatments for this problem including diet therapy, acupuncture, and herbal therapy. Treatment must involve more than just the symptoms presented and the patient can only be treated successfully if they are willing to work at changing their own perceptions, and ways of relating to stressors in their world.

8217. Gore-Felton C, Vosvick M, Power R, Koopman C, Ashton E, Bachmann MH, Israelski D, Spiegel D. Alternative therapies: a common practice among men and women living with HIV. J Assoc Nurses AIDS Care. 2003 May-Jun;14(3):17-27.

This study examined the prevalence and factors associated with alternative therapy use in an ethnically diverse, gender-balanced sample of persons living with HIV/AIDS. More than two thirds (67%) of the participants who were taking HIV-related medications were also taking an alternative supplement. Half of the sample (50%) reported that they took one or more multivitamins, 17% reported using mineral supplements, 12% reported using Chinese herbs, and 12% reported using botanicals. Substantial proportions of the sample also reported using acupuncture (31%), massage (23%), and meditation (28%) to specifically treat HIV-related symptoms. Women were four times more likely to use alternative therapies than men. Also, Caucasians were nearly four times more likely to use alternative treatments compared to other ethnic groups. The results of this study indicate a strong need to assess individual patients' use of alternative treatment approaches as well as to further investigate their efficacy among HIV-positive patients.

8218. Ishida Y. Acupuncture for gastrointestinal disorders. Gut. 2003 Apr;52(4):614. No abstract.

8219. Lacey JM, Tershakovec AM, Foster GD. Acupuncture for the treatment of obesity: a review of the evidence. Int J Obes Relat Metab Disord. 2003 Apr;27(4):419-27. Review.

Although acupuncture is being utilized to treat a variety of important health problems, its usefulness in obesity management has not yet been fully evaluated. The aim of this review paper was to survey and critically evaluate the descriptive and controlled trials of acupuncture for enhancing weight loss. The underlying principles of acupoint stimulation are described, with an emphasis on auricular (ear) acupuncture, the method most often chosen for obesity studies. The difficulties of selecting suitable placebo controls are highlighted. To date, most trials have been descriptive in nature, of short duration (< or = 12 weeks), and designed using nonstandard treatment protocols. Despite the unique challenges involved, further careful study of acupuncture's potential usefulness as an adjunct in weight management is recommended. An agenda for future research in this area is provided.

8220. Seki T, Kurusu M, Tanji H, Arai H, Sasaki H. Acupuncture and swallowing reflex in poststroke patients. J Am Geriatr Soc. 2003 May;51(5):726-7. No abstract.

Alternative / Complementary Medicine:

8221. Abdin MZ, Israr M, Rehman RU, Jain SK. Artemisinin, a novel antimalarial drug: biochemical and molecular approaches for enhanced production. Planta Med. 2003 Apr;69(4):289-99. Review.

Artemisinin, a sesquiterpene lactone containing an endoperoxide bridge, has been isolated from the aerial parts of Artemisia annua L. plants. It is effective against both drug-resistant and cerebral malaria-causing strains of Plasmodium falciparum. The relatively low yield (0.01-0.8 %) of artemisinin in A. annua is a serious limitation to the commercialization of the drug. Therefore, the enhanced production of artemisinin either in cell/tissue culture or in the whole plant of A. annua is highly desirable. It can be achieved by a better understanding of the biochemical pathway leading to the synthesis of artemisinin and its regulation by both exogenous and endogenous factors. Furthermore, genetic engineering tools can be employed to overexpress gene(s) coding for enzyme(s) associated with the rate limiting step(s) of artemisinin biosynthesis or to inhibit the enzyme(s) of other pathway competing for its precursors. These aspects which may be employed to enhance the yield of artemisinin both in vitro and in vivo are discussed in this review.

8222. Allen JK, Scott LB. Alternative models in the delivery of primary and secondary prevention programs. J Cardiovasc Nurs. 2003 Apr-Jun;18(2):150-6. Review.

Despite the strong scientific evidence supporting the effectiveness of cardiovascular risk reduction interventions, their application is inconsistent across medical care settings and patient groups. Traditional approaches have been largely ineffective. Thus, there is an urgent need to develop and implement innovative approaches that provide persons with or at risk for coronary heart disease effective risk reduction interventions that are accessible and affordable. Advanced practice nurses and community health workers providing care as members of multidisciplinary teams have been successful strategies for improving outcomes. This paper describes the evidence supporting these alternative models and suggests strategies for the delivery of such programs for the primary and secondary prevention of coronary heart disease.

8223. Ananth S. Small steps toward integrating CAM. Health Forum J. 2003 Spring;46(2):43. No abstract.

8224. Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, Binder M, Cerroni L, De Rosa G, Ferrara G, Hofmann-Wellenhof R, Landthaler M, Menzies SW, Pehamberger H, Piccolo D, Rabinovitz HS, Schiffner R, Staibano S, Stolz W, Bartenjev I, Blum A, Braun R, Cabo H, Carli P, De Giorgi V, Fleming MG, Grichnik JM, Grin CM, Halpern AC, Johr R, Katz B, Kenet RO, Kittler H, Kreusch J, Malvehy J, Mazzocchetti G, Oliviero M, Ozdemir F, Peris K, Perotti R, Perusquia A, Pizzichetta MA, Puig S, Rao B, Rubegni P, Saida T, Scalvenzi M, Seidenari S, Stanganelli I, Tanaka M, Westerhoff K, Wolf IH, Braun-Falco O, Kerl H, Nishikawa T, Wolff K, Kopf AW. Dermoscopy of pigmented skin lesions: results of a consensus meeting via the Internet. J Am Acad Dermatol. 2003 May;48(5):679-93. Review.

BACKGROUND: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. OBJECTIVE: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. METHODS: Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. RESULTS: Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53). CONCLUSION: The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions.

8225. Aspinal F, Addington-Hall J, Hughes R, Higginson IJ. Using satisfaction to measure the quality of palliative care: a review of the literature. J Adv Nurs. 2003 May;42(4):324-39. Review.

BACKGROUND: The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions. AIMS: Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built. METHODS: Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed. FINDINGS: There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure. CONCLUSIONS: Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.

8226. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003 Jun 3;138(11):871-81. Review. Summary for patients in: Ann Intern Med. 2003 Jun 3;138(11):I33.

BACKGROUND: Low back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low back pain. PURPOSE: To resolve the discrepancies related to use of spinal manipulative therapy and to update previous estimates of effectiveness by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. DATA SOURCES: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews. STUDY SELECTION: Randomized, controlled trials of patients with low back pain that evaluated spinal manipulative therapy with at least 1 day of follow-up and at least one clinically relevant outcome measure. DATA EXTRACTION: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). DATA SYNTHESIS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.

8227. Baldwin E. Time for a fresh look at complementary medicine. BMJ. 2003 Jun 14;326(7402):1322. No abstract.

8228. Basnyat B, Murdoch DR. High-altitude illness. Lancet. 2003 Jun 7;361(9373):1967-74. Review.

High-altitude illness is the collective term for acute mountain sickness (AMS), high-altitude cerebral oedema (HACE), and high-altitude pulmonary oedema (HAPE). The pathophysiology of these syndromes is not completely understood, although studies have substantially contributed to the current understanding of several areas. These areas include the role and potential mechanisms of brain swelling in AMS and HACE, mechanisms accounting for exaggerated pulmonary hypertension in HAPE, and the role of inflammation and alveolar-fluid clearance in HAPE. Only limited information is available about the genetic basis of high-altitude illness, and no clear associations between gene polymorphisms and susceptibility have been discovered. Gradual ascent will always be the best strategy for preventing high-altitude illness, although chemoprophylaxis may be useful in some situations. Despite investigation of other agents, acetazolamide remains the preferred drug for preventing AMS. The next few years are likely to see many advances in the understanding of the causes and management of high-altitude illness.

8229. Bloch AS. Nutrition for health promotion: phytochemicals, functional foods, and alternative approaches to combat obesity. Dent Clin North Am. 2003 Apr;47(2):411-23, viii-ix. Review.

Functional foods are a new area of interest because of their potential health benefits. Functional foods may contain significant levels of biologically active components that impart health benefits when consumed in optimal serving sizes. Phytochemicals are components of plants that convey healthful properties beyond their use as macronutrients or micronutrients. Scientists have identified thousands of phytochemicals in vegetables, fruits, grains, legumes, and other plant sources. Even though the consumption of fat has steadily decreased over the past decade as Americans have became a fat-phobic society, body weight has continued to rise. Health professionals need to consider options or alternatives to the only recommendation currently being offered (ie, low-fat, low-calorie, portion-controlled diets) because the obesity problem is not being solved with current methods and recommendations. A new paradigm is needed. The controlled-carbohydrate diet is one viable alternative dietary approach. There also is emerging evidence to show that lipid profiles improve on a controlled-carbohydrate diet.

8230. Brewer D, Nashelsky J. What nonhormonal therapies are effective for postmenopausal vasomotor symptoms? J Fam Pract. 2003 Apr;52(4):324-5, 329; discussion 329. Review. No abstract.

8231. Burton B. Complementary medicines industry in crisis after recall of 1546 products. BMJ. 2003 May 10;326(7397):1001. No abstract.

8232. Cassileth BR, Vickers AJ. Complementary and alternative therapies. Urol Clin North Am. 2003 May;30(2):369-76. Review.

Patients with prostate cancer increasingly use complementary and alternative therapies. A well-informed oncologist can guide patients to use such treatments to maximize their benefits and reduce the risk of harm. Patients should be dissuaded from using alternative therapies instead of mainstream care to treat cancer. Preliminary evidence suggests that botanical medicines such as PC-SPES may be of benefit, but comparative human trials are yet to be conducted and problems of contamination resolved. Some complementary therapies help reduce symptoms in early-stage prostate cancer, but botanical remedies must be treated with caution because of the possibility of adverse effects and interactions with

conventional medicine.

8233. Chaaib F, Queiroz EF, Ndjoko K, Diallo D, Hostettmann K. Antifungal and antioxidant compounds from the root bark of Fagara zanthoxyloides. Planta Med. 2003 Apr;69(4):316-20.

Phytochemical investigation of the CH 2 Cl 2 extract of Fagara zanthoxyloides Lam. (Rutaceae) led to the isolation of eleven compounds. One phenylethanoid derivative is a new natural product. The isolation of the antifungal and the antioxidant compounds was monitored by direct TLC bioautographic assays. The structures of the isolated compounds were elucidated by classical spectroscopic methods including UV, NMR, MS and HR-MS.

8234. Chang GY, Lee KH. Sino-cerebral aspergillosis due to chronic herbal medicine use. QJM. 2003 May;96(5):379. No abstract.

8235. Cheng TO. Why did green tea not protect against coronary artery disease but protect against myocardial infarction? Am J Cardiol. 2003 May 15;91(10):1290-1. No abstract.

8236. Cuellar NG, Cahill B, Ford J, Aycock T. The development of an educational workshop on complementary and alternative medicine: what every nurse should know. J Contin Educ Nurs. 2003 May-Jun;34(3):128-35. Review.

As complementary and alternative medicine (CAM) is becoming more accepted in Western culture, healthcare consumers are choosing CAM as an adjunct to

conventional healthcare practices. A variety of cultural backgrounds contributes to the need to advance knowledge and evaluate outcomes of healthcare practices related to CAM. The issues presented in this article provide critical information for nurses and other healthcare providers to integrate conventional medicine with CAM practices to improve healthcare outcomes for patients who use CAM.

8237. Damre AS, Gokhale AB, Phadke AS, Kulkarni KR, Saraf MN. Studies on the immunomodulatory activity of flavonoidal fraction of Tephrosia purpurea. Fitoterapia. 2003 Apr;74(3):257-61.

The flavonoid fraction of Tephrosia purpurea (FFTP) was studied for its effect on cellular and humoral functions and on macrophage phagocytosis in mice. Oral administration of FFTP (10-40 mg/kg) significantly inhibited sheep red blood cells (SRBC)-induced delayed-type hypersensitivity reactions. It also produced a significant, dose-related decrease in sheep erythrocyte-specific haemagglutination antibody titre. However, the fraction failed to show a significant change in the macrophage phagocytic activity. The results obtained indicate the ability of the flavonoidal fraction of T. purpurea to modulate both the cell-mediated and the humoral components of the immune system.

8238. Davis MP, Darden PM. Use of complementary and alternative medicine by children in the United States. Arch Pediatr Adolesc Med. 2003 Apr;157(4):393-6.

BACKGROUND: Current estimates of pediatric complementary and alternative medicine (CAM) use range from 10% to 15%. These estimates are derived from children sampled at health care facilities, with chronic conditions, and/or from countries other than the United States. OBJECTIVE: To provide a population-based estimate of the prevalence of pediatric CAM use in the United States. DESIGN: We used the 1996 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the noninstitutionalized US population. The survey asks parents if their children used alternative care practitioners within the previous year. Our analysis included children younger than 18 years and accounted for the complex sampling design of MEPS. RESULTS: Weighted for the US population, pediatric CAM use was 1.8% (95% confidence interval, 1.3%-2.3%). Participants who used CAM were found in each age category, and the mean age was 10.3 years; 76.8% were white, 54% were female, 32% lived in the West, 66% lived in a metropolitan statistical area, and 36% lived at 100% to 199% of the poverty level. Bivariate chi2 analysis shows that CAM use increased with age (P =.006) and was twice as common in children not living in a metropolitan statistical area (P =.02). CONCLUSIONS: The use of CAM among US children, as measured by the MEPS, is far less prevalent than has previously been asserted. With such disparate estimates, future CAM research efforts would benefit from a consensus regarding what practices constitute CAM and how these practices should be measured.

8239. Donia M, Hamann MT. Marine natural products and their potential applications as anti-infective agents. Lancet Infect Dis. 2003 Jun;3(6):338-48. Review.

The oceans are a unique resource that provide a diverse array of natural products, primarily from invertebrates such as sponges, tunicates, bryozoans, and molluscs, and from marine bacteria and cyanobacteria. As infectious diseases evolve and develop resistance to existing pharmaceuticals, the marine environment provides novel leads against fungal, parasitic, bacterial, and viral diseases. Many marine natural products have successfully advanced to the late stages of clinical trials, including dolastatin 10, ecteinascidin-743, kahalalide F, and aplidine, and a growing number of candidates have been selected as promising leads for extended preclinical assessment. Although many marine-product clinical trials are for cancer chemotherapy, drug resistance, emerging infectious diseases, and the threat of bioterrorism have all contributed to the interest in assessing natural ocean products in the treatment of infectious organisms. In this review, we focus on the pharmacologically tested marine leads that have shown in-vivo efficacy or potent in-vitro activity against infectious and parasitic diseases.

8240. Dunning T. Complementary therapies and diabetes. Complement Ther Nurs Midwifery. 2003 May;9(2):74-80.

There is increasing recognition that people with diabetes use a range of complementary therapies (CT), for a number of conditions, but do not always inform their conventional health practitioners about their use. Controlling blood glucose levels in people with diabetes is important to reduce the consequent metabolic abnormalities and symptoms and the incidence of long term complications. Conventional medical and nursing practitioners often incorrectly assume that they are used to control blood glucose levels, e.g. using herbal medicines to increase insulin production or reduce insulin resistance. CT can be beneficial for people with diabetes. They can also lead to adverse events. This paper describes the outcome of monitoring complementary therapy use in our diabetic outpatient services in 2001, the results of a focus group (n=10) to explore issues identified in the monitoring process and a survey undertaken with a convenience sample of diabetes educators (n=40).Twenty percent of patients used CT and there were three adverse events in the monitoring phase. Eight of the 10 focus group participants used CT and 16 of the diabetes educators used CT in patient care. Only one had a complementary therapy qualification.

8241. Ernst E. Panel discussions about CAM and research: science friction. Complement Ther Nurs Midwifery. 2003 May;9(2):81-2. No abstract.

8242. Evans W. Chiropractic care: attempting a risk-benefit analysis. Am J Public Health. 2003 Apr;93(4):522-3; author reply 523. No abstract.

8243. Fleischhacker WW, Czobor P, Hummer M, Kemmler G, Kohnen R, Volavka J. Placebo or active control trials of antipsychotic drugs? Arch Gen Psychiatry. 2003 May;60(5):458-64. Review.

The placebo-controlled trial has been the standard method to demonstrate efficacy and safety of antipsychotic drugs. We reviewed the scientific and ethical advantages and disadvantages of the placebo-controlled trial and an alternative method, the active-control trial, focusing more specifically on the active-control noninferiority trial. Recent meta-analyses indicate that a therapeutic dose of second-generation antipsychotic will very likely be statistically superior to placebo in an adequate trial, and that the average improvement of schizophrenia symptoms in a placebo arm will be small. These findings strengthen the scientific and ethical justification for the active-control noninferiority trial. New drugs in the pharmacotherapy for schizophrenia are often claimed to differ from their marketed competitors in their safety profile rather than in antipsychotic efficacy. Thus, in many cases, it appears sufficient to demonstrate mere noninferiority (rather than superiority) of antipsychotic efficacy in comparison with a standard antipsychotic. The active-control noninferiority trial is suitable for such demonstration. Sample size requirements for various equivalence margins in noninferiority trials are provided. Scientific and ethical arguments should lead to a more frequent use of the active-control noninferiority trial design.

8244. Fugh-Berman A. "Bust enhancing" herbal products. Obstet Gynecol. 2003 Jun;101(6):1345-9. Review.

"Bust enhancing" herbal products are widely advertised. No clinical trials have been published. These products contain a variety of ingredients, including grains, hops, saw palmetto, dong quai, chaste-tree berry, wild yam, kava, fennel, black cohosh, and fenugreek. Several of these herbs are hormonally active; for example, hops contain 8-prenylnaringenin, a phytoestrogen that is more potent than other dietary phytoestrogens. Many bust-enhancing dietary supplements contain substrates for Fusarium, a fungus that produces zearalenone, a potent estrogen that has been associated with breast enlargement in humans and other species. The use of bust-enhancing products should be discouraged because of lack of evidence for efficacy and long-term safety concerns.

8245. Furler MD, Einarson TR, Walmsley S, Millson M, Bendayan R. Use of complementary and alternative medicine by HIV-infected outpatients in Ontario, Canada. AIDS Patient Care STDS. 2003 Apr;17(4):155-68.

Little is known about complementary and alternative medicine (CAM) use in Canadian patients with HIV. We sought to determine the prevalence of CAM use by patients attending HIV outpatient clinics in Ontario, Canada, and to compare the characteristics of users and nonusers. Impact of CAM definition on reported utilization rates was also assessed, specifically in relation to the inclusion and exclusion of vitamins, minerals, and multivitamins in CAM definition. In-person interviews were conducted between 1999 and 2001 with 104 HIV-positive outpatients enrolled in the HIV Ontario Observational Database project (HOOD) and attending HIV outpatient clinics in Ontario. Self-reported CAM utilization and demographic data were collected. Clinical data were obtained from medical chart review. Seventy-seven percent of participants reported current CAM use. Inclusion of vitamins and minerals (CAMVIT) increased this estimate to 89%. Nearly all patients used CAM in conjunction with antiretroviral medications. Out of pocket costs ranged from CAD$0 to more than CAD$250 per month. Most patients reported CAM use was beneficial and had improved their overall health. Female gender, HIV risk group, number of prescriptions, and overall number of drugs used were associated with CAM use. CAM use in Canadian patients with HIV is extremely common, with higher use among women. The definition of CAM has a substantial impact both on reported prevalence rates and on predictors of CAM use.

8246. Gene E, Calvet X, Azagra R, Gisbert JP. Triple vs. quadruple therapy for treating Helicobacter pylori infection: a meta-analysis. Aliment Pharmacol Ther. 2003 May 1;17(9):1137-43.

BACKGROUND: Triple therapy (proton pump inhibitor, clarithromycin and amoxicillin or an imidazole) is the first-line treatment for Helicobacter pylori infection. However, the effectiveness of triple therapy is decreasing due to the increase in antibiotic resistance. Quadruple therapy (proton pump inhibitor, tetracycline, metronidazole and a bismuth salt) is a very effective regimen even in areas of high prevalence of antibiotic resistance, and may be an alternative first-line treatment. AIM: To compare triple vs. quadruple therapy for the first-line treatment of H. pylori infection. METHODS: An extensive literature search was performed to identify randomized trials comparing triple vs. quadruple therapy. Selected trials were included in a meta-analysis using Review Manager 4.1. RESULTS: Four studies met the inclusion criteria. Eradication rates with quadruple therapy were slightly higher in both the intention-to-treat (81% vs. 78%; odds ratio, 0.83; 95% confidence interval, 0.61-1.14) and per protocol (88% vs. 85%; odds ratio, 0.81; 95% confidence interval, 0.55-1.20) analysis, although the differences were not statistically significant. Nor were there significant differences in compliance or adverse effects between the therapies. CONCLUSION: Triple and quadruple therapies seem to be roughly equivalent in terms of effectiveness, compliance and side-effects profile when administered as first-line treatment for H. pylori infection.

8247. Geyoushi BE, Matthews Z, Stones RW. Pathways to evidence-based reproductive healthcare in developing countries. BJOG. 2003 May;110(5):500-7.

OBJECTIVE: Developing country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries. DESIGN: Qualitative study using semi-structured interviews. SETTING: India and Yemen. SAMPLE: Forty-one doctors working in obstetrics, gynaecology, general practice and family planning services. METHODS: Interviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis. MAIN OUTCOME MEASURES: Descriptions of experiences, attitudes and needs. RESULTS: Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice. CONCLUSIONS: Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.

8248. Gorman C. Steeped in health. Ordinary tea may help fight cancer, heart disease and, now, infection. Time. 2003 May 5;161(18):86. No abstract.

8249. Gow PJ, Connelly NJ, Hill RL, Crowley P, Angus PW. Fatal fulminant hepatic failure induced by a natural therapy containing kava. Med J Aust. 2003 May 5;178(9):442-3.

We describe a case of acute liver failure and death associated with the use of a preparation containing the "natural" anxiolytic kava (Piper methysticum) and passionflower (Passiflora incarnata). The patient died after a report by the Therapeutic Goods Administration (TGA) warning of the potential for hepatotoxicity associated with the use of kava-containing products. The general public and alternative medicine practitioners need to be aware of the potential for non-prescription drugs to cause serious hepatic reactions.

8250. Hall J, Bulik R, Sierpina V. Community preceptors' attitudes toward and practices of complementary and alternative medicine: a Texas survey. Tex Med. 2003 May;99(5):50-3.

To assess attitudes toward and practices of complementary and alternative medicine (CAM) in Texas, a survey was developed and sent to 143 community preceptor physicians in September 2001. The results of the survey represent what the physicians of Texas believe about CAM as a practice and about the relationship of CAM to the medical community. Results indicate that the concept of CAM is relatively well accepted, continuing education is enthusiastically accepted, and support for medical school education is strong; however, physicians also report concerns over the attitudes of their colleagues toward CAM as well as a wide range of concerns about CAM therapy in general. The physicians verify that patients seem to expect them to be knowledgeable about CAM therapies and note some frustrations with the lack of opportunity for fact-based continuing education.

8251. Hall JD, Bissonette EA, Boyd JC, Theodorescu D. Motivations and influences on the use of complementary medicine in patients with localized prostate cancer treated with curative intent: results of a pilot study. BJU Int. 2003 May;91(7):603-7.

OBJECTIVES: To analyse descriptively the use of complementary medicine (CM) by patients with localized prostate cancer treated with curative intent, assessing the major influences on their choice to use CM, and the major critics and advocates of CM. PATIENTS AND METHODS: From January 1997 to June 2000, 351 men with stage T1c-T3 adenocarcinoma of the prostate were treated with either radical prostatectomy (RP) or brachytherapy. On the final date all patients were mailed a questionnaire relating to their use of CM and the results analysed cross-sectionally. RESULTS: In all, 238 (67.8%) patients returned the questionnaires, of whom 37% acknowledged using some type of CM, with a similar overall use of CM among those treated with RP or brachytherapy. Of these, 43% began using CM before and 32% after starting conventional treatment, and most indicated they would never discontinue these therapies. The most common reason for using CM was the patient's impression that it made them feel better, and secondarily that they felt it helped to cure their cancer. Physicians were the most common source of information about CM, with twice as many patients identifying physicians as being advocates rather than critics of CM. Many patients felt their urologist or radiation oncologist was neutral or chose not to discuss CM. However, when these physicians discussed CM, more patients felt that they encouraged rather than discouraged the use of CM. CONCLUSIONS: These data on the motivations for patient choices relating to CM are novel; the sources of information, both positive and negative, that patients find useful in their decision to use these therapies were explored. Interestingly, physicians were generally supportive of the use of such approaches.

8252. Hurvitz EA, Leonard C, Ayyangar R, Nelson VS. Complementary and alternative medicine use in families of children with cerebral palsy. Dev Med Child Neurol. 2003 Jun;45(6):364-70.

In order to assess patterns of usage of complementary and alternative medicine (CAM) in families of children with cerebral palsy (CP), 213 families with a child (0 to 18 years) with CP were recruited at the university medical center in Ann Arbor, MI, USA as part of a descriptive survey. Two hundred and thirty-five surveys were distributed. Mean age of the child was 8 years 6 months (SD 4y : 9mo) and 56% of the sample was male with 35% full-time independent ambulators, while the rest used an assistive device or a wheelchair. Fifty-four percent were in special education classrooms. Families were given a survey on functional status of the child with CP, CAM usage of the child and the parent, factors influencing the decision to use CAM, demographics, and clinical information. Of the families, 56%, used one or more CAM techniques. Massage therapy (25%) and aquatherapy (25%) were the most common. Children of families that used CAM were significantly younger (7y : 9mo, SD 4y : 7mo) than non-users (9y : 6mo, SD 4y : 6mo: t-test p < 0.01 two-tailed). Children with quadriplegic CP, with spasticity, and those who could not walk independently were more commonly exposed to CAM (Pearson's chi2 [P(chi)2] p = 0.01 two-tailed; for mobility, odds ratio [OR] of 2.5 with regression). Mothers with a college degree had a greater tendency to use CAM for their child than those without (P(chi)2 p = 0.01 two-tailed). Fathers of children who used CAM were older than fathers of those who did not (37y : 9mo versus 33y : 2mo, p = 0.04 two-tailed). There was no significant difference between groups for mother's age, father's education, income, or for population of home town. Parents who used CAM for themselves were more likely to try CAM for their child (70% versus 47%, OR 2.1), and were much more likely to be pleased with the outcome (71% versus 42%, OR 3.5). Child's age (younger), lack of independent mobility, and parental use of CAM were the most significant predictive factors identified via logistic regression.

8253. Hyodo I, Eguchi K, Nishina T, Endo H, Tanimizu M, Mikami I, Takashima S, Imanishi J. Perceptions and attitudes of clinical oncologists on complementary and alternative medicine: a nationwide survey in Japan. Cancer. 2003 Jun 1;97(11):2861-8.

BACKGROUND: The prevalence of complementary and alternative medicine (CAM) is increasing worldwide because of the growing public interest in natural or holistic therapies and because of the flow of information through the Internet. However, there is a lack of communication between cancer patients and their physicians on topics relating to CAM. The authors performed a cross-sectional survey to evaluate the perceptions and attitudes of Japanese clinical oncologists toward cancer CAM. METHODS: The CAM questionnaires were sent to 2118 clinical oncologists. The questionnaires gathered data on background (age, gender, years in practice, specialty, and knowledge of cancer CAM), perception (effectiveness/ineffectiveness, scientific evidence, and drug interactions), and attitude (experience with and response to CAM users). Questions about oncologists' perceptions and attitudes to CAM were limited to herbs and other natural products that were sold over the counter. RESULTS: One hundred sixty-six questionnaires were returned as undeliverable. Of the remaining questionnaires, 751 were returned (a response rate of 39%). Two-thirds of the responders were surgical oncologists and most of the remaining responders were medical oncologists. The majority of oncologists (82%) believed that CAM products were ineffective against cancer. The main reason for this belief was a lack of reliable information (as cited by 85% of oncologists). Only 13% of oncologists had experienced CAM-associated disease improvement in their cancer patients. Of all the oncologists, 84% considered the possibility of drug interactions between anticancer drugs and CAM products. The majority of oncologists (80%) replied that they could neither promote the use of CAM products nor recommend quitting the products, when they were asked about the use of CAM products by cancer patients. CONCLUSIONS: Negative perceptions of CAM products persist among clinical oncologists. A lack of proven effectiveness of CAM products and concerns about drug interactions with anticancer treatment suggest a need for both accurate information on CAM products and clinical trials. Copyright 2003 American Cancer Society.

8254. Isbell B. Clinical training in complementary therapies for the 21st century. Complement Ther Nurs Midwifery. 2003 May;9(2):83-9.

Over the past 6 years an innovative portfolio of degree courses in complementary therapies has been developed at the University of Westminster. In 1996, when the first three courses of the BSc Scheme were validated, the high-quality clinical experience needed to consolidate the academic and practical skills was planned. The opening of the unique multidisciplinary Polyclinic in 1998 marked the beginning of an exciting clinical training and research dimension to the University's complementary therapies provision. The Polyclinic represents a unique opportunity for integrated medicine, not only with other healthcare professionals but also between complementary therapies. The rationale for the creation of the Polyclinic is discussed. The development of the integrated medicine theme of the Complementary Therapies Scheme and its consolidation within the clinical experience for the students is described. The further enrichment of the students' clinical experience with placements in other healthcare settings is also described. The development of the clinical provision is discussed including clinical governance, the management structures, and influence of nursing and midwifery, introduction of supervision for the clinic tutors, data collection and plans for the future.

8255. Jordan M. A response to 'Herbal medicines - harmless or harmful?', Sehgal A, Hall JE, Anaesthesia 2002; 57: 947-8. Anaesthesia. 2003 Apr;58(4):403. No abstract.

8256. Katz AR. Urinary tract infections and acupuncture. Am J Public Health. 2003 May;93(5):702; author reply 702-3. No abstract.

8257. Killestein J, Hoogervorst EL, Reif M, Blauw B, Smits M, Uitdehaag BM, Nagelkerken L, Polman CH. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. J Neuroimmunol. 2003 Apr;137(1-2):140-3.

Cannabinoids can modulate the function of immune cells. We here present the first human in vivo study measuring immune function in 16 MS patients treated with oral cannabinoids. A modest increase of TNF-alpha in LPS-stimulated whole blood was found during cannabis plant-extract treatment (p=0.037), with no change in other cytokines. In the subgroup of patients with high adverse event scores, we found an increase in plasma IL-12p40 (p=0.002). The results suggest pro-inflammatory disease-modifying potential of cannabinoids in MS.

8258. Kim CG, June KJ, Song R. Effects of a health-promotion program on cardiovascular risk factors, health behaviors, and life satisfaction in institutionalized elderly women. Int J Nurs Stud. 2003 May;40(4):375-81.

This study applied a 3-month health-promotion program to institutionalized elderly people to examine changes in cardiovascular risk factors, health behaviors, and life satisfaction. Twenty-one elderly women with an average age of 77 years participated in the program consisting of cardiovascular risk assessments, Korean traditional dance movements (KTDMs), and health education/counseling. Paired t-tests revealed that the participants exhibited significant reductions in total risk score, improvements in health behaviors and life satisfaction at the end of the program. However, the positive effects tend to decrease at 3 months after the program ended. In conclusion, the health-promotion program using KTDM exercises was safely applicable and beneficial to institutionalized elderly women.

8259. Kim YS, Kim JS, Park SH, Choi SU, Lee CO, Kim SK, Kim YK, Kim SH, Ryu SY. Two cytotoxic sesquiterpene lactones from the leaves of Xanthium strumarium and their in vitro inhibitory activity on farnesyltransferase. Planta Med. 2003 Apr;69(4):375-7.

Two xanthanolide sesquiterpene lactones, 8- epi-xanthatin (1) and 8- epi-xanthatin epoxide (2), isolated from the leaves of Xanthium strumarium (Compositae), demonstrated a significant inhibition on the proliferation of cultured human tumor cells, i. e., A549 (non-small cell lung), SK-OV-3 (ovary), SK-MEL-2 (melanoma), XF498 (central nervous system) and HCT-15 (colon) in vitro. They were also found to inhibit the farnesylation process of human lamin-B by farnesyltransferase (FTase), in a dose-dependent manner in vitro (IC 50 value was calculated as 64 and 58 microM, respectively). Due to the relatively high concentrations of 1 and 2 required to obtain an FTase inhibition as compared with those necessary for a cytotoxic effect on tumor cells, it remains unclear whether a relationship between these two activities exists.

8260. Kumarasamy Y, Cox PJ, Jaspars M, Nahar L, Wilcock CC, Sarker SD. Biological activity of Euonymus europaeus. Fitoterapia. 2003 Apr;74(3):305-7.

The n-hexane, dichloromethane and methanol extracts of the seeds of Euonymus europaeus have been screened for antibacterial and free radical scavenging activity. General toxicity (brine shrimp lethality assay) of these extracts has also been assessed.

8261. Laws MB, Carballeira N. Use of nonallopathic healing methods by Latina women at midlife. Am J Public Health. 2003 Apr;93(4):524-5; author reply 525. No abstract.

8262. Leach M. Natural, complementary, alternative: which term to use? Aust J Holist Nurs. 2003 Apr;10(1):46-9. Review.

Although natural therapies are slowly infiltrating Australian nursing practice, there is still no consensus over which term to use and what these terms actually denote and infer. This article will address these concerns to reduce the confusion and misperception that currently surrounds the terminology currently in use.

8263. Leclercq C, Arcella D, Le Donne C, Piccinelli R, Sette S, Soggiu ME. Stochastic modelling of human exposure to food chemicals and nutrients within the "Montecarlo" project: an exploration of the influence of brand loyalty and market share on intake estimates of intense sweeteners from sugar-free soft drinks. Toxicol Lett. 2003 Apr 11;140-141:443-57. Review.

To get a more realistic view of exposure to food chemicals, risk managers are getting more interested in stochastic modelling as an alternative to

deterministic approaches based on conservative assumptions. It allows to take into account all the available information in the concentration of the chemical present in foods and in food consumption patterns. Within the EC-funded "Montecarlo" project, a comprehensive set of mathematical algorithms was developed to take into account all the necessary components for stochastic modelling of a variety of food chemicals, nutrients and ingredients. An appropriate computer software is being developed. Since the concentration of food chemicals may vary among different brands of the same product, consumer behaviour with respect to brands may have an impact on exposure assessments. Numeric experiments were carried out on different ways of incorporating indicators of market share and brand loyalty in the mathematical algorithms developed within the stochastic model of exposure to intense sweeteners from sugar-free beverages. The 95th percentiles of intake were shown to vary according to the inclusion/exclusion of these indicators. The market share should be included in the model especially if the market is not equitably distributed between brands. If brand loyalty data are not available, the model may be run under theoretical scenarios.

8264. Livingston J. Pregnant children and half-dead adults: modern living and the quickening life cycle in Botswana. Bull Hist Med. 2003 Spring;77(1):133-62.

This paper utilizes ethnography and oral history to examine local perspectives on one aspect of the health transition, the female life cycle, in postcolonial Botswana. Botswana has undergone a remarkably rapid epidemiologic transition in recent decades, and it thus provides a unique context within which local actors analyze the interaction between biological and sociocultural change. Improvements in the standard of living have resulted in both an earlier onset for puberty in girls and an increased incidence of stroke among older women, thus refashioning the female life course. Local analysis and commentary on the shifting norms of women's bodies read this phenomenon alongside broader historical transformations. In the process they complicate basic assumptions in international health about the meanings of health and development.

8265. Makalowski W. Genomics. Not junk after all. Science. 2003 May 23;300(5623):1246-7. No abstract.

8266. Mariam DH. Indigenous social insurance as an alternative financing mechanism for health care in Ethiopia (the case of eders). Soc Sci Med. 2003 Apr;56(8):1719-26.

With increasing demand for services further propagated by population growth and by people's response to newly emerging pathologies, nations in sub-Saharan Africa are faced with insurmountable problems in sustaining their health systems. Realizing the inadequacy of solely relying on the public sector, these countries are seeking alternative mechanisms for health financing. Among the alternatives suggested are risk-sharing mechanisms that include community-based schemes that tap the potential of indigenous social arrangements.In Ethiopia, eders are major forms of indigenous arrangements utilized mainly for assisting victims in bereavement and executing funeral-related activities. These associations are also called upon in various self-help activities and sometimes provide health insurance, even though mostly in an informal manner. Therefore,they have the potential to serve as social financing mechanisms. Since these are already functioning groups, the administrative cost for the extra health-related activity will not be as high as in the case of forming a new insurance entity. In addition, the fact that eders are based on mutual understanding among members minimizes the possibility of adverse selection.Based on the above background, an exploratory study was conducted in 40 villages distributed in various parts of Ethiopia to assess the possible roles eders might play in providing insurance for health financing. Both qualitative and quantitative (household and health facility exit interview surveys) methods of data collection were utilized. The study concludes that eder-based schemes are, indeed, options for experimentation as mechanisms for financing health care in rural Ethiopia. It was also found that 21.5% of respondents in the household and 16% of those in the exit surveys were already utilizing eders to finance part of their health expenditure. In addition, 86% of the respondents in the household and 90% of those in the exit survey were willing to participate in eder-based health insurance schemes.

8267. Mendel J. Scientific, philosophical and social informants of holistic health care. Aust J Holist Nurs. 2003 Apr;10(1):13-21. Review.

Concepts drawn from the broad area of non-linear dynamics including chaos and general systems theories have found widespread acceptance not only among health carers but in the broader community. These concepts are presented as partial informants of holistic health care. An uptake of monistic philosophy in Western society and changing social values are also presented as further informants of contemporary notions of holistic health care. Due to the diverse epistemology underpinning contemporary health care practice, the article concludes that individual concepts of holistic health care must differ markedly between health care practitioners who employ a holistic framework in practice.

8268. Paller AS, Nimmagadda S, Schachner L, Mallory SB, Kahn T, Willis I, Eichenfield LF. Fluocinolone acetonide 0.01% in peanut oil: therapy for childhood atopic dermatitis, even in patients who are peanut sensitive. J Am Acad Dermatol. 2003 Apr;48(4):569-77.

BACKGROUND: Fluocinolone acetonide 0.01% in a blend of refined peanut and mineral oils has been used as treatment for scalp psoriasis for several years, but only more recently for atopic dermatitis. OBJECTIVE: We sought to study the effectiveness for atopic dermatitis, potential for adrenal axis suppression, and safety of the fluocinolone acetonide 0.01% in oil in children with atopic dermatitis, including children with atopic dermatitis and peanut allergic sensitivity. METHODS: Three separate studies were performed in children aged 2 to 12 years with atopic dermatitis: multicenter double-blind, randomized, and vehicle-controlled trial; cortisol stimulation testing; and prick testing, patch testing, and monitored medication use in children with peanut allergic sensitivity. RESULTS: Improvement of >/=50% was demonstrated within 2 weeks in 81% to 87% of 81 patients treated with active medication versus 39% of 45 children treated with vehicle oil alone. No adrenal suppression occurred after 4 weeks of therapy in 32 patients. None of 9 patients who were peanut sensitive reacted to either the full formulation or vehicle in prick or patch testing; 20 children who were peanut sensitive showed no allergic reactions after application of the medication. CONCLUSION: Fluocinolone 0.01% in peanut oil is an effective alternative to the use of topical corticosteroid agents in ointment, cream, and lotion forms in children. No evidence of adrenal suppression or adverse local effects were demonstrated in these studies. The medication was well tolerated in patients with peanut allergic sensitivity.

8269. Parkman C. The furor over alternative therapy for menopause. Case Manager. 2003 May-Jun;14(3):32-4. No abstract.

8270. Partridge MR, Dockrell M, Smith NM. The use of complementary medicines by those with asthma. Respir Med. 2003 Apr;97(4):436-8.

Complementary therapies attract considerable media attention and previous surveys of members of an asthma patient organisation suggested that their use by those with asthma was commonplace. This report concerns a study of a stratified cross section of the asthma population designed to give a more representative insight into current usage of complementary therapies. A sift questionnaire was used to identify those with asthma and 785 of those so identified undertook a semi-structured face-to-face interview. Only 6% of the study population were current users of complementary therapies with use being more common amongst those who expressed most concern regarding their current medication. Low use of complementary therapies may well reflect satisfaction with current management and suggests that previous surveys may have been unrepresentative of a more balanced population of those with asthma. Rawlings F, Meerabeau L. Implementing aromatherapy in nursing and midwifery practice. J Clin Nurs. 2003 May;12(3):405-11.

8271. Reynolds EH. Brain and mind: a challenge for WHO. Lancet. 2003 Jun 7;361(9373):1924-5. No abstract.

8272. Richardson J, Wildman J, Robertson IK. A critique of the World Health Organisation's evaluation of health system performance. Health Econ. 2003 May;12(5):355-66.

The World Health Organisation's (WHO) approach to the measurement of health system efficiency is briefly described. Four arguments are then presented. First, equity of finance should not be a criterion for the evaluation of a health system and, more generally, the same objectives and importance weights should not be imposed upon all countries. Secondly, the numerical value of the importance weights do not reflect their true importance in the country rankings. Thirdly, the model for combining the different objectives into a single index of system performance is problematical and alternative models are shown to alter system rankings. The WHO statistical analysis is replicated and used to support the fourth argument which is that, contrary to the author's assertion, their methods cannot separate true inefficiency from random error. The procedure is also subject to omitted variable bias. The econometric model for all countries has very poor predictive power for the subset of OECD countries and it is outperformed by two simpler algorithms. Country rankings based upon the model are correspondingly unreliable. It is concluded that, despite these problems, the study is a landmark in the evolution of system evaluation, but one which requires significant revision. Copyright 2002 John Wiley & Sons, Ltd.

8273. Robertson WO. Tomorrow today: plant-made pharmaceuticals. Vet Hum Toxicol. 2003 Jun;45(3):165-6. No abstract.

8274. Roitberg B. The power of the mind. Surg Neurol. 2003 May;59(5):343-4. No abstract.

8275. Scrace J. Complementary therapies in palliative care of children with cancer: a literature review. Paediatr Nurs. 2003 Apr;15(3):36-9. No abstract.

8276. Smith-Toner M. How Buddhism influences pain control choices. Nursing. 2003 Apr;33(4):17. No abstract.

8277. Tamaki Y, Miyoshi Y, Kim SJ, Tanji Y, Taguchi T, Noguchi S. Aromatase inhibitors for treatment of postmenopausal patients with breast cancer. Expert Rev Anticancer Ther. 2003 Apr;3(2):193-201. Review.

The third generation of aromatase inhibitors and inactivators, such as anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin), have become available for treatment of postmenopausal breast cancer patients. Several clinical trials have demonstrated that these new drugs can achieve better treatment results than megestrol acetate (Megace) and may replace tamoxifen for the first-line hormonal therapy for metastatic breast cancer patients. In fact, these drugs are now used in many hospitals and clinics for patients with metastatic breast cancer who were previously given tamoxifen as adjuvant treatment. However, the primary concern is whether they can be used as first-line agents for adjuvant treatment of primary breast cancer or are suitable for breast cancer prevention in view of possible adverse side effects. Recently, the Arimidex and Tamoxifen Alone or in Combination trial demonstrated the superiority in terms of disease-free survival of anastrozole over tamoxifen in adjuvant use for postmenopausal patients with Stage I and II primary breast cancer. The results of this report indicate the potential of anastrozole as an alternative drug in the adjuvant setting, although the mean follow-up time is so far only 47 months. Additional data regarding survival resulting from comparative trials of letrozole and tamoxifen and of exemestane and amoxifen are expected to be available in a few years. However, limited information is available regarding adverse events caused by long-term administration of aromatase inhibitors. Longer follow-up is needed to determine the efficacy and safety of these new aromatase inhibitors when used for adjuvant treatment of postmenopausal patients with breast cancer.

8278. Tarabar AF, Nelson LS. The resurgence and abuse of heroin by children in the United States. Curr Opin Pediatr. 2003 Apr;15(2):210-5. Review.

Heroin, one of the most addictive and "hardest" drugs of abuse, carries significant morbidity and mortality. Although its use is usually associated with the adult population in the United States, the last decade has witnessed a decrease in the median age of heroin users. An increase in the availability of inexpensive and pure heroin that could be snorted rather than injected made the drug accessible to adolescents and reduced the fear associated with the transmission of the human immunodeficiency virus (HIV). Because of the atypical demographics and the alternative drug use patterns, this young population of heroin users is not easily identified by parents or by healthcare providers. Lack of social support or access to healthcare prevents young heroin users from participation in detoxification programs, suggesting that changes may be needed in our healthcare and social systems to properly target and provide care to the youngest heroin abusers.

8279. Taylor JR. Alternative medicine for glaucoma. Ophthalmology. 2003 Jun;110(6):1267; author reply 1267-8. No abstract.

8280. Taylor JR. Alternative medicine for glaucoma.Ophthalmology. 2003 Apr;110(4):630; author reply 630-1. No abstract.

8281. Tesch BJ. Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol. 2003 May;188(5 Suppl):S44-55. Review.

OBJECTIVE: To review the evidence of herbs commonly used by women. DATA SOURCES: Articles were located by searching Medline, Cochrane Database of Systemic Reviews, and the Combined Health Information Database and by hand searching the reference lists of recent systematic reviews. The databases were searched in January 2000 and October 2000 by using the Latin and common name of each herb. METHODS OF STUDY SELECTION: Preference was given to randomized, placebo-controlled trials. When available, English language studies were reviewed. If not, data are presented from review articles that summarize the foreign study. RESULTS: Many women use herbal therapies. In the United States, herbs are considered dietary supplements. The Food and Drug Administration (FDA) cannot remove them from the market unless they are proven unsafe. The herb industry plans to improve monitoring. Many prospective randomized controlled trials are being funded. Gingko biloba seems to slow the progression of dementia but increases the risk of bleeding. St John's Wort is efficacious for treating mild to moderate depression but has many drug interactions. Ginseng seems to improve well being in perimenopausal women, but it is often impure and has side effects and drug interactions. Garlic slightly lowers blood pressure and lipids. Echinacea slightly decreases the duration of colds but does not prevent them. Valerian is beneficial for insomnia, but there is no long-term safety data. Black cohosh may help the symptoms of perimenopause, and chasteberry may improve premenstrual syndrome. More study is needed on both herbs. CONCLUSION: Some herbs are medically useful, but the American public would benefit from increased regulation. Manufacturers should be able to ensure that herbs contain pure ingredients. Side effects and drug interactions should be listed. Well-designed studies are being conducted. The results will be helpful to physicians and patients when the clinical evidence becomes available.

8282. Thompson Coon J, Pittler M, Ernst E. Herb-drug interactions: survey of leading pharmaceutical/herbal companies. Arch Intern Med. 2003 Jun 9;163(11):1371. No abstract.

8283. Tsang HW, Mok CK, Au Yeung YT, Chan SY. The effect of Qigong on general and psychosocial health of elderly with chronic physical illnesses: a randomized clinical trial. Int J Geriatr Psychiatry. 2003 May;18(5):441-9.

OBJECTIVES: Based on the model by Tsang et al. (2002) which summarized the etiological factors and consequences of depression in elderly with chronic physical illnesses, a randomized clinical trial of a special form of Qigong (The Eight Section Brocades) was conducted to assess if it improved the biopsychosocial health of participants. DESIGN: 50 geriatric patients in sub-acute stage of chronic physical illnesses were recruited and randomly assigned into the intervention and control group. The intervention group was given a 12-week period of Qigong practice while the control group was given traditional remedial rehabilitation activities. RESULTS: The intervention group participants expressed improvement in physical health, ADL, psychological health, social relationship, and health in general as reflected by scores of the Perceived Benefit Questionnaire and informal feedback. CONCLUSION: Although results are not significant in the generalization measures, it may be due to small effect size, small sample size, and short intervention period. Although not all of the hypotheses are supported, this report shows that Qigong (the Eight Section Brocades) is promising as an alternative intervention for elderly with chronic physical illness to improve their biopsychosocial health. More systematic evaluation with larger sample size and longer period of intervention is now underway in Hong Kong. Results will be reported once available. Copyright 2003 John Wiley & Sons, Ltd.

8284. Tsay SL, Rong JR, Lin PF. Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. J Adv Nurs. 2003 Apr;42(2):134-42.

BACKGROUND: Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. METHODS: The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study - Short Form 36. FINDINGS: The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study - Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. CONCLUSION: This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.

8285. Tseng CC, Tsai TL, Chen KT, Lin CZ. Choanal atresia: an unusual serious complication of complementary and alternative medical treatment. Arch Otolaryngol Head Neck Surg. 2003 Apr;129(4):475-7.

The use of complementary and alternative medicine (CAM) is common among patients with chronic, long-standing nasal disease. Complications resulting from inappropriate CAM practices are sometimes reported, but serious complications such as choanal atresia and stenosis are rare. We report a case of choanal atresia and stenosis due to herbal drug (ie, chemical) cauterization of the nasal cavity in a 39-year-old man. We reviewed the literature on why patients previously given conventional treatment seek alternative therapies. The patient underwent surgical intervention to relieve choanal atresia and stenosis. The postoperative course was unremarkable, and follow-up for 1 year revealed no evidence of restenosis. Choanal atresia and stenosis resulting from CAM treatment are rare. Otolaryngologists should be aware of possible complications occurring in patients receiving such treatments.

8286. Vallerand AH, Fouladbakhsh JM, Templin T. The use of complementary/alternative medicine therapies for the self-treatment of pain among residents of urban, suburban, and rural communities. Am J Public Health. 2003 Jun;93(6):923-5. No abstract.

8287. Veasey SC. Molecular and physiologic basis of obstructive sleep apnea. Clin Chest Med. 2003 Jun;24(2):179-93. Review.

Obstructive sleep apnea-hypopnea syndrome occurs because of various combinations of anatomic, mechanical, and neurologic anomalies that jeopardize ventilation only when normal state-dependent reductions in drive to upper airway respiratory muscles and pump muscles occur. A well thought out and carefully described infrastructure of the normal and abnormal physiology in persons with OSAHS has been developed over the past few decades, which enables the development of innovative and largely effective therapies. The most recent data complement the infrastructure with the neurochemical changes underlying the state-dependent respiratory disorder and observations that the disease process itself can impair muscles, neural inputs, and soft tissue in a manner that has the potential to worsen disease. Oxidative and nitrosative stress from the repeated oxyhemoglobin desaturations and re-oxygenations is implicated in the injury to these tissues. An improved understanding of the mechanisms through which OSAHS progresses may lead to alternative therapies and aid in the identification of persons at risk for disease progression.

8288. Vitetta L, Thomsen M, Sali A. Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust. 2003 Apr 21;178(8):411-2. No abstract.

8289. Wiener P. Neuroactive steroids, relaxation, and seizure control. Int J Neurosci. 2003 May;113(5):631-9. Review.

Neuroactive steroids alter the excitability of membrane-bound receptors in the nervous system and have a modulatory role in the stress response and in

epileptogenic activity. These changes can be detected in brain as well as in plasma. The resulting rapid (<1 min) action of neuroactive steroids might explain the success of some "alternative" approaches in seizure control. Design requirements for research to adequately examine relaxation training in epileptic patients, as well as corresponding changes in neuroactive steroid levels and seizure frequency, are described.

8290. Wilkinson S, Chodak GW. Critical review of complementary therapies for prostate cancer. J Clin Oncol. 2003 Jun 1;21(11):2199-210. Review.

Despite its prominence as the most frequently diagnosed solid tumor among men in the United States, relatively little is known about the etiology of prostate cancer. Furthermore, research into treatment strategies for prostate cancer continues to lag behind research for the other most common cancers. At the same time, however, the popularity of complementary therapies among prostate cancer patients continues to grow. In this article, we provide a critical review of the most recent evidence for dietary modifications, food supplements, and herbs in prostate cancer prevention and treatment. Despite encouraging data for some of these interventions, even the strongest proponents of complementary therapy agree that only randomized controlled trials can provide sufficient evidence on which to create universal guidelines. However, such trials are highly complex and expensive, and they require lengthy follow-up. Until such trials are completed, an opportunity exists for health care professionals to improve their knowledge and understanding of the current evidence for or against complementary therapy in prostate cancer.

8291. Wing SL, Askew EW, Luetkemeier MJ, Ryujin DT, Kamimori GH, Grissom CK. Lack of effect of Rhodiola or oxygenated water supplementation on hypoxemia and oxidative stress. Wilderness Environ Med. 2003 Spring;14(1):9-16.

OBJECTIVE: This study investigated the effects of 2 potentially "oxygen promoting" dietary supplements on hypoxia and oxidative stress at a simulated altitude of 4600 m. METHODS: Fifteen volunteers (ages 20-33) received 3 separate 60-minute hypoxic exposures by breathing 13.6% oxygen at an ambient barometric pressure of 633 mm Hg (simulating the partial pressure of oxygen at 4600 m elevation). Each subject received, in random order, treatments of a 7-day supply of placebo, Rhodiola rosca, and an acute dose of stabilized oxygen dissolved in water. Arterialized capillary blood oxygen samples (PcO2) were measured at baseline and at 30 and 60 minutes of exposure. Pulse oximeter oxyhemoglobin saturation (SaO2) was measured at baseline and at every 10 minutes of hypoxic exposure. Oxidative stress markers measured included baseline and 60-minute exposure serum lipid peroxides (LPO) and urine malondialdehyde (MDA). RESULTS: For each treatment group, PcO2 decreased by approximately 38% from baseline to 60-minute hypoxic exposure. Similarly, SaO2 also decreased among groups from approximately 97 to 81%. Serum lipid peroxides increased significantly in the placebo group and decreased significantly from baseline in response to the stabilized oxygen treatment (P = .02); there was a trend for decreased LPO with the Rhodiola treatment (P = .10). There were no significant changes for MDA among groups. CONCLUSIONS: The 2 dietary supplements investigated did not have a significant effect on blood oxygenation after 60 minutes of sedentary hypoxic exposure. Hypoxia-induced oxidative stress was observed in the control group only. Both supplements appeared not to increase oxidative stress and may decrease free radical formation after hypoxic exposure compared with the control.

8292. Winkelman M. Complementary therapy for addiction: "drumming out drugs". Am J Public Health. 2003 Apr;93(4):647-51. Review.

OBJECTIVES: This article examines drumming activities as complementary addiction treatments and discusses their reported effects. METHODS: I observed drumming circles for substance abuse (as a participant), interviewed counselors and Internet mailing list participants, initiated a pilot program, and reviewed literature on the effects of drumming. RESULTS: Research reviews indicate that drumming enhances recovery through inducing relaxation and enhancing theta-wave production and brain-wave synchronization. Drumming produces pleasurable experiences, enhanced awareness of preconscious dynamics, release of emotional trauma, and reintegration of self. Drumming alleviates self-centeredness, isolation, and alienation, creating a sense of connectedness with self and others. Drumming provides a secular approach to accessing a higher power and applying spiritual perspectives. CONCLUSIONS: Drumming circles have applications as complementary addiction therapy, particularly for repeated relapse and when other counseling modalities have failed.

8293. Wood MJ, Stewart RL, Merry H, Johnstone DE, Cox JL. Use of complementary and alternative medical therapies in patients with cardiovascular disease. Am Heart J. 2003 May;145(5):806-12.

BACKGROUND: Complementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD). METHODS: Interviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD. RESULTS: The current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent's usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement. CONCLUSION: The use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.

8294. Yawn BP, Wollan P, Scanlon PD, Kurland M. Outcome results of a school-based screening program for undertreated asthma. Ann Allergy Asthma Immunol. 2003 May;90(5):508-15.

BACKGROUND: Undertreatment of asthma is associated with significant potentially preventable morbidity, including frequent school absences. Guideline dissemination and clinician education have met with variable success. School-based identification of children with potentially undertreated asthma may provide an alternative strategy for improving asthma management in children. OBJECTIVE: To evaluate the effectiveness of school-based identification of potentially undertreated asthma. METHODS: A controlled trial of school-based identification of children with known but symptomatic asthma using mailed parent surveys, letters recommending medical follow-up, and medical record review to evaluate changes in asthma treatment after referral. RESULTS: Most parents (79.9%, n = 5,116 respondents) responded to the survey and 19.4% (n = 994) of children were reported to have a physician diagnosis of asthma or reactive airway disease. Letters of referral were sent to 489 children with parent-reported asthma who were identified as having potentially undertreated asthma. Approximately one-third (31.2%, n = 153) of these children had physician visits, and 92 (18.8% of all referred) had documented medication changes. In addition, there were 20 new physician diagnoses in this group of children. In the control group of 604 children with asthma, there were significantly fewer children with asthma-related visits (131, 21.7%, P = 0.0004) and children with medication changes (74, 12.3%, P = 0.002) in a comparable 6-month window. CONCLUSIONS: School-based screening or case identification increased the number of physician asthma-related visits and changes in asthma therapy.

8295. Yueh B, Piccirillo JF. On equivalence trials and alternative medicine. Arch Otolaryngol Head Neck Surg. 2003 Apr;129(4):403-4. No abstract.

Aroma therapy:

8296. Edge J. A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health. Complement Ther Nurs Midwifery. 2003 May;9(2):90-7.

This study was carried out with eight subjects specifically referred for aromatherapy; each received a standardised aromatherapy massage weekly for 6 weeks. The subjects' levels of anxiety and depression were measured using the Hospital Anxiety and Depression (HAD) Scale prior to the first massage and after the final massage. The subjects' levels of mood, anxiety and relaxation were recorded using a visual analogue before and after each massage and then again 6 weeks after the last massage. Comparison was made between the HAD Scale results for each client and also the visual analogue scale results for before and after massage and also first massage and 6 weeks postmassage for the sample group. Improvements were shown in six out of eight subjects' HAD Scale results. Improvements were also shown in all areas when comparing the visual analogue scale results. The study was carried out over an 8-month period. To date there have been few studies addressing the effect of aromatherapy massage on mood, anxiety and relaxation (Therapist 9 (1996) 38). It is acknowledged that there may be a number of reasons for this such as factors related to obtaining a sample group, informed consent, the interaction of current medication regimes and so forth. It is acknowledged that whilst this is a small pilot study a number of methodological issues are raised concerning research into the use of aromatherapy in this clinical field. By reporting on this work, it is hoped that this paper will generate reflection, discussion and debate so forwarding the knowledge base in this discipline.

Ayurveda:

8297. Kurup RK, Kurup PA. Hypothalamic digoxin, hemispheric chemical dominance, and the tridosha theory. Int J Neurosci. 2003 May;113(5):657-81.

Ayurveda, the traditional Indian System of Medicine, deals with the theory of the three tridosha states (both physical and psychological): Vata, Pitta, and Kapha. They are the three major human constitutional types that both depend on psychological and physical characteristics. The Pitta state is described as a critical, discriminative, and rational psychological state of mind, while the Kapha state is described as being dominant for emotional stimuli. The Vata state is an intermediate unstable shifting state. The Pitta types are of average height and built with well developed musculature. The Vata types are thin individuals with low body mass index. The Kapha types are short stocky individuals that tend toward obesity, and who are sedentary. The study assessed the biochemical differences between right hemispheric dominant, bihemispheric dominant, and left hemispheric dominant individuals, and then compared this with the patterns obtained in the Vata, Pitta, and Kapha states. The isoprenoid metabolites (digoxin, dolichol, and ubiquinone), glycoconjugate metabolism, free radical metabolism, and the RBC membrane composition were studied. The hemispheric chemical dominance in various systemic diseases and psychological states was also investigated. The results showed that right hemispheric chemically dominant/Kapha state had elevated digoxin levels, increased free radical production and reduced scavenging, increased tryptophan catabolites and reduced tyrosine catabolites, increased glycoconjugate levels and increased cholesterol: phospholipid ratio of RBC membranes. Left hemispheric chemically dominant/Pitta states had the opposite biochemical patterns. The patterns were normal or intermediate in the bihemispheric chemically dominant/Vata state. This pattern could be correlated with various systemic and neuropsychiatric diseases and personality traits. Right hemispheric chemical dominance/Kapha state represents a hyperdigoxinemic state with membrane sodium-potassium ATPase inhibition. Left hemispheric chemical dominance/Pitta state represents the reverse pattern with hypodigoxinemia and membrane sodium-potassium ATPase stimulation. The Vata state is the intermediate bihemispheric chemical dominant state. Ninety-five percent of the patients/individuals in the tridosha, pathological, and psychological groups were right-handed/left hemispheric dominant, however, their biochemical patterns were different--either left hemispheric chemical dominant or right hemispheric chemical dominant. Hemispheric chemical dominance/tridosha states had no correlation with cerebral dominance detected by handedness/dichotic listening test.

Herbal Medicine:

8298. Berrada D, Lembo T. Novel therapies in the treatment of irritable bowel syndrome. Expert Opin Investig Drugs. 2003 Apr;12(4):635-45. Review.

Irritable bowel syndrome (IBS) is characterised by abnormalities in motility, sensation and perception. It is one of the most common conditions encountered in clinical practice, especially by gastroenterologists. Pharmacological treatment of IBS is aimed at the predominant symptom and recent advances in pathophysiology has opened the door to the development of new compounds that target specific receptors. During this review, the most promising investigational and recently approved drugs will be discussed.

8299. Glover DD, Amonkar M, Rybeck BF, Tracy TS. Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population. Am J Obstet Gynecol. 2003 Apr;188(4):1039-45.

OBJECTIVE: The purpose of this study was to identify the medications that are consumed by a rural obstetric population during pregnancy. STUDY DESIGN: Over a period of 26 months, pregnant women were interviewed about medication use. Interviews on subsequent visits provided a longitudinal study of medication usage and discontinuation. Trend differences were analyzed according to the number of medications, the trimester of use, and insurance status. RESULTS: Five hundred seventy-eight participants had 2086 interviews. The compilation of the interviews showed that 95.8% of the participants took prescription medications, 92.6% of the participants self-medicated with over-the-counter medications, and 45.2% of the participants used herbal medications. Over time, consumption of over-the-counter medications exceeded prescription medication use. Fifteen percent of the pregnant women took ibuprofen at some point during the pregnancy (5.7% in the third trimester). Eight percent of the women were noncompliant and 20% incompletely compliant with prenatal vitamin and mineral formulations. CONCLUSION: Medication use was substantial in this population. Medications (eg, ibuprofen) that are contraindicated in pregnancy were used at unexpectedly high rates. Of the three medication classes, over-the-counter medications were used most frequently.

8300. Ness J, Johnson D, Nisly N. "Polyherbacy": herbal supplements as a form of polypharmacy in older adults. J Gerontol A Biol Sci Med Sci. 2003 May;58(5):M478. No abstract.

8301. Rigassio Radler D. Nutritional supplements, ergogenic aids, and herbals. Dent Clin North Am. 2003 Apr;47(2):245-58, vi. Review.

The availability of supplements is keeping up with consumer demand. The dental practitioner should be aware of various supplements used in wellness and in illness. This article discusses popular nutrition supplements, ergogenic aids, and botanicals used in general health and disease, as well as those specifically touted for use in oral health. Side effects and interactions will be noted, along with practice points for interviewing and advising patients in clinical practice.

8302. Talley NJ. Pharmacologic therapy for the irritable bowel syndrome. Am J Gastroenterol. 2003 Apr;98(4):750-8. Review.

The management of the irritable bowel syndrome (IBS) remains unsatisfactory. For abdominal pain, antispasmodics are, at best, of only modest efficacy. Tricyclic antidepressants in low dose are useful (with the number needed to treat being three), but side effects and patient concerns regarding use of a centrally acting agent for depression remain limitations. Selective serotonin reuptake inhibitors are of uncertain efficacy in IBS. Opioid agonists, especially loperamide, are useful for diarrhea but not for pain in IBS; rebound constipation also remains a problem. Bile salt sequestering agents are not of established value in IBS but seem to be useful clinically in a small group of IBS patients with diarrhea. Aloestron, a 5HT(3) antagonist, should be reserved, if available, for women with severe diarrhea predominant IBS who have failed to respond to conventional therapy, and started at a low dose. Fiber and bulking agents may help constipation in some trials, but the evidence that they are efficacious in IBS is equivocal; they are frequently prescribed as first-line drugs for IBS regardless of the primary bowel disturbance but often increase bloating, gas, and pain. Laxatives are not of established value in IBS but are often taken by patients with constipation predominant IBS. Tegaserod, a partial 5HT(4) agonist, is now available in the United States and other countries for use in women with IBS whose primary bowel symptom is constipation; its efficacy in men and in those with alternating bowel habits is unknown. Probiotics are of uncertain efficacy. Chinese herbal medicine data are insufficient. Other new drugs in development include the cholecystokinin antagonists and novel visceral analgesics. Both current and potential therapies for IBS are reviewed in this article.

8303. Thabrew MI, Dharmasiri MG, Senaratne L. Anti-inflammatory and analgesic activity in the polyherbal formulation Maharasnadhi Quathar. J Ethnopharmacol. 2003 Apr;85(2-3):261-7.

Maharasnadhi Quathar (MRQ) is a polyherbal preparation recommended by Ayurvedic medical practitioners for treatment of arthritic conditions. An investigation has been carried out with rats and human rheumatoid arthritis (RA) patients, to determine the anti-inflammatory and analgesic potential of MRQ. Results obtained demonstrate that MRQ can significantly and dose-dependently inhibit carrageenan-induced rat paw oedema (the inhibition at 3h was greater than at 1h after induction of oedema). MRQ could also increase the reaction time of rats in the hot-plate test (by 57% after the first hour of treatment), although it had no effect on the reaction time in the tail-flick test, indicating that MRQ possesses analgesic activity that is probably mediated via a supra-spinal effect.MRQ also exerted a dose-dependent (a) protective effect on heat-induced erythrocyte lysis, and (b) inhibition of 5-lipoxygenase activity.In RA patients, after 3 months of MRQ treatment, there was a marked improvement in the pain and inflammation experienced by the patients as well as in the mobility of the affected joints. From the overall results obtained, it may be concluded that MRQ possesses significant anti-inflammatory and analgesic activities. Alteration in synthesis of prostaglandins and leukotrienes, membrane stabilization and anti-oxidant activity are some of the possible mechanisms through which MRQ mediates its anti-arthritic effects.

Homeopathy:

8304. Stockton A. Homeopathy as an integral part of maternity care--why not? RCM Midwives J. 2003 Apr;Suppl:6-7. No abstract.

8305. White A, Slade P, Hunt C, Hart A, Ernst E. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax. 2003 Apr;58(4):317-21.

BACKGROUND: Homeopathy is frequently used to treat asthma in children. In the common classical form of homeopathy, prescriptions are individualised for each patient. There has been no rigorous investigation into this form of treatment for asthma. METHODS: In a randomised, double blind, placebo controlled trial the effects of individualised homeopathic remedies were compared with placebo medication in 96 children with mild to moderate asthma as an adjunct to conventional treatment. The main outcome measure was the active quality of living subscale of the Childhood Asthma Questionnaire administered at baseline and follow up at 12 months. Other outcome measures included other subscales of the same questionnaire, peak flow rates, use of medication, symptom scores, days off school, asthma events, global assessment of change, and adverse reactions. RESULTS: There were no clinically relevant or statistically significant changes in the active quality of life score. Other subscales, notably those measuring severity, indicated relative improvements but the sizes of the effects were small. There were no differences between the groups for other measures. CONCLUSIONS: This study provides no evidence that adjunctive homeopathic remedies, as prescribed by experienced homeopathic practitioners, are superior to placebo in improving the quality of life of children with mild to moderate asthma in addition to conventional treatment in primary care.

Naturopathy:

8306. Sarrell EM, Cohen HA, Kahan E. Naturopathic treatment for ear pain in children. Pediatrics. 2003 May;111(5 Pt 1):e574-9.

OBJECTIVE: Otitis media is 1 of the most frequent diseases of early infancy and childhood and 1 of the most common reasons for children to visit a physician. In the past 2 decades, there has been a substantial increase in the diagnosis of otitis media worldwide. In the United States, 93% of all children have had at least 1 episode of acute otitis media (AOM) by 7 years of age. Otalgia is the hallmark of AOM. Most affected children either complain of earache or manifest behavior that the parents interpret as indicating ear pain. Treatment of the ear pain early in the course of AOM decreases both parental anxiety and the child's discomfort and accelerates the healing process. The objective of this study was to determine the efficacy and tolerability of naturopathic versus traditional treatment for the management of otalgia commonly associated with AOM in children. METHODS: The study was designed as a double-blind trial in an outpatient community clinic. A total of 171 children who were aged 5 to 18 years and had otalgia and clinical findings associated with middle-ear infection were studied. The children were randomly assigned to receive treatment with Naturopathic Herbal Extract Ear Drops (NHED) or anesthetic ear drops, with or without amoxicillin. On enrollment, the children were assigned by computer-numbered randomization to receive NHED (contents: allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil) 5 drops 3 times daily, alone (group A) or together with a topical anesthetic (amethocaine and phenazone in glycerin) 5 drops 3 times daily (group B), or oral amoxicillin 80 mg/kg/d (maximum 500 mg/dose) divided into 3 doses with either NHED 5 drops 3 times daily (group C) or topical anesthetic 5 drops 3 times daily (group D). A double-blind design was used, and all ear drops were placed in identical bottles. Treatment was initiated by the nurse in all cases. A single physician (M.S.) evaluated and treated all of the patients included in the study and recorded all of the data. The presence or absence of ear pain was assessed over 3 days with a visual analog scale. Ear pain was assessed by a specially devised observational instrument based on previous reports. One side of the instrument consisted of a linear numbered scale, from 1 (no pain) to 10 (worst possible pain), and a corresponding color scale, ranging from blue to dark red. The reverse side contained a scale of 5 facial expressions, ranging from broad smile (no pain) to a sad and crying face (worst possible pain), and a corresponding color scale, ranging from blue to dark red. RESULTS: There were no significant between-group differences in patient age or gender, degree of fever, main symptoms, associated symptoms, and severity or laterality of acute otitis media. Each group had a statistically significant improvement in ear pain over the course of the 3 days. Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin. Results were better in the NHED group than in the controls. Nevertheless, the findings indicated that the pain was mostly (80%) self-limited and could be explained simply by the time elapsed. The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease. Because no evidence was found that systemic antibiotics alone improved treatment outcome, if antibiotics do not change the natural course of otitis media, then the main goal of treatment, as in the present study, should be to alleviate the ear pain. The alternative, naturopathic herbal extract medications, may offer many new possibilities in the management of ear pain associated with AOM. Primary care physicians should be aware that at least 10% of their patients may have tried 1 or more forms of alternative/complementary medicine before presenting for consultation. As it was widely reported in the medical literature, these herb, these herbal extracts have the potential to meet all of the requirements of appropriate medication that could be routinely used in the pediatric patient, namely in vitro bacteriostatic and bacteriocidal activity against common pathogens, immunostimulation ability, antioxidant activity, and anti-inflammatory effects. They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane. They have been found to enhance local immunologic activity. Finally, herbal extracts are well-tolerated (owing to their long elimination time), easy to administer, and less expensive than the new antibiotics. There are no documented side effects. On the basis of our findings that the group with the most significant treatment effects (NHED with topical anesthetic) explained only 7.3% of the total pain reduction, we propose that sometimes the general practitioner or pediatrician needs to give the human body a chance to repair itself. Nevertheless, if the physician believes that there is an indication for some treatment, especially if the parents are anxious, then a local treatment such as one used in our study might be adequate. CONCLUSIONS: This study suggests that in cases of ear pain caused by AOM in children in which active treatment, besides a simple 2- to 3-day waiting period, is needed, an herbal extract solution may be beneficial. Concomitant antibiotic treatment is apparently not contributory.

Reflexology:

8307. Stephenson NL, Dalton JA. Using reflexology for pain management. A review. J Holist Nurs. 2003 Jun;21(2):179-91. Review.

More than two thirds of Americans with chronic pain are now using complementary and alternative therapies. One complementary and alternative therapy, reflexology, has a long history and has been found useful on a case-by-case basis. This article provides a review of the literature on the use of reflexology as a therapy in pain management. Although reflexology is widely used, systematic research is needed to examine its effectiveness. To date, however, only a few studies have focused on reflexology's use in pain management. Because reflexology is a noninvasive, nonpharmacological therapy, nurses are in a position to do research on and make decisions about its clinical effectiveness.

Traditional Medicine:

8308. Eccles R. Menthol: effects on nasal sensation of airflow and the drive to breathe. Curr Allergy Asthma Rep. 2003 May;3(3):210-4. Review.

Menthol, in lozenges, nasal sprays, vapo-rubs, inhalers, and cough syrups, is widely used as a treatment for rhinitis that is associated with acute upper respiratory tract infection and allergy. Menthol as a plant extract has been used in traditional medicine in Asia for the treatment of respiratory diseases for hundreds of years, but it was only introduced to the West as a medicine at the end of the 19th century. With the recent discovery of a menthol receptor on the sensory nerves that modulate the cool sensation, menthol has graduated from the realms of herbal medicine into the field of molecular pharmacology. This review concerns the physiologic and pharmacologic mechanisms that underlie the widespread use of menthol as a treatment for the relief of nasal congestion associated with rhinitis and its effects on the drive to breathe and symptomatic relief of dyspnea.

8309. Ficker CE, Smith ML, Susiarti S, Leaman DJ, Irawati C, Arnason JT. Inhibition of human pathogenic fungi by members of Zingiberaceae used by the Kenyah (Indonesian Borneo). J Ethnopharmacol. 2003 Apr;85(2-3):289-93.

Extracts from 11 plant species belonging to the Zingiberaceae were tested for antifungal activity using disc diffusion bioassays. Extracts from several members, especially Alpinia galanga, Curcuma zedoaria and Zingiber purpureum, were found to have pronounced inhibitory activities against a wide variety of human pathogenic fungi, including strains resistant to the common antifungals amphotericin B and ketoconazole. As members of the Zingiberaceae are generally regarded as safe for human consumption, these species are excellent candidates for development as novel therapeutics.

8310. Lo V. The territory between life and death. Essay review. Med Hist. 2003 Apr;47(2):250-8. No abstract.

8311. Xue T, Roy R. Studying traditional Chinese medicine. Science. 2003 May 2;300(5620):740-1. No abstract.

Yoga:

8312. Adams J. Exploring yoga to relieve menopausal symptoms. Holist Nurs Pract. 2003 May-Jun;17(3):166-7. No abstract.

8313. Ram FS, Holloway EA, Jones PW. Breathing retraining for asthma. Respir Med. 2003 May;97(5):501-7.

Breathing retraining is used increasingly throughout the world by many patients with asthma in addition to their usual medical care. We undertook a systematic review of the literature in order to determine the effectiveness of breathing retraining in the management of asthma. Six randomised-controlled trials were identified that involved breathing retraining in asthma. Due to the variation in reported trial outcomes, limited reporting of study data and small number of included trials it was not possible to draw any firm conclusions as to its effectiveness. However, outcomes that were reported from individual trials do show that breathing retraining may have a role in the treatment and management of asthma. Further large-scale trials using breathing retraining techniques in asthma are required to address this important issue.

Back to reference