Use of complementary and alternative medicine in Korean cancer patients: Results of a survey from the Korean Cancer Study Group (KCSG)

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Background: The aim of this study was to explore the use of complementary and alternative medicine (CAM) in cancer patients of Korea. This study was performed to identify the prevalence, types, subjective effects, and side effects of CAM use, reasons for CAM use, and patients' expectations of doctors regarding their CAM use among Korean cancer patients. Methods: From August to December, 2006, face to face structured interviews were conducted and the data were analyzed in the KCSG. Results: A total 251 patients were recruited. 84% of patients had used at least one type of CAM since the time of initial diagnosis. The most prevalent types of CAM used by these patients included special diet (60%), ginseong (54%), medicinal mushrooms (50%). Energy therapies, acupuncture and spiritual therapy were used uncommonly. The main reported reason for the use of CAM was to feel hopeful. Patients expected that CAM could cure cancer (64%) and improve immune system (52%). 62 % of patients did not inform their physicians about their CAM use. Patients attributed the reason of nondisclosure that physicians never asked about CAM (43%) and physicians would disapprove the CAM use (23%). 6% of CAM users experienced side effects. Demographic variables were not predictive for the use of CAM. 60% of patients wanted to get more information about CAM with their doctors. Conclusions: More than two-thirds of cancer patients used various kinds of CAM. Physicians treating cancer patients should aware of the frequency of CAM use and should share their opinion about CAM use with cancer patients. In order to help patients make informed decisions, physician should pay more attention to CAM for making appropriate utilization of CAM.

No significant financial relationships to disclose.

Taxonomic, genetic, chemical and estrogenic characteristics of Epimedium species

To understand the factors contributing to estrogenic properties of extracts from the genus Epimedium L. (Berberidaceae), we performed taxonomic, genetic and chemical characterization on 37 specimens from 18 species and related these to estrogen receptor (ERalpha and ERbeta) bioactivity, as measured by reporter genes in stable human cells. Boot strap values derived from amplified fragment length polymorphisms indicated that specimens of E. koreanum, E. brevicornum, E. myrianthum, E. leishanense, and E. membranaceum were genetically distinct and this was supported by their very similar ERalpha activities. In contrast, specimens from E. pubescens and E. sagittatum were diverse both genetically, chemically and in terms of ERalpha and ERbeta bioactivities. Strikingly, a genetic cluster comprising six rare Epimedium species exhibited strongest ERalpha and ERbeta activity, and this bioactivity was positively correlated with content of trace flavonoid aglycones (kaempferol, apigenin, quercetin, luteolin and breviflavone B). In contrast, there was no association between estrogenic activity and the major flavonol glycoside constituents (icariin and epimedin A-C). Although they exhibited equally strong ERalpha and ERbeta activity, E. koreanum can be clearly differentiated from E. pubescens and E. brevicornum by genetic distance and its significantly lower content of epimedin C. Our morphologic, genetic, chemical and bioactivity profiling provide the basis for the production of extracts with reproducible estrogenic properties. Such reproducibility will be critical for the standardization of Epimedium-based products.

Protecting genomic integrity in somatic cells and embryonic stem cells

Mutation frequencies at some loci in mammalian somatic cells in vivo approach 10(-4). The majority of these events occur as a consequence of loss of heterozygosity (LOH) due to mitotic recombination. Such high levels of DNA damage in somatic cells, which can accumulate with age, will cause injury and, after a latency period, may lead to somatic disease and ultimately death. This high level of DNA damage is untenable for germ cells, and by extrapolation for embryonic stem (ES) cells, that must recreate the organism. ES cells cannot tolerate such a high frequency of damage since mutations will immediately impact the altered cell, and subsequently the entire organism. Most importantly, the mutations may be passed on to future generations. ES cells, therefore, must have robust mechanisms to protect the integrity of their genomes. We have examined two such mechanisms. Firstly, we have shown that mutation frequencies and frequencies of mitotic recombination in ES cells are about 100-fold lower than in adult somatic cells or in isogenic mouse embryonic fibroblasts (MEFs). A second complementary protective mechanism eliminates those ES cells that have acquired a mutational burden, thereby maintaining a pristine population. Consistent with this hypothesis, ES cells lack a G1 checkpoint, and the two known signaling pathways that mediate the checkpoint are compromised. The checkpoint kinase, Chk2, which participates in both pathways is sequestered at centrosomes in ES cells and does not phosphorylate its substrates (i.e. p53 and Cdc25A) that must be modified to produce a G1 arrest. Ectopic expression of Chk2 does not rescue the p53-mediated pathway, but does restore the pathway mediated by Cdc25A. Wild type ES cells exposed to ionizing radiation do not accumulate in G1 but do so in S-phase and in G2. ES cells that ectopically express Chk2 undergo cell cycle arrest in G1 as well as G2, and appear to be protected from apoptosis.

Comparison between anagrelide and hydroxycarbamide in their activities against haematopoietic progenitor cell growth and differentiation: selectivity of anagrelide for the megakaryocytic lineage

Anagrelide (ANA) and hydroxycarbamide (HC) are two distinct pharmacological agents used to treat thrombocythaemia associated with myeloproliferative disorders. Although both drugs have been in clinical use for a number of years, comparative studies of their selectivity and mode of action are still lacking. Here, we have evaluated the activities of ANA and HC on the growth and differentiation of human haematopoietic progenitor cells in liquid culture. Both drugs inhibited thrombopoietin-induced megakaryocytopoiesis in a dose-dependent manner, but with strikingly different potencies (IC(50)=26 nM for ANA and 30 muM for HC) and modes of action. Whereas HC inhibited cell proliferation, ANA acted primarily on the differentiation process. At doses that abrogated megakaryocytopoiesis, HC also inhibited the expansion of CD34(+) cells stimulated by stem cell factor, interleukin-3 and Flt-3 ligand and also induced apoptosis. Furthermore, HC inhibited erythroid and myelomonocytic cell growth, induced by erythropoietin or granulocyte-macrophage colony-stimulating factor, respectively. In contrast, ANA showed none of these additional effects. Taken together, these results demonstrate that ANA is a potent and selective inhibitor of megakaryocytopoiesis, having no significant activity against haematopoietic progenitor cell expansion or differentiation into other lineages. In contrast, the anti-megakaryocytopoietic activity of HC cannot be dissociated from its more general cytoreductive and cytotoxic actions.

The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise

BACKGROUND

Tai Chi exercise improved the balance control and muscle strength of the lower extremities. The aim of this study is to quantify the one-leg stance duration and plantar pressure distribution during the one-leg stance in Tai Chi and to try to elaborate on its probable effects on the ability to balance on one leg.

METHODS

Sixteen experienced Tai Chi practitioners participated in this study. The Novel Pedar-X insole system was used to record the plantar forces during the execution of a set of 42-form Tai Chi movements and during normal walking. The one-leg stance duration and plantar pressure distribution during the one-leg stance were analyzed.

FINDINGS

In Tai Chi exercise, the total duration spent in the one-leg stance was less (p<0.05), the duration of each one-leg stance was longer (p<0.01) and the medial-lateral displacement of the centre of pressure was greater (p<0.05) than during normal walking. The peak pressure and pressure-time integral of the second and third metatarsal heads and the fourth and fifth metatarsal heads were significantly greater (p<0.05) than those of other plantar regions during the one-leg stance in normal walking, whereas the peak pressure and pressure-time integral of the first metatarsal head and the great toe were significantly greater (p<0.05) than those of other plantar regions during the one-leg stance in Tai Chi exercise.

INTERPRETATION

The longer duration of each one-leg stance and the plantar pressure distribution characteristics during the one-leg stance in Tai Chi exercise may be associated with an improved ability to balance on one leg. The findings may provide useful information toward the development of strengthening programs, strategies for the prevention of falls, and the promotion of a physically active lifestyle.

Death predicictive factor in terminal cancer patients

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Background: One of the most important role of a end-of-life care is to control physical symptoms of patients and help them to face comfortable end. In terminally ill cancer patients, accurate prediction of survival is necessary for clinical and ethical reasons, especially in helping to avoid harm, discomfort and inappropriate therapies and in planning specific care strategies. The aim of the study was to investigate prognostic factor of death for the patients with terminal cancer. Methods: We enrolled 121 patients with the terminal cancer of Kangnam St. Mary’s Hospital from September 2004 until their death. We observed symptoms shown in dying patients and assess 17 common symptoms shown in terminally ill cancer patients, performance status, pain and analgesic use. The common symptoms were measured in a score of 0-none, 1-mild, 2-moderate, 3-severe or 4-severe by objective criteria. Results: Mean period from enrollment to death was 34.7days. The most important prognostic factor is performance status (KPS), average KPS at enrollment is 52.2% and at last 48hours is 29.8%. Physical symptoms that have significant prognostic importance are weakness, anorexia, dry mouth, dysphagia, dyspnea. VAS and analgesic use dose not impact on the prognosis. But cognitive impairment and delirium are the reliable prognostic factor. Especially weakness, dry mouth, poor oral intake, drowsiness, edema, dyspnea, ascites, icterua gradually worsened with significance. Dying patients showed markedly decreased blood pressure, cyanosis, cold extremity, death rattle, abnormal respiration frequently at 48hours before death. Conclusions: Terminally ill cancer patients have various prognostic factor and the most important factor is performance status. The death predictive symptoms such as markedly decreased pressure, cyanosis, cold extremity, death rattle, abnormal respiration appeared at last 48hours. If we assess the symptoms more carefully, we can predict the more accurate prognosis. The communication about the prognostic information will influence the personal therapeutic decision and specific care planning.

No significant financial relationships to disclose.

Aggressiveness of cancer-care near the end of life

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Background: The objective of this study were to observe the markers of aggressive care in cancer patients including appropriateness of chemotherapy and to evaluate the trends in cancer-care and to assess their association with the availability of related health care resources. Methods: We designed restrospective cohort composed of patients who diagnosed as metastatic cancer and received palliative chemotherapy at Seoul National University Hospital in 2002. Hematologic malignancy and hepatocellular carcinoma with local treatment alone were excluded. Two hundreds ninety eight patients who died of cancer were finally evaluated the appropriateness of cancer-care including chemotherapy. Results: The median duration of chemotherapy was 6.02 months (mo) compared to 8.67 mo of median overall survival. Median periods between last chemotherapy and death were 2.02 mo. Among the 298 patients, 50.3% of the patients received chemotherapy in the last two months of life. Furthermore, 17 patients (5.7%) died within 2 weeks after receiving chemotherapy. It seemed that the patients had not enough time to prepare the death with dignity. The mean number of regimens and cycles the patients had received were 1.83 and 5.52, respectively. However, timing of discontinuance chemotherapy did not affect use of chemotherapy that there was no difference in numbers of regimens and cycles according to months between last chemotherapy and death. The proportion with >1 ER visit in the last months of life were 33.6% and average numbers of ER visits after cancer diagnosed were 1.72. Only 9.1% of patients referred to hospice center and 11.7% of patients agreed with written DNR. The lack of hospice centers and harmony with referring system in Korea might affect to this results. Conclusions: Among the patients who died of cancer, significant portion of patients received chemotherapy till the end of life as well as ER visiting. Relatively, hospice referral and discussions about DNR did not conducted well in end of life care. Not to interfere the dignity of life, the physicians should be concerned whether the patients dying of cancer are overtreated with chemotherapy and receiving the appropriate cancer-care.

No significant financial relationships to disclose.

Chemical fingerprinting of Isatis indigotica root by RP-HPLC and hierarchical clustering analysis

The aim was to establish a method for extraction and chemical fingerprinting of extracts of Isatis indigotica roots ("Ban-Lan-Gen") and to apply the method developed to 18 Ban-Lan-Gen samples. RP-HPLC with gradient elution was performed on authentic reference standards of powdered I. indigotica roots, indigotin and indirubin purchased from the National Institute for the Control of Pharmaceutical and Biological Products (NICPBP) of China. Eighteen "Ban-Lan-Gen" samples (including the reference powdered herb) were bought from Singapore and different regions in China. Comparisons of the chromatograms showed that the samples can be divided into three groups. The chromatograms of the extracts of five samples were found to be similar to that of the extract of the authentic sample. Eight other samples had similar peaks as the authentic sample but the intensities of the peaks were generally lower, except for the peaks between retention times of 10-40 min. Peaks in these regions were more intense than those found in the extract of the authentic sample. Forty-five characteristic peaks could be found in the extracts of all the above samples. Peaks at retention times 52 and 53 min were determined to be indigotin and indirubin, respectively. The remaining four samples had similar chemical fingerprints to each other but were different from that of the authentic sample. Hierarchical clustering analysis gave similar results as the visual comparison. The RP-HPLC method developed allows simple identification and comparisons of I. indigotica roots. This is the first report of hierarchical clustering analysis of I. indigotica root.

DNA methylation levels in porcine fetal fibroblasts induced by an inhibitor of methylation, 5-azacytidine

Removal of the somatic DNA methylation pattern from donor cells and remodeling of embryonic status have been suggested as integral processes for successful nuclear transfer (NT) reprogramming. This study has investigated the effects of 5-azacytidine (5-azaC), a DNA methylation inhibitor, on global methylation changes in porcine fetal fibroblasts (PFF); this may improve NT attributable to the potential reprogramming of the methyl groups. PFF in 5th passage cultures were treated with 0, 0.5, 1.0, 2.0, and 3.0 microM 5-azaC for 96 h; 5-azaC inhibited the growth at all tested concentrations. At the higher concentrations of 5-azaC used, cells appeared to exhibit morphological changes and to become apoptotic as observed by TUNEL assay. Thus, cells were negatively affected by 5-azaC. Differences in cellular ploidy were also observed at higher concentrations. Analysis showed no considerable changes in the proportion of cells at the G1-phase of the cell cycle with 5-azaC concentrations. The fractional part of the methylated DNA of these cells was significantly reduced by 5-azaC treatment. Confocal microscopy confirmed the inhibition of methylation levels in PFF with increased concentrations of 5-azaC. Exposure to 5-azaC altered the expression of genes involved in imprinting (IGF2) or pro-apoptosis (BAX), whereas there was a reduction in the expression of the main enzyme responsible for replicating the DNA methylation pattern (DNMT1) and anti-apoptosis (BCL2L1). Therefore, 5-azaC induces a relative reduction in methylation in PFF, and cells treated with 0.5 microM 5-azaC may have enhanced potential for porcine NT.

Effect of PEG2000 on drug delivery characterization from solid lipid nanoparticles

The purpose of this work is to develop a PEG2000-modified solid lipid nanoparticles (SLN) intended to encapsulate a drug within their matrix and to study their characteristics. In the present report, drug-loaded SLN were prepared by a novel solvent diffusion method in an aqueous system. Monostearin and PEG2000 were used as carrier material and modifying agent, respectively. The model drug salbutamol sulphate was incorporated to study the characterization of entrapment efficiency, size, zeta potential (charge) and drug delivery characterization. In the test solution of pH 7.2 phosphate buffer, drug-release behavior from SLN suspension exhibited a biphasic pattern. With the monoastearin-based SLN, a distinctly prolonged release over a monitored period of 14 days was observed after a burst drug release in the first 8 hours. Over the monitored period of prolonged release, there was delayed release in the first 5 days with nearly 2.51% of the drug released each day, following which a slightly higher release rate (8.14% per day) appeared in the last 9 days. In contrast, the drug release rate from PEG2000-modified SLN was faster. Nevertheless, further work is required in order to optimize the release behavior of various entrapped drugs. These results also demonstrate that modification with PEG2000 can accelerate release of hydrophilic small molecule drugs from SLN.

Effects of long term Tai Chi practice and jogging exercise on muscle strength and endurance in older people

OBJECTIVES

To investigate the influence of regular Tai Chi (TC) practice and jogging on muscle strength and endurance in the lower extremities of older people.

METHODS

Twenty one long term older TC practitioners were compared with 18 regular older joggers and 22 sedentary counterparts. Maximum concentric strength of knee flexors and extensors was tested at angular velocities of 30 degrees/s and 120 degrees/s. Ankle dorsiflexors and plantar flexors were tested at 30 degrees/s and the dynamic endurance of the knee flexors and extensors was assessed at a speed of 180 degrees/s.

RESULTS

The differences in the muscle strength of the knee joint amongst the three experimental groups were significant at the higher velocity. The strengths of knee extensors and flexors in the control group were significantly lower than those in the jogging group and marginally lower than those in the TC group. For the ankle joint, the subjects in both the TC and jogging groups generated more torque in their ankle dorsiflexors. In addition, the muscle endurance of knee extensors was more pronounced in TC practitioners than in controls.

CONCLUSION

Regular older TC practitioners and joggers showed better scores than the sedentary controls on most muscle strength and endurance measures. However, the magnitude of the exercise effects on muscles might depend on the characteristics of different types of exercise.

Intrathecal sensory neuron-specific receptor agonists bovine adrenal medulla 8-22 and (Tyr6)-γ2-msh-6-12 inhibit formalin-evoked nociception and neuronal Fos-like immunoreactivity in the spinal cord of the rat

The finding that sensory neuron-specific G-protein-coupled receptor mRNA is solely expressed in small primary sensory neurons suggests involvement of the receptor in nociceptive modulation. The present study was designed to assess effects of intrathecal administration of bovine adrenal medulla 8-22 and (Tyr6)-gamma2-MSH-6-12, selective sensory neuron-specific receptor agonists, on nocifensive behaviors and expression of spinal c-Fos-like immunoreactivity evoked by intraplantar injection of 2.5% formalin in rats. The agonists were administered 10 min before (pretreatment) and/or after (post-treatment) injection of formalin. Pretreatment with bovine adrenal medulla 8-22 dose-dependently (3, 10 and 30 nmol) decreased time lifting and licking the paw mainly in the second phase. Intrathecal bovine adrenal medulla 8-22 (30 nmol) remarkably suppressed nocifensive behaviors in the first and second phases and the expression of formalin-evoked c-Fos-like immunoreactivity in laminae I-II and V-VI of the spinal dorsal horn at L4-5. Moreover, naloxone (20 microg, intrathecal) failed to antagonize the inhibitory effects of bovine adrenal medulla 8-22. Post-treatment with bovine adrenal medulla 8-22 also exerted inhibition on the second phase behaviors in a dose-dependent manner with a similar efficacy observed in pretreatment groups. Furthermore, post-treatment with (Tyr6)-gamma2-MSH-6-12 (0.5, 1.5 and 5 nmol) also suppressed formalin-evoked nocifensive behaviors in the second phase and c-Fos-like immunoreactivity in the spinal dorsal horn similar with bovine adrenal medulla 8-22. Our results suggest that sensory neuron-specific receptor may play an important role in modulation of spinal nociceptive transmission. This is the first to demonstrate that activation of sensory neuron-specific receptor produces analgesia in the persistent pain model.

Genetic diversity and variation of saponin contents in Panax notoginseng roots from a single farm

Radix notoginseng, the root of Panax notoginseng (Burk.) F. H. Chen, has been widely used in traditional Chinese medicine. Its main components, saponins, have been reported to have many pharmacological activities. To test the general assumption that herbs of a single species planted and harvested from a single location are uniform in chemical and genetic makeup, chemical analysis and DNA fingerprinting were carried out. High-performance TLC together with HPLC analysis were used to analyze 17 randomly sampled 3-year-old roots from a single farm for the presence of six saponins. Five roots showed distinct chemical profiles with changed ratios of ginsenosides Rd/Rg1, Re/Rg1, or Rb1/Rg1. The same samples, together with some 1- and 2-year-old samples, were also subjected to fluorescent amplified fragment length polymorphism (AFLP) analysis, and their internal transcribed spacer 2 (ITS 2) regions were sequenced. Fluorescent AFLP analysis was found to be much more polymorphic than the ITS 2 sequence and showed clear evidence of genetic diversity within the tested population. In conclusion, genetic diversity and variation of saponin contents between individual P. notoginseng roots have been detected. We suggest that genetic diversity affects the contents of the six saponins. The saponin contents variation and genetic diversity were also found among P. notoginseng root samples collected from China and Singapore markets. Since variable saponin contents may affect therapeutic efficacy, combining the use of genetic profiling with chemical profiling will help ensure greater uniformity in the quality of P. notoginseng roots. The genetic and chemical diversity within a population also provides the opportunity for breeding new cultivars with more desirable chemical constituents.

Soccer injury in the lower extremities

Information about soccer injuries is required to develop prevention and rehabilitation programmes. Most soccer injuries occur in the lower extremities. This type of injury is reviewed here. Definitions of injury, injury rate, injury percentage, mechanism of injury, anatomical region of injury, type of injury, and severity of injury are summarised. In each section, a description and summary of the data are provided. Finally, the limitations of the studies and suggestions to improve the investigation of soccer injuries are provided.

Enhanced anthocyanin synthesis in foliage plant Caladium bicolor

A protocol was developed for Agrobacterium-mediated genetic transformation of monocotyledon foliage plant Caladium bicolor cv. Jackie Suthers using leaf disc and petiole as the explants. The explants were inoculated with Agrobacterium strain LBA4404 harboring a binary vector with the maize anthocyanin regulatory gene Lc under the control of the cauliflower mosaic virus promoter. Callus formation was induced in MS medium supplemented with 0.5 mg/l 6-benzylaminopurine (6-BA), 0.1 mg/1 2,4-dichlorophenoxyacetic acid (2,4-D), 30 g/l sucrose and kanamycin 50 mg/l for selection. Resistant calli were induced for shoot generation in MS medium with 2 mg/l 6-BA and 0.2 mg/l alpha-naphthaleneacetic acid. As much as 10% of the explants gave rise to kanamycin-resistant shoots with our procedure. Transformed plants had enhanced anthocyanin accumulation in the roots, leaves and stems (epidermis and vascular bundles). Integration of the transgene into the host genome was confirmed by genomic Southern blot hybridization, and RNA blot hybridization analysis indicated that the expression of the transgene correlated with anthocyanin accumulation. This investigation illustrates the utility of anthocyanin regulatory genes in the genetic manipulation of the color of foliage plants. It also supports the premise that the Lc gene can be used as a powerful non-destructive cell autonomous visual marker in a wide variety of plants, as exemplified by the perfect symmetrical half-green/half-red plant presumably derived from the symmetrical division of one transgenic and one non-transgenic precursor meristematic cell.