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Kwok HC, Chan W. Aristolochic Acid Exposure via Dermal Contact or Inhalation of Herbal Powders: Evidence of Occupational Exposure in Herbalists with Urothelial Cancer. Chem Res Toxicol 2024; 37:873-877. [PMID: 38780306 DOI: 10.1021/acs.chemrestox.4c00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Emerging evidence showing urothelial cancer in herbalists is linked to aristolochic acid (AA) exposure; however, the exposure pathway remains unclear. Here, we show that dermal contact and inhalation of fine powders of AA-containing herbs are significant occupational AA exposure pathways for herbalists. We initiated the study by quantifying the amount of AA in the AA-containing powder deposited on gloves and face masks worn by the operators of an AA-containing herb grinding machine. Then, we measured the kinetics of dermal absorption and dissolution of AA from fine powders of AA-containing herbs into artificial sweat and surrogate lung fluid. Lastly, we quantified the mutagenic AA-DNA adduct levels formed in the kidneys of mice exposed to AA-containing fine powders through dermal contact. Our findings highlight an urgent occupational risk that should demand implementation of safety standards for herbalists exposed to AA-containing fine powders.
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Affiliation(s)
- Hong-Ching Kwok
- Department of Chemistry, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Wan Chan
- Department of Chemistry, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
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2
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Jabeen T, Amjad MS, Ahmad K, Bussmann RW, Qureshi H, Vitasović-Kosić I. Ethnomedicinal Plants and Herbal Preparations Used by Rural Communities in Tehsil Hajira (Poonch District of Azad Kashmir, Pakistan). PLANTS (BASEL, SWITZERLAND) 2024; 13:1379. [PMID: 38794449 PMCID: PMC11124858 DOI: 10.3390/plants13101379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
The present study emphasizes the importance of documenting ethnomedicinal plants and herbal practices of the local rural communities of Tehsil Hajira (Pakistan). The aim was to document, explore and quantify the traditional ethnomedicinal knowledge. Ethnobotanical data were collected using semi-structured questionnaires and analyzed using various quantitative indices. The results showed that 144 medicinal plant species from 70 families and 128 genera play an important role in herbal preparations. The most common type of preparation was powder (19.0%), followed by paste (16.7%), aqueous extract (15.7%), decoction (14.7%) and juice (11.0%). Fragaria nubicola (0.94) and Viola canescens (0.93) had the highest relative frequency of mention (RFC), while Berberis lycium (1.22) and Fragaria nubicola (1.18) had the highest use value (UV). Geranium wallichianum (85.5), Ligustrum lucidum (83) and Indigofera heterantha (71.5) were the most important species in the study area with the highest relative importance (RI) value. The diseases treated were categorized into 17 classes, with diseases of the digestive system and liver having the highest Informant Consensus Factor (ICF) value, followed by diseases of the oropharynx and musculoskeletal system. Important plants mentioned for the treatment of various diseases of the gastrointestinal tract are Zanthoxylum alatum, Berberis lycium, Mentha longifolia, Punica granatum, Rubus ellipticus and Viola canescens. New applications of rarely documented plants from this area are: Oxalis corniculata paste of the whole plant to treat vitiligo, Carthamus tinctorius flowers to treat chicken pox, Dioscorea deltoidea tuber powder to treat productive cough, Inula cappa root decoction to treat miscarriage, Habenaria digitata tuber juice for the treatment of fever, Viola canescens leaves and flowers for the treatment of sore throat and Achillea millefolium root and leaf juice for the treatment of pneumonia. These plants may contain interesting biochemical compounds and should be subjected to further pharmacological studies to develop new drugs. Traditional medicinal knowledge in the area under study is mainly limited to the elderly, traditional healers and midwives. Therefore, resource conservation strategies and future pharmacological studies are strongly recommended.
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Affiliation(s)
- Tahira Jabeen
- Department of Botany, Women University of Azad Jammu & Kashmir Bagh, Bagh 12500, Pakistan;
| | - Muhammad Shoaib Amjad
- Department of Botany, Women University of Azad Jammu & Kashmir Bagh, Bagh 12500, Pakistan;
| | - Khalid Ahmad
- Department of Environmental Sciences, COMSATS University Islamabad, Abbottabad Campus, Abbottabad 22060, Pakistan;
| | - Rainer W. Bussmann
- Department of Ethnobotany, Institute of Botany, Ilia State University, Tbilisi 0162, Georgia;
- Department of Botany, State Museum of Natural History, 76135 Karlsruhe, Germany
| | - Huma Qureshi
- Department of Botany, University of Chakwal, Chakwal 48800, Pakistan;
| | - Ivana Vitasović-Kosić
- Division of Horticulture and Landscape Architecture, Department of Agricultural Botany, University of Zagreb Faculty of Agriculture, Svetošimunska cesta 25, 10000 Zagreb, Croatia
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Chung F, Zavadil J. New risk factors and molecular landscapes of hepatic angiosarcoma in the Taiwanese population †. J Pathol 2024; 262:1-3. [PMID: 37929656 DOI: 10.1002/path.6224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Hepatic angiosarcoma is a rare, highly aggressive malignancy of the liver. The tumorigenesis of hepatic angiosarcoma has been relatively understudied in terms of aetiology and molecular properties. A recent study published in The Journal of Pathology revealed a strong association between hepatic angiosarcoma incidence and chronic kidney disease, particularly in end-stage renal disease using population-based data from the National Health Insurance Research Database in Taiwan and an institutional cohort. The study also revealed enrichment in the mutational signature of aristolochic acid exposure and is the first reported observation of this mutational signature in human sarcomas. © 2023 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Felicia Chung
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia
| | - Jiri Zavadil
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, Rhône-Alpes, France
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Mathis S, Sierpina VS. Kidney Cancer Integrative Oncology: Possible Options for Care. Curr Oncol Rep 2023; 25:1071-1080. [PMID: 37466849 DOI: 10.1007/s11912-023-01437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW This study aims to review how complementary and integrative medicine (CIM), defined as therapies utilizing nutrition, physical activity, herbs, supplements, mind-body therapies, homeopathy, and other non-traditional therapies, can address the prevention, treatment, side effects, and recurrence of kidney cancer. This review discusses advances and discoveries in research, gaps in research, current debates on the subject, and directions for future research. We queried Ovid MEDLINE and PubMed databases using the search terms kidney cancer, integrative medicine, integrative oncology, nutrition, supplements, treatment, prevention, and therapy. Searches were limited to integrative medicine and integrative oncology. We reviewed CIM therapies related to prevention, treatment, side effect mitigation, and recurrence of kidney cancers. RECENT FINDINGS Search results yielded 211 studies, of which 87 were relevant to this review. Studies related to CIM and kidney cancer were clustered into themes, including nutrition, physical activity, supplements, mind-body therapies, and alternative therapies. This review provides a foundation for utilizing the principles of integrative medicine in the prevention of and care for patients with kidney cancer and the need for further focused research on the effectiveness of CIM in kidney cancers.
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Affiliation(s)
- Samuel Mathis
- Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd, Rt. 1123, Galveston, TX, 77555-1123, USA.
| | - Victor S Sierpina
- Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd, Rt. 1123, Galveston, TX, 77555-1123, USA
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Das S, Thakur S, Korenjak M, Sidorenko VS, Chung FFL, Zavadil J. Aristolochic acid-associated cancers: a public health risk in need of global action. Nat Rev Cancer 2022; 22:576-591. [PMID: 35854147 DOI: 10.1038/s41568-022-00494-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
Aristolochic acids (AAs) are a group of naturally occurring compounds present in many plant species of the Aristolochiaceae family. Exposure to AA is a significant risk factor for severe nephropathy, and urological and hepatobiliary cancers (among others) that are often recurrent and characterized by the prominent mutational fingerprint of AA. However, herbal medicinal products that contain AA continue to be manufactured and marketed worldwide with inadequate regulation, and possible environmental exposure routes receive little attention. As the trade of food and dietary supplements becomes increasingly globalized, we propose that further inaction on curtailing AA exposure will have far-reaching negative effects on the disease trends of AA-associated cancers. Our Review aims to systematically present the historical and current evidence for the mutagenicity and carcinogenicity of AA, and the effect of removing sources of AA exposure on cancer incidence trends. We discuss the persisting challenges of assessing the scale of AA-related carcinogenicity, and the obstacles that must be overcome in curbing AA exposure and preventing associated cancers. Overall, this Review aims to strengthen the case for the implementation of prevention measures against AA's multifaceted, detrimental and potentially fully preventable effects on human cancer development.
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Affiliation(s)
- Samrat Das
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, France
| | - Shefali Thakur
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, France
- BIOCEV, First Faculty of Medicine, Charles University, Vestec, Czech Republic
- Faculty of Science, Charles University, Prague, Czech Republic
| | - Michael Korenjak
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, France
| | - Viktoriya S Sidorenko
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, NY, USA
| | - Felicia Fei-Lei Chung
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, France.
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Petaling Jaya, Malaysia.
| | - Jiri Zavadil
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer WHO, Lyon, France.
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Dickman KG, Chen CH, Grollman AP, Pu YS. Aristolochic acid-containing Chinese herbal medicine and upper urinary tract urothelial carcinoma in Taiwan: a narrative review. World J Urol 2022; 41:899-907. [PMID: 35867141 DOI: 10.1007/s00345-022-04100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The high incidence of upper urinary tract urothelial carcinoma (UTUC) in Taiwan is largely due to exposure to aristolochic acid (AA), a principal component of Aristolochia-based herbal medicines. Here we systematically review the molecular epidemiology, clinical presentation and biomarkers associated with AA-induced UTUC. METHODS This is a narrative review. Medline, Embase, and Web of Science were searched from inception to December 31, 2021. Studies evaluating the association, detection, and clinical characteristics of AA and UTUC were included. RESULTS A nationwide database revealed 39% of the Taiwanese population had been exposed to AA-containing herbs between 1997 and 2003. Epidemiological reports revealed AA posed a significantly higher hazard for renal failure and UTUC in herbalists and the general population who ingested AA-containing herbs. The presence of aristolactam-DNA adducts and a distinctive signature mutation, A:T to T:A transversions, located predominantly on the non-transcribed DNA strand, with a strong preference for deoxyadenosine in a consensus sequence (CAG), was observed in many UTUC patients. Clinically, AA-related UTUC patients were characterized by a younger age, female gender, impaired renal function and recurrence of contralateral UTUC. To date, there are no preventive measures, except prophylactic nephrectomy, for subjects at risk of AA nephropathy or AA-related UTUC. CONCLUSION AA exposure via Aristolochia-based herbal medicines is a problem throughout Taiwan, resulting in a high incidence of UTUC. Aristolactam-DNA adducts and a distinctive signature mutation, A:T to T:A transversions, can be used as biomarkers to identify AA-related UTUC. AA-related UTUC is associated with a high recurrence rate of contralateral UTUC.
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Affiliation(s)
- Kathleen G Dickman
- Departments of Pharmacological Sciences and Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan, ROC.
| | - Arthur P Grollman
- Departments of Pharmacological Sciences and Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan, ROC
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Duan Y, Xu Z, Deng J, Lin Y, Zheng Y, Chen J, Tang X, Zhang X, Tang C, Miao J, Bian Z. A scoping review of cohort studies assessing traditional Chinese medicine interventions. BMC Complement Med Ther 2020; 20:361. [PMID: 33228628 PMCID: PMC7684743 DOI: 10.1186/s12906-020-03150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/09/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUNDS Identifying topics and assessing the reporting quality of Traditional Chinese Medicine (TCM) cohort studies. METHODS A scoping review of the literature was performed. A descriptive approach to summarize the core study characteristics was prepared, along with structured tables and figures to identify salient points of differences noted across studies. The reporting quality of TCM cohort studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-cohort checklist. RESULTS A total of 199 TCM cohort studies were included. The largest number of TCM cohort studies was conducted in Mainland China (70.9%). The TCM cohort study was first published in 2003. The top three diseases studied were Acquired Immune Deficiency Syndrome (AIDS), Stroke, and Asthma. As for the intervention methods, Chinese herbal medicine formulas (60.3%), acupuncture (14.1%) and single herbs (12.6%) accounted for the majority, followed by moxibustion (4.0%) and qigong (2.0%). The overage sufficient reporting rate of included TCM cohort studies according to the STROBE-cohort checklist was 42.9%. Comparing with Chinese literature, the reporting rates of English literature in most items were higher. CONCLUSION For the application of cohort studies to inform the effects of TCM interventions, the interventions assessed and conditions studied were diverse, the reporting quality was unsatisfied.
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Affiliation(s)
- Yuting Duan
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong, SAR, China.,Chinese EQUATOR Center, Hong Kong, SAR, China
| | - Zhirui Xu
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingjing Deng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanjia Lin
- Puning Traditional Chinese Medicine Hospital, Jieyang, China
| | - Yan Zheng
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Juexuan Chen
- American Academy of Acupuncture and Oriental Medicine, Roseville, Minnesota, USA
| | - Xiaoyu Tang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuan Zhang
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong, SAR, China.,Chinese EQUATOR Center, Hong Kong, SAR, China
| | - Chunzhi Tang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiangxia Miao
- School of Chinese medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Zhaoxiang Bian
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 3/F, Jockey Club School of Chinese Medicine Building, 7 Baptist University Road, Kowloon Tong, Hong Kong, SAR, China. .,Chinese EQUATOR Center, Hong Kong, SAR, China.
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Chen CJ, Yang YH, Lin MH, Lee CP, Tsan YT, Lai MN, Yang HY, Ho WC, Chen PC. Herbal medicine containing aristolochic acid and the risk of hepatocellular carcinoma in patients with hepatitis B virus infection. Int J Cancer 2018; 143:1578-1587. [PMID: 29667191 DOI: 10.1002/ijc.31544] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
It was suspected that aristolochic acid-induced mutations may be associated with hepatitis B virus (HBV), playing an important role in liver carcinogenesis. The purpose of this study was to investigate the association between the use of Chinese herbs containing aristolochic acid and the risk of hepatocellular carcinoma (HCC) among HBV-infected patients. We conducted a retrospective, population-based, cohort study on patients older than 18 years who had a diagnosis of HBV infection between January 1, 1997 and December 31, 2010 and had visited traditional Chinese medicine clinics before one year before the diagnosis of HCC or the censor dates. A total of 802,642 HBV-infected patients were identified by using the National Health Insurance Research Database in Taiwan. The use of Chinese herbal products containing aristolochic acid was identified between 1997 and 2003. Each patient was individually tracked from 1997 to 2013 to identify incident cases of HCC since 1999. There were 33,982 HCCs during the follow-up period of 11,643,790 person-years and the overall incidence rate was 291.8 HCCs per 100,000 person-years. The adjusted hazard ratios (HRs) were 1.13 (95% confidence interval [CI], 1.11-1.16), 1.21 (95% CI, 1.13-1.29), 1.37 (95% CI, 1.24-1.50) and 1.61 (95% CI, 1.40-1.84) for estimated aristolochic acid of 1-250, 251-500, 501-1,000 and more than 1,000 mg, respectively, relative to no aristolochic acid exposure. Our study found a significant dose-response relationship between the consumption of aristolochic acid and HCC in patients with HBV infection, suggesting that aristolochic acid which may be associated with HBV plays an important role in the pathogenesis of HCC.
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Affiliation(s)
- Chi-Jen Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan.,Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Yu-Tse Tsan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ming-Nan Lai
- Department of Statistics, Feng Chia University, Taichung, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Hung PH, Tsai HB, Hung KY, Muo CH, Chung MC, Chang CH, Chung CJ. Patients with urothelial carcinoma have poor renal outcome regardless of whether they receive nephrouretectomy. Oncotarget 2018; 7:61679-61689. [PMID: 27533250 PMCID: PMC5308682 DOI: 10.18632/oncotarget.11223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/27/2016] [Indexed: 01/20/2023] Open
Abstract
The association between urothelial carcinoma (UC) and subsequent ESRD incidence has not been confirmed. This was a population-based study using claims data from the Taiwan National Health Institutes from 1998 to 2010. The study cohort consisted of 26,017 patients with newly diagnosed UC and no history of ESRD, and the comparison cohort consisted of 208,136 matched enrollees without UC. The incidence of ESRD was ascertained through cross-referencing with a registry for catastrophic illnesses. Cox proportional hazard regression analysis was used to estimate the risk of ESRD associated with UC and UC subtype. A total of 979 patients (3.76%) from the UC group and 1,829 (0.88%) from the comparison group developed ESRD. Multivariable analysis indicated that compared with the comparison group, the hazard ratios (HRs) for ESRD were 7.75 (95% confidence interval [CI]: 6.84 to 8.78) and 3.12 (95% CI: 6.84 to 8.78) in the cohort with upper urinary tract UC (UT-UC) and bladder UC (B-UC), respectively. In addition, there were significantly increased risks for ESRD in UC patients receiving and not receiving nephrouretectomies or aristolochic acids (AA). Moreover, the UC patients receiving segmental ureterectomy and ureteral reimplantation had approximately 1.3-fold and 2.4-fold increased risk for ESRD after control for confounders, respectively. Thus, our data indicate that UT-UC and B-UC independently increased the risk for ESRD in patients after considering about nephrouretectomies or aristolochic acids (AA). In addition, UC patients receiving segmental ureterectomy and ureteral reimplantation had increased risk for ESRD.
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Affiliation(s)
- Peir-Haur Hung
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hung-Bin Tsai
- Department of Tramatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Yoo KD, Lee JP, Lee SM, Park JY, Lee H, Kim DK, Kang SW, Yang CW, Kim YL, Lim CS, Joo KW, Kim YS. Cancer in Korean patients with end-stage renal disease: A 7-year follow-up. PLoS One 2017; 12:e0178649. [PMID: 28692695 PMCID: PMC5503228 DOI: 10.1371/journal.pone.0178649] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 05/16/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The effectiveness of dialysis on the incidence of cancer in patients with end-stage renal disease (ESRD) remains to be clarified. In this study, we evaluated the incidence rate and type of cancer among patients with ESRD, compared to the general population, through a prospective 7-year follow-up. We also calculated the cumulative incidence rate of cancer associated with ESRD, with stratification to control for the competing risk of death. METHODS This prospective observational cohort study was conducted using data from a nationwide study on patients with ESRD in Korea. A total of 5,235 patients, ≥18 years old, with ESRD were identified from the national registry as being treated by dialysis between August 2008 and December 2014. The standardized incidence ratio (SIR) and cumulative incidence rate of specific cancers were evaluated and compared to the general population. RESULTS A total of 5,235 participants were included. During the 7 year observation period, 116 (2.2%) participants had been diagnosed as cancer. The SIR of overall cancer was 0.94 [95% confidence interval (CI), 0.72-1.19] and was comparable to the rate for the general population. Although the digestive organs were the most frequent site of a primary site cancer (N = 39, 33.6%), the SIR was highest for urinary tract cancer [4.7, 95% CI, 2.42-8.19]. The five year standardized cumulative incidence of cancer was higher for females than for males, and for non-diabetic compared to diabetic causes of ESRD. We estimated that the five year standardized cumulative incidence was highest [8.4, 95% CI, 5.07-13.75] in patients with ESRD, caused by glomerulonephritis. CONCLUSION A screening program should be necessary for urinary tract cancer in Korean patients with ESRD. Cancer screening programs for patients with ESRD in Korea should be emphasized on female patients and patients with non-diabetic ESRD.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Su Mi Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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Woodman KG, Coles CA, Lamandé SR, White JD. Nutraceuticals and Their Potential to Treat Duchenne Muscular Dystrophy: Separating the Credible from the Conjecture. Nutrients 2016; 8:E713. [PMID: 27834844 PMCID: PMC5133099 DOI: 10.3390/nu8110713] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/20/2016] [Accepted: 11/04/2016] [Indexed: 12/20/2022] Open
Abstract
In recent years, complementary and alternative medicine has become increasingly popular. This trend has not escaped the Duchenne Muscular Dystrophy community with one study showing that 80% of caregivers have provided their Duchenne patients with complementary and alternative medicine in conjunction with their traditional treatments. These statistics are concerning given that many supplements are taken based on purely "anecdotal" evidence. Many nutraceuticals are thought to have anti-inflammatory or anti-oxidant effects. Given that dystrophic pathology is exacerbated by inflammation and oxidative stress these nutraceuticals could have some therapeutic benefit for Duchenne Muscular Dystrophy (DMD). This review gathers and evaluates the peer-reviewed scientific studies that have used nutraceuticals in clinical or pre-clinical trials for DMD and thus separates the credible from the conjecture.
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MESH Headings
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Antioxidants/adverse effects
- Antioxidants/therapeutic use
- Biomedical Research/methods
- Biomedical Research/trends
- Combined Modality Therapy/adverse effects
- Dietary Supplements/adverse effects
- Evidence-Based Medicine
- Humans
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/physiopathology
- Muscular Dystrophy, Duchenne/diet therapy
- Muscular Dystrophy, Duchenne/metabolism
- Muscular Dystrophy, Duchenne/physiopathology
- Muscular Dystrophy, Duchenne/therapy
- Peer Review, Research/methods
- Peer Review, Research/trends
- Reproducibility of Results
- Severity of Illness Index
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Affiliation(s)
- Keryn G Woodman
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville 3052, Australia.
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville 3010, Australia.
| | - Chantal A Coles
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville 3052, Australia.
| | - Shireen R Lamandé
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville 3052, Australia.
- Department of Pediatrics, The University of Melbourne, Parkville 3010, Australia.
| | - Jason D White
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville 3052, Australia.
- Faculty of Veterinary and Agricultural Science, The University of Melbourne, Parkville 3010, Australia.
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12
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Chang CH, Liu CS, Liu HJ, Huang CP, Huang CY, Hsu HT, Liou SH, Chung CJ. Association between levels of urinary heavy metals and increased risk of urothelial carcinoma. Int J Urol 2015; 23:233-9. [PMID: 26663353 DOI: 10.1111/iju.13024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate possible sources of exposure to heavy metals in the general population, and to determine the association between urinary heavy metals and urothelial carcinoma risk. METHODS We recruited 205 patients with urothelial carcinoma and 406 control participants for a case-control study between June 2011 and December 2013. The control participants were frequency-matched with cases according to sex and age. We measured the urinary levels of arsenic, cadmium, chromium, nickel and lead by using inductively coupled plasma mass spectrometry. We collected environmental exposure-related information through questionnaires. Multivariate logistic regression and 95% confidence intervals were applied to estimate the urothelial carcinoma risk and potential effects of urothelial carcinoma-related risk factors on the levels of urinary heavy metals. RESULTS Patients with urothelial carcinoma showed higher urinary levels of arsenic, cadmium, chromium, nickel and lead than the controls. After considering other potential risk factors, a significantly increased risk for urothelial carcinoma was observed in patients with increased urinary levels of cadmium, chromium, nickel and lead. Smokers showed a high urinary cadmium level. In addition to cadmium, a high urinary lead level was associated with cumulative cigarette smoking and herbal medicine use. CONCLUSION Environmental factors might contribute to higher urinary levels of heavy metals and ultimately result in urothelial carcinoma carcinogenesis. These findings can promote proper environmental surveillance of exposure to heavy metals in the general population.
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Affiliation(s)
- Chao-Hsiang Chang
- Department of Medicine, China Medical University and Hospital, Taichung, Taiwan.,Department of Urology, China Medical University and Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Medicine, China Medical University and Hospital, Taichung, Taiwan.,Department of Family Medicine, China Medical University and Hospital, Taichung, Taiwan
| | - Huei-Ju Liu
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Tsung Hsu
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
| | - Saou-Hsing Liou
- Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chi-Jung Chung
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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13
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Liu SL, Qi L, Han WQ, Zhu BS, Zhou X, Jiang SS, Chen MF, Li Y, He W, Liu LF, Hu XH, Xie Y, Zeng FH, Zu XB. Shorter hemodialysis duration is a risk factor for the recurrence of urothelial carcinoma of the bladder in patients on maintenance hemodialysis. Clin Transl Oncol 2015. [PMID: 26220096 DOI: 10.1007/s12094-015-1368-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the association of hemodialysis duration with the recurrence of urothelial carcinoma (UC) of the bladder and overall survival in patients undergoing maintenance hemodialysis (MHD). PATIENTS AND METHODS 52 bladder cancer patients who underwent MHD at the Xiangya Hospital of The Central South University between 2001 and 2011 were enrolled in the study. The patients were divided into three groups according to hemodialysis duration, and patient mortality and tumor recurrence rates were analyzed. The association of hemodialysis duration with occurrence and recurrence of UC of the bladder was analyzed by Cox regression analysis. Survival was evaluated by the Kaplan-Meier method. RESULTS Out of 6266 chronic hemodialysis patients, 52 patients had UC of the bladder after the initiation of hemodialysis for 6 months. The mean age at hemodialysis onset was 55 years (IQR 36, 71). The major complaints were painless gross hematuria and urethral bloody discharge. Tumors were generally large and multifocal. The standardized incidence ratio of UC of the bladder was 43.9 compared with general population, and it was higher in women (76.7) and in the age group 61-65 years (186.6). The mean hemodialysis duration before the diagnosis of bladder cancer was 32 months. 30 (57.7 %) patients received hemodialysis no more than 3 years, 10 (19.2 %) patients received hemodialysis between 3 and 6 years, and 12 (23.1 %) patients received hemodialysis for more than 6 years. CONCLUSION Preoperative shorter hemodialysis duration is a risk factor for the occurrence and recurrence of UC of the bladder in patients undergoing MHD.
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Affiliation(s)
- S-L Liu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - L Qi
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
| | - W-Q Han
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - B-S Zhu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - X Zhou
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - S-S Jiang
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - M-F Chen
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Y Li
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - W He
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - L-F Liu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - X-H Hu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Y Xie
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - F-H Zeng
- Department of Urology, The Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, 410008, China
| | - X-B Zu
- Department of Urology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
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14
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Lin MY, Kuo MC, Hung CC, Wu WJ, Chen LT, Yu ML, Hsu CC, Lee CH, Chen HC, Hwang SJ. Association of dialysis with the risks of cancers. PLoS One 2015; 10:e0122856. [PMID: 25874862 PMCID: PMC4395337 DOI: 10.1371/journal.pone.0122856] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/15/2015] [Indexed: 11/22/2022] Open
Abstract
Background To increase the survival span after dialysis in patients with end-stage renal disease (ESRD), identifying specific cancer risks is crucial in the cancer screening of these patients. The aim of this study was to investigate the risks of various cancers in an incident dialysis group in comparison with a non-dialysis group. Method We conducted a nationwide cohort study by using data from the Taiwan National Health Insurance Research Database. Patients who initially received long-term dialysis between January 1997 and December 2004, were selected and defined as the dialysis group and were matched with the non-dialysis patients (control group) according to age, sex, and index year. Competing risk analysis was used to estimate cumulative incidence and subdistribution hazard ratios (SHRs) of the first cancer occurrence. Results After consideration for the competing risk of mortality, the dialysis group showed a significantly higher 7-year cancer incidence rate than did the control group (6.4%; 95% confidence interval [CI], 6.0%-6.7% vs 1.7%; 95% CI, 1.4%-2.1%; P <0.001).The modified Cox proportional hazard model revealed that the dialysis group had significantly association with increased risks for all cancers (SHR, 3.43; 95% CI, 3.02-3.88). The risk of cancers was dominated in younger and female patients. Specific cancer risks were significantly higher in the dialysis group particularly in the development of oral, colorectal, liver, blood, breast, renal, upper urinary tract, and bladder cancer than in the control group. Multivariable stratified analyses confirmed the association between long-term dialysis and cancer in all subgroups of patients. Conclusions Dialysis is associated with a higher risk of cancer in patients with ESRD. However, cancer screening in ESRD population should be a selective approach, based on individual patient health condition and life expectancy.
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Affiliation(s)
- Ming Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Instrument Technology Research Center, National Applied Research Laboratories, Hsinchu, Taiwan
| | - Mei Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen Jeng Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li Tzong Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Ming Lung Yu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- * E-mail:
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15
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Chinese herbs containing aristolochic acid associated with renal failure and urothelial carcinoma: a review from epidemiologic observations to causal inference. BIOMED RESEARCH INTERNATIONAL 2014; 2014:569325. [PMID: 25431765 PMCID: PMC4241283 DOI: 10.1155/2014/569325] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/08/2014] [Indexed: 02/03/2023]
Abstract
Herbal remedies containing aristolochic acid (AA) have been designated to be a strong carcinogen. This review summarizes major epidemiologic evidence to argue for the causal association between AA exposure and urothelial carcinoma as well as nephropathy. The exposure scenarios include the following: Belgian women taking slimming pills containing single material Guang Fang Ji, consumptions of mixtures of Chinese herbal products in the general population and patients with chronic renal failure in Taiwan, occupational exposure in Chinese herbalists, and food contamination in farming villages in valleys of the Danube River. Such an association is corroborated by detecting specific DNA adducts in the tumor tissue removed from affected patients. Preventive actions of banning such use and education to the healthcare professionals and public are necessary for the safety of herbal remedies.
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16
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Wardle J(JL, Adams J. Indirect and non-health risks associated with complementary and alternative medicine use: An integrative review. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.01.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol 2014; 4:177. [PMID: 24454289 PMCID: PMC3887317 DOI: 10.3389/fphar.2013.00177] [Citation(s) in RCA: 1191] [Impact Index Per Article: 119.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/23/2013] [Indexed: 12/11/2022] Open
Abstract
The use of herbal medicinal products and supplements has increased tremendously over the past three decades with not less than 80% of people worldwide relying on them for some part of primary healthcare. Although therapies involving these agents have shown promising potential with the efficacy of a good number of herbal products clearly established, many of them remain untested and their use are either poorly monitored or not even monitored at all. The consequence of this is an inadequate knowledge of their mode of action, potential adverse reactions, contraindications, and interactions with existing orthodox pharmaceuticals and functional foods to promote both safe and rational use of these agents. Since safety continues to be a major issue with the use of herbal remedies, it becomes imperative, therefore, that relevant regulatory authorities put in place appropriate measures to protect public health by ensuring that all herbal medicines are safe and of suitable quality. This review discusses toxicity-related issues and major safety concerns arising from the use of herbal medicinal products and also highlights some important challenges associated with effective monitoring of their safety.
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Affiliation(s)
- Martins Ekor
- Department of Pharmacology, School of Medical Sciences, University of Cape Coast Cape Coast, Ghana
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18
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Lin HH, Chou SA, Yang HY, Hwang YH, Kuo CH, Kao TW, Lo TC, Chen PC. Association of blood lead and mercury with estimated GFR in herbalists after the ban of herbs containing aristolochic acids in Taiwan. Occup Environ Med 2013; 70:545-51. [DOI: 10.1136/oemed-2012-101066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Yang HY, Wang JD, Chen PC. Author response to "Increased risks of upper tract urothelial carcinoma in male and female Chinese herbalists". J Formos Med Assoc 2013; 112:502-3. [PMID: 23685084 DOI: 10.1016/j.jfma.2013.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/27/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hsiao-Yu Yang
- Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
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20
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Kim EJY, Chen Y, Huang JQ, Li KM, Razmovski-Naumovski V, Poon J, Chan K, Roufogalis BD, McLachlan AJ, Mo SL, Yang D, Yao M, Liu Z, Liu J, Li GQ. Evidence-based toxicity evaluation and scheduling of Chinese herbal medicines. JOURNAL OF ETHNOPHARMACOLOGY 2013; 146:40-61. [PMID: 23286904 DOI: 10.1016/j.jep.2012.12.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/19/2012] [Accepted: 12/19/2012] [Indexed: 05/19/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE While there is an increasing number of toxicity report cases and toxicological studies on Chinese herbal medicines, the guidelines for toxicity evaluation and scheduling of Chinese herbal medicines are lacking. AIM The aim of this study was to review the current literature on potentially toxic Chinese herbal medicines, and to develop a scheduling platform which will inform an evidence-based regulatory framework for these medicines in the community. MATERIALS AND METHODS The Australian and Chinese regulations were used as a starting point to compile a list of potentially toxic herbs. Systematic literature searches of botanical and pharmaceutical Latin name, English and Chinese names and suspected toxic chemicals were conducted on Medline, PubMed and Chinese CNKI databases. RESULTS Seventy-four Chinese herbal medicines were identified and five of them were selected for detailed study. Preclinical and clinical data were summarised at six levels. Based on the evaluation criteria, which included risk-benefit analysis, severity of toxic effects and clinical and preclinical data, four regulatory classes were proposed: Prohibited for medicinal usage, which are those with high toxicity and can lead to injury or death, e.g., aristolochia; Restricted for medicinal usage, e.g., aconite, asarum, and ephedra; Required warning label, e.g., coltsfoot; and Over-the-counter herbs for those herbs with a safe toxicity profile. CONCLUSION Chinese herbal medicines should be scheduled based on a set of evaluation criteria, to ensure their safe use and to satisfy the need for access to the herbs. The current Chinese and Australian regulation of Chinese herbal medicines should be updated to restrict the access of some potentially toxic herbs to Chinese medicine practitioners who are qualified through registration.
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Affiliation(s)
- Ellie J Y Kim
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia
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Yang HY, Wang JD, Lo TC, Chen PC. Occupational exposure to herbs containing aristolochic acids increases the risk of urothelial carcinoma in Chinese herbalists. J Urol 2012; 189:48-52. [PMID: 23164394 DOI: 10.1016/j.juro.2012.08.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Aristolochic acid can cause urothelial carcinoma. Herbal remedies containing aristolochic acids were previously categorized as proven group 1 human carcinogens by the WHO cancer agency, the International Agency for Research on Cancer. However, the health effect on workers exposed to aristolochic acid is unclear. Fangchi, a representative herb containing aristolochic acid, is commonly used in the Chinese herbal medicine industry. We determined whether workers exposed to fangchi are at increased risk for urothelial carcinoma. MATERIALS AND METHODS We designed a case-control study based in a national representative cohort of Chinese herbalists. This study analyzed 6,564 Chinese herbalists employed between 1985 and 1998. All incident cases of urothelial carcinoma that occurred between 1988 and 2001 were defined as the case group. Controls were selected from the baseline cohort in a randomized manner. A total of 24 cases and 140 controls were included in analysis. Information about fangchi exposure was obtained in a questionnaire survey administered in 2002. RESULTS Processing, selling or dispensing herbs containing fangchi significantly increased the risk of urothelial carcinoma (HR 2.4, 95% CI 1.1-5.3, p = 0.03). This relationship was independent of cigarette smoking or potential arsenic exposure from drinking water from deep wells. CONCLUSIONS Exposure to the Chinese herbal drug fangchi increases the risk of urothelial carcinoma in herbalists. Appropriate medical monitoring is warranted for workers who have similar exposure.
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Affiliation(s)
- Hsiao-Yu Yang
- Department of Occupational Medicine, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China
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22
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Chung CJ, Huang CY, Tsai HB, Muo CH, Chung MC, Chang CH, Huang CC. Sex differences in the development of malignancies among end-stage renal disease patients: a nationwide population-based follow-up study in Taiwan. PLoS One 2012; 7:e44675. [PMID: 22957098 PMCID: PMC3434189 DOI: 10.1371/journal.pone.0044675] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/10/2012] [Indexed: 01/20/2023] Open
Abstract
Increasing evidence indicates that end-stage renal disease (ESRD) is associated with the morbidity of cancer. However, whether different dialysis modality and sex effect modify the cancer risks in ESRD patients remains unclear. A total of 3,570 newly diagnosed ESRD patients and 14,280 controls matched for age, sex, index month, and index year were recruited from the National Health Insurance Research Database in Taiwan. The ESRD status was ascertained from the registry of catastrophic illness patients. The incidence of cancer was identified through cross-referencing with the National Cancer Registry System. The Cox proportional hazards model and the Kaplan–Meier method were used for analyses. A similar twofold increase in cancer risk was observed among ESRD patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) after adjusting for other potential risk factors. Patients with the highest cancer risk, approximately fourfold increased risk, were those received renal transplants. Urothelial carcinoma (UC) had the highest incidence in HD and PD patients. However, renal cell carcinoma (RCC) had the highest incidence in the renal transplantation (RT) group. In addition, female patients undergoing RT or PD had a higher incidence of RCC and UC, respectively. Male patients under HD had both higher incidence of RCC and UC. In conclusion, different dialysis modality could modify the cancer risks in ESRD patients. We also found sex effect on genitourinary malignancy when they are under different dialysis modality.
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Affiliation(s)
- Chi-Jung Chung
- Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan
- Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan
| | - Hung-Bin Tsai
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University and Hospital, Taichung, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University and Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University and Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- Department of Medicine, College of Medicine, China Medical University and Hospital, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University and Hospital, Taichung, Taiwan
- * E-mail:
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Yang HY, Wang JD, Lo TC, Chen PC. Increased risks of upper tract urothelial carcinoma in male and female chinese herbalists. J Formos Med Assoc 2011; 110:161-8. [PMID: 21497279 DOI: 10.1016/s0929-6646(11)60026-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/29/2009] [Accepted: 02/12/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND/PURPOSE It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed. METHODS We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan. RESULTS There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists. CONCLUSION The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity.
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Affiliation(s)
- Hsiao-Yu Yang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
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Hung PH, Shen CH, Tsai HB, Hsiao CY, Chiang PC, Guo HR, Hung KY. Gender effect on renal outcome in patients with urothelial carcinoma. World J Urol 2011; 29:511-6. [PMID: 21594710 DOI: 10.1007/s00345-011-0682-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 04/18/2011] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Taiwan is a highly endemic area for urothelial carcinoma (UC) and chronic kidney disease (CKD). We evaluate the gender effect on the relationship between renal outcome and clinical characteristics of CKD patients with UC. METHODS The clinical and pathologic records of 404 patients were retrospectively analyzed. We calculated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation, and staged CKD status according to K/DOQI guideline. RESULTS The female group had a significantly higher proportion (67.6% vs 29.0%, P < 0.001) of upper urinary tract urothelial carcinoma (UUT-UC). Pathologically, the frequency of high T stage UC (32.4% and 19.1%; P = 0.003), high-grade UC (89.4% and 75.6%; P = 0.001), and larger UC (51.4% and 37.8%; P = 0.009) in the female patients were significantly higher, when compared with the male group. Male gender, diabetes, anemia, poor preoperative renal function, UUT-UC, and low-grade tumor were independent risk factors of poor renal outcome by multivariate analysis in these UC patients. Diabetes was a risk factor of poor renal outcome in male UUT-UC patients, but not in the female patients (P = 0.009). CONCLUSION Female gender had a more aggressive histological urothelial carcinoma pattern than male patients did, but paradoxically had a more favorable renal outcome.
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Affiliation(s)
- Peir-Haur Hung
- Division of Nephrology, Department of Internal Medicine, Chia-yi Christian Hospital, Chia-yi, Taiwan
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25
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Barriers to patient referral for Complementary and Alternative Medicines and its implications on interventions. Complement Ther Med 2010; 18:135-42. [DOI: 10.1016/j.ctim.2010.05.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 02/09/2010] [Accepted: 05/17/2010] [Indexed: 11/23/2022] Open
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Lin SH, Lee HY, Chang YY, Jang Y, Chen PC, Wang JD. Increased mortality risk for workers with a compensated, permanent occupational disability of the upper or lower extremities: a 21-year follow-up study. Am J Epidemiol 2010; 171:917-23. [PMID: 20237152 DOI: 10.1093/aje/kwq003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This 1986-2006 study sought to determine whether specific causes led to increased mortality risks for Taiwanese workers with an approved compensation claim for permanent occupational disability (ACCPOD) of the upper or lower extremities. All cases of ACCPOD between 1986 and 2006 were collected from the database of compensation claims at the Bureau of Labor Insurance. Standardized mortality ratios and 95% confidence intervals were calculated for different causes of death among workers with an ACCPOD of the upper or lower extremities. A total of 800,047 person-years were accrued for 71,001 workers with a single type of disability. Standardized mortality ratios were significantly increased for all causes, including liver cirrhosis, injuries, and intentional self-harm. Standardized mortality ratios for workers with amputations of the lower extremities increased to 7.66 (95% confidence interval (CI): 5.36, 10.61), 2.40 (95% CI: 1.44, 3.75), 2.07 (95% CI: 1.03, 3.70), and 5.09 (95% CI: 2.20, 10.03) for those with diabetes mellitus, cerebrovascular disease, liver cirrhosis, and chronic renal failure, respectively. The authors concluded that workers with occupational disabilities involving an upper or lower extremity should be assisted to prevent further injuries or intentional self-harm, whereas those with lower limb amputations should be provided care related to proactive control of diabetes mellitus and associated complications during rehabilitation.
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Affiliation(s)
- Sheng-Hsuan Lin
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Hsieh SC, Lai JN, Chen PC, Chen CC, Chen HJ, Wang JD. Is Duhuo Jisheng Tang containing Xixin safe? A four-week safety study. Chin Med 2010; 5:6. [PMID: 20181195 PMCID: PMC2829565 DOI: 10.1186/1749-8546-5-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 02/11/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though the nephrotoxicity and carcinogenicity of aristolochic acid (AA) are known, its safety in clinical usage is not clear. This study aims to evaluate the safety of Duhuo Jisheng Tang (DJT) in a four-week study to treat osteoarthritis (OA) of the knee. METHODS A qualitative and quantitative investigations on DJT were conducted. A list of adverse events (AEs), complete blood counts, and liver and kidney function tests were measured for participants with knee OA at their scheduled hospital visits. Each detected AEs was independently assessed for severity and causality by site investigators (Chinese medical doctors) and study nurses. RESULTS A total of 71 eligible subjects were included in the clinical study where 287 AEs were reported. DJT did not contain detectable aristolochic acid (AA) under thin-layer chromatography (TLC) analysis and gas chromatography coupled with mass spectrometry (GC-MS). There were no significant changes in liver or kidney functions. CONCLUSION In four-week use of DJT, no renal tubular damage, no severe incidences of AEs and adverse drug reactions (ADRs) were observed. The present study obtained safety data from active surveillance of DJT.
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Affiliation(s)
- Shu-Ching Hsieh
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
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