Cost-effectiveness of real-world administration of chemotherapy and add-on Viscum album L. therapy compared to chemotherapy in the treatment of stage IV NSCLC patients

Background

For stage IV lung cancer patients receiving add-on Viscum album L. (VA) treatment an improved overall survival was detected. Information regarding cost-effectiveness (CE) for comparisons between chemotherapy (CTx) and CTx plus additive VA in stage IV lung cancer treatment is limited. The present study assessed the costs and cost-effectiveness of CTx plus VA (V) compared to CTx alone (C) for stage IV non-small cell lung cancer (NSCLC) patients treatment in a hospital in Germany.

Methods

In the observational real-world data study, data from the Network Oncology clinical registry were utilized. Enrolled stage IV lung cancer patients received the respective therapy (C or V) in a certified German Cancer Center. Cost and cost-effectiveness analyses from the hospital’s perspective were investigated on the basis of overall survival (OS) and routine financial controlling data. In addition, the incremental cost-effectiveness ratio (ICER) was calculated. The primary result of the analysis was tested for robustness in a bootstrap-based sensitivity analysis.

Results

118 patients (C: n = 86, V: n = 32) were included in the analysis, mean age 63.8 years, the proportion of male patients was 55.1%. Adjusted hospital’s total mean costs for patients from the C and V group were €16,289, 95%CI: 13,834€-18,744€ (over an adjusted mean OS time of 13.4 months) and €17,992, 95%CI: 13,658–22,326 (over an adjusted mean OS time of 19.1 months), respectively. The costs per additional OS year gained (ICER) with the V-therapy compared to C therapy were €3,586.

Conclusion

The findings of the present study suggest that the combined use of chemotherapy and VA was clinically effective and comparably cost-effective to chemotherapy alone in our analysed patient sample from the hospital’s perspective. Further randomized and prospective cost-effectiveness studies are necessary to complement our findings.

Exploring medicinal use of cannabis in a time of policy change in New Zealand

AIMS

To explore patterns of medicinal cannabis use prior to implementation of the new Medicinal Cannabis Scheme (MCS) in New Zealand.

METHODS

An anonymous online convenience survey of 3,634 last-year medicinal users of cannabis promoted via Facebook™ from May to August 2019.

RESULTS

Fifty percent of the sample were female, 18% were Māori and the median age was 38 years. The medical conditions for which cannabis was most often used were pain (81%), sleep (66%) and mental health conditions (64%). Respondents perceived cannabis to be an effective therapy and reported reducing use of other pharmaceutical medicines. Fifty-two percent reported side effects from cannabis use, including increased appetite (29%), drowsiness (12%), eye irritation (11%), dependency (10%), memory impairment (10%) and lack of energy (9%). Smoking was the dominant route of administration. Nearly half (47%) had discussed their use of cannabis with a medical professional in the previous year, while 14% had requested a prescription and 5% accessed a prescribed cannabis-based product (mostly oral CBD).

CONCLUSION

Respondents self-medicated with cannabis to treat a wide range of health complaints. Only half discussed medicinal cannabis use with their medical professional, and a minority requested a prescription and used a prescribed cannabis-based product.

Recent Patents on Phytoconstituents-based Formulations for the Treatment of Acne Infection: A Review

BACKGROUND

Acne is an infection of the skin that occurs in both men and women during their lifespan. There are various natural or synthetic products available in the market to prevent and cure this disease.

INTRODUCTION

The majority of the world population depends on the herbs or natural resources for the relief of acne disease. These are used to lessen the cost of treatment and the side effects of synthetic analogs.

METHODS

We have explored the various authentic web resources to compile information regarding different patented and marketed herbal formulations for acne treatment.

RESULTS

It has been found that most of the herbal formulation for acne include the plant actives/extracts having the potential activity against the Propionibacterium acne. The occurrence of this skin disease is also associated with the presence of free radicals in the body, which also causes the inflammation and redness of the skin. Further, the study of various patents also revealed that herbs with anti-oxidant properties have been used in most of the herbal anti-acne formulations. Moreover, the various patents also give the idea that herbal formulations also prevent the appearance of pimples on the skin.

CONCLUSION

It has been concluded that the herbal anti-acne formulation is not only used to treat acne but also prevents this disease safely and economically.

Effects of Latitude and Weather Conditions on Proanthocyanidins in Blackcurrant (Ribes nigrum) of Finnish Commercial Cultivars

Blackcurrants of three Finnish commercial cultivars 'Mortti', 'Ola', and 'Melalahti' cultivated in southern and northern Finland were compared on the basis of the content and composition of proanthocyanidins (PAs). Seventeen B-type PA oligomers (degree of polymerization 2-5 and 7) were detected by hydrophilic interaction liquid chromatography and electrospray ionization mass spectrometry. Total PAs, dimers, trimers, and tetramers were quantified. Among the three cultivars, 'Ola' had the highest contents of both total PAs and PA oligomers. 'Melalahti' was separated from both 'Mortti' and 'Ola' by PA profiles in the partial least-squares discriminant analysis model. All three cultivars revealed distinct responses to latitude and weather conditions. The content of total PAs showed a positive correlation to latitude in 'Ola' and 'Melalahti'. Among the meteorological variables, high temperature and radiation correlated negatively with total PAs, while only specific variables showed a correlation with PA oligomers.

Natural plant extracts as an economical and ecofriendly alternative for harvesting microalgae

The study investigated the ability of plant based natural coagulants from Azadirachta indica; Ficus indica; Moringa oleifera; Citrus sinensis; Punica granatum and Musa acuminata to harvest the microalgal biomass. Influence of eluent type (water and NaCl) and concentration (1-5 N) on coagulant extraction; coagulant dosage (1-5 g) and volume (20-100 ml); pH (6-12) and algal concentration (0.1-1 g l^-1) on harvesting were analyzed. The results obtained were compared with alum and chitosan. FTIR and biochemical analysis confirmed the presence of bioactive compounds to aid coagulation. Biomass removal efficiency of 75.50% was obtained with M. oleifera extracts (8 mg ml^-1) at pH 7.5-7.8, within 100 min. The harvesting efficiency increased to 95.76% when 4 mg ml^-1M. oleifera extracts was combined with 0.75 mg ml^-1 chitosan. The life cycle and cost analysis acknowledged the eco-friendly coagulants as strong alternative for conventional coagulants used in microalgal harvesting, thereby improvising the overall bioprocess.

Determination of macro, micro, trace essential, and toxic elements in Garcinia cambogia fruit and its anti-obesity commercial products

BACKGROUND

Garcinia (Clusiaceae) species are traditionally used as flavoring agents in curries and to cure several human health complications. This study investigated 31 macro, micro, and trace elements in microwave-assisted digested samples of Garcinia cambogia fruit and its anti-obesity commercial products by inductively coupled plasma-optical emission spectroscopy (ICP-OES) and inductively coupled plasma-mass spectrometric (ICP-MS) techniques. The methods were also validated using the coefficient of determination (R² ), limits of detection and quantification (LOD, LOQ), precision (CV%), analysis of certified reference materials, spiking recovery experiments, and participation in an accredited laboratory proficiency test organized by Food Analysis Performance Assessment Scheme (FAPAS).

RESULTS

Quality assurance confirmed that the methods were efficient and in accordance with criteria set by the Association of Official Analytical Chemists (AOAC). In the elemental analysis, the analyzed macro, micro, and trace essential elements were present in appreciable concentrations, which could meet the human nutritional requirements. Traces of toxic elements were within safe limits.

CONCLUSION

From the results of the current study, the fruit and its commercial products could be considered potential sources of mineral elements without posing any threats to consumers. © 2018 Society of Chemical Industry.

Biomolecular Composition and Revenue Explained by Interactions between Extrinsic Factors and Endogenous Rhythms of Saccharina latissima

This review provides a systematic overview of the spatial and temporal variations in the content of biomolecular constituents of Saccharina latissima on the basis of 34 currently-available scientific studies containing primary measurements. We demonstrate the potential revenue of seaweed production and biorefinery systems by compiling a product portfolio of high-value extract products. An investigation into the endogenous rhythms and extrinsic factors that impact the biomolecular composition of S. latissima is presented, and key performance factors for optimizing seaweed production are identified. Besides the provisioning ecosystem service, we highlight the contribution of green-engineered seaweed production systems to the mitigation of the ongoing and historical anthropogenic disturbances of the climate balance and nutrient flows. We conclude that there are risks of mismanagement, and we stress the importance and necessity of creating an adaptive ecosystem-based management framework within a triple-helix partnership for balancing the utilization of ecosystem services and long-term resilience of aquatic environment.

Production from both wild harvest and cultivation: The cross-border Swertia chirayita (Gentianaceae) trade

ETHNOPHARMACOLOGICAL RELEVANCE

Swertia chirayita is the most widely traded species in a genus of 150 species, many of which are used in traditional medicine. S. chirayita is used mainly in Ayurvedic and Tibetan systems of medicine and the homoeopathic system of medicine as well as in regional folk medicine. Primarily wild collected, with some cultivation. S. chirayita is traded as a medicinal substance and exported in the forms of dried whole plant or extract of whole plant individually and/or as active ingredients of Ayurvedic medicines. S. chirayita export valuations continue to make S. chirayita one of Nepal's highest foreign exchange earning medicinal plant species.

AIMS OF THE REVIEW

The aims of this review were first, to assess the scale of the global trade in S. chirayita, second, to review evidence from plant population biology and from studies on the impacts of wild harvest on S. chirayita populations and cultivation as an alternative source of supply.

METHODS

The taxonomy and trade names for S. chirayita were reviewed, followed by a synthesis of published information on Swertia population biology and studies on impacts of wild S. chirayita harvest from across the geographic range of this species. Data on the prices paid for S. chirayita were then compiled for the period 2001-2017, followed by an analysis of global trade data for S. chirayita.

RESULTS AND CONCLUSIONS

Based on India import data and assuming an estimate in an earlier study that 60% of Nepal's S. chirayita production goes to India and 35% to Tibet, then Nepal's 2013 annual production was about 711 metric tonnes (MT) of which about 675.6 MT would be exported (India + Tibet). Nepal's 2014 annual production would be an estimated 503.25 MT of which about 478 MT would be exported. Declines in S. chirayita populations have been widely noted across its range. In India, since 2004, a ban was placed on the export of wild harvested S. chirayita by the Government of India, where the Director General of Foreign Trade prohibited export of S. chirayita plants, plant portions and their derivatives and extracts obtained from the wild with the exception of 'formulations'. Cultivation of S. chirayita to meet commercial demand has been an important part of a solution to over-exploitation of wild stocks in eastern Nepal for 25 years, producing significant quantities that enter the export trade to India and Tibet. In Sankhuwasabha district, for example, 53.1 MT of S. chirayita were produced in 2013/014, just over half of which (27 MT) were exported to India, with the remainder exported to Tibet. Based on value-chain analysis and cost-benefit assessments, S. chirayita cultivation has been shown to be profitable in Nepal. However, since the first cost-benefit assessment was done (2013), prices dropped from NRs750/kg in April 2013 to a low of 250 NRs/kg in December 2017). Taking inflation into account further highlights the steep decline in the profitability for local farmers, who have limited options for value-adding. Consequently, farmers prefer to grow more profitable alternative crops, such as Nepal cardamom (Amomum subulatum Roxb.).

Cost-effectiveness of grass pollen subcutaneous immunotherapy (SCIT) compared to sublingual immunotherapy (SLIT) and symptomatic treatment in Austria, Spain, and Switzerland

BACKGROUND

While specific immunotherapy (SIT) has been proven to be cost-effective for the treatment of allergic rhinitis compared to symptomatic treatment, there is a lack of European studies in which sublingual (SLIT) and subcutaneous (SCIT) immunotherapy were compared. The present analysis is focused on the cost-effectiveness of SCIT compared to SLIT and symptomatic treatment of grass pollen allergy in Austria, Spain, and Switzerland. It will address specific properties of the underlying healthcare systems.

METHODS

The investigation is based on a previously published health economic model calculation. This was designed as a Markov model with pre-defined health stages and a duration of 9 years covering specific preparations for SCIT (Allergovit) and SLIT (Oralair). The effectiveness was assessed as symptom-score based quality-adjusted life years (QALYs). Additionally, total cost has been determined as well as the cost-effectiveness of SCIT. The robustness of model results was proved in further sensitivity analyses.

RESULTS

With regard to the effectiveness of both SCIT and SLIT, preparations were dominant compared to pharmacological symptomatic therapy. Both strategies were associated with additional cost, but, combined with the results on effectiveness, both have to be regarded as cost-effective. A direct comparison of the SCIT (Allergovit) and SLIT (Oralair) showed lower total costs of SCIT vs SLIT for Austria, Spain, and Switzerland (€1,368 vs €2,012, €2,229 vs €2,547, and €1,901 vs €2,220) and superior effectiveness (SCIT =8.02 QALYs; SLIT =7.98 QALYs; and symptomatic therapy =7.90 QALYs).

CONCLUSION

In patients with allergic rhinitis, SIT offers cost-effective treatment options compared to symptomatic treatment. When comparing SCIT (Allergovit) and SLIT (Oralair), SCIT was dominant in terms of QALYs as well as costs, in particular due to a slightly higher patient compliance and lower drug costs.

Anti-oxidant activity and major chemical component analyses of twenty-six commercially available essential oils

This study analyzed 26 commercially available essential oils and their major chemical components to determine their antioxidant activity levels by measuring their total phenolic content (TPC), reducing power (RP), β-carotene bleaching (BCB) activity, trolox equivalent antioxidant capacity (TEAC), and 1,1-diphenyl-2-picrylhydrazyl free radical scavenging (DFRS) ability. The clove bud and thyme borneol essential oils had the highest RP, BCB activity levels, and TPC values among the 26 commercial essential oils. Furthermore, of the 26 essential oils, the clove bud and ylang ylang complete essential oils had the highest TEAC values, and the clove bud and jasmine absolute essential oils had the highest DFRS ability. At a concentration of 2.5 mg/mL, the clove bud and thyme borneol essential oils had RP and BCB activity levels of 94.56% ± 0.06% and 24.64% ± 0.03% and 94.58% ± 0.01% and 89.33% ± 0.09%, respectively. At a concentration of 1 mg/mL, the clove bud and thyme borneol essential oils showed TPC values of 220.00 ± 0.01 and 69.05 ± 0.01 mg/g relative to gallic acid equivalents, respectively, and the clove bud and ylang ylang complete essential oils had TEAC values of 809.00 ± 0.01 and 432.33 ± 0.01 μM, respectively. The clove bud and jasmine absolute essential oils showed DFRS abilities of 94.13% ± 0.01% and 78.62% ± 0.01%, respectively. Phenolic compounds of the clove bud, thyme borneol and jasmine absolute essential oils were eugenol (76.08%), thymol (14.36%) and carvacrol (12.33%), and eugenol (0.87%), respectively. The phenolic compounds in essential oils were positively correlated with the RP, BCB activity, TPC, TEAC, and DFRS ability.

Sativex in resistant multiple sclerosis spasticity: Discontinuation study in a large population of Italian patients (SA.FE. study)

Background

The approval of Sativex for the management of multiple sclerosis (MS) spasticity opened a new opportunity to many patients. In Italy, the healthcare payer can be fully reimbursed by the involved pharma company with the cost of treatment for patients not responding after a 4 week (28 days) trial period (Payment by Results, PbR), and 50% reimbursed with the cost of 6 weeks (42 days) treatment for other patients discontinuing (Cost Sharing, CS). The aim of our study was to describe the Sativex discontinuation profile from a large population of spasticity treated Italian MS patients.

Methods

We collected data of patients from 30 MS centres across the country starting Sativex between January 2014 and February 2015. Data were collected from the mandatory Italian Medicines Agency (AIFA) web-registry. Predictors of treatment discontinuation were assessed using a multivariate Cox proportional regression analysis.

Results

During the observation period 631 out of 1597 (39.5%) patients discontinued Sativex. The Kaplan-Meier estimates curve showed that 333 patients (20.8%) discontinued treatment at 4 weeks while 422 patients (26.4%) discontinued at 6 weeks. We found after adjusted modeling that a higher NRS score at T1 (adjHR 2.23, 95% 2.07–2.41, p<0.001) and a lower baseline NRS score (adjHR 0.51 95% CI 0.46–0.56, p<0.001) were predictive of treatment discontinuation.

Conclusion

These data show that the first 6 weeks are useful in identifying those patients in which Sativex could be effective, thus avoiding the cost of longer term evaluation.

Xanthohumol from hop cones (Humulus lupulus L.) prevents ADP-induced platelet reactivity

Hop cones (Humulus lupulus L.), very rich source of phenolic compounds, possessing anticancer, antioxidant and anti-inflammatory activities, are considered as beneficial diet ingredients improving human health. In this study, the antiplatelet action of xanthohumol (XN), the principal flavonoid in hop cones, was investigated. XN significantly attenuated ADP-induced blood platelet aggregation (97.2 ± 35.7 AU for 6 μg/ml of XN vs. 120.4 ± 30.1 AU for 0.17% dimethyl sulfoxide (DMSO), p < 0.001) and significantly reduced the expression of fibrinogen receptor (activated form of GPIIbIIIa) on platelets' surface (47.6 ± 15.8 for 1.5 μg/ml XN, 44.6 ± 17.3% for 3 μg/ml XN vs. 54.5 ± 19.2% for control or 43.3 ± 18.4% for 6 μg/ml XN vs. 49.7 ± 19.4% for 0.17% DMSO, p < 0.05 or less). These findings suggest that the phenolic compounds originating from hops (XN) have a novel role as antiplatelet agents and can likely be used as dietary supplements in prophylactic approaches.

Thinned stone fruits are a source of polyphenols and antioxidant compounds

BACKGROUND

Thinned fruits are agricultural by-products that contain large quantities of interesting compounds due to their early maturity stage. In this work, the phenolic profile and the antioxidant activity of six thinned stone fruits (apricot, cherry, flat peach, peach, plum and nectarine) have been investigated, focussing on proanthocyanidins.

RESULTS

Thinned nectarine had the highest content of total phenols [67.43 mg gallic acid equivalents (GAE) g^-1 dry weight (DW)] and total flavonoids (56.97 mg CE g^-1 DW) as well as the highest antioxidant activity measured by DPPH scavenging (133.30 mg [Trolox equivalents (TE) g^-1 DW] and FRAP assay (30.42 mg TE g^-1 DW). Proanthocyanidins were very abundant in these by-products, and the main phenolic group quantified in cherry (10.54 mg g^-1 DW), flat peach (33.47 mg g^-1 DW) and nectarine (59.89 mg g^-1 DW), while hydroxycinnamic acids predominate in apricot, peach and plum (6.67, 22.04 and 23.75 mg g^-1 DW, respectively). The low, mean degree of polymerisation of proanthocyanidins suggests that their bioavailability could be very high.

CONCLUSIONS

This study shows that thinned stone fruit extracts might be used as antioxidants in foods or as a source of compounds with health-related benefits that can be used in the pharmaceutical, cosmetic and food industries. © 2016 Society of Chemical Industry.

Antimicrobial activity of pomegranate peel extracts as affected by cultivar

BACKGROUND

Some studies have reported that different parts of the pomegranate fruit, especially the peel, may act as potential antimicrobial agents and thus might be proposed as a safe natural alternative to synthetic antimicrobial agents. The high tannin content, especially punicalagin, found in pomegranate extracts, has been reported as the main compound responsible for such antimicrobial activity. Because the pomegranate peel chemical composition may vary with the type of cultivar (sweet, sour-sweet and sour), pomegranates may also differ with respect to their antimicrobial capacity.

RESULTS

The extract from PTO8 pomegranate cultivar peel had the highest antimicrobial activity, as well as the highest punicalagins (α and β) and ellagic acid concentrations. In the results obtained from both antibacterial and antifungal activity studies, the sour-sweet pomegranate cultivar PTO8 showed the best antimicrobial activity, and the highest ellagic acid concentrations.

CONCLUSION

The results of the present study suggest that ellagic acid content has a significant influence on the antimicrobial activity of the pomegranate extracts investigated. The pomegranate peel of the PTO8 cultivar is a good source of antifungal and antibacterial compounds, and may represent an alternative to antimicrobial agents of synthetic origin. © 2016 Society of Chemical Industry.

Phytochemicals for human disease: An update on plant-derived compounds antibacterial activity

In recent years, many studies have shown that phytochemicals exert their antibacterial activity through different mechanisms of action, such as damage to the bacterial membrane and suppression of virulence factors, including inhibition of the activity of enzymes and toxins, and bacterial biofilm formation. In this review, we summarise data from the available literature regarding the antibacterial effects of the main phytochemicals belonging to different chemical classes, alkaloids, sulfur-containing phytochemicals, terpenoids, and polyphenols. Some phytochemicals, besides having direct antimicrobial activity, showed an in vitro synergistic effect when tested in combination with conventional antibiotics, modifying antibiotic resistance. Review of the literature showed that phytochemicals represent a possible source of effective, cheap and safe antimicrobial agents, though much work must still be carried out, especially in in vivo conditions to ensure the selection of effective antimicrobial substances with low side and adverse effects.

Review - Glycyrrhiza glabra L. (Liquorice)

Medicinal plants are being used for treating various diseases. According to World Health Organization 80% of the world population depends on indigenous medicinal plant remedies. Herbal medicine employs fruits, vegetables, as dry materials or their extracts for the treatment of different diseases and health maintenance. Glycyrrhiza glabra (Liquorice) has been used in Europe since prehistoric times. It is well documented in written form starting with the ancient Greeks. Glycyrrhizin is the major active constituent obtained from liquorice roots, one of the most widely used in herbal preparations for the treatment of liver complaints. The plant is used as anti-inflammatory, spasmolytic, laxative, anti-depressive, anti-ulcer and anti-diabetic. The present review focuses Glycyrrhiza glabra distribution, ethno botany, ethno pharmacology, chemical constituents, medicinal uses, cultivation and trade. Plant requires a lot of attention as it has been reduced in population due to over-use in Baluchistan. The plant conservationists should consider this herb as priority species and should start its cultivation on the commercial scale to fulfill the requirements of the local markets and pharmaceutical industries as well as reduce the pressure on the wild plants.

Power, policy and the Prunus africana bark trade, 1972-2015

ETHNOPHARMACOLOGICAL RELEVANCE

After almost 50 years of international trade in wild harvested medicinal bark from Africa and Madagascar, the example of Prunus africana holds several lessons for both policy and practice in the fields of forestry, conservation and rural development. Due to recent CITES restrictions on P. africana exports from Burundi, Kenya and Madagascar, coupled with the lifting of the 2007 European Union (EU) ban in 2011, Cameroon's share of the global P. africana bark trade has risen from an average of 38% between 1995 and 2004, to 72.6% (658.6 metric tons) in 2012. Cameroon is therefore at the center of this international policy arena.

METHODS AND MATERIALS

This paper draws upon several approaches, combining knowledge in working with P. africana over a 30-year period with a thorough literature review and updated trade data with "ground-truthing" in the field in 2013 and 2014. This enabled the construction of a good perspective on trade volumes (1991-2012), bark prices (and value-chain data) and the gaps between research reports and practice. Two approaches provided excellent lenses for a deeper understanding of policy failure and the "knowing-doing gap" in the P. africana case. A similar approach to Médard's (1992) analyses of power, politics and African development was taken and secondly, studies of commodity chains that assess the power relations that coalesce around different commodities (Ribot, 1998; Ribot and Peluso, 2003).

RESULTS

Despite the need to conserve genetically and chemically diverse P. africana, wild populations are vulnerable, even in several "protected areas" in Burundi, Cameroon, the Democratic Republic of Congo and in the forest reserves of Madagascar. Secondly, hopes of decentralized governance of this forest product are misplaced due to elite capture, market monopolies and subsidized management regimes. At the current European price, for P. africana bark (US$6 per kg) for example, the 2012 bark quota (658.675t) from Cameroon alone was worth over US$3.9 million, with the majority of this accruing to a single company. In contrast to lucrative bark exports, the livelihood benefits and financial returns to local harvesters from wild harvest are extremely low. For example, in 2012, the 48 active harvesters working within Mount Cameroon National Park (MCNP) received less than 1US$ per day from bark harvests, due to a net bark price of 0.33 US$ per kg (or 43% of the farm gate price for wild harvested bark). In addition, the costs of inventory, monitoring and managing sustainable wild harvests are far greater than the benefits to harvesters.

CONCLUSION

Without the current substantial international donor subsidies, sustainable harvest cannot be sustained. What is required to supply the current and future market is to develop separate, traceable P. africana bark supply chains based on cultivated stocks. On-farm production would benefit thousands of small-scale farmers cultivating P. africana, including local women, for whom wild harvesting is too onerous. This change requires CITES and EU support and would catalyze P. africana cultivation in across several montane African countries and Madagascar, increasing farm-gate prices to harvesters compared to economic returns from wild harvest.

[INDENA SPA company's patent portfolio of Ginkgo biloba preparation]

INDENA SPA Company in Italy is a multi-national company that produces and sells plant extracts. Based on its own re- search advantages in the field of Ginkgo biloba preparation, the company protects its own products market effectively through building patent portfolio around the patents of its opponent. Based on the multi-angle analysis for patent portfolio of G. biloba preparation from the aspects of application time, legal status, technical development route, and patent portfolio layout, this article provides technical reference on research and development of G. biloba preparation, and the author suggest that Chinese applicants learn techniques and layout experiences of other patents fully to enhance the level of research and patent protection level.

Evaluation of cost versus antioxidant determinants in green tea dietary supplements

OBJECTIVE

To investigate the association between cost and (a) chemical constituents and (b) antioxidant activity as quality determinants of select green tea supplements available in the United States.

DESIGN/SETTING

Laboratory analysis of green tea using HPLC and antioxidant assay methods.

MAIN OUTCOME MEASURES

Correlation between selected quality parameters and daily cost based on the serving size as stated in the label. Quality was defined in terms of (a) catechin levels (validated high-performance liquid chromatography method), (b) total phenolic content (Folin-Ciocalteu method), and (c) antioxidant activity (total antioxidant capacity and diphenylpicryl hydrazyl free-radical scavenging).

RESULTS

A wide range of variation in marker levels and antioxidant activity was observed in the evaluated products. Catechin levels correlated well with the total phenolic content in each product while antioxidant activities were not as consistent when correlated with catechin/polyphenol levels. There was also a low correlation between product cost and quality.

CONCLUSION

Our results indicate that product cost does not always reflect quality, at least within the selected range of products. Thus, for a pharmacist to be able to recommend quality green tea dietary supplements, factors other than cost should be considered.

Economically viable components from Jerusalem artichoke (Helianthus tuberosus L.) in a biorefinery concept

Biorefinery applications are receiving growing interest due to climatic and waste disposal issues and lack of petroleum resources. Jerusalem artichoke (Helianthus tuberosus L.) is suitable for biorefinery applications due to high biomass production and limited cultivation requirements. This paper focuses on the potential of Jerusalem artichoke as a biorefinery crop and the most viable products in such a case. The carbohydrates in the tubers were found to have potential for production of platform chemicals, e.g., succinic acid. However, economic analysis showed that production of platform chemicals as a single product was too expensive to be competitive with petrochemically produced sugars. Therefore, production of several products from the same crop is a must. Additional products are protein based ones from tubers and leaves and biogas from residues, although both are of low value and amount. High bioactive activity was found in the young leaves of the crop, and the sesquiterpene lactones are of specific interest, as other compounds from this group have shown inhibitory effects on several human diseases. Thus, future focus should be on understanding the usefulness of small molecules, to develop methods for their extraction and purification and to further develop sustainable and viable methods for the production of platform chemicals.

Anti-diabetic effect of dietary mango (Mangifera indica L.) peel in streptozotocin-induced diabetic rats

BACKGROUND

In the present study, the composition of mango peel powder (MPP) collected from the mango pulp industry was determined and the effect of MPP on ameliorating diabetes and its associated complications was studied.

RESULTS

Mango peel was rich in polyphenols, carotenoids and dietary fibre. Peel extract contained various bioactive compounds and was found to be rich in soluble dietary fibre. Peel extract exhibited antioxidant properties and protected against DNA damage. Therefore, the effect of peel on ameliorating diabetes was investigated in a rat model of diabetes. A significant increase in urine sugar, urine volume, fasting blood glucose, total cholesterol, triglycerides and low density lipoprotein, and decrease in high density lipoprotein were observed in the rats; however, these parameters were ameliorated in diabetic rats fed with diet supplemented with mango peel at 5% and 10% levels in basal diet. Treatment of diabetic rats with MPP increased antioxidant enzyme activities and decreased lipid peroxidation in plasma, kidney and liver compared to untreated diabetic rats. Glomerular filtration rate and microalbuminuria levels were ameliorated in MPP treated diabetic group.

CONCLUSIONS

Mango peel, a by-product, can be used as an ingredient in functional and therapeutic foods.

Cost-effectiveness study of pediatric atopic dermatitis in Asia: atopiclair vs. regular emollient (AD-ATOP)

BACKGROUND

Atopic dermatitis (AD) is a highly prevalent, chronic relapsing condition in childhood with significant financial burden and impact on the quality of life of patients and caregivers. Proactive maintenance treatment with moisturizing agents is the mainstay AD therapy.

OBJECTIVES

The aim of this study was to assess the cost-effectiveness of a non-steroidal barrier cream (Atopiclair), compared to regular emollient in pediatric patients with mild-to-moderate AD.

METHODS

A Markov decision model was developed to evaluate the cost-effectiveness of Atopiclair versus regular emollient in 12 Asia-Pacific countries, grouped by income categories based on gross domestic product (GDP) per capita. Data was obtained from structured literature review, expert opinion, fee schedules, and findings from a 2012 survey of 12 Asia-Pacific countries. Analysis was performed a societal perspective.

RESULTS

In the base case analysis, Atopiclair was cost-effective against regular emollient, with USD786, USD499, and USD289 in cost savings per year for high, middle, and low-income countries, respectively. Sensitivity analyses showed that Atopiclair remained cost-effective versus regular emollient.

CONCLUSIONS

Modelling analysis showed that Atopiclair is a cost-effective treatment compared to regular emollient for mild-to-moderate pediatric AD in the countries included in the study.

The use of an integrated molecular-, chemical- and biological-based approach for promoting the better use and conservation of medicinal species: a case study of Brazilian quinas

ETHNOPHARMACOLOGICAL RELEVANCE

Quina is a popular name originally attributed to Cinchona pubescens Vahl (=Cinchona succirubra) and Cinchona. calisaya Wedd., species native from Peru that have the antimalarial alkaloid quinine. In Brazil, bitter barks substitutes for the Peruvian species began to be used centuries ago, and they still are sold in popular markets. To assess the authenticity and the conditions on which samples of quinas have been commercialized, using the DNA barcode, chemical and biological assays.

MATERIALS AND METHODS

Starting with 28 samples of barks acquired on a popular market, 23 had their DNA extracted successfully. The regions matK and rbcL were amplified and sequenced for 15 and 23 samples, respectively. Phytochemical analyses were performed by chromatographic methods, and biological essays were done by antimalarial tests in vitro.

RESULTS

The identified species belonged to six different families, many of them endangered or with no correlation with use in traditional medicine as a Brazilian quina. The absence of typical bitter chemical substances indicated that barks have been collected from other species or from very young trees. The results of biological essays confirm the lack of standardization of the sold materials.

CONCLUSION

The integrated approaches proved to be efficient to evaluate medicinal plants sold in popular markets and can be useful for promoting their better use and conservation.

Influence of olive leaf processing on the bioaccessibility of bioactive polyphenols

Olive leaves are rich in bioactive compounds, which are beneficial for humans. The objective of this work was to assess the influence of processing conditions (drying and extraction) of olive leaves on the extract's bioaccessibility. Thus, extracts obtained from dried olive leaves (hot air drying at 70 and 120 °C or freeze-drying) by means of conventional or ultrasound-assisted extraction were subjected to in vitro digestion. Antioxidant capacity, total phenolic content, and HPLC-DAD/MS/MS analysis were carried out during digestion. The dehydration treatment used for the olive leaves did not have a meaningful influence on bioaccessibility. The digestion process significantly (p<0.05) affected the composition of the extracts. Oleuropein and verbascoside were quite resistant to gastric digestion but were largely degraded in the intestinal phase. Nevertheless, luteolin-7-O-glucoside was the most stable polyphenol during the in vitro simulation (43% bioaccessibility). Therefore, this compound may be taken into consideration in further studies that focus on the bioactivity of olive leaf extracts.

Phenolic-enriched fractions from brewers' spent grain possess cellular antioxidant and immunomodulatory effects in cell culture model systems

BACKGROUND

Large quantities of brewers' spent grain (BSG), a co-product of the brewing industry, are produced annually. BSG contains hydroxycinnamic acids, and phenolic-rich extracts from BSG have previously demonstrated the ability to protect against oxidant-induced DNA damage. The present study investigated the anti-inflammatory potential of eight phenolic extracts from BSG: four pale (P1-P4) and four black (B1-B4) extracts.

RESULTS

BSG extracts were more cytotoxic in Jurkat T than U937 cells, with lower IC₅₀ values in Jurkat T cells, measured using the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Pale BSG extracts P2 and P3 showed the greatest anti-inflammatory potential, significantly (P < 0.05) reducing interleukin-2 (IL-2), interleukin-4 (IL-4, P2 only), interleukin-10 (IL-10) and interferon-γ (IFN-γ) production. In addition, extracts P1-P3 and B2-B4 showed significant (P < 0.05) antioxidant effects, determined by the cellular antioxidant activity assays superoxide dismutase, catalase and glutathione content (GSH).

CONCLUSION

Phenolic extracts from BSG, particularly the pale BSG extracts, have the ability to reduce a stimulated cytokine production and may also protect against cellular oxidative stress. Results of the present study highlight the potential of BSG phenolic extracts to act as functional food ingredients, providing an alternative use and improving the value of this brewing industry co-product.

An in vitro study reveals nutraceutical properties of Ananas comosus (L.) Merr. var. Mauritius fruit residue beneficial to diabetes

BACKGROUND

Rapid urbanisation and nutritional transition is fuelling the increased global incidence of type 2 diabetes. Pineapple fruit residue was explored for its nutraceutical properties as an alternative or adjunct to currently available treatment regime. Ethyl acetate and methanolic extracts of pineapple fruit residue were evaluated for anti-diabetic activity in cell free and cell based systems. Specifically, we assessed: (1) antioxidant potential, (2) anti-glycation potential, (3) carbohydrate digestive enzyme inhibition, and (4) lipid accumulation and glycerol-3-phosphate dehydrogenase activity in differentiating 3T3-L1 cells.

RESULTS

The active components in the ethyl acetate and methanolic extracts were identified as sinapic acid, daucosterol, 2-methylpropanoate, 2,5-dimethyl-4-hydroxy-3(2H)-furanone, methyl 2-methylbutanoate and triterpenoid ergosterol using DART/HRMS and ESI/HRMS. Micronutrient analysis revealed the presence of magnesium, potassium and calcium. Adipogenic potential, anti-glycation property of the ethyl acetate extract, and DNA damage protection capacity of the methanolic extract are promising.

CONCLUSION

Results from this study clearly indicate that pineapple fruit residue could be utilised as a nutraceutical against diabetes and related complications.

Thermal stability of liquid antioxidative extracts from pomegranate peel

BACKGROUND

Liquid extracts from pomegranate peel have the potential for use as natural antioxidant products. This study investigates the quality changes of liquid extracts before and after thermal treatment during sterilization and storage. Liquid pomegranate peel extracts were prepared, sterilized under ultra-high temperature (UHT) at 121 °C for 10 s and then stored at three temperatures (4, 25 and 37 °C) for up to 180 days. The industrial, color, UV-visible spectrum profile and antioxidant (phenolics) characteristics were measured.

RESULTS

Thermal sterilization treatment had no negative effects on the industrial, color, spectral and antioxidant characteristics of the extracts. After 180 days, the extracts stored at 4 °C retained 67% of the initial total soluble phenolic content and 58% of the original scavenging activity. The major antioxidant components in the extracts (stored at 4 °C for 180 days) were gallic acid, punicalagin A, punicalagin B and ellagic acid having concentrations of 19.3, 197.2, 221.1 and 92.4 mg L⁻¹, respectively.

CONCLUSION

The results show that liquid pomegranate peel extracts had acceptable thermal stability after sterilization and storage. The recommended storage condition of this product was low temperature.

Bioactive stilbenes from Vitis vinifera grapevine shoots extracts

BACKGROUND

Viticultural residues from commercial viticultural activities represent a potentially important source of bioactive stilbenes such as resveratrol. The main aim of the present study was therefore to isolate, identify and perform biological assays against amyloid-β peptide aggregation of original stilbenes from Vitis vinifera shoots.

RESULTS

A new resveratrol oligomer, (Z)-cis-miyabenol C (3), was isolated from Vitis vinifera grapevine shoots together with two newly reported oligostilbenes from Vitis vinifera shoots, vitisinol C (1) and (E)-cis-miyabenol C (2), and six known compounds: piceatannol, resveratrol, (E)-ε-viniferin (trans-ε-viniferin), ω-viniferin, vitisinol C and (E)-miyabenol C. The structures of these resveratrol derivatives were established on the basis of detailed spectroscopic analysis including nuclear magnetic resonance experiments. All the newly reported compounds were tested for their anti-aggregative activity against amyloid-β fibril formation. Vitisinol C was found to exert a significant activity against amyloid-β aggregation.

CONCLUSION

Vitis vinifera grapevine shoots are potentially interesting as a source of new bioactive stilbenes, such as vitisinol C.

Momordica charantia and type 2 diabetes: from in vitro to human studies

Type 2 diabetes is a growing health problem worldwide that is particularly severe in India and China. In these areas, bitter gourd (Momordica charantia) is a popular vegetable which is traditionally known to have health beneficial effects not only, but mainly, on diabetes. Bitter gourd could be a cheap possibility to help the poor in these and other countries to control their blood glucose levels. This review describes anti-diabetic effects of bitter gourd reported in the literature and discusses what still needs to be clarified for developing an evidence-based and safe use of the bitter gourd for diabetes. Analyses of bioactive compounds have shown that bitter gourd is rich in nutrients and phytochemicals of which some have anti-diabetic effects. Juices, powders, extracts, and isolated compounds have been tested in vitro and in vivo. Bitter gourd increases insulin secretion of the pancreas, decreases intestinal glucose uptake, and increases uptake and utilization of glucose in peripheral tissues. Although human studies with type 2 diabetics are weak in their design and/or results, some of the studies do indicate anti-diabetic effects in patients and safety for bitter gourd treatment in humans. In the future, well designed studies with rodents will help to understand what kind of bitter gourd variety, dosage, preparation, and duration of administration is optimal. Such results will help to design human studies which are necessary to prove the effectiveness of bitter gourd in patients.

Influence of apple and citrus pectins, processed mango peels, a phenolic mango peel extract, and gallic Acid as potential feed supplements on in vitro total gas production and rumen methanogenesis

Several food processing byproducts were assessed as potential feed and feed supplements. Since their chemical composition revealed a high nutritional potential for ruminants, the Hohenheim in vitro gas test was used to investigate total gas, methane, and volatile fatty acid production as well as protozoal numbers after ruminal digestion of different substrate levels. Processing byproducts used were low- and high-esterified citrus and apple pectins, integral mango peels, and depectinized mango peels. In addition, the effect of a phenolic mango peel extract and pure gallic acid was investigated. The highest decrease in methane production (19%) was achieved by supplementing high levels of low-esterified citrus pectin to the hay-based diet. Interestingly, total gas production was not affected at the same time. Showing valuable nutritional potential, all byproducts exhibited, e.g., high metabolizable energy (11.9-12.8 MJ/kg DM). In conclusion, all byproducts, particularly low-esterified citrus pectin, revealed promising potential as feed and feed supplements.

Literature review on production process to obtain extra virgin olive oil enriched in bioactive compounds. Potential use of byproducts as alternative sources of polyphenols

This review describes the olive oil production process to obtain extra virgin olive oil (EVOO) enriched in polyphenol and byproducts generated as sources of antioxidants. EVOO is obtained exclusively by mechanical and physical processes including collecting, washing, and crushing of olives, malaxation of olive paste, centrifugation, storage, and filtration. The effect of each step is discussed to minimize losses of polyphenols from large quantities of wastes. Phenolic compounds including phenolic acids, alcohols, secoiridoids, lignans, and flavonoids are characterized in olive oil mill wastewater, olive pomace, storage byproducts, and filter cake. Different industrial pilot plant processes are developed to recover phenolic compounds from olive oil byproducts with antioxidant and bioactive properties. The technological information compiled in this review will help olive oil producers to improve EVOO quality and establish new processes to obtain valuable extracts enriched in polyphenols from byproducts with food ingredient applications.

Life cycle assessment of biodiesel production in China

This study aims to evaluate energy, economic, and environmental performances of seven categories of biodiesel feedstocks by using the mixed-unit input-output life cycle assessment method. Various feedstocks have different environmental performances, indicating potential environmental problem-shift. Jatropha seed, castor seed, waste cooking oil, and waste extraction oil are preferred feedstocks for biodiesel production in the short term. Positive net energy yields and positive net economic benefits of biodiesel from these four feedstocks are 2.3-52.0% of their life cycle energy demands and 74.1-448.4% of their economic costs, respectively. Algae are preferred in the long term mainly due to their less arable land demands. Special attention should be paid to potential environmental problems accompanying feedstock choice: freshwater use, ecotoxicity potentials, photochemical oxidation potential, acidification potential and eutrophication potential. Moreover, key processes are identified by sensitivity analysis to direct future technology improvements. Finally, supporting measures are proposed to optimize China's biodiesel development.

Cost effectiveness of oromucosal cannabis-based medicine (Sativex®) for spasticity in multiple sclerosis

BACKGROUND

Spasticity is common in patients with multiple sclerosis (MS) and is a major contributor to disability. Sativex®, an oromucosal spray containing cannabis-based medicinal products, has been found to be effective in reducing spasticity symptoms.

OBJECTIVE

Our objective was to estimate the cost effectiveness of Sativex® plus oral anti-spasticity medicines compared with the current standard treatment for moderate or severe spasticity in MS in the UK.

METHODS

A Markov model was used to assess the costs and benefits of Sativex® plus oral anti-spasticity medicines or current standard treatment based on their effects on the quality of life of patients. The main outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per additional QALY gained over 5 years of treatment. One-way, multi-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the findings.

RESULTS

In the base case, Sativex® plus oral anti-spasticity medicines resulted in incremental costs of £7600 and a QALY gain of 0.15 per person over 5 years (ICER = £49 300 per QALY).[year 2009 data for costs]. Findings were sensitive to the costs of Sativex® (price and dose) and differences in utilities between responders and non-responders.

CONCLUSIONS

Using a willingness-to-pay threshold of £30 000 per QALY, Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.

What place for ▾ cannabis extract in MS?

Multiple sclerosis (MS) is a neurological condition that is estimated to affect around 60,000 people in England and Wales, with a lifetime risk in the UK of 1 in 1,000.(1,2) Spasticity (an increase in muscle tone) is a common symptom of MS, resulting in muscle spasms, immobility, disturbed sleep and pain.(3,4) Complex drug combinations are sometimes necessary to manage symptoms of MS, but these are often only partially effective and associated with unacceptable side effects.(5) Cannabis extract containing delta9-tetrahydrocannabinol (dronabinol) and cannabidiol are the principal extracts from the cannabis plant present in a licensed preparation (▾Sativex - GW Pharma Ltd), the first cannabinoid preparation to be approved for medical use. Sativex has been licensed "for symptom improvement in adult patients with moderate to severe spasticity due to MS who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy".(6) Here we review the evidence for cannabis extract and its place in the treatment of the condition.

Antimicrobial activity of Chinese bayberry extract for the preservation of surimi

BACKGROUND

Chemical preservatives such as sodium nitrite and potassium sorbate have been widely used to keep surimi products fresh. However, the potential harmfulness to human health cannot be ignored. This study was conducted to develop natural preservatives for the storage of Collichthys surimi.

RESULTS

Among the eight Chinese traditional herbs and fruits, Chinese bayberry extract showed the greatest inhibitory effect against surimi spoilage bacteria Serratia marcescens and Pseudomonas aeruginosa. Moreover, N-butanol phase extract of bayberry (NB) showed the greatest activity among the different phases of bayberry extract. When Chinese bayberry extract was combined with tea polyphenol, an additive inhibitory effect was observed on growth of Hansenula anomala, Micrococcus luteus, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Our results further indicated that the shelf life of surimi products stored at room temperature can be extended when supplemented with Chinese bayberry extract.

CONCLUSION

Our results suggest that Chinese bayberry extract can be used as a natural preservative for the storage of Collichthys surimi.

Ethnopharmacological use of plants by Sisala traditional healers in northwest Ghana

CONTEXT AND OBJECTIVE

The Sisala traditional healers of northwest Ghana have a rich ethnomedical tradition. The purpose of this study was to collect and analyse data on medicinal plants commonly used by Sisala traditional healers.

METHODS

A total of 30 traditional healers were interviewed using a mixture of open- and closed-ended questionnaires after obtaining prior-informed consent. Plant materials of each species of medicinal plant mentioned being used were collected and processed as voucher specimens following standard ethnobotanical methods.

RESULTS

The majority (65%) of traditional healers were males, age ≥ 38, and their knowledge about medicinal plants was acquired orally largely from their parents (81.3%). A total of 35 species of plants were reported used to treat 24 diseases. Most (55%) of the plant materials were harvested from the bush and about half (54.8%) of the healers collected plant materials in the morning. Leaf (20%) and root (17.5%) plant materials were most commonly used in the preparation of 27 herbal remedies for treatments. The modes of administration of the herbal remedies were both through internal and external routes.

CONCLUSION

The results of this study show that Sisala traditional healers possess rich traditional knowledge about medicinal plants and new therapeutic use claims for 34 medicinal plants used in Ghana and widely within Africa are documented for the first time.

Value chains of herbal medicines--research needs and key challenges in the context of ethnopharmacology

BACKGROUND

Value chain analyses are commonly used to understand socioeconomic and power relationships in the production chain from the initial starting material to a final (generally high value) product. These analyses help in terms of understanding economic processes but also have been used in the context of socioeconomic and socioecological research.

AIMS OF THE STUDY

However, there is a gap in the ethnopharmacological literature in terms of understanding what relevance a critical analysis of value chains of herbal medicines could have. Here we provide a research framework for achieving such an analysis.

METHODS

An extensive review of the literature available on value chains and their analysis was conducted, based both on a systematic online search of the relevant literature and a hand search of bibliographies and discussions with experts in value chain analysis

RESULTS

While the concept of value chains is commonly used in the relevant industries, very few studies investigate the value chains of herbal medicines and products derived from them. The studies identified mostly look at socio-ecological aspects, especially in the context of sustainable resource use. We suggest an analytical framework which can help in understanding value chains in the context of ethnopharmacology and can serve as a basis for addressing questions related to value chains and their relevance in ethnopharmacology.

CONCLUSIONS

We identified a crucial gap in current ethnopharmacological and medicinal plant research which impacts on a wide-range of factors relevant for a sustainable, socio-culturally equitable and safe supply of herbal medicines.

Successful management of bleeding after dental procedures with application of blood stopper: a single center prospective trial

AIM

Ankaferd Blood Stopper (ABS), as an herbal complementary medicine, has been approved for the management of clinical hemorrhages in Turkey, including dental interventions. Basic, preclinical and clinical studies disclosed the settings of the topical hemostatic use of ABS. The aim of this study is therefore to assess the efficacy and safety of ABS as an antihemorrhagic agent in the bleedings associated with dental procedures in patients with normal and impaired hemostasis.

MATERIALS AND METHODS

ABS has been topically applied by homogeneously spraying to the 113 patients during dental interventions within its on-label indications. A median of 0.5 ml (IQR:0.5-1 ml) ABS was administered after tooth extraction with prolonged hemorrhages.

RESULTS

After the administration, bleeding stopped in less than 10 seconds in 59 (52.2%) patients, and below 22.5 seconds (IQR: 18, 8-30) in 54 patients (47.8%). A total of 141 procedures were performed in these 113 patients, and nearly 72.5 ml ABS was used with a total cost of 98 €.

CONCLUSION

ABS as a new herbal medicine was found to be an effective method for controlling bleeding related to dental procedures. No patient had wound infection and the healing process appeared to be normal. Topical ABS could be useful for the local hemostasis and wound healing in periodontal surgeries.

CLINICAL SIGNIFICANCE

In this prospective study ABS, for the first time, has demonstrated its potential for being an effective hemostatic agent for the management of bleedings due to dental procedures.

An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial

BACKGROUND

Atopic dermatitis (AD) is a prevalent skin disorder with significant cost of treatment. Several prescription device moisturizers have been approved by the FDA to treat AD but are significantly more expensive than well-crafted over-the-counter (OTC) moisturizers. No studies have been performed to compare both the clinical efficacy and cost-efficacy of these prescription devices to OTC moisturizers.

PURPOSE

The purpose of this study is to compare the clinical efficacy and cost-efficacy of a glycyrrhetinic acid-containing barrier repair cream (BRC-Gly, Atopiclair®), a ceramide-dominant barrier repair cream (BRC-Cer, EpiCeram®) and an OTC petroleum-based skin protectant moisturizer (OTC-Pet, Aquaphor Healing Ointment®) as monotherapy for mild-to-moderate AD in children.

METHODS

Thirty-nine patients, age 2-17 years, with mild-to-moderate AD were randomized 1:1:1 to receive one of three treatments-BRC-Gly, BRC-Cer or OTC-Pet-with instructions to apply the treatment three times daily for three weeks. Disease severity and improvement was assessed at baseline and on days 7 and 21.

RESULTS

No statistically significant difference for any efficacy assessment was found between the three groups at each time point. The OTC-Pet was found to be at least 47 times more cost-effective than BRC-Gly or BRC-Cer.

LIMITATIONS

The relatively small sample size of 39 subjects was not sufficient to establish OTC-Pet as superior treatment in AD.

CONCLUSIONS

OTC-Pet is as effective in treating mild-to-moderate AD as both BRC-Gly and BRC-Cer and is at least 47 times more cost-effective.

NAME OF REGISTRY

II-AF-ATD-Aquaphor, Comparing the Efficacy and Cost-Effectiveness of Aquaphor to Atopiclair and EpiCeram in Children with Mild to Moderate Atopic Dermatitis. REGISTRATION IDENTIFIER: NCT01093469.

Development of easy made low cost bindless monolithic electrodes from biomass with controlled properties to be used as electrochemical capacitors

The aim of the work now reported is the development of low cost electrodes in the monolithic shape without the need for a pos-production step with potential to be used in supercapacitors. The tested materials were activated carbon fibres prepared and activated carbons made from coffee endocarp. The main functional groups identified were quinone, lactone, Si-H, phenol, hydroxyl, carbonyl and ether for activated carbon samples and amine, amide, pyrone, lactone, carbonyl and hydroxyl for activated carbon fibres samples. The nanostructure of the materials is predominantly microporous but with a significant variety of porosity development with BET surface area and pore volume given by α(s) method range from 89 to 1050 m(2) g(-1) and 0.04 to 0.50 cm(3) g(-1), respectively. The electrochemical properties of the materials were investigated using classic cyclic voltammetry, chronopotentiometry and electrochemical impedance spectroscopy. The higher specific capacitance achieved was 176 F g(-1).

Assessment of antibacterial efficacy of triphala against mutans streptococci: a randomised control trial

PURPOSE

Triphala is an ayurvedic preparation with known antimicrobial action. This study was carried out to assess the antibacterial efficacy of triphala against salivary mutans streptococci in comparison with the 'gold standard' chlorhexidine.

MATERIALS AND METHODS

A double blind randomised control trial was conducted among 57 volunteers who were assessed to be in the high caries risk category. They were randomly allocated into three study groups: 1) 15 ml of 6% triphala mouthwash; 2) 15 ml of 0.2% chlorhexidine (active control); 3) no mouthwash (passive control). Mouthwashes were given twice a day for 15 days. Unstimulated saliva samples were collected at baseline and at 15 and 45 days. Mutans streptococci (MS) were cultured on MSB agar and colony counts obtained. The α error was fixed at 5%. ANOVA and post-hoc LSD tests were performed using SPSS version 14.

RESULTS

After using mouthwash for 15 days, an 83% and 80% reduction and at 45 days a 67% and 65% reduction in salivary MS colony count was observed in the triphala and chlorhexidine groups, respectively (P = 0.0001). The control group showed an increase of 3% in MS colony count at 15 days and a reduction of 7% at 45 days. (P = 0.116).

CONCLUSION

The antimicrobial action of triphala against mutans streptococci closely parallels that of chlorhexidine. It does not have the side effects commonly associated with chlorhexidine and is cost effective.

Economic incentive for applying vetiver grass to remediate lead, copper and zinc contaminated soils

The application of vetiver grass (Chrysopogon zizaniodes) for phytoremediation of heavy metal contaminated soils can be promoted by economic return through essential oil production. Four levels of lead (0, 500, 2000, and 8000 mg kg(-1) dry soil), copper (0, 100, 400, and 1600 mg kg(-1) dry soil) and zinc (0, 400, 1600, and 6400 mg kg(-1) dry soil) were used to study their effects on vetiver growth, essential oil composition and yield. This study also investigated the effect of nitrogen concentrations on vetiver oil yield. Vetiver accumulated high concentrations of Pb, Cu and Zn in roots (3246, 754 and 2666 mg kg(-1), respectively) and small amounts of contaminants in shoots (327, 55, and 642 mg kg(-1), respectively). Oil content and yield were not affected at low and moderate concentrations of Cu and Zn. Only the application of Pb had a significant detrimental effect on oil composition. Extraction of vetiver essential oils by hydrodistillation produced heavy metal free products. High level of nitrogen reduced oil yields. Results show that phytoremediation of Cu and Zn contaminated soils by vetiver can generate revenue from the commercialization of oil extracts.

Antioxidant enrichment and antimicrobial protection of fresh-cut fruits using their own byproducts: looking for integral exploitation

Fresh-cut fruit consumption is increasing due to the rising public demand for convenience and awareness of fresh-cut fruit's health benefits. The entire tissue of fruits and vegetables is rich in bioactive compounds, such as phenolic compounds, carotenoids, and vitamins. The fresh-cut fruit industry deals with the perishable character of its products and the large percentage of byproducts, such as peels, seeds, and unused flesh that are generated by different steps of the industrial process. In most cases, the wasted byproducts can present similar or even higher contents of antioxidant and antimicrobial compounds than the final produce can. In this context, this hypothesis article finds that the antioxidant enrichment and antimicrobial protection of fresh-cut fruits, provided by the fruit's own byproducts, could be possible.

An efficient and economical MTT assay for determining the antioxidant activity of plant natural product extracts and pure compounds

Antioxidants scavenge free radicals, singlet oxygen, and electrons in cellular redox reactions. The yellow MTT [3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide] is reduced to a purple formazan by mitochondrial enzymes. NADPH is the basis of established in vitro cell viability assays. An antioxidant assay has been developed utilizing the redox reaction between MTT and selected natural product extracts and purified compounds. This simple, fast, and inexpensive MTT antioxidant assay is comparable with the lipid peroxidation inhibitory assay and can be mechanized to achieve high throughput.

A cost-effectiveness analysis of sinecatechins in the treatment of external genital warts

OBJECTIVE

To evaluate the cost-effectiveness and treatment-cost impact of sinecatechins (Veregen) as first-line therapy against its principal comparator, imiquimod (Aldara), in the treatment of external genital warts (EGWs).

METHOD

A two-stage decision model is proposed to compare sinecatechins with its principal comparator, imiquimod, as a first-line topical therapy in the treatment of EGWs. The model utilizes estimates of sustained clearance from two pivotal sinecatechins trials and from a systematic literature review for imiquimod. Resource inputs are: (1) trial-based estimates of average drug utilization and (2) CPT (Current Procedural Terminology) codes describing anticipated office visits and utilization of second-line ablative procedures. The analysis considers: (1) comparative costs of achieving a successful outcome with sinecatechins versus imiquimod, and (2) comparative cost-consequences of sinecatechins versus imiquimod. As a modeled approach to evaluating comparative product effectiveness, the claims made reflect the structure of the model, which focuses on topical products as first-line therapy in EGW interventions and in its reliance on estimates of sustained clearance from pivotal randomized clinical trials (RCTs). Sustained clearance in this context being defined as the proportion of patients who report initial wart clearance over the RCT period corrected for subsequent recurrence.

RESULTS

As first-line therapy, sinecatechins dominates imiquimod as a lower cost treatment with a higher sustained clearance rate (51.9 vs. 40.6%). First-line average cost of treatment with sinecatechins is $774 compared to imiquimod at $930. Cost per successful outcome with sinecatechins is $1,492, which is lower than $2,289 for imiquimod. Taking account of patients failing first-line therapy moving to a second-line ablative therapy yields an average cost of treatment for patients initiated to sinecatechins of $943 and $1,138 for those initiated to imiquimod. A sensitivity assessment confirmed the position of sinecatechins within the decision-model framework.

CONCLUSION

Sinecatechins yields a lower cost of treatment compared to imiquimod in the treatment of EGW. It also offers cost savings to healthcare systems. This conclusion should be qualified by the limitations of the decision framework within which the assessment has been made. The model focuses on topical preparations as first-line therapies, with estimates of sustained clearance taken from pivotal RCTs. Treatment cost estimates are generated independently, but reflect current product and ancillary costs.

Effect of jaggery on the quality and intake levels of maize silage

Silage, which is anaerobically fermented green fodder, is valued throughout the world as a source of animal feed during lean months. Several farms in India use carbohydrate sources like jaggery or molasses at 2% for preparation of silage, and this increases cost of production. The present study was undertaken to assess the effect of jaggery on quality and intake of maize silage, with an objective to find out whether additional carbohydrate source is essential in preparation of silage using green maize. Three silage types, one without jaggery (A), the second with 1% jaggery (B), and the third with 2% jaggery (C) were prepared in cylindrical bins under similar conditions. They were compared for colour, pH, lactic acid bacteria count, lactic acid content, proximate composition and silage intake by sheep. Silage type C with 2% jaggery was significantly different from the other two types with values of 3.98 and 805.66 g for pH and mean silage intake, respectively. Even though the values of pH and dry matter intake for all three silage types were within normal levels, silage type C was significantly superior in terms of fermentation and palatability. The method of preparation followed could be ideal for small holder farmers requiring less quantity of silage.

Willingness to pay for a treatment for pain in multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic neurological disease that affects 240 per 100 000 Canadians. Of these patients, 10-80% (average 70%) experience pain. Sativex is a cannabis-based drug recently approved for neuropathic pain.

OBJECTIVES

In this study, we determine individuals' preferences between two treatment options as well as the willingness to pay (WTP) for Sativex, expressed as the amount they would pay in insurance premiums to have access to that treatment.

METHODS

The WTP instrument comprised a decision board as a visual aid, and a questionnaire. A decision board helps clinicians standardize the presentation of treatment information. In this study, the decision board described two treatment options: a three-drug combination (gabapentin, amytriptyline, acetaminophen [paracetamol] {i.e. pills}) and the three-drug combination plus Sativex (i.e. 'pills and oral spray'). Information on efficacy and adverse effects was taken from trial data; wording was guided by a panel of neurologists and tested for clarity on lay people. The instrument was administered to 500 participants from Canada's general population using the bidding game approach. Descriptive statistics were calculated.

RESULTS

Mean (SD) age of participants was 39 (13) years, with a female : male distribution of 56 : 44. The decision board was presented in both English (85%) and French (15%). Of 500 interviewees, 253 (50.6%) chose the 'pills and oral spray'. Mean monthly WTP for the insurance premium for those who chose the 'pills and oral spray' was Can dollars 8 (SD +/- 15, median 4, range 0-200).

CONCLUSIONS

Assuming that 51% of the general population are willing to pay additional premiums as reported in this study, the premiums collected would cover the cost of Sativex for all Canadian MS patients experiencing pain, with a surplus.