Koh-Woon Kim

Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial.

Study Design. Multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Objective. To investigate the efficacy of acupuncture treatment with individualized setting for reduction of bothersomeness in participants with chronic low back pain (cLBP). Summary of Background Data. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment of cLBP, but it remains unclear whether acupuncture is superior to placebo. Methods One hundred thirty adults aged 18 to 65 years with nonspecific LBP lasting for at least last 3 months prior to the trial participated in the study from 3 Korean medical hospitals. Participants received individualized real acupuncture treatments or sham acupuncture treatments for more than 6 weeks (twice a week) from Korean Medicine doctors. Primary outcome was change of visual analogue scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included VAS score for pain intensity and questionnaires including Oswestry Disability Index, general health status (Short Form-36), and Beck Depression Inventory (BDI). Results There were no baseline differences observed between the 2 groups, except in the Oswestry Disability Index. One hundred sixteen participants finished the treatments and 3- and 6-month follow-ups, with 14 subjects dropping out. Significant difference in VAS score for bothersomeness and pain intensity score of cLBP has been found between the 2 groups (P < 0.05) at the primary end point (8 wk). In addition, those 2 scores improved continuously until 3-month follow-up (P = 0.011, P = 0.005, respectively). Oswestry Disability Index, the Beck Depression Inventory, and Short Form-36 scores were also improved in both groups without group difference. Conclusion. This randomized sham-controlled trial suggests that acupuncture treatment shows better effect on the reduction of the bothersomeness and pain intensity than sham control in participants with cLBP.

The Protective Effect of Cassia obtusifolia on DSS-Induced Colitis

Cassia obtusifolia (CO) has been traditionally used in Korea to treat eye inflammation, photophobia, and lacrimation. However, the regulatory effect and molecular mechanism of CO in intestinal inflammation has not been understood. In this study, we investigate the protective effect of CO in dextran sulfate sodium (DSS)-induced colitis. CO reduced clinical signs of DSS-induced colitis, including body weight loss, shortened colon length, and increased disease activity index. The results show that CO significantly suppressed the levels of interleukin (IL)-6 and expression of cyclooxygenase-2 in DSS-treated colon tissues. Additionally, we observed that CO reduced the activation of transcription nuclear factor-κB p65 in DSS-treated colon tissues. Taken together, these findings suggest that CO has improving effects on DSS-induced ulcerative colitis, which may explain its beneficial effect in the regulation of chronic intestinal inflammation.

Transcriptomic analysis of the bitter taste receptor-mediated glucagon-like peptide-1 stimulation effect of quinine

Quinine is a bitter taste receptor agonist that has been studied its anti-pyretic, anti-malarial, anti-pain, and anti-inflammatory activity. In this study, glucagon-like peptide-1 (GLP-1) stimulation effect of quinine was investigated. Bitter taste receptors are G protein-coupled receptor (GPCR), which transfer the molecular signal through its downstream cascade. The activation of bitter taste receptor, which expressed in the enteroendocrine L cells, stimulates the GLP-1 secretion and therefore can be a therapeutic target of the type-2 diabetes mellitus (T2DM). Here, we studied GLP-1 stimulation effect of quinine on the endocrine differentiated NCI-H716 cells. To investigate the molecular mode-of-action of the GLP-1 stimulation effect of quinine in the enteroendocrine L cells, transcriptomic analysis was performed. Our data suggest that quinine stimulates the GLP-1 secretion through the bitter taste receptor-signaling pathway, and thus has the possibility of therapeutic agent of T2DM.

Efficacy of a 0.1% Capsaicin Hydrogel Patch for Myofascial Neck Pain: A Double-Blinded Randomized Trial

OBJECTIVE The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. DESIGN The study was designed as a double-blinded randomized controlled trial. Setting.  The study was set at Kyung-hee University Hospital at Gangdong, Korea. SUBJECTS Sixty-one participants between 18 and 65 years with at least 3 months duration of neck pain and a clinical presentation of myofascial pain syndrome were enrolled in the study from September 1 to November 20, 2010. Interventions.  Participants received capsaicin 0.1% hydrogel patches or control hydrogel patches without capsaicin according to the randomization scheme. All participants were instructed to apply one patch to each side of the neck and shoulder girdle overlying the point of maximal pain for 12 hours daily during the duration of the 4-week study. OUTCOME MEASURES Each participant completed five surveys at baseline, at 2 weeks after the start of treatments, and at the conclusion of the 4-week study. The primary outcome measure was visual analog scale (VAS). Other outcome measures included the Neck Disability Index (NDI), Becks Depression inventory (BDI), Short Form 36 Korean version, and Euroqol 5-D. RESULTS Fifty-seven patients completed the study. The mean VAS, NDI, and BDI scores were significantly decreased at 2 and 4 weeks after the start of the intervention in both groups. There was no significant difference between the two groups in any of the outcome measures. CONCLUSIONS   Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.

Osteogenic differentiation of human mesenchymal stem cells promoted by the crude extracts of the mixture of Cortex mori radicis, Patrinia saniculaefolia

The present study investigated the effect of Cortex mori radicis (CMR) and Patrinia saniculaefolia (PS) on the osteogenic differentiation of the human mesenchymal stem cell. CMR and PS have been used as herbal medicine in traditional Korean medicine for a long time. Mesenchymal stem cells that can differentiate into adipocyte, chondrocyte and osteocyte recently issued as a therapeutic agent for degenerative disease. Here, mesenchymal stem cells isolated from synovial fluid of osteoarthritis patient, were cultured in specific media to differentiate into osteogenesis. Osteogenic differentiated mesenchymal stem cells were confirmed using Von Kossa and Arizarion Red S staining. And, the cells were divided into 4 groups: control group, CMR treated group, PS treated group and mixture treated group. To determine the effect of the herbal samples on the osteogenic mesenchymal stem cell, OCT4, SOX2 and NANOG mRNA expressions, known as the key maintenance factors of mesenchymal stem cell was measured using real-time Polymerase Chain Reaction (PCR). As a result, the maintenance factors, OCT4, SOX2 and NANOG, were more increased in cells treated by CMR, PS and the mixture of two herbs than control group. Therefore, we confirmed the enhancing effect of CMR, PS and their mixture on the osteogenic differentiation of mesenchymal stem cells which derived from the synovial fluid of osteoarthritis patient. This study demonstrates that the effect of the herbal samples on the osteogenic differentiation of human mesenchymal stem cell may have a possibility to be a therapeutic agent for the osteoarthritis patients.

Effects of acupuncture on serum metabolic parameters in premenopausal obese women: study protocol for a randomized controlled trial

BackgroundComplex metabolic changes cause obesity, making weight loss difficult. For this reason, understanding metabolism is important, and considering the shortcomings of conventional treatment options for obesity, acupuncture is a possible option. However, evidence supporting its efficacy on metabolic parameters in obese patients is lacking. The aim of this study is to investigate the effects of acupuncture on serum metabolic parameters in premenopausal obese women.Methods/designThis ongoing study is a randomized, patient-assessor blind, two-arm parallel non-penetrating sham-controlled clinical trial. Eligible participants, premenopausal adult women (19 years of age or older) with a clinical diagnosis of obesity (body mass index of 25 kg/m2 or more) blinded to the treatment received, will be randomly allocated blindly into the real acupuncture treatment group (manual acupuncture plus electroacupuncture, n = 60) or the sham acupuncture control group (sham acupuncture plus placebo acupuncture without electrical stimulation, n = 60) and receive treatment two times a week for a total of 12 sessions over 6 weeks. The primary outcome measure is the serum cholesterol and triglyceride (TG) levels at baseline and endpoint. The secondary outcomes are body weight, body fat mass, muscle mass, waist and hip circumference, other serum metabolic profiles, International Physical Activity Questionnaire (IPAQ), Social Readjustment Rating Scale (SRRS), Stress Response Inventory (SRI), Fatigue Severity Scale (FSS), the Korean version of the Beck Depression Inventory (BDI), and urine metabolites. Adverse events will be assessed at every visit.DiscussionThe results of this trial (which will be available in 2015) will provide important clinical evidence for the effect of acupuncture on serum metabolites and demonstrate how acupuncture can be helpful for the treatment of obesity.Trial registrationTrial registration registered via US National Institutes of Health Clinical Trials registry (ClinicalTrials.gov) on 11 November 2014, identifier: NCT02066090.

Complementary and alternative medicine treatments in the management of chronic fatigue syndrome: a systematic review of randomized controlled trials

Chronic fatigue greatly deteriorates the quality of life and is a frequent reason for consulting a physician. Since conventional medicine usually provides limited help, patients with chronic fatigue syndrome (CFS) tend to use complementary and alternative medicines (CAM). The objective of this review was to summarize the evidence of the effectiveness of CAM treatments in the management of CFS. Electronic databases were systematically searched up to December 2010. All randomized controlled trials (RCTs) of CAM used in patients with CFS were considered for inclusion if they included placebo controls or were controlled against a comparator intervention. Methodology quality was assessed using modified Jadad score and the Cochrane criteria for allocation concealment. A total of 414 possibly relevant articles were identified, of which eight RCTs met our inclusion criteria: three dietary interventions, two herbal medicines, one distant healing, one homeopathic medicine, and one massage. The methodology quality of the trials varied, and on average, was moderate (mean Jadad score, 3.625; range, 0–5). Details on allocation concealment were reported for seven of the trials, of which six were classified as adequate. Of the eight included RCTs, three reported significant differences between the treatment and placebo groups in the primary outcome measures. However, the total number of RCTs included in the analysis was too small to provide definite evidence for the effectiveness of CAM in treating CFS. More RCTs on the effectiveness of CAM in the management of CFS should be conducted with larger patient samples, longer treatment periods, and appropriate methodology.

Effect of modified fasting therapy on body weight, fat and muscle mass, and blood chemistry in patients with obesity.

OBJECTIVE The aim of this study was to investigate the effects and safety of modified fasting therapy using fermented medicinal herbs and exercise on body weight, fat and muscle mass, and blood chemistry in obese subjects. METHODS Twenty-six patients participated in a 14-day fast, during which they ingested a supplement made from fermented medicinal herbs and carbohydrates (intake: 400-600 kcal/d). The schedule included 7 prefasting relief days and 14 days of stepwise reintroduction of food. The patients also took part in an exercise program that incorporated Qigong, weight training, and walking exercises. The efficacy of treatments was observed by assessing body fat mass and muscle mass, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholesterol, and triglycerides in each study period. Specific symptoms or side effects were reported. RESULTS Body weight and body fat mass both decreased significantly by (5.16 ± 0.95) and (3.89 ± 0.79) kg (both P < 0.05), while muscle mass decreased by an average of (0.26 ± 0.22) kg, without statistical significance. ALT levels were significantly decreased (P < 0.05), while AST levels decreased without statistical significance (P = 0.052). The levels of total cholesterol and triglycerides were also significantly decreased (both P < 0.05). There were few adverse events except for mild dizziness, which did not affect everyday living. CONCLUSION These results suggest that modified fasting therapy using fermented medicinal herbs and exercise could be effective and safe on obese patients.

A multi-center, randomized controlled clinical trial, cost-effectiveness and qualitative research of electroacupuncture with usual care for patients with non-acute pain after back surgery: study protocol for a randomized controlled trial

BackgroundAlthough pain after back surgery is known to be difficult to control, various treatment options are available to patients and physicians. A protocol for a confirmatory randomized controlled trial (RCT) on pain and function after back surgery was designed based on the results of a pilot trial. The aim of this study is to compare the effectiveness and safety of electroacupuncture (EA) with usual care (UC) versus UC alone on pain control and functional improvement after back surgery.Methods/designThis study is a multi-center, randomized, assessor-blinded trial with an active control conducted in conjunction with a cost-effectiveness analysis and qualitative research. Participants with non-acute low back pain with or without leg pain after back surgery who have a Visual Analogue Scale (VAS) pain intensity score ≥ 50 mm will be randomly assigned to either the EA with UC group (n = 54) or the UC group (n = 54). Following randomization, participants in both groups will receive the same UC treatment twice a week for a four-week treatment period. Participants assigned to the EA with UC group will additionally receive EA twice a week for the same four-week period. The primary outcome measure will be assessed using a VAS pain intensity score for low back pain. The secondary outcomes will include the Oswestry Disability Index, EuroQol 5-Dimension score, and drug intake. The primary and secondary outcomes will be measured at one, four, and eight weeks post randomization.DiscussionThe results of this study will provide evidence of the effectiveness and cost-effectiveness of EA in managing postoperative pain following back surgery. In addition, the qualitative research results will help improve the quality of integrative medical interventions.Trial registrationClinical Research Information Service (CRIS), Republic of Korea, KCT0001939. Registered on 8 June 2016.

Association between temporomandibular disorders, chronic diseases, and ophthalmologic and otolaryngologic disorders in Korean adults: A cross-sectional study

Introduction Temporomandibular disorders (TMDs) are common musculoskeletal conditions in the maxillofacial area. Although strong relationships between TMDs and other pain and diseases exist, few studies have comprehensively assessed the association between chronic diseases, ophthalmologic and otolaryngologic disorders and TMD. Methods Of 25,534 individuals included in the fifth Korea National Health and Nutrition Examination Survey (2010–2012), 17,575 aged ≥20 years who completed survey items on TMD symptoms were included for cross-sectional analysis. Logistic regression analysis was performed to assess the association between chronic diseases, ophthalmologic and otolaryngologic disorders and examination findings, and TMD symptoms after adjusting for various confounding variables. Results Out of 17,575 participants, 2,059 (11.75%) reported experience of ≥1 TMD symptom(s). Compared to individuals without chronic disease, those with asthma (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.09–1.96), migraine (1.44; 1.26–1.65), osteoarthritis (1.51; 1.20–1.89), thyroid dysfunction (1.49; 1.13–1.96), and depressive symptoms (1.51; 1.29–1.77) had higher ORs for TMD prevalence. Participants with tinnitus (1.97; 1.70–2.27), hearing difficulties (1.55; 1.29–1.87), dizziness (1.52; 1.27–1.82), rhinitis (1.46; 1.28–1.65), and xerophthalmia (1.82; 1.57–2.12) also displayed higher ORs for TMD prevalence. Patients diagnosed with chronic rhinosinusitis upon otolaryngologic examination exhibited an OR of 1.44 (95% CI 1.11–1.87) for TMD prevalence, while that for individuals with abnormal laryngoscopic results was 0.57 (95% CI 0.36–0.90). Conclusions These findings imply that TMDs, chronic diseases, and ophthalmologic and otolaryngologic disorders hold various correlations, suggesting the need for multitarget approaches to effectively address this phenomenon.