Lun-Chien Lo

Therapeutic efficacy of traditional Chinese medicine, Shen-Mai San, in cancer patients undergoing chemotherapy or radiotherapy: study protocol for a randomized, double-blind, placebo-controlled trial

BackgroundCancer is one of the major health issues worldwide. An increasing number of cancer patients are offered treatment with surgery, chemotherapy and radiotherapy. Traditional Chinese medicine (TCM) is one of the most common complementary therapies offered to cancer patients in Taiwan. We designed a randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy of TCM in patients with cancer.Methods/designIn this study, inclusion criteria are postoperative patients with histologically confirmed cancer within 3 years who are undergoing chemotherapy or radiotherapy, more than 18 years old, have given signed informed consent, have the ability to read Chinese, and the ability for oral intake.Exclusion criteria include being pregnant, breast feeding, having completed chemotherapy or radiotherapy, brain metastasis with Eastern Cooperative Oncology Group (ECOG) performance status of two to four, delusion or hallucinations, acute infection, and have received medications under other clinical trials.The patients were separated into an intervention group (Shen-Mai-San, SMS) and a placebo group for four weeks using a randomized, double-blind procedure. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire (QOL-C30) was used to evaluate the quality of life. General data, hemoglobin (Hb), hematocrit (Hct), glutamic-oxalacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine, carcinoembryonic antigen (CEA), TCM diagnosis data and heart rate variability (HRV) were also recorded. These data were collected at baseline, two weeks and four weeks after receiving medication. The patients were prescribed granules which contained therapeutic medicines or placebo. Paired-T test was used for statistical analysis.DiscussionShen-Mai-San is composed of processed Ginseng radis, Liriope spicata, and Schizandrae fructus. It was found to be effective for treating cancer-related fatigue and had anti-fatigue activity. In TCM theory, SMS has a synergistic effect for qi and yin deficiency and has the ability to prevent fatigue. The symptoms of qi and yin deficiency are similar to chemotherapy- or radiotherapy-induced side effects. In order to evaluate the efficacy of SMS on cancer treatment, we designed a randomized, double-blind, placebo-controlled trial.Trial registrationThis study is registered to Clinical Trails.gov NCT01580358

Automatic tongue feature extraction

Tongue diagnosis is crucial to the inspection diagnosis in Chinese Medicine. Clinically, doctors mostly rely on their own knowledge and experience when determining major lesions of a patient by observing the coloration, overall modalities, and volume of sputum of different parts of the tongue. The subjective determination is likely to be affected by the doctors color sensitivity and interpretation. Therefore, it is important to develop scientific methods that can help doctors diagnose based on standardized differentiation procedures and render reliable diagnoses in order to enhance the clinical application value of Chinese Medicine. The computerized automatic capture of characteristics shown on the images of the surface comprises breakup of the tongue image and capture of the tongue characteristics.

Pseudo three-dimensional vision-based nail-fold morphological and hemodynamic analysis

In this study, a Pseudo three-dimensional Vision-based Nail-fold Morphological and Hemodynamic Analysis (PTVNMHA) is proposed to automatically extract morphological/hemodynamic features from a microscopic nail-fold image sequence, reconstruct the corresponding pseudo three-dimensional microvascular models, and visualize the dynamic blood flow in the model constructed. The morphological features extracted include the number, width/height, density, arteriolar limb caliber, curved segment caliber, venular limb caliber, blood color, tortuosity, and width of the curved segment of capillaries. The hemodynamic features identified are blood flow velocity and blood flow rate. All are significant pathological indicators with a spatial precision up to 1.6 μm. The diameters of cross-sections along the centerlines of capillaries are identified and employed to reconstruct the pseudo three-dimensional microvascular surface meshes. The microscopic image sequence acquired is mapped to the corresponding microvascular model constructed to perform dynamic blood flow visualization. Compared with laser Doppler velocimetry, PTVNMHA can derive blood flow velocities for each capillary across the microscopic range separately in much higher precision and obtain diversified morphological and hemodynamic features of capillaries with a low-cost equipment setup. In addition to the blood flow velocity, blood flow rate, which keeps almost constant no matter where the measuring position is in a capillary, has also been measured and proposed as a useful feature to discriminate patients with hypertension from the normal with great significance (p<0.001). In the future, large scale experiments will be conducted to diagnose patients with anemia as well as patients with essential and secondary hypertension to verify effectiveness of the PTVNMHA system.

Visual agreement analyses of traditional chinese medicine: a multiple-dimensional scaling approach.

The study of TCM agreement in terms of a powerful statistical tool becomes critical in providing objective evaluations. Several previous studies have conducted on the issue of consistency of TCM, and the results have indicated that agreements are low. Traditional agreement measures only provide a single value which is not sufficient to justify if the agreement among several raters is strong or not. In light of this observation, a novel visual agreement analysis for TCM via multiple dimensional scaling (MDS) is proposed in this study. If there are clusters present in the raters in a latent manner, MDS can prove itself as an effective distinguisher. In this study, a group of doctors, consisting of 11 experienced TCM practitioners having clinical experience ranging from 3 to 15 years with a mean of 5.5 years from the Chinese Medicine Department at Changhua Christian Hospital (CCH) in Taiwan were asked to diagnose a total of fifteen tongue images, the Eight Principles derived from the TCM theorem. The results of statistical analysis show that, if there are clusters present in the raters in a latent manner, MDS can prove itself as an effective distinguisher.

Three-dimensional Vision-based Nail-fold Morphological and Hemodynamic Analysis

In this paper, a Three-dimensional Vision-based Nail-fold Morphological and Hemodynamic Analysis (TVNMHA) is proposed to automatically extract morphological/hemodynamic features from an image sequence, reconstruct the corresponding three-dimensional vacular tubular models, and visualize the dynamic blood flow in the model constructed. The morphological features extracted include number, density, width/height, width of the curved segment, arteriolar limb caliber, curved segment caliber, venular limb caliber, blood color and tortuosity of capillaries. The corresponding pathological information derived has a spatial precision accurate up to 1.6£gm. TVNMHA also employs optical flow method (OFM) to measure the velocity of the flowing plasma gaps between two consecutive frames with an error 10~32£gm/sec [1]. The laser Doppler velocimetry is a common tool employed in measuring capillary with larger diameter (is about 500£gm). The average velocity of an area measured comes with an error around 100£gm/sec [2], much higher than that of TVNMHA. TVNMHA can separately derive velocities for each capillaries within the whole microscopic range and obtain diversified morphological/hemodynamic features of capillaries with a low-cost equipment setup.

Automatic Tongue Diagnosis System

Tongue diagnosis tops the four diagnoses and hence is crucial to the inspection diagnosis in Chinese Medicine. Clinically, doctors mostly rely on their own knowledge and experience when determining major lesions of a patient by observing the coloration, overall modalities, and volume of sputum of different parts of the tongue. Different doctors may come to drastically different judgments on the same tongue presentation with little overlap. Therefore, it is important to develop scientific methods that can help doctors diagnose based on standardized differentiation procedures and render reliable diagnoses in order to enhance the clinical application value of Chinese Medicine. The computerized automatic capture of characteristics shown on the images of the surface and the back of the tongue comprises breakup of the tongue image and capture of the tongue characteristics. And that, tongue characteristics include the shape, fur, body, and fluid. Sublingual collateral vessels are used to examine traits of veins on the back of the tongue and detect the length, width, number of branches, solidness, and color. By far, 29 images of the surface of the tongue and 69 images of the back of the tongue have been collected.

Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study

Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n = 45) received a series of fixed points of acupuncture. The control group (n = 14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001) for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely.

TCM tongue diagnosis index of early-stage breast cancer.

OBJECTIVES This paper investigates discriminating tongue features to distinguish between early stage breast cancer (BC) patients and non-breast cancer individuals through non-invasive traditional Chinese medicine (TCM) tongue diagnosis. DESIGN The tongue features for 67 patients with 0 and 1 stages of BC, and 70 non-breast cancer individuals are extracted by the automatic tongue diagnosis system (ATDS). A total of nine tongue features, namely, tongue color, tongue quality, tongue fissure, tongue fur, red dot, ecchymosis, tooth mark, saliva, and tongue shape are identified for each tongue. Features extracted are further sub-divided according to the areas located, i.e., spleen-stomach, liver-gall-left, liver-gall-right, kidney, and heart-lung areas. This study focuses on deriving significant tongue features (p<0.05) to discriminate early-stage BC patients from non-breast cancer individuals. RESULTS The Mann-Whitney test shows that the amount of tongue fur (p=0.024), maximum covering area of tongue fur (p=0.009), thin tongue fur (p=0.009), the average area of red dot (p=0.049), the maximum area of red dot (p=0.009), red dot in the spleen-stomach area (p=0.000), and red dot in the heart-lung area (p=0.000) demonstrate significant differences. The data collected are further classified into two groups. The training group consists of 57 early-stage BC patients and 60 non-breast cancer individuals, while the testing group is composed of 10 early-stage BC patients and 10 non-breast cancer individuals. The logistic regression by utilizing these 7 tongue features with significant differences in Mann-Whitney test as factors is performed. In order to reduce the number of tongue features employed in prediction, tongue features with the least amount of significant difference, namely, maximum area of red dot and average area of red dot, are removed progressively. The tongue features of the testing group are employed in the aforementioned three models to test the power of significant tongue features identified in predicting early-stage BC. An accuracy of 80%, 80% and 90% is reached on non-breast cancer individuals by applying the 7, 6 and 5 significant tongue features obtained through Mann-Whitney test, respectively, while 60%, 60% and 50% is reached on the corresponding early-stage BC patients. CONCLUSION The TCM tongue diagnosis can serve as a preliminary screening procedure in the early detection of BC in light of its simple and non-invasive nature, followed by other more accurate testing process. To the best of our knowledge, this is the first attempt in applying non-invasive TCM tongue diagnosis to the discrimination of early-stage BC patients and non-breast cancer individuals.

Breast cancer index: a perspective on tongue diagnosis in traditional chinese medicine.

Breast cancer (BC) ranks second in the cancer fatality rate among females worldwide. Mammogram, ultrasound, magnetic resonance imaging (MRI), blood testing, and fine needle aspiration biopsy are usually applied to discriminate BC patients from normal persons. False-negative results, undetectable calcifications, movement-incurred blurry image, infection, and sampling error are commonly associated with these traditional means of diagnosis. Traditional Chinese medicine (TCM) covers a broad range of medical practices sharing common theoretical concepts. Tongue diagnosis plays an important role in TCM. Organ conditions, properties, and variation of pathogens can be revealed through observation of tongue. In light of this observation, this paper investigates discriminating tongue features to distinguish between BC patients and normal people, and establishes differentiating index to facilitate the non-invasive detection of BC. The tongue features for 60 BC patients and 70 normal persons were extracted by the Automatic Tongue Diagnosis System (ATDS). The Mann-Whitney test showed that the amount of tongue fur (P = 0.007), tongue fur in the spleen-stomach area, maximum covering area of tongue fur, thin tongue fur, the number of tooth marks, the number of red dots, red dot in the spleen-stomach area, red dot in the liver-gall-left area, red dot in the liver-gall-right area, and red dot in the heart-lung area demonstrated significant differences (P < 0.05). The tongue features of the testing group were employed to test the power of significant tongue features identified in predicting BC. An accuracy of 80% was reached by applying the seven significant tongue features obtained through Mann-Whitney test. To the best of our knowledge, this is the first attempt in applying TCM tongue diagnosis to the discrimination of BC patients and normal persons.

Analysis of agreement on traditional chinese medical diagnostics for many practitioners.

In Traditional Chinese Medicine (TCM) diagnostics, it is an important issue to study the degree of agreement among several distinct practitioners. In order to study the reliability of TCM diagnostics, we have to design an experiment to simultaneously deal with both of the cases when the data is ordinal and when there are many TCM practitioners. In this study, we consider a reliability measure called “Krippendorffs alpha” to investigate the agreement of tongue diagnostics in TCM. Besides, since it is not easy to obtain a large data set with patients rated simultaneously by many TCM practitioners, we use the renowned “bootstrapping” to obtain a 95% confidence interval for the Krippendorffs alpha. The estimated Krippendorffs alpha for the agreement among ten physicians that discerned fifteen randomly chosen patients is 0.7343, and the 95% bootstrapping confidence interval for the true alpha coefficient is [0.6570, 0.7349]. The data was collected and analyzed at the Department of Traditional Chinese Medicine, Changhua Christian Hospital (CCH) in Taiwan.