Me-riong Kim

Anti-osteoporotic activity of harpagide by regulation of bone formation in osteoblast cell culture and ovariectomy-induced bone loss mouse models

ETHNOPHARMACOLOGICAL RELEVANCE Harpagide, an iridoid glucoside, is a constituent of the root of Harpagophytum procumbens var. sublobatum (Engl.) Stapf, Devils claw which has been used in patients with osteoarthritis (OA). In the present study, we investigated the anti-osteoporotic potential of harpagide and its underlying mechanism of action in in vitro cell culture and in vivo bone loss animal models. MATERIAL AND METHODS Harpagide was obtained from the alkalic hydrolysis of harpagoside, a major constituent of H. procumbens var. sublobatum Analysis of biomarkers for bone formation in osteoblastic MC3T3-E1 cells and bone resorption in osteoclast cells derived from mouse bone marrow cells was performed to evaluate the mechanism of action. The protective activity of harpagide against bone loss was also evaluated in ovariectomized (OVX) mouse model. RESULTS Harpagide improved bone properties by stimulating the process of differentiation and maturation of osteoblast cells and suppressing the process of RANKL-induced differentiation of osteoclast cells. In OVX-induced bone loss mouse model, oral administration of harpagide significantly improved recovery of bone mineral density, trabecular bone volume, and trabecular number in the femur. Harpagide also prevented increase of trabecular separation and structure model index induced by OVX. Harpagide effectively inhibited the serum levels of biochemical markers of bone loss, including alkaline phosphatase, osteocalcin, C-terminal telopeptide, and tartrate-resistant acid phosphatase. CONCLUSION Taken together, the present study demonstrates that harpagide has a potential for prevention of bone loss in OVX mice by regulating the stimulation of osteoblast differentiation and the suppression of osteoclast formation. Therefore, these findings suggest that harpagide might serve as a bioactive compound derived from H. procumbens var. sublobatum for improvement of age-dependent bone destruction disease.

Long-term Course of Alternative and Integrative Therapy for Lumbar Disc Herniation and Risk Factors for Surgery: A Prospective Observational 5-year Follow-up Study.

Study Design. Prospective observational 5-year study. Objective. To assess pain, functional disability, surgical status, and health care use of patients who actively selected complementary and alternative medicine treatment and risk factors for lumbar surgery. Summary of Background Data. Controversy continues regarding difference in long-term outcomes of conservative and surgical treatment. Methods. We recruited 150 consecutive lumbar disc herniation patients with radiating pain (numeric rating scale ≥5) from November, 2006 at a Korean medicine hospital outpatient department, of which 128 patients completed 6 months of complementary and alternative medicine treatment (herbal medicine, acupuncture, bee-venom pharmacopuncture, and Chuna manipulation). Follow-up data was collected every year for 5 years. Results. We assessed surgical status in 105 patients (82%), of which 8 replied that they had received surgery. Ninety-two patients (72%) attended the 5-year follow-up. Visual analog scale of back pain which was 4.19 ± 2.60 at baseline improved after treatment, decreasing to 0.94 ± 1.13 at 6 months, and was maintained at 1.25 ± 1.81 at 5 years. Visual analog scale of leg pain decreased from 7.50 ± 1.32 to 0.94 ± 1.29 and was sustained at 0.98 ± 1.73. Participants reported less disability with Oswestry Disability Index scores decreasing from 41.50 ± 15.07 at baseline to 11.24 ± 10.44 at 6 months, which then declined further to 7.61 ± 9.82 at 5 years. SF-36 quality-of-life health survey scores also improved, increasing from 33.41 ± 12.67 at baseline to 66.04 ± 15.77 at 6 months, and reaching 75.43 ± 15.79 at 5 years. In assessment of satisfaction with current state, 20% replied “highly satisfied,” 67% “satisfied,” 10% “fairly satisfied,” and 2% “dissatisfied.” Patients with younger age, previous treatment for current pain episode, and higher levels of sensory impairment and pain in the lower extremities were at higher risk of lumbar surgery. Conclusion. The long-term results of lumbar disc herniation patients receiving nonsurgical complementary and alternative medicine treatment were favorable and satisfaction rates were high. Level of Evidence: 2

Safety of Acupuncture and Pharmacopuncture in 80,523 Musculoskeletal Disorder Patients: A Retrospective Review of Internal Safety Inspection and Electronic Medical Records.

AbstractWe investigated the range and frequency of significant adverse events (AEs) in use of pharmacopuncture and acupuncture using large-scale, single-center safety data as evidence supporting safety of acupuncture with pharmacopuncture, used extensively in Asia, is scarce. Status reports (nurse records in ambulatory and inpatient care units, and administrative event records) as a part of an internal audit at a Korean Medicine hospital specializing in the treatment of musculoskeletal disorders, patient complaints filed through the hospital website, and medical records of patients visiting from December, 2010 (inception of internal audit) to October, 2014 were retrospectively reviewed. A total 80,523 patients (5966 inpatients and 74,557 outpatients) visited during this period. Inpatients received an average 31.9 ± 20.7 acupuncture, 23.0 ± 15.6 pharmacopuncture, and 15.4 ± 11.3 bee venom pharmacopuncture sessions, and outpatients were administered 8.2 ± 12.2 acupuncture, 7.8 ± 11.5 pharmacopuncture, and 10.0 ± 12.3 bee venom sessions, respectively. AEs associated with acupuncture/pharmacopuncture were forgotten needle (n = 47), hypersensitivity to bee venom (n = 37), presyncopic episode (n = 4), pneumothorax (n = 4), and infection (n = 2). Most cases were mild requiring little or no additional intervention and leaving no sequelae. Although serious AEs including infection (n = 2) and anaphylaxis associated with bee venom treatment (n = 3) were also reported, incidence was rare at 0.002% in infection and 0.019% in anaphylaxis. Incidence of AEs associated with acupuncture/pharmacopuncture treatment was low, and most cases were not serious. Still, however rare, avoidable AEs can and should be prevented through education and corrective action. Further prospective studies on the effect of error reduction strategies on incidence of adverse effects are warranted.

Evaluation of use and cost of medical care of common lumbar disorders in Korea: cross-sectional study of Korean Health Insurance Review and Assessment Service National Patient Sample data

Objectives To assess medical care and costs of the 3 highest prevalence lumbar disorders—non-specific low back pain (nLBP), intervertebral disc disorder (IDD) and spinal stenosis (SS)—from national billing data to provide basic information for standards of appropriate management. Design Retrospective analysis of National Health Insurance National Patient Sample data provided by the Korean Health Insurance Review and Assessment Service (HIRA). Setting 2011 claims data from all medical institutions which filed billing statements to HIRA. Participants A total of 135 561 patients with lumbar disorder who received medical services during 2011. Outcome measures Patient characteristics, medical procedures, medication, cost, injection and surgery. Results In the nLBP and IDD groups, the 50–59 age range had the highest prevalence, whereas prevalence increased with age in SS. All 3 groups showed a higher percentage in women. The average treatment cost was 196 552 KRW in the nLBP and 362 050 KRW in the IDD group, and highest in the SS group at 439 025 KRW. While in the nLBP group women spent more on medical expenses, in the other 2 groups men showed higher expenditure. Expenditure grew with age in the nLBP and SS groups, whereas that of the IDD group peaked in their 40s. Analgesics were used in 73.43% of patients with nLBP, 82.64% of patients with IDD and 86.46% of patients with SS, and opioids in 4.12% of patients with IDD and 5.36% of patients with SS. Surgery rates were highest in the SS group at 4.85%, with 0.9% for nLBP and 4.59% for IDD. The most frequent injection code was lumbar/caudal epidural nerve block. Expenditure and surgery rates were higher in the injection than in the non-injection subgroup in all 3 groups. Conclusions Patterns of medical care of most frequent lumbar disorders from HIRA data showed significant difference between groups and provide a basic standard for future usual care guidelines linked with health policy and budget appropriation.

Effectiveness of Acupuncture and Electroacupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis

The aim of this systematic review was to assess evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture and electroacupuncture in patients with chronic neck pain. We searched nine databases including Chinese, Japanese and Korean databases through 30 July 2016. The participants were adults with chronic neck pain and were treated with acupuncture or electroacupuncture. Eligible trials were those with intervention groups receiving acupuncture and electroacupuncture with or without active control, and control groups receiving other conventional treatments such as physical therapy or medication. Outcomes included pain intensity, disability, quality of life (QoL) and adverse effects. For statistical pooling, the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a fixed-effects model. Sixteen RCTs were selected. The comparison of the sole acupuncture group and the active control group did not come out with a significant difference in pain (SMD 0.24, 95% CI [Formula: see text]0.27-0.75), disability (SMD 0.51, 95% CI [Formula: see text]0.01-1.02), or QoL (SMD [Formula: see text]0.37, 95% CI [Formula: see text]1.09-0.35), showing a similar effectiveness of acupuncture with active control. When acupuncture was added into the control group, the acupuncture add-on group showed significantly higher relief of pain in studies with unclear allocation concealment (SMD [Formula: see text]1.78, 95% CI [Formula: see text]2.08-[Formula: see text]1.48), but did not show significant relief of pain in studies with good allocation concealment (SMD [Formula: see text]0.07, 95% CI [Formula: see text]0.26-0.12). Significant relief of pain was observed when the sole electroacupuncture group was compared to the control group or electroacupuncture was added onto the active control group, but a lot of the results were evaluated to have low level of evidence, making it difficult to draw clear conclusions. In the result reporting adverse effects, no serious outcome of adverse event was confirmed. Acupuncture and conventional medicine for chronic neck pain have similar effectiveness on pain and disability when compared solely between the two of them. When acupuncture was added onto conventional treatment it relieved pain better, and electroacupuncture relieved pain even more. It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision. Therefore better designed large-scale studies are needed in the future.

Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study.

Background Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans. Methods A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007–2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity. Results Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70–0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70–0.94, and 0.81; 95% CI 0.68–0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63–0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively). Conclusions Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.

Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients.

Study Design.. Prospective observational 1-year study. Objective.. To determine minimum clinically important difference (MCID) and substantial clinical benefit (SCB) of outcome measures in failed back surgery syndrome (FBSS) patients, as these metrics enable assessment of whether and when an intervention produces clinically meaningful effects in a patient. Summary of Background Data.. Several methods have been devised to quantify clinically important difference, but MCID and SCB for FBSS patients has yet to be determined. Methods.. Patients with persisting/recurrent low back pain (LBP) and/or leg pain after lumbar surgery who completed 16 weeks of treatment (n = 105) at two hospitals in Korea from November 2011 to September 2014 were analyzed. Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale (VAS), Oswestry disability index (ODI), and short form-36 (SF-36) in an anchor-based approach. Results.. MCIDs for ODI, LBP and leg pain VAS, physical component summary, mental health component summary (MCS), and overall health scores of SF-36 were 9.0, 22.5, 27.5, 10.2, 4.0, and 8.9, and SCBs were 15.0, 32.5, 37.0, 19.7, 19.3, and 21.1, respectively. MCID and SCB area under the curve was ≥0.8, and ≥0.7, respectively. Conclusion.. LBP and leg pain VAS, ODI, and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients. Level of Evidence: 3

The Short-Term Effect of Integrated Complementary and Alternative Medicine Treatment in Inpatients Diagnosed with Lumbar Intervertebral Disc Herniation: A Prospective Observational Study

OBJECTIVES This study aimed to investigate the short-term effect of hospital-based intensive nonsurgical treatment in lumbar intervertebral disc herniation (IDH) inpatients admitted to an integrated hospital that offers both complementary and alternative medicine (CAM) and conventional medicine treatment. DESIGN A prospective observational study. SETTINGS A private Korean medicine hospital inpatient setting in Korea. PATIENTS A total of 524 inpatients diagnosed with lumbar IDH admitted from June 1, 2012, to May 31, 2013. INTERVENTIONS The participants received treatment according to a CAM treatment protocol (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation) and conventional medicine treatment as needed. OUTCOME MEASURES Numeric rating scale (NRS) of low back pain (LBP) and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. The study also assessed whether improvement was obtained over minimal clinically important difference (MCID) in LBP or leg pain. RESULTS The average hospital stay was 24.4 ± 13.2 days. The majority of patients received CAM treatment and a few selected conventional medicine, such as pain killers (22.7%; 4.2 ± 3.0 administrations) or nerve blocks (14.1%; 1.4 ± 0.7 sessions). At discharge, the average reduction in NRS was 3.18 ± 2.29 (95% confidence interval [CI], 2.99-3.38) for LBP and 2.61 ± 2.60 (95% CI, 2.38-2.83) for leg pain the average reduction in ODI was 19.45 ± 19.53 (95% CI, 17.77-21.12). Two-hundred and seventy patients (51.5%) showed improvement over MCID in both NRS and ODI, 150 (28.6%) in either NRS or ODI, and 104 (19.8%) in neither. CONCLUSIONS Integrated CAM treatment during hospitalization was effective for patients with lumbar IDH who had severe LBP and disability. However, these results must be investigated further to assess whether the effects surpass those seen with placebo and are cost-effective.

Association between direct and indirect smoking and osteoarthritis prevalence in Koreans: a cross-sectional study

Objectives To assess the association between smoking patterns and knee and hip joint osteoarthritis (OA) prevalence in Koreans aged 50 years or older with focus on knee OA. Design Cross-sectional study using nationally representative data. Setting Data were collected at portable Health Examination Centres in Korea. Participants Data of 9064 participants of the 5th Korean National Health and Nutrition Examination Survey (2010–2012) aged 50 years or older who received knee or hip joint X-rays out of 31 596 total surveyees were analysed. Primary outcome measures OA prevalence by smoking behaviour (current smoking, past smoking, indirect smoking and non-smoking). Secondary outcome measures Estimated risk of OA by smoking amount, period, pack-years and indirect smoking exposure time to assess the association between smoking-related factors and knee OA by calculating ORs and adjusting for covariates in a complex sampling design. A multinomial logistic regression analysis and backward elimination method was used. Results OA prevalence in Koreans aged 50 years or older was 13.9%, with prevalence about 3.5 times higher in women (men 5.7%, women 20.1%). ORs for knee and hip joint OA prevalence by smoking behaviour in male indirect-smokers were lower than those in non-smokers in age and sex (OR 0.271; 95% CI 0.088 to 0.828), and selective adjustments (OR 0.314; 95% CI 0.102 to 0.966). All other analyses for smoking behaviour and total OA prevalence, and knee OA prevalence were not significantly different. Associations between smoking amount, period, pack-years and knee OA prevalence were non-significant in ever-smokers. Associations between indirect smoking exposure time and knee OA prevalence were also non-significant. Conclusions This study found that though direct and previous smoking and OA prevalence were not associated, there was a weak relationship between indirect smoking and OA.

Gender Difference in Associations between Chronic Temporomandibular Disorders and General Quality of Life in Koreans: A Cross-Sectional Study.

Background Chronic temporomandibular disorder (TMD) is known to have strong correlations with psychological factors and to display gender disparity. However, while chronic TMD is known to affect quality of life, large-scale studies investigating the influence on quality of life by gender are scarce. Methods This cross-sectional study assessed the data of 17,198 participants aged ≥19 years who completed chronic TMD and EuroQol-5 Dimension sections in the 4th Korean National Health and Nutrition Examination Survey (2007–2009). We adjusted for covariates (health behavior, sociodemographic factors) in regression analysis for complex sampling design to calculate regression coefficients and 95% CIs for gender difference in the association between chronic TMD and quality of life. We also evaluated which covariates of somatic health, mental health, health behavior, and sociodemographic factors weakened the relationship between TMD and EQ-5D. Results Prevalence of chronic TMD was 1.6% (men 1.3%, women 1.8%), and chronic TMD persisted to negatively impact quality of life even after adjusting for confounding variables. Low sociodemographic factors and health behavior had a negative effect on quality of life. Somatic health and mental health were most affected by chronic TMD. As for quality of life, women were affected to a greater extent than men by TMD. Women were more affected by osteoarthritis and general mental health (stress, depressive symptoms, and thoughts of suicide), and men by employment. Conclusions These results imply that chronic diseases and psychological factors are important in chronic TMD, and that there may be physiological and pathological gender differences in TMD.