A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity.

BACKGROUND: Chinese herbal medicine (CHM) is a common complementary therapy used by patients with cancer for reduction of chemotherapy-induced toxic effects. This study applied the highest standard of clinical trial methodology to examine the role of CHM in reducing chemotherapy-induced toxicity, while maintaining a tailored approach to therapy. PATIENTS AND METHODS: Patients with early-stage breast or colon cancer who required postoperative adjuvant chemotherapy were eligible for the study. Enrolled patients were randomly assigned to one of three Chinese herbalists who evaluated and prescribed a combination of single-item packaged herbal extract granules. Patients received either CHM or placebo packages with a corresponding serial number. The placebo package contained nontherapeutic herbs with an artificial smell and taste similar to a typical herbal tea. The primary end points were hematologic and non-hematologic toxicity according to the National Cancer Institute Common Toxicity Criteria Version 2. RESULTS: One hundred and twenty patients were accrued at the time of premature study termination. Patient characteristics of the two groups were similar. The incidence of grade 3/4 anemia, leukopenia, neutropenia, and thrombocytopenia for the CHM and placebo groups were 5.4%, 47.3%, 52.7%, and 1.8% and 1.8%, 32.2%, 44.7%, and 3.6%, respectively (P = 0.27, 0.37, 0.63, and 0.13, respectively). Incidence of grade 2 nausea was the only non-hematologic toxicity that was significantly reduced in the CHM group (14.6% versus 35.7%, P = 0.04). CONCLUSIONS: Traditional CHM does not reduce the hematologic toxicity associated with chemotherapy. CHM, however, does have a significant impact on control of nausea.     

Real‐Time Craving Differences between Black and White Smokers

Black and White smokers may experience aspects of nicotine dependence, including craving, differently. This study used a naturalistic technique, ecological momentary assessment (EMA), to explore differences in craving, mood, expectancy, and smoking enjoyment between Black and White smokers. Participants carried personal digital assistants (PDAs) programmed to obtain multiple daily assessments. Black smokers reported higher craving after smoking and at random assessment times and higher cigarette enjoyment. No differences were found in mood or expectancy. Racial differences in psychological factors related to smoking are explored in the contexts of genetic, sociological, and psychophysiological distinctions. Implications for practice and research are discussed. (Am J Addict 2010;00:1–5)     

A PROSPECTIVE RANDOMIZED TRIAL TO COMPARE ONE DOSE PREOPERATIVE,THREE‐DOSE PERIOPERATIVE AND 5‐DAY FULL COURSE ANTIBIOTICS FOR NON‐PERFORATED ACUTE APPENDICITIS

Aim: To evaluate prospectively use of the haemorrhoid circular stapler (HCS) in day case haemorrhoidectomy. Methods: Patients with prolapsing piles needing haemorrhoidectomy who met the criteria for day surgery were recruited. In addition to the standard practice, a comprehensive explanation regarding the procedure was given at the preoperative assessment clinic. All patients received lactulose 2 consecutive days before surgery and a prophylactic dose of intravenous metronidazole on induction of anaesthesia. Haemorrhoidectomy was performed with the circular stapler (HCS33‐Ethicon Endosurgery) employing the Longo technique. A diclofenac suppository and absorbable anal dressing were administered at the end of the procedure. Postoperative pain was assessed using the visual analogue scale prior to discharge on the same day. Patients were discharged with a bulking agent plus lactulose, oral diclofenac, TNG ointment and a telephone number to call for queries. Patients were seen at 1, 4 and 12 weeks after surgery during which time they would report on symptoms, duration of rest and overall satisfaction. Results: 20 patients underwent the procedure. Only 1 patient required hospital admission, due to side effects of general anaesthesia. The mean pain score on discharge was 3.8 (range: 0–8). All patients were able to take up normal activities within the first week and passed regular motions with relatively mild symptoms. Conclusion: Day case haemorrhoidectomy is not only feasible using the HCS, good patient satisfaction can also be achieved.     

Low plasma adiponectin level, white blood cell count and Helicobacter pylori titre independently predict abnormal pancreatic β-cell function

Adiponectin is an adipocytokine with insulin sensitizing effect while chronic inflammation damages pancreatic β-cells leading to reduced insulin response. We aimed to prove the hypothesis that adiponectin levels and inflammatory markers (white blood cell counts [WCC], Helicobacter pylori [HP] titers, high sensitivity C-reactive protein [hs-CRP]) may interact to affect risk of diabetes. We studied 288 Chinese men (age-median: 41.0 years, IQR: 35.3–46.0 years) being recruited from the community in Hong Kong. The mean adiponectin level was 5.39 ± 2.81 μg/ml and 40.9% (n = 107) had low adiponectin level (<4 μg/ml). On multiple regression analysis, adiponectin was negatively associated with diabetes, HOMA insulin resistance top quartile, plasma glucose (PG) and 2 h insulin; and positively associated with HOMA insulin sensitivity index. WCC was independently associated with PG and 15′ insulin, and negatively associated with HOMA insulin sensitivity top quartile. HP titre was associated with 30′ PG level and diabetes. hs-CRP did not enter the multivariable model. In conclusion, adiponectin, WCC and HP titer are independent predictors for hyperglycemia and reduced insulin sensitivity in Chinese men. These findings may explain the high risk for diabetes in Chinese population despite their relatively low adiposity.     

Thoracic outlet syndrome

Thoracic Outlet Syndrome (TOS) is the constellation of symptoms caused by compression of neurovascular structures at the superior aperture of the thorax, properly the thoracic inlet! The diagnosis and treatment is contentious and some even question its existence. Symptoms are often confused with distal compression neuropathies or cervical radiculopathies.