The application and sustainable development of coral in traditional medicine and its chemical composition, pharmacology, toxicology, and clinical research

This review discusses the variety, chemical composition, pharmacological effects, toxicology, and clinical research of corals used in traditional medicine in the past two decades. At present, several types of medicinal coral resources are identified, which are used in 56 formulas such as traditional Chinese medicine, Tibetan medicine, Mongolian medicine, and Uyghur medicine. A total of 34 families and 99 genera of corals are involved in medical research, with the Alcyoniidae family and Sarcophyton genus being the main research objects. Based on the structural types of compounds and the families and genera of corals, this review summarizes the compounds primarily reported during the period, including terpenoids, steroids, nitrogen-containing compounds, and other terpenoids dominated by sesquiterpene and diterpenes. The biological activities of coral include cytotoxicity (antitumor and anticancer), anti-inflammatory, analgesic, antibacterial, antiviral, immunosuppressive, antioxidant, and neurological properties, and a detailed summary of the mechanisms underlying these activities or related targets is provided. Coral toxicity mostly occurs in the marine ornamental soft coral Zoanthidae family, with palytoxin as the main toxic compound. In addition, nonpeptide neurotoxins are extracted from aquatic corals. The compatibility of coral-related preparations did not show significant acute toxicity, but if used for a long time, it will still cause toxicity to the liver, kidneys, lungs, and other internal organs in a dose-dependent manner. In clinical applications, individual application of coral is often used as a substitute for orthopedic materials to treat diseases such as bone defects and bone hyperplasia. Second, coral is primarily available in the form of compound preparations, such as Ershiwuwei Shanhu pills and Shanhu Qishiwei pills, which are widely used in the treatment of neurological diseases such as migraine, primary headache, epilepsy, cerebral infarction, hypertension, and other cardiovascular and cerebrovascular diseases. It is undeniable that the effectiveness of coral research has exacerbated the endangered status of corals. Therefore, there should be no distinction between the advantages and disadvantages of listed endangered species, and it is imperative to completely prohibit their use and provide equal protection to help them recover to their normal numbers. This article can provide some reference for research on coral chemical composition, biological activity, chemical ecology, and the discovery of marine drug lead compounds. At the same time, it calls for people to protect endangered corals from the perspectives of prohibition, substitution, and synthesis

Pain Management

This book has seven chapters, from more than 15 authors from different countries (Korea, Poland, Saudi Arabia, Taiwan, Turkey and USA) edited by Professor Milica Prostran MD, PhD. The potential reader is shown the modern approach to pain management because the chapters deal at length and clearly with their topics. I believe that this book that I edited with great pleasure and dedication will capture the attention of many readers, from medical students to practicing doctors. All of them need to deal with this extremely important field of medicine: pain treatment. I do believe that the answers they may find in Pain Management will make their practice easier. Also, the life of their patients will be considerably more pleasant, or at least more bearable

Acupuncture for quality of life in patients having pain associated with the spine: a systematic review

Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Evaluation of the effectiveness and safety of acupuncture in the management of shoulder pain in adults

Shoulder pain affects 6-26% of the population globally with a substantial health and economic impact on the community. This review was to evaluate the effectiveness and safety of acupuncture in the management of shoulder pain in adults by systematically reviewing the currently available randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs). A total of 16 English and Chinese electronic databases were searched from their respective inceptions to 18 September 2012. The data on pain intensity, range of motion and adverse events as well as risk of bias were analysed. Meta-analysis was performed using Review Manager 5.1. A total of 6,609 studies were identified. Thirty-eight RCTs and six non-RCTs met the inclusion criteria and were included in this review. Among the 38 RCTs, 4,115 participants were randomised. There was a high risk of performance bias and an unclear risk of selection, detection, attrition and reporting bias across most RCTs. The pooled data showed that acupuncture was more effective than sham acupuncture to relieve pain and improve abduction degree of the shoulder at the end of treatment and follow-up. There was no significant difference in alleviating pain between acupuncture and Western medication (WM) at the end of treatment period. However, nerve block (Xylocaine) was superior to acupuncture in improving shoulder movement in all directions after one-session treatment. Acupuncture reduced more pain than conventional orthopaedic therapy after three-month treatment and three-month follow-up. Comparing with other therapy (such as Trager psychophysical integration and conventional orthopaedic therapy), the pooled data indicated that acupuncture was more beneficial for improving abduction degree at the end of treatment. However, the synthesised data did not show any significant difference in pain relief or improvement of abduction degree between acupuncture plus WM and WM alone. It demonstrated that acupuncture was more effective to alleviate pain as an adjunct treatment to Tuina at the end of treatment. However, there was no significant difference between acupuncture plus Tuina group and Tuina alone group for abduction degree or between electroacupuncture plus exercise and interferential electrotherapy plus exercise for pain relief after the last treatment. Six non-RCTs involved 570 participants. All the non-RCT studies had a high a risk of selection bias (random sequence generation) and performance bias (blinding of participants). Majority had an unclear risk of selection (allocation concealment), detection, attrition, reporting and other bias. Although all the investigators claimed that the acupuncture treatment group was more effective than the control group, due to lack of data for outcome measures, meta-analysis was not performed. No severe adverse events were observed in either RCTs or non-RCTs. The outcomes from the current project indicate that acupuncture is potentially beneficial and safe for relieving pain and improving abduction movement of the shoulder joint. However, due to the various confounders and high or unclear risk of bias, the findings need to be interpreted with caution. A large scaled, rigorously designed RCT is warranted to confirm the current results