A Herbal Medicine, Gongjindan

This study protocol aims to explore the effectiveness, safety, and cost-effectiveness of a herbal medication, Gongjindan (GJD), in patients with chronic dizziness. This will be a prospective, multicenter, randomized, double-blind, placebo-controlled, parallel-group, clinical trial. Seventy-eight patients diagnosed with Meniere’s disease, psychogenic dizziness, or dizziness of unknown cause will be randomized and allocated to either a GJD or a placebo group in a 1 : 1 ratio. Participants will be orally given 3.75 g GJD or placebo in pill form once a day for 56 days. The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will be as follows: severity (mean vertigo scale and visual analogue scale) and frequency of dizziness, balance function (Berg Balance Scale), fatigue (Fatigue Severity Scale) and deficiency pattern/syndrome (qi blood yin yang-deficiency questionnaire) levels, and depression (Korean version of Beck’s Depression Inventory) and anxiety (State-Trait Anxiety Inventory) levels. To assess safety, adverse events, including laboratory test results, will be monitored. Further, the incremental cost-effectiveness ratio will be calculated based on quality-adjusted life years (from the EuroQoL five dimensions’ questionnaire) and medical expenses. Data will be statistically analyzed at a significance level of 0.05 (two-sided). This trial is registered with ClinicalTrials.gov NCT03219515, in July 2017

Estimation of Validity of A-Mode Ultrasound for Measurements of Muscle Thickness and Muscle Quality

This study aimed to determine whether amplitude modulation (A-mode) ultrasound (US) provides accurate and reliable measurements comparable to those obtained using brightness modulation (B-mode) US under diverse conditions. Thirty healthy participants (15 women and 15 men) underwent measurements of subcutaneous fat thickness (SFT), muscle thickness (MT), and muscle quality (MQ) in the trapezius and biceps brachii muscles using both US modes before and after exercises designed to stimulate the respective muscles. Among the three key indices, the results demonstrated the high validity of the A-mode, with minimal mean differences (MDs) between the two devices less than 0.91 mm and intra-class correlation coefficients (ICCs) exceeding 0.95 for all measures. In addition, the correlation coefficients between the error scores and average scores for the trapezius and biceps brachii suggested no evidence of systematic error. The trapezius MT and MQ significantly increased, and the biceps brachii MT significantly increased after the exercises (p < 0.05). Notably, both the A- and B-modes exhibited the same trend in these post-exercise changes in the muscle. This study suggests that low-cost and low-resolution A-mode US provides measurements of SFT, MT, and MQ similar to the more expensive, high-resolution B-mode imaging. A-mode US is an affordable and portable alternative for muscle assessment

Flos Lonicera ameliorates obesity and associated endotoxemia in rats through modulation of gut permeability and intestinal microbiota.

BACKGROUND AND AIM: Increasing evidence has indicated a close association of host-gut flora metabolic interaction with obesity. Flos Lonicera, a traditional herbal medicine, is used widely in eastern Asia for the treatment of various disorders. The aim of this study was to evaluate whether unfermented or fermented formulations of Flos Lonicera could exert a beneficial impact to combat obesity and related metabolic endotoxemia. METHODS: Obesity and metabolic endotoxemia were induced separately or together in rats through feeding a eight-week high fat diet either alone (HFD control group) or in combination with a single LPS stimulation (intraperitoneal injection, 0.75 mg/kg) (LPS control group). While, the mechanism of action of the Lonicera formulations was explored in vitro using RAW 264.7 and HCT 116 cell lines as models. RESULTS: In cell-based studies, treatment with both unfermented Flos Lonicera (UFL) and fermented Flos Lonicera (FFL) formulations resulted in suppression of LPS-induced NO production and gene expression of vital proinflammatory cytokines (TNF-α, COX-2, and IL-6) in RAW 264.7 cells, reduced the gene expression of zonula occludens (ZO)-1 and claudin-1, and normalized trans epithelial electric resistance (TEER) and horseradish peroxidase (HRP) flux in LPS-treated HCT-116 cells. In an animal study, treatment of HFD as well as HFD+LPS groups with UFL or FFL resulted in a notable decrease in body and adipose tissue weights, ameliorated total cholesterol, HDL, triglyceride, aspartate transaminase and endotoxin levels in serum, reduced the urinary lactulose/mannitol ratio, and markedly alleviated lipid accumulation in liver. In addition, exposure of HFD as well as HFD+LPS groups with UFL or FFL resulted in significant alteration of the distribution of intestinal flora, especially affecting the population of Akkermansia spp. and ratio of Bacteroidetes and Firmicutes. CONCLUSION: This evidence collectively demonstrates that Flos Lonicera ameliorates obesity and related metabolic endotoxemia via regulating distribution of gut flora and gut permeability

Can a Traditional Korean Manual Therapy Be a Complementary and Alternative Strategy for Cervicogenic Dizziness? A Study Protocol for a Randomized Controlled Trial

Cervicogenic dizziness is dizziness triggered by movement or positioning of the cervical spine and is often accompanied by neck pain or stiffness. This is a prospective, pragmatic, assessor-blind, randomized controlled trial aimed at testing the efficacy and safety of adjuvant Chuna Manual Therapy (CMT) in patients with cervicogenic dizziness under usual care treatments. Fifty patients with cervicogenic dizziness will be randomly allocated to CMT or usual care (UC) groups in a 1 : 1 ratio. Extensive screening procedures, including examinations for central nervous system problems and nystagmus, will be applied to exclude other dizziness-inducing disorders. The eligible participants will receive 12 sessions of CMT plus UC or only UC over 6 weeks. CMT includes mandatory and discretionary techniques, whereas UC includes electrotherapy, thermotherapy, and patient education. The efficacy will be evaluated primarily as Dizziness Handicap Inventory score. The severity and frequency of dizziness, the level of neck pain or stiffness, and the cervical range of motion will also be evaluated. Safety will be assessed by adverse events. The data will be statistically analyzed at p<0.05. Trial Registration. This trial was registered with Clinical Research Information Service (CRIS) in Korea, KCT0002565, on 29 November 2017, https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=9610&ltype=&rtype=

Body/adipose tissue weights and serum biochemistry parameters.

<p>Abbreviations: Rela. Of Abf, relative weight of abdominal fat; Rela. of Epf, relative weight of epididymal fat; T. chol, total cholesterol; HDL, high density lipoprotein; TG: triglyceride. Body weights were measured after 18 h LPS injection before sacrifice, and relative organ weight was calculated as fat weight/body weight. Data were shown as mean ± SD; ^#<i>P<</i>0.05, ^##<i>P<</i>0.01, compared to the normal group; ^*<i>P<</i>0.05, ^**<i>P<</i>0.01 compared to the HFD control group; ^$<i>P<</i>0.05, ^$$<i>P<</i>0.01, compared to the normal group; ^&<i>P<</i>0.05, ^&&<i>P<</i>0.01 compared to the LPS control group (n = 8).</p

The <i>in vitro</i> anti-inflammatory activities of UFL and FFL in terms of their ability to suppress the LPS-induced production of NO and proinflammatory cytokines.

<p>(A) Immediately after pretreatment with UFL or FFL at 0 (normal, received DMEM instead of herbal extraxt), 100, 200, 400 µg/ml doses for 4 h, RAW 264.7 cells were exposed to DMEM (normal and LPS-alone) or 0.2 µg/ml LPS for 24 h following which NO measurement was performed as described in Materials and Methods section. ^b<i>P</i><0.01 compared to the normal and^c<i>P</i><0.05, ^d<i>P</i><0.01 compared to the LPS alone. (B–D) Immediately after pretreatment with UFL or FFL at 0 (normal, received DMEM instead of herbal extraxt), 100, 200, 400 µg/ml doses for 4 h, RAW 264.7 cells were exposed to DMEM (normal and LPS-alone) or 0.2 µg/ml LPS for 24 h following which the gene expression profile of proinflammatory cytokines (TNF-α, COX-2 and IL-6) were determined as described in Materials and Methods section. The results are expressed as normalized fold values relative to the normal.^b<i>P</i><0.01 compared to the normal and^c<i>P</i><0.05, ^d<i>P</i><0.01 compared to the LPS alone.</p

UFL and FFL treatment reduce the elevation of membrane permeability <i>in vitro</i>.

<p>(A) Immediately after pretreatment with UFL or FFL at 0 (normal, received McCoy’s 5A medium instead of herbal extraxt), 100, 200, 400 µg/ml doses for 24 h, HCT-116 cells were exposed to McCoy’s 5A medium (normal and LPS-alone) or 10 µg/ml LPS for 24 h following which measurement of transepithelial electrical residence (TEER) was performed as described in Materials and Methods section. (B) Immediately after pretreatment with UFL or FFL at 0 (normal, received McCoy’s 5A medium instead of herbal extract), 100, 200, 400 µg/ml doses for 24 h, HCT-116 cells cells were exposed to McCoy’s 5A medium (normal and LPS-alone) or 10 µg/ml LPS for 24 h following which horseradish peroxidase (HRP) flux assay was performed as described in Materials and Methods section. The experimental results in both cases are expressed as a percentage of the normal.^a<i>P</i><0.05, ^b<i>P</i><0.01 compared to the normal and^c<i>P</i><0.05, ^d<i>P</i><0.01 compared to the LPS alone.</p

Analyses of correlation between gut flora composition and host metabolic parameters.

<p>The entire data of all experimental groups except normal were gathered and analyzed by SPSS software (17.0 version) using two-tailed Pearson’s correlation test. The scores of Pearson’s correlation were figured by PermutMatrix software (Version 1.9.3 EN) using heatmap plots. As the colors scale shown, green color indicates a positive correlation, while red color shows a negative correlation. (A symbol of ○ indicates absolute value of Pearson r >0.4; a symbol of ☆ indicates statistical significance of <i>P</i><0.05).</p

UFL and FFL attenuate HFD+LPS-induced increase in gut permeability and serum endotoxin level.

<p>(A) Following the termination of treatment schedule, the animals were fasted for 12 h with access to water <i>ad libitum</i>. Subsequently, 1.0 ml of lactulose-mannitol solution (containing 66 mg/ml lactulose and 50 mg/ml mannitol) was administered to the animals by oral gavage. After another 20 h of fasting, the urine samples were collected to determine the level of lactulose and mannitol as described in Materials and Methods section. The data are expressed as a ratio of lactulose to mannitol. (B) After the termination of experimental schedule, the blood was collected from the animals following which the serum endotoxin level was determined as described in Materials and Methods section. ^##<i>P</i><0.01, compared to the normal group; ^*<i>P</i><0.05, ^**<i>P</i><0.01 compared to the HFD control group; ^$<i>P</i><0.05, ^$$<i>P</i><0.01, compared to the normal group; ^&<i>P</i><0.05 compared to the LPS control group (n = 8).</p