Ximenia americana: Economic Importance, Medicinal Value, and Current Status in Ethiopia.

Ximenia americana is one of the most valuable wild edible plants in the world. In different countries, it is utilized as food, medicine, an essential oil source, and the industrial component to other products. In Ethiopia, it was one of the most known and very important plants for a long period of time. It was utilized as food, a medicinal plant, and animal feed. It was also one of the most economically important and culturally valuable plants. But nowadays, it is not adequately available in the country due to deforestation problem in the years. In addition, its economic importance, current status, and medicinal roles are not well documented and understood. As for research studies, it is concluded that unless a collective effort is taken, the existence of this plant is under severe threat and needs to have some measures. This review article is aimed at addressing the abovelined topics in detail and to pinpoint and explain the importance and status of Ximenia americana.

Recent Patents on Phytoconstituents-based Formulations for the Treatment of Acne Infection: A Review.

BACKGROUND: Acne is an infection of the skin that occurs in both men and women during their lifespan. There are various natural or synthetic products available in the market to prevent and cure this disease. INTRODUCTION: The majority of the world population depends on the herbs or natural resources for the relief of acne disease. These are used to lessen the cost of treatment and the side effects of synthetic analogs. METHODS: We have explored the various authentic web resources to compile information regarding different patented and marketed herbal formulations for acne treatment. RESULTS: It has been found that most of the herbal formulation for acne include the plant actives/extracts having the potential activity against the Propionibacterium acne. The occurrence of this skin disease is also associated with the presence of free radicals in the body, which also causes the inflammation and redness of the skin. Further, the study of various patents also revealed that herbs with anti-oxidant properties have been used in most of the herbal anti-acne formulations. Moreover, the various patents also give the idea that herbal formulations also prevent the appearance of pimples on the skin. CONCLUSION: It has been concluded that the herbal anti-acne formulation is not only used to treat acne but also prevents this disease safely and economically.

Marcgrave and Piso's plants for sale: The presence of plant species and names from the Historia Naturalis Brasiliae (1648) in contemporary Brazilian markets.

ETHNOPHARMACOLOGICAL RELEVANCE: Parallelisms between current and historical medicinal practices as described in the seventeenth century treatise Historia Naturalis Brasiliae (HNB) provide us with an overview of traditional plant knowledge transformations. Local markets reflect the actual plant use in urban and rural surroundings, allowing us to trace cross-century similarities of ethnobotanical knowledge. AIMS OF THE STUDY: We aim to verify in how far the HNB, created in seventeenth-century northeastern Brazil, correlates with contemporary plant use in the country by comparing the plant knowledge therein with recent plant market surveys at national level. MATERIALS AND METHODS: We conducted a literature review on ethnobotanical market surveys in Brazil. We used the retrieved data on plant composition and vernacular names, together with our own fieldwork from the Ver-o-Peso market in Belém, to compare each market repertoire with the useful species in the HNB. We analyzed similarities among markets and the HNB with a Detrended Correspondence Analysis and by creating Venn diagrams. We analyzed the methods of the different markets to check whether they influenced our results. RESULTS: Out of the 24 markets reviewed, the greatest similarities with the HNB are seen in northern Brazilian markets, both in plant composition and vernacular names, followed by the northeast. The least overlap is found with markets in the central west and Rio de Janeiro. Most of the shared vernacular names with the HNB belonged to languages of the Tupi linguistic family. CONCLUSION: The similarity patterns in floristic composition among Brazilian markets and the HNB indicate the current wider distribution and trade of the species that Marcgrave and Piso described in 1648 in the northeast. Migration of indigenous groups, environmental changes, globalized and homogenous plant trade, and different market survey methods played a role in these results. The HNB is a reference point in time that captures a moment of colonial cultural transformations.

Effectiveness, safety, and economic evaluation of topical application of a herbal ointment, Jaungo, for radiation dermatitis after breast conserving surgery in patients with breast cancer (GREEN study): Study protocol for a randomized controlled trial.

INTRODUCTION: This is a prospective, open-label, parallel-group, randomized controlled trial that evaluates the effectiveness and safety of adjuvant application of Jaungo (JUG) for radiation-induced dermatitis (RD) in breast cancer patients undergoing radiation therapy, in comparison with general supportive care (GSC). METHODS/DESIGN: Eighty female patients, who have been diagnosed with unilateral breast cancer, will be allocated to either the JUG or GSC group with an allocation ratio of 1:1 after breast conservation surgery, in the Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea. Both the groups will be subjected to GSC, but only the JUG group participants will apply adjuvant JUG ointment on the irradiated skin for 6 weeks, twice a day. The primary outcome of this study is the assessment of incidence rate of RD using the Radiation Therapy Oncology Group (RTOG) for toxicity gradation of 2 or more. Maximum pain level, quality of life, adverse reactions, and pharmacoeconomic evaluations will also be included. DISCUSSION: The primary outcome will be statistically compared using the logrank test after estimating the survival curve using the Kaplan-Meier method. Continuous variables will be tested using independent t test or Mann-Whitney U test. The adverse events will be evaluated with Chi-square or Fisher exact test. All the data will be analyzed at a significance level of 0.05 (two-sided) with R software (The R Foundation). TRIAL REGISTRATION: CRIS (Clinical Research Information Service), KCT0003506, 14 February 2019.

Oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting: a study protocol for a pilot and definitive randomised double-blind placebo-controlled trial (CannabisCINV).

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) remains an important issue for patients receiving chemotherapy despite guideline-consistent antiemetic therapy. Trials using delta-9-tetrahydrocannabinol-rich (THC) products demonstrate limited antiemetic effect, significant adverse events and flawed study design. Trials using cannabidiol-rich (CBD) products demonstrate improved efficacy and psychological adverse event profile. No definitive trials have been conducted to support the use of cannabinoids for this indication, nor has the potential economic impact of incorporating such regimens into the Australian healthcare system been established. CannabisCINV aims to assess the efficacy, safety and cost-effectiveness of adding TN-TC11M, an oral THC/CBD extract to guideline-consistent antiemetics in the secondary prevention of CINV. METHODS AND ANALYSIS: The current multicentre, 1:1 randomised cross-over, placebo-controlled pilot study will recruit 80 adult patients with any malignancy, experiencing CINV during moderate to highly emetogenic chemotherapy despite guideline-consistent antiemetics. Patients receive oral TN-TC11M (THC 2.5mg/CBD 2.5 mg) capsules or placebo capsules three times a day on day -1 to day 5 of cycle A of chemotherapy, followed by the alternative drug regimen during cycle B of chemotherapy and the preferred drug regimen during cycle C. The primary endpoint is the proportion of subjects attaining a complete response to CINV. Secondary and tertiary endpoints include regimen tolerability, impact on quality of life and health system resource use. The primary assessment tool is patient diaries, which are filled from day -1 to day 5. A subsequent randomised placebo-controlled parallel phase III trial will recruit a further 250 patients. ETHICS AND DISSEMINATION: The protocol was approved by ethics review committees for all participating sites. Results will be disseminated in peer-reviewed journals and at scientific conferences. DRUG SUPPLY: Tilray. PROTOCOL VERSION: 2.0, 9 June 2017. TRIAL REGISTRATION NUMBER: ANZCTR12616001036404; Pre-results.

Patterns of Dietary Supplement Use in Children with Down Syndrome.

OBJECTIVE: To determine the frequency of dietary supplement use for children with Down syndrome, and to obtain additional descriptive data regarding the age of initial treatment, cost, perceived benefits, and disclosure of use to the pediatrician. STUDY DESIGN: An anonymous questionnaire in English and Spanish was created for parents of children under age 18 years with Down syndrome. Surveys were completed in our clinic, or accessed on a number of Down syndrome-related websites. RESULTS: A total of 1167 responses were completed and analyzed. Forty nine percent of responders currently/previously gave their child supplement(s). The average child received 3 supplements (ranging from 1-18). Although Nutrivene, curcumin, and green tea extract were most common, over 150 different products were reported. Supplementation began most often in infancy, generally between age 4 and 6 months. Average cost was $90.53/month. Overall, 87% of users noted improvement, mainly in speech, immunity, and attention; 17% reported side-effects, predominantly gastrointestinal disturbance. Lack of improvement and cost were the main reasons for discontinuation. Most parents learned of supplements through a parent group or friend. In almost 20%, the pediatrician was unaware of the supplement use. CONCLUSIONS: Almost one-half of parents surveyed administer or have administered supplement(s) to their children with Down syndrome. Many of the supplements have concerning ingredient profiles and are given to children too young to articulate potential ill effects. Providers need to be aware of these products and question families about their use.

Cinnamon and Cassia Nomenclature Confusion: A Challenge to the Applicability of Clinical Data.

Several Cinnamomum species' barks are generally labeled as cinnamon, although only Cinnamomum verum carries the common name of true cinnamon. Cassia, a common name for a related species, is rarely used on labels; instead, various cassia types may also be labeled "cinnamon." Confusion of true cinnamon and cassia spices in foods generally does not present a risk to health, except possibly at the highest intake levels. However, clinical studies with Cinnamomum investigational products have been published that inadequately describe or lack botanical identification information. The results of such studies are confounded by an inability to determine which species was responsible for the observed effects. Due to differences in the quality and composition of various Cinnamomum species, safety and efficacy data are not generalizable or transferable. Pharmacopeial monographs for characterizing the identity, composition, purity, quality, and strength of Cinnamomum investigational products should be applied to remove the ambiguity of cinnamon.

The Hospital-Acquired Conditions (HAC) reduction program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties.

OBJECTIVE: The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals' HAC scores and likelihood of avoiding the Medicare-reimbursement penalty. METHODS: A simulation model is developed and implemented using public data from the CMS' Hospital Compare website to determine how hospitals' unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals' HAC scores. RESULTS: Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction. LIMITATIONS: The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter patients would be able to consume cranberry in either juice or capsule form, but this may not be true in 100% of cases. CONCLUSION: Most hospitals can improve their HAC scores and many can avoid Medicare reimbursement reductions if they are able to attain a percentage reduction in CAUTI comparable to that documented for cranberry-treatment regimes in the existing literature.

Economic botany collections: A source of material evidence for exploring historical changes in Chinese medicinal materials.

ETHNOPHARMACOLOGICAL RELEVANCE: Many Chinese medicinal materials (CMMs) have changed over centuries of use, particularly in terms of their botanical identity and processing methods. In some cases, these changes have important implications for safety and efficacy in modern clinical practice. As most previous research has focused on clarifying the evolution of CMMs by analyzing traditional Chinese materia medica ("bencao") literature, assessments of historical collections are needed to validate these conclusions with material evidence. AIM OF THE STUDY: Historical collections of Chinese medicines reveal the market materials in circulation at a given moment in time, and represent an underexploited resource for analyzing the evolution of Chinese herbal medicines. This study compares specimens from a rare collection of CMMs from the 1920s with contemporary market materials; by highlighting examples of changes in botanical identity and processing that remain relevant for safe clinical practice in the modern era, this work aims to stimulate further research into previously unexplored historical collections of Chinese medicines. MATERIALS AND METHODS: 620 specimens of CMMs that were collected from Chinese pharmacies in the Malay peninsula in the 1920s were examined macroscopically and compared with current pharmacopoeia specifications and authentic contemporary samples. These historical specimens, which are stored in the UK in the Economic Botany Collections (EBC) of Royal Botanic Gardens Kew, were morphologically examined, photographed, and compared to authentic CMMs stored at the Bank of China (Hong Kong) Chinese Medicines Center at Hong Kong Baptist University, as well as authentic herbarium-vouchered specimens from the Leon Collection (LC) at the Kew EBC. Case studies were selected to illustrate examples of historical changes in botanical identity, used plant parts, and processing methods. RESULTS: This investigation confirmed that confusion due to shared common names and regional variations in the botanical identity of certain CMMs has been a persistent issue over time. Additionally, historical changes in processing methods and the plant parts used were observed for some CMMs. In some cases, these changes have direct implications for the safe clinical practice of Chinese medicine. CONCLUSIONS: This preliminary assessment illustrated the significant potential of collections for clarifying historical changes in CMMs. More research is needed to investigate pre-modern collections of CMMs, including a more comprehensive assessment of the holdings in the Kew EBC and other European collections that have not yet been explored from the perspective of Chinese medicine.

The effectiveness, safety, and economic evaluation of Korean medicine for unexplained infertile women: A multi-center, prospective, observational study protocol.

Infertility is a condition in which a woman has not been pregnant despite having had normal intercourse for 1 year. The number of unexplained infertile females is increasing because of late marriage customs, as well as environmental and lifestyle habits. In Korea, infertile females have been treated with Korean medicine (KM). However, these effects have not been objectively confirmed through clinical trials. Therefore, this study was conducted to demonstrate the effectiveness of herbal medicine treatment in infertile patients and to demonstrate the economic feasibility through economical evaluation with assisted reproductive technology.This study is designed as a multicenter, single-arm clinical trial. All participants included will be from 3 Korean Medicine hospitals in Korea and will voluntarily sign an informed consent agreement. All recruited patients will conduct related surveys and tests, and be provided with treatment according to their menstrual cycle. Patients will take herbal medicines for 4 menstruation cycles and receive acupuncture and moxibustion treatment at 3 times (menstrual cycle day 3, 8, 14) during 4 menstruation cycles. They will also undergo an approximately 4 menstrual cycle treatment period, and 3 menstrual cycle observation period. If pregnant during the study, participants will take the herbal medicine for implantation for about 15 days. In this study, the primary outcome will be the clinical pregnancy rate, whereas the secondary outcome will include the implantation rate, ongoing pregnancy rate, and live birth rate.Ultimately, this study will provide clinical data regarding the effectiveness and safety of KM treatment for females with unexplained infertility and important evidence for establishing standard KM treatments for unexplained infertility. Moreover, we will identify the most cost-effective way to treat unexplained infertility. TRIAL REGISTRATION IDENTIFIER: Korean Clinical Trial Registry (CRIS), Republic of Korea: KCT0002235. Date: February 21, 2017 (retrospectively registered).

A Review of Indigo Naturalis as an Alternative Treatment for Nail Psoriasis.

INTRODUCTION: Nail psoriasis is challenging to treat. The few currently available therapies are limited in efficacy, and often produce unfavorable side effects. A plant extract widely used in Traditional Chinese Medicine, indigo naturalis (Qing Dai), is presented in this review as an alternative topical treatment for skin and nail psoriasis. The purpose of this article is to present information on a viable alternative treatment with a favorable side effect profile for a difficult disease to treat. METHODS: A PubMed search for the term "indigo naturalis" was performed, and literature from 2006 to the present relevant to indigo naturalis and treatment of psoriasis and nail psoriasis was reviewed. RESULTS: Indigo naturalis shares several therapeutic mechanisms with current psoriasis treatments, such as regulation of keratinocyte proliferation and differentiation, restoration of epidermal barrier function, and reduction of inflammatory processes. Clinically, it is well tolerated. CONCLUSION: Recent research of indigo naturalis suggests that it is a safe, inexpensive, and effective alternative topical treatment for skin and nail psoriasis.

Use of Chinese medicine correlates negatively with the consumption of conventional medicine and medical cost in patients with uterine fibroids: a population-based retrospective cohort study in Taiwan.

BACKGROUND: Chinese medicine is commonly used and covered by health insurance to treat symptoms of uterine fibroids in Taiwan. This retrospective cohort study compared the consumption of conventional western medicine and medical cost between Chinese medicine (CM) users and nonusers among patients with uterine fibroids. METHODS: We extracted 44,122 patients diagnosed with uterine fibrosis between 1996 and 2010 from the National Health Insurance reimbursement database, which is a population-based database released by a government-run health insurance system. Multivariate linear regression models were used to find association between using Chinese medicine and the consumption of conventional medicine, and between using Chinese medicine and medical cost. RESULTS: The total fibroid-related conventional western medicine consumed by CM users was less than that by nonusers (ß = -10.49, P < 0.0001). Three categories of conventional medicines, including antianemics (-3.50 days/year/patient, P < 0.0001), hemostatics (- 1.89 days/year/patient, P < 0.0001), and hormone-related agents (-3.13 days/year/patient, P < 0.0001), were used less in patients who were CM users. Moreover, although using CM increased 16.9 USD per patient in CM users annually (P < 0.0001), the total annual medical cost for treating fibroid was 5610 USD less in CM users than in nonusers (P < 0.0001). CONCLUSIONS: Our results suggested that CM reduced the consumption of conventional medicine, and might be a potential therapeutic substitute for conventional western medicines to treat uterine fibroids with low cost.

Effect of medicinal plants on wound healing.

In the United States alone, chronic wounds affect 6.5 million patients. It is expected that the number of chronic wounds will increase worldwide due to the increase in age-related conditions and pathologies such as diabetes, obesity, and cardiovascular diseases. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds, and the burden is rapidly growing due to increasing healthcare costs, an aging population, and a sharp rise in the incidence of diabetes and obesity worldwide. While current therapeutic agents have generally inadequate efficacy and number of serious adverse effects, the medicinal plants have been used in medicine since ancient times and are well known for their abilities to promote wound healing and prevent infection without grave side effects. Thus, herbal therapy may be an alternative strategy for treatment of wounds. The purpose of this review is to provide the verified data on the medicinal plants of the world flora with wound healing activity including the biologically active substances belonging to these herbal preparations and describe in detail the various cellular and molecular mechanisms of their actions.

[SCHWABE Company's patent portfolio of Ginkgo biloba preparation].

SCHWABE Company in German is the first and largest manufacturer of Ginkgo biloba preparation. The company not only has leading technology in this field, but also protects its own market effectively through the high quality of patent drafting and exactly patent layout. Based on multi-angle analysis for patent portfolio of G. biloba preparation at application time, legal status, globally layout, Chinese layout, the article provides technical reference of research and development of G. biloba, also provides valuable experience of traditonal Chinese medicine patent portfolio layout for Chinese enterprises.

Cost-effectiveness of cranberry capsules to prevent urinary tract infection in long-term care facilities: economic evaluation with a randomized controlled trial.

OBJECTIVES: To investigate whether the preventive use of cranberry capsules in long-term care facility (LTCF) residents is cost-effective depending on urinary tract infection (UTI) risk. DESIGN: Economic evaluation with a randomized controlled trial. SETTING: Long-term care facilities. PARTICIPANTS: LTCF residents (N = 928, 703 female, median age 84), stratified according to UTI risk. MEASUREMENTS: UTI incidence (clinically or strictly defined), survival, quality of life, quality-adjusted life years (QALYs), and costs. RESULTS: In the weeks after a clinical UTI, participants showed a significant but moderate deterioration in quality of life, survival, care dependency, and costs. In high-UTI-risk participants, cranberry costs were estimated at €439 per year (1.00 euro = 1.37 U.S. dollar), which is €3,800 per prevented clinically defined UTI (95% confidence interval = €1,300-infinity). Using the strict UTI definition, the use of cranberry increased costs without preventing UTIs. Taking cranberry capsules had a 22% probability of being cost-effective compared with placebo (at a willingness to pay of €40,000 per QALY). In low-UTI-risk participants, use of cranberry capsules was only 3% likely to be cost-effective. CONCLUSION: In high-UTI-risk residents, taking cranberry capsules may be effective in preventing UTIs but is not likely to be cost-effective in the investigated dosage, frequency, and setting. In low-UTI-risk LTCF residents, taking cranberry capsules twice daily is neither effective nor cost-effective.

[Study on early-warning of Chinese materia medica price base on ARMA model].

This study sets up an early-warning system framework of Chinese materia medica price, using price index as early warning indicator to establish black early-warning model, with indicator of price index volatility and limit line of "price principal". The research divides warning degree into 5 parts named negative heavy warning, negative light warning, no warning, positive light warning and positive heavy warning, with 5 corresponding lights to describe the change level of the medicine price. Then make an early-warning empirical research based on Chengdu Chinese materia medica price index from December in 2010 to October in 2013. ARMA model is applied to forecast index and the result of early-warning is analyzed, and finally farmer households, companies, customers and the government are recommended respectively.

[Research progress on standards of commodity classes of Chinese materia medica and discussion on several key problems].

Standards of commodity classes of Chinese materia medica is an important way to solve the "Lemons Problem" of traditional Chinese medicine market. Standards of commodity classes are also helpful to rebuild market mechanisms for "high price for good quality". The previous edition of commodity classes standards of Chinese materia medica was made 30 years ago. It is no longer adapted to the market demand. This article researched progress on standards of commodity classes of Chinese materia medica. It considered that biological activity is a better choice than chemical constituents for standards of commodity classes of Chinese materia medica. It is also considered that the key point to set standards of commodity classes is finding the influencing factors between "good quality" and "bad quality". The article also discussed the range of commodity classes of Chinese materia medica, and how to coordinate standards of pharmacopoeia and commodity classes. According to different demands, diversiform standards can be used in commodity classes of Chinese materia medica, but efficacy is considered the most important index of commodity standard. Decoction pieces can be included in standards of commodity classes of Chinese materia medica. The authors also formulated the standards of commodity classes of Notoginseng Radix as an example, and hope this study can make a positive and promotion effect on traditional Chinese medicine market related research.

Volume, value and floristic diversity of Gabon׳s medicinal plant markets.

ETHNOPHARMACOLOGICAL RELEVANCE: African medicinal plant markets offer insight into commercially important species, salient health concerns in the region, and possible conservation priorities. Still, little quantitative data is available on the trade in herbal medicine in Central Africa. The aim of this study was to identify the species, volume, and value of medicinal plant products sold on the major domestic markets in Gabon, Central Africa. MATERIALS AND METHODS: We surveyed 21 herbal market stalls across 14 of the major herbal medicine markets in Gabon, collected vouchers of medicinal plants and documented uses, vernacular names, prices, weight, vendor information and weekly sales. From these quantitative data, we extrapolated volumes and values for the entire herbal medicine market. RESULTS: We encountered 263 medicinal plant products corresponding with at least 217 species. Thirteen species were encountered on one-third of the surveyed stalls and 18 species made up almost 50% of the total volume of products available daily, including the fruits of Tetrapleura tetraptera and seeds of Monodora myristica. Although bark comprised the majority of the floristic diversity (22%) and the highest percentage of daily stock (30%), the resin of IUCN red-listed species Aucoumea klaineana represented 20% of the estimated daily volume of the entire herbal market. Plants sold at the market were mainly used for ritual purposes (32%), followed by women׳s health (13%), and childcare (10%). The presence of migrant herbal vendors selling imported species, especially from Benin, was a prominent feature of the Gabonese markets. CONCLUSION: An estimated volume of 27 t of medicinal plant products worth US$ 1.5 million is sold annually on the main Gabonese markets. Aucoumea klaineana and Garcinia kola are highlighted as frequently sold species with conservation priorities. The herbal market in Gabon is slightly higher in species diversity but lower in volume and value than recently surveyed sub-Saharan African markets.