Rationale for routine collection of patient reported outcomes during integrative medicine consultation visits.

OBJECTIVES: Integrative medicine (IM) is whole-person care utilizing complementary health approaches to address numerous physical or emotional influences that can impact an individual's health. Patient-reported outcomes (PRO) are subjective measures that quantify patients' perception of their quality of life. While PRO measures have been routinely assessed in specific oncology clinics, our objective was to assess the ability and utility of routine collection of PRO measures in an IM clinic. DESIGN/SETTING/MAIN OUTCOME: Patients receiving a clinical consultation in an ambulatory IM clinic completed the PROMIS Global Health Form in the clinic waiting room. RESULTS: From November 2013 through October 2016, the PROMIS Global Health Form (PROMIS-10) was administered during 59% of IM provider consultation visits (7172/12,207), representing 3473 unique patients. Most patients were female (81%), White (93%), middle-aged (49.2; SD 15.4) and had commercial health insurance (66%). Baseline Mental (44.9; SD 9.1) and Physical Health (44.2; SD 8.6) scores were roughly 0.5 standard deviation below the national mean values (50; SD 10). Factors such as age, race and non-commercial insurance were associated with lower PROMIS-10 scores. Patients completing at least two PROMIS-10 questionnaires (n = 1541) exhibited increases of 2.3% and 2.8% from first to last PROMIS-10 assessment in Mental and Physical Heath scores respectively. CONCLUSIONS: It is possible to routinely collect PRO measures in large IM clinic and longitudinal improvements in Mental and Physical Health scores were observed. Future research should focus on understanding how providers can utilize PRO results in real-time to improve patients' clinical outcomes and potentially decrease healthcare utilization.

Abiotic elicitation of Trifolium pratense L. suspension culture.

Important substances of secondary metabolism include flavonoids and isoflavonoids. The Trifolium pratense L. (Fabacae) suspension culture is characterized by low production of these metabolites and therefore we tried to influence the production output with elicitation. From their origin point of view, the elicitors are divided into two groups - biotic and abiotic. The latter group includes, for instance, the salts of heavy metals. Our work was aimed at observing the effect of the copper sulphate abiotic elicitor on the production of the Trifolium pratense L. suspension culture (variety DO-8 and variety DO-9) that was cultivated in Gamborg media supplemented with 2 mg l(-1) of 2,4-dichlorophenoxyacetic acid and 2 mg l(-1) of 6-benzylaminopurine. The maximum increase in the flavonoid production took place, when compared with the test check, during the 168-hour application of the 100 micromol concentration. The DO-8 variety isoflavonoids production was stimulated namely during the 48-hour application of the I micromol concentration; the best elicitation effect of the DO-9 variety was achieved with the 168-hour application of the 10 micromol concentration.

Fagopyrum esculentum in vitro.

Common buckwheat is a valuable source of the flavonoid rutin. Its in vitro culture was derived from a young seedling plant and the content of flavonoids in the callus culture was compared with their content in an intact plant. The optimal nutrient medium for the cultivation of the in vitro culture and for the production of flavonoids is Murashige and Skoog medium which contains, during the cultivation in the normal light regime, the growth regulators combination of 2,4-D 1 mg/l and kinetin 1 mg/l.

Flavonoid accumulation in Scutellaria baicalensis Georgii in vitro cultures upon treatment with sodium cinnamate.

The production of secondary metabolites by plant cell cultures has been suggested as a feasible technology that attracted considerable industrial and academic interest in the past three decades. However, many secondary pathways are not well expressed in plant cell cultures. Optimization of culture medium, elicitation, genetic engineering and the supply of biosynthetic precursors are among the strategies adopted to increase secondary metabolite production in vitro. In this study, the effects of five potential biosynthetic precursors on the production of baicalin and baicalein in Scutellaria baicalensis Georgii suspension and callus cultures were measured. The results of this work show that flavonoid biosynthesis was most stimulated by the addition of sodium cinnamate in the concentration of 5 mg x l(-1) and by cinnamic acid (1 mg x l(-1)). Feeding with L-phenylalanine, malonic acid and sodium malonate did not induce changes in the amounts of flavonoids, and the biomass production was not affected.

[Arbutin, salicin: the possibilities of their biotechnological production]. / Arbutin, salicin--moznosti jejich biotechnologické produkce.

The paper aimed to transform exogenous precursors with in vitro cultures of Datura meteloides, Coronilla varia, Leuzea carthamoides and Schisandra chinensis. These cultures were added the precursors of arbutin and salicin (phenylalanine, cinnamic, p-coumaric, p-anisoic, o-coumaric, salicylic acids, salicylaldehyde, helicin), not yet tested by the present authors. The culture of Schisandra chinensis was also added, besides the above-mentioned precursors, hydroquinone, because this culture had not been employed for biotransformation purposes yet. The precursors tested were used in a concentration of 100 mg x l(-1) and the period of their action was 6; 12; 24; 48, and 168 hours. Positive results (both TLC and HPLC) in arbutin production were obtained in the culture of Schisandra chinensis after an addition of hydroquinone. The largest amount of arbutin in callus cultures was measured after a week's cultivation with hydroquinone (5.08 %). In this experimental variant, arbutin was released also to the culture medium. Our results revealed salicylaldehyde to be the optimal precursor of salicin. It was transformed by the culture of Datura meteloides after 6; 24, and 168 hours and by the culture of Coronilla varia after 6 hours. In comparison with arbutin, its amount was smaller.

Evaluation of in vitro effects of natural substances of plant origin using a model of protein glycoxidation.

In an in vitro model with purified porcine aspartate aminotransferase (AST, EC 2.6.1.1) as the protein, the effects of phenolic antioxidants of plant origin (arbutin, methylarbutin, ferulic and isoferulic acids, o-coumaric and p-coumaric acids, quinic acid), flavonoids (baicalin and baicalein), and of hydroxycitric acid (HCA) at 0.5-50 mM concentration on the enzyme activities and on its glycation by 50 mM D-fructose as the glycating agent were studied. During incubation with AST at 37 degrees C up to 24 days, fructose alone decreased AST activities as a result of protein glycation. In the absence of fructose, 50 mM phenolic compounds gradually decreased AST activity, while no or a weak effect of individual compounds was found at 3 mM concentration. A direct negative effect on AST was pronounced with ferulic acid. On the other hand, beneficial influences of phenolic compounds on glycation of AST by fructose were found mostly at 3 mM concentration. Effects on glycation were vague at 50 mM concentration, probably due to a combination of direct negative influences and antiglycation effects of individual compounds. No effect, neither positive nor negative, on AST activity and protein glycation, was found with quinic acid. The flavonoid baicalin and its aglycon baicalein rapidly decreased the in vitro activity of the enzyme in all concentrations used (0.5-3 mM), and no beneficial effects of the compounds on glycation of the enzyme by fructose were found. The influence of HCA on glycation was concentration-depended, ranging from beneficial inhibition of glycation at 2.5 mM concentration to a strong decrease in AST activity at 10 mM HCA. Both the beneficial and undesirable effects of natural antioxidants should be considered in case they are used as antiglycation factors. The results obtained can contribute to the evaluation of quality of various generally recommended antioxidants.

[Leonurus cardiaca in vitro]. / Leonurus cardiaca in vitro.

Segments of sterile germinating plants were used to derive the tissue culture. Tests of the optimal hormonal composition of the medium from the standpoint of the growth of cultures revealed that the highest growth in biomass was achieved in the medium with an addition of 2.4-D (0.1, 1.0 mg.l-1), NAA (10.0 mg.l-1), and a combination of IAA (1.0 mg.l-1) + K (1.0 mg.l-1). The difference between these values was statistically insignificant. Other tested concentrations of growth regulators showed statistically significantly lower increases. The effects of different types of growth regulators and their concentrations on the production of selected metabolites in the tissue cultures were also examined and compared with the results obtained from the extract of the drug. Of alkaloids, stachydrine was demonstrated both in the extract of the drug and the extracts from all tested calluses regardless of the type and concentration of the growth regulator. Of flavonoid substances, two stains were demonstrated in the extract from the drug as well as in the extracts from all tested calluses. Neither of them was identical with the employed standards of rutin and quercetin. The results of TLC of iridoid substances were different in the extract from the drug (12 stains) and in the extracts from calluses (4 stains--3 identical with the stains in the extract from the drug). As to saccharides, three of them--glucose, fructose, and sucrose--were identified in the extract of the drug as well as in the extracts from all calluses.

[Therapeutic and toxicologic aspects of biological effects of Saint John's wort (Hypericum perforatum L.)]. / Terapeutické a toxikologické aspekty biologickej aktivity l'ubovníka bodkovaného (Hypericum perforatum L.).

Saint-John's-wort (Hypericum perforatum L.) has been used in traditional medicine since time immemorial and it has its position also in the contemporary list of medicinal plants of pharmaceutical importance. Though it originally comes from Europe and Asia, it has been domesticated and, thanks to its properties, has been cultivated in many other parts of the world. The herbaceous plant contains a wide spectrum of substances, out of which anthraglycosides, flavonoids, and floroglucin derivatives participate in principal pharmacological effects. In recent years this plant has become greatly popular as an effective alternative means for the treatment of weak to medium forms of depression. Large quantities of mass-produced drugs with its extract are sold mainly in the United States and Germany and successfully penetrate into the markets of other European countries including the Czech Republic. Some adverse side-effects are also connected with the plant, the best known being photosensitivity, lesser known being its interactions with other drugs or foodstuffs. The present review aims to process literary references concerning the biological activities of the plant and point out its most important therapeutic and toxicological aspects.

[The Baikal scullcap (Scutellaria baicalensis Georgi)--a potential source of new drugs]. / Sisák bajkalský (Scutellaria baicalensis Georgi)--potencionální zdroj nových léciv.

The scullcap (Scutellaria baicalensis Georgi) is a medicinal plant of traditional Chinese medicine and the drug--Scutellariae radix--is, because of its antioxidant, antiviral, antibacterial, antiinflammatory, antiallergic, and sedative properties, the subject of intensive development. This paper reports the results of pharmacological-toxicological studies of this drug and its flavonids approximately from the year 1990 till the year 2001. The results confirm the validity of traditional use and at the same time indicate that some flavonoids have more utilizable therapeutic effects. Mainly baicalein seems to be a prospective medicine for the treatment of some kinds of cancer.

[Bergenia crassifolia (L.) Fritsch in vitro]. / Bergenia crassifolia (L.) Fritsch in vitro.

Sterile germinating plants were used to derive a tissue culture. The greatest stimulating effect on the growth of the culture was exerted by NAA cultures in all concentrations tested, by IAA in concentrations of 1.0 and 10.0 mg.l-1, by IBA in a concentration of 0.1 mg.l-1, and by the combination of IBA + K. The difference between the values of growth on these media was statistically insignificant. TLC analysis of callus extracts demonstrated the presence of bergenin, arbutin, hydroquinone, and methylarbutine. HPLC analysis confirmed the findings (arbutin 0.25%, hydroquinone 0.05%, methylarbutin 0.28%). The results of biotransformation tests show that the highest increase in arbutin took place after addition of 4-hydroxybenzoic acid and withdrawal of the sample after 24 hours (3.82%). No transformation of arbutin or 4-methoxyphenol to produce methylarbutin took place in the culture under the given conditions. The highest increase in the summary content of phenolic substances occurred with the use of the elicitor Pseudomonas aeruginosa--88% (conc. 0.0001 g/100 ml, 12-hour action).

Self-reported health, and illness and the use of conventional and unconventional medicine and mind/body healing by Christian Scientists and others.

A cross-sectional national telephone survey was used to determine whether Christian Scientists (N = 230), a religious group that uses mind/body (including spiritual) healing, self-report more or less illness than non-Christian Scientists (N = 589). The primary outcome measure was the proportion of Christian Scientists and non-Christian Scientists that, during the previous 12 months: a) experienced any of 13 common medical conditions or symptoms; and b) used conventional medicine, unconventional medicine, and mind/body (including spiritual) healing. Fewer Christian Scientists experienced an illness or symptom than non-Christian Scientists (73% vs. 80%, respectively, p = .05). A multivariate analysis showed that Christian Scientists were less likely to have experienced illness than non-Christian Scientists (odds ratio [OR] .66, 95% confidence interval [CI] .44 to .99, p = .04). Similar proportions of Christian Scientists and non-Christian Scientists used some type of conventional medicine (74% vs. 78%, respectively), although Christian Scientists were less likely to take prescription medications than non-Christian Scientists (p = .034). Although use of unconventional medicine was similar in both groups (52% vs. 45%), more Christian Scientists than non-Christian Scientists used at least one type of mind/body medicine (67% vs. 42% p < .00001), notably special religious services and spiritual healing. Additional studies are needed to determine whether there are health benefits associated with the use of conventional and unconventional medicine in combination with mind/body (including spiritual) healing.

Phase I/II study of stage III and IV non-small cell lung cancer patients taking a specific dietary supplement.

This phase I/II study evaluates the influence of selected vegetables (SV) that contain known antitumor components on the survival of stage III-IV non-small cell lung cancer (NSCLC) patients. All patients were treated with conventional therapies. SV was added to the daily diet of 5 stage I patients in the toxicity study group (TG) and 6 stage III and IV patients in the treatment group (SVG), but not to the diet of 13 stage III and IV patients in the control group (CG). Age, Karnofsky performance status (KPS), and body mass index of SVG and CG patients were comparable at entry. KPS declined in the CG patients (79 +/- 8 to 55 +/- 11) but improved in the SVG patients (75 +/- 8 to 80 +/- 13) one to three months after entry. Weight change in the CG, SVG, and TG patients was -12 +/- 5%, -2 +/- 2%, and +4 +/- 4%, respectively. The median survival time and mean survival of the CG patients were 4 and 4.8 months, but in the SVG patients they were 15.5 and 15 months (p < 0.01). No clinical signs of toxicity were found in the TG patients in the 24-month study period. Adding SV to the daily diet of NSCLC patients was found to be nontoxic and associated with improved weight maintenance, KPS, and survival of stage III and IV NSCLC patients.

[Natural substances with antioxidant activity]. / Vybrané prírodní látky s antioxidacní aktivitou.

The review summarizes information about natural substances of phenolic nature (flavonoids, hydroxycinnamic acids, tannins), in which antioxidant effects and ability to quench free radicals have been demonstrated. A number of substances seem to be perspective in the treatment of cardiovascular diseases, cancer and liver diseases.