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Insights into skullcap herb-induced liver injury

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World Journal of Hepatology 2024年第2期16卷 120-122页

作者： Jonathan Soldera Post Graduate Program at Acute Medicine and Gastroenterology University of South WalesCardiff CF371DLUnited Kingdom

This editorial addresses the growing concern of herb-induced liver injury(HILI),focusing on a unique case of Skullcap-induced HILI report.This editorial underscore the significant mortality rate linked to Skullcap-induced HILI,emphasizing the importance of vigilant monitoring and intervention.As herbal supplement usage rises,collaboration among clinicians and researchers is crucial to comprehend and address the complexities of HILI,particularly those involving Skullcap.

关键词： Herb-induced liver injury Drug induced liver injury dietary supplements Herbal hepatotoxicity Liver transplantation

Drug and herbal/dietary supplements-induced liver injury:A tertiary care center experience

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World Journal of Hepatology 2020年第5期12卷 207-219页

作者： Ayesha S Siddique Osama Siddique Michael Einstein Eva Urtasun-Sotil Saverio Ligato Department of Pathology and Laboratory Medicine Hartford HospitalHartfordCT 06102United States Department of Gastroenterology and Hepatology Hartford HospitalUniversity of ConnecticutHartfordCT 06102United States

BACKGROUND Drug-induced liver injury(DILI)and herbal/dietary supplements(HDS)related liver injury present unique diagnostic challenges.Collaboration between the clinician and the pathologist is required for an accurate diagnosis and management.AIM To report our experience on the clinical-pathological findings of hepatic injury caused by drugs/HDS.METHODS A retrospective review of clinically proven cases of DILI/HDS who presented to our institution from January 1,2013 to December 31,2017 was performed.Slides were reviewed for histopathological patterns of injury and correlated with the causative agent.Out of 600 patients presenting with unexplained rise in liver enzymes undergoing biopsy,107 were suspected to have DILI/HDS.Of these,53 had a directly linked exposure to drug/herbal supplements.Fifteen patients were excluded for concurrent known liver disease.Thirty-eight patients with clinically proven DILI/HDS were finally included.RESULTS Thirty-eight cases of DILI/HDS with a male:female of 1:1.5 and mean age of 51±3 years were identified.DILI was identified in 84.2%cases while HDS injury in 15.8%.Acute hepatitis(42.1%)was the most common pattern of injury while granulomatous hepatitis(2.6%)was the least common.We found one case of acute-cholestasis due to rivaroxaban and two cases of cholestatic-hepatitis due to rizatriptan and trimethobenzamide-hydrochloride that,to the best of our knowledge,have not been previously reported.One case of steatohepatitis due to trimethoprim-sulfamethoxazole and three unusual cases of cholestatic-hepatitis with bile duct injury and steatosis due to dronedarone,C4-Extreme and hydroxycut,were also seen.Of our cohort,81.6%of the patients fared well with discontinuation of drug and 18.4%underwent transplant;of which 42.9%were deceased.CONCLUSION We describe the clinical findings,histopathological patterns of injury and clinical outcomes caused by drugs.In particular,we report a few previously unreported/rarely observed clinical and histopathological patterns of hepatic injury.

关键词： Drug-induced liver injury Herbals dietary supplements Liver enzymes Biopsy supplements

Detection of illegally added drugs in dietary supplements by near-infrared spectral imaging

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Journal of Innovative Optical Health Sciences 2014年第6期7卷 90-96页

作者： Rui Zhang Lihui Yin Shaohong Jin National Institutes for Food and Drug Control Beijing 100050 P.R.China

The application to detect ilally added drugs in dietary supplerments by near-infrared spectral imaging was studied with the focus on nifedipine,diclofenac and metformin.The method is based on near-infrared spectral images correlation cofficient to detect ilally added drugs.The results comply 100%with HPLC methods test results with no false positive results.

关键词： Near infrared spectral imaging ilgally added dietary supplements

Beyond Nutrition Recommendations: What Healthcare Professionals Should Know about dietary supplements to Best Serve Their Patients

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Health 2021年第4期13卷 334-346页

作者： Jacquelyn C. Pence Keith R. Martin Richard J. Bloomer Center for Nutraceutical and dietary Supplement Research College of Health Sciences University of Memphis Memphis TN USA

Although whole food nutrition will likely influence physical health more than any other lifestyle component besides exercise, the use of dietary supplements among men and women continues to be high. Due to this fact, it is imperative that healthcare professionals understand how supplements may impact overall health and wellness of their patients. With the majority of adults taking some form of dietary supplements and many concomitantly taking prescription medications, healthcare providers should be conscientious of adverse effects and interactions that may occur between dietary supplements and prescription drugs. As many consumers are misled by false marketing, healthcare providers should encourage them to be wary of exaggerated claims and direct them to products that are scientifically supported and safe. Continuing education for healthcare providers on dietary supplements is crucial, with new dietary supplement products constantly reaching the markets, in addition to new findings being made through clinical research and case studies. While some dietary supplements provide no meaningful benefit, many dietary supplements have been identified that can be used to ameliorate nutritional deficiencies and reduce the risk of some common health conditions. Others can serve to improve mental and physical performance, while truly enhancing health. This article presents relevant information on dietary supplements that will be useful to the healthcare professional.

关键词： dietary supplements Nutraceuticals Healthcare Professionals Adverse Events

Effect of citrulline on post-exercise rating of perceived exertion,muscle soreness,and blood lactate levels:A systematic review and meta-analysis

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Journal of Sport and Health Science 2020年第6期9卷 553-561页

作者： Hye Chang Rhim Sung Jong Kim Jewel Park Ki-Mo Jang College of Medicine Korea UniversitySeoul 02842Republic of Korea Department of Orthopaedic Surgery Anam HospitalKorea University College of MedicineSeoul 02841Republic of Korea

Background:Citrulline is one of the non-essential amino acids that is thought to improve exercise performance and reduce post-exercise muscle soreness.We conducted a systematic review and meta-analysis to determine the effect of citrulline supplements on the post-exercise rating of perceived exertion(RPE),muscle soreness,and blood lactate levels.Methods:A random effects model was used to calculate the effect sizes due to the high variability in the study design and study populations of the articles included.A systematic search of PubMed,Web of Science,and ClinicalTrials.gov was performed.Eligibility for study inclusion was limited to studies that were randomized controlled trials involving healthy individuals and that investigated the acute effect of citrulline supplements on RPE,muscle soreness,and blood lactate levels.The supplementation time frame was limited to 2 h before exercise.The types and number of participants,types of exercise tests performed,supplementation protocols for L-citrulline or citrulline malate,and primary(RPE and muscle soreness)and secondary(blood lactate level)study outcomes were extracted from the identified studies.Results:The analysis included 13 eligible articles including a total of 206 participants.The most frequent dosage used in the studies was 8 g of citrulline malate.Citrulline supplementation significantly reduced RPE(n=7,p=0.03)and muscle soreness 24-h and 48-h after post-exercise(n=7,p=0.04;n=6,p=0.25,respectively).However,citrulline supplementation did not significantly reduce muscle soreness 72-h post-exercise(n=4,p=0.62)or lower blood lactate levels(n=8,p=0.17).Conclusion:Citrulline supplements significantly reduced post-exercise RPE and muscle soreness without affecting blood lactate levels.

关键词： Amino acids dietary supplements Ergogenic aid Nitric oxide Watermelon juice

Herb-induced liver injury: Systematic review and meta-analysis

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World Journal of Clinical Cases 2021年第20期9卷 5490-5513页

作者： Vinícius Remus Ballotin Lucas Goldmann Bigarella Ajacio Bandeira de Mello Brandão Raul Angelo Balbinot Silvana Sartori Balbinot Jonathan Soldera School of Medicine Universidade de Caxias do SulCaxias do Sul 95070-560RSBrazil Post-Graduate Program in Medicine Division of HepatologyUniversidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre90050-110RSBrazil Department of Clinical Gastroenterology Universidade de Caxias do SulCaxias do Sul 95070-560RSBrazil

BACKGROUND The use of herbal supplements and alternative medicines has been increasing in the last decades.Despite popular belief that the consumption of natural products is harmless,herbs might cause injury to various organs,particularly to the liver,which is responsible for their metabolism in the form of herb-induced liver injury(HILI).AIM To identify herbal products associated with HILI and describe the type of lesion associated with each product.METHODS Studies were retrieved using Medical Subject Headings Descriptors combined with Boolean operators.Searches were run on the electronic databases Scopus,Web of Science,MEDLINE,BIREME,LILACS,Cochrane Library for Systematic Reviews,SciELO,Embase,and Opengray.eu.Languages were restricted to English,Spanish,and Portuguese.There was no date of publication restrictions.The reference lists of the studies retrieved were searched manually.To access causality,the Maria and Victorino System of Causality Assessment in Drug Induced Liver Injury was used.Simple descriptive analysis were used to summarize the results.RESULTS The search strategy retrieved 5918 references.In the final analysis,446 references were included,with a total of 936 cases reported.We found 79 types of herbs or herbal compounds related to HILI.He-Shou-Wu,Green tea extract,Herbalife,kava kava,Greater celandine,multiple herbs,germander,hydroxycut,skullcap,kratom,Gynura segetum,garcinia cambogia,ma huang,chaparral,senna,and aloe vera were the most common supplements with HILI reported.Most of these patients had complete clinical recovery(82.8%).However,liver transplantation was necessary for 6.6%of these cases.Also,chronic liver disease and death were observed in 1.5%and 10.4%of the cases,respectively.CONCLUSION HILI is normally associated with a good prognosis,once the implied product is withdrawn.Nevertheless,it is paramount to raise awareness in the medical and non-medical community of the risks of the indiscriminate use of herbal products.

关键词： Herb-induced liver injury Drug induced liver injury dietary supplements Herbal hepatotoxicity Liver transplantation

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

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Journal of Integrative Medicine 2013年第6期11卷 422-427页

作者： Dagmar Ehling Oriental Health Solutions LLC.

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

关键词： polycystic ovary syndrome infertility Hashimoto disease acupuncture therapy medicine, Chinese traditional medicine, herbal diet dietary supplements case reports

Investigation of the nutraceutical potential of monofloral Indian mustard bee pollen

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Journal of Integrative Medicine 2014年第4期12卷 379-389页

作者： Sameer S.Ketkar Atul S.Rathore Sathiyanarayanan Lohidasan Lakshmi Rao Anant R.Paradkar Kakasaheb R.Mahadik Centre for Advanced Research in Pharmaceutical Sciences Poona College of Pharmacy Bharati Vidyapeeth University Central Bee Research and Training Institute Centre for Pharmaceutical Engineering Sciences University of Bradford

OBJECTIVE： This study was designed to investigate the nutraceutical potential of monofloral Indian mustard bee pollen （MIMBP）. METHODS： The nutritional value of MIMBP was examined in terms of proteins, fats, carbohydrates, and energy value. Its chemical composition in terms of total polyphenol and flavonoid content was determined. MIMBP was screened for free flavonoid aglycones by developing and validating a high-performance liquid chromatography-photo diode array （HPLC-PDA） method. MIMBP was analyzed for in vitro antioxidant effect in terms of 2,2-diphenyl-l-picrylhydrazyl （DPPH） radical-scavenging activity. RESULTS： MIMBP was found to be comprised of proteins （（182.2±5.9） g/kg）, fats （（137.7±6.8） g/kg） and carbohydrates （（560.6±17.4） g/kg）, which result in its high energy value （（17 616.7±78.6） kJ/kg）. MIMBP was found to contain polyphenols （（18 286.1±374.0） mg gallic acid equivalent/kg） and flavonoids （（1 223.5±53.1） mg quercetin equivalent/kg）. The HPLC-PDA analysis revealed the presence of kaempferol （（65.4±0.5） mg/kg） and quercefin （（51.4±0.4） mg/kg） in MIMBP, which can be used as markers for determining the quality of bee pollen. The MIMBP extract showed DPPH free radical-scavenging activity with a half maximal inhibitory concentration of 54.79 μg/mL. CONCLUSION： The MIMBP was found to be a rich source of nutrients providing high caloric value, which makes it a candidate for a potential nutraceutical agent. The study also illustrated the high antioxidant content of MIMBP, especially in the principle polyphenols and flavonoids, which suggests its potential role in the prevention of free radical-implicated diseases. The DPPH-scavenging effect of MIMBP further confirmed its antioxidant potential. Additionally, we developed a simple, specific and accurate HPLC-PDA method for the identification and quantification of free flavonoid aglycones. This can be applied in future screenings of the quality of pollen collected by honeybees.

关键词： dietary supplements bee pollen flavonoids mustard plants

Saffron (Crocus sativus L.) and major depressive disorder:a meta-analysis of randomized clinical trials

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Journal of Integrative Medicine 2013年第6期11卷 377-383页

作者： Heather Ann Hausenblas Debbie Saha Pamela Jean Dubyak Stephen Douglas Anton Department of Sport and Exercise Sciences Jacksonville University Department of Aging and Geriatric Research University of Florida

Due to safety concerns and side effects of many antidepressant medications, herbal psychopharmacology research has increased, and herbal remedies are becoming increasingly popular as alternatives to prescribed medications for the treatment of major depressive disorder （MDD）. Of these, accumulating trials reveal positive effects of the spice saffron （Crocus sativus L.） for the treatment of depression. A comprehensive and statistical review of the clinical trials examining the effects of saffron for treatment of MDD is warranted. OBJECTIVE： The purpose of this study was to conduct a meta-analysis of published randomized controlled trials examining the effects of saffron supplementation on symptoms of depression among participants with MDD. SEARCH STRATEGY： We conducted electronic and non-electronic searches to identify all relevant randomized, double-blind controlled trials. Reference lists of all retrieved articles were searched for relevant studies. INCLUSION CRITERIA： The criteria for study selection included the following：（1） adults （aged 18 and older） with symptoms of depression, （2） randomized controlled trial, （3） effects of saffron supplementation on depressive symptoms examined, and （4） study had either a placebo control or antidepressant comparison group. DATA EXTRACTION AND ANALYSIS： Using random effects modeling procedures, we calculated weighted mean effect sizes separately for the saffron supplementation vs placebo control groups, and for the saffron supplementation vs antidepressant groups. The methodological quality of all studies was assessed using the Jadad score. The computer software Comprehensive Meta- analysis 2 was used to analyze the data. RESULTS： Based on our pre-specified criteria, five randomized controlled trials （n = 2 placebo controlled trials, n = 3 antidepressant controlled trials） were included in our review. A large effect size was found for saffron supplementation vs placebo control in treating depressive symptoms （M ES = 1.62, P 〈 0.001）, revealing that saffron supplementation

关键词： Crocus depressive disorder dietary supplements mood disorders quality of life medicine, herbal meta-analysis