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Lin DY, Huang WT, Lin YC, Hung HH, Ou SC, Chang CW, Lin HE, Lin TY, Chang CW, Hung HC, Huang ST. Prescription system to calculate precise doses of Chinese herbal medicine to avoid toxic effects. Heliyon 2023; 9:e16612. [PMID: 37332963 PMCID: PMC10275772 DOI: 10.1016/j.heliyon.2023.e16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background and objectives Traditional Chinese Medicine (TCM) is a therapeutic system which has been practiced for thousands of years. Although for much of its history the decoction of medicinal herbs was the most common method of consuming the herbal treatments, TCM prescriptions are now primarily prepared using concentrated Chinese herbal extracts (CCHE) in powder or granular form. However, determining the precise dose of each single Chinese herbal constituent within a prescription creates a challenge in clinical practice due to the potential risk of toxicity. To alleviate this, we invented the Chinese Intelligence Prescription System (CIPS) to calculate the exact dose of each single herb within an individual prescription. Methods In this study, we applied CIPS in a real-world setting to analyze clinical prescriptions collected and prepared at the TCM Pharmacy of China Medical University Hospital (CMUH). Results Our investigation revealed that 3% of all prescriptions filled in a 1-month period contained inexact dosages, suggesting that more than 170,000 prescriptions filled in Taiwan in a given month may contain potentially toxic components. We further analyzed the data to determine the excess dosages and outline the possible associated side effects. Conclusions In conclusion, CIPS offers TCM practitioners the ability to prepare exact Chinese herbal medicine (CHM) prescriptions in order to avoid toxic effects, thereby ensuring patient safety.
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Affiliation(s)
- Dai-Ying Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Te Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shi-Chen Ou
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Wei Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hung-En Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Yen Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Wen Chang
- Graduate Institute of Network Learning Technology, National Central University, Taiwan
| | - Hui-Chun Hung
- Graduate Institute of Network Learning Technology, National Central University, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Cancer Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
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Huang TY, Huang WT, Lin YC, Hung HH, Ou SC, Chang CW, Lin HE, Lin TY, Chang CW, Hung HC, Huang ST. Chinese Intelligence Prescription System improves prescription accuracy while decreasing labor and drug costs. BMC Health Serv Res 2023; 23:514. [PMID: 37211610 DOI: 10.1186/s12913-023-09487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/02/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND AND AIM The traditional method of taking Chinese Medicine involves creating a decoction by cooking medicinal Chinese herbs. However, this method has become less popular, being replaced by the more convenient method of consuming concentrated Chinese herbal extracts, which creates challenges related to the complexity of stacking multiple formulas. METHODS We developed the Chinese Intelligence Prescription System (CIPS) to simplify the prescription process. In this study, we used data from our institutions pharmacy to calculate the number of reductions, average dispensing time, and resulting cost savings. RESULTS The mean number of prescriptions was reduced from 8.19 ± 3.65 to 7.37 ± 3.34 ([Formula: see text]). The reduction in the number of prescriptions directly resulted in decreased dispensing time, reducing it from 1.79 ± 0.25 to 1.63 ± 0.66 min ([Formula: see text]). The reduced dispensing time totaled 3.75 h per month per pharmacist, equivalent to an annual labor cost savings of $15,488 NTD per pharmacist. In addition, drug loss was reduced during the prescription process, with a mean savings of $4,517 NTD per year. The combined savings adds up to a not insignificant $20,005 NTD per year per pharmacist. When taking all TCM clinics/hospitals in Taiwan into account, the total annual savings would be $77 million NTD. CONCLUSION CIPS assists clinicians and pharmacists to formulate precise prescriptions in a clinical setting to simplify the dispensing process while reducing medical resource waste and labor costs.
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Affiliation(s)
- Ting-Yu Huang
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Wei-Te Huang
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Shi-Chen Ou
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Wei Chang
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Hung-En Lin
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Ting-Yen Lin
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan
| | - Ching-Wen Chang
- Graduate Institute of Network Learning Technology, National Central University, Taichung, Taiwan
| | - Hui-Chun Hung
- Graduate Institute of Network Learning Technology, National Central University, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, North District, No. 2, Yude Rd, Taichung, 40447, Taiwan.
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
- Research Cancer Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
- An-Nan Hospital, China Medical University, Tainan, Taiwan.
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Chen PE, Hung HH, Huang WT, Yeh CH, Kao YW, Shia BC, Huang ST. Chinese Herbal Medicine Improved Survival in Stage IV Breast Cancer Patients: Data Mining of the Incorporated Taiwan Cancer Registry Database and Hospital Database. Integr Cancer Ther 2023; 22:15347354231178898. [PMID: 37278256 DOI: 10.1177/15347354231178898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND According to recent research, breast cancer has become the most commonly diagnosed non-skin cancer type among the entire population. Meanwhile, Chinese herbal medicine (CHM) has become an important therapy to improve the survival rate and quality of life in metastatic cancer patients, as part of a wider trend toward more personalized medicine. However, there is a lack of research in terms of the association between stage IV breast cancer and CHM. Therefore, this study aimed to investigate the association between CHM and the survival rate in breast cancer patients at different cancer stages, with a particular focus on patients diagnosed with stage IV. METHODS Patients with an initial diagnosis of breast cancer identified from the Taiwan Cancer Registry Database (TCRD) and China Medical University Hospital (CMUH) database were included in this study. Demographic characteristics including gender, age, and comorbidities were evaluated. Between-group differences for continuous and categorical variables were evaluated by the Student's t-test and Chi-square test, respectively. Patients diagnosed with breast cancer were recruited and divided into cohorts of CHM users and non-users with a 1:1 propensity score matching. The survival of breast cancer patients was assessed by the Cox proportional hazard model. The cumulative incidence of survival was assessed by Kaplan-Meier analysis. RESULTS The adjuvant CHM treatment was associated with a higher survival rate in stage IV breast cancer patients (HR: 0.45, 95% CI: 0.2853-0.7044]. Additionally, the use of CHM had a positive impact on survival in stage IV breast cancer patients who had received surgery (P: .0273, HR: 0.3406, 95% CI: 0.1309-0.8865), chemotherapy (P: .0004, HR: 0.3893, 95% CI: 0.231-0.656), and hormone therapy (P: .0013, HR: 0.3491, 95% CI: 0.1836-0.6636). In terms of the specific CHM associated with survival, Zhi-Gan-Cao-Tang (ZGCT), Phellodendron chinense Schneid. (huang-bai), and Paeonia lactiflora Pall. (chi-shao) were the 3 most commonly prescribed herbal medicines correlated with a higher survival rate among stage IV breast cancer patients. CONCLUSIONS CHM associated with conventional management achieved significant survival benefits in patients with stage IV breast cancer. Additional randomized controlled trials for prospective study are recommended for further validation.
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Affiliation(s)
- Po-En Chen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Te Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Hsuan Yeh
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Wei Kao
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan City, Taiwan
| | - Ben-Chang Shia
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- A-Nan Hospital, China Medical University, Tainan, Taiwan
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Hung HH, Lai JN, Chen WC, Chen YH, Chiu LT, Chen HY. Evaluation of the efficacy of traditional Chinese medicine for the reproductive and pregnancy outcomes in women with endometriosis: A nationwide population-based study. Taiwan J Obstet Gynecol 2021; 60:685-689. [PMID: 34247807 DOI: 10.1016/j.tjog.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Patients with endometriosis may seek traditional Chinese medicine (TCM) to help them conceive. The present study aims to evaluate the effects of TCM on reproductive and pregnancy outcomes in patients with endometriosis. MATERIALS AND METHODS The patients with endometriosis taken from the National Health Insurance (NHI) research database between 2000 and 2012 were divided into two cohorts based on the use of TCM treatment. The two cohorts were matched by age and comorbidities and followed up until a new diagnosis of infertility, ectopic pregnancy, or miscarriage. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of reproductive and pregnancy outcomes. RESULTS A total of 5244 patients with endometriosis were analyzed, including 1748 TCM users and 3496 matched control subjects. The proportion of infertility was higher in TCM users than in non-TCM users (adjusted hazard ratio [HR]: 1.34, 95% confidence interval [CI]: 1.13-1.60). However, there was no significant difference in the proportion of ectopic pregnancies between TCM users and non-TCM users (adjusted HR: 0.82, 95% CI: 0.60-1.13). There was no significant difference in the proportion of miscarriages between TCM users and non-TCM users (adjusted HR: 1.23, 95% CI: 0.95-1.61). CONCLUSION TCM treatment showed insignificant efficacy in decreasing the risk of ectopic pregnancy and miscarriage in patients with endometriosis.
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Affiliation(s)
- Hao-Hsiu Hung
- Department of Chinese Medicine, Obstetrics and Gynecology, Urology, and Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Nien Lai
- Department of Chinese Medicine, Obstetrics and Gynecology, Urology, and Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Chi Chen
- Department of Chinese Medicine, Obstetrics and Gynecology, Urology, and Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yung-Hsiang Chen
- Department of Chinese Medicine, Obstetrics and Gynecology, Urology, and Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Lu-Ting Chiu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Huey-Yi Chen
- Department of Chinese Medicine, Obstetrics and Gynecology, Urology, and Medical Research, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Hung HH, Huang CC, Lin MC, Huang ST, Jeng LB. Evaluation of delayed bleeding risks associated with partial hepatectomy: A nationwide population-based propensity score matching study. Int J Surg 2021; 90:105980. [PMID: 34082138 DOI: 10.1016/j.ijsu.2021.105980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is an increased bleeding risk following hepatectomy either due to surgical complications or the nature of liver dysfunction among these patients. For better prevention of delayed bleeding in patients undergoing hepatectomy with different kinds of comorbidities and medications, we examined the risk of major bleeding up to 10 years following hepatectomy. MATERIALS AND METHODS This retrospective study used data from Taiwan's National Health Insurance Research Database. Patients who underwent hepatectomy between 2000 and 2012 were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. The non-hepatectomy cohort was defined as patients without any record of hepatectomy. Variables including gender, age, comorbidities, and prescribed medications were matched between the hepatectomy and non-hepatectomy cohorts. RESULTS A total of 1155 patients with hepatectomy and 1155 matched non-hepatectomy subjects were included in this study. The risk of major bleeding was significantly higher in the hepatectomy cohort than that of the non-hepatectomy cohort (adjusted hazard ratio: 1.60). The gastrointestinal tract was the most common site of bleeding among patients with bleeding tendencies (adjusted hazard ratio: 1.93). Compared with the non-hepatectomy cohort, patients who underwent hepatectomy were at greater risk of delayed major bleeding in the first decade following surgery (adjusted hazard ratios ranged from 1.56 to 1.70). CONCLUSION Hepatectomy poses a significant risk of delayed major bleeding, especially in the first decade following surgery. Proper prevention methods and close monitoring for bleeding complications are indicated for patients undergoing hepatic surgeries.
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Affiliation(s)
- Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chao-Chun Huang
- Division of General Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
| | - Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
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Hung HH, Chen WC, Chen YH, Chiu LT, Chen HY. Evaluation of the efficacy of Chinese herbal medicine and acupuncture for the prevention of mental disorders in interstitial cystitis patients: A nationwide population-based study. Medicine (Baltimore) 2020; 99:e21422. [PMID: 32791761 PMCID: PMC7386994 DOI: 10.1097/md.0000000000021422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Traditional Chinese medicine (TCM) is commonly used for urinary symptoms in Eastern countries. Since there are few effective treatments available for patients with interstitial cystitis/bladder pain syndrome (IC/BPS), the psychological burden leads to increased healthcare-seeking behavior. Some patients may therefore seek TCM treatment for related urinary symptoms. Due to limited clinical research evaluating the effects of TCM on IC/BPS, we conducted a nationwide population-based cohort study to investigate the relationship between TCM and mental disorders among these patients. The IC/BPS cohort and its matched non-IC/BPS comparison cohort were recruited from the National Health Insurance (NHI) Research Database between 2000 and 2011. Patients with the use of Chinese herbal medicine (CHM) granules or acupuncture over 90 days per year were enrolled as the TCM users. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of mental disorders related to interstitial cystitis. The incidence of mental disorders in the 2 cohorts was assessed with Kaplan-Meier curves. A total of 1123 patients with IC/BPS and 4492 matched non-IC/BPS subjects were included in this study. The IC/BPS cohort demonstrated higher incidence rate of mental disorders than the cohort without IC/BPS (adjusted HR: 2.21, 95% confidence interval [CI]: 1.73-2.81). There was no statistically significant difference in the risk of mental disorders between IC/BPS patients with and without CHM granules or acupuncture treatment (adjusted HR: 0.99, 95% CI: 0.58-1.68). Our results indicated that CHM and acupuncture showed insignificant efficacy in the prevention of mental disorders in IC/BPS patients.
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Affiliation(s)
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
- Department of Psychology, College of Medical and Health Science, Asia University
| | - Lu-Ting Chiu
- Management office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
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Huang ST, Lai HC, Lin YC, Huang WT, Hung HH, Ou SC, Lin HJ, Hung MC. Principles and treatment strategies for the use of Chinese herbal medicine in patients at different stages of coronavirus infection. Am J Cancer Res 2020; 10:2010-2031. [PMID: 32774998 PMCID: PMC7407358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a novel, human-infecting β-coronavirus enveloped, positive-sense single-stranded RNA viruses, similar to the severe acute respiratory syndrome (SARS) infection that emerged in November 2002. In traditional Chinese medicine (TCM), the epidemic disease concepts of "febrile epidemics" (wenyi) or "warm diseases" (wenbing) are based on geographic and cultural aspects, and Chinese herbal medicine (CHM) played an important role in the treatment of epidemic diseases. CHM was widely used to treat patients suffered with SARS almost two decades ago during outbreak of SARS, with proven safety and potential benefits. TCM has also been widely used to treat cancer patients for a long history and much of them associate with immunomodulatory activity and are used to treat coronavirus-related diseases. We propose the use of CHM treatment principles for clinical practice, based on four main stages of COVID-19 infection: early, intermediate, severe, and convalescence. We suggest corresponding decoctions that exhibit antiviral activity and anti-inflammatory effects in the early stage of infection; preventing the disease from progressing from an intermediate to severe stage of infection; restoring normal lung function and improving consciousness in the severe stage; and ameliorating pulmonary and vascular injury in the convalescent stage. We summarize the pharmaceutical mechanisms of CHM for treating coronavirus via antiviral, anti-inflammatory and immunomodulatory effects.
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Affiliation(s)
- Sheng-Teng Huang
- School of Chinese Medicine, China Medical UniversityTaichung, Taiwan
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
- Research Cancer Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University HospitalTaichung, Taiwan
- An-Nan Hospital, China Medical UniversityTainan, Taiwan
| | - Hsiang-Chun Lai
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Yu-Chun Lin
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Wei-Te Huang
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Shi-Chen Ou
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Hung-Jen Lin
- School of Chinese Medicine, China Medical UniversityTaichung, Taiwan
- Department of Chinese Medicine, China Medical University HospitalTaichung, Taiwan
| | - Mien-Chie Hung
- Graduate Institute of Biomedical Sciences, Research Center for Cancer Biology and Center for Molecular Medicine, China Medical UniversityTaichung, Taiwan
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Huang WT, Hung HH, Kao YW, Ou SC, Lin YC, Cheng WZ, Yen ZR, Li J, Chen M, Shia BC, Huang ST. Application of Neural Network and Cluster Analyses to Differentiate TCM Patterns in Patients With Breast Cancer. Front Pharmacol 2020; 11:670. [PMID: 32457636 PMCID: PMC7227602 DOI: 10.3389/fphar.2020.00670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Pattern differentiation is a critical element of the prescription process for Traditional Chinese Medicine (TCM) practitioners. Application of advanced machine learning techniques will enhance the effectiveness of TCM in clinical practice. The aim of this study is to explore the relationships between clinical features and TCM patterns in breast cancer patients. Methods The dataset of breast cancer patients receiving TCM treatment was recruited from a single medical center. We utilized a neural network model to standardize terminologies and address TCM pattern differentiation in breast cancer cases. Cluster analysis was applied to classify the clinical features in the breast cancer patient dataset. To evaluate the performance of the proposed method, we further compared the TCM patterns to therapeutic principles of Chinese herbal medication in Taiwan. Results A total of 2,738 breast cancer cases were recruited and standardized. They were divided into 5 groups according to clinical features via cluster analysis. The pattern differentiation model revealed that liver-gallbladder dampness-heat was the primary TCM pattern identified in patients. The main therapeutic goals of the top 10 Chinese herbal medicines prescribed for breast cancer patients were to clear heat, drain dampness, and detoxify. These results demonstrated that the neural network successfully identified patterns from a dataset similar to the prescriptions of TCM clinical practitioners. Conclusion This is the first study using machine-learning methodology to standardize and analyze TCM electronic medical records. The patterns revealed by the analyses were highly correlated with the therapeutic principles of TCM practitioners. Machine learning technology could assist TCM practitioners to comprehensively differentiate patterns and identify effective Chinese herbal medicine treatments in clinical practice.
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Affiliation(s)
- Wei-Te Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Wei Kao
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,Research Center of Big Data, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Shi-Chen Ou
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Zen Cheng
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Zi-Rong Yen
- Information Technology Office, China Medical University Hospital, Taichung, Taiwan
| | - Jian Li
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ben-Chang Shia
- Research Center of Big Data, College of Management, Taipei Medical University, Taipei, Taiwan.,College of Management, Taipei Medical University, Taipei, Taiwan.,Executive Master Program of Business Administration in Biotechnology, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, An-Nan Hospital, China Medical University, Tainan, Taiwan
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Lin YC, Huang WT, Ou SC, Hung HH, Cheng WZ, Lin SS, Lin HJ, Huang ST. Neural network analysis of Chinese herbal medicine prescriptions for patients with colorectal cancer. Complement Ther Med 2018; 42:279-285. [PMID: 30670255 DOI: 10.1016/j.ctim.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022] Open
Abstract
Traditional Chinese Medicine (TCM) is an experiential form of medicine with a history dating back thousands of years. The present study aimed to utilize neural network analysis to examine specific prescriptions for colorectal cancer (CRC) in clinical practice to arrive at the most effective prescription strategy. The study analyzed the data of 261 CRC cases recruited from a total of 141,962 cases of renowned veteran TCM doctors collected from datasets of both the DeepMedic software and TCM cancer treatment books. The DeepMedic software was applied to normalize the symptoms/signs and Chinese herbal medicine (CHM) prescriptions using standardized terminologies. Over 20 percent of CRC patients demonstrated symptoms of poor appetite, fatigue, loose stool, and abdominal pain. By analyzing the prescription patterns of CHM, we found that Atractylodes macrocephala (Bai-zhu) and Poria (Fu-ling) were the most commonly prescribed single herbs identified through analysis of medical records, and supported by the neural network analysis; although there was a slight difference in the sequential order. The study revealed an 81.9% degree of similarity of CHM prescriptions between the medical records and the neural network suggestions. The patterns of nourishing Qi and eliminating dampness were the most common goals of clinical prescriptions, which corresponds with treatments of CRC patients in clinical practice. This is the first study to employ machine learning, specifically neural network analytics to support TCM clinical diagnoses and prescriptions. The DeepMedic software may be used to deliver accurate TCM diagnoses and suggest prescriptions to treat CRC.
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Affiliation(s)
- Yu-Chuan Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Te Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shi-Chen Ou
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hao-Hsiu Hung
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wie-Zen Cheng
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Shing Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, Taiwan; Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan; Tainan Municipal An-Nan Hospital, China Medical University, Taichung, Taiwan.
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Fan JCH, Hung HH, Fung KY. Infection in primary total knee replacement. Hong Kong Med J 2008; 14:40-45. [PMID: 18239242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVES To determine the infection rate and identify the risk factors of primary total knee replacement in a general hospital and discuss possible preventive measure. DESIGN Retrospective study. SETTING Regional hospital, Hong Kong. PATIENTS All cases of primary total knee replacement performed between the period July 1997 and June 2006 were reviewed. MAIN OUTCOME MEASURES Infection rate of primary total knee replacement and its relationship to risk factors. RESULTS In the defined period, 479 total knee replacements were performed in 353 patients (291 female and 62 male); 105 women and 21 men had bilateral replacements. The mean patient age was 69 (range, 40-88) years. In all, 447 knees had osteoarthritis, and 32 had rheumatoid arthritis. The mean follow-up period was 46 (range, 1-107) months; 345 knees were followed up longer than 24 months, but seven had no postoperative follow-up. Wound infection was defined by clinical, bacteriological, and/or histological examination. Primary total knee replacement was invariably performed in a theatre with vertical laminar flow, under prophylactic antibiotic cover, and body exhaust suits, water impermeable gowns, and double gloves were always used. The overall infection rate was 3.0% (14/472); the acute deep infection rate (within 4 weeks) was 0.2% (1/472), the delayed deep infection rate (4 weeks-2 years) was 0.6% (2/345). The superficial infection rate was 1.9% (9/472) and the late deep infection rate (after 2 years) was 0.6% (2/345). Diabetic patients had a three-fold higher risk of infection than non-diabetic patients, though this difference did not attain statistical significance (P=0.077). CONCLUSIONS Our infection rates for primary total knee replacement were comparable to those encountered internationally.
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Affiliation(s)
- Jason C H Fan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong.
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Chu CPW, Yap JCCM, Chen PP, Hung HH. Postoperative outcome in Chinese patients having primary total knee arthroplasty under general anaesthesia/intravenous patient-controlled analgesia compared to spinal-epidural anaesthesia/analgesia. Hong Kong Med J 2006; 12:442-7. [PMID: 17148797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To compare postoperative outcomes in patients having primary total knee arthroplasty receiving general or regional anaesthesia. DESIGN Randomised prospective study. SETTING Regional hospital, Hong Kong. PATIENTS Patients having primary total knee replacement were randomised to either general anaesthesia followed by postoperative intravenous patient-controlled analgesia with morphine, or combined spinal-epidural anaesthesia followed by postoperative epidural infusion of bupivacaine 0.1% with fentanyl 2 microg/mL. MAIN OUTCOME MEASURES Visual analogue scale pain scores, perioperative blood loss, time to first meal and ambulation, and prevalence of postoperative complications. RESULTS Sixty consecutive patients were enrolled in this study. Postoperative median pain scores were consistently lower at 1 (P<0.0001), 6 (P=0.08), 12 (P=0.003), 24 (P=0.14), and 48 hours (P=0.007) in those given regional anaesthesia. Although there was a trend towards fewer complications in the latter group, there were no statistically significant differences between the two groups with respect to the incidence of postoperative blood loss, haemodynamic instability, pruritus, nausea, vomiting, urinary retention, or other surgical/medical complications. Postoperatively, patients given regional anaesthesia also resumed meals earlier (P<0.0001), and showed a trend towards earlier ambulation and hospital discharge. CONCLUSION Chinese patients undergoing total knee arthroplasty with regional anaesthesia/regionally delivered analgesia enjoyed better postoperative pain relief and resumed meals earlier than those receiving general anaesthesia/intravenous patient-controlled analgesia. The former also showed trends towards less adverse effects, postoperative complications, earlier ambulation, and earlier hospital discharge.
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Affiliation(s)
- C P W Chu
- Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, Hong Kong: Department of Anaesthesia and Operating Services.
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Hung HH, Chen YL, Lin SJ, Yang SP, Shih CC, Shiao MS, Chang CH. A salvianolic acid B-rich fraction of Salvia miltiorrhiza induces neointimal cell apoptosis in rabbit angioplasty model. Histol Histopathol 2001; 16:175-83. [PMID: 11193193 DOI: 10.14670/hh-16.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Apoptosis has been suggested to participate in stabilizing cell number in restenosis. Salvia miltiorrhiza (SM) Bunge which is a Chinese herb widely used for the treatment of cardiovascular disorders contains a potent antioxidant, Salvianolic acid B. To determine whether the antioxidant affects vascular apoptosis, the present study examined the frequency of apoptotic cell death in atherosclerotic plaques and in restenotic lesions of cholesterol-fed rabbits. New Zealand White rabbits were treated with a normal diet (normal), a 2% cholesterol diet (HC), a 2% cholesterol diet and endothelial denudation (HC-ED), a 2% cholesterol diet with 5% water-soluble extract of SM (4.8 g/Kg B.W./day) and endothelial denudation (HC-ED-SM), or with a 2% cholesterol diet containing probucol (0.6 g/kg B.W./day) and endothelial denudation (HC-ED-probucol). Apoptosis and associated cell types were examined in serial paraffin sections by in situ terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling and immunohistochemistry. The expression of p53, an apoptosis-related protein, was also examined. Apoptosis was mainly detected in the neointima of the three groups with endothelial denudation. The percentage of apoptotic cells in SM-treated group (68.5+/-5.9%) was significantly higher than that of normal (0%), HC (1.9+/-1.2%), HC-ED (46.1+/-5.4%), and probucol-treated (32.8+/-3.9%) groups. The SM treatment markedly reduced the thickness of the neointima which was mainly composed of smooth muscle cells with few macrophages. In accordance with the apoptotic cell counts, positive immunoreactivity for p53 was observed in restenotic lesions from HC-ED, SM-treated and probucol-treated groups but not in the intima of the other two groups. These results suggest that the treatment with salvianolic acid B-rich fraction of SM induces apoptosis in neointima which in turn may help prevent the neointimal thickening.
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Affiliation(s)
- H H Hung
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
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Ragan PM, Chin VI, Hung HH, Masuda K, Thonar EJ, Arner EC, Grodzinsky AJ, Sandy JD. Chondrocyte extracellular matrix synthesis and turnover are influenced by static compression in a new alginate disk culture system. Arch Biochem Biophys 2000; 383:256-64. [PMID: 11185561 DOI: 10.1006/abbi.2000.2060] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The goal of this study was to examine the effects of mechanical compression on chondrocyte biosynthesis of extracellular matrix (ECM) components during culture in a new alginate disk culture system. Specifically, we have examined chondrocyte biosynthesis rates, and the structure of aggrecan core protein species present in the cell-associated matrix (CM), in the further removed matrix (FRM) and in the surrounding culture medium. In this alginate disk culture system, chondrocytes can be subjected to mechanical deformations similar to those experienced in vivo. Our results show that over an 8-week culture period, chondrocytes synthesize a functional ECM and can respond to mechanical forces similarly to chondrocytes maintained in native cartilage. In the alginate disk system, static compression was shown to decrease and dynamic compression to increase synthesis of aggrecan of bovine chondrocytes. Western blot analysis of the core proteins of aggrecan molecules identified a number of different species that were present in different relative amounts in the CM, FRM, and medium. Over 21 days of culture, the predominant form of aggrecan found in the ECM was a full-length link-stabilized species. In addition, our data show that the application of 40 h of static compression caused an increase in the proportion of newly synthesized aggrecan molecules released into the medium. However, this was not accompanied by a significant change in the size and composition of aggrecan and aggrecan fragments in the different compartments, suggesting that mechanical compression did not alter the catabolic pathways. Together, these data show that chondrocyte function is maintained in an alginate disk culture system and that this culture system is a useful model to examine chondrocyte ECM assembly and some aspects of catabolism normally found in vivo.
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Affiliation(s)
- P M Ragan
- Center for Biomedical Engineering, Division of Bioengineering and Environmental Health, Massachusetts Institute of Technology, Cambridge 02139, USA
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Loening AM, James IE, Levenston ME, Badger AM, Frank EH, Kurz B, Nuttall ME, Hung HH, Blake SM, Grodzinsky AJ, Lark MW. Injurious mechanical compression of bovine articular cartilage induces chondrocyte apoptosis. Arch Biochem Biophys 2000; 381:205-12. [PMID: 11032407 DOI: 10.1006/abbi.2000.1988] [Citation(s) in RCA: 263] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A bovine cartilage explant system was used to evaluate the effects of injurious compression on chondrocyte apoptosis and matrix biochemical and biomechanical properties within intact cartilage. Disks of newborn bovine articular cartilage were compressed in vitro to various peak stress levels and chondrocyte apoptotic cell death, tissue biomechanical properties, tissue swelling, glycosaminoglycan loss, and nitrite levels were quantified. Chondrocyte apoptosis occurred at peak stresses as low as 4.5 MPa and increased with peak stress in a dose-dependent manner. This increase in apoptosis was maximal by 24 h after the termination of the loading protocol. At high peak stresses (>20 MPa), greater than 50% of cells apoptosed. When measured in uniaxial confined compression, the equilibrium and dynamic stiffness of explants decreased with the severity of injurious load, although this trend was not significant until 24-MPa peak stress. In contrast, the equilibrium and dynamic stiffness measured in radially unconfined compression decreased significantly after injurious stresses of 12 and 7 MPa, respectively. Together, these results suggested that injurious compression caused a degradation of the collagen fibril network in the 7- to 12-MPa range. Consistent with this hypothesis, injurious compression caused a dose-dependent increase in tissue swelling, significant by 13-MPa peak stress. Glycosaminoglycans were also released from the cartilage in a dose-dependent manner, significant by 6- to 13-MPa peak stress. Nitrite levels were significantly increased above controls at 20-MPa peak stress. Together, these data suggest that injurious compression can stimulate cell death as well as a range of biomechanical and biochemical alterations to the matrix and, possibly, chondrocyte nitric oxide expression. Interestingly, chondrocyte programmed cell death appears to take place at stresses lower than those required to stimulate cartilage matrix degradation and biomechanical changes. While chondrocyte apoptosis may therefore be one of the earliest responses to tissue injury, it is currently unclear whether this initial cellular response subsequently drives cartilage matrix degradation and changes in the biomechanical properties of the tissue.
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Affiliation(s)
- A M Loening
- Center for Biomedical Engineering, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge 02139, USA
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Towle CA, Hung HH, Bonassar LJ, Treadwell BV, Mangham DC. Detection of interleukin-1 in the cartilage of patients with osteoarthritis: a possible autocrine/paracrine role in pathogenesis. Osteoarthritis Cartilage 1997; 5:293-300. [PMID: 9497936 DOI: 10.1016/s1063-4584(97)80008-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The interleukin-1 (IL-1) cytokines stimulate the synthesis of degradative enzymes in joint tissues and may play a role in the pathological joint destruction in osteoarthritis (OA). In this study, we have used immunohistochemistry and Western blot analysis to identify IL-1 in human OA cartilage. IL-1 alpha and IL-1 beta were evident in chondrocytes at the articular surface, as well as distributed throughout the cartilage. In many specimens, IL-1 beta but not IL-1 alpha was detected as a diffuse staining of the extracellular matrix especially surrounding superficial zone chondrocytes. Although chondrocyte-associated IL-1 alpha and IL-1 beta were detected in most specimens, cartilages exhibiting early osteoarthritic changes had the highest intensity of staining and the highest frequency of positive cells. Western blot analysis revealed intense immunoreactive bands corresponding to the 35 kDa precursor form of IL-1 alpha in all four chondrocyte lysates tested. The processed 18 kDa IL-1 beta species was present in only one of four chondrocyte lysates, and there was no clear evidence of precursor form within these cells. The results of this study indicate increased IL-1 alpha in cartilage showing early degenerative changes, suggesting an autocrine/paracrine role for this cytokine in OA pathogenesis.
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Affiliation(s)
- C A Towle
- Orthopaedic Research Laboratories, Massachusetts General Hospital, Boston 02114, USA
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Rivers SB, Unertl WN, Hung HH, Liang KS. Order-disorder transition at the (001) surface of a 3 at. %-Au-rich Cu3Au crystal. Phys Rev B Condens Matter 1995; 52:12601-12613. [PMID: 9980419 DOI: 10.1103/physrevb.52.12601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Trippel SB, Corvol MT, Dumontier MF, Rappaport R, Hung HH, Mankin HJ. Effect of somatomedin-C/insulin-like growth factor I and growth hormone on cultured growth plate and articular chondrocytes. Pediatr Res 1989; 25:76-82. [PMID: 2919122 DOI: 10.1203/00006450-198901000-00017] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To determine whether growth hormone has a direct effect on skeletal tissues not mediated by somatomedins, and to better define the role of somatomedin-C/insulin-like growth factor I (Sm-C/IGF-I) in skeletal development, bovine growth plate, and rabbit articular and growth plate chondrocytes in primary culture were evaluated under a variety of experimental conditions designed to elicit growth hormone and Sm-C/IGF-I stimulation. Under none of these conditions did bovine growth plate chondrocytes respond to either homologous bovine growth hormone or heterologous hGH. Under the same conditions, these cells were highly responsive to human Sm-C/IGF-I with respect to both [3H]thymidine and [35S]sulfate incorporation, indices of mitotic and differentiated cell functions, respectively. Similarly, both rabbit articular and growth plate chondrocytes showed enhanced incorporation of [3H] thymidine and [35S]sulfate in the presence of Sm-C/IGF-I, but did not respond to either native or recombinant hGH. Cells at different stages of maturation within the bovine growth plate differed in their reaction to Sm-C/IGF-I with proliferative zone cells manifesting a greater response to the peptide than cells of the reserve zone. These results suggest that the action of Sm-C/IGF-I on growth plate and articular chondrocytes is direct and that the effect of GH on these cells is indirect. The data further suggest that within the growth plate, the transition from reserve to proliferative status is associated with an increased Sm-C/IGF-I responsiveness, a change which may contribute to the functional differences in these cells.
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Affiliation(s)
- S B Trippel
- Department of Orthopedics, Massachusetts General Hospital, Boston 92114
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