PSNews 01 19 maggio 2010

Newsletter mensile di Materiali sulle Medicine non Convenzionali

A cura del centro di documentazione dell’Istituto Prosa - Spinea (VE)

Supplemento di Propulsione Salute

Registrazione del Tribunale di Venezia N°1243 del 06.11.96

Redazione: e.mail: istprosa@tin.it

Responsabile di redazione:

Sommario: Elettroagopuntura nell'insonnia cronica Effetti dell'agopuntura sulla pressione intraoculare Correlazione tra punti di agopuntura e reazione pupillare

Agopuntura e disordini della motilità gastrointestinale Tossine vegetali per combattere I tumori Garattini, sull'oncologia New Study Confirms Blueberries Boost Memory

Qigong e cancro Yoga e qigong nella prevenzione di disturbi mentali Omeopatia e ormesi

L'ormesi e la sua relazione con l'omeopatia Auricolo e rinite allergica Agopuntura e tuina per tunnel carpale

Agopuntura e insonnia Agopuntura e neuropatia diabetica Moxa ed ictus

Caratteristiche pazienti con lombalgia cronica che possono beneficiare dell’agopuntura Omeopatia e fibromialgia Medicina cinese e diabete Fitoterapia e diabete

Medicina cinese e cancro Agopuntura e meridiani Farmacopuntura e osteoartrite

Fitoterapia e canrcinoma gastrico Fitoterapia e radioterapia: interazioni Medicina integrata per il cancro a Taiwan

Astragalo e cancro Oncologia integrata Biologico: etichetta

Cancro in pediatria e CAM Omeopatia e effetto placebo

Fiori di Bach e omeopatia

Uso dell’iperico nella depressione

Effetti della respirazione diaframmatica sulla variabilità del battito cardiaco in ischemia con diabete.

Efficacia delle terapie manuali: uno studio dal regno unito

Qigong e qualità della vita in pazienti con tumore

Tai qi e qigong per la salute negli Usa

Efficacia del canto in pazienti affetti da ostruzioni polmonari (copd)

Te verde e effetti avversi

Metodi naturali e ipertensione

Broccoli e cellule cancerogene

Studio sulla biodisponiiblità degli antocianosidi del mirtillo.

Elettroagopuntura nell'insonnia cronica

Ruan JW, Wang CH, Liao XX, et al.Electroacupuncture treatment of chronic insomniacs.Chin Med J (Engl). 2009 Dec 5;122(23):2869-73.

I ritmi frenetici della vita moderna portano sempre più soggetti a soffrire di problemi del sonno. Lo studio in questione indaga gli effetti dell'elettroagopuntura (EA), e la sua sicurezza, nella gestione dell'insonnia cronica. Sono stati selezionati 47 pazienti affetti da insonnia cronica e sottoposti a quattro sedute di EA; i risultati sono stati valutati, in termini di qualità del sonno, con il Pittsburgh sleep quality index (PSQI). La sicurezza della tecnica è stata valutata monitorando gli eventuali effetti collaterali e negativi riportati dai soggetti. L'analisi dei risultati dimostra che l'EA aumenta notevolmente la qualità del sonno nei soggetti testati, migliorando anche le funzionalità sociali surante il giorno. Da un punto di vista neurologico, la tecnica sembra aumentare la durata delle onde lente del sonno e del sonno REM, senza alcun effetto negativo o collaterale riportato dai soggetti. Il 23% dei pazienti ha segnalato però una ripresa dei sintomi ad un mese dalla terapia. Gli studiosi concludono comunque sulla sicurezza ed efficacia dell'EA nel trattamento di questa diffusa patologia e sulle possibilità effettive di miglioramento della qualità del sonno e di vita dei soggetti con insonnia cronica trattati con questa tecnica.

Effetti dell'agopuntura sulla pressione intraoculare

Meira-Freitas D, Cariello AJ, Vita RC, et al. Short-term effect of acupuncture on intraocular pressure in healthy subjects.Acupunct Med. 2010 Mar;28(1):25-7.

Questa ricerca di un gruppo di studiosi brasiliani ha come scopo la valutazione degli eventuali effetti dell'agopuntura sulla pressione intraoculare. Sono stati randomizzati 48 volontari sani e allocati in tre gruppi separati: il primo, di 19 soggetti, trattato con sessioni di agopuntura di 20 minuti a livello dei punti GB1, GB14 e BL1, il secondo di 14 soggetti, trattato con sham-agopuntura e il terzo gruppo di 15 soggetti, di controllo, senza trattamento. Un ricercatore ha misurato la pressione intraoculare di tutti i soggetti, in modo mascherato, immediatamente prima del trattamento, successivamente ad esso e dopo 24 ore. I risultati non hanno mostrato differenze significative a breve termine dei parametri misurati nei tre gruppi.

Correlazione tra punti di agopuntura e reazione pupillare

Mori H, Tanaka TH, Kuge H, et al.Is there any difference in human pupillary reaction when different acupuncture points are stimulated?.Acupunct Med. 2010 Mar;28(1):21-4.

L'obiettivo di questo studio canadese è quello di determinare eventuali differenze nella reazione pupillare a seguito di stimolazione con agopuntura in punti differenti del corpo. Sono stati selezionati 14 soggetti sani, senza alcuna patologia o anomalia a livello delle pupille, e sono stati sottoposti a cinque diversi tipi di intervento: nessuna stimolazione con agopuntura e stimolazione con agopuntura a livello di TE5, ST7, CV12 e ST36, per un tempo di 90 secondi ciascuna. Il diametro pupillare è stato misurato in continuo dai due minuti precedenti fino ai due minuti successivi alla fine della stimolazione. I risultati dimostrano che il diametro pupillare si riduce dopo 30 secondi di stimolazione a livello di ST7 e 60 secondi dopo la stimolazione, rispetto alla pre-stimolazione, mentre per TE5 il diametro si è ridotto 60 secondi dopo la stimolazione. Non sono state registrate variazioni significative per le stimolazioni a livello di ST36 e CV12 e in assenza di stimolazione.

Agopuntura e disordini della motilità gastrointestinale

Yin J, Chen JD.Gastrointestinal motility disorders and acupuncture.Auton Neurosci. 2010 Apr 2

Negli ultimi anni sono stati svolti vari studi per valutare l'effetto e i meccanismi dell'agopuntura o dell'elettroagopuntura (EA) sulla motilità gastrointestinale in pazienti affetti da patologie funzionali del tratto gastrointestinale. Questo articolo è basato su una revisione di questi studi, ricercati in PubMed, in lingua inglese. I dati analizzati indicano che gli effetti dell'agopuntura, nei punti più studiati quali ST36 e PC6, sono piuttosto consistenti E' stata studiata soprattutto la motilità gastrointestinale mentre i dati sull' EA sono di gran lunga inferiori in numero e spesso inconclusivi nei risultati. Gli autori sottolineano quindi l'apparente beneficio che sembrano indicare gli studi presi in esame, riguardo all'uso di queste tecniche nei pazienti affetti da problemi funzionali del tratto gastroenterico, pur insistendo sulla necessità di condurre maggiori e migliori studi sugli effetti terapeutici dell'EA in questo ambito.

Tossine vegetali per combattere I tumori

Des toxines végétales pour combattre les tumeurs et les leucémies http://www.bulletins-electroniques.com/actualites/63022.htm Pour en savoir plus, contacts : L'étude complète a été publiée sur Faseb Journal : Lombardi et al. "Pichia Pastoris as a host for secretion of toxic saporin chimaeras", FASEB J. vol. 24, pp. 253-265, 2010 - http://www.fasebj.org

Produites à partir de méthodologies innovantes - faisant actuellement l'objet d'un dépôt de brevet européen - des molécules hybrides seraient en mesure de tuer les cellules cancéreuses sans endommager les cellules saines. Cette découverte devrait faire l'objet d'études pré-cliniques pour en confirmer l'efficacité thérapeutique. Ce sont des scientifiques du groupe de recherche anglo-italien RICG (Recombinant Immunotoxin Collaborative Group), dont fait partie l'Institut de Biologie et Biotechnologie agraire du CNR (Ibba-CNR) qui, en utilisant les techniques de l'ADN recombinant, ont obtenu l'expression de molécules hybrides qui véhiculent de façon sélective l'activité toxique de la saporine contre les cellules cancéreuses, permettant de les éliminer. Ces molécules hybrides sont créées en unissant la saporine, une toxine végétale identifiée à la base dans les graines de Saponaria Officinalis, à un fragment protéique qui sert à orienter la toxine vers les cellules cancéreuses. Quand la molécule hybride entre dans la cellule cible, la synthèse des protéines s'arrête et la cellule est éliminée. Le réseau RICG qui implique des laboratoires du CNR à Milan et des universités de Vérone et de l'Aquila travaille depuis 2005 au développement de médicaments contre la leucémie basés sur des anticorps recombinants, en mesure de diriger les toxines contre les cellules leucémiques, sans porter atteinte aux cellules saines. Il s'agit d'une approche très différente de la chimiothérapie conventionnelle que le groupe cherche à développer sur certains types de leucémies et de lymphomes, répandus chez les adultes comme chez les enfants.

Garattini, sull'oncologia

DoctorNews 21 aprile 2010 - Anno 8, Numero 70

Per vincere la guerra contro il cancro «bisogna cambiare un po’ di cose». Parola di Silvio Garattini. Per il direttore dell'Istituto di ricerche farmacologiche Mario Negri di Milano, la prima rivoluzione deve riguardare il modo di ragionare degli scienziati: «Non illudersi per i passi avanti - ha spiegato ieri a Milano durante la presentazione del libro "Una guerra per vincere", scritto dall'oncologo dell'Istituto nazionale tumori (Int) Gianni Bonadonna - soprattutto perché negli ultimi anni i progressi sono stati relativamente modesti. I più significativi li abbiamo fatti prima del '95».

Dopo questa fase, prosegue, «si può parlare solo di piccoli passi avanti che costano sempre di più». Tanto che, a chi gli chiede se si aspettava di arrivare fin qui, Garattini risponde: «Per la verità mi aspettavo di arrivare prima. Sono passati più di 50 anni da quando ho iniziato a lavorare sui tumori e francamente mi aspettavo di più. Speriamo di poter accelerare». Al momento, riflette, il cambiamento che può davvero fare la differenza e migliorare drasticamente i numeri della malattia è la prevenzione: «È più forte di qualsiasi farmaco - dice Garattini - perché la maggior parte dei tumori deriva da cattive abitudini di vita. È anche una questione di sostenibilità economica del sistema sanitario. Su questo fronte dunque dobbiamo investire molto, mettendoci in gioco noi per primi. I medici che fumano non fanno che vanificare l'attività di prevenzione con il loro cattivo esempio». Altro passaggio fondamentale: «Spostare l'attenzione dal tumore primario al problema delle metastasi», spiega il farmacologo. Oggi, osserva, «abbiamo fatto qualche progresso di carattere conoscitivo: abbiamo un'idea più precisa del patrimonio genetico delle cellule tumorali, sappiamo che le cellule metastatiche sono diverse e hanno bisogno di trattamenti diversi, siamo a conoscenza di una certa instabilità genetica che caratterizza i tumori e del fatto che le cellule possono restare dormienti a lungo».

«Ma non basta», assicura Garattini. «Sono le metastasi che dobbiamo cercare di colpire. E per questo dobbiamo cominciare a conoscerle meglio. Oggi si riserva loro poca attenzione perché si è convinti che le metastasi segnino la fine di un percorso arrivato a uno stadio irreversibile. Invece dobbiamo lavorarci. Cercare di sviluppare altri strumenti che affianchino, per importanza, la chirurgia». E poi c'è il lavoro di squadra. «Mi auguro che i medici tengano sempre un occhio puntato sul laboratorio e lo stesso facciano i ricercatori di base con la clinica. Fino a ora - sottolinea - ci sono troppe separazioni. Queste figure dovrebbero essere più vicine, più unite. Invece il ricercatore di base guarda al clinico come a un essere un po' grezzo che non coglie appieno tutti gli aspetti metodologici e il clinico è convinto che chi lavora in laboratorio sia un sognatore che vive fuori dalla realtà».

Note di redazione: Curiosamente sono sempre le stesse persone che fanno e disfano tutto. Garattini molti anni fa era sostenitore fanatico del progresso e ora lo critica come prima criticava la vecchia medicina. non ammettono il loro fallimento. Sono stati loro a distruggere il lavoro di squadra. Adesso ripropongono un ritorno al passato impossibile perchè non esiste più la possibilità di ricreare le condizioni in cui si lavorava 50 - 40 30 anni fa. Non esistono più, o per lo meno sono rarissime persone (). Usano tecnologia che diventa vuota se non hai le basi umanistiche per poterla utilizzare. Vogliono continuare ad avere il potere e visto il fallimento delle loro cretinerie moderniste propongono, sotto la loro guida, un ritorno al passato ma in chiave moderna e "scientifica". Auguri (gn).

New Study Confirms Blueberries Boost Memory

HealthyPages 23/04/2010 Irish Times

The occurrence of dementia is continuing to rise and so scientists are looking for a way to prevent and treat it. One of the most natural ways of preventing dementia is blueberries according to results from a new study. This Most recent study confirms what was discovered in a study conducted in 2008, that easting Blueberries improves memory and world list recall. The study involved 9 elderly people whose average age was 76, all recruited by study leader Dr Krikorian. They were administered a daily dose of wild Blueberry juice, the amount depending on their body weight. The average was about half a litre per day. The control group were a demographically matched and were given a placebo to drink. Researcher Donal O'Mathuna said about the value of Blueberries that, “Because blueberries are high in antioxidants, which have beneficial health effects, they are being examined in many research projects," adding that Blueberries are a nutritious and safe food... adding blueberries to a diet rich in fruits and vegetables is warranted." Dr Jeremy Spencer, who conducted the study at the University of Reading in 2008 into the effect of Blueberries, discovered that anthocyanins existing in blueberries were responsible for triggering the section of the brain that is concerned with learning and memory. He said, “Scientists have known of the potential health benefits of diets rich in fresh fruits for a long time. Our research provides scientific evidence to show that blueberries are good for you and supports the idea that a diet-based approach could potentially be used to increase memory capacity. We will be taking these findings to the next level by investigating the effects of diets rich in flavonoids on individuals suffering from cognitive impairment and possibly Alzheimer's disease." The study entitled ‘Blueberry Supplementation Improves Memory in Older Adults‘was published in the Journal of Agricultural and Food Chemistry.

Qigong e cancro

Yan X, Shen H, Jiang H, Hu D, Zhang C, Wang J, Wu X. External Qi of Yan Xin Qigong Induces apoptosis and inhibits migration and invasion of estrogen-independent breast cancer cells through suppression of Akt/NF-kB signaling. Cell Physiol Biochem. 2010;25(2-3):263-70. Epub 2010 Jan 12.

The antitumor effects of external Qi of Yan Xin Qigong (YXQ-EQ) have been widely described over the past three decades. To gain a better understanding of the mechanisms underlying YXQ-EQ's antitumor effects, in the present study we investigated its effects on growth, migration, invasion and apoptosis of breast cancer cells and the underlying molecular mechanisms. We show that YXQ-EQ treatment caused a time-dependent reduction in viability, blocked clonogenic growth and induced apoptosis in estrogen-independent breast cancer MDA-MB-231 cells. Furthermore, YXQ-EQ treatment blocked migration and invasion of MDA-MB-231 cells. Biochemically, YXQ-EQ treatment markedly inhibited constitutive and EGF-induced Akt phosphorylation. YXQ-EQ also substantially repressed NF-kappaB activity, resulting in decreased expression of anti-apoptotic Bcl-2, Bcl-X(L), XIAP and survivin proteins. These findings suggest that YXQ-EQ may induce apoptosis and inhibition of migration and invasion of MDA-MB-231 cells through the repression of Akt/NF-kappaB signaling.

Yoga e qigong nella prevenzione di disturbi mentali

Posadzki P, Parekh S, Glass N. School of Medicine, Health Policy and Practice, University of East Anglia, NR4 7TJ, Norwich, Norfolk, UK. P.Posadzki@uea.ac.uk Yoga and qigong in the psychological prevention of mental health disorders: a conceptual synthesis. Chin J Integr Med. 2010 Feb;16(1):80-6. Epub 2009 Sep 15

The study proposes to explore two alternative medicine therapies-qigong and yoga for balancing the essential duo of holistic mind-body and consequently offer a solution for stress, uncertainty, anxiety and depression. Qualitative research methods have been used to create a conceptual synthesis of yoga and qigong. It is suggested that an increased sense of control is the interface between these two modalities. This conceptual congruence of qigong and yoga is thought to be a selective, curative method, a prescription for ideal living and a ground of human essence existence. Furthermore, this essence is thought to enhance the mind's self-regulatory processes and prevent mental health disorders. The two alternative therapies can prevent mental health disorders such as anxiety, depression and,

minimize mental health disruptions such as stress and poor quality of life. It is suggested that patients and/or clients can benefit from this fusion.

Omeopatia e ormesi

S. Bernardini. Ormesi e omeopatia, le opinioni di BELLE Newsletter. Omeopatia33 n. 150 del 6 maggio 2010.

Il dibattito internazionale prende spunto dal recente lavoro di Edward Calabrese e Wayne B. Jonas: “Homeopathy: clarifying its relationship to hormesis” pubblicato su BELLE Newsletter dell’aprile del 2010. Vi prendono parte alcuni esperti internazionali di omeopatia e alcuni accademici. Calabrese, nell’introduzione al dibattito, ammette di aver scelto a suo tempo di non occuparsi delle possibili implicazioni tra ormesi e omeopatia dal momento che l’ormesi era, alla fine degli anni ottanta, un fenomeno ancora poco conosciuto dalla farmacologia e tossicologia convenzionale ed era opinione da lui stesso condivisa, che la correlazione con l’omeopatia avrebbe provocato (come già era successo un secolo fa) una chiusura del mondo accademico alla riconsiderazione di tale fenomeno. Infatti la sfida più importante affrontata dal fenomeno dell’ormesi per molte decadi passate è stata quella di essere accreditata dalla comunità scientifica. Ma, ora che la letteratura riporta più di 1200 lavori, l’80% dei quali è stato prodotto a partire dal 2000, l’Autore riconsidera le proprie convinzioni riconoscendo che in effetti (come dimostrato dai lavori di Van Wijk e Wiegant dell’università di Utrect), alcuni tipi di trattamento omeopatico possano essere esempi di post-condizionamento ormetico. E curiosamente Calabrese paragona oggi se stesso proprio a Hugo Shulz, pur avendolo in passato criticato. La considerazione di un possibile meccanismo ormetico riguarda ovviamente il meccanismo d’azione dei medicinali omeopatici a diluizioni molecolari e non di quelli in diluizione ultra-low. Calabrese sottolinea di aver avviato la pubblicazione del suo lavoro a The Lancet ma di non aver ricevuto nessun commento. Per questo motivo ha scelto di pubblicarlo sul sito BELLE e di avviare il dibattito internazionale. Egli ritiene che la riconsiderazione del fenomeno dell’ormesi a proposito di omeopatia possa rappresentare un punto di contatto tra le comunità medica convenzionale e omeopatica, le quali sono state a lungo separate. E’ oggi dell’opinione che grazie alla attenzione riservata oggi all’ormesi dal mondo scientifico convenzionale, il tema delle eventuali relazioni tra ormesi ed omeopatia possa essere riaperto; ritiene inoltre che l’ormesi possa essere utile per testare l’omeopatia attraverso un metodo moderno biomedico, riconoscendo che il modello sperimentale isopatico proposto da van Wijk and Wiegant (2010) possa essere uno strumento in grado di avviare un dialogo scientifico tra l’omeopatia e la moderna scienza biomedica, come proposto nel 2006 da Andrea Dei e dalla scrivente dalle pagine di Toxicology and Applied Pharmacology.

Vaa Wijk e Viegant dell’Università di Utrect sostengono che i loro lavori che evidenziano una risposta cellulare di protezione alla intossicazione da metalli pesanti attraverso un’ azione positiva esercitata da un postcondizionamento con basse dosi degli stessi metalli pesanti può rappresentare un esempio del principio di similitudine a livello cellulare. Essi concludono che il principio del simile può essere una interessante sfida sia per la scienza convenzionale che per quella omeopatica.

Suresh e coll. dell’Università danese di Aarus, sono concordi nel ritenere che l’ormesi possa avere qualche connessione con il principio del simile e auspicano che la comunità dei ricercatori omeopatici compia uno sforzo maggiore per testare scientificamente tale legame, utilizzando nelle proprie ricerche i concetti e i metodi dell’ormesi.

Oberbaum e coll. del Center for Integrative Complementary Medicine di Gerusalemme desiderano focalizzare l’attenzione sul fatto che l’omeopatia si avvale di un metodo peculiare e utilizza medicinali anche in dosi ultralow e dinamizzate. Per tale motivo vi è, a loro giudizio, necessità di ricercare eventuali differenze nell’impiego di sostanze diluite e non dinamizzate rispetto a sostanze diluite e dinamizzate. C’è da notare che, rispetto alla posizione di maggiore chiusura espressa in passato, il gruppo di Gerusalemme oggi ammette che l’ormesi possa essere considerata un sottoinsieme dell’omeopatia. Più precisamente che l’ormesi possa essere considerata una “forma rudimentale” di omeopatia dimostrando che sostanze diluite possono indurre una risposta compensatoria. Conclude che l’ormesi offre un modello razionale per studiare gli effetti omeopatici nell’ambito di sostanze in basse concentrazioni.

Anche Peter Fisher del Royal London Homeopathic Hospital desidera rimarcare le peculiarità del metodo omeopatico e si interroga se realmente occorra una dose soglia di xenobiotico per ipotizzare un meccanismo ormetico. La questione sollevata da Fisher potrebbe essere condivisibile dal momento che esistono dati sperimentali ottenuti con diluizioni superiore al numero di Avogadro che potrebbero essere letti nell’ottica del post condizionamento. Tuttavia personalmente riteniamo che alla luce dei pochi dati disponibili tale proposta non sia utile in questa fase ancora preliminare ad incoraggiare il dibattito in corso con la comunità scientifica convenzionale.

L’osservazione che rivolgiamo alla proposta di Fisher trova conferme nella lettura del commento del prof. John R. Moffet dell’Università di Betesda il quale afferma senza mezzi termini che in assenza di conferme scientifiche dell’azione di diluizioni ultralow l’ormesi non debba essere in alcun modo avvicinata all’omeopatia. A tale proposito, il nostro personale commento è che possono esserci importanti connessioni tra ormesi e omeopatia ma che esse sono anche limitate in particolare dal fatto che l’ormesi non richiede particolari preparazioni della sostanza come richiede il

principio della dinamizzazione omeopatica e che vi è la necessità di indagare il fenomeno ormetico con l’uso di sostanze in concentrazioni molecolari. Tuttavia è nostra opinione che il fenomeno dell’ormesi possa offrire una chiave di lettura del meccanismo di azione di sostanze molecolari in basse concentrazioni e quindi anche delle sostanze classificate come medicinali omeopatici. Questa riflessione permette di ipotizzare una possibile chiave di lettura unica e univoca della farmacologia convenzionale che, in tale ottica, si svilupperebbe senza soluzione di continuo dalle microdosi alle macrodosi del farmaco pur implicando meccanismi farmacologici opposti, stimolanti in basse dosi e inibenti in alte dosi. L’opinione di Paolo Bellavite non è qui riportata perché affidata all’Autore.

In conclusione pensiamo che il dibattito internazionale avviato dal Prof Calabrese costituisca un punto di svolta nella considerazione delle ipotesi del meccanismo d’azione del medicinale omeopatico in dosi molecolari. Siamo concordi con l’affermazione del professore di Ahmrest che l’ormesi possa rappresentare un veicolo per studiare il medicinale omeopatico in chiave biomedica avviando, finalmente, un dialogo tra scienziati appartenenti alle due comunità. Se questa è l’opinione di Calabrese non possiamo che registrarla con grande soddisfazione dal momento che essa va nella direzione proposta dalla SIOMI fin dal 2006.

L'ormesi e la sua relazione con l'omeopatia

P. Bellavite. L'ormesi e la sua relazione con l'omeopatia. Omeopatia33, 6 maggio 2010 - Anno 5, Numero 15

L'ormesi è un fenomeno biologico, farmacologico e tossicologico evidenziato da una stimolazione a basse dosi e inibizione ad alte dosi da parte di una medesima sostanza; considerando una curva nel tempo, un fenomeno ormetico è rappresentato da un'iniziale diminuzione di attività seguita da una risposta in cui l'attività del sistema trattato supera quella basale. Questo approccio matematico e statistico si applica ad una serie estremamente ampia di fenomeni - dalla medicina all'ecologia - e quindi l'ormesi ha giustamente assunto sempre maggiore rilevanza. L'ormesi ha avuto il grande merito di confutare con evidenze incontrovertibili la visione secondo cui il rapporto tra causa ed effetto sarebbe sempre di tipo lineare; questa confutazione di una vecchia idea ha fatto crollare come in un "domino" tante teorie particolari sbagliate, tra cui la pretesa della farmacologia "convenzionale" di una proporzionalità tra dose di un medicinale e suo effetto clinico. Uno dei massimi studiosi di ormesi, Edward J. Calabrese, fino a non molto tempo fa aveva sostenuto l'incompatibilità con le teorie omeopatiche, spingendosi a dichiarare che l'apparentamento con l'omeopatia (fatto ad esempio da Arndt e Schulz) aveva rappresentato, nel XX secolo, uno degli ostacoli all'accettazione dell'ormesi stessa nel mondo scientifico. Negli ultimi anni, Calabrese e collaboratori hanno iniziato a cambiare questa prospettiva e recentemente un intero fascicolo della rivista "BELLE Newsletter - Human & Experimental Toxicology" è stato dedicato alle relazioni tra omeopatia e ormesi. L'ormesi, parola-concetto che descrive una gran serie di fenomeni naturali e sperimentali, non rappresenta una "spiegazione" dell'omeopatia, perché nessun fenomeno di per sé può costituire una teoria. Ogni fenomeno di ormesi necessita di una sua teoria esplicativa, che individua il "meccanismo" che determina il comportamento paradossale dell'essere vivente nelle precise circostanze in cui è osservato. D'altra parte l'omeopatia è un metodo terapeutico fondato su alcuni principi - la similitudine, le minime dosi, la visione sistemica - che non sono ancora teorie scientifiche ma sono sulla strada per diventarlo. Il problema dell'omeopatia è lo stesso di ogni campo della medicina e della scienza, cioè che ogni teoria per "tenere" necessita di prove sperimentali. E qui avviene l'incontro proprio con l'ormesi, che rivitalizza e "prova" in modo scientificamente ineccepibile la frequenza e la realtà del fenomeno della "inversione degli effetti" di un medicinale secondo le dosi. Certamente, il "simile" omeopatico non è solo questo e le "dosi" omeopatiche non sono solo quelle - basse ma pur sempre "molecolari" - dell'ormesi attualmente accettata. Un altro limite dell'ormesi sta nel fatto che le sostanze "ormetiche" di tipo classico sono quelle che ad alte dosi hanno un effetto tossico, mentre non tutte le materie di partenza usate in omeopatia sono di questo tipo. Ma la strada è aperta e in compagnia di scienziati con mente aperta, competenza metodologica e - cosa non indifferente - capacità di incidenza nell'editoria scientifica, gli omeopati possono percorrerla con maggiore sicurezza.

Auricolo e rinite allergica

Zhang CS, Yang AW, Zhang AL, Fu WB, Thien FU, Lewith G, Xue CC. WHO Collaborating Centre for Traditional Medicine, RMIT University, Bundoora, Vic., Australia. Ear-acupressure for allergic rhinitis: a systematic review. Clin Otolaryngol. 2010 Feb;35(1):6-12.

BACKGROUND: Allergic rhinitis affects 10-40% of the population globally with a substantial health and economic impact on the community. OBJECTIVE OF REVIEW: To assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials. TYPE OF REVIEW: This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. SEARCH STRATEGY: A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of

ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms. EVALUATION METHOD: The methodological quality was assessed using Jadad's scale. The effect size analysis was performed to explore the difference between interventional groups. RESULTS: Ninety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect. CONCLUSIONS: The benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies.

Agopuntura e tuina per tunnel carpale

Cai DF. Warm-needling plus Tuina relaxing for the treatment of carpal tunnel syndrome. J Tradit Chin Med. 2010 Mar;30(1):23-4.

OBJECTIVE: To probe into quick and effective therapies for carpal tunnel syndrome. METHODS: Totally 98 cases of carpal tunnel syndrome were randomly divided into a treatment group and a control group. The treatment group received warm-needling plus Tuina relaxing, while the control group was treated by hormone block therapy and drug medication. RESULTS: The cure rate was 81.7% in the treatment group and 47.4% in the control group, with a significant difference between the two groups (P < 0.01). CONCLUSION: Acupuncture plus Tuina manipulation is a simple therapy for carpal tunnel syndrome, but with remarkable therapeutic effects.

Agopuntura e insonnia

Li LF, Lu JH. Clinical observation on acupuncture treatment of intractable insomnia. J Tradit Chin Med. 2010 Mar;30(1):21-2.

OBJECTIVE: To observe the effects of acupuncture for treatment of intractable insomnia. METHODS: Totally 90 patients were randomly divided into a treatment group (50 cases), treated by the body acupuncture plus auricular-plaster therapy, and a control group (40 cases), the Baihui (GV 20)-through-Sishencong (EX-HN1). puncture, auricular-plaster therapy and moxibustion on the back-shu points were not used in the control group. The clinical effects were observed. RESULTS: The total effective rate was 98.0% in the treatment group and 77.5% in the control group. The therapeutic effect in the treatment group was much better than that in the control group (P < 0.01). CONCLUSION: The body acupuncture plus auricular-plaster therapy may show better effect for intractable insomnia.

Agopuntura e neuropatia diabetica

Zhang C, Ma YX, Yan Y. Clinical effects of acupuncture for diabetic peripheral neuropathy. J Tradit Chin Med. 2010 Mar;30(1):13-4.

OBJECTIVE: To observe the clinical effects of acupuncture for diabetic peripheral neuropathy. METHODS: Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes, acupuncture was used in the treatment group, and inositol was orally administered in the control group. During a 3-month treatment, changes in the symptoms were observed. RESULTS: In the treatment group, 16 cases were markedly relieved, 12 cases improved, and 4 cases failed, with a total effective rate of 87.5%. In the control group, 7 cases were markedly relieved, 14 cases improved and 12 cases failed, with a total effective rate of 63.6%. There was a significant difference in the total effective rate between the 2 groups (P < 0.05). CONCLUSION: Acupuncture may show good effects for diabetic peripheral neuropathy.

Moxa ed ictus

Lee MS, Shin BC, Kim JI, Han CH, Ernst E. Moxibustion for stroke rehabilitation: systematic review. Stroke. 2010 Apr;41(4):817-20. Epub 2010 Feb 11.

BACKGROUND AND PURPOSE: Positive effects of moxibustion for stroke rehabilitation may be seen in real clinical practice. Currently, no systematic reviews are available. The aim of this systematic review was to analyze the trial data on the effectiveness of moxibustion for stroke rehabilitation. METHODS: Fourteen databases were searched without language restriction. Randomized clinical trials were included if moxibustion was tested as the sole treatment or as an adjunct to other treatments for stroke rehabilitation. RESULTS: Nine randomized clinical trials met our inclusion

criteria. Three randomized clinical trials reported favorable effects of moxibustion plus standard care on motor function versus standard care alone (N=142; standardized mean difference=0.72; 95% confidence interval, 0.37 to 1.08; P<0.0001). Three randomized clinical trials compared the effects of moxibustion on activities of daily living alone but failed to show favorable effects of moxibustion. CONCLUSION: This systematic review found limited effectiveness of moxibustion as an adjunct to standard care in stroke rehabilitation.

Caratteristiche pazienti con lombalgia cronica che possono beneficiare dell’agopuntura

Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Barlow WE, Khalsa PS, Deyo RA. Characteristics of patients with chronic back pain who benefit from acupuncture. BMC Musculoskelet Disord. 2009 Sep 21;10:114.

BACKGROUND: Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low back pain, we sought to identify subgroups of participants that were particularly responsive to acupuncture. METHODS: We performed a secondary analysis of data for the 638 participants in our clinical trial comparing different types of acupuncture to usual care to identify baseline characteristics that predicted responses to individualized, standardized, or simulated acupuncture treatments. After identifying factors that predicted improvements in back-related function or symptoms, we determined if these factors were more likely to predict improvement for those receiving the acupuncture treatments than for those receiving usual care. This was accomplished by testing for an interaction between the prognostic factors and treatment group in four models: functional outcomes (measured by the Roland-Morris Disability Scale) at 8 and 52 weeks post-randomization and symptom outcomes (measured with a numerical rating scale) at 8 and 52 weeks. RESULTS: Overall, the strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of an acupuncture treatment, and non-use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater with worse pre-treatment levels of back dysfunction (interaction p < 0.004 for the functional outcome, Roland Morris Disability Scale at 8 weeks). No other consistent interactions were observed. CONCLUSION: This secondary analysis found little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short-term benefit from acupuncture.

Omeopatia e fibromialgia

Erik W. Baars, Ernst L. Ellis The effect of Hepar Magnesium D10 on fibromyalgia syndrome: A pilot study.European Journal of Integrative Medicine 2 (2010) 15–21

Objectives: To evaluate the effect of the anthroposophic drug Hepar Magnesium D10 intravenously administered weekly on fibromyalgia symptoms. Methods: Forty-two patients attending their general practitioner for FM complaints were included by 18 general practitioners. Patients were asked to complete the Fibromyalgia Impact Questionnaire (FIQ) at baseline, after five and ten weeks of treatment. Forty-one patients completed the FIQ at baseline and after five weeks. Thirty patients completed the FIQ at baseline and after ten weeks. Cohen’s delta effect sizes were calculated for all FIQ items. Results: After five weeks, nine out of ten FIQ items demonstrated a statistically significant improvement. Cohen’s delta effect size was small in two items, medium in seven items and large in one item. In nine FIQ items the mean improvement was at least 20%. After ten weeks seven FIQ items demonstrated a statistically significant improvement. Cohen’s delta effect size was zero in one item, small in two items, medium in six items, and large in one item. In four FIQ items the mean improvement was at least 20%. Total FIQ score improved by at least 20% in 41.5% and 50% of patients after, five and ten weeks, respectively. Conclusion: There are clear indications that Hepar Magnesium D10 intravenously administered can have a positive effect on FM symptoms after five and ten weeks of treatment. There are indications that a large subgroup benefits from this treatment. A randomized controlled trial is indicated to study the effects of Hepar Magnesium on FM symptoms.

Medicina cinese e diabete

Hui Zhang, Conge Tan, Miqu Wang. Study on the history of Traditional Chinese Medicine to treat diabetes. European Journal of Integrative Medicine 2 (2010) 41–46

Introduction: In order to introduce the diabetology history in Traditional Chinese Medicine (TCM), including nomenclature, understanding, treatment, prevention, etc., our research specifically focused on ancient medical literature used in the evaluation of diabetes inTCM or wasting-thirst (xiao-ke). Methodology: The history of wasting-thirst was classified into four periods: (1) the nomenclature of wasting-thirst; (2) the monograph of wasting-thirst; (3)

the understandings of sweet urine and its extensive development; and (4) the integration of wasting-thirst and diabetes. Results: By mining and reviewing the literature in the 2000-year history of wasting-thirst, it is believed that TCM has a profound understanding of, and effective management on, diabetes and its complications. For period one, wasting-thirst was first recorded in The Yellow Emperor’s Classic of Internal Medicine. For period two, it was elaborated in Treatise on Febrile and Miscellenous Disease, and its “pathology” was summarized as “three wasting-thirsts (upper, middle, lower)” from the perspectives of spatial locations of organs, which serves as a guide in clinical practice. For period three, a self-contained system, including diagnosis, treatment, prevention, nursing, and education, had been established. For period four, wasting-thirst was intimately integrated into diabetes in The Integration of Traditional Chinese Medicine and Western Medicine. Discussion: Traditional Chinese Medicine harbors a long history of treating wasting-thirst/diabetes. With its unique therapeutic approaches, TCM is an effective system of understanding and managing diabetes as proven by medical literatures, clinical benefits and basic research studies.

Fitoterapia e diabete

Sinnathambi Arulmozhi, Papiya Mitra Mazumderb, Antidiabetic and antihyperlipidemic activity of leaves of Alstonia scholaris Linn. R.Br., European Journal of Integrative Medicine 2 (2010) 23–32

Aim of the study: Alstonia scholaris Linn. (R.Br.,) has been used in traditional and folklore medicine for the treatment of diabetes. The aim of the present study was to evaluate the effect of ethanolic extract of the leaves of A. scholaris (known as EEAS) in streptozotocin-induced diabetic rats. Materials and methods: The streptozotocin-induced diabetic rats were orally treated with vehicle (2% w/v Tween 80), glibenclamide (0.25 mg/kg) and EEAS (100, 200 and 400 mg/kg) to the respective treatment groups. The blood glucose level, body weight, glycosylated hemoglobin, muscle and liver glycogen, lipid profile, lipid peroxidation, antioxidant status were measured and histopathology of pancreas was performed after 6 weeks of treatment and compared to the control. Results: EEAS and glibenclamide were found to significantly (p < 0.001) reduce the blood glucose level, glycosylated hemoglobin and lipid peroxidation, whereas they increased body weight, liver and muscle glycogen and antioxidant status. The antidiabetic effect was sustained from 1 week onwards till the end of the study. The histopathology of pancreas revealed that the pancreatic �-cell damage with streptozotocin did not reverse in any of the treatment groups. Conclusion: It has been concluded that EEAS, in addition to the antidiabetic activity, also possess antihyperlipidemic and antioxidant activities in the streptozotocin-induced diabetic model.

Medicina cinese e cancro

YANG Yu-fei and LIAO Juan Exploration of Key Points in Evaluation Criteria of Chinese Medicine in the Treatment of Cancer. Chin J Integr Med 2010 Feb;16(1):3-5

According to the theory of Chinese medicine (CM), the evaluation of how to treat cancer with CM is a criterion of whether the patient's subjective symptoms are being improved or not, which point cannot be understood by Western medicine (WM). On the one hand, almost all cancer patients in China would turn to CM treatment; on the other hand, valid evidences in the CM field cannot be offered to convince specialists in the WM field, and the effectiveness of CM cannot be explained either. Although tumor node metastasis (TNM) staging in WM has been accepted and used with no reserve in the criteria of CM diagnosis and treatment of cancer, some differences still exist between CM and WM in the evaluation criterion. The reason for this focuses on evaluation criterion of effects on solid tumor made by the World Health Organization (WHO), which does not reflect some aspects such as survival time of tumor patients or improvement in quality of life (QOL). Therefore, forerunners in the CM field have been making efforts to try to find an evaluation criteria that would integrate CM and WM, and thus could be approved by CM and WM specialists.

Agopuntura e meridiani

Guang-Jun Wang, M. Hossein Ayati, Wei-Bo Zhang. Meridian Studies in China: A Systematic Review. J Acupunct Meridian Stud 2010;3(1):1−9

Meridian theory is a major part of Chinese medicine and has guided acupuncture and clinical practice for thousands of years. Meridian theory describes many important concepts about the rules of human body function and regulation, but has comparatively huge differences with the basic concepts of modern medicine. These differences have caused deep concern and attracted attention from scholars, both inside and outside of China. The interest in meridian theory lies in determining the structural nature of meridians. Not only is this information still unclear, it is very difficult to achieve clear results in a short period of time. Despite this, the phenomena of meridians can be used as the entry point for meridian studies. After many years of effort, although the physical structure of meridians has not been

found, the existence of the meridian phenomena has been fully confirmed. Although there is a lack of morphological evidence for the existence of the meridian, concluding non-existence may be incorrect as morphology techniques develop and structures previously not determined are being found. Since the phenomenon of meridians exists, some biological basis behind its occurrence must be present. This implies that research on meridians needs to continue as research techniques advance and may eventually reveal the biological basis of the meridian phenomenon. In the present review, we analyze the history of meridian studies in China.

Farmacopuntura e osteoartrite

Eun-Jung Kim et al. Efficacy of Pharmacopuncture Using Root Bark of Ulmus davidiana Planch in Patients With Knee Osteoarthritis: A Double-blind Randomized Controlled Trial. J Acupunct Meridian Stud 2010;3(1):16-23

The aim of this study was to determine whether pharmacopuncture is a clinically effective and safe method for the treatment of knee osteoarthritis. Patients were recruited between August 2008 and December 2008 at the Ilsan Hospital associated with Dongguk University. Patients were randomly assigned to one of the two groups. The experimental group (n = 30) received pharmacopuncture using root bark of Ulmus davidiana Planch (UDP) twice a week for 6 weeks; the control group (n = 30) received normal saline injections. Fifty-three patients completed the trial. After the seventh treatment, we found that UDP pharmacopuncture was more effective in pain improvement using a Visual Analog Scale than was normal saline injection. However, the two interventions were not significantly different as measured by the Western Ontario and McMaster Universities pain score and total pain scores, 36-Item Short Form Health Survey, and Korean Health Assessment Questionnaire. No subject showed any serious adverse effects. The effects of pharmacopuncture treatment were a combination of placebo, needle stimulation, mechanical effect of the solution, and a chemical effect of UDP. However, normal saline used as the control intervention displayed the first three effects, and thus its effect was not inert. This may have influenced the results of the trial, which was statistically insignificant between the two groups, except following the seventh treatment session.

Fitoterapia e canrcinoma gastrico

Kyung-Jun Jang et al. Induction of Apoptosis by Ethanol Extracts of Ganoderma lucidum in Human Gastric Carcinoma Cells. J Acupunct Meridian Stud 2010;3(1):24-31

Ganoderma lucidum, a well-known medicinal mushroom, is highly valued and commonly used in Oriental medicine. Although recent experimental data has revealed the proapoptotic potency of G. lucidum extracts, the underlying mechanisms of this apoptotic activity have not yet been studied in detail. In the present study, the effects of ethanol extracts of G. lucidum (EGL) on the growth of an AGS human gastric carcinoma cell line were investigated. We found that EGL treatment resulted in a dose- and time-dependent significant decrease in the viability of AGS cells. This decreased viability was caused by apoptotic cell death, with observed chromatin condensation and an accumulation of apoptotic fraction. EGL treatment induced the expression of death receptor-related proteins such as death receptor 5 and tumor necrosis factor-related apoptosis-inducing ligand, which further triggered the activation of caspase-8 and the cleavage of Bid. In addition, the increase in apoptosis that was induced by EGL was correlated with activation of caspase-9 and -3, downregulation of IAP family proteins such as XIAP and survivin, and concomitant degradation of poly (ADP-ribose) polymerase. Moreover the activity of Akt was downregulated in EGL-treated cells, and the phosphatidylinositol-3 kinase/Akt inhibitor LY294002 sensitized the cells to EGL-induced apoptosis. The results indicated that EGL induces the apoptosis of AGS cells through a signaling cascade of death receptor-mediated extrinsic, as well as mitochondria-mediated intrinsic, caspase pathways which are associated with inactivation of the Akt signal pathway.

Fitoterapia e radioterapia: interazioni

Stephen M. Sagar, MD Can the Therapeutic Gain of Radiotherapy Be Increased by Concurrent Administration of Asian Botanicals? Integrative Cancer Therapies, Vol. 9, No. 1, 5-13 (2010) McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada, stephen.sagar@jcc.hhsc.ca

Question: Therapeutic gain by radiotherapy can be achieved through improved targeting, selectively sensitizing malignant cells, or protecting normal tissue. The majority of synthetic chemical radiation sensitizers and normal tissue protectors have proved to be too toxic at effective clinical doses. However, Asian botanicals (from both Chinese and Ayurvedic medicine) are being evaluated for their ability to improve therapeutic gain through the modulation of reactive oxygen species. An increase in the efficacy of radiotherapy on tumor tissue allows a reduction in the dose

applied to normal tissues. In addition, some botanicals may selectively protect normal tissue or increase its repair following radiation therapy. The results are promising enough to consider clinical trials.

Response: Brian D. Lawenda, University of the Health Sciences, Bethesda, MD, USA, Indiana University, Indianapolis, IN, USA, brian.lawenda@med.navy.mil . Numerous botanical agents, many of which are used in whole medical system practices (i.e. traditional Chinese medicine, Ayurvedic medicine, etc.), have been shown to exhibit radiomodifying effects on tumors and normal tissues in-vitro and invivo studies. Some of these agents can enhance the therapeutic gain of radiation therapy by either acting as a radiosensitizer to tumor cells and/or as a radioprotector to normal cells. Botanical agents are comprised of multiple phytochemical compounds that may work individually or synergistically to not only improve radiation therapy outcomes, but may also exhibit a variety of anti-cancer effects as well. It will be important to evaluate these botanicals for efficacy, tumor specificity, and safety profiles before they can be recommended during radiation therapy.

Medicina integrata per il cancro a Taiwan

Yi-Hsien Lin, Jen-Hwey Chiu, Kuang-Kuo Chen. Prostate Cancer Patients: A Population-Based Study in Taiwan. Integrative Cancer Therapies, Vol. 9, No. 1, 16-23 (2010). Institute of Traditional Medicine, Division of General Surgery, Cheng Hsin General Hospital, Taipei, Taiwan, ROC, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC, chiujh@mailsrv.ym.edu.tw

Background. Taiwan’s National Health Insurance (NHI) is a comprehensive and universal program, providing Western medicine (WM) and Chinese medicine (CM). This study aims to explore CM use among prostate cancer patients in NHI. Methods. A cross-section retrospective analysis was conducted using registration and claim data sets from the NHI Research Database. In 2007, 22 352 prostate cancer patients with 265 497 visits of CM and WM ambulatory services were identified. Patient demographics, patterns of therapies, and costs were analyzed. Results. In 2007, 592 prostate cancer patients (2.6%) had 4141 CM outpatient visits (7.0 on average). The median age was 73.9. The majority (90.5%) of CM users also used WM ambulatory services. About one third of CM outpatient services were provided by private clinics. The most frequently used CM therapies were Chinese herbal medication (93.6%), followed by acupuncture/traumatology manipulative therapies (7.0%). CM accounted for 0.2% expenditure ($87 500) and 1.6% visits of ambulatory services. The average cost per visit for WM was 6.3 times higher than that for CM ($133.6 vs $21). Conclusions. The prevalence and costs of insurance-covered CM among prostate cancer patients were low. Most prostate cancer patients did not use insurance-covered CM. The majority of CM users also used WM. CM appeared to play a complementary rather than an alternative role.

Astragalo e cancro

Jae Jin Lee, Jung Joo Lee. A Phase II Study of an Herbal Decoction That Includes Astragali Radix for Cancer-Associated Anorexia in Patients With Advanced Cancer. Integrative Cancer Therapies, Vol. 9, No. 1, 24-31 (2010). East-West NeoMedical Center, Kyung Hee University, Seoul, Republic of Korea, lj2lj2@hanmail.net

Hypothesis: Anorexia and cancer cachexia produce significant loss of adipose tissue and muscle mass and eventually reduce survival in cancer patients. Study design: This phase II study was conducted to assess the efficacy and the safety of an herbal decoction with Astragali Radix in patients with anorexia in advanced cancer. Methods: All patients with histologic evidence of an incurable malignancy had a weight loss of at least 5% during the preceding 6 months and a patient-estimated severe anorexia.The herbal decoction was administered 30 minutes after meals, three times a day for 3 weeks.The score of appetite, body weight, the cytokines, IL-1β, IL-6, TNF-, and anthropometric measurements were assessed. For the assessment of anorexia, a visual analog scale (VAS: 0 mm = no anorexia, 100 mm = maximal anorexia) was used. Results: Eleven patients were recruited from January, 2007 to January, 2009. The mean age was 59.8 years old. The change in anorexia from baseline with the herbal decoction was significantly different and anorexia was improved (anorexia VAS score, 60mm vs. 40mm, p = 0.008). The mean value of the maximal body weight was 55.6 kg and differed significantly from the 54.6 kg at baseline (p = 0.009). Changes in cytokine levels and anthropometric measurements from baseline to the 3rd week were not significant. All toxicities were manageable. Conclusion: Appetite and body weight were improved with the herbal decoction. This herbal decoction shows some potential for management of cancer-related anorexia.

Oncologia integrata

Jeremy R. Geffen, MD, FACP. Geffen Visions International Inc, Boulder, CO, USA, jgeffen@geffenvisions.com Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care. Integrative Cancer Therapies, Vol. 9, No. 1, 105-121 (2010)

Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing— a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.

Biologico: etichetta

Emanuele Piccari. Etichettatura - la nuova etichetta dei biologici. Newsletter dell'unione nazionale consumatori, maggio 2010

Dal 1 luglio prossimo sull’etichetta degli alimenti biologici deve essere obbligatoriamente riportato il nuovo logo comunitario costituito da una foglia su fondo verde, formata da stelle una delle quali è una cometa. Inoltre deve essere riportata l’indicazione del luogo in cui sono state coltivate le materie prime da cui il prodotto è composto (per esempio, Agricoltura UE o Agricoltura non UE), oppure anche Agricoltura italiana quando tutte le materie sono state coltivate in Italia. L’uso del logo comunitario e l’indicazione di origine sono facoltativi per i prodotti importati dai paesi terzi. Tuttavia, se il logo comunitario figura nell’etichettatura dei prodotti dei Paesi terzi, questa riporta anche l’indicazione d’origine per tale categoria di prodotti. Devono altresì figurare obbligatoriamente in etichetta:

1. il numero di codice dell’Organismo di controllo che compare in etichetta è rappresentato dal codice attribuito dal MIPAAF a ciascun Organismo di controllo al momento dell’autorizzazione ad operare;

2. al codice di cui al precedente paragrafo, è aggiunto il termine BIO tra la sigla IT e il codice dell’Organismo di controllo, che è rappresentato da tre lettere. Tale codice deve essere preceduto dalla dicitura: “Organismo di controllo autorizzato dal MIPAAF”;

3. fatte salve le disposizioni vigenti in materia di etichettatura dei prodotti alimentari, sui prodotti preconfezionati da agricoltura biologica deve essere riportato il nome o la ragione sociale dell’operatore che ha effettuato la produzione o la preparazione più recente, ivi inclusa l’etichettatura, nonché il codice identificativo attribuito dall’organismo di controllo. Il codice è preceduto dalla dicitura “operatore controllato n. …”;

4. nelle more della definizione di specifiche norme per la produzione di “vino e prodotti ottenuti da vino da agricoltura biologica” da parte della Commissione UE, viene consentita la possibilità di fare riferimento in etichetta al metodo di produzione biologica esclusivamente per le uve.

Cancro in pediatria e CAM

Bishop FL, Prescott P, Chan YK, Saville J, von Elm E, Lewith GT. Prevalence of complementary medicine use in pediatric cancer: a systematic review. Pediatrics. 2010 Apr;125(4):768-76. Epub 2010 Mar 22.

CONTEXT: Complementary and alternative medicine (CAM) is used by pediatric patients with cancer, but the actual frequency of CAM use is undetermined. OBJECTIVE: In this systematic review we summarize the current evidence on the prevalence of CAM use in pediatric patients with cancer and assess the reported quality of included studies. METHODS: We systematically searched 6 major electronic databases, reference lists of existing reviews, and personal files. We included full articles about primary research studies (without language restriction) that reported the prevalence of CAM use if all or a defined subsample of participants were pediatric patients with cancer. Detailed information regarding methods and results was extracted from the original articles. A quality-assessment tool was rigorously developed on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology

(STROBE) statement and used to assess reported study quality. Formal tests of interrater agreement were conducted. RESULTS: We included 28 studies with survey data (collected from 1975 to 2005) from 3526 children. In 20 studies with 2871 participants, the prevalence of any CAM use (since cancer diagnosis) ranged from 6% to 91%; considerable heterogeneity across studies precluded meta-analysis. Study quality was mixed and not correlated with CAM prevalence. Herbal remedies were the most popular CAM modality, followed by diets/nutrition and faith-healing. Commonly reported reasons for CAM use included to help cure or fight the child's cancer, symptomatic relief, and support of ongoing use of conventional therapy. There was little evidence of an association between CAM use and patients' sociodemographic characteristics. CONCLUSIONS: Many pediatric patients with cancer use CAM. It is important that pediatricians be aware of this fact and encourage open communication with patients and their parents. Using standardized survey methods and CAM definitions in future studies could improve their quality and help generate comparable data. Our quality-assessment tool could prove valuable for other reviews of prevalence studies.

Omeopatia e effetto placebo

Nuhn T, Lüdtke R, Geraedts M. Placebo effect sizes in homeopathic compared to conventional drugs - a systematic review of randomised controlled trials. Homeopathy. 2010 Jan;99(1):76-82.

BACKGROUND: It has been hypothesised that randomised, placebo-controlled clinical trials (RCTs) of classical (individualised) homeopathy often fail because placebo effects are substantially higher than in conventional medicine. OBJECTIVES: To compare placebo effects in clinical trials on homeopathy to placebo effects on trials of conventional medicines. METHODS: We performed a systematic literature analysis on placebo-controlled double-blind RCTs on classical homeopathy. Each trial was matched to three placebo-controlled double-blind RCTs from conventional medicine (mainly pharmacological interventions) involving the same diagnosis. Matching criteria included severity of complaints, choice of outcome parameter, and treatment duration. Outcome was measured as the percentage change of symptom scores from baseline to end of treatment in the placebo group. 35 RCTs on classical homeopathy were identified. 10 were excluded because no relevant data could be extracted, or less than three matching conventional trials could be located. RESULTS: In 13 matched sets the placebo effect in the homeopathic trials was larger than the average placebo effect of the conventional trials, in 12 matched sets it was lower (P=0.39). Additionally, no subgroup analysis yielded any significant difference. CONCLUSIONS: Placebo effects in RCTs on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

Fiori di Bach e omeopatia

Halberstein RA, Sirkin A, Ojeda-Vaz MM. When less is better: a comparison of Bach Flower Remedies and homeopathy. Ann Epidemiol. 2010 Apr;

PURPOSE: Homeopathy and Bach Flower Remedies (BFRs), historically-related complementary healing modalities classified as prescription/nonprescription drugs and over-the-counter homeopathic nutritional supplements, respectively, are compared with respect to indications, dosage philosophies, associated procedures, reported outcomes, safety profiles, and the possible operation of the placebo effect. METHODS: Original data and published research reports, including case studies, retrospective meta-analyses, and double-blind clinical trials are compiled and evaluated for both healing systems. RESULTS: Homeopathy and BFR therapy both feature highly diluted natural medicinal substances, flexible dosage schedules tailored to individual patients, and energy-based healing action. They differ with respect to practitioner training and certification, number and types of medicinal source materials, remedy combinations and applications, and potential toxicity or other side-effects. CONCLUSIONS: Extensive testing has produced mixed or equivocal results regarding the efficacy of both of these health care systems. While a variety of positive outcomes have been frequently recorded with Homoeopathy and BFR treatments, it is likely that the placebo effect operates to a significant extent in both approaches.

Uso dell’iperico nella depressione

Klaus Linde, Gilbert Ramirez, Cynthia D Mulrow, Andrej Pauls, Wolfgang Weidenhammer, Dieter Melchart St John's wort for depression - an overview and meta-analysis of randomised clinical trials. BMJ No. 7052 Volume 313 Saturday 3 August 1996

Objective - To investigate if extracts of Hypericum perforatum (St John's wort) are more effective than placebo in the treatment of depression, are as effective as standard antidepressive treatment, and have fewer side effects than standard antidepressant drugs. Design - Systematic review and meta-analysis of trials revealed by searches.

Trials - 23 randomised trials including a total of 1757 outpatients with mainly mild or moderately severe depressive disorders: 15 (14 testing single preparations and one a combination with other plant extracts) were placebo controlled, and eight (six testing single preparations and two combinations) compared hypericum with another drug treatment. Main outcome measures - A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group), and numbers of patients reporting and dropping out for side effects. Results - Hypericum extracts were significantly superior to placebo (ratio = 2.67; 95% confidence interval 1.78 to 4.01) and similarly effective as standard antidepressants (single preparations 1.10; 0.93 to 1.31, combinations 1.52; 0.78 to 2.94). There were two (0.8%) drop outs for side effects with hypericum and seven (3.0%) with standard antidepressant drugs. Side effects occurred in 50 (19.8%) patients on hypericum and 84 (52.8%) patients on standard antidepressants. Conclusion - There is evidence that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders. Further studies comparing extracts with standard antidepressants in well defined groups of patients and comparing different extracts and doses are needed.

Effetti della respirazione diaframmatica sulla variabilità del battito cardiaco in ischemia con diabete.

Anupama Bangra Kulur; Nagaraja Haleagrahara; Prabha A; Jeganathan P. S. Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes. Cardiologia vol.92 no.6 São Paulo June 2009

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved. OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes. METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year. RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM:

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved. OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes. METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year. RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients. CONCLUSION: The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.

Efficacia delle terapie manuali: uno studio dal regno unito

Effectiveness of manual therapies: the UK evidence report. Bronfort G, Haas M, Evans R, Leiniger BTriano J. Chiropractic & Osteopathy 2010, 18:3

ABSTRACT: BACKGROUND: The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. METHODS: The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. RESULTS: By September

2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines. Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. CONCLUSIONS: Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation. Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.

Qigong e qualità della vita in pazienti con tumore

Oh B, Butow P, Mullan B, Clarke S, Beale P, Pavlakis N, Kothe E, Lam L, Rosenthal D. Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial, Annals of Oncology, Volume 21, Issue 3, pp. 608-614

BACKGROUND: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. PATIENTS AND METHODS: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy-General and Functional Assessment of Cancer Therapy-Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. RESULTS: Regression analysis indicated that the MQ group significantly improved overall QOL (t(144) = -5.761, P < 0.001), fatigue (t(153) = -5.621, P < 0.001), mood disturbance (t(122) =2.346, P = 0.021) and inflammation (CRP) (t(99) = 2.042, P < 0.044) compared with usual care after controlling for baseline variables. CONCLUSIONS: This study indicates that MQ can improve cancer patients' overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Tai qi e qigong per la salute negli usa

Birdee GS, Wayne PM, Davis RB, Phillips RS, Yeh GY. T'ai chi and qigong for health: patterns of use in the United States. Journal of Alternative and Complementary medicine, 2009 September, 19 (9): 969-73

BACKGROUND: Little is known in the United States about those who practice t'ai chi and qigong, two mind-body techniques that originated in Asia. OBJECTIVE: The objective of this study is to characterize use of t'ai chi and qigong for health with regard to sociodemographics, health status, medical conditions, perceptions of helpfulness, and disclosure of use to medical professionals. METHODS: We analyzed associations of t'ai chi and qigong use for health using cross-sectional data from the 2002 National Health Interview Survey (NHIS) Alternative Medicine Supplement (n = 31,044). The 2002 NHIS estimated the number of t'ai chi and qigong users for health to be 2.5 and 0.5 million persons, respectively. We collapsed t'ai chi and qigong use into a single category (TCQ) for analysis, representing 2.8 million individuals. RESULTS: We found that neither age nor sex was associated with TCQ use. TCQ users were more likely than nonusers to be Asian than white (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.30-3.15), college educated (OR 2.44, 95% CI 1.97-3.03), and less likely to live in the Midwest (OR 0.64, 95% CI 0.42-0.96) or the southern United States (OR 0.51, 95% CI 0.36-0.72) than the West. TCQ use was associated independently with higher reports of musculoskeletal conditions (OR 1.43, 95% CI 1.11-1.83), severe sprains (OR 1.65, 95% CI 1.14-2.40), and asthma (OR 1.50, 95% CI 1.08-2.10). Half of TCQ users also used yoga for health in the last 12 months. Most TCQ users reported their practice to be important to maintain health, but only a quarter of users disclosed their practice to a medical professional. CONCLUSIONS: In the United States, TCQ is practiced for health by a diverse population, and users report benefits for maintaining health. Further research is needed to establish efficacy and safety for target populations, including those with musculoskeletal and pulmonary disease, as well as for preventive health.

Efficacia del canto in pazienti affetti da ostruzioni polmonari (copd)

Bonilha AG, Onofre F, Vieira ML, Prado MY, Martinez JA. Effects of singing classes on pulmonary function and quality of life of copd patients. Int J Chron Obstruct Pulmon Dis. 2009; 4: 1–8. Published online 2009 April 15.

This study aimed to investigate the effects of weekly singing classes on pulmonary function parameters and quality of life (QoL) of COPD patients. Forty-three patients were randomized to weekly classes of singing practice, or handcraft work. They performed spirometry and completed maximal respiratory pressure measurements, evaluations of dyspnea, and the Saint George's Respiratory Questionnaire, before and after 24 training classes. A functional evaluation, immediately after 10 minutes of singing practice, was also performed at the end of the study. Fifteen subjects completed the study in each group. In comparison to controls the singing group exhibited transitory elevations on the dyspnea Borg scale (p = 0.02), and inspiratory capacity (p = 0.01), and decreases of expiratory reserve volume (p = 0.03), just after a short session of singing. There was a significant difference on changes of maximal expiratory pressures in the comparison between groups at the end of training. While the control group showed deterioration of maximal expiratory pressure, the singing group exhibited a small improvement (p = 0.05). Both groups showed significant improvements of QoL in within group comparisons. We have concluded that singing classes are a well tolerated activity for selected subjects with COPD. Regular practice of singing may improve QoL, and preserve the maximal expiratory pressure of these patients.

Te verde e effetti avversi

George D. Liatsos; Antonios Moulakakis; Ioannis Ketikoglou; Stella Klonari. Possible Green Tea-induced Thrombotic Thrombocytopenic Purpura; American Journal of Health-System Pharmacy. 2010;67(7):531-534.

Purpose. A case of a patient who developed thrombotic thrombocytopenic purpura (TTP) after consuming a weight-loss product containing green tea is reported. Summary. A 38-year-old, 68-kg Caucasian woman arrived at the emergency department with a one-week history of malaise, fatigue, and petechiae of the skin. She had no symptoms of infection and denied illegal drug use. Her medical history included hypothyroidism, for which she was treated with levothyroxine 150 µg daily for the past four years. She reported that she had been using a green tea preparation for the two months before admission to lose body weight. The daily preparation contained 200 mg of green tea extract 5:1, equivalent to 1 g of natural green tea. On clinical examination, the patient appeared acutely ill and was afebrile, with pallor, petechiae, and purpura of the extremities. Laboratory test results at the time of admission revealed that the patient had anemia and marked thrombocytopenia. A peripheral blood smear demonstrated a feature of microangiopathic hemolytic anemia. Immunoglobulin G autoantibodies against ADAM metallopeptidase with thrombospondin type 1 motif, 13 were detected. On hospital day 3, the patient appeared confused and exhibited aphasia that was initially transient but then recurrent. Brain computerized tomography did not exhibit focal pathology. Over the next few days, her neurologic symptoms subsided and her platelet count and hematocrit value gradually increased. Plasmapheresis was performed (12 procedures). Corticosteroid treatment was also initiated. After 20 days of hospitalization, the patient was discharged. Conclusion. A 38-year-old woman developed TTP after consuming a weight-loss product containing green tea extract for two months.

Metodi naturali e ipertensione

Marvin Moser, Effective Treatment of Hypertension Without Medication: Is It Possible? Journal of Clinical Hypertension

In this issue of The Journal of Clinical Hypertension, Wilburn and associates review data on the management of hypertension using vitamins, minerals, herbs, and other botanicals and discuss specific agents that were found, in a review of the literature, to lower blood pressure to a degree that was considered clinically significant.[1] It is important to put these and other nonpharmacologic approaches to the treatment of hypertension in perspective.

Lifestyle Changes. For many years, the media has advised the general public that losing weight, reducing sodium intake, performing moderate exercise, and moderating alcohol intake are sufficient to reduce blood pressure in a large number of patients. National committees also appropriately suggest this approach as initial therapy for hypertensive individuals[2] -- but how well does this work, and in how many patients is it effective without some medication?

Numerous studies have demonstrated that in a number of people, blood pressure can be reduced by following a low-sodium diet. Many of these trials were short term, many involved a reduction in sodium that would be impractical for most people, and many lacked adequate controls. However, based on long-term epidemiologic data and the overall results of studies that demonstrated the benefits of dietary sodium reduction, national guideline committees have recommended a reduction in sodium for all hypertensive patients and indeed for most everyone.[3] This is a reasonable recommendation. As a nation we ingest far too much sodium. As a public health measure, a decrease in

sodium intake is to be encouraged. But sodium restriction alone will not lower blood pressure to goal levels except in some cases of stage 1 hypertension.

Another nonpharmacologic recommendation for hypertension treatment is weight loss, and there is little doubt that weight loss is an effective treatment for many patients (in fact, probably the most effective of all recommended strategies). However, persistent weight loss is difficult to maintain over time. If weight loss is achieved and maintained and blood pressure is reduced, no further action is needed. But this approach should not be considered definitive treatment for most persons with hypertension. If, in the course of medical management with specific antihypertensive drugs, a weight loss of 15 or 20 lb occurs and goal blood pressures have been achieved, medication can be stopped to see if blood pressures remain at acceptable levels.[4]

There is little doubt that increasing exercise can reduce blood pressure. Again, however, there are few data indicating that this modality can be depended on as definitive treatment for the majority of persons with hypertension, especially if the newer goals of blood pressure control are to be met.

Moderation of alcohol from an intake of more than four or five drinks per day to one or two drinks per day has also been shown to reduce blood pressure to some degree in some patients.

If all of the interventions that have proven most effective (weight loss, sodium intake reduction, and a program of moderate exercise) are followed, it is possible that as many as 20% of patients with hypertension will not have to be treated with medication (exact numbers have not been quantified in real-world situations). This is a considerable number, but the large remaining percentage of the population will require pharmacologic therapy to control blood pressure.

Under ideal conditions, a weight reduction of about 20 lb will reduce systolic blood pressure by about 10-20 mm Hg, sodium restriction by about 3-6 mm Hg, physical activity by about 5-8 mm Hg, and moderation of alcohol intake by 2-4 mm Hg. If a Dietary Approaches to Stop Hypertension (DASH) diet eating plan (emphasizing fruits, vegetables, and low-fat dairy products) can be followed, a decrease of about 10-12 mm Hg can be expected.[5] These are not insignificant changes but are not as readily achievable in practice as they are in specialized clinics or studies.

The bottom line is that the nonpharmacologic approach to management of hypertension with lifestyle changes may be effective in some patients but should not be depended on by most as definitive treatment.

Natural Treatments. The natural treatment of hypertension, which has been advocated by many groups through the years, is being reexamined. People are reacting to being bombarded by advertisements for medications. But there are questions. "Natural" products, which are often considered safe, are preferred by many patients instead of medication. Yet some of these substances, as pointed out by Wilburn et al., are not quite as safe as might be imagined. In fact, some may be less safe or more harmful than some of the antihypertensive medications in use today. Advertisements in nutrition magazines herald improvement in lifestyle and equivalent results to medicines with natural remedies. Billions of dollars per year are spent on these therapies with the expectation that not only can hypertension be controlled but also hyperlipidemia and other disease states. An example of this is garlic. Wilburn and colleagues note that garlic is considered "possibly effective" when taken by mouth for hypertension. Several years ago, my colleagues and I attempted to determine (in a placebo-controlled study) if the use of a garlic preparation with little odor would result in a decrease in blood pressure. An adequate dose of garlic was given in this study, which reported no effect on blood pressure (and also no effect on lipid parameters).[6] Several studies and meta-analy-ses have, however, claimed that garlic is effective and, as we all know, it is still being advertised as a measure to lower cholesterol levels and blood pressure. The data upon which these advertisements are based are either from uncontrolled, short-term studies or from meta-analyses that included short-term, uncontrolled studies. Garlic adds flavor to food and is harmless (except in people who may have a sensitivity to its active ingredients), but despite the theoretic considerations about its effects on blood clotting and cholesterol synthesis, should not be used with expectations of important benefits regarding cholesterol or blood pressure reductions. Wilburn and colleagues also present a fair view of what can be expected with the use of agents such as L-arginine, a substrate of nitric oxide. It might be assumed that this agent would be effective in lowering blood pressure. Nitric oxide is a vasodilator that also has some beneficial effects on platelet aggregation and endothelial dysfunction. However, as the authors point out, L-arginine might not be effective in the long-term management of hypertension. A review of data on vitamin C, a substance that is also listed as "possibly effective" in the treatment of hypertension and is taken by literally millions of people, indicates that the message is not clear. Although some studies demonstrate a reduction of more than 10 mm Hg in systolic blood pressure, the effect on diastolic pressure is minimal. Here again, many of the studies on vitamin C failed to have an adequate control group. A great deal of emphasis has been placed in recent years on the use of high doses of omega-3 fatty acids. It has been reported that the intake of these substances reduces cholesterol levels. It has been claimed that blood pressure is lowered. Benefit, however, is only reported when large numbers of capsules of omega-3 acids are taken. Side effects are noted and most people stop taking the capsules. While there is some evidence that large doses of omega-3 acids will lower blood pressure, the use of this method of treatment is probably not practical for a

majority of patients. Should Nonpharmacologic or Natural Therapies Be Depended on as Definitive Therapy for Hypertension? It appears that while the commonly used non-pharmacologic approaches to hypertension management, such as weight loss, sodium restriction, exercise, and moderation of alcohol intake, will lower blood pressure, the majority of patients will require specific antihypertensive medication to achieve blood pressure goals.[7] With regard to the use of natural substances to support a "healthy cardiovascular system," there is little definitive long-term proof that the use of these agents, even the ones culled from the literature by Dr. Wilburn's group, have a sustained, dependable effect on blood pressure lowering. One can consider using these agents as adjuncts to lifestyle changes or along with conventional antihypertensive therapy. Some may produce some decrease in blood pressure, but major effects may not be noted. The public and physicians alike should also be concerned that these so-called safe and natural substances may produce side effects and may interfere with the action of other agents. Although all of us would like to be in charge of our own destiny and be able to control cardiovascular risk factors such as hypertension and dyslipidemia without medication, this is the wrong message to pass on to the public. We have progressed from the time when Dr. Irvine Page, a pioneer in hypertension treatment, described the use of watermelon seeds, garlic, and a host of other relatively ineffective remedies for the management of hypertension to a time when we have specific, effective and safe antihypertensive medications. We no longer should depend on anecdotal evidence or poorly designed studies to determine therapy choice. It is possible that additional studies may demonstrate that some of the herbal products, vitamins, or plant substances do have an ongoing significant effect on blood pressure. Until then, we can continue to use nonpharmacologic interventions and lifestyle changes and acknowledge that some of the natural treatments described by Wilburn and coworkers may help to lower blood pressure still further. At the same time, however, it should be recognized that specific medications are necessary in almost all cases and that side effects or drug-drug interactions may further limit the use of so-called natural remedies.

Broccoli e cellule cancerogene

Yanyan Li et al. Sulforaphane, a Dietary Component of Broccoli/Broccoli Sprouts, Inhibits Breast Cancer Stem Cells. Clin Cancer Res 16(9); 2580–90. May 1, 2010

Purpose: The existence of cancer stem cells (CSCs) in breast cancer has profound implications for cancer prevention. In this study, we evaluated sulforaphane, a natural compound derived from broccoli/broccoli sprouts, for its efficacy to inhibit breast CSCs and its potential mechanism. Experimental Design: Aldefluor assay and mammosphere formation assay were used to evaluate the effect of sulforaphane on breast CSCs in vitro. A nonobese diabetic/severe combined immunodeficient xenograft model was used to determine whether sulforaphane could target breast CSCs in vivo, as assessed by Aldefluor assay, and tumor growth upon cell reimplantation in secondary mice. The potential mechanism was investigated using Western blotting analysis and β-catenin reporter assay. Results: Sulforaphane (1-5 μmol/L) decreased aldehyde dehydrogenase–positive cell population by 65% to 80% in human breast cancer cells (P < 0.01) and reduced the size and number of primary mammospheres by 8- to 125-fold and 45% to 75% (P < 0.01), respectively. Daily injection with 50 mg/kg sulforaphane for 2 weeks reduced aldehyde dehydrogenase–positive cells by >50% in nonobese diabetic/severe combined immunodeficient xenograft tumors (P = 0.003). Sulforaphane eliminated breast CSCs in vivo, thereby abrogating tumor growth after the reimplantation of primary tumor cells into the secondary mice (P < 0.01). Western blotting analysis and β-catenin reporter assay showed that sulforaphane downregulated the Wnt/β-catenin self-renewal pathway. Conclusions: Sulforaphane inhibits breast CSCs and downregulates the Wnt/β-catenin self-renewal pathway. These findings support the use of sulforaphane for the chemoprevention of breast cancer stem cells and warrant further clinical evaluation. ©2010 AACR.

Studio sulla biodisponiiblità degli antocianosidi del mirtillo.

P. E. Milbury, J. A. Vita, J. B. Blumberg: Anthocyanins are Bioavailable in Humans following an Acute Dose of Cranberry Juice. The Journal of Nutrition

A new US study shows cranberry juice anthocyanins have only limited absorption but the researchers note that, in spite of this low bioavailability, the levels may be sufficient to generate a sustained health beneficial effect in terms of cell metabolism and gene expression. Cranberries contain a variety of anthocyanins, which are a sub-group of flavonoids, with reports in the literature suggesting flavonoids are powerful antioxidants, protecting the body from oxidative stress. Health benefits recently linked to cranberries include cardioprotective effects, anti-cancer properties and reversal of age-related motor behavioural deficits. However, the authors of the study, which was published in The Journal of Nutrition, said that teh compounds responsible for this bioactivity have not yet been fully determined. The researchers, based at Tufts University and Boston University Medical Center, said that, to their knowledge, there have been no detailed pharmacokinetic studies of anthocyanins after acute cranberry juice consumption. They added that little is known about the absorption and metabolism of anthocyanins. And the trigger for their research, they said, was

a desire to increase understanding of the bioavailability and benefits of these compounds. Method. Fifteen volunteers with an average age of 62 and with established coronary artery disease were recruited to participate in this research, said the authors. They explained that after fasting overnight, the participants arrived at the Boston University Medical Center where they each drank 480 ml of a double-strength cranberry juice containing 94 mg anthocyanins. Plasma samples, continued the scientists, were taken immediately prior to juice consumption and then at intervals of one, two, three and fours hours subsequent to drinking the juice. They added that urine was collected at the beginning and end of the four hour study, with samples then analyzed for anthocyanin concentrations. Findings. Following cranberry juice consumption, the researchers said they were able to detect 7 of the 15 known cranberry-derived anthocyanins in both blood and urine, while highest plasma concentrations tended to occur within 1.4 hours after consumption. However, they found that the concentrations detected in plasma confirmed a relatively low level of intestinal absorption of these compounds. In addition, the scientists said they found significant variability among individuals in terms of when and how much of the anthocyanins were absorbed and excreted. Recovery of these compounds in the urine ranged from 0.078-3.2 per cent, added the authors. This variability, they explained, might be due to small genetic differences (polymorphisms) leading to differences in absorption and metabolic clearance between individuals or to differences intestinal microorganism populations that break down and metabolize the various anthocyanins. The authors concluded that circulating anthocyanin levels after cranberry juice consumption are too low to have health beneficial effects in terms of free radical quenching. But they concluded that the levels of the compounds may be sufficient to influence cell signal transduction, gene expression, and cellular metabolism and could have a more sustained health beneficial effect.