text:
Is economic evaluation...
Is economic evaluation in touch with society's health values?
Education And Debate
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7476.1233 (Published 18 November 2004) Cite this as: BMJ 2004;329:1233
Joanna Coast (jo.coast{at}bristol.ac.uk), senior lecturer in health economics1
1 Department of Social Medicine, University of Bristol, Bristol BS8 2PR
Accepted 16 September 2004
Health funding is increasingly based on the results of economic evaluation. But current methods fail to consider all society's health objectives and are too complex for policy makers to use
The technical expertise required for conducting economic evaluations and interpreting their results continues to increase. Current best practice includes cost effectiveness acceptability curves, net-benefit frameworks, and probabilistic modelling.1 These methods are valuable, but by generating a pseudoscientific aura around economic evaluation, they camouflage critical weaknesses in current techniques. In this article, I describe the evolution of economic evaluation in health care (see box for terminology), explore the assumptions underlying current approaches and the resulting concerns, and suggest an alternative approach.
Why do we need economic evaluation?
People who are not economists often find it difficult to understand the importance of the theory behind the comparison of costs and effects. After all, if we compare two washing machines of equal cost and one works for 10 years and the other for 15, it is clear that the machine lasting 15 years is a better buy. The need for theory arises, however, because interpersonal rather than within individual comparisons are involved; in health care the question is not, generally, whether I choose the 10 or 15 year washing machine but whether I get the 10 year washing machine or you get the one lasting 15 years.
Welfare economics
Economic evaluation stems from Paretian welfare economics. It incorporates the principles that individuals are the best judges of their own wellbeing and that, if one person can be made better off without another being made worse off, there is global improvement in welfare. This value judgment is uncontroversial but, in policy terms, practically useless: few policies benefit some individuals without affecting others.
Terminology used in economic evaluation
Cost benefit analysis—Costs valued in money and compared with outcomes also valued in money
Cost effectiveness analysis—Costs valued in money and compared with a single primary outcome
Cost utility analysis—A specific form of cost effectiveness analysis in which outcomes are measured in terms of QALYs gained
QALY—Quality adjusted life year. A measure that combines length of life and quality of life (valued on an index where 1 represents perfect health and 0 represents death) into a single outcome
Cost-benefit analysis translates welfare economics into something that can inform decision making. The compensation principle is used to make interpersonal comparisons. This states that global improvement will occur if individuals gaining from change could potentially compensate those who lose and still be better off. So, if my "welfare" increases more than yours from receiving a washing machine, I could potentially compensate you and still be better off; global welfare increases if I get the washing machine and you do not. An important caveat is that compensation is not actually paid: the aim is to generate global welfare improvements and distribution is irrelevant.
Cost-benefit analysis uses individuals' willingness to pay to assess the benefit of an intervention. So, for example, if group A is willing to pay more for programme X than group B requires in compensation for the loss of programme Y, there is global welfare improvement from allocating resources to X (benefiting A) rather than Y (benefiting B). Funding programme X maximises benefit to society and is thus more efficient.
There are two difficulties with cost-benefit analysis in health care. Firstly, the use of willingness to pay to measure welfare implicitly incorporates income into decision making. This may skew allocation of healthcare resources towards the wealthy. Secondly, many people are uncomfortable with valuing length and quality of life in monetary terms and thus unwilling to participate in such exercises. These difficulties have led to the development of alternative techniques of economic evaluation and, indeed, changes in underlying theory.
Non-welfare approaches
Alternatives to welfare economics move away from reliance on individual welfare and instead aim to pursue societal objectives. They are referred to as non-welfarist approaches2 or, more specifically, decision maker approaches3 4 and extra-welfarism.5 These approaches all subscribe to the same healthcare objective: maximising health output from available resources. They differ in the stated theoretical bases for this objective. The decision maker approach focuses on societal objectives as given by decision makers; extra-welfarism is ostensibly based in Sen's notions of functioning and capabilities6 but, given dissent about whether this moral theory provides sufficient basis for relying on health alone as an outcome for economic evaluation,7 the non-welfarist approaches largely rely on achieving societal healthcare objectives.2
Cost effectiveness analysis results from this theoretical perspective, with the quality adjusted life year (QALY) as the chosen outcome. Over the past 10 years, the QALY has become increasingly accepted and used despite the continued existence of theoretical and methodological problems noted during its development.8 Recent advances in economic evaluation are clearly situated in this non-welfarist approach, with emphasis on methodological advances in dealing with uncertainty.1
Camouflaged assumptions associated with recent advances
The non-welfarist approach has enabled economic evaluation to move forward despite the perceived constraints of welfare economics. Three fundamental assumptions of this approach are, however, overlooked: congruence between the objectives of decision makers and those enshrined in economic evaluation; the validity of funnelling multiple outcomes into one simplistic outcome such as the QALY; and the meaningfulness of these complex techniques to decision makers.
Coherent basis for economic evaluation
Non-welfarist approaches to economic evaluation assume that a decision maker acts on behalf of society and that the objective of the healthcare system is thus to maximise health output (as valued by society) from available resources. Even aside from doubts over the existence of this mythical decision maker with a clear set of objectives, the desire to maximise health seems to be largely the objective of economists rather than society. There are three reasons for this view. Firstly, empirical evidence shows that the single objective of maximising health output would not be the basis on which society would wish to allocate its healthcare resources.9 10 Secondly, approaches to rationing based entirely on the cost-utility approach have failed to convince decision makers in practice.11–13 This suggests that maximising health output is not an exclusive objective for decision makers. Thirdly, work on the values on which the NHS is based shows that health is only one of many values and that maximisation of health (as opposed to achieving some form of equity in health) is only a subcategory.14
Thus, ascribing the objective of maximising health to decision makers is no more than a convenience. Any genuine decision maker approach would involve aspects related to equity, need, access, and so on. Economic evaluation based on the non-welfarist approach thus falls into a theoretical void: it is not based on welfare economic theory, nor does it represent all of the decision maker's objectives.
Cost per QALY gained provides sufficient information about the efficiency of an intervention
Even if maximising health output is the appropriate objective for the health system, increasing emphasis on cost-utility analysis results in a conflation of "health" with QALYs gained by the patient. This "funnelling" of various health outcomes into one, simplistic, single measure, is a further camouflaged assumption receiving less attention than it should.
Indeed, cost effectiveness analysis is increasingly aligned with the biostatistical desire for a single primary outcome in design efficient trials. For many interventions, the focus on a single outcome, even with extensive complex statistical analysis of the uncertainty around the estimates obtained, misses the point. For organisational and other complex interventions, in particular, several health outcomes will be important, not just QALYs. For example, a systematic review of interventions to improve access to health and social care after discharge from hospital found patient outcomes related to mortality, function and disability, quality of life, social support, self esteem, cognitive ability, and satisfaction with services.15 Furthermore, there are often health outcomes for others, including informal caregivers and parents, as well as important external effects—for example, development of antimicrobial resistance. Use of a single outcome for cost effectiveness analysis fails to recognise that decision making involves making judgments about a variety of important effects rather than just one.
Presentation of economic evaluations is meaningful to decision makers
The third questionable assumption is that the complex technical presentation of results from economic evaluation is meaningful to the decision makers for whom it is intended. Studies have shown that decision makers find the concepts behind QALYs difficult to understand16 and that knowledge about formal methodology is limited.17 Recent advances in method place even greater burden on understanding than when these studies were done. The use of cost effectiveness acceptability curves is now advocated. These plot the relative probabilities of each intervention being the most cost effective option given different levels of maximum societal willingness to pay for the unit of outcome, usually QALYs. Decision makers must now identify their maximum willingness to pay for a QALY and then interpret the relative probabilities that different alternatives are the most cost effective option at that particular maximum. When many decision makers do not fully understand the basis for QALYs, expecting them to identify their maximum willingness to pay for additional QALYs on behalf of society seems nonsensical.
An alternative route
Two potential dangers arise from following the narrow philosophy with which recent advances are associated. The first is that economic evaluation becomes margin-alised and the anxiety among health economists about its lack of influence continues to grow. The second, more worrying, is that this limited approach is followed by those who do not fully understand its basis and thus decisions are taken which neither reflect society's objectives nor its health beliefs. Discussion among economists about the NICE threshold for cost per QALY gained is a disquieting example of this phenomenon.18
An alternative is to restrict all economic evaluations to the approach of cost-consequences. Different options are contrasted clearly and explicitly in tabular form for all the relevant costs (resource use) and consequences (for a recent example see Jacklin et al19). This approach allows decision makers (on behalf of society) to impute their own values to these costs and consequences, which could differ according to local context. Decision makers can see clearly what is included and what is omitted, where information is quantitative and where qualitative. Information about implications for equity, need, and other relevant objectives can be presented as well as information about the health effect on others such as informal caregivers.
To illustrate the outputs from, and uses of, the two approaches let's examine an hypothetical analysis for a comparison of hospital at home and hospital care. The outcome is based on QALYs formed from a five dimension quality of life scale. The cost of treating the patient in the hospital at home was £1200 more than in hospital and made little difference to the mean number of QALYs gained (0.02), where QALYs combine information about mortality and quality of life. This results in an incremental cost per QALY gained for hospital at home of £60 000 ($107 000, €87 000). Using the cost effectiveness acceptability curve (figure), decision makers would estimate their maximum willingness to pay for a QALY. If, for example, this was £30 000, the probability that hospital at home is more cost effective is slightly less than 20%, but if their willingness to pay for an additional QALY was as high as £80 000, the probability that hospital at home is the more cost effective option would be more than 80%.
Cost effectiveness acceptability curve for hospital at home care versus hospital care
Summary points
Cost effectiveness analysis is based on achieving an assumed societal objective of maximising health
Little evidence exists that this is the desired objective of the public or decision makers
Use of QALYs as a single outcome measure for economic evaluation means that important health consequences are excluded
Complex technical presentation makes the findings difficult to understand and use
Cost-consequences analysis would better approach the objectives of decision makers and be easier to understand
The table shows a simplified version of the cost-consequences analysis. A full table might additionally include: anxiety and depression, pain control, carer quality of life, costs to social services, accessibility to the service. Decision makers would use the information provided in the table to make decisions or, if desired, they could also use monetary valuation or discrete choice experiments to obtain utility values for the different elements. The relative efficiency of different options would depend on the implicit or explicit values attached by decision makers to the different elements of cost and outcome.
Simplified cost-consequence analysis of hospital at home care
A cost-consequences approach would more closely meet the needs of decision makers than current practice and avoid extensive use of inadequate assumptions. Such an approach may not earn researchers the same kudos for methodological research or technical capability as current methods, but it is closer to both Paretian welfare economics and a true decision making approach. It has the additional benefit of being easily understood and thus more likely to influence decision making in practice.
The Department of Social Medicine of the University of Bristol is the lead centre of the MRC Health Services Research Collaboration. I thank Richard Smith, Shah Ebrahim, Stephen Clarke, Terry Flynn, Ingolf Griebsch, Sandra Hollinghurst, and Oya Asim for helpful comments.
Contributors and sources JC has worked as an academic health economist for almost 15 years. She has conducted economic evaluations for various interventions, mainly in the area of service delivery and organisation and conducted qualitative research among the public and local decision makers.
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US ecommerce grows 7.3% in Q2 2022
Jessica Young | Aug 19, 2022
The quarter's ecommerce performance was more muted as Amazon Prime Day dollars shifted to Q3 this year. The increase in digital sales outpaced that of stores for the first time since early 2021, and more than 20% of consumer spending from April-June occurred online.
U.S. ecommerce spending in Q2 marked its fourth straight quarter of single-digit growth following the 45%-50% jumps during the first year of the pandemic, according to a Digital Commerce 360 analysis of U.S. Department of Commerce figures released Friday. But the year-over-year increase in online sales also outpaced that of stores for the first time since early 2021.
How fast is ecommerce growing in the US?
Digital revenue hit $252.14 billion in the second quarter, up a modest 7.3% from $234.89 billion for the same period the prior year, according to Commerce Department data. That was less than half of the 15.4% U.S. ecommerce growth registered in Q2 2021 and nowhere near the 53.4% surge during the lockdowns and store closures in Q2 2020.
But it's still notable that retailers could grow online revenue during the three months, given the massive — and some speculated, unsustainable — bump in web sales they received as COVID-19 raged and Americans shopped from home. The U.S. ecommerce market has managed to maintain and even build upon those early pandemic shifts in consumer buying behavior.
Additionally, Q2 2022's performance was more muted since Amazon.com Inc., No. 1 in the 2022 Digital Commerce 360 Top 1000 rankings, moved its popular Prime Day sale from June to July this year. That meant the big spike in online retail spending for Amazon and competitors around the two-day event shifted to Q3, and U.S. ecommerce grew 7.3% year over year last quarter despite the loss of Prime Day dollars.
What share of US sales is ecommerce?
More than $1 in every $5 spent on retail purchases still came from online orders in the second quarter, according to Digital Commerce 360's analysis of Commerce Department data. Online's share of total retail sales was roughly the same in Q2 2022 as it was for the same period the prior year — 20.6% vs. 20.4%. But penetration greatly accelerated from the 14.3% digital penetration in a pre-pandemic Q2 2019. Since COVID-19 took hold in the U.S., online's quarterly share of all retail spending has hovered in the 20%-23% range.
In the years leading up to 2020, digital's share of total retail sales reached the mid-teens, having grown each year incrementally. That happened organically as shoppers got increasingly comfortable purchasing items online and retailers made improvements to their ecommerce operations. But the pandemic accelerated that trend in a big way. Temporary store closures and lingering consumer anxiety over being in crowded spaces during a global pandemic prompted many to shop on the web, boosting online penetration.
How is ecommerce penetration calculated?
Digital Commerce 360 studies non-seasonally adjusted Commerce Department data and excludes spending in segments that don't typically sell online. These segments include restaurants, bars, automobile dealers, gas stations and fuel dealers. U.S. ecommerce penetration reflects the share of dollars consumers could potentially spend online.
2022 Top 1000 Report
Analysis of North America's leading 1,000 online retailers. Includes over 100 charts, rankings by 2021 web sales, benchmarking data, growth analyses by category and merchant type, and an executive overview on the current state of ecommerce.
Total retail sales growth sees big slowdown in Q2
Sales through all channels reached $1.22 trillion last quarter, up from $1.15 trillion in Q2 2021, according to Digital Commerce 360's analysis of Commerce Department data. The 6.2% increase is a far cry from the massive 20.5% swell in total retail sales for Q2 2021, which was spurred by pent-up demand from newly vaccinated shoppers eager to return to in-store shopping. That period marked the highest growth of any quarter or year in at least the last three decades for which data is available. But again, part of the Q2 sales growth drop-off this year was due to Amazon Prime Day spending being pushed from June into July, or Q3.
Additionally, although the 6.2% jump in combined online and in-store sales was less than a third of what it was during the same three months of 2021, it was still significantly higher than the usual performance of total retail before COVID-19 hit. The typical year-over-year increase for the five years pre-pandemic was just 3.5%.
This year's second quarter total retail sales growth was also double the 3.1% rate in Q2 2020, the height of the pandemic when lockdowns left offline sales plummeting and ecommerce exploding by more than 50.0%.
At 5.9%, sales through stores and other offline channels grew more slowly in the April-June quarter than the online segment. That hasn't happened since Q1 2021, the last period before widespread vaccinations brought shoppers back to in-person shopping. Because of that, ecommerce's share of total retail gains increased to 24.1% — the highest quarterly share since Q1 2021.
The retail industry registers single-digit gains in first half of 2022
Here's how the retail industry performed through the first half of the year:
U.S. ecommerce hit $483.46 billion, up 7.0% from $451.63 billion in the first two quarters of 2021.
Online penetration reached 20.8%, flat vs. the same period last year.
Offline sales increased 7.0% year over year.
Total retail sales reached $2.32 trillion, up 7.0% from $2.17 trillion in the first half of 2021.
Digital sales accounted for 20.9% of gains in retail spending across all channels.
Percentage changes may not align exactly with dollar figures due to rounding.
Stay on top of the latest developments in the ecommerce industry. Sign up for a complimentary subscription to Digital Commerce 360 Retail News.
Follow us on LinkedIn, Twitter and Facebook. Be the first to know when Digital Commerce 360 publishes news content.
Coronavirus (COVID-19) Coverage
Amazon revenue rises 9%: Ecommerce sales fall 2% in Q4
Target to cut as much as $3 billion in spending; Q3 digital sales rise just 0.3%
Paul Conley | Nov 16, 2022
Walmart online sales grow 16%
James Melton | Nov 16, 2022
Jessica Young | May 19, 2022

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WEIRTON, W.Va. – Delegate Mark Zatezalo, R-Hancock, today announced West Virginia has been admitted as a member of the Energy Council, an international coalition that focuses on energy-related issues within states and international provinces.
The Council voted unanimously on Sunday, Sept. 23, to admit West Virginia as the 13th state to join the organization during its recent meeting in Oklahoma City, which Delegate Zatezalo attended. The Council also voted to support the development of a regional natural gas and natural gas liquids (NGL) storage, pipeline and trading hub in West Virginia.
Formed in 1975, the Energy Council is an international non-partisan legislative organization now comprised of 13 energy-producing states and two Canadian provinces.
The Council provides a forum for member legislators to engage in dialogue and learn about energy and related-environmental issues of importance to their states or provinces, citizens, and environment, as well as employment and revenue bases.
Immediately following the admission of West Virginia at the Council's 2018 Annual Meeting in Oklahoma City, the Energy Council unanimously adopted a policy statement related to the proposed West Virginia Natural Gas and NGL Hub.
Prior to the West Virginia membership vote and the policy statement proposal, the Council's Chairman, North Dakota Representative Jeff Delzer, called on Delegate Zatezalo to make a presentation to the committee.
Attending the 2018 Annual Meeting on behalf of the state, Delegate Zatezalo introduced West Virginia University Energy Institute Director Dr. Brian Anderson, who briefed participants by teleconference regarding the significance of the regional natural gas and NGL hub.
Entitled "West Virginia and a Regional Natural Gas and NGL Storage, Pipeline and Trading Hub," the Energy Council's policy statement urges federal policy makers to support West Virginia's efforts to develop a regional natural gas and NGL storage, pipeline and trading hub that would maximize usage of Marcellus and Utica Shale natural gas resources, providing the basis for petrochemical production and manufacturing to serve all of North America.
The motions to admit West Virginia and approve the policy statement were made by two former Energy Council Chairmen, Wyoming Senate President Eli Bebout and Oklahoma Representative Weldon Watson, as well as Chairman Delzer. All three had earlier visited the state Capitol in Charleston to meet with legislative leadership regarding West Virginia's participation.
West Virginia becomes the eastern-most of the Energy Council's 13 member states, which include Alabama, Mississippi, Louisiana, Arkansas, Texas, Oklahoma, Kansas, New Mexico, Colorado, Wyoming, North Dakota and Alaska. The Canadian provinces of Alberta and Saskatchewan are also members.


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MID-ATLANTIC CHRISTIAN UNIVERSITY-- It is with profound sadness that we announce the death of the founder and first president of Mid-Atlantic Christian University, George W. BonDurant. He went home to be with the Heavenly Father on July 11, 2017 at the age of 101.
President BonDurant was a leader in the Restoration Movement in the 20th century, a movement that saw believers and preachers from various denominational backgrounds seek unity by looking to the New Testament for guidance in matters of doctrine and spiritual disciplines.
He grew up in Mt. Rainer, Maryland, the son of William W. and Helen Lawrence BonDurant, who were committed leaders in the Restoration Movement. BonDurant received a four year scholarship to Columbia University but his mother, concerned about his faith in a hostile atmosphere, sent him to Erieside Christian Service Camp. After one year at Columbia University he transferred to the Cincinnati Bible Seminary. There he met and married Sarah Lou Presley. Together, George and Sarah reopened Atlanta Christian College (now Point University), where he served as president. In 1947 BonDurant came to eastern North Carolina as an evangelist for the Roanoke District Churches of Christ, the strongest concentration of New Testament churches on the east coast.
Under his leadership, Mid-Atlantic Christian University received its first accreditation in 1979 from the American Association of Bible Colleges (now Association of Biblical Higher Education). Enrollment at Mid-Atlantic Christian University grew significantly during his term. Several buildings were constructed and historical homes along Poindexter Street were renovated. On December 2, 2009, he was awarded the Order of the Long Leaf Pine by North Carolina Governor Bev Perdue for his work at the university and his contributions to the state.
President BonDurant had a passion for proclaiming the gospel and reaching the lost. For years he taught all week, preached every weekend, and taught extension classes or seminars in churches during the week. He helped to establish several congregations, often taking students with him to learn the work of church planting. Mr. B served as a professor and president of the college from 1948 until 1986.
Today his influence lives on in the thousands who have attended MACU and who serve in 48 states, 1 territory, and 26 different countries. His footprint will be forever remembered on the campus of Mid-Atlantic Christian University. Well done, good and faithful servant.
His wife of 66 years, and co-founder of the university, Sarah Presley BonDurant, preceded him in death. "Mr. B," as he is fondly known, is survived by their only child, S. Elizabeth BonDurant.
Funeral arrangements are pending. The family and university will announce details in the coming days.


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Subjects -> PHARMACY AND PHARMACOLOGY (Total: 575 journals)
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Advances in Traditional Medicine
Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2662-4052 - ISSN (Online) 2662-4060
Published by Springer-Verlag [2467 journals]
Nigella sativa tea mitigates type-2 diabetes and edema: a case report
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Abstract: Abstract Diabetes is a major deadly disease. In 2019 alone, it caused an estimated 1.5 million deaths world-wide. Cases of diabetes are rising rapidly in low- and middle-income countries. Natural remedies that can lower the glucose level would be very useful, particularly to people living in low- and middle-income countries. A 2-year case study was carried out, therefore, to determine if Nigella sativa tea can lower the glucose level in a 72-year-old man with type-2 diabetes, stage 3–4 chronic kidney disease, and congestive heart failure. Changes in body weight, lipids, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (UACR) were also studied. N. sativa tea was prepared with N. sativa, barley, and wheat seeds. The 72-year-old drank approximately 50 ml of N. sativa tea daily, in the morning. Results showed that after drinking N. sativa tea daily, hypoglycemia started to occur and occurred more frequently as time went by and that the glycated hemoglobin, HbA1c, was decreasing. Subsequently, the dosages of insulin glargine and insulin aspart were reduced by 33% and 50%, respectively. Results also showed that weight loss led to the 72-year-old cutting back his intake of the diuretic furosemide by at least 50%. His triglycerides level was also lower and there were no changes in his total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. His eGFR was stable but his UACR was worsening. N. sativa tea is easy to prepare, costs very little, and could be a natural remedy for mitigating diabetes and edema. Many more studies on N. sativa are warranted.
PubDate: 2023-01-17
Amaranthus spinosus (Spiny Pigweed) methanol leaf extract alleviates
oxidative and inflammation induced by doxorubicin in male sprague dawley
Abstract: Abstract This study evaluated the ameliorative effect of Amaranthus spinosus leaf methanol extract (ASLME) against doxorubicin-induced multi-organ damage in Sprague Dawley Rats. Forty-nine (49) male Sprague Dawley rats were randomly stratified into 7 groups with 7 rats per group. Groups A and B received distilled water for 7 days. Groups C, D, and E were pretreated for 7 days with 200 mg/kg silymarin, 500 and 1000 mg/kg ASLME, respectively followed by intraperitoneal injection of 20 mg/kg doxorubicin (DOX) to groups B, C, D, and E on the 8th day. Groups F and G were orally administered 500 and 1000 mg/kg ASLME respectively for 7 days with an intraperitoneal injection of distilled water on the 8th day. After 48 h of DOX administration, blood was withdrawn by cardiac puncture, and organs were excised for biochemical and histopathological assays. Pretreatment with ASLME decreased the levels of tissues malondialdehyde and nitric oxide as well as serum tumor necrosis factor alpha (TNF-α) with a concomitant (p < 0.05) increase in the levels of serum interleukin-10 (IL-10) and tissues reduced glutathione in a dose-dependent manner compared to group B. The activities of antioxidant enzymes increased significantly (p < 0.05) in the ASLME pretreated groups as well as groups F and G when compared to group B. Administration of doxorubicin induced degenerative hepatic, nephrotic and cardiac biomarkers and histological changes in Group B, while remarkable reversal of these pathological features was observed in groups pretreated with ASLME. Our findings suggest the chemo-protective effect of ASLME against doxorubicin-induced multi-organ damage, by alleviating oxidative stress and inflammation in rats.
Gastroprotective and ulcer healing potentials of Nigerian Bee Propolis
flavonoid extract on acetic acid-induced gastric ulcers in albino rats
(Wistar Strains)
Abstract: Abstract Gastric ulcer is a serious global health challenge, and various natural products are being investigated to prevent and manage the condition. This study evaluated the gastroprotective and ulcer healing potentials of Nigerian bee propolis flavonoid-rich extract (NPE) on acetic acid-induced gastric ulcers in albino rats. Sixty adult male albino rats (222 ± 6.4 g) randomised into 5 groups (n = 12) were studied. Group A (SHAM) was left untreated, while gastric ulcer was induced in groups B (NPE), C (omeprazole) and D (saline). Group E (PRPE) was pre-treated with NPE prior to ulcer induction. The rate of ulcer contraction, volume and pH of gastric juice, and histopathological parameters were evaluated. The results showed a significantly higher rate of contraction (P = 0.001) between days 9 and 12 (NPE > OME > PRPE > SAL) and a significant decrease (P = 0.003) in the volume of gastric juice between days 9 and 12 (NPE < OME < PRPE). Gradual increase in pH was observed in all the groups from days 3 to 12, with a significantly higher rate (P < 0.001) between day 6 and 12 (SHAM > NPE > OME > PRPE > SAL). Histological evaluation showed significantly high neutrophils and macrophages on day 6 (P = 0.006) and lymphocytes (P = 0.004) between day 6 and 12 in the OME and NPE groups. NPE showed gastroprotective and ulcer healing properties by inhibiting ulcer formation and facilitating the curation of induced ulcers and is, therefore, a valuable alternative to conventional gastric ulcer therapy, especially in poor resource settings.
A versatile untargeted metabolomics-driven technology for rapid
phytochemical profiling of stem barks of Zanthoxylum species with
antioxidant and antimicrobial activities
Abstract: Zanthoxylum species are credited with various uses in ethnomedicine due to their rich metabolite composition. In Kenya, these include management of cancer and microbial related ailments. However, there are limited reports showing how the bioactivity of Kenyan Zanthoxylum species is linked to their phytochemical profiles. This study therefore aimed at examining the chemical variation among five Zanthoxylum species found in Kenya (Z. chalybeum, Z. gilletii, Z. holtzianum, Z. paracanthum and Z. usambarense) using metabolomics approaches and the anti-oxidant and antimicrobial activities of these species. In a Folin–Ciocalteu test, the phenolic content of the stem bark extracts of these species were 73.083–145.272 mg TAE/g, while the alkaloids (in bromothymol blue chromogenic test) and flavonoids (in aluminium chloride test) were found to be 152.39–207.19 mg ME/g, and 109.416–186.413 mg CE/g, respectively. These extracts also exerted strong antioxidant activities in the 2,2-iphenyl-1-picrylhydrazyl (DPPH) and ferric ion reducing antioxidant power assays. In a broth dilution assay, the extract of the stem bark of Z. holtzianum ability showed the highest antimicrobial activity, followed by Z. chalybeum stem bark extract. The activities were positively correlated to both flavonoids and alkaloids concentrations, while the concentration of phenolics had weak negative correlation to antimicrobial activities. A chemometric analysis of the liquid-chromatography mass spectrometry profiles led to grouping of the species into three clusters. This study illustrates the variation in the bioactivity of Zanthoxylum species based on metabolite composition and justifies the wide usage of Zanthoxylum species in Kenyan traditional medicinal practices. Graphical abstract
Effectiveness of hyper and hypothermic application revulsively on range of
motion, symptom score and quality of life in patients with cervical
spondylosis: a randomized controlled trial
Abstract: Abstract Cervical spondylosis (CS) is a degenerative age-related disorder affecting the cervical region of the spinal cord which manifests mainly with radiating pain in the neck, numbness in fingers, and headache. To control the symptoms and manage the disease progression, a combination of Complementary and Alternative Medicine with conventional management is necessary. Hence this study is aimed to evaluate the effect of Revulsive Compress (RC) along with the Integrated Naturopathy and Yoga (INY) approach in patients with CS. Out of 210 subjects screened, 60 subjects between the ages of 40 to 85 years were selected for the study. The subjects were randomly assigned into two groups, Group 1 (n = 30) Case group taking RC with INY and Group 2 (n = 30) control group taking only INY protocol for 10 days. Pain, Symptom score, Range of Motion (ROM), and Quality of life (QOL) were assessed before and after the intervention on the 11th day. The result of this study shows that with 10 days of RC and INY intervention, there was a significant reduction in the pain [Visual analog scale (VAS): p = 0.001] and symptom score [Neck disability index: p = 0.001] when compared to the control group. There was a significant improvement in QOL and ROM. The results of this study show that RC intervention with INY is having a substantial effect on patients with CS. Pain and Symptom score have been reduced significantly with marked improvement in QOL and ROM. Hence, this intervention can be used in the management of patients with CS, either as an individual or accompanied by management.
Tetrapleura tetraptera curtails oxidative and proinflammatory biochemical
events in lithium-pilocarpine model of status epilepticus
Abstract: Tetrapleura tetraptera Taub. (Fabaceae), commonly known as Aidan is ethnopharmacologically used for the management of health conditions such as diabetes mellitus, leprosy, epilepsy, and stroke in Nigeria. This study evaluated the anti-oxidoinflammatory properties of T. tetraptera methanol leaf extract (TTE) in lithium-pilocarpine-induced status epilepticus in Wistar rats. The extract was phytochemically screened and HPLC fingerprinting was performed. Animals were intraperitoneally administered with 127 mg/kg lithium chloride followed by 25 mg/kg pilocarpine 20 h later to induce status epilepticus. The animals were post treated with 50, 100 and 200 mg/kg TTE with 10 mg/kg valproic acid as the reference standard drug. Phytochemical screening of TTE confirmed the presence of tannins, phenols, alkaloids, terpenoids, flavonoids, saponins, glycosides and steroids. Quantitative phytochemical and antioxidant analyses of the extract indicated significant in vitro antioxidant and radical scavenging activity. HPLC analysis of the extract confirmed the presence of aridanin and polyphenols. TTE ameliorated redox imbalance by increasing markers for oxidative stress such as ferric reducing antioxidant power, glutathione level, catalase, glutathione S-transferase and superoxide dismutase activities. Moreover, TTE ameliorated pro-inflammatory events by reducing the level of the pro-inflammatory mediator nitric oxide, attenuating lipid peroxidation (which produces inflammatory lipid peroxidation-derived aldehydes), and decreasing the activities of xanthine oxidase and lactate dehydrogenase in the brain. These results indicated that the leaf of Tetrapleura tetraptera has therapeutic potential against status epilepticus by reversing oxidoinflammatory events. Tetrapleura tetraptera leaf extracts could be used to produce novel plant-based pharmaceuticals for treating status epilepticus and associated disorders. Graphic abstract
Aqueous extract of Moringa oleifera Lam. induced mitodepression and
chromosomal aberration in Allium cepa, and reproductive genotoxicity in
male mice
Abstract: Abstract Moringa oleifera is a multipurpose plant with nutritional and medicinal value. Despite its widely acclaimed therapeutic benefits in traditional medicine, there are reports on its toxicity in living cells. Information is however, limited on toxic effect of the plant on the genetic component and male reproductive cells. We evaluated genotoxicity of aqueous extract of the leaves of M. oleifera using the Allium cepa chromosome aberration (CA) and mouse sperm morphology assays. Roots of onion bulbs were exposed to 0.5–20% of the extract for analysis of root growth inhibition, mitotic index (MI) and CA. Swiss male mice orally exposed to the aqueous extract (50–800 mg/kg) for 35 consecutive days were analysed for body and testes weight, testicular histology and sperm morphology. There was a significant (p < 0.05) root growth inhibition, decrease in MI and induction of CA compared to the negative control bulbs. The extract did not cause adverse effect on body and testes weight, but maturation arrest, atrophy and germ cell sloughing and degeneration were observed in testicular sections of exposed mice. A significant increase in sperm morphology was observed in exposed mice relative to the control group. Aqueous extract of M. oleifera was cytotoxic, mitodepressive and genotoxic in A. cepa. It induced DNA damage in the sperm head and interfered with spermatogenesis. This suggests potentials of M. oleifera to modulate somatic cell cycle and impact male fertility.
Ameliorative effects of Guilandina bonduc L. aqueous seed extract on
letrozole induced polycystic ovary syndrome in female wistar albino rats
Abstract: Abstract The current study aims to identify the phytochemical constituents of Guilandina bonduc L. aqueous seed extract to evaluate their antioxidant potential through in vitro and in vivo toxicity models in female wistar albino rats. Phytochemical screening and in vitro antioxidant activities of G. bonduc aqueous seed extract (GBASE), were evaluated using 2, 2-diphenyl-1-picrylhydrazyl radical (DPPH) and hydroxyl radical along with the estimation of total phenolic and flavonoid contents. Three different doses (100, 200 and 300 mg/kg) were used for the proposed study to evaluate the efficacy against Letrozole induced PCOS in rats. Renal toxicity and hepatotoxicity were evaluated by quantifying the serum levels of Kidney Function Test (KFT) and Liver Function Test (LFT). Histopathologic changes of kidney and liver were also evaluated. In vitro studies revealed that G. bonduc seed extracts strongly scavenging the DPPH with an IC50 value of 276.95 μg/ml and hydroxyl scavenging radical with an IC50 value of 296.34 μg/ml. Our phytochemical evaluation reveals the presence of phenolic compounds (2.834 ± 0.09 mg of gallic acid equivalent/g dried extract) and flavonoids (0.905 ± 0.01 mg of catechol equivalents/g dried extract) content. In vivo activity was evaluated in rats as an PCOS model, when compared to control and vehicle group, a normal arrangement of the hepatocyte sheath and central vein was observed. The letrozole induced by PCOS groups also exhibited no remarkable changes in hepatic histology but a minor irregularity in hepatocyte arrangement was observed. In the treatment group, the histopathological evaluation of the kidneys showed a prevalent control-like morphology with a sufficient mobile structure and a standard atrophy free glomerulus. Moreover, the treated animals showed significant changes in their liver and kidney weights. The biochemical evaluation shows elevated levels of serum AST and it indicates harm to the liver due to necrosis, inflammation, or bruising, indicating ill health. The aqueous seed extracts of 200 mg/kg exhibited a significant response compare favorably to that of the standard drug treated group (PCOS + Pioglitazone) which also had substantially reduced KFT and LFT levels in their serum when compared to the PCOS induced group. Herbal medications strengthen the immune system and help regulate the menstrual cycle. The results suggest that G. bonduc L. could be considered as an important candidate for its possible role in the treatment of PCOS and for the future drug discoveries.
Diuretic efficacy and prophylactic effects of hydroethanolic extract from
Musa balbisiana fruits against urolithiasis
Abstract: Abstract The use of herbs as prophylactic and prevent recurrence of urolithiasis was counseled. Musa balbisiana fruits have long been used folk in the treatment of urinary stones. However, there is no clear scientific evidence. This study was designed to investigate the diuretic and prophylactic effects of M. balbisiana fruit extract in ethylene glycol-induced urolithiasis in rats. In this study, crude extracts were extracted by maceration, hot extraction, and decoction methods. The extracts were examined in vitro biological activities of anti-urolithiatic, anti-inflammatory, antibacterial, and antioxidant properties. For in vivo study, the experimental groups of rats were given the extract for 7-day to evaluate the diuretic potential. In prophylactic activity against urolithiasis, rats were given the extract for 28-day on ethylene glycol-induced urolithiasis in male Wistar rats. The results showed that all extracts of M. balbisiana fruits exhibited in vitro anti-urolithiatic, anti-inflammatory, antibacterial, and antioxidant activities with the hydroethanolic extract by hot extraction presented the highest activities. The hydroethanolic extract at the doses of 0.8 and 1.6 g/kg had diuretic effect after 7-day of treatment. The extract at these two doses had significantly prophylactic activity restored the parameters in urine and serum to near-normal level. The histopathological examinations revealed that calcium oxalate crystal deposits in the renal tubules and congestion and dilation of the renal tubules were significantly reverted after the extract treatment for 28-day. Taken together, the hydroethanolic extract of M. balbisiana fruits had diuretic effect and reduced the growth of urinary stones showing its effect as an antiurolithiatic support agent.
In vitro and in silico evaluation of some plant extracts and
phytocompounds against multidrug-resistant Gram-negative bacteria
Abstract: Abstract The spread of multidrug-resistant Gram-negative (MDR) bacteria is a global public health problem, as infections caused by MDR Gram-negative bacteria are difficult to treat. New antibiotic agents need to be developed to overcome this problem, and phytochemicals show promise at this point. In this study, methanol extracts were prepared from cinnamon, thyme, nettle, white tea, rosehip, and antibacterial activity of the methanol extracts was studied against two MDR Gram-Negative bacteria (K. pneumoniae and A. baumannii) by broth microdilution method. The MICs of methanol extracts of cinnamon, rosehip, thyme, white tea for A. baumannii were found as 0.015125 g/ml, 0.07825 g/ml, 0.030625 g/ml, 0.00796875 g/ml, respectively. It was found that only cinnamon methanol extract had antibacterial activity in the used extract concentrations against K. pneumoniae and the MIC value was 0.0605 g/ml. The effects of plant methanol extract with antibacterial activity and imipenem combinations were studied in vitro using the checkerboard method. The FIC Indexes were obtained from the checkerboard results and it was observed that the combination of methanol extract and imipenem showed an antagonistic or additive/indifferent effect but not a synergistic effect. We evaluated the binding affinity of epigallocatechin 3-gallate, quercetin, cinnamaldehyde, carvacrol, and thymol phytocompounds using in silico methods, which are well known as a phytocompounds in white tea, cinnamon, thyme, nettle, and rosehip and have antibacterial activities. The results suggested that these phytocompounds should be supported with in vivo and in vitro experiments to investigate their potential for being inhibitor candidates.
Antimicrobial evaluation and molecular docking studies of Swertiamarin and
Quercetin targeting dihydropteroate synthase enzyme
Abstract: Present study was aimed to evaluate synergistic antimicrobial activity of iridoid (Swertiamarin) and flavonoid glycoside (Quercetin). Swertiamarin (Sw) was isolated from methanol extract of Enicostemma axillare and quercetin (Qu) was purchased. The antimicrobial activity of Sw, Qu and combination of swertiamarin and quercetin (SQC) was evaluated against Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans using turbidimetric method. Molecular docking study of Sw and Qu was done on the target site of dihydropteroate synthase (DHPS) of protein data bank (PDB) ID: 3TYC (Dihydropteroate Synthase in complex with DHP +). Sw and Qu exhibited good antimicrobial activity in all the tested microorganisms at lower concentration (2.5 µg/ml). The SQC displayed significant antimicrobial activity and found high percentage of inhibition and comparable to standard ciprofloxacin. In molecular docking study, Sw and Qu have found good binding energy and interaction energy with the selected target site of DHPS of 3TYC. Graphical abstract
Phytochemicals from Nigerian medicinal plants modulate
therapeutically-relevant diabetes targets: insight from computational
Abstract: Abstract Traditional medicines have played critical roles in the treatment of diabetes in Nigeria. Since plants extracts contain many phytochemical compounds, it is quite challenging to experimentally determine the exact pharmacological agent responsible for their antidiabetic activity from the abundant constituents. In this study, the antidiabetic potentials of compounds identified from Nigerian plants was explored using computational technique. Fifty chemical compounds commonly found in Nigerian medicinal plants were docked with diabetes prime targets adiponectin, α-amylase, α-glucosidase, dipeptidyl peptidase-iv, glycogen synthase kinase-3β, peroxisome proliferator-activated receptor-γ and glucose transporter-1 using autodock vina software. From the analysis, rutin, 1, 5-Dicaffeoylquinic acid, vitexin, chlorogenic acid, taxifolin, luteolin and alstonine had better docking score than the standard drug for each target. The seven top-scoring compounds were stable with the targets after calculating their binding free energy. DFT calculations (HOMO/LUMO and global descriptive parameters) was performed to determine the compounds reactivity, and it shows that alstonine, Dicaffeoylquinic acid and chlorogenic acid are the most chemical reactive ligands. The AMET filtering of the compounds through pain alert, RO5, carcinogenicity and oral availability showed that alstonine and vitexin exhibited better profile among the rest. Finally, the intrinsic biological activity of the ligands by webserver identified the compounds as potential antidiabetic compounds, with more potency to act as aldose reductase inhibitor. Although this study identified alstonine and vitexin as the most suitable ligands against the understudied diabetes implicated proteins, all the 7-top scoring compounds possess promising features which may be useful to develop drug targeting multiple therapeutically-relevant proteins of diabetes.
Microwave-assisted extraction of Clausena anisata leaves and Vernonia
cinerea whole plants to maximize nitrate content: optimization approach,
antioxidant activity, and cytotoxicity
Abstract: Nitrate-rich plants—Clausena anisata leaves and Vernonia cinerea whole plants—are used as smoking cessation aids in Thailand. This work sought to optimize the extraction condition of nitrate from the two plants using microwave-assisted extraction. The Box-Behnken design was applied in this work. Antioxidant activity and in vitro cytotoxicity tests were also evaluated. Three factors including microwave power, duration time, and irradiation cycle, were varied from 300 to 600 W, 10 to 30 s, and 1 to 3 cycles, respectively. Two responses including extraction yield and nitrate content were monitored. Results demonstrated that the low microwave power (300 W) with short duration time (10 s), and low irradiation cycle (one cycle) gave the highest nitrate content. The optimum condition provided extraction yield of 26.0 ± 1.1% and nitrate content of 1.31 ± 0.03% for C. anisata leaves, and extraction yield of 15.9 ± 0.2% and nitrate content of 1.32 ± 0.01% for V. cinerea whole plants. Furthermore, their crude extracts exhibited good antioxidant activity and safety profile. In summary, microwave-assisted extraction was an alternative modern technique for the extraction of nitrate from C. anisata leaves and V. cinerea whole plants. Recently, only V. cinerea was officially included in the National List of Essential Medicines. This work could be used to support the potential of C. anisata leaves as a smoking cessation aid like V. cinerea. Graphical abstract
Evaluation of the antiproliferative effect of β-sitosterol isolated from
Combretum platypetalum Welw. ex M.A. Lawson (Combretaceae) on Jurkat-T
cells and protection by glutathione
Abstract: Abstract Combretum species are distributed widely in Southern Africa and are known for their medicinal properties. The species have potential as sources of anticancer agents. Combrestanin-A4 isolated from Combretum caffrum is one of the pure compounds now under clinical trials. The aim of this study was to fractionate and isolate plant phytoconstituents of C. platypetalum and determine their antiproliferative effects on a human leukemic cancer cell line, Jurkat-T cells. Dried powdered leaf plant samples were extracted serially with hexane, DCM, acetone, ethyl acetate, ethanol, methanol, and water. The total combined extracts were run on a silica gel column using a mobile phase of increasing polarity. β-Sitosterol was isolated from pool 94–98 of the fractions and identified by 1H-NMR and 13C-NMR and its molecular formula confirmed by mass spectrometry. The effects of β-sitosterol on proliferation of cells, effect of combining β-sitosterol and glutathione, effect of combining β-sitosterol and camptothecin and effect of β-sitosterol on glutathione S-transferase activity were determined. β-sitosterol showed dose-dependent antiproliferative effects against Jurkat-T cells and these effects were shown to be irreversible. Reduced glutathione protected the cells from the effects of β-sitosterol. Enhance antiproliferative effects were observed when β-sitosterol was combined with camptothecin. β-sitosterol was also shown to inhibit the activity of glutathione S-transferases in the cancer cell line. The results of the study suggested that β-sitosterol has antiproliferative effects in the Jurkat-T cells. Further work needs to be done on normal cells to determine if β-sitosterol affects cancer cells only.
An overview on pharmaceutical properties and biotechnological advancement
of Withania coagulans
Abstract: Abstract Withania coagulans is a therapeutic plant, commonly known as Rishyagandha. It is used in treatment of various diseases like indigestion, diabetes mellitus, liver disorders, purification of blood and controls blood pressure. In addition, it is reported to control plasma glucose levels and preventing renal complications. The plant contains various metabolites, and the most important being withanolides isolated from its fruits. Apart from above, the plant is known for its various pharmacological effects viz. cardioprotective, hepatoprotective, and anti-inflammatory activity. The current review includes information about pharmacological effects, therapeutic uses, extraction of plant metabolites and its use in treatment of various diseases. Furthermore, biotechnological advancement of W. coagulans has also been discussed.
Study of compounds, cytotoxicity and biological activities of essential
oil of Satureja rechingeri Jamzad
Abstract: Abstract Nowadays, the essential oil has received a special position for the treatment of diseases. Although Satureja rechingeri Jamzad is an endemic species of Iran, unfortunately few studies have been conducted on its biological properties. In this study, along with the analysis of the compounds of Satureja rechingeri essential oil, cytotoxic, antioxidant and antibacterial properties of the essential oil of this species were investigated. The compounds of prepared essential oil were analyzed by GC-FID and GC–MS using Clevenger. Disc diffusion and MTT methods were used to determine the antibacterial activity and cytotoxicity of the essential oil, respectively. The antioxidant activity of the essential oil was measured by two methods of reducing power assay and DPPH free radical scavenging. p-Cymene (46.5%) was the most identified compound in the essential oil. The essential oil showed higher inhibitory effect on seven bacterial strains relative to the standard antibiotics. The studied essential oil showed significant concentration-dependent inhibitory effect on four cancer cells of Vero, SW480, MCF7 and JET3 with 50% lethal effect of 15.6, 125, 15.6 and 250 µg/mL for each line, respectively. The highest adsorption (2.6 nM) was at 500 µg/mL for reducing power assay and 50% free radical inhibition at a concentration of 375 µg/mL for DPPH antioxidant assay. In general, the essential oil of Satureja rechingeri with high antioxidant, antibacterial and anticancer activity can be used as a cheap and affordable natural product in clinical and pharmaceutical fields.
Evaluation of biologically active secondary metabolites isolated from the
toothache plant Acmella ciliata (Asteraceae)
Abstract: Acmella ciliata (HBK) Cass. (basionym: Spilanthes ciliata HBK) is an herb of high medicinal value. Spilanthol, the prime N-alkamide in A. ciliata, is used as an active ingredient in several anti-ageing herbal tonics and in mouth washes. Here we describe quantification of spilanthol, phenolics, flavonoid and antioxidant activity in the methanol extracts prepared from flower, leaf, root and stem of the plant. HPLC of the sample extracts revealed that spilanthol was found to be maximum in flowers (18.44 mg/g), as compared to other parts of the plant as well as several of other Acmella (syn: Spilanthes) species. Estimation of phenolics and flavonoids in the extract by spectrophotometry with their values expressed respectively as equivalence of gallic acid (GAE) and quercetin (QE), revealed that phenolics content was highest in the flower extract (5.58 mg GAE/g), whereas, flavonoid content was found maximum in the leaf extract (31.65 mg QE/g). Antioxidant activity of the extract remained proportional to phenolic content of the extract. Flower extract further showed highest free radical scavenging activity in DPPH and ABTS assays, as compared to the extracts from other parts of the plant. Pearson's correlation for antioxidant activity with respect to the phenolic and flavonoid content turned out to be positive. To the best of our knowledge this is the first report on quantification of the three secondary metabolites considered here and the antioxidant activity in the methanol extract prepared from different parts of A. cilitata. Graphic abstract
Antibacterial phytocomplexes and compounds from Psychotria sycophylla
(Rubiaceae) against drug-resistant bacteria
Abstract: Abstract In this study, we examined the antibacterial and antibiotic-resistance reversal properties of methanol (MeOH) and ethyl acetate (EtOAc) extracts and compounds from Psychotria sycophylla aerial parts against drug-resistant bacteria. The tests were performed using the microdilution method. The mechanisms of action were investigated on growth kinetic and proton pumps of Escherichia coli. The structures of isolated compounds including oleanolic acid (1), ursolic acid (2), lupeol (3), betulinic acid (4), β-sitosterol glucoside (5), and stigmasterol (6), were established based on nuclear magnetic resonance (NMR) and electrospray ionization-mass spectrometry (ESI–MS). The extracts displayed noteworthy antibacterial activities, with recorded minimal inhibitory concentrations (MIC) ranging from 4 to 1024 µg/mL. Significant activities (MIC < 100 µg/mL) were obtained with the MeOH extract against Providencia stuartii PS2636 and Staphylococcus aureus MRSA9 (MIC of 16 µg/mL) as well as the EtOAc extract against S. aureus MRSA3 (MIC of 32 µg/mL) and Enterobacter aerogenes EA27 (MIC of 4 µg/mL). MeOH extract displayed a broad-spectrum antibacterial activity, acting against 21 out of 22 studied bacteria. The MICs of compounds (1–6) varied from 16 to 256 µg/mL. Oleanolic acid (1) appeared to be the most effective, preventing the growth of 100% of studied bacteria. The MeOH extract significantly enhanced the efficacy of conventional antibiotics against selected multidrug-resistant Gram-negative bacteria. The mechanistic investigations showed interference of MeOH with bacterial growth kinetic (by extending the lag phase) and inhibition of proton pumps. The current study provides a strong experimental baseline to consider P. sycophylla extracts and compounds as potent antibacterial natural products.
Curcuma longa extract ameliorates motor and cognitive deficits of
6-hydroxydopamine-infused Parkinson's disease model rats
Abstract: Abstract Parkinson's disease (PD) results mostly from the degeneration of dopaminergic neurons in the substantia nigra pars compacta. It is characterized by the manifestations of anxiety, tremor, muscle rigidity, bradykinesia and cognitive impairments. Oxidative stress is attributed to the neurodegeneration of PD. Curcuma longa is a commonly used spice and has high levels of anti-oxidative phyto-constituents. Here, we evaluated whether the chronic oral administration of C. longa extract affects the degree of anxiety, neuromotor and cognitive deficits of 6-hydroxydopamine (6-OHDA)-infused PD model rats. Following the surgery, animals were orally administered with C. longa extract for twelve weeks. The degree of anxiety/depression, motor and cognitive performances were determined with a variety of neurobehavioral experimental paradigms, including elevated plus, Morris water maze task, rotarod, open field, forced swim, sucrose preference and tail suspension tests. Brain levels of lipid peroxide (LPO) were measured by standard method. Tumor necrosis factor-α (TNFα), α-synuclein, synaptosome-associated protein-25 (SNAP25) and brain-derived neurotrophic factor (BDNF) of the brain tissues were measured by ELISA. Oral administration of C. longa significantly (P < 0.05) protected the deterioration of the motor activity, learning-related memory cognitions and the degree of anxiety- and depression-like behaviors in PD model rats. The preventive effects were accompanied with decreased brain levels of LPO, TNFα, α-synuclein and increased levels of cognition-related proteins SNAP-25 and BDNF. The experimental results suggest that C. longa ameliorates PD-like symptoms by suppressing the oxidative/pro-inflammatory stress and levels of α-synuclein and increasing the levels of SNAP-25 and BDNF.
Effectiveness and safety of Korean medicine for pain management after
musculoskeletal surgery: a retrospective study
Abstract: Abstract To assess the effectiveness and safety of Korean medicine in managing postoperative pain. Retrospective, observational study. Medical records of 233 inpatients at a Korean medicine hospital who underwent Korean medicine treatments such as acupuncture, moxibustion, cuppping, bee-venom and herbal acupuncture, electrical therapy, herbal medicine, and carbon-beam therapy after musculoskeletal surgery were reviewed, and numeric ratings for pain were compared between baseline and follow-up. A correlation analysis between pain improvement and therapeutic factors was performed, and a regression analysis was conducted to determine the predictors of pain reduction. Serum laboratory test results at baseline and follow-up were subsequently compared to identify safety. Numeric rating scale scores for pain; presence of infection, drug-induced liver injury (DILI), and drug-induced kidney injury (DIKI) for safety. After Korean medicine treatment, the pain scores decreased from an average of 4.09 to 1.79 in the numeric rating scale (p < 0.001). Frequency of acupuncture therapy during hospitalization showed the strongest positive correlation with pain improvement (r = 0.341, p = 0.000) and was a predictor of pain reduction (adjusted R2 = 0.145). Improvements in serum laboratory data to reference limits were observed. All kappa coefficient values, except for white blood cell (WBC) count, were between 0.3 and 0.7, indicating that the follow-up data matched the baseline data. The low kappa coefficient value of WBC count was due to the high ratio of outliers. One (0.43%) and no cases of DILI and DIKI were identified, respectively. Korean medicine could be used for managing pain after musculoskeletal surgery.


The K&Company Basics Paper Pad is perfect for scrapbook projects, cards and other paper crafts. This pack contains one paper pad with 36 single-sided sheets with three each of 12 designs. Combine them with other cardstocks, stickers, brads, decorative tapes and much more. Experiment with craft techniques, die-cutting and embossing designs to add texture and dimension on these scrapbook papers. You can also use paints or add glitter for added visual appeal.


text:
H444 Palmoplantar keratoderma 1 (FNEPPK1)
In the Dogue de Bordeaux breed a hyperkeratosis mainly affecting the footpads was described. Affected dogs show thickening of the footpads, severe keratinous proliferations and fissures which increase the susceptibility to secondary infections. The disorder is inherited as an autosomal recessive trait with onset of symptoms between 10 weeks and 1 year of age. A genetic study identified a complex mutation in the KRT16 gene as cause for the disease. The mutation leads to a truncated protein and impairs normal keratin assembly.
The disease may show itself on different ages, in which it cannot be estimated when the first symptoms may show themselves. Differences may exist between littermates, and between breeds.
This disease is present in the entire body, but causes main effects in the internal organs such as stomach, intestinal tract, liver and / or kidneys. In a number of cases, the disease affects one major internal organ.
This DNA test is available for the following breeds: Dogue de Bordeaux. Additional information is available in the Frequently Asked Questions (FAQ).
For this DNA test we accept the following materials: Blood EDTA, Blood Heparin, Semen, Swab, Tissue. Please contact Dr. Van Haeringen Laboratorium if you wish to submit other material as listed.
Code H444
Palmoplantar keratoderma 1 (FNEPPK1)


Feel like living on the edge? Please RSVP at the "Announce" link below.
We're planning to host a "Bug Squish" event for more experienced Ubuntu users and developers to coincide with the "Ubuntu Global Jam" event.
Participants will bring computers already running 10.10 Maverick Meerkat. There will be a tutorial on how to file bugs in Launchpad. We'll put our newly upgraded machines to the test, seeing how (and if) they break.


text:
Eagle County wages still lag behind Colorado average
Workers in the Vail Valley earn $11,000 less than state average
Randy Wyrick
rwyrick@vaildaily.com
Tourism and recreation dominate the regional job market. Those jobs tend to pay less than many other professions, which explains the $11,000 gap between the average Eagle County wage and the Colorado state average.
Northwest Colorado Council of Governments
Wage survey highlights:
Jobs: +1.9%
Unemployment rate: 2.4% (Feb. 2019)
Regional Population: 119,779
Fastest growing towns (2010-2017)
Silverthorne (+18.8%) - Pop. 4,639
Frisco (+15.9%) - Pop. 2,977
Granby (+12.0%) - Pop. 1,813
Gypsum (+11.1%) - Pop. 6,926
Basalt (+9.1%) - Pop. 3,849
5-Year Job growth in Key Industries (2013-2018):
Construction (+32.3%)
Healthcare (+22.8%)
Accommodations & Food Services (+10.9%)
Professional, Technical, Scientific (+16.3%)
Management of Companies & Enterprises (+64.5%)
Average Annual Wage:
Eagle County: $46,124 (+3.4)
Grand County: $36,920 (+4.7%)
Jackson County: $39,416 (+11.8%)
Pitkin County: $50,700 (+0.2%)
Summit County: $43,004 (+4.8%)
State of Colorado: $57,408 (+3.5%)
The data is from the Bureau of Labor Statistics, Quarterly Census of Employment and Wages, Q3 2018. The full report can be found on the NWCCOG EDD website, as can past reports.
EAGLE COUNTY — If you work in Eagle County, your annual wages went up 3.4% last year but your paycheck still lags more than $11,000 behind the state average.
The Northwest Colorado Council of Governments' latest wage survey found that in Eagle County, workers earn an average of $46,124 a year. That's up 3.4% year-over-year, but it's still $11,000 less than the state average of $57,408.
Tourism jobs pay poorly
Local average wages lag because the regional economy is dominated by the tourism industry and the low-wage jobs it tends to generate, Rachel Lunney, the NWCCOG's Economic Development District Director explained.
In Eagle County, 45% of all jobs are tied to the tourism industry in some way — accommodation and food services (8,061 jobs), retail (3,560 jobs) arts/entertainment/recreation (3,287 jobs). The ratios hold true in three of the four other NWCCOG counties: Pitkin, Summit and Grand. Across the region, 48% of the jobs fall into that sector, Lunney said.
"A quarter of Eagle County's jobs are in accommodations/food service sector," Lunney said.
Econ Update March 2019 by Anonymous kjzT4MA on Scribd
Better-paying jobs are growing
The good news is that the region's five fastest growing job sectors are higher-paying professionals.
"We are seeing some positive growth in higher-paying sectors. That's encouraging and speaks to some diversification of our regional economy," Lunney said.
Job numbers outside the tourism industry have leaped during the past five years, including:
Management jobs up 64.5%
Manufacturing jobs up 40.6 percent
Construction jobs up 32.3%
Transportation and warehousing jobs up 29.5%
Health care up 22.8%
Health care jobs pay around $56,000 annually, compared to arts/entertainment/recreation jobs that pay $32,344 in Eagle County.
While local wages lag the state average, the number of Eagle County jobs rose 3% to 33,033 in 2018.
Across the NWCCOG's five counties — Eagle, Summit, Pitkin, Jackson and Grand — 78,230 jobs are held down by 84,446 workers. Unemployment across the region is 2.4%, 2.6% in Eagle County — essentially full employment.
"We're dealing with full employment and then some," Lunney said.
The drive to affordability
Besides tourism, the five counties share the workers that make it work, and the commutes they're forced to make.
"A significant amount of our workforce doesn't necessarily reside in our five counties," Lunney said.
Many Lake County residents commute to Pitkin, Eagle and Summit counties. Many Park County residents commute over Hoosier Pass to Summit County and Breckenridge.
High housing costs drive many of those residents to drive, says a 2018 Housing Demand Study.
"As households stretch to find and retain housing in a tight market, the proportion of their income spent on housing increases, leaving less for food, health care, childcare, transportation, and retirement savings," that study says.
When a household spends more than 30% of its income on housing, it's considered "cost burdened." If that's more than 50% they're "severely cost burdened," the study says.
The lower your income, the more likely you are to spend a higher percent on housing, the study says. About 64% of all households that earn less than 60% of the area median income are cost burdened; a third are severely cost burdened.
Of renters, 38% are cost burdened, compared to 10% of owners.
About 2,000 midvalley households (about a quarter) are cost burdened. About 21% of down valley households are, and 19% of up valley households, the 2018 study said.


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