Carrot-based Japanese herbal medicine may improve muscle complications associated with COPD

Chronic obstructive pulmonary disease (COPD) is a lung disease caused by long-term inhalation of harmful gases such as cigarette smoke. Scientists have recognized deterioration of muscle tissue, known as, as a secondary effect of damaged lungs. This frailty makes it difficult for individuals to move around and exercise, which is turn worsens the state of their lungs, causing an endless downward spiral in overall health.

Exercise therapy is the only established treatment for the skeletal muscle complications of COPD, however, depending on the severity of sarcopenia frailty in the patient, such treatment may not be possible. This imbalance has become an urgent issue to address. Ninjin’yoeito is a carrot-based Japanese herbal medicine commonly given to people recovering from anorexia and physical weakness after illness or surgery for its supplementary effect in restoring physical strength. Also, the medicine has been seen to improve muscle mass loss in aging mice through the activation of PGC-1α- a protein involved in improving muscle function.

Based on this, we hypothesized that Ninjin’yoeito enhances PGC-1α expression in skeletal muscle and may improve muscle complications associated with COPD.”


Kazuhisa Asai, Associate Professor, Osaka City University Graduate School of Medicine

He led a research group in testing this hypothesis by including Ninjin’yoeito in the diet of mice who had been exposed to cigarette smoke for 12 weeks. Their findings were published online in the international scientific journal International Journal of Chronic Obstructive Pulmonary Disease on November 27, 2020.

Professor Asai’s team measured the lower leg muscle mass of the smoke-exposed group of mice with a microCT and noticed they had atrophied, like human COPD patients. However, he saw no such change in muscle mass with the experimental group of mice, suggesting that the addition of the carrot-rich medicine cancels out the effects of sarcopenia frailty.

“We believe that this is a useful finding and that Ninjin’yoeito may break the vicious circle of sarcopenia frailty in COPD patients”, adds Associate Professor Asai. “We would like to consider clinical trials in the future.”

Source:

Journal reference:

Miyamoto, A., et al. (2020) Ninjin’yoeito Ameliorates Skeletal Muscle Complications in COPD Model Mice by Upregulating Peroxisome Proliferator-Activated Receptor γ Coactivator-1α Expression. International Journal of Chronic Obstructive Pulmonary Disease. doi.org/10.2147/COPD.S280401.

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Newborns Getting Preoperative Blood Transfusions Have More Complications

Newborns undergoing surgery suffered worse outcomes if they had received preoperative blood transfusion, registry data showed.

The incidence of 30-day mortality (16.8% vs 2.6%, P<0.01) and morbidity (46.2% vs 16.2%, P<0.01) put neonates who received blood transfusion within 48 hours of surgery at a disadvantage compared with peers not getting transfusion, reported Loren Berman, MD, of Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and colleagues in the November 2020 issue of Pediatrics.

Blood transfusion remained associated with worse postoperative outcomes after multivariable adjustment and propensity-score matching, they noted.

Specific postoperative complications that occurred more frequently in the transfusion group included infection, bleeding requiring transfusion, reintubation, reoperation, and hospital stay beyond 30 days.

However, babies who did not receive transfusion had more readmissions within 30 days of surgery.

“This finding can be explained by the fact that those neonates who received a PBT [preoperative blood transfusion] were more likely to remain in the hospital for >30 days postoperatively and were therefore ineligible for readmission,” Berman’s group reasoned.

“This study is the first to describe the association between preoperative transfusions and worse postoperative outcomes and raises questions about the safety of liberal approaches to transfusion in neonates undergoing surgery,” they wrote.

Transfusion practices in neonatal ICUs remain highly variable despite several randomized trials showing no harm with a restrictive transfusion strategy in babies compared with a liberal one, they noted. It’s not uncommon for anemic newborns to receive transfusions prior to surgery as a precaution.

Berman’s team identified 12,184 neonates who underwent surgery as listed in the American College of Surgeons National Surgical Quality Improvement Program in 2012-2015. Of these babies, 9.9% received a preoperative blood transfusion for anemia.

Transfusion was more likely in babies who were premature or had chronic lung disease, cardiac disease, or required ventilatory support.

There appeared to be a stronger relationship between mortality and morbidity and blood transfusion with rising preoperative hematocrit (up to 35%), though this finding did not reach statistical significance for interaction, the investigators reported.

“It is likely that there is a tipping point or range in which the risks associated with anemia outweigh the risks associated with blood transfusion,” Berman’s group suggested.

“For infants with significant anemia, it is plausible that the benefits of a blood transfusion, such as increased oxygen delivery, outweigh the associated risks (i.e., transfusion-related immunomodulation and a proinflammatory state), but as the anemia becomes less severe, the harm of a blood transfusion begins to outweigh the benefit,” they continued.

They acknowledged that their retrospective study design left room for selection bias. In addition, the database used captured only transfusion of packed red blood cells and whole blood.

“A prospective trial is needed to define transfusion thresholds that maximize the benefit of treatment of anemia and minimize the risk associated with transfusion,” wrote Berman and colleagues.

In the meantime, preoperative blood transfusion appears to be associated with increased harm among newborns undergoing surgery, they concluded.

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    Nicole Lou is a reporter for MedPage Today, where she

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