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| 1 | Herbal traditional Chinese medicine and its evidence base in gastrointestinal disorders显示文摘Herbal traditional Chinese medicine(TCM) is used to treat several ailments, but its efficiency is poorly documented and hence debated, as opposed to modern medicine commonly providinge ffective therapies. The aim of this review article is to present a practical reference guide on the role of herbal TCM in managing gastrointestinal disorders, supported by systematic reviews and evidence based trials. A literature search using herbal TCM combined with terms for gastrointestinal disorders in Pub Med and the Cochrane database identified publications of herbal TCM trials. Results were analyzed for study type, inclusion criteria, and outcome parameters. Quality of placebo controlled, randomized, double-blind clinical trials was poor, mostly neglecting stringent evidence based diagnostic and therapeutic criteria. Accordingly, appropriate Cochrane reviews and meta-analyses were limited and failed to support valid, clinically relevant evidence based efficiency of herbal TCM in gastrointestinal diseases, including gastroesophageal reflux disease, gastric or duodenal ulcer, dyspepsia, irritable bowel syndrome, ulcerative colitis, and Crohn's disease. In conclusion, the use of herbal TCM to treat various diseases has an interesting philosophical background with a long history, but it received increasing skepticism due to the lack of evidence based efficiency as shown by high quality trials; this has now been summarized for gastrointestinal disorders, with TCM not recommended for most gastrointestinal diseases. Future studies should focus on placebo controlled, randomized, double-blind clinical trials, herbal product quality and standard criteria for diagnosis, treatment, outcome, and assessment of adverse herb reactions. This approach will provide figures of risk/benefit profiles that hopefully are positive for at least some treatment modalities of herbal TCM. Proponents of modern herbal TCM best face these promising challenges of pragmaticmodern medicine by bridging the gap between the two medicinal cultures. | Rolf Teschke Albrecht Wolff Christian Frenzel Axel Eickhoff Johannes Schulze | 2015 | World Journal of Gastroenterology2015，21，15： | 19 |
| 2 | Herbal Traditional Chinese Medicine and suspected liver injury: A prospective study显示文摘AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine(TCM) in order to evaluate the frequency of newly detected liver injury.METHODS Patients with normal values of alanine aminotransferase(ALT) as a diagnostic marker for ruling out pre-existing liver disease were enrolled in a prospective study of a safety program carried out at the First German Hospital of TCM from 1994 to 2015. All patients received herbal products, and their ALT values were reassessed 1-3 d prior to discharge. To verify or exclude causality for suspected TCM herbs, the Roussel Uclaf Causality Assessment Method(RUCAM) was used.RESULTS This report presents for the first time liver injury data derived from a prospective, hospital-based and largescale study of 21470 patients who had no liver disease prior to treatment with herbal TCM. Among these, ALT ranged from 1 × to < 5 × upper limit normal(ULN) in 844 patients(3.93%) and suggested mild or moderate liver adaptive abnormalities. However, 26 patients(0.12%) experienced higher ALT values of ≥ 5 × ULN(300.0 ± 172.9 U/L, mean ± SD). Causality for TCM herbs was RUCAM-based probable in 8/26 patients, possible in 16/26, and excluded in 2/26 cases. Bupleuri radix and Scutellariae radix were the two TCM herbs most commonly implicated. CONCLUSION In 26(0.12%) of 21470 patients treated with herbal TCM, liver injury with ALT values of ≥ 5 × ULN was found, which normalized shortly following treatment cessation, also substantiating causality. | Dieter Melchart Stefan Hager Sabine Albrecht Jingzhang Dai Wolfgang Weidenhammer Rolf Teschke | 2017 | World Journal of Hepatology2017，9，29： | 11 |
| 3 | Drug and herb induced liver injury: Council for International Organizations of Medical Sciences scale for causality assessment显示文摘Causality assessment of suspected drug induced liver injury(DILI) and herb induced liver injury(HILI) is hampered by the lack of a standardized approach to be used by attending physicians and at various subsequent evaluating levels. The aim of this review was to analyze the suitability of the liver specific Council for International Organizations of Medical Sciences(CIOMS) scale as a standard tool for causality assessment in DILI and HILI cases. PubMed database was searched for the following terms: drug induced liver injury; herb induced liver injury; DILI causality assessment; and HILI causality assessment. The strength of the CIOMS lies in its potential as a standardized scale for DILI and HILI causality assessment. Other advantages include its liver specificity and its validation for hepatotoxicity with excellent sensitivity, specificity and predictive validity, based on cases with a positive reexposure test. This scale allows prospective collection of all relevant data required for a valid causality assessment. It does not require expert knowledge in hepatotoxicity and its results may subsequently be refined. Weaknesses of the CIOMS scale include the limited exclusion of alternative causes and qualitatively graded risk factors. In conclusion, CIOMS appears to be suitable as a standard scale for attending physicians, regulatory agencies, expert panels and other scientists to provide a standardized, reproducible causality assessment in suspected DILI and HILI cases, applicable primarily at all assessing levels involved. 2014 Baishideng Publishing Group Co., Limited. All | Rolf Teschke Albrecht Wolff Christian Frenzel Alexander Schwarzenboeck Johannes Schulze Axel Eickhoff | 2014 | World Journal of Hepatology2014，6，1： | 11 |
| 4 | Herbal hepatotoxicity:Challenges and pitfalls of causality assessment methods显示文摘The diagnosis of herbal hepatotoxicity or herb induced liver injury(HILI) represents a particular clinical and regulatory challenge with major pitfalls for the causality evaluation.At the day HILI is suspected in a patient,physicians should start assessing the quality of the used herbal product,optimizing the clinical data for completeness,and applying the Council for International Organizations of Medical Sciences(CIOMS) scale for initial causality assessment.This scale is structured,quantitative,liver specific,and validated for hepatotoxicity cases.Its items provide individual scores,which together yield causality levels of highly probable,probable,possible,unlikely,and excluded.After completion by additional information including raw data,this scale with all items should be reported to regulatory agencies and manufacturers for further evaluation.The CIOMS scale is preferred as tool for assessing causality in hepatotoxicity cases,compared to numerous other causality assessment methods,which are inferior on various grounds.Among these disputed methods are the Maria and Victorino scale,an insufficiently qualified,shortened version of the CIOMS scale,as well as various liver unspecific methods such as thead hoc causality approach,the Naranjo scale,the World Health Organization(WHO) method,and the Karch and Lasagna method.An expert panel is required for the Drug Induced Liver Injury Network method,the WHO method,and other approaches based on expert opinion,which provide retrospective analyses with a long delay and thereby prevent a timely assessment of the illness in question by the physician.In conclusion,HILI causality assessment is challenging and is best achieved by the liver specific CIOMS scale,avoiding pitfalls commonly observed with other approaches. | Rolf Teschke Christian Frenzel Johannes Schulze Axel Eickhoff | 2013 | World Journal of Gastroenterology2013，19，19： | 9 |
| 5 | Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests显示文摘AIM: To analyze the validity of applied test criteria and causality assessment methods in assumed Herbalife hepatotoxicity with positive reexposure tests. METHODS: We searched the Medline database for suspected cases of Herbalife hepatotoxicity and retrieved 53 cases including eight cases with a positive unintentional reexposure and a high causality level for Herbalife. First, analysis of these eight cases focused on the data quality of the positive reexposure cases, requiring a baseline value of alanine aminotransferase(ALT) < 5 upper limit of normal (N) before reexposure, with Nas the upper limit of normal, and a doubling of the ALT value at reexposure as compared to the ALT value at baseline prior to reexposure. Second, reported methods to assess causality in the eight cases were evaluated, and then the liver specific Council for International Organizations of Medical Sciences (CIOMS) scale validated for hepatotoxicity cases was used for quantitative causality reevaluation. This scale consists of various specific elements with scores provided through the respective case data, and the sum of the scores yields a causality grading for each individual case of initially suspected hepatotoxicity. RESULTS: Details of positive reexposure test conditions and their individual results were scattered in virtually all cases, since reexposures were unintentional and allowed only retrospective rather than prospective assessments. In 1/8 cases, criteria for a positive reexposure were fulfilled, whereas in the remaining cases the reexposure test was classified as negative (n = 1), or the data were considered as uninterpretable due to missing information to comply adequately with the criteria (n = 6). In virtually all assessed cases, liver unspecific causality assessment methods were applied rather than a liver specific method such as the CIOMS scale. Using this scale, causality gradings for Herbalife in these eight cases were probable (n = 1), unlikely (n = 4), and excluded (n = 3). Confounding variables in- cluded low data quality, alternative diagnoses, poor exclusion of important other causes, and comedication by drugs and herbs in 6/8 cases. More specifically, problems were evident in some cases regarding temporal association, daily doses, exact start and end dates of product use, actual data of laboratory parameters such as ALT, and exact dechallenge characteristics. Short-comings included scattered exclusion of hepatitis A-C, cytomegalovirus and Epstein Barr virus infection with only globally presented or lacking parameters. Hepatitis Evirus infection was considered in one single patient and found positive, infections by herpes simplexvirus and varicella zoster virus were excluded in none. CONCLUSION: Only one case fulfilled positive reexposure test criteria in initially assumed Herbalife hepatotoxicity, with lower CIOMS based causality gradings for the other cases than hitherto proposed. | Rolf Teschke Christian Frenzel Johannes Schulze Alexander Schwarzenboeck Axel Eickhoff | 2013 | World Journal of Hepatology2013，5，7： | 6 |
| 6 | Regulatory causality evaluation methods applied in kava hepatotoxicity: Are they appropriate?显示文摘 | Rolf Teschke Albrecht Wolff | 2010 | Regulatory Toxicology and Pharmacology2010，，1： | 2 |
| 7 | Kava hepatotoxicity: Comparison of aqueous, ethanolic, acetonic kava extracts and kava–herbs mixtures显示文摘 | Rolf Teschke Alexander Genthner Albrecht Wolff | 2009 | Journal of Ethnopharmacology2009，，3： | 2 |
| 8 | Herbal hepatotoxicity: suspected cases assessed for alternative causes显示文摘 | Rolf Teschke Johannes Schulze Alexander Schwarzenboeck Axel Eickhoff Christian Frenzel | 2013 | European Journal of Gastroenterology & Hepatology2013，，9： | 2 |
| 9 | Trace element levels in adults from the west coast of C-nada and associations with age,gender,diet,activities and levels of other trace elements显示文摘 | CLARK N A TESCHKE K RIDEOUT K | 2007 | Chemosphere2007，70，1： | 1 |
| 10 | Drug-induced liver diseases显示文摘 | Teschke R | 2002 | Z Gastroenterol2002，40，5： | 1 |
| 11 | Simple all-optical FFT scheme enabling Tbit/s real-time sig- nal processing 显示文摘 | Hillerkuss D Winter M Teschke M | 2010 | Optics Express2010，18，9： | 1 |
| 12 | High-speed photographs of a dielectric barrier atmospheric pressure plasma jet显示文摘 | Teschke M Kedzierski J Finantu-Dinu E G | | 0，，2： | 1 |
| 13 | Trace element levels in adults from the west coast of Canada and associations with age,gender,diet,activities,and levels of other trace elements显示文摘 | CLARK N A TESCHKE K RIDEOUT K | 2007 | Chemosphere2007，70，1： | 1 |
| 14 | Parental occupational exposures to electromagnetic fields and radiation and the incidence of neuroblastoma in offspring显示文摘 | Teschke K Savitz D | 2001 | Epidemiology2001，12，5： | 1 |
| 15 | Mortality from Lung Cancer in Workers Exposed to Sulfur Dioxide in the Pulp and Paper Industry 显示文摘 | Lee WJ Teschke K Kauppinen T | 2002 | Environmental Health Perspectives2002，110，10： | 1 |
| 16 | Trace ele- ment levels in adults from the west coast of Canada and associations with age, gender, diet, activities, and levels of other trace elements显示文摘 | Clark NA Teschke K Rideout K | 2007 | Chemosphere2007，70，1： | 1 |
| 17 | ATPase activity of Mycobacterium tuberculosis SecA1 and SecA2 proteins and its importance for SecA2 function in macrophages显示文摘 | Hou JM D'Lima NG Rigel NW Gibbons HS McCann JR Braunstein M Teschke CM | 2008 | J Bacteriol2008，190，14： | 1 |
| 18 | A new type of PTFE-covered gas evolving electrode 显示文摘 | de Moares M A B Teschke O | 1986 | J Electrochem Soc1986，133，9： | 1 |
| 19 | The impact of transportation infrastructure on bicycling injuries and crashes:a review of the literature显示文摘 | Reynolds CC Harris MA Teschke K | 2009 | Environ Health2009，8，： | 1 |
| 20 | 显示文摘 | Soares D M Teschke O Torriani I | 1992 | J Electrochem Soc1992，139，： | 1 |
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