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Objective To explore the correlation between metabolic syndrome (MS) and noise-induced hearing loss (NIHL) in noise-exposed workers. Methods Using the convenient sampling method, a total of 850 male noise-exposed workers in an automobile manufacturing enterprise were studied. The questionnaire survey and occupational health examination were combined to collect general demographic data, physical examination data, and other information. According to the results of high-frequency hearing loss, the noise-exposed workers were divided into the hearing loss group (326 workers) and the normal hearing group (524 workers). The single-factor analysis was used to compare the above data differences between the two groups. The binary multiple-factor logistic regression model was used to analyze the influencing factors of NIHL in noise-exposed workers. Results The non-compliance rate of noise intensity in the enterprise was 39.47% (15/38), with the highest occurrences in the welding and painting posts. The morbidity of hearing loss was 38.35% (326/850), and the MS morbidity was 27.53% (234/850). The frequency of obesity, high-level triglyceride, high-level fasting blood glucose, hypertension, MS,and the contact noise level in the hearing loss group were higher than those in the normal hearing group (P < 0.05). The results of multiple-factor logistic regression showed that, compared with the workers with a noise exposure duration ≤ 5 years, the risk of NIHL in the workers with a noise exposure duration of 11 - 15 years or > 15 years increased to 1.553 and 1.727 times, respectively (P < 0.001). Compared with the workers without MS, the risk of NIHL in the workers with MS increased to 1.863 times (P < 0.001). The risk of NIHL increases by 1.567 times for each 1 dB(A) increase in noise level (P < 0.001). Conclusions There was a correlation between MS and NIHL. In addition to emphasizing control of noise level in the workplace, attention should also be paid to adopting a low-sugar, low-salt, and low-sodium diet, reducing the intake of saturated fatty acids, and strengthening physical exercise to effectively control the blood pressure, blood sugar, and blood lipid levels of workers so as to reduce the risk of NIHL. [ABSTRACT FROM AUTHOR]

This article proposes an electromagnetic acoustic transducer (EMAT) for selectively improving the purity and amplitude of ultrasonic Lamb waves in non-ferromagnetic plates. The developed EMAT consists of a racetrack coil and a group of periodic permanent magnets (PPMs). Two-dimensional finite element simulations and experiments are implemented to analyze the working mechanism and performance of the PPM EMAT. Thanks to the specific design, the eddy currents increase with increasing wire density and the directions of the magnetic fields and Lorentz forces alternate according to the polarities of the magnet units. Wires laid uniformly beneath the magnets, and the gaps between adjacent magnets generate tangential and normal Lorentz forces, resulting in-plane (IP) and out-of-plane (OP) displacements, respectively. The constructive interference occurs when the wavelength of the generated Lamb wave is twice the spacing of the magnets, leading to large amplitudes of the targeted ultrasonic Lamb waves. Therefore, the PPM EMAT is capable of generating pure symmetric or antisymmetric mode Lamb waves at respective frequencies. The results prove that the developed PPM EMAT can generate pure either S0 or A0 mode Lamb waves at respective frequencies. The increase in wire width and wire density further increases the signal amplitudes. Compared with the case of conventional meander-line-coil (MLC) EMAT, the amplitudes of the A0 and S0 mode Lamb waves of our PPM EMAT are increased to 880% and 328%, respectively. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to develop a scale for evaluating and grading the evidence of prevention and treatment in ancient books of traditional Chinese medicine (TCM), in view of providing a reference for TCM clinicians, supporting the compilation or revision of evidence-based practice guidelines for TCM, improving the level of evidence-based research on ancient TCM books, and supplementing the development of evidence-based ancient TCM books. Methods. The Delphi method was used for consultation among 40 experts in relevant fields. Excel 2016 and SPSS 21.0 were used to analyze the positive coefficient, authority coefficient, degree of concentration, degree of coordination, and degree of expert consensus. Results. In the first round of the questionnaire, a total of 17 evaluation indexes were formulated in three aspects: 5 were deleted, 1 was modified according to the expert opinions, and no additional index was added. In addition, quantitative standards, weight assignment, and grading standards were developed according to the findings of the expert consultation. The positive coefficients of experts in the first and second rounds of questionnaires were 87.5% and 82.9%, respectively. The authority coefficient was 0.835 (>0.7). The coefficient of variation of the first and second rounds were 0.14∼0.29 and 0.09∼0.27, respectively. Kendall's coefficient of concordance of the first and second rounds were 0.135 (p < 0.05) and 0.081 (p < 0.05), respectively. Conclusion. The evaluation indexes and quantitative reference values of the developed scale conform to the characteristics of prevention and treatment evidence in ancient TCM books. It can provide a useful exploration tool for the evaluation and grading of evidences in TCM ancient books. [ABSTRACT FROM AUTHOR]

Background: Aicardi-Goutières syndrome (AGS) is a severe infant or juvenile-onset autoimmune disease characterized by inflammatory encephalopathy with an elevated type 1 interferon-stimulated gene (ISG) expression signature in the brain. Mutations in seven different protein-coding genes, all linked to DNA/RNA metabolism or sensing, have been identified in AGS patients, but none of them has been demonstrated to activate the IFN pathway in the brain of an animal. The molecular mechanism of inflammatory encephalopathy in AGS has not been well defined. Adenosine Deaminase Acting on RNA 1 (ADAR1) is one of the AGS-associated genes. It carries out A-to-I RNA editing that converts adenosine to inosine at double-stranded RNA regions. Whether an AGS-associated mutation in ADAR1 activates the IFN pathway and causes autoimmune pathogenesis in the brain is yet to be determined.Methods: Mutations in the ADAR1 gene found in AGS patients were introduced into the mouse genome via CRISPR/Cas9 technology. Molecular activities of the specific p.K999N mutation were investigated by measuring the RNA editing levels in brain mRNA substrates of ADAR1 through RNA sequencing analysis. IFN pathway activation in the brain was assessed by measuring ISG expression at the mRNA and protein level through real-time RT-PCR and Luminex assays, respectively. The locations in the brain and neural cell types that express ISGs were determined by RNA in situ hybridization (ISH). Potential AGS-related brain morphologic changes were assessed with immunohistological analysis. Von Kossa and Luxol Fast Blue staining was performed on brain tissue to assess calcification and myelin, respectively.Results: Mice bearing the ADAR1 p.K999N were viable though smaller than wild type sibs. RNA sequencing analysis of neuron-specific RNA substrates revealed altered RNA editing activities of the mutant ADAR1 protein. Mutant mice exhibited dramatically elevated levels of multiple ISGs within the brain. RNA ISH of brain sections showed selective activation of ISG expression in neurons and microglia in a patchy pattern. ISG-15 mRNA was upregulated in ADAR1 mutant brain neurons whereas CXCL10 mRNA was elevated in adjacent astroglia. No calcification or gliosis was detected in the mutant brain.Conclusions: We demonstrated that an AGS-associated mutation in ADAR1, specifically the p.K999N mutation, activates the IFN pathway in the mouse brain. The ADAR1 p.K999N mutant mouse replicates aspects of the brain interferonopathy of AGS. Neurons and microglia express different ISGs. Basal ganglia calcification and leukodystrophy seen in AGS patients were not observed in K999N mutant mice, indicating that development of the full clinical phenotype may need an additional stimulus besides AGS mutations. This mutant mouse presents a robust tool for the investigation of AGS and neuroinflammatory diseases including the modeling of potential "second hits" that enable severe phenotypes of clinically variable diseases. [ABSTRACT FROM AUTHOR]

Flexible supercapacitors are of great significance for the development of intelligent electronic products and wearable devices. Herein, through reasonable design, self-supporting flexible film composites that can be used as supercapacitor electrodes, are synthesised by vacuum filtration. The composites are composed of electrochemically exfoliated graphene nanosheets and MnO2 nanowires, in which the graphene nanosheets mainly play the role of skeleton support, enhance conductivity, and provide electric double-layer capacitance, while the MnO2 nanowires mainly provide pseudocapacitance. Results show that the sample with 20 % MnO2 possesses the best electrochemical performance due to the mass ratio which can give full play to the pseudocapacitive properties of MnO2 and the conductivity of graphene. The maximum mass specific capacitance reaches 106.2 F g−1 at 0.5 A g−1, and the areal specific capacitance is 767.0 mF cm−2 at 1 mA cm−2. The electrode also maintains 86.7 % of the initial capacitance after 10000 cycles, indicating good cyclic stability. Furthermore, an asymmetric solid supercapacitor based on flexible thin films is assembled. The energy density is 20.7 W h kg−1, the power density is 1000 W kg−1, and the capacitance remains 84.2 % after 3000 cycles at 5.0 A g−1. These results suggest that the as-prepared self-supporting material has the potential to be used to construct flexible supercapacitors for wearable equipment. Electrochemically exfoliated graphene/manganese dioxide nanowire composites have been prepared as efficient electrode materials for flexible supercapacitors. In the composites, graphene nanosheets mainly play the role of skeleton support, enhance conductivity, and provide electric double-layer capacitance, while the MnO2 nanowires mainly provide pseudocapacitance. [ABSTRACT FROM AUTHOR]

Background: Aicardi-Goutières syndrome (AGS) is a severe neurodegenerative disease with clinical features of early-onset encephalopathy and progressive loss of intellectual abilities and motor control. Gene mutations in seven protein-coding genes have been found to be associated with AGS. However, the causative role of these mutations in the early-onset neuropathogenesis has not been demonstrated in animal models, and the mechanism of neurodegeneration of AGS remains ambiguous.Methods: Via CRISPR/Cas-9 technology, we established a mutant mouse model in which a genetic mutation found in AGS patients at the ADAR1 coding gene (Adar) loci was introduced into the mouse genome. A mouse model carrying double gene mutations encoding ADAR1 and MDA-5 was prepared using a breeding strategy. Phenotype, gene expression, RNA sequencing, innate immune pathway activation, and pathologic studies including RNA in situ hybridization (ISH) and immunohistochemistry were used for characterization of the mouse models to determine potential disease mechanisms.Results: We established a mouse model bearing a mutation in the catalytic domain of ADAR1, the D1113H mutation found in AGS patients. With this mouse model, we demonstrated a causative role of this mutation for the early-onset brain injuries in AGS and determined the signaling pathway underlying the neuropathogenesis. First, this mutation altered the RNA editing profile in neural transcripts and led to robust IFN-stimulated gene (ISG) expression in the brain. By ISH, the brains of mutant mice showed an unusual, multifocal increased expression of ISGs that was cell-type dependent. Early-onset astrocytosis and microgliosis and later stage calcification in the deep white matter areas were observed in the mutant mice. Brain ISG activation and neuroglial reaction were completely prevented in the Adar D1113H mutant mice by blocking RNA sensing through deletion of the cytosolic RNA receptor MDA-5.Conclusions: The Adar D1113H mutation in the ADAR1 catalytic domain results in early-onset and MDA5-dependent encephalopathy with IFN pathway activation in the mouse brain. [ABSTRACT FROM AUTHOR]

Infectious bursa disease virus causes an acute infection in bursal B cells. The Toll-like receptor (TLR) signaling pathway plays a key role in innate immunity during virus infection. In this study, an Agilent microarray was used to investigate different transcriptional profiles of the TLR pathway and related genes of chicken bursa at 48 h after infection with IBDV, compared with simulated infection. Expression of >58 genes changed significantly. Forty-six genes associated with chicken bursa proinflammatory effects, chemotactic effects, and T-cell stimulation were upregulated, which meant enhancement of these features. Twelve genes that are related to proliferation and differentiation of bursal cells were downregulated, implying suppression of these features. These results revealed that genes of the TLR pathway play an important role in the pathogenicity of IBDV infection. The findings are helpful for understanding the molecular basis of viral pathogenesis and the underlying mechanism of the host antiviral response. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to quantitatively assess the effectiveness of self-practiced qigong for treatment of essential hypertension. Methods: Six major electronic databases were searched up to July 2006 to retrieve any potential randomized controlled trials designed to evaluate the clinical effectiveness of self-practiced qigong for essential hypertension reported in any language, with main outcome measures as systolic blood pressure (SBP) and diastolic blood pressure (DBP). The quality of included studies were assessed with the Jadad Scale and a customized standard quality assessment scale. Results: Ninety-two (92) studies were identified. Nine (9) of these studies qualified for meta-analysis, comprising a total of 908 cases. Results were as follows: (1) The mean decrease of SBP in those practicing qigong was a 17.03 mm Hg reduction (95% confidence interval (CI) 11.53–22.52) compared with nonspecific intervention controls, but not superior to that in drug controls (1.19 mm Hg, 95% CI −5.40–7.79) and conventional exercise controls (−1.51 mm Hg, 95% CI −6.98–3.95). (2) Mean decrease of DBP in those practicing qigong was 9.98 mm Hg (95% CI 2.55–17.41) compared with nonspecific intervention controls, but not superior to that in drug controls (2.49 mm Hg, 95% CI −0.16–5.13) and conventional exercise controls (−1.59 mm Hg, 95% CI −4.91–1.74). (3) No obvious side effects were identified. Conclusions: Self-practiced qigong for less than 1 year is better in decreasing BP in patients with essential hypertension than in no-treatment controls, but is not superior to that in active controls. More methodologically strict studies are needed to prove real clinical benifits of qigong, and to explore its potential mechanism. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the correlations between body composition and traditional Chinese medicine (TCM) constitution in normal-weight, overweight, and obese outpatients in Department of Acupuncture for Endocrine-related Obesity. Methods The "YiJianZhong Weight Management" We Chat app was used to record patients' weight, TCM constitution (only five types of TCM constitutions were included: balanced constitution, phlegm-dampness constitution, damp-heat constitution, yang-deficiency constitution, and qi-stagnation constitution), and other information. In addition, a body composition analyzer was used to collect the information including the percentage of body fat, body mass index (BMI), basal metabolic rate, and visceral fat index. Finally, the body constitution data of patients with different TCM constitutions were summarized and analyzed. Results A total of 308 patients were included in the analysis, including 100 cases of normal-weight patients and 208 cases of obese or overweight patients. The proportions of TCM constitutions in the normal-weight patients were ranked from most to least as follows; balanced constitution > yang-deficiency constitution > damp-heat constitution > qi-stagnation constitution > phlegm-dampness constitution, while the proportions of TCM constitutions in obese and overweight patients were ranked in the same order as follows; balanced constitution > phlegm-dampness constitution > damp-heat constitution > yang-deficiency constitution > qi-stagnation constitution. There was no significant difference in the composition ratio of the different TCM constitutions between normal-weight patients and overweight, obese patients. The BMIs of all the patients were negatively correlated with the qi-stagnation constitution scores. The BMI decreased by 0.152 kg/m when the qi-stagnation constitution score increased by one point. The age and qi-stagnation constitution scores had a positive interaction with the BMI. For every 1-year increase in the average age of patients, the effect of the qi-stagnation constitution scores on the BMI changed from -0.152 kg/m to -0.147 kg/m. Conclusion In terms of the TCM constitution, a balanced constitution accounted for the highest proportion in normal-weight patients, overweight, and obese patients, while phlegm-dampness and damp-heat constitution accounted for a higher proportion in overweight and obese patients, except for the balanced constitution. In addition, in terms of the relationship between the TCM constitution and body composition, due to the negative correlation between the BMI and the qi-stagnation constitution score, overweight or obese patients with a qi-stagnation constitution should pay more attention to the influence of body composition indicators other than BMI on the development of disease. [ABSTRACT FROM AUTHOR]

In this work, a novel method for fabrication of a flexible SERS substrate was designed and implemented by combining colloidal lithography, oxygen plasma etching, ionic exchange and in-situ chemical reduction on Nafion membrane. First of all the periodic nanopillar arrays were produced on Nafion membrane by colloidal lithography and oxygen plasma etching. Further, ionic exchange and in-situ chemical reduction were carried out through which three-dimensional (3D) Nafion stabilized Ag nanopillar arrays were obtained that showed significant contribution to SERS enhancement. The SERS results showed that the optimized Nafion stabilized Ag nanopillar arrays exhibited high SERS sensitivity to R6G and good reproducibility to p-ATP. The R6G with a low concentration of 10−11 M could be detected and the good reproducibility with relative standard deviation (RSD) less than 10% could be obtained using a portable Raman spectrometer. After undergoing the cyclic bending deformation, the flexible substrate still maintain stable SERS signals, implying that it can withstand mechanical deformation without losing SERS performance. In addition, the designed platform achieved high sensitivity to detect the harmful malachite green (MG) with a low concentration of 10−10 M, signifying a pronounced prospect as a potential flexible SERS platform for trace harmful chemical sensing. Image 1 • A novel method to fabricate a flexible SERS substrate based on Nafion was designed. • The proton exchange of Nafion membrane facilitated preparation of SERS substrate. • The excellent SERS performance relied on a highly ordered 3D nanostructure. • The substrate achieved high sensitivity to detect the harmful malachite green. [ABSTRACT FROM AUTHOR]

Background. The prophylactic effects of Chinese herbal medicine (CHM) for migraine were examined in numerous clinical trials. This review aimed to analyze the effectiveness and safety of CHM as prophylactic treatment of migraine compared to flunarizine. Methods. Nine databases were searched for randomized controlled trials (RCTs) that evaluated effects of CHM for episodic migraine prophylaxis compared to flunarizine, published before March 2019. Results. Thirty-five RCTs with 2,840 participants met the inclusion criteria, and 31 of them were included in meta-analyses. The overall meta-analysis indicated that, when compared to flunarizine, CHM reduced the frequency of migraine attacks at the end of treatment (EoT) (21 studies, mean difference (MD) −1.23, 95% confidence interval (CI) (−1.69, −0.76)) and at the end of follow-up (EoFU) (five studies, MD −0.96, 95% CI (−1.70, −0.21)). Subgroup analyses based on the treatment duration, follow-up duration, and the dosage of flunarizine showed that CHM was superior to or comparable with flunarizine in reducing migraine frequency. Similar results were also found for secondary outcomes such as the pain visual analogue scale, migraine duration, responder rate, and acute medication usage. In particular, the studies that used CHM containing herb pairs (Chuan Xiong plus Bai Zhi and Chuan Xiong plus Tian Ma) showed promising results. However, the certainty of this evidence was evaluated as "low" or "very low" using the Grading of Recommendations, Assessment, Development and Evaluations approach. Conclusion. CHM appeared to be comparable with flunarizine in reducing the frequency of episodic migraine attacks in adults at EoT and EoFU and well-tolerated by participants, regardless of the treatment duration, follow-up duration, and dosage of flunarizine. Due to the low certainty of the evidence, the suggested promising prophylactic outcomes require higher quality evidence from further rigorous RCTs. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aims to: assess the effectiveness and safety of orally administered Chinese herbal medicines (CHMs) as adjuncts to the post-surgical management of chronic rhinosinusitis (CRS); inform clinicians of the current evidence; identify the best available evidence; and suggest directions for further research. Randomised controlled trials (RCTs) were identified from searches of nine databases plus clinical trial registries. Participants were adults and/or children diagnosed with sinusitis or rhinosinusitis, with or without nasal polyps, who had received surgery. Interventions were CHMs used orally following surgery for CRS as additions to conventional post-surgical management. Controls received conventional post-surgical management without CHMs. Studies reported results for Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy endoscopic score (LK), mucociliary transport time (MTT), mucociliary transport rate (MTR), mucociliary clearance (MC) or quality of life (QoL). Twenty-one RCTs were included. All used oral CHMs following functional endoscopic sinus surgery (FESS). The pooled results showed no significant difference between groups for SNOT-20 at the end of treatment (EoT) but there was a significant difference at follow up (FU) in favour of additional CHMs. The VAS for total nasal symptoms (VAS-TNS) showed greater improvements in the CHM groups at EoT and FU. Only FU data were reported for LM which showed greater improvement in the CHM groups. LK showed greater improvements at EoT and FU. The measures of mucociliary transport (MTT, MTR, and MC) each showed significantly greater improvement at EoT in the group that received additional CHMs. No study reported QoL. Adverse events were not serious, but reporting was incomplete. The meta-analyses suggested the addition of oral CHMs to conventional management following FESS may improve recovery. However, most studies were not blinded, and substantial heterogeneity was evident in some meta-analyses. Blinded studies are required to further investigate the roles of oral CHMs in post-surgical recovery. Systematic review registration number: The protocol was registered in PROSPERO (CRD42019119586). [ABSTRACT FROM AUTHOR]

The title compound is prepared by solid state reaction of a stoichiometric mixture of MgO, Sr(NO3)2, and H3BO3 (Pt crucible, 1. [ABSTRACT FROM AUTHOR]

A rapid and efficient method using high-speed counter-current chromatography was established for the bioassay-guided separation of an active compound with protein tyrosine phosphatase 1B inhibitory activity from Sargassum fusiforme. Under the bioassay guidance, the ethyl acetate extract with the best IC50 value of 0.37 ± 0.07 μg/mL exhibited a potential protein tyrosine phosphatase 1B inhibitory activity, which was further separated by high-speed counter-current chromatography. The separation was performed with a two-phase solvent system composed of n-hexane/methanol/water (5:4:1, v/v). As a result, dibutyl phthalate (19.7 mg) with the purity of 95.3% was obtained from 200 mg of the ethyl acetate extract. Its IC50 was 14.05 ± 0.06 μM, which was further explained by molecular docking. The result of molecular docking showed that dibutyl phthalate enfolded in the catalytic site of protein tyrosine phosphatase 1B. The main force between dibutyl phthalate and protein tyrosine phosphatase 1B was the hydrogen bond interaction with Gln266. In addition, hydrogen bond, van der Waals force and hydrophobic interaction with the amino acids (Ala217, Ile219, and Gly220) were also responsible for the stable protein-ligand complex. [ABSTRACT FROM AUTHOR]

This systematic review aims to assess the effects and safety of Chinese herbal medicines (CHMs) in the management of rhinosinusitis (RS); inform clinicians of the current state of the evidence; identify the best available evidence; and suggest further directions for research. Five English and four Chinese language databases, and four clinical trial registries were searched. Eligible studies were randomised controlled trials (RCTs). Participants were diagnosed with RS based on established criteria. Test interventions were CHMs administered orally and/or nasally, excluding injections and displacement techniques. Control interventions included placebos, no additional treatment, and conventional non-invasive treatments including pharmacotherapies and/or nasal irrigation, and/or inhalations. Polyposis and post-surgical recovery were excluded. Outcomes were Sino-Nasal Outcome Test (SNOT), visual analogue scales (VAS), Lund-Mackay computed tomography score (LM), Lund-Kennedy Endoscopic score (LK), Mucociliary transport time (MTT), Mucociliary transport rate (MTR), quality of life and adverse events (AEs). Risk of bias used the Cochrane tool. Meta-analysis in Review Manager 5.4.1 used random effects for mean difference (MD) or risk ratio (RR) with 95% confidence intervals. Heterogeneity was assessed as I2. Thirty-four RCTs were included, 30 of chronic RS (CRS) and four of acute RS (ARS). These enrolled 3,752 participants. Five RCTs blinded participants. For CRS, comparisons with placebo showed greater improvements in the CHM groups for SNOT-20 and VAS-TNS (total nasal symptoms). Blinded comparisons with pharmacotherapies showed no differences between groups in the degree of improvement for SNOT-20, VAS-TNS, and LM, suggesting these CHMs had similar effects, at least in the short term. In ARS, pooled results found improved scores on VAS-TNS and LK suggesting a benefit for combining these CHMs with pharmacotherapies. Limitations included inadequacies in study design and methodological reporting, and insufficient reporting of AEs. Heterogeneity in some pooled results precluded strong conclusions. Further well-designed studies are needed to test whether the results are replicable. Systematic review registration number: PROSPERO (CRD42019119586). [ABSTRACT FROM AUTHOR]

This systematic review is to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for people with insomnia. Randomized controlled trials (RCTs) investigating oral CHM alone or in combination with conventional therapies for primary insomnia were identified by searching English and Chinese publications and databases of clinical trial registration. Risk of bias was assessed according to the Cochrane Handbook 5.1. Meta-analysis was conducted using RevMan 5.2.4. Seventy-nine trials (7886 participants) were finally included in the review, and 76 were included in the meta-analysis. Twenty-seven trials reported the methods of random sequence generation, and five of them used the allocation concealment. Blinding of participants and personnel were used in 10 studies. The main meta-analysis showed that CHM alone was more effective than placebo by reducing scores of Pittsburgh Sleep Quality Index (mean difference, MD: -3.06, 95% confidence interval, CI: -5.14 to -0.98, I(2) = 97%) and benzodiazepine drugs (BZDs) (MD: -1.94, 95% CI: -2.45 to -1.43, I(2) = 96%). The effect was also seen when CHM was combined with BZDs compared with placebo plus BZDs (MD: -1.88, 95% CI: -2.78 to -0.97, I(2) = 0%) or cognitive and behavioral therapy (MD: -3.80, 95% CI: -4.91 to -2.68, I(2) = 68%) alone. There was no significant difference between CHM and placebo regarding the frequency of adverse events (relative risk, RR: 1.65, 95% CI: 0.67-4.10, I(2) = 0). Overall, oral CHM used as a monotherapy or as an adjunct to conventional therapies appears safe, and it may improve subjective sleep in people with insomnia. However, the typical effect of CHM for insomnia cannot be determined due to heterogeneity. Further study focusing on individual CHM formula for insomnia is needed. The development of a comparable placebo is also needed to improve the successful blinding in RCTs. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is a disabling, recurrent headache disorder with complex comorbidities. Conventional treatments for migraine are unsatisfactory, with side effects and limited effectiveness. Chinese herbal medicine (CHM) has been used as an alternative or complementary treatment option for migraine in China. Currently, the existing evidence of benefit of CHM for migraine has been generated from randomised clinical trials using standardised intervention with a focus on internal validity hence with limited external validity. Moreover, CHM individualised intervention design, patients' preferences and concerns, and clinicians' experience are critical to clinical decision making and therapeutic success. This real-world observational study aims to gather practice-based evidence of effects and safety of CHM for migraine in the context of integrating Chinese medicine diagnostic procedures, patients' preferences and matters relevant to clinical decision making. Methods and analysis: The study is being undertaken at the Guangdong Provincial Hospital of Chinese Medicine (GPHCM) from December 2020 to May 2022. We anticipate that approximately 400 adult migraineurs will be enrolled and observed on their migraine severity, analgesic consumption, quality of life, anxiety, depression and insomnia at baseline and then every four weeks over 12 weeks. Treatments, diagnostic information, and patient-reported most bothersome symptoms will be collected from patient clinical records. Patient's demographic data, preferences and concerns on CHM treatments will also be gathered at baseline and be analysed. Factors related to clinical outcomes will be explored with multiple correlation and multivariable regression analyses. Effects of CHM will be evaluated using generalised estimated equation, based on clinical outcome data. Discussion: This study will provide comprehensive evidence of CHM for migraine in the context of evidence-based practice. Trial registration number: ChiCTR2000041003 [ABSTRACT FROM AUTHOR]

Background: This study aims to develop an evidence-based clinical practice guideline of acupuncture in the treatment of patients with moderate and severe cancer pain. Methods: The development of this guideline was triggered by a systematic review published in JAMA Oncology in 2020. We searched databases and websites for evidence on patient preferences and values, and other resources of using acupuncture for treatment of cancer pain. Recommendations were developed through a Delphi consensus of an international multidisciplinary panel including 13 western medicine oncologists, Chinese medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient preferences and values, resources, and other factors were fully considered in formulating the recommendations. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was employed to rate the certainty of evidence and the strength of recommendations. Results: The guideline proposed three recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced arthralgia. Conclusion: This proposed guideline provides recommendations for the management of patients with cancer pain. The small sample sizes of evidence limit the strength of the recommendations and highlights the need for additional research. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) has turned into a pandemic and resulted in huge death tolls and burdens. Integrating Chinese and western medicine has played an important role in the fight against the COVID‐19 pandemic. Purpose: We aimed to develop a living evidence‐based guideline of integrating Chinese and western medicine for COVID‐19. Study design: Living evidence‐based guideline. Methods: This living guideline was developed using internationally recognized and accepted guideline standards, dynamically monitoring the release of new clinical evidence, and quickly updating the linked living systematic review, evidence summary tables, and recommendations. Modified Delphi method was used to reach consensus for all recommendations. The certainty of the evidence, resources, and other factors were fully considered, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of evidence and the strength of recommendations. Results: The first version of this living guidance focuses on patients who are mild or moderate COVID‐19. A multidisciplinary guideline development panel was established. Ten clinical questions were identified based on the status of evidence and a face‐to‐face experts' consensus. Finally, nine recommendations were reached consensus, and were formulated from systematic reviews of the benefits and harms, certainty of evidence, public accessibility, policy supports, feedback on proposed recommendations from multidisciplinary experts, and consensus meetings. Conclusion: This guideline panel made nine recommendations, which covered five traditional Chinese medicine (TCM) prescription granules/decoction (MXXFJD, QFPD, XFBD, TJQW, and JWDY), three Chinese patent medicines (LHQW granules/capsule, JHQG granules, and LHQK granules), and one Chinese herbal injection (XBJ injection). Of them, two were strongly recommended (LHQW granules/capsule and QFPD decoction), and five were weakly recommended (MXXFJD decoction, XFBD decoction, JHQG granules, TJQW granules, and JWDY decoction) for the treatment of mild and moderate COVID‐19; two were weakly recommended against (XBJ injection and LHQK granules) the treatment of mild and moderate COVID‐19. The users of this living guideline are most likely to be clinicians, patients, governments, ministries, and health administrators. [ABSTRACT FROM AUTHOR]

Introduction. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) imposes a large burden on economy and society worldwide. In addition to western medicine, multiple kinds of qi-tonifying Chinese medicine injections have been widely used in China as adjunctive treatments. Previous small-sample clinical trials have proven their efficacy in the treatment of AECOPD. However, data on comparative effectiveness and safety of qi-tonifying injections are limited. We conducted this network meta-analysis to compare the efficacy and safety of 7 commonly used qi-tonifying injections in patients with AECOPD. Methods. Literature search was conducted through electronic databases, including PubMed, the Cochrane Library, EMBASE, CINAHL, AMED, CBM, CNKI, Wanfang database, and VIP database. Randomized clinical trials (RCTs) exploring the efficacy of any of these 7 qi-tonifying injections were included. The primary outcome was lung function (FEV1 and FVC). R 4.0.0 and STATA 12.0 were adopted to perform the network meta-analysis using Bayesian statistics. Results. A total of 36 RCTs involving 2657 participants were included. The results of network meta-analyses indicated that Chuankezhi injection (CKZ) combined with routine treatment (RT) was superior to other qi-tonifying injections combined with RT in terms of FEV1 improvement (MD = 0.63, 95% CI: 0.22, 1.04). For improving FVC, Shengmai injection (SGM) combined with RT showed the greatest therapeutic effect (MD = 0.38, 95% CI: 0.13, 0.61). Moreover, SGM combined with RT revealed the best estimates for response rate (MD = 4.00, 95% CI: 1.34, 13.63). The main adverse events in this study were gastrointestinal reactions and injection site reactions. No serious adverse events were reported. Conclusion. In this network meta-analysis, SGM and CKZ were potential best adjunctive therapies in the treatment of AECOPD. [ABSTRACT FROM AUTHOR]

Purpose: The patient's preference plays an important role in clinical practice. There currently is no available evidence regarding the perception and attitudes of patients with chronic obstructive pulmonary disease (COPD) towards the use of Chinese medicine (CM) approaches. This study was designed to explore preferences and factors associated with CM among COPD patients. Patients and Methods: A pilot survey was conducted among COPD patients using a structured, pre-tested questionnaire. The perceptions of CM therapies (including herbal medicine, non-pharmacotherapies), and expected clinical outcomes were investigated based on patient preference. Factors associated with preference of treatment scenarios were estimated in order of importance. Results: Thirty patients were enrolled in the survey, including 27 males and 3 females. Two-thirds of the patients preferred integrative Chinese and Western medicine for the treatment of COPD. Chinese patent medicines and CM decoction therapy were more popular than CM injections. The preferred non-drug therapy was point application, followed by acupuncture, Tai chi, or Qigong. More than 70% of patients reported that important clinical outcomes were improvements in lung function (77%) and dyspnea, cough, and sputum symptoms (73%), followed by exercise endurance (50%). Besides clinical efficacy, costs and side effects were also important factors for treatment selection. Conclusion: This pilot study showed that Chinese patent medicine and CM decoctions were preferred options for complementary medicines to combine with routine pharmacotherapy for COPD treatment according to the patients' preferences. The improvement of dyspnea, cough symptoms, and lung function was the most desired clinical outcomes for patients. Quicker symptom relief, lower costs, and fewer side effects were key attributes for the treatment selection. Further research with a larger sample size is needed to definitively address the comprehensive conclusion. [ABSTRACT FROM AUTHOR]

Patient participation is essential for Core Outcome Set (COS) development studies. Patient education during participation may help patients better express their views in COS studies. This study aimed to investigate the current status of patient participation and the specified educational information in COS studies. We conducted a systematic review of COS development studies. Information on patient participation in COS research, and especially details of patient education, was analyzed. In total, 146 COS development studies were included in this review. Of these, 125 studies (85.6%) mentioned patient participation. Most studies did not provide explicit information on patient participation. Some studies mentioned recruiting patients, but ultimately, none of them responded. Six studies reported conducting patient education through workshops, creating patient forums, or providing videos and slides. However, these studies did not provide details on education. Twenty-three studies used the plain language to explain patient outcomes. COS developers are increasingly focusing on patient participation. However, only a few COS studies have explicitly reported conducting measures related to patient education. Further patient education is necessary when they participate in the development of a new Core Outcome Set. This article provides implementation strategies related to patient education for future COS development studies. • Core outcome set (COS) is a minimum set that should be measured and reported in all clinical trials. • Attaching importance to patients' views, opinions, and participation in the COS development study is necessary. Patient education enables patients to express their perspectives better in the COS study. • COS developers are increasingly focusing on patient participation. However, only a few COS studies included in this review explicitly mentioned patient education during participation. • Conducting patient education is essential for future COS development. [ABSTRACT FROM AUTHOR]

Background. Ischemic stroke (IS) seriously impacts the quality of life of survivors. Chinese medicine (CM) has been developed for more than 2000 years and plays a key role in the treatment of ischemic stroke. Many Chinese medicine clinical trials have been conducted; however, the heterogeneity of outcome measurements and reporting limits implications of the findings in clinical practice and health policy development. Therefore, it is important to develop a core outcome set (COS) that should be used and reported in trials for ischemic stroke treated by Chinese medicine. This protocol describes the process of developing the IS-CM-COS. Methods and Analysis. The development of the COS will involve the following four steps: (1) A list of outcomes reported in the registered and published Chinese medicine trials of ischemic stroke will be extracted by conducting a systematic literature review. (2) An additional outcome list will be collected by semistructured interview to patients with ischemic stroke. (3) A two-round Delphi survey will be performed to prioritize and condense the outcomes. (4) In the consensus meeting, a final recommended COS will be developed. Discussion. The COS could improve the reliability and consistency of outcome reporting. We hope that this IS-CM-COS will be used in the future Chinese medicine trials for the treatment of ischemic stroke and improve research quality. Trial Registration. This study was registered with the Core Outcome Measures in Effectiveness Trials Initiative (http://www.comet-initiative.org/studies/details/1282). [ABSTRACT FROM AUTHOR]

Background. Rheumatoid arthritis (RA) is an autoimmune disease characterized by multijoint swelling, pain, and destruction of the synovial joints. Treatments are available but new therapies are still required. One source of new therapies is natural products, including herbs used in traditional medicines. In China and neighbouring countries, natural products have been used throughout recorded history and are still in use for RA and its symptoms. This study used text-mining of a database of classical Chinese medical books to identify candidates for future clinical and experimental investigations of therapeutics for RA. Methods. The database Encyclopaedia of Traditional Chinese Medicine (Zhong Hua Yi Dian) includes the full texts of over 1,150 classical books. Eight traditional terms were searched. All citations were assessed for relevance to RA. Results and Conclusions. After removal of duplications, 3,174 citations were considered. After applying the exclusion and inclusion criteria, 548 citations of traditional formulas were included. These derived from 138 books written from 206 CE to 1948. These formulas included 5,018 ingredients (mean, 9 ingredients/formula) comprising 243 different natural products. When these text-mining results were compared to the 18 formulas recommended in a modern Chinese Medicine clinical practice guideline, 44% of the herbal formulas were the same. This suggests considerable continuity in the clinical application of these herbs between classical and modern Chinese medicine practice. Of the 15 herbs most frequently used as ingredients of the classical formulas, all have received research attention, and all have been reported to have anti-inflammatory effects. Two of these 15 herbs have already been developed into new anti-RA therapeutics—sinomenine from Sinomenium acutum (Thunb.) Rehd. & Wils and total glucosides of peony from Paeonia lactiflora Pall. Nevertheless, there remains considerable scope for further research. This text-mining approach was effective in identifying multiple natural product candidates for future research. [ABSTRACT FROM AUTHOR]

Objectives:Bupleurum chinense (BC; Radix Bupleuri) formulae are widely used in herbal medicine clinical practice for major depressive disorder (MDD). This study provides an up-to-date and comprehensive systematic review and meta-analysis of BC formula for MDD. Design: Randomized controlled trials were retrieved from English and Chinese databases, from their inceptions to March 2019. Included studies compared BC formula alone or as integrative medicine to selective serotonin reuptake inhibitor (SSRI) antidepressants. Studies included adults 18–65 years of age. People with other types of depression or physical comorbidities, such as poststroke depression, bipolar, and other mental or physical disorders, were excluded. Meta-analysis was performed using STATA software. Grading of Recommendations Assessment, Development, and Evaluation was also conducted to assess the quality of evidence. Results: Thirty studies compared BC formula to antidepressants and 25 studies compared BC formula plus antidepressants to antidepressants alone. BC formula was more effective than antidepressants at improving depression severity measured on the Hamilton Rating Scale for Depression (HRSD) (standardized mean difference [SMD] −0.35, 95% confidence interval [CI] −0.52 to −0.18, I2 = 81.2%). Integrative use of BC formula plus SSRIs was also superior to SSRIs alone at improving HRSD scores (SMD −1.03, 95% CI −1.43 to −0.62, I2 = 94.2%). However, heterogeneity of the included studies was high and quality was low. The total number and severity of adverse events in the BC formula groups were less than that in the antidepressant groups. Conclusions: BC formula alone or given as integrative medicine with antidepressants reduced depression severity. However, the evidence is low quality and at risk of bias. Well-designed studies are needed to validate the results we identified in this review. [ABSTRACT FROM AUTHOR]

Gegen (Radix Puerariae Lobatae), the root of Pueraria lobata, is an edible and medicinal herb which has been used in treating diabetic symptoms in the orient for thousands of years. We present an evidence map of the efficacy and safety of Gegen and Gegen formulas (GGFs) that use Gegen as an essential herb for diabetes, and also its mechanism of actions. We comprehensively searched the ancient medical records to identify empirical evidence; conducted a systematic review (SR) based on moderate- to high-quality randomized controlled trials (RCTs) to synthesize the clinical evidence; and reviewed the possible mechanisms of its antidiabetic effects. Empirical application of Gegen in treating diabetic symptoms dated back to more than 2000 years ago. Common herbs used in RCTs that accompany with Gegen included Radix et Rhizoma Glycyrrhizae, Radix et Rhizoma Ginseng, Rhizoma Dioscoreae, Poria, and Radix Ophiopogonis. The combinations used today are consistent with their usage in ancient times. Results of the SR showed that GGFs could benefit patients with type 2 diabetes for blood glucose control. When in combination with hypoglycemic agents or insulin, GGFs enhanced the glucose-lowering effect as well as the lipid-lowering effects. Also, the incidence and the risk of adverse events (AE), especially the hypoglycemic episodes, were lower in the combination group. No serious or life-threatening AE was reported. The experimental evidence presented that Gegen and GGFs might exert and enhance the anti-diabetic effects through activation of multiple mechanisms, such as reducing insulin resistance, increasing insulin release, inhibiting glucose absorption and reabsorption, and improving insulin sensitivity, glucose uptake, and metabolism. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the traditional use of Chinese herbal medicine (CHM) for insomnia in pre-contemporary times. Materials and methods: The Encyclopedia of Traditional Chinese Medicine (fifth edition) was systematically searched using seven Chinese medicine disease nomenclatures to identify insomnia citations. Citations were coded, and frequently used herbal formulae specific for insomnia were analyzed. Results: Insomnia treatments were mentioned in 940 citations, and insomnia diagnosis treated with Chinese herbal formulae was specifically described in 800 citations. The traditional use of CHM appeared to be individualized based on the cause, pathogenesis, phase, phenotype, demographics, and concurrent medical conditions of insomnia. The most common herbal formulae for insomnia included Wen dan tang, Suan zao ren tang, Ban xia shu mi tang, and Gui pi tang. The most frequently cited herb was suan zao ren (Ziziphi spinosae semen). Conclusions: A number of herbal formulae for insomnia were cited in the historical literature. The commonly cited formulae such as Wen dan tang and Suan zao ren tang are consistent with current clinical practice and are good prospects for further therapeutic development. [ABSTRACT FROM AUTHOR]

Abstract CH 3 NH 3 PbI 3 system of organic-inorganic hybrid perovskite structure solar cells absorption material was established by using first-principle calculations based on density functional theory (DFT). Orthorhombic CH 3 NH 3 PbI 3 system model is optimized by different functional theories of CASTEP in Materials Studio. It revealed that the results of WC/GGA calculation method are more close to the experimental value. Electron band structure, state density are calculated in the paper and the results indicated that top orbital of the valence band is mainly contributed by Pb atom and I atomic orbital. At the same time, the conduction band bottom is mainly contributed by the orbital contribution of Pb atoms and strong σ bond is formed between terminal iodine atom and Pb atomic orbital. Moreover, the contribution of organic element density of states near the Fermi surface is very weak and the band gap of organic-inorganic hybrid CH 3 NH 3 PbI 3 materials is basically determined by inorganic elements. Highlights • Top orbital of the valence band of CH3NH3PbI3 is mainly contributed by Pb atom and I atomic orbital. • Conduction band bottom is mainly contributed by the orbital contribution of Pb atoms and strong σ bond is formed between terminal iodine atom and Pb atomic orbit. • Contribution of organic element density of states near the Fermi surface is very weak and the band gap of organic-inorganic hybrid CH 3 NH 3 PbI 3 materials is basically determined by inorganic elements. [ABSTRACT FROM AUTHOR]

Delays in recovery of intestinal function following abdominal surgery are associated with longer hospital stays, increased postoperative complications, and higher costs to the health care system. Studies of acupuncture for postoperative ileus and other postoperative issues have reported improvements. This systematic review and meta-analysis aimed to assess whether acupuncture assisted recovery following surgery for colorectal cancer (CRC). Randomized controlled trials (RCTs) were identified from major English and Chinese language biomedical databases. Participants (aged 18 years plus) had received surgical resection for CRC. 22 studies (1,628 participants) were included. Five were sham-controlled. Outcomes included gastrointestinal function recovery (21 studies), recovery of urinary function (1 study), postoperative abdominal distension (3 studies), and quality of life (1 study). Meta-analyses found significant reductions in time to first bowel sounds, first flatus, and first defecation in both the sham-controlled and nonblinded studies. These results suggested that the addition of acupuncture following CRC surgery improved recovery of gastrointestinal function based on four blinded good quality RCTs (281 participants) and 17 nonblinded lower quality RCTs (1,265 participants). The best available evidence was for interventions that included electroacupuncture at the point ST36 Zusanli and there is supporting evidence for other types of acupuncture therapies that involve stimulation of this point. This review is registered with the following: systematic review registration in PROSPERO: CRD42017079590. [ABSTRACT FROM AUTHOR]

Purpose. To conduct a systematic review and meta-analysis to determine the current best available evidence of the efficacy and safety of acupuncture and related therapies for acne vulgaris. Methods. Eleven English and Chinese databases were searched to identify randomized controlled trials (RCTs) of acne vulgaris compared to pharmacotherapies, no treatment, and sham or placebo acupuncture. Methodological quality was assessed using Cochrane Collaboration’s risk of bias tool. Meta-analysis was conducted using RevMan software. Results. Twelve RCTs were included in the qualitative review and 10 RCTs were included in meta-analysis. Methodological quality of trials was generally low. The chance of achieving ≥30% change in lesion count in the acupuncture group was no different to the pharmacotherapy group (RR: 1.07 [95% CI 0.98, 1.17]; I2=8%) and ≥50% change in lesion count in the acupuncture group was not statistically different to the pharmacotherapy group (RR: 1.07 [95% CI 0.98, 1.17]; I2=50%). Conclusions. While caution should be exercised due to quality of the included studies, acupuncture and auricular acupressure were not statistically different to guideline recommended treatments but were with fewer side effects and may be a treatment option. Future trials should address the methodological weaknesses and meet standard reporting requirements stipulated in STRICTA. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical evidence for traditional medicines (TMs) used in East Asia on measures of cognition in Alzheimer disease, determine the effect sizes at different time points for the TMs and pharmacotherapies, and assess the tolerability of the TMs.Methods: We searched 12 databases in English, Chinese, and Japanese for eligible randomised controlled trials that compared orally administered TMs with pharmacotherapy and reported cognitive outcomes. Meta-analyses were conducted for Alzheimer's Disease Assessment Scale-cognitive subscale and/or Mini-Mental State Examination (MMSE). Mean differences and 95% confidence intervals were calculated to evaluate treatment effects.Results: Thirty randomised controlled trials met inclusion criteria. Twenty-nine compared TMs with donepezil. Single studies provided comparisons with galantamine, rivastigmine, or memantine. There were no significant differences between the TM and donepezil groups at 12 or 24 weeks for Alzheimer's Disease Assessment Scale-cognitive subscale or MMSE. Improvements over baseline were significant for MMSE at 12 and 24 weeks within the TM and donepezil groups and remained significant at 1 year. Effect sizes were reduced in the 3 double-blind studies. At 24 weeks, donepezil 10 mg/d generally produced greater improvements in MMSE than 5 mg/d. Tolerability reporting was incomplete and inconsistent between studies.Conclusions: The results suggested that the clinical benefits of the TMs were not less than donepezil at comparable time points, with both groups showing improvements. However, lack of blinding in most studies and other design and measurement issues are likely to have resulted in overestimation of effect sizes in both groups. Further well-designed studies are needed. [ABSTRACT FROM AUTHOR]

Herpes zoster is an acute inflammatory condition which can have a significant impact on quality of life. Antiviral therapies are effective, but do not meet patients' expectations of symptomatic relief. Acupuncture and moxibustion have been used for herpes zoster; this systematic review evaluated their efficacy and safety. Nine English and Chinese databases were searched from their inceptions to March 2016. Randomized controlled trials evaluating the combination of acupuncture plus moxibustion in adult herpes zoster were included. Outcomes included pain intensity and duration, quality of life and adverse events. Meta-analysis was performed using RevMan software (version 5.3). Nine studies (945 participants) were included. Studies were of low to moderate methodological quality based on risk of bias assessment. Pain intensity (visual analogue scale) was lower among those who received acupuncture plus moxibustion compared with pharmacotherapy (one study; MD −8.25 mm, 95% CI −12.36 to −4.14). The clinical significance of this result is yet to be established. Some benefits were seen for other pain and cutaneous outcomes, and global improvement in symptoms. Mild adverse events were reported in the intervention groups. Acupuncture plus moxibustion may improve pain and cutaneous outcomes, although current evidence is limited by the number of studies and methodological shortcomings. [ABSTRACT FROM AUTHOR]

A rational liquid–liquid extraction approach was established to pre–treat samples for high–speed counter–current chromatography (HSCCC). n -Hexane–ethyl acetate–methanol–water (4:5:4:5, v/v) and (1:5:1:5, v/v) were selected as solvent systems for liquid–liquid extraction by systematically screening K of target compounds to remove low- and high-polarity impurities in the sample, respectively. After liquid–liquid extraction was performed, 1.4 g of crude sample II was obtained from 18.5 g of crude sample I which was extracted from the flowers of Robinia pseudoacacia L., and then separated with HSCCC by using a solvent system composed of n –hexane–ethyl acetate–methanol–water (1:2:1:2, v/v). As a result, 31 mg of robinin and 37 mg of kaempferol 7– O –α– l –rhamnopyranoside were isolated from 200 mg of crude sample II in a single run of HSCCC. A scale–up separation was also performed, and 160 mg of robinin with 95% purity and 188 mg of kaempferol 7– O –α– l –rhamnopyranoside with 97% purity were produced from 1.2 g of crude sample II. [ABSTRACT FROM AUTHOR]

Background: Psoriasis vulgaris is a chronic skin condition affecting patients' quality of life. Long-term use of conventional therapy increases risk of unwanted side effects. Compound glycyrrhizin in conjunction with conventional therapy has been used in clinical practice, but the evidence for such practice has not been evaluated systematically.Objective: This review aims to evaluate the efficacy and safety of compound glycyrrhizin in combination with conventional therapy for psoriasis vulgaris.Methods: PubMed, Excerpta Medica dataBASE (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database (AMED), CiNii, Chinese Biomedical Literature, China National Knowledge Infrastructure, Chinese Scientific Journals Full Text Database and Wanfang Data were searched from their respective inceptions to July 2015. Randomized controlled trials comparing compound glycyrrhizin plus conventional therapy to conventional therapy alone for psoriasis vulgaris were included. Data analysis was performed using Review Manager 5.3.Results: Eleven randomized controlled trials were included in this review. Meta-analysis of the 11 randomized controlled trials indicated that the addition of compound glycyrrhizin increased the number of patients achieving Psoriasis Area and Severity Index (PASI) 60 (RR: 1.30 [1.21, 1.40], I2 = 6%), when compared with conventional therapy alone. Comparable numbers of patients experienced adverse events in the two groups.Conclusions: Compound glycyrrhizin in conjunction with conventional therapy enhances clinical response, and compound glycyrrhizin as add-on therapy does not appear to pose any additional risk in the treatment of psoriasis vulgaris. However, the findings should be interpreted with caution of methodological flaws in the included studies. PROSPERO registration number: CRD42015027763. [ABSTRACT FROM AUTHOR]

Management of the behavioural and psychological symptoms of dementia remains a challenge worldwide. Herbal medicines may play a role in the development of new interventions. To determine effects of herbal medicines for management of the behavioural and psychological symptoms of dementia, meta-analysis was conducted of 31 controlled trials (3613 participants). Frequently tested herbal medicines were the Ginkgo biloba leaf extract EGb 761 (seven studies) and the multi-ingredient formula Yokukansan (eight studies). Sixteen studies tested other herbal medicines. Improvements were detected in Neuropsychiatric Inventory scores in EGb 761 groups compared to placebo (MD -3.46 [-5.94, -0.98]; I2 = 93%; n = 1757) and Yokukansan groups compared to no treatment (SMD -0.53 [-0.86, -0.21]; I2 = 0%; n = 150). Cognitive scores were improved in EGb 761 groups while Yokukansan did not appear to affect cognitive function. Of the other herbal medicines, there were improvements in the behavioural and psychological symptoms of dementia and cognitive outcomes in two of four placebo-controlled studies. EGb 761 and Yokukansan appeared safe and well tolerated. Adverse effects and dropouts were not reported consistently for the other herbal medicines. Weaknesses of these included short durations, small sample sizes, lack of blinding and other risks of bias. Well-designed studies are needed to further investigate the reported effects of these interventions on the behavioural and psychological symptoms of dementia. [ABSTRACT FROM AUTHOR]

This study seeks to investigate potential cardioprotection of Danlou Tablets in patients undergoing PCI with non-ST elevation acute coronary syndrome (NSTE-ACS). 219 patients with NSTE-ACS were randomised to Danlou Tablet pretreatment (n=109) or placebo (n=110). No patients received statins prior to PCI and all patients were given atorvastatin (10 mg/day) after procedure. The main endpoint was the composite incidence of major adverse cardiac events (MACEs) within 30 days after PCI. The proportion of patients with elevated levels of cTn I>5 × 99% of upper reference limit was significantly lower in the Danlou Tablet group at 8 h (22.0% versus 34.5%, p=0.04) and 24 h (23.9% versus 38.2%, p=0.02) after PCI. The 30-day MACEs occurred in 22.0% of the Danlou Tablet group and 33.6% in the placebo group (p=0.06). The incidence of MACE at 90-day follow-up was significantly decreased in the Danlou Tablet group compared to the placebo group (23.9% versus 37.3%, p=0.03). The difference between the groups at 90 days was the incidence of nonfatal myocardial infarction (22% versus 34.5%, p=0.04). These findings might support that treatment with Danlou Tablet could reduce the incidence of periprocedural myocardial infarction in patients with ACS undergoing PCI. [ABSTRACT FROM AUTHOR]

Background: Many people with asthma use herbal medicines to help reduce symptoms and improve asthma control.Objective: To update the systematic review and meta-analysis of randomised controlled trials of herbal medicine for adult asthma.Data Sources: Nine English and Chinese databases were searched (PubMed, Embase, CINAHL, CENTRAL, AMED, CBM, CNKI, CQVIP, Wanfang).Study Selections: Herbal medicines combined with routine pharmacotherapies compared with the same pharmacotherapies alone or placebo. Cochrane Risk of Bias Tool and GRADE Summary of Findings tables were used to evaluate methodological quality.Results: Twenty-nine (29) studies involving 3,001 participants were included. Herbal interventions used multi-ingredients such as licorice root, crow-dipper, astragali, and angelica. Compared with routine pharmacotherapies alone, herbal medicines as add-on therapy improved lung function (FEV1: MD 7.81%, 95% CI 5.79, 9.83,I2= 63%; PEFR: MD 65.14 L/min, 95% CI 58.87, 71.41,I2= 21%); asthma control (MD 2.47 points, 95% CI 1.64, 3.29,I2= 55%); reduced salbutamol usage (MD −1.14 puffs/day, 95% CI −2.20, −0.09,I2= 92%); and reduced acute asthma exacerbations over one year (MD −1.20, 95% CI −1.82, −0.58, one study). Compared with placebo plus pharmacotherapies herbal medicines as add-on therapy improved lung function (FEV1: MD 15.83%, 95% CI 13.54, 18.12 and PEFR: MD 55.20 L/min, 95% CI 33.41, 76.99). Other outcomes were not reported in these placebo studies. Included studies were low to moderate quality. Adverse events were rare.Conclusions: Herbal medicines combined with routine pharmacotherapies improved asthma outcomes greater than pharmacotherapies alone. Included studies did not blind participants therefore more studies that address such weaknesses are warranted. [ABSTRACT FROM PUBLISHER]

Background: Psoriasis vulgaris is a chronic disease that significantly affects patient's quality of life and poses an economic burden. Acitretin is a second-generation retinoid used for psoriasis in clinical practice. Orally administered Chinese herbal medicine (CHM), alone or combined with acitretin, has been used for the clinical management of psoriasis vulgaris. This systematic review evaluates the efficacy of oral CHM in comparison with acitretin and the add-on effect of oral CHM to acitretin. Methods: Five English databases and four Chinese databases were searched from their inceptions to May 2014. Included randomized, controlled trials (RCTs) were published in English or Chinese, compared oral CHM or the combination of oral CHM and acitretin with acitretin, and used Psoriasis Area and Severity Index (PASI) as the outcome measure. Results: A total of 25 RCTs were included in this review: 8 studies compared oral CHM with acitretin, 12 compared the combination with acitretin alone, and 5 were three-arm studies that compared both with acitretin. Conclusion: The meta-analysis indicated that oral CHM was effective for psoriasis vulgaris as follows: (1) Oral CHM is neither superior nor inferior to acitretin, and (2) oral CHM could produce add-on effects when combined with acitretin. Oral CHM itself appeared safe for treating psoriasis vulgaris and possibly could reduce the common adverse events seen with acitretin. However, the long-term effect and safety of oral CHM could not be assessed. Further research should consider including a placebo control and using outcome measures according to international guidelines to evaluate CHM, as well as include follow-ups to monitor longer-term efficacy and safety. [ABSTRACT FROM AUTHOR]

Qingkailing (QKL), Reduning (RDN), Xiyanping (XYP), Tanreqing (TRQ) and Yuxingcao (YXC) injections are all phlegm-heat clearing Chinese medicine (CM) injections composed of the extract from traditional CM materials. Evidence from clinical studies and animal experiments indicates that the above CM injections are effective supplementary therapy for acute exacerbation chronic obstructive pulmonary disease (AECOPD), and clinicians are faced with a difficult choice on the optimal phlegm-heat clearing CM injection for AECOPD. This systematic review and Bayesian network meta-analysis aimed to evaluate the comparative effectiveness of five commonly used phlegm-heat clearing CM injections for COPD. A pairwise and network meta-analyses were performed to assess the effectiveness of QKL, RDN, TRQ, XYP and YXC on AECOPD. Randomized controlled trials (RCTs) were identified by searching English and Chinese databases. The primary outcome was lung function (forced expiration volume [FEV1] and forced vital capacity [FVC]), blood gas analysis index was secondary outcome measure. Winbugs and Stata 15.0 software were used for data analysis. A total of 57 RCTs were included. The pairwise analyses showed that each of the injections combined with routine treatment were superior to routine treatment alone [FEV1: QKL, MD 0.20, 95% CI (0.06, 0.35); RDN, MD 0.24, 95% CI (0.08, 0.40); TRQ, MD 0.24, 95% CI (0.19, 0.29); XYP, MD 0.26, 95% CI (0.20, 0.32); YXC MD 0.73, 95% CI (0.06, 1.41)]. The network meta-analysis provided the following rank of lung function improvement: FEV1: YXC > TRQ > XYP > RDN > QKL; FVC: YXC > TRQ > QKL > RDN > XYP. RDN and YXC ranked highest in blood gas analysis index. RDN was the highest ranked injection for effectiveness, followed by QKL, TRQ, XYP, then YXC. Most of the injections appeared safe, with severe adverse events rarely reported. This study suggests that YXC and TRQ are the most effective therapies in treating AECOPD patients. RDN and YXC are more effective in the alleviation of clinical symptoms. Given that the safety of YXC is controversial, TRQ and RDN may be preferable as phlegm-heat clearing CM injections in the adjuvant treatment of AECOPD. [Display omitted] ● This study is the first network meta-analysis that examines phlegm-heat clearing injections related to the treatment of acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients. ● The surface under the cumulative ranking curves was used to estimate the hierarchy of the different injections. ● Phlegm-heat clearing Chinese medicine injections can improve the effective rate, lung function, and arterial blood gas in treating AECOPD. ● Tanreqing injection and Reduning injection were more recommended for treating AECOPD as complementary and alternative therapy. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility and acceptability of a randomized controlled trial compared auricular acupressure (AA) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis (MHD) patients with insomnia. Methods: Sixty three (63) eligible subjects were randomly assigned into either AA group received AA on specific acupoints (n=32), or sham AA (SAA) group received AA on points irrelevant to insomnia treatment (n=31) for eight weeks. All participants were followed up for 12 weeks after treatments. The primary outcome was clinical response at eight weeks after randomization, defined as a reduction of Pittsburgh Sleep Quality Index (PSQI) global score by 3 points and more. Results: Fifty-eight (58) participants completed the trial and five dropped out. Twenty participants in AA group (62.5%) and ten in SAA group (32.3%) responded to the eight-week interventions (χ2 = 5.77, P = 0.02). PSQI global score declined 3.75 ± 4.36 (95%CI -5.32, -2.18) and 2.26 ± 3.89 (95%CI -3.68, -0.83) in AA group and SAA group respectively. Three participants died during the follow-up period. No evidence supported their deaths were related to the AA intervention. No other adverse event was observed. Conclusion: Feasibility and logistics of patient recruitment, randomization procedure, blinding approach, interventions application and outcome assessment had been tested in this pilot trial. The preliminary data appeared to show a favorable result on AA treatment. A full-scale trial is warranted. Trial Registration: Chinese Clinical Trial Registry . [ABSTRACT FROM AUTHOR]

Chinese herbal medicine (CHM) is increasingly used by patients with chronic obstructive pulmonary disease (COPD); however, there has been no systematic evaluation of its safety. This review examined the adverse events (AEs) reported in clinical studies of CHM for COPD. Five English databases (PubMed, Embase, CINAHL, AMED, and CENTRAL) and four Chinese databases (CBM, CNKI, CQVIP, and Wanfang Data) were searched from inception to May 2013. Adverse event data, including nature, severity, author-assigned causality, management, and outcome, were extracted from included studies. Descriptive statistics were used for the rate of adverse events. Of the 152 included studies, AEs were reported in 47 studies. The rate of adverse events was slightly lower in the CHM groups compared with controls (84 events in 5,909 participants, 1.4% versus 102 events in 5,676 participants, 1.8%). The most frequently reported adverse event was nausea (28 cases in the CHM groups and 19 cases in the control groups), which was more common in studies where CHM was combined with pharmacotherapy to treat acute exacerbation of COPD. Other frequent adverse events were abdominal discomfort, dry mouth, and dizziness. Detailed information about the adverse events was scant. Overall, CHM appears to be well tolerated in people with COPD. [ABSTRACT FROM AUTHOR]

Context · Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and is projected to be the third leading cause of death by 2030. Acupuncture, a traditional Chinese therapy, has been used for more than 2000 years to treat respiratory conditions and may treat COPD effectively. In previous literature reviews, researchers have noted significant heterogeneity among the included studies, and none of the reviewers found convincing evidence to recommend routine use of acupuncture therapies for COPD. Objective · This literature review examined the efficacy and safety of acupuncture therapies for patients with COPD in improving lung function, increasing exercise capacity, creating positive subjective changes in symptoms, and enhancing health-related quality of life (QoL). Design · The research team searched the following electronic databases from inception to April 2013: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), Embase (Elsevier), the China National Knowledge Infrastructure (CNKI), Chongqing VIP Information Company (CQVIP), the Chinese Biomedical Literature Database (CBM), and Wanfang Data. The review included randomized, controlled trials (RCTs) that examined the benefits of acupuncture or other related therapies for treatment of COPD. Data were extracted into a predefined form; risk of bias was assessed according to the Cochrane Risk of Bias tool; and statistical analyses were made. Results · In total, 16 studies were included in the review. The research team found that the acupuncture therapies used in these studies improved health-related QoL. The team's conclusions, comparing results from the interventions with placebo, were based on data from 3 questionnaires that the studies used: (1) the St George's Respiratory Questionnaire (SGRQ), with a mean difference (MD) of -8.33 units (95% CI, -13.13 to -3.53); (2) dyspnea on the Medical Research Council's (MRC's) dyspnea scale, with an MD of -0.34 units (95% CI, -0.38 to -0.30); and (3) the Dyspnea Visual Analogue Scale (DVAS), with an MD of -8.85 mm (95% CI, -11.81 to -5.89). Compared with placebo, acupuncture therapies also increased the distance walked in 6 min (6MWT), with an MD of -28.14 (95% CI, 23.92 to 32.36) compared with placebo. No benefit was seen on measures of lung function when acupuncture therapies were compared with either placebo or drug therapy. Conclusion · Acupuncture therapies may result in clinically important improvements in QoL and dyspnea. Future high-quality RCTs should be undertaken to provide conclusive evidence concerning the benefits of acupuncture therapies in the treatment of COPD. [ABSTRACT FROM AUTHOR]

Background and Objective: In Parkinson's disease (PD), wearing off and side effects of long-term medication and complications pose challenges for neurologists. Although Tai Chi is beneficial for many illnesses, its efficacy for PD remains uncertain. The purpose of this review was to evaluate the efficacy and safety of Tai Chi for PD. Methods: Randomized controlled trials (RCTs) of Tai Chi for PD were electronically searched by the end of December 2013 and identified by two independent reviewers. The tool from the Cochrane Handbook 5.1 was used to assess the risk of bias. A standard meta-analysis was performed using RevMan 5.2 software. Results: Ten trials with PD of mild-to-moderate severity were included in the review, and nine trials (n = 409) were included in the meta-analysis. The risk of bias was generally high in the blinding of participants and personnel. Improvements in the Unified Parkinson's Disease Rating Scale Part III (mean difference (MD) −4.34, 95% confidence interval (CI) −6.67–−2.01), Berg Balance Scale (MD: 4.25, 95% CI: 2.83–5.66), functional reach test (MD: 3.89, 95% CI: 1.73–6.04), Timed Up and Go test (MD: −0.75, 95% CI: −1.30–−0.21), stride length (standardized MD: 0.56, 95% CI: 0.03–1.09), health-related quality of life (standardized MD: −1.10, 95% CI: −1.81–−0.39) and reduction of falls were greater after interventions with Tai Chi plus medication. Satisfaction and safety were high. Intervention with Tai Chi alone was more effective for only a few balance and mobility outcomes. Conclusions: Tai Chi performed with medication resulted in promising gains in mobility and balance, and it was safe and popular among PD patients at an early stage of the disease. This provides a new evidence for PD management. More RCTs with larger sample size that carefully address blinding and prudently select outcomes are needed. PROSPERO registration number CRD42013004989. [ABSTRACT FROM AUTHOR]

Historical literature and pharmacological studies both suggest that Astragalus membranaceus (A. membranaceus) holds potential benefits for diabetic kidney disease (DKD), which is a growing burden with limited proven renal protective options. Aim of the study : An updated systematic review was conducted to evaluate the efficacy and safety of A. membranaceus preparations as an adjunctive therapy to conventional therapies for DKD. Nine databases and five clinical trial registries were searched for randomized controlled trials (RCTs) of A. membranaceus preparations added to conventional therapies compared with conventional therapies alone for people with DKD. Study screening, data collection, and quality assessment were performed independently by two reviewers. Estimated effects were pooled as mean differences or standardized mean differences with 95% confidence intervals by using a random-effects model. Sixty-six studies, involving 4785 DKD participants, were included. The quality of the included studies was low due to methodological shortfalls. Meta-analysis showed that additional use of A. membranaceus injection reduced more albuminuria (32 RCTs, 2253 participants; SMD: 2.05 [–2.49, −1.61], I2 = 94%), proteinuria (26 RCTs, 1812 participants; SMD: 1.85 [–2.34, −1.37], I2 = 95%), and serum creatinine levels (32 RCTs, 2880 participants; −14.78 μmol/L [–19.22, −10.33], I2 = 97%) than conventional therapies alone did. An anti-albuminuria effect was also observed in the oral A. membranaceus preparation group (four RCTs, 236 participants; SMD: 1.27 [–1.82, −0.73], I2 = 73%). Meta-regression suggested that the treatment effect of A. membranaceus injection was associated with the baseline serum creatinine level. The adverse-events profile was similar between the additional A. membranaceus and control groups. The low quality of evidence suggested that adjunctive use of A. membranaceus preparations in addition to conventional therapies may be effective and tolerated for short-term reduction of albuminuria, proteinuria, and serum creatinine in DKD patients. The findings should be considered with caution due to the lack of high-quality RCTs and significant heterogeneity and publication bias. Further RCTs are needed to confirm the long-term efficacy and safety of A. membranaceus preparations, especially of the oral form, in patient-important outcomes. Image 1 [ABSTRACT FROM AUTHOR]

Background: Patients on maintenance hemodialysis (MHD) frequently complain of insomnia. Poor sleep quality impairs their quality of life and adversely affects long-term outcome. Previously we applied auricular acupressure therapy (AAT) for MHD patients with insomnia and yielded favorable results. AAT probably improves sleep quality by stimulating the vagus nerve and inhibiting sympathetic overactivity. However, the efficacy of AAT for insomnia in this population is still lacking. The proposed randomized controlled trial (RCT) will evaluate the efficacy and safety of AAT for improvement of sleep quality in MHD patients with insomnia.Methods/design: The proposed study is a multi-center, double-blind (participants and assessors), parallel-group RCT. A total of 112 participants with insomnia will be recruited from six hemodialysis centers in Guangzhou, China, and randomly allocated in a 1:1 ratio to receive auricular acupressure on either active points (AA group) or control points (points irrelevant to insomnia management, SAA group). The treatment will last for 8 weeks prior to a follow-up period of 12 weeks. Evaluation by blinded assessors at baseline, at 8 weeks (end of treatment) as well as at 4-week, 8-week and 12-week follow-ups (after intervention) will include Pittsburgh Sleep Quality Index (PSQI) scores and average weekly dose of hypnotics. The primary endpoint is clinical response rate (percentage of participants who reach a reduction of PSQI global score ≥ 3 in each group) at 8 weeks from baseline. Secondary endpoints include the changes in PSQI scores over time from baseline, as well as the changes in weekly dose of hypnotics.Discussion: This paper describes the rationale and design of a double-blind RCT that aims to determine the efficacy and safety of AAT for insomnia of hemodialysis patients. If successful, this project will provide evidence of the efficacy and safety of AAT for insomnia of hemodialysis patients.Trial Registration: ClinicalTrials.gov , Identifier: NCT03015766 . Registered on 22 December 2016. [ABSTRACT FROM AUTHOR]