European Journal of Integrative Medicine最新文献

Introduction

Acacia leucophloea (AL) has been used traditionally to treat diabetes, cancer, inflammation, ophthalmia, haemorrhoids and leukoderma, however the scientific evidence validating its antidiabetic activity is limited. Employing a multi-targeted therapeutic strategy could be advantageous for the management of type 2 diabetes mellitus which is strongly correlated with oxidative stress-induced pathways. The present study was intended to evaluate the antidiabetic and antioxidant potential of AL via in vitro assays, validating its traditional medicinal significance.

Methods

Anti-diabetic potential of the AL extract, its fractions and isolated compounds was assessed through the determination of α-glucosidase, DPP-IV inhibition, anti-glycation activity, and glucose uptake using 2-NBDG in differentiated L6 myoblast, along with cytotoxicity studies. Total phenolic and flavonoid content was measured and the antioxidant potential was evaluated using in vitro assays i.e., DPPH, ABTS and FRAP. In addition, quantitative determination of isolated compounds and their purity was analysed using HPLC-DAD.

Results

Fractions with the highest phenolic/flavonoid content (VI to XIII of AL) demonstrated substantial antioxidant and antidiabetic potential across selected therapeutic targets and these active fractions yielded six compounds upon fractionation using column chromatographic techniques. Structures of these compounds were examined using spectroscopic techniques and were identified as isoquercitrin, quercitrin, luteolin, epigallocatechin-3-O-(3″-O-methyl)-gallate, apigenin-7-O-glucoside and ethyl gallate. Isolated compounds showed significant DPP-IV inhibitory activity in a concentration-dependent manner with the highest activity with minimum IC₅₀ being possessed by isoquercitrin (IC₅₀ 4.28 ± 0.32 µM). At a concentration of 200 µM, apigenin-7-O-glucoside displayed a considerable glycation inhibitory effect (81.57 ± 2.66 %), surpassing the effect of other compounds. Moreover, at a concentration of 50 μM, the compounds apigenin-7-O-glucoside and isoquercitrin have increased the glucose uptake in L6 myotubes by 11.5 % and 11 % respectively, compared to a 6.1 % increase by the standard drug metformin. Notably, this study reveals for the first time the potential of both apigenin-7-O-glucoside and isoquercitrin to enhance glucose uptake in L6 myotubes.

Conclusion

AL and its isolated compounds exhibit promising effects in ameliorating post-prandial hyperglycemia. Their multifaceted therapeutic potential prompts further investigation to elucidate the underlying molecular mechanisms.

Introduction

Chinese medicine (CM)/integrative medicine have been widely used to treat dampness syndrome, regarded as the main pathogenesis of many chronic diseases. Many clinical trials of CM/integrative medicine for dampness syndrome have been conducted. However, most of their conclusions should be viewed with caution because of their methodological quality defects. One of the defects is the inconsistency of outcomes, which results in obstacles to comparing and combining the results of related studies. This issue could be addressed by developing a core outcome set (COS).

Method

This study aims to develop a COS for clinical research of CM dampness syndrome (COS-CMDS). We will set up a study advisory group to organize and guide the development of the COS. The study consists of four stages: (1) a systematic review of CM dampness syndrome; (2) qualitative interviews with experts and patients to construct a preliminary outcome pool based on the systematic review; (3) a two-round Delphi survey; and (4) a consensus meeting to determine the final COS-CMDS. This study has been approved by the institute review board and has been registered at the Core Outcome Measures in Effectiveness Trials Initiative (COMET) database (https://www.comet-initiative.org/Studies/Details/1950).

Discussion

The development of COS-CMDS will provide a reference for outcome selection in clinical research on CM dampness syndrome, and contribute to the combination and comparison of results reported during systematic reviews and meta-analyses. It may help generate more high-quality evidence.

Conclusion

COS-CMDS will standardize the selection and reporting of outcomes in clinical research of CM dampness syndrome. It will be published in appropriate ways to promote further widespread use after completion.

Introduction

Studies on different species of Onobrychis, a member of the Fabaceae family, have revealed a number of biological activities with potential applications in alternative medicine. The phytochemical content of the plant Onobrychis argyrea subsp. argyrea and some of the important biological activities linked to its metabolism are quite limited. Therefore, this study was the first to determine the content of secondary metabolites in this species and to elucidate important biological activities related to metabolism.

Methods

LC-MS/MS was used for the quantitative analysis of bioactive compounds in the aerial part of O. argyrea extracts. The antioxidant properties of the extracts were assessed based on their ability to scavenge DPPH radicals and reduce iron ions. The anti-diabetic effect of the extracts was tested by the inhibition of α-amylase and α-glycosidase enzymes, and the anti-Alzheimer's ability was tested by the inhibition of the enzymes AChE and BChE. The cytotoxic effects of the extracts were tested on four different cancer lines, namely A-549, HT-29, MCF-7 and MDA-MB 453 using the XTT assay. The mechanism of the anti-cancer effect was determined by means of flow cytometry analysis on HT-29 cells.

Results

Twenty-nine phytochemicals were identified via the LC-MS/MS analysis in the plant extracts. The most abundant phytochemicals in the extracts were quinic acid, isoquercitrin, epicatechin, and routine, respectively. Antioxidant analysis showed that among all extracts, methanol extract (ME) was most effective in scavenging DPPH (IC₅₀: 23.93 ± 0.96 µg/mL) and in reducing iron ions (53.24 ± 2.14 mgTEAC/g). Enzyme activity studies demonstrated that ME is a potent inhibitor of α-glycosidase (IC₅₀: 15.06±0.64 µg/mL), AChE (IC₅₀: 24.75±0.76 µg/mL), and BChE (IC₅₀: 3.36±0.14 µg/mL). XTT assay results disclosed the strongest anti-proliferative activity of ME against the human colorectal adenocarcinoma HT-29 cell line with an IC₅₀ value of 33.35±0.92 µg/mL. Flow cytometry analysis revealed that ME caused mitochondrial membrane damage in HT-29 cells (**p<0.01) and subsequently induced apoptosis (**p<0.01) by activating the caspase pathway (**p<0.001).

Conclusion

O. argyrea, rich in bioactive compounds, showed remarkable antioxidant, antidiabetic, Alzheimer's, and anticancer properties in vitro, demonstrating that this plant contains secondary metabolites that may be potential drug candidates for the treatment of metabolic diseases.

Introduction

Poor sleep quality may have a negative effect on health. Clinical studies have assessed the ability of transcutaneous electrical acupoint stimulation (TEAS) to improve sleep quality. This review aims to explore the efficacy and safety of TEAS to improve sleep quality, as well as the most promising application scenarios for TEAS.

Methods

Eight databases were searched from their inception to 25 March 2023 to identify randomized controlled trials (RCTs) of the effects of TEAS on sleep quality compared to sham stimulation or pharmacotherapy. In the meta-analysis, Pittsburgh sleep quality index (PSQI) global score was the main outcome. The methodological quality of each included article was assessed using the Cochrane Risk of Bias tool. Publication bias was assessed by funnel plots.

Results

A total of 16 studies involving 1555 participants met the inclusion criteria. Twelve RCTs had low or moderate risk of bias and four RCTs had high risk of bias. Overall, the findings indicated that TEAS was effective in improving sleep quality (mean difference (MD) -2.22; 95% confidence interval (CI) [-3.29, -1.15]; p<0.0001) with high heterogeneity (I²=92%; p<0.00001). Among different causes of insomnia, TEAS was found to be effective in patients with postoperative insomnia (MD -0.95; 95% CI [-1.62, -0.27]; p=0.006; I²=66%). Subgroup analyses showed that TEAS was more effective in middle-aged patients (MD -1.60; 95% CI [-2.14, -1.06]; p<0.00001; I²=0%), and Neiguan (PC6) and Hegu (LI4) were effective acupoints during the perioperative period (MD -1.45; 95% CI [-1.95, -0.95]; p<0.00001; I²=6%). Four studies reported adverse effects, none of which were serious.

Conclusions

TEAS could effectively improve postoperative insomnia. For postoperative insomnia, the effect of TEAS was more significant in middle-aged patients, and simultaneous stimulation of PC6 and LI4 was effective. However, due to the small number of included studies and variation in patient types, additional high-quality, large-scale, multicenter RCTs of the effect of TEAS on sleep quality are needed.

Registration

CRD42023440453.

Funding

Military Special Program to Cultivate and Improve TCM Service Capability [2021ZY002]; Shanghai “Science and Technology Innovation Action Plan” Yangfan Project [23YF1459200].

Introduction

Reflexology is a non-pharmacological method that helps normalization of bodily functions by applying pressure to the reflex points on the hands, feet and ears, which correspond to all the organs and glands in the body. This study aimed to evaluate the effect of reflexology on pain, anxiety, fatigue, and sleep in patients undergoing cardiovascular surgery.

Methods

This open-label, randomized parallel-group controlled trial was conducted between September 2020 to May 2021 in a university hospital in Turkey. Seventy eligible patients who underwent cardiovascular surgery were randomized into reflexology group (n = 35) or control group (n = 35). While foot reflexology was applied to the reflexology group for 40 min in the first three days after surgery, no intervention was applied to control group. The primary outcome was pain severity, assessed using the Visual Analog Scale, in the first three postoperative days. The other outcomes were anxiety level assessed using the State-Trait Anxiety Inventory, fatigue level assessed using the Visual Analog Scale in the first three postoperative days, and sleep quality assessed using the Richards-Campbell Sleep Questionnaire in the first four postoperative days.

Results

After applying reflexology on the first, second, and third postoperative days, pain scores (d=-2.736, 95% Cl=-3.388 to -2.084) (d=-7.954, 95% Cl=-9.352 to -6.555) (d=-7.528, 95% Cl=-8.860 to -6.196), anxiety scores (d=-3.462, 95% Cl=-4.202 to -1.721) (d=-6.077, 95% Cl=-7.187 to -4.967) (d=-6.537, 95% Cl=-7.717 to -5.357), and fatigue scores (d=-2.490, 95% Cl=-3.115 to -1.866) (d=-6.245, 95% Cl=-7.380 to -5.109) (d=-8.223, 95% Cl=-9.675 to -6.791, respectively) were statistically significantly lower in reflexology group compared to control group. On the second, third, and fourth postoperative days, sleep scores in reflexology group were statistically significantly higher than control group (d = 3.230, 95% Cl=2.519 to 3.941) (d = 4.280, 95% Cl=3.431 to 5.130) (d = 6.106, 95% Cl=4.992 to 7.221, respectively). During the study period, no adverse events were noted in either groups.

Conclusion

This study showed that applying foot reflexology to patients undergoing cardiovascular surgery reduced pain, anxiety, and fatigue and improved sleep quality. Further studies on reflexology practice are recommended to be conducted with larger sample sizes and different groups.

Trial registration Clinical

Trials.gov NCT04473287.

Introduction

Persicaria amphibia L. (water knotweed), an edible plant with pharmaceutical properties, is found in Asia, Europe, North America, and Africa. Despite its worldwide distribution and prominence, scientific literature on the plant's therapeutic properties is scarce. This study aimed to comprehensively investigate the antioxidant activity, DNA binding potential, GC–MS, and fluorescence analysis and photoprotective properties of P. amphibia.

Method

Water and ethanol maceration and Soxhlet extraction samples (Pa1–4) of P. amphibia were prepared. Bioactive properties of the plant were investigated. Qualitative and quantitative chemical markers of the samples were described using UV–Vis., fluorescence, and gas chromatography-mass spectrometry (GC–MS) analyses, and phytochemical screening. Photoprotective properties of the plant were also revealed using Mansur method.

Results

The phenolic and flavonoid contents varied between 22.06 ± 0.49 and 28.92 ± 0.51 μg gallic acid equivalent (GAE)/1 mg and 24.54 ± 1.19 and 34.09 ± 0.61 μg quercetin equivalent (QE)/1 mg, respectively. The fluorescence emission spectra of the samples indicated that the samples may contain berberine alkaloid, and riboflavin and quercetin flavonoids. The sun protection factor (SPF) values revealed that the plant [Pa1 (750 and 1000 μg/mL = 10.22 ± 0.05; 13.29 ± 0.25), Pa2 (500 μg/mL = 7.58 ± 0.04) and Pa4 (1000 μg/mL: 11.86 ± 0.13)] has more photoprotective activity compared with carrot seed oil (500, 750 and 1000 µg/mL = 5.22 ± 0.07; 7.72 ± 0.09 and 9.69 ± 0.14) (P ˃ 0.001). Moreover, the samples exhibited considerable antioxidant activity. All four extracts could generally inhibit lipid peroxidation (Pa1–4 = 83.14 % ± 0.36; 82.05 % ± 0.82; 80.87 % ± 0.23 and 81.38 % ± 1.26) as effectively as the standards of ascorbic acid (81.89 % ± 0.88) and α-tocopherol (85.45 ± 1.37) for 25 µg/mL (P ˃ 0.05). The binding affinities between the plant samples and Calf Thymus DNA (CT-DNA) were also determined. The order of the binding affinity is Pa3 > Pa4 > Pa2 > Pa1.

Conclusion

The P. amphibia plant has a significant amount and variety of phytocomponents. Along with bioactive and sun protection properties, this plant could be a cheap, beneficial, and safe ingredient for cosmetic and pharmaceutical formulations.

Introduction

In April 2022, the “Guidance and recommendations on Chinese Medicine Rehabilitation during COVID-19 recovery stage (pilot version)” (the CM Rehabilitation Guidance) was formulated for Hong Kong COVID-19 survivors. However, no consensus regarding traditional Chinese medicine (TCM) diagnostic patterns, symptoms, and herbal formulas in the Guidance has been reached among Hong Kong Chinese medicine practitioners (CMPs). Thus, this study aimed to establish a consensus among them as a guidance for practice.

Methods

A modified Delphi method was conducted from July 28 to September 14, 2022. Each survey gathered feedback by using a five-point Likert scale and open-ended questions. Descriptive statistics for quantitative data and thematic analysis for qualitative data were used. The consensus was defined as ≥80 % level of agreement with interquartile range (IQR) ≤1.

Results

A total of 13 CMPs with clinical experience in managing COVID-19 survivors participated in the three-round Delphi survey. A final consensus was reached regarding the following: (1) the diagnostic pattern qi deficiency of the lung and spleen (median = 4; IQR = 0; level of agreement = 92.31 %) with six new suggested symptom items; (2) the diagnostic pattern dual deficiency of qi and yin (median = 4; IQR = 0.5; level of agreement = 100 %) with three new suggested symptom items; and (3) the suggested herbal formulas for these two diagnostic patterns after modification.

Conclusions

Through the three-round Delphi survey, we established a modified CM Rehabilitation Guidance for Hong Kong COVID-19 survivors. The modified Guidance based on the views of Hong Kong CMPs with frontline clinical experience in COVID-19 should be more applicable to current COVID-19 survivors.

Introduction

Human immunodeficiency virus (HIV) has spread globally. Both acquired immune deficiency syndromes (AIDs) and its complications pose a serious threat to human health. Acupuncture has been reported as a complement to Western medicine for relieving HIV/AIDs-related symptoms, but systematic reviews on acupuncture for HIV/AIDs and its complications are lacking.

Methods

Six databases were searched for both randomized controlled trials (RCTs) and quasi-randomized controlled trials (q-RCTs) using any types of acupuncture for HIV/AIDs and their complications. The primary outcome included global clinical efficacy assessment (i.e., number of patients with improving symptoms), pain, numbness intensity, sleep quality, depression and severe adverse events (i.e., death or hospitalization), and the secondary outcomes included other HIV/AIDs related outcomes such as immune response markers (CD4+ T-lymphocyte count), biochemical markers, functional outcomes (quality of life, level of physical activity), follow-ups and other adverse outcomes such as nausea, vomiting, and fever. Two reviewers independently applied the inclusion criteria, extracted data and evaluated the risk of bias in the included trials. This systematic review is registered with PROSPERO (CRD42020214490).

Results

Sixteen trials (thirteen RCTs and three q-RCTs) on complications including peripheral neuropathy, gastrointestinal symptoms, inflammation, insomnia and depression were included. The results revealed that manual acupuncture plus moxibustion (RR 1.58, 95 % CI [1.10, 2.28], 1 RCT, n = 60), manual acupuncture only (RR 1.56, 95 % CI [1.20, 2.03], 1 RCT, 1 q-RCT, n = 175) or auricular acupuncture (RR 2.02, 95 % CI [1.35, 3.02], 1 RCT, n = 72) could improve the symptoms in HIV-infected patients; reduce pain and numbness intensity, reduce score of Hamilton Depression Scale andimprove sleep quality. Meanwhile, acupuncture appeared to improve biochemical indicators whilst not increasing the drop-out rate, recurrence, mortality or adverse events. The quality of evidence was moderate quality for sleep quality; low quality for global clinical efficacy assessment rate, pain and numbness intensity; and very low quality for pain and depression.

Conclusions

Acupuncture may be an effective and safe intervention for HIV/AIDs related complications, including peripheral neuropathy, inflammation, insomnia and depression. However, the low quality of the evidence limits the relevance of those findings.

Introduction: The potential targets and action mechanism of Yiguanjian (YGJ) decoction in treating acute liver failure (ALF) were determined using network pharmacology, molecular docking and cell experiments.

Methods: The Pharmacology of Traditional Chinese Medicine Systems (TCMSP) and BATMAN-TCM databases were used to find YGJ decoction targets. The Genecard database was employed to predict targets associated with ALF. Cytascape software was utilised to visualise and select common targets along with establishing a protein–protein interaction (PPI) network. Core targets were screened and putative function was assessed via gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyzes. Molecular docking was performed using AutodockTools, PyMoL and Discovery Studio software to verify the correlation between the YGJ decoction and selected targets. MTT assay was conducted to determine the effect of the YGJ decoction on the viability of Huh-7 human hepatoma cells. The effects of the YGJ decoction on the expression of putative targets in Huh-7 cells were determined via western blot and quantitative real-time polymerase chain reaction analyzes.

Results: Overall, 9153 YGJ decoction and 576 ALF-related targets were obtained, and 469 YGJ decoction and ALF cross targets were obtained. Of these, 20 key targets, including AKT1, estrogen receptor 1 (ESR1), catalase (CAT), interleukin-1β (IL-1β) and discs large homolog 4 (DLG4), were selected from the PPI network. GO function enrichment analysis revealed that these targets were primarily associated with regulating system processes, cell body, oxidoreductase activity and other processes. An enrichment analysis using the KEGG pathway database revealed that the treatment of ALF using the YGJ decoction was primarily associated with the AGE-RAGE, cGMP-PKG and HIF-1 signalling pathways. Molecular docking indicated that quercetin, stigmasterol and β- sitosterol as well as AKT1, ESR1, CAT, IL-1β and DLG4 exhibited good binding affinity. In vitro experiments revealed that the YGJ decoction significantly reversed lipopolysaccharide (LPS)-induced apoptosis (P < 0.01), inhibited LPS-induced increase in IL-1β and ESR1 levels and upregulated LPS-induced decrease in AKT1, CAT and DLG4 levels (P < 0.05).

Conclusions: The YGJ decoction alleviates ALF by regulating multiple targets and its action mechanism may be associated with ameliorating oxidative stress and inflammation.

Introduction: Physical activity (PA) is considered an important factor to enhance the survival rate and overall quality of life in colorectal cancer (CRC) patients. However, a small percentage of patients comply with PA recommendations and most of them decrease their PA levels during chemotherapy. Theoretical frameworks could be useful for guiding exercise programs focused on the promotion of patients’ adherence to PA. Nevertheless, few studies have applied self-determination theory (SDT), one of the most prominent motivational theories, to understand exercise motivation in interventions with CRC patients. The aim of this study was to explore the benefits of an SDT-based 6-month exercise program (FIT-CANCER) regarding satisfaction of basic psychological needs and different psychological and behavioural consequences in CRC patients (stage II-III) during adjuvant chemotherapy. Methods: Qualitative data from 16 patients (nine men and seven women; M_age = 64.00, SD = 11.58), six relatives (M_age = 55.00, SD = 15.09) and five healthcare professionals (M_age = 40.40, SD = 9.66) were obtained through semi-structured interviews and field notes (N = 27). Results: Participants perceived that the motivational exercise program satisfied CRC patients’ needs for autonomy, competence, relatedness and novelty, giving rise to positive psychological consequences during chemotherapy treatment, such as enjoyment of exercise, optimism, vitality, sociability and keeping some good memories. The program allowed patients to feel that they were actively doing something important to overcome their cancer, an aspect that could foster their psychological well-being. Participants perceived that patients increased their exercise participation during chemotherapy treatment, even during the COVID-19 pandemic, with an online adaptation of the exercise program, and integrated exercise into their lifestyle. Participants also highlighted the importance of patients belonging to a group undergoing a similar situation and the instructor's knowledge, specialization and empathy. Conclusion: Motivational exercise programs could help improve CRC patients’ psychosocial and behavioural outcomes during chemotherapy treatment.