European Journal of Integrative Medicine最新文献

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.

Introduction

The hazard of Parkinson's disease-related constipation (PDC) cannot be ignored. Acupuncture has the potential to become a mainstream treatment option for PDC. This review aimed to investigate the effect of acupuncture on PDC, which might provide evidence-based recommendations for clinical application.

Methods

Six databases were searched for randomized controlled trials (RCTs) about acupuncture for PDC. The primary outcome was response rate. The secondary outcomes were rectal resting pressure, anal resting pressure, anal maximum contraction pressure, rectal sensation threshold, rectal maximum tolerable volume, the Constipation Scoring System (CSS) score, the Patient Assessment of Constipation Quality of Life (PAC-QOL) score, and adverse events (AEs).

Results

Eight trials involving 591 participants were included. The methodological quality was generally low. A significant difference was found in response rate when comparing acupuncture with medicine (95 %CI= 1.09 to 1.54, P = 0.003) or blank control (95 %CI= 1.04 to 1.74, P = 0.02), while no significant difference was observed when comparing acupuncture + medicine with medicine. Acupuncture + medicine did have a significant effect on rectal resting pressure, anal resting pressure, anal maximum contraction pressure, rectal sensation threshold and rectal maximum tolerable volume when compared with medicine, while no significant effect was found when acupuncture was compared with medicine. A significant difference was found in the CSS score when acupuncture was compared with blank and in the PAC-QOL score when acupuncture was compared with sham or blank, while no significant difference was found in the PAC-QOL score when acupuncture was compared with medicine. One study reported mild AEs.

Conclusions

Acupuncture might be an effective treatment for PDC. Due to the limited quality of evidence, high-caliber and multi-center RCTs with large sample sizes should be carried out.

(PROSPERO ID is CRD42023422102)

Introduction

The limitations of hormone therapy for managing primary ovarian insufficiency (POI) have prompted trialists to evaluate the Chinese herbal medicine, Er-xian decoction (containing Curculiginis Rhizome, Epimrdii Herba, Angelicae Sinensis Radix, Morindae Officinalis Radix, Phellodendri Chinrnsis Cortex and Anemarrhenae Rhizoma) for treating POI. This review was conducted to evaluate the effectiveness and safety of Er-xian decoction alone or in addition to hormone therapy in treating POI.

Methods

We conducted a systematic review of randomized controlled trials (RCTs) that reported on Er-xian decoction alone or in addition to hormone therapy in women with POI. Seven databases were searched from inception to 7 June 2023. The included studies were screened with Endnote X9, and methodological quality was assessed using the Cochrane “Risk of bias” tool v1.0. Effects were calculated as mean difference (MD), standard mean difference (SMD), or relative risk with 95% confidence interval (CI) using Review Manager 5.4.1, and data not suitable for statistical analyses were assessed by qualitative methods.

Results

Fifteen studies involving 1274 participants (13 drop-outs) were included. Er-xian decoction plus hormone therapy significantly lowered the follicle-stimulating hormone level (MD –12.48, 95 %CI –15.90 to –9.06; N = 8; P < 0.001) and luteinizing hormone level (MD –8.20, 95 %CI –11.22 to –5.17; N = 8; P < 0.001) and increased the estrogen level (SMD 2.35, 95 %CI 1.52 to 3.18; N = 8; P < 0.001) compared with hormone therapy. There was no significant difference between Er-xian decoction alone and hormone therapy alone in terms of follicle-stimulating hormone level (MD –0.69; 95 %CI, –7.94 to 6.56; N = 5; P = 0.85), luteinizing hormone level (MD 0.29, 95 %CI –3.96 to 4.54; N = 5; P = 0.89) or estrogen level (SMD 0.16, 95 %CI –0.36 to 0.67; N = 5; P = 0.55). In addition, both Er-xian decoction alone and Er-xian decoction plus hormone therapy effectively improved women's menopausal symptoms. Seven studies reported on the occurrence of adverse events, and no severe events were reported.

Conclusion

The findings suggest Er-xian decoction, with or without hormone therapy, may be an effective treatment for POI. However, limitations in the evidence included a high risk of bias and substantial heterogeneity. Further research should be conducted in well-designed and rigorously executed clinical trials with large samples.

Review registration

INPLASY 2,021,110,107.

Introduction

Patients with cancer often experience anxiety during cancer diagnosis and treatment, which can negatively impact their treatment outcomes. Although aromatherapy is believed to be effective in reducing anxiety in patients with cancer, the evidence has been limited. This review aimed to investigate the effectiveness of aromatherapy in reducing anxiety in patients with cancer and identify potential moderators of the intervention effects.

Methods

This review was conducted using data from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science, Regional Information Sharing Systems (RISS), Korean Information Service System (KISS), KoreaMed, and DBpia until March 16, 2023. The final analysis included 11 comparisons from 10 studies that administered aromatherapy to patients with cancer aged 18 years or older. The intervention effect was calculated by the standardized mean difference (SMD), and moderator analysis was performed using subgroup, meta-analysis of variance, and meta-regression analyses. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.

Results

The overall impact of aromatherapy on anxiety reduction in patients with cancer indicated a large effect size (SMD = -0.97, 95 % confidence interval: -1.60 – -0.35, I² = 94 %). In the subgroup analysis, the types of delivery methods and duration of the intervention were not found to be moderators causing heterogeneity in the effect sizes between trials. However, it was confirmed that the types of essential oils moderated the effects (Qb = 7.80, df = 2, p_b = 0.020). Additionally, continuous moderators were not found to significantly moderate the intervention effect.

Conclusion

This review demonstrates that aromatherapy reduces anxiety in patients with cancer, suggesting the possibility of its application in clinical and community settings. However, considering the limited quantity of randomized controlled trials (RCTs) available for subgroup analysis, which potentially impacts the precision of study outcomes, further research is warranted by incorporating additional RCTs.

Introduction

Type 2 diabetes mellitus (T2DM) is characterized by defects in insulin action and secretion. Bauhinia forficata has been observed to exhibit an effect in diabetes treatment due to its hypoglycemic activity. This systematic review with meta-analysis aimed to assess the effects of using Bauhinia forficata as an adjuvant treatment for individuals with T2DM.

Methods

We conducted a comprehensive search strategy using relevant keywords and their synonyms, focusing on "Bauhinia forficata" and "diabetes mellitus." The search encompassed online databases such as Medline, Embase via OVID, and the Cochrane Library, without imposing language restrictions. We included studies that evaluated individuals diagnosed with T2DM, who were administered Bauhinia forficata, compared to placebo or active control, and who presented glycemia and glycated hemoglobin as outcome measures. Studies not meeting these criteria, as well as literature reviews, animal or in vitro experiments, were excluded. The methodological quality of the included studies was assessed using the Risk of Bias 2 tool. The results were presented through tables and graphs, and forest plots were generated to illustrate the effects of interventions on various outcomes, using RevMan software 5.4.

Results

Four studies met the inclusion criteria, comprising two randomized controlled trials (RCT) and two non-randomized studies of interventions (NRSI). Compared to placebo, Bauhinia forficata significantly improved glycemia (SMD -0.60, 95 % CI -0.15 to -1.05, p = 0.009, 1 RCT, n = 111, low certainty evidence; SMD -0.64, 95 % CI -1.25 to -0.03, p = 0.04, I²=42 %, 2 NSRIs pre-test/post-test, n = 40, very low certainty evidence). However, only the RCT evidence demonstrated significant improvements in HbA1c (SMD -0.48, 95 % CI -0.93, p = 0.03, 1 RCT, n = 111, low certainty evidence; SMD -0.25, 95 %CI -0.69 to 0.19, p-0.27, I²=0 %, 2 NSRIs pretest/post-test, n = 40, very low certainty evidence). No differences were found between Bauhinia forficata and Imperata brasiliensis (glycemia SMD -0.03, 95 % CI -1.01 to 0.95, p = 0.96, 1 RCT, n = 16, very low certainty evidence; HbA1c SMD 0.06, 95 % CI -0.92 to 1.04, p = 0.96, 1 RCT, n = 16, very low certainty evidence).

Conclusions

The findings suggest that Bauhinia forficata may be effective in reducing blood glucose levels; however, this evidence needs to be interpreted with caution.

PROSPERO registration

CRD42022370143.

Introduction

Infertility affects approximately one in six couples of reproductive age. Many women use traditional, complementary and integrative medicine to improve their chances of conceiving. While there is evidence of the use of naturopathy by women attempting to conceive, there is no evidence of the way that naturopaths approach and manage their treatment. This study aims to describe how naturopaths manage female infertility, including their approaches, clinical decisions, knowledge sources, and safety considerations in providing naturopathic care.

Methods

Naturopaths in Australia or New Zealand, routinely treating female reproductive health concerns and practicing for at least two years were invited to complete an online survey through their professional naturopathic associations.

Results

Data from 45 respondents were included. Women seeking preconception health and fertility promotion were frequently seen by 53 % and 44 % of the naturopaths, respectively. The naturopaths’ clinical management approaches for infertility were wide-ranging and extended beyond fertility. They reported prioritising peer-reviewed journal articles in guiding clinical decisions, collaborating with health practitioners (mostly general practitioners) and reporting adverse events. Most naturopaths (95 %) utilised multiple treatment strategies, recommending dietary and lifestyle modifications and a combination of ingestible substances.

Conclusions

The naturopathic approach to management of women with infertility is holistic, considering physical, emotional, and environmental factors and promoting natural healing mechanisms. Greater knowledge of scientific methods for clinical decision-making and improved awareness of adverse event reporting would enhance naturopathic care. Additionally, evaluating the effectiveness of naturopathic treatment would improve safety, inform the profession, and clarify the role of naturopathy within a multidisciplinary approach to infertility.

Introduction

Patients with insomnia can use Korean medicine (KM) alongside conventional medicine (CM) as treatment options within the Korean healthcare system, but the treatment patterns for insomnia remain unclear. This study evaluated the incidence of newly diagnosed insomnia and medical service utilization, including untreated, CM, KM, and concurrent use of CM and KM, and the determinants of treatment after the insomnia diagnosis.

Methods

This retrospective cohort study analyzed adult Korean patients newly diagnosed with insomnia between 2016 and 2018 using National Health Insurance Service data. The cohort who met the eligibility criteria for insomnia was followed up until 2019 to identify their medical service utilization and the determinants. The medical service utilization was defined based on outpatient visits or hospitalization records with insomnia as the primary diagnosis. Descriptive statistics and logistic regression analysis were used to identify the medical service utilization and its determinants.

Results

Among the 336,578 patients newly diagnosed with insomnia in 2016–2018, only 155,538 (46.21 %) received more than two insomnia treatments during the follow-up period. Of these, 104,751 (67.35 %), 41,762 (26.85 %), and 9,025 (5.80 %) patients received CM monotherapy, KM alone, and both CM and KM, respectively. The statistically significant factors for receiving insomnia treatment after diagnosis were female, age ≥30 years, Seoul capital area residents, lowest income quintile, National Health Insurance Service (NHIS) enrollment types excluding the employee type, and longer elapsed time after diagnosis. The factors for receiving KM alone rather than CM alone were female, aged 40–79 years, residents of the Seoul capital area and metropolitan city, higher income, employee type among the NHIS enrollment types, and a more recent diagnosis. The common factor for concurrent use rather than CM alone was aged 40–79 years, and concurrent use rather than KM alone was being male.

Conclusions

More than half of the patients with insomnia received treatment only once. The utilization of CM or KM alone was higher than that of their combined use. Healthcare professionals can utilize these findings to manage patients with insomnia effectively.

Introduction

Simiao Xiaobi decoction (SXD) is a traditional Chinese medicine (TCM) formula that has been clinically applied for rheumatoid arthritis (RA). This meta-analysis aimed to systematically assess the therapeutic efficacy and safety of SXD compared to conventional therapy.

Methods

Twelve worldwide databases were searched for randomized controlled trials (RCTs) of treating RA with SXD and comparing non-operative conventional treatments (e.g., medication) from inception to August 2023. Primary outcomes for disease activity were effective rate (ER), joint pain score (JPS), joint swelling score (JSS), and morning stiffness (MS), and secondary outcome measures were laboratory inflammation markers and adverse events. The efficacy was presented as the risk ratio (RR) or mean difference (MD) with 95 % confidence interval (CI) using Review Manager. Risk of bias and the quality of evidence were assessed by using Cochrane “risk of bias” tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results

A total of 16 RCTs involving 1,749 patients were included. Compared with conventional treatments, SXD monotherapy significantly improved the ER (RR = 1.34, 95 % CI [1.26, 1.43], 14 RCTs, n = 1,578), JPS (MD = -1.00, 95 % CI [–1.33, –0.68], 4 RCTs, n = 327), JSS (MD = -1.59, 95 % CI [–2.12, –1.05], 4 RCTs, n = 327), MS (MD = -0.39, 95 % CI [–0.59, –0.18], 6 RCTs, n = 525), and laboratory results, and SXD add-on therapy significantly improved the ER (RR = 1.22, 95 % CI [1.00, 1.49], 1 RCT, n = 70). Due to some concerns with risk of bias, small sample sizes, and/or inconsistency, the certainty of evidence for SXD monotherapy was moderate for ER, low for JPS and JSS, very low for MS, and very low for SXD add-on therapy. There were fewer cases of adverse events in the SXD group.

Conclusion

Our findings suggest that SXD can be a complementary treatment option. However, the methodological quality of the included RCTs was unsatisfactory, so further high-quality research is needed to confirm our results.