Journal of Evidence-based Integrative Medicine最新文献

The study's objective is to conduct a comprehensive systematic review for assessing the safety and efficacy of Ayurvedic interventions in managing hemiplegia/Pakshaghata. The study involved a search across multiple online databases and online clinical trial registries. Additionally, major Ayurveda postgraduate institutes were contacted to acquire unpublished trial data related to hemiplegia/Pakshaghata. The review covered articles published until July 2023. Two reviewers independently performed data extraction and risk of bias assessment. The risk of bias assessment utilised the RoB 2 tool for randomised trials and the ROBINS-I tool for non-randomised trials. The screening process identified 28 articles from online databases and two dissertations from online repositories. However, practical challenges prevented access to grey literature from Ayurveda institutes. The 30 studies selected for this review, comprises nine randomised controlled trials (RCTs), eight non-randomised comparative trials, and thirteen pre-post studies. Quantitative analysis was unfeasible due to inadequate studies, leading to a qualitative analysis. All studies, except one, exhibited substantial bias upon risk of bias assessment. Moreover, most studies demonstrated methodological weaknesses attributed to a lack of masking, improper sampling techniques, non-validated outcome measurement tools, inadequate follow-up procedures, and confounding factors. The trials frequently did not document safety parameters, adverse events (AE), and adverse drug reactions (ADR). Current review could not definitively establish the efficacy and safety of Ayurvedic interventions in hemiplegia/Pakshaghata. Hence, the authors strongly advocate for good quality research incorporating proper methodology.

Diabetes mellitus, diagnosed as Madhumeho (sweet urine) in Thai traditional medicine, is believed to stem from imbalanced life elements. Ya That Opchoei mixture (YTO), a polyherbal mixture, is used to treat its symptoms. This study assessed the hypoglycemic potential of YTO and conducted qualitative and quantitative analyses of its bioactive constituents. YTO significantly inhibited α-glucosidase at IC₅₀ 0.05 ± 0.00 mg/mL and α-amylase activities at IC₅₀ 0.04±mg/mL. YTO at concentrations of 2.22 mg/mL significantly increased C-peptide secretion and stimulated glucose uptake. Liquid chromatography-mass spectrometry revealed constituents from Amomum testaceum, Cinnamomum bejolghota, C. burmanii, Syzygium aromaticum, and Glycyrrhiza glabra. High-performance liquid chromatography enabled quantification of bioactive compounds, including glycyrrhizic acid, eugenol, cinnamic acid, cinnamaldehyde, and coumarin. The coumarin content in 100 mL YTO was within the tolerable daily intake set by the European Food Safety Authority. This study confirms the hypoglycemic potential of YTO and presents its quality control process for safety assurance.

BackgroundWarfarin, a commonly used anticoagulant, interacts with medicinal plants, potentially complicating patient management. Clinical Decision Resources (CDRs) provide guidance on these interactions, but inconsistencies across resources may impact clinical decisions. This study aims to evaluate the consistency of interaction reports between warfarin and medicinal plants across four online CDRs.MethodsA cross-sectional study was conducted. Medicinal plants assessed were selected from the World Health Organization's Phytotherapy Manual. Interaction reports were manually reviewed across four CDRs: UpToDate, ClinicalKey, DynaMed, and DrugBank. Interactions were categorized by severity as mild, moderate or severe.ResultsOf 141 medicinal plants reviewed, 28 were documented as interacting with warfarin in at least one of the four assessed CDRs. DynaMed reported interactions for 18 plants, ClinicalKey for 15, UpToDate for 13, and DrugBank for 3. Only one plant (Ginseng - Panax ginseng) was consistently identified across all CDRs, although discrepancies in the direction of the interaction (whether it increased or decreased anticoagulant effect) were observed. Regarding interaction severity classifications, there was substantial variability, with ClinicalKey identifying the highest proportion of severe interactions (32.1%).ConclusionWe identified significant variability among CDRs in reporting interactions between warfarin and medicinal plants, which may lead to inconsistencies in clinical decision-making. To ensure more consistent and reliable patient care, standardized and comprehensive methodologies for assessing these interactions are needed.

Obesity is primarily due to excessive energy intake and lipid accumulation, leading to type 2 diabetes. Studies showed radish seed extract (RSE) can impede weight gain in mice, but the mechanism was unclear. We hypothesized that RSE inhibits obesity by stimulating adipocyte browning. Radish seeds were water-extracted, yielding a sulforaphene (SE) concentration of 1.381 ± 0.005 mg/g RSE. In 3T3-L1 adipocyte differentiation experiments, RSE and SE increased the expression of beige adipocyte markers uncoupling protein 1 (UCP1) and peroxisome proliferator-activated receptor-γ coactivator 1-α (PGC1α). In C57BL/6 mice, RSE and SE mitigated weight increase, averted fatty liver, and diminished fat accumulation. In the adipose tissue, we also noted the enhanced browning of white adipocytes through elevated expression of UCP1 and PGC1α. Increased mitochondrial numbers in treated adipocytes supported this effect. Additionally, RSE and SE improved glucose homeostasis and insulin sensitivity in high-fat diet-fed mice, indicating RSE's potential to prevent obesity and diabetes by enhancing adipocyte thermogenesis.

Background: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder associated with increased risk of kidney and liver damage. Current treatments have shown contradictory outcomes, and their long-term use causes unwanted side effects. G. tournefortii could serve as a complementary medicine to current PCOS treatments.

Purpose: This study evaluates the effect of G. tournefortii in alleviating liver and kidney damage induced by PCOS via the regulation of oxidative stress pathways.

Study design: PCOS was induced in female Balb/c mice using dehydroepiandrosterone over 21 days. They included a Sham group, a Vehicle group, a group treated with the extract only, and an untreated PCOS mice group. Positive Controls were treated with Metformin. The other PCOS groups were either co-treated while inducing PCOS or treated with the extract post-disease induction.

Methods: Histological analysis was performed. Serum liver and kidney biochemical markers, levels of oxidative stress, and two pro-inflammatory markers were measured. NLRP3 and its associated genes (caspase-1 and ASC) gene expression was assessed.

Results: The extract restored normal kidney and liver histology post-PCOS induction. It decreased ALT and AST levels by 50% and the oxidant marker malondialdehyde (MDA) by 65% (P < .05). Superoxide dismutase (SOD)/catalase (CAT) activities were normalized in PCOS treated group. IL-1β/TNF-α significantly decreased (80% and 68%, respectively, P < .05) in the post-treated group. NLRP3 genes decreased in kidney tissues post-treatment with G. tournefortii extract.

Conclusion: G. tournefortii reduced oxidative stress by modifying the ASC/caspase-1/IL-1β signaling pathway, thus protecting livers and kidneys highlighting the herb as a potential preventative and complementary agent in mitigating PCOS associated damage.

Aims: Gut microbiota are reported to be associated with the incidence and prognosis of Esophageal cancer (EC) but their genetic association is unclear. We carried out a bidirectional MR analysis to assess the causal relationship between EC and gut microbiota from fecal samples.

Methods: The microbiome genome-wide association studies (GWAS) data of 18,340 individuals provided by MiBioGen consortium and the EC GWAS data (740 esophageal cancers cases and 372 016 controls) provided by UK Biobank were respectively utilized as exposure and/or outcome data. Reliable single nucleotide polymorphisms (SNPs) were obtained after rigorous screening. A bidirectional Mendelian randomization (MR) analysis was conducted using the inverse-variance weighted (IVW) method. The sensitivity analyses including the MR-Egger method, weighted median, weighed mode and leave-one-out method were performed to examine the stability, heterogeneity and pleiotropy of the results.

Results: Forward MR analysis revealed the increase in abundance of the microbial trait by each standard deviation was associated with a higher risk of EC (Coprobacter (OR = 1.001,95%CI = 1.000-1.002, P = .0281, FDR = 0.0424); Ruminococcus1(OR = 1.001,95%CI = 1.000-1.002, P = .0318, FDR = 0.0424); Senegalimassilia (OR = 1.002,95%CI = 1.000-1.003, P = .0062, FDR = 0.0372); Veillonella (OR = 1.001,95%CI = 1.000-1.002, P = .0182, FDR = 0.0372)) or a lower risk of EC (Eubacterium oxidoreducens (OR = 0.999, 95%CI = 0.998-1.000, P = .0379, FDR = 00 433); Lachnospira (OR = 0.998,95%CI = 0.996-1.000, P = .0186, FDR = 0.0372); Romboutsia (OR = 0.999,95%CI = 0.998-1.000, P = .0482, FDR = 0.0482); Turicibacter (OR = 0.999,95%CI = 0.998-1.000, P = .0133, FDR = 0.0372)). Reverse MR analysis showed that genetic liability to EC was also causally linked toincreased susceptibility of changes in the gut microbiome (genera Eggerthella (Beta = 37.63,95%CI = 4.76-70.50, P = .0248, FDR = 0.0331); Coprococcus 2 (Beta = 23.90,95%CI = 1.65-46.15, P = .0353, FDR = 0.0353); Christensenellaceae R.7 (Beta = 22.75,95%CI = 4.22-41.28, P = .0161, FDR = 0.0322); Intestinimonas (Beta = -33.24,95%CI = -54.90-11.58, P = .0026, FDR = 0.0104)).

Conclusions: Our findings supported a bidirectionally causal relationship between gut microbiota and EC, implying the potential role of gut microbiota in preventing the occurrence and development of EC.

BackgroundMedicinal plants and herbal preparations have been used in Ayurveda medicine to treat diabetes for centuries. Link Gluconorm (LG) is a standardized solid formulation comprising seven medicinal herbs that have been used as herbal ingredients in Ayurveda for treating type 2 diabetes mellitus (T2DM). This study evaluated the efficacy and safety of the solid form of LG, and its effect on the quality of life (QoL) in T2DM patients.Materials and methodsAn observational study was conducted on 37 newly diagnosed uncomplicated T2DM patients aged between 35 and 65 years, whose fasting blood glucose levels ranged between 110 and 160 mg/dL. They were being treated for diabetes using the LG herbal formulation as the sole treatment. Laboratory tests for assessing glycemic control and safety were done at baseline and repeated at 4-weekly intervals for 24-weeks. A validated diabetes-specific QoL inventory was administered every 2 weeks.ResultsThe mean age was 48 ± 9y, and the mean body mass index was 25.0 ± 4.4 kg/m² and 25.2 ± 4.2 kg/m² for females and males, respectively. Statistically significant reductions in mean fasting blood glucose (153.85 mg/dL ± 15.62 to 129.01 mg/dL ± 12.88, p = 0.006), postprandial blood glucose (191.27 mg/dL ± 21.40 to 140.72 mg/dL ± 8.92, p < 0.001), glycosylated hemoglobin (8.51%±0.44 to 7.43%±0.40, p < 0.001) and improved QoL scores (1.93 ± 0.22 to 1.55 ± 0.08, p < 0.01) were observed at 24 weeks. There were no adverse changes in the hematological, liver and renal function safety parameters assessed using laboratory investigations. No adverse events or hypoglycemia were reported.ConclusionsThe polyherbal formulation LG significantly improved the QoL and glycaemic parameters and appeared safe after 24 weeks of treatment. Due to the small sample size, unblinded nature of this preliminary study, and the lack of a control arm, a randomized double-blinded controlled clinical trial on a larger group of patients is recommended.

BackgroundThe Tibetan medicine Ershiwuwei Guijiu Pill (EWGP), a classic Tibetan medicine prescription for the treatment of postmenopausal osteoporosis (PMOP) in the Qinghai-Tibet region, has attracted extensive attention due to its curative effects on gynecological diseases. However, its chemical ingredients and molecular mechanism are still unclear.Aim of the studyTo analyze the chemical constituents and effective serum chemical metabolites of EWGP and to explore the molecular mechanism of EWGP in treating PMOP through network analysis and experimental validation.MethodsThe ethanol extract of EWGP and its drug-containing serum were detected by liquid chromatography-mass spectrometry (LC-MS), and the chemical constituents were analyzed and identified. SwissTarget prediction was used to predict the corresponding potential target genes of the identified chemical components. Thereafter, a visualization network of the components and corresponding targets was constructed with Cytoscape software. Moreover, a specific disease database for animals was used to search and filter for osteoporosis (OP) targets, and a drug-disease target protein-protein interaction (PPI) network was constructed. Cytoscape 3.7.0 was used for visualization and cluster analysis, and R Studio was used for GO and KEGG enrichment analysis. AutoDock Tools were applied for molecular docking of the serum metabolites and specific target proteins. The potential mechanism of EWGP in preventing and treating PMOP was predicted by network pharmacology analysis and was experimentally studied and verified in vivo and in vitro.ResultsA total of 199 chemical substances were identified in the ethanol extract, and 11 were found in the serum. A total of 419 predicted targets and 128 target genes related to osteoporosis were screened. There were 16 common targets identified between the predicted targets and OP genes. Following the enrichment analysis, 16 KEGG signaling pathways and 63 GO biological process items were identified. The results of molecular docking showed that the main active compounds may be Protopine, Hetisine, Piperine, Visaminol, Boldine, and Trigonelline, and the specific targets may be CYP17A1, ESR2, MAPK14, and the vitamin D receptor (VDR). The results of cell and animal experiments showed that EWGP may improve bone metabolism via estrogen and calcium signaling pathways regulated by estrogens and calcium ions.ConclusionsEWGP contains multiple herbal drugs and treats PMOP through multiple targets and signaling pathways. We preliminarily tested the chemical compounds of EWGP, especially in the serum, to determine the chemical metabolites of EWGP and revealed the molecular mechanism of EWGP in preventing and treating PMOP; moreover, we used computer-virtual molecular docking and experiments for preliminary verification of the core targets of network pharmacology analysis.

Hypertrophic scarring is an aberrant wound-healing response to reestablish dermal integrity after an injury and can cause significant abnormalities in physical, aesthetic, functional, and psychological symptoms, impacting the patient's quality of life. There is currently no gold standard for preventing and treating hypertrophic scars. Therefore, many researchers have attempted to search for antihypertrophic scar agents with greater efficacy and fewer side effects. Natural therapeutics are becoming attractive as potential alternative anti-scarring agents because of their high efficacy, safety, biocompatibility, low cost, and easy accessibility. This review demonstrates various kinds of natural product-based therapeutics, including onion, vitamin E, Gotu kola, green tea, resveratrol, emodin, curcumin, and others, in terms of their mechanisms of action, evidence of efficacy and safety, advantages, and disadvantages when used as anti-scarring agents. We reviewed the literature based on data from in vitro, in vivo, and clinical trials. A total of 23 clinical trials were identified in this review; most clinical trials were ranked as having uncertain results (level of evidence 2b; n = 16). Although these natural products showed beneficial effects in both in vitro and in vivo studies of potential anti-scarring agents, there was limited clinical evidence to support their efficacy due to the limited quality of the studies, with individual flaws including small sample sizes, poor randomization, and blinding, and short follow-up durations. More robust and well-designed clinical trials with large-scale and prolonged follow-up durations are required to clarify the benefits and risks of these agents.