Objective
The morphological and color characteristics of the tongue sublingual veins (SLVs) can manifest differently within the subjects, depending on the way their tongue is curled upward. This study was conducted in order to investigate the clinical relevancy of tongue SLV diagnosis in relation to menstrual clinical symptoms (pain, clots, heavy, and scanty), using three different inspection procedures (IP1, IP2, and IP3).
Methods
Three-hundred and seventy-seven female patients were asked to stick out their tongues in three specific ways which were intended to create different tongue protrusion angles. The SLV parameters for thickness (TK), length (LE), color (CL), shape (SP), and nodules (ND) were then evaluated.
Results
According to the results of the Wald χ2 test, IP1 provides the best model for pain (R² = 0.155), IP3 for clots (R² = 0.437), IP2 for heavy (R² = 0.268), and scanty (R² = 0.192). Abnormal SLV diagnostic parameters were most strongly associated with the clinical symptom of clots (R² = 0.492).
Conclusion
While the study showed the relations between tongue SLV features and menstrual clinical symptoms, as well it showed that IP2 was the best overall predictor for the symptomatic indexes used in this study, and using one particular SLV inspection procedure may not be sufficient. The application of a particular inspection method alone may cause under- or over-estimation of SLV abnormalities.

目的：检验顺势疗法药物Arsenicum Album 30C（Ars Alb 30C）是否能够降低亚砷酸钠对大肠杆菌（Escherichia coli）的毒性。
方法：将在标准培养基中培养至对数生长期的大肠杆菌暴露于低剂量砷剂下。1或2 mmol/L亚砷酸钠单独作用于大肠杆菌作为对照,在此基础上加入Ars Alb 30C作为治疗组,或加入按顺势疗法原则配置的乙醇作为安慰剂组。分别于45 min和90 min后检测大肠杆菌的葡萄糖摄取量,细胞内己糖激酶、脂质过氧化物酶、超氧化物歧化酶及过氧化氢酶活性,细胞内外亚砷酸钠含量,细胞生长情况,细胞膜电位,DNA损伤情况,细胞内活性氧、三磷酸腺苷及自由型谷胱甘肽含量,以及arsB和ptsG基因表达情况。实验按照随机分组原则及盲法原则进行。
结果：暴露于亚砷酸钠的大肠杆菌的葡萄糖摄取量、细胞内活性氧、脂质过氧化反应及DNA损伤增加;己糖激酶、超氧化物歧化酶及过氧化氢酶活性降低;细胞内三磷酸腺苷及自由型谷胱甘肽含量降低;细胞膜电位降低且细胞生长缓慢;arsB和ptsG基因表达水平增高。Ars Alb 30C作用后降低了亚砷酸钠对大肠杆菌的毒性,表现为抑制细胞内活性氧的生成和对细胞生长的促进作用。
结论：Ars Alb 30C能够降低亚砷酸钠对大肠杆菌的毒性,证实了这一顺势疗法原则下高度稀释的药物的效用。

Hypothyroidism (Qillat-e-Ifraz-e-Darqiyya) is a condition where the thyroid gland is underactive and unable to produce enough thyroid hormone. The description of hypothyroidism as a disease is not directly found in Unani texts. However, the signs and symptom of hypothyroidism resemble the clinical manifestation associated with Su-e-Mizaj Barid Maddi (derangement in cold temperament), such as plethora (Imtila), excessive salivation (Kasrat-e-Luabe-e-Dahan), tiredness (Aa’yan), loss of appetite (Zoaf-e-Ishteha), excessive sleeping (Kasrat-e-Naum) and cold skin (Baroodat-e-Jildia). These signs and symptoms are the result of an excess in abnormal phlegm (Ghair Tabayi Balgham) in the body. This review article identifies the observations from Unani literature that describe derangement in cold temperament and relate them to the clinical presentation of primary hypothyroidism in conventional medicine. We also discuss management of these symptoms in Unani medicine.

Background
Posttraumatic stress disorder (PTSD) is a common and debilitating disorder among war veterans. Although complementary and alternative therapies are gaining acceptance in the treatment of PTSD, the efficacy of animal-based therapies in this disorder is unknown. The goal of equine-assisted psychotherapy (EAP) is to improve the social, emotional, and/or cognitive functions of individuals with PTSD.
Objective
This study aims to explore the effects of EAP on PTSD symptoms. We hypothesized that veterans with PTSD who participate in a standardized EAP program for 1 h per week for 6?weeks would experience decreased PTSD symptoms and would demonstrate increased resilience as compared with individuals who do not receive EAP intervention.
Design, setting, participants and interventions
We conducted a sequentially assigned, two-arm parallel group trial comparing 6?weeks of EAP with standard, previously established, ongoing PTSD therapy. Therapy was conducted at a community EAP facility in conjunction with an academic University Hospital. Twenty adult veterans with symptomatic PTSD completed the study. Ten adult veterans with previously diagnosed PTSD were assigned to EAP and received directed interaction with trained horses for one hour a week in groups of 3 or 4 individuals, while also continuing their previously established therapies. A certified therapist supervised the sessions, and a professional horse handler was also present. Results were compared with those from 10 adult veterans who only received their standard previously established PTSD care as prescribed by their provider.
Main outcome measures
Changes in salivary cortisol, scores for the PTSD Check List-Military Version (PCL-M) and the Connor-Davidson Resilience Scale (CD-RISC) after 6?weeks of study were measured.
Results
Of the 20 enrolled patients, 10 served in Afghanistan, 5 served in Iraq, and 3 served in Vietnam. Subjects were (47?±?14)?years old, were predominantly male, and had a body mass index of (29?±?7)?kg/m2. They had (9.2?±?6.1)?years of military service and carried 66%?±?37% service-connected disability. PCL-M scores declined significantly in both groups and CD-RISC scores increased significantly in the EAP group. There was no difference between the groups with respect to the magnitude of change.
Conclusion
As compared to the control group, a 6-week EAP program did not produce a statistically significant difference with respect to PCL-M and CD-RISC scores, or salivary cortisol. However, our results suggest that EAP may work as well as standard therapy with respect to these parameters. This study supports further inquiry into EAP as a potentially efficacious alternative for veterans suffering from PTSD.
Trial registration
ClinicalTrials.gov NCT #03039361.

Background

Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.

Objective

In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.

Search strategy

The search strategy was structured by medical subject headings and search terms such as “acupuncture therapy” and “functional constipation.” Electronic searches were conducted in eight databases from their inception to September 2020.

Inclusion criteria

SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.

Data extraction and analysis

Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.

Results

Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as “critically low” confidence and one study as “low” confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have “low risk” of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as “moderate” quality, 57.5% (23/40) as “low” quality, and 20.0% (8/40) as “very low” quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.

Conclusion

Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

Systematic review registration

PROSPERO CRD42020189173.

目的

研究中医体质类型与原发性高血压的相关性,为体质与疾病相关理论提供流行病学调查依据。
方法

汇集我国9省市（江苏、安徽、甘肃、青海、福建、北京、吉林、江西、河南）横断面中医体质调查数据7 782例。中医体质调查采用标准化的中医体质量表实施,体质类型（平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质）的判定应用判别分析法。采用多元逐步logistic回归分析筛选原发性高血压有意义的主要体质影响因素。
结果

控制性别、年龄、婚姻状况、职业、文化程度因素后,多元逐步logistic回归分析模型入选了3个中医体质因素,按影响程度的大小依次为痰湿质、阴虚质和气虚质,其比值比（odds ratio, OR）和95%可信区间（confidence interval, CI）分别为2.00 [1.58, 2.55]、1.66 [1.33, 2.08]和1.37 [1.13, 1.66]。以性别分层分析,男性高血压的主要体质影响因素是痰湿质、阴虚质,其OR值和95% CI分别为1.61 [1.22, 2.14]、1.60 [1.17, 2.19];女性高血压的主要体质影响因素是痰湿质、阴虚质和气虚质,其OR值和95% CI分别为2.80 [1.79, 4.39]、1.55 [1.13, 2.14]和1.39 [1.05, 1.84],痰湿质对女性高血压的影响更显著。
结论

痰湿质、阴虚质和气虚质是原发性高血压的主要体质影响因素,男性和女性高血压的中医体质影响因素不同。

Background
Fibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels in patients with fibromyalgia and have found negative correlation between magnesium levels and fibromyalgia symptoms.
Objective
To gather preliminary data on whether transdermal magnesium can improve quality of life for women who have fibromyalgia.
Design, setting, participants and interventions
This is a patient questionnaires and survey in a fibromyalgia clinic at a tertiary medical center. Forty female patients with the diagnosis of fibromyalgia were enrolled. Each participant was provided a spray bottle containing a transdermal magnesium chloride solution and asked to apply 4 sprays per limb twice daily for 4 weeks. Participants were asked to complete the Revised Fibromyalgia Impact Questionnaire, SF-36v2 Health Survey, and a quality-of-life analog scale at baseline, week 2, and week 4.
Main outcome measure
Questionnaire and survey scores, evaluated through intent-to-treat and per-protocol analyses.

Results

Twenty-four patients completed the study (mean [SD] age, 57.2 [7.6] years; white, 95%; mean body mass index, 31.3 kg/m²). With intention-to-treat analysis, Revised Fibromyalgia Impact Questionnaire subscale and total scores were significantly improved at week 2 and week 4 (total score, P = 0.001). Per-protocol analysis results were similar: all subscales of the Revised Fibromyalgia Impact Questionnaire were significantly improved at week 2 and week 4 (total score, P = 0.001).

Conclusion
This pilot study suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients with fibromyalgia.
Trial registration
ClinicalTrials.gov. ldentifier NCT01968772.

Cupping (Hijama in Arabic) is an ancient, holistic method for the treatment of a variety of diseases. Though the exact origin of cupping therapy is a matter of controversy, its use has been documented in early Egyptian and Chinese medical practices. Diverse human civilizations have contributed to the historical development and continuation of cupping therapy. This narrative review describes the history of cupping, historical definitions, cupping instruments and uses of cupping therapy. Electronic searches of relevant databases (PubMed, Google Scholar and OvidSP) were conducted using keywords and Boolean operators. Manual searches and references of published articles and books were also conducted. A number of articles (N = 625) were retained for extensive review, and finally 83 articles were included in this paper. The historical descriptions of cupping therapy were found in ancient human civilizations of the Eastern and Western world. There were inconsistent data concerning the origin of cupping, definitions, instruments, procedures, definite advancements and research in Hijama over centuries. Cupping therapy fell out of favor in 17th and mid-18th centuries but recovered popularity in modern medicine. Currently, cupping therapy is used for health promotion, prophylaxis and treatment of a variety of diseases around the world. Cupping therapy with a good safety profile has a checkered history and is a well-recognized traditional method for managing medical conditions. Currently, the scope of cupping therapy is expanding, and a growing body of research is providing additional evidence-based data for the further advancement of cupping therapy in the treatment of a variety of diseases.

Background

 Some research exists on the effect of non-pharmacological approaches for labor pain relief. However, there is limited information about effectiveness of breathing exercises in pregnant women to reduce maternal pain during labor.

Objective

To determine whether breathing exercises for pregnant women during the second stage of labor have beneficial effects on maternal pain, duration of labor, and the first-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores.

Design, Setting, Participants and Interventions

This randomized clinical trial involved 250 pregnant women, who were randomly divided into two groups: intervention group (IG; n = 125) and control group (CG; n = 125). IG received one session breathing exercise training and performed breathing exercises during the second stage of labor versus the CG that did not receive any breathing exercise training.

Main Outcome Measures

The effects of breathing exercises on maternal pain were determined by Visual Analogue Scale (VAS), duration of the second stage of labor, and the first-minute APGAR scores.

Results: The mean age of the participants was (23.2 ± 4.2) (range: 18 to 42) years. Both IG and CG had similar baseline characteristics in terms of age, education level, occupation, and smoking (P > 0.05). The mean VAS scores of IG and CG were (88.2 ± 6.3) and (90.5 ± 7.0), respectively (P < 0.001). The duration of the second stage of labor was (369.6 ± 92.0) s for IG and (440.7 ± 142.5) s for CG (P < 0.001). The mean first-minute APGAR scores were (8.84 ± 0.50) for IG and (8.73 ± 0.89) for CG (P > 0.05).

Conclusion

Based on this study, breathing exercises with deep inhalation and exhalation in pregnant women are effective in reducing the perception of labor pain and shortening the duration of the second stage of delivery. Therefore, we recommend breathing exercises as an effective modality for labor pain management and shortening the duration of labor.

Trial Registration

This study is registered on the website of ClinicalTrials.gov (www.clinicaltrials.gov) with the number of NCT03066973.

Objective

To prepare the Praval bhasma (PB) and to perform its characterization. 

Methods

The preparation was performed strictly as per method prescribed in Ayurvedic formulary of India followed by preliminary tests including Nischandratva, Rekhapurnatvam, Varitaramtavm, Nisvadutvam and Amla pariksha. The physicochemical characterization was done with the use of instrumental techniques such as Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), X ray diffraction (XRD), and energy dispersive X-ray (EDAX). 

Results

The FTIR bands appearing in final product spectra showed a significant shift in infrared vibration frequency as well as intensity when compared with the raw material, which was indicative of formulation of bhasma. The XRD analysis revealed that raw material contained CaCO3 whereas in case of final product of bhasma, CaO was identified. SEM analysis revealed the difference in particles size of bhasma (10-15 μm) and raw material (100-150 μm). The EDAX analysis showed presence of different concentration of carbon in both the samples. 

Conclusion

It may be concluded that modern analytical techniques may be involved to evaluate the quality aspects of PB. The findings of the present research work may be helpful for further formulation and standardization of PB in routine analysis.

目的 建立人结肠腺癌细胞系（human colon adenocarcinoma cell line, Caco-2）细胞模型和标准操作规程,用于研究和评价中药化学成分的肠吸收。方法 通过电镜扫描和倒置显微镜观察Caco-2细胞单层细胞形态学特点,并通过测定跨Caco-2细胞单层细胞膜电阻、碱性磷酸酶活性以及易吸收阳性对照药普萘洛尔和难吸收阳性对照药阿替洛尔的转运特性等指标对Caco-2细胞模型进行评价。结果 建立的Caco-2细胞模型完整性、紧密性和通透性等良好,各项指标的测定值与文献值一致。结论 建立的Caco-2细胞单层模型符合各项指标的要求,可用于研究口服中药化学成分的肠吸收及其转运的吸收机制。

Background

Dysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined.

Objective

In this study, the effects of ginger and exercise on primary dysmenorrhea were compared.

Design, Setting, Participants and Interventions

This randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week.

Main Outcome Measures

Intensity of pain was assessed according to a visual analogue scale after the first and the second month.

Results

Exercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle.

Conclusion

Stretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea.

Trial registration

The trial was registered in www.IRCT.ir with No. 201203118822N2.

仙茅（石蒜科）是一种濒临灭绝的多年生草本植物,是印度本土药,作为强有力的适应原和春药在印度传统药物中占有重要位置。它也是多种印度传统药物处方的重要组成部分,被认为具有促进性欲、刺激免疫、保护肝脏、抗氧化、抗癌和治疗糖尿病等作用。已有报道,从仙茅中提取出多种化学成分,如植物黏胶,酚苷、皂苷和脂肪族化合物等。仙茅也是中医和日本汉方医学中各种草药处方的重要成分。本文对仙茅的多种生物活性和其不同化学成分的作用进行了综述。

大量证据显示随机对照临床试验（randomised controlled trial, RCT）的报告质量不理想。报告不透明,则读者既不能评判试验结果是否真实可靠,也不能从中提取可用于系统综述的信息。最近的方法学分析表明,报告不充分和设计不合理与对治疗效果产生评价偏倚有关。这种系统误差对RCT损害严重,而RCT正是以其能减少或避免偏倚而被视为评价干预措施的金标准。
为了提高RCT的报告质量,一个由专家和编辑组成的工作组制定了临床试验报告的统一标准（Consolidated Standards of Reporting Trials, CONSORT）声明。CONSORT声明于1996年首次发表,并于2001年更新。声明由对照检查清单和流程图组成,供作者在报告RCT时使用。许多核心医学期刊和主要国际性编辑组织都已认可CONSORT声明。该声明促进了对RCT的严格评价和解释。
2001年,在对CONSORT进行修订时,人们就已经清楚地认识到,解释和说明制定CONSORT声明的原理,有助于研究人员等撰写或评价临床试验报告。一篇CONSORT说明与详述文章于2001年同2001版CONSORT声明一起发表。
2007年1月的专家会议之后,对CONSORT声明作了进一步修订并已发表,即“CONSORT 2010声明”。这次更新对原版对照检查清单作了文字上的修改,使其更为明晰,并收入了与一些新近才认识到的主题相关的建议,如选择性报告结局产生的偏倚。
说明与详述文件旨在加强人们对CONSORT声明的理解、应用和传播,这次也作了大量修订,对每一项新增或更新的清单条目的含义和增改理由进行了解释,提供了优秀的报告实例,还尽可能地提供了相关的经验性研究的参考文献。文中收入了若干流程图实例。
“CONSORT 2010声明”、其说明与详述文件,以及相关网站（www.consort-statement.org）,对于改进随机临床试验报告必将有所裨益。

植物药在人类的医学实践中已有上千年的应用历史,特别是在亚洲的一些国家,植物药用资源被认为是一种可以随时取用的宝贵的医疗保健资源?印度拥有众多种类的药用植物,然而,其中很大一部分传统药用植物并没有被开发使用或未被现代医学科学研究证明其功效?因此,目前很有必要开发传统药用植物并使其最大限度地造福人类?本篇综述总结报道了一种很有潜力的药用植物即金钮扣属植物?过去几年中,很多从这类植物中提取的新化合物及其功效已经得到证实,因此本文旨在总结最新的有关金钮扣属植物的植物化学及民族药物学应用?药理学作用及物种保护方法的科学研究报道?

由于自然产品有化学多样性的特点,使之具有很高的实用性,无论是作为纯天然化合物或是标准化植物提取物,它们都为新药的开发提供了很多可能。与现代西药比较,草药通常被用于治疗慢性疾病。规范化操作可保证植物的一个或多个活性成分及化合物的含量。在新药研发方面,植物药的开发成本较低且资源丰富,但植物的生长环境和基因等因素会在很大程度上影响植物提取物的生物化学成分。植物药的生产要求源植物在基因方面的单种栽培完全符合标准条件,以保证其生物化学指标的一致性,并可以优化植物药的安全性和有效性。本文旨在讨论如何改进植物药提取的规范化操作方法以及如何有效制备质量及效果稳定的植物药。

In this review, the phytochemistry and pharmacology of two ornamental gingers, Hedychium coronarium (butterfly ginger) and Alpinia purpurata (red ginger), are updated, and their botany and uses are described. Flowers of H. coronarium are large, showy, white, yellow or white with a yellow centre and highly fragrant. Inflorescences of A. purpurata are erect spikes with attractive red or pink bracts. Phytochemical investigations on the rhizomes of H. coronarium generated research interest globally. This resulted in the isolation of 53 labdane-type diterpenes, with little work done on the leaves and flowers. Pharmacological properties of H. coronarium included antioxidant, antibacterial, antifungal, cytotoxic, chemopreventive, anti-allergic, larvicidal, anthelminthic, analgesic, anti-inflammatory, anti-urolithiatic, anti-angiogenic, neuro-pharmacological, fibrinogenolytic, coagulant and hepatoprotective activities. On the contrary, little is known on the phytochemistry of A. purpurata with pharmacological properties of antioxidant, antibacterial, larvicidal, cytotoxic and vasodilator activities reported in the leaves and rhizomes. There is much disparity in terms of research effort within and between these two ornamental gingers.

Plants synthesize certain phytoconstituents for their protection, which, because they are not of primary need, are known as secondary metabolites. These secondary metabolites of plants, have often been found to have medicinal uses for human beings. One such gymnosperm having secondary metabolites of medicinal potential for humans is Taxus wallichiana (Himalayan yew). Besides being the source of taxol, this plant has been investigated for its essential oil, diterpenoids, lignans, steroids, sterols and biflavonoids. Traditionally, it is used to treat disorders of the digestive, respiratory, nervous and skeletal systems. Although pharmacologically underexplored, it has been used for antiepileptic, anti-inflammatory, anticancer, antipyretic, analgesic, immunomodulatory and antimicrobial activities. The present review compiles traditional uses, phytochemical constituents (specifically the secondary metabolites) pharmacological activities and the toxicity of T. wallichiana.

Objective
Acupuncture guidelines have advised caution when treating women during pregnancy, because historical “forbidden” acupuncture points are believed to stimulate miscarriage or early labor. Despite recent research demonstrating that acupuncture is a useful and safe treatment tool for pregnancy-related low-back pain (LBP) and pelvic girdle pain (PGP), it is postulated that fear of miscarriage and subsequent blame by association, restricts its provision. More recently, an increase in dry needling (DN) courses for physiotherapists has potentiated the rapid growth in DN practice in New Zealand (NZ). Many dry needlers do not consider DN to be a form of acupuncture; it is unknown if they have similar safety concerns.
Methods
NZ registered physiotherapists practicing acupuncture and/or DN were invited to participate in an electronic survey to examine their practice and level of understanding in regard to safe needling during pregnancy.
Results
Of 124 respondents, only 60 (48%) would needle pregnant women, with a further 66% of those still expressing safety concerns. NZ physiotherapists practicing DN only, were more likely to needle areas related to “forbidden” points in all trimesters. However, overall, NZ physiotherapists were less likely to needle “forbidden” points than their UK peers.
Conclusion
Conflicting literature and a “fear of blame” influences NZ physiotherapists’ decisions to offer needling (both acupuncture and DN) during pregnancy. Further training in this field is recommended to ensure safe practice and adequate provision of acupuncture treatment options for pregnant women suffering musculoskeletal pain, such as LBP and PGP. Further research, particularly into DN, for women during pregnancy, is warranted.

目的：本研究从澳大利亚病人的角度去理解和感受他们对手法治疗的看法,并从中分析手法治疗师们所用的手法特点。
方法: 本研究采用社会学研究的观点进行定性研究,对在一个特定环境中的服务对象（病人）对治疗服务的特定感受进行调查。本文的主要研究设计是用非结构性访谈,访谈的方法和临床观察方法相结合。本研究纳入了30个符合纳入标准的研究参与者,最后有19名病人,5名中医师参与调研。
结果：本研究中,大多数病人是通过新闻媒体和家庭医生的推荐知晓物理治疗的;很多病人在物理治疗师的手法理疗后,希望体验中医推拿。虽然94%的病人对推拿治疗满意,但是很多病人并不能区别推拿和手法理疗在手法技术上的不同。一部分病人认为推拿是一种比较昂贵的治疗选择。大多数治疗师喜欢用比较强的压力性手法作用在肌肉敏感点上,而那些受过推拿正规训练的治疗师则喜欢用比较温和的手法。
结论：澳大利亚病人通常将手法理疗作为缓解其疼痛的首选治疗方案。由于缺少恰当的私人医疗保险,病人通常把推拿当作最后的治疗选择。大多数病人参与者比较喜欢类似推拿类的比较温和的手法,不喜欢强性压力性手法。本研究提示病人的感受和需要可能影响治疗的效果,如果手法治疗课程能含有相应的教育内容,鼓励手法治疗师的进一步教育以及鼓励病人参与制定手法治疗方案或许能提高对患者的治疗质量。

Background

An increasingly aging population implies an increasing prevalence of osteoarthritis (OA) of hip or knee. It has been ascertained that unspecific hydrotherapy of OA according to Sebastian Kneipp not only improves the range of mobility but also reduces pain significantly and increases the quality of life of the patients affected. 

Objective

The main aim of this pilot study was to determine the effects of hydrotherapy in comparison to conventional physiotherapy, and to analyze the feasibility of the study design under clinical circumstances.

Design, Setting, Participants and interventions

The study design is a prospective randomized controlled three-arm clinical pilot trial, carried out at a specialist clinic for integrative medicine. Thirty patients diagnosed with symptomatic OA of hip or knee and radiologic findings were randomly assigned to one of two intervention groups and a control group: hydrotherapy (group 1), physiotherapy (group 2), and both physiotherapy and hydrotherapy (group 3, control group) of the affected joint.

Main Outcome Measures

Primary outcome: pain intensity of the affected joint in the course of inpatient treatment; secondary outcome: health-related quality of life, joint-specific pain and mobility in the course of the study. 

Results

Concerning the main outcome, intervention group 1 showed most beneficial effects in the course of inpatient treatment, followed by groups 3 and 2, and also the indirect flexion ability of hip or knee together with the general patient mobility through the “timed up and go” test were mainly improved within group 1 followed by groups 3 and 2. 

Conclusion

The results of this pilot study demonstrate beneficial effects of hydrotherapy. The study design is feasible. For statistically significant evidence and a robust conclusion of efficacy of Kneipp’s hydrotherapy, a larger sample size is necessary.

Trial Registration Number

NCT 00950326.

Spinal manipulation has been an effective intervention for the management of various musculoskeletal disorders. However, the mechanisms underlying the pain modulatory effects of spinal manipulation remain elusive. Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin. In this article, we reviewed the relevance of various neurophysiological theories with respect to the findings of mechanistic studies that demonstrated neural responses following spinal manipulation. This article also discussed whether these neural responses are associated with the possible neurophysiological mechanisms of spinal manipulation. The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more. However, the clinical relevance of these changes in relation to the mechanisms that underlie the effectiveness of spinal manipulation is still unclear. In addition, there were some major methodological flaws in many of the reviewed studies. Future mechanistic studies should have an appropriate study design and methodology and should plan for a long-term follow-up in order to determine the clinical significance of the neural responses evoked following spinal manipulation.

Background
Burnout (encompassing emotional exhaustion, depersonalization and personal accomplishment) in healthcare professionals is a major issue worldwide. Emergency medicine physicians are particularly affected, potentially impacting on quality of care and attrition from the specialty.
Objective
The aim of this study was to apply an attention-based training (ABT) program to reduce burnout among emergency multidisciplinary team (MDT) members from a large urban hospital.
Design, setting, participants and interventions
Emergency MDT members were randomized to either a no-treatment control or an intervention group. Intervention group participants engaged in a four session (4?h/session) ABT program over 7?weeks with a practice target of 20?min twice-daily. Practice adherence was measured using a smart phone application together with a wearable Charge 2 device.
Main outcome measures
The primary outcome was a change in burnout, comprising emotional exhaustion, depersonalization and personal achievement. The secondary outcomes were changes in other psychological and biometric parameters.
Results
The ABT program resulted in a significant reduction (P?<?0.05; T1 [one week before intervention] vs T3 [follow-up at two months after intervention]) in burnout, specifically, emotional exhaustion, with an effect size (probability of superiority) of 59%. Similar reductions were observed for stress (P?<?0.05) and anxiety (P?<?0.05). Furthermore, ABT group participants demonstrated significant improvements in heart rate variability, resting heart rate, sleep as well as an increase in pro-inflammatory cytokine expression.
Conclusion
This study describes a positive impact of ABT on emergency department staff burnout compared to a no-treatment control group.
Trial registration
ClinicalTrials.gov identifier NCT02887300.

Juglans regia Linn. (Juglandaceae), popularly known as English or Persian walnut, is a valuable medicinal plant with a potency to cure various diseases in traditional medicine. Since ancient time, different local ethnic groups have used various part of J. regia for a wide array of ailments including helminthiasis, diarrhea, sinusitis, stomach ache, arthritis, asthma, eczema, scrofula, skin disorders, diabetes mellitus, anorexia, thyroid dysfunction, cancer and infectious diseases. Biological activities of J. regia have been reported in several peer review journals and scientific attention is increasing. The present review attempts to provide comprehensive information on plant description, ethnobotanical use, toxicity, phytochemical profile, pharmacology, clinical studies and current research prospective of the J. regia. Currently, there is an immense interest on isolation/identification of active constituents from walnut and screening those active compounds for pharmacological activities. In addition, researchers are performing clinical trials as well as screening various solvent extracts or fractions of J. regia in several animal diseases models to identify promising therapeutic benefits. In the present work, we review the latest information based on published scientific investigations of J. regia.

Objective
This study examined the antimicrobial activity of Cannabis sativa, Thuja orientalis and Psidium guajava against methicillin-resistant Staphylococcus aureus (MRSA) and used a standardized purification protocol to determine the presence and abundance of bioactive compounds in the leaf extracts.

Methods

In vitro antimicrobial activities of the ethanolic extracts of C. sativa, T. orientalis and P. guajava were tested against MRSA. The presence of bioactive molecules in these three leaves was evaluated using biochemical assays and high-performance thin-layer chromatography (HPTLC).

Results

Resistance to methicillin, penicillin, oxacillin and cefoxitin was observed in each of the clinical and nonclinical MRSA isolates. However, they were still vulnerable to vancomycin. Used individually, the 50% extract of each plant leaf inhibited MRSA growth. A profound synergism was observed when C. sativa was used in combination with T. orientalis (1:1) and when P. guajava was used in combination with T. orientalis (1:1). This was shown by larger zones of inhibition. This synergism was probably due to the combined inhibitory effect of phenolics present in the leaf extracts (i.e., quercetin and gallic acid) and catechin, as detected by HPTLC.

Conclusion

The leaf extracts of C. sativa, T. orientalis and P. guajava had potential for the control of both hospital- and community-acquired MRSA. Moreover, the inhibitory effect was enhanced when extracts were used in combination.

中药药性是中药有别于现代药物的根本属性,是药物与疗效有关的各种属性和性质?中药药性理论肇始于四气五味,经过几千年不同历史时期的补充完善,形成了目前以四气?五味?归经?升降沉浮?有毒无毒为主体的中药药性理论?由于阴阳五行哲学思维的渗透和不同历史时期格物传统的差异,中药药性理论的形成具有复杂性特征,表现在以下几个方面?第一,药性确定的途径具有多源性,除了药效反推法,还有以药材质地?颜色?生长环境?加工处理等自然属性为依据的取象比类法,并受到易家?道家?巫家思想等的影响;第二,就药效反推法来看,药性与功效之间的多选性普遍存在,同一药性可以通过不同的功效反推得到?因此,中药药性形成具有多源性特征,药性实质研究应密切关注特定药物的认知起源及相对应的功效特点?

土丁桂属草药是作用于中枢神经系统的印度传统药物,特别是对促进记忆和改善智力有较好疗效。从印度传统医学和梵语文献中提取的大量信息提示,冠以土丁桂属草药名称的植物类别共4种：旋花科田旋花、旋花科土丁桂、蝶形花科蝴蝶花豆和龙胆科穿心草。这些草药名称均在古代文献中有所记载,可单独使用或与其他药材组合成各种草药处方。本文就现有的科学信息,如土丁桂属不同植物来源物种的生药学特征、化学成分、药理作用、临床前及临床应用等方面进行述评,以期为科学地应用土丁桂提供依据。此外,还可根据不同植物来源土丁桂属草药的不同功效进行鉴别应用。

Traditional Chinese medicine (TCM) syndrome, also known as TCM ZHENG or TCM pattern, is an integral and essential part of TCM theory that helps to guide the design of individualized treatments. A TCM syndrome, in essence, is a characteristic profile of all clinical manifestations in one patient that can be readily identified by a TCM practitioner. In this article, the authors reviewed the presentations of TCM syndromes in seven common malignancies (liver, lung, gastric, breast, colorectal, pancreatic and esophageal cancers), the objectivity and the standardization of TCM syndrome differentiation, the evaluation of TCM syndrome modeling in cancer research, and syndrome differentiation-guided TCM treatment of cancers. A better understanding of TCM syndrome theory, as well as its potential biological basis, may contribute greatly to the clinical TCM diagnosis and the treatment of cancer.

背景

很多随机对照试验和系统综述得出了针刺对下腰背部疼痛无效的结论并且认为针刺和安慰性针刺对于下腰背部疼痛的治疗疗效并没有区别?

目的

本研究是从临床的角度,特别是从专业针灸医师的角度来评估近年来发表的有关针刺治疗下腰背部疼痛的随机对照试验和系统综述的价值?

数据来源和搜集

对Cochrane图书馆?PubMed/MEDLINE?EMBASE进行检索,检索的时间范围是从2007年1月至2010年1月?本研究共纳入18个用英语写作的关于针刺治疗下腰背部疼痛或者针刺作为治疗手段之一的随机对照试验?

评估方法

临床定性批评性价值评估是本文的研究特点?运用临床基本技能和知识以及统计学概念,建立5个价值评估标准对被纳入的随机对照试验和系统综述的质量和可靠性进行价值评估?这种评估方法与随机对照试验中的纳入和排除标准评估很相似?通过使用这种评估方法,尽管随机对照试验和系统综述有较完善的内部有效性,它们之中的不足之处?局限性和错误就会暴露出来?

结果

下腰背部疼痛的研究使用了很多种定义?纳入的18个研究中,16个(80%)随机对照试验中没有使用医学诊断;所有的随机对照试验没有使用客观的测量方法去判断研究的结果?由于使用了多种治疗方法或多个治疗师参与治疗,使这些随机对照试验产生了很大的变异;10个(55%)试验运用了针刺联合其他治疗的方法,其中6个(33%)试验使用了非甾体抗炎药或镇痛剂?由于没有使用医学诊断,所有的试验的外部有效性均不可靠?所有这些被纳入的随机对照试验和系统综述都没有使用logistic回归的方法去解决研究中的异质性问题?

结论

所有被纳入的随机对照试验在应用本研究设定的价值评估标准衡量时,都不能完全符合这些标准?这些随机对照试验的主要问题在于没有正确的医学诊断和没有客观的测量方法去判断治疗效果,导致了纳入及排除标准制定的不正确,配对的不恰当和数据进入统计分析前记录的不精确?由于治疗效果测量的主观性,随机对照试验和以随机对照试验为基础的系统综述就出现了过于泛化或是含有交叉结论的偏倚估算?此外,在治疗过程中产生的众多变量是很难控制和估算的,这种不确定因素影响了随机对照试验结论的可靠性?基于上述原因,在将来的随机对照试验和系统综述中应该考虑在随机分配之前建立一个恰当的医学诊断和设立一个与临床相关的客观的结局测量方法?

This article explores the most recent evidence-based information on ethnomedicinal, phytochemical and pharmacological understanding of Hygrophila auriculata for the treatment of various diseases and health conditions. Various ethnomedicinal writings suggest the use of the plant or its parts for the treatment of jaundice, oedema, gastrointestinal ailments, diarrhoea, dysentery, urinogenital disorder, gall stones, urinary calculi, kidney stone, leucorrhoea, rheumatism, tuberculosis, anaemia, body pain, constipation, skin disease, and as an aphrodisiac. The plant has been reported to contain flavonoids (apigenin, luteolin, ellagic acid, gallic acid and quercetin), alkaloids (asteracanthine and asteracanthicine), triterpenes (lupeol, lupenone, hentricontane and betulin), sterols (stigmasterol and asterol), minerals, amino acids, fatty acids, aliphatic esters and essential oils. Extracts and bioactive compounds from the plant have been found to possess antimicrobial, anthelmintic, antitermite, nephroprotective, hepatoprotective, central nervous system protective, antitumour, antidiabetic, anticataract, antioxidant, haematopoietic, diuretic, antinociceptive, anti-inflammatory, antipyretic, antimotility, aphrodisiac, neuroprotection, anti-endotoxin and anti-urolithiatic activities. For this paper, we reviewed patents, clinical studies, analytical studies and marketed formulations from the earliest found examples from 1887 to the end of 2017.

目的

评价新近开发的抗感冒中药治疗急性上呼吸道感染（普通感冒）的疗效和安全性。
方法

收集中药治疗急性上呼吸道感染（普通感冒）随机对照试验文献,对符合纳入标准的文献按Jadad计分表评价其质量,对纳入的试验作系统评价,同时按中医感冒病的辨证分型进行分层分析。
结果

符合纳入标准的文献共13篇。Meta分析结果显示,中药治疗组与对照组相比,显效率相对危险度（relative risk, RR）为1.10,95%可信区间（confidence interval, CI）[1.05,1.16],两组指标比较,差异有统计学意义（P=0.000 2）。降温起效时间加权均数差（weighted mean difference, WMD）为–1.70,95% CI [–2.76,–0.65],两组指标比较,差异有统计学意义（P=0.002）。体温解热时间WMD为–1.32,95% CI [–3.14,0.49],两组指标比较,差异无统计学意义（P=0.15）。亚组分型显示,风热感冒中药治疗组与对照组相比,显效率RR为1.11,95% CI[1.05,1.19],两组指标比较,差异有统计学意义（P=0.000 7）;风寒感冒中药治疗组与对照组相比,显效率RR为1.07,95% CI[0.99,1.16],两组指标比较,差异无统计学意义（P=0.10）。未报道与中药临床应用相关的严重不良反应。
结论

近几年来新开发的抗感冒中药较既往抗感冒中药能够明显提高降温起效时间,更好地改善患者的全身症状,具有起效快、疗效好的特点,未见明显的不良反应。由于所纳入的文献无一篇使用安慰剂,尚需开展使用安慰剂对照的高质量研究。

Background
Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal complaints. GERD, caused by the reflux of stomach contents into the esophagus, leads to troublesome symptoms such as heartburn and regurgitation. It is classified into two types: erosive esophagitis, characterized by visible esophageal mucosa erosion in endoscopy, and non-erosive reflux disease (NERD). GERD is a chronic and recurrent disease that impairs the quality of life and imposes socioeconomic and therapeutic burdens to both patients and society.

Objective

Due to the failure of the conventional treatments for GERD and to the traditional use of Amla (Phyllanthus emblica L.), in addition to beneficial effects shown in recent studies, we evaluated the safety and efficacy of Amla tablet for improvement of symptoms of patients with NERD.

Design, setting, participants and interventions

We designed a double-arm, randomized, double-blind, placebo-controlled clinical trial. Sixty-eight patients who had classic symptoms of GERD (heartburn, regurgitation and epigastralgia) for at least three months before the start of the trial were randomized in two parallel groups. Patients in the Amla group received two 500?mg Amla tablets twice a day, after meals, for 4?weeks. In the control group, patients received placebo tablets similar to the Amla prescription.

Main outcome measures

The patients were visited at baseline, and at the end of the 2nd and 4th weeks of intervention; their symptoms were measured on a frequency and severity scale for the symptoms of NERD, according to the quality of life in reflux-associated disease questionnaire.

Results

Frequencies of heartburn and regurgitation in both groups of the study were significantly reduced after intervention (P?<?0.001). Repeated measures logistic regression analysis showed that, in the Amla group, there was a more significant reduction in regurgitation frequency, heartburn frequency, regurgitation severity and heartburn severity during the study period, compared with the placebo group (P?<?0.001).

Conclusion

This randomized double-blind, placebo-controlled clinical trial demonstrated that Amla could reduce frequencies of heartburn and regurgitation and improve heartburn and regurgitation severity in patients with NERD.

Trial registration

Iranian Registry of Clinical Trials IRCT2016061428469N1.

Background
Sexual health positively correlates with overall wellbeing. Existing therapeutics to enhance male sexual health are limited by factors that include responsiveness, adherence and adverse effects. As the population ages, safe and effective interventions that preserve male sexual function are needed. Published research suggests that various preparations of Kaempferia parviflora, a plant in the Zingiberaceae (ginger) family, support cardiovascular health and may ameliorate erectile function.

Objective

The aim of this study was to examine the effects of KaempMax^TM, an ethanol extract of the K. parviflora rhizome, on erectile function in healthy middle-aged and older men.

Design, setting, participants and interventions

We conducted an open-label, one-arm study on 14 generally healthy males aged 50–68?years with self-reported mild erectile dysfunction, who were not using prescription treatments. Participants took 100?mg KaempMax^TM daily for 30?days.

Main outcome measures

Evaluations were conducted at baseline and on the final study assessment. Primary efficacy analyses included the International Index of Erectile Function (IIEF); secondary efficacy analyses included the Global Assessment Question about erectile function.

Results

Thirteen participants completed the 30-day study. Supplementation with KaempMax^TM resulted in statistically significant improvements in erectile function, intercourse satisfaction and total scores on the IIEF questionnaire. KaempMax^TM was well tolerated and exhibited an excellent safety profile.

Conclusion

Our results suggest that KaempMax^TM may improve erectile function in healthy middle-aged and older men. While the effects were not as pronounced as what might be seen with prescription medication, most participants found them satisfactory. Additional, longer and placebo-controlled clinical trials will be needed.

Trial registration

Clinicaltrials.gov identifier NCT03389867.

背景: 多囊卵巢综合征（polycystic ovary syndrome, PCOS）是一组复杂的症候群。许多研究表明,中草药可作为治疗PCOS的替代疗法,故分析和观察中国传统医药对PCOS的疗效是必要和有价值的。

目的:观察中药天癸胶囊治疗PCOS的有效性,比较天癸胶囊与二甲双胍和达英-35治疗PCOS在调整卵巢功能、改善胰岛素抵抗和改变卵巢形态学等方面的效果。设计、场所、对象和干预措施：收集复旦大学附属妇产科医院门诊符合PCOS诊断标准的PCOS患者共47例,随机分入A、B、C三个治疗组。A组（19例）给予天癸胶囊治疗,B组（17例）给予二甲双胍治疗,C组（11例）给予达英-35 治疗,3组均治疗3个月。主要结局指标：检测治疗前后雄激素（testosterone, T）、性激素结合球蛋白（sex hormone binding globulin, SHBG）、硫酸脱氢表雄酮（dehydroepiandrosterone sulfate, DHEA-S）水平以及游离雄激素指数（free androgen index, FAI）、空腹血糖（fasting blood glucose, FPG）、空腹胰岛素（fasting insulin, FINS）、胰岛素稳态模型指数（hemeostasis model assessment-insulin resistance, HOMA-IR）、胰岛素敏感指数（insulin sensitive index, ISI）和双侧卵巢体积的变化。

结果:A组治疗后血清T、SHBG水平及FAI、FINS下降（P<0.05）,双侧卵巢缩小（P<0.05）,血清DHEA-S水平增加（P<0.05）,FPG有增加趋势但无统计学意义。治疗3个月后3组间血清T水平比较虽无差异,但在降低FAI及增加血SHBG作用方面A组比B组强,比C组弱;3种药物降低FINS水平作用相似,但仅B组治疗后胰岛素敏感性增加;3组治疗后FPG均似有增加趋势,但C组FPG水平增加幅度最大。

结论:中药天癸胶囊改善高雄激素血症作用比达英-35弱,优于二甲双胍;改善高胰岛素血症作用比二甲双胍弱,优于达英-35。天癸胶囊在不抑制下丘脑-垂体-卵巢轴功能的基础上,通过调整卵巢功能、改善胰岛素水平及改变卵巢形态等多方面治疗PCOS。以上结果值得进一步扩大样本量予以证实。

Objective
Although Angelica archangelica is a medicinal and aromatic plant with a long history of use for both medicinal and food purposes, there are no studies regarding the antineoplastic activity of its root. This study aimed to evaluate the cytotoxicity and antitumor effects of the crude extract of A. archangelica root (CEAA) on breast cancer.
Methods
The cytotoxicity of CEAA against breast adenocarcinoma cells (4T1 and MCF-7) was evaluated by a 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. Morphological and biochemical changes were detected by Hoechst 33342/propidium iodide (PI) and annexin V/PI staining. Cytosolic calcium mobilization was evaluated in cells staining with FURA-4NW. Immunoblotting was used to determine the effect of CEAA on anti- and pro-apoptotic proteins (Bcl-2 and Bax, respectively). The 4T1 cell-challenged mice were used for in vivo assay.
Results
Using ultra-high-performance liquid chromatography–mass spectrometry analysis, angelicin, a constituent of the roots and leaves of A. archangelica, was found to be the major constituent of the CEAA evaluated in this study (73?μg/mL). The CEAA was cytotoxic for both breast cancer cell lines studied but not for human fibroblasts. Treatment of 4T1 cells with the CEAA increased Bax protein levels accompanied by decreased Bcl-2 expression, in the presence of cleaved caspase-3 and cytosolic calcium mobilization, suggesting mitochondrial involvement in breast cancer cell death induced by the CEAA in this cell line. No changes on the Bcl-2/Bax ratio were observed in CEAA-treated MCF7 cells. Gavage administration of the CEAA (500?mg/kg) to 4T1 cell-challenged mice significantly decreased tumor growth when compared with untreated animals.
Conclusion
Altogether, our data show the antitumor potential of the CEAA against breast cancer cells in vitro and in vivo. Further research is necessary to better elucidate the pharmacological application of the CEAA in breast cancer therapy.

Progressive loss of retinal ganglion cells (RGCs) and their axons is the main pathogenesis of glaucoma. The cause of glaucoma is not fully understood, but the neurodegeneration of glaucoma involves many mechanisms such as oxidative stress, glutamate toxicity and ischemia/reperfusion insult. In order to target these mechanisms, multiple neuroprotective interventions have been investigated to prevent the death of RGCs. Of note are some tonic herbs from the traditional Chinese medicine (TCM) pharmacopeia that have shown neuroprotective effects in glaucoma. TCM differs from Western medicine in that TCM exhibits complicated bioactive components, triggering many signaling pathways and extensive actions on vital organs. Modern scientific approaches have demonstrated some of their underlying mechanisms. In this review, we used Lycium barbarum and Ginkgo bilobaas examples to elaborate the characteristics of TCM and their potential applications in neuroprotection in glaucoma.

Objective

Tephrosia purpurea (Linn.) Pers. is widely used in traditional medicine to treat liver disorders, febrile attacks, enlargement and obstruction of liver, spleen, and kidney. In the present study, investigations were carried out to determine the seasonal impact on the content of flavonoid glycosides and on antioxidant activities so as to identify the optimal time of harvesting.

Methods

The plant materials were collected in different seasons during 2013-2014. Air-dried, powdered plant materials were extracted with 95% ethanol and ethanol:water (1:1) by ultrasound-assisted extraction process. Their chemical composition in terms of total polyphenol and flavonoid contents (TPCs and TFCs) was determined using modified colorimetric Folin-Ciocalteu method and aluminum chloride colorimetric assay respectively. To determine the in vitroantioxidant activity, diphenyl-picryl hydrazyl (DPPH) radical-scavenging assay and total antioxidant capacity by phosphomolybdate antioxidant assay were carried out. High-performance liquid chromatography (HPLC)/photo-diode array (PDA) analysis was used to quantify the flavonoid glycosides in the samples collected in different seasons. Correlation studies were also carried out between antioxidant activities and TPCs.

Results

The highest TPC and TFC were found to be in the 95% ethanolic extract of the August sample and the lowest in the 50% hydro-alcoholic extract of the plant sample collected in winter season. It was observed that in both the assays used to determine the antioxidant activity, the 95% ethanolic extracts in all the seasons showed a higher activity than their respective 50% hydro-alcoholic extracts with an increase in activity as we go from cold to hot to rainy seasons. Based on correlation analysis, DPPH radical-scavenging activities as well as the spectrophotometrically measured phosphomolybdenum complex were also strongly correlated with TPC of the extracts. The most abundant flavonoid glycoside was quercetin-3-O-rhamnoglucoside in all the seasons. The content of all flavonoids was observed highest in the 95% ethanolic extract of the plant collected in August (TP-3). The 50% hydro-alcoholic extract of the plant collected in December (TP-6) showed the lowest amount of flavonoids and antioxidant activity.

Conclusion

The findings of this study confirmed that the metabolism and production of flavonoids in T. purpurea are vigorously affected by seasonal factors. Significant differences were observed in the TPC, TFC and flavonoid glycoside composition in the 95% ethanolic as well as 50% hydro-alcoholic extracts of T. purpurea collected in different seasons. Since the 95% ethanolic extract of the August sample (TP-3), which also happens to be its flowering season, exhibited the highest TPC, TFC and antioxidant activities in both DPPH and phosphomolybdate assays as well as contained the highest content of all flavonoids, it could be recommended as the optimal season of harvesting T. purpurea with respect to its pharmaceutically important constituents, i.e., flavonoids.

Objective
The main objectives of this study were to qualitatively evaluate the profile of phytochemical constituents present in methanolic extract of Microcos paniculata bark (BME) and fruit (FME), as well as to evaluate their anti-inflammatory, analgesic and antipyretic activities.
Methods
Phytochemical constituents of BME and FME were determined by different qualitative tests such as Molisch's test, Fehling's test, alkaloid test, frothing test, FeCl₃ test, alkali test, Salkowski's test and Baljet test. The anti-inflammatory, analgesic and antipyretic activities of the extracts were evaluated through proteinase-inhibitory assay, xylene-induced ear edema test, cotton pellet-induced granuloma formation in mice, formalin test, acetic acid-induced writhing test, tail immersion test and Brewer's yeast-induced pyrexia in mice.
Results
M. paniculata extracts revealed the presence of carbohydrates, alkaloids, saponins, tannins, flavonoids and triterpenoids. All of the extracts showed significant (P < 0.05, vs aspirin group) proteinase-inhibitory activity, whereas the highest effect elicited by plant extracts was exhibited by the BME (75.94% proteinase inhibition activity) with a half-maximal inhibitory concentration (IC₅₀) of 61.31 μg/mL. Each extract at the doses of 200 and 400 mg/kg body weight showed significant (P < 0.05, vs control) percentage inhibition of ear edema and granuloma formation. These extracts significantly (P < 0.05, vs control) reduced the paw licking and abdominal writhing of mice. In addition, BME 400 mg/kg, and FME at 200 and 400 mg/kg showed significant (P < 0.05, vs control) analgesic activities at 60 min in the tail immersion test. Again, the significant (P < 0.05, vs control) post-treatment antipyretic activities were found by BME 200 and 400 mg/kg and FME 400 mg/kg respectively.
Conclusion
Study results indicate that M. paniculata may provide a source of plant compounds with anti-inflammatory, analgesic and antipyretic activities.

Hepatocellular carcinoma (HCC) is one of leading causes of death in the world. Although various treatments have been developed, the therapeutic side effects are far from desirable. Chinese medicines (CMs, including plants, animal parts and minerals) have drawn a great deal of attention in recent years for their potential in the treatment of HCC. Most studies have shown that CMs may be able to retard HCC progression with multiple actions, either alone or in combination with other conventional therapies to improve quality of life in HCC patients. Additionally, CMs are used for preventing HCC occurrence. The aim of this study is to review the potential prophylactic and curative effects of CMs on human HCC and the possible mechanisms that underlie these pharmacological actions. Publications were collected and reviewed from PubMed and China National Knowledge Infrastructure from 2000 to 2014. Keywords for literature searches include “Chinese medicine”, “Chinese herb”, “traditional Chinese Medicine”, “hepatocellular carcinoma” and “liver cancer”. CMs in forms of pure compounds, isolated fractions, and composite formulas are included. Combination therapies are also considered. Both in vitro and in vivo efficacies of CMs are being discussed and the translational potential to bedside is to be discussed with clinical cases, which show the actions of CMs on HCC may include tumor growth inhibition, antimetastatic activities, anti-inflammation, anti-liver cancer stem cells, reversal on multi-drug resistance and induction/reduction of oxidative stress. Multiple types of molecules are found to contribute in the above actions. The review paper indicated that CMs might have potential to both prevent HCC occurrence and retard HCC progression with several molecular targets involved.

Background
Reducing labor pain and anxiety is one of the most important goals of maternity care.

Objective

This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.

Design, setting, participants and interventions

This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08?mL of Rosa damascena essence in the aromatherapy group and 0.08?mL of normal saline in the control group, every 30?min. Pain was measured 3 times, once each at three stages of cervical dilation (4–5, 6–7, and 8–10?cm). Anxiety was measured twice, once each at two stages of cervical dilation (4–7 and 8–10?cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann–Whitney U test and Chi-square test.

Main outcome measures

Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.

Results

Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4–5, 6–7, and 8–10?cm; P?<?0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4–7 and 8–10?cm; P?<?0.05).

Conclusion

Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.

Trial registration

Iranian Registry of Clinical Trial: IRCT201306258801N3.

Recent studies have shown exercise is associated with changes in the gut microbiota in humans as well as in experimental animals. Tai Chi is an exercise that integrates a martial art, deep breathing and mediation, and has various beneficial effects for health. This review summarizes current knowledge and recent literature on the association between exercise and gut microbiota, and explores the feasibility of Tai Chi for improving gut microbiota composition and function. PubMed/MEDLINE was used to search the English literature for the keywords exercise and gut microbiota. Fourteen relevant studies were identified. In humans, exercise increases the gut microbial diversity. However, the evidence for this association is weak, as previous studies were small-scale, non-controlled studies of short duration or cross-sectional design. In animals, exercise alters the composition of gut microbiota, with some studies suggesting exercise increases the Bacteroidetes/Firmicutes ratio. However, these results are controversial, partly because host genetics and physical fitness also influence gut microbiota. Furthermore, the intensity of exercise may play a key role in how exercise affects gut microbiota. Tai Chi is a moderate-intensity exercise that improves immune function and inflammation of the gut. Tai Chi may also affect gut microbiota through vagal modulation and mediating the hypothalamic-pituitary-adrenal axis. However, no studies have investigated the association between Tai Chi and gut microbiota. Well designed studies exploring the effects of Tai Chi on gut microbiota are needed.

Traditional Chinese medicine (TCM) is commonly used in treating liver diseases worldwide, especially in China. The advantages of using TCM for treatment of liver diseases include: protecting hepatocytes, inhibiting hepatic inflammation and antifibrosis in the liver. In this article, we introduce TCM herbal preparations from the Chinese materia medica (such as Fuzheng Huayu) that are typically used for the treatment of liver diseases. Literature surrounding the mechanisms of TCM therapy for treatment of liver diseases is presented and discussed. We propose that side effects of herbal compounds are often under-appreciated, and that more care should be taken in the prescription of potentially hepatotoxic medicines. Further, to deepen the understanding of TCM mechanisms, new techniques and methodologies must be developed. Future studies will lead to the enhancement of clinical outcomes of TCM. As complementary and alternative therapies, TCMs will play an expanding role in the future of liver disease treatment.

Curcumin is a widely studied natural compound which has shown tremendous in vitro therapeutic potential. Despite that, the clinical efficacy of the native curcumin is weak due to its low bioavailability and high metabolism in the gastrointestinal tract. During the last decade, researchers have come up with different formulations with a focus on improving the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with the varying range of enhanced bioavailability. The purpose of this review is to collate the published clinical studies of curcumin products with improved bioavailability over conventional (unformulated) curcumin. Based on the literature search, 11 curcumin formulations with available human bioavailability and pharmacokinetics data were included in this review. Further, the data on clinical study design, analytical method, pharmacokinetic parameters and other relevant details of each formulation were extracted. Based on a review of these studies, it is evident that better bioavailability of formulated curcumin products is mostly attributed to improved solubility, stability, and possibly low first-pass metabolism. The review hopes to provide a quick reference guide for anyone looking information on these bioavailable curcumin formulations. Based on the published reports, NovaSol^?(185), CurcuWin^? (136) and LongVida^? (100) exhibited over 100-fold higher bioavailability relative to reference unformulated curcumin. Suggested mechanisms accounting for improved bioavailability of the formulations and details on the bioanalysis methods are also discussed.

目的：研究纳米铂金颗粒的抗癌作用并分析其与小牛胸腺DNA及蜂蜜的相互作用。
方法：使用绿色纳米技术合成纳米铂金颗粒Bioplatin并确定其物理特性如颗粒大小、电动电位及表面形态学。使用圆二色光谱分光光度法及傅里叶变换红外光谱技术以小牛胸腺DNA和蜂蜜作为靶点检测药物-DNA相互作用。使用噻唑蓝、荧光显微镜及DNA片段分析法检测其对外周血单核细胞及A375细胞的体外抗癌作用。
结果：Bioplatin的纳米直径为137.5 nm,表面电荷为–35.8 mV。Bioplatin与DNA相互作用后对DNA的结构产生了明显的作用,使其发生改变,并形成了一种能够提高DNA稳定性的新的化合物。体外实验表明Bioplatin能够抑制细胞增殖,引起细胞核染色质凝固和DNA核小体断裂。
结论：Bioplatin能够引起肿瘤细胞凋亡,因此具有一定的抗肿瘤作用。它能够与DNA相互作用,增加DNA的稳定性,从而抑制DNA的复制。

Background

Disease recurrence is a main challenge in treatment of hepatocellular carcinoma (HCC). There is no generally accepted method for preventing recurrence of HCC after resection.

Objective

To compare the efficacy of a traditional herbal medicine (THM) regimen and transarterial chemoembolization (TACE) in preventing recurrence in post-resection patients with small HCC.

Design, setting, participants and interventions

This is a multicenter, open-label, randomized, controlled study, which was undertaken in five centers of China. A total of 379 patients who met the eligibility criteria and underwent randomization were enrolled in this trial. One hundred and eighty-eight patients were assigned to the THM group and received Cinobufacini injection and Jiedu Granule, and the other 191 patients were assigned to the TACE group and received one single course of TACE.

Main outcome measures

Primary outcome measures were the annual recurrence rate and the time to recurrence. Incidence of adverse events was regarded as the secondary outcome measure.

Results

Among the 364 patients who were included in the intention-to-treat analysis, 67 patients of the THM group and 87 of the TACE group had recurrence, with a hazard ratio of 0.695 (P = 0.048). Median recurrence-free survival of the patients in the THM and TACE groups was 46.89 and 34.49 months, respectively. Recurrence rates at 1, 2 and 3 years were 17.7%, 33.0% and 43.5% for the THM group, and 28.8%, 42.5% and 54.0% for the TACE group, respectively (P = 0.026). Multivariate analysis indicated that the THM regimen had a big advantage for prolonging the recurrence-free survival. Adverse events were mild and abnormality of laboratory indices of the two groups were similar.

Conclusion

In comparison with TACE therapy, the THM regimen was associated with diminished risk of recurrence of small-sized HCC after resection, with comparable adverse events.

Trial registration identifier

This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-07000033.

Objective

To evaluate the effects of Zingiber cassumunar (Plai cream) in either 7% or 14% concentration on delayed onset muscle soreness (DOMS).

Methods

Seventy-five untrained healthy volunteers (28 males and 47 females), performed 4 sets of 25 eccentric repetitions of the dominant quadriceps muscle on an isokinetic dynamometry machine. Participants were then randomized into 3 groups: 14% Plai cream, 7% Plai cream and placebo cream. Two grams of the cream (strips of 5-cm long) were gently rubbed into the quadriceps muscles for 5 min immediately following the exercise and every 8 h thereafter for 7 d in all groups. Muscle soreness, muscle strength, jump height, thigh circumference and creatine kinase were measured before and after eccentric exercise.

Results

Compared to the placebo cream the 14% Plai cream substantially reduced muscle soreness over the 7 d by -82% (95% CI = -155% to -6%, P = 0.03), but had similar muscle soreness effects to 7% Plai cream (-34%, -96% to 27%, P = 0.2). Compared to the placebo cream the 7% Plai cream resulted in a small non-significant reduction in muscle soreness levels over the following 7 d (-40%, -116% to 36%, P = 0.3). Compared to placebo cream there was little effect of Plai cream (7% or 14%) on muscle strength, jump height, thigh circumference or creatine kinase concentration.

Conclusion

Using 14% Plai cream over a 7-day period substantially reduced muscle soreness symptoms compared to 7% Plai cream or a placebo cream. The authors suggest that the administration of 14% Plai cream is a useful alternative in the management of DOMS.