Responses to the correspondence from McDowell et al.'s on CAM integrative review of health care professionals in New Zealand.

The authors of the manuscript 'Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review' [1] disagree with the assertion by McDowell et al. that our manuscript has extrapolation errors.

Effect of overnight orthokeratology lenses on tear film stability in children.

PURPOSE: To assess the tear film surface quality after orthokeratology using an automated Medmont E300 corneal topographer. METHODS: Children who wore orthokeratology lenses for more than one year were selected in this retrospective study. Tear film disruption (TFD) and central tear film disruption (cTFD) were measured with Medmont E300 corneal topographer at initial and each follow-up visit after fitting with orthokeratology lenses, providing a nominal value from 0 (perfect) to 1 (poor). Tear film surface quality before and after ortho-k treatment was compared. RESULTS: 145 children using orthokeratology lenses were observed. TFD and cTFD significantly increased at 1-day follow up (TFD, t = -17.3, P < 0.001; cTFD, t = -10.4, P < 0.001). This change remained consistent through to 12-months visit (TFD, F = 51.1, P < 0.001; cTFD, F = 28.0, P < 0.001). A sub-group of n = 11 children were discontinued for 1-month before being refit with OrthoK lenses of a different design. Similarly, there was a significant increase in TFD compared to pre-orthoK scans (0.172 ± 0.161), but this returned to baseline levels after ceasing lens wear (0.084 ± 0.059). A sub-group of monocular OrthoK wearers (n = 23) found that TFD and cTFD values increased in eyes with monocular lens-wearing but remained stable in the lateral eyes. CONCLUSIONS: Objective measurements of tear-film quality are reduced in children after fitting with orthokeratology lenses, but return to baseline after 1-month of lens cessation. It is of importance to ensure tear film surface quality is continuously monitored throughout use of orthoK lenses.

Acupoints sensitization in people with and without chronic low back pain:A matched-sample cross-sectional study.

BACKGROUND: Acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. In pathological states, disease-related acupoints are believed to be activated, which is known as acupoint sensitization. OBJECTIVE: This study aimed to investigate the major manifestations of acupoint sensitization in patients with chronic low back pain (cLBP) to provide better understanding of acupoint sensitization phenomena in the context of cLBP. METHODS: This study was a matched-sample cross-sectional study 16 participants diagnosed with cLBP and 16 healthy controls matched in age, sex, and ethnicity were included. The following aspects of sensitization phenomena of targeted points were compared: pressure pain threshold (PPT), skin temperature, surface electrical conductance, receptive field, and morphological change of skin. RESULTS: PPT at points of interest were significantly lower in cLBP participants compared with healthy controls (P< 0.05); in addition, receptive field was found to be larger at left BL 23 in cLBP participants (P< 0.05). There was no statistically significant difference in skin temperature, electrical conductance, or morphology between the two groups. CONCLUSIONS: Reduced PPT at all detected points and enlarged receptive field at left BL 23 were found in cLBP participants. These two features appear key in defining acupoint sensitization in cLBP, and provide evidence for selecting and locating acupuncture points in future clinical studies.

Factors associated with faster axial elongation after orthokeratology treatment.

BACKGROUND: To study the baseline factors that related to faster axial elongation after orthokeratology (OK) treatment and the characteristics of cases with axial length decrease in a group of myopia children. METHODS: This is a retrospective study. The records of 73 children who had wear OK lens for at least one year were reviewed. Only the data of right eyes were included. Baseline data included: age, gender, parental myopia, refractive error, corneal power, central corneal thickness, axial length and anterior chamber depth. Corneal power, central corneal thickness, anterior chamber depth and axial length after one-year of OK lens wear were also collected. The related factors affecting axial length change were analyzed. A comparison was made on the cases of axial length increase and axial length decrease. RESULTS: Of the 73 eyes, axial length increased by 0.18 ± 0.17 mm (P < 0.001) after one year of OK lens wear. Correlation analysis showed that one-year axial length change was negatively correlated with age and positively correlated with the parental myopia and baseline myopia. Stepwise multiple linear regression analysis showed that the factors associated with faster axial elongation were lower baseline myopic spherical equivalent (P = 0.018), higher parental myopia degree (P = 0.026), and younger age at the onset of lens wear. (P = 0.039). Nine eyes showed negative axial growth (-0.06 ± 0.04 mm), and had older initial age of lens wear, higher baseline myopic spherical equivalent, and lager baseline corneal power, when compared with cases of axial length increase. CONCLUSIONS: Myopia children with lower baseline myopic spherical equivalent, younger initial age and higher parental myopia had faster axial elongation after orthokeratology treatment. More aggressive treatment should be considered. In children with slow axial elongation, OK lens wear may lead to negative axial growth. Whether there are reasons other than central corneal thinning and choroidal thickening needs further study.

Paeoniflorin is a promising natural monomer for neurodegenerative diseases via modulation of Ca2+ and ROS homeostasis.

Neurodegenerative diseases (NDDs) are a range of neurological disorders featured by neuronal degeneration and apoptosis. Cellular Calcium (Ca2+) and reactive oxygen species (ROS) dyshomeostasis are the earliest and important events in the development of NDDs and may yield promising therapeutic targets for NDDs. Paeoniflorin, a water-soluble monoterpene glucoside, is the major bioactive monomer extracted from the root of Paeonia lactiflora pall. Increasing evidence has suggested that this natural compound might be used to treat various NDDs, and its potential molecular mechanisms are related to the modulation of Ca2+/ROS homeostasis in cells. In addition, paeoniflorin accounts for more than 40% of the total glucosides of herbaceous peonies with abundant herbaceous sources. Furthermore, it has also been validated as a safe extraction in clinical pharmacological research with a wide therapeutic window. Hence, it is rational to anticipate paeoniflorin being a promising candidate for the treatment of NDDs via regulating Ca2+/ROS dyshomeostasis.

Efficacy and safety of Chinese herbal footbaths for the treatment of dysmenorrhea: Protocol for a systematic review and meta-analysis.

BACKGROUND: Chinese herbal footbaths are an external therapy of traditional Chinese medicine that has been widely used to treat dysmenorrhea. This review aims to systematically evaluate its efficacy and safety for the treatment of dysmenorrhea. METHODS: Databases of PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, China Biomedical Literature Database(CBM), and Chinese Biomedical Literature Service System (SinoMed) will be searched from the inception to September 30, 2020. The eligible randomized controlled trials (RCTs) will be identified and included. The primary outcomes include pain intensity measured by validated scales of visual analog scale, numeric rating scale, and response rate of symptom reduction. The secondary outcomes are scores on validated pain questionnaires, quality of life measured by SF-36 or other validated scales, and adverse events. Study selection, data extraction, and assessment of bias risk will be conducted by two reviewers independently. RevMan software (V.5.3.5) will be utilized to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System. RESULTS: A high-quality synthesis of current evidence of Chinese herbal footbaths for patients with dysmenorrhea will be provided in this study. CONCLUSION: This systematic review will provide evidence of whether Chinese herbal footbaths are an effective and safe intervention for the treatment of dysmenorrhea. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188256.

Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review.

BACKGROUND: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). METHODS: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. RESULTS: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. CONCLUSIONS: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand.

Acute and cumulative benefits of Photobiomodulation for xerostomia: A systematic review and meta-analysis.

The objective was to explore the effectiveness of photobiomodulation therapy for treating patients who suffer xerostomia and/or hyposalivation due to the most prevalent clinical diagnoses. We searched PubMed, Scopus, Web of Science, CINAHL and Cochrane Library for randomized or clinical controlled trials published until 31 October 2019. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 274 records were retrieved, and 11 met the inclusion criteria. Interventions whose parameters ranged between wavelengths of 790-830 nm (infrared), 30-120 mW of power and an energy density below 30 J/cm-2 were associated with improvements in xerostomia/hyposalivation. As for the assessment of methodological quality, 10 of the 11 articles included had a high risk of overall bias. Only 3 articles provided sufficient information to conduct a meta-analysis for quality of life, compared with placebo in patients with burning mouth syndrome, showing a standardized mean difference between groups from baseline of -0.90 (-1.48; -0.32). The present review and meta-analysis suggest that photobiomodulation therapy is an effective, non-invasive and safe approach in patients with xerostomia. However, despite the potential, it is not possible to reach a reliable consensus on the parameters to be used, and future studies should be conducted by standardizing intervention protocols.

Effectiveness and safety of traditional Chinese medicine Shaoyao Gancao Tang for the treatment of restless leg syndrome: A protocol for systematic review and meta-analysis.

BACKGROUND: A growing body of clinical trials has demonstrated that traditional Chinese medicine Shaoyao Gancao Tang may improve restlessness leg syndrome (RLS). This review aims to systematically assess its effectiveness and safety in the treatment of patients with RLS. METHODS: Eight databases will be searched from the inception to 31 August 2020, including the Chinese Biological Medicine Database, China National Knowledge Infrastructure, Wanfang Database, VIP Information Database, the Cochrane Library, PubMed, EMBASE, and the Web of Science. All published randomized controlled trials that meet the prespecified eligibility criteria will be included. The primary outcomes include the changes in the International Restless Legs Syndrome Rating Scale and the restless sensation assessed by visual analog scales, and the secondary outcomes include effective rate, adverse event rate, quality of life measures, and improvement in the sleep quality index. Study selection, data extraction, and assessment of bias risk will be conducted independently by 2 reviewers. Data synthesis will be carried out with RevMan software (V.5.3.5). Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluation System. RESULTS: A high-quality synthesis of current evidence of Shaoyao Gancao Tang's effectiveness and safety for patients with RLS will be provided. CONCLUSION: This systematic review will provide evidence of whether Shaoyao Gancao Tang is an effective and safe intervention for RLS.

Six things you need to know about low back pain.

Low back pain (LBP) is the leading contributor to years lived with disability, and imposes an enormous burden on individuals and on health-care systems. General practitioners and physiotherapists are generally the front-line health professionals dealing with patients with LBP, and have a key role in minimising its effect. Here we review six key issues associated with LBP including its effects, diagnosis and management in primary care, and highlight the importance of the biopsychosocial model and matched care for patients with LBP.

Traditional Chinese herbal bath therapy for insomnia: A protocol for systematic review.

INTRODUCTION: Insomnia is a major public health problem. Due to the side effects of pharmacological therapy, people are seeking to choose complementary and alternative therapies for insomnia disorder. Traditional Chinese herbal bath therapy is an important complementary therapy which combines advantages of Chinese herbs and bathing therapy. This protocol describes the methodology of a systematic review assessing the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia. METHODS AND ANALYSIS: Reporting of this review will be adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We will electronically search the following seven databases from inception to January 23, 2020: PubMed, Cochrane database (CENTRAL), EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database, and Wanfang Database. Parallel randomized controlled trials evaluating the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia will be included. Study selection, data extraction and assessment of risk of bias will be performed independently by two researchers. The sleep quality will be assessed as the primary outcome. Global symptom improvement, anxiety and depression, and adverse events will be evaluated as secondary outcomes. The Cochrane's risk of bias tool will be utilized for assessing the methodological quality of included studies. Revman software (v.5.3) will be used for data synthesis and statistical analysis. Data will be synthesized by either fixed-effects or random-effects model according to a heterogeneity test. If it is not appropriate for a meta-analysis, a descriptive analysis will be conducted. GRADE system will be used to assess the quality of evidence. PROSPERO REGISTRATION NUMBER: CRD42020168507.

CBS-Induced H2S Generation in Hippocampus Inhibits EA-Induced Analgesia.

Hydrogen sulfide (H2S) is an important mediator participating in both physiological and pathological systems and related to the inflammatory process. Acupuncture has a therapeutic effect on inflammatory pain. However, whether H2S generated in the central nervous system (CNS) is a mediator of electroacupuncture (EA) treatment for inflammatory pain is unknown. We injected complete Freund's adjuvant (CFA) to induce inflammatory pain and applied EA treatment as an interventional strategy for pain relief. The results presented here show that S-adenosyl-l-methionine (SAM), an allosteric activator of cystathionine-ß-synthetase (CBS), may reverse the therapeutic effect of EA. CBS-induced H2S generation might get involved in the mechanism of EA-induced analgesia in the hippocampus on chronic inflammatory pain.

Thermal profiles over the Patella tendon in a cohort of non-injured collegiate athletes over the course of a cross-country season.

OBJECTIVES: To determine normal temperatures over the Patella tendon over eleven weeks. DESIGN: A prospective cohort study with eleven weeks of observation. SETTING: University's Human Biomechanics and Physiology Laboratory. PARTICIPANTS: Male or female collegiate runners running at least 25 miles per week who did not report pain in the region of the Patella tendon over 11 weeks of data collection. MAIN OUTCOME MEASURES: Thermal images taken at the same time and day of the week, were used to measure the temperature of the skin over the Patella tendon. RESULTS: Eighteen athletes were eligible for analysis. The mean temperature of the Patella tendon was 30.13 °C (SD = 1.51 °C). Patella tendon temperature changes over time were insignificant (right p = 0.66, left p = 0.90) with ICC right = 0.92, left = 0.94. Mean temperature difference side to side was 0.14 °C (SD = 0.60 °C). Mixed-model Linear regression for mean temperature differences found the effect of (i) time (t = 0.39, p = 0.70, df = 361) and (ii) side (t = -0.89, p = 0.38, df = 361) to be insignificant. CONCLUSIONS: This is the first report of normal thermal profiles of collegiate runners over an extended period. Temperature variation above 1.20 °C may represent an abnormal asymmetry in the running population. Variations in Patella tendon temperatures left to right, and over time were not significant.

The effectiveness of tai chi in breast cancer patients: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Tai chi has been suggested as a potential effective intervention for improving function and wellbeing in breast cancer patients. This systematic review evaluated the current evidence for the effectiveness of tai chi in patients with breast cancer. METHODS: Randomized Controlled Trials (RCTs) evaluating the effects of tai chi in breast cancer patients were identified through searches in OVID MEDLINE, AMED, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, CNKI, VIP, and Wanfang Data, up to June 2019. Meta-analyses were performed for results syntheses. RESULTS: Sixteen RCTs involving 1268 participants were included in this review. It was demonstrated that tai chi is no different from conventional supportive care interventions in improving fatigue, sleeping quality, depression or body mass index at either 3 months or 6 months; however it significantly improves overall quality of life (QoL) at 3 months. Moreover, tai chi, when offered as an adjunct to conventional therapy, is more effective in improving fatigue at 3 months, and QoL at 3 months and 6 months compared to conventional therapy alone. CONCLUSION: Tai chi shows no improvement in fatigue compared with conventional supportive interventions, but it significantly relieves fatigue symptom for breast cancer patients when used with conventional supportive care interventions. Tai chi versus conventional supportive care interventions, and as an adjunct to conventional therapy is effective in improving QoL for breast cancer patients.

Understanding Acupoint Sensitization: A Narrative Review on Phenomena, Potential Mechanism, and Clinical Application.

As part of traditional Chinese medicine, acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. When the body is suffering from disease or injury, corresponding acupoints are believed to be activated and manifest in several sensitized forms, including expansion of the receptive field, pain sensitization, and heat sensitization. Such phenomena are believed to gradually disappear concomitantly with recovery from the disease. Acupoint states are therefore changeable according to health status, a phenomenon known as acupoint sensitization. This review aims to provide an overview of acupoint sensitization based on existing research results and determine priorities for future research. Systematic literature retrieval was conducted in Medline, Embase, Cochrane Library, CINAHL, and AMED from inception to 18 July 2018. Current evidence from research findings to date indicate that acupoint sensitization is based on neurogenic inflammation and that stimulation of sensitized acupoints presents a potential trend of generating a better clinical effect when compared with stimulation of unsensitized points.

Low level laser therapy for the management of breast cancer-related lymphedema: A randomized controlled feasibility study.

OBJECTIVES: This study aimed to determine the feasibility of conducting a full scale randomized controlled trial investigating the effectiveness of low level laser therapy (LLLT), also known as photobiomodulation (PBM) therapy, used in addition to conventional therapy, for managing breast cancer related lymphedema (BCRL). MATERIALS AND METHODS: Patients with BCRL were recruited from the Southern District Health Board (New Zealand) via lymphedema therapists' referrals, and randomly allocated into either the laser group, which received BCRL conventional therapy (e.g., wearing compression garments, massage therapy, and/or exercise) plus a 6-week LLLT (PBM) intervention program (wavelength: 980/810 nm (80:20 ratio); output power: 500 mW beam spot size: 5 cm2 ; irradiance: 100 mW/cm2 ; treatment time per area: 1 minute dosage per area treated: 30J (6J/cm2 ); 10 points of treatment from axilla to wrist total LLLT (PBM) treatment time: 10 minutes total dosage delivered: 300 J), or the control group, which received BCRL conventional therapy alone. Feasibility was determined by recruitment and randomization rates, retention of participants and treatment protocol adherence, and was assessed during the recruiting and intervention periods. Data on participant satisfaction and adverse reactions of LLLT (PBM) were collected on completion of this study. Clinical outcomes (i.e., limb circumference, participant's perceived symptoms, psychological impacts, and activity disability) were assessed at baseline, and 6 and 12 weeks post-randomization. RESULTS: Over a 6-month recruitment window, 17 participants with BCRL were recruited in the study, and randomized into the two groups (recruitment rate of 81%, and randomization rate of 100%). Treatment adherence was high in the laser group (88.9% of participants completed all treatments). Retention rates were 88.9% for the laser group and 100% for the control group at both 6 and 12 weeks post-randomization. All participants who completed LLLT (PBM) treatment indicated that they were satisfied with the treatment. No serious adverse reactions were reported in this study. Clinical outcomes failed to show additional benefits of LLLT (PBM) intervention. CONCLUSION: This study demonstrated that it is feasible to conduct a fully powered RCT to definitively test the effectiveness of the additional use of LLLT (PBM) in the management of BCRL. For such a trial, 114 participants will be needed at baseline. Lasers Surg. Med. 50:924-932, 2018. © 2018 Wiley Periodicals, Inc.

An integrative Tai Chi program for patients with breast cancer undergoing cancer therapy: study protocol for a randomized controlled feasibility study.

BACKGROUND: Breast cancer patients experience various side effects during cancer therapy, often resulting in reduced quality of life and poor adherence to treatment. A limited range of proven interventions has been developed to target such side effects. While Tai Chi offers benefits for the health and well-being of breast cancer survivors, the effectiveness of Tai Chi across the treatment continuum has not been evaluated. Improved patient education and support has been suggested as a priority for breast cancer care. This pilot study assesses the feasibility of a randomized controlled trial (RCT) to evaluate the effectiveness of "an integrative Tai Chi" (ANITA) program for breast cancer patients undergoing cancer therapy. METHODS/DESIGN: This is a single-centre, two-arm feasibility RCT. Twenty-four patients with breast cancer who have undergone surgical treatment will be recruited from the Dunedin Hospital (New Zealand) over a 12-month period (from August 2017 to July 2018). Subject to informed consent, patients will be randomized to receive standard cancer treatment alone or standard cancer treatment plus the ANITA program, consisting of peer support, health education, and Tai Chi Ruler exercise. The program runs alongside the patient's adjuvant cancer therapy, which may include chemotherapy, radiation therapy, antibody treatment, and/or antihormonal therapy. Analysis in this study will focus on process evaluation of participant recruitment, retention, treatment fidelity, acceptability of the program, and occurrence of adverse events. Clinical outcomes (i.e., fatigue, sleep quality, anxiety and depression and quality of life) will be assessed at baseline, and at 12 weeks and 24 weeks post-randomization. DISCUSSION: Outcomes from this study will inform the feasibility and methodology for a future fully-powered RCT. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry with the identifier ACTRN12617000975392.

Low level laser therapy (Photobiomodulation therapy) for breast cancer-related lymphedema: a systematic review.

BACKGROUND: Breast cancer related lymphedema (BCRL) is a prevalent complication secondary to cancer treatments which significantly impacts the physical and psychological health of breast cancer survivors. Previous research shows increasing use of low level laser therapy (LLLT), now commonly referred to as photobiomodulation (PBM) therapy, for BCRL. This systematic review evaluated the effectiveness of LLLT (PBM) in the management of BCRL. METHODS: Clinical trials were searched in PubMed, AMED, Web of Science, and China National Knowledge Infrastructure up to November 2016. Two reviewers independently assessed the methodological quality and adequacy of LLLT (PBM) in these clinical trials. Primary outcome measures were limb circumference/volume, and secondary outcomes included pain intensity and range of motion. Because data were clinically heterogeneous, best evidence synthesis was performed. RESULTS: Eleven clinical trials were identified, of which seven randomized controlled trials (RCTs) were chosen for analysis. Overall, the methodological quality of included RCTs was high, whereas the reporting of treatment parameters was poor. Results indicated that there is strong evidence (three high quality trials) showing LLLT (PBM) was more effective than sham treatment for limb circumference/volume reduction at a short-term follow-up. There is moderate evidence (one high quality trial) indicating that LLLT (PBM) was more effective than sham laser for short-term pain relief, and limited evidence (one low quality trial) that LLLT (PBM) was more effective than no treatment for decreasing limb swelling at short-term follow-up. CONCLUSIONS: Based upon the current systematic review, LLLT (PBM) may be considered an effective treatment approach for women with BCRL. Due to the limited numbers of published trials available, there is a clear need for well-designed high-quality trials in this area. The optimal treatment parameters for clinical application have yet to be elucidated.