Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis.

BACKGROUND: Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI). OBJECTIVES: To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women. SEARCH STRATEGY: Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019. SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included. DATA COLLECTION AND ANALYSIS: Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS: Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I2  = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I2  = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92). CONCLUSIONS: Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture. TWEETABLE ABSTRACT: This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

[Comparison of efficacy and safety between the anterior and the posterior approaches to total hip arthroplasty].

OBJECTIVE: To compare the efficacy and safety between direct anterior approach (DAA) and posterior approach (PA) in total hip arthroplasty. METHODS: This study evaluated postoperative results of 92 consecutive total hip arthroplasties performed by a single surgeon; 44 from the DAA, and 48 from PA. The age, body mass index, operation time, blood loss, hospital stay, positioning of the artificial hip, postoperative Harris score and postoperative complications were recorded and analyzed. RESULTS: Both the average age of the patients separately (58.0±11.9) years in DAA group and (61.0±10.4) years in PA group and the body mass index (25.1±3.7) in DAA group and (24.7±3.3) in PA group, showed no significant difference between the two groups. The DAA group had significantly reduced the hospital stay (3.8±1.7) days vs.(4.9±2.3) days for the PA group (P<0.05) and operation time was (76.0±17.4) min in DAA group, and (71.0±14.3) min in PA group (P>0.05). The amount of blood loss: in group DAA (238.0±55.3) mL, and in group PA (387.0±61.2) mL (P<0.05). There was no statistical difference in the positioning of the artificial hip: the cup anteversion in DAA group and PA group was 17.3°±5.3° vs. 18.6°± 5.1°, the cup inclination was 38.5°±5.7° vs. 37.7°±5.2°. In DAA group, there was significantly less use of assistive devices [(24.6±7.8) d vs. (31.7±10.2) d, P<0.05], and the pain was significantly lower. Harris score at the end of 6 weeks of the follow-up: in DAA group 85.7±5.4, and in PA group 81.3±6.1 (P<0.05); at the end of the last follow-up: in DAA group 93.4±4.7, and in PA group 92.3±5.3 (P>0.05). Complications were encountered in the two groups. There were two intraoperative complications (4.4%), 1 great trochanter fracture and 1 lateral cutaneous nerve injury in DAA group. No dislocation was observed in DAA group. One dislocations and 1 groin pain were recorded in PA group. No prosthesis loosening, deep vein thrombosis, sciatic nerve injury and other complications occurred in the two groups. CONCLUSION: Total hip arthroplasty using the anterior approach allows for superior recovery and better stability.

Efficacy of acupuncture in the management of atopic dermatitis: a systematic review.

Atopic dermatitis (AD) has a high negative impact on quality of life. Acupuncture has antipruritic actions and may assist in treatment of AD; however, the current state of evidence for this remains unknown. We aimed to evaluate the efficacy of acupuncture against placebo/sham acupuncture in the management of AD. Electronic searches were conducted on a number of databases, from their inception until November 2013. Studies comparing the effects of acupuncture with those of placebo/sham acupuncture on severity of disease or symptoms/signs of AD were included. We did not find any studies that were eligible to be included in this systematic review. Among the excluded studies, there were two studies that evaluated the antipruritic effects of acupuncture and one study that evaluated the effects of acupuncture on IgE-mediated allergy. However, there were no randomized controlled trials evaluating the effects of acupuncture on AD as a disease. This finding therefore provides an indication of the current state of evidence of acupuncture in the management of AD, and highlights the research gap that exists, in that there is a lack of gold-standard studies (i.e. RCTs) to support valid conclusions. There is currently no evidence of the effects of acupuncture in the management of AD, and no evidence-based recommendations or conclusions can be made from this review. Several studies indicated that acupuncture may have a role in reducing itch or regulating IgE-mediated allergy, both of which are major characteristics of AD. However, there were no RCTs evaluating the effects of acupuncture on AD as a disease. There is therefore an urgent need for rigorously designed RCTs to assess the efficacy of acupuncture in the management of AD.

Selected ginsenosides of the protopanaxdiol series are novel positive allosteric modulators of P2X7 receptors.

BACKGROUND AND PURPOSE: The P2X7 receptor is an ATP-gated ion channel predominantly expressed in immune cells and plays a key role in inflammatory processes. Ginseng is a well-known Chinese herb with both pro- and anti-inflammatory properties and many of its actions have been ascribed to constituent ginsenosides. We screened a number of ginsenoside compounds for pharmacological activity at P2X7 receptors, that might contribute to the reported immunomodulatory actions of ginseng. EXPERIMENTAL APPROACH: We used several assays to measure responses of P2X7 receptors, ATP-mediated dye uptake, intracellular calcium measurement and whole-cell patch-clamp recordings. HEK-293 cells stably expressing human P2X7 receptors were used in addition to mouse macrophages endogenously expressing P2X7 receptors. KEY RESULTS: Four ginsenosides of the protopanaxdiol series, Rb1, Rh2, Rd and the metabolite compound K (CK) potentiated the dye uptake responses of P2X7 receptors, whereas other ginsenosides tested were ineffective (1-10 µM). The potentiation was rapid in onset, required a threshold concentration of ATP (>50 µM) and had an EC50 of 1.08 µM. CK markedly enhanced ATP-activated P2X7 currents, probably via an extracellular site of action. One of the consequences of this potentiation effect is a sustained rise in intracellular Ca(2+) that could account for the decrease in cell viability in mouse macrophages after a combination of 500 µM ATP and 10 µM CK that are non-toxic when applied alone. CONCLUSIONS AND IMPLICATIONS: This study identifies selected ginsenosides as novel potent allosteric modulators of P2X7 channels that may account for some of the reported immune modulatory actions of protopanaxdiol ginsenosides in vivo.

Local and distant acupuncture points stimulation for chronic musculoskeletal pain: A systematic review on the comparative effects.

One in four people suffers from chronic musculoskeletal pain (CMP). Acupuncture points stimulation is increasingly used for pain relief for CMP. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is unknown. This systematic review aimed to determine if there was a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. English and Chinese electronic databases were searched to identify randomized controlled trials, where local or distant points were stimulated in adults with CMP. Pain intensity was the primary outcome measure. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.

Therapeutic potential of Panax ginseng and ginsenosides in the treatment of chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major global health burden and will become the third largest cause of death in the world by 2030. It is currently believed that an exaggerated inflammatory response to inhaled irritants, in particular cigarette smoke, cause progressive airflow limitation. This inflammation, where macrophages, neutrophils and lymphocytes are prominent, leads to oxidative stress, emphysema, airways fibrosis and mucus hypersecretion. COPD responds poorly to current anti-inflammatory treatments including corticosteroids, which produce little or no benefit. Panax ginseng has a long history of use in Chinese medicine for respiratory conditions, including asthma and COPD. OBJECTIVES: In this perspective we consider the therapeutic potential of Panax ginseng for the treatment of COPD. RESULTS: Panax ginseng and its compounds, ginsenosides, have reported effects through multiple mechanisms but primarily have anti-inflammatory and anti-oxidative effects. Ginsenosides are functional ligands of glucocorticoid receptors and appear to inhibit kinase phosphorylation including MAPK and ERK1/2, NF-κB transcription factor induction/translocation, and DNA binding. They also inhibit pro-inflammatory mediators, TNF-α, IL-6, IL-8, ROS, and proteases such as MMP-9. Panax ginseng protects against oxidative stress by increasing anti-oxidative enzymes and reducing the production of oxidants. CONCLUSION: Given that Panax ginseng and ginsenosides appear to inhibit processes related to COPD pathogenesis, they represent an attractive therapeutic target for the treatment of COPD.

Cloning and expression analysis of a stress-induced GmIMT1 gene in soybean (Glycine max).

Here, we aimed to clone and identify the GmIMT1 gene related to the salt stress response in soybean. The full-length cDNA sequence of the GmIMT1 gene was amplified in soybean using degenerate primers of Mesembrythmum crystallium. To understand the stress response, the GmIMT1 gene was cloned and sequenced. Then, the expression vectors of the gene were constructed, and introduced into the model plant Arabidopsis thaliana through Agrobacterium mediated transformation, and the salt tolerance was analyzed in the transgenic plants. In addition, the expression patterns of GmIMT1 gene in soybean were analyzed. The expression was examined in different organs (roots, leaves, flower seeds, and stem) and under different stress conditions (drought, high salt, low temperature, salicylic acid, ethane, abscisic acid, and methyl jasmonate) by real-time fluorescent quantitative polymerase chain reaction analysis. The results showed that the root, leaves, and stems exhibited high level of GmIMT1 gene expression, whereas there was no expression in the seeds. In addition, the GmIMT1 gene expression was upregulated under all stress conditions. Overall, the results clearly indicate that GmIMT1 might be involved in multiple plant response pathways to the different environmental conditions. Furthermore transgenic plants exhibited higher salt-tolerance compared to wild type plants.

Plant extracts for the topical management of psoriasis: a systematic review and meta-analysis.

Patients with psoriasis frequently use preparations of plant extracts. Physicians need to be aware of the current evidence concerning these products. This review evaluates the efficacy and safety of preparations of plant extracts used topically for psoriasis. Searches were conducted in PubMed, Embase, the Cochrane library, two Chinese databases and article reference lists. Randomized controlled trials investigating extracts of single plants were included. Preparations of multiple plants and combinations of plant extracts plus conventional therapies were excluded. Two authors conducted searches, extracted data and assessed risk of bias. Outcomes used in meta-analyses were: clinical efficacy, Psoriasis Area and Severity Index score, and quality of life and symptom scores. The 12 included studies investigated extracts of: Mahonia aquifolium (n = 5), Aloe vera (n = 3), indigo naturalis (n = 2), kukui nut oil (n = 1) and Camptotheca acuminata nut (n = 1). Methodological quality was variable. Six studies provided data suitable for meta-analysis of clinical efficacy, and five were vs. placebo (relative risk 3·37, 95% confidence interval 1·36-8·33). Experimental studies indicate components of indigo naturalis, Mahonia and Camptotheca have anti-inflammatory, antiproliferative and other actions of relevance to psoriasis. The clinical trial evidence provides limited support for preparations containing extracts of M. aquifolium, indigo naturalis and Aloe vera for the topical management of plaque psoriasis based on multiple studies. No serious adverse events were reported. Because of the small size of most studies and methodological weaknesses, strong conclusions cannot be made. The magnitudes of any effects cannot be measured with accuracy, so it is difficult to assess the clinical relevance of these preparations.

Lack of efficacy of a herbal preparation (RCM-102) for seasonal allergic rhinitis: a double blind, randomised, placebo-controlled trial.

BACKGROUND: A herbal preparation, known as RMIT Chinese Medicine 102 (RCM-102) consisting of eight herbs which demonstrates inhibition of the release of key inflammatory mediators associated with seasonal allergic rhinitis (SAR) was used. This study evaluated the efficacy and safety of RCM-102 for SAR. OBJECTIVE: This study evaluated the efficacy and safety of RCM-102 for SAR. METHODS: This randomised placebo-controlled trial involved subjects aged between 18 and 65 who were randomly assigned to either RCM-102 or a placebo group. After a two-week baseline period, all subjects took either RCM-102 or placebo capsules (two capsules each time, three times daily with a four hour interval) for a period of eight weeks. The primary end-points were the Five-Point Scale symptom scores. Rhinoconjunctivitis Quality of Life Questionnaire, relief medication usage, adverse events, kidney and liver function tests and full blood examination were secondary end-points. Intention-to-treat analysis was applied. RESULTS: One hundred and four subjects were randomised with 52 in each group. Ninety-five subjects (47 and 48 subjects in RCM-102 and placebo groups) completed the trial. Nine subjects withdrew from the study prior to the end of the second treatment week. At the end of the trial, there were no significant differences between the two groups with respect to all outcome measures. There were no liver or kidney function abnormalities reported. CONCLUSION: This mechanism-based RCM-102 was safe but not more beneficial than placebo for patients with SAR.

Chinese herbs for dementia diseases.

In the last twenty years a considerable body of information has accumulated on the chemical constituents of Chinese herbs and their therapeutic potential. Our evaluation/systematic review [1, 2] of well-designed, randomized double blind controlled trials on Chinese herbal medicines beneficial for the improvement of cognitive function revealed a range of either single herbs or herbal mixtures that provided neuroprotective benefits. Oxidative stress may directly initiate neurodegeneration and herbal antioxidant neuroprotection is considered as a preventative and therapeutic approach. We encountered Acoris gramineus rhizome (AGR), Panax ginseng, Polygala tenuifolia and Poria cocos as the four most frequently used herbs as single/herbal mixtures that were associated with positive cognitive enhancing outcomes. This review focuses on the evidence of their medicinal effects attributed to those constituents present in relatively high concentration.

Chemistry and bioactivity of Flos Magnoliae, a Chinese herb for rhinitis and sinusitis.

Flos Magnoliae (FM, Chinese name: Xin-yi) is one of the most commonly used Chinese medicinal herbs. It has a long history of clinical use for managing rhinitis, sinusitis and headache. More than 20 different FM species have been used clinically, which makes species identification and evaluation of pharmacological effects of individual chemical ingredients difficult. In this review, we have summarized the current knowledge on FM phytochemistry and its bioactivity activities. The bioactive compounds in FM include both lipid and water-soluble components. More than 90% of the essential components of FM species are terpenoids, including monoterpenes and sesquiterpenes. Lignans and neolignans including tetrahydrofurofuran, tetrahydrofuran and aryltetralin are also present in FM species. A small number of water-soluble compounds have been isolated from Magnolia flower buds, including a benzylisoquinoline alkaloid magnoflorine, an ester ethyl-E-p-hydroxyl-cinnamate and a flavonoid biondnoid. A wide range of pharmacological actions of FM have been reported, including anti-allergy, anti-inflammation and anti-microbial activity. The structure-activity relationship analysis revealed the influence of methylation at position 5 on the 3,7-dioxabicyclo-(3,3,0)-octane backbone of six lignans in antagonistic activities against platelet-activating factor. In addition, the trans stereoisomer fargesin had a much lower bioactivity than the cis stereoisomer demethoxyaschantin. Recent studies have been directed towards the isolation of other bioactive compounds. Further studies on FM may help to develop new anti-inflammatory and anti-allergic drugs.

Inhibitions of mast cell-derived histamine release by different Flos Magnoliae species in rat peritoneal mast cells.

Flos Magnoliae (FM) is a commonly used Chinese medicinal herb for symptomatic relief of allergic rhinitis, sinusitis and headache. A number of FM species have been used as substitutes or adulterants for clinical application, although the differences in their pharmacological actions have not been reported. The present study investigated the effects of six identified FM species M. biondii, M. denudata, M. kobus, M. liliflora, M. sargentiana and M. sprengeri, as well as the marker compounds magnolin and fargesin on compound 48/80-induced histamine release in rat peritoneal mast cells (RPMC) in vitro. Ethanolic extracts of all FM species produced a concentration-dependent inhibition of compound 48/80-induced histamine release in RPMC. The rank order of the IC(50)s was M. biondii

Role of P-glycoprotein in restricting the brain penetration of tanshinone IIA, a major active constituent from the root of Salvia miltiorrhiza Bunge, across the blood-brain barrier.

Tanshinone IIA (TSA) is a major constituent of Salvia miltiorrhiza Bunge widely used in the treatment of stroke. This current study aimed to investigate the nature of brain penetration of TSA using several in vitro and in vivo models. The uptake and efflux of TSA in primary rat brain microvascular endothelial cells (RBMVECs) were altered in the presence of a PgP inhibitor or multidrug-resistance-associated protein (Mrp1/2) inhibitor. A polarized transport of TSA was found in RBMVEC monolayers with facilitated efflux from the abluminal to the luminal side. The polarized transport of TSA was attenuated by PgP or Mrp1/2 inhibitors. In an in situ rat brain perfusion model, TSA crossed the blood-brain barrier at a greater rate than that for sucrose, and the brain penetration was increased in the presence of a PgP or Mrp1/2 inhibitor. The brain levels of TSA were only about 31% of that in the plasma and it increased to 74-77% of plasma levels when verapamil or quinidine was coadministered in rats. The entry of TSA to the central nervous system (CNS) significantly increased in rats subjected to middle cerebral artery occlusion or treatment with quinolinic acid. The normalized brain penetration of TSA in mdr1a((-/-)) mice was much higher than the wild-type mice. Taken collectively, these findings provide evidence that TSA has limited brain penetration through the blood-brain barrier owing to the contribution of PgP and possibly Mrp1/2.

Efficacy, chemistry and pharmacology of chinese herbal medicine for allergic rhinitis.

An extensive literature search identified six randomized controlled clinical trials in which the efficacy of Chinese herbal medicine had been investigated for the treatment of allergic rhinitis. Although four of these trials had methodological flaws, the therapeutic outcomes of all six have been reviewed. One of two trials considered to be of high quality was concerned with the treatment of seasonal allergic rhinitis and the other with perennial allergic rhinitis. It is considered that all six studies demonstrated various degrees of alleviation of the symptoms of allergic rhinitis. No serious side effects were reported in any of the trials. A number of the herbs in the Chinese herbal formulae used in the trials, and/or their constituent compounds have been reported to possess anti-allergic, anti-inflammatory or immune modulation activity. Such actions include inhibition of the release or action of mast cell mediators such as histamine, inhibition of inflammation induced by chemical agents, and modulation of serum IgE levels or of lymphocyte and/or macrophage activity. An aqueous, unresolved extract of the herbal formula used in one of the six trials has been reported to exhibit a range of pharmacological actions relevant to the treatment of allergic rhinitis. Essential oils, lignans, flavonoids and saponins are chemical classes that are frequently represented in individual herbs of the six Chinese herbal formulae used in the trials. The chemical structures characterising these classes of compound and the pharmacological actions of these and other constituents of the herbs, relevant to allergic rhinitis, have been reviewed.

Regression of squamous cell carcinoma of the lung by Chinese herbal medicine: a case with an 8-year follow-up.

A 51-year-old woman diagnosed with squamous cell carcinoma (SCC) of the lung (T2N2M0) by cytological tests and a CT scan has survived for 8 years. During this period of time, she had been treated with Chinese herbal medicine alone for 4 years. The herbal prescription consisted of nine Chinese medicinal herbs. These herbs have been reported to possess anti-tumour and immune enhancing effects. Therefore, it is suggested that the herbal treatment for this patient might have contributed to the complete regression of her lung carcinoma. Further research on the actions of these herbs is warranted.

Electroacupuncture for tension-type headache on distal acupoints only: a randomized, controlled, crossover trial.

OBJECTIVE: To investigate the efficacy of electroacupuncture, applied to distal acupoints only, for tension-type headache. BACKGROUND: Electroacupuncture is commonly used for tension-type headache, but when applied to distal acupoints only, evidence of its efficacy is lacking. DESIGN: A randomized, single-blinded, sham-controlled, crossover clinical trial. Methods.-The trial had 5 stages: baseline (2 weeks), phases I and II (each 4 weeks), washout period (2 weeks), and follow-up (3 months after phase II). Forty patients were randomly assigned to either group A or group B. Group A received real electroacupuncture during phase I, then sham electroacupuncture in phase II. Group B received the treatments in reverse order. Outcome measures were headache frequency and duration, pain intensity using a visual analog scale, mechanical pain threshold, headache disability, and sickness impact. Data were analyzed by univariate 2-way analysis of variance. RESULTS: Thirty-seven patients completed the trial. There were no significant differences between the 2 groups at baseline. At the end of phase I, group A, but not group B, demonstrated significant improvement in mean (standard error of the mean [SEM]) headache frequency (3.0 per month [0.3] versus 12.0 per month [1.7]), duration (13.3 hours [3.5] versus 32.0 hours [6.2]), pain intensity (32.8 mm [4.1] versus 47.5 mm [2.7]), pain threshold (right side, 2.9 kg/second [0.1] versus 0.9 kg/second [0.1]; left side, 2.4 kg/second [0.1] versus 1.1 kg/second [0.1]), headache disability score (6.0 [1.0] versus 16.3 [1.6]), and sickness impact score (288.7 [48.0] versus 687.1 [77.2]). For each parameter, significant differences also were demonstrated for both groups between baseline and phase II, and baseline and follow-up. There were no significant differences between the groups at the end of follow-up (P >.05). CONCLUSION: Electroacupuncture to distal points alone is effective for short-term symptomatic relief of tension-type headache.

Effect of adding a Chinese herbal preparation to acupuncture for seasonal allergic rhinitis: randomised double-blind controlled trial.

OBJECTIVE: To assess whether the addition of a Chinese herbal medicine formula to acupuncture affects the severity of symptoms and quality-of-life scores among patients with seasonal allergic rhinitis. DESIGN: Randomised double-blind placebo-controlled trial. SETTING: University teaching and research clinic, Australia. PARTICIPANTS: Sixty-five patients with seasonal allergic rhinitis, who were recruited through public media. INTERVENTION: Between July and December 1999, patients received acupuncture twice a week for 8 weeks plus either a Chinese herbal drug formula (n=33) or placebo (n=32) at a dosage of four capsules, three times daily. MAIN OUTCOME MEASURES: The severity of nasal and non-nasal symptoms on a five-point scale, as assessed by both patients and an ear, nose, and throat specialist, and quality-of-life scores as measured by the Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire. RESULTS: Sixty-one patients completed the study (31 in the intervention group and 30 in the control group). After 8 weeks, no significant difference was found between the two groups in the severity of nasal and non-nasal symptoms and in the Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire scores. Intention-to-treat analysis of categorical variables showed moderate-to-marked improvement rates of 72.7% and 81.2% for intervention and control groups, respectively. Six patients reported mild adverse events-three from each of the study groups. CONCLUSION: The Chinese herbal formulation under investigation did not provide additional symptomatic relief or improvement in quality-of-life scores among patients with seasonal allergic rhinitis who were receiving acupuncture.