Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 55 appraisals
Journal of molecular neuroscience : MN
Scalp Acupuncture Combined with Mouse Nerve Growth Factor Acupoint Injection for Post-stroke Cognitive Impairment
Post-stroke cognitive impairment (PSCI) markedly impairs rehabilitation efficacy and quality of life. Safe and effective interventions are urgently needed. Eighty-four patients with PSCI were randomly allocated into three groups (n = 28 per group). Group A received conventional cognitive training. Group B received conventional training plus scalp acupuncture. Group C received the treatment of Group B combined with mouse nerve growth factor (mNGF) acupoint injection. All interventions lasted 4 weeks. All groups exhibited significant within-group improvements in MoCA, ADL, MBI, and FMA scores after intervention. Group C achieved the optimal cognitive efficacy: the post-treatment MoCA score was 26.7 ± 2.9 (95% CI, 25.53-27.87), significantly higher than that in Group A (21.5 ± 3.5 (95% CI, 20.22-22.78), P < 0.001) and Group B (23.8 ± 3.2)(95% CI, 22.48-25.12), P = 0.003). The ADL score in Group C was the lowest among the three groups (F = 28.963, P < 0.001), suggesting better independence. Moreover, motor function (FMA) and basic self-care ability (MBI) were also significantly improved in all groups after intervention. There were significant inter-group differences in post-treatment FMA and MBI scores (F-FMA = 29.745, P < 0.001; F-MBI = 35.872, P < 0.001). The scores increased gradually from Group A to Group C, with Group C achieving the best improvement. Conventional cognitive training improves cognitive function and daily living ability in patients with PSCI. Scalp acupuncture combined with conventional training is more effective than training alone. The triple therapy of conventional training, scalp acupuncture, and mNGF acupoint injection further enhances rehabilitation outcomes, with prominent clinical application value.
13 July 2026
Read appraisal →Journal of integrative medicine
Deep learning in traditional Chinese medicine
As an alternative medicine approach, traditional Chinese medicine (TCM) is mainly built on an ancient understanding of the world. In order to translate the promises of TCM into modern therapies, rigorous scientific techniques are applied, which generates big data from experiments, clinical practices and medical literature. Recently, deep learning (DL) has attracted the attention of TCM researchers due to its application in data mining. In this review, we summarized recent examples of DL application in the study of TCM, including medical image processing, medicinal substances investigation, data fusion and natural language processing. We find that DL methods have considerable potential to extract valuable information from TCM data, but high-quality TCM data are still needed for further development of DL techniques. Please cite this article as: Liu LP, Yang C, Cen SX, Suo TC. Deep learning in traditional Chinese medicine. J Integr Med. 2026; 24(4):471-480.
1 July 2026
Read appraisal →BMJ supportive & palliative care
Efficacy and safety of acupuncture for breast cancer-related insomnia: a systematic review and meta-analysis
Breast cancer-related insomnia (BCRI) is a common and burdensome sequela. Acupuncture is frequently used, but robust evidence is limited, and previous systematic reviews included few trials yielding imprecise estimates. This updated systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for BCRI. We systematically searched eight databases for randomized controlled trials (RCTs) up to July 1, 2025. RCTs comparing acupuncture with any control for BCRI were eligible. Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the modified Jadad scale. Meta-analyses employed a random-effects model. Subgroup analyses explored heterogeneity sources, and the GRADE framework rated evidence certainty. Twenty-seven RCTs (n=2,025) were included. Acupuncture significantly reduced Pittsburgh Sleep Quality Index (PSQI) scores (MD= -2.74, 95% CI [-3.92, -1.55], P<0.00001) and increased the overall efficacy rate (RR=1.51, 95% CI [1.27, 1.81], P<0.00001) compared to control, but did not significantly improve Insomnia Severity Index (ISI) scores. Subgroup analyses identified control intervention type and treatment frequency as significant sources of heterogeneity. Adverse events were infrequent and typically mild. GRADE assessments rated the certainty of evidence as low or very low, primarily due to risk of bias and substantial heterogeneity. Current evidence suggests acupuncture may improve sleep in patients with BCRI, with effects moderated by comparator type and treatment frequency. However, conclusions are limited by methodological weaknesses and heterogeneity. Future rigorous RCTs using validated sham controls, standardized protocols, and objective outcomes are needed to confirm efficacy and guide practice. PROSPERO Registration number (ID: CRD42024559828).
1 July 2026
Read appraisal →Medicine
Efficacy and safety of traditional Chinese medicine decoctions as an adjuvant treatment for rheumatoid arthritis: A systematic review and meta-analysis
BACKGROUND: To assess the effectiveness and safety of traditional Chinese medicine (TCM) decoctions as an additional therapy for rheumatoid arthritis (RA) via a systematic review and meta-analysis. METHODS: Databases including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang were searched up to June 2024. Randomized controlled trials (RCTs) on TCM decoctions as adjunctive RA treatment were included. Primary outcomes were efficacy and safety. Effect sizes were measured using standardized mean difference, risk ratio, and 95% confidence intervals. Sensitivity and subgroup analyses were conducted to test result robustness and identify heterogeneity sources. Data were analyzed using RevMan 5.4 and Stata 15. In addition, the quality of evidence was assessed using grading of recommendations assessment, development and evaluation grading. RESULTS: Thirty-six RCTs with 6934 participants showed that TCM decoctions significantly improved overall efficacy versus control (risk ratio = 1.25, 95% confidence interval [1.21-1.29], P < .00001). They also reduced erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, swollen joint count, Disease Activity Score, and morning stiffness duration compared to placebo. Subgroup analysis suggested treatment duration, disease duration, and age may affect efficacy. Among them, the quality of evidence was high for Visual Analog Scale, and moderate for overall efficacy, C-reactive protein, Disease Activity Score, Traditional Chinese Medicine Symptom Score, and interleukin-1. CONCLUSION: TCM decoctions as adjunctive RA treatment significantly enhance efficacy. However, due to study limitations, further large-scale, multicenter RCTs are needed to confirm these findings.
28 June 2026
Read appraisal →Life sciences
The interplay of plant polysaccharide structure, gut microbiota metabolism, and host health: Mechanisms and perspectives
Plant polysaccharides, as natural biomolecules, possess the capability to modulate the structure and function of gut microbiota, subsequently influencing host health. Nevertheless, the molecular mechanisms underlying their interactions remain insufficiently understood. This article presents a systematic review of the impact of the chemical structure of plant polysaccharides, including monosaccharide composition and types of glycosidic bonds, on the metabolic preferences of gut microbiota. It emphasizes how structural variations in polysaccharides can promote the proliferation of specific gut microbiota, such as Bacteroidetes and Firmicutes. Additionally, the study analyzes critical enzymatic systems, including glycoside hydrolases (GHs) and polysaccharide lyases (PLs), alongside metabolic pathways associated with the production of short-chain fatty acids (SCFAs) that facilitate the degradation of plant polysaccharides by gut microbiota. Furthermore, it explores the influence of these metabolites on conditions such as obesity, diabetes, inflammatory bowel disease (IBD), and non-alcoholic fatty liver disease. The findings provide a robust theoretical framework for enhancing the utilization efficiency of bioactive polysaccharide components through targeted extraction and characterization techniques, thereby fostering potential advancements in innovative nutritional formulations and pharmacological applications.
16 June 2026
Read appraisal →Journal of ethnopharmacology
Exploring the molecular mechanism of Shenling baizhu formula in the treatment of ulcerative colitis via the cGMP-PKG signaling pathway
ETHNOPHARMACOLOGICAL RELEVANCE: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by symptoms such as persistent diarrhea. Shenlingbaizhu Formula (SLBZ), a classical Chinese herbal formula with centuries of clinical application, has long been used to treat such gastrointestinal disorders. This historical efficacy provides a strong ethnopharmacological rationale for investigating its therapeutic potential and underlying mechanisms in UC. AIM OF THE STUDY: To elucidate the molecular mechanism by which SLBZ ameliorates UC by restoring the intestinal barrier via the sGC-cGMP-PKG signaling pathway. MATERIALS AND METHODS: To systematically investigate the therapeutic effects of SLBZ on UC, we established a dextran sulfate sodium (DSS)-induced colitis model in 57BL/6 mice. Comprehensive evaluations were conducted to assess intestinal barrier function and elucidate underlying mechanisms, including histological analysis, immunofluorescence staining of tight junction proteins, 16S rDNA sequencing for gut microbiota profiling, transcriptomic analysis for gene expression patterns, and Western blot validation of key proteins. Furthermore, a multi-tiered experimental strategy was employed, integrating molecular modeling, machine learning algorithms, graph neural network (GNN) approaches and in vitro experiments using Caco-2 cell monolayers, to systematically validate the sGC-cGMP-PKG signaling pathway and identify bioactive compounds responsible for SLBZ's therapeutic effects. RESULTS: SLBZ treatment markedly alleviated UC symptoms in mice and restored intestinal barrier function through dual mechanisms: upregulation of tight junction proteins (ZO-1/Occludin) and modulation of gut microbiota composition. Transcriptomic analysis pinpointed the cGMP-PKG signaling pathway as a central therapeutic target. Through an integrated approach combining molecular docking, machine learning (random forest algorithm), and deep neural network analysis, we identified soluble guanylate cyclase (sGC) as the primary molecular target, with Choerospondin emerging as a key bioactive component. Mechanistic investigations demonstrated that SLBZ robustly activated the sGC-cGMP-PKG axis both in vivo (colon tissues) and in vitro (Caco-2 cells), culminating in significant suppression of intestinal epithelial apoptosis. CONCLUSION: SLBZ alleviates UC by activating the sGC-cGMP-PKG pathway to restore intestinal barrier function through tight junction upregulation and microbiota modulation. Our study both validates SLBZ's traditional use and identifies this pathway as a novel therapeutic target for UC.
12 June 2026
Read appraisal →Journal of ethnopharmacology
Insight of traditional Chinese medicine in treating pulmonary hypertension: Achievements from 2021 to 2025.
ETHNOPHARMACOLOGICAL RELEVANCE: Pulmonary hypertension (PH) significantly impairs patients' quality of life and imposes a substantial economic burden. Despite advances in pharmacotherapy, PH remains a life-threatening pulmonary vascular disease. Traditional Chinese Medicine (TCM), with its multi-target and multi-pathway mechanisms, has shown therapeutic potential for PH management. AIMS OF THE REVIEW: This review systematically summarizes TCM formulas, extracts, and active components, along with their pharmacological mechanisms, for the treatment of PH, and highlights the advantages of TCM in managing PH. MATERIALS AND METHODS: A systematic review of the literature on TCM for PH was conducted. The search included scientific publications from January 2021 to August 2025. Relevant articles were identified through comprehensive searches of PubMed, Web of Science, ScienceDirect, and Google Scholar. The search strategy combined keywords including "pulmonary hypertension", "pulmonary arterial hypertension", "Traditional Chinese Medicine", "Chinese herbal medicine", "herb", "formula", "extract", "active component", and "active ingredient". Retrieved publications were screened and analyzed using pre-defined inclusion and exclusion criteria to ensure relevance and methodological quality. RESULTS: This review synthesizes findings on TCM-based theory, experimental models, TCM formulas (both classical and novel), extracts (including ethanol/aqueous extracts, volatile oils, total flavonoids, saponins, and alkaloids), and active components (terpenoids, flavonoids, glycosides, and alkaloids) for the treatment of PH. Predominant models include monocrotaline-induced pulmonary arterial hypertension (PAH) in vivo and hypoxia-induced in vitro models using pulmonary artery smooth muscle cells (PASMCs). Mechanistic studies indicate that TCM target multiple signaling pathways, including NF-κB to alleviate inflammation, PI3K-AKT-mTOR signaling to mitigate oxidative stress, modulation of K+/Ca2+ channels to attenuate pulmonary vascular remodeling, the HIF-2α-Arg-NO signaling pathway to protect endothelial function, inhibition of the TGF-β1/Smad pathway to suppress endothelial-to-mesenchymal transition, and regulation of JAK2-STAT3 and p53-p21 pathways to inhibit abnormal proliferation, migration, apoptosis resistance, and phenotypic transformation. CONCLUSION: TCM, including formulas, extracts, and components exhibit significant therapeutic potential for PH, positioning TCM as a promising complementary strategy for managing this disease.
12 June 2026
Read appraisal →Journal of medical Internet research
Daily Stress and Heart Rate Variability Among Mindfulness Meditation Practitioners: mHealth Observational Study
BACKGROUND: Mindfulness meditation has been reported to reduce stress and enhance well-being. However, its effects on heart rate variability (HRV)-a physiological marker of stress-remain underexplored. OBJECTIVE: This study aimed to examine how meditation practice is associated with subjective stress, HRV, and their interaction, using mobile health technologies. METHODS: This 3-week observational study included 90 participants-19 meditation practitioners (meditation group), 32 recreational runners as an active control group characterized by lower stress and higher HRV (running group), and 39 individuals without regular meditation or exercise habits (control group). HRV was continuously recorded using Garmin smartwatches. Subjective stress levels and activity states were assessed 3 times daily through a smartphone-based experience sampling method, yielding a total of 4557 responses (mean 50.6, SD 22.8 per participant). From the meditation group, start and end times of 632 daily meditation sessions (mean 33.3, SD 18.3 per participant) were also collected via the app. Standardized questionnaires on stress and related measures were administered at the end of the study period. RESULTS: The questionnaire survey confirmed that stress levels were significantly lower in both the meditation and running groups compared with controls (median Perceived Stress Scale scores: meditation 21, IQR 17-24; running 22, IQR 19-25; control 25, IQR 21-30; Kruskal-Wallis P=.02; adjusted Wilcoxon P=.05 and .04, respectively). Smartwatch-derived HRV (root-mean-square of successive differences [RMSSD]) was elevated in the running group relative to controls (median 47.0, IQR 44.0-54.2 and median 42.0, IQR 34.2-47.8, respectively; P<.001), whereas no significant difference was observed between the meditation and control groups (median 40.8, IQR 35.5-44.4 and median 42.0, IQR 34.2-47.8, respectively). Bayesian analysis of the experience sampling method data indicated that higher subjective stress levels were associated with a concurrent RMSSD reduction of -2.24 (95% credible interval -3.97 to -0.26) milliseconds. Although this pattern was consistent across groups, the steeper decline of -3.94 (95% CI -7.04 to -0.74) milliseconds was observed only in the running group, likely reflecting their elevated baseline HRV. Additionally, Bayesian modeling of 632 logged meditation sessions revealed an acute RMSSD increase of +4.68 (95% CI 2.96 to 6.38) milliseconds during meditation, with effects maintained for at least 30 minutes post practice. CONCLUSIONS: Although HRV among meditation practitioners did not appear elevated in overall daily life, the ability to increase HRV at arbitrary timings, along with the prolonged residual effect, may correlate with stress reduction. This hypothesis requires further exploration with adequate controls. Despite the preliminary nature of this study due to its limited sample size, our findings highlight the potential of mobile health-based methodologies to capture stress and HRV dynamics in real-world settings.
1 June 2026
Read appraisal →Medicine
The clinical efficacy of Astragalus-containing Chinese patent medicines in the effective treatment of heart failure: A systematic review and network meta-analysis
BACKGROUND: The incidence of cardiovascular diseases, particularly heart failure, has been rising year by year. Traditional Chinese medicines containing Astragalus have been widely used in clinical research. However, there is no definitive research on the efficacy of proprietary Chinese medicines containing Astragalus. A network meta-analysis was conducted to investigate the efficacy and safety of oral traditional Chinese medicines containing Astragalus for the treatment of heart failure. METHODS: This study searched 6 databases for clinical randomized controlled trials involving the use of traditional Chinese herbal medicines containing Astragalus alone or in combination with other drugs, with a search period from the establishment of the databases to May 27, 2025. Using the Cochrane Quality Assessment Manual, we conducted a bias analysis of the included studies, and the extracted data were analyzed using network meta-analysis in Stata 18. RESULTS: A total of 18 studies were included, involving 1584 patients with heart failure, with 16 types of traditional Chinese medicines containing Astragalus. The network meta-analysis via Surface Under the Cumulative Ranking Curve analysis indicated that: Compared to using Western medicine (WM) alone, Astragalus Granule + WM ranked best for improving overall clinical efficacy rate; Qiangxin Capsule + WM was optimal for improving six-minute walk test; Astragalus Granule + WM showed the best efficacy for reducing B-type natriuretic peptide levels; Yanxing Decoction + WM ranked first for lowering N-terminal pro-B-type natriuretic peptide levels; Xinlishen Compound + WM was the optimal combination for improving left ventricular ejection fraction; Qili Qiangxin Capsule + WM performed best for reducing left ventricular end-diastolic diameter; Yangxin Tongmai II Prescription + WM exhibited the highest efficacy for decreasing Minnesota Heart Failure Quality of Life Questionnaire scores. CONCLUSIONS: Adding oral traditional Chinese medicine containing Astragalus to WM treatment can further improve the clinical efficacy of heart failure. However, due to the limited number and quality of the included studies in this research, the above conclusions still require further validation through well-designed randomized double-blind controlled trials.
31 May 2026
Read appraisal →PloS one
Probiotics, synbiotics and berberine in Type 2 diabetes mellitus: A systematic review, meta-analysis, and molecular dynamics simulation study
BACKGROUND: Type 2 diabetes mellitus is characterized by impaired regulation of blood glucose. Probiotics, synbiotics, and berberine (BBR) have been proposed as adjunctive interventions, but their overall effectiveness remains uncertain. OBJECTIVE: To evaluate the effects of these interventions on glycemic control and to explore a potential molecular interaction of BBR with a key carbohydrate-digesting enzyme. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted. Pooled effects were estimated for fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) using random-effects models. A subgroup analysis compared probiotics with placebo. An exploratory computational analysis examined the interaction of BBR with α-glucosidase. RESULTS: More than 30 trials involving over 2,000 participants were included. The pooled analysis showed significant but modest reductions in FPG (-0.71 mmol·L ⁻ ¹) and HbA1c (-0.19%), with substantial between-study variability. Probiotics alone also reduced FPG (approximately -0.80 mmol·L ⁻ ¹) and HbA1c (approximately -0.21%) compared with placebo. Computational analysis indicated weaker enzyme binding for BBR than for the reference inhibitor acarbose. CONCLUSIONS: Probiotics, synbiotics, and BBR provide statistically significant but clinically modest improvements in glycemic control. These findings support their use as adjunctive, rather than primary, therapeutic options and highlight the need for larger and longer trials with standardized interventions. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251116387, identifier CRD420251116387.
30 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Structured yoga program as supportive care to enhance quality of life in head and neck cancer patients undergoing radiotherapy: a prospective matched controlled study
PURPOSE: Head and neck cancer (HNC) patients undergoing radiotherapy often experience significant deterioration in quality of life (QoL) due to physical and psychological challenges. This study evaluates the effect of a structured yoga program-including physical postures, breathing exercises, and meditation-on QoL among these patients. METHODS: A prospective matched controlled nonrandomized study was conducted at a Tertiary Care Centre in North East India. Then, 140 patients undergoing definitive or adjuvant radiotherapy were equally divided into experimental (yoga intervention) and control groups. QoL was assessed using the EORTC QLQ-C30 questionnaire at baseline, end of treatment, and two months posttreatment. The yoga intervention consisted of thrice-weekly sessions for two months. All primary statistical analysis was done using nonparametric methods. RESULTS: Statistically significant improvement was seen in the experimental group in global health status/QoL (p-value < 0.001), pain (< 0.001), financial difficulties (< 0.001), emotional functioning (0.001), and fatigue aspect (0.024). CONCLUSION: A structured yoga program significantly improved key QoL domains in head and neck cancer patients receiving radiotherapy. Yoga can be considered an effective supportive therapy in this population.
30 May 2026
Read appraisal →JAMA
The Veterans Affairs' Whole Health Approach for Chronic Pain Management: The wHOPE Randomized Clinical Trial
IMPORTANCE: The US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits. OBJECTIVE: To evaluate the effectiveness of a whole health team intervention in VA patients with chronic pain compared with cognitive behavioral therapy and with usual care, and to evaluate the effectiveness of cognitive behavioral therapy compared with usual care in reducing long-term pain interference. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial involving 6 VA health systems in the US enrolled participants between September 18, 2020, and January 19, 2024. Final follow-up occurred on January 27, 2025. Analyses took place between April 1, 2025, and February 3, 2026. Participants were patients with chronic pain receiving VA primary care. INTERVENTIONS: Patients with chronic pain were randomized (11:11:2) to receive a whole health team intervention (n = 343), cognitive behavioral therapy for chronic pain delivered in group sessions (n = 339), or usual care (n = 82) for 12 months. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. The team provided interdisciplinary, individualized care consistent with the VA Whole Health model to attain personal health goals aligned with patients' personal values and life goals. MAIN OUTCOMES AND MEASURES: The primary outcome was the Brief Pain Inventory interference (BPI-I) subscale score (range, 0-10 points; higher scores indicate worse interference from pain; minimal clinically important difference, 1.0) at 12 months. RESULTS: Of 764 randomized patients (mean [SD] age, 60.5 [12.3] years; 66.5% were men), 632 (82.7%) completed 12-month follow-up. At 12 months, the whole health group had significantly improved pain interference scores (from 6.6 to 4.9) compared with the cognitive behavioral therapy (from 6.4 to 5.5) (mean difference, -0.58 [97% CI, -1.11 to -0.05]; P = .02) and usual care (from 6.4 to 5.7) (mean difference, -0.77 [99% CI, -1.40 to -0.15]; P = .002) groups. At 12 months, cognitive behavioral therapy did not improve pain interference scores significantly more than usual care (mean difference, -0.19 [99% CI, -0.89 to 0.50]; P = .46). The most common adverse event was suicidal ideation, which occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group. CONCLUSIONS AND RELEVANCE: These results support use of the whole health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04330365.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Nonpharmacological dyspnoea-relief strategies in lung cancer: a systematic review and network meta-analysis
BACKGROUND: Dyspnoea is a common and distressing symptom in lung cancer patients. While various dyspnoea-relief strategies show promise, their comparative effectiveness remains unclear. METHODS: We conducted a systematic review and network meta-analysis of randomised controlled trials on nonpharmacological dyspnoea-relief strategies in lung cancer patients, using studies published until 12 June 2025 from the databases PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The primary outcome was dyspnoea score post-intervention. RESULTS: 4138 participants from 46 randomised controlled trials were included in the analysis. Among 10 nonpharmacological dyspnoea-relief strategies in lung cancer patients, acupressure (surface under the cumulative ranking curve (SUCRA) 98.7%, Hedges' g -1.96, 95% CI -2.92 to -0.99) demonstrated the highest efficacy, followed by fan (SUCRA 83.7%, Hedges' g -1.11, 95% CI -1.72 to -0.50), and multicomponent interventions (SUCRA 80.7%, Hedges' g -1.01, 95% CI -1.49 to -0.52). In post-operative lung cancer patients, multicomponent interventions (SUCRA 97.4%, Hedges' g -1.55, 95% CI -2.16 to -0.94) were the most effective, followed by cognitive behavioural therapy (SUCRA 74.8%, Hedges' g -0.90, 95% CI -1.75 to -0.05). For patients with pre-existing dyspnoea, acupressure (SUCRA 90.9%, Hedges' g -1.72, 95% CI -3.01 to -0.42) and fan therapy (SUCRA 77.3%, Hedges' g -1.18, 95% CI -2.10 to -0.27) were the top interventions. CONCLUSIONS: Acupressure is the primary strategy for alleviating dyspnoea in lung cancer patients, including those with pre-existing dyspnoea, followed by fan therapy, while multicomponent interventions are recommended for post-operative patients.
29 May 2026
Read appraisal →Journal of perinatal medicine
Plant-based antioxidant strategies with potential for preeclampsia prevention: clinical and mechanistic insights
BACKGROUND: Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality, driven by oxidative stress, endothelial dysfunction, and systemic inflammation. Current preventive strategies, such as low-dose aspirin, offer modest benefit, highlighting the need for alternative approaches. Medicinal plants with antioxidant and anti-inflammatory properties, long used in maternal health traditions, may provide biological pathways relevant to preeclampsia prevention. SUMMARY: This review synthesizes human clinical and mechanistic evidence on four medicinal plants with documented antioxidant activity - Curcuma longa, Moringa oleifera, Orthosiphon aristatus, and Centella asiatica. These botanicals demonstrate potential mechanisms of action including redox modulation, preservation of endothelial function, and suppression of pro-inflammatory pathways, all of which are implicated in preeclampsia pathophysiology. CONTENT: A PRISMA-guided systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library (2000-2025) identified human studies evaluating these plants' effects on oxidative stress and vascular health. Evidence was synthesized narratively due to heterogeneous study designs and outcomes. Most studies were small, often not pregnancy-specific, and used non-standardized botanical formulations. OUTLOOK: These medicinal plants offer biologically plausible pathways to reduce preeclampsia risk. However, pregnancy-focused randomized trials, dose optimization, pharmacokinetic profiling, and safety evaluations are essential before clinical integration into maternal care.
26 May 2026
Read appraisal →Pharmaceutical biology
Ginger-based formulations for allergic rhinitis disease: a systematic review and meta-analysis of experimental studies in animals and humans
BACKGROUND: Allergic rhinitis is a chronic non-communicable disease that adversely affects respiratory health and quality of life. Ginger-based formulations, owing to their anti-inflammatory and immunomodulatory properties, may offer a promising alternative therapeutic option. OBJECTIVE: To systematically review and meta-analyze evidence from animal studies and human randomized controlled trials assessing the efficacy of ginger-based formulations in allergic rhinitis. METHODS: A systematic search of the Cochrane Library, Embase, PubMed, and Scopus (April 2025) identified studies comparing ginger-based formulations with control interventions. Outcomes included clinical symptoms and relevant biomarkers. Risk of bias was assessed using the SYRCLE tool for animal studies and RoB2 for human studies. Meta-analyses were conducted using random-effects models, with results expressed as standardized mean difference (SMD) and 95% confidence intervals (CIs). RESULTS: Twenty-one studies (6 animal and 15 human studies) were included. In rodents, ginger-based formulations significantly reduced nasal rubbing (SMD = -1.99; 95%CI, -3.15 to -0.83), sneezing (SMD = -1.99; 95%CI, -2.78 to -1.20), and biomarkers (IL-4, IL-5, and OVA-specific IgE). In humans, ginger-based formulations significantly improved itching (SMD = -0.51; 95%CI, -0.79 to -0.24), runny nose (SMD = -0.59; 95%CI, -0.87 to -0.30), sneezing (SMD = -0.56; 95%CI, -0.75 to -0.37), total nasal symptom scores (SMD = -0.63; 95%CI, -1.00 to -0.26), and quality of life (SMD = -0.56; 95%CI, -0.87 to -0.24), and eosinophil levels. CONCLUSION: Ginger-based formulations improve symptoms and biomarkers of allergic rhinitis in both animal and human studies. As many interventions are multi-component, the observed effects are more appropriately attributed to the overall formulations rather than ginger alone. Further research is needed to explore mechanisms and clarify clinical applications.
26 May 2026
Read appraisal →Medicine
The effects of electroacupuncture and the Otago Exercise Program in older adults with sarcopenia: A randomized controlled study
BACKGROUND: The aim of this study was to investigate the effects of a combination of electroacupuncture (EA) and the Otago Exercise Program (OEP) for sarcopenia in older individuals and provide treatment recommendations for this patient population. METHODS: In this assessor-blinded randomized controlled trial, 120 older patients with sarcopenia were randomly divided into an OEP group (n = 58) and an EA + OEP group (n = 62). The OEP group received OEP 5 times/week, with each session lasting 30 minutes, for a duration of 12 weeks. In addition to OEP treatment, the EA + OEP group was treated with EA at ST31, ST32, GB34 and ST36 for 30 minutes 3 times/week for 12 weeks. The appendicular skeletal muscle mass-height index (ASM/H2) was the primary outcome. The secondary outcomes included grip strength, 4-m gait speed and 6-min walk distance. Outcomes were measured before initiation and at 6 and 12 weeks after initiation. RESULTS: Significant differences in ASM/H2, grip strength, 4-m gait speed and 6-min walk distance were detected between the 2 groups at week 12, whereas no differences were detected at weeks 0 and 6. In the EA + OEP group, as the treatment time increased, ASM/H2, grip strength, 4-m gait speed and 6-min walk distance increased significantly. In the OEP group, as the treatment time increased, no significant difference was found in ASM/H2, whereas grip strength, 4-m gait speed and 6-min walk distance increased significantly (P < .05). CONCLUSION: In older patients with sarcopenia, EA + OEP was associated with increased skeletal muscle mass, but no such effect was found for OEP alone. Moreover, EA + OEP was superior to OEP alone in terms of improving muscle strength and walking ability. EA + OEP may be considered an effective treatment for sarcopenia in older adults.
25 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Utility of Acupuncture Therapy for Adult Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis
BACKGROUND Chronic daily headache (CDH) management remains challenging due to limited efficacy of standard preventive pharmacotherapies. Acupuncture has shown promise in chronic headache management. This study evaluated its sustained prophylactic efficacy for CDH. MATERIAL AND METHODS Following PRISMA guidelines, we systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, VIP, Sinomed, and Wanfang Data (inception to September 2025) for randomized controlled trials (RCTs) comparing acupuncture with other interventions for CDH. Primary outcomes included headache frequency, days, intensity, duration, and analgesic use; subgroup analyses covered treatment modality, CDH subtype, and duration. RESULTS Twenty-two RCTs (1449 patients) were included. Compared with control, acupuncture significantly reduced headache frequency (mean difference [MD], -0.32; P=0.001), headache days (MD, -0.72; P<0.00001), intensity (standardized mean difference [SMD], -0.63; P=0.001), duration (SMD, -1.18; P=0.0001), and analgesic use (MD, -0.52; P<0.00001) after the intervention. These benefits persisted during follow-up: headache days (standardized mean difference [SMD], -0.70; P<0.00001), intensity (SMD, -1.11; P=0.008), duration (SMD, -1.83; P=0.003), and analgesic use (SMD, -0.60; P=0.007) remained reduced; headache frequency showed a trend toward reduction (SMD, -0.47; P=0.05). Subgroup analyses revealed consistent efficacy across various CDH subtypes, including chronic migraine and chronic tension-type headache, treatment durations (4-12 weeks), and intervention strategies (acupuncture alone or combined with medication), indicating broad clinical applicability. CONCLUSIONS Acupuncture yields clinically meaningful, sustained improvements in CDH, supporting its role as an effective routine and adjunctive prophylaxis and broader application in this population.
25 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Facilitators and barriers to the implementation of traditional Chinese exercises in cancer patients: a mixed-methods systematic review
PURPOSE: To identify barriers and facilitators to the implementation of traditional Chinese exercises in cancer patients. METHODS: This was a mixed-methods systematic review. It searched for published studies from nine different sources. Data synthesis followed a convergent integrated approach according to the Joanna Briggs Institute methodology for mixed-methods systematic reviews. Quantitative data were qualitized using thematic analysis and synthesized with qualitative data using thematic synthesis. RESULTS: Twenty-one studies were included. Forty-three implementation determinants were identified across five domains of the Consolidated Framework for Implementation Research (CFIR), including 25 facilitators and 18 barriers. Key facilitators included perceived benefits, simplicity, social support, and flexible delivery, whereas major barriers involved symptom burden, resource constraints, competing life demands, and limited organizational support. CONCLUSIONS: The implementation of traditional Chinese exercises in cancer patients is shaped by multilevel determinants across CFIR domains. Implementation outcomes depend on the alignment between intervention characteristics, patient capacity, and contextual conditions. Context-sensitive and tailored strategies are required to improve uptake and long-term sustainability.
25 May 2026
Read appraisal →Journal of ethnopharmacology
Comparative efficacy and safety of Chinese patent medicines in coronary heart disease patients after percutaneous coronary intervention: A systematic review and network meta-analysis
ETHNOPHARMACOLOGICAL RELEVANCE: Patients with coronary heart disease (CHD) remain at high risk of major adverse cardiovascular events (MACEs) after percutaneous coronary intervention (PCI). Chinese Patent Medicines (CPMs) have demonstrated therapeutic potential as adjunctive therapies, however, direct comparative evidence regarding their effectiveness is lacking. AIM OF THE STUDY: This network meta-analysis (NMA) aims to systematically evaluate and compare the clinical efficacy and safety of CPMs combined with conventional therapy (CT) in post-PCI management. MATERIALS AND METHODS: A systematic literature search was performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP, and Wanfang databases up to December 24, 2024. Randomized controlled trials investigating CPMs in CHD patients following PCI were included. Methodological quality was assessed using the Cochrane Risk of Bias tool. Outcome measures included major adverse cardiovascular events (MACEs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), high-sensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and nitric oxide (NO) levels. NMA was implemented using STATA 16.0 and R 4.1.2. Odds ratios and standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. Model selection was guided by heterogeneity assessed using the I2 statistic. Intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA), with robustness and publication bias evaluated through sensitivity analyses and funnel plots. RESULTS: A total of 84 RCTs involving 10,524 patients and eight CPMs were included. For the primary outcome (MACEs), the SUCRA ranking indicated that Tongxinluo capsules combined with conventional therapy (TXLJN + CT) was the most effective intervention, followed by Shensong Yangxin capsules plus CT (SSYXJN + CT), Shexiang Baoxin pills plus CT (SXBXW + CT), Qili Qiangxin capsules plus CT (QLQXJN + CT), Qishen Yiqi dripping pills plus CT (QSYQDW + CT), Xinyu capsules plus CT (XYJN + CT), Fufang Danshen Dripping Pills plus CT (FFDSDW + CT), and Guanxin Shutong capsules plus CT (GXSTJN + CT), while CT alone ranked last. Correspondingly, the NMA demonstrated that TXLJN + CT was associated with the greatest reduction in LVEDD (SMD -1.01, 95% CI -1.35 to -0.66) and hs-CRP levels (SMD -2.50, 95% CI -3.33 to -1.68). The most significant improvement in LVEF (SMD 1.25, 95% CI 0.85 to 1.64) and NO levels (SMD 1.02, 95% CI 0.73 to 1.29) was observed with QSYQDW + CT. Meanwhile, SXBXW + CT showed the greatest efficacy in reducing NT-proBNP levels (SMD -3.43, 95% CI -4.68 to -2.18). CONCLUSION: CPMs combined with CT may provide clinical benefits in post-PCI management. According to SUCRA rankings, TXLJN + CT ranked first in reducing MACE and in lowering LVEDD and hs-CRP levels. QSYQDW + CT ranked first in improving LVEF and NO levels, while SXBXW + CT showed the highest ranking for reducing NT-proBNP levels. However, larger-scale, high-quality RCTs are needed to validate these findings.
25 May 2026
Read appraisal →Journal of ethnopharmacology
Therapeutic potential of pharmacological components of Salvia miltiorrhiza against atherosclerosis: A preclinical systematic review and meta-analysis
ETHNOPHARMACOLOGICAL RELEVANCE: Atherosclerosis (AS) severely threatens global health, while current therapies exhibit limitations. Recognized as a 'superior-grade' herb in the Shennong Ben Cao Jing, Salvia miltiorrhiza Bunge (Danshen) has been shown in modern studies to protect against cardiovascular diseases. AIM OF THE STUDY: The aim of this study was to investigate the therapeutic potential and protective mechanism of pharmacological components of Salvia miltiorrhiza against AS. MATERIALS AND METHODS: Relevant animal studies were collected from 8 databases, namely, PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, VIP, and SinoMed. Risk of bias of the included studies was evaluated using the SYRCLE's tool. Statistical analysis was performed using R 4.2.0 and Python 3.14.2 software. Machine learning model was trained to predict optimal intervention parameters and was subsequently validated. RESULTS: A total of 64 studies were included. The pharmacological components of Salvia miltiorrhiza ameliorated atherosclerotic plaque formation and stability, and modulated various biomarkers, including lipid profiles, inflammatory cytokines, oxidative stress indicators, endothelial function markers, as well as matrix metalloproteinases. Machine learning identified an optimal Tanshinone IIA regimen against AS, which was defined as a single dose of 33.18 mg/kg dose over 84 days and demonstrated predictive robustness in validation. CONCLUSIONS: The pharmacological components of Salvia miltiorrhiza attenuate AS by regulating lipid metabolism, anti-inflammatory and antioxidant actions, improving endothelial function, modulating of vascular smooth muscle cells, remodeling extracellular matrix, and regulating programmed cell death. These findings provide translational insights that pave the way for subsequent preclinical and early-clinical studies, pending systematic validation through more rigorous research.
24 May 2026
Read appraisal →International journal of yoga therapy
Systematic Review on the Effect of Yoga Nidra on Menstrual Disorders Among Adult Women
Menstrual disorders including amenorrhea, premenstrual syndrome, and dysmenorrhea significantly disrupt the normal menstrual cycle and negatively impact quality of life. Yoga nidra, a guided meditation technique, has been explored for its potential therapeutic benefits in menstrual health, although comprehensive evidence remains limited. The present systematic review aimed to assess the effect of yoga nidra on menstrual disorders by analyzing existing research and synthesizing findings. The review followed PRISMA guidelines and involved searches in PubMed/MEDLINE, Cochrane Library, Science Direct, and Google Scholar using keywords related to yoga nidra and menstrual disorders. Studies were selected based on predefined inclusion criteria. A total of seven randomized controlled trials were included. The findings indicated improvements across four key areas of women's health: (1) psychological well-being, (2) hormonal balance, (3) hematological profile, and (4) physiological parameters. These results suggest that yoga nidra may be an effective complementary therapy for managing menstrual disorders because of its noninvasive and low-cost nature. However, further high-quality randomized controlled trials are necessary to confirm its efficacy.
24 May 2026
Read appraisal →Scientific reports
A randomized controlled trial of adjunctive speleotherapy in asthma, COPD and long COVID
Speleotherapy (underground climate therapy) is a non-pharmacological intervention for chronic respiratory diseases. This randomized controlled trial investigated whether a 3-week speleotherapy course (6 sessions, 2 h/week) improves respiratory outcomes in patients on standard background therapy with asthma, COPD, or Long COVID, and whether it affects blood CO2 levels. The control group did not receive speleotherapy but continued their standard therapy. A total of 208 patients (asthma: n = 107; COPD: n = 59; Long COVID: n = 42) were enrolled across nine centers in Germany, Austria, and Italy. Assessments were conducted pre-intervention (T1), post-intervention (T2), and at 3-month follow-up (T3). Outcome measures included airway inflammation (FeNO), pulmonary function parameters (FVC% predicted values, FEV₁% predicted values, FEV₁/FVC, PEF% predicted values), and respiratory muscle strength (MIP and MEP in absolute values). In addition the following validated questionnaires were administered: Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Nijmegen Questionnaire (NQ), and Fatigue Assessment Scale (FAS), along with the Long COVID questionnaire from the Median Clinic Group. CO2 levels were assessed via capillary blood (SpCO2) and end-tidal CO2 (PetCO2). Between-group comparisons used the Mann-Whitney U test; within-group changes were assessed with the Wilcoxon signed-rank test (Bonferroni-Holm corrected). In patients with asthma, the predefined primary endpoint (FeNO) showed no significant improvement. In contrast, patient-reported outcomes improved significantly, with clinically relevant gains in asthma control (ACT: p < 0.001) and asthma-related quality of life (total AQLQ: p = 0.005). Lung function parameters showed statistically significant but modest improvements at T2 (FVC: p = 0.011; PEF: p = 0.010; FEV₁ in participants < 70 years: p = 0.035). In patients with COPD, symptom burden improved according to CAT scores (p = 0.036), while no improvements in lung function were observed. Patients with Long COVID reported significant improvements in dysfunctional breathing (NQ: T2: p = 0.014), dyspnea (T2: p = 0.026; T3: p = 0.001), and "problems with stair climbing/muscle exertion" (T2: p = 0.042), as well as improvements in anxiety and sleep-related symptoms (T2: p = 0.021). No improvements in lung function were observed in this group. In the total cohort, the intervention group showed statistically significant improvements compared to controls in respiratory muscle strength (MIP: p = 0.002; MEP: p = 0.018) and dysfunctional breathing (NQ scores at T2: p = 0.007; T3: p = 0.017). In CO₂-rich speleotherapy centers, both SpCO₂ (p = 0.026) and PetCO₂ (p < 0.001) increased at T2. While speleotherapy did not improve FeNO, it was associated with clinically relevant improvements in patient-reported outcomes across disease groups. Changes in lung function and respiratory muscle strength were statistically significant but modest and should be interpreted with caution. Overall, speleotherapy may have direct effects on the airways and breathing regulation, with more consistent evidence for improvements in breathing patterns than for direct effects on the airways.Trial registration: DRKS00033365 (retrospectively registered).
24 May 2026
Read appraisal →Medicine
Efficacy of traditional Chinese medicine in treating severe pneumonia: A meta-analysis and systematic review
BACKGROUND: Severe pneumonia (SP) is a critical respiratory disease characterized by its severity and high mortality rate. Traditional Chinese medicine (TCM) has gradually been used as an adjunctive therapy in clinical treatment of SP, yet its efficacy and safety lack systematic evidence. This study aims to analyze, evaluate, and compare current research evidence on TCM adjunctive therapy for SP, providing a basis for clinical treatment of this condition. METHODS: A systematic search was conducted on both English and Chinese online databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP) to identify relevant papers published from inception to November 2023. High-quality randomized controlled tests (RCTs) were selected for analysis. Outcome measures related to SP were extracted from the literature. Statistical analysis was performed using RevMan 5.3 (Cochrane) software to assess heterogeneity among included studies, calculate mean differences, odds ratios, and their 95% confidence intervals, and detect publication bias. RESULTS: A total of 34 RCTs met the inclusion criteria. Comparative analysis revealed that integrating TCM with conventional treatment significantly improves the overall clinical effective rate(P < .05). Specifically, it markedly alleviates TCM symptoms (P < .05). Additionally, TCM adjunctive therapy reduces levels of inflammatory markers including white blood cells, C-reactive protein (P < .05), and decreases Clinical Pulmonary Infection Score and Acute Physiology and Chronic Health Evaluation II scores compared to conventional treatment alone (P < .05). Compared to conventional treatment alone, TCM adjunctive therapy also enhances arterial blood gas indices (PaO2) (P < .05) and pulmonary function (forced expiratory volume in 1 second) (P < .05). Complication rates and mortality are lower in the TCM adjunctive therapy group(P < .05). Moreover, TCM treatment significantly boosts immune function (cluster of differentiation 4+ T lymphocyte) (P < .05). CONCLUSION: Integrating TCM with conventional treatment shows advantages in the efficacy of SP treatment, clinical symptoms management, inflammatory markers, and severity grading. Compared to conventional treatment alone, TCM adjunctive therapy improves immune function, pulmonary function, complication rates. However, future research should focus on large-scale, high-quality RCTs to further validate the effectiveness and safety of TCM adjunctive therapy for SP.
24 May 2026
Read appraisal →Journal of ethnopharmacology
Efficacy and safety of medicine-food homology Shenqi paste in older adults with diabetic sarcopenia: A randomized, double-blind, placebo-controlled trial
ETHNOPHARMACOLOGICAL RELEVANCE: Diabetic sarcopenia (DS), an emerging diabetes complication, poses an increasing challenge to the elderly population. Shenqi paste (SQP) consists of 8 medicine-food homology substances: Astragalus membranaceus (Fisch.) Bge., Codonopsis pilosula (Franch.) Nannf., Polygonatum sibiricum Red., Dioscorea opposita Thunb., Poria cocos (Schw.) Wolf, Eucommia ulmoides Oliv., Hordeum vulgare L., and Ophiopogon japonicus (L.f.) Ker Gawl. SQP has shown potential benefits for sarcopenia in clinical practice. Its efficacy and safety in DS have not been validated in a randomized controlled trial. AIM OF THE STUDY: This study aimed to evaluate the efficacy, safety, and limitations, and provide insights into methods and strategies for utilizing SQP in DS management. MATERIALS AND METHODS: In this randomized, double-blind, placebo-controlled trial, community-dwelling older adults (≥60 years) with DS and spleen-kidney deficiency syndrome were allocated 1:1 to receive either SQP or placebo paste for 12 weeks. Primary outcomes were skeletal muscle mass index (SMI), handgrip strength, and five-time chair stand test (FCST) duration. Secondary outcomes included health-related scales and biochemical indicators. Assessments were conducted at the baseline (T0), week 6 (T1), and week 12 (T2). Safety evaluation included blood routine, liver and kidney function tests. Intention-to-treat analysis was applied to the primary outcomes data from all participants, with per-protocol analysis for sensitivity. Generalized estimating equations with covariate adjustment and t-tests or Wilcoxon rank-sum tests were used for statistical analysis. RESULTS: Of 90 randomized participants, the SQP group showed greater improvements in handgrip strength (T2: interact p < 0.001), SMI (T2: interact p < 0.001), and FCST (T2: interact p < 0.001) versus control. Secondary outcome measures of 74 participants, including frailty, nutrition, physical activity, sleep quality, depression, and TCM syndrome scores, significantly improved (p < 0.05), with significant fasting blood glucose reduction (T2: interact p = 0.018) and C-reactive protein decrease (T2: interact p < 0.001). There was no statistically significant difference in the change in the difference between the two groups in fasting insulin, glycated hemoglobin and insulin resistance index before and after intervention (p > 0.05). Within-group analysis demonstrated significant reductions of SQP group in inflammatory cytokines, and sarcopenia-related biomarkers (p < 0.001) post-intervention. No serious adverse events occurred. CONCLUSION: A 12-week SQP intervention enhanced muscle mass, strength, function, and metabolic and inflammatory profiles in older adults with DS, with good tolerability, supporting its potential as a safe, complementary therapy.
23 May 2026
Read appraisal →PloS one
Effect of an herbal supplement on quality of life in participants with insomnia: A randomized placebo controlled cross-over pilot trial
BACKGROUND: Insomnia is a common sleep disorder linked to poor quality of life. Patients with insomnia frequently rely on herbal supplements to improve sleep and quality of life; however, most supplements do not undergo rigorous testing to determine their effectiveness. The primary objective of the pilot trial was to test the effectiveness of the herbal supplement on sleep and quality of life. METHODS: In a double-blind, randomized, placebo-controlled, crossover pilot trial, participants were assigned study drinks consisting of the herbal supplement containing extracts from chicory and green tea or placebo for 7 days. This was followed by a crossover to the other arm after 2 weeks of a washout period. Participants were healthy individuals of the age of 50 years or more with insomnia. Study measures included subjective assessments of sleep, daytime sleepiness, fatigue, and quality of life via questionnaires. Habitual sleep patterns and sleep architecture were objectively evaluated by a 7-day accelerometry and polysomnography. RESULTS: Ten participants (9 women; age 59 ± 6 y; BMI 30 ± 10 kg/m2) with insomnia severity index of 21 ± 4 and wake after sleep onset (WASO) of 75 ± 33 min were enrolled in the study. The impact of placebo and supplement was different for measures related to daytime sleepiness and physical fatigue but not quality of life. No within and between treatment differences were observed for any objective measures of habitual sleep patterns or sleep architecture. Within group analysis showed improvement in subjective sleep quality, daytime sleepiness, and general fatigue after 7-day consumption of the placebo drink, but not after consumption of herbal supplement. There were no adverse events related to study participation. CONCLUSION: Compared to placebo drink, daily consumption of the herbal supplement for 7 days did not improve any aspect of quality of life or sleep in our pilot study participants with insomnia. Well controlled clinical trials are needed to confirm the claims related to supplements.
22 May 2026
Read appraisal →Chinese medical journal
Estimating minimal, moderate, and marked clinically important differences for patient reported outcome measure in randomised controlled trial
BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly used in clinical trials, yet thresholds that define clinically important difference (CID) within patients and treatment effects beyond placebo remain inconsistently reported, limiting its utility in clinical research and practice. Using chronic pelvic pain and its core PROM as a worked example, the study aims to present a structured framework for CID thresholds that separates within-group change from between-group difference in treatment effect, each further stratified as minimal, moderate, and marked. METHODS: We used data from a multicenter randomized controlled trial of acupuncture vs . sham acupuncture in 440 men with chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) conducted from October 2017 to April 2019. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) served as the PROM and the Patient Global Impression of Change (PGI-C) as the anchor. CIDs were estimated using a linear mixed-effects model to assess changes in NIH-CPSI scores across PGI-C categories. RESULTS: At the end of treatment, 12.3% (51/414) participants reported no change, 34.1% (141/414) slight improvement, 32.1% (133/414) moderate improvement, and 19.6% (81/414) marked improvement; and 1.9% (8/414) reported worsening. The estimated Clinically important within-group difference (CIDs within-group ) in NIH-CPSI total score was 4.6 points for minimal, 6.0 points for moderate, and 7.3 points for marked improvement. The corresponding Clinically important between-group difference (CIDs between-group ) were 1.4, 2.7, and 4.1 points, respectively. CONCLUSIONS: In this methodological study, we proposed a pragmatic and scalable operational framework to derive thresholds for minimal, moderate, and marked CIDs. By explicitly distinguishing CIDs within-group and CIDs between-group , the approach clarifies two frequently conflated terms that serve distinct purposes in interpretation and decision-making. This framework offers benchmarks to strengthen inference on treatment response, trial design, and guideline decision thresholds.
21 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Wrist-Ankle Acupuncture on Postoperative Nausea and Vomiting Prophylaxis in High-Risk Female Patients: A Pragmatic, Randomized, Single-Blind, Sham-Controlled Trial
BACKGROUND: Postoperative nausea and vomiting (PONV) affects up to 80% of high-risk patients, compromising Enhanced Recovery After Surgery (ERAS) outcomes and prolonging hospitalization. This randomized controlled trial evaluated wrist-ankle acupuncture (WAA) efficacy for PONV prevention in high-risk female surgical patients. METHODS: This single-center, randomized, patient- and assessor-blinded, sham-controlled trial enrolled female patients (aged 18-60 years, ASA I-II) scheduled for elective surgery under general anesthesia with documented motion sickness or previous PONV. Participants received either WAA (sterile needles at four standardized acupoints, 30-minute retention) or sham acupuncture postoperatively. The primary outcome was 24-h PONV incidence using the Rhodes Index of Nausea, Vomiting, and Retching (R-INVR). RESULTS: Among 132 patients (median age 41 years), WAA significantly reduced 24-h PONV incidence versus sham (42.4% vs. 71.2%; RR 0.60, 95% CI 0.42-0.82; p = 0.002). Median R-INVR scores were lower with WAA [0 (0-5) vs. 8 (0-11); p < 0.001]. WAA patients reported significantly reduced nausea/vomiting at 30 min, 6 h, and 24 h (all p ≤ 0.006) and higher satisfaction scores (p < 0.001). Antiemetic use was comparable (9.1% vs. 16.7%; p = 0.299). No adverse events occurred. CONCLUSIONS: WAA significantly reduced PONV incidence and severity with sustained effects and improved satisfaction, offering a promising non-pharmacological prevention strategy.
21 May 2026
Read appraisal →Current oncology reports
Mind-Body Therapies for Depression and Anxiety Symptoms in People with Cancer: A Systematic Review with Network Meta-Analysis
INTRO: Mind-body therapies (MBTs) are promising forms of treatment for depression and anxiety symptoms in people with cancer, however, their effectiveness has not been compared. The objective of this study is to rank the effectiveness of MBTs for depression and anxiety symptoms in people with cancer. METHODS: EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI were searched until February 2025 for randomised controlled studies in which MBTs were tested in a cancer population. Network meta-analyses were used on the selected studies to rank the reduction in depression and anxiety symptoms compared with usual care. RESULTS: A total of 182 studies which involved 16,835 participants were included. The network meta-analysis showed a statistically significant large effect compared with usual care for biofeedback (standardised mean difference, SMD = -1.18, p = 0.038), spiritual interventions (SMD = -0.98, p = 0.047), and mindfulness-based interventions (MBIs; SMD = -0.87, p < 0.001) for depression symptoms and yoga (SMD = -1.13, p < 0.001), MBIs (SMD = -1.02, p < 0.001), physical relaxation (SMD = -0.93, p < 0.001), qigong/Tai Chi (QTC; SMD = -0.90, p = 0.004) and music therapy (SMD = -0.90, p < 0.001) for anxiety symptoms. CONCLUSIONS: The MBTs that should be prioritised are biofeedback, spiritual interventions, and MBIs for depression symptoms and yoga, MBIs, physical relaxation, QTC, and music therapy for anxiety symptoms in people with cancer.
20 May 2026
Read appraisal →African journal of reproductive health
Effect of a herbal galactagogic formula combined with auricular acupressure on breast milk production and hormonal profiles in women with postpartum hypogalactia: A randomized controlled study
Postpartum hypogalactia is a common condition that may impair breastfeeding and maternal-infant health. This randomized controlled study evaluated the efficacy of a herbal galactagogic decoction combined with auricular acupressure in improving lactation outcomes. A total of 104 women with postpartum hypogalactia were enrolled between July 2023 and June 2025 and randomly assigned to a control group (auricular acupressure alone, n=52) or an intervention group (auricular acupressure plus herbal decoction, n=52) for 2 weeks. Primary outcomes included breast milk production and formula supplementation, while secondary outcomes comprised serum hormone levels (estradiol, progesterone, and prolactin), symptom scores, psychological status, and clinical effectiveness. Both groups showed significant post-treatment improvements (P<0.05). Compared with the control group, the intervention group demonstrated lower estradiol and progesterone levels, higher prolactin levels, increased milk production, and reduced formula supplementation (P<0.05). Symptom scores and anxiety/depression levels were also significantly improved. The overall effective rate was higher in the intervention group (96.15% vs 80.77%, P<0.05), with comparable safety profiles. This combined therapy appears to be a safe and effective complementary approach for improving lactation in women with postpartum hypogalactia. L’hypogalactie post-partum est une affection fréquente pouvant compromettre l’allaitement et la santé maternelle et infantile. Cette étude randomisée contrôlée a évalué l’efficacité d’une décoction galactagogue à base de plantes associée à l’acupression auriculaire pour améliorer les résultats de lactation. Au total, 104 femmes atteintes d’hypogalactie post-partum ont été recrutées entre juillet 2023 et juin 2025 et réparties aléatoirement en un groupe témoin (acupression auriculaire seule, n=52) et un groupe intervention (acupression auriculaire associée à une décoction à base de plantes, n=52) pendant 2 semaines. Les critères de jugement principaux comprenaient la production de lait maternel et le volume de supplémentation en lait artificiel, tandis que les critères secondaires incluaient les niveaux hormonaux sériques (estradiol, progestérone et prolactine), les scores symptomatiques, l’état psychologique et l’efficacité clinique. Les deux groupes ont montré des améliorations significatives après le traitement (P<0,05). Comparé au groupe témoin, le groupe intervention présentait des niveaux plus faibles d’estradiol et de progestérone, des niveaux plus élevés de prolactine, une production de lait accrue et une réduction de la supplémentation (P<0,05). Les scores symptomatiques ainsi que les niveaux d’anxiété et de dépression ont également été significativement améliorés. Le taux global d’efficacité était plus élevé dans le groupe intervention (96,15 % vs 80,77 %, P<0,05), sans différence significative en termes d’effets indésirables. Cette thérapie combinée pourrait constituer une approche complémentaire sûre et efficace pour améliorer la lactation chez les femmes présentant une hypogalactie post-partum.
18 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effects of yoga on depressive symptoms in breast cancer patients: a meta-analysis of randomized controlled trials
BACKGROUND: While yoga is known to benefit depression in breast cancer patients, its efficacy as an adjunct to diverse treatment regimens remains unclear. This study evaluated yoga's efficacy in alleviating depression during varied breast cancer therapies and supports its clinical integration as a complementary intervention. METHODS: Following PRISMA 2020 guidelines, we systematically searched for RCTs in English and Chinese. Literature quality was assessed using the Cochrane Risk of Bias tool. Data were analyzed with Review Manager 5.4.1, including subgroup analyses by treatment type and assessment scale. RESULTS: Analysis of 21 studies showed yoga significantly reduced depression levels [SMD = -0.58, 95% CI (-0.83, -0.32), P < 0.00001]. Subgroup analyses revealed a significant combined mean difference among the surgery group [SMD: -1.04], the postoperative radiotherapy group [SMD: -2.47], and the postoperative chemotherapy group [SMD: -0.46]. The group receiving postoperative radiotherapy demonstrated a significantly greater improvement in depression. Subgroup analyses of scale-assessed effects confirmed the validity of the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CESD), the Hospital Anxiety and Depression Scale (HADS), and the Zung Self-Rating Depression Scale (SDS). The HADS demonstrated a greater effect size [SMD = -1.19, 95% CI (-2.13, -0.24), P = 0.01]. CONCLUSIONS: The impact varied among those undergoing different treatment regimens. Notably, the degree of improvement in depression appeared to be greater in the postoperative radiotherapy group. HADS is a practical self-assessment scale that has demonstrated considerable improvement and is recommended for use in breast cancer patients with depression.
18 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Acupuncture for chemotherapy-induced dysgeusia (AcuDysg): a randomized controlled trial
PURPOSE: The study investigated the effectiveness of dysgeusia-specific acupuncture combined with self-acupressure compared to supportive acupuncture and self-acupressure for chemotherapy-induced dysgeusia in cancer patients with cancer-related fatigue (CRF) and dysgeusia. METHODS: This multicenter, randomized, controlled, two-armed parallel-group, single-blind trial included cancer patients with CRF and dysgeusia during chemotherapy. All participants received CRF treatment consisting of eight acupuncture sessions over 8 weeks and had access to an eLearning course for self-acupressure. Patients in the intervention group received additional dysgeusia-specific acupuncture treatment and an eLearning with instructions to acupressure points, whereas the control group received an intervention focused solely on addressing CRF. The main outcome was perceived dysgeusia over 8 weeks, measured weekly after each acupuncture session on a numeric rating scale from 1 to 10. Other outcomes included taste and smell tests, and assessments of perceived dysgeusia, fatigue, distress, and quality of life. Due to a small sample size, results can be only judged exploratory. The study was approved by the Cantonal Ethics Committee (CEC) (Kanton Zürich Kantonale Ethikkommission) (approval no. KEK-ZH-Nr. 2020-01900). RESULTS: Since we included only twenty-one patients (11 intervention, 10 control, 90% female) instead of the target sample size of 130, no confirmatory effectiveness analyses were conducted. All participants showed a substantial decrease in dysgeusia over time, regardless of treatment type (estimated mean reduction per session - 0.30; 95% CI - 0.43 to - 0.18), reflecting a 0.30-point reduction per session. Quality of life and cancer-related fatigue improved over time. The exploratory analyses did not show substantial differences between groups in any outcomes. No serious adverse events occurred. CONCLUSIONS: Exploratory findings showed no substantial differences between the study groups in perceived dysgeusia, but both study groups improved over time. TRIAL REGISTRATION NUMBER: DRKS00023348 at 03.11.2020, SNCTP000004128.
14 May 2026
Read appraisal →PloS one
Efficacy and safety of the ayurvedic formulation 'Trikatu' as an add-on to standard care in dyslipidemia: Study protocol for a randomized, double-blind, placebo-controlled trial evaluating lipid parameters, and gut microbiota.
BACKGROUND: Dyslipidemia is a leading modifiable risk factor for cardiovascular disease (CVD), with early and sustained LDL-C reduction offering significant preventive benefits. However, in low- and middle-income countries, long-term adherence to statin therapy remains alarmingly low, highlighting the need for culturally acceptable and safer adjunctive options. Trikatu, a classical Ayurvedic formulation traditionally known to enhance metabolism, may offer supportive benefits in lipid regulation. This study protocol was developed to assess the efficacy and safety of Trikatu as an add-on to standard statin therapy on lipid parameters and assess changes in gut microbiota in response to the intervention and identify microbial correlates associated with favorable lipid outcomes. METHODS: This randomized, double-blind, placebo-controlled clinical trial is being conducted at AIIMS Bhubaneswar, a tertiary care center. Total 170 participants (aged 25-60 years) with moderate to high Atherosclerotic cardiovascular disease (ASCVD) risk. Dyslipidemia, as defined by the 2019 ACC/AHA Guidelines and indicated for statin therapy, will be randomized in a 1:1 ratio to receive either Trikatu (1000 mg) or matching placebo, administered orally twice daily after food for 12 weeks along with standard statin therapy (dose/intensity as per guidelines). Primary outcome includes change in fasting serum LDL-C from baseline to 12 weeks. Secondary outcomes include changes in total cholesterol, HDL-C, triglycerides, glycemic markers (fasting glucose, HbA1c, insulin, HOMA-IR), inflammatory and metabolic markers (hs-CRP, TNF-α, IL-6, adiponectin, ghrelin, ApoA1, ApoB), resting blood pressure, and gut microbiota. The proportion of participants achieving normal cholesterol levels (<200 mg/dL) will also be assessed. Drug compliance and any adverse events will also be recorded. DISCUSSION: In individuals with moderate to high ASCVD risk, achieving and sustaining optimal lipid control remains a cornerstone of cardiovascular prevention. However, poor long-term adherence to statin therapy, especially in low-resource settings, limits real-world impact. By assessing Trikatu, effects on lipid profiles, glycemic and inflammatory markers, and gut microbiota, the study aims to explore its potential to augment cardiovascular risk reduction in a holistic and culturally acceptable manner. If proven effective and safe, Trikatu could serve as a valuable complementary strategy in dyslipidemia management. CLINICAL TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2023/04/051942) Registered on 25/04/2023.
13 May 2026
Read appraisal →Stress (Amsterdam, Netherlands)
Safety and efficacy of ashwagen (a standardized withania somnifera extract) in stress and anxiety with hypertension and associated cardiometabolic risk factors: a randomized, placebo-controlled trial
Stress and anxiety are prevalent mental health conditions that often coexist with cardiovascular comorbidities, resulting in a complex interplay between psychological and physiological processes, partly mediated through activation of the hypothalamic-pituitary-adrenal (HPA) axis. Ashwagen®, a standardized extract of Withania somnifera (Ashwagandha), has demonstrated adaptogenic and anxiolytic properties in preclinical and clinical studies. This study aimed to evaluate the safety and efficacy of Ashwagen® in managing stress and anxiety in patients with pre-existing hypertension and associated cardiometabolic risk factors. A randomized, double-blind, placebo-controlled Phase III clinical trial was conducted over 60 days in 60 patients diagnosed with stress, anxiety, and pre-existing hypertension with cardiometabolic risk profiles. Participants received either Ashwagen® (300 mg capsule) or placebo twice daily. Efficacy assessments included validated psychological scales-Hamilton Anxiety Rating Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS), Clinical Global Impression-Improvement (CGI-I), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS)-along with serum cortisol, triglycerides, LDL, and blood pressure measurements. Ashwagen® significantly reduced anxiety and stress markers compared with placebo. HAM-A, GAD-7, and PSS scores decreased by 26.94%, 50.77%, and 30.47%, respectively, in the Ashwagen® group. Cortisol levels declined by 28.99% and triglycerides by 13.00%, with favorable trends in LDL and blood pressure. No serious adverse events were reported. Ashwagen® was found to be a safe and effective adjunctive integrative intervention for stress and anxiety management in patients with pre-existing hypertension.
13 May 2026
Read appraisal →Journal of ethnopharmacology
Moxibustion with Artemisia argyi H.Lév. & Vaniot in rheumatoid arthritis animal models: A meta-analysis linking clinical efficacy to inflammasome and cytokine signaling mechanisms
ETHNOPHARMACOLOGICAL RELEVANCE: Moxibustion, a traditional Chinese healing method, uses mugwort (Artemisia argyi H.Lév. & Vaniot) to apply heat to specific points, treating conditions like "Bi Zheng", which is akin to rheumatoid arthritis (RA). According to traditional theory, its therapeutic actions are attributed to warming the meridians and regulating the flow of Qi and blood. AIM OF THE STUDY: To quantitatively evaluate the therapeutic efficacy of moxibustion and to map its anti-arthritic mechanisms in animal models of RA. MATERIALS AND METHODS: The protocol was registered with PROSPERO (CRD42024503829) and reported according to PRISMA 2020. Eight databases were searched through 28 July 2025 for randomized controlled animal studies comparing moxibustion with the control in RA models. The primary outcome was arthritis severity, assessed by the arthritis index, paw volume, and histopathological score. Secondary endpoints included serum or tissue levels of pro-inflammatory cytokines (IL-1β, TNF-α, IL-6), immunomodulatory cytokines (IL-10, IL-4), and key signaling proteins (NF-κB, NLRP3, TLR4, MyD88). The SYRCLE tool was used to assess the risk of bias. RESULTS: Seventy-three studies were included. Meta-analysis showed that moxibustion significantly reduced arthritis severity (arthritis index: SMD -3.72, 95% CI -4.25 to -3.20; paw volume: SMD -4.59, 95% CI -5.54 to -3.63; histopathological score: SMD -2.24, 95% CI -2.80 to -1.67). Moxibustion also lowered the levels of pro-inflammatory cytokines: IL-1β (SMD -3.52, 95% CI -4.19 to -2.86), IL-6 (SMD -3.17, -4.17 to -2.16), and TNF-α (SMD -3.38, -3.97 to -2.79) and suppressed key signaling pathways, including NF-κB (SMD -2.29, 95% CI -3.20 to -1.37), NLRP3 (SMD -1.74, 95% CI -2.49 to -0.99), TLR4 (SMD -6.72, 95% CI -12.54 to -0.90), and MyD88 (SMD -9.16, 95% CI -15.28 to -3.04). CONCLUSION: This meta-analysis suggests that moxibustion alleviates arthritis severity and histopathological damage in RA animal models, potentially through modulating inflammatory networks and inhibiting key pathways such as NF-κB and NLRP3. These findings provide preclinical evidence supporting the rationale for future clinical investigation of moxibustion as a potential adjunct therapy for RA.
13 May 2026
Read appraisal →Current oncology reports
Physicians' Knowledge and Experiences of Counseling on Complementary, Alternative, and Integrative Medicine in Cancer Care: a Qualitative Systematic Review
PURPOSE OF REVIEW: The increasing use of complementary, alternative, and integrative medicine (CAIM) among patients with cancer raises questions about physicians' knowledge and counseling practices in this area. This qualitative systematic review used a narrative synthesis approach to explore physicians' understanding and experiences with CAIM counseling in cancer care. RECENT FINDINGS: A systematic search of MEDLINE, EMBASE, and AMED, supplemented by hand-searching reference lists, identified 35 eligible studies. Analysis revealed four key themes: limited knowledge and training on CAIM; concerns about CAIM safety and efficacy; recognition of CAIM's role in holistic cancer care; and challenges in patient-physician communication regarding CAIM. Physicians acknowledge the importance of CAIM in person-centered cancer care but express concerns about its safety and effectiveness, underscoring the need for improved CAIM education and training. Future research should include perspectives from medical trainees and other healthcare providers to enhance counseling practices and support integrative cancer care.
12 May 2026
Read appraisal →Journal of ethnopharmacology
Anti-inflammatory properties of Dendrobium: A systematic review of pharmacological mechanisms
ETHNOPHARMACOLOGICAL RELEVANCE: In Traditional Chinese Medicine (TCM), Dendrobium species have long been used to alleviate various inflammatory conditions, particularly those characterized by Yin deficiency with internal heat and stomach deficiency-heat, including impaired fluid production, stomach Qi dysfunction, and poor appetite. The inflammatory response is regulated by multiple signaling pathways that drive disease pathogenesis, making these pathways promising targets for anti-inflammatory therapy. Medicinal Dendrobium, enriched with anti-inflammatory bioactive constituents, exhibits substantial systemic anti-inflammatory activity. Its growing research interest stems from favorable properties such as low toxicity, broad therapeutic efficacy, and minimal risk of drug resistance. AIM OF THE STUDY: Medicinal Dendrobium and its bioactive constituents have demonstrated significant anti-inflammatory properties, underscoring their pharmacological potential. Nevertheless, substantial efforts remain an urgent priority to advance the translation of basic research findings into clinical applications. Therefore, pharmacological studies published within the past six years were systematically reviewed to elucidate the mechanisms by which Medicinal Dendrobium and its bioactive constituents modulate inflammatory processes, thereby evaluating their potential as multi-targeted natural anti-inflammatories. This will facilitate the translation of anti-inflammatory research on medicinal Dendrobium from basic research to clinical investigation, thereby laying a solid foundation for its eventual clinical application in managing inflammatory diseases. MATERIALS AND METHODS: A literature search and screening strictly followed the PRISMA 2020 guidelines and employed a predefined Boolean strategy. A comprehensive search was conducted across Web of Science, PubMed, Elsevier, ScienceDirect, Scopus, CNKI, Wanfang Data, Baidu Scholar, and Google Scholar. No language restrictions were applied; this review includes key findings from Chinese-language literature. The predefined keywords included "Dendrobium," "Shihu," "bioactive constituents," "anti-inflammatory," "cytokines," "signaling pathways," as well as their corresponding Chinese terms. Taxonomic validation was conducted using the World Flora Online (http://www.worldfloraonline.org) and the Medicinal Plant Names Services (http://mpns.kew.org) databases. RESULTS: Eight Medicinal Dendrobium species and their bioactive constituents-such as polysaccharides, alkaloids, flavonoids, bibenzyls, polyphenols and stilbenoids-exert anti-inflammatory effects by modulating multiple signaling cascades, including NF-κB, MAPK/NF-κB, TLR4/NF-κB, PI3K/AKT, Nrf2/HO-1, JAK/STAT, and AMPK/SIRT1 pathways, indicating their multi-target therapeutic potential for inflammatory diseases. This review further underscores the innovative role of Dendrobium in regulating these pathways and its potential for integration with conventional pharmacological treatments, supporting its synergistic use in precision medicine. CONCLUSIONS: Medicinal Dendrobium represents a promising ethnopharmacological resource, exhibiting broad-spectrum anti-inflammatory effects through multi-target, multi-pathway, and multi-organ mechanisms. To advance its modernization, therapeutic development, and clinical translation, future research should prioritize several key directions: establishing standardized quality control system and prioritizing the structures of core bioactive constituents; applying a multi-omics approach combined with artificial intelligence-assisted modeling, network pharmacology and advanced molecular imaging techniques to systematically map its systemic anti-inflammatory regulatory network; strengthening systematic pharmacokinetic and bioavailability studies; exploring precision and synergy delivery formulations; and conducting rigorous assessments of safety profiles and side-effect management. By focusing on these priorities, research can further elucidate the systemic anti-inflammatory mechanisms of medicinal Dendrobium, thereby bridging its traditional use with contemporary precision medicine, and supporting integrated interventions for complex inflammatory diseases.
12 May 2026
Read appraisal →Journal of ethnopharmacology
Advances in the pharmacology and mechanism of anti-skin aging in Tonifying Traditional Chinese Medicines
ETHNOPHARMACOLOGICAL RELEVANCE: According to the Traditional Chinese Medicine (TCM) tenet that "internal imbalances manifest externally," skin aging reflects deficiencies in qi, blood, and organ systems-particularly the liver and kidneys. Tonifying Traditional Chinese Medicines (TTCM) address these root causes, nourishing the skin and delaying aging through internal regulation, as documented in classical texts including the Shennong Ben Cao Jing and the Compendium of Materia Medica. AIM OF THE STUDY: This article systematically reviews the anti-skin-aging mechanisms of TTCM by integrating traditional applications with modern pharmacological evidence. It explores their multi-component, multi-target, and multi-pathway actions, evaluates current experimental models, and investigates the emerging role of artificial intelligence (AI) in advancing TTCM research. MATERIALS AND METHODS: We systematically searched PubMed, China National Knowledge Infrastructure (CNKI), Web of Science and Scopus for articles published from January 2015 to August 2025 with keywords such as "skin aging", "anti-aging" and the Latin names of TTCM (e.g. Panax ginseng, Astragalus membranaceus). Cellular, animal and clinical studies were analyzed for active constituents, molecular targets, ageing biomarkers and related signalling pathways. RESULTS: TTCM demonstrates anti-skin-aging effects through systemic regulation of organ function and qi-blood-yin-yang balance. At the molecular level, TTCM attenuates senescence through antioxidative, anti-inflammatory, extracellular matrix (ECM) stabilizing mechanisms, mediated by modulation of multiple pathways, such as Mitogen-Activated Protein Kinase (MAPK), Tumor Protein p53 (p53) and Nuclear factor erythroid 2-related factor 2 (Nrf2), exemplifying a "holistic regulation-targeted intervention" therapeutic paradigm. CONCLUSIONS: TTCM exerts anti-skin-aging effects through multi-component, multi-target and multi-pathway synergism. We strongly recommend the further integration of TTCM with modern medicine and in-depth mechanistic studies to promote translational applications.
12 May 2026
Read appraisal →European journal of heart failure
The efficacy and safety of qiliqiangxin according to baseline ejection fraction in patients with heart failure and reduced ejection fraction in QUEST.
AIMS: Qiliqiangxin (QLQX), a Chinese traditional medicine, improved outcomes in patients with heart failure and reduced ejection fraction (HFrEF) when added to guideline-directed therapy. As treatment effects in heart failure (HF) may vary with left ventricular ejection fraction (LVEF), this post hoc analysis of the QUEST (Qiliqiangxin in Heart Failure: Assessment of Reduction in Mortality) trial examined whether baseline LVEF modified the efficacy and safety of QLQX. METHODS: QUEST randomized 3110 patients with symptomatic HF and LVEF ≤40%. The primary outcome was cardiovascular death or first HF hospitalization. Baseline LVEF was categorized as ≤25% (n = 482), >25-30% (n = 692), >30-35% (n = 829), and >35% (n = 1107). RESULTS: Mean LVEF was 32% (median 33%, interquartile range 28%-37%). Patients with LVEF ≤25% had the highest rate of the primary outcome (25.4 per 100 patient-years), while rates were similar across higher LVEF groups (18.7-19.8). After multivariable adjustment, lower LVEF was independently associated with higher risks of the primary outcome and mortality. The effect of QLQX on the primary outcome was consistent across LVEF categories (hazard ratio [95% CI] from the lowest to highest: 0.91 [0.64-1.30], 0.65 [0.47-0.89], 0.94 [0.71-1.26], and 0.71 [0.55-0.91], respectively; Pinteraction = .28), and as a continuous variable (Pinteraction = .45). Similar results were observed for individual components and total HF hospitalizations (all Pinteraction > .10). The safety of QLQX was also consistent across LVEF categories. CONCLUSION: In patients with HFrEF, lower LVEF was associated with worse cardiovascular outcomes. QLQX reduced cardiovascular events consistently across the range of LVEF examined in QUEST, despite the limited use of sodium-glucose co-transporter 2 inhibitors. CHICTR REGISTRATION: ChiCTR1900021929.
10 May 2026
Read appraisal →Journal of ethnopharmacology
A multicenter, placebo-controlled clinical trial and preliminary experimental study exploring the efficacy of modified Banxia Xiexin Decoction in the treatment of advanced colorectal cancer
ETHNOPHARMACOLOGICAL RELEVANCE: Recent studies in China have increasingly focused on the evidence-based evaluation of malignant tumors, including colorectal cancer (CRC), leveraging the unique properties of herbal medicine. This has led to notable progress in the development of novel therapies. Clinical observations indicate that the modified Banxia Xiexin Decoction (mBXD) exhibits significant anti-cancer effects. However, well-designed clinical trials and foundational research in this field remain insufficient. AIMS OF THE STUDY: This study aims to assess the clinical efficacy and safety of mBXD in the treatment of advanced CRC, alongside preliminary in vivo and in vitro verification of its anti-CRC effects. METHODS: A clinical trial was conducted from October 2020 to October 2024 across 12 hospitals in Southwest China. Eligible participants were randomly assigned to either the mBXD group or the placebo group. Both groups received standard chemotherapy combined with targeted therapy; the mBXD group received mBXD granules (Ready-to-use), while the placebo group received a placebo. Treatment lasted for six months (six cycles). The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and serum tumor markers. Efficacy was assessed every two cycles, with follow-ups conducted every three months after treatment completion until disease progression or death. This study is registered with the Chinese Clinical Trial (No. ChiCTR2100041643). Basic research included the establishment of a subcutaneous CT26 colon cancer model and the use of the HCT116 cell line, with mBXD interventions to monitor tumor growth and evaluate the viability, invasion, and migration of HCT116 cells. RESULTS: A total of 129 participants were enrolled. Compared to the placebo group, the mBXD group showed a 1.9-month and 2.8-month extension in PFS and OS, respectively, with a 17 % reduction in the risk of disease progression and a 15 % reduction in the risk of death (P = 0.341, 0.465). After two, four, and six cycles, the ORR and DCR in the mBXD group were 3.7-12.6 % and 1.2-18.5 % higher than those in the placebo group, respectively, with only the DCR after six cycles reaching statistical significance (P = 0.037). Moreover, serum levels of CEA and CA724 were significantly reduced in the mBXD group after four and six cycles (P ≤ 0.05). No severe adverse events were reported during the trial. Additionally, mBXD significantly inhibited subcutaneous tumor growth after 14 days of treatment (P < 0.05), and its drug-containing serum notably suppressed the viability, migration, and invasion of HCT116 cells. CONCLUSIONS: mBXD demonstrates clinical efficacy in prolonging PFS and OS, stabilizing tumor lesions, and reducing serum tumor marker levels in advanced CRC patients. The treatment is both safe and well-tolerated. Furthermore, mBXD significantly inhibits the growth of subcutaneous CT26 colon cancer and suppresses the viability, invasion, and migration of HCT116 cells.
28 Apr 2026
Read appraisal →Journal of ethnopharmacology
Salvia plebeia R.Br.: A comprehensive review of its ethnopharmacology, phytochemistry, pharmacological activities, quality control, and current applications.
ETHNOPHARMACOLOGICAL RELEVANCE: Salvia plebeia R.Br. (Lamiaceae), the dried aerial parts, has been traditionally used across China and East/South Asia to treat sore throat, bronchitis, nephritis edema, abscesses, mastitis, hemorrhoids, and bleeding disorders, consistent with traditional indications of heat-clearing, detoxifying, cooling blood, and promoting diuresis. AIM OF THE REVIEW: This study provides a systematic overview of the ethnopharmacology, phytochemistry, pharmacological activities, quality control, and current applications of S. plebeia, while highlighting current research gaps and future perspectives. MATERIALS AND METHODS: A comprehensive literature search was conducted using multiple scientific databases, including Web of Science, PubMed, Elsevier, ACS, CNKI, and Google Scholar, covering publications from database inception to October 2025. Relevant information on the ethnopharmacology, phytochemistry, pharmacological activities, quality control, and applications of S. plebeia was systematically collected, screened, and synthesized according to predefined inclusion/exclusion criteria. RESULTS: To date, 325 constituents have been identified, dominated by flavonoids, phenolic acids, terpenoids, volatile oils, sterols, lignans, and others. Extracts and purified compounds show tradition-relevant anti-inflammatory, antiviral, immunoregulatory, and antioxidant activities, while other reported effects (hepatoprotective, hypolipidemic, cardiovascular-protective, sedative/anticonvulsant, anticancer, and anti-photoaging) are presented as exploratory findings. Quality evaluation evolved from UV and HPLC to UPLC-MS fingerprinting using flavonoids and sesquiterpenes as markers. In practical applications, S. plebeia has been used in medicinal preparations for the management of pharyngitis, bronchitis, nephritis, dermatitis, and anorectal inflammation. In food sector, it has been developed into functional products, including health teas, chewable or effervescent tablets, composite beverages, and co-fermented vinegars. CONCLUSION: Although S. plebeia shows broad pharmacological potential, current investigations remain constrained by incomplete chemical space coverage, limited pharmacokinetic and toxicological characterization, and insufficient well-designed clinical evidence. Future research should focus on comprehensive constituent profiling, mechanism-oriented validation aligned with traditional indications, standardized quality markers/fingerprints, and rigorous PK-toxicology-clinical translation, to promote safe, effective, and evidence-based utilization of S. plebeia in medicine and functional food development.
27 Apr 2026
Read appraisal →PloS one
Effects of peppermint (Mentha x piperita L.) oil on cardiometabolic outcomes in patients with pre- and stage 1 hypertension: A placebo randomized controlled trial.
Hypertension represents the predominant risk factor for cardiovascular disease morbidity and mortality; with significant healthcare utilization and expenditure. Pharmaceutical management is habitually adopted; although its long-term effectiveness remains ambiguous, and accompanying adverse effects are disquieting. Peppermint, which is rich in menthol and flavonoids, may exert potential benefits relevant to hypertension. This trial aimed to explore the effects of twice-daily peppermint oil supplementation in individuals with pre- and stage 1 hypertension. A 20 day, parallel randomized, placebo-controlled trial was adopted (NCT05561543). 40 individuals with pre- and stage 1 hypertension were randomly assigned to receive 100 μL per day of either peppermint oil or peppermint-flavoured placebo. The primary trial outcome was the between-group difference in systolic blood pressure from baseline to 20 days. Secondary outcome measurements were the between-group differences in anthropometric, haematological, diastolic blood pressure/resting heart rate, psychological wellbeing, and sleep efficacy indices. Statistical analysis was conducted on an intention-to-treat basis using baseline-adjusted linear regression models comparing post intervention values between trial arms with the corresponding baseline value entered as a covariate; adjusted mean differences (b), 95% confidence intervals, and effect sizes (d) were calculated. In relation to the primary outcome, adjusted systolic blood pressure at 20 days was significantly lower (b = -8.48 mmHg, 95% CI = -14.24 to -2.73, d = -0.94) in the peppermint trial arm (baseline = 130.05 mmHg, 20 days = 121.97 mmHg) than in placebo (baseline = 130.93 mmHg, 20 days = 131.05 mmHg). Loss to follow-up (N = 1) and adverse events (N = 1) were low, both occurring in the peppermint arm, and compliance was very high in the peppermint (93.3%) trial arm. Given the substantial health and economic burden associated with hypertension worldwide, these findings suggest that twice-daily peppermint supplementation may represent a simple, low-cost, and well-tolerated strategy to support blood pressure reduction in this population. Trial registration ClinicalTrials.gov NCT05561543.
27 Apr 2026
Read appraisal →PloS one
The stress reduction potential of Bhagavad Gita and Yoga for healthcare workers during the COVID-19 pandemic: A randomized controlled trial
BACKGROUND: Healthcare workers (HCWs) experienced elevated psychological distress during the COVID-19 pandemic. Culturally embedded, non-stigmatizing approaches may improve uptake of mental health support in this population. We aimed to evaluate the impact of Yoga, Bhagavad Gita learning, and their combination (Yoga+Gita) on psychological distress among HCWs. METHODS: We conducted a prospective, single-center, parallel-group randomized controlled trial at a secondary hospital in India. Eligible HCWs (>18 years, without pre-existing diagnosed mental health conditions) were randomized in a 1:1:1:1 ratio to: Yoga (daily 60-min sessions for one week), Gita (daily 60-min teaching of Bhagavad Gita Chapter 2 for one week), Yoga+Gita (30 min Yoga + 30 min Gita daily for one week), or Control (usual care). Psychological distress was assessed using the Generalized Anxiety Disorder-7 (GAD7) scale at baseline (B-GAD7), immediately post-intervention (IPI-GAD7), and 45 days post-intervention (DPI-GAD7). Participants were aware of group assignment, but data analysts were blinded. Group comparisons used Friedman and Kruskal-Wallis tests with Bonferroni-adjusted post-hoc analyses. We hypothesized that (1) all three interventions would reduce GAD-7 scores compared with control, (2) Gita would produce more durable effects than Yoga alone, and (3) the combined Yoga+Gita intervention would yield the greatest overall reduction in psychological distress. FINDINGS: Sixty-eight participants were enrolled (17 per group), with no losses to follow-up. B-GAD7 did not differ across groups (p = 0.908). Compared with Control, Yoga+Gita reduced anxiety immediately (p = 0.009), and Gita reduced anxiety at 45 days (p = 0.047). A clinically meaningful (≥4-point) GAD7 reduction at 45 days occurred in 17.6% (Yoga), 47.1% (Gita), 41.2% (Yoga+Gita), and 11.8% (Control) of the participants. Exploratory analyses suggested larger benefits among women and among those who continued practice. INTERPRETATION: Yoga and Gita-learning, particularly in combination, were associated with reductions in psychological distress among HCWs. TRIAL REGISTRATION: Prospectively registered with the CTRI (CTRI/2021/10/037365).
27 Apr 2026
Read appraisal →Journal of ethnopharmacology
Tianjing Zelan formula improves polycystic ovary syndrome by regulating steroid biosynthesis and arachidonic acid metabolism
ETHNOPHARMACOLOGICAL RELEVANCE: Polycystic ovary syndrome (PCOS) is a set of symptoms related to menstrual irregularities that can cause infertility in women of reproductive age. Unfortunately, there are currently no authorized treatment medications for PCOS. The Tianjing Zelan (TJZL) formula, a herbal formulation developed from the ancient Chinese medical classic Beiji Qianjin Yaofang in Tang Dynasty, is employed in the clinical management of menstrual irregularities and amenorrhea. However, its clinical characteristics and mechanism have not been systematically evaluated. AIM OF THE STUDY: To reveal the clinical characteristics and mechanisms of TJZL in treating PCOS. MATERIALS AND METHODS: A multicenter and single-arm clinical trial, and two PCOS models were used to evaluate the effectiveness of TJZL. The chemical constituents of TJZL were analyzed by UHPLC-QTOF-MS/MS. In addition, a combination of untargeted metabolomics and transcriptomics was used to reveal the complex therapeutic mechanisms of TJZL on PCOS. Subsequently, a metabolite-gene network analysis was performed to reveal potential differentially expressed genes associated with metabolites in PCOS patients. Key targets and pathways were further validated using quantitative real-time polymerase chain reaction (qRT-PCR), Western blot and immunohistochemistry in PCOS mice. Finally, molecular docking analysis was employed to explore the potential active ingredients of TJZL. RESULTS: Clinical trials provided evidence that TJZL significantly improved the menstrual cycle, sex hormone levels, and hyperandrogenic phenotypes, and reduced insulin resistance in PCOS patients. TJZL significantly improved the fertility, estrous cycle, ovarian morphology, sex hormone levels, and oral glucose tolerance in PCOS model. Transcriptomic and metabolomics results show that TJZL has a significant regulatory effect on metabolites and gene expression profiles in pathways such as steroid synthesis, arachidonic acid metabolism, and fatty acid metabolism. Utilizing metabolite-gene association analysis, We further verified that TJZL significantly improved the expression of genes and proteins related to the ovarian steroidogenesis and arachidonic acid metabolism pathways, including CYP17A1, CYP19A1, HSD17B3 and PTGS2. Furthermore, molecular docking results showed that berberine, rosmarinic acid and glycyrrhizinic acid in TJZL had strong affinity with PTGS2 in arachidonic acid metabolism, and hesperidin, naringin and liquiritin have strong affinity with CYP19A1 in steroid synthesis. CONCLUSION: TJZL exerts beneficial therapeutic effects on PCOS in both clinical and laboratory studies. TJZL improves PCOS by regulating multiple endogenous metabolites and correcting abnormal steroid synthesis and arachidonic acid metabolism in the ovaries. Our research provides a promising therapeutic agent for PCOS patients.
25 Apr 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Acupoint Stimulation After Anesthesia Induction Does Not Decrease Nausea and Vomiting After Hepatectomy: A Multi-Center Double-Blinded Clinical Trial
INTRODUCTION: This study evaluated whether adding transcutaneous electrical acupoint stimulation (TEAS) to a double-antiemetic regimen during hepatectomy reduces the incidence of postoperative nausea and vomiting (PONV). METHODS: In this multicenter double-blinded randomized controlled trial conducted across three tertiary hospitals in China, patients scheduled for elective hepatectomy were randomized to either the TEAS group (stimulation at PC6 during surgery) or the control group (no stimulation). The primary outcome was the incidence of PONV within 24 h postoperatively. Key secondary outcomes included the severity of PONV and pain after surgery. RESULTS: Among 161 randomized patients, 159 completed the study. No significant difference was observed in the incidence of PONV within 24 h postoperatively between the TEAS and control groups (23.8% vs. 26.6%; OR, 95% CI: 0.86, 0.42-1.76). However, the TEAS group exhibited less patient controlled analgesia (PCA) attempts (2.7 vs 3.5) or deliveries (2.6 vs 3.5) by 24 h postoperatively. Recovery outcomes, including time to ambulation and to gastrointestinal function recovery, did not differ between groups. CONCLUSION: Intraoperative TEAS did not significantly reduce PONV incidence in hepatectomy patients receiving antiemetic therapy. Nonetheless, its potential to decrease the need for analgesics warrants further investigation to refine its role in perioperative care. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov (NCT05396716), https://clinicaltrials.gov.
21 Apr 2026
Read appraisal →Blood pressure
Acupuncture for primary hypertension: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomised controlled trials (RCTs) published between 2015 and 2024. METHODS: We searched seven major databases for RCTs comparing acupuncture to control interventions. The primary outcomes were changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Meta-analyses utilised random-effects models, and the Cochrane Risk of Bias tool assessed study quality. RESULTS: Seven RCTs (n = 812) were included. Acupuncture was associated with lower SBP [mean differences (MD) = -6.73 mmHg, 95% confidence interval (CI): -8.84 to -4.62] and DBP (MD = -6.59 mmHg, 95% CI: -9.42 to -3.76). Heterogeneity was substantial for SBP (I2 = 73.3%) and considerable for DBP (I2 = 90.9%). Notably, the SBP analysis included seven studies, whereas the DBP analysis included six studies, and the similar absolute pooled reductions should be interpreted cautiously, given the small and not fully overlapping study sets. Exploratory subgroup analyses suggested blood pressure reductions across several acupuncture modalities, though each subgroup contained very few studies. Adverse-event reporting was limited and inconsistent across studies. Formal tests for publication bias were underpowered given the small number of included studies. CONCLUSIONS: Acupuncture may have blood pressure-lowering effects in patients with primary hypertension, but the evidence is limited by substantial heterogeneity, a small number of studies and considerable variation in intervention type and exposure. Larger, well-designed, multi-centre RCTs with standardised protocols and longer follow-up are needed to confirm these findings and establish optimal treatment parameters. High blood pressure (hypertension) is a major health concern worldwide. Acupuncture, a component of traditional Chinese medicine, has been used to manage blood pressure, but evidence of its effectiveness remains limited. This review examined seven recent randomised controlled trials involving 812 participants to assess whether acupuncture reduces blood pressure in people with primary hypertension. The findings suggest that acupuncture may reduce both systolic and diastolic blood pressure; however, the included studies were few and varied considerably in the type of acupuncture used, the number of treatment sessions (ranging from a single session to 60 sessions over 12 weeks) and the populations studied. Reported side effects were minor, such as temporary pain at the needle site, though safety reporting was incomplete. Therefore, while the results are encouraging, they are not definitive. Further large-scale, rigorously designed trials are needed before firm conclusions can be drawn about the role of acupuncture in hypertension management.
20 Apr 2026
Read appraisal →Pharmaceutical biology
Valeriana species and insomnia: multi-organ mechanisms and translational perspectives.
CONTEXT: Insomnia is a common sleep disorder that substantially impairs quality of life. Conventional treatments, including cognitive behavioral therapy and pharmacological agents, are often limited by side effects and insufficient long-term safety data. Valeriana species, such as Valeriana officinalis L. and Valeriana jatamansi Jones, have been traditionally used for their sedative and neuroprotective properties. OBJECTIVE: This review evaluates the therapeutic potential of Valeriana species for insomnia, emphasizing their pharmacological mechanisms, multi-organ effects, and evidence from preclinical and clinical studies. METHODS: A systematic literature search was performed in databases including PubMed and Web of Science. Studies addressing Valeriana-induced sleep regulation, neurotransmitter modulation, oxidative stress reduction, and neural, hepatic, and gastrointestinal interactions were included to assess efficacy and safety. RESULTS: Valeriana species modulate neurotransmission, mitigate oxidative stress, and influence hepatic and gastrointestinal functions. Preclinical studies support their sedative and neuroprotective effects, while clinical outcomes vary with formulation, dosage, and individual response. Overall, safety profiles are favorable, though inconsistencies remain. CONCLUSION: Valeriana species represent a promising multi-target strategy for insomnia, integrating neural and peripheral pathways. Future research should clarify the mechanisms underlying multi-organ effects, optimize formulations, and conduct rigorous clinical trials to establish standardized, effective, and safe interventions.
19 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
The effectiveness of electroacupuncture in the treatment of cancer-related fatigue: a systematic review
INTRODUCTION: Cancer-related fatigue (CRF) is a frequent, subjective, and difficult-to-manage symptom, for which few interventions have proven effective. Recent evidence suggests that electroacupuncture (EA) can reduce fatigue, although specific studies on this technique remain scarce. OBJECTIVE: To evaluate the efficacy of EA in treating CRF in cancer patients. METHODS: A systematic review registered in PROSPERO was conducted, including clinical trials assessing the effects of EA in patients with CRF. Searches were performed in the PubMed, Embase, Virtual Health Library, Scopus, and CAPES databases, with no restrictions on date, language, sex, ethnicity, or type of cancer. We assessed the methodological quality using the PEDro scale and evaluated the risk of bias using the RoB-2 tool. RESULTS: A total of 2,110 studies were identified. After applying inclusion criteria, five trials were included: three randomized, one non-randomized, and one single-arm clinical trial. In total, 251 patients were analyzed, 132 of whom received EA treatment. Interventions varied from two to three weekly sessions, each lasting 20 to 30 minutes, over a period of four to eight weeks. Acupuncture points and electrical frequencies (0.2-25 Hz) differed between studies. Outcomes were measured by the Brief Fatigue Inventory, Functional Assessment of Cancer Therapy - Fatigue, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Despite the potential benefits observed in EA-treated groups, the findings remain inconsistent. CONCLUSION: EA shows promising therapeutic potential for managing CRF. However, the small number of studies, methodological heterogeneity, and small sample sizes limit generalizability. Multicenter clinical trials with larger samples and standardized protocols are needed to confirm efficacy.
16 Apr 2026
Read appraisal →Journal of affective disorders
The effects of Omega-3 supplementation on stress, anxiety, depression, sleep quality, and everyday memory in individuals with psychological distress: A randomized, double-blind, placebo-controlled trial
BACKGROUND/OBJECTIVES: Psychological stress, anxiety, depression, memory impairment, and poor sleep quality are prevalent issues that affect individuals' quality of life and overall health. Omega-3 polyunsaturated fatty acids (PUFAs) have been suggested to have mood-regulating effects. However, there is lack of data on the effect of omega-3 supplementation on depression, stress, anxiety, everyday memory, and sleep quality on Saudi population. Therefore, this study aimed to evaluate the impact of omega-3 supplementation on stress, anxiety, depression, everyday memory, and sleep quality in individuals with severe psychological distress. METHODS: A randomized, double-blind, placebo-controlled trial was conducted involving 64 participants with high levels of stress, anxiety, depression, memory issues and with poor quality of sleep with 32 allocated to the intervention group and 32 to the control group. The participants received either omega-3 supplementation (500 mg EPA + 250 mg DHA) or a placebo daily for three months. Pre- and post-intervention assessments were conducted using validated scales, including the Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Everyday Memory Questionnaire (EMQ). RESULTS: Significant improvements were observed in the intervention group regarding stress, anxiety, depression, sleep quality, and memory outcomes (p < 0.001 for PSS, GAD-7, PHQ-9, PSQI, and EMQ). Between-group comparisons showed statistically significant reductions in post-intervention scores for the intervention group versus the control group. Regression analysis revealed strong predictive relationships between pre- and post-scores, particularly for stress and depression. CONCLUSIONS: Omega-3 supplementation resulted in notable psychological and cognitive improvements, suggesting its potential as a safe and effective adjunct for managing stress, mood disorders, and sleep disturbances among participants with psychological distress. Further research should explore how individual responses are influenced by baseline inflammation and omega-3 status. CLINICALTRIALS: gov: NCT07157241.
16 Apr 2026
Read appraisal →Food & function
Metabolic and inflammatory effects of oleuropein and olive leaf extract: a systematic review and meta-analysis
Background: Olive leaves, a by-product of olive oil production, are rich in oleuropein, a phenolic compound with antioxidant and anti-inflammatory properties. This systematic review and meta-analysis evaluated the effects of olive leaf extract (OLE) and oleuropein on glucose metabolism, lipid profile, and inflammatory markers in randomized clinical trials (RCTs). Methods: The review was registered in PROSPERO (CRD42022375615) and followed PRISMA guidelines. PubMed, Scopus, and Web of Science were searched up to January 2026 without restrictions. Eligible studies were RCTs in adults comparing OLE or oleuropein with placebo or control. Study selection, data extraction, and risk of bias (RoB 2) assessment were performed independently by two reviewers; certainty of evidence was assessed with GRADE. Meta-analyses were conducted when at least two trials reported suitable data. Results: Eleven RCTs were included (4 short-term and 7 continuous-intake trials). Short-term crossover studies showed heterogeneous effects on postprandial glycemia and insulin responses, precluding meta-analysis. In continuous-intake, parallel-design RCTs, pooled analyses demonstrated no statistically or clinically significant effects on glycemic or lipid outcomes. Evidence regarding inflammatory markers was scarce and of low certainty. Conclusion: The current evidence does not support clinical recommendations for OLE supplementation aimed at health benefits. Data from methodologically consistent and robust trials indicate no statistically significant metabolic or inflammatory effects under usual human consumption patterns, whereas evidence from other study designs remains inconclusive. Further high-quality RCTs are required to clarify potential metabolic benefits.
15 Apr 2026
Read appraisal →Analytica chimica acta
Point-of-need and portable sensing strategies for quality and safety assessment of Traditional Chinese Medicine products: A critical analytical review.
Sensor technology has emerged as a transformative tool for point-of-need and portable quality control and safety assessment of Traditional Chinese Medicine (TCM) products. Although separation and detection technologies have improved, there is still a strong need to critically evaluate the entire analytical workflow from sample preparation to data interpretation to meet regulatory and routine monitoring requirements. This review critically evaluates the complete analytical workflow, from sample pretreatment to intelligent data interpretation, necessary to bridge the gap between laboratory prototypes and real-world deployment. Additionally, it provides a systematic summary of the mechanisms and applications of common types of sensors, utilising nanomaterials and molecular recognition elements to overcome the specific challenge of complex TCM matrices. A particular focus is placed on the emerging roles of Artificial Intelligence (AI) and Machine Learning (ML) in resolving high-dimensional spectral data and enhancing pattern recognition accuracy. Furthermore, we critically analyze current bottlenecks, including matrix interference, the lack of standardized validation protocols, and the reliability of portable devices in uncontrolled environments. Future directions are highlighted towards the development of self-validating, cloud-integrated (IoT), and eco-friendly sensing systems, aiming to support the global standardization and safety assurance of TCM products.
9 Apr 2026
Read appraisal →Journal of ethnopharmacology
Unveiling the genus Taraxacum: From folk medicine to chemodiversity-driven pharmacological and toxicological outcomes-A systematic review
ETHNOPHARMACOLOGICAL RELEVANCE: The genus Taraxacum (dandelion), belonging to the Asteraceae family, encompasses over 2800 species predominantly found in temperate to subtropical regions of the Northern Hemisphere. Dandelion has a long history as a functional food and traditional medicine in numerous countries, including China, Turkey, Spain, Italy, etc. Traditional application records indicate that dandelion might be used extensively to treat kidney stones, constipation, eczema, ulcers, inflammation, etc. However, the therapeutic application of different Taraxacum species varies significantly across regions, which may be influenced by local cultural and medical traditions. AIM OF THE REVIEW: This review provides a comprehensive summary of recent advancements in traditional applications, phytochemistry (highlighting 184 newly identified compounds), pharmacology, and toxicology, offering novel insights into both genus-wide characteristics of Taraxacum (covering 55 species) and species-specific differences. MATERIALS AND METHODS: A comprehensive search for relevant data was conducted using keywords such as "Taraxacum", "dandelion", "Taraxaci Herba", "pu gong ying", and others across multiple scientific databases, including Google Scholar, Web of Science, PubMed, ScienceDirect, Baidu Scholar, CNKI, online ethnobotanical databases, ethnobotanical monographs, The Plant List, Dictionary of Chinese Ethnic Medicine and considered data from 1972 to 2025. World Flora Online (http://www.worldfloraonline.org/) was utilized for confirming the correct species names of Taraxacum genus. The gathered information on the ethnobotanical usages, phytochemistry, pharmacology, and toxicology is comprehensively summarized in this paper. RESULTS: The literature review indicates that dandelion, a medicinal and edible plant, has been extensively utilized in traditional Chinese medicine since the 7th century. In Europe, its edible and medicinal properties began to be acknowledged and applied during the Middle Ages. In ethnomedical practice, dandelion has been used as diuretic, laxative, anti-inflammatory remedy, digestive aid, etc. Building on the 197 compounds reported from T. officinale, this review highlights over 180 newly identified compounds from 19 Taraxacum species, expanding the genus-wide catalog to more than 380 constituents. Recent toxicological and safety evaluations corroborate that T. officinale F.H.Wigg., T. mongolicum Hand.-Mazz., and T. lacistrum Sahlin possess a favorable safety profile. CONCLUSIONS: The genus Taraxacum is a promising medicinal and edible plant, exhibiting a range of biological activities, including anti-cancer, anti-inflammatory, and antioxidant effects. These properties align with its ethnobotanical usages, confirming its traditional use as diuretic, laxative, anti-inflammation, and digestive aid. However, research on its effects on neurodegenerative and cardiovascular diseases remains limited. Future studies should focus on in vivo experiments to explore the material basis and mechanisms underlying the therapeutic effects of dandelion species. Furthermore, current phytochemical and pharmacological research has overlooked several Taraxacum species with well-documented traditional uses. Investigating these understudied species is essential to fully elucidate the potential therapeutic value of the genus Taraxacum.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Efficacy of Yuxintong capsule on cardiorespiratory fitness in patients with stable coronary heart disease: A multicentre, randomized, double-blind, placebo-controlled, parallel-group clinical trial
ETHNOPHARMACOLOGICAL RELEVANCE: Yuxintong capsule, a traditional Chinese patent medicine, has been widely used in the treatment of coronary heart disease (CHD). However, whether it can improve cardiopulmonary fitness (CRF) in patients with CHD remains unclear. AIM OF THE STUDY: To evaluate the efficacy and safety of Yuxintong capsule in CRF in patients with stable CHD. MATERIALS AND METHODS: A multicentre, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in 13 hospitals in China from March 2021 to November 2021, and 404 patients with stable CHD were randomly assigned to receive either Yuxintong capsule and conventional Western medicine (Yuxintong group) or placebo and conventional Western medicine (placebo group) in a 1:1 ratio for 12 weeks (ChiCTR2000041293, December 23, 2020). The primary outcomes were peak oxygen uptake (VO2peak) and anaerobic threshold (AT). The secondary outcomes were metabolic equivalents (METs), duration and onset time of 1-mm ST-segment depression on electrocardiography (ECG), and 36-Item Short Form Health Survey (SF-36) scores. The main safety indicators included complete blood count, urinalysis, liver function, renal function, coagulation function, and 12-lead electrocardiogram. And adverse events were recorded throughout the trial. RESULTS: 369 patients, 187 in the Yuxintong group and 182 in the placebo group, were finally included for analysis. Compared with placebo group, 12-week treatment with Yuxintong showed an improvement in AT (0.98 ± 2.88 vs. 0.12 ± 2.79 mL kg-1·min-1; LSMD, 0.80 [95 % CI: 0.28 to 1.32]; P < 0.025), and general health (13.61 ± 15.13 vs. 8.29 ± 14.14; LSMD 5.30, [95 % CI: 2.33 to 8.31]; P < 0.05) and vitality scores (12.46 ± 11.32 vs. 6.01 ± 11.41; LSMD 6.43, [95 % CI: 4.13 to 8.31]; P < 0.05) on SF-36 scale. The other outcomes did not significantly differ between the two groups. The adverse events were similar between the two groups. CONCLUSIONS: Yuxintong capsule, as an adjunctive therapy to conventional treatment, improved AT, and general health and vitality scores on SF-36 scale in patients with stable CHD. However, the improvements in VO2peak, METs, and the duration and onset time of 1-mm ST-segment depression on ECG were not statistically significant.
6 Apr 2026
Read appraisal →Journal of ethnopharmacology
Efficacy and safety of Qiliqiangxin capsule as adjunctive therapy in heart failure with reduced ejection fraction: A systematic review and meta-analysis of randomized controlled trials
ETHNOPHARMACOLOGICAL RELEVANCE: The Qiliqiangxin (QLQX) capsule is a prominent traditional Chinese medicine formulation developed based on the collateral disease theory, specifically for the treatment of heart failure (HF). Its composition includes 11 medicinal botanicals, such as Huang Qi, Ren Shen, and Dan Shen, and is designed to tonify qi, activate blood circulation, and promote diuresis. Supported by over 20 years of extensive clinical application, modern pharmacological research, and stringent quality control, QLQX has been incorporated into the national heart failure guidelines in China. AIM OF THE STUDY: This study evaluates the efficacy and safety of QLQX as adjunctive therapy for heart failure with reduced ejection fraction (HFrEF). METHODS: We systematically searched seven databases until February 24, 2025, for randomized controlled trials (RCTs) evaluating QLQX in patients with HFrEF. Two independent researchers screened trials, extracted data, and assessed the risk of bias using the Cochrane RoB 2.0 tool. Meta-analyses were conducted for efficacy and safety outcomes, with evidence quality evaluated through the GRADE framework. RESULTS: Twenty-four RCTs (n = 5580) were included. Compared with conventional treatments (CTs) alone, QLQX adjunctive therapy significantly reduced the risk of cardiovascular death (RR = 0.82, 95 %CI [0.69, 0.96], P = 0.02), hospitalization for HF (RR = 0.78, 95 %CI [0.67, 0.91], P = 0.001), and composite cardiovascular events by 18 % (RR = 0.82, 95 %CI [0.73, 0.92], P = 0.0005), with evidence quality rated as moderate. QLQX significantly improved cardiac function parameters compared to controls: increased left ventricular ejection fraction (MD = 7.14, 95 % CI [6.75, 7.54], P < 0.05), reduced left ventricular end-diastolic diameter (MD = -5.25, 95 % CI [-5.75, -4.75], P < 0.05), improved NYHA class (RR = 1.19, 95 %CI [1.14, 1.25]), decreased NT-proBNP (SMD = -2.01, 95 %CI [-2.26, -1.95], P < 0.05), and increased 6-min walking distance (MD = 44.80, 95 %CI [42.37, 47.22], P < 0.05). CONCLUSION: QLQX adjunct therapy effectively reduces cardiovascular death and HF hospitalization while improving cardiac function in HFrEF, with favorable safety. Large-scale multicenter RCTs with extended follow-up are required to confirm long-term benefits and address existing study limitations.
6 Apr 2026
Read appraisal →Journal of computer-aided molecular design
Identification of potential inhibitors of 3‑mercaptopyruvate sulfurtransferase with a deep-learning based screening of natural products
3-Mercaptopyruvate sulfurtransferase (3-MST), a key enzyme in sulfur metabolism, has recently gained attention as a potential anticancer target. However, reported 3-MST inhibitors remain limited, motivating the exploration of new scaffolds such as natural products. In this study, a library of 3744 natural products was virtually screened against human 3-MST using DiffDock (diffusion-model-based docking) followed by AutoDock Vina docking. Top-ranking candidates were further analyzed via molecular dynamics simulations and Molecular Mechanics Poisson-Boltzmann Surface Area binding free energy calculations. Methylophiopogonanone A (4), Daphnoretin (5), and L-asarinin (9) exhibited stable binding with favorable energetics, displaying binding free energies comparable to the reference ligand 7NC301. Binding mode analyses revealed that Methylophiopogonanone A primarily engaged in hydrophobic interactions, whereas Daphnoretin and L-asarinin formed extensive polar contacts, accompanied by higher desolvation penalties. In vitro cytotoxicity assays showed that Methylophiopogonanone A and L-asarinin reduced HCT116 cell viability by 40.3% and 26.3% at 25 µM, which is consistent with their inhibitory of 3-MST with IC50 = 5.83 ± 0.69 µM and IC50 = 19.11 ± 3.37 µM, respectively. These results suggested that the natural products identified in this study represent promising scaffolds for further optimization as potential 3-MST inhibitors. This work provides an AI-guided natural-product screening workflow for 3-MST and delivers prioritized inhibitor scaffolds for subsequent optimization and experimental validation.
6 Apr 2026
Read appraisal →Medicine
Effectiveness of mindfulness-based stress reduction in managing fatigue, anxiety, and depression among non-small cell lung cancer patients receiving surgery and adjuvant chemotherapy: A randomized controlled trial
BACKGROUND: Non-small cell lung cancer (NSCLC) patients undergoing surgery and adjuvant chemotherapy often experience debilitating physical and psychological symptoms, including cancer-related fatigue, anxiety, and depression. Mindfulness-based stress reduction (MBSR) has emerged as a complementary intervention to alleviate these burdens and enhance quality of life, but evidence in NSCLC populations remains limited. METHODS: This randomized controlled trial enrolled 80 NSCLC patients, evenly divided into an MBSR group and a Control group. The MBSR group underwent an 8-week mindfulness program, while the Control group received standard care. Outcomes, including fatigue (Piper Fatigue Scale), anxiety (Self-Rating Anxiety Scale), depression (Self-Rating Depression Scale), self-efficacy (General Self-Efficacy Scale), and mindfulness awareness (Mindful Attention Awareness Scale), were assessed at 4 time points: baseline (before surgery), at the fourth week (before chemotherapy), and at 1 and 3 months post-intervention. Statistical analyses included repeated-measures ANOVA and t tests to evaluate group differences. RESULTS: The MBSR group demonstrated significant improvements across all outcomes compared to the Control group. Fatigue levels in the MBSR group peaked at the fourth week but returned close to baseline levels by 3 months post-intervention, while the Control group maintained elevated fatigue scores (P < .05). Anxiety (Self-Rating Anxiety Scale) and depression (Self-Rating Depression Scale) scores significantly decreased in the MBSR group by the fourth week and continued to improve at subsequent time points (P < .01). Self-efficacy (General Self-Efficacy Scale) and mindfulness awareness (Mindful Attention Awareness Scale) showed consistent improvements in the MBSR group, with significant differences evident at 1 and 3 months post-intervention (P < .01). CONCLUSIONS: Mindfulness-based stress reduction effectively reduced fatigue, anxiety, and depression while enhancing self-efficacy and mindfulness awareness in NSCLC patients undergoing surgery and chemotherapy. These findings support the integration of mindfulness-based interventions into routine care to improve patient well-being during and after treatment.
5 Apr 2026
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