Traditional Chinese medicine treatment for COVID-19: An overview of systematic reviews and meta-analyses

Shining light on knee osteoarthritis: an overview of vitamin D supplementation studies

Background

The impact of knee osteoarthritis on individuals' daily functioning is significant. In recent years, Vitamin D supplements cure osteoarthritis has garnered attention from medical professionals and patients due to its simplicity and portability. Several systematic reviews (SRs) and meta-analyses (MAs) have examined the efficacy of vitamin D supplementation for knee osteoarthritis, yet there is variability in their methodology and quality.

Objective

To search, gather, and analyze data on the characteristics and quantitative results of SR/MA in patients with KOA treated with Vitamin D supplementation, and objectively evaluate the efficacy of supplements. Then, provides clinical evidence and recommendations the clinical use of vitamin D supplementation.

Methods

Two individuals reviewed and collected data from four databases until October 2023. AMSTAR-2, ROBIS, PRISMA 2020, and GRADE tools were used to evaluate the methodological quality, bias risk, reporting quality, and evidence strength of all SR/MA. Additionally, we applied the corrected covered area (CCA) method to measure overlap in randomized controlled trials (RCTs) cited among the SR/MA.

Results

3 SRs and 6 MAs were included in the analysis: 3 studies were low quality by AMSTAR-2, and 6 studies were very low quality. According to ROBIS, 6 studies were high-risk and 3 were low-risk. In PRISMA 2020 reporting quality, most studies showed deficiencies in comprehensive literature search strategy, reasons for literature exclusion, data preprocessing for meta-analysis, exploration of reasons for heterogeneity, sensitivity analysis, publication bias, and disclosure of funding and conflicts of interest. Grading the quality of evidence in GRADE consisted of 5 items of moderate quality, 14 items of low quality, and 10 items of very low quality. Bias risk and imprecision were the main factors for downgrading. The calculation of RCT overlap between SR/MA using CCA showed a high degree of overlap.

Conclusion

Vitamin D supplementation may show potential efficacy in ameliorating symptoms of KOA. The evidence indicates that Vitamin D supplements for knee osteoarthritis can improve patients' Total WOMAC scores and synovial fluid volume in the joints. Nevertheless, due to the generally low quality of current studies, future research should prioritize improving the quality of primary studies to establish the efficacy of vitamin D supplementation for KOA with more robust scientific evidence.

Systematic review registration

The protocol of this overview was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (https://www.crd.york.ac.uk/PROSPERO/) with the registration number CRD42024535841.

Traditional Chinese Medicine for Viral Pneumonia Therapy: Pharmacological Basis and Mechanistic Insights

Different respiratory viruses might cause similar symptoms, ranging from mild upper respiratory tract involvement to severe respiratory distress, which can rapidly progress to septic shock, coagulation disorders, and multiorgan failure, ultimately leading to death. The COVID-19 pandemic has shown that predicting clinical outcomes can be challenging because of the complex interactions between the virus and the host. Traditional Chinese medicine (TCM) has distinct benefits in the treatment of respiratory viral illnesses due to its adherence to the principles of "different treatments for the same disease" and "same treatment for different diseases". This paper examines the effectiveness and underlying mechanisms of key TCM treatments for viral pneumonia in recent years. The aim of this study was to discover and confirm the active substances of TCM with potential therapeutic effects on viral pneumonia and their integrative effects and synergistic mechanisms and to provide a scientific basis for elucidating the effectiveness of TCM treatment and drug discovery. Furthermore, a thorough analysis of previous research is necessary to evaluate the effectiveness of TCM in treating viral pneumonia.

Use of integrative and complementary practices in Brazil during the COVID-19 pandemic

The SARS-CoV-2 coronavirus pandemic posed an unprecedented challenge to global health. In the context of an overwhelmed healthcare system and the rising demand for alternative strategies to manage stress and anxiety, this study aims to investigate and analyze the use of Integrative and Complementary Practices (ICP) in Brazil during the COVID-19 pandemic, emphasizing their importance in promoting health and well-being. We conducted a cross-sectional study among n = 12,136 Brazilian adults predominantly female, white, under 40 years of age and with a predominantly higher education level between August 24 and December 16, 2020, to assess the use of ICP. An online questionnaire was applied, with questions validated in previous health surveys. The sampling method employed was 'virtual snowball,' post-stratification procedures were used to consider the Brazilian regions, gender, age group, and educational level. The reported prevalence of ICP use was 61.8%, with meditation (28.2%), Reiki (21.7%), herbal medicine (28.2%), and aromatherapy (16.5%) being the most utilized practices. ICPs were more frequently adopted by females, older age groups, individuals with health insurance, and those who practiced social distancing. Health promotion and well-being were the primary reasons for engaging in ICP. The high adherence to ICP during the COVID-19 pandemic in Brazil reflects the population's search for therapeutic alternatives focused on the well-being and mental health. The utilization of ICP indicates the need to integrate these practices into healthcare systems, considering their potential to complement conventional treatment, especially in times of crisis. Public health policies should recognize and facilitate access to such practices to reduce inequities and promote integrative health. This study contributes to the understanding of the role of ICP in a public health crisis, encouraging further investigation into the potential inclusion of these practices in the healthcare system.

Interferon Point Alteration in Hospitalized Patients with and Without COVID-19

Introduction

Integrating traditional Chinese medicine with Western medicine has been extensively studied in managing respiratory disease. Therefore, in this study, we aimed to examine interferon point alteration (IPA) and its association with disease severity in patients with COVID-19.

Methods

This cross-sectional study was conducted on patients hospitalized due to COVID-19 with lung involvement. The control group consisted of patients hospitalized with a diagnosis other than COVID-19. The prevalence of IPA was compared between patients with and without COVID-19. Clinical and laboratory findings were compared in patients with and without IPA.

Results

A total of 126 participants, with a mean (SD) age of 57.2 (16.4) years, were included in this study. 54.8% of participants were men. There was a significant difference between patients with and without COVID-19 regarding the frequency of IPA (p = 0.045). No significant differences were observed between variables in patients with and without IPA (p ≥ 0.05). The only variable that could significantly predict the IPA in COVID-19 patients was the severity score of lung involvement in HRCT (OR: 5.32, 95% CI: 1.08-26.05, p = 0.039). IPA showed a sensitivity and specificity of 80.9% and 34.9% in identifying COVID-19 patients, respectively.

Conclusion

Our study found a significant association between IPAs and the severity of lung involvement in hospitalized COVID-19 patients and a significant association of COVID-19 with IPAs.

Evaluating deep learning techniques for identifying tongue features in subthreshold depression: a prospective observational study

Objective

This study aims to evaluate the potential of using tongue image features as non-invasive biomarkers for diagnosing subthreshold depression and to assess the correlation between these features and acupuncture treatment outcomes using advanced deep learning models.

Methods

We employed five advanced deep learning models-DenseNet169, MobileNetV3Small, SEResNet101, SqueezeNet, and VGG19_bn-to analyze tongue image features in individuals with subthreshold depression. These models were assessed based on accuracy, precision, recall, and F1 score. Additionally, we investigated the relationship between the best-performing model's predictions and the success of acupuncture treatment using Pearson's correlation coefficient.

Results

Among the models, SEResNet101 emerged as the most effective, achieving an impressive 98.5% accuracy and an F1 score of 0.97. A significant positive correlation was found between its predictions and the alleviation of depressive symptoms following acupuncture (Pearson's correlation coefficient = 0.72, p<0.001).

Conclusion

The findings suggest that the SEResNet101 model is highly accurate and reliable for identifying tongue image features in subthreshold depression. It also appears promising for assessing the impact of acupuncture treatment. This study contributes novel insights and approaches to the auxiliary diagnosis and treatment evaluation of subthreshold depression.

Exploring the mechanism of agarwood moxa smoke in treating sleep disorders based on GC-MS and network pharmacology

Background

Agarwood moxibustion is a folk therapy developed by individuals of the Li nationality in China. There is evidence that agarwood moxa smoke (AMS) generated during agarwood moxibustion therapy can treat sleep disorders via traditional Chinese medicines' multiple target and pathway characteristics. However, the specific components and mechanisms involved have yet to be explored.

Objective

GC-MS (Gas Chromatography-Mass Spectrometry) and network pharmacology were used to investigate AMS's molecular basis and mechanism in treating sleep deprivation.

Method

GC-MS was used to determine the chemical composition of AMS; component target information was collected from TCMSP (Traditional Chinese Medicine Systems Pharmacology), PubChem (Public Chemical Database), GeneCards (Human Gene Database), and DisGeNet (Database of Genes and Diseases) were used to identify disease targets, and JVenn (Joint Venn) was used to identify the common targets of AMS and sleep disorders. STRING was used to construct a protein interaction network, Cytoscape 3.9.1 was used to build a multilevel network diagram of the "core components-efficacy targets-action pathways," the targets were imported into Metascape and DAVID for GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) analyses and Autodock was used for molecular docking. This research used a network pharmacology methodology to investigate the therapeutic potential of Agarwood Moxa Smoke (AMS) in treating sleep problems. Examining the target genes and chemical constituents of AMS offers insights into the molecular processes and targets of the disease.

Result

Nine active ingredients comprising anti-inflammatory substances and antioxidants, such as caryophyllene and p-cymene, found seven sleep-regulating signaling pathways and eight targets linked to sleep disorders. GC-MS was used to identify the 94 active ingredients in AMS, and the active ingredients had strong binding with the key targets. Key findings included active components with known medicinal properties, such as p-cymene, eucalyptol, and caryophyllene. An investigation of network pharmacology revealed seven signaling pathways for sleep regulation and eight targets linked to sleep disorders, shedding light on AMS's effectiveness in enhancing sleep quality.

Conclusion

AMS may alleviate sleep disorders by modulating cellular and synaptic signaling, controlling hormone and neurotransmitter pathways, etc. Understanding AMS's material basis and mechanism of action provides a foundation for future research on treating sleep disorders with AMS. According to the study, Agarwood Moxa Smoke (AMS) may improve sleep quality by modifying cellular and synaptic signaling pathways for those who suffer from sleep problems. This might lead to the development of innovative therapies with fewer side effects.

Exploring the Molecular Mechanism of Niuxi-Mugua Formula in Treating Coronavirus Disease 2019 via Network Pharmacology, Computational Biology, and Surface Plasmon Resonance Verification

BACKGROUND

In China, Niuxi-Mugua formula (NMF) has been widely used to prevent and treat coronavirus disease 2019 (COVID-19). However, the mechanism of NMF for treating COVID-19 is not yet fully understood.

OBJECTIVE

This study aimed to explore the potential mechanism of NMF for treating COVID- 19 by network pharmacology, computational biology, and surface plasmon resonance (SPR) verification.

MATERIALS AND METHODS

The NMF-compound-target network was constructed to screen the key compounds, and the Molecular Complex Detection (MCODE) tool was used to screen the preliminary key genes. The overlapped genes (OGEs) and the preliminary key genes were further analyzed by enrichment analysis. Then, the correlation analysis of immune signatures and the preliminary key genes was performed. Molecular docking and molecular dynamic (MD) simulation assays were applied to clarify the interactions between key compounds and key genes. Moreover, the SPR interaction experiment was used for further affinity kinetic verification.

RESULTS

Lipid and atherosclerosis, TNF, IL-17, and NF-kappa B signaling pathways were the main pathways of NMF in the treatment of COVID-19. There was a positive correlation between almost the majority of immune signatures and all preliminary key genes. The key compounds and the key genes were screened out, and they were involved in the main pathways of NMF for treating COVID-19. Moreover, the binding affinities of most key compounds binding to key genes were good, and IL1B-Quercetin had the best binding stability. SPR analysis further demonstrated that IL1B-Quercetin showed good binding affinity.

CONCLUSION

Our findings provided theoretical grounds for NMF in the treatment of COVID-19.

WGCNA combined with machine learning to find potential biomarkers of liver cancer

The incidence of hepatocellular carcinoma (HCC) has been increasing in recent years. With the development of various detection technologies, machine learning is an effective method to screen disease characteristic genes. In this study, weighted gene co-expression network analysis (WGCNA) and machine learning are combined to find potential biomarkers of liver cancer, which provides a new idea for future prediction, prevention, and personalized treatment. In this study, the "limma" software package was used. P < .05 and log2 |fold-change| > 1 is the standard screening differential genes, and then the module genes obtained by WGCNA analysis are crossed to obtain the key module genes. Gene Ontology and Kyoto Gene and Genome Encyclopedia analysis was performed on key module genes, and 3 machine learning methods including lasso, support vector machine-recursive feature elimination, and RandomForest were used to screen feature genes. Finally, the validation set was used to verify the feature genes, the GeneMANIA (http://www.genemania.org) database was used to perform protein-protein interaction networks analysis on the feature genes, and the SPIED3 database was used to find potential small molecule drugs. In this study, 187 genes associated with HCC were screened by using the "limma" software package and WGCNA. After that, 6 feature genes (AADAT, APOF, GPC3, LPA, MASP1, and NAT2) were selected by RandomForest, Absolute Shrinkage and Selection Operator, and support vector machine-recursive feature elimination machine learning algorithms. These genes are also significantly different on the external dataset and follow the same trend as the training set. Finally, our findings may provide new insights into targets for diagnosis, prevention, and treatment of HCC. AADAT, APOF, GPC3, LPA, MASP1, and NAT2 may be potential genes for the prediction, prevention, and treatment of liver cancer in the future.

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

There appear to be huge variations and aberrations in the reported data in COVID-19 2 years now into the pandemic. Conflicting data exist at almost every level and also in the reported epidemiological statistics across different regions. It is becoming clear that COVID-19 is a polymorphic inflammatory spectrum of diseases, and there is a wide range of inflammation-related pathology and symptoms in those infected with the virus. The host's inflammatory response to COVID-19 appears to be determined by genetics, age, immune status, health status and stage of disease. The interplay of these factors may decide the magnitude, duration, types of pathology, symptoms and prognosis in the spectrum of COVID-19 disorders, and whether neuropsychiatric disorders continue to be significant. Early and successful management of inflammation reduces morbidity and mortality in all stages of COVID-19.

Efficacy of Kan Jang® in Patients with Mild COVID-19: A Randomized, Quadruple-Blind, Placebo-Controlled Trial

Background and aim. This study aimed to assess the efficacy of the treatment of Kan Jang®, a fixed combination of Andrographis paniculata (Burm. F.) Wall. ex. Nees and Eleutherococcus senticosus (Rupr. & Maxim.) Maxim extracts in patients with mild symptoms of COVID-19. Methods. One hundred and forty patients received six capsules of Kan Jang® (n = 68, daily dose of andrographolides-90 mg) or placebo (n = 72) and supportive treatment (paracetamol) for 14 consecutive days in a randomized, quadruple-blinded, placebo-controlled, two-parallel-group design. The efficacy outcomes were the rate of cases turning to severe, the detection rate of coronavirus SARS-CoV-2 over the time of treatment, the duration, and the severity of symptoms (sore throat, runny nose, cough, headache, fatigue, loss of smell, taste, pain in muscles) in the acute phase of the disease. Other efficacy measures included improving cognitive and physical performance, quality of life, and the levels of inflammatory blood markers-interleukin 6 (IL-6), C-reactive protein, and D-dimer. Results. Kan Jang® significantly (p < 0.05) reduced the rate of cases turning to severe (5.36%) compared to the placebo (17.86%) and decreased the detection rate of SARS-CoV-2 virus over the time of the treatment. The statistical difference in the rates of patients with clinical deterioration in the Kan Jang treatment and placebo control groups was significant (p = 0.0176) both in the 112 patients in the included-per-protocol (IPP) analysis and in the 140 patients in the intended-to-treat (ITT) analysis (p = 0.0236); the absolute risk reduction in cases thanks to the Kan Jang treatment was 12.5%, and the number we needed to treat with Kan Jang was 8. The patient's recovery time (number of sick days at the home/clinic) was shorter in the Kan Jang group compared with the placebo group. The rate of attenuation of inflammatory symptoms in the Kan Jang® group was significantly higher, decreasing the severity of cough, sore throat/pain, runny nose, and muscle soreness compared with the placebo group. Kan Jang® significantly decreased the Wisconsin Upper Respiratory Symptoms scores compared to the placebo in the sample size of 140 patients. However, the relief of fatigue and headache and the decrease in IL-6 in the blood were observed only in a subset of 86 patients infected during the second three waves of the pandemic. Kan Jang® significantly increased physical activity and workout; however, it did not affect cognitive functions (attention and memory), quality of life score, inflammatory marker D-dimer, and C-reactive protein compared with the placebo group. Conclusions. Overall, the results of this study suggest that Kan Jang® is effective in treating mild and moderate COVID-19 irrespective of the SARS-CoV-2 variant of infection.

Fangchinoline inhibits the PEDV replication in intestinal epithelial cells via autophagic flux suppression

Animal and human health are severely threatened by coronaviruses. The enteropathogenic coronavirus, porcine epidemic diarrhea virus (PEDV), is highly contagious, leading to porcine epidemic diarrhea (PED), which causes large economic losses in the world's swine industry. Piglets are not protected from emerging PEDV variants; therefore, new antiviral measures for PED control are urgently required. Herein, the anti-PEDV effects and potential mechanisms of fangchinoline (Fan) were investigated. Fan dose-dependently inhibited a PEDV infection at 24 h post-infection (EC₅₀ value = 0.67 μM). We found that Fan mainly affected the PEDV replication phase but also inhibited PEDV at the attachment and internalization stages of the viral life cycle. Mechanistically, Fan blocked the autophagic flux in PEDV-infected cells by regulating the expression of autophagy-related proteins and changing PEDV virus particles. In summary, Fan inhibits PEDV infection by blocking the autophagic flux in cells. Our findings will help develop new strategies to prevent and treat PEDV infection.

Convalescent Plasma Therapy against COVID-19: An Update on the Changing Facets of the ongoing Pandemic

The severe respiratory infections in the current pandemic coronavirus disease-19 (COVID-19) have influenced more or less every human life. The first person to get infected with this virus was reported in the capital of Hubei province (Wuhan), China, in late December 2019. Since the disease has been declared a pandemic, research scholars and experts have been manufacturing new vaccines or targeted therapies to curb the spread of SARS-CoV-2. However, only limited options have emerged so far, which yet require complete scientific validation by long-term data collection regarding safety and efficacy. In the wake of the recent emerging wave of the pandemic viz omicron variant, changing facets of the viral genome and dearth of preventative and therapeutic possibilities for the management of COVID-19, the usage of Convalescent Plasma Therapy (CPT) may be looked at as a potentially viable option of treatment in the existing situation. Earlier, immune plasma has been used with success in the management of H1N1 influenza virus, MERS-CoV, and SARS-CoV-1 epidemics. In the present unpredictable situation created by the COVID-19 pandemic, the CPT is used with a positive outcome amongst many infected individuals in different parts of the world with acceptable efficacy. This article aimed to present an up-to-date evaluation of existing literature on the efficacy of convalescent plasma as a potential therapy, its safety and effectiveness and the challenges in treating COVID-19.

Practices, Knowledge, and Attitudes of Chinese University Students Toward Traditional Chinese Herbal Medicine for the Control of COVID-19

BACKGROUND

The application of traditional Chinese herbal medicine has been officially recommended and strongly promoted in China as an important complement to conventional prevention and treatment for COVID-19. Capturing the practices, knowledge and attitudes of young adult population toward using Chinese herbs for COVID-19 is important for understanding the future of Chinese herbal medicine over the coming decades.

METHODS

This cross-sectional questionnaire-based study was conducted from May to June, 2022, among 313 student volunteers in Wuhan University of Science and Technology, a provincial comprehensive university in China.

RESULTS

Results showed that only 18% of students had used Chinese herbs to prevent COVID-19. The main information sources were social media, the students' family members, relatives, friends, etc. as well as the healthcare professionals. However, most students only sometimes paid close attention to related reports and news articles in social media. Clear pharmacological and toxicological properties of herbs were considered by 43% students as the most important factor to promote their own application of Chinese herbs to fight COVID-19. The mean knowledge score was 1.64 out of 5. Students' overall attitudes toward application of Chinese herbal medicine to fight COVID-19 were very positive.

CONCLUSION

These data suggests most university young adults had a positive attitude but lack of practices and knowledge towards traditional Chinese herbal medicine for COVID-19 control.