Perspectives of international multi-center clinical trials on traditional Chinese herbal medicine

Effectiveness and safety of traditional Chinese therapies intreating patients with amyotrophic lateral sclerosis: a protocol for systematic review and meta-analysis

Background

Amyotrophic lateral sclerosis (ALS) is a chronic, progressive disease that affects both upper and lower motor neurons. Some physicians have used traditional Chinese therapies (TCT) to treat ALS. However, there has been no systematic review or meta-analysis to evaluate the effectiveness and safety of TCT interventions. This review aims to analyze the effects of TCT interventions for patients with amyotrophic lateral sclerosis.

Methods and analysis

This study will include randomized, non-randomized, and quasi-experimental clinical trials, with participants being any age Amyotrophic Lateral Sclerosis (ALS) patients who have undergone TCT treatment. Two researchers will independently search databases including CENTRAL, PubMed, PEDro, EMBASE, CNKI, CBM, and SPORTDiscus, without restrictions on language or publication date. These researchers will independently screen titles and abstracts and extract data from the included studies. If deemed suitable for meta-analysis, data synthesis will be conducted using Review Manager V.5.3 software; any discrepancies will be resolved by a third researcher. The meta-analysis will compare the effects of TCT with placebo or other interventions. The main endpoint evaluated was the decrease in the overall score of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R; scoring from 0 to 48, where higher scores denote greater functionality) over a period of 24 weeks. Additional endpoints included the reduction rates in isometric muscle power, levels of phosphorylated axonal neurofilament H subunits in plasma, and slow vital capacity measurements. Furthermore, the study monitored the duration until occurrence of death, tracheostomy, or the need for long-term ventilation, as well as the time until death, tracheostomy, long-term ventilation, or hospital admission.

Ethics and dissemination

Throughout the entire process of this systematic review, no personal information was used, hence ethical review is not required. The results of this meta-analysis will be disseminated through publication in peer-reviewed journals and/or conference presentations.

Clinical practice guidelines of Chinese patent medicine in China: A critical review

OBJECTIVES

To analyze the methodology, evidence, recommendations, quality, and implementation of traditional Chinese patent medicine (CPM) guidelines.

METHODS

We retrieved clinical application guidelines of CPM published from 2019 to 2022. Independent screening and data extraction were performed by two evaluators. The basic information about the guidelines, including evidence and recommendations, were extracted and statistically analyzed. Quality and implementation were evaluated using the Implementation Evaluation Tool and Appraisal of Guidelines for Research & Evaluation (AGREE) II.

RESULTS

In total, 29 guidelines were analyzed, including 262 recommendations and 2308 references. All the CPM guidelines followed the principle of "evidence as a core, consensus as a supplement, and experience as a reference" and the methods provided by WHO Handbook. An average of 89 references were cited in each guideline and 8 in each recommendation. Randomized controlled trials and systematic reviews constituted 89 % and 0.9 %, respectively, of all references. Low or very low-quality evidence characterized 74.5 % and weak recommendations characterized 83.6 %. Of all recommendations, 13.7 % were based on expert consensus, and 9.5 % of strong recommendations were based on low or very low-quality evidence. The AGREE II scores for each domain were: scope and purpose (79.63 %) and editorial independence (79.27 %), followed by clarity of presentation (72.59 %), stakeholder involvement (69.99 %), rigor of development (53.97 %) and applicability (5.11 %). The implementation quality of most guidelines was either high (44.8 %) or moderate (55.2 %).

CONCLUSIONS

The results for CPM guidelines were impressive in terms of methodology, quality, and implementation. However, confidence in CPM recommendations was downgraded by low quality of evidence.

A new perspective on proteinuria and drug therapy for diabetic kidney disease

Diabetic kidney disease (DKD) is one of the leading causes of end-stage renal disease worldwide and significantly increases the risk of premature death due to cardiovascular diseases. Elevated urinary albumin levels are an important clinical feature of DKD. Effective control of albuminuria not only delays glomerular filtration rate decline but also markedly reduces cardiovascular disease risk and all-cause mortality. New drugs for treating DKD proteinuria, including sodium-glucose cotransporter two inhibitors, mineralocorticoid receptor antagonists, and endothelin receptor antagonists, have shown significant efficacy. Auxiliary treatment with proprietary Chinese medicine has also yielded promising results; however, it also faces a broader scope for development. The mechanisms by which these drugs treat albuminuria in patients with DKD should be described more thoroughly. The positive effects of combination therapy with two or more drugs in reducing albuminuria and protecting the kidneys warrant further investigation. Therefore, this review explores the pathophysiological mechanism of albuminuria in patients with DKD, the value of clinical diagnosis and prognosis, new progress and mechanisms of treatment, and multidrug therapy in patients who have type 2 diabetic kidney disease, providing a new perspective on the clinical diagnosis and treatment of DKD.

Nanoemulsion and nanoencapsulation of a hydroethanolic extract of Nettle (Urtica dioica) and Wormwood (Artemisia absinthium): comparison of antibacterial and anticancer activity

Introduction: Nanoemulsion and nanoencapsulation are attractive novel methods that can be used for incorporating active plant extracts in food preparations and pharmaceutical formulations. In the current study, we aimed to investigate the anticancer and antibacterial effects of hydroethanolic extracts of Nettle (NE), Wormwood (WE), and the combination of the two plants (CNWE), as well as their nanoemulsion forms (NN, NW, CNNW) and nanoencapsulation forms (CN, CW, and CCNW). Methods: The morphology and structure of the nanoemulsion and nanoencapsulation preparations were assessed utilizing dynamic light scattering (DLS) along with transmission electron microscopy (TEM). The antibacterial activity of the prepared formulations were assessed by determining minimum inhibitory concentration (MIC), zone of inhibition diameter, minimum bactericidal concentration (MBC), along with biofilm growth inhibition against Salmonaella typhimurium and Klebsiella. pneumoniae. The anticancer activity was evaluated via a MTT assay in the colon cancer cell line (HCT116). Results: The nanoemulsion and nanoencapsulation particle size varied between 10 and 50 nm and 60 and 110 nm, respectively. The MIC values were between 11.25 and 95 µg/mL along with MBC values between 11.25 and 190 µg/mL. The highest inhibition of biofilm formation was observed with CCNW against K. pneumoniae (∼78.5%) and S. typhimurium (∼73%). In descending order, the inhibition of biofilm formation was CCNW > CW > CN > CNNW > NN > NW > CNWE > NE > WE against the tested bacteria. The IC50 values for NE, WE, CNWE, NN, NW, CNNW, CN, CW, and CCNW were determined as 250, 170, 560, 380, 312, 370, 250, 420, and 700 µg/mL, respectively. Exposure to a high concentration of NW resulted in a significantly lower HCT116 viability compared to other groups. Taken together, CNNW, and CCNW showed the highest antibacterial and anticancer activitiy. Discussion: Nanoemulsion and nanoencapsulation were effective ways to increase the antibacterial and anticancer activity of the extracts and could be used in the food and pharmaceutical industries.

Cultivable Endophyte Resources in Medicinal Plants and Effects on Hosts

With the increasing demand for medicinal plants and the increasing shortage of resources, improving the quality and yield of medicinal plants and making more effective use of medicinal plants has become an urgent problem to be solved. During the growth of medicinal plants, various adversities can lead to nutrient loss and yield decline. Using traditional chemical pesticides to control the stress resistance of plants will cause serious pollution to the environment and even endanger human health. Therefore, it is necessary to find suitable pesticide substitutes from natural ingredients. As an important part of the microecology of medicinal plants, endophytes can promote the growth of medicinal plants, improve the stress tolerance of hosts, and promote the accumulation of active components of hosts. Endophytes have a more positive and direct impact on the host and can metabolize rich medicinal ingredients, so researchers pay attention to them. This paper reviews the research in the past five years, aiming to provide ideas for improving the quality of medicinal plants, developing more microbial resources, exploring more medicinal natural products, and providing help for the development of research on medicinal plants and endophytes.