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Objective: To evaluate the incidence rate of nephrotoxicity in Tripterygium wilfordii Hook. f (TwHF) preparations approved by the China Food and Drug Administration and the potential risk factors. Methods: CENTRAL, PubMed, SinoMed, Chinese National Knowledge Infrastructure, VIP, China Important Conference Papers Database, China Dissertation Database, and online clinical trial registry websites were searched for articles that reported on nephrotoxicity of TwHF preparations until November 23, 2017. There was no limitation for study design. Results: A total of 36 articles involving 2,017 participants were included. Results showed that the incidence of nephrotoxicity associated with TwHF preparations was 5.81% (95% confidence interval: 4.43–7.57). Subgroup analysis showed that the disease type, combined medication, duration, and study design were not correlated with the incidence of nephrotoxicity. Conclusion: The incidence rate of nephrotoxicity in TwHF preparations was 5.81%. The possible risk factors, such as disease type, the combination with other drugs, medication time, and study design, were not found to be correlated with the incidence of nephrotoxicity. However, due to the limited number of included articles, the limited sample size, and the poor methodology quality, the incidence rate of nephrotoxicity of TwHF preparations might be overestimated, and more prospective articles are needed to explore the potential influence factor. [ABSTRACT FROM AUTHOR]

Objective: This bibliometric study was designed to evaluate the scientific output of Brazilian acupuncture publications and compare that output to the global trends in the same area. Methods: The analyzed data were retrieved from the online version of Science Citation Index Expanded (SCIE) database and covered the period from 2000 to 2014. The documents were searched by using the topic filter to find acupuncture-related documents (ARDs) and the title filter for acupuncture-specific documents (ASDs). The analyzed categories included number of publications, type of documents, number of citations, universities/ institutions, research areas, and journals. Results: A total of 9301 ARDs and 5974 ASDs were published in the past 15 years worldwide. The global average number of citations per document was 10.61 for ARDs and 9.24 for ASDs. Brazil has published 252 ARDs and 169 ASDs, which corresponds to the tenth and ninth positions on the global correspondent rankings. The United States is the most productive country, with 2503 ARD publications, followed by China with 2143 and South Korea with 925. Norway is in the first position for the ARD citation rank, with 25.77 citations per document; Switzerland is in the first position for the ASD citation rank, with 26.66. Brazil has 4.19 citations per document, which corresponds to the 20th position in the ASD citation rankings. Evidence-Based Complementary Medicine, Acupuncture in Medicine, and The Journal of Alternative and Complementary Medicine are the leading journals in terms of numbers of ARDs and ASDs in Brazil and globally. Conclusion: The bibliometric analysis of the SCI-E database shows that global numbers of ARDs and ASDs and citations have constantly increased from 2000 to 2014. Brazil is among the top 10 most productive countries in the world in terms of number of acupuncture publications. However, the number of citations of Brazilian documents is below the global average. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the pattern of Traditional Chinese Medicine (TCM) usage for urolithiasis patients in Taiwan and to determine the most common Chinese herbal products used for urolithiasis. Design: Retrospective review of urolithiasis patients treated with TCM treatment. Settings/Location: One million randomly selected samples in the Taiwanese National Health Insurance Research Database between 1997 and 2008. Patients: Eighty-two thousand five hundred and fifty-one newly diagnosed urolithiasis patients. Outcome measures: The correlation between TCM treatment, demographic factors, or medical conditions. Results: A total of 62.6% of urolithiasis patients use TCM treatment. A younger age, female gender, polypharmacy, multiple comorbidities, and stone in the lower urinary tract result in a greater tendency to use TCM, after adjusting for demographic factors. Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder are the most frequently prescribed Chinese medicine formulae. Conclusion: This is the first study to examine the use of and the prescription pattern for TCM in urolithiasis patients using a random, national population-based sample. More than 62% of urolithiasis patients use TCM, and patients with polypharmacy, multiple comorbidities, and stone in the ureter are more likely to use TCM. The most frequently prescribed Chinese medicine formulae were Jia-Wei-Xiao-Yao-San Extract Powder and Ji-Sheng-Shen-Qi-Wan Extract Powder, which were reported to retard the progression of renal failure and alleviate flank pain or tenderness. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy and safety of combined selective serotonin reuptake inhibitors (SSRIs) and electroacupuncture therapies for the early treatment of primary depression. Methods: Randomized controlled trials (RCTs) were analyzed to compare therapy combining SSRIs and electroacupuncture to SSRI therapy alone. The RCTs were identified by searching, among others, PubMed, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the Chinese Biological Medical Literature Database. Scores from Self-Rated Depression Scale (SDS), the Hamilton Depression Scale (HAMD), the Side Effect Rating Scale (SERS), and the Treatment Emergent Symptom Scale (TESS) were analyzed and coded by two independent investigators and used to evaluate the safety and efficacy of treatment. Statistical analyses were performed using RevMan 5.2 software. Results: Six RCTs were analyzed. The meta-analysis revealed that the combined therapy of SSRIs and electroacupuncture were associated with superior scores on the HAMD, SDS, and SERS measures compared with SSRIs alone after 1-4 weeks of treatment: HAMD scores, mean difference (MD)1 week, 2.32 (95% confidence interval [CI]1 week, 1.47-3.16, p1 week<0.00001); MD2 weeks, 2.65 (95% CI2 weeks, 1.81- 3.50, p2 weeks<0.00001); MD4 weeks, 2.70 (95% CI4 weeks, 1.90-3.51, p4 weeks<0.00001); SDS scores: MD1 week, 3.13 (95% CI1 week, 1.22-5.03, p1 week = 0.001); MD2 weeks, 4.05 (95% CI2 weeks, 0.22-7.87, p2 weeks = 0.04); MD4 weeks, 5.02 (95% CI4 weeks, 1.61-8.43, p4 weeks = 0.004); SERS scores: MD2 weeks, 2.20 (95% CI2 weeks, 1.43-2.96, p2 weeks<0.00001); MD4 weeks, 2.12 (95% CI4 weeks, 1.42-2.83, p4 weeks<0.00001). However, two of the aforementioned outcomes were rated as medium quality because of heterogeneity, as assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Conclusions: The available evidence suggests that the early treatment of primary depression using both SSRI and electroacupuncture therapies is more efficient than treatments with SSRIs alone and leads to a better and earlier control of depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical effect of transcutaneous electrical nerve stimulation over acupoints (acu-TENS) on patients with stable chronic obstructive pulmonary disease (COPD). Design: Prospective, single-blind, randomized, placebo-controlled study. Settings/Locations: Outpatient center of West China Hospital, Sichuan University. Patients: Fifty patients with stable COPD enrolled in the study. Interventions: Patients were randomly assigned to one of two groups: the acu-TENS group ( n=25), who underwent acu-TENS over acupoints of bilateral EX-B-1( Dingchuan), BL-13 ( Feishu), BL-23 ( Shenshu), ST-36 ( Zusanli), and the placebo acu-TENS control group ( n=25), who had the same electrode placement but no electrical output. Treatments were performed for 40-minute sessions every 2 days for 4 weeks. Outcome measures: Lung function (forced expiratory volume in 1 second, percentage predicted (FEV1% predicted); forced vital capacity, percentage predicted (FVC% predicted), 6-minute walk distance (6MWD) and oxygen saturation (SpO2), COPD assessment test (CAT), and Dyspnea Visual Analogue Scale (DVAS) were assessed before and after the intervention. Results: Compared to control group, FEV1% predicted was improved and CAT score was decreased significantly in the acu-TENS group after treatment ( p<0.05). The DVAS score decreased significantly in the acu-TENS group ( p=0.039), with a slight but insignificant improve in 6MWD, SpO2, and FVC% predicted after treatment. Conclusions: Acu-TENS over acupoints of bilateral EX-B-1 ( Dingchuan), BL-13 ( Feishu), BL-23 ( Shenshu), and ST-36 ( Zusanli) improved FEV1% predicted and reduced DVAS and CAT scores on patients with stable COPD. This may be a novel treatment strategy in COPD. [ABSTRACT FROM AUTHOR]

Objectives: To observe the effect of a Baduanjin exercise intervention on fatigue in people with fatigue-predominant subhealth (FPSH). Participants: A total of 131 participants were included in this cohort study. Those who met the inclusion criteria were grouped into the Baduanjin cohort ( n=64) or the control cohort ( n=67). Intervention: The Baduanjin cohort exercised for 30 minutes twice a day for 6 weeks; the control cohort received no treatments. The study period was 18 weeks. Outcome measures: The fatigue states of all participants were evaluated by using the Fatigue Self-Assessment Scale (FSAS) at baseline, the fourth and sixth weeks of treatment, and during post-treatment follow-ups at the end of the 12th and 18th weeks. Results: The scores for the six factors on the FSAS at baseline did not significantly differ between the two groups. In the Baduanjin cohort, the total score on the FSAS (TSF) and scores for physical fatigue (PF), mental fatigue (MF), consequence of fatigue (CF), and response of fatigue to sleep and rest (RFSAR) were significantly decreased at the end of the sixth week. These patients also had significantly decreased scores for TSF, PF, MF, and CF at baseline, at the end of the fourth and sixth weeks of the intervention, and during post-treatment follow-ups at the end of the 12th and 18th weeks. No adverse effects of treatment were reported. Conclusions: This study suggests that Baduanjin exercise has an effect on relieving fatigue in patients with FPSH. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to document clinical use of Traditional Chinese Medicine (TCM) for chronic conditions in all TCM hospitals in a Chinese province and to recommend treatments most in need of evaluation for use in community health centers. Design: A cross-sectional survey was conducted in the summer of 2010. It included 119 of 132 TCM hospitals in Hubei Province, China. TCM physicians were asked to recommend specific TCM treatments for common chronic conditions. Nine types of chronic conditions recommended more than 3.7 times (mean of frequencies of chronic conditions) are included in this analysis. Frequency of each TCM treatment and the number of visits by type of chronic conditions were calculated. Results: The total number of recommendations by TCM physicians was 411. For seven types of treatments, six were recommended for musculoskeletal pain, five for soft tissue injuries, four for visceral pain and fractures, three for stroke and asthma, two for hemorrhoids, and one for hypertension. The most frequently recommended treatments for specific conditions include orally ingested herbs for visceral pain ( n=3), type 2 diabetes ( n=5), and hypertension ( n=7); herbs for external use for soft tissue injuries ( n=10), asthma ( n=6), and hemorrhoids ( n=8); acupuncture for musculoskeletal pains ( n=43) and for stroke ( n=10); and Chinese external fixation for fractures ( n=24). The number of visits for recommended treatments per year of was 671,759. The most frequently recommended treatments for specific chronic conditions have most visits, except for chronic conditions such as musculoskeletal pains, visceral pains, soft tissue injuries, and asthma. Conclusions: Patients with musculoskeletal pain have more treatment options than other patients. Herbal medicine is the option most commonly used for chronic conditions. These treatments for these conditions should be targeted for further evaluation of effectiveness and, only if found effective, considered for use in primary care settings. [ABSTRACT FROM AUTHOR]

Objectives: To assess the clinical evidence of auriculotherapy for constipation treatment and to identify the efficacy of groups using Semen vaccariae or magnetic pellets as taped objects in managing constipation. Methods: Databases were searched, including five English-language databases (the Cochrane Library, PubMed, Embase, CINAHL, and AMED) and four Chinese medical databases. Only randomized controlled trials were included in the review process. Critical appraisal was conducted using the Cochrane risk of bias tool. Results: Seventeen randomized, controlled trials (RCTs) met the inclusion criteria, of which 2 had low risk of bias. The primary outcome measures were the improvement rate and total effective rate. A meta-analysis of 15 RCTs showed a moderate, significant effect of auriculotherapy in managing constipation compared with controls (relative risk [RR], 2.06; 95% confidence interval [CI], 1.52- 2.79; p<0.00001). The 15 RCTs also showed a moderate, significant effect of auriculotherapy in relieving constipation (RR, 1.28; 95% CI, 1.13-1.44; p<0.0001). For other symptoms associated with constipation, such as abdominal distension or anorexia, results of the meta-analyses showed no statistical significance. Subgroup analysis revealed that use of S. vaccariae and use of magnetic pellets were both statistically favored over the control in relieving constipation. Conclusions: Current evidence illustrated that auriculotherapy, a relatively safe strategy, is probably beneficial in managing constipation. However, most of the eligible RCTs had a high risk of bias, and all were conducted in China. No definitive conclusion can be made because of cultural and geographic differences. Further rigorous RCTs from around the world are warranted to confirm the effect and safety of auriculotherapy for constipation. [ABSTRACT FROM AUTHOR]

Objective: This meta-analysis was conducted to evaluate the efficacy of acupuncture on cognitive impairment (function) after a stroke. Design: Randomized controlled trials (RCTs) comparing acupuncture with no acupuncture in addition to medicine or rehabilitation were identified from databases (PubMed, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wangfang Chinese Periodical Database, Chinese Bio-medicine Database, Cochrane Library, and Chinese medical literature databases) and two relevant journals ( Chinese Acupuncture and Moxibustion and the Journal of Shanghai Acupuncture and Moxibustion). Meta-analyses were conducted for the eligible RCTs. Results: Twenty-one trials with a total of 1421 patients met inclusion criteria. Pooled random-effects estimates of the change in the Mini-Mental State Examination were calculated for the comparison of acupuncture with no acupuncture in addition to medicine or rehabilitation. Following 4 weeks and 8 weeks of intervention with acupuncture, the merged mean difference was 3.14 (95% confidence interval [CI], 2.06-4.21; p<.00001) and 2.03 (95% CI, 0.26-3.80; p=0.02), respectively. For the comparison of 3-4 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the merged MD in Neurobehavioral Cognitive State Examination total scores was 5.63 (95% CI, 3.95-7.31; p<.00001). For the comparison of 8-12 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the P300 latency merged MD was −12.80 (95% CI, −21.08 to −4.51; p<.00001), while the P300 amplitude merged MD was 1.38 (95% CI, 0.93-1.82; p<.00001). Overall, the study quality was rated as moderate on the basis of the Cochrane Handbook for Systematic Reviews of Interventions (part 2: 8.5). Conclusions: This meta-analysis suggests that acupuncture had positive effects on cognitive function after stroke and supports the need for additional research on the potential benefits of this therapeutic approach. [ABSTRACT FROM AUTHOR]

Objective: Traditional Chinese Medicine (TCM) has many postulates that explain the occurrence and co-occurrence of symptoms using syndrome factors such as yang deficiency and yin deficiency. A fundamental question is whether the syndrome factors have verifiable scientific content or are purely subjective notions. This analysis investigated the issue in the context of patients with cardiovascular disease (CVD). Design: In the past, researchers have tried to show that TCM syndrome factors correspond to real entities by means of laboratory tests, with little success. An alternative approach, called latent tree analysis, has recently been proposed. The idea is to discover latent variables behind symptom variables by analyzing symptom data and comparing them with TCM syndrome factors. If there is a good match, then statistical evidence supports the validity of the relevant TCM postulates. This study used latent tree analysis. Setting: TCM symptom data of 3021 patients with CVD were collected from the cardiology departments of four hospitals in Shanghai, China, between January 2008 and June 2010. Results: Latent tree analysis of the data yielded a model with 34 latent variables. Many of them correspond to TCM syndrome factors . Conclusions: The results provide statistical evidence for the validity of TCM postulates in the context of patients with CVD; in other words, they show that TCM postulates are applicable to such patients. This finding is important because it is a precondition for the TCM treatment of those patients. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes mellitus with coronary heart disease (DM with CHD) poses a health challenge to people in China and elsewhere in the world. In Traditional Chinese Medicine (TCM), DM with CHD is classified as a type of disease called Xiaoke and Xiongbi. In Asia, TCM has been used to treat Xiaoke and Xiongbi conditions for centuries, especially in China. In this study, it was evaluated whether integrated strategies incorporating both TCM and Western medicines (iTCWM) could improve the curative efficacy of DM with CHD. Methods: An extensive search for randomized clinical trials (RCTs) published up to November 2011 in either English or Chinese about iTCWM for DM with CHD was conducted. All listings in PubMed, EMBASE, the Cochrane Library, CBM, CNKI, VIP, and the Wanfang database were included in the literature search. The quality of each trial was assessed using the Cochrane Reviewers' Handbook 5.0. Data analysis was performed by the RevMan 5.0 provided by the Cochrane Collaboration. Results: After an initial selection of 207 articles, 21 RCTs and quasi-RCTs were ultimately included in the analysis for this study. All of these trials were conducted in China and published in Chinese journals. The methodological quality of the trials was low in most studies. Selection bias and measurement bias were common in all of the studies. A meta-analysis was not conducted, due to the poor quality of the available studies. Conclusions: The current state of the literature regarding the utility of iTCWM for the treatment of DM with CHD is inadequate. The poor quality of the available trials makes it difficult to draw any conclusions regarding the efficacy of iTCWM for the treatment of DM with CHD. This study highlights the paucity of reliable clinical evidence for iTCWM and the need for higher quality RCTs to be conducted in the future. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to make non-Chinese readers better informed about the current safety situation of acupuncture in China. Methods: Four (4) major Chinese comprehensive databases were searched: Chinese Journal Full-text Database (1949-2010), China Biomedical Literature Database (1978-2010), Chinese Technology Journal Database (1989-2010), and Wanfang (1998-2010). Case reports of adverse events related to acupuncture therapy were included. Literature reviews, case-control study, translations, duplicate literatures in various databases, and duplicate published articles with duplicate data were excluded. Results: One hundred and sixty-seven (167) articles were included with 1038 cases, among which 35 patients died. The most frequent adverse events were syncope (468 cases), pneumothorax (307 cases), and subarachnoid hemorrhage (64 cases). Conclusions: Acupuncture-related adverse events were mainly caused by mental tension of the patient, improper operation by the doctor, and incompleteness of sterilization. Most of them can be avoided by standardizing teaching and clinical practices. Making the corresponding safety standards can greatly lower the risk of adverse events and protect patient safety to the greatest extent. [ABSTRACT FROM AUTHOR]

Objective: In China, most patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are usually treated with Tanreqing injection plus conventional Western medicine. However, the value of its use remains uncertain. The objective of this systematic review is to compare the efficacy of Tanreqing injection plus conventional Western medicine with that of conventional Western medicine alone (therapy A versus therapy B, respectively) in the management of acute exacerbations of COPD. Methods: Literature retrieval was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE,® EMBASE, Chinese Biomedical Database (CBM), and other electronically available databases from respective inception to August 2009. In addition, manual search of some traditional Chinese journals was performed to identify potential studies. Review authors independently extracted the trial data and assessed the quality of each trial. The following outcomes were evaluated: (1) forced expiratory volume in 1 second as a percentage of the predicted value; (2) arterial partial pressure of oxygen (P o2); (3) arterial partial pressure of carbon dioxide (P co2); (4) length of hospital stay; (5) marked efficacy rate; (6) interleukin-8; and (7) adverse events. Results: Based on the search strategy, 14 trials involving 954 patients were finally included. Our results showed that compared with therapy B, therapy A improved P o2, clinical efficacy, and lung function, reduced P co2, shortened the length of hospital stay, and was thus more therapeutically beneficial. No serious adverse events were reported. Conclusions: Within the limitations of this systematic review, we can conclude that compared with therapy B, therapy A may provide more benefits for patients with acute exacerbations of COPD. Further large-scale high-quality trials are warranted. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is commonly used in treating insomnia in China, and clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication. Methods: We included randomized controlled trials on acupuncture for insomnia. We searched PubMed, the Cochrane Library (2008 Issue 3), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in December 2008. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.17 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). Results: Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed a beneficial effect of acupuncture compared with no treatment (MD −3.28, 95% CI −6.10 to −0.46, p = 0.02; 4 trials) and real acupressure compared with sham acupressure (MD −2.94, 95% CI −5.77 to −0.11, p = 0.04; 2 trials) on total scores of Pittsburgh Sleep Quality Index. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours (RR 1.53, 95% CI 1.24–1.88, p < 0.0001). However, there was no difference between acupuncture and medications in average sleep duration (MD −0.06, 95% CI −0.30–0.18, p = 0.63). Acupuncture plus medications showed better effect than medications alone on total sleep duration (MD 1.09, 95% CI 0.56–1.61, p < 0.0001). Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates (RR 1.67, 95% CI 1.12–2.50, p = 0.01). There were no serious adverse effects with related to acupuncture treatment in the included trials. Conclusions: Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous designed trials are warranted. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the effectiveness of Chinese herbal medicine for treating chronic prostatitis (CPT) in China. Design: Electronic medical database from China National Knowledge Infrastructure (CNKI) was searched, language is Chinese; date is from January 1, 1994 to December 31, 2003. A total of 108 trials were found, and all studies with words like "randomization" or "quasi-randomization" in their abstracts were included, whether they used blinding or not. Nineteen theses that met the entry criteria were downloaded and fully printed. Four groups were divided: Chinese herbs orally treated group (based on syndrome differentiation), Chinese herbs externally treated group, Chinese herbs orally and externally treated group, and integrated Western with Chinese herbs treated group. Results: All 19 articles that met the entry criteria were clinical trial studies with low quality (Jadad Score <3). The results showed that Traditional Chinese Medicine (TCM) may benefit the patients who had CPT. However, from the results of the funnel plots analysis of all four groups of clinical trials that met the inclusion criteria in this systematic review are distant asymmetrical and irregular plots, which indicate that a positive publication bias may exist. There was no obvious evidence indicating that the efficacy of the therapy in the treated groups using TCM was superior to that of the control group (Western medicine treatment group). Conclusions: All of the four groups in the clinical trials have not provided evidence of evidence-based medicine (EBM) A class (including 1a, 1b, 1c level), failed to prove that the TCM may have beneficial effects for patients with CPT, because of low quality in all the trials and a positive publication bias. Therefore, in light of some positive outcomes, a good design of multicentered, randomized, parallel-controlled and blinding trials is needed in order to make further studies, and deserve further examination for the treatment of CPT with TCM. [ABSTRACT FROM AUTHOR]