-
Frontiers in Pharmacology 2023Stroke is the major cause of mortality and permanent disability and is associated with an astonishing economic burden worldwide. In the past few decades, accumulated...
Stroke is the major cause of mortality and permanent disability and is associated with an astonishing economic burden worldwide. In the past few decades, accumulated evidence has indicated that Xuesaitong (XST) has therapeutic benefits in cases of acute ischemic stroke (AIS). Our study aimed to provide the best current body of evidence of the efficacy and safety of XST for patients with AIS. This is a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched eight electronic databases from inception to 17 July 2023 for relevant RCTs. The investigators independently screened trials, extracted data, and assessed the risk of bias. A meta-analysis was conducted using RevMan 5.3 and STATA 16.0 software. In total, 46 RCTs involving 7,957 patients were included. The results showed that XST improved the long-term functional outcomes with lower modified Rankin Scale (mRS) scores (MD = -0.67; 95% CI [-0.92 to -0.42]; < 0.00001) and a higher proportion of functional independence (mRS ≤2) (RR = 1.08; 95% CI [1.05 to 1.12]; < 0.00001). Low-quality evidence indicated that XST improved the activities of daily living (MD = 10.17; 95% CI [7.28 to 13.06]; < 0.00001), improved the neurological impairment (MD = -3.39; 95% CI [-3.94 to -2.84]; < 0.00001), and enhanced the total efficiency rate (RR = 1.19; 95% CI [1.15 to 1.23]; < 0.00001). No significant difference was found in the all-cause mortality or incidence of adverse events between the XST and control groups. The certainty of evidence was estimated as moderate to very low. Presently, the administration of XST within 14 days of AIS is associated with favorable long-term functional outcomes. In addition, XST can improve activities of daily living, alleviate neurological deficits, and has shown good tolerability. However, the current evidence is too weak, and the confidence of evidence synthesis was restricted by the high risk of bias. Given the insufficient evidence, appropriately sized and powered RCTs investigating the efficacy and safety of XST for patients with AIS are warranted. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=446208, CRD42023446208.
PubMed: 37908976
DOI: 10.3389/fphar.2023.1280559 -
Chinese Medicine Sep 2023Age-related hearing loss (ARHL) is one of the main illnesses afflicting the aged population and has a significant negative impact on society, economy, and health.... (Review)
Review
BACKGROUND
Age-related hearing loss (ARHL) is one of the main illnesses afflicting the aged population and has a significant negative impact on society, economy, and health. However, there is presently no appropriate therapeutic treatment of ARHL due to the absence of comprehensive trials.
OBJECTIVES
The goal of this review is to systematically evaluate and analyze recent statistics on the pathologic classifications, risk factors, treatment strategies, and drug candidates of ARHL, including that from traditional Chinese medicine (TCM), to provide potential new approaches for preventing and treating ARHL.
METHODS
Literature related to ARHL was conducted in databases such as PubMed, WOS, China National Knowledge Infrastructure (CNKI), and Wanfang from the establishment of the database to Jan, 2023. The pathology, causal factor, pathophysiological mechanism, treatment strategy, and the drug candidate of ARHL were extracted and pooled for synthesis.
RESULTS
Many hypotheses about the etiology of ARHL are based on genetic and environmental elements. Most of the current research on the pathology of ARHL focuses on oxidative damage, mitochondrial dysfunction, inflammation, cochlear blood flow, ion homeostasis, etc. In TCM, herbs belonging to the kidney, lung, and liver meridians exhibit good hearing protection. Seven herbs belonging to the kidney meridian, 9 belonging to the lung meridian, and 4 belonging to the liver meridian were ultimately retrieved in this review, such as Polygonum multiflorum Thunb., Panax ginseng C.A. Mey, and Pueraria lobata (Willd.) Ohwi. Their active compounds, 2,3,4',5-Tetrahydroxystilbene-2-O-D-glucoside, ginsenoside Rb1, and puerarin, may act as the molecular substance for their anti-ARHL efficacy, and show anti-oxidative, neuroprotective, anti-inflammatory, anti-apoptotic, or mitochondrial protective effects.
CONCLUSION
Anti-oxidants, modulators of mitochondrial function, anti-inflammation agents, vasodilators, K channel openers, Ca channel blockers, JNK inhibitors, and nerve growth factors/neurotrophic factors all contribute to hearing protection, and herbs are an important source of potential anti-ARHL drugs.
PubMed: 37730634
DOI: 10.1186/s13020-023-00825-6 -
Evidence-based Complementary and... 2023This meta-analysis evaluated the curative effect of the compatibility of and (ARPN) as main components on diabetic nephropathy. (Review)
Review
OBJECTIVE
This meta-analysis evaluated the curative effect of the compatibility of and (ARPN) as main components on diabetic nephropathy.
METHODS
We used various Chinese and English databases, including the Cochrane Library, PubMed, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), China Biology Medicine Disc (SinoMed), VIP, and Wanfang, to search for randomized controlled trials on the compatibility of and as main components. After data extraction, meta-analysis was performed with Review Manager 5.4.0 and Stata 15, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate the quality of the evidence.
RESULT
A total of 17 studies involving 1342 patients with diabetic nephropathy were included. Compared with the control group, ARPN can significantly improve the clinical effective rate of diabetic nephropathy (OR 5.12, 95% CI 3.42 to 7.66, < 0.00001), and the curative effect of reducing UAER (MD -26.67, 95% CI -31.30 to -22.04, < 0.00001) and 24 h urinary protein (SMD -0.58, 95% CI -0.75 to -0.41, < 0.00001) is also significantly better than that of the control group, and it can also improve the renal function(Scr: MD -13.78, 95% CI -25.39 to -2.17, =0.02; BUN: MD -0.74, 95% CI -1.27 to -0.20, =0.007). In addition, it can also reduce glycosylated hemoglobin (SMD -1.30, 95% CI -2.33 to -0.27, =0.01) and blood lipid(TC: SMD -0.62, 95% CI -0.95 to -0.29, =0.0002; TG: SMD -0.47, 95% CI -0.75 to -0.19, =0.0009; LDL: SMD -0.43, 95% CI -0.68 to -0.18, =0.0008), and improve the TCM syndrome score (MD -4.87, 95% CI -6.17 to -3.57, < 0.00001). Subgroup analysis suggested that the treatment plan of the control group could be the sources of heterogeneity. All the included studies had no obvious adverse effects.
CONCLUSIONS
The compatibility of Radix Astragali and Radix notoginseng as the main components can effectively improve the renal function of patients with diabetic nephropathy and delay the progress of diabetic nephropathy. However, the results of this study need further research to be confirmed because of the uncertainty of the evidence and the suboptimal risk bias.
PubMed: 37101717
DOI: 10.1155/2023/2945234 -
Evidence-based Complementary and... 2021To assess the efficacy and safety of PNS on antiplatelet therapy in the treatment of AIS. (Review)
Review
OBJECTIVE
To assess the efficacy and safety of PNS on antiplatelet therapy in the treatment of AIS.
METHODS
We searched 7 literature databases and 2 clinical studies databases for randomized controlled studies (RCTs) evaluating PNS as an adjuvant therapy for AIS. Relevant studies were retrieved and screened, and data were extracted independently by two reviewers. The quality of the included studies was assessed using the Cochrane Risk Assessment Tool. Meta-analysis was carried out with the Rev Man 5.4 software.
RESULTS
Of 8267 records identified, 43 RCTs met our inclusion criteria ( = 4170 patients). Patients assigned to PNS with conventional treatments (CTs) had improved functional independence at 90 days compared with those assigned to CTs alone ( = 1.87, 95% = 1.37, to 2.55, < 0.0001). Patients who received PNS combined with CTs showed significantly high improvements in neurological function among individuals with AIS on the neurologic deficit score (NDS) ( = -5.71, 95% = -9.55 to -1.87, =0.004; = -3.94, 95% = -5.65 to -2.23, < 0.00001). The results also showed PNS contributed to a betterment in activities of daily living (ADL) on the Barthel index ( = 4.86, 95% = 2.18, to 7.54, < 0.00001; = 13.92, 95% = 11.46 to 16.38, < 0.00001; = 7.16, 95% = 0.60, to 13.72, < 0.00001). In addition, PNS, compared with CTs alone, could significantly improve overall response rate (ORR) ( = 1.20, 95% = 1.16, to 1.24, < 0.00001; = 1.15, 95% = 1.08, to 1.24, < 0.0001), hemorheological parameters, maximum platelet aggregation rate (MPAR) ( = -6.82, 95% = -9.62 to -4.02, < 0.00001), platelet parameters ( = 4.85, 95% = 1.82 to 7.84, =0.002; = -0.79, 95% = -1.09 to -0.48, < 0.00001), and serum CD62P ( = -0.21, 95% = -0.29 to -0.13, < 0.00001). The incidence of adverse reactions in PNS was lower than that in the control group ( = 0.62, 95% = 0.39 to 0.97, =0.04). Adverse reactions in the PNS were mild adverse reactions.
CONCLUSION
PNS may be effective and safe in treating AIS on ameliorating neurological deficit, improving activities of daily living function, and enhancing antiplatelet effects. However, more high-quality evidence is needed before it can be recommended for routine antiplatelet therapy in patients with AIS.
PubMed: 34335808
DOI: 10.1155/2021/4694076 -
Frontiers in Pharmacology 2020Fatigue, as a complex, multidimensional symptom, is associated with many physical illnesses. C. A. Mey (PG) is an important herbal drug which has been used for...
BACKGROUND
Fatigue, as a complex, multidimensional symptom, is associated with many physical illnesses. C. A. Mey (PG) is an important herbal drug which has been used for benefiting Qi for thousand years. C. A. Mey and its compounds (PGC) possess various pharmacological activities, including anti-fatigue. Here, we conducted a systematic review of both randomized clinical trials (RCTs) and preclinical animal studies to investigate the efficacy and safety of PGC for fatigue.
METHODS
Electronic searches were performed in 7 databases from the time of each database's inception to August 2019. The methodological quality of RCTs was assessed using 7-item checklist recommended by Cochrane Collaboration or by the CAMARADES 10-item quality checklist. All the data were analyzed using Rev-Man 5.3 and Stata SE software.
RESULTS
Eight eligible RCTs and 30 animal studies were identified. The risk of bias scores in RCTs ranged from 4/7 to 7/7, and of animal studies varied from 4/10 to 7/10. Meta-analyses showed that PGC was superior to placebo according to their respective fatigue scales, heart rate recovery, and clinical effect (P < 0.05). There were a similar number of adverse effects between PGC and placebo group (P > 0.05). Meta-analyses showed that PGC can significantly decrease level of blood lactate, blood urea nitrogen, creatine kinase, malondialdehyde, and lactic dehydrogenase in serum, level of malondialdehyde in liver and level of gamma-aminobutyric acid, 5-hydroxytryptamine in brain tissue, and increase swimming time, level of glutathione peroxidase, glucose, superoxide dismutase in serum, level of glycogen and activity of superoxide dismutase, glutathione peroxidase, and catalase in skeletal muscle, level of hepatic glycogen in liver and level of dopamine, acetylcholine in brain tissue, compared with control (P < 0.05). Meta-analyses showed no significant difference in animal body weight between PGC and control (P > 0.05).
CONCLUSION
The present findings supported, to a certain degree, that PGC can be recommended for routine use in fatigue. The possible mechanism of PGC resists fatigue, mainly through antioxidant stress, regulating carbohydrate metabolism, delaying the accumulation of metabolites, promoting mitochondrial function, neuroprotection, antiapoptosis, and regulating neurotransmitter disorder in central nervous system.
PubMed: 32765262
DOI: 10.3389/fphar.2020.01031 -
Nutrients Jan 2023Although tremendous research has reported the protective effects of natural compounds in nonalcoholic fatty liver disease (NAFLD), there is still no approved drug. This... (Meta-Analysis)
Meta-Analysis Review
Although tremendous research has reported the protective effects of natural compounds in nonalcoholic fatty liver disease (NAFLD), there is still no approved drug. This study aimed to examine the efficacy of in NAFLD in preclinical studies. A total of 41 studies were identified by searching the PubMed, Web of Science, and Cochrane Library databases. The methodological quality was assessed by the risk of bias tool from the Systematic Review Center for Laboratory Animal Experimentation. The standardized mean difference (SMD) with a 95% confidence interval was calculated, and the random effects model was used to examine overall efficacy or heterogeneity. The publication bias was analyzed by Egger's test. The results showed that treatment significantly reduced the systemic levels of alanine aminotransferase (SMD: -2.15 IU/L; < 0.0001), aspartate aminotransferase (SMD: -2.86 IU/L; < 0.0001), triglyceride (SMD: -2.86 mg/dL; < 0.0001), total cholesterol (SMD: -1.69 mg/dL; < 0.0001), low-density lipoprotein (SMD: -1.46 mg/dL; < 0.0001), and fasting glucose (SMD: -1.45 mg/dL; < 0.0001) while increasing high-density lipoprotein (SMD: 1.22 mg/dL; = 0.0002) in NAFLD regardless of animal models or species. These findings may suggest that is a promising therapeutic agent for NAFLD treatment.
Topics: Animals; Non-alcoholic Fatty Liver Disease; Panax; Triglycerides; Lipoproteins, HDL; Lipoproteins, LDL
PubMed: 36771427
DOI: 10.3390/nu15030721 -
Frontiers in Pharmacology 2024As a bioactive metabolite preparation widely used in acute ischemic stroke (AIS), the efficacy and safety of saponins injections (PNSI) in patients with AIS after...
BACKGROUND
As a bioactive metabolite preparation widely used in acute ischemic stroke (AIS), the efficacy and safety of saponins injections (PNSI) in patients with AIS after intravenous thrombolysis remain to be evaluated.
METHODS
This study included randomized controlled trials published before 26 April 2024 in 8 databases. AIS patients who received intravenous thrombolysis were included. The control group receiving conventional treatment and the treatment group receiving additional PNSI. Primary outcomes were selected as mortality, disability, and adverse events. Secondary outcomes were selected as all-cause mortality, improvement of neurological deficit, quality of life, and cerebral injury indicators. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Risk ratio (RR) and mean differences (MD) were calculated for binary variables and continuous variables, respectively, based on a 95% confidence interval (CI).
RESULTS
A total of 20 trials involving 1,856 participants were included. None of them reported mortality or disability. There was no significant difference in the adverse events [RR: 1.04; 95% CI: 0.60 to 1.81] and hemorrhagic transformation [RR: 0.99; 95% CI: 0.36 to 2.70] between the two groups. Compared to the control group, the treatment group had a better effect in neurological improvement assessed by National Institutes of Health Stroke Scale [MD: -2.91; 95% CI: -4.76 to -1.06], a better effect in activities of daily living changes in Barthel Index [MD: 9.37; 95% CI: 1.86 to 16.88], and a lower serum neuron-specific enolase level [MD: -2.08; 95% CI: -2.67 to -1.49].
CONCLUSION
For AIS patients undergoing intravenous thrombolysis, the use of PNSI improved neurological deficits and enhanced activity of daily living in the short term without increasing the occurrence rate of adverse events. However, due to the moderate to very low certainty of evidence, it is advisable to conduct high-quality clinical trials to validate the findings of this study.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466851, Identifier CRD42023466851.
PubMed: 38898926
DOI: 10.3389/fphar.2024.1376025 -
Frontiers in Pharmacology 2022Although increasing clinical trials studying Shenfu injection (SFI) comprising panaxoside 0.8 mg/ml extracted from Panax ginseng C.A. Mey. and aconitine 0.1 mg/ml...
Although increasing clinical trials studying Shenfu injection (SFI) comprising panaxoside 0.8 mg/ml extracted from Panax ginseng C.A. Mey. and aconitine 0.1 mg/ml extracted from Debeaux for elderly patients with severe pneumonia on biomarkers associated with COVID-19 progression are emerging, there is no evidence-based evaluation for the effect of SFI on elderly severe pneumonia. To evaluate the effect of SFI on elderly patients with severe pneumonia providing hints for treating critical COVID-19, we conducted a systematic review and meta-analysis. Nine databases, namely, PubMed, EMBASE, Web of Science, Science Direct, Google Scholar, Wanfang, Chongqing VIP Database, CNKI, and SinoMed were used to search clinical trials reporting the effect of SFI as an adjuvant for elderly severe pneumonia on outcomes of interest. Primary outcomes were total effective rate, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mortality, and safety. Secondary outcomes were predictors associated with COVID-19 progression. Duplicated or irrelevant articles with unavailable data were excluded. Cochrane Collaboration's tool was used to evaluate the risk of bias by two reviewers independently. All data were analyzed by Rev Man 5.4. Continuous variables were shown as weighted mean difference (WMD) or standard mean difference (SMD) with 95% confidence intervals (95% CI), whereas dichotomous data were calculated as the risk ratio (RR) with 95% CI. We included 20 studies with 1, 909 participants, and the pooled data showed that compared with standard control, SFI could improve the total effective rate (RR = 1.25, 95% CI = 1.14-1.37, and = 689), APACHE II score (WMD = -2.95, 95% CI = -3.35, -2.56, and = 809), and predictors associated with COVID-19 progression (brain natriuretic peptide, creatine kinase, stroke volume, cardiac output, left ventricular ejection fraction, cardiac index, sE-selectin, von Willebrand factor, activated partial thromboplastin time, platelet counts, D-Dimer, procalcitonin, and WBC count). SFI may reduce mortality (RR = 0.52, 95% CI = 0.37-0.73, and = 429) and safety concerns (RR = 0.29, 95% CI = 0.17-0.51, and = 150) for elderly severe pneumonia. SFI as an adjuvant may improve the total effective rate, APACHE II score, gas exchange, and predictors associated with COVID-19 progression, reducing mortality and safety concerns for elderly patients with severe pneumonia.
PubMed: 36091817
DOI: 10.3389/fphar.2022.779942 -
Frontiers in Pharmacology 2023Liver injury is a severe liver lesion caused by various etiologies and is one of the main areas of medical research. C.A. Meyer has traditionally been used as medicine... (Review)
Review
Liver injury is a severe liver lesion caused by various etiologies and is one of the main areas of medical research. C.A. Meyer has traditionally been used as medicine to treat diseases and regulate body functions. Ginsenosides are the main active components of ginseng, and their effects on liver injury have been extensively reported. Preclinical studies meeting the inclusion criteria were retrieved from PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wan Fang Data Knowledge Service Platforms. The Stata 17.0 was used to perform the meta-analysis, meta-regression, and subgroup analysis. This meta-analysis included ginsenosides Rb1, Rg1, Rg3, and compound K (CK), in 43 articles. The overall results showed that multiple ginsenosides significantly reduced alanine aminotransferase (ALT) and aspartate aminotransferase (AST), affected oxidative stress-related indicators, such as superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), and catalase (CAT), and reduced levels of inflammatory factor, such as factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6). Additionally, there was a large amount of heterogeneity in the meta-analysis results. Our predefined subgroup analysis shows that the animal species, the type of liver injury model, the duration of treatment, and the administration route may be the sources of some of the heterogeneity. In a word, ginsenosides have good efficacy against liver injury, and their potential mechanisms of action target antioxidant, anti-inflammatory and apoptotic-related pathways. However, the overall methodological quality of our current included studies was low, and more high-quality studies are needed to confirm their effects and mechanisms further.
PubMed: 37251340
DOI: 10.3389/fphar.2023.1184774 -
Annals of Translational Medicine Sep 2021Sanqi injection and safflower yellow injection were Chinese traditional medicine injections for the treatment of cardiovascular diseases and were used to treat acute...
BACKGROUND
Sanqi injection and safflower yellow injection were Chinese traditional medicine injections for the treatment of cardiovascular diseases and were used to treat acute cerebral infarction patients in public hospital widely. The aim of this study was to compare and analyze the published reports of efficacy and safety of Sanqi injection and safflower yellow injection for the treatment of acute cerebral infarction. The cost-effectiveness of these drug formulations was also evaluated.
METHODS
China National Knowledge Infrastructure (CNKI), Wanfang, SinoMed, VIP, PubMed, Embase, and the Chinese Biomedical Literature (CBM) were searched with the restrictions keywords in Chinese and English between 2006 and 2019 to obtain RCTs. A meta-analysis and a meta-regression analysis were undertaken in Reviewer Manager 5.3 software to compare the efficacy and safety of Sanqi and safflower yellow injection. This study used a decision tree model to analyze the cost-effectiveness of the two treatments. The TreeAge Pro software was used to comprehensively evaluate the economics of these medications.
RESULTS
Twelve papers were all randomized controlled trials (RCTs) in which Sanqi injection was applied in the control group, while safflower yellow injection was applied in the experimental group and the quality of them were good. The results of the 12 papers were compared, and the total effective rate of the treatment group (91.18%) was significant and showed no significant difference with the control group (74.83%) (RR =1.24, 95% CI: 1.19, 1.30, P<0.00001). From the perspective of pharmacoeconomics, compared with Sanqi group, the ICER of safflower yellow injection is 3,885.75 RMB. The sensitivity analysis results were consistent with the basic analysis results, indicating that the basic analysis results were relatively stable.
CONCLUSIONS
Comparing with Sanqi injection, safflower yellow injection and related combination therapy can improve the total effective rate and are safer with fewer adverse reactions. It is also more cost-effective than the use of Sanqi injection.
PubMed: 34733959
DOI: 10.21037/atm-21-782