Efficacy and safety of acupuncture for vocal nodules: A systematic review and meta-analysis with trial sequential analysis.

In this study, we aim to evaluate the efficacy and safety of acupuncture for vocal nodules, concerning qualitive overall efficacy and quantitative improvement on quality of voice. Four English and four Chinese databases were searched up to December 10th, 2022. Risk of bias among the included trials were evaluated by the Cochrane ROB tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using RevMan 5.4 Software, and trial sequential analyses were performed by TSA 0.9. Meta-influence analyses, subgroup-analyses, meta-regression, and evaluation of publication bias were performed for exploration of heterogeneity by Stata V.14. Quality of the results was accessed through the GRADE-pro GDT. Cluster analyses and correlation coefficient were performed by R 4.1.3. Finally, 15 trials involving 1,888 participants were included. Results showed that compared with western medicine alone or Chinese herbal medicine alone, acupuncture alone yielded significantly (p<0.05) higher clinical effective rate and more improvement on scores of voice analyses. However, reduction on scores of grade, roughness, and breathiness and voice handicap index during follow-ups, and results of clinical effective rate suggested that acupuncture was inferior to voice training. In addition, meta-regression and sub-group analyses firstly revealed advanced efficacies of acupuncture when performed with local and remote acupoints, compared with local acupoints only. Acupuncture specified adverse event was denied in six trials while it was not mentioned in other nine trials. Results of cluster analyses and correlation coefficient showed that Kai yin yi hao and He gu (LI-4) were the most frequently applied matching-acupoints in trials. In conclusion, compared with western medicine (level of evidence: low ⨁⨁◯◯, GRADE C) and Chinese herbal medicine (level of evidence: moderate ⨁⨁⨁◯, GRADE B), acupuncture is safe and of better efficacy for patients with vocal nodules, while there is also need for RCTs with improvements on designing and interventions in experimental and controls.

Driving forces of the complex formation between highly charged disordered proteins.

Highly disordered complexes between oppositely charged intrinsically disordered proteins present a new paradigm of biomolecular interactions. Here, we investigate the driving forces of such interactions for the example of the highly positively charged linker histone H1 and its highly negatively charged chaperone, prothymosin α (ProTα). Temperature-dependent single-molecule Förster resonance energy transfer (FRET) experiments and isothermal titration calorimetry reveal ProTα-H1 binding to be enthalpically unfavorable, and salt-dependent affinity measurements suggest counterion release entropy to be an important thermodynamic driving force. Using single-molecule FRET, we also identify ternary complexes between ProTα and H1 in addition to the heterodimer at equilibrium and show how they contribute to the thermodynamics observed in ensemble experiments. Finally, we explain the observed thermodynamics quantitatively with a mean-field polyelectrolyte theory that treats counterion release explicitly. ProTα-H1 complex formation resembles the interactions between synthetic polyelectrolytes, and the underlying principles are likely to be of broad relevance for interactions between charged biomolecules in general.

Total aglycones from Marsdenia tenacissima increases antitumor efficacy of paclitaxel in nude mice.

Marsdeniae tenacissimae Caulis (MTC) is a Chinese herbal medicine used mainly for treatment of cancer, whose pharmacologically active constituents responsible for its in vivo activity and clinical efficacy have not been clearly elucidated. In this study, total aglycones of MTC (ETA) showed the ability to sensitize KB-3-1, HeLa, HepG2 and K562 cells to paclitaxel treatment. More inspiringly, ETA markedly enhanced the antitumor activity of paclitaxel in nude mice bearing HeLa or KB-3-1 xenografts. Compared to treatment with paclitaxel alone, treatment with combination of paclitaxel and ETA achieved significant reduction in volume and weight of HeLa tumors (p<0.05), and remarkable inhibition to the growth of KB-3-1 tumors (p<10⁻6). ETA was characterized by the presence of a group of tenacigenin B ester derivatives, among which four reference compounds, 11α-O-tigloyl-12ß-O-acetyltenacigenin B, 11α,12ß-di-O-tigloyltenacigenin B, 11α-O-2-methylbutanoyl-12ß-O-tigloyltenacigenin B, and 11α-O-(2-methylbutanoyl)-12ß-O-benzoyltenacigenin B, accounted for 42.14% of the total peak area of 19 detectable components assayed by HPLC. Our study has identified ETA as a promising sensitizer for cancer chemotherapy.