Atractylodes macrocephala-Paeonia lactiflora Class Formula for the Treatment of Irritable Bowel Syndrome: A Systematic Review With Meta-Analysis and Trial Sequential Analysis.

Previous meta-analyses suggested that Chinese herbal medicine (CHM) is effective for irritable bowel syndrome (IBS). Formulas with Atractylodes macrocephala and Paeonia lactiflora as the core pairs have been widely used by traditional Chinese medicine (TCM) practitioners for the treatment of IBS. We aimed to examine the efficacy and safety of the Atractylodes macrocephala-Paeonia lactiflora class formula (A-P CHM) for IBS through a meta-analysis and trial-sequential analysis (TSA). The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023439087. We searched seven databases for data up to May 23, 2023. The primary outcome was global IBS symptom relief. The secondary outcomes included the IBS severity scoring system (IBS-SSS) score and treatment-related adverse events. The relative ratio (RR) (dichotomous variables), the standardized mean difference (SMD) (continuous variables), the number needed to treat (NNT), the number needed to harm (NNH), and the required information size (RIS) were calculated. Twenty-four eligible articles with 3,768 participants were included. Thirteen trials were at low risk of bias (RoB). Compared with placebo or Western medication, A-P CHM was associated with a significantly higher proportion of relief of global IBS symptoms. The TSA analysis verified the primary outcome. For the secondary outcome, the A-P CHM IBS-SSS score was lower than Western medication or placebo at the end of the treatment, which was further confirmed by the TSA analysis. We asserted that A-P CHM might be a potential candidate for patients with IBS, especially for IBS-D. It may provide a theoretical basis for future optimization of irritable bowel syndrome with diarrhea (IBS-D) herbal formulas. The overall certainty of the evidence was not high; more tightly designed randomized controlled trials (RCTs) are required in the future.

[Clinical effects of acupoint catgut embedding with quadruple therapy on Hp (+) chronic atro-phic gastritis of spleen and stomach deficiency syndrome].

OBJECTIVE: To evaluate the clinical effects of acupoint catgut embedding combined with quadruple therapy on Helicobacter pylori (Hp)-positive (+) chronic atrophic gastritis (CAG) of spleen and stomach deficiency syndrome and explore the underlying mechanism. METHODS: Hp (+) CAG patients with spleen and stomach deficiency syndrome were randomly divi-ded into a control group (n=68) and a treatment group (n=71). In addition to the routine quadruple therapy for two weeks, the patients in the control group received oral Weifuchun Tablets (4 tablets once, tid.), and those in the treatment group underwent acupoint catgut embedding at Pishu (BL20), Weishu (BL21), Zhongwan (CV12), and Zusanli (ST36), once a week. The two groups were treated for three months in total. The scores of traditional Chinese medicine (TCM) symptoms and signs, clinical efficacies, quality of life scale scores (PRO scores and HAMA scores), endoscopic and histopathologic scores, Hp eradication rates detected by 13C breath test, and the recurrence rates after six months of the two group were compared. The changes in serum gastrin 17 (G-17), pepsinogen Ⅰ (PGⅠ) and pepsinogen Ⅱ (PGⅡ) were detected by ELISA, and PGⅠ/PGⅡ was calculated. RESULTS: There was no significant difference in the eradication rate of Hp between the two groups after treatment (P>0.05), but the recurrence rate after six months in the treatment group was lower than that of the control group (P<0.05). After treatment, the scores of TCM symptoms and signs, endoscopic and histopathologic scores, PRO scores, and HAMA scores were decreased in both groups (P<0.01), while serum levels of G-17, PG Ⅰ, PG Ⅱ, and PG Ⅰ/PG Ⅱ were increased (P<0.05, P<0.01). The treatment group was superior to the control group in alleviating stomach discomfort by pressing or warmth, decreasing the total score of TCM symptoms and signs, relieving anorexia, mottled gastric mucosa, mucosal ulcer, chronic inflammation, and activity, improving anxiety, and regulating G-17 (P<0.05, P<0.01). The effective rates of the treatment group and the control group were 40.85% (29/71) and 23.53% (16/68)，the treatment group was higher than the control group (P<0.05). CONCLUSION: Acupoint catgut embedding combined with quadruple therapy in the treatment of Hp (+) CAG of spleen and stomach deficiency syndrome is significant in clinical efficacy and low in recurrence rate, which is presumedly achieved by repairing gastric mucosa and sensitizing the secretion of G-17 and pepsinogen.

Efficacy and Safety of Ningmitai Capsule in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

OBJECTIVE: To validate the efficacy and safety of Ningmitai capsule (NMT) in the patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: We conducted a multicenter, randomized, double-blind, placebo-controlled trial in 120 men with CP/CPPS to evaluate the efficacy and safety of NMT. Participants were randomly assigned (1:1) to NMT or placebo treatment for 4 weeks at 3 centres. The patients were evaluated by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at baseline, the end of 2 and 4 weeks of treatment. The primary endpoints were the changes of the NIH-CPSI pain scores from baseline to the end of 2 and 4 weeks of the treatment. The secondary endpoints include the changes of the NIH-CPSI total scores, urinary symptoms scores and the quality of life (QoL) as well as the responder rate. RESULTS: After 2 and 4 weeks of treatment, the mean decreases of the NIH-CPSI pain scores, total scores and QoL in the NMT group were all significantly superior to those in the placebo group. The responder rate was significantly higher in the NMT group than that in the placebo group at both 2 and 4 weeks. No adverse events were reported during the treatment. CONCLUSION: NMT could significantly improve the pain symptoms and QoL in the patients with CP/CPPS as early as in 2 weeks, and the efficacy enhanced at the end of the 4-week treatment. The safety of NMT was confirmed in this trial.

Chinese urologists' practice patterns of diagnosing and treating chronic pelvic pain syndrome: a questionnaire survey.

OBJECTIVE: To investigate the application of the Chinese Urological Association (CUA) guidelines on prostatitis and the effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists. METHODS: We conducted a questionnaire investigation of the CUA guidelines on prostatitis among the urologists from 399 hospitals in 63 cities of China, and performed statistical analyses on all the eligible questionnaires collected. RESULTS: Of the 2 251 questionnaires distributed, 2 046 (90.9%) were eligible, of which 92.5% were from the urologists in tertiary or secondary hospitals, of whom 72.3% had senior or intermediate professional titles, and 90.2% had studied the CUA guidelines. Most respondents agreed that Type III prostatitis was a clinical syndrome, of which the diagnosis should be made after other conditions with similar symptoms had been ruled out and the aim was to relieve pain, alleviate urination symptoms and improve quality of life. Those who had and those who had not studied the CUA guidelines differed in their viewpoints on CPPS as illustrated in the guidelines. In clinical practice, the most common treatment options for CPPS were pharmaceutical therapy (95.0%), life style adjustment (88.9%), and psychotherapy (79.9%), and the most frequently prescribed drugs were phytotherapy (84.5%), α-blockers (79.0%) and antibiotics (64.0%). CONCLUSION: CUA guidelines on prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.

[Application of CUA Guidelines on Prostatitis in the management of chronic pelvic pain syndrome: a nationwide survey].

OBJECTIVE: To investigate the application of the Chinese Urological Association (CUA) Guidelines on Prostatitis and its effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists and andrologists. METHODS: We conducted a questionnaire investigation on the application of the CUA Guidelines on Prostatitis among the urologists and andrologists of 173 hospitals in 21 cities of China, and performed statistical analyses on all the eligible questionnaires collected. RESULTS: Of the 1 056 questionnaires distributed, 851 (80.6%) were eligible, of which 71.6% were from the urologists or andrologists in grade 3 hospitals, 80.7% of them with senior or intermediate professional titles and 97.5% had studied the CUA Guidelines. Most of the subjects agreed that Type III prostatitis is a clinical syndrome, whose diagnosis should exclude other conditions with similar symptoms, and whose treatment should aim at relieving pain, alleviating urination symptoms and improving the quality of life. Those who had and those who had not studied the CUA Guidelines differed in their viewpoints on CPPS as illustrated in the book. In clinical practice, the most common treatment options for CPPS were psychological therapy (80.7%), medication (80.4%) and life style adjustment (79.6%), and the most frequently used drugs were phytotherapy (80.0%), alpha-blockers (68.9%) and antibiotics (61.0%). CONCLUSION: CUA Guidelines on Prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.

[Partial ejaculatory duct obstruction induces hemospermia syndrome in the rat model].

OBJECTIVE: To investigate the pathogenesis of hematospermia syndrome using the rat model of hemospermia induced by partial ejaculatory duct obstruction. METHODS: Fifty male rats were divided into Groups A (n=20) and B (n=30), the former subjected to incomplete ligation of the right ejaculatory duct, while the latter open-close sham operation. Electro-stimulation was performed for ejaculation induction one week after the operation. Those that developed hematospermia in Group A were chosen as Group A1, while those with normal ejaculation in Group B included in Group B1. The semen indexes and seminal vesicle pressure were compared between Groups A1 and B1. RESULTS: Compared with Group B1, Group A1 showed significantly decreased semen volume (P < 0.01), lower sperm motility (P < 0.01) and higher seminal vesicle pressure (P < 0.01), but no statistically significant differences were observed in the WBC count and sperm density in the semen between the two groups (P > 0.05). CONCLUSION: Hemospermia syndrome can be induced by partial ejaculatory duct obstruction, with changes of semen indexes, and it is closely correlated with high seminal vesicle pressure.