Pharmaceutical preparations of Periplaneta americana (KangFuXin liquid) in the treatment of pressure ulcer: A meta-analysis.

Pressure ulcers often become chronic wounds that are difficult to treat and that tend to recur after healing. In China, convincing data from randomised trials have demonstrated that the pharmaceutical preparations of Periplaneta americana (KangFuXin Liquid, KFX) have a significant efficacy for pressure ulcers. To provide more reference to the clinicians and experts, we conducted a meta-analysis based on the existing randomised controlled trials (RCTs). We searched the RCTs about KFX for the treatment of pressure ulcers published up to July 2022 in major English and Chinese databases with no language restriction, including PubMed, EMBASE, Web of Science (WOS), Cochrane Central Register of Controlled Trials (CENTRAL), China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and WanFang database. Cochrane Handbook guidelines were used to assess the risk of bias and to evaluate the methodological quality of included RCTs. Estimates of the intervention's effects are expressed as the risk ratio (RR) (95% CI) for binary outcomes and mean difference or standardised mean difference (95% CI) for continuous outcomes. We applied fixed or random effects models, and all analyses were performed using Review Manager version 5.4 and Stata/SE version 12.0. We included 22 studies with a total of 1575 participants. Compared with controls, KFX combined with basic wound care or KFX combined with basic wound care and another topical drug or physical treatment significantly increase clinical efficacy (RR: 1.17; 95% CI, 1.06-1.28; P = 0.001; I2  = 81%) and shorten the complete healing time (MD = -5.11; 95% CI [-8.19, -2.02]; P = 0.001) for pressure ulcers. Subgroup analysis showed a significant difference in the total clinical effect rate between KFX combined with basic wound care and controls. (n = 1018, RR 1.21, 95% CI [1.07, 1.36], I2  = 82%, P = 0.003). No difference was found in the total clinical effective rate between patients using KFX combined with basic wound care and another topical drug or physical treatment with controls (KFX combined with basic wound care and topical physical treatment: n = 267, RR 1.15, 95% CI [0.86, 1.52], I2  = 87%, P = 0.34; KFX combined with basic wound care and topical drug: n = 290, RR 1.05, 95% CI [0.80, 1.37], I2  = 86%, P = 0.71). Based on treatment duration, subgroup analysis indicated that increasing treatment duration increased the total clinical effective rate when treatment duration was not long. (treatment duration: 14 days: n = 158, OR 5.48, 95% CI [1.47, 20.43], I2  = 0%, P = 0.01; 21 days: n = 132, OR 5.93, 95% CI [1.86, 18.91], I2  = 65%, P = 0.003). When treatment duration was 28 days or 30 days, the results showed that there was no significant difference in total clinical effective rate between interventions and controls (treatment duration: 28 days: n = 107, OR 3.04, 95% CI [0.25, 37.32], I2  = 50%, P = 0.38; 30 days: n = 256, OR 0.58, 95% CI [0.11, 3.15], I2  = 65%, P = 0.53). No data on side effects were reported in any of the 22 studies. The conclusion is that the combination of KFX and basic wound care is effective in increasing the total clinical effectiveness and shortening the complete healing time of pressure ulcers.

The immunoregulatory effects of natural products on psoriasis via its action on Th17 cells versus regulatory T cells balance.

Psoriasis is an incurable, chronic inflammatory disease, which brings a substantial burden on individuals and society. Currently, the treatment of psoriasis has entered the era of biologics, but its highly targeting of inflammatory mediators may enable the immune response to circumvent the blockade, leading to disease recurrence, or other clinical and immunological characteristics. Therefore, the discovery of new therapies that have the ability of multidirectional regulation on immunity and maintain the dynamic balance of immunity in psoriasis, may be the key to the treatment of the disease. Natural products extracted from herbal medicines have synergistic effects to alleviate psoriasis and its comorbidities because of their structural diversity and multiple active mechanisms. To date, the characteristics of natural products regulating T helper 17 (Th17) cells/regulatory T (Treg) cells balance in the treatment of psoriasis have attracted more and more attention from basic and clinical studies. In this review, we systematically introduced the natural products regulating the balance of Th17/Treg and their specific mechanism of action, finding Datura metel L, Grape seed proanthocyanidin extract (GSPE), Thymol, Kaempferol, Aloperine, Abietic acid (AA), Isogarcinol, Luteolin reduced the frequency and function of Th17 cells and simultaneously increased that of Treg cells. It is expected that our work can provide a reference for clinicians in drug use.