New Iridoids and Acyclic Monoterpenoids from the Roots and Rhizomes of Valeriana officinalis var. latifolia.

Five new iridoids, valeralides A-E (1-5), two new acyclic monoterpenoids, valeralides F (6) and G (7), together with two known iridoids (8 and 9), were isolated from the roots and rhizomes of Valeriana officinalis var. latifolia. Their structures were elucidated based on 1D and 2D NMR, as well as HR-ESI-MS spectroscopic data. The absolute configuration of compounds 1-4 were elucidated based on electronic circular dichroism (ECD) calculation. In addition, all the isolates were evaluated for their inhibition on nitric oxide production, cytotoxicity and anti-influenza A virus activity.

Uncertainties in the Analysis of Heart Rate Variability: A Systematic Review.

Heart rate variability (HRV) is an important metric with a variety of applications in clinical situations such as cardiovascular diseases, diabetes mellitus, and mental health. HRV data can be potentially obtained from electrocardiography and photoplethysmography signals, then computational techniques such as signal filtering and data segmentation are used to process the sampled data for calculating HRV measures. However, uncertainties arising from data acquisition, computational models, and physiological factors can lead to degraded signal quality and affect HRV analysis. Therefore, it is crucial to address these uncertainties and develop advanced models for HRV analysis. Although several reviews of HRV analysis exist, they primarily focus on clinical applications, trends in HRV methods, or specific aspects of uncertainties such as measurement noise. This paper provides a comprehensive review of uncertainties in HRV analysis, quantifies their impacts, and outlines potential solutions. To the best of our knowledge, this is the first study that presents a holistic review of uncertainties in HRV methods and quantifies their impacts on HRV measures from an engineer's perspective. This review is essential for developing robust and reliable models, and could serve as a valuable future reference in the field, particularly for dealing with uncertainties in HRV analysis.

Blood-letting therapy combined with Master Tung's Five-tiger Point Scraping (Gua Sha) for patients with hematological malignancy and chemotherapy-induced peripheral neuritis.

OBJECTIVE: To investigate the clinical efficacy of Shixuan and Qiduan blood-letting therapy combined with Master Tung's Five-tiger Point (11.27) Scraping for patients with hematological malignancy and peripheral neuritis. METHODS: A total of 70 patients with hematological malignancy who were admitted to Langfang TCM Hospital between January 2020 and December 2022 for treating chemotherapy-induced peripheral neuritis were enrolled retrospectively. The patients were divided into a single treatment group that received western nutritional interventions alone, and a combined treatment group that underwent additional Traditional Chinese Medicine (TCM) Shixuan and Qiduan blood-letting therapy, along with Master Tung's Five-tiger Point (11.27) Scraping. Statistical analyses were carried out to compare the clinical efficacy of the two treatment plans in the patients. Scores of sensory disturbance rating (SDR), numeric rating scale (NRS) for pain, nail fold microcirculation (NFM) of the infected extremity, and the quality of life (QoL), as well as the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of the median and peroneal nerves of patients in both groups were recorded and compared before and after treatment. The incidence rate of adverse events was compared between the two groups. Furthermore, the clinical outcomes of patients in the two groups were followed up and analyzed for correlated factors using univariate and multivariate analyses. RESULTS: The clinical efficacy rate achieved by the combined therapy was 88.57%, significantly higher than 68.57% for patients undergoing single therapy (P=0.041). Moreover, the scores of SDR, pain NRS, QoL, and NFM of the affected extremity, as well as the MNCV and SNCV of patients in the two groups were all improved after treatment, with better improvements in the combined treatment group than in the single treatment group. The incidence rate of adverse events was higher in the single treatment group compared to that of the combined treatment group (17.14% vs. 11.42%) (P=0.466). In addition, during the six-month follow-up period, a total of 27 patients in both groups developed chronic neural disorders. Logistic regression analysis revealed that the MNCV and SNCV of the median and peroneal nerves, together with the duration of chemotherapy, served as independent influencing factors. CONCLUSION: Shixuan and Qiduan blood-letting therapy combined with Master Tung's Five-tiger Point (11.27) Scraping could improve the SDR and pain NRS scores, facilitate the recovery of neural functions, and advance the QoL of patients with chemotherapy-induced peripheral neuritis without increasing the risk of adverse reactions.

Heterogeneity of Outcomes Reporting in Trials Evaluating Traditional Chinese Medicine Breast Massage for Stasis Acute Mastitis: A Methodological Review.

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Embase, Cochrane library, JBI, CINAHL, PsycINFO, Clinical Trials Registry Platform portal, Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Center Watch Registry from inception to May 15, 2022 to find randomized controlled trials, non-randomized controlled trials, case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage, with search terms of mastitis, acute mastitis, lactation mastitis, puerperal mastitis, breast problem, breast engorgement, milk stasis, blocked ducked, breast pain, breast massage, and acupoint massage. Outcomes and the measurement schemes (measurement methods, timing of assessing outcome, frequency of assessing outcome, measurers) were extracted from the included studies. We used the Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) to assess the quality of each study, then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials (OMERACT) Filter 2.1 framework.Results We identified 85 clinical trials, in which 54 different outcomes were reported. A total of 81.2% (69/85) of studies were assessed as medium quality with a mean score of 2.6, and 18.8% (16/85) as low quality with a mean score of 0.9. These outcomes were organized in three core areas. Lump size (89.4%, 76/85) was the most frequently reported outcome, followed by breast pain (69.4%, 59/85) and milk excretion (68.2%, 58/85). Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous. Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.

Apigenin suppresses mycoplasma-induced alveolar macrophages necroptosis via enhancing the methylation of TNF-α promoter by PPARγ-Uhrf1 axis.

BACKGROUND: Mycoplasma-associated pneumonia is characterized by severe lung inflammation and immunological dysfunction. However, current anti-mycoplasma agents used in clinical practice do not prevent dysfunction of alveolar macrophages caused by the high level of the cytokine tumor necrosis factor-α (TNF-α) after mycoplasma infection. Apigenin inhibits the production of TNF-α in variet inflammation associated disease. PURPOSE: This study aimed to investigate apigenin's effect on mycoplasma-induced alveolar immune cell injury and the mechanism by which it inhibits TNF-α transcription. METHODS: In this study, we performed a mouse model of Mycoplasma hyopneumoniae infection to evaluate the effect of apigenin on reducing mycoplasma-induced alveolar immune cell injury. Furthermore, we carried out transcriptome analysis, RNA interference assay, methylated DNA bisulfite sequencing assay, and chromatin immunoprecipitation assay to explore the mechanism of action for apigenin in reducing TNF-α. RESULTS: We discovered that M. hyopneumoniae infection-induced necroptosis in alveolar macrophages MH-S cells and primary mouse alveolar macrophages, which was activated by TNF-α autocrine. Apigenin inhibited M. hyopneumoniae-induced elevation of TNF-α and necroptosis in alveolar macrophages. Apigenin inhibited TNF-a mRNA production via increasing ubiquitin-like with PHD and RING finger domains 1 (Uhrf1)-dependent DNA methylation of the TNF-a promotor. Finally, we demonstrated that apigenin regulated Uhrf1 transcription via peroxisome proliferator activated receptor gamma (PPARγ) activation, which acts as a transcription factor binding to the Uhrf1 promoter and protected infected mice's lungs, and promoted alveolar macrophage survival. CONCLUTSION: This study identified a novel mechanism of action for apigenin in reducing alveolar macrophage necroptosis via the PPARγ/ Uhrf1/TNF-α pathway, which may have implications for the treatment of Mycoplasma pneumonia.

Core-shell structured hollow copper sulfide@metal-organic framework for magnetic resonance imaging guided photothermal therapy in second near-infrared biological window.

Multifunctional core-shell hybrids formed by integration of metal-organic framework (MOF) and functional materials have attracted extensive attention as promising theranostic nanoplatforms due to their combined novel properties and enhanced therapeutic efficacy. Recently, the second near-infrared (NIR-II, 1000-1700 nm) laser-induced photothermal therapy (PTT) as compared to the NIR-I(700-950 nm) laser-induced PTT has displayed improved therapeutic effects owing to its merits that include deeper tissue penetration and increased maximum permissible exposure. Herein, a novel core-shell hollow copper sulfide@metal-organic framework (HCuS@MIL-100) has been successfully fabricated by a layer-by-layer technique for the first time and their collective theranostic effects are investigated in vitro and in vivo. In this platform, the inner HCuS was applied as the NIR-II photothermal agent with excellent NIR-II absorption feature, leading to impressive photothermal effects under irradiation by 1064 nm light. With MIL-100 as the shell, HCuS@MIL-100 not only displayed optimal biocompatibility but also presented superior T2 magnetic resonance imaging (MRI) ability. In the current study multifunctional hollow core-shell HCuS@MIL-100 are fabricated for the MRI-guided PTT. This study also offers a facile and effective strategy for the development of novel theranostic platforms with high efficiency through the integration of MOFs and functional materials.

Demonstration of a bi-directionally tunable arrayed waveguide grating with ultra-low thermal power using S-shaped architecture and parallel-circuit configuration.

A thermally bi-directionally tunable arrayed waveguide grating (TBDTAWG) is proposed and demonstrated on a silicon-on-insulator (SOI) platform. The device is composed of passive and active designs for realizations of an AWG and fine tuning of its filtering responses. Given that the required length difference between adjacent arrayed waveguides for the SOI platform is considerably short (∼3-5 µm) due to a high index contrast, an S-shaped architecture with a larger footprint instead of a rectangular one is employed in the AWG. Bi-directionally tunable functions, i.e., both red- and blue-shift tunable functions, can be achieved by using two triangular thermal-tuning regions with complementary phase distributions in the S-shaped architecture despite using only materials with positive thermo-optic coefficients, i.e., Si and SiO2. Measurement results illustrate that both red- or blue-shifted spectra can be achieved and a linear bi-directional shift-to-power ratio of ±30.5 nm/W as well as a wide tuning range of 8 nm can be obtained under an electrical voltage range of 0-2.5 V, showing an agreement between the measurement results and two-dimensional simulation results. This also shows the potential of the proposed TBDTAWG for automatically stabilizing the spectral responses of AWG-based (de)multiplexers for coarse or dense wavelength division multiplexing communication systems by using a feedback control circuit.

Indirect moxibustion for the treatment of allergic rhinitis: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To synthesize the results of randomized clinical trials (RCTs) and evaluate the effectiveness and safety of indirect moxibustion for the treatment of allergic rhinitis (AR). METHODS: PubMed, the Cochrane Library, Embase, Web of Science, CNKI, WanFang, VIP, and CBM from the establishment to May 22, 2020 were searched. This was a PRISMA review. Reviewers identified studies, extracted data, and assessed the quality, independently. RCTs for AR patients treated with IM alone or IM combined with other positive interventions (e.g. western medicine, conventional therapy, etc.) were included. The main outcomes included: total effective rate and TNSS. The secondary outcomes included: TNNSS, Graded symptom score, RQLQ, VAS, Serum IgE level and adverse events. RCTs were collected, methodological quality was evaluated using the Cochrane risk-of-bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 manager. RESULTS: We included 21 RCTs involving 1549 patients. Five RCTs adopt IM treatment alone; 16 RCTs adopt IM+other positive interventions. In the assessment of the quality, the evidence differs from low to high based on the Cochrane Bias Evaluation Tools. Six trials were high quality, twelve were moderate quality, and three were low quality. Therefore, the quality of the included studies was moderate. The total evidence quality of all outcome indicators was low. The main adverse reactions of moxibustion are burns and blisters, whereas the western medicine group was nasal bleeding. The results of pooled analysis indicated a statistically significant effect in total effective rate of (RR=1.16, 95%CI=1.11-1.21, I2 =30%, P = 0.10). Besides, indirect moxibustion intervention also showed significant difference in graded symptom score (SMD=-1.10; 95% CI [-1.58, -0.61]; P < 0.00001; I2 =88%), TNSS score (SMD=-1.36; 95% CI [-2.14, -0.58]; P = 0.76; I2 =0%), and RQLQ scale (SMD=-2.60; 95% CI [-4.06, -1.14]; P < 0.00001; I2 =92%) in patients with AR. However, there was no statistical significance in VAS score (SMD=-0.38; 95% CI [-1.06, 0.30]; P < 0.003; I2 =83%). Since only one literature was included in TNNSS and Serum IgE levels, descriptive analysis was conducted.And the results showed that the trial group was better than the control group in reducing TNNSS score (P < 0.05). In serum IgE levels,there was no significant difference between the two groups (P > 0.05). CONCLUSION: From the analysis results, indirect moxibustion may have a good clinical effect on the overall treatment of AR, and improve the clinical symptoms of patients;but there was no obvious advantage in improving VAS score and Serum IgE level.Due to the limitations of small sample size, moderate quality and low level of evidence in the included literature, clinical trials should be designed in strict accordance with the standard of RCT in the future to verify this result.

Taraxasterol mitigates Con A-induced hepatitis in mice by suppressing interleukin-2 expression and its signaling in T lymphocytes.

Discovery of anti-inflammatory drugs that can suppress T lymphocyte activation and proliferation by inhibiting TCR/CD3 and IL-2/IL-2R signaling is still needed in clinic, though rapamycin and other related reagents have made great success. Taraxasterol (TAS) is an active ingredient of dandelion, an anti-inflammatory medicinal herb with low in vivo toxicity that has long been used in China. Yet the action mechanism of TAS on lymphocytes remains elusive. The anti-inflammatory effects of TAS were evaluated in C57BL/6 mouse primary lymphocytes stimulated with concanavalin A (Con A) in vitro and in mouse model of Con A-induced acute hepatitis in vivo. Our results showed that TAS significantly suppressed Con A-induced acute hepatitis in a mouse model, reducing the hepatic necrosis areas, the release of aminotransferases, and the production of IL-2 and other inflammatory cytokines. Supporting this, in vitro study also showed that TAS reduced the production of IL-2 and the expression of IL-2 receptor subunit α (CD25) upon the stimulation of Con A, which was likely mediated by suppressing NF-κB activation. The downstream pathways of IL-2/IL-2R signaling, including the activation of PI3K/PDK1/mTOR, STAT3 and STAT5, were also suppressed by TAS. Consistently, Con A-induced T cell proliferation was also inhibited by TAS in vitro. Our data indicate that TAS can suppress both T lymphocyte activation and cell proliferation by down-regulating IL-2 expression and its signaling pathway thereby ameliorating Con A-induced acute hepatitis, highlighting TAS as a potential drug candidate for treating inflammatory diseases including autoimmune hepatitis.

A comprehensive synthesis unveils the mysteries of phosphate-solubilizing microbes.

Phosphate-solubilizing microbes (PSMs) drive the biogeochemical cycling of phosphorus (P) and hold promise for sustainable agriculture. However, their global distribution, overall diversity and application potential remain unknown. Here, we present the first synthesis of their biogeography, diversity and utility, employing data from 399 papers published between 1981 and 2017, the results of a nationwide field survey in China consisting of 367 soil samples, and a genetic analysis of 12986 genome-sequenced prokaryotic strains. We show that at continental to global scales, the population density of PSMs in environmental samples is correlated with total P rather than pH. Remarkably, positive relationships exist between the population density of soil PSMs and available P, nitrate-nitrogen and dissolved organic carbon in soil, reflecting functional couplings between PSMs and microbes driving biogeochemical cycles of nitrogen and carbon. More than 2704 strains affiliated with at least nine archaeal, 88 fungal and 336 bacterial species were reported as PSMs. Only 2.59% of these strains have been tested for their efficiencies in improving crop growth or yield under field conditions, providing evidence that PSMs are more likely to exert positive effects on wheat growing in alkaline P-deficient soils. Our systematic genetic analysis reveals five promising PSM genera deserving much more attention.

Meta-analysis of the clinical effectiveness of combined acupuncture and Western Medicine to treat post-stroke depression.

OBJECTIVE: To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis. METHODS: The China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, Chinese Biomedical Literature Database, PubMed, Embase, and the Cochrane Library were searched from their establishment to August 2018 for randomized controlled trials (RCTs) of combined acupuncture and Western Medicine to treat post-stroke depression. Two researchers independently extracted and cross-checked data, and then applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the risk of bias. Review Manager 5.3 was used to conduct the meta-analysis. RESULTS: A total of 1860 patients in 24 RCTs were analyzed. The results of the Meta-analysis showed that: (a) The effective rate of acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride was significant [relative risk (RR) = 1.16, 95% confidence interval (CI) (1.08, 1.26)], as was that of acupuncture + flupentixol/melitracen vs flupentixol/melitracen [RR = 1.23, 95% CI (1.10, 1.37)]. (b) When analyzing Hamilton Depression Scale (HAMD)-17 scores, six trials showed that acupuncture combined with Western Medicine was superior to Western Medicine alone, and could relieve the depressive symptoms of patients. For HAMD-24 scores, five trials were included for acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride, with significance at 2 weeks [WMD = －6.51, 95% CI(－ 8.62, － 4.40)], as well as at 4 weeks [WMD = －8.40, 95% CI (－11.86, －4.94)] and 8 weeks. (c)For the activities of daily living scale, acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride [WMD = 22.65, 95% CI (18.34, 26.95)], acupuncture + flupentixol/melitracen vs flupentixol/melitracen [WMD = 8.08, 95% CI (2.57, 13.59)], acupuncture + sertraline hydrochloride vs sertraline hydrochloride [WMD = 6.94, 95% CI (3.59, 10.29)], and acupuncture + doxepin hydrochloride vs doxepin hydrochloride [WMD = 18.80, 95% CI (15.84, 21.76)] had significance. (d) For Treatment Emergent Symptom Scale scores, there was significance in all four included studies. CONCLUSION: The therapeutic effects of acupuncture combined with Western Medicine on post-stroke depression are often better than those of Western Medicine alone, and fewer adverse reactions occur. However, more high-quality RCTs are needed to further confirm these findings.

The Quality of Methodological and Reporting in Network Meta-Analysis of Acupuncture and Moxibustion: A Cross-Sectional Survey.

BACKGROUND: Acupuncture had long been a primary treatment in the healthcare system of China. In recent years, there were more and more network meta-analyses (NMAs) in the field of acupuncture and moxibustion, but the quality evaluation of NMAs was rare. OBJECTIVES: The goal of this study was to evaluate the methodological and reporting quality of NMAs and summarize the effects of different treatments of acupuncture and moxibustion. METHODS: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database (WF), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) were searched from inception to January 2020 without any language restriction. In addition, the unpublished studies and the references of initially included literature were also retrieved manually. We included all relevant NMAs treated with acupuncture and moxibustion; other therapies such as traditional Chinese medicine and Western medicine may also be included, but at least three types fall under the category of acupuncture in each NMA. Outcome indicators were not limited. We selected AMSTAR2 and PRISMA-NMA to evaluate the methodological and reporting quality of eligible studies, respectively. RESULTS: In total, 29 NMAs were included finally, including 12 Chinese references and 17 English references. All eligible studies were published from May 2013 to August 2019. The number of interventions was between 4 and 22. The number of clinical trials included ranged from 10 to 121, with a total of 1098 clinical trials. The NMAs were involved in up to 23 diseases, knee osteoarthritis and primary dysmenorrhea covered with 3 NMAs separately, others focusing on chronic functional constipation, lumbar disc herniation, chronic fatigue syndrome, and the like. The Jadad scale and RoB scale were used as the bias risk assessment tools. Among them, 7 articles adopted the Jadad scale, 22 articles adopted the RoB scale (1 article adopted both the Jadad scale and RoB scale), and only 1 article did not mention the risk assessment tool. The AMSTAR2 methodological evaluation showed that the highest score was 13.5 points and the lowest was 4, with an average of 8.64 and a median of 9.5. According to the quality criteria, only one of them was in high quality, twenty-four were in medium quality, and four were in low quality. The PRISMA-NMA reporting quality evaluation showed that the highest score was 29 points and the lowest was 13.5, with an average of 23.62 and a median of 24.5; severe flaws also existed in some items, especially in "Structured summary," "Protocol and registration," "Search," "Data collection process," "Data items," "Additional analyses," "Risk of bias across studies," and "Results of additional analyses." CONCLUSION: The number of NMAs in the field of acupuncture and moxibustion was still in the initial stage. Overall, their methodology and reports were of moderate quality. However, severe flaws also existed in some items. Because the eligible NMAs were limited, the conclusion needed further research to confirm its authenticity and reliability.

The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis.

BACKGROUND: Allergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR. METHODS: PubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software. RESULTS: A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P = 0.45; I 2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P = 0.03; I 2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = -1.42; 95% CI [-1.55, -1.29]; P = 0.03; I 2 = 60%) in patients with AR. CONCLUSION: Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.

The effectiveness of thunder fire moxibustion for treating allergic rhinitis: A protocol for systematic review and meta analysis.

BACKGROUND: Allergic rhinitis (AR) is a chronic disease, resulting in severe syndromes such as sneezing, itching, nasal blockage, and rhinorrhea. The major medications treating AR cause side effects, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Thus, this systematic review and meta analysis aims to systematically evaluate the effectiveness and safety of TFM in the treatment of AR. METHODS: Nine databases, including Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database (WF), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) from inception to July 2020 will be searched. In addition, the grey literature and the references of all included literature will be retrieved manually. Reviewers will identify studies, extract data and assess the quality independently. The outcomes of interest include: total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, Laboratory indicators: serum immunoglobulin E, immunoglobulin A, or immunoglobulin G level and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis will be performed using RevMan5.3.0 software. RESULTS: Because the review is ongoing, no results can be reported. CONCLUSIONS: The findings from this review will provide reliable evidence for effectiveness and safety of TFM for AR. ETHICS AND DISSEMINATION: Ethical approval requirements are not necessary for this review. This systematic review and meta analysis will be disseminated online and on paper to help guide the clinical practice better. PROSPERO REGISTRATION NUMBER: CRD42019141113.

Effectiveness and safety of indirect moxibustion for the treatment of allergic rhinitis: A protocol for systematic review and meta-analysis of RCTs.

BACKGROUND: Allergic rhinitis (AR) is a common allergic disorder worldwide. Western medicine is not optimistic about the therapeutic effect of this disease. However, moxibustion can enhance vital energy or immunity through a great number of clinical trials. Thus, the aim of this systematic review and meta-analysis is to systematically evaluate the effectiveness and safety of indirect moxibustion for treating AR. METHODS: We will conduct a comprehensive literature search in Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database, WanFang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database from inception to August 2020 without any language restriction. In addition, we will retrieve the unpublished studies and the references of initially included literature manually. Reviewers will identify studies, extract data, and assess the quality independently. The outcomes of interest include: total effective rate, total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, laboratory indicators (i.e., serum levels of IgE, IgA, or IgG), and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analysis will be performed using RevMan 5.3.0 software. The heterogeneity test will be conducted between the studies, and P < .1 and I > 50% are the thresholds for the tests. We will utilize the fixed effects model or the random effects model according to the size of heterogeneity. RESULTS: Because the review is ongoing, no results can be reported. CONCLUSIONS: The results of this review will provide reliable evidence for effectiveness and safety of indirect moxibustion for treating AR. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. This systematic review and meta-analysis will be disseminated online and on paper to help guide clinicians. PROSPERO REGISTRATION NUMBER: CRD42019140944.

The effectiveness and safety of acupuncture for allergic rhinitis: Protocol for an overview of systematic reviews and meta-analyses.

BACKGROUND: Allergic rhinitis (AR) is one of the most common allergic disorders globally. Several systematic reviews and meta-analyses have reported the effectiveness of acupuncture for patients with AR. However, the evidence has not been systematically synthesized. This overview aims to map, synthesize, and assess the reliability of evidence generated from these systematic reviews (SRs) and meta-analyses of acupuncture for AR. METHODS: A Comprehensive literature search will be conducted through the PubMed, Embase, the Cochrane Library of Systematic Reviews, the China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database from inception until January 2020. Additionally, the PROSPERO database and the reference list of included studies will be searched for unpublished, ongoing, or recently completed SRs and meta-analyses. The reviewers will identify reviews independently and extract data according to the methodological guidelines for overviews provided by the Cochrane Collaboration. The risk of bias will be assessed based on the Risk of Bias in Systematic Reviews. The methodological and reporting quality of the included reviews will be assessed using the Assessing the Methodological Quality of Systematic Reviews (V.2) tool and the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The outcomes of interest include total nasal symptom score, rhinoconjunctivitis quality-of-life questionnaire, immunoglobulin E, visual analog scale, laboratory examination, and side effects. The quality of evidence of outcomes will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The evidence will be synthesized where appropriate based on patient subgroups and outcomes. ETHICS AND DISSEMINATION: Ethical approval is not required for overviews. We plan to publish results in peer-reviewed journals and present at international and national academic, clinical, and patient conferences. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: This overview will provide comprehensive evidence of acupuncture for patients with AR. PROSPERO REGISTRATION NUMBER: CRD42019140756.

Moxibustion for treating knee osteoarthritis: A protocol for systematic review and meta analysis.

BACKGROUND: Knee osteoarthritis (KOA) is a significant health issue because it causes pain and functional limitation. Many studies have reported that moxibustion, a treatment in traditional Chinese medicine, is effective in treating KOA. The aim of this overview is to synthesize and assess the reliability of evidence generated from these systematic reviews of the effectiveness of moxibusition for KOA. METHODS: This is a protocol for a systematic overview of reviews. We will search 7 databases: PubMed, Embase, Cochrane Library, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure, WangFang Database, Chinese Scientific Journal Database from their inception to April 2020. We will consider systematic reviews and meta-analysis of randomized controlled trials evaluating the effectiveness of moxibustion for KOA. Independent reviewers will sift, perform data extraction in duplicate, and assess the quality of the reviews using the Change MeaSurement Tool to Assess Systematic Reviews-2 to Assessment of Multiple Systematic Reviews-2 and the Preferred Reporting Item for Systematic Review and Meta-Analysis statement. The outcomes of interest include: quality of life, knee function, and pain relief outcomes prioritized in the individual reviews. The evidence will be synthesized where appropriate by patient subgroups, intervention type, context, and outcome. Revman 5.3 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The quality of evidence was assessed according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) considering the methodological quality of the randomized controlled trials and meta-analysis. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSIONS: We expect to compile evidence from multiple systematic reviews of symptomatic improvement in patients with KOA in an accessible and useful document. TRIAL REGISTRATION NUMBER: CRD42019141029 in PROSPERO 2019.

Effectiveness and Safety of Acupuncture and Moxibustion for Primary Dysmenorrhea: An Overview of Systematic Reviews and Meta-Analyses.

BACKGROUND: Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea (PD). So far, several systematic reviews (SRs) and meta-analyses (MAs) have reported on the efficacy and safety of acupuncture and moxibustion in treating PD. OBJECTIVES: The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD. MATERIALS AND METHODS: Seven electronic databases, including Cochrane Database of Systematic Reviews, EMBASE, PubMed, SinoMed, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database, were systematically searched. SRs or MAs about acupuncture for PD published up to May 2019 were included in the analysis. More than two authors independently assessed the quality of the evidence by AMSTAR2, PRISMA, PRISMA-A, and GRADE approach. RESULTS: A total of 28 SRs and MAs, 281 original studies, reporting on 26,459 female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality. Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects. CONCLUSION: Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results.

Heat-sensitive moxibustion for anaphylactic rhinitis: A protocol of systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Anaphylactic rhinitis (AR) is one of the most common allergic disorders globally. Heat-sensitive moxibustion (HSM) is an effective method for AR without the occurrence of drug damage. This study aims to systematically investigate the effectiveness and safety of HSM for patients with AR. METHODS: Seven relevant electronic databases from inception until January 2020 including PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database will be searched. All relevant randomized clinical trials published in English and Chinese about HSM for AR regardless of blinding or publication types can be included. The Cochrane Central Register of Controlled Trials and other potential articles in the reference list of included studies will also be searched. We recommend total nasal symptom score as primary outcomes. Secondary outcomes includes rhinoconjunctivitis quality of life questionnaire, IgE, visual analogue scale, laboratory examination, and side effects. Study selection, data extraction, and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be conducted by RevMan 5.3 software. ETHICS AND DISSEMINATION: Ethical approval is not required for no personal data involved. The results of this SR will be disseminated through peer-reviewed publications according to the Preferred Reporting Items for Systematic reviews and Meta Analysis Protocols guidelines. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The findings will provide further evidence for the management of AR. PROSPERO REGISTRATION NUMBER: CRD42019140723.