Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent and debilitating adverse effect in breast cancer patients. Despite growing interest, evidence specific to acupuncture-related interventions in this population remains fragmented. This systematic review and meta-analysis aimed to evaluate the efficacy of acupuncture-related interventions for CIPN in breast cancer patients and assess the certainty of evidence. Methods We conducted a systematic review and pairwise meta-analysis of randomized controlled trials (RCTs). We searched nine electronic databases from inception to September 30, 2025, without language restrictions. The primary outcomes were pain intensity and sensory symptoms; the secondary outcome was quality of life. A post hoc dichotomous outcome of global symptom improvement was additionally analyzed. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool separately for each outcome. Meta-analyses used restricted maximum likelihood random-effects models with Hartung-Knapp-Sidik-Jonkman adjustment. Certainty of evidence was evaluated using GRADE. Results Eleven RCTs (786 participants) were included; nine (586 participants) were included in the meta-analysis. For pain intensity (6 RCTs), acupuncture showed a significant reduction versus controls (Hedges's g = −0.71; 95% CI −1.34 to −0.08; I² = 71%). For sensory symptoms (6 RCTs), the effect was not significant (g = −0.41; 95% CI −0.88 to 0.05; I² = 58%). Quality of life (4 RCTs) showed no significant difference (g = 0.48; 95% CI −0.15 to 1.12; I² = 32%). Global symptom improvement (9 RCTs) favored acupuncture (RR 1.49; 95% CI 1.24 to 1.78; I² = 12%). Adverse events were predominantly mild. GRADE certainty ranged from very low to low. Conclusions Acupuncture-related interventions may reduce pain and improve global symptoms in breast cancer patients with CIPN, but effects on sensory symptoms and quality of life remain uncertain. Evidence certainty is low to very low. These interventions appear safe and may be considered within shared decision-making as adjunctive supportive care. High-quality RCTs with standardized outcomes are needed. Registration: PROSPERO CRD420251082686 (October 1, 2025).
Introduction : As HIV/AIDS transitions to a chronic manageable condition due to highly active antiretroviral therapy, there is growing clinical interest in integrative therapeutic approaches to address treatment-related complications, improve the quality of life (QOL), and enhance overall patient care. Traditional East Asian medicine (TEAM), which includes herbal medicine, acupuncture (e.g., manual acupuncture, electroacupuncture, auricular acupuncture, and pharmacopuncture), moxibustion, manual therapies (e.g., tuina or chuna), and acupoint herbal patching, is increasingly being applied in HIV care, with several clinical trials supporting its efficacy. However, there is a lack of comprehensive and systematic evidence synthesis regarding TEAM in HIV/AIDS management. Methods : This scoping review investigated the current evidence for TEAM interventions in HIV/AIDS management, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of scoping reviews (PRISMA-ScR) and the Arksey and O'Malley framework. This scoping review investigated the current status of research on the use of TEAM in HIV/AIDS to understand its effects and suggest future research and methods. Articles were retrieved from six databases in April 2025. Results : Of the 4,136 articles identified, 29 randomized clinical trials were selected. The research objectives were related to HIV-related pain and symptoms, QOL, the immune system, and opportunistic infections in patients with HIV. The outcomes varied according to pain, HIV-related symptoms, psychological assessment, QOL, and immune system examination. TEAM interventions have shown potential benefits in HIV-related symptom management, pain relief, QOL, and immune-related outcomes in patients with HIV/AIDS. Conclusion : This scoping review suggests that TEAM interventions have potential value in HIV/AIDS management, particularly in terms of symptom control and immune-related outcomes. Further studies on individual interventions, safety, adverse effects, and qualitative methods are required.
Introduction Acupuncture has undergone a long and contested process of institutionalization in Brazil, involving cultural circulation, professional training, regulatory disputes, and gradual incorporation into public health policies. However, the literature on this trajectory remains fragmented across historical, educational, legal, and policy sources. The objective was to map and characterize the historical, professional, academic, and legislative trajectory of acupuncture in Brazil, from its nineteenth-century introduction to the enactment of federal regulation in 2026. Methods This scoping review followed Joanna Briggs Institute (JBI) guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, SciELO, and Google Scholar, as well as in official Brazilian legislative and institutional sources, including the National Congress, Federal Senate, Chamber of Deputies, Planalto, Official Gazette, and Ministry of Health websites. Screening, data charting, and narrative synthesis distinguished studies from legislative documents. Results A total of 1478 bibliographic records were identified; after deduplication and screening, 10 scientific studies were included. In the documentary search, 355 records were identified, resulting in 7 legislative and normative documents included in the final corpus. Four analytical domains emerged: (1) historical introduction and diffusion of acupuncture in Brazil; (2) professional training and education; (3) professional disputes and regulatory frameworks; and (4) the legislative trajectory culminating in Federal Law No 15,345/2026. The findings show that acupuncture in Brazil evolved as a progressively institutionalized and multiprofessional field, marked by heterogeneous training pathways, disputes over jurisdiction, gradual incorporation into the Brazilian Unified Health System, and eventual legal stabilization. Conclusions The 2026 law represents not the beginning, but the formalization of a long-standing historical and institutional process. Future progress in Brazil will depend on post-regulatory governance, educational standardization, public registries, and stronger integration into health services. Registration Open Science Framework under registration code: 10.17605/OSF.IO/KW247, accessible at: https://doi.org/10.17605/OSF.IO/KW247. Funding This work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brazil (CAPES), grant numbers 88887.115699/2025-00 and 88887.272589/2026-00.
Introduction Whether exercise alone, independent of dietary or supplementation co-interventions, alters gut microbial alpha diversity remains unresolved. Prior syntheses pooled exercise-only trials with combined lifestyle programmes, admitted non-randomized designs, and treated ecologically distinct indices as interchangeable. Traditional Chinese Exercise had not been examined as a separate modality. Methods Ten English-, Chinese- and Japanese-language databases were searched from inception to 1 March 2026 for randomized controlled trials of exercise-only interventions, with alpha diversity from 16S amplicon sequencing. Chao1, Shannon and Simpson were synthesized separately as change-score standardized mean differences (Hedges g, assumed pre-post correlation r = 0.5) using random-effects models with the Knapp-Hartung adjustment. Post-intervention and extended sets, modality and health status subgroups, sensitivity analyses, RoB 2 and GRADE were also applied. Results Fourteen trials were included. Exercise had no significant effect on any index: Chao1 g = 0.194 (95% CI -0.253 to 0.640, p = 0.329, I² = 35.4%, k = 7, N = 182), Shannon g = -0.033 (-0.486 to 0.420, p = 0.867, I² = 46.5%, k = 8, N = 206) and Simpson g = -0.331 (-0.943 to 0.281, p = 0.234, I² = 63.6%, k = 7, N = 182). None of the twelve pooled estimates was significant. Traditional Chinese Exercise (Chao1 g = 0.441, p = 0.159, k = 3) did not differ from conventional exercise (p = 0.219), and healthy and clinical populations did not differ. Estimates were stable across r = 0.3 to 0.7; in leave-one-out analysis Chao1 became significant when one trial was omitted (g = 0.366, p = 0.040). No trial was at low overall risk of bias and certainty was very low for all three indices. Conclusions Exercise alone did not measurably alter gut microbial alpha diversity, and no effect was specific to Traditional Chinese Exercise; a modest true effect cannot be excluded. Previously reported positive effects are most plausibly attributable to combined lifestyle interventions, non-randomized designs, or index pooling. Alpha diversity appears an insensitive endpoint; future trials should report the three indices separately and prioritize taxon-level, functional and metabolite outcomes. Registration: PROSPERO CRD420261329368.
Traditional Chinese Medicine (TCM) diagnosis faces a fundamental challenge in modernization: balancing individualized clinical reasoning with the need for reproducible and transparent evaluation. This tension reflects the subjectivity–standardization paradox arising from the gap between experience-based interpretation and objective assessment. In this perspective article, we propose a dual-path framework in which artificial intelligence (AI) bridges clinical observation and diagnostic reasoning. Objective phenotypic quantification transforms manifestations from the Four Diagnostic Methods into standardized representations, while computational knowledge formalization enables theory-guided reasoning beyond data-driven prediction. Through knowledge–data fusion, these pathways provide a conceptual foundation for clinically meaningful AI-assisted TCM diagnosis. However, successful clinical translation requires more than technological advancement. Future development depends on reliable evidence, interpretable reasoning, and rigorous validation. A transition from accuracy-centered algorithms toward trustworthiness-centered clinical intelligence is essential. AI should complement rather than replace clinical expertise, enhancing reproducibility, transparency, and communication of TCM diagnostic knowledge.
Introduction Osteoarthritis (OA) is a prevalent degenerative arthritic condition associated with significant disability. The present study evaluated the efficacy of the Ayurvedic formulations Rasnadi Guggulu and Maharasnadi Kwatha (with Shunthi Churna as an adjuvant) in the management of knee osteoarthritis (KOA), in comparison with Etoricoxib. Methods A randomized, controlled, open-label, parallel-group clinical trial was conducted in a tertiary care teaching hospital. Eighty participants aged 40–70 years, diagnosed with KOA according to the American College of Rheumatology criteria and Sandhigata Vata as per Ayurveda, were randomized into two groups. Group A (n=40) received Etoricoxib 60 mg once daily, while Group B (n=40) received Rasnadi Guggulu (500 mg) and Maharasnadi Kwatha (10 mL) with Shunthi Churna (1 g), administered three times daily for 60 days. Outcomes included pain assessed through Visual analogue scale (VAS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), walking velocity, knee joint range of motion, WHO quality of life-Bref (WHOQOL-BREF), and serum interleukin-6 (IL-6). Assessments were done every 15 days during the intervention. Results Group B demonstrated significantly greater improvement in pain and function, with a marked reduction in VAS (p<0.001, mean difference: 0.82, 95 % confidence interval [CI]: 0.47 to 1.13), and WOMAC-Total (p=0.002, mean difference: 5.39, 95 % CI: 2.12 to 8.66). Outcome difference comparison showed a significant decrease in group B in BMI (p<0.001, mean difference: -0.40, 95 % CI: -0.57 to -0.23). Significant improvements in Group B were noted in walking velocity (p<0.001, mean difference:0.04, 95 % CI: 0.02 to 0.05), flexion (p<0.001, mean difference: 3.02, 95 % CI: 2.08 to 3.95), extension (p<0.001, mean difference: -1.21, 95 % CI: -1.75 to -0.67), and WHOQOL-BREF-Total (p=0.004, mean difference:6.56, 95 % CI: -10.92 to -2.19). Conclusion Ayurveda interventions showed promising improvements in managing knee osteoarthritis when compared to Etoricoxib. These interventions resulted in significant clinical enhancements in pain relief, functional abilities, quality of life, and body weight.
Introduction Leech saliva is a rich natural source of bioactive molecules with well-established anticoagulant properties and emerging anticancer potential. Hirudo sulukii (H. sulukii), a recently identified Turkish leech species, remains largely uncharacterized. Understanding the biological activity of H. sulukii saliva extract (HSSE) may offer novel therapeutic options for thrombotic disorders and cancer, particularly prostate cancer, in which dysregulation of the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) signaling pathway (PI3K/AKT/mTOR signaling) plays a critical role. This study aimed to evaluate the thrombin inhibitory activity and cytotoxic effects of HSSE in human prostate cancer cell lines. Methods HSSE was prepared by extracting saliva from adult H. sulukii specimens maintained under controlled laboratory conditions, followed by filtration and lyophilization. Thrombin inhibition was assessed using a fluorometric thrombin activity assay, with hirudin serving as a reference standard. Cytotoxicity was evaluated in LNCaP and DU-145 prostate cancer cells using a real-time cell viability monitoring system (xCELLigence) over 48 hours at various HSSE concentrations. Western blot analysis was performed to examine the expression of key signaling proteins involved in the PI3K/AKT/mTOR signaling pathway. Results HSSE demonstrated potent thrombin inhibitory activity, with an IC₅₀ value of 21.99 ± 0.73 µg/mL, corresponding to 28.65 ± 0.81 antithrombin units (ATU)/mg. It also exerted dose-dependent cytotoxicity, with DU-145 cells showing greater sensitivity (IC₅₀ = 31.00 ± 1.63 µg/mL) than LNCaP cells (IC₅₀ = 71.08 ± 1.88 µg/mL). Western blot results revealed downregulation of phosphorylated AKT, proline-rich AKT substrate of 40 kDa (PRAS40), and ribosomal protein S6 kinase beta-1 (p70S6K), alongside upregulation of the tumor suppressor Forkhead box O3 (FOXO3). Conclusion These findings suggest that HSSE inhibits thrombin activity and suppresses the PI3K/AKT/mTOR signaling pathway in prostate cancer cells. These findings highlight the therapeutic potential of HSSE as a promising natural candidate for the development of anticoagulant and anticancer agents. The isolation and characterization of bioactive compounds, in vivo evaluation of anticancer activity, and investigation of HSSE effects on cardiovascular diseases are strongly recommended for future studies.
Introduction The aim of this study was to evaluate the effect of Baduanjin (a form of Chinese traditional mind-body exercise) on physical function, mental health, and wellbeing in community-dwelling adults aged ≥40 years. Secondary aims explored the influence of age, participant health status, and Baduanjin dosage on outcomes. Methods This systematic review adhered to PRISMA guidelines. Comprehensive searches were conducted in five English language databases and four Chinese language databases, targeting studies evaluating the effects of Baduanjin on physical function, mental health, and wellbeing. Data extraction and risk of bias assessments were performed independently by two reviewers. Where appropriate, separate random-effects meta-analyses were conducted for placebo-controlled and control-controlled comparisons, reporting pooled effect sizes and heterogeneity statistics. Results Twenty-six randomized controlled trials with 2305 participants (mean age 64.4 years, 67.4 % female) were included. Most studies were conducted in mainland China. Compared with placebo, Baduanjin significantly improved cognition, quality of life (general health), and quality of life (mental health). Compared with control conditions, no statistically significant overall improvement was observed for depressive symptoms, although subgroup analyses suggested improvements among participants receiving ≥50 h of Baduanjin practice. In the age subgroup analysis, Baduanjin significantly improved mental health–related quality of life among participants aged ≥65 years compared with placebo. Physical function outcomes could not be pooled because of the diversity of outcome measures; however, narrative synthesis suggested potential benefits for balance, mobility, frailty, gait, cardio-pulmonary function, anxiety, and sleep. Adherence rates were high (17 studies reported 100 %). Conclusion Baduanjin shows promise for improving cognition and selected domains of health-related quality of life, particularly when compared with placebo. Although evidence for depression remains inconclusive overall, longer intervention durations (≥50 h) may provide additional mental health benefits. Future research should use standardized outcome measures, clearly defined comparator groups, and longer follow-up periods to strengthen the evidence base and evaluate the effectiveness and implementation of Baduanjin in non-Chinese populations.
Introduction Glaucoma is an irreversible, sight-threatening optic neuropathy. Current therapies are limited by inadequate neuroprotection and ocular surface adverse effects. Traditional Chinese Medicine (TCM) presents unique advantages in glaucoma management. Bushen Mingmu Wan (BSMMW), a TCM formula that tonifies the liver and kidney, demonstrates clinical efficacy in preserving visual function in glaucoma patients; however, its underlying molecular mechanisms remain poorly defined. This study explored BSMMW's therapeutic mechanisms against glaucoma via network pharmacology and experimental validation. Methods Active compounds and targets of BSMMW were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and PharmMapper. Glaucoma-related targets were from GeneCards, the Online Mendelian Inheritance in Man (OMIM) database, the Therapeutic Target Database (TTD), and DrugBank. A protein-protein interaction (PPI) network was constructed using STRING and Cytoscape. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed via Metascape. Furthermore, BSMMW's therapeutic efficacy against glaucoma was validated in Sprague-Dawley (SD) rats and R28 cells using enzyme-linked immunosorbent assay, quantitative real-time polymerase chain reaction, western blot, immunohistochemistry, and haematoxylin and eosin staining. Results A total of 118 overlapping targets shared between BSMMW compounds and glaucoma were identified by network pharmacology analysis. Core hub targets of BSMMW in glaucoma treatment, including ALB, interleukin-6 (IL-6), tumor necrosis factor (TNF), AKT serine/threonine kinase 1 (AKT1), and interleukin-1β (IL-1β), were revealed by PPI network and KEGG enrichment analyses; AKT1 and prostaglandin-endoperoxide synthase 2 (PTGS2) were further validated as key functional nodes in the integrated TCM component-target-pathway network. Significantly enriched pathways, including the phosphatidylinositol 3-kinase/Akt (PI3K/Akt), advanced glycation end products-receptor for advanced glycation end products (AGE/RAGE), mitogen-activated protein kinase (MAPK), and hypoxia-inducible factor-1 (HIF-1) signaling pathways, were observed. In vivo, retinal histopathological damage was alleviated and the upregulation of key inflammatory factors (IL-1β, IL-6, TNF-α) in retinal tissue and serum was suppressed by BSMMW, particularly at the high dose; consistent suppressive effects on these factors were observed in R28 cells in vitro. Conclusion BSMMW exerts therapeutic effects against glaucoma through a multi-component, multi-target, and multi-pathway mechanism, primarily by modulating anti-inflammatory responses, thus offering experimental evidence supporting its clinical use.
Introduction Ekebergia senegalensis is an African medicinal plant traditionally used to treat gynecological and inflammatory disorders, suggesting that it contains bioactive metabolites with therapeutic potential. Cervical cancer is strongly linked to persistent infection with human papillomavirus type 16 (HPV16), and the limitations of current therapies justify continued exploration of plant-derived anticancer agents. This study aimed to investigate the phytochemical composition of E. senegalensis roots and evaluate the cytotoxic activity of isolated compounds against HeLa cervical cancer cells through in vitro and computational approaches targeting HPV16 E6 and E7 oncoproteins. Methods The hydroethanolic root extract was fractionated by chromatographic techniques to isolate secondary metabolites. Structures were characterized using electrospray ionization mass spectrometry and one- and two-dimensional nuclear magnetic resonance spectroscopy. Cytotoxic activity against HeLa cells and normal BJ fibroblasts was assessed using the MTT assay. Molecular docking, ADMET prediction, and molecular dynamics simulations were performed with HPV16 E6 and E7 oncoproteins. Results Six compounds were identified: epi‑oleanolic acid, oleanonic acid, koetjapic acid, Astragalin, a polyhydroxylated tetracosatetraene derivative, and gadoleic acid. Koetjapic and gadoleic acids are reported here for the first time in Ekebergia. Docking showed favorable interactions, particularly with HPV16 E6. The crude extract exhibited moderate cytotoxic activity (IC₅₀ = 45.55 ± 0.70 μg/mL), whereas oleanonic acid showed greater potency and selectivity against HeLa cells (IC₅₀ = 27.51 ± 0.23 μg/mL). Conclusion These findings support the traditional medicinal use of E. senegalensis and identify oleanonic acid as a promising lead compound for the development of therapeutic agents targeting HPV-associated cervical cancer.
Introduction Older adults with asthma and multimorbidity face complex management challenges. Persistent asthma is linked to increased carotid plaque burden and heightened risk of atherosclerotic cardiovascular disease (ASCVD). High-dose inhaled corticosteroids (ICS) further elevate systemic risk in this population. This mixed-methods single case study examines the use of personalised Eight Constitution Medicine (ECM)—integrating constitution-specific acupuncture and lifestyle interventions (diet, breathing, bathing, and exercise)—to improve asthma control, cardiovascular health, and quality of life in a geriatric patient. Case presentation A 70-year-old man with poorly controlled asthma (Asthma Control Questionnaire [ACQ] = 1.5), moderate carotid artery stenosis (50–60%), and mobility impairment underwent 27 weeks of personalised ECM therapy. Despite high-dose inhaled corticosteroids/long-acting β₂-agonist (ICS/LABA; 1000/100 mcg daily), he safely tapered ICS by 75% and LABA by 50%, achieving complete asthma control (ACQ = 0), exceeding the minimal clinically important difference (MCID ≥ 0.5). Quality of life improved significantly (Mini Asthma Quality of Life Questionnaire [Mini-AQLQ] = 6.8; +89%; Z = +1.27) (MCID ≥ 0.5), with a 312% (Z = 1) gain in emotional function and an 86% (Z = 0.36) improvement in activity limitation. Peak expiratory flow (PEF) steadily increased, exceeding predicted values by 154% (Z = +2.21) at Week 23, while spirometry remained within normal limits. Carotid artery stenosis regressed to <30%, with normalisation of homocysteine and an increase in morning cortisol levels. Conclusion This case study suggests that ECM may serve as an integrative support to conventional asthma therapy in older adults with multimorbidity. Constitution-specific acupuncture and personalised lifestyle interventions supported a step-down of medication, improved asthma control, and enhanced quality of life, with possible reductions in ASCVD and adrenal suppression risks. These findings indicate that ECM, as a personalised, whole-person approach, may help address the broader systemic challenges of managing asthma in older adults. However, further controlled case series, longitudinal cohort studies, and pragmatic clinical trials are required to evaluate these preliminary findings and determine their efficacy, safety, and generalisability. Funding This research was supported by the Higher Degree by Research (HDR) program at the University of Technology Sydney (UTS).
Introduction Interest in tyrosinase inhibitors is intensifying due to the critical role this enzyme plays in the management of hyperpigmentation pathologies and enzymatic browning in food products. Aiming to develop potent new inhibitors, this study proposes a bio-guided identification of the bioactive compounds of Daphne gnidium L., a medicinal plant traditionally valued for its depigmenting effect. Methods Ethanolic extracts from the plant stem were characterized using a bio-guided approach, combining LC-MS, FTIR, and NMR, to identify anti-tyrosinase compounds. The enzyme kinetics of the most potent fractions were determined to establish their inhibition type. Furthermore, the mechanism of action was investigated by correlating tyrosinase inhibition with copper-chelating/reducing activities, specifically targeting the bi-copper center of the enzyme's active site. Finally, molecular docking was performed to elucidate the specific inhibitor–enzyme interactions. Results The crude stem extract exhibited a potent inhibitory effect (IC50 = 40.87 ± 2.43 µg/mL). Among the obtained fractions, fraction D, characterized by the presence of daphnetin and daphnin, demonstrated the highest inhibitory activity (IC50 = 50.89 ± 2.87 µg/mL). Kinetic studies revealed non-competitive inhibition for daphnin, whereas the daphnetin–daphnin combination exhibited mixed-type inhibition. No significant correlation was observed between tyrosinase inhibition and copper chelation/reduction activities, suggesting that these coumarins interact on sites other than the enzyme’s active center. Molecular docking further supported the proposed binding of daphnin to a distinct allosteric site on tyrosinase. Conclusion Daphnetin and its glycosylated derivatives extracted from D. gnidium L. emerge as potent tyrosinase inhibitors with promising applications in the pharmaceutical, cosmeceutical, and food industries.
Introduction Chronic musculoskeletal pain is a leading cause of disability worldwide and is commonly managed through multimodal rehabilitation strategies. Whole-body vibration (WBV) therapy has been proposed as a complementary intervention, with potential analgesic effects mediated by neurophysiological and neuromuscular mechanisms. However, existing evidence remains inconsistent regarding its comparative effectiveness against active interventions. This systematic review and meta-analysis of randomized controlled trials aimed to evaluate the effects of WBV on chronic musculoskeletal pain and explore potential moderators of effectiveness. Methods Searches were conducted on September 5, 2025, across PubMed, Embase, CENTRAL, CINAHL, SPORTDiscus, Web of Science, LILACS, PEDro, and SciELO. Methodological quality was assessed using the PEDro scale, and the certainty of evidence was evaluated using the GRADE approach. Meta-analyses were performed using the standardized mean difference (SMD). Results Thirty-four randomized controlled trials (1808 participants) were included; 38.2% of studies were rated as having low methodological quality according to the PEDro scale. At immediate post-intervention assessment, moderate-certainty evidence demonstrated a large but heterogeneous analgesic effect of WBV compared with inactive control conditions (SMD = −0.82; p < 0.001; I² = 76%). In contrast, no significant between-group differences were observed when WBV was compared with other active interventions (SMD = 0.11; p = 0.52; I² = 69%). Pre-specified subgroup analyses only partially explained the observed between-study heterogeneity. At follow-up, low-certainty evidence indicated a small but statistically significant effect favoring WBV over inactive controls (SMD = −0.27; p = 0.04; I² = 0%), while no differences were found relative to active comparators (SMD = 0.04; p = 0.82; I² = 0%). Half of the included studies did not report any safety data, and only 17.6% documented adverse events. Conclusion WBV therapy is associated with short-term reductions in chronic musculoskeletal pain when compared with inactive controls; however, comparisons with other active interventions showed no significant differences, although these findings remain limited by considerable heterogeneity among comparator modalities. Additionally, the safety profile of WBV remains understudied, and benefits do not appear to persist after treatment cessation. These findings suggest WBV may serve as an adjunctive modality within multimodal rehabilitation, rather than a stand-alone alternative. Systematic review registration in the Prospero database CRD42023468025.
Introduction Diminished Ovarian Reserve (DOR) is a major cause of female infertility, especially in modern society, where childbearing age is increasingly delayed. While assisted reproductive technology has improved infertility treatment, effective therapies for DOR remain limited. Therefore, identifying strategies to enhance ovarian function and delay ovarian aging is crucial. Methods This study investigated Qinghao Biejia Decoction (QBD) through network pharmacology and in vitro experimental validation. Active compounds and putative targets of QBD were screened from multiple traditional Chinese medicine databases, and disease-related targets for DOR were retrieved from public biomedical resources. The intersecting targets were used to construct a herb–ingredient–target network and a protein-protein interaction (PPI) network, followed by GO and KEGG enrichment analyses to predict potential biological functions and pathways. In vitro experiments were then conducted using an H₂O₂–induced granulosa cell injury model. QBD extract, together with representative active compounds, was applied to the cell system, and cell viability was assessed using the MTT assay. qPCR was performed for further validation. Results Network pharmacology analysis identified 144 overlapping targets between QBD and DOR, with significant enrichment in inflammatory pathways (TNF and IL-17 signaling), oxidative stress, and apoptosis. Experimental validation confirmed that QBD (3.08 mg/mL) restored cell viability by 19.7% and suppressed IL-6 and TNF-α expression by 29% and 20%, respectively, in H₂O₂-induced granulosa cells. These findings suggest that QBD may exert beneficial effects on DOR through multi-target regulation of inflammation, oxidative stress, and cell survival. Conclusion QBD may offer a multi-target complementary approach for DOR by modulating key targets, inflammation, and immune responses. In vitro experimental evidence further supports its potential effectiveness, providing a scientific basis for its clinical application.
Introduction The chiropractic profession encompasses diverse philosophical orientations, creating challenges in establishing a unified professional identity. The International Chiropractic Education Collaboration (ICEC) Education Position Statement promotes evidence-based practice (EBP), interprofessional collaboration, and the rejection of vitalistic, non-scientific paradigms. To date, no study has assessed student alignment with ICEC principles in a South African context. Methods A web-based, cross-sectional survey was conducted among chiropractic students at the University of Johannesburg during the 2023 academic year. All enrolled students (first-year BHSc to second-year MHSc) were invited to participate. Participants rated their agreement with statements derived from the ICEC Education Position Statement, as well as items measuring attitudes towards EBP, vitalistic philosophy, and interprofessional collaboration, using a 10-point Likert scale. Internal consistency was assessed using Cronbach's alpha and mean inter-item correlations. The Mann-Whitney U test compared attitudes between junior (first to third year) and senior (fourth to sixth year) students. Results A total of 144 students participated (response rate: 58.78%). Students demonstrated high agreement with EBP (mean 7.87), interprofessional collaboration (mean 8.13), and most ICEC statements (mean 8.47), although agreement with the vertebral subluxation statement was neutral (mean 5.98). Vitalistic philosophy agreement was neutral overall (mean 5.23). Senior students exhibited significantly lower agreement with vitalistic philosophy (N < 0.001) and interprofessional collaboration (N = 0.04) compared to juniors. A significant difference was observed between groups regarding "Evidence-based Practice, Scope of Practice, Identity and Setting" (N < 0.001). No significant difference was found for the ICEC Education Position Statement (N = 0.84). Conclusion Chiropractic students at the University of Johannesburg demonstrate strong alignment with evidence-based principles, interprofessional collaboration, and the majority of ICEC principles. Cross-sectional comparisons revealed lower agreement with vitalistic philosophy among senior students, suggesting an association with academic progression. These findings highlight the potential role of structured educational frameworks in shaping professional identity, although causal inferences cannot be drawn from this cross-sectional design.
Introduction Hwanglyeonhaedok-tang (Huanglian-jie-du decoction, HHT) is a traditional East Asian herbal formula with potential efficacy for insomnia. This study examined whether combining HHT with Brief Behavioral Treatment for Insomnia (BBTI) provides additional benefits for adults with insomnia and bedtime procrastination. Methods This open-label, parallel-group, superiority randomized controlled trial enrolled 44 adults aged 19–59 years with DSM-5 insomnia disorder and bedtime procrastination at a single Korean medicine hospital. Participants were randomized 1:1 to HHT decoction (3 g twice daily) combined with BBTI or BBTI alone for 4 weeks, with follow-up at week 8. The primary outcome was change in Insomnia Severity Index (ISI) score at week 4. Results At week 4 (HHT + BBTI: n = 20; BBTI only: n = 22), the between-group difference in ISI change was −2.49 (95% CI −5.08 to 0.11; p = 0.0598), showing a trend favoring HHT + BBTI. In exploratory analysis, this difference became significant at week 8 (−2.86, 95% CI −5.32 to −0.40; p = 0.0238). The Bedtime Procrastination Scale score at week 4 significantly favored HHT + BBTI (−4.09, 95% CI −7.06 to −1.12; p = 0.0082). No serious adverse events occurred. Conclusions HHT combined with BBTI did not significantly improve insomnia severity at the primary endpoint of week 4, possibly reflecting limited statistical power due to early trial termination. Bedtime procrastination was significantly reduced in the HHT + BBTI group compared to BBTI alone. Further research with larger, placebo-controlled trials is warranted. Registration Clinical Research Information Service (cris.nih.go.kr) KCT0009329 (Registered on April 12, 2024)
Introduction Children and adolescents with cancer face complex physical and psychosocial challenges. Integrative mindbody interventions such as yoga are increasingly incorporated into paediatric oncology to mitigate treatment side effects and improve well-being. However, research evidence remains fragmented and variable in quality.This scoping review aimed to map and synthesize evidence on the contributions of yoga to the physical and emotional well-being of children and adolescents with cancer, identify implementation challenges, and highlight gaps requiring further research. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, studies were eligible if they examined yoga interventions for participants <19 years diagnosed with any cancer type, used any research design (quantitative, qualitative, or mixed-methods), and were published in English or Portuguese. Editorials, opinion pieces, and adult-only studies were excluded. Electronic databases including MEDLINE complete, Embase, CINAHL (EBSCOhost), and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through March 31, 2026. Reference lists of included articles were screened for additional sources. Data were extracted using a pilot-tested Joanna Briggs Institute (JBI) form capturing study characteristics, intervention components, and outcomes. Results Fourteen studies met the inclusion criteria, including pilot, feasibility, and qualitative designs, plus two literature reviews. Yoga interventions were associated with reported improvements in flexibility, sleep quality, fatigue, and pain, as well as reductions in anxiety and emotional distress. Statistically significant reductions in pain and anxiety were reported in some single-session or short-term interventions; however, most studies described trends toward physical and emotional benefit within small feasibility samples. Conclusions Yoga is a feasible, low-risk mindbody therapy that supports physical and emotional well-being in paediatric oncology. Future research should prioritize multicentre randomized studies with larger samples, standardized and developmentally adapted yoga protocols, and validated outcome measures for physical and emotional well-being, as well as longer follow-up periods to assess sustained effects and implementation feasibility. Across fourteen studies (mostly feasibility/pilot designs), yoga was reported to improve flexibility, sleep and emotional outcomes; some primary studies reported statistically significant reductions in pain or anxiety, although samples were small and interventions heterogeneous. Registration The protocol for this scoping review was previously published in OSF https://doi.org/10.17605/OSF.IO/K54QC.
Introduction Clinical reasoning underpins safe and effective practice across health professions. However, limited empirical research has examined how clinical reasoning is enacted and developed within naturopathic medicine, where existing models are largely theoretical or consensus-based with little attention to developmental differences between practitioners. This study aimed to explore how clinical reasoning is enacted by novice and experienced naturopathic practitioners, and to examine differences in reasoning processes across levels of experience to inform the development of an empirically grounded clinical reasoning framework. Methods A qualitative descriptive study was conducted using semi-structured interviews with novice (n = 15) and experienced (n = 16) naturopathic practitioners in Australia. Data were analysed using reflexive thematic analysis, followed by interpretive synthesis to organise findings into higher-order process and determinant facets. Results Five process facets were identified: Explore, Understand, Determine, Manage, and Consolidate. Four determinant facets, The Patient, The Practitioner, Naturopathic Medicine Principles and Philosophy, and The Thinking Process, shaped clinical reasoning across naturopathic consultations. Both novice and experienced practitioners engaged in all facets; however, differences in timing, integration, fluency, and confidence reflected developmental progression rather than categorical distinction. Together, these findings supported development of the Naturopathic Medicine Clinical Reasoning Framework. Conclusion Clinical reasoning in naturopathic medicine is dynamic, non-linear, and developmentally acquired. The Naturopathic Medicine Clinical Reasoning Framework provides an empirically grounded model that integrates reasoning processes with contextual, philosophical, and cognitive influences shaping clinical practice. The framework offers a foundation for supporting clinical reasoning development in naturopathic education and practice.
Introduction This systematic review evaluated the efficacy and safety of moxibustion as an adjuvant therapy for endometriosis (EMs), focusing on symptom relief and reproductive outcomes. Methods Randomized controlled trials (RCTs) comparing moxibustion combined with conventional therapy versus conventional therapy alone were identified from seven databases. Data were synthesized using meta-analysis. The robustness of the effect estimates was verified using trial sequential analysis and sensitivity analysis. Effects were measured by mean differences (MDs), risk ratios (RRs) and their 95% confidence intervals (CIs). The certainty of evidence was assessed using the GRADE approach. Results Twenty RCTs (n = 1513) were included. Pooled results demonstrated that, compared with the control group, adjuvant moxibustion significantly improved dysmenorrhea, evidenced by significantly greater reductions in Visual Analogue Scale (VAS) (MD −1.11, 95% CI −1.78 to −0.45, I2 = 90%; n = 508) and Cox Menstrual Symptom Scale (CMSS) severity scores (MD −2.54, 95% CI −4.18 to −0.91, I2 = 96%; n = 385). A significantly higher pregnancy rate (RR 2.71, 95% CI 1.31 to 5.63; one RCT, n = 70) and greater reductions of volume (MD −2.21 cm3, 95% CI −4.03 to −0.39, I² = 84%; n = 192) and maximum cross-sectional area (MD −2.41 cm2, 95% CI −3.30 to −1.52; one RCT, n = 70) of pelvic masses were also observed in the moxibustion group. Furthermore, moxibustion significantly improved serum inflammatory markers, hemodynamic parameters, and quality of life, but had no significant effect on dysmenorrhea duration. Subgroup analyses indicated that ≥ 30 moxibustion sessions, direct moxibustion, and concurrent treatment of Chinese herbal medicine were associated with greater improvements in CMSS severity scores or TNF-α levels. Moxibustion showed sustained benefits in reducing IL-6 levels and the recurrence rate of pelvic masses, but showed no sustained long-term improvement in VAS, CA125 and TNF-α levels. Adverse events were mild. Conclusions Current evidence, ranging from moderate to very low certainty, suggests that adding moxibustion to conventional treatments for EMs may alleviate dysmenorrhea, reduce pelvic masses, modulate inflammation, and enhance fertility without evidence of harm. However, the effects of moxibustion on dysmenorrhea duration and long-term VAS, CA125, and TNF-α levels remain uncertain.
