Narcolepsy is an uncommon brain condition characterized by falling asleep suddenly without any proper reason or time. In this chapter, the authors include a brief history of narcolepsy, clinical symptoms, pathophysiology, and current treatments for the disease. The review explains narcolepsy according to the theory of TCM. The authors review the curative effect, pharmacological properties, and clinical results of herbs and prescriptions against narcolepsy. The study searched keywords such as ‘narcolepsy,' ‘Traditional Chinese medicine,' ‘sleep disorder,' ‘excessive sleepiness,' and ‘medicinal treatment' using databases such as CNKI, PubMed, and Google Scholar. Based on the analysis of data obtained from 110 articles, the authors have classified the herbs and prescriptions by their curative effects, following the theory of traditional Chinese medicine. Some herbs can be used alone, while others can use in conjunction with other prescriptions.

Background: The mental health issues due to COVID-19, such as intolerance of uncertainty (IOU), anxiety, stress, and depression, have attracted extensive attention from researchers. The challenges for Pakistani university students could be worse than developed countries due to the lack of online courses/programs and online mental health support provided by academic institutions. Therefore, the current study aims to assess the intolerance of uncertainty, depression, anxiety, and stress of Pakistani university students after the second wave of COVID-19 and the relationship among these constructs. Methods: A convenience cross-sectional sampling method was used to collect data from university students in Pakistan between January 2021 and April 2022 via a structured online questionnaire. The Descriptive analysis focused on frequencies, percentages, mean, and standard deviation (SD) were calculated on IOU-12 and DASS-21. Covariance for the research model and confirmatory factor analyses fit indices for the IOU-12 and DASS-21 were analyzed by AMOS statistical packages. Results: As expected, anxiety, depression, and stress persist among Pakistani university students. On average, they report mild to moderate mental health problems regarding anxiety, depression, stress, and intolerance of uncertainty. Our results indicate a strong positive relationship among the three emotional distress components - anxiety, depression, and stress. However, our results suggest no significant relationship between IOU and the three subcomponents of emotional distress (anxiety, depression, and stress). Limitations: First, the cross-sectional survey design means we cannot conclude on the causal relations. Second, the self-report questionnaire embeds subjectivity issues. Last, the generalizability of the sample to the whole student population in Pakistan is limited, considering the sampling method. Conclusion: This study expanded the current knowledge in the psychological health domain (intolerance of uncertainty, anxiety, depression, and stress) due to the COVID-19 pandemic. In practice, higher education institutions should further mitigate university students' mental health issues. For researchers, our findings inspire future studies to delve into the relationship between IOU and mental health issues due to COVID-19 since our findings display contrary evidence for various reasons.

Bayesian design of experiment (B-DOE) uses the principle of Bayesian Epistemology that explain the evidence as a logical-probalistic coherence on the basis of rational degrees of belief (or degrees of confidence). The researcher has design the (B-DOE) using Multilevel Hierarchy (MH), and data that may be obtained at the weak to moderate evidence level (literature, biological. Mechanism, computational and retrospective) may be helpful to identify bioactive compounds for treating (CMT) and provide the knowledge on pathogenesis, prognostic of the disease and collective mechanism of drug of action. The investigators will classify the evidence on the basis of hierarchy as moderate and weak, which will ultimately help to study new promising bioactive compounds potentially able to solve some of the issues related to CMT.

Although the skin tissue on our bodies is a well-organized structure with high biomechanical properties like tensile strength and friction, we have all experienced various types of wounds throughout our lives owing to numerous etiological factors. In the general population, it is a substantial source of morbidity. For instance, in the case of burnt skin tissue, self-healing is in fact a large and challenging barrier to tissue regeneration. Squalene is a bioactive triterpene that occurs naturally and plays a key role in the process of making sterols. The most well-known source of squalene is shark liver oil. Vegetable oils may contain squalene in a range of concentrations. They have been extracted using a variety of techniques, including supercritical carbon dioxide, microwave, ultrasonic, cold press, and traditional Soxhlet extractions. In vitro and in animal models, these substances have been demonstrated to have anticancer, antioxidant, drug carrier, detoxifier, skin moisturising, and emollient effects.

目的:采用核磁共振氢谱(1H NMR)技术研究加味黄连汤对应激性胃溃疡小鼠胃黏膜组织代谢物表达的影响.方法:40只SPF级KM小鼠随机分为正常组、模型组、西药组和中药组,每组10只.利用束缚-冷应激法制备应激性胃溃疡模型,造模成功后连续7 d分别用加味黄连汤中药汤液和艾司奥美拉唑镁肠溶片水溶液对中药组和西药组小鼠进行干预.采用HE染色法观察小鼠胃黏膜组织病理形态,采用1H NMR技术进行代谢组学检测,通过模式识别方法分析各组间的代谢轮廓差异,并筛选出差异性代谢物,通过在线分析网站寻找相关代谢通路.结果:正常组小鼠胃黏膜上皮结构完整,腺体紧密,细胞排列整齐;模型组小鼠胃黏膜上皮结构缺损,腺体散乱,细胞排列紊乱,可见炎症细胞浸润和毛细血管出血;中药组和西药组小鼠胃黏膜上皮结构完整,无充血及水肿.胃黏膜组织代谢组学共筛选出有关代谢标志物13种,参与了15条代谢通路.结论:加味黄连汤能够调节胃溃疡模型小鼠胃黏膜组织代谢物的表达,促进胃溃疡愈合.

Background: Electroacupuncture is a common treatment for chronic atrophic gastritis (CAG) in China. We aimed to determine the effects of electroacupuncture at zusanli (ST36) on intestinal microbiota in CAG rats. Methods: In total, 42 SD rats were randomly divided into normal (NC, 10 rats) and model (MG, 32 rats) groups. Rats in the MG group were established as CAG disease models. After that, the rats in the MG group were randomly divided into CAG (10 rats), electroacupuncture (EA, 10 rats), and Vitacoenzyme (Vit, 10 rats) groups. Rats in the NC and CAG groups were subjected to a 30-min/d confinement for 4 weeks. Rats in the EA group were given electroacupuncture at zusanli for 30 min/d for 4 weeks. Rats in the Vit group were given Vitacoenzyme solution 10 ml/(kg d) for 4 weeks. Histopathological changes in the gastric mucosa were observed with hematoxylin and eosin staining, and the gene expression level of p53, Bcl-2, and c-myc was determined using the qPCR method. The 16S rDNA sequencing technique was used to determine structural changes and relative abundance expression of intestinal flora. Results: Compared with the NC group, gastric mucosal pathology in the CAG group revealed significant inflammatory infiltration, and the gastric mucosal lesions in the electroacupuncture group were improved remarkably; the expression of p53 and c-myc genes in the CAG group increased (p < 0.05), while the expression of Bcl-2 genes decreased (p < 0.05) in the EA group, that of p53 and c-myc genes decreased (p < 0.05), and that of Bcl-2 genes increased (p < 0.05). The abundance of bacteria such as Lactobacillus, Desulfobacterota, and Bacteroides pectinophilus group in the CAG group increased (p < 0.05), while that of bacteria such as Gastranaerophilales, Romboutsia, and Blautia decreased (p < 0.05). The relative abundance of Desulfobacterota and Helicobacter in the EA group decreased (p < 0.05), while that of probiotic bacteria such as Oscillospirales, Romboutsia, and Christensenellaceae increased (p < 0.05). Conclusion: Electroacupuncture at zusanli can promote the repair of pathological damage to the gastric mucosa in rats with CAG, and the mechanism might relate to the reduction in the relative abundance of harmful bacteria, increase in the relative abundance of intestinal probiotics, and regulation of the intestinal microbiota.

Introduction Professionalism and ethical practices in the field of acupuncture is scarcely discussed. Professionalism and medical ethics are important topics in conventional medicine and is the supporting structure gathering human trust and belief in the medical system. Medical professionalism is a set of values, behaviors, and relationships that underpin public trust in doctors.1 It lies at the core of the contract between medical professionals and society,2 and is a stabilizing morally protective force in the society.3 Unprofessional conduct in doctors has been associated with an increased risk of adverse medical outcomes in patients. Thus, to ensure better medical outcomes and well-being of the patient, a uniform system of professional practices must be established within acupuncture. Before this, some research has been done regarding this topic, and our study serves to identify open questions regarding professionalism in acupuncture, including whether biomedical and Traditional Chinese Medicine (TCM) knowledge should be a requirement for professionalism, whether ethics should be considered an aspect of professionalism, differences between interpretations of professionalism, who is responsible for establishing these professional standards, and what we the authors suggest to establish a uniform system of professional values in acupuncture. The objective of this study is to review information related to professionalism in acupuncture and to organize the information in a manner that is presentable and clear to the reader. The review highlights professional standards that needs to be adhered to as well as professional practices in acupuncture, including educational requirements, ethics, professional medical practices, as well as ideal implementation of establishing professionalism. The intended purpose of this article is to support uniform adoption of the recommendations for professional and ethical practices in acupuncture practice. Discussion Limitations: Our study has the following limitations. First, due to the lack of relevant resources about professionalism in acupuncture, we selected relevant sources regarding medical professionalism in conventional medicine as well as surveys in a medical college setting to compare with attributes of professionalism based on requirements set by the Ministry of Health in Malaysia, interviews of TCM practitioners, and two relevant case studies of the professionalization in acupuncture in the United States. The requirements and standards for professionalism in conventional medicine cited in this study are only used as means for comparison. In this study, they are merely representative of professional standards set in the field of biomedicine. Second, we used the databases Google Scholar, Web of Science, and PubMed in conducting the search for relevant articles. Literature in Chinese or other languages have not been browsed. Third, the ethical aspects of professional practice as well as professional research and clinical trial methods will only be briefly discussed as they are not part of this main topic. Finally, ethics in the context of TCM based on ancient texts will not be covered. Our article will mainly focus on available literature regarding professionalism in acupuncture, and we aim to redefine and reconceptualize what we think are necessary attributes of professionalism that are effective in enhancing the professionalism in acupuncture and provide directions for future research. Owing to such limitations, further research in the form of surveys, behavioral inspections, and wider search for available literature in different languages is crucial in conceptualizing a uniform international standard for professionalism in acupuncture. ?Profession can refer to the conventions by which people recognize a given expertise, including knowledge and related skills.?4 Comparing the attributes of professionalism stated by relevant sources, we discovered that only one source mentioned the word principles,5 referring to fundamental principles of professionalism (patient welfare, patient autonomy, and social justice). Commitment to competence,5 continuous improvement,6 lifelong/self-directed learning skills,7 excellence5,6 are similar terms mentioned across different sources. Although there are some similarities, it is evident that even within the field of biomedicine, professionalism is not firmly established with a consensus. However, biomedical standards have found its way into influencing the professionalism of acupuncture.4 Biomedicine has claimed a universally untouchable place in the international medical system and is clearly evidenced by its generally being known as medicine. Supreme Court authorities have deemed it as neither a business nor a trade, and had given it immunity from antitrust suits, and had upheld the exclusivity of its license and of its monopoly and control over practice. Owing to this, biomedicine cannot be referred as the gold standard of professional medical identity for all medical modalities, nor is it the perfect authority to set the gold standards for other medical modalities.4 It is evident that two very different paradigms are at work because acupuncture and biomedicine have mutually exclusive conceptualizations of the body. Owing to the differences in knowledge, theoretical composition, and historical constructs of medical modalities, it is almost impossible for one modality to understand the other, much less define what is professional for the other. That is some experts have recommended to establish a separate standard of professionalism for acupuncture. After reviewing available data, we recommend that professionalism be redefined for acupuncture with unique standards in knowledge, practice, and implementation. The ultimate goal is to bring acupuncture to a professional standard that is acceptable by the biomedical model in knowledge, clinical practice, and efficacy, whereas keeping the TCM theories and philosophies that serve as the guidance for practice. In the following sections, we will discuss several important topics within the profession of acupuncture that are still in debate. Does professionalism include ethics and physician conduct? A survey of 109 students and 83 faculty members of Oman Medical College attained surprising and unexpected results about medical professionalism and identified an unaddressed issue: the current generation may have a different perception of professionalism as their personal values and opinions.8 Although medical students expressed a positive attitude toward professionalism, many in the interview felt that ethical thinking and behavior should not be a part of medical professionalism. However, according to Table 1, most sources regarding medical professionalism (government documents included) place a strong emphasis on the ethical thinking and behavior as a professional attribute. Table 1. List Source of the Attributes of Medical Professionalism Source Attributes of medical professionalism General Medical Council's publication of Good Medical Practice5 Providing good clinical care, maintaining good medical practice, teaching and training, relationships with the patients, working with colleagues, probity, and health ABIM Project Professionalism5 Altruism, accountability, excellence, duty, honor/integrity, and respect The Physician's Charter5 Three fundamental principles: patient welfare, patient autonomy, and social justiceTen professional responsibilities: commitment to competence, honesty, confidentiality, relationships, quality of care, access to care, distribution of finite resources, scientific knowledge, and managing conflicts Qualitative Study of TCM Practitioners9 Doctor?patient relationship skills, reflective skills, time management, and interprofessional relationship skillsTwo new subdomains: ?communicated effectively with patient? and ?demonstrated understanding and integrated with conventional medicine? Royal College of Physicians (2005)6 Integrity, compassion, altruism, continuous improvement, excellence, and working in partnership Elements of Professionalism in a Questionnaire conducted in Oman Medical College7 Up-to-date knowledge, teamwork, good communication skills, patient safety, self-management, self-restraint/risk management, humanity, integrity/honesty, logical/critical/creative thinking, physical and mental health, ethical thinking and behavior, lifelong/self-directed learning skills, service oriented, respect for others, self-confidence/self-efficacy, appearance/behavior, etiquette, and foreign language skills ABIM, American Board of Internal Medicine; TCM, Traditional Chinese Medicine. Behavioral and ethical aspects are denoted by doctor?patient relationship5,9 and characteristics such as honor, integrity, honesty, compassion, ethical thinking and behavior, respect, and etiquette.5?7 This brings to concern a dire need for medical institutions and teachers to identify and make explicit the expectations of medical students during the interaction in a clinical setting. Formal teaching of medical professionalism must be deployed. In the Program Standards for Traditional and Complementary Medicine published by the Malaysian Qualifications Agency in 2021,10 Ethics and Professionalism are placed under the same category for student learning outcomes. Thus, it is evident that ethics and moral behavior play a critical role in defining professionalism. Is there a need for TCM knowledge? Biomedical knowledge? In recent decades, acupuncture is introduced into various Western communities.1 Since then, many health professionals reinterpreted and reinforced the theoretical background of the practice with anatomical, physiological, and pathological knowledge. A clear separation appeared in the field of acupuncture, dividing practitioners into two main categories: Traditional and Modern. The attributes of medical professionalism include lifelong learning, scientific knowledge,5 and demonstrating understanding and integration with conventional medicine.9 It is of no doubt that TCM theory is important in explaining the ancient theoretical background guiding acupuncture treatment. However, since the emersion of modern acupuncture, some practitioners firmly believe that biomedicine alone is sufficient for explaining the efficacy of acupuncture. Knowledge of modern anatomy, physiology, and pathology can provide clearer guidelines for the identification of acupuncture points, explain the efficacy of acupuncture from a scientific perspective, and professionalize acupuncture to meet the modern expectations of the scientific and conventional medical community. However, the importance of TCM theory should not be rejected or ignored. Biomedicine and acupuncture are two very different medical modalities. One is guided by Western roots, whereas the other has roots tracing back to China. Biomedicine can only assess the efficacy and validity of the treatment, not the theoretical framework of TCM theories and philosophies. It is nearly impossible to explain concepts in acupuncture such as qi, yin, yang, and meridians in biomedical terms. Moreover, TCM is unique due to its specialization and holistic philosophy of treatment. In TCM, two patients with similar illnesses may be treated in two very different ways depending on their constitution and the symptoms they present.11 Neglecting TCM knowledge for the sake of standardization and integration of acupuncture with Western medicine would lead to the indirect suppression of the variety of acupuncture traditions and remove its strong roots in Chinese Medicine. It is absurd for a medical treatment to be used without the guidance under which it was established. Thus, we suggest for acupuncturists be educated in both TCM and biomedical knowledge, and that in utilizing biomedical strengths to increase the acceptance of acupuncture, implementation of good clinical standards equivalent to biomedicine be practiced. As acupuncture is increasingly being called upon to demonstrate its efficacy, safety, and legitimacy, scientific research and validation under proper clinical trials and methods must be deployed.4 Furthermore, since working with colleagues, interprofessional relationship skills, working in partnership are listed as elements of professionalism, knowledge in both TCM and biomedicine can provide the language of science and ease communication with professionals such as other acupuncturists, physicians, as well as other biomedical professionals. Thus, institutions must ensure that both TCM theory and modern anatomy, physiology, and pathology are emphasized to develop medical professionalism in future acupuncturists. Medical professionalism is patient-centered: Should we also consider prioritizing the well-being of the practitioner? During the Covid-19 pandemic, hospitals are understaffed and have to work with sleep deprivation, excessive or conflicting job demands, long hours, and an imbalance between work and home life.6 Suicide rates appear higher among doctors than in other occupations. In the United States, estimates suggest one physician dies by suicide every day. Also, physical and mental health7 and health5 are listed as elements of professionalism in relevant sources. Thus, it is undeniable that the well-being of the practitioner should be valued in health care systems. Values around professionalism should not force medical professionals into a set of rigid rules that only serve to define who they are professionally, but not who they are truly. Medical professionalism should be genuine and not forced through self-regulation for the sake of professional work. Self-care and self-awareness must be placed before the practice of medical professionalism. After all, we can only properly care for others once we are in a good condition. Rights to health, equity, social justice, diversity and inclusion, physician well-being, and workforce planning should be discussed and implemented for the maintenance of the modern health care system. Reconceptualizing Professionalism in Acupuncture Up till now, there has not been a clear definition for professionalism in acupuncture. Modern efforts to professionalize acupuncture, such as the Clean Needle Technique method and other hygienic requirements, are important constituents that have helped establish professionalism. Other efforts are demonstrated in the transformation of the Chinese Medicine course in West Coast University, highlighting its uniqueness as a science-based school of natural medicine.11 Even earlier, the professionalizing of American Acupuncture as seen in Massachusetts in a step-by-step historical process documented by Linda L. Barnes.4 Two dimensions have been considered in the efforts to professionalize acupuncture: the establishment of schools of TCM and acupuncture, and Accommodation to the Biomedical Model. Establishment of schools with a standard in education ensures enhancement of professionalism in the field of acupuncture as a whole. The Biomedical model requires students to be professional in both appearance and attitude, being neat and clean at all times. Implementation of proper hygiene and precautions can help reinforce the fact that acupuncture is a professional medical system. Medical physicians in the west who have incorporated the use of acupuncture with health systems and hospitals should be evaluated with the same standards set for all acupuncturists.2 However, several crucial aspects of professionalism must also be addressed. First, the accreditation of clinics and practitioners must be renewed on a timed basis (annual/every 5 years) to ensure the validity and credibility of the treatment. Licensing requirements and professional accreditation must not be ignored or circumvented. In Malaysia, the accreditation of practitioners must be renewed every year. Second, a standard should be established for educational institutions to prevent major differences in treatment efficacy and patient distrust in acupuncture as a whole. Finally, cultural and ethical values must be respected and practitioners should flexibly adapt and form a system for establishing professionalism in new areas (countries, cities, etc.) to obtain public recognition and political legitimation.8 In countries such as Malaysia where Complementary Medicine, Traditional Medicine, and acupuncture have been practiced for many years, the public already recognizes their efficacy. However, in countries where acupuncture has never been introduced or known to the public, it must undergo stages as presented in the case of Massachusetts, namely, initial reception of the modality by the public and biomedical community, establishment of specialized training requirement, formation of professional associations, and official licensing and credentialing.4 Of course, it is difficult for all in the acupuncture community to come to a consensus, but establishing professionalism is an achievable feat when shared values are identified. What it means to be a professional acupuncturist As a professional, the practitioner is expected to maintain high standards in treatment, conduct themselves morally, prioritize the well-being of the patient, equally provide treatment without bias, communicate effectively to ensure patients understand the treatment options before confirmation of treatment, maintain proper personal conduct, and should not abuse patient trust by using their position and influence as a TCM practitioner.12 In light of relevant literature, we propose the following aspects as necessary elements of professionalism in acupuncture: knowledgeable (well learned and engaged in lifetime learning in both TCM and biomedicine), providing good quality (hygienic) clinical care, equipped with ethical thinking and behavior, possess interprofessional communication skills (with acupuncturists, physicians, and other professionals), and holds a practitioner license and accreditation. From Conceptualization to Implementation: A Discussion of Responsibilities Sure, there is a need to establish medical professionalism in acupuncture, but whose responsibility is it? What has to be done? It has long been assumed that establishing medical professionalism is the physician's (in this case the practitioner's) responsibility, but is this really correct? Government institutions, accreditation organizations, medical institutions (hospitals and health systems), and educational institutions all have a responsibility in establishing medical professionalism. The practitioner places his values in caring and ensuring patient well-being and providing treatment for patients, but who is there to care for the practitioner? Health systems and hospitals should be responsible for caring for the well-being of the practitioner. Government systems in charge of Traditional and Complementary Medicine should uncover illegal practice and ensure that illegal practitioners and uncertified practitioners face legal consequences. acupuncture accreditation organizations have the responsibility of accrediting and validating acupuncture practitioners as well as clinics. Proper standards must be set and maintained for effective implementation. Finally, educational institutions have a responsibility in proper student selection, developing effective teaching and learning methods, use role modeling (excellence in three aspects: clinical competence, teaching skills, and personal qualities), and constantly perform assessments on professionalism to ensure that quality of professionalism is maintained.13 In West Coast University's example, the author demonstrated how the strategy of delineating boundaries is useful in helping acupuncturists understand what acupuncture is and what it is not.11 With an increased internal awareness of the scopes and boundaries of their practice, acupuncturists can help ?increase the acceptance of acupuncture by establishing its identity as a complement and not an alternative to biomedicine, and the identity of acupuncturists as team players, not competitors.? As for the education curriculum, it is highly suggested for institutions to adapt to an increasingly science-oriented curriculum with a blend of diverse, energetically oriented Asian medicine courses and philosophical concepts to prevent a loss of diversity that is unique to Chinese Medicine. This will ensure that acupuncture becomes a professional system inculcated with professional values associated with biomedical education, examination, practice, and reimbursement. Acupuncture plays a prominent role among complementary, alternative, and integrative medicines and is being widely accepted and recognized by professionals in the biomedical community. Thus, there is a need for continued evaluation of the education curriculum of acupuncture schools as well as how they relate to biomedicine. It is best if the perspective of peers and patients are incorporated in assessments for an accurate measure of professionalism to predict clinical outcomes. Conclusion Medical professionalism is important in establishing credibility, building patient confidence, and improving the professional image of the entire acupuncture profession. This review article is an attempt to collate the recommendations documented by researchers in the context of professionalism in acupuncture. As discussed previously, the present review highlights professional standards that needs to be adhered to as well as professional practices in acupuncture, including educational requirements, ethics, professional medical practices, as well as ideal implementation of establishing professionalism. It is also notable that practitioner health (both mentally and physically) is also included as a characteristic of professionalism to care for the well-being of the practitioner in a patient-centered standard of professionalism. Viewpoints documented as a part of active research in this domain strongly suggest that these recommendations need to be adopted by practitioners elsewhere also. In retrospect, the authors also note that in this era of constant technological advancement and AI, the marriage of medical practices (even complementary medicine) with technology is only a step away. During such synergies, the humaneness of the technology must be emphasized to promote patient trust and enhance technological credibility.14 Other sectors, such as journalism, have demonstrated the important role humaneness14 and algorithmic literacy15 plays in determining information credibility. Future directions in this topic points to the study of the ?coevolution between algorithms and humans, with a focus on the constant interaction, coupling, and mutual tuning of humans and their algorithmic counterparts.?16?18 This review article will serve its intended purpose if it is able to guide acupuncturists toward thinking about the professional aspect of their learning and practice. Uniform adoption of the recommendations highlighted in the review will be a remarkable contribution to the ongoing reforms in professionalizing acupuncture. It may be mentioned in this study that further research on this topic will possibly lead to more insights and better outcome in the future. Implementations by acupuncturists across the globe would go a long way in shaping the future of professionalizing acupuncture. Thus, government health departments, health institutions, accreditation groups, and educational institutions should place a strong value on professionalism and work together in establishing and maintaining professionalism in acupuncture practice.

Objective: After the commencement of the Internet and the popularity of various electronic devices, cyberloafing has become prevalent in the workplace regardless of professional type, demographic characteristics, and country. Individuals use the Internet for work-irrelevant purposes during work hours, which is believed to have a controversial role in work productivity. However, rare studies have paid attention to the prevalence of cyberloafing behavior among Pakistan pharmacists. Considering pharmacists' essential role in the health sector, this study investigates the prevalence of cyberloafing activities among workplace pharmacists in Pakistan. Methods: This cross-sectional survey was conducted among 242 registered pharmacists in Pakistan between October 2021 and February 2022 with a structured self-administered online questionnaire. The final sample consisted of 200 valid responses after screening. Data were processed through exploratory factor analysis and confirmatory factor analyses. Pearson Chi-square analysis was also used to test the correlation between factors. Findings: Descriptive analysis shows that pharmacists spend more time on sharing-related activities and least on gambling/gaming-related activities in the workplace. All the items' Cronbach's alpha values range from 0.923 to 0.927. The analysis indicates that (60%) pharmacists have intermediate Internet skills. The results also suggest that age, Internet usage, and work area have a strong relationship with cyberloafing behaviors which also, in turn, are linked with their perceived Internet skills. This study has important practical implications for pharmacy management in Pakistan. Conclusion: Cyberloafing behavior is prevalent among Pakistan pharmacists. Our findings could inspire how managers and all other relevant stakeholders could improve the pharmacy system in Pakistan.

新型冠状病毒肺炎(以下简称新冠肺炎)归属中医"疫病"的范畴,是一类具有强烈传染性的外感时邪疫毒.古人有云"时病重舌,杂病重脉",中医舌象特征的变化体现了新冠肺炎在不同阶段的传变,对临床诊疗和判断预后均有十分重要的意义.文章通过梳理舌象在新冠肺炎诊疗中判断正气盛衰、分辨病位深浅、区别病邪性质、推断病情进退的应用价值,并举例如何应用舌象变化指导中医药治疗新冠肺炎,以期更好发挥中医药在新冠肺炎诊疗中的应用价值.

Background Stress ulcer (SU) is a serious gastrointestinal mucosal lesion under acute stress. Huanglian decoction is a famous traditional Chinese medicine prescription, which has been used to treat digestive system diseases for thousands of years. Many clinical cases have proved that Huanglian decoction has a good effect on SU. Some studies have shown that the intestinal bacteria will be changed accordingly when the gastrointestinal mucosa is damaged. However, there are few published reports on the effect of the intestinal microbiome with SU mice that were treated by Huanglian decoction. In this study, we investigated the effect of the fecal microbiome in mice with SU by the 16S rDNA sequencing technology. Methods Male KM mice were induced by cold-restraint stress except for the normal control group and then treated by Huanglian decoction (Group HD) and Esomeprazole magnesium solution (Group ES) separately for 7 days. 16S rDNA sequencing technology analysis was applied to evaluate the changes of bacterial flora in mice feces. And, histopathological methods and molecular biological detection methods were also performed. Results Huanglian decoction could help to repair the gastric mucosal injury and regulate the relative content of TNF-α and IL-1β. Moreover, Huanglian decoction could increase the relative abundance of intestinal probiotics in the intestine of mice with SU, especially in Verrucomicrobiae and Akkermansia. Conclusions Huanglian decoction might effectively promote the repair of gastrointestinal mucosal injury and regulate the number and species of intestinal bacteria to maintain the stability of gastrointestinal microecology.

The climate change is a worldwide catastrophe and several fatal health issue such as stroke are increasing all around the world. A global strike has started on 15 march 2019 to raise an awareness on climate change. It was an international movement started from school students who skip classes to participate in demonstration to demand from leaders to stop climate disaster. The current study documented the data sets of #climatestrike hashtags, from the twitter between 2nd April 2019 till 30th October 2020. The current dataset will helpful to determine the mobilizing information and characteristics of participants.

Background: There has been an increasing trend in Clinacanthus nutans’ research, an important medicinal herb of Malaysia and Thailand, well known as an anti-viral, anti-cancer, and insect bite treatment. This study examines the trend in Clinacanthus nutans’ research from 2000 to 2019 and compares the contribution of research on this topic from different institutions and authors. Methods: Publications from the Scopus database were retrieved using keywords and identify top ten institutions/universities, list of prominent authors, top ten journals that published research, top five influential articles, top fifty cited papers, and global distribution of publications on Clinacanthus nutans. Microsoft Excel 2016, Wordcloud, SPSS version 26, and GunnMap 2 were used to analyse indicators. A total of 167 articles were identified from the Scopus database. All research publications were screened initially. Five articles (n=5) were removed due to the unavailability of the full-text version of the article. 162 articles were included in the final study. Results: Universiti Putra Malaysia and the Journal of Ethnopharmacology published the highest number of articles on Clinacanthus nutans. Herpes, antioxidant, phenolic, flavonoids, cancer, antimicrobial were common keywords identified using a word cloud. Over the past 20 years, the literature on Clinacanthus nutans has continuously grown, with the rate increasing after 2012. Conclusion: The prominent research on Clinacanthus nutans was based upon their identified and isolated bioactive constituents, and there is a need for more research on clinical trials.

Cyberbullying behaviour is an international public health concern all around the world due to the increasing trend of working from home during COVID-19. The prevalence of workplace cyberbullying behaviour (WCB) has been shown to be increased prior to COVID-19 among allied health professionals, such as nurses and trainee doctors. There has been a lack of bibliometric analysis on scientific publications concerning this subject; therefore, the current articles presents a protocol for bibliometric analysis of WCB. An indicator-based search will have carried out from documents on PubMed and Scopus to retrieve data from primary peer-reviewed WCB research articles using relevant keywords. Articles that involve WCB research will be included in the analysis. The dataset will identify documents all around the world, and data will be validated using the VAKS assessment tool. Analysis will be carried out by comparing the relationship among institutions, authors, countries and keywords. The dataset will be publicly accessible in the Zenodo repository. There will be no involvement of human participants; therefore, the current research does not require an ethical review. Results will be publish in a peer-reviewed journal and at related conferences

BACKGROUND:Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia.OBJECTIVE:This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors.METHODS:A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants' sociodemographic characteristics, social factors, and substance abuse behavior.RESULTS:This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward.CONCLUSIONS:The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners.TRIAL REGISTRATION:Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/29582.

Objective: The present research is the first comprehensive cross-sectional study of consumer satisfaction with community pharmacies in Sindh, Pakistan. Moreover, the study has also designed a nonorder theoretical model for consumer satisfaction with community pharmacies. Methods: This is a cross-sectional descriptive study from a general population of Sindh, Pakistan, with a total of four hundred and fifteen (n = 415) participants. A confirmatory factor analysis was used to verify the factor structure between Pharmaceutical services (PS), the Skill of Pharmacists, Non-pharmaceutical services (NPS), and pricing (P). Pearson correlation analysis, Kendall's tau correlation analysis, and Spearman's rho correlation analysis were used to identify the correlation between different factors, such as PS, SKP, NPS, and P. Findings: The 23-item scale that consisted of four elements have shown an acceptable root mean squared error of approximation (0.076), Cronbach's alpha (0.787), and Chi-square value (3.381) (P < 0.001). Of the respondents, 56.4% rated their satisfaction on pharmacist attitude, whereas 67.2%, 41.4%, and 51.8% were satisfied with other services, such as receipt provided on medication they take, prescription drug service and availability of pharmacies on the weekend and public holidays, respectively Conclusion: This cross-sectional study confirms that there are relationships among PS, SPK, NPS, and P. Moreover, there is a lack of facilities in community pharmacies in Sindh, such as the unavailability of a consultation room, immunization services, information on routine health matters, and medication record.

Background: Ciji-Hua'ai-Baosheng II Formula (CHB-II-F) is a traditional Chinese medicine formula, which specifically targets different aspects of chemotherapy-induced adverse effects in patients with cancer. In our clinical application, CHB-II-F significantly alleviated chemotherapy-induced anorexia (loss of appetite) and improved the quality of life for patients with tumor during and after chemotherapy. However, the mechanism of CHB-II-F in alleviation of chemotherapy-induced anorexia remains to be further investigated. Aim of Study: To explore the therapeutic effect and mechanism of CHB-II-F on chemotherapy-induced anorexia in the mice model of H-22 hepatoma. Materials and Methods: A total of 72 Kunming mice of SPF grade were inoculated subcutaneously with H-22 hepatoma cells into the right anterior armpit of the mice. After 1 week of seeding, mice were injected intraperitoneally with a high dose of 5-fluorouracil (200 mg/kg 5-FU) to establish the model of chemotherapy. The mice were randomly divided into six groups: untreated group, 5-FU group, 5-FU plus Yangzheng Xiaoji capsule (YZXJC) group, and three groups of 5-FU plus different concentrations of CHB-II-F. All the mice in each group were treated for 14 days. The body weight, food intake, tumor volume, and tumor weight of mice were measured, and pathological examinations of tumor tissue, stomach, and duodenum were carried out. Expressions of serum Leptin, Neuropeptide Y (NPY), epidermal cell growth factor (EGF), Motilin (MTL), Orexin A (OXA), Gastrin (GAS), Ghrelin, Prostaglandin E-2 (PGE(2)), and jejunum superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were examined. The protein and mRNA levels of proopiomelanocortin (POMC), Orexin receptor 1 (OX1R), neuropeptide Y (NPY), cocaine and amphetamine regulated transcript peptide (CART), Agouti gene-related protein (AgRP), Leptin receptor (Ob-R), and Ghrelin receptor (GHSR) were examined in hypothalamus, and the protein levels of substance P (SP) and 5-hydroxytryptamine (5-HT) in duodenum were measured. Results: The combination of CHB-II-F and 5-FU could enhance the inhibitory effect of 5-FU on tumor. The tumor inhibition rates of 5-FU group, YZXJC group, CHB-II-F(H) group, CHB-II-F(M) group, and CHB-II-F(L) group were 58.88, 28.08, 54.96, 37.69, and 28.61%, respectively. Compared with untreated group and 5-FU group, CHB-II-F significantly increased the body weight and food intake of tumor-bearing mice; increased the content of NPY, Orexin A, Ghrelin, GAS, MTL, EGF, and PGE(2) in serum and the activity of SOD in jejunum; and decreased the content of Leptin in serum and the content of MDA in jejunum. Compared with untreated group and 5-FU group, CHB-II-F also enhanced the expression of OX1R, GHSR, NPY, and AgRP protein and gene and decreased the expression of Ob-R, POMC, and CART protein and gene in hypothalamus of mice, and the gene expression was consistent with the protein expression. In addition, CHB-II-F decreased the expression of 5-HT and SP protein in duodenum. Conclusion: In the murine model of H22 hepatocellular carcinoma (HCC) receiving chemotherapy, CHB-II-F enhances the inhibitory effect of 5-FU on tumor, significantly improves the pathological injury of gastrointestinal tract caused by chemotherapy, and regulates the secretion of gastrointestinal hormones. It may alleviate chemotherapy-induced anorexia by affecting appetite regulatory factors in the feeding area of hypothalamus central nervous system and peripheral appetite regulatory factors.

运用中医状态辨治理论对于拓展中医辨证、辨症、辨病论治有重要价值,突破了针对健康人群"未病态"无证可辨、无症可察的缺陷.同时把状态辨治应用于新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)的诊断与治疗,能较好地认识其传变迅速的发展态势,并及时依"态"施治,对于防治新型的病毒性传染病将有积极的意义.掌握COVID-19的湿疫郁肺轻证、疫毒闭肺、毒损肺络、危重脱症不同阶段"已病态"的特征与内在演变机理,方能对其及早实施个性化治疗,截断其病势.

BackgroundWorkplace cyberbullying harms the psychological and social functioning of professionals working in an organization and may decrease the productivity and efficiency of daily life tasks. A recent study on trainee doctors across 8 different United Kingdom National Health Service trusts found health issues and job dissatisfaction in people who have experienced workplace cyberbullying. This disabling effect is even more noticeable in low-socioeconomic communities within low-income countries. In Malaysia, there is a need to create a personalized mobile mental health intervention program for health care professionals. These programs should be directed to prevent and decrease psychosocial issues and enhance coordination among health care professionals to solve health issues in the community. ObjectiveOur main objective is to study the pre-effects and posteffects of the Personalized Mobile Mental Health Intervention (PMMH-I) for workplace cyberbullying in public and private hospitals in Malaysia. MethodsA hospital-based multimethod multi-analytic evidential approach is proposed, involving social and psychological health informatics. The project has been subdivided into 3 stages, starting with Phase 1, a prevalence study, followed by exploratory studies. Phase 2 consists of a quasi-experimental design, whereas the development of a prototype and their testing will be proposed in Phase 3. Each stage includes the use of quantitative and qualitative methods (mixed-method program), using SPSS (version 26.0; IBM Corp) and Stata (version 16.1; StataCorp) as tools for quantitative research, and NVivo (version 1.0; QSR International) and Atlas.ti (version 9.0.16; ATLAS.ti Scientific Software Development GmbH) for qualitative research. ResultsThe results of this study will determine the pre- and posteffectiveness of an integrated PMMH-I for health care professionals. The prototype system platform will be developed and implemented in a public and private hospital. Results from Phase 1 will be published in 2021, followed by the implementation of Phase 2 in subsequent years. ConclusionsThis study will provide evidence and guidance regarding the implementation of a personalized mobile mental health intervention for health care professionals into routine public and private hospitals to enhance communication and resolve conflicts. International Registered Report Identifier (IRRID)PRR1-10.2196/23112

Viral pneumonia is one kind of acute respiratory tract infection caused by the virus. There have been many outbreaks of viral pneumonia with high contagiousness and mortality both in China and abroad, such as the great influenza in 1918, the severe acute respiratory syndrome (SARS) coronavirus in 2003, the Influenza A (H1N1) virus in 2009, and the Middle East Respiratory Syndrome coronavirus (MERS-CoV) in 2012 and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019. These outbreaks and/or pandemic have significant impact on human life, social behaviors, and economic development. Moreover, no specific drug has been developed for these viruses. Traditional Chinese medicine (TCM) plays an important role in the treatment of viral pneumonia during these outbreaks especially in SARS and SARS-CoV-2 because studies suggest that TCM formulations may target several aspects of the disease and may have lesser side effects than manufactured pharmaceuticals. In recent years, a lot of clinicians and researchers have made a series of in-depth explorations and investigations on the treatment of viral pneumonia with TCM, which have understood TCM therapeutic mechanisms more specifically and clearly. But critical analysis of this research in addition to further studies are needed to assess the potential of TCM in the treatment of viral pneumonia.

Substance use disorder (SUD) is associated with a high risk of physical and mental illness such as anxiety, depression, personality disorders, eating disorders, and abnormal mood changes. During the pandemic, SUD, a significant problem related to Coronavirus disease 2019 (COVID-19), is affecting adolescents. The recent available literature also emphasizes understanding the relationship between mental illness and SUD. Hence, it is essential to evaluate the scientific approach and examine the presented findings of articles published on SUD during the COVID-19 pandemic. A systematic review will be conducted using PubMed, PubMed Central, and Scopus bibliographic databases. The grey literature on the impact of SUD on mental health during the COVID-19 pandemic among adolescents will be identified using scholar google. The dependability and credibility of the findings will be examined using the ConQual approach. The methodologies of the included studies will be compared using ROBIS (risk of bias in systematic reviews tool), a measurement tool to assess systematic reviews (AMSTAR), and the JBI critical appraisal tool. The systematic review will be carried out on published articles, so it is exempt from ethics approval. The Center for Open Science (OSF) will be used as a data repository during the preparation of the protocol and completion of the systematic review. The research findings will be published in a related peer-reviewed journal.