Roles of conventional and complementary therapies in recurrent hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the fifth most common type of cancer and the fourth leading cause of cancer-related deaths in the world.HCC has a reported recurrence rate of 70%-80%after 5 years of follow-up.Controlling tumor recurrence is the most critical factor associated with HCC mortality.Conventional salvage therapies for recurrent HCC include re-hepatectomy or liver transplantation,transcatheter arterial chemoembolization,Y-90,target therapy,and immunotherapy;however,these conventional treatment modalities have yet to achieve consistently favorable outcomes.Meanwhile,previous studies have demonstrated that conventional therapies in combination with traditional Chinese medicine(TCM),acupuncture,moxibustion or dietary supplements could notably benefit patients with HCC recurrence by strengthening and augmenting the overall management strategy.However,systemic reviews related to the interactions between complementary therapies and conventional therapy in recurrent HCC are limited.In this review,we discuss the molecular mechanisms underlying the functions of complementary therapies for recurrent HCC,which include augmenting the local control to improve the congestion status of primary tumors and reducing multicentric tumor occurrence via inducing autophagy,apoptosis or cell cycle arrest.TCM and its derivatives may play important roles in helping to control HCC recurrence by inhibiting epithelial-mesenchymal transition,migration,invasion,and metastasis,inhibiting cancer stem cells,and ameliorating drug resistance.

Analysis of the hotspots and trends in traditional Chinese medicine immunomodulation research based on bibliometrics

Objective To analyze the intellectual structure,hotspots and trends of traditional Chinese medicine(TCM)in immune regulation research.Methods The data were extracted from the Web of Science Core Collection(WoSCC)and the China National Knowledge Infrastructure(CNKI)and verified by two experienced TCM researchers.The time of literature retrieval is up to 2020.CiteSpace 5.7.R1 and Microsoft Excel 2016 were used for the statistical analysis and bibliometric diagrams,including the co-occurrence network of authors,institutions,countries,keywords,references,dual-map overlays of journals and citation bursts,etc.Results A total of 12270 publications related to TCM in immune regulation were included.The annual number of publications has increased in this field.There was close cooperation of countries and institutions,while the distribution of scholars was scattered.China was the core of the cooperation network.The dual-map overlays analysis of journals showed that core and marginal fields had increased.The keywords and references analysis showed that network pharmacology,metabolism and cancer were the most high-frequency keywords with high-intensity bursts.Conclusion TCM in immune regulation has attracted wider attention,with multi-country,multi-field,multi-disciplinary and multi-level research developing toward informatization.Network pharmacology,metabolism and cancer may be the focus of future research in this field.

Country Report on Traditional & Complementary Medicine of Malaysia

HEALTHCARE SITUATION IN THE DEVELOPMENT OF T&CM IN MALAYSIA Conventional Western medicine is the main healthcare system in Malaysia.However,traditional and complementary medicine(T&CM)remains in high demand.The T&CM practices in Malaysia include traditional Malay medicine,traditional Chinese medicine(TCM),traditional Indian medicine,homeopathy,and Islamic medical practice.

Using complementary and alternative medicines to prevent and treat pressure ulcers: a systematic review

Background:Pressure ulcers are skin lesions generated by ischemic conditions caused by pressure on soft tissues.Several studies have investigated complementary and alternative medicine(CAM)as preventative and treatment measures for pressure ulcers.Therefore,we systematically reviewed the CAM literature in preventing and treating pressure ulcers.Methods:All clinical trial studies which used CAM were included.We searched different databases,including Scientific Information Database,Irandoc,Google Scholar,PubMed,Medline,Scopus,Cochrane Library,Embase,and Science Direct.The following keywords were used:“complementary and alternative medicine-CAM”,“integrative medicine”,“traditional medicine”,“pressure ulcer”,“bedsore”,“pressure sore healing”,and“prevention”.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 checklist was used to perform analyses.Results:After screening,35 studies were selected.Our investigations suggested that honey,medicinal plants,such as resin salve,Angelica dahurica,Aloe vera,fruits,herbal oils,a combination of several traditional medicine methods,sheepskin,maggot therapy,massage,charcoal,and acupuncture were the most common CAM methods.Conclusion:CAM strategies can prevent and treat pressure ulcers.They reduce wound size,exudate and necrotic tissue levels,inflammation,pain,bleeding,and infections.

Aloe Vera Gel as a Traditional and Complementary Method for Chronic Skin Burn: A Case Report

Burn victims around the world are forced to a life of long lasting morbidity and high mortality rate. Although physiotherapy and occupational therapy subside the painful side of morbidity after severe skin burns, patients are under huge financial pressure in order to return to health. Various treatment plans are used for severe burn injuries. Aloe Vera Gel is introduced recently as an alternative management for burn injuries through betterment of granulation tissue formation and epithelialization. Moreover, numerous studies reported Aloe Vera healing effect on chronic wounds by manipulating collagen layout. This study aims to present the therapeutic impact of Aloe Vera Gel on chronic skin burns of a 17-year-old female who was referred to our department because of rejected skin graft.

Personal and professional influences on practitioners’ attitudes to traditional and complementary approaches to health in the UK

Objective:To explore primary care practitioners’personal and professional beliefs about traditional and complementary approaches(TCA)to health and the influence of professional socialization in the UK.Methods:As part of a larger study on child TCA use in a multi ethnic community,semi-structured,one on one,face-to-face interviewswith 30 primary care practitioners(GPs,nurses and health visitors)explored experience,knowledge and attitudes regarding TCA.Framework analysiswas used.This paper explores the key emergent issues of personal and professional beliefs and professional socialization resulting from the qualitative data obtained during the interviews.Results:Personal factors(ethnicity and personal use)influence attitudes,but professional factors appear to dominate,including biomedical theory,evidence basedmedicine,safety and treatment choice.Curbing of personal views and experience may be due to caution and conformity from increasing regulatory power.Inter-and intra-professional group differences also emerged,likely due to variation in training,status and professional role.Conclusions:Practitioners need to understand patients’diverse health beliefs and practices and discuss TCAwith families,despite regulatory and organizational constraints,to fulfil their professional duty to patients,particularly regarding safety.Further research is needed to verify the professional socialization process and the influence of specific regulation on training.

Antiviral activity of traditional Chinese medicinal plants Dryopteris crassirhizoma and Morus alba against dengue virus

Dengue virus(DENV) has emerged as a major virus that is spread by mosquitoes. Recently, it has spread to more than a hundred nations but continues to lack specific treatable medication. Many traditional Chinese medicinal(TCM) plants are in practice for dengue fever in dengue endemic regions. These traditional medicines persevere with treatments, which modern medicines lack. The study aims to substantiate the anti-dengue potential of some traditional herbs and make them available for further studies to facilitate TCM users. Twelve TCM plants aqueous extracts were evaluated, which are described as cool herbs used for the diseases with high fever. Lead plants were established through detailed in vitro foci forming unit reduction analysis(FFURA) against all four serotypes and validated through quantitative real-time RT-PCR(q RT-PCR). Four plants potentially inhibited the virus in primary phenotypic in vitro evaluation. Two lead plants Dryopteris crassirhizoma(DC) and Morus alba(MA) were identified with half minimal inhibitory concentration(IC50) 130 and 221 μg m L^-1, respectively, while the selectivity indices(SI) were 4.21 and 4.62, respectively. Lead plants equally inhibited all four serotypes of DENV. Time-of-addition analysis suggested that, DC was active at later stages of viral replication, whereas MA was active during the early stages and even showed some prophylactic activity. Liquid chromatography-mass spectrometry(HPLC/MS) analysis revealed presence of flavonoids. DC and MA are identified as potential anti-dengue plants, active against varied stages of dengue virus replication cycle. These results may serve as the base knowledge for further investigation on their combined treatments or integrative treatment with western medicines, which may improve the overall anti-dengue activity in future.

Complementary and alternative medicine on cognitive defects and neuroinflammation after sepsis

Sepsis-associated encephalopathy(SAE)is a common manifestation of sepsis,ranging from mild confusion and delirium to severe cognitive impairment and deep coma.SAE is associated with higher mortality and long-term outcomes,particularly substantial declines in cognitive function.The mechanisms of SAE probably include neuroinflammation that is mediated by systemic inflammation and ischemic lesions in the brain,a disrupted blood–brain barrier,oxidative stress,neurotransmitter dysfunction,and severe microglial activation.Increasing evidence suggests that complementary and alternative medicine,especially Traditional Chinese Medicine(TCM),is favorable in alleviating cognitive decline after sepsis.Here,we summarized the studies of traditional herbal remedies,TCM formulas and acupuncture therapy in animal models of neurological dysfunctions after sepsis in recent decades and reviewed their potential mechanisms.

Acute moderate to severe ulcerative colitis treated by traditional Chinese medicine:A case report

BACKGROUND Ulcerative colitis(UC),also known as chronic nonspecific UC,is an inflammatory bowel disease characterized by diffuse colonic mucosal inflammation.The incidence and prevalence of UC have risen markedly,and the disease seriously affects the quality of life of patients and imposes a great burden on the world health care infrastructure and economy.CASE SUMMARY Case I describes a 34-year-old female who came to see a doctor because of repeated abdominal pain,diarrhoea and purulent blood for 2 mo.This patient had UC with an initial onset,an active stage and a wide range of lesions.After the poor effect of sulfasalazine and mesalazine,the patient’s condition gradually deteriorated,her abdominal pain and bloody stools continued,and anemia occurred.She began treatment with the Chinese medicine Guizhi Dahuang decoction,which was taken orally twice a day,200 mL each time.After 6 mo of treatment,abdominal pain,diarrhoea,bloody stool and other symptoms disappeared.No abnormality was found by repeat electronic enteroscopye,and the anemia was corrected.The patient’s condition did not recur after nearly 4 years of follow-up.CONCLUSION A series of symptoms in this UC patient significantly improved with the administration of traditional Chinese medicine.

Clinical efficacy and safety of TCM prescriptions combined with nucleoside(acid)analogues in treating chronic hepatitis B:a meta-analysis

Objective There are many clinical reports on traditional Chinese medicine(TCM)combined with nucleoside(acid)analogues(NAs)for the treatment of chronic hepatitis B(CHB),but its efficacy and safety are not completely clear.This meta-analysis aims to evaluate the clinical efficacy and safety thus providing evidence for clinical applications.Methods We searched Chinese databases the China National Knowledge Infrastructure(CNKI),Wanfang Data,and China Science and Technology Journal Database(VIP),as well as English databases Pub Med and Cochrane Library,from time of establishment to April 14,2021.Literature quality was evaluated according to the bias risk assessment criteria of Cochrane Collaboration network.Rev Man 5.3 and Stata 12.0 software were used to perform this research.Results A total of 23 articles,3282 patients,and 25 TCM prescriptions were included in this study.NAs plus TCM remarkably improved the clinical total effective rate[Odds ratio(OR)=3.92,P<0.00001],TCM syndrome score(Mean difference=-3.73,P<0.00001),hepatitis B virus(HBV)DNA negative conversion rate(OR=1.49,P=0.0001),hepatitis Be antigen(HBe Ag)negative conversion rate(OR=2.03,P<0.00001),alanine aminotransferase levels[Std mean difference(SMD)=-0.95,P<0.00001],and aspartate aminotransferase levels(SMD=-0.70,P=0.0004).Adverse reaction rates did not increase in the combined treatment group(OR=0.97,P=0.84).A comprehensive analysis of the 25 TCM prescriptions suggested that the combination of spleen-strengthening prescriptions with NAs showed better effects than other prescriptions.Conclusion TCM in combination with NAs,demonstrated better clinical efficacy against CHB than NAs alone.In addition,the combination of spleen-strengthening prescriptions and NAs was identified as the best therapeutic strategy.However,more randomized controlled trials of high quality are needed to provide more reliable clinical basis for the application of TCM.

Economic impact of traditional medicine practice worldwide

The aim of this literature review was to summarize available findings from publications that reported expenditure on traditional/complementary and alternative medicine(TM/CAM)within a representative general population sample of a nation or a defined geographical area.A total of 24 publications met the inclusion criteria and were included in the review.The expenditure on TM/CAM varies worldwide,but direct comparison of the findings of publications included in this review is limited due to the differences in the definitions of TM/CAM,inclusion of various forms of TM/CAM,use of different names and categorization,as well as differences in reported currencies and time periods in which data were collected.Data about the expenditure on TM/CAM in most countries throughout the world are scarce.Further national studies should be conducted in order to provide up-to-date assessment of the TM/CAM related expenditure patterns and use.Uniform nomenclature,definition of TM/CAM and standardized instruments would provide basis for comparability of data of studies conducted in various regions and time periods.

Euclea undulata Thunb.:Review of its botany,ethnomedicinal uses,phytochemistry and biological activities

Euclea undulata(E. undulata) is traditionally used for the treatment of body pains, chest complaints, cough, diabetes, diarrhoea, headaches, heart diseases and toothaches in southern Africa. This study was aimed at reviewing the botany, ethnopharmacology and biological activities of E. undulata in southern Africa. Results presented in this study are based on review of literature using search engines such as Science Direct, Springerlink,Scopus, Pub Med, Web of Science, Bio Med Central and Google Scholar. Herbal medicine is prepared from the decoctions of the roots, bark and leaves, and extracts of these plant parts have demonstrated anticholinesterase, anti-inflammatory, antimicrobial, antimycobacterial, antiplasmodial, antioxidant and hypoglycaemic activities. Multiple classes of phytochemical compounds such alkaloids, diterpenes, fatty acids, flavonoids, glycosides, naphthoquinones, phenolics, phytosterols, reducing sugars, saponins and tannins have been isolated from the species. E. undulata has a lot of potential as herbal medicine in tropical Africa, and advanced research is required aimed at correlating its medicinal uses with the phytochemistry and pharmacological properties.

Efficacy of acupuncture on treating obesity and adipose-incurred illnesses

Being overweight and obese impacts health due to adiposity itself and illnesses it incurs,which produces individual and societal financial burdens.This urges effective interventions,including adjunct therapies.Acupuncture,a traditional Chinese medical practice,indicates positive signs for tackling these problems.Investigating 101 empirical human-based projects,this narrative review analyses their outcomes and then provides an overview of the effects of acupuncture in body weight reduction and obesity-induced diseases,either performed alone or with other approaches.It involves 15941 participants from 9-80 years old in China's Mainland,Taiwan,Turkey,Brazil,Egypt,Iran,Greece,Korea,Sudan,Thailand,and the USA.It also reveals practical implications and future research directions,benefiting the development of acupuncture in the modern medical arena for both patients and practitioners.

中医药治疗系统性红斑狼疮的研究进展

中医药治疗系统性红斑狼疮的方法如分证论治、分期论治、经典方剂、中成药及自拟方等,可明显改善系统性红斑狼疮患者临床症状与体征,疗效显著,不良反应少。该文采用文献检索,归纳近年来中医药治疗系统性红斑狼疮及其系统病变的研究进展,为中医药更好地治疗系统性红斑狼疮及其全身病变提供参考。

Prevalence and Determinants of Traditional,Complementary and Alternative Medicine Provider Use among Adults from 32 Countries

Objective： To estimate recent prevalence data（2011-2013） on traditional,complementary and alternative medicine（TCAM） provider use and sociodemographic and health related correlates in nationally representative population samples from 32 countries from all world regions.Methods： This secondary analysis was based on the International Social Survey Program（ISSP）,2011-2013,Health and Health Care Module.In a cross-sectional population-based survey（N=52,801）,simple or multi-stage stratified random sampling was used,resulting in representative samples of the adult population of respective countries.Results： Overall,the 12-month TCAM provider use prevalence was 26.4%,ranging from under 10% in Bulgaria,Poland and Slovenia to over 50% in China mainland,the Philippines and Republic of Korea.Over 80% TCAM treatment satisfaction was found in Europe in Denmark,Slovenia,Spain and Switzerland,in Asia in Taiwan（China） and USA.Multivariate logistic regression found sociodemographic variables（middle age,female sex,lower educational status,not having a religious affiliation,and lower economic indicators） and health variables（perceived poor or fair health status,being unhappy and depressed,having a chronic condition or disability,and having positive attitudes towards TCAM） were associated with TCAM provider use.Conclusions： A high prevalence TCAM provider use was found in all world regions and several sociodemographic and health related factors of its use were identified.

The meaning of complementary, alternative and traditional medicine among the Indonesian psychology community: a pilot study

OBJECTIVE： Complementary, alternative and traditional medicine （CATM） is a new field, as well as a promising area of study and practice in psychology. It is important to research the cultural context and meaning of CATM, including its definitions and examples, among different communities of psychology because CATM＇s use is dependent on how it is understood by the members. The aim of this pilot study is to provide an interpretation of the Indonesian psychology community＇s understanding of CATM through a qualitative approach. METHODS： Online interviews with open-ended questions and purposive sampling were used. Participants were dominantly psychologists or lecturers in clinical psychology area. Ten males and 12 females with an average age of 28.0 ＋ 2.5 years voluntarily participated in this study. Interviews were audio-recorded, transcribed verbatim, and reviewed and analysed by the two authors to ensure accuracy of interpretation. RESULTS： It was found that there was no single meaning of CATM among the Indonesian community of psychology. Participants were not familiar enough with the terms and tended to use them with overlap. It can be suggested that ＂complementary medicine＂ and ＂alternative medicine＂ or ＂complementary- alternative medicine＂ combined provides more suitable terminology for use among Indonesian psychology community when communicating with other health care professionals. CONCLUSION： The understanding of the terms and examples of CATM were diverse and were often used interchangeably in the projects/interviews. It was also found that Indonesian psychologists required more education regarding CATM. In addition, future studies with more participants from various aspects of the psychology community should be conducted to capture a more representative sample.

The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran

Background: The use of traditional and complementary medicine (T&CM) is increasing in both developed and developing countries. The school of Persian medicine (PM) in Iran is a comprehensive medical school that is rich in history and has its own special principles, elements, philosophy, and diagnostic and treatment options. Many complementary therapy modalities are also popular and in demand among patients and physicians. The aim of this paper is to provide logic for the policymakers in Iranian medical education to make changes in medical education curricula, particularly on integrating T&CM. Methods: We reviewed the global experience in teaching T&CM to medical students, and highlighting the strengths of PM, described why it is necessary to integrate T&CM into general medicine curricula in Iran. Results: PM is a traditional system of medicine that dates back about 7000 years. Although there are few studies about the safety and effectiveness of PM, research into it has recently been accelerated. There is a suitable opportunity for integrating T&CM with conventional medicine. Physicians should be familiar with T&CM to avoid any contraindications, interactions, and unwanted effects. Conclusion: Traditional medicine is part of Iran's heritage and. thus, needs special attention. Familiarization of physicians with T&CM can help them choose the best treatment options for their patients. To integrate T&CM into the medical education curricula of Iran, a two-credit course has been proposed for implementation across the country.

Perceptions of traditional,complementary and alternative medicine among conventional healthcare practitioners in Accra,Ghana:Implications for integrative healthcare

OBJECTIVE： Integrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine （TM-CAM） remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine. METHODS： A qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana. RESULTS： Participants＇ knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes： the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants. CONCLUSION： The conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration practitioners＇ understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and evidence-based practice of TM-CAM products and services in Ghana.

The Importance of Evidence for the Integration of Traditional and Complementary Medicine into Western Healthcare?

Policy makers should consider improving access to treatments normally considered outside of healthcare in the west, particularly given the recent WHO strategy. However, research on integrating traditional and complementary medicines(T&CM) into conventional health care is lacking. T& CM approaches, may provide a cost effective option given the increase in chronic diseases with evidence of effectiveness of T& CM being key if such approaches are to be offered as part of integrative patient care, in most countries, an integrated healthcare approach is unavailable to patients. Evidence based clinical guidelines on T& CM should influence care provision. However evidence that is available may not even be cited. Poor use of evidence may possibly be a reflection of lack of knowledge and/or biases of guideline developers but additionally stakeholders vary in their perceived need for evidence to implement health policy change. Journal editors should focus on publishing high quality manuscripts, with clear rationales, design and reporting frameworks. Researchers should consider carrying out careful feasibility studies prior to conducting trials taking into account the UK Medical Research Council's framework on complex interventions. Examples of feasibility studies highlighting their importance for trial design are given in this paper. If preparation for more definitive studies is conducted this will in turn improve the quality of research being designed, executed and published and subsequently encourage the inclusion of evidence by guideline developers. Robust evidence is necessary in order to inform governments' health policies providing appropriate T&CM interventions which can ultimately help to provide best patient care.

Complementary and alternative medicine practices,traditional healing practices,and cultural competency in pediatric oncology in Hawai'i

OBJECTIVE： Hawai＇i is an ethnically diverse island state with a high rate of both traditional healing （TH） and complementary and alternative medicine （CAM） use. The aim of this project was to assess TH and CAM use within the pediatric oncology population in Honolulu and improve the delivery of culturally competent care. METHODS： A 9-item survey was distributed to all pediatric oncology patients at Kapi＇olani Medical Center for Women and Children for 3 months. The survey inquired about patient ethnicity, TH practices CAM practices and perception of cultural competence of the care received. Descriptive statistics were calculated for the survey items. Qualitative analysis was done with participant comments to identify themes. RESULTS： Sixty-two surveys were completed. TH was used by 39% of the respondents in the home, and 10% in the hospital （top method was traditional foods）. CAM was used by 27% of the respondents in the home, and 68% in the hospital （top method was healing touch）. Ninety-seven percent of the respondents reported receiving culturally competent care. Areas for improvement included language services and dietary choices. CONCLUSION： CAM and TH are used frequently by pediatric oncology patients in Hawai＇i, and the vast majority of patients and families felt that the care they received was culturally competent.