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Lino VTS, Marinho DS, Rodrigues NCP, Andrade CAF. Efficacy and safety of ozone therapy for knee osteoarthritis: an umbrella review of systematic reviews. Front Physiol 2024; 15:1348028. [PMID: 38444768 PMCID: PMC10912569 DOI: 10.3389/fphys.2024.1348028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
The objective of this study is to evaluate the effectiveness and safety of ozone therapy (OT) in the treatment of knee osteoarthritis (KOA), which is the most common form of the disease. We analysed systematic reviews (SRs) of randomised controlled trials (RCTs) using the "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR2) instrument to evaluate their quality. We developed a narrative synthesis report with eight SRs (15 RCTs/3,685 patients) to summarise the findings. The AMSTAR2 analysis indicated that all reviews had critically low confidence ratings. Statistically significant effects in pain reduction using OT compared to placebo groups were reported in three SRs. OT was shown to be comparable to other therapies in one SR and not superior in the other five. Six SRs highlighted the need for additional RCTs with improved methodological quality to confirm the efficacy of OT for KOA. SRs found fewer consistent effects for improving joint function. Regarding safety, seven SRs reported a low prevalence of minor adverse events linked with OT. Finally, this umbrella review highlights the beneficial effects and safety of OT in the treatment of KOA, particularly in pain control. The low methodological quality of RCTs and SRs limits the possibility of drawing conclusions on the effectiveness of the procedure in comparison to other therapies. Ensure adequate compliance with guidelines such as Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR2 has the ability to improve the quality of SRs in this area.
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Affiliation(s)
- Valéria T. S. Lino
- Primary Care Department- Germano Sinval Faria School Health Center, Sergio Arouca National School of Public Health- Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Daniel S. Marinho
- Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health- Oswaldo Cruz Foundation- Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nadia C. P. Rodrigues
- Primary Care Department- Germano Sinval Faria School Health Center, Sergio Arouca National School of Public Health- Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos A. F. Andrade
- Department of Epidemiology and Quantitative Methods in Health, Sergio Arouca National School of Public Health- Oswaldo Cruz Foundation- Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Medicine, Vassouras University–Vassouras–Rio de Janeiro, Vassouras, Brazil
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Liang Y, Xu Y, Zhu Y, Ye H, Wang Q, Xu G. Efficacy and Safety of Chinese Herbal Medicine for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 100:154029. [PMID: 35316726 DOI: 10.1016/j.phymed.2022.154029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aims to evaluate the effectiveness and safety of oral Chinese herbal medicine (CHM) in the treatment of knee osteoarthritis (KOA). STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS A computer was used to retrieve all RCTs of CHM in the treatment of KOA from 7 databases (PubMed; Embase; Cochrane Central Register of Controlled Trials; China National Knowledge Infrastructure; Chinese VIP Information Database; Chinese Biomedical Database and Wanfang Med Database) from the establishment to August 2021. The literature was organized using NoteExpress, and literature screening and data extraction were conducted by two researchers independently by the inclusion and exclusion criteria. Quality evaluation was performed using GRADE, and the meta-analysis was performed using RevMan5.4. RESULTS A total of 31 RCTs and 3115 cases are included. The following meta-analysis results are observed: (1) WOMAC: CHM vs. placebo (SMD = -0.87, 95% CI: -1.27 to -0.47, P < 0.0001), CHM vs. Western medicine (SMD = -1.64, 95% CI: -2.09 to -1.19, P < 0.00001), and CHM + Western medicine vs. Western medicine (SMD = -2.17, 95% CI: -3.01 to -1.33, P < 0.00001); (2) VAS: CHM vs. Western medicine (SMD = -1.02, 95% CI: -1.63 to -0.41, P < 0.00001) and CHM + Western medicine vs. Western medicine (SMD = -2.68, 95% CI: -4.36 to -1.00, P < 0.00001); (3) Lequesne severity index: CHM vs. Western medicine (SMD = -0.90, 95% CI: -1.40 to -0.39, P = 0.0005) and CHM + Western medicine vs. Western medicine (SMD = -0.94, 95% CI: -1.36 to -0.52, P < 0.0001); (4) Lysholm knee joint function score: CHM vs. Western medicine (MD = 9.10, 95% CI: 4.20 to 14.01, P = 0.0003), and CHM + Western medicine vs. Western medicine in a single trial (MD = 21.15, 95% CI: 19.71 to 22.59, P < 0.00001); (5) SOD: in a single trial, CHM vs. Western medicine (MD = 1.62, 95% CI: 0.9 to 2.30, P < 0.00001) and CHM + Western medicine vs. Western medicine (MD = 17.08, 95% CI: 10.71 to 23.44, P < 0.00001); (6) TNF-α: CHM vs. Western medicine (SMD = -1.90, 95% CI: -2.04 to -0.14, P = 0.02) and CHM + Western medicine vs. Western medicine (SMD = -2.32, 95% CI: -4.33 to -0.30, P = 0.02); (7) IL-1β: CHM vs. Western medicine (SMD = -1.60, 95% CI: -2.36 to -0.84, P < 0.0001); and (8) IL-6: in a single trial, CHM vs. Western medicine (MD = -0.75, 95% CI: -1.20 to -0.30, P = 0.001) and CHM + Western medicine vs. Western medicine (MD = -3.18, 95% CI: -6.24 to -0.12, P = 0.04). CONCLUSION The efficacy of CHM in the treatment of KOA is superior to those of placebo and Western medicine. At the same time, the combination of CHM + Western medicine is superior to Western medicine alone in the treatment of KOA. However, due to the existence of certain biases in the included studies, and the need for further study on the effective components of Chinese medicine, a positive conclusion on the efficacy of traditional CHM in the treatment of KOA cannot be drawn and needs to be confirmed by high-quality clinical RCTs.
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Affiliation(s)
- Yongqi Liang
- School of Nursing, Nanjing University of CHM, Nanjing, China
| | - Yue Xu
- School of Nursing, Nanjing University of CHM, Nanjing, China
| | - Yuan Zhu
- School of Nursing, Nanjing University of CHM, Nanjing, China
| | - Hui Ye
- School of Nursing, Nanjing University of CHM, Nanjing, China
| | - Qing Wang
- School of Nursing, Nanjing University of CHM, Nanjing, China.
| | - Guihua Xu
- Nanjing University of CHM, Nanjing, China.
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The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6887988. [PMID: 35035664 PMCID: PMC8759838 DOI: 10.1155/2022/6887988] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022]
Abstract
Objective This systematic review and meta-analysis were performed to investigate the efficacy and safety of Chinese herbal medicine (CHM) in the treatment of knee osteoarthritis (KOA). Methods An electronic search was conducted in eight databases (PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese VIP Database, and Wanfang Database) from inception until December 2019. The risk of bias assessment of the included RCTs was evaluated by Cochrane collaboration's tool. The inclusion criteria were RCTs that investigated the efficacy and safety of CHM in the treatment of KOA, with no restrictions on publication status or language. The exclusion criteria included nonrandomized or quasi-RCTs, no clear KOA diagnostic approach, combined Chinese medicinal herbs with other traditional Chinese medicine treatment modalities, and published using repeated data and missing data. We computed the relative risk (RR) and the standard mean difference (SMD) for dichotomous outcomes and continuous outcomes, respectively. When heterogeneity was detected or there was significant statistical heterogeneity (P < 0.05 or I2 > 50%), a random-effects model was employed, followed by further subgroup analysis and metaregression estimations to ascertain the origins of heterogeneity. Otherwise, we used a fixed-effects model (P ≥ 0.05 or I2 ≤ 50%). The primary outcome measures were visual analog score (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and Lequesne index. Secondary outcome measures were the total clinical effective rate and adverse events. The meta-analysis was performed using the Stata 14.0 software. Results A total of 56 RCTs comprising 5350 patients met the inclusion criteria. This meta-analysis showed that application of CHM as adjuvant therapy or monotherapy for KOA can significantly decrease VAS, WOMAC, and the Lequesne index and improve the Lysholm score as well as the total effective rate. In addition, this treatment has fewer adverse effects, suggesting that CHM is generally safe and well tolerated among patients with KOA. Conclusion Our study offers supportive evidence that CHM, either adjuvant therapy or monotherapy, reduces the VAS, WOMAC, and Lequesne index and improves the Lysholm score and overall effective rate in patients with KOA. Additionally, CHM was well tolerated and safe in KOA patients. We found frequently used CHMs that might contribute to the formulation of a herbal formula that could be considered for further clinical use. However, given the heterogeneity and limited sample size in this study, larger multicenter and high-quality RCTs are needed to validate the benefits of CHM in the treatment of KOA.
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Wang H, Ma B. Healthcare and Scientific Treatment of Knee Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5919686. [PMID: 35126931 PMCID: PMC8816538 DOI: 10.1155/2022/5919686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 01/08/2022] [Indexed: 01/22/2023]
Abstract
Knee osteoarthritis is a chronic degenerative disease companied with chronic knee pain and dysfunction. However, the etiology and pathogenesis of knee osteoarthritis were unclear. Currently, age, diet, trauma, obesity, and inheritance are the main risk factors. The major pathological hallmarks of knee osteoarthritis included subchondral bone sclerosis, articular cartilage degeneration, arthrosynovitis, and osteophyte. With the acceleration of the aging process in China, the treatment of knee arthritis and the methods to improve the quality of life have become the focus of medical staff. Currently, therapies in clinical practice include surgery and nonoperative treatment; however, the clinical effects of different individuals at different stages will still be very different. This article reviews the recent advances in the treatment of knee osteoarthritis from three aspects: nonsurgical treatment, surgical treatment, and modern new medical means.
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Affiliation(s)
- Huan Wang
- Orthopedics, The Second Affiliated Hospital of the Air Military Force Military Medical University, Xi'an, Shanxi Province 710000, China
| | - Baoan Ma
- Orthopedics, The Second Affiliated Hospital of the Air Military Force Military Medical University, Xi'an, Shanxi Province 710000, China
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Yang L, Wu BY, Ma L, Li ZD, Xiong H. Comparative efficacy and safety of Chinese herbal medicine for knee osteoarthritis: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e26671. [PMID: 34398031 PMCID: PMC8294919 DOI: 10.1097/md.0000000000026671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a major public health concern causing chronic disability as well as a substantial burden on health care and the economy. However, effective treatments for knee OA were still not available. Numerous clinical studies have suggested that Chinese herbal medicine (CHM) seems to be clinically effective in treating knee OA. Thus, this study aims to evaluate the efficacy and safety of CHM in the treatment of knee OA through a systematic review and network meta-analysis. METHODS A comprehensive search will be performed in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database, Chinese Biomedical Database, and 3 clinical trials registration websites, from the database inception to May 2021. Randomized controlled trials meeting the eligible criteria based on the PICOS framework will be included. All studies fulfilling the eligible criteria will be assessed for risk of bias using the Cochrane Collaboration's tool. The primary outcome will be the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index, and total effective rate. The secondary outcome is the incidence of adverse events. Data analysis will be performed using Stata, Addis, and WinBUGS. DISCUSSION This study will provide a reliable evidence to assess effectiveness and safety of CHM for knee OA, which may provide guidance for clinical practice. SYSTEMATIC REVIEW REGISTRATION This study protocol has been registered on INPLASY202160060.
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Kamsan SS, Singh DKA, Tan MP, Kumar S. The knowledge and self-management educational needs of older adults with knee osteoarthritis: A qualitative study. PLoS One 2020; 15:e0230318. [PMID: 32226047 PMCID: PMC7105111 DOI: 10.1371/journal.pone.0230318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/26/2020] [Indexed: 12/12/2022] Open
Abstract
Knee osteoarthritis (KOA) is closely related with ageing, physical disability and functional dependency. The course of KOA is considered progressive and irreversible. Engagement with self-management may, however, minimize the impact of KOA. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is limited empirical data on older adults’ understanding on KOA and their information needs about KOA. Therefore, the aims of this study were to explore older adults’ knowledge about KOA and their perspectives on the information required to enable self-management. Three focus groups were conducted with 16 older adults with KOA. The sample consisted of three men and thirteen women with the mean age 73.2 years (range from 61 to 89). Thematic content analysis revealed two themes which were understanding about KOA and information needed about KOA. Participants’ knowledge about KOA varied between individuals with many expressing that they needed more information about KOA. A targeted strategy is needed to educate older adults about KOA in order to support and prepare them for self-management.
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Affiliation(s)
- Siti Salwana Kamsan
- Physiotherapy Program & Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physical Rehabilitation Sciences, Faculty of Allied Health Sciences, International Islamic University Malaysia, Selayang, Pahang, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Program & Centre for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Saravana Kumar
- School of Health Sciences, City East Campus, University of South Australia, Adelaide, South Australia
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Huang H, Huang S, Liang G, Zeng L, Pan J, Yang W, Chen H, Liu J, Pan B. Comparison of kidney-tonifying and blood-activating medicinal herbs vs NSAIDs in patients with knee osteoarthritis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19370. [PMID: 32118781 PMCID: PMC7478677 DOI: 10.1097/md.0000000000019370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. In recent years, people are more and more interested in the use of Chinese herbal medicine (CHM) in the treatment of KOA, such as kidney-tonifying and blood-activating medicinal herbs (KTBAMs) in the treatment of KOA. Many studies have confirmed that KTBAMs are effective in the treatment of KOA. However, it is still unknown whether KTBAMs and NSAIDs are more effective in the treatment of KOA. Therefore, we evaluated the efficacy and safety of KTBAMs and NSAIDs in the treatment of KOA. METHODS Randomized controlled trials (RCTs) from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data, and Chinese Biomedical Literature Database that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain and adverse effects. The Cochrane risk of bias (ROB) tool was used to assess methodological quality. RESULTS The literature will provide a high-quality analysis of the current evidence supporting KTBAMs for KOA based on various comprehensive assessments including the total effective rate, visual analog scale scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequence scores, Knee Society Scale (KSS) scores, and adverse effects. CONCLUSION This proposed systematic review will provide up-to-date evidence to assess the effect of KTBAMs in the treatment for patients with KOA. RESEARCH REGISTRY REGISTRATION NUMBER: : reviewregistry 783.
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Affiliation(s)
- Hetao Huang
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine
| | - Sicong Huang
- Department of Orthopaedics, Foshan Second People's Hospital
| | - Guihong Liang
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Lingfeng Zeng
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Jianke Pan
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Weiyi Yang
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Hongyun Chen
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Jun Liu
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine
| | - Biqi Pan
- Department of Traditional Chinese Medicine, GuangDong Women and Children Hospital, China
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Are Kidney-Tonifying and Blood-Activating Medicinal Herbs Better than NSAIDs for Knee Osteoarthritis? A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:9094515. [PMID: 31885673 PMCID: PMC6899304 DOI: 10.1155/2019/9094515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 01/12/2023]
Abstract
Objective To compare the efficacy and safety of kidney-tonifying and blood-activating medicinal herbs (KTBAMs) and nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of knee osteoarthritis (KOA). Methods Randomized controlled trials (RCTs) from online databases that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain, and adverse effects. The Cochrane risk-of-bias (ROB) tool was used to assess methodological quality. Results A total of 38 RCTs (3994 participants) were included in our meta-analysis. We found that KTBAMs had a significantly higher total effective rate (P < 0.00001, risk ratio (RR) = 1.08, confidence interval (CI) = 1.05 to 1.11, I2 = 4%) and a lower gastrointestinal adverse reaction rate (P < 0.00001, RR = 0.36, CI = 0.24 to 0.53, I2 = 33%) than NSAIDs. KTBAMs showed greater improvements in the Knee Society Scale (KSS) scores (mean difference (MD) = 7.17, 95% CI 0.71 to 13.64, P=0.03). Regarding the visual analog scale (VAS) scores, WOMAC scores, and Lequence scores, there were no significant differences between the KTBAM group and the NSAID group. The GRADE quality level of this systematic review indicated that the very low-quality evidence showed that KTBAMs had a higher total effective rate, while the moderate-quality evidence showed that the adverse reactions of KTBAMs were lower and the KSS scores were higher. Low-quality evidence showed no significant differences in improving VAS scores, WOMAC scores, or Lequence scores. Conclusion KTBAMs were superior to NSAIDs in terms of a higher total effective rate, a lower adverse reaction rate, and a higher KSS score. There were no significant differences between KTBAMs and NSAIDs in improving VAS scores, WOMAC scores, and Lequence scores of patients with KOA. Therefore, KTBAMs may be an alternative effective method for treating KOA. However, high-quality, well-designed RCTs with long-term follow-up are still required.
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Sul JU, Kim MK, Leem J, Jo HG, Yoon SH, Kim J, Lee EJ, Yoo JE, Park SJ, Kim YI, Kim E, Jung IC, Jeon JH, Park YC. Efficacy and safety of gyejigachulbutang (Gui-Zhi-Jia-Shu-Fu-Tang, Keishikajutsubuto, TJ-18) for knee pain in patients with degenerative knee osteoarthritis: a randomized, placebo-controlled, patient and assessor blinded clinical trial. Trials 2019; 20:140. [PMID: 30782208 PMCID: PMC6381693 DOI: 10.1186/s13063-019-3234-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/29/2019] [Indexed: 01/04/2023] Open
Abstract
Background Degenerative knee osteoarthritis is a leading cause of disability in the elderly. If patients do not respond to pharmacological or nonpharmacological intervention, total knee replacement surgery is recommended. However, owing to the contraindications and adverse effects of surgery, the need for a new treatment strategy is emerging. Traditional herbal medicine is a widely used intervention in east Asia to treat knee osteoarthritis. Gyejigachulbutang is one of the frequently prescribed herbal formulae. The aim of our study is to evaluate the efficacy and safety of gyejigachulbutang for knee osteoarthritis. Methods This study is a randomized, placebo-controlled, patient and assessor blinded, superiority clinical trial. A total of 80 patients with knee osteoarthritis will be enrolled. The participants will be randomly assigned to the gyejigachulbutang or placebo group in a 1:1 ratio in two Korean medical hospitals. Every participant will take gyejigachulbutang or placebo at a dose of 2.5 g three times a day for 4 weeks. Additional follow-up will be conducted 4 weeks after treatment completion. Any concomitant treatment to relive knee pain will not be allowed except for rescue medicine (acetaminophen). The primary outcome will be a comparison of the change in the visual analogue scale score for knee pain from baseline to visit 3 (week 4) for both the treatment and placebo groups. Secondary outcomes include clinical relevance, minimal clinically important difference, disability, quality of life, and safety. Discussion This protocol presents a research methodology for clinical trials of gyejigachulbutang for knee osteoarthritis. Various secondary outcomes make this trial more informative. Our trial will provide fundamental evidence for knee osteoarthritis management via herbal medicine treatment. Trial registration Clinical Research Information Service (CRIS), KCT0003024. Registered on 25 July 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3234-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae-Uk Sul
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea.,Chung-Yeon Korean Medicine Hospital, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea
| | - Myung Kwan Kim
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea
| | - Jungtae Leem
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea.,Dongshin Korean Medicine Hospital, 351, Omok-ro, Yangcheon-gu, Seoul, 07999, South Korea
| | - Hee-Geun Jo
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea.,Chung-Yeon Korean Medicine Hospital, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea
| | - Sang-Hoon Yoon
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea.,Chung-Yeon Korean Medicine Hospital, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea
| | - Jeeyong Kim
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea.,Chung-Yeon Korean Medicine Hospital, 64, Sangmujungang-ro, Seo-gu, Gwangju, 61949, South Korea
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea
| | - Jeong-Eun Yoo
- Department of Korean Medicine Obstetrics & Gynecology, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea
| | - So Jung Park
- East West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University, 75, 176 Bun-gil, Daedeok-daero, Seo-gu, Daejeon City, 35235, South Korea
| | - Young Il Kim
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea
| | - Eunseok Kim
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea
| | - In Chul Jung
- Department of Neuropsychiatry, Dunsan Korean Medicine Hospital of Daejeon University, 75, Daedeok-daero 176 beon-gil, Seo-gu, Daejeon, 35235, South Korea
| | - Ju-Hyun Jeon
- Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon, 34520, South Korea.
| | - Yang-Chun Park
- Department of Internal Medicine, Dunsan Korean Medicine Hospital of Daejeon University, 75, Daedeok-daero 176 beon-gil, Seo-gu, Daejeon, 35235, South Korea.
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Hou ZL, Yuan BY, Fu MX, Ni L, Bao Q. Efficacy of Duohuojisheng decoction monotherapy for the treatment of knee osteoarthritis: A protocol of a systematic review of randomized controlled trials. Medicine (Baltimore) 2019; 98:e14510. [PMID: 30762784 PMCID: PMC6408025 DOI: 10.1097/md.0000000000014510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This systematic review investigates the efficacy and safety of Duohuojisheng decoction (DHJSD) monotherapy for the treatment of patients with knee osteoarthritis (KOA). METHODS We searched relevant studies on DHJSD monotherapy for KOA from the databases of CENTRAL, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from the inception to January 1, 2019. Two researchers independently selected studies, collected data, and assessed the methodology quality by using Cochrane risk of bias tool. RESULTS This study evaluates the efficacy and safety of DHJSD monotherapy for KOA by assessing the pain intensity, stiffness, and disability of affected knee joints, and quality of life, as well as the adverse events. CONCLUSION The results of this study provide latest updated evidence of DHJSD monotherapy alone for KOA. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review, because it is based on the published data, and not on individual patient data. Its findings is published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019120405.
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Affiliation(s)
- Zhi-ling Hou
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University
| | - Bo-yang Yuan
- Department of Hematology, Jiamusi Hospital of Traditional Chinese Medicine
| | - Ming-xia Fu
- Department of Hematology, Jiamusi Hospital of Traditional Chinese Medicine
| | - Lei Ni
- Department of Chinese Medicine, First Affiliated Hospital of Jiamusi University, Jiamusi
| | - Qiang Bao
- First Ward of Orthopedics Department, Inner Mongolia Xilin Gol League Hospital, Xilinhot, China
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Ren T, Li M, Zheng H, Liu W, Zhang J. Microdialysis combined with RRLC–MS/MS for the pharmacokinetics of two major alkaloids of Bi qi capsule and the potential roles of P-gp and BCRP on their penetration. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1092:72-81. [DOI: 10.1016/j.jchromb.2018.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 01/21/2023]
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[Shaoyangzhugu Formula regulates p19 Arf-p53-p21 Cip1 signaling pathway to ameliorate cartilage degeneration in aged cynomolgus monkeys with knee osteoarthritis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38. [PMID: 29643043 PMCID: PMC6744164 DOI: 10.3969/j.issn.1673-4254.2018.03.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the effect of Shaoyangzhugu (SYZG) Formula (a formula consisting of 9 traditional Chinese drugs) in delaying the degeneration of articular cartilage and the role p19Arf-p53-p21Cip1 signaling pathway in mediating this effect. METHOD Thirteen aged cynomolgus monkeys with degenerative knee joints were selected based on X-ray findings, and one of them was randomly selected for pathological observation. The other monkeys were randomized equally into SYZG Formula group (treated with SYZG decoction), ammonia moxime group and saline group. All the monkeys were sacrificed after 8 weeks of treatment with intragastric administration of the drugs or saline. The pathology in the knee joint articular cartilage was observed and the mRNA and protein expressions of p19Arf, p53, and p21Cip1 in the articular cartilage were detected using RT-qPCR and Western blotting. RESULTS The pathological findings of the articular cartilage in old cynomolgus monkeys were consistent with the characteristics of knee osteoarthritis (KOA). Mankin scores of the cynomolgus monkeys were 7.38∓0.52 in SYZG Formula group, 7.88∓0.83 in ammonia moxime group, and 8.38∓0.74 in saline group, showing a significant difference between SYZG Formula group and saline group (P<0.05). The expressions of p19Arf, p53, and p21Cip1 were the lowest in SYZG Formula group and the highest in saline group with significant differences among the 3 groups (P<0.05). CONCLUSION SYZG Formula can delay chondrocyte senescence by regulating p19Arf-p53-p21Cip1 signaling pathway to delay articular cartilage degeneration in aged cynomolgus monkeys.
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周 鑫, 张 磊, 扶 世, 刘 刚, 郭 晓, 易 刚, 刘 洋, 汪 国. [Shaoyangzhugu Formula regulates p19 Arf-p53-p21 Cip1 signaling pathway to ameliorate cartilage degeneration in aged cynomolgus monkeys with knee osteoarthritis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:346-352. [PMID: 29643043 PMCID: PMC6744164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To study the effect of Shaoyangzhugu (SYZG) Formula (a formula consisting of 9 traditional Chinese drugs) in delaying the degeneration of articular cartilage and the role p19Arf-p53-p21Cip1 signaling pathway in mediating this effect. METHOD Thirteen aged cynomolgus monkeys with degenerative knee joints were selected based on X-ray findings, and one of them was randomly selected for pathological observation. The other monkeys were randomized equally into SYZG Formula group (treated with SYZG decoction), ammonia moxime group and saline group. All the monkeys were sacrificed after 8 weeks of treatment with intragastric administration of the drugs or saline. The pathology in the knee joint articular cartilage was observed and the mRNA and protein expressions of p19Arf, p53, and p21Cip1 in the articular cartilage were detected using RT-qPCR and Western blotting. RESULTS The pathological findings of the articular cartilage in old cynomolgus monkeys were consistent with the characteristics of knee osteoarthritis (KOA). Mankin scores of the cynomolgus monkeys were 7.38∓0.52 in SYZG Formula group, 7.88∓0.83 in ammonia moxime group, and 8.38∓0.74 in saline group, showing a significant difference between SYZG Formula group and saline group (P<0.05). The expressions of p19Arf, p53, and p21Cip1 were the lowest in SYZG Formula group and the highest in saline group with significant differences among the 3 groups (P<0.05). CONCLUSION SYZG Formula can delay chondrocyte senescence by regulating p19Arf-p53-p21Cip1 signaling pathway to delay articular cartilage degeneration in aged cynomolgus monkeys.
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Affiliation(s)
- 鑫 周
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 磊 张
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
- 南方医科大学 中医药学院,广东 广州 510515School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - 世杰 扶
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 刚 刘
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 晓光 郭
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 刚 易
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 洋 刘
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
| | - 国友 汪
- 西南医科大学附属中医医院骨科,四川 泸州 646000Department of Orthopedics, Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University, Luzhou 646000, China
- 泸州市院士工作站,四川 泸州 646000Academician Workstation in Luzhou, Luzhou 646000, China
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Yang M, Jiang L, Wang Q, Chen H, Xu G. Traditional Chinese medicine for knee osteoarthritis: An overview of systematic review. PLoS One 2017; 12:e0189884. [PMID: 29267324 PMCID: PMC5739454 DOI: 10.1371/journal.pone.0189884] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 12/04/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Traditional Chinese medicine (TCM) has been accepted as a complementary therapy for knee osteoarthritis. However, the efficacy and safety of the intervention were still conflicting and uncertain. Meanwhile, the quality of methodology and evidence in the field was unknown. OBJECTIVE To summarize the characteristics and critically evaluate the quality of methodology, as well as the evidence of systematic reviews (SRs) on TCM for knee osteoarthritis. METHODS Five electronic databases were searched from inception to April 2016. The methodological quality of the included studies was assessed by AMSTAR and ROBIS. The quality of the evidence was determined using the GRADE approach. RESULTS Ten SRs were included. The conclusions suggest that TCM provides potential benefits for patients with knee osteoarthritis. These benefits include pain relief, functional improvement, and presence of few adverse events. Limitations of the methodological quality mainly included the lack of a-priori protocol or protocol registration and incomprehensive literature search. A list of excluded studies was also not provided. The overall quality of evidence in the SRs was poor, ranging from "very low" to "low," mainly because of the serious risk of bias of original trials, inconsistencies, and imprecision in the outcomes. CONCLUSIONS TCM generally appears to be effective for knee osteoarthritis treatment. However, the evidence is not robust enough because of the methodological flaws in SRs. Hence, these conclusions on available SRs should be treated with caution for clinical practice.
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Affiliation(s)
- Min Yang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Li Jiang
- Jingjiang College, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qing Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Hao Chen
- The Second Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Martel J, Ko YF, Ojcius DM, Lu CC, Chang CJ, Lin CS, Lai HC, Young JD. Immunomodulatory Properties of Plants and Mushrooms. Trends Pharmacol Sci 2017; 38:967-981. [DOI: 10.1016/j.tips.2017.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 01/11/2023]
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Sobhan MR, Mehdinejad M, Jamaladini MH, Mazaheri M, Zare-Shehneh M, Neamatzadeh H. Association between aspartic acid repeat polymorphism of the asporin gene and risk of knee osteoarthritis: A systematic review and meta-analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:409-415. [PMID: 28889984 PMCID: PMC6197333 DOI: 10.1016/j.aott.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/08/2017] [Accepted: 08/21/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Studies have assessed the association between aspartic acid (D)-repeat polymorphism in the gene encoding Asporin (ASPN) and knee osteoarthritis (KOA) risk, but the results were inconclusive and contradictory. Therefore, we performed a meta-analysis to investigate the association between ASPN gene D-repeat polymorphism and KOA risk. METHODS Eligible studies were identified by searching several electronic databases for relevant reports published before September 2016. The pooled odds ratios (ORs) for the association between ASPN polymorphism and KOA and their corresponding 95% confidence intervals (CIs) were estimated using the random- or fixed-effect model. RESULTS A total of eleven case-control studies in ten publications with 4610 KOA cases and 3621 controls were included for the ASPN D-repeat polymorphism. Overall, no significant association was detected for D14 allele carrier (D14 vs. D13: OR = 1.10, 95% CI = 0.90-1.36, p = 0.32). Meta-analysis of D14 vs. other alleles and D13 vs. other alleles showed the same pattern of KOA association as the D14 vs. D13 (OR = 1.30, 95% CI = 1.00-1.70, p = 0.06; OR = 0.93, 95% CI = 0.82-1.06, p = 0.33, respectively). Also, in the stratified analysis by ethnicity, no significant association of this polymorphism with risk of KOA was found in the European and Asians populations (OR = 1.05, 95% CI = 0.91-1.21, p = 0.49; OR = 0.98, 95% CI = 0.78-1.23, p = 0.88, respectively). CONCLUSIONS The present meta-analysis suggests that the ASPN D-repeat polymorphism is not associated with an increased KOA risk. However, future large studies with gene-gene and gene-environment interactions are needed to validate these findings. LEVEL OF EVIDENCE Level III diagnostic study.
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Affiliation(s)
- Mohammad Reza Sobhan
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mehdinejad
- Department of Orthopedics, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | | | - Mahta Mazaheri
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Zare-Shehneh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Neamatzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Chen N, Wang J, Mucelli A, Zhang X, Wang C. Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2017; 45:965-985. [DOI: 10.1142/s0192415x17500513] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Knee osteoarthritis (KOA) is a common chronic degenerative disease of the elderly. Electro-acupuncture (EA) is considered as a beneficial treatment for KOA, but the conclusion is controversial. This systematic review compiled the evidence from 11 randomized controlled trials to objectively assess the effectiveness and safety of EA for KOA. Eight databases including PubMed, Cochrane Library, Clinic trials, Foreign Medical Literature Retrial Service (FMRS), Science Direct, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang Data were extensively searched up to 5 July 2016. The outcomes included the evaluation of effectiveness, pain and physical function. Risk of bias was evaluated according to the Cochrane risk of bias tool. Eleven RCTs with 695 participants were included. Meta-analysis indicated that EA was more effective than pharmacological treatment (RR [Formula: see text] 1.14; 95% CI [Formula: see text] 1.01,1.28; [Formula: see text]) and manual acupuncture (RR [Formula: see text] 1.12; 95% CI [Formula: see text] 1.02,1.22; [Formula: see text]). Also, EA had a more significant effect in reducing the pain intensity (SMD [Formula: see text]; 95% CI [Formula: see text]; [Formula: see text]) and improving the physical function in the perspective of WOMAC (MD [Formula: see text]; 95% CI [Formula: see text], 5.56; [Formula: see text]) and LKSS (pharmacological treatment: MD [Formula: see text]; 95% CI [Formula: see text], 6.64; [Formula: see text]). Furthermore, these studies implied that EA should be performed for at least 4 weeks. Conclusively, the results indicate that EA is a great opportunity to remarkably alleviate the pain and improve the physical function of KOA patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of EA for KOA.
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Affiliation(s)
- Na Chen
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
| | - Jing Wang
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
| | - Attilio Mucelli
- School of Economics “Giorgio Fuà”, Polytechnic University of Marche, Ancona 60121, Italy
| | - Xu Zhang
- Jiangsu Collaborative Innovation Center of Traditional, Chinese Medicine Prevention and Treatment of Tumor, Nanjing 210023, P. R. China
| | - Changqing Wang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China
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Chemometrics-enhanced one-dimensional/comprehensive two-dimensional gas chromatographic analysis for bioactive terpenoids and phthalides in Chaihu Shugan San essential oils. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1052:158-168. [DOI: 10.1016/j.jchromb.2017.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/25/2017] [Accepted: 03/24/2017] [Indexed: 01/09/2023]
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