Elderly

Sara Izadi-Najafabadi et al. (2025) · Integrative cancer therapies

This retrospective study compared 67 people with grade IV glioblastoma (GBM), a fast-growing brain cancer, who received integrative naturopathic care at a Canadian clinic with 243 matched patients from the U.S. SEER cancer registry. The clinic's approach added modulated electro-hyperthermia (mEHT), a radiofrequency treatment that heats tumour tissue, plus high-dose intravenous vitamin C, supplements, acupuncture and diet counselling, on top of standard surgery, radiotherapy and temozolomide chemotherapy. Standard care for GBM extends median survival only to about 14.6 months, so the authors looked for any signal that the extra treatments might add survival time. Patients had at least six mEHT sessions between 2010 and 2024, with a median of 13 sessions of up to 60 minutes each at powers rising from 50 to 140 watts. Controls were matched on age, sex, diagnosis year and whether they had surgery, radiation and chemotherapy. To avoid giving the clinic group credit for the months before they arrived, survival was counted from the start of clinic treatment (or the matched patient's start date for controls) and compared with Kaplan-Meier curves and Cox regression. Median survival from that starting point was 15 months with integrative care versus 11 months in controls, and the hazard ratio of 0.72 (95% CI 0.53-1.00, p = 0.05) sat right at the edge of statistical significance (a 28% lower hazard of death). The difference was concentrated in people who started within 120 days of diagnosis (hazard ratio 0.52, p = 0.006, roughly half the hazard of death) and in those under 50 (0.51, p = 0.009); starting later or being 50 or older showed no difference (0.98 and 0.96). Treatment began a median of 124 days after diagnosis, so these patients had already survived that long. The authors saw no seizures or other side effects. Those subgroup analyses were exploratory, unadjusted for multiple testing, and the matched groups still differed in how many had chemotherapy and radiotherapy. Because treatment was not randomised and many factors that shape GBM survival, such as tumour genetics, extent of surgery and general fitness, were unavailable, the results cannot show that the integrative care caused the longer survival. Clinic patients also paid for their own care, which may favour those with more resources, and the dose and timing of mEHT varied between individuals. The authors describe the findings as hypothesis-generating, a signal rather than an effect estimate, and call for randomised trials.

Sandra Utz et al. (2025) · Biomedicines

This prospective observational study followed 101 adults with long-standing fibromyalgia syndrome (FMS) through a two-week integrative inpatient stay in Bamberg, Germany, with no control group. FMS is a chronic condition marked by widespread pain, fatigue, sleep problems, anxiety and depression, and the authors describe it as the third most common rheumatic disease. The program was built on classical European naturopathy: water-based therapies and heat, exercise, plant-based nutrition or medical fasting, herbal remedies and mind-body practices such as relaxation. The question was whether such a combined approach would ease symptoms at discharge and six months later. Of 134 patients who joined (127 women, ages 22 to 80), 101 returned questionnaires on admission, at discharge and after six months. During the stay they took part in meditative movement, physical therapy, hydrotherapy, lectures and cooking classes, and some had whole-body heat sessions or a 5-day fast on under 300 kcal a day. Pain, fatigue, anxiety, depression, stress and quality of life were measured with standard questionnaires (such as the HADS for anxiety and depression and the MFI-20 for fatigue) and compared over time with repeated-measures statistics. Overall pain intensity dropped from 71.5 to 63.0 on a 0-100 scale at discharge (a moderate effect, dz = 0.62) and was still lower at six months (64.4). Current pain fell sharply during the stay (6.56 to 4.37 out of 10) but crept back to 5.96 at six months. Fatigue improved from 71.1 to 63.3 and then partly returned (68.0). Anxiety and depression scores each fell by roughly 2.5 points at discharge and were still lower than baseline at six months. Stress and feelings of helplessness improved mainly after discharge, and mental quality of life rose between discharge and follow-up. Patients who fasted kept their pain gains at six months (p = 0.006), whereas non-fasters did not (p = 0.062), although this difference was borderline (interaction p = 0.050) and not randomised. The results come from an uncontrolled, single-centre sample in which a quarter of the participants did not complete the six-month questionnaire, so the changes cannot be attributed to the program alone. More than half the patients reported obstacles to continuing the methods at home, such as lack of time and exhaustion. The authors call for randomised trials with long-term follow-up and propose a follow-up day-clinic programme to help consolidate the learned self-management skills and everyday routines.

Philipp Klemm et al. (2026) · European journal of physical and rehabilitation medicine

This randomized, double-blind, sham-controlled trial of 38 analyzed adults in Bad Nauheim, Germany, explored whether mineral water baths for the hands ease pain from hand osteoarthritis (HOA). HOA is wear-and-tear damage in the finger and thumb joints that causes pain, stiffness and reduced grip. Balneotherapy, the treatment of conditions with natural mineral waters, is well known for knee osteoarthritis, but evidence for hand osteoarthritis was thin. The tested water was natural thermal brine, a salty spring water (sodium chloride and hydrogen carbonate, rich in carbon dioxide), used at its natural 25 degrees C. Participants averaged 72 years, 86% were women, and all had painful, X-ray-confirmed HOA. One group soaked both hands in thermal brine and the other in ordinary tap water at the same temperature, in identical covered bowls so neither participants nor staff knew which was which. Each bath lasted 15 minutes, with six baths over three weeks. Pain was rated on a 100 mm visual analog scale (VAS, 0 meaning no pain), alongside hand function questionnaires, grip strength, skin blood flow and a blood marker (VEGF). After six baths, pain averaged 7 mm with thermal brine versus 33 mm with tap water, a 26.4 mm gap (P < 0.0001) larger than the 20 mm threshold for a clinically meaningful change. The gap was already present after the first bath (5.3 mm, P = 0.0017) and was still about 26 to 27 mm at 4 and 12 weeks. Pain on the hand index (AUSCAN pain subscore) was also lower (5.86 points, P < 0.0001), though that difference was gone at follow-up. Stiffness, function, grip strength, skin blood flow and VEGF did not differ between groups. Satisfaction favored thermal brine: 72% (13 of 18) rated pain relief good or very good versus 32% (6 of 19) with tap water. No adverse events occurred. The trial was small, ran at one center during the COVID-19 pandemic, and lost 12 of 50 participants, so only 38 were analyzed. Tap water may also have effects of its own. Because blood flow and VEGF showed no change, how the baths relieve pain remains unexplained; the authors note that 25 degrees C is below the 32 to 35 degrees C range where carbon dioxide baths are expected to widen blood vessels. They propose thermal brine baths as a non-pharmacological adjunct and call for larger multicenter trials with longer treatment and optimized temperatures.

Vahid Reisi-Vanani et al. (2025) · The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale

This double-blind, randomized trial of 66 hospitalized COVID-19 pneumonia patients in Shahrekord, Iran, tested whether pomegranate tea added to standard hospital care improves recovery. Pomegranate (Punica granatum) is rich in plant polyphenols such as punicalagin and anthocyanins, compounds that antioxidant and antiviral lab studies suggest could dampen inflammation and block the virus's spike protein from binding to its human receptor, ACE2. Lab results do not always carry over to patients, so the researchers tested the idea in a placebo-controlled clinical trial. Patients aged 18 or older with a positive SARS-CoV-2 test, low blood oxygen (SpO2 of 93% or less) and pneumonia on imaging were randomly assigned, balanced by how much oxygen support they needed. Half received a freeze-dried pomegranate fruit extract syrup (110 mg per 10 cc), dissolved in warm water as a tea, four times a day; the rest received a matching coloured placebo syrup. Treatment continued through the hospital stay and after discharge until symptoms eased. The team tracked recovery, hospital days, deterioration, death, symptom severity on a four-point scale, blood tests and side effects. The results were flat. By day 14, 84.8% of the tea group and 83.3% of the placebo group had improved (p = 1.0, meaning no difference). Median time to improvement was 6 versus 5 days (p = 0.83), and hospital stay 6 versus 5 days (p = 0.87). Deterioration occurred in 18.2% versus 20.0% (p = 1.0). Death at 28 days was 18.2% versus 6.7%, a gap that was not statistically significant (p = 0.26) in groups this small. Cough, fever, fatigue, breathlessness and other symptom scores did not differ, and day-14 blood markers such as CRP, ferritin and ESR were similar between groups. Some serious events such as ARDS (15.2% versus 3.3%) and liver dysfunction (15.2% versus 6.7%) were numerically more common with pomegranate but not significantly different, and no allergic reactions were reported. The authors conclude that pomegranate tea did not help in COVID-19. The small trial had unevenly matched groups at baseline, including time since symptom onset, and used an extract that was not chemically standardized. They recommend standardized extracts and adaptive trial designs, noting that laboratory activity does not guarantee clinical benefit. Nearly all patients in both groups also received antivirals (93.9% and 93.3%), and only 63 completed follow-up, so larger trials would be needed to detect modest effects or rare harms.

Valérie Dormal et al. (2025) · Nutrients

This randomized, double-blind, placebo-controlled trial with 180 adults in Belgium asked whether two plant extracts, saffron and Chinese skullcap (Scutellaria baicalensis), help people with mild-to-moderate depressive symptoms, alone or together. Saffron's compounds crocin and safranal are thought to keep the brain chemicals norepinephrine, dopamine and serotonin active for longer, a mechanism similar to common antidepressants. Skullcap's flavonoids, mainly baicalin, had shown calming and mood-lifting effects in animal studies, but had never been tested for mood in people. The researchers also wanted to see whether combining the two gave extra benefit. Participants aged 18 to 75, all with a recent depressive episode and Beck Depression Inventory (BDI) scores of 14 to 28, were split into four groups of 42 to 48. For six weeks each person took one capsule every morning: 30 mg saffron extract, 20 mg skullcap extract, both together, or a placebo of 450 mg maltodextrin. Depression was scored with the BDI and the clinician-rated Hamilton scale, anxiety with the STAI-S, and mood and well-being with PANAS, WHO-5 and other short questionnaires at weeks 0, 3, 6 and 8. Everyone improved, including the placebo group: BDI fell significantly in all four groups (p < 0.001), with no difference between them. Differences appeared only in the second half of treatment. Between week 3 and week 6, depression scores kept dropping in the saffron group (-2.4 points, p = 0.036) and combination group (-3.5 points, p = 0.004) but not placebo, and the Hamilton score fell more with saffron than placebo (p = 0.024). Anxiety fell in all three active groups, and well-being (WHO-5) rose more with skullcap and the combination than placebo. Compliance was about 99% in every group, and two weeks after stopping, scores had mostly held steady. The authors attribute the large placebo gains partly to participants being engaged in a study that encouraged them to talk about their problems and act to improve their well-being. Side effects were mostly minor, such as headaches and gastrointestinal complaints. The authors suggest saffron, skullcap and their combination may help mood, and propose a synergistic effect. The strong placebo response, scarce between-group differences, six-week duration, self-report measures and exclusion of severe depression limit how far the results reach. An author works for an ingredient supplier, and whether the findings extend beyond French-speaking adults at one Belgian center is not established. Longer trials, higher doses, severe depression and objective biomarkers such as stress hormones or neurotransmitter levels are recommended for future work, since long-term safety remains unestablished.

Shujie Wang et al. (2022) · Gut microbes

This randomized trial with 365 adults who had newly diagnosed type 2 diabetes explored whether combining berberine, a plant compound extracted from the Chinese herb Coptis chinensis (Huanglian), with a probiotic mix lowers postprandial lipidemia, the rise in blood fats and cholesterol after a meal. The authors note that cholesterol measured after eating is also an important heart-disease risk marker, that after-meal blood fats are common in diabetes, and that very few treatments target them. Berberine was already known to lower fasting cholesterol, but whether it helps after meals was unknown. Probiotics are live bacteria, and the nine-strain mix here included Bifidobacterium breve. This analysis came from a 12-week, double-blind, placebo-controlled trial at 20 centers in China, with 365 participants split into four groups: placebo (91), probiotics alone (92), berberine alone (84), and both (98). Participants were drug-naive adults aged 20 to 70, averaging about 52. They took berberine pills twice daily before meals, and probiotic powder once daily at bedtime. After a standard 100 g carbohydrate meal, blood drawn 120 minutes later measured cholesterol and triglycerides, and stool samples tracked gut bacteria. Only the combination significantly cut after-meal total cholesterol (24.29 mg/dL drop versus 8.66 with placebo, adjusted P = .001, a gap that chance is very unlikely to explain) and after-meal LDL cholesterol (16.54 versus 7.35 mg/dL, P = .043). Berberine alone and probiotics alone did not differ significantly from placebo for these two measures. After-meal triglycerides fell with berberine alone (P = .037) and the combination (P = .035) equally, so probiotics added nothing there, and HDL (good) cholesterol did not differ between groups. Thirty-one blood lipid molecules changed only with the combination, versus eight with berberine and two with probiotics. In stool, B. breve rose with the combination, and higher levels went with lower after-meal cholesterol. In lab dishes, berberine slowed B. breve growth but switched on its fatty-acid-uptake genes (called fadD). Adverse events were not reported in this paper. The authors conclude that berberine plus probiotics acts synergistically on after-meal blood fats, with the probiotic replacing Bifidobacteria that berberine suppresses and berberine activating the bacteria's fat-handling genes. They state the limits plainly: only 13 weeks and no heart-attack or stroke outcomes, testing only after a carbohydrate meal, and unknown applicability to people already on statins. The authors propose that probiotics containing Bifidobacterium may be needed when berberine is used as a lipid-lowering agent. They suggest studying fatty meals and other gut-related pathways in future work.

Ying Cao et al. (2025) · QJM : monthly journal of the Association of Physicians

This randomized trial with 84 emergency department patients explored whether acupuncture started right away, before a diagnosis is confirmed, eases the pain of suspected renal colic, the sudden, severe cramping pain in the back or abdomen that usually comes from a kidney or urinary stone. Imaging to confirm a stone takes time while patients are in extreme pain, and the authors note that the usual painkillers have drawbacks: anti-inflammatory drugs can raise heart risk with higher doses and longer use, and opioids cause side effects including nausea, drowsiness and dependence concerns. Acupuncture, a traditional Chinese medicine technique that places thin needles at specific body points, had already been reported by this group to reduce pain in confirmed cases. Adults aged 18 to 80 with one-sided colicky pain and tenderness over the kidney area, and pain of at least 4 on a 0 to 10 scale, were treated at a Beijing hospital emergency department. Half received needles in the back of both hands at Yaotongdian, a point the authors use for lumbar pain, with the needles lifted and rotated until a soreness or heaviness sensation appeared and then left in for 30 minutes. The other half had very shallow needling with tiny short needles at spots that are not acupuncture points, with no manipulation. Ten minutes after needling, 64.3% of the acupuncture group (27 of 42) had at least halved their pain, versus 16.7% of the sham group (7 of 42), a 47.6 percentage point gap (P < 0.01, so chance is very unlikely to explain it). By 30 minutes the figures were 85.7% versus 31.0%. Average pain scores at 10 minutes were 3.38 versus 6.00. Fewer acupuncture patients needed an analgesic injection by 30 minutes (33.3% vs 59.5%; P = 0.03) and satisfaction scores were higher (4.69 vs 3.69). Patients, outcome assessors and statisticians did not know the group, and patients guessed their group at similar rates, so the blinding held. Surgery and return visits did not differ between groups, and each group had one adverse event (bleeding with acupuncture; nausea and vomiting with sham). The authors suggest that early acupuncture is a safe option for pain relief while a diagnosis is awaited and that it did not appear to interfere with later care. The authors also note that a single acupuncture point may give limited improvement in critically ill patients. They state plainly that the study was done at one center with experienced acupuncturists, included only 3 acupuncture-group patients who turned out not to have a urinary stone, and did not analyze results by stone size. They call for multicenter confirmation.

Jian-Feng Tu et al. (2022) · JAMA network open

This randomized trial with 80 emergency department patients explored whether adding acupuncture to a standard painkiller injection brings faster relief from renal colic, the severe cramping flank pain that occurs when a kidney stone blocks or moves through the urinary tract. Renal colic is described by the authors as one of the worst types of pain, and the guideline first-choice drugs, nonsteroidal anti-inflammatory medicines such as diclofenac, take time to work: in an earlier study, 37.5% of patients still had moderate or severe pain 15 minutes after an injection. Acupuncture, a traditional Chinese medicine technique that inserts thin needles at specific body points, had shown quick pain reduction in other settings. Adults aged 18 to 75 with stone-related renal colic and pain of at least 4 out of 10 on a visual analog scale (a line on which patients mark their pain) were treated at a Beijing hospital emergency department in 2020. Everyone received a 50 mg diclofenac injection into the muscle. Half then had 30 minutes of needling at Yaotongdian, a point on the back of each hand, with the needles twisted and lifted until a soreness or heaviness sensation (called De qi) appeared. The other half had shallow needle pricks at forearm spots that are not acupuncture points. Ten minutes after needling, 77.5% of the acupuncture group (31 of 40) had at least halved their pain score, compared with 10.0% of the sham group (4 of 40), a gap of 67.5 percentage points (P < .001, so chance is very unlikely to explain it). Average pain fell to 3.0 versus 5.9 out of 10. Acupuncture also led at 0, 5, 15, 20 and 30 minutes (97.5% vs 80.0% at 30 minutes; P = .03). Patients, assessors and the statistician did not know the group, and patients guessed their group about equally often in both arms (P = .48). The advantage faded as the injection took effect: by 45 and 60 minutes both groups had about 92% to 98% responding (P = .62), and only 1 patient needed stronger rescue medication. No adverse events were recorded. The authors suggest acupuncture may serve as an optional add-on for faster relief, since it uses a single point and needs no individual diagnosis. They attribute the absence of a rescue-medication difference to a possible ceiling effect from the diclofenac. They note limitations plainly: one hospital, treatment given after diagnostic imaging, experienced acupuncturists who could not be blinded, and no follow-up of pain beyond 60 minutes or analysis by stone size. They plan to study acupuncture before imaging.

Rita Chiaramonte et al. (2026) · The Journal of manual & manipulative therapy

This systematic review of 18 randomized controlled trials explored whether hands-on treatment eases pain and improves jaw movement in adults with temporomandibular disorders (TMD). TMD is a group of conditions affecting the jaw joint, the chewing muscles and nearby tissues, and it is estimated to affect about 31% of adults. Its subtypes include muscle pain (myalgia), disc displacement (the cushioning disc slips out of position, sometimes locking the jaw) and joint pain. Manual therapy covers thrust manipulation, soft-tissue release, massage and intra-oral techniques, delivered by physiotherapists, chiropractors, osteopaths, dentists and physicians. The review asked which techniques help most and whether results differ by profession. Researchers searched four databases through March 2025 and screened 561 records, keeping 18 trials of adults with a clinical TMD diagnosis. Trials compared manual therapy with sham treatment, no treatment, splints, medication, exercise or education. Pain was rated on the visual analogue or numeric rating scale (0 to 10), and maximum mouth opening was measured in millimetres. Risk of bias was checked with the Cochrane tool and certainty with GRADE. Because the trials differed so widely in technique, dose, comparator and follow-up, results were summarized in words rather than pooled statistically. Most trials reported short-term pain reduction and wider mouth opening, but certainty was low to moderate for pain and low for mouth opening. High-velocity low-amplitude (HVLA) thrusts made up 56% of interventions and fascial manipulation with myofascial release made up 37.5%. Dry needling plus upper neck HVLA beat splint therapy, diclofenac and joint mobilization at three months (p < 0.001), and intra-oral therapy kept benefits for one year in chronic jaw-muscle pain. Upper thoracic HVLA showed no significant effect (p > 0.05), and jog manipulation gained only 6.86 mm of mouth opening at first visit with no later group difference. Massage and fascial manipulation by physiotherapists were linked to relief of jaw-muscle symptoms, while chiropractic, osteopathic and dental trials also reported gains. Physiotherapy trials were the most numerous, which the authors attribute to publication volume rather than superior effectiveness. The authors describe manual therapy as associated with short-term benefit and treat professional comparisons as descriptive, since profession was tangled with setting, technique and country. Limitations include small samples, short follow-up, mixed diagnoses, English-only searching and no meta-analysis. Safety findings were not reported in pooled form, and the evidence mostly covers weeks to months rather than years. The authors call for larger trials with longer follow-up and standardized protocols, and they state that manual therapy is best delivered by trained, licensed professionals.

Zheping Quan et al. (2026) · Frontiers in immunology

This systematic review and network meta-analysis of 16 randomized controlled trials (943 participants) explored which forms of exercise are linked to better outcomes in irritable bowel syndrome (IBS). IBS is a functional gut disorder, meaning the bowel looks normal on testing but causes recurring abdominal pain and altered bowel habits, and it often occurs alongside anxiety and depression. The authors framed the gut and brain as communicating through the brain-gut axis, with the immune system, intestinal barrier and gut microbiota also involved. A network meta-analysis is a statistical method that compares several treatments at once, even when some were never tested head to head, and ranks them using SUCRA, a percentage score where higher values mean a greater chance of being best. The included trials, published between 2004 and 2025, tested yoga, Pilates, Baduanjin (a traditional Chinese gentle movement routine), running and moderate-intensity aerobic exercise for 4 to 24 weeks. Participants were adults with constipation-predominant, diarrhea-predominant or mixed IBS, mostly in Asia, Europe and North America. Comparison groups received conventional treatment, dietary advice, probiotics or education. Researchers measured symptom severity with the IBS Symptom Severity Scale, quality of life with the IBS Quality of Life scale, and mood with anxiety and depression scores. Exercise improved several outcomes. Depression scores fell overall (SMD -0.56, a moderate-sized benefit), though heterogeneity was very high (I2 = 95%, meaning results varied widely between trials), and yoga alone was not significant. Anxiety dropped with yoga (SMD -1.82), Pilates (SMD -3.84) and aerobic exercise (SMD -6.31). Symptom severity improved with running (MD -72.68 points), Pilates (-71.32), aerobic exercise (-46.50) and Baduanjin (-16.94), with running ranked first (SUCRA 90.3%). Quality of life ranked Baduanjin first (99.9%) and yoga second (80.1%), while aerobic exercise showed no significant difference from conventional treatment. In subscale analyses, Pilates cut pain severity (MD -17.90) and aerobic exercise improved dysphoria, activity interference, body image, health worries and relationships, while yoga helped only bowel satisfaction and interference with life. Rankings differed by outcome, which the authors describe as functional specificity. The authors describe exercise as a safe, low-cost non-pharmacological option that may hold value in comprehensive IBS management, but the evidence carries clear limits. Heterogeneity was high, many trials did not clearly blind participants or assessors, and some effect sizes were unusually large, which the authors attribute to small samples. Study counts were reported inconsistently across sections, and safety was not analysed. Too few trials came from outside East Asia to judge differences across ethnic groups. The immune mechanisms remain unproven, and the authors call for trials that add immune markers, biomarkers and gut microbiome measures.

Massimo Chiaretti et al. (2020) · Scientific reports

This randomized clinical trial with 199 adults at an Italian university proctology clinic compared two plant-based venotonic products, called phlebotonics, with routine care for hemorrhoidal disease (swollen anal cushions that cause bleeding, itching or irritation, and pain) and for recovery after hemorrhoid surgery. One product was a flavonoid preparation containing rutin, borage, horse chestnut and witch hazel. The other was a Centella asiatica (gotu kola) preparation containing triterpenic acids, asiaticoside, arnica and aloe. Flavonoids are plant antioxidants reported to improve venous tone and reduce inflammation, while Centella is reported to stimulate collagen and repair connective tissue. Participants aged 18 to 85 were randomized to three groups. Group A (73 people) took 300 mg flavonoid tablets twice daily for 15 days and applied a 3 g ointment inside the anus once daily. Group B (66 people) took 60 mg Centella tablets twice daily for 15 days and used a 3 g Centella-based ointment. Group C (60 people) received routine care only. Everyone followed a water- and vegetable-rich diet and used a medicated soap for 42 days. Time until bleeding stopped was tracked, and irritation or pain was rated on a visual analogue scale. Among 130 people with hemorrhoidal disease, bleeding stopped after a median of 2 weeks with flavonoids and 3 weeks with Centella or routine care (flavonoids versus routine care p < 0.001, meaning a clear difference; Centella versus routine care p = 0.152, meaning no significant difference). Irritation scores were lower than routine care for both products (flavonoids p = 0.007; Centella p = 0.041), and the two products did not differ (p = 0.782). After hemorrhoidectomy (31 people), bleeding time did not differ significantly between groups, and pain differed only for flavonoids versus routine care (p = 0.045). In 34 people with thrombosed hemorrhoids, pain fell faster with either product (all p < 0.001). Tissue examination linked flavonoids to fibrosis, a fibrous tissue change in the excised piles (p = 0.008). No adverse reactions were reported except burning from the Centella ointment in one person, which led to suspension of that ointment. The authors interpret the results as favouring flavonoids for bleeding and irritation, with Centella comparable on irritation. Limitations are stated plainly: a single centre, only 42 days of follow-up, small surgical and thrombosis subgroups added after the original protocol, no described blinding of participants, and multi-ingredient products that prevent attributing effects to individual plants. A medicated soap containing Centella was also given to every group. The authors suggest longer trials to test whether the benefits last.

José de Oliveira Vilar Neto et al. (2025) · Nutrients

This systematic review of 10 clinical studies (483 men in total) examined whether Tribulus terrestris supplements improve erectile dysfunction (ED, difficulty achieving or keeping an erection) and testosterone levels. Tribulus is a plant used for centuries in India and China as a sexual stimulant. Its steroidal saponins (plant compounds with hormone-like structure) are proposed to raise testosterone and to boost nitric oxide, a molecule that relaxes blood vessels and supports erections, though the authors note the mechanism is not fully understood. The review asked whether the evidence supports either claim, and it looked at men with and without low testosterone. Researchers searched 13 databases for studies in which men took Tribulus on its own, without other supplements or drugs. Ten studies qualified: nine clinical trials and one study without a control group, conducted in Egypt, Bulgaria, Brazil, Australia, India, China and Spain. Participants were aged 16 to 70: healthy men, men with ED (some also with low testosterone), and men with low sperm counts or unexplained infertility. Doses ran from 400 mg to 12 g per day for 4 weeks to 3 months. Study quality was graded with the Jadad scale, a 5-point checklist of randomization, blinding and dropouts. Three of the five studies that measured erectile function found improvement, and all three enrolled men with ED. One trial using 500 mg daily for 3 months raised International Index of Erectile Function (IIEF-5) scores against placebo, with significance already at 4 weeks (p = 0.0119) and stronger by the end (p < 0.0001). Eight of ten studies found no significant testosterone change, and those men did not have low testosterone at the start. Two studies in men with low testosterone found rises of about 58 to 71 ng/dL (27 to 33%), a small increase in clinical terms (roughly from 215 to 273 and 213 to 284 ng/dL), and both scored poorly for methodological quality (Jadad 2 and 0). None of the studies reported side effects, and lipid and liver tests showed no impairment. The authors conclude that evidence for improved erectile function at 400 to 750 mg per day is of low level and that no solid evidence shows Tribulus raises testosterone. Half of the studies had a high risk of bias, samples were small, saponin content varied between products, and no meta-analysis was possible. The authors state that Tribulus is not a substitute for first-line treatment of severe ED and call for well-controlled randomized trials to define dose and duration, including trials in men with low testosterone.

Xinrong Chen et al. (2024) · BMC medicine

This systematic review and network meta-analysis explored which kinds of breathing support, given while people with chronic obstructive pulmonary disease (COPD) do supervised exercise training, help most. COPD is a long-term lung disease that limits airflow and makes exercise uncomfortable, so many patients struggle to exercise hard enough to benefit from pulmonary rehabilitation. The authors compared six approaches: conventional oxygen through a nasal tube or mask, high-flow nasal cannula (HFNC, which delivers warmed, humidified air at high flow), noninvasive positive pressure ventilation (NPPV, a mask that pushes air in to ease breathing effort), nighttime NPPV, heliox (a helium-oxygen mix), and plain air. The protocol was registered with PROSPERO. The team searched five databases through December 2023 and included 35 randomized trials with 1321 patients from 19 countries. All had stable, severe COPD (GOLD stage III or IV), with average ages from 59 to 76 and mostly men. Programs ran 6 to 12 weeks, with two to three sessions weekly of 30 to 45 minutes. A network meta-analysis lets treatments be ranked even when they were not directly compared. Outcomes included the 6-minute walk test (distance covered in 6 minutes), peak work rate, endurance time, breathlessness on the Borg scale, oxygen uptake, and quality of life. NPPV performed best. Compared with plain air, NPPV improved walk distance (SMD 0.36, where SMD is a standardized effect size), peak work rate (0.69) and peak oxygen uptake (0.75), and it was the only option to do so on those measures. Versus oxygen, NPPV also improved walk distance (0.44) and peak work rate (0.56). It also lowered blood lactate and improved tidal volume and minute ventilation. For endurance time, both NPPV (0.38) and oxygen (0.31) beat air, and HFNC ranked highest. Breathlessness dropped more with NPPV (-0.47), HFNC (-0.46) and oxygen (-0.36) than with air. No therapy changed quality of life significantly, heliox showed no benefit, and nighttime NPPV did not reach significance. The evidence quality ranged from critically low to moderate. The authors suggest that NPPV is the most promising option for stable severe COPD during pulmonary rehabilitation exercise, while noting that results apply only to GOLD stage III or IV disease. They state limitations including small, varied trials, few direct comparisons, high risk of bias in many studies, and unclear best device settings. They call for larger trials that also examine safety, feasibility, cost and personalization. The authors add that the analysis used change from baseline to limit differences between groups, and that the lack of direct comparisons between some therapies weakens confidence in the rankings.

Gregory E Hicks et al. (2024) · The Lancet. Rheumatology

This clinical trial focused on a specific, higher-risk group of older adults with chronic low back pain (LBP): those who also have hip pain and weak hip muscles, a combination the researchers had previously linked to worse pain and disability outcomes over time. Older adults are usually left out of low-back-pain research entirely, so there has been little evidence to guide their care. This trial, called MASH, asked whether physical therapy specifically targeting the hips would work better for this subgroup than standard physical therapy focused on the spine. 184 adults aged 60 to 85 (average age 70) with this hip-and-back pattern were randomly assigned to one of two physical therapy programs, delivered twice a week for eight weeks by trained therapists at three US research sites. One group received hands-on therapy and stretching for the hips plus hip-strengthening and core exercises (hip-focused); the other received hands-on therapy for the lower back plus some of the same core exercises and gentle stationary cycling (spine-focused). Both groups also did home exercises. The two main measures tracked were self-reported back-pain disability (using a standard 0-100 scale) and walking speed, checked at 8 weeks (the main comparison point) and again at 6 months. At 8 weeks, people who got the hip-focused therapy reported meaningfully less disability than those who got spine-focused therapy, though this difference faded by 6 months - not because the hip-focused group got worse, but because the spine-focused group kept catching up. Walking speed improved similarly in both groups the whole time. However, several other measures did favor hip-focused therapy throughout the study: people in that group walked farther in a 6-minute walk test, stood up from a chair more times in 30 seconds by 6 months, and reported less pain and better physical function, mood, and quality of life at 8 weeks. Both treatments were about equally safe, with mostly mild, expected muscle soreness; a small number of more serious health events occurred in each group, but none were linked to the therapy itself. The researchers see this as encouraging evidence that matching physical therapy to a person's specific pattern of hip and back impairments, rather than giving everyone the same generic back-focused program, can produce faster improvement, especially in physical performance. Both approaches were active, hands-on treatments (there was no do-nothing comparison group), participants obviously knew which type of therapy they were receiving, and the 16-session program is a substantial time commitment, so the researchers say more work is needed on cost and on whether a shorter or more flexible version could achieve similar results before this approach could be widely recommended.

Sudesh Prabhakar et al. (2020) · Annals of Indian Academy of Neurology

This trial put Bacopa monnieri (Brahmi), a traditional Ayurvedic memory herb, head-to-head against donepezil, the standard prescription drug for Alzheimer's disease, in people already diagnosed with Alzheimer's or the earlier-stage memory decline called mild cognitive impairment. The goal was to see whether a natural alternative could match the drug doctors currently rely on, since no treatment yet slows the underlying disease. The trial planned to enroll 48 adults over age 50 with brain-imaging-confirmed diagnoses, giving half 300 mg of Bacopa daily and half 10 mg of donepezil daily for a full year, then comparing memory and thinking-skills tests (governing recall, word-finding, and daily-living ability) at regular checkpoints. Because recruitment was slower than expected, the study ran for nearly four years but still only enrolled 34 of the planned 48 participants before it had to close early. On the main measure of cognitive decline (ADAS-Cog, a standard Alzheimer's test), Bacopa and donepezil performed statistically the same at every checkpoint through one year. A second memory test (the PGI Memory Scale) also showed no difference at 3, 6, or 9 months, though the total score did differ significantly between groups at the final 12-month assessment, favoring donepezil, while the individual parts of that same test showed no difference. Because the trial closed early with roughly a third fewer participants than planned, its ability to detect a real difference between the two treatments was limited, and the one late significant result should be read cautiously alongside the many outcomes that showed no difference. The findings suggest Bacopa performs comparably to donepezil on most measures over one year, but the authors themselves call for larger, multi-site trials before drawing firmer conclusions about how the two options truly compare.

Michael Frass et al. (2026) · Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

This three-arm, double-blind, placebo-controlled trial (98 randomized patients plus 52 observed controls) examined whether add-on homeopathy — an individualized complementary treatment using highly diluted plant-, mineral-, or animal-derived preparations chosen for each patient's overall symptom picture — could improve quality of life and survival in people with advanced non-small cell lung cancer (NSCLC, the most common form of lung cancer) already receiving standard chemotherapy. An earlier report of this exact same trial dataset was published in The Oncologist in 2020 and was retracted by that journal in November 2025 after two corrections, a decision most of the trial's own co-authors disagreed with; this article is an independently re-analyzed, more conservative account of the same underlying data. Ninety-eight adults (mean age 63, most with stage IV NSCLC) at four Austrian hospitals were randomly assigned, double-blind, to individualized homeopathic remedies or an identical-looking placebo alongside their usual chemotherapy, while a further 52 patients who declined randomization were tracked as an untreated comparison group. Quality of life was measured with the EORTC QLQ-C30 cancer questionnaire, the SF-36 health survey, and a visual-analogue well-being scale at the start of treatment and again at 9 and 18 weeks, while survival was followed for up to two years. Patients receiving homeopathy reported markedly better global health status than the placebo group at both 9 and 18 weeks (p<0.001, a difference well above the 10-point size doctors consider clinically meaningful), and nearly every functioning and symptom score — physical, emotional, and social functioning, fatigue, pain, and appetite among them — favored homeopathy by 18 weeks; results from the SF-36 health survey and the well-being scale pointed the same direction. Survival differed too: median survival was 435 days with homeopathy versus 257 days with placebo (p=0.010) and 228 days in the untreated comparison group, translating to 2-year survival rates of 45.1%, 23.4%, and 13.5% respectively (homeopathy vs. placebo p=0.020; homeopathy vs. control p<0.001). No side effects were attributed to either the homeopathic remedy or the placebo, and every death in the trial was confirmed to be a direct result of the cancer itself rather than a treatment complication. The authors are careful to note that their design cannot tell whether the benefit came from the remedy itself or from the long, attentive homeopathic consultation both randomized groups received; that the untreated comparison group was not randomized and may differ from the treated groups in ways beyond homeopathy; and that the trial ran before modern immunotherapy became standard NSCLC care. Combined with the dataset's retraction history, these findings should be read as encouraging but preliminary, awaiting independent replication by researchers not previously involved in homeopathy research before they influence clinical decisions.

Anna Pyszora et al. (2017) · Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

This randomized trial with 60 adults tested whether a short course of physiotherapy could ease cancer-related fatigue in people with advanced cancer who were receiving palliative (comfort-focused) rather than curative care -- a group rarely included in fatigue research even though fatigue is one of their most common and distressing symptoms, often dismissed as an inevitable part of advanced illness rather than something physiotherapy could actually help treat. Conducted at a palliative care unit and hospice in Poland, the study split participants evenly into a physiotherapy group and a no-exercise control group, with everyone continuing their usual medications. The physiotherapy group did six 30-minute sessions over two weeks, combining gentle active arm-and-leg exercises with myofascial release (a hands-on technique that eases tight connective tissue) and proprioceptive neuromuscular facilitation, or PNF (stretching-and-contracting patterns that improve movement and reduce stiffness). Fatigue and its impact on daily life were measured with the Brief Fatigue Inventory, while nine common symptoms -- including pain, mood and appetite -- were tracked with the Edmonton Symptom Assessment Scale. By day 8, the physiotherapy group already showed significantly less fatigue than the control group, and by day 12 their fatigue scores had dropped from about 6.4 to 4.4 out of 10 (p<0.01) across every fatigue measure, while the control group barely changed on most items. The therapy group also reported significantly less pain, depression, anxiety and drowsiness, and better appetite and overall well-being (all p<0.01) -- benefits the control group did not show over the same two weeks. Nearly all physiotherapy patients (26 of 29 evaluated) rated the program positively on a satisfaction scale, and not a single patient rated it negatively, suggesting the approach was both effective and well tolerated even in a population that is frail and seriously ill, which many clinicians would have assumed could not handle any exercise at all. These results suggest that even patients in palliative care, who are often assumed too frail for exercise, can safely benefit from a brief, well-tailored physiotherapy program that reduces fatigue and improves overall comfort. The study's small size, single location, lack of blinding, and short two-week follow-up mean the findings need confirmation in larger, longer trials, and a chance imbalance in gender between the two groups (more women ended up in the control group) is a limitation worth noting, though it did not appear to affect the fatigue results.

Genxiang Mao et al. (2017) · International journal of environmental research and public health

This study asked whether older adults with chronic heart failure (CHF) — a serious condition where the heart struggles to pump blood effectively — might benefit from a short forest retreat. Thirty-six CHF patients aged 65 to 80 from Hangzhou, China, were split into two groups: most went on a 4-day trip to a forest park, while a smaller group stayed in an urban area, under otherwise matched conditions (food, activity, lodging). Both groups walked outdoors twice a day for about 90 minutes at a gentle, unhurried pace — safe enough that a nurse and doctor accompanied the walks — and avoided smoking, alcohol, and caffeine throughout the trip. Blood was drawn before and after to check heart-failure markers, blood vessel and hormone factors related to heart disease, inflammation, and antioxidant status, and everyone completed a standard mood questionnaire (POMS) before and after. After the forest trip, participants had a significantly lower level of BNP, a key blood marker doctors use to gauge heart-failure severity, compared with both their own starting level and the city group — whose BNP didn't change. The forest group also had lower endothelin-1 (a blood-vessel-constricting hormone linked to heart disease) and lower interleukin-6 (an inflammation marker) than the city group, along with signs of less oxidative cell damage. Mood improved significantly in the forest group too — less tension, depression, anger, and confusion — while the city group's mood stayed about the same. The forest site's air was dramatically cleaner: about 30 times more of the negative ions associated with fresher air, and a small fraction of the fine-particle pollution found in the city. These early results suggest that even a short, four-day forest trip may offer measurable benefits in people living with heart failure — studied as a complement to regular medical care, not a replacement for it. The study was small (33 people finished it) and short, tested in only one season, and can't fully separate the effect of the forest itself from other differences like travel, group size, or simply a change of routine. Larger, longer trials are needed before forest bathing becomes a standard recommendation for heart failure patients.

Aibo Li et al. (2025) · Frontiers in public health

This study tested whether spending three days in a forest could help lower blood pressure in older adults who already have essential hypertension (high blood pressure with no single identifiable cause). Thirty-six adults aged 60 to 80 with diagnosed hypertension took part: 24 went to a subtropical forest national park in China for a 3-day retreat, while 12 stayed in the city of Hangzhou following the same daily schedule, so researchers could compare the two settings directly. The forest group took part in daily gentle activities designed to immerse them in nature: eight trigrams boxing (a slow, breath-focused Qigong practice), a few hours of guided forest walking, a traditional tea ceremony, and a meditation session. Both groups ate the same meals and kept the same schedule. Before and after the trip, researchers measured blood pressure, heart rate, blood oxygen, heart-rate variability (a marker of nervous-system balance), several inflammation and stress-hormone markers in the blood, and mood using a standard questionnaire. After the trip, the forest group's blood pressure was significantly lower than the city group's, both the top number (systolic, ~134 vs. 147) and bottom number (diastolic, ~78 vs. 85). Inflammation, measured by a sensitive CRP blood test, was also significantly lower in the forest group. Heart-rate variability shifted in a pattern the researchers interpreted as a healthy autonomic-nervous-system adjustment for this population. On mood, the forest group reported significantly less tension and anxiety and significantly more energy and vitality than the city group; other mood measures trended better but weren't statistically significant. Heart rate, blood oxygen, and most other blood markers (IL-6, cortisol, oxidative-stress markers) didn't differ significantly between the groups. These results suggest a short forest retreat combining gentle nature-based activities may meaningfully help lower blood pressure, ease inflammation, and improve mood in older adults with hypertension, as a complement to standard care. Because the forest program bundled several practices together (forest walking, qigong, meditation, tea ceremony) and compared a larger forest group to a much smaller city group in a different location, it's hard to know how much came from the forest setting itself versus the other activities. The trial only lasted three days, so it can't say whether the benefits last, and larger, longer studies are needed before forest bathing becomes a standard recommendation for hypertension.

Nima Javadzade et al. (2024) · BMC public health

This randomized controlled trial with 60 depressed older adults living in nursing homes in Isfahan, Iran, explored whether an 8-week Mindfulness-Based Stress Reduction (MBSR) program could ease depression, improve emotion regulation, and reduce sleep problems. MBSR is a structured group program, originally developed for stress and chronic illness, that trains people to notice thoughts, emotions, and body sensations without judgment through practices like body scanning and gentle movement. Emotion regulation here covers two distinct skills the study measured separately: cognitive reappraisal (reinterpreting a situation to change its emotional impact) and expressive suppression (holding back outward emotional expression), the latter generally considered a less adaptive coping strategy. Participants, referred by geriatricians and screened with the Geriatric Depression Scale, were randomly split into an MBSR group (30 people, average age 66) and a no-treatment control group (30 people, average age 67); 60% of each group were women. The MBSR group attended eight weekly 90-minute sessions with a certified instructor, practicing body scans, mindful movement, loving-kindness meditation, walking meditation, and mindful eating, plus home practice between sessions. Before the program and one week after it ended, both groups completed the Geriatric Depression Scale, the Emotion Regulation Questionnaire, and the Pittsburgh Sleep Quality Index. After 8 weeks, the MBSR group showed significantly lower depression scores than the control group (adjusted averages 6.28 vs. 8.82, p<0.001), with a large effect size (partial eta squared=0.57, meaning the intervention accounted for over half the variance in the outcome). Emotion regulation shifted favorably on both subscales: cognitive reappraisal rose (22.67 vs. 20.36, p<0.001) while expressive suppression fell (12.32 vs. 15.65, p<0.001, partial eta squared=0.56) — a pattern consistent with Gross's emotion regulation model, in which stronger reappraisal skills reshape an emotional response early, reducing reliance on effortful suppression later. Sleep quality also improved, with lower Pittsburgh Sleep Quality Index scores in the MBSR group (11.58 vs. 13.35, p<0.001), which the authors link to MBSR increasing attentional control over the automatic arousal and rumination that disrupt sleep. All four outcomes reached statistical significance with observed power near 1.00 (a near-certain ability to detect a true effect). For nursing-home psychologists and caregivers, MBSR appears to be a practical, side-effect-free complement to standard depression care for older residents, requiring only a certified instructor and a weekly 90-minute time commitment. Limitations are real: outcomes relied entirely on self-report in a population prone to inaccurate self-assessment, the control group received no intervention at all rather than an active comparison, there was no follow-up beyond one week, and the sample was limited to depressed nursing-home residents in Iran. Future research should add objective measures and longer follow-up before these findings are treated as conclusive.