Ultrasound

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.

Dan Wang et al. (2026) · JAMA network open

This phase 3 randomized trial of 606 adults in China explored whether Guang Jing, a capsule made from the total flavonoids (plant pigment compounds with antioxidant activity) of the traditional Chinese herb Desmodium styracifolium, helps ureteral stones pass out of the body. A ureteral stone is a mineral deposit lodged in the tube that carries urine from the kidney to the bladder. Treatment that encourages passage is called medical expulsive therapy, and the authors note that alpha-blocker drugs, the guideline option, have shown mixed results in large trials. No oral medicine is currently approved for urolithiasis, and Guang Jing is already approved in China for ureteral stones. Participants were adults aged 18 to 70 with a newly diagnosed ureteral stone of 5 to 10 mm and a traditional Chinese medicine pattern called damp-heat accumulation (urethral burning, lower back pain or blood in the urine). At 34 hospitals, three of every four received 3 capsules (0.6 g) of Guang Jing three times daily for 28 days, and the rest received identical placebo capsules. Neither participants nor investigators knew who received which. Passage was confirmed by CT scan on day 28, read by blinded investigators. By day 28, 44.6% of the Guang Jing group (204 of 457) had passed their stone versus 33.8% of the placebo group (50 of 148). That is a 10.9 percentage point difference (relative risk 1.32, so passage was about one-third more likely; P = .03). At day 14 the groups did not differ significantly (29.1% vs 22.3%; P = .14), and stone movement distance was almost identical (29.5 vs 29.7 mm). Among those with 0.6 to 1.0 cm stones, passage was 37.2% vs 24.4% (a larger gap in the bigger stones), and 66.2% of Guang Jing participants with distal stones, the lower part of the ureter near the bladder, passed them. Adverse events were similar (19.3% vs 18.2%, meaning side effects were about as common with the capsule as with placebo), with no medication-related serious events. The authors describe the absolute benefit as modest, since 55.4% of the Guang Jing group did not pass a stone by day 28. The trial enrolled a fairly uniform group, mostly from southern China, and the subgroup results were exploratory. The authors state that this homogeneous population limits how far the findings generalize, and that CT slice thickness may have missed small differences in stone movement. They plan further trials in Europe and North America and call for studies to identify who benefits most and to establish how the extract works in humans.

Béla E Tóth et al. (2025) · Nutrients

This prospective, double-blind, two-phase randomized controlled trial with 84 analyzed participants explored whether weekly high-dose vitamin D3 (a fat-soluble vitamin that also acts on hormone-producing tissue through its receptor, VDR) could improve ovarian function in polycystic ovary syndrome (PCOS), a common hormonal condition marked by irregular or absent ovulation (the release of an egg), elevated androgens ("male-pattern" hormones such as testosterone), and, frequently, vitamin D deficiency. Earlier studies had linked low vitamin D status to PCOS but disagreed on whether raising vitamin D levels actually changes ovulation, cycle length, or hormone levels. Conducted at eight Hungarian clinical sites between 2016 and 2020, the trial randomized women meeting Rotterdam PCOS criteria to one of two oral regimens: 30,000 IU of vitamin D3 weekly, plus calcium, either immediately for 24 continuous weeks or only after a 12-week placebo lead-in period. Ovarian morphology was tracked with transvaginal ultrasound, and ovulation was confirmed through luteal-phase progesterone testing (values above 10 ng/mL) rather than self-report alone, at baseline and after 12 and 24 weeks of treatment. After 12 weeks of vitamin D3, average menstrual cycle length dropped by 11.7 days (p = 0.032, meaning this reduction was unlikely to be due to chance), and confirmed ovulation rose from about 40% to 59-65% of participants (p = 0.044). Serum vitamin D rose to a mean of 45.1 ng/mL (p < 0.001), confirming adequate repletion. Testosterone fell significantly only in two specific subgroups: women with elevated androstenedione ("hyperandrogenic," p = 0.047) and those with a higher LH/FSH hormone ratio (p = 0.0082) — a pattern the authors connect to differing PCOS phenotypes rather than one uniform hormonal response. Ultrasound-confirmed normal ovarian appearance was reached in 20% of participants after 12 weeks (p < 0.05 versus placebo), improving further by 24 weeks, though that later difference was not statistically significant. No serious treatment-related side effects were reported, and vitamin D levels stayed within the study's predefined safety range throughout. The authors suggest vitamin D3 could serve as a standalone or add-on approach for PCOS, particularly for hyperandrogenic phenotypes and those with a higher LH/FSH ratio. They identify the trial's sample size (84 analyzed participants), the relatively short 12-plus-12-week duration, and luteal-phase-only hormone sampling as limitations restricting broader conclusions, and note that longer trials with serial ultrasound monitoring and larger, phenotype-defined groups are needed to confirm these phenotype-specific patterns and to establish how long the ovulatory and cycle-length benefits persist after treatment ends.

Beyza Nur Erayata et al. (2025) · PloS one

This single-blind randomized controlled trial with 24 adults recovering from anterior cruciate ligament (ACL) reconstruction explored whether percussion massage therapy (PMT) — handheld devices that deliver rapid, rhythmic vibration pulses to muscle, sometimes called massage guns — adds benefit when combined with a structured post-surgical exercise program. ACL reconstruction requires months of rehabilitation focused on restoring knee range of motion, strength, and proprioception (the body's sense of joint position, tested here as joint position sense), while managing pain that can otherwise limit progress. PMT has mostly been studied in healthy athletes; this trial asked whether it also helps people recovering from surgery. Twenty-four participants aged 18-40, all within eight weeks of hamstring-autograft ACL reconstruction, were randomly split into two equal groups of 12. Both groups followed the same progressive, three-phase neuromuscular exercise program, five days a week for six weeks (30 sessions total). The PMT group also received five minutes of percussion massage per muscle group (quadriceps, hamstrings) with a Hypervolt device at 40 Hz before each session. Researchers measured pain (Visual Analog Scale), knee function (WOMAC), balance (Berg Balance Scale), quality of life (SF-36), range of motion, joint position sense, and muscle thickness by ultrasound, before and after the six weeks. Both groups improved significantly across every outcome after six weeks (p<0.001), confirming that structured exercise alone works well after ACL reconstruction. But adding PMT produced significantly larger gains in several key areas: resting pain dropped further (5.75 versus 4.17 points on a 0-10 scale, p=0.004), activity pain dropped further (6.92 versus 5.50 points, p=0.003), knee function scores improved more (71.7 versus 46.1 points on WOMAC, p=0.002 — a large effect, Cohen's d=1.41), balance improved more (24.7 versus 15.5 points on the Berg scale, p=0.040), and knee-bending range of motion gained more (43.1 versus 30.2 degrees, p=0.048). Joint position sense at 60 degrees also improved more with PMT (p=0.023), though at 30 degrees the two groups were statistically similar. Muscle thickness gains and most quality-of-life measures were comparable between groups, suggesting PMT's edge lies mainly in pain relief, function, balance, and motion rather than muscle bulk. For people recovering from ACL surgery, these results suggest a few minutes of percussion massage before each exercise session may meaningfully speed up pain relief, functional recovery, and balance, with no adverse events reported. The trial is small (12 people per group) and single-site, the groups started with somewhat different baseline pain and muscle measurements, and there was no long-term follow-up, so the durability of these gains beyond six weeks is unknown. Larger trials testing different PMT frequencies and durations are needed before this becomes a standard rehabilitation recommendation.

Janmejaya Samal (2015) · Journal of intercultural ethnopharmacology

This systematic review pooled published research on using Ayurveda, India's traditional medical system, alongside standard drugs for pulmonary tuberculosis (PTB) — a bacterial lung infection that remains one of India's leading causes of death. The review searched PubMed through April 2015 and found six studies worth including: four human trials testing Ayurvedic herbal formulas as add-ons to standard anti-TB drugs (ATDs), and two lab studies testing plant extracts directly against the TB bacterium. In Ayurveda, PTB is traditionally understood as Rajayakshma, a wasting condition tied to depleted bodily tissues (dhatu) and vital reserve (ojas) — explaining why many of the formulas studied are rejuvenative "Rasayana" tonics rather than antibiotics. The four clinical trials enrolled 30 to 133 PTB patients each, all in India, and ran from 28 days to 6-8 months. Participants took Ayurvedic formulas — a nine-herb Rasayana capsule, a liquid tonic called Bhringarajasava, Ashwagandha with Chyawanprash, or a hepatoprotective blend called Liv-600 — alongside their prescribed drug regimen (DOTS). Researchers tracked symptoms like cough and fever, body weight, X-ray changes, drug blood levels, and liver enzymes. The two lab studies tested leaf and plant extracts against TB bacteria in culture, measuring the lowest concentration that stopped bacterial growth. Across the trials, Ayurvedic add-ons consistently eased symptoms and supported weight gain more than standard treatment alone (p<0.001 in the largest trial). One striking finding: Ashwagandha plus Chyawanprash raised blood levels of two key TB drugs, isoniazid and pyrazinamide, by 7-10% (meaning the body absorbed more of the medicine that actually kills the bacteria) — potentially valuable given rising drug resistance. The hepatoprotective blend showed no harmful rise in liver enzymes, suggesting it may guard against the liver damage these drugs can cause. In the lab, extracts from four of five tested legumes completely stopped bacterial growth at a low concentration (50 micrograms per milliliter), and extracts from five other plants inhibited even drug-resistant TB strains by up to 95%. These findings position Ayurvedic formulas as promising supportive care — easing symptoms, protecting the liver, and possibly boosting drug absorption — rather than replacements for standard TB treatment, which no study tested. The evidence base is thin: only six studies total, all small, mostly from India, with just one describing blinding and none pooling results statistically. The authors call for properly designed clinical trials of the lab-active plants, especially against multidrug-resistant TB. The evidence reviewed concerns Ayurvedic preparations as adjuncts to prescribed drug therapy; none of it addresses their use instead of it.

Yolanda Nadal-Nicolás et al. (2020) · International journal of environmental research and public health

This randomized controlled trial with 24 women asked whether hands-on massage therapy can move the needle on fibromyalgia — the chronic condition that combines widespread muscle pain with fatigue, unrefreshing sleep, and mood struggles. Researchers in Alicante, Spain recruited women aged 47 to 59 with rheumatologist-confirmed fibromyalgia affecting the neck and upper back, then randomized them to real treatment or a convincing placebo. The real treatment was manual therapy with moderate finger pressure on the back of the neck and upper back — fifteen minutes, twice a week, for four weeks, growing gradually firmer as each patient tolerated. The placebo was clever: an ultrasound machine applied to the same area for the same time, but switched off and used without gel, so participants experienced an equally plausible clinical ritual. Pain, fatigue, sleep, anxiety, and mood were measured before and after the month of treatment. Pain responded decisively. The manual therapy group's pain scores dropped by 4.2 points from baseline (p<0.001 — a large within-group effect of 2.07), and after treatment they sat 2.9 points below the placebo group (p=0.044, a moderate between-group effect of 0.59). Everything else stayed flat: fatigue, sleep quality, anxiety, and mood showed no significant improvement over placebo. An interesting side note - fatigue and poor sleep moved together (R=0.411), as did pain and anger-hostility scores (R=0.436), hinting at how fibromyalgia symptoms interlock. For women with fibromyalgia, this trial offers a practical, specific prescription: gentle-to-moderate pressure massage on the neck and upper back, twice weekly, genuinely reduces pain beyond the placebo effect — but on this evidence it should be expected to help pain, not the full fibromyalgia symptom cluster. The trial was small (24 analyzed), dropout hit the placebo arm harder, and all participants were women from one region, so larger trials are needed before firmer conclusions.