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- A Short-Term Safety Evaluation of Silbinol®- an Extract from Pterocarpus
marsupium in Healthy Adults- a Randomized, Double-Blind, Placebo-Controlled Study Authors: Muhammed Majeed, Kalyanam Nagabhushanam, Shaji Paulose, Lakshmi Mundkur Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Background: Pterostilbene is an active molecule from the bark of the Pterocarpus marsupium tree with antioxidant and anti-inflammatory properties. Objective: This study aimed to evaluate the clinical safety of a standardized P. marsupium extract (PME) containing 90% pterostilbene (200 mg per day) in healthy adults. Methods: In a randomized, double-blind, placebo-controlled study, 60 healthy adult participants (27 males and 33 females) were randomized to receive PME-100 mg or placebo capsule twice a day for two months. The primary objectives of the study were to assess any changes in laboratory parameters, vital signs, and the occurrence of adverse events from screening to the final visit. Serum antioxidant enzyme levels were evaluated as a secondary outcome. Results: The hematological, lipid, glycemic, thyroid profiles and liver and renal functions remained within the normal range in all participants, with no difference between PME and placebo. Vital signs, including blood pressure, pulse rate, body weight, body mass index and electrocardiogram, did not reveal any significant differences between the PME and placebo groups at the beginning and end of the study. No serious adverse events were observed in any participant throughout the study period. The serum antioxidant profile was not significantly different between the treatment groups, although the glutathione levels were relatively higher in the PME group. Conclusions: Scientific evaluation of clinical safety of standardized extract is mandatory for its use as a supplement for various health benefits. The results of this study convincingly establish the safety of PME (>90% Pterostilbene) at 200 mg/day (100 mg bid) for human use. The study was approved by the Institutional Ethics Committee of BGS Global Institute of Medical Sciences & Hospital, Bangalore with the registration number CTRI/2019/08/020736. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-09-06T08:13:34Z DOI: 10.1177/2515690X231198312 Issue No: Vol. 28 (2023)
- Acupoint Transcutaneous Electrical Nerve Stimulation in Hospitalized COPD
Patients with Severe Dyspnoea: A Randomized Controlled Trial Authors: Carles Fernández-Jané, Jordi Vilaró, Lluís Costa-Tutusaus Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. ObjectiveTo evaluate the effect of acupuncture transcutaneous electrical nerve stimulation (acuTENS) on the reduction of dyspnoea during acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsA multicentric randomized control trial with masked patients and evaluators was carried out. During hospitalization, AECOPD patients received 45 min of acuTENS (experimental group) or sham acuTENS (controls) daily on 5 consecutive days. The trial was conducted at the Hospital del Mar, Barcelona, and Hospital Sant Joan de Déu, Manresa (both in Spain). Dyspnoea and peak expiratory flow were measured daily from the first to fifth days. Length of stay, readmissions at 3 months and adverse events were also analysed.ResultsFinally, 19 patients with moderately to severely exacerbated COPD were included. Although some tendencies in dyspnoea during day 1 and length of hospital stay were found favouring acupuncture, no significant differences were shown between groups.ConclusionsThe acuTENS intervention was feasible#well tolerated in AECOPD patients and no important side effects were reported. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-09-06T08:12:55Z DOI: 10.1177/2515690X231198308 Issue No: Vol. 28 (2023)
- Clinicopathological Characteristics and Prognosis of Diffuse Large B-Cell
Lymphoma in Relation to CA-125 and CA 19-9 Expression Authors: Abd AlRahman Mohammad Foda, Tarek Atia,
Hader I. Sakr, Khaled Abd Elaziz Ahmed Elnaghi,
Wagih M. Abdelhay, Eman T. Enan Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Background: Some epithelial tumors express the carbohydrate antigen 125 (Cancer antigen-125, CA-125) and CA 19-9, especially ovarian and pancreatic tumors. Patients with non-Hodgkin lymphoma (NHL) were reported to have a close association between serum CA-125 levels and adverse prognostic factors with worse survival. We aimed to investigate CA-125 and 19-9 expression in nodal diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) tissues using immunohistochemistry (IHC) and their relations to clinicopathological manifestations and patients' survival. Methods: 65 cases of DLBCL NOS were examined. A modified mechanical pencil tip was used to construct Manual Tissue Micro-array (TMA) blocks. Immunohistochemical staining for CA-125 and CA 19-9 was performed and scored semi-quantitatively. All relations were analyzed using established statistical methodologies. Results: Aberrant expression of CA 19-9 was detected in 12% of cases without any expression of CA-125. Moreover, 75% of the CA 19-9 positive cases were statistically significantly associated with anemia and performance status 1. Also, 75% of the CA 19-9 positive cases were females. Conclusions: CA 19-9 was aberrantly expressed in 12% of nodal DLBCL NOS cases and significantly related to anaemia and performance status but not to survival. In cases of DLBCL NOS, CA 19-9 expression cannot be considered an independent prognostic factor. CA-125 was not expressed in nodal DLBCL NOS tissues, necessitating re-evaluation studies. Therefore, it is advised to conduct more research to clarify the potential correlation between serum and tissue CA 19-9 levels and other clinic-pathological characteristics of nodal and extranodal DLBCL NOS patients. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-09-01T06:30:51Z DOI: 10.1177/2515690X231198315 Issue No: Vol. 28 (2023)
- Antiproliferative and Anti-Inflammatory Activities of Deprungsith
Formulation and Its Bioactive Compounds Against Mild Psoriasis and Potential of Metabolic Herb-Drug Interactions Authors: Kesara Na-Bangchang, Monthaka Teerachaisakul, Phunuch Muhamad, Yositha Kasemnitichok, Nattida Sangnarong, Kanyarat Boonprasert, Mayuri Tarasuk, Tullayakorn Plengsuriyakarn Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Psoriasis is an incurable, chronic and auto-immune skin disorder with a global prevalence rate of approximately 2–3%. The study investigated the antipsoriasis activities of Deprungsith formulation and its bioactive components and their potential for inhibitory activities on human cytochrome P450 (CYP450). HaCaT and peripheral blood mononuclear cells (PBMCs) from healthy volunteers (n = 9) and psoriasis patients (n = 10) were exposed to Deprungsith formulation (Thai traditional medicine for psoriasis consisting of 16 plants), ethyl p-methoxycinnamate (EPMC), ligustilide and cyclosporin for 24 and 48 h. The antiproliferative, cell apoptosis and cell cycle arrest activities were evaluated using MTT assay and flow cytometry, respectively. The pro-inflammatory cytokine mRNA expression levels were measured using real-time polymerase chain reaction (RT-PCR). The CYP450 inhibitory effect was investigated using a bioluminescent-based CYP450 assay. Deprungsith formulation and the bioactive compounds inhibited HaCaT cells and PBMCs with weak to moderate potencies. EPMC and ligustilide combination produced an additive effect. Most substances arrested cell transition at sub-G1 and S phases, leading to early and late apoptosis induction. With prolonged exposure (48 h), all test substances decreased PBMCs necrosis. The mRNA expression of all pro-inflammatory cytokines was downregulated. Deprungsith formulation, EPMC, ligustilide and ferulic acid inhibited CYP1A2, CYP2C9, CYP2D6 and CYP3A4 activities with weak to moderate potencies. Deprungsith formulation and bioactive components induced cell apoptosis by inhibiting cell transition at specific cell cycle phases, which was correlated with the mRNA downregulation of interleukin (IL-6, IL-12p19, IL-23) and tumor necrosis factor (TNF-α). There is a low risk of potential adverse drug reactions and toxicity due to CYP450 interaction when Deprungsith formulation is concurrently administered with modern medicines. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-08-09T06:45:09Z DOI: 10.1177/2515690X231191101 Issue No: Vol. 28 (2023)
- In Vitro Antiproliferative Effects and Phytochemical Characterization of
Carissa edulis ((Forssk) Vahl) and Pappea capensis (Eckyl and Zeyh) Extracts Authors: Carolyn Wanjira Muruthi, Mathew Piero Ngugi, Steven Maina Runo, Peter Githaiga Mwitari Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Cancer mortality is a global concern. The current therapeutic approaches despite showing efficacy are characterized by several limitations. Search for alternatives has led to the use of herbal plants including C. edulis and P. capensis. However, there is limited research on antiproliferative effects of these medicinal plants. The study sought to evaluate antiproliferative effects of the plants against human breast and prostate cancers using cell viability, and gene expression assays to determine modulation of apoptotic genes. Further, Liquid Chromatography Mass Spectrophotometer (LC-MS) and Gas Chromatography Mass Spectrophotometer (GC-MS) analyses were performed to confirm phytocompounds in the extracts. The results indicated that ethylacetate extracts of C. edulis and P. capensis had the highest activity against cancer cells with IC50 values of 2.12 ± 0.02, and 6.57 ± 0.03 μg/ml on HCC 1395 and 2.92 ± 0.17 and 5.00 ± 0.17 μg/ml on DU145, respectively. Moreover, the plants extracts exhibited relatively less cytotoxic activities against Vero cell lines (IC50 > 20 μg/ml). The extracts also exhibit selectivity against the cancer cells (SI > 3). Further, mRNA expression of p53 in the treated HCC 1395 was increased by 7 and 3-fold, whereas by 3 and 2-fold in DU145 cells, upon treatment with ethylacetate extracts of C. edulis and P. capensis, respectively. Similarly, several-fold increases were observed in the number of transcripts of Bax in HCC 1395 and HOXB13 in DU145 cells. Phytochemical analyses detected presence of phytocompounds including flavonoids, phenolics, tocopherols and terpenoids which are associated with anticancer activity. Findings from this study provide a scientific validation for the folklore use of these plants in management of cancer. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-07-25T06:24:45Z DOI: 10.1177/2515690X231187711 Issue No: Vol. 28 (2023)
- Cardioprotective Effects of Vitex negundo: A Review of Bioactive Extracts
and Compounds Authors: Boniface Nyamweya, Dilani Rukshala, Narmada Fernando, Rajiva de Silva, Sunil Premawansa, Shiroma Handunnetti Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. There has been accumulating interest in the application of medicinal plants as alternative medicine to treat various diseases and/or to develop modern medicines. Vitex negundo is one of such medicinal plants that has been of interest to many researchers and has been of use in traditional medicine. V. negundo is found in Sri Lanka, Madagascar, Malaysia, India, China, The Philippines and East Africa. Therapeutic properties of V. negundo have previously been reviewed. Different parts, preparations and bioactive components of V. negundo possess potential protective and therapeutic effects against cardiovascular disease and related conditions as demonstrated in previous studies. We review the present state of scientific knowledge on the potential use of V. negundo and some of its bioactive components in protecting against cardiovascular diseases and related pathologies. Previous studies in animal and non-animal experimental models, although limited in number and vary in design, seem to support the cardioprotective effect of V. negundo and some of its active components. However, there is need for further preclinical and clinical studies to validate the use of V. negundo and its active constituents in protection and treatment of cardiovascular diseases. Additionally, since only a few V. negundo compounds have been evaluated, specific cardioprotective effects or mechanisms and possible side effects of other V. negundo compounds need to be extensively evaluated. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-06-07T12:06:00Z DOI: 10.1177/2515690X231176622 Issue No: Vol. 28 (2023)
- The Effect of Tang Forte (Royal Jelly) Capsule on Hypoglycemia and
Clinical Course in COVID-19 Patients Under Corticosteroid Therapy Authors: Hamidreza Pourfard, Ali Ahmadi,
Zahra Habibi, Majid Asadi-Samani, Najmeh Shahinfard, Akbar Soleimani Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Corticosteroids improve the complications of Covid-19 but may cause some side effects such as hyperglycemia. Royal jelly is one of the bee products that exert anti-inflammatory, insulin-like, and hypoglycemic activities. The present study was conducted to investigate the effect of royal jelly capsules on blood sugar and the clinical course of Covid-19 in the patients receiving corticosteroid therapy. In this clinical trial, 72 Covid-19 patients with positive reverse transcription polymerase chain reaction (RT-PCR) test and pulmonary involvement hospitalized in Shahrekord Hajar Hospital were enrolled and randomized into two groups: treatment (receiving corticosteroids and Royal Jelly 1000 mg capsules daily for 7 days) and placebo (given corticosteroids and placebo). Laboratory tests, blood sugar, and clinical courses were determined and compared. Data was analyzed using SPSS version 16. On day 7 after the onset of the intervention, the dosage and frequency of insulin, FBS level, and required corticosteroid showed a decrease in both groups but the inter-group difference was not significant (P > .05). As well, the Spo2 level indicated a non-significant increase and hospital stay length indicated a non-significant decrease in the intervention group (P > .05). Among the symptoms, only headache, cough, and dyspnea indicated an improvement in the intervention group (P Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-04-11T05:20:05Z DOI: 10.1177/2515690X231165333 Issue No: Vol. 28 (2023)
- Evaluation of Antimalarial Activity of Ethanolic Extract of Annona
muricata L.: An in vivo and an in silico Approach Authors: Charles Obiora Nwonuma, Elizabeth Abiodun Balogun, Gideon Ampoma Gyebi Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. In Nigeria, Annona muricata L. has been used to treat a variety of ailments. The mechanism of the antimalarial activity of ethanolic leaf extract of Annona muricata (EEAML) was investigated using both an in vivo and an in silico approach. The experimental mice were divided into five groups: A-F. The mice in groups B-F were inoculated with Plasmodium berghei NK-65 and treated accordingly. Groups A and B are the negative and positive controls (infected and untreated), respectively. Group C received 10 mg/kg chloroquine (standard drug), whereas groups D-F received 100, 200, and 300 mg/kg body weight of the extract orally respectively. The mice were euthanized eight days after infection, and their liver and blood were collected and used in biochemical tests. Molecular docking was performed using the extract's HPLC compounds and Plasmodium falciparum proteins. In the suppressive, prophylactic, and curative tests, there was a significant decrease (p Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-04-05T11:25:57Z DOI: 10.1177/2515690X231165104 Issue No: Vol. 28 (2023)
- Quantitative Phytochemical Profile and In Vitro Antioxidant Properties of
Ethyl Acetate Extracts of Xerophyta spekei (Baker) and Grewia tembensis (Fresen) Authors: Paul Nyalo, George Omwenga, Mathew Ngugi Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Overproduction of free radicals in excess of antioxidants leads to oxidative stress which can cause harm to the body. Conventional antioxidants have drawbacks and are believed to be carcinogenic. The present study seeked to confirm folklore use and validate the antioxidant potentials of Grewia tembensis and Xerophyta spekei which have been widely used in the Mbeere community as medicinal plants. Antioxidant properties were determined through scavenging effects of diphenyl-1-picrylhydrazyl (DPPH) and hydrogen peroxide radicals as well as iron chelating effects. The data obtained was assayed in comparison to the standards (Ascorbic acid and EDTA). Ascorbic acid had a significantly greater DPPH radical scavenging property with an inhibitory concentration (IC50) value of 20.54 ± 2.24 µg/mL in comparison to the plant extracts, which had IC50 values of 33.00 ± 1.47 µg/mL, 69.66 ± 1.01 µg/mL and 86.88 ± 2.64 µg/mL for X. spekei, G. tembensis leaf and G. tembensis stem bark extracts, respectively. EDTA demonstrated a significantly greater iron chelating effect having a significantly lesser IC50 value of 25.05 ± 0.79 µg/mL as opposed to 43.56 ± 0.46 µg/mL, 89.78 ± 0.55 µg/mL, and 120.70 ± 0.71 µg/mL for X. spekei, G. tembensis leaf, and G. tembensis stem bark extracts respectively. Additionally, ascorbic acid also exhibited stronger hydrogen peroxide radical scavenging effect than the studied extracts. Generally, X. spekei extract had higher antioxidant activities as compared to both the leaf and stem bark extracts of G. tembensis. The phytochemical screening demonstrated the presence of secondary metabolites associated with antioxidant properties. The present study therefore, recommends ethno medicinal and therapeutic use of G. tembensis and X. spekei in the treatment and management of oxidative stress related infections. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-03-22T07:10:34Z DOI: 10.1177/2515690X231165096 Issue No: Vol. 28 (2023)
- Attenuation of Seizures, Cognitive Deficits, and Brain Histopathology by
Phytochemicals of Imperata cylindrica (L.) P. Beauv (Poaceae) in Acute and Chronic Mutant Drosophila melanogaster Epilepsy Models Authors: Fred Ssempijja, Samuel Sunday Dare, Edmund E. M. Bukenya, Keneth Iceland Kasozi, Ritah Kenganzi, Edgar Mario Fernandez, Marta Vicente-Crespo Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Imperata cylindrica is a globally distributed plant known for its antiepileptic attributes, but there is a scarcity of robust evidence for its efficacy. The study investigated neuroprotective attributes of Imperata cylindrica root extract on neuropathological features of epilepsy in a Drosophila melanogaster mutant model of epilepsy. It was conducted on 10-day-old (at the initiation of study) male post-eclosion bang-senseless paralytic Drosophila (parabss1) involved acute (1-3 h) and chronic (6-18 days) experiments; n = 50 flies per group (convulsions tests); n = 100 flies per group (learning/memory tests and histological examination). Administrations were done in 1 g standard fly food, per os. The mutant flies of study (parabss1) showed marked age-dependent progressive brain neurodegeneration and axonal degeneration, significant (P Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-03-03T09:26:25Z DOI: 10.1177/2515690X231160191 Issue No: Vol. 28 (2023)
- Melanogenesis Inhibitory Activity, Chemical Components and Molecular
Docking Studies of Prunus cerasoides Buch.-Ham. D. Don. Flowers Authors: Nateelak Kooltheat, Aman Tedasen, Kenshi Yamasaki, Moragot Chatatikun Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Safe depigmenting agents are currently increasing in the cosmetic or pharmaceutical industry because various compounds have been found to have undesirable side effects. Therefore, the present study aimed to investigate the melanogenesis inhibitory effects of Prunus cerasoides Buch. -Ham. D. Don. flower extracts and their molecular mechanism in B16F10 mouse melanoma cells. Moreover, we also examined phenolic and flavonoid contents, antioxidant activity, chemical constituents of potential extracts, and molecular docking. The highest phenolic and flavonoid contents with the greatest scavenging activity were found in the butanol extract of the P. cerasoides flower compared to other extracts. From all extracts, only crude, diethyl ether, and butanol extracts showed an inhibition of mushroom tyrosinase activity, cellular tyrosinase activity, and melanin content as well as the downregulation of the gene expression of the microphthalmia-associated transcription factor (MITF), tyrosinase, tyrosinase-related protein-1 (TRP-1), and tyrosinase-related protein-2 (TRP-2) in α-MSH-stimulated B16F10 cells. Based on the molecular docking study, n-hexadecanoic acid, heptadecanoic acid, octadecanoic acid, 9,12-octadecadienoic acid, 9,12,15-octadecanoic acid, and eicosanoic acid might show an inhibitory effect against tyrosinase and MITF. In conclusion, this finding demonstrates that both the diethyl ether and butanol extracts of the P. cerasoides flower can effectively reduce tyrosinase activity and melanin synthesis through the downregulation of the melanogenic gene expression in B16F10 cells and through the molecular docking study. Taken together, the diethyl ether and butanol extracts of the P. cerasoides flower could be an anti-melanogenic ingredient for hyperpigmentary or melasma treatment. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-02-06T07:31:10Z DOI: 10.1177/2515690X231152928 Issue No: Vol. 28 (2023)
- Cananga odorata Aromatherapy Reduces Anxiety in Unexperienced Patients
Hospitalized for Interventional Neuroradiology Procedures: A Randomized Control Trial Authors: Jetsada Sriboonlert, Waranon Munkong, Sunantha Rintawut, Soodjai Paladkhua, Ratchalita Suwongsa, Woranan Kirisattayakul Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. The hospitalization and the unfamiliar experiences of patients in interventional radiology procedures cause a moderate to high levels of anxiety. This study was aimed to evaluate the anxiolytic effect of Cananga odorata essential oil (COE) aromatherapy in unexperienced patients hospitalized for interventional neuroradiology (INR) procedures. Forty-four patients admitted for their first INR procedure were randomly divided into COE and placebo control groups. COE or distilled water was dropped onto 2 pieces of mulberry paper and attached to the participant's gown at the shoulder level overnight. The main outcomes were observed from the morning salivary cortisol levels and salivary alpha-amylase activity after intervention. The Thai version of Spielberger State-Trait Anxiety Inventory (STAI) and the vital signs (blood pressure and heart rate) were also assessed before and after COE intervention as the secondary outcome. The demographic and baseline data of both groups did not show any significant difference. After intervention, COE group had a significantly lower salivary alpha-amylase activity than placebo control group. The post-intervention scores of Trait (STAI-T) and State (STAI-S) anxiety were significantly less than those of baseline in both groups. Interestingly, the COE group had a greater percentage reduction on STAI-T after intervention than placebo control group. No significant difference was observed in other outcomes. In addition, the salivary alpha-amylase activity was weak but showed significant correlation with STAI anxiety scores. This study indicates that COE aromatherapy reduces the saliva alpha amylase activity and STAI-T anxiety in unexperienced patients hospitalized for INR procedures. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-01-20T06:02:18Z DOI: 10.1177/2515690X221150527 Issue No: Vol. 28 (2023)
- Gymnema inodorum Leaf Extract Improves Cardiac Function in Experimental
Mice Infected with Plasmodium Berghei Authors: Sakaewan Ounjaijean, Rujikorn Rattanatham, Voravuth Somsak, Worakan Boonhoh, Sirirat Surinkaew Abstract: Journal of Evidence-Based Integrative Medicine, Volume 28, Issue , January-December 2023. Malaria-associated cardiac injury has been reported to be the primary cause of death due to severe malaria. The discovery of substances showing a protective effect on cardiac injury during malaria infection is urgently needed. Hence, the purpose of this study was to evaluate the efficacy of Gymnema inodorum leaf extract (GIE) on cardiac function in mice infected with Plasmodium berghei. ICR mice were treated with 1 × 107 infected red blood cells of P. berghei ANKA (PbANKA), administered orally with GIE in 100, 250 and 500 mg/kg body weight of mice. Creatine phosphokinase (CPK) and echocardiography were carried out. It was found that CPK and heart-weight to body-weight (HW/BW) ratios were significantly higher in untreated mice than the healthy control. Moreover, impaired cardiac function in the untreated group was observed as indicated by changes in echocardiography. Interestingly, GIE exerted a protective effect on cardiac injury induced by PbANKA infection. Our results demonstrated that the parasitemia percentage, CPK, HW/BW ratio, and echocardiography in GIE treated mice were improved. However, there was no significant difference between GIE dosages. Therefore, GIE possessed a cardio-protective effect during malaria infection in mice. Citation: Journal of Evidence-Based Integrative Medicine PubDate: 2023-01-09T06:43:58Z DOI: 10.1177/2515690X221150526 Issue No: Vol. 28 (2023)
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