Ginkgo Leaf Research Articles

Development of an HPLC-MS method for the determination of four terpene trilactones in Ginkgo biloba leaf extract via quality by design.

Previously reported HPLC-evaporative light scattering detection methods for terpene trilactone determination in Ginkgo biloba leaf extract (EGBL) have complicated sample preparation steps and are time-consuming. Thus, in this work, an HPLC-MS method for the determination of terpene trilactones in EGBL was developed with a novel analytical quality by design approach to provide robust and simple measurements. For this purpose, analytical target profiles and systematic risk analyses were performed to identify potential critical method attributes and critical method parameters. After screening experiments, a Box-Behnken design approach was utilized to investigate the relationships between critical method attributes and critical method parameters. A hypercube design space obtained by a Monte Carlo method was used for choosing the analytical control strategy. Then, verification experiments were performed within the design space, and the models were found to be accurate. After that, the optimized method was verified and successfully used for quality control analysis of EGBL from different manufacturers, and the results were almost the same as those determined by HPLC-evaporative light scattering detection. To our knowledge, this is the first study to establish a robust HPLC-MS method for determination of terpene trilactones in EGBL based on a novel analytical quality by design concept, which can improve the quality control of commercial EGBL.

Ginkgo biloba leaf extract suppresses intestinal human breast cancer resistance protein expression in mice: Correlation with gut microbiota

In this study, we investigated the effects of treatment with Gingko biloba leaf extract (GLE) on intestinal transporter expression and gut microbiota composition in mice and the correlation between intestinal transporter expression and gut microbiota composition in mice. When GLE was orally administered to mice, intestinal BCRP expression was significantly suppressed. Pharmacokinetic studies showed that the maximum plasma concentration and area under the curve values of sulfasalazine were increased more than twice by treatment with GLE compared with those in the control group. GLE treatment significantly decreased the populations of Proteobacteria and Deferribacteres at the phylum level. Correlation analysis showed that BCRP expression was positively or negatively correlated with the composition of gut bacteria. In Caco-2 cells, GLE treatment did not affect BCRP expression, but treatment with the lysates of GLE-treated mouse feces significantly suppressed BCRP expression. These findings demonstrate that the suppression of intestinal BCRP expression following GLE treatment may occur through modulation of the gut microbiota composition. Thus, the present study suggests that modulation of gut microbiota composition may cause drug transporter-mediated herb–drug interactions.

Effects of Methanolic Extract of Ginkgo biloba Leaf against Hypoxia-Induced Lethality in Mice

Introduction: Hypoxia defines as a condition in which body tissues do not take sufficient oxygen supply. Chronic hypoxia has various medical consequences. Recently, the role of hypoxia in the progression of COVID-19 disease has been proven. Ginkgo biloba is a valuable plant from more than 2000 years ago. Ginkgo has antioxidant activity and exhibits good scavenging activity on the free radicals therefore, it is considered helpful in treating diseases associated with the generation of free radicals, including chronic inflammation, cerebral infarction, ischemic heart disease, and aging.Material and Methods: In this study, anti-hypoxic activities of G. biloba methanolic leaf extract have been determined against hypoxia-induced lethality in mice to understand its usefulness in treating ischemia.Results: The extract showed weak activity in asphyctic model. At 125 mg/kg, it significantly delayed the time of death compared to the control group (p<0.05) but did not show any activities in haemic or circulatory hypoxia tests even at a higher tested dose, 250 mg/kg. Although, at this dose, extract prolonged the survival time more than 1 minute in circulatory model, but this increase was not statistically significant.Conclusion: In conclusion, results from this study showed that extract has weak anti-hypoxic effects in the treatment of hypoxia.

Combined therapy of hypertensive nephropathy with ginkgo leaf extract and dipyridamole injection and antihypertensive drugs: A systematic review and meta-analysis.

Background:In recent years, the incidence rate of hypertensive nephropathy has been increasing quickly, which has been a major threat to people's health. Renin-angiotensin-aldosterone system blockers have certain curative effects. However, there are some patients having serious adverse reactions, and the benefit population is limited, so the treatment of hypertensive renal damage is necessary to have beneficial supplement. More and more clinical studies have shown that ginkgo leaf extract and dipyridamole injection (GDI) combined with antihypertensive drugs has achieved good results in the treatment of hypertensive renal damage. It is supposed to be a supplementary treatment in hypertensive nephropathy.Objectives:To systematically assess the efficacy and safety of GDI combined with antihypertensive drugs on hypertensive renal injury.Methods:Seven databases including PubMed, Cochrane Library, Embase, Wanfang database, China biomedical literature service system (Sino Med), VIP Chinese Sci-tech journal database (VIP), and China national knowledge internet (CNKI) were retrieved to collect randomized controlled trials (RCTs) in the experimental group containing combined therapy of hypertensive nephropathy with GDI and antihypertensive drugs. The retrieval time was from the establishment of database to July 8, 2020. Two researchers independently selected literature, extracted data, and evaluated the risk of bias in the study. The methodological quality was evaluated with Cochrane handbook and meta-analysis was performed with Stata 14.0 software.Results:Eight studies were included in this study which involved 556 patients. The meta-analyses indicated that, compared with using antihypertensive drugs alone, combined treatment of GDI with antihypertensive drugs can decrease 24-hour urinary total protein (weighted mean difference [WMD] –0.61, 95% confidence interval [CI]: –0.82, –0.39; k = 6, P ≤ .001), blood urea nitrogen (WMD –1.27, 95% CI: –2.45, –0.10; k = 6, P = .033, serum creatinine (WMD –29.50, 95% CI: –56.44, –2.56; number of estimates [k] = 6, P = .032).Conclusions:Our meta-analyses showed that GDI combined with antihypertensive drugs can improve the renal function of hypertensive patients with renal injury.

Effect of Ginkgo biloba leaf extract on serum nuclear factor‐κB content and intracellular calcium concentration after traumatic spinal cord injury

Objective To study the effects of Ginkgo biloba leaf extract on serum nuclear factor-κB(NF-κB) content and intracellular calcium ion concentration after traumatic spinal cord injury. Methods Forty-two SD rats were randomly divided into three groups: sham operation group (group S), trauma group (group T) and ginkgo biloba extract intervention group (group G), with an average of 14 rats in each group, The weight of the rat was 200±20g. Rats model of spinal cord injury was established in accordance with the model of Allen's hit. Rats in group G were intraperitoneally injected with Ginkgo biloba extract 100mg/kg every day for 3 consecutive days after injury. Group S and group T were given intraperitoneal injection of the same dose of normal saline. On day 4, the rats were sacrificed and the spinal cord tissues were taken out after blood collection. The calcium content of spinal cord cells was detected by laser scanning confocal microscopy, and the serum NF-κB concentration was determined by enzyme linked immunosorbent assay(ELISA). Results The calcium fluorescence intensity of spinal cord cells in the group S, group T and group G) had statistical significance (P<0.05).The intracellular calcium ion concentration of spinal cord cells in group T was the highest, followed by group G,and the intracellular calcium ion concentration of spinal cord cells in group S was the lowest. Similarly, the difference of serum NF-κB content in group S, group T and group G had statistically significant (P<0.05). The highest in group T, followed by group G, and the lowest in group S. Conclusion Ginkgo biloba leaf extract can reduce the content of nuclear factor-κB in serum and the concentration of calcium ions in spinal cord cells after traumatic spinal cord injury, reduce inflammation and calcium overload, and then might reduce the occurrence of spinal cord cell injury and edema.

Mechanism of Huo-Xue-Qu-Yu Formula in Treating Nonalcoholic Hepatic Steatosis by Regulating Lipid Metabolism and Oxidative Stress in Rats.

Huo-Xue-Qu-Yu formula (HXQYF) is a prescription consisting of Ginkgo biloba leaf and Paeonia lactiflora Pall. for treating hyperlipidemia and NAFLD in China. Here, we investigated the hepatic and renal function, oxidative stress and lipid metabolism, and potential mechanisms of HXQYF on nonalcoholic fatty liver disease (NAFLD) rat models. NAFLD rat models were induced with high-fat diet (HFD) and 10% fructose water for 18 weeks and orally administered with or without HXQYF simultaneously. The results showed that HXQYF (22.5, 45, 90 mg/kg) significantly improved blood lipid levels via reducing serum TC, TG, LDL-C, and APOB values and elevating HDL-C and APOA1 levels in NAFLD rats. The higher levels of ALT, AST, CR, and BUN in serum induced by HFD were reduced by HXQYF. HE staining showed that HXQYF (90 mg/kg) reduced the accumulation of fat droplets and alleviated inflammatory response in liver cells. Three doses of HXQYF exhibited notable antioxidant effects by elevating SOD, GSH, and CAT activities and decreasing MDA and OH-1 levels in the liver. Furthermore, abnormal lipid metabolism caused by HFD was alleviated by HXQYF, which was associated with the upregulation of PPAR-α, AdipoR2, and CPT1 mRNAs as well as the downregulation of CYP2E1 and SREBP-1c mRNAs in liver tissue. In conclusion, our work verified that HXQYF could reduce the degree of hepatic steatosis, suppress oxidative stress, and attenuate lipid metabolism, thus preventing NAFLD.

Antioxidant and skin anti-aging effects of the aqueous ethanol extract of Ginkgo biloba leaf: an in vitro study using HaCaT keratinocytes

Oxidative stress is considered a prime contributor to skin aging. Aged skin can be characterized by increased wrinkles and dry and dull appearance, which are associated with increased collagen degradation and inadequate desquamation, respectively. We investigated the antioxidant and skin anti-aging effects of a Ginkgo biloba leaf extract (GLE), an aqueous ethanol extract of Ginkgo biloba leaves, and the molecular mechanisms involved, using HaCaT keratinocytes. HaCaT cells were pretreated with GLE (0–15 μg/mL) and then treated with H2O2 (0.2 mM), and the cell viability and metalloproteinase 1 (MMP-1) protein level were measured. To investigate the mechanisms underlying the GLE’s effects, the cells were incubated with GLE, and then glutathione content, cell migration rate, and the levels of proteins, i.e., MMPs, Kallikrein-related peptidases (KLKs), nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase 1 (HO-1), and mitogen-activated protein kinases, were measured. GLE pretreatment caused decreases in cytotoxicity and the level of MMP-1, a key enzyme that degrades collagen in dermis, induced by H2O2 in HaCaT cells. GLE (5–15 μg/mL) caused increases in glutathione content and HO-1 level in cells, which appeared to be associated with the increase in Nrf2, a principal transcription factor for the antioxidant response. GLE also increased keratinocyte migration, which might result from the increase in KLK-7, a key enzyme that degrades corneodesmosomes and thus stimulates desquamation of corneocytes in epidermis. GLE increased the phosphorylation of c-Jun N-terminal protein kinase and extracellular signal-regulated kinase, which might contribute to the antioxidant and skin anti-aging effects of GLE demonstrated in our results. Our results suggest that GLE may have skin anti-aging effects by protecting keratinocytes against excessive oxidative stress via stimulation of antioxidant response, reducing wrinkle formation via a decrease in MMP-1 expression, and stimulating desquamation via an increase in KLK-7 expression.

A novel nutritional mixture, MBN, prevents memory impairment via inhibiting NLRP3 inflammasome formation in 5xFAD transgenic mice

ABSTRACT Objectives Amyloid beta (Aβ)-induced abnormal neuroinflammation is recognized as a major pathological factor of Alzheimer’s disease (AD), which results in memory impairment. Inhibition of excessive neuroinflammation mediated by Aβ is considered a promising strategy to ameliorate AD symptoms. To regulate the inflammatory response, nutritional and dietary supplements have been used for centuries. Based on this idea, we investigated whether MBN, a novel nutritional mixture including cassia bark, turmeric root, and ginkgo leaf, can prevent AD progression through neuroinflammatory regulation. Methods MBN (10, 30, or 100 μg/ml) and Aβ1-42 monomer were incubated together, and the degree of Aβ aggregation was measured using Thioflavin T assay. The effects of MBN on Aβ pathology in vivo were evaluated by orally administering MBN (40 mg/kg/day for 16 weeks) to five familial AD (5xFAD) mice. Results We found that treatment with MBN inhibited Aβ aggregation in vitro. Next, MBN treatment significantly inhibited the activation of microglia induced by aggregated Aβ in 5xFAD mice. Caspase-1 activation, which plays an important role in the maturation of interleukin-1β, was markedly reduced by MBN. We also found that oral administration of MBN in 5xFAD mice alleviated memory decline. Taken together, our findings demonstrate that MBN suppresses neuroinflammation by downregulating the caspase-1 expression, thereby ameliorating memory impairment in 5xFAD mice. Discussion Based on these results, we suggest that MBN may be a preventive and therapeutic supplement for AD through the regulation of neuroinflammation.

Mild Cognitive Impairment and Mild Dementia: The Role of Ginkgo biloba (EGb 761®).

Mild cognitive impairment (MCI) and dementia are clinically prevalent in the elderly. There is a high risk of cognitive decline in patients diagnosed with MCI or dementia. This review describes the effectiveness of Ginkgo biloba leaf special extract EGb 761® for the treatment of dementia syndromes and EGb 761® combination therapy with other medications for symptomatic dementia. This drug has shown convincing results, improving cognitive function, neuropsychiatric symptoms and consequent reduction of caregiver stress and maintenance of autonomy in patients with age-related cognitive decline, MCI and mild to moderate dementia. Currently, there is little evidence to support the combination therapy with anti-dementia drugs and, therefore, more evidence is needed to evaluate the role of EGb 761® in mixed therapy.

Citrinin Determination in Food and Food Supplements by LC-MS/MS: Development and Use of Reference Materials in an International Collaborative Study.

The development of incurred reference materials containing citrinin (CIT) and their successful application in a method validation study (MVS) in order to harmonize CIT determination in food and food supplements are demonstrated. CIT-contaminated materials made of red yeast rice (RYR), wheat flour, and Ginkgo biloba leaves (GBL), as well as food supplements made of red yeast rice (FS-RYR) and Ginkgo biloba leaves (FS-GBL), were manufactured in-house via fungal cultivation on collected raw materials. The homogeneity and stability from randomly selected containers were verified according to the ISO 13528. CIT was found to be homogenously distributed and stable in all contaminated materials, with no significant degradation during the timescale of the MVS when storage was performed up to +4 °C. Next, an MVS was organized with eighteen international laboratories using the provided standard operating procedure and 12 test materials, including three RYRs (blank, <50 µg/kg, <2000 µg/kg), two wheat flours (blank, <50 µg/kg), two GBL powders (blank, <50 µg/kg), three FS-RYRs (blank, <50 µg/kg, <2000 µg/kg), and two FS-GBLs (blank, <50 µg/kg). The results of seven CIT-incurred materials showed acceptable within-laboratory precision (RSDr) varying from 6.4% to 14.6% and between-laboratory precision (RSDR) varying from 10.2% to 37.3%. Evidenced by HorRat values < 2.0, the results of the collaborative trial demonstrated that the applied analytical method could be standardized. Furthermore, the appropriateness of producing CIT reference materials is an important step towards food and feed quality control systems and the organization of proficiency tests.

Spatial prediction and delineation of Ginkgo biloba production areas under current and future climatic conditions

Ginkgo (Ginkgo biloba L.) is an ancient medicinal tree species that is widely cultivated in China for its leaves which possess pharmacologically active metabolites. Knowledge about the effects of climate change on ginkgo leaf yield (biomass) and quality (target metabolites concentration) remains unknown. Here, we first examined the extent of several phenotypic traits (growth: leaf area and weight, main branch basal diameter and length; metabolites: concentration of flavonoids, ginkgolides, and polyprenols) variation of genetically homogeneous ginkgo clones (including gender differences) along climatic gradients. Second, we used univariate and bivariate modeling techniques to quantify the impact of several essential climatic factors on the performance of the studied phenotypic traits. Finally, we predicted the growth potential of the studied traits and delineated their suitable production areas under current and future climate conditions. Results showed that the studied 4 growth and 12 metabolites traits varied significantly (P < 0.05) among the 17 assessed diverse growing environments, while female trees consistently outperformed male trees for growth traits, but not for metabolites. Climate variables related to sub-zero temperature were considered to be the most key factor restricting the distribution of ginkgo (growth potential); however, they promoted the biosynthesis of some defense compounds (e.g., flavonoids). Future projections under the RCP8.5 scenario indicated that the area suitable for ginkgo growth (leaf area) would increase by mid-century as well the high-yield, high-quality areas of ginkgo cultivation would shift northward and upward.

Extracting flavonoid from Ginkgo biloba using lignocellulolytic bacteria Paenarthrobacter sp. and optimized via response surface methodology

AbstractGinkgo biloba flavonoids are important natural bioactive compounds with strong physiological effects. To develop an eco‐friendly and effective method for extracting flavonoids from plants, a microbial method involving lignocellulose‐degrading bacterial enzymes was developed to improve flavonoid extraction from Ginkgo biloba leaves. In this study, a newly isolated bacterial strain, Paenarthrobacter sp. S1.3, was employed for the fermentation processing of Ginkgo biloba leaf powder. The enzymatic characteristics of xylanase, CMCase, polygalacturonase, and β‐glucosidase from Paenarthrobacter sp. S1.3 were also investigated. The major fermentation parameters for the microbial extraction of Ginkgo biloba flavonoids were optimized using response surface methodology. Under optimal conditions (30.6 °C, initial pH 7.6, and fermentation time 25 h), a total flavonoid yield of 34.15 ± 0.52 mg g−1 dry weight was obtained, which was 2.11 fold and 1.42 fold higher than the yields obtained from the unfermented and ethanol extraction methods, respectively. The optimized results also suggest that the polygalacturonase and β‐glucosidase might play an important role in flavonoid extraction. Fermentation utilizing lignocellulose‐degrading bacteria was a feasible green approach to improve the extraction of natural compounds from plants. © 2021 Society of Chemical Industry and John Wiley &amp; Sons, Ltd

Transcriptome Analysis of Ginkgo biloba L. Leaves across Late Developmental Stages Based on RNA-Seq and Co-Expression Network

The final size of plant leaves is strictly controlled by environmental and genetic factors, which coordinate cell expansion and cell cycle activity in space and time; however, the regulatory mechanisms of leaf growth are still poorly understood. Ginkgo biloba is a dioecious species native to China with medicinally and phylogenetically important characteristics, and its fan-shaped leaves are unique in gymnosperms, while the mechanism of G. biloba leaf development remains unclear. In this study we studied the transcriptome of G. biloba leaves at three developmental stages using high-throughput RNA-seq technology. Approximately 4167 differentially expressed genes (DEGs) were obtained, and a total of 12,137 genes were structure optimized together with 732 new genes identified. More than 50 growth-related factors and gene modules were identified based on DEG and Weighted Gene Co-expression Network Analysis. These results could remarkably expand the existing transcriptome resources of G. biloba, and provide references for subsequent analysis of ginkgo leaf development.

Ginkgo Leaf Extract from Permage Effects of Hair Improvement on the Permutations

Ginkgo Leaf Extract from Permage Effects of Hair Improvement on the Permutations

Systematic review and Meta-analysis of clinical efficacy and safety of Ginkgo Leaf Tablets in treatment of acute cerebral infarction

To systematically evaluate the clinical efficacy and safety of Ginkgo Leaf Tablets(GLT) in the treatment of acute cerebral infarction(ACI). Seven databases both at home and abroad were systematically retrieved from their establishment to March 2020. The data of the included studies were extracted after review and screening. The quality of the included studies was assessed with the Cochrane risk bias assessment tool, and then the included studies were put into Meta-analysis by RevMan 5.3 to evaluate the total cli-nical efficiency, neurological function score, blood lipids and incidence of adverse reactions in treatment of ACI by GLT. Finally, the GRADE system was adopted to evaluate the evidence quality of each outcome indicator and form recommendations. Ten studies involving 886 participants were included, all of which were of low quality. Meta-analysis results showed that,(1)in terms of the total clinical efficiency, GLT+Western medicine was superior to Western medicine alone(RR_(NDS)=1.20, 95%CI[1.06, 1.36], P=0.005; RR_(NIHSS)=1.35, 95%CI[1.09, 1.69], P=0.007), and there was no statistical difference between GLT+Xuesaitong Injection+Wes-tern medicine and Xuesaitong Injection+Western medicine(RR=1.16, 95%CI[1.00, 1.35], P=0.05).(2)In terms of improving neurological function score, GLT+Western medicine was superior to Western medicine alone(MD_(NIHSS[moderate(severe)])=-1.55, 95%CI[-2.22,-0.88], P&lt;0.000 01; MD_(NIHSS(severe))=-7.51, 95%CI[-8.00,-7.02], P&lt;0.000 01; MD_(NDS)=-1.36, 95%CI[-2.39,-0.33], P=0.01), and GLT+Danshen Injection+Western medicine was superior to Danshen Injection+Western medicine(MD_(NDS)=-3.09, 95%CI[-3.84,-2.34], P&lt;0.000 01).(3)In terms of regulating blood lipids, GLT+Western medicine was superior to Wes-tern medicine alone(MD_(TC)=-1.40, 95%CI[-2.13,-0.66], P=0.000 2; MD_(TG)=-1.29, 95%CI[-1.86,-0.73], P&lt;0.000 01; MD_(LDL-C)=-1.48, 95%CI[-2.91,-0.04], P=0.04; MD_(HDL-C)=0.07, 95%CI[0.02, 0.12], P=0.009).(4)In terms of incidence of adverse reactions, there was no statistical difference between GLT+Western medicine and Western medicine alone(RR=0.63, 95%CI[0.30, 1.32], P=0.22). The results of the evaluation showed that the evidence level of each outcome indicator was low, and the recommendation was at weak level. In conclusion, GLT+Western medicine could improve the total clinical efficiency, neurological function score, and blood lipid status, with a low incidence of adverse reactions. However, due to the small amount of included stu-dies, low study quality and low level of evidence, it is expected to carry out clinical studies with standardized design and large sample size in the future to further investigate the clinical efficacy and safety of GLT in the treatment of ACI.

Variation of terpene lactones composition in Ginkgo biloba (L.) leaves under the influence of harvesting time and growing location

Our research aim was to investigate quantitative composition of terpene lactones in G. biloba leaf samples cultivated in the Nordic Baltic region (Lithuania) and present recommendations to industry on rational planning of the collection of plant material rich in terpene lactones. The data of our study showed that the location of the tree and the time of harvest have significant effect (p < 0.05) on the amount of terpene lactones. Studies have shown that the age of the plant affects the amount of the accumulated terpene lactones in Ginkgo biloba leaves, and thus it is important to determine the optimal age of the plantation trees for the harvesting of raw material. A tendency was found that the amount of terpene lactones in Ginkgo biloba leaf samples decrease with the increasing age of the plant. To ensure the optimal collection of raw material, it is recommended to place the G. biloba plantations in northern (to collect the highest amount of ginkgolide A, B, C) and western (to collect the highest amount of bilobalide) phyto-regions. Due to the maximum concentration of ginkgolide C, A, B and bilobalide in samples, October is recommended as appropriate times to collect G. biloba leaves for the industry.

Design and Research of Large Ginkgo Biloba Leaf Picker

In view of the different growth patterns of ginkgo branches and the need to avoid injury to Ginkgo branches when picking ginkgo leaves, this design provides a kind of ginkgo leaf picking machine that can carry out large-scale mechanized picking in the ginkgo leaf planting area and improve ginkgo leaf picking efficiency. The picker puts the picking mechanism in the front of the tractor, which is driven by the tractor. The power needed for the picking mechanism to rotate is provided by the tractor. The picking mechanism contains the storage mechanism of ginkgo leaves in order to achieve harvesting and gathering. Mechanization of ginkgo leaf picking, the picking efficiency of ginkgo biloba leaves was improved to a greater extent.

Sudden sensorineural hearing loss during pregnancy: etiology, treatment, and outcome.

ObjectiveTo analyze the etiologies, treatments, and outcomes of sensorineural hearing loss (SSNHL) during pregnancy.Study designRetrospective chart review of 25 pregnant patients treated for SSNHL between January 2012 and September 2019. Forty-nine age matched non-pregnant women with severe and profound hearing loss diagnosed with SSNHL during the same period served as controls. Data were recorded on age, symptoms, onset of hearing loss, audiometric results, treatments, and outcomes.ResultsThe mean age was 29.6 years (range 23–38 years). Intratympanic steroids (ITS) were administered in 15 (60.0%) pregnant women with SSNHL. Three women were treated with postauricular steroids only, while another woman was treated with intravenous ginkgo leaf extract and dipyridamole. The remaining six women received no medications. More than half (8/15, 53.3%) of pregnant women with SSNHL receiving ITS experienced hearing improvement. Pregnant women with profound hearing loss who received no medication had no hearing improvement. Most pregnant women with SSNHL (12/15, 80.0%) had higher fibrinogen levels than controls (mean values 3.77±0.71 g/L and 2.54±0.48 g/L, respectively).ConclusionFibrinogen could be a risk factor for SSNHL during pregnancy. ITS may benefit pregnant women with severe and profound SSNHL.

Complementary and alternative medicine mentions and recommendations in glaucoma guidelines: Systematic review and quality assessment

IntroductionGlaucoma is one of the leading causes of irreversible vision loss and blindness. The global prevalence of glaucoma is 3.54% of the population aged 40–80 years old. Glaucoma and its associated symptoms are often self-medicated using CAM therapies. This study aims to determine the quantity and quality of CAM recommendations within clinical practice guidelines (CPGs) for the treatment and/or management of glaucoma. MethodsMEDLINE, EMBASE and CINAHL were systematically searched from 2009 to April 2020, alongside the Guidelines International Network and the National Center for Complementary and Integrative Health websites. Eligible CPGs containing CAM therapy recommendations were assessed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. ResultsFrom 148 unique search results, 7 eligible CPGs were identified, however, only 1 CPG contained CAM recommendations. This eligible CPG scored high in the scope and purpose, editorial independence, and clarity of presentation domains for both the overall CPG and CAM sections. CAM therapies recommended for use included Dan Zhi Xiaoyaosan; Taohong Siwu decoction and Wuling powder; Wendan Tang; Lycii and Chrysanthemi and Rehmanniae bolus; gingko leaf tablets; Erigeron breviscapus tablets; Wuling capsule; fuming tablets; Mingmu Dihuang Wan; and acupuncture. ConclusionThis review highlights the general lack of CAM recommendations across glaucoma CPGs; this hinders the ability of clinicians to have meaningful discussions surrounding shared-decision making with their patients. Despite the high prevalence of CAM use in glaucoma patients, extremely limited evidence-based CPGs with CAM therapy recommendations are available to guide their safe and effective use.

Molten salt template-assisted synthesis of N, S-codoped hierarchically porous carbon nanosheets for efficient energy storage

To enrich the type of carbons for double-layer supercapacitors and optimize their electrochemical performances, N/S co-doped hierarchical porous carbons (KISPCs) with well-balanced pore characteristic have been prepared by taking ginkgo leaf as carbon source and KCl/K2CO3 molten-salt as template/activation agent. The as-obtained carbons possess a well-developed interconnected sheet-like structure, accompanying with high N, S and O contents, conductive to abundant ions transport channels and exposure of more ions-accessible active sites. Moreover, the types and contents of surface functional groups of hierarchical porous carbon could also be adjusted by K2CO3 content. A symmetrical supercapacitor was assembled to validate its electrochemical performance. The KISPCs electrodes manifest a specific capacitance of 215.2 F g−1 at 0.05 A g−1, splendid capacitance retention of 78.9 % (169.8 F g−1 at 20 A g−1) and exceptional cycling stability with only 1.6 % capacity decay after 10000 charge/discharge cycles. This work can afford promising new tactics for the preparation of hierarchical porous carbon nanosheets and offer insights into the application of energy storage fields.