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BackgroundThis is a meta-analysis of randomized controlled trials (RCTs) of mindfulness-based interventions (MBIs) for a current episode of major depressive disorder. Methods Both English (PubMed, PsycINFO, Embase, and Cochrane Library databases) and Chinese (WanFang and CNKI) databases were systematically and independently searched. Standardized mean differences (SMDs) and risk ratio (RR) ± their 95% confidence intervals (CIs) based on the random effects model were calculated. Results A total of 11 RCTs with 12 treatment arms (n = 764; MBIs = 363; and control group = 401) were identified and analyzed. Compared to the control group, MDD subjects receiving MBIs showed significant reduction in depressive symptoms (n =722; SMD: −0.59, 95% CI: −1.01 to −0.17, I2 = 85%, p = 0.006) at post-MBIs assessment, but the significance disappeared by the end of posttreatment follow-up. Subgroup analyses revealed that positive benefits of MBIs was associated with studies that had treatment as usual (TAU) control group, Chinese participants, open label design, no gender predominance, subjects younger than 44.4 years, and Jadad score ≥ 3, other illness phase and MBIs as augmentation group. Conclusion This meta-analysis found that MBIs was associated with reduction of depression severity immediately after MBIs but not at follow up endpoint. Further, the positive effects of MBIs were mainly driven by outlying studies. Higher quality of RCTs with larger samples and longer study duration are needed to confirm the findings.

Previous studies have shown that mindfulness is associated with less negative traumatic outcomes in people who experienced traumatic events. The present study investigated how mindfulness is related to posttraumatic stress disorders (PTSD) symptoms, depression and social functioning impairment in Chinese traumatized adolescents by considering the role of posttraumatic cognitive change (PCC). A total of 247 Chinese adolescents, who had experienced a severe tornado six months prior to this study, were recruited to complete a series of questionnaires. Results showed that the proposed model fitted the data very well (χ2 = 16.200, df = 8, χ2/df = 2.025, GFI = 0.983, CFI = 0.991, TLI = 0.976, RMSEA = 0.063). Further analyses revealed that PCC mediated the relation between dispositional mindfulness and all negative posttraumatic outcomes (including PTSD symptoms, depression and social functioning impairment). Limitations, clinical implications, and directions for future research were discussed.

Tibetan medicine Asteris Flos is the flowers of Aster souliei, A. flaccidus, and A. asteroides, with the function of clearing away heat and toxic matter, relieving cough, and removing phlegm. In order to control the quality of Asteris Flos, the morphological and chemical methods were established for identification of three origins. The morphological features of three species were described and photographed, and the microscopic characteristics of three drug powders were also described in detail and pictured. The results showed that three origins of Asteris Flos could be easily distinguished by their macro- and micro-morphologic features, and a key for distinguishing the three origins was given. Moreover, a TLC method, with apigenin-7-O-β-D-glucurono pyranoside and chlorogenic acid as chemical references, was also established for the identification of three origins. The results showed that the TLC chromatograms of the flowers of A. souliei and A. flaccidus were very similar, but different from that of A. asteroides. The established macroscopic, powder microscopic and TLC methods for identification of three origins of AF were simple, accurate, and reproducible, and also effective and easy to operate.

<bold>Background: </bold>Tong Luo Hua Shi (TLHS) is a new formulation of the traditional Tibetan medicine Wu-wei-gan-lu that has been used for the treatment of rheumatoid arthritis (RA) for hundreds of years in China. This study aimed to evaluate the efficacy and safety of TLHS in patients with RA.<bold>Methods: </bold>This was a randomized, double-blind, placebo-controlled, dose-finding study performed in patients with active RA from five medical centers. Patients received three doses (4.8, 3.6, or 2.4 g/day po) of TLHS or placebo (tid po) for 8 weeks. Blood sampling, physical examination, and assessment of the American College of Rheumatology (ACR) 20 % improvement (ACR20) criteria were performed before and every 2 weeks after starting treatment. The primary endpoint was the ACR20. The secondary endpoints included safety.<bold>Results: </bold>A total of 240 participants were screened and 236 patients were randomized (n = 59/group); 20 dropped out. After 8 weeks, ACR20 improvements in the TLHS 4.8 g and 3.6 g groups were significantly higher than in the placebo group (P < 0.01 and P < 0.05, respectively). ACR50 improvement in the TLHS 4.8 g group was significantly higher compared with the placebo group (P < 0.01). Symptoms of RA were significantly relieved in the TLHS groups. In the TLHS groups, insomnia (n = 1), gastroenteric reactions (n = 2), arrhythmia (n = 1), and minor hepatic lesion (n = 1) were reported; in the placebo group, hepatic dysfunction (n = 1) was reported (P = 0.878).<bold>Conclusions: </bold>TLHS improved the symptoms of patients with RA according to the ACR20. Moreover, TLHS was safe.<bold>Trial Registration: </bold>Chinese Clinical Trial Registry: ChiCTR-TRC-12003871 . Registered on 1 January 2012. [ABSTRACT FROM AUTHOR]

Past studies have documented interpersonal benefits of natural environments. Across four studies, we tested the hypothesis that exposure to more beautiful nature, relative to less beautiful nature, increases prosocial behavior. Study 1 yielded correlational evidence indicating that participants prone to perceiving natural beauty reported greater prosocial tendencies, as measured by agreeableness, perspective taking, and empathy. In Studies 2 and 3, exposure to more beautiful images of nature (versus less beautiful images of nature) led participants to be more generous and trusting. In Study 4, exposure to more beautiful (versus less beautiful) plants in the laboratory room led participants to exhibit increased helping behavior. Across studies, we provide evidence that positive emotions and tendencies to perceive natural beauty mediate and moderate the association between beauty and prosociality. The current studies extend past research by demonstrating the unique prosocial benefits of beautiful nature.
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Past studies have documented interpersonal benefits of natural environments. Across four studies, we tested the hypothesis that exposure to more beautiful nature, relative to less beautiful nature, increases prosocial behavior. Study 1 yielded correlational evidence indicating that participants prone to perceiving natural beauty reported greater prosocial tendencies, as measured by agreeableness, perspective taking, and empathy. In Studies 2 and 3, exposure to more beautiful images of nature (versus less beautiful images of nature) led participants to be more generous and trusting. In Study 4, exposure to more beautiful (versus less beautiful) plants in the laboratory room led participants to exhibit increased helping behavior. Across studies, we provide evidence that positive emotions and tendencies to perceive natural beauty mediate and moderate the association between beauty and prosociality. The current studies extend past research by demonstrating the unique prosocial benefits of beautiful nature.

Past studies have documented interpersonal benefits of natural environments. Across four studies, we tested the hypothesis that exposure to more beautiful nature, relative to less beautiful nature, increases prosocial behavior. Study 1 yielded correlational evidence indicating that participants prone to perceiving natural beauty reported greater prosocial tendencies, as measured by agreeableness, perspective taking, and empathy. In Studies 2 and 3, exposure to more beautiful images of nature (versus less beautiful images of nature) led participants to be more generous and trusting. In Study 4, exposure to more beautiful (versus less beautiful) plants in the laboratory room led participants to exhibit increased helping behavior. Across studies, we provide evidence that positive emotions and tendencies to perceive natural beauty mediate and moderate the association between beauty and prosociality. The current studies extend past research by demonstrating the unique prosocial benefits of beautiful nature.

"Zuotai" is one of the main raw material of many rare Tibetan medicine, and it plays a important role in the system of Tibetan medicine. There are some toxic heavy metals in "Zuotai", such as Hg, Au, Pb and so on. As a result, it's urgent to study the safety and effectiveness of "Zuotai" in depth. This paper will analyze and induce the resent progress of the study about "Zuotai". With constipation, "Zuotai" and "Zuotai" as key words, CNKI, CHINAINFO, CQVIP were retrieved, Springer were retrieved besides. Relevant 86 references were obtained. Twenty-two for reference were adopted through screening. The paper reviewed the resent progress of the study about "Zuotai" in chemical composition, pharmacodynamics and pharmacokinetics, toxicology and clinical application. This will establish the basis for further study.

Oxyfadichalcones A and B, two unprecedented chalcone dimers fused through a cyclobutane ring by head-to-tail [2+2] cycloaddition of two chalcones that had never been found previously in nature, along with oxyfadichalcone C, a new head-to-head [2+2] cyclized chalcone dimer, were simultaneously obtained from Oxytropis falcata. Structural elucidation was succeeded by spectroscopic and single-crystal synchrotron radiation analysis. Additionally, the photosynthesis of the chalcone dimers was performed and the plausible biosynthesis was discussed. (C) 2013 Elsevier Ltd. All rights reserved.

Mercury sulfide is an insoluble inorganic mercury compound, and it is the main chemical form in traditional oral mercury-containing medicines. Hg2+ has a high affinity for thiols, and small molecule thiols in the gastrointestinal tract may promote mercury dissolution of mercury sulfide by binding to Hg2+. L-cysteine is the only amino acid that possesses a reducing sulfhydryl group (-SH), out of the 20 amino acids. This study investigates the effect of L-cysteine on mercury dissolution of mercury sulfide at pHs ranging from 1.2 to 7.2. The results showed that L-cysteine had different pH-dependent effects on the mercury dissolution of α-HgS and β-HgS. For α-HgS, the dissolved mercury concentration increased from 5.47 ± 0.97 ng/mL to 12.49 ± 0.54 ng/mL when the pH rose from 1.2 to 4.2, and decreased to 3.37 ± 0.70 ng/mL at pH 6.0 and then increased to 9.36 ± 0.79 ng/mL at pH 7.2. For β-HgS, the dissolved mercury concentration increased from 151.09 ± 2.25 ng/mL to 2346.71 ± 62.62 ng/mL when the pH increased from 1.2 to 7.2. In conclusion, L-Cys was distinctly enhanced upon mercury dissolution of α-HgS and β-HgS with increasing pH. These results may contribute to our understanding of the mercury absorption mechanism of traditional oral mercury-containing medicines.

• Gelatin was extracted from the Yak (<b>bos grunniens</b>) skin. • The different molecular weight distribution (MWD) Yak skin gelatin was extracted with pepsin by controlling the enzymolysis time. • The broad MWD Yak skin gelatin has higher imino acids contents and lower foamability and emulsibility compared with the narrow MWD gelatin. • The Yak skin gelatin has good thermotolerance.<br>Different molecular weight distribution (MWD) gelatin was extracted from Yak skin after enzymatic pretreatments and their physicochemical and functional properties (SDS-PAGE, UV-vis absorption spectra, DSC, FT-IR, Amino acid analysis, AFM, emulsibility and foamability) were analyzed. The gelatin was extracted by pepsin and got different MWD of Yak skin gelatin by controlling the enzymolysis time. The SDS-PAGE showed the MWD of the Yak skin gelatin. The UV-vis absorption turned out that the broad MWD of Yak skin gelatin had a higher maximum absorption peaks. The FT-IR and AFM indicated that the gelatin structures and microstructures changed with the change of the MWD. The broad MWD of the Yak skin gelatin had a higher denaturation temperature (TD), and it was higher than most of the other mammals and marine biological gelatin. The broad MWD gelatin also had higher imino acids (proline and hydroxyproline) contents and lower foamability and emulsibility compared to the narrow MWD gelatin. These findings, obtained for the first time for Yak skin gelatin, showed that it has great potential for application as an alternative to commercial gelatin due to its good thermotolerance, particularly in the applications of the biological materials, stabilizer of thermo-tolerant and so on.

It was estimated that about 428 species of genus Corydalis are distributed all worldwide, with about 298, especially 10 groups and 219 species being uniquely spread in China. The genus Corydalis have been widely employed as folk medicines in China, especially as traditional Tibetan medicines, for treatment of fever, hepatitis, edema, gastritis, cholecystitis, hypertension and other diseases. The phytochemical studies revealed that isoquinoline alkaloids are its major bioactive ingredients. The extensive biological researches suggested its pharmacological activities and clinic applications against cardiovascular diseases and central nervous system, antibacterial activities, analgesic effects, anti-inflammatory, anti-oxidation and anti-injury for hepatocyte, and so on. As an effort in promoting the research of pharmacodynamic ingredients, this article presents an overview focusing on the distribution, phytochemical and pharmacological results of Corydalis species that have been applied in traditional Tibetan medicinal, hopefully to provide a reference for the new Tibetan medicine development from Corydalis plant resource.

Ethnopharmacological relevanceFrankincense oil and water extracts (FOE, FWE) have long been used for external treatment of inflammation and pain. The present study was conducted to identify the active ingredients responsible for the anti-inflammatory and analgesic effects and to determine the underlying mechanisms. Materials and methods The compositions of FOE and FWE were identified and compared by GC–MS. The anti-inflammatory and analgesic activities of the two extracts and their possible active ingredients (α-pinene, linalool, and 1-octanol) were evaluated and compared in a xylene-induced ear edema model and a formalin-inflamed hind paw model. Inflammatory infiltrates and cyclooxygenase-2 (COX-2) expression in hind paw skin were investigated by histological staining. Results The contents of α-pinene, linalool, and 1-octanol in FOE were much higher than those in FWE. Mice treated with FOE exhibited greater and faster lessening of swelling and pain than mice treated with FWE. The combination of the three components had more potent pharmacological effects on hind paw inflammation and COX-2 overexpression than the three components used alone. Conclusions These findings suggest that topical application of FOE or its active ingredients (including α-pinene, linalool, and 1-octanol) exhibit significantly anti-inflammatory and analgesic effects through inhibiting nociceptive stimulus-induced inflammatory infiltrates and COX-2 overexpression.

A robust, direct, rapid and non-destructive X-ray diffraction crystallography method for detecting the Tibetan medicine Zuotai is presented. Powder samples of Zuotai, cinnabar and calomel were unambiguously characterized using powder X-ray diffractometry (PXRD) by comparing a practical identification of metacinnabar in the analyzed material, which confirmed the present of metacinnabar in Zuotai. At the same time, 11 strong lines in the fingerprint of Zuotai were selected to indicate the effective constituents of Zuotai, which were listed in the form of d-( I/I0 )%: metacinnabar 3.356 4/100, 2.061 4/55.0, 2.911 8/35.0, 1.760 1/37.0, 1.339 5/12.0, 1.304 5/10.0, 1.192 0/10.0, 1.683 4/7.0, 1.458 0/5.6. sulfur 3.824 4/100, 3.197 5/40.2, 3.442 2/38.1, 3.095 6/19.7, 5.690 9/16.8, 2.851 0/16.3, 2.414 4/11.3. The results showed that mercury chemical state is metacinnabar with sulfur in Tibetan medicine Zuotai. This method should be supplemented to quality control of rare traditonal Chinese medicine.

Chrysosplenium nudicaule,Tibetan name " Yajima",is recorded as an effective medicine for the treatment of liver and gallbladder diseases by Tibetan Pharmacopoeia published in the past dynasties,but its traditional efficacy has not yet been investigated by means of modern pharmacological research methods. In this paper,the protective effect of extract of C. nudicaule(ECN) on liver injury in mice was observed by using the mice model of intrahepatic cholestasis(IC) induced by α-naphthyl isothiocyanate(ANIT) and the possible mechanism by which ECN work as the therapeutic agent was discussed. The results showed that the serum levels of AST,ALT,ALP,DBIL,TBIL and TBA of the model mice were notably reduced in dose-dependent manner(P<0. 01,P<0. 05). The activity of SOD and GSH-Px in the liver homogenate of mice was increased,while the content of MDA was decreased(P<0. 01,P<0. 05).Pathological examination of liver in mice showed that ECN could improve the pathological changes of liver tissue in mice. The mRNA expression level of genes related to bile acid metabolism were detected by RT-PCR and the results suggested that ECN could significantly increase the expression of genes such as BSEP,FXR and MRP2(P<0. 01,P<0. 05),meanwhile significantly reduce the expression of CYP7 A1(P<0. 01,P<0. 05). These results confirmed the protective effect of ECN on intrahepatic cholestasis-induced liver injury in mice,and indicated that the mechanism may be related to activating FXR and its target genes,reducing bile acid synthesis and increasing bile acid excretion. This study provides a modern pharmacological basis for the clinical application of Yajima in Tibetan medicine.

OBJECTIVE: To establish the method of quality control for traditional Tibetan Medicine Zsuotai.METHODS: Collecting the samples of Tsuotai from Qinghai, Tibet, Sichuan, and Gansu province, to detect Hg2+ by Zsuotai reacted with HCl-HNO3 (3:1), and to determine the quantity of HgS in Zsuotai by sulfocyanate volumetric method. RESULTS: The method for the determination of HgS in Zsuotai was in good reproducibility (RSD = 0.68%). The calibration curve was linear (r = 0.9999) within -0.0002 - 0.2123 g of mercuric sulfide. The recovery was 100.94% (RSD = 0.66%). CONCLUSIONS: This method is convenient and accurate, so it can be used to establish quality control of the medicinal material.

Breast cancer (BC) patients in China suffered from a variety of psychology stress such as perceived stress and anxiety, posttraumatic growth (PTG) as a positive factor could promote their psychology health and quality of life. This study aimed to investigate the efficacy of mindfulness-based stress reduction (MBSR) on promoting PTG, decreasing perceived stress and anxiety of Chinese BC patients. A randomized controlled trial of 60 BC patients (Stages I–III) was conducted. They were randomly divided to the 8-week MBSR group or usual care (UC) group. PTG inventory, Perceived Stress Scale of Chinese version (CPSS) and State Trait Anxiety Inventory (STAI) evaluated the PTG level, perceived stress and anxiety at three times(before intervention-T1, after intervention-T2 and follow up at 3 months-T3). A repeated-measures analysis of variance model was used to compare each outcome measure of two groups at the three times. There was one patient discontinued the intervention and one lose to follow up in MBSR group, finally 58 BC patients completed the research. There was no difference between two groups before the intervention. The results showed significant improvements in MBSR group comparing with the UC group that PTG level was much higher after the 8-week intervention and the follow up (F = 34.73, p < .00). At the same time, CPSS (F = 14.41, p < .00) and STAI (F = 15.24, p < .00) scores were significant decreased at T2 and T3. The results showed that MBSR promoted the level of PTG and decreased perceived stress and anxiety state of Chinese BC patients, and the results persisted at three months after intervention. The research preliminary proved that MBSR was suitable to Chinese BC patients. MBSR should be recommending to BC survivors in China.

Purpose Previous research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings. Patients and Methods Patients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n = 53) or stretching (ST; n = 56) three times a week for 6 weeks during XRT or waitlist (WL; n = 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later. Results The YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P = .01 and P = .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P < .05), with ST and WL differences at only 3 months (P < .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P < .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P = .023 and P = .008) and 1 month after XRT (P = .05 and P = .04). Conclusion YG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability.

Purpose Previous research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings. Patients and Methods Patients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n = 53) or stretching (ST; n = 56) three times a week for 6 weeks during XRT or waitlist (WL; n = 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later. Results The YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P = .01 and P = .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P < .05), with ST and WL differences at only 3 months (P < .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P < .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P = .023 and P = .008) and 1 month after XRT (P = .05 and P = .04). Conclusion YG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability.

BACKGROUND: The current randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer who were undergoing chemotherapy. METHODS: Women with stage (American Joint Committee on Cancer (AJCC) TNM) I to III breast cancer who were undergoing chemotherapy were randomized to TYP (74 women), STP (68 women), or UC (85 women). Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by 3 booster sessions over the subsequent 6 months, and were encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline; 1 week after treatment; and at 3, 6, and 12 months. RESULTS: There were no group differences noted in total sleep disturbances or fatigue levels over time. However, patients in the TYP group reported fewer daily disturbances 1 week after treatment compared with those in the STP (difference, -0.43; 95% confidence interval [95% CI], -0.82 to -0.04 [P = .03]) and UC (difference, -0.41; 95% CI, -0.77 to -0.05 [P = .02]) groups. Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for patients in the STP group 1 week after treatment versus those in the TYP (difference, 15.36; 95% CI, 7.25-23.48 [P = .0003]) and UC (difference, 14.48; 95% CI, 7.09-21.87 [P = .0002]) groups. Patients in the TYP group who practiced at least 2 times a week during follow-up reported better Pittsburgh Sleep Quality Index and actigraphy outcomes at 3 months and 6 months after treatment compared with those who did not and better outcomes compared with those in the UC group. CONCLUSIONS: Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least 2 times a week. Cancer 2018;124:36-45. (c) 2017 American Cancer Society.

BACKGROUND: The current randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer who were undergoing chemotherapy. METHODS: Women with stage (American Joint Committee on Cancer (AJCC) TNM) I to III breast cancer who were undergoing chemotherapy were randomized to TYP (74 women), STP (68 women), or UC (85 women). Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by 3 booster sessions over the subsequent 6 months, and were encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline; 1 week after treatment; and at 3, 6, and 12 months. RESULTS: There were no group differences noted in total sleep disturbances or fatigue levels over time. However, patients in the TYP group reported fewer daily disturbances 1 week after treatment compared with those in the STP (difference, -0.43; 95% confidence interval [95% CI], -0.82 to -0.04 [P = .03]) and UC (difference, -0.41; 95% CI, -0.77 to -0.05 [P = .02]) groups. Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for patients in the STP group 1 week after treatment versus those in the TYP (difference, 15.36; 95% CI, 7.25-23.48 [P = .0003]) and UC (difference, 14.48; 95% CI, 7.09-21.87 [P = .0002]) groups. Patients in the TYP group who practiced at least 2 times a week during follow-up reported better Pittsburgh Sleep Quality Index and actigraphy outcomes at 3 months and 6 months after treatment compared with those who did not and better outcomes compared with those in the UC group. CONCLUSIONS: Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least 2 times a week. Cancer 2018;124:36-45. (c) 2017 American Cancer Society.

BACKGROUND The current randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer who were undergoing chemotherapy. METHODS Women with stage (American Joint Committee on Cancer (AJCC) TNM) I to III breast cancer who were undergoing chemotherapy were randomized to TYP (74 women), STP (68 women), or UC (85 women). Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by 3 booster sessions over the subsequent 6 months, and were encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline; 1 week after treatment; and at 3, 6, and 12 months. RESULTS There were no group differences noted in total sleep disturbances or fatigue levels over time. However, patients in the TYP group reported fewer daily disturbances 1 week after treatment compared with those in the STP (difference, -0.43; 95% confidence interval [95% CI], -0.82 to -0.04 [P = .03]) and UC (difference, -0.41; 95% CI, -0.77 to -0.05 [P = .02]) groups. Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for patients in the STP group 1 week after treatment versus those in the TYP (difference, 15.36; 95% CI, 7.25-23.48 [P = .0003]) and UC (difference, 14.48; 95% CI, 7.09-21.87 [P = .0002]) groups. Patients in the TYP group who practiced at least 2 times a week during follow-up reported better Pittsburgh Sleep Quality Index and actigraphy outcomes at 3 months and 6 months after treatment compared with those who did not and better outcomes compared with those in the UC group. CONCLUSIONS Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least 2 times a week. Cancer 2018;124:36-45. © 2017 American Cancer Society.

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