Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility:A systematic review and meta-analysis

BACKGROUND Acupuncture(AT)is widely used in treatment of ovulatory disorder infertility(ODI),but the safety and efficacy of AT for ODI still lack an evidence-based basis.AIM To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.METHODS The Cochrane Library,Embase,PubMed,VIP,China National Knowledge Infrastructure,WanFang Data,and Chinese biomedical literature databases were searched from inception to January 20,2024.Two reviewers independently selected studies,collected data,and evaluated methodological quality through the Cochrane Risk of Bias tool.Revman 5.4 was used for meta-analysis,and the Grade system was performed to evaluate the level of evidence for the outcomes of the meta-analysis.RESULTS A total of 20 randomized controlled trials with 1677 ODI patients were included.Compared with the clomiphene citrate(CC)group,the AT plus CC group exhibited significant improvement of the pregnancy rate[relative risk(RR)=1.68,95%confidence interval(CI):1.45-1.95,P<0.00001,I^(2)=23%],ovulation rate(RR=1.34,95%CI:1.22-1.47,P<0.00001,I^(2)=32%),serum E2 level[mean difference(MD)=31.36,95%CI:21.83-40.88,P<0.00001,I^(2)=97%],thickness of endometrium(MD=1.76,95%CI:0.71-2.81,P=0.001,I^(2)=98%)and decreasing miscarriage rate(RR=0.25,95%CI:0.09-0.65,P=0.005,I^(2)=0%),serum follicle-stimulating hormone level(MD=-2.10,95%CI:-3.27 to-0.94,P=0.0004,I^(2)=99%),serum luteinizing hormone level(MD=-6.94,95%CI:-9.89 to-4.00,P<0.00001,I^(2)=100%),and serum progesterone level(MD=-1.66,95%CI:-2.98 to-0.34,P=0.01,I^(2)=96%).The AT group had a more favorable effect than CC group for improving pregnancy rate(RR=1.52,95%CI:1.33-1.73,P<0.00001,I^(2)=0%),thickness of endometrium(MD=2.48,95%CI:2.15-2.81,P<0.00001,I^(2)=0%)and reducing miscarriage rate(RR=0.23,95%CI:0.13-0.44,P<0.00001,I^(2)=0%),serum follicle-stimulating hormone level(MD=-0.55,95%CI:-0.86 to-0.24,P=0.0005,I^(2)=0%),and serum progesterone level(MD=-0.24,95%CI:-0.28 to-0.20,P<0.00001).However,the level of evidence was predominantly assessed as very low to moderate.CONCLUSION AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI.However,further studies are needed to confirm these findings.

Electroacupuncture alleviates cerebral ischemia and reperfusion injury via modulation of the ERK1/2 signaling pathway

Electroacupuncture（EA） has anti-oxidative and anti-inflammatory actions,but whether the neuroprotective effect of EA against cerebral ischemia-reperfusion（I/R） injury involves modulation of the extracellular regulated kinase 1/2（ERK1/2） signaling pathway is unclear.Middle cerebral artery occlusion（MCAO） was performed in Sprague-Dawley rats for 2 hours followed by reperfusion for 24 hours.A 30-minute period of EA stimulation was applied to both Baihui（DU20） and Dazhui（DU14） acupoints in each rat（10 mm EA penetration depth,continuous wave with a frequency of 3 Hz,and a current intensity of 1–3 m A） when reperfusion was initiated.EA significantly reduced infarct volume,alleviated neuronal injury,and improved neurological function in rats with MCAO.Furthermore,high m RNA expression of Bax and low m RNA expression of Bcl-2 induced by MCAO was prevented by EA.EA substantially restored total glutathione reductase（GR）,glutathione（GSH） and glutathione peroxidase（GSH-Px） levels.Additionally,Nrf2 and glutamylcysteine synthetase（GCS） expression levels were markedly increased by EA.Interestingly,the neuroprotective effects of EA were attenuated when ERK1/2 activity was blocked by PD98059（a specific MEK inhibitor）.Collectively,our findings indicate that activation of the ERK1/2 signaling pathway contributes to the neuroprotective effects of EA.Our study provides a better understanding of the regulatory mechanisms underlying the therapeutic effectiveness of EA.

Moxibustion alleviates decreased ovarian reserve in rats by restoring the PI3K/AKT signaling pathway

Objective:Moxibustion,a common therapy in traditional Chinese medicine,has potential benefits for treating decreased ovarian reserve(DOR).The present study investigates the protective effect of moxibustion in a rat model of DOR and explores the possible mechanisms.Methods:Sixty-four female Sprague-Dawley rats were randomly divided into four groups:control,DOR,moxibustion(MOX),and hormone replacement therapy(HRT).The DOR rat model was established by intragastric administration of 50 mg/kg Tripterygium glycoside suspension(TGS),once daily for 14 days.MOX and HRT treatments were given from the day TGS administration was initiated.The ovarian reserve function was evaluated by monitoring the estrus cycle,morphological changes in ovaries,levels of serum estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),and anti-Mullerian hormone(AMH),pregnancy rate and embryo numbers.Terminal-deoxynucleotidyl transferase-mediated nickend-labeling staining was used to identify ovarian granulosa cell apoptosis,while the protein and m RNA expressions of Bax,B-cell lymphoma-2(Bcl-2),phosphatidylinositol 3-kinase(PI3 K)and protein kinase B(AKT)in ovarian tissues were examined by immunohistochemistry,Western blot and quantitative reverse transcription-polymerase chain reaction.Results:Compared with the DOR group,MOX improved the disordered estrous cycle,promoted follicular growth,reduced the number of atresia follicles,increased the concentrations of serum E2 and AMH,and decreased serum FSH and LH concentrations.More importantly,the pregnancy rate and embryo numbers in DOR rats were both upregulated in the MOX treatment group,compared to the untreated DOR model.Further,we found that the MOX group had reduced apoptosis of ovarian granulosa cells,increased Bcl-2 expression and reduced expression of Bax.Furthermore,the PI3 K/AKT signaling pathway was triggered by the moxibustion treatment.Conclusion:Moxibustion improved ovarian function and suppressed apoptosis of ovarian granulosa cells in a rat model of DOR induced by TGS,and the mechanism may involve the PI3 K/AKT signaling pathway.