Acupuncture at Baihui and Dazhui reduces brain cell apoptosis in heroin readdicts

Acupuncture at Baihui （GV20） and Dazhui （GV14） reduces neuronal loss and attenuates ultra- structural damage in cerebral ischemic rats. However, whether acupuncture can treat addiction and prevent readdiction through changes to brain cell ultrastructure remains unknown. In this study, cell apoptosis was observed in the hippocampus and frontal lobe of heroin readdicted rats by electron microscopy. Immunohistochemical staining displayed a reduction in Bcl-2 ex- pression and an increase in Bax expression in the hippocampus and frontal lobe. After rats were given acupuncture at Baihui and Dazhui, the pathological damage in the hippocampus and frontal lobe was significantly reduced, Bcl-2 expression was upregulated and Bax expression was downregulated. Acupuncture exerted a similar effect with methadone, a commonly used drug for clinical treatment of drug addiction. Experimental findings suggest that acupuncture at Dazhui and Baihui can prevent brain cell apoptosis in heroin readdicted rats.

An acupuncture meta-analysis for optic atrophy Seven randomized,controlled trials

OBJECTIVE： To evaluate the efficacy and safety of acupuncture for optic atrophy. DATA SOURCES： A computer-based online search was conducted in Medline （1966-2008）, Embase （1986-2008）, the Cochrane Library （up to 2008）, Chinese Biomedical Literature Database （1975-2008）, China National Knowledge Infrastructure （1994-2008）, VIP Database （1989-2008）, Wanfang Database （1980-2008） and the National Research Register for ongoing trials. DATA SELECTION： Randomized, controlled trials addressing acupuncture treatment for patients with optic atrophy were included in this review. Inclusion criteria evaluated all forms of acupuncture therapy, such as filiform needle, electro-acupuncture, laser-acupuncture, acupressure, and auricular-acupuncture. Comparisons between acupuncture therapy and no treatment （blank） or placebo or Chinese medicine or Western medicine, as well as between acupuncture as an adjuvant and other treatments, were included. Exclusion criteria included studies comparing different forms of acupuncture therapy, different manipulations of acupuncture, and different acupuncture prescriptions, as well as non-randomized, controlled trials and animal studies. The domain-based evaluation criteria recommended by the guidelines in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1 was used to assess quality of the included studies. According to the type of outcome index, measurement data as assessed by weighted mean difference or standardized mean difference and 95% confidence interval; numeration data was estimated by relative risk and 95% confidence interval. Heterogeneity was analyzed by Meta-analysis using RevMan 5.0 software. MAIN OUTCOME MEASURES： Improved visual acuity and visual field was sought between treatment and control groups in the included articles. RESULTS： Seven randomized, controlled trials were included after screening and application of inclusion and exclusion criteria. However, the studies were of low methodological quality and lacked comparisons between acupuncture and no treatment or placebo. Applying visual acuity as the outcome index, meta-analysis indicated： the effect of medicine combined with acupuncture was superior to the medicine alone （relative risk = 1.41, 95% confidence interval 1.14-1.70, P 〈 0.01 ）, the efficacy of acupuncture was better than medicine alone （relative risk =1.42, 95% confidence interval 1.14-1.77, P 〈 0.01 ）. Using visual field as the other outcome index, meta-analysis revealed： effectiveness of acupuncture or acupuncture in combination with medicine was superior to medicine alone （relative risk = 1.47, 95% confidence interval 1.27-1.69, P 〈 0.01 ）. The 7 included articles were incorporated in a sensitivity analysis, and the overall effect showed a significant difference （relative risk = 1.35, 95% confidence interval 1.16-1.56, P 〈 0.01）. Acupuncture was not associated with any adverse events in any of the studies. CONCLUSION： Acupuncture therapy was determined to be superior to medicine in terms of improved visual acuity and visual field. However, well-designed, randomized, controlled trials with adequate controls and scientific rigor are urgently needed.

Cerebral mechanism of puncturing at He-Mu point combination for functional dyspepsia: study protocol for a randomized controlled parallel trial

Acupuncture is widely used to treat functional dyspepsia with satisfactory outcomes. Combination of the He and Mu acupoints is commonly used and has a synergistic effect on functional dyspepsia; however, its underlying mechanisms remain unclear. Therefore, a randomized controlled parallel clinical trial is currently underway at Chengdu University of Traditional Chinese Medicine, China. This trial is designed to explore the efficacy of and central responses to the He-Mu point combination in patients with functional dyspepsia using functional magnetic resonance imaging. A total of 105 patients with functional dyspepsia will be allocated into 3 groups： the low-He point group（puncturing at Zusanli（ST36））, Mu point group（puncturing at Zhongwan（CV12））, and He-Mu point combination group（puncturing at ST36 and CV12）. Every participant will receive 20 sessions of manual acupuncture for 4 weeks. The needles will be inserted perpendicularly to a depth of 1 to 2 cun. The angle of rotation and twisting will range from 90 to 180 degrees, while lifting and thrusting will range from 0.3 to 0.5 cm. The various manipulations will be performed 60 to 90 times per minute. The needles will remain in place for 30 minutes, during which manipulation will be applied every 10 minutes. Magnetic resonance imaging will be performed before and after 20 sessions of acupuncture. The primary outcome is symptom improvement according to the Chinese version of the Nepean Dyspepsia Index. Secondary outcomes include the Leeds dyspepsia questionnaire, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Beck Anxiety Inventory, Beck Depression Inventory, and visual analogue scale scores before and after 10 and 20 sessions of acupuncture. Needle sensation and adverse events will be used to assess the therapeutic effects. This study will promote more widespread awareness of the benefits of acupoint combination in the clinical setting and provide a further explanation of the neuromechanism by which acupuncture at the He-Mu point combination for functional dyspepsia. Registration： Chinese Clinical Trial Registry, Chi CTR-IOR-15006402.

Neuroprotective effects of tectoridin on H_(2)O_(2)-induced damage in PC12 cells and an amyloid-infused rat model of Alzheimer's disease

Tectoridin,the main active ingredient in Belamcandachinensis(L.)Redoute,has been found to possess profound anti-inflammatory and antioxidant effects.However,the neuroprotective effects of tectoridin on Alzheimer's disease remain unclear.In our study,treatment with 400μmol/L H_(2)O_(2) on PC12 was employed to establish the oxidative stress cellular damage model in vitro.

Pathophysiological changes of muscle after ischemic stroke:a secondary consequence of stroke injury

Sufficient clinical evidence suggests that the damage caused by ischemic stroke to the body occurs not only in the acute phase but also during the recovery period,and that the latter has a greater impact on the long-term prognosis of the patient.However,current stroke studies have typically focused only on lesions in the central nervous system,ignoring secondary damage caused by this disease.Such a phenomenon arises from the slow progress of pathophysiological studies examining the central nervous system.Further,the appropriate therapeutic time window and benefits of thrombolytic therapy are still controversial,leading scholars to explore more pragmatic intervention strategies.As treatment measures targeting limb symptoms can greatly improve a patient’s quality of life,they have become a critical intervention strategy.As the most vital component of the limbs,skeletal muscles have become potential points of concern.Despite this,to the best of our knowledge,there are no comprehensive reviews of pathophysiological changes and potential treatments for post-stroke skeletal muscle.The current review seeks to fill a gap in the current understanding of the pathological processes and mechanisms of muscle wasting atrophy,inflammation,neuroregeneration,mitochondrial changes,and nutritional dysregulation in stroke survivors.In addition,the challenges,as well as the optional solutions for individualized rehabilitation programs for stroke patients based on motor function are discussed.

Electroacupuncture Promotes Functional Recovery after Facial Nerve Injury in Rats by Regulating Autophagy via GDNF and PI3K/m TOR Signaling Pathway

Objective:To explore the mechanism of electroacupuncture(EA) in promoting recovery of the facial function with the involvement of autophagy,glial cell line-derived neurotrophic factor(GDNF),and phosphatidylinositol-3-kinase(PI3K)/mammalian target of rapamycin(mTOR) signaling pathway.Methods:Seventy-two male Sprague-Dawley rats were randomly allocated into the control,sham-operated,facial nerve injury(FNI),EA,EA+3-methyladenine(3-MA),and EA+GDNF antagonist groups using a random number table,with 12 rats in each group.An FNI rat model was established with facial nerve crushing method.EA intervention was conducted at Dicang(ST 4),Jiache(ST 6),Yifeng(SJ 17),and Hegu(LI 4) acupoints for 2 weeks.The Simone’s 10-Point Scale was utilized to monitor the recovery of facial function.The histopathological evaluation of facial nerves was performed using hematoxylin-eosin(HE) staining.The levels of Beclin-1,light chain 3(LC3),and P62 were detected by immunohistochemistry(IHC),immunofluorescence,and reverse transcriptionpolymerase chain reaction,respectively.Additionally,IHC was also used to detect the levels of GDNF,Rai,PI3K,and mTOR.Results:The facial functional scores were significantly increased in the EA group than the FNI group(P<0.05 or P<0.01).HE staining showed nerve axons and myelin sheaths,which were destroyed immediately after the injury,were recovered with EA treatment.The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats(P<0.01);however,EA treatment reversed these abnormal changes(P<0.01).Meanwhile,EA stimulation significantly increased the levels of GDNF,Rai,PI3K,and mTOR(P<0.01).After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist,the repair effect of EA on facial function was attenuated(P<0.05 or P<0.01).Conclusions:EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI.EA may exert this neuroreparative effect through mediating the release of GDNF,activating the PI3K/mTOR signaling pathway,and further regulating the autophagy of facial nerves.

Immediate Effect of Electro-acupuncture on Endometrial Blood Flow in Patients with Recurrent Implantation Failure:A Randomized Controlled Trial

Objective To investigate the immediate effects of electro-acupuncture(EA)on endometrial blood flow among recurrent implantation failure(RIF)patients.Methods Eighty RIF patients,enrolled from March 2022 to December 2022,were randomly allocated into either the EA group(40 cases)or the waiting-list(WL)group(40 cases)by using a random number table.The EA group underwent acupuncture at points of Shenting(GV 24),Baihui(GV 4),Benshen(GB 13),bilateral Zigong(EX-CA 1),Huangshu(KI 16),Sanyinjiao(SP 6)and Xuehai(SP10),and electric acupuncture apparatus was connected to EX-CA 1,KI 16,SP 6,and SP 10 with disperse-dense waves at 4/20 Hz frequencies for 30 min after transvaginal ultrasound,while the WL group received no intervention.The primary outcome measured was the endometrial volume blood flow.The secondary outcomes included the bilateral uterine artery index,endometrial volume,endometrial blood flow type,vascular distribution index(VI^(MV))for endometrial and ovary,clinical pregnancy rate,and embryo implantation rate.Results In the EA group,there was a notable decrease in the bilateral pulsatility index and a significant improvement in the endometrial blood flow type post-EA(P<0.05).Both the endometrial blood flow type and VI^(MV) for the endometrium and right ovary were markedly higher in the EA group compared to the WL group post-treatment(P<0.05).Conversely,no significant disparities were observed in vascular index,flow index,vascular blood flow index,uterine arterial blood flow indices,endometrial volume,clinical pregnancy rate and embryo implantation rate between the two groups after treatment(P>0.05).Besides,no adverse events related to EA were observed.Conclusions EA can promptly ameliorate VI^(MV) for the endometrial and right ovary,and endometrial blood flow type.Future randomized controlled trials are warranted to investigate the long-term effects of EA on blood flow of RIF patients and its implications for pregnancy outcomes.(Trial registration No.ChiCTR2200057377).

Global research trends in postoperative ileus from 2011 to 2023:A scientometric study

BACKGROUND Postoperative ileus(POI)is a common complication after abdominal surgery with high morbidity,which hinders patient recovery,prolongs hospitalization,and increases healthcare costs.Therefore,POI has become a global public health challenge.POI triggering is multifactorial.Autonomic and hormonal mechanisms are generally involved in POI pathogenesis.Recent studies have shown that beta adrenergic signaling of enteric glia is a POI trigger.Currently,the status quo,trends,and frontiers of global research on POI remain unclear.AIM To explore the current status,trends,and frontiers of POI research from 2011 to the present based on bibliometric analysis.METHODS Publications published on POI research from 2011 to 2023 were retrieved on June 1,2023,from the Web of Science Core Collection.CiteSpace 6.2.R2 and VOSviewer were used to conduct bibliometric visualization.RESULTS In total,778 POI records published from 2011 to 2023 were retrieved.Over the past few decades,the annual cumulative number of related articles has linearly increased,with China and the United States of America contributing prominently.All publications were from 59 countries and territories.China and the University of Bonn were the top contributing country and institution,respectively.Neurogastroenterology&Motility was the most prolific journal.The Journal of Gastrointestinal Surgery had the highest number of citations.Wehner Sven was the most productive author.Burst keywords(e.g.,colon,prolonged ileus,acupuncture,paralytic ileus,pathophysiology,rectal cancer,gastrointestinal function,risk)and a series of reference citation bursts provided evidence for the research frontiers in recent years.CONCLUSION This study demonstrates trends in the published literature on POI and provides new insights for researchers.It emphasizes the importance of multidisciplinary cooperation in the development of this field.

Efficacy of acupuncture in refractory irritable bowel syndrome patients:a randomized controlled trial

Previous studies have confirmed that acupuncture for irritable bowel syndrome(IBS)provided an additional benefit over usual care alone.Therefore,we performed a multicenter,randomized,sham-controlled trial to assess the efficacy and safety of acupuncture versus sham acupuncture for refractory IBS in patients in the context of conventional treatments.Patients in the acupuncture and sham acupuncture groups received real or sham acupuncture treatment in 3 sessions per week for a total of 12 sessions.The primary outcome was a change in the IBS–Symptom Severity Scale(IBS-SSS)score from baseline to week 4.A total of 521 participants were screened,and 170 patients(85 patients per group)were enrolled and included in the intention-to-treat analysis.Baseline characteristics were comparable across the two groups.From baseline to 4 weeks,the IBS-SSS total score decreased by 140.0(95%CI:126.0 to 153.9)in the acupuncture group and 64.4(95%CI:50.4 to 78.3)in the sham acupuncture group.The between-group difference was 75.6(95%CI:55.8 to 95.4).Acupuncture efficacy was maintained during the 4-week follow-up period.There were no serious adverse events.In conclusion,acupuncture provided benefits when combined with treatment as usual,providing more options for the treatment of refractory IBS.

Clinical research on Tai Chi:a review of health benefits

Tai Chi,a traditional Chinese martial art and health exercise,has gained significant global attention and recognition.The clinical benefits of Tai Chi have been studied extensively in recent decades.We conducted a systematic search of PubMed,Web of Science,EMBASE databases,and the China National Knowledge Infrastructure,identifying and reviewing 241 clinical trials on the benefits of Tai Chi from their inception to June 1,2023.Most of these studies have consistently demonstrated the positive impact of Tai Chi on balance,cognitive function,mood regulation,sleep quality,pain relief,cardiorespiratory function,and overall health.In the future,the key to fostering the ongoing development of this field lies in comprehensive research on standardized study designs and reporting,the scope of Tai Chi applications,and the core factors influencing its efficacy.

Moxibustion inhibits the macrophage M1 polarization toll-like receptor 4/myeloid differentiation factor 88/nuclear factor kappa B signaling pathway by regulating T-cell immunoglobulin and mucin-containing protein-3 in rheumatoid arthritis

OBJECTIVE: To explore whether moxibustion exerts therapeutic effects on rheumatoid arthritis(RA) by regulating the expression of T-cell immunoglobulin and mucin-containing protein-3(TIM-3) and subsequently modulating the macrophage M1 polarization toll-like receptor 4(TLR4)-myeloid differentiation factor 88(My D88)-nuclear factor kappa B(NF-κB) signaling pathway. METHODS: We utilized moxibustion treatment in RA rat models using the Zusanli(ST36) and Shenshu(BL23) acupoints. Hematoxylin and eosin(HE) staining was used to observe the pathological changes of the synovial tissue under a section light microscope, and pathological scoring was performed according to the grading standard of the degree of synovial tissue disease. Enzyme-linked immunosorbent assay(ELISA) was applied to verify the efficacy of moxibustion in reducing inflammation. Quantitative real-time polymerase chain reaction(q RTPCR) was used to detect the expression of the TIM-3/TLR4-My D88-NF-κB signaling pathway-related molecules, and Western blot was used to detect the contents of synovial NF-κB. RESULTS: We established the Freund's complete adjuvant(FCA)-induced RA model in rats. The expression level of M1 polarization signaling pathway TLR4-My D88-NF-κB and the inflammatory factors interleukin-12(IL-12), tumor necrosis factor alpha(TNF-α), and tumor necrosis factor beta(TNF-β) were significantly increased in the RA model. After moxibustion treatment, the expression level of TLR4-My D88-NF-κB was significantly decreased, and the inflammatory factors IL-12, TNF-α, and TNF-β were decreased, but the expression level was significantly increased in the RA model. When TIM-3 expression was inhibited, the expression level of TLR4-My D88-NF-κB, and the inflammatory factors IL-12, TNF-α, and TNF-β were not suppressed, even after moxibustion treatment. CONCLUSIONS: Moxibustion regulates the key target TIM-3 by acting on the Zusanli(ST36) and Shenshu(BL23) points, thereby inhibiting the M1 polarization of macrophages;that is, it inhibits the TLR4-My D88-NF-κB signaling pathway, and finally achieves alleviation of pathological changes and anti-inflammatory effects.

Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial

Background: Insomnia is a common complaint that is closely related to gastrointestinal symptoms, which is consistent with the traditional Chinese medicine classical theory of ‘‘stomach disharmony leading to restless sleep." Acupuncture is an effective complementary and alternative medicine therapy to improve gastrointestinal function and restore the normal sleep-wake cycle. However, studies on the effectiveness of acupuncture for insomnia due to spleen-stomach disharmony syndrome are limited to case reports and few randomized controlled trials; deeper research on its mechanism is still lacking. This randomized controlled trial aims to assess the treatment efficacy of ‘‘harmonizing stomach to tranquilize mind"acupuncture for insomnia and its influence on the intestinal microbiome.Methods/design: This is a randomized, single-blind, parallel-group study. Sixty eligible patients with insomnia due to spleen-stomach disharmony syndrome will be randomly divided into two groups(1:1 allocation ratio). The intervention group will use ‘‘harmonizing stomach to tranquilize mind"acupuncture, and the control group will receive sham acupuncture. Participants will receive 5 acupuncture treatment sessions per week for 4 consecutive weeks. The Pittsburgh Sleep Quality Index will be used to evaluate the clinical efficacy of acupuncture treatment by making assessments at baseline, the end of treatment and the end of the follow-up. High-throughput 16 S ribosomal ribonucleic acid gene sequencing will be performed to detect changes in the intestinal microbial composition before and after treatment.Discussion: The results of this trial are expected to confirm that ‘‘harmonizing stomach to tranquilize mind" acupuncture can effectively relieve insomnia and alter the intestinal microbiome.

Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis

Background: Some depressed patients receive acupuncture as an adjunct to their conventional medications.Objective: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.Search strategy: English and Chinese databases were searched for randomized controlled trials(RCTs)published until December 1, 2021.Inclusion criteria: RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.Data extraction and analysis: Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran’s Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose.The Grading of Recommendations Assessment, Development and Evaluation(GRADE) framework was used to evaluate the overall quality of evidence in the included studies.Results: This review included 16 studies(with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17(HAMD-17) scores(standard mean difference [SMD]-0.44, 95% confidence interval [CI]-0.55 to-0.33, P < 0.01;I^(2)= 14%), Self-rating Depression Scale(SDS) scores(SMD-0.53, 95% CI-0.84 to-0.23, P < 0.01;I^(2)= 79%), and the Side Effect Rating Scale(SERS) scores(SMD-1.11, 95% CI-1.56 to-0.66, P < 0.01;I^(2)= 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores(SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01;I^(2)= 15%), decreased the number of participants who increased their antidepressant dosages(relative risk[RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01;I^(2)= 0%), and resulted in significantly higher remission rates(RR1.52, 95% CI 1.26 to 1.83, P < 0.01;I^(2)= 0%) and treatment responses(RR 1.35, 95% CI 1.24 to 1.47, P < 0.01;I^(2)= 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.Conclusion: Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.Systematic review registration: INPLASY202150008.

Efficacy of acupuncture therapy for post-stroke fatigue:a systematic review and Meta-analysis

OBJECTIVE:To assess the effectiveness and safety of acupuncture for post-stroke fatigue(PSF).METHODS:Eight online databases were searched to collect relevant trials of acupuncture for PSF published before April 2021.Meta-analysis was performed by using RevMan 5.4 software.The Grading of Recommendations,Assessment,Development and Evaluation system was used to assess the certainty of evidence.RESULTS:Four randomized controlled trials involving 289 PSF patients were identified and included in the systematic review.The results of the Meta-analysis revealed that acupuncture group was significantly better than routine treatment group in improving the effective rate[risk ratio(RR)=1.15,95%CI(1.01,1.33),P=0.04],reducing the FSS score[mean difference(MD)=-4.71,95%CI(-6.22,-3.20),P<0.00001]and FMA score[MD=15.60,95%CI(11.96,19.23),P<0.00001].Side effects of acupuncture were mild and rarely reported.The certainty of evidence of the outcomes based on the four trials was assessed as low.CONCLUSIONS:The existing evidence suggests acupuncture as an adjunct to routine treatment may benefit in managing fatigue in stroke patients.However,high-quality RCTs are needed to further confirm these findings.

Regional brain structural abnormality in ischemic stroke patients:a voxel-based morphometry study

Our previous study used regional homogeneity analysis and found that activity in some brain areas of patients with ischemic stroke changed significantly. In the current study, we examined structural changes in these brain regions by taking structural magnetic resonance imaging scans of 11 ischemic stroke patients and 15 healthy participants, and analyzing the data using voxel-based morphometry. Compared with healthy participants, patients exhibited higher gray matter density in the left inferior occipital gyrus and right anterior white matter tract. In contrast, gray matter density in the right cerebellum, left precentral gyrus, right middle frontal gyrus, and left middle temporal gyrus was less in ischemic stroke patients. The changes of gray matter density in the middle frontal gyrus were negatively associated with the clin- ical rating scales of the Fugl-Meyer Motor Assessment （r = -0.609, P = 0.047） and the left middle temporal gyrus was negatively correlated with the clinical rating scales of the nervous functional deficiency scale （r = -0.737, P = 0.010）. Our findings call objectively identify the functional abnormality in some brain regions of ischemic stroke patients.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews

Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.

Effect of Acupuncture on Expressions of InsR—β;mRNA and Protein in the Liver of Rats with Insulin Resistance

Objective： To observe the effect of acupuncture on the expressions of insulin receptor β （InsR-β） mRNA and protein in the liver of experimental rats with insulin resistance （IR）. Method： Twenty-four rats were randomly divided into 3 groups, control group （n=8）, model group （n=8） and acupuncture group （n=8）. Rats in the control group were fed with conventional food, and the other rats were induced into insulin resistance model with high fatsugar-salt food. Once model was induced successfully, rats in the control group were fed with conventional food continually, rats in the model group were fed with high fat-sugar-salt food continually, and rats in the acupuncture group were fed with high fat-sugar-salt food, and treated with acupuncture for 2 weeks. The expression of InsR-β mRNA was detected by real-time fluorescent quantitative RT-PCR, and the expression of InsR-β protein was detected by Western blot. Result： Expressions of InsR-β mRNA and protein in the model group were significantly lower than those in the control group （P〈0.01）, and those in the acupuncture group were higher than those in the model group （P〈0.0l, P〈0.05）. The expressions of InsR-β mRNA and protein between the acupuncture and control group had no significant difference. Conclusion： Acupuncture treatment can increase the expressions of InsR-β mRNA and protein in IR rats＇ liver to improve insulin resistance.

Head Acupuncture Plus Schuell's Language Rehabilitation for Post-Stroke Aphasia:A Systematic Review and Meta-Analysis of 32 Randomized Controlled Trials

Objective:To evaluate the existing randomized controlled trials(RCTs)for evidence of the efficacy and safety of head acupuncture(HA)plus Schuell’s language rehabilitation(SLR)in post-stroke aphasia.Methods:Seven databases including Embase,PubMed,Cochrane Library,Technology Periodical Database,the China National Knowledge Infrastructure,SinoMed and Wanfang Data Information Site were searched for RCTs published from database inception until November 14,2021.RCTs that compared HA plus SLR with sham(or blank)control,acupuncture therapy alone,certain language rehabilitation therapy alone or other therapies for post-stroke aphasia were included.Data were extracted and assessed,and the quality of RCTs was evaluated.Fixed-effects model was used,with meta-influence analysis,meta-regression,and regression-based sub-group analyses applied for exploration of heterogeneity.Publication bias was estimated by funnel plots and Egger’s tests.Results:A total of 32 RCTs with1,968 patients were included and 51 comparisons were conducted classified as types of strokes and aphasia.(1)For patients with aphasia after ischemic stroke,HA plus PSA showed significantly higher accumulative markedly effective rate[relative risk(RR)=1.55,95% confidence interval(CI):1.19-2.02,I^(2)=0%]and accumulative effective rate(RR=1.22,95%CI:1.09-1.36,I^(2)=0%).(2)For patients with comprehensive types of stroke,HA plus PSA was more effective in increasing recovery rate(RR=1.89,95%CI:1.39-2.56,I^(2)=0%),accumulative markedly effective rate(RR=1.53,95%CI:1.36-1.72,I^(2)=9%)and accumulative effective rate(RR=1.14,95%CI:1.09-1.19,I^(2)=34%).(3)For patients with aphasia after stroke,HA plus PSA was superior to PSA alone with statistical significance in increasing recovery rate(RR=2.08,95%CI:1.24-3.46,I^(2)=0%),accumulative markedly effective rate(RR=1049,95%CI:1.24-1.78,I^(2)=0%)and accumulative effective rate(RR=1.15,95%CI:1.06-1.24,12=39%).(4)For patients with multiple types of aphasia,HA plus PSA also demonstrated significantly higher recovery rate(RR=1.86,95%CI:1.28-2.72,I^(2)=0%),accumulative markedly effective rate(RR=1.55,95%CI:1.35-1.78,I2=22%),and accumulative effective rate(RR=1.17,95%CI:1.11-1.23,I^(2)=41%).(5)For patients with motor aphasia after ischemic stroke,compared with PSA alone,HA plus PSA showed significantly higher accumulative markedly effective rate(RR=1.38,95%CI:1.06-1079,I^(2)=0%)and accumulative effective rate(RR=1.20,95%CI:1.05-1.37,I^(2)=0%).Meta-regression analyses were performed without significant difference,and publication bias was found in some comparisons.Conclusion:HA plus SLR was significantly associated with better language ability and higher effective rate for patients with post-stroke aphasia,and HA should be operated cautiously especially during acupuncture at eye and neck.(Registration No.CRD42020154475).

嘌呤信号通路对成熟神经祖细胞功能的调节

细胞外的嘌呤是胚胎发育过程中脑和脊髓原位内的信号分子,它们通过激活胚胎神经干细胞(NSCs)及成熟神经祖细胞(NPCs)表面的嘌呤受体发挥作用。虽然NSCs/NPCs内表达了能和几乎所有核苷酸敏感型P2X/P2Y受体和核酸敏感型腺苷受体相作用的m RNA和蛋白,但其中只有一部分具有功能。ATP被异位核苷酸酶依次降解为ADP,AMP和腺苷,它们都是神经激动剂并作用于不同类型的受体。核苷酸/核苷促进或抑制NSC/NPC增殖、迁移和分化。所有激动剂(特别是ATP和ADP)的最普遍的作用是促进细胞增殖,常通过P2Y1Rs,有时也通过P2X7Rs。但P2X7R的激活通常导致NPCs的坏死或凋亡。激活P2Y2R或阻断P2X7R可促进神经细胞的分化。转导机制的核心是细胞内游离钙离子浓度的升高,游离的钙离子可能来自细胞内的释放(G蛋白偶联;P2Y),或细胞外的钙离子通过被激活的受体通道进入细胞内(ATP门控离子通道;P2X)。进一步的研究将着重阐明嘌呤信号通道如何调控NSC/NPC的分化,以及静息和活化状态之间的平衡如何通过精细和动态的调节来建立。

Common traditional Chinese medicine therapies for diarrhea-predominant irritable bowel syndrome: An overview of systematic reviews

Objective: To critically evaluate and summarize the methodological quality of systematic reviews(SRs)and present objective and important outcomes on the effectiveness of traditional Chinese medicine(TCM) therapies, including Chinese herbal medicine(CHM), acupuncture, and moxibustion, for diarrheapredominant irritable bowel syndrome(IBS-D).Methods: We conducted a comprehensive literature search for SRs in 7 databases until April 16, 2022.Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2(AMSTAR-2), the Risk of Bias in Systematic reviews(ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis(PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation(GRADE) was used to rate the quality of evidence.Results: IBS-D patients included in 12 reviews were diagnosed in accordance with the Rome criteria, 9 reviews focused on CHM, 2 articles observed moxibustion and heat-sensitive moxibustion, 1 article studied acupuncture and CHM. The outcomes of the SRs were the effectiveness rate, the total effectiveness rate,global symptom improvement, and adverse effects. Based on AMSTAR-2, which measures the quality of methodology, all of the included studies were of low or critically low quality. According to the ROBIS tool, 10 SRs(83.33%) had a high risk of bias. With the PRISMA checklist, only 3 SRs reached over 90% compliance.Based on GRADE, most evidence was of low quality, and there was a moderate quality of evidence that the effectiveness rate of modified-Tongxie Yaofang was superior to Western medicine in the treatment of IBS-D.Conclusion: Given the suboptimal reporting and methodological quality of existing SRs, more studies are needed to clarify whether TCM therapies are more effective or safe than pharmacological medicine.Future studies should combine evidence-based medicine with TCM research according to the characteristics of TCM.