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.

Acupuncture therapies in combination with conservative treatments for postoperative ileus:a systematic review and network meta-analysis

Background:Although acupuncture therapies have been widely used in combination with conservative treatments(CT)for postoperative ileus(POI),evidence of their safety and efficacy remains scarce.To evaluate and rank the efficacy of different acupuncture therapies combined with CT for POI.Methods:A comprehensive search was carried out in several databases(Embase,PubMed,Cochrane Library,Chinese National Knowledge Infrastructure,Wanfang Data,VIP Chinese Science and Technology Periodical Database and China Biology Medicine disc)for relevant randomized controlled trials(RCTs)investigating different acupuncture therapies for POI from inception to February 17,2023.The Cochrane risk of bias tool was used to determine the risks of bias of the included RCTs.The primary outcomes included the time to first defecation,time to first flatus,and time to first bowel movement;and the secondary outcome was the response rate.Pairwise meta-analysis was performed by Review Manager 5.3 software,and network meta-analysis was carried out by Stata v.15.0 software.The cumulative ranking curve was obtained with Stata v.15.0 and was utilized to rank the included treatments.Results:29 studies with 2,600 participants were included in this systematic review.This meta-analysis demonstrated that all acupuncture therapies combined with CT were superior to conservative treatments alone in time to first defecation,time to first flatus,time to first bowel movement,and response rate.Among 10 evaluated methods,auricular needle with CT was the most effective treatment to reduce the time to first defecation.Furthermore,moxibustion with CT was the most effective in reducing the time to first flatus,and warm needling with CT most markedly reduced the time to first bowel movement among 9 interventions.Moreover,manual acupuncture with CT showed the largest improvement in response rate.Conclusion:This meta-analysis revealed that all acupuncture therapies are effective and safe for POI,with warm needling+CT being the most effective way to relieve symptoms.These results indicated that acupuncture therapies combined with CT should be considered for POI patients.However,most of the included trials were ranked as moderate quality,and further large-scale,high-quality RCTs are required to confirm the optimal interventions for POI patients.

Changes of resting cerebral activities in subacute ischemic stroke patients

This study aimed to detect the difference in resting cerebral activities between ischemic stroke pa- tients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunc- tion and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage （15 days to 11.5 weeks） and 15 age-matched healthy participants. A rest- ing-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely po- tential targets for the neural regeneration of subacute ischemic stroke patients.

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.

Translation and validation of the Nepean Dyspepsia Index for functional dyspepsia in China

AIM： To assess the reliability and validity of the translated version of Nepean Dyspepsia Index （NDI） in Chinese patients with documented functional dyspepsia （FO）. METHODS： The translation process included forward translation, back translation, pretest and cross-cultural adaptation. Reliability and validity of the translated version were examined by asking 300 subjects to complete the Chinese version of the NDI. The mean age of subjects was 39.24 years and 68.7% of the subjects were women. Internal consistency analysis with Cronbach＇s α was performed to test the reliability. Correlation analysis was used to assess the content validity. Factor analysis and structural equation models were used to assess the construct validity. RESULTS： The Cronbach＇s α coefficients ranged 0.833-0.960, well above the acceptable level of 0.70. Correlation analysis showed that each item had a strong correlation with the corresponding domain, but a weak correlation with other domains. Confirmatory factor analysis indicated that the comparative fit index was 0.94, higher than the acceptable level of 0.90.CONCLUSION： The Chinese version of the NDI is a reliable and valid scale for measuring health-related quality of life and disease severity in Chinese patients with FD.

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.

Acupuncture and/or moxibustion for the treatment of lumbar disc herniation:quality assessment of systematic reviews

Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.

Transcutaneous electrical acupoint stimulation benefits postoperative pain relief of oocyte retrieval:A randomized controlled trial

Background Transvaginal oocyte retrieval is frequently followed by adverse events related to anesthesia and the procedure.Some research showed that transcutaneous electrical acupoint stimulation(TEAS)can relieve intraoperative pain and postoperative nausea.Objective This study examined whether TEAS can alleviate pain and relieve adverse symptoms after oocyte retrieval.Design,setting,participants and interventions Altogether 128 patients were randomly divided into the TEAS group and the mock TEAS group.The two groups received a 30-minute-long TEAS or mock TEAS treatment that began 30 min after oocyte retrieval.Main outcome measures The primary outcome was the visual analog scale(VAS)pain score.Secondary outcomes were pressure pain threshold,McGill score,pain rating index(PRI),present pain intensity(PPI),VAS stress score,VAS anxiety score,and postoperative adverse symptoms.Results The baseline characteristics of the two groups were comparable(P>0.05).The VAS pain scores of the TEAS group were lower than those of the mock TEAS group at 60 and 90 min after oocyte retrieval(P<0.05).The McGill score,PRI and PPI in the TEAS group were significantly lower than those in the control group at 60 min after oocyte retrieval(P<0.05).However,the two groups had equivalent beneficial effects regarding the negative emotions,such as nervousness and anxiety(P>0.05).The TEAS group was superior to the mock TEAS group for relieving postoperative adverse symptoms(P<0.05).Conclusion TEAS treatment can relieve postoperative pain and postoperative adverse symptoms for patients undergoing oocyte retrieval.

Efficacy and safety of acupuncture for polycystic ovary syndrome:An overview of systematic reviews

Background:Polycystic ovary syndrome(PCOS)is the primary cause of anovulatory infertility,bringing serious harm to women’s physical and mental health.Acupuncture may be an effective treatment for PCOS.However,systematic reviews(SRs)on the efficacy and safety of acupuncture for PCOS have reported inconsistent results,and the quality of these studies has not been adequately assessed.Objective:To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS,as well as to assess the quality and risks of bias of the available SRs.Search strategy:Nine electronic databases(Cochrane Library,MEDLINE,Embase,PsycINFO,CINAHL,Chinese National Knowledge Infrastructure,Wanfang Data,Chongqing VIP Chinese Science and Technology Periodical Database,and China Biology Medicine disc)were searched from their establishment to July 27,2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“acupuncture,”“polycystic ovary syndrome,”and“systematic review.”Inclusion criteria:SRs of randomized controlled trials that explored the efficacy and(or)safety of acupuncture for treating patients with PCOS were included.Data extraction and analysis:Two authors independently extracted study data according to a predesigned form.Tools for evaluating the methodological quality,risk of bias,reporting quality,and confidence in study outcomes,including A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),Risk of Bias in Systematic Reviews(ROBIS),Preferred Reporting Items for Systematic Reviews and Metaanalyses for Acupuncture(PRISMA-A),and the Grading of Recommendations Assessment,Development and Evaluation(GRADE),were used to score the included SRs.Results:A total of 885 studies were retrieved,and 11 eligible SRs were finally included in this review.The methodological quality of 2 SRs(18.18%)was low,while the other 9 SRs(81.82%)were scored as extremely low.Four SRs(36.36%)were considered to be of low risk of bias.As for reporting quality,the reporting completeness of 9 SRs(81.82%)was more than 70%.Concerning the confidence in study results,2study results were considered to have a high quality of evidence(3.13%),14(21.88%)a“moderate”quality,28(43.75%)a“low”quality,and 20(31.24%)considered a“very low”quality.Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate(CPR)and ovulation rate,and reduce luteinizing hormone/follicle-stimulating hormone ratio,homeostasis model assessment of insulin resistance,and body mass index(BMI).When compared with medicine alone,acupuncture alone also can improve CPR.Further,when compared with no intervention,acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI.Acupuncture was reported to cause no adverse events or some adverse events without serious harm.Conclusion:The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence.More high-quality studies are needed to support the use of acupuncture in PCOS.

Changed ACC-DMN functional connectivity after acupuncture with deqi for functional dyspepsia treatment

Objective:To clarify altered whole brain functional connectivity of the anterior cingulate cortex(ACC)in functional dyspepsia(FD)patients,and then to explore cerebral influence of acupuncture with deqi treating for FD.Methods:Thirty-two FD patients and 35 healthy subjects(HS)were firstly scanned by the resting-state blood oxygenation level-dependent functional magnetic resonance imaging(BOLD-fMRI)to compare differences of ACC-based functional connectivity(FC).Then 32 FD patients were randomized to receive 20 sessions’acupuncture treatment with(n=16)and without deqi(n=16),as well as underwent functional magnetic resonance imaging(fMRI)scans after treatment.After group re-division according to deqi response,changes of ACC subregions-based resting-state FC(rsFC)were compared between the actual with and without deqi group.Two seeds with bilateral of each were selected as regions of interest(ROIs)of the ACC,including two from the dorsal ACC:S2(BA24)(x=±5,y=2,z=46,r=3.5 mm)and two from the pregenual ACC:17(BA24)(x=±5,y=38,z=6,r=3.5 mm).The clinical changes of the Nepean Dyspepsia Index(NDI)that measuring symptoms and quality of life(QOL)were also used to further assess the correlation with ACC subregions rsFC in FD patients.Results:Compared to HS,FD patients showed significantly increased ACC subregions rsFC with left fusiform gyrus,temporal cortex,hippocampus(HIPP)/amygdala,temporal pole,and right INS,superior occipital gyrus,and bilateral precuneus,superior parietal lobule(SPL),and decreased rsFC with left postcentral/precentral gyrus(PoG/PrG),supplementary motor area(SMA)and right cerebellum.32 FD patients which were then re-divided into the actual deqi group(n=16)and actual without deqi group(n=16).The decrease of the NDI symptom score(pre-pos)in the actual deqi group was significantly greater than that in the actual without deqi group(P<0.05).Among the two groups,the actual deqi group showed increased ACC subregions rsFC with right SMA and bilateral PrG/PoG,and decreased rsFC with right precuneus,middle occipital gyrus,bilateral posterior cingulate cortex(PCC),HIPP/paraHIPP,angular gyrus and SPL after treatment.In addition,the changed NDI QOL scores(pre-post)of the actual deqi group was significantly positively correlated with their Fisher’s transformed Z value of the altered ACC subregion(left I7)rsFC with right SPL(r=-0.597,P=0.04<0.05,FDR corrected P>0.05).Conclusion:The results tested the hypothesis that the advantage of deqi on efficacy is related to affecting the ACC subregions rsFC.It suggested that deqi might participate in the adaptive modulation of disrupted relationship between the ACC subregions and the default mode network(DMN).

Comparison of traditional Chinese medicine education between China's Mainland and Australia —a case study

OBJECTIVE： To analyze and compare the curriculum and delivery of a Chinese and Australian university-level Chinese medicine program.METHODS： A review of PubMed and the Chinese National Knowledge Infrastructure for relevant educational papers was undertaken. Online and paper documents available at the University of Technology Sydney （UTS） and the Chengdu University of Traditional Chinese Medicine （CDUTCM） were read and analyzed. In addition, in-depth interviews with academics from the two universities were conducted during 2014 to 2015.RESULTS： The two Chinese medicine programs share the common goal of providing health services to the local community, but differ in some aspects when the curricula are compared. Areas such as student profile, curriculum structure, teaching approaches and education quality assurance were found to be different. The UTS program adopts a ＂flipped learning＂ approach with the use of educational technology aiming at improving learning outcomes. On the other hand, the CDUTCM has better clinical facilities and specialist physician resources.CONCLUSION： A better understanding of the different curricula and approaches to Chinese medicine education will facilitate student learning and educational outcomes.

The meridian distribution on the lacquer figure unearthed in the Han dynasty tomb in Chengdu Laoguan mountain

In 2012,a lacquer figure was unearthed from the Han dynasty tomb(188 BC-87 BC) at Chengdu Laoguanshan.The lines intaglioed on the Laoguan mountain lacquer figure were similar to the meridians.Objective:To investigate the relationship between the lines on this Laoguanshan lacquer figure and the regular meridians so as to explore the development of meridian system in ancient China.Methods:Based on collecting the photos of the Laoguan mountain lacquer figure and the representative acupuncture classics,the double evidence method(combining the unearthed relics/literature and extant literature) was performed to investigate the relationship between the lines on this Laoguanshan lacquer figure and the regular meridians.Furthermore,the development of regular meridians theory was analyzed from the number,distribution,direction and branches.Results:The routes of the 28 longitudinal white lines on the Laoguan mountain lacquer figure are similar to the regular meridians in the ancient literature including Huángdì Nèijīng 《黄帝内经》 Yellow Emperor’s Inner Classic).The number,distribution and branches of the meridians intaglioed on the Laoguanshan lacquer figure suggested the evolution of the regular-meridian system from the eleven-meridian system to the twelve-meridian system.Conclusions:The meridian system of Laoguanshan lacquer figure was a link connecting the preceding and the following.The Laoguanshan lacquer figure played an important role in the development of the early meridian theory.

Clinical Practice Guideline of Acupuncture for Bell's Palsy

Backgroud: Acupuncture is common used for Bell's palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell's palsy because ofthe poor quality and heterogeneity. It's urgently necessary to develop a guideline of acupuncture for Bell's palsy based on principles of evidence-based medicine to optimize acupuncture treating,standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell's palsy under general circumstances.Objective: To improve the accuracy of diagnosing and managing Bell's palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell's palsy, and to improve the quality of acupuncture for patients with Bell's palsy in most instances.Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts' consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions,searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline.Results:(1)The guideline development group made a Grade A recommendation that ①With a course of Bell's palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs,whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable.②Acupuncture should be applied as early as possible for Bell's palsy.③The principle of selecting acupoints for Bell's palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally,the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell's palsy,including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice.(2) The development group formed expert consensus on the principles of acupuncture treatment for Bell' palsy. Bell's palsy is suitably treated according to the stages, differentiation and symptoms.

A case on acupuncture for Wilson disease

Wilson disease(WD),an autosomal recessive disease with abnormal copper metabolism,is caused by mutations in the ATP7 B gene.The symptoms are characterized by liver,nervous system,and ocular manifestations related to the deposition of copper in the liver,lens nucleus,and cornea.The case reported in this article was a 30-year-old woman with high muscle tension,unable to stand or walk,low voice,and short-term memory loss.Brain MRI showed that patchy Tl,long T2 signals,and high FLAIR presented signals in the basal ganglia thalamus area,subcortex,and brain stem.Low signal shadows were presented in magnetically sensitive bilateral basal ganglia region,callus,and cerebellar dentate nucleus.Ceruloplasmin was significantly reduced.With conventional treatments by western medicine,the symptoms were not alleviated.However,after the application of acupuncture-assisted treatment,the patient is capable with self-care ability,thus a desired effect was achieved.It is therefore suggested that acupuncture shall be applied to assist the treatment of WD to relieve symptoms and help patients regain self-care ability.