The effect of electroacupuncture preconditioning on cognitive impairments following knee replacement among elderly:A randomized controlled trial

Objective: To investigate if electroacupuncture(EA) preconditioning can mitigate cognitive impairments and reduce the incidence of postoperative cognitive dysfunction(POCD) following knee replacement and its safety among elderly.Methods: Totally 60 participants met the inclusion criteria were enrolled in a randomized controlled trial a ratio of 1:1, with 30 cases allocated to the treatment group and 30 cases allocated to the control group, respectively. The participants in the treatment group were provided with real-EA therapy whereas participants in control group were provided with placebo-EA therapy(Streitberger Placebo-needle). In both groups, Tou sanshen(头三神)acupoints, including Sìshéncōng(四神聪EX-HN1), Sh6 ntíng(神庭 GV24),and bilateral Běnsh6 n(本神GB13) were adopted as the main acupoints, while Bǎihui(百会GV20), bilateral Hégǔ(合谷Ll4), and bilateral Tàich6 ng(太冲LR3) were adopted as matching acupoints. Interventions were offered 5 days prior to the surgery, once daily, and continued for total 5 days. The global scores of MiniMental State Examination(MMSE), and levels of serum inflammatory cytokines including interleukin 1β(IL-1β) and tumor necrosis factor-α(TNF-α), and S100-β protein were observed at 24 h prior to the surgery, and postoperative 24 and 72 h respectively for assessing the incidence of POCD and the severity of cognitive impairments among patients. Meanwhile, adverse effects were monitored and recorded.Results:(1) Compared with baseline, MMSE global scores in both treatment and control groups markedly decreased at postoperative 24 h. MMSE global scores in treatment group decreased from 29.43 ±0.97 to27.10 ±1.95 while that in control group decreased from 29.27 ± 1.01 to 26.83 ± 2.25(all ?P< 0.05), and this trend continued until postoperative 72 h(at postoperative 72 h, MMSE global scores in treatment group was 26.53 ±2.26 versus 24.79 ±3.03 in control group). Moreover, decline in control group was more significant than that in treatment group at postoperative 72 h(P<0.05).(2) Compared with baseline, levels of serum IL-1β, TNF-α and S100-β in both groups increased markedly at postoperative 24 and 72 h. IL-1β in treatment group increased from 43.13 ±5.51 to 73.13 ±2.32 at postoperative 24 h and reached 83.17 士 5.95 at postoperative 72 h, while IL-1β in control group increased from 44.87 土 5.83 to91.10 ±3.55 at postoperative 24 h and reached 111.93 ±9.18 at postoperative 72 h;TNF-α in treatment group increased from 51.27 士 6.48 to 88.80 ± 3.55 at postoperative 24 h and reached 94.37 ± 5.22 at postoperative 72 h, while TNF-α in control group increased from 52.07 ±7.48 to 116.37 ±3.14 at postoperative24 h and reached 121.40 ±3.68 at postoperative 72 h(both ?P< 0.05), furthermore, increases of IL-1β and TNF-α levels in control group were more significant(P<0.05). Statistical difference in level of S100-β was not observed(P>0.05).(3) There was no statistical difference in POCD incidence at postoperative 24 h and postoperative 72 h between two groups(P> 0.05), though the incidence of POCD in patients receiving real-EA therapy was indeed much lower than that in patients receiving placebo-EA therapy, particularly at postoperative 72 h(POCD incidence rate at postoperative 24 h in treatment group was 26.67%, 30.00%in control group;POCD incidence rate at postoperative 72 h in treatment group was 30.00%, 46.67% in control group).(4) No serious adverse events were reported in this trial. No one dropped out from this trial.Conclusion: EA preconditioning can mitigate cognitive impairments at post-knee replacement surgery 24 and 72 h in elderly through inhibiting expression of inflammation. However, there is insufficient evidence to support that EA pretreatment can reduce the incidence of POCD.

Manual acupuncture for patients with major depressive disorder and comorbid insomnia:Evidence from polysomnography and serum biomarkers

Objective:This study is conducted to determine effects of manual acupuncture(MA)in patients with a diagnosis of major depressive disorder(MDD)and comorbid insomnia.Methods:A total of 67 participants who met the inclusion criteria were randomly enrolled in a two-arm randomized,placebo controlled,patients-blind trial and allocated to a real-MA group(patients=34)and a sham-MA group(patients=33).Patients in the real-MA group were treated on‘Five-shen acupoints’,including Sishencong(四神聪EX-HN 1),Shenting(神庭GV 24),Shendao(神道GV 11),bilateral Benshen(本神GB 13),and bilateral Shenmen(神门HT 7).Though being punctured on the same acupoints,patients in the sham-MA group were treated by a placebo acupuncture approach(Streitberger Placeboneedle).Each group received corresponding interventions every other day,three times a week for total eight weeks.Both polysomnography(PSG)and testing of serum biological markers such as neuropeptide Y(NPY)and substance P(SP)were performed at pre-and post-treatment.Additionally,the global scores of Pittsburgh sleep quality index(PSQI)and the global scores of 17-items Hamilton Depression Rating Scale(HAMD17)were used for assessing the subjective sleep and emotion experience of patients,respectively.Meanwhile,adverse effects were monitored and recorded.Results:After eight-week treatment,the global scores of PSQI and global scores of HAMD17 declined significantly(both P<0.05)in the real-MA group but not in the sham-MA group(both P>0.05).According to the parameters of PSG,striking decline were observed in sleep latency(SL)and wake after sleep onset(WASO)and striking climb were observed in total sleep time(TST)and sleep efficiency(SE)in the real-MA group after treatment(P<0.05,respectively)but not in the sham-MA group(P>0.05,respectively).Additionally,there were no significant differences in awakening times(ATs)and rapid eyes movement sleep latency(REM-SL)in both two groups after treatment(both P>0.05).Meanwhile,the expression of NPY increased significantly and the expression of SP decreased significantly in the real-MA group after interventions(both P<0.05)while those indicators only slightly fluctuated in the sham-MA group(P>0.05).No serious adverse event was reported in either real-or sham-MA group.Conclusion:(1)MA may be a potential alternative therapy for improving MDD and comorbid insomnia(particularly in extending total sleep time and shortening wake-up duration and sleep latency)via upregulating the expression of NPY and downregulating the expression of SP;more importantly,this efficacy of acupuncture can not be replaced by sham-acupuncture acting on the same acupoints with the same treatment frequency.(2)There is insufficient evidence to prove that MA can effectively reduce the number of arousals.

Occupational therapy with or without combined acupuncture on upper limb pain and hand functions in children with spastic hemiplegic cerebral palsy:A three-arm randomized,placebo-controlled trial

Objective:This study is conducted to investigate the effects of occupational therapy(OT) with or without combined acupuncture for upper limb pain and hand functions among children with spastic hemiplegic cerebral palsy.Methods:A total of 90 patients who met the inclusion criteria were enrolled in a three-arm randomized,placebo-controlled trial,and were allocated to mono-occupational therapy(OT) group(patients=30),OT combined with real-acupuncture(ORA) group(patients=30),and OT combined with placeboacupuncture(OPA) group(patients=30),respectively.In addition to receiving the conventional OT program as the basic treatment for total 8 weeks,patients in ORA and OPA group also received corresponding acupuncture treatment 5 days per week for the first two weeks,3 days per week for the next two weeks,2 days per week for another two weeks,and 1 day per week for the last two weeks.Non-communicating children’s pain checklist-revised scale(NCCPC-R) was used for assessing the upper limb pain among patients.Squeeze dynamometry,modified Ashworth scale(MAS),manual muscle testing(MMT),JebsenTaylor hand function test(JTHFT) and box and block test(BBT) were used for assessing various aspects of upper limb and hand functions among patients.Meanwhile,adverse effects were monitored and recorded.Results:After 8-week treatment,NCCPC-R global scores witnessed a dramatic decline in ORA group(P<0.05),but not in either OPA(P> 0.05) or OT group(P> 0.05).Dramatic increases were identified in both squeeze dynamometry scores and MMT scores in all three groups(all P <0.05).Furthermore,the increases of ORA group were more significant than those of another two groups(both P <0.05).There were no significant changes in MAS global scores in each group(all P> 0.05).The BBT global scores of all three groups significantly increased(all P <0.05) after treatment.Among them,the increase of the ORA group was more than that of the other two groups(P <0.05).The 8-week treatment also had a significant impact on several sub-tests of JTFHT in each group.No significant adverse event was reported.Conclusion:ORA is a potential and promising alternative therapy for mitigating upper limb pain as well as improving both upper limb and hand functions among children with spastic hemiplegic cerebral palsy.

SOOJI CHIM (Koryo hand acupuncture) for perimenopausal insomnia:Evidence from actigraphy and serum hormone testing

Objective:This study is conducted to determine the effects of SOOJI CHIM(Koryo hand acupuncture,KHA)therapy on sleep structures and perimenopause symptoms among insomniacs.Methods:Totally 49 participants who met the inclusion criteria were enrolled in a two-arm randomized,placebo controlled,patients-blind trial,with 24 cases allocated to a real-KHA group and 25 cases allocated to a sham-KHA group.Patients in each group received corresponding treatment every other day,three times a week for total eight weeks.Both actigraphy and testing of serum hormones level reflected by biological markers such as follicle-stimulating hormone(FSH),luteinizing hormone(LH)and estradiol(E2)were performed at pre-and post-treatment.Additionally,the scores of Pittsburgh sleep quality index(PSQI)was used for assessing the subjective sleep experience of insomniacs.Meanwhile,adverse effects were monitored and recorded.Results:After eight-week treatment,the global scores of PSQI declined significantly(P<0.05)in the realKHA group but not in the sham-KHA group(P>0.05).According to the outcomes of actigraphy,a striking increase was observed in both sleep efficiency(SE)and total sleep time(TST)in the real-KHA group(both P<0.05)but not in the sham-KHA group(P>0.05).However,no significant changes of sleep awakenings(SA)in both groups was found after treatment(both P>0.05).Meanwhile,FSH and LH in the real-KHA group decreased markedly after intervention(both P<0.05)while those indicators only slightly changed in the sham-KHA group(P>0.05).The fluctuation of E2 levels were not significant in both groups(both P>0.05).No serious adverse event was reported in either real-or sham-KHA group.Conclusion:KHA may be a potential alternative therapy for improving perimenopausal insomnia via down regulating the levels of FSH and LH.

Escitalopram with or without combined electroacupuncture on protracted alcohol withdrawal symptoms(PAWS)among male inpatients with alcohol dependence

Objective:This study is conducted to investigate the effects differences of escitalopram with or without combined electroacupuncture(EA)among male inpatients with a diagnosis of alcohol dependence and comorbid protracted alcohol withdrawal symptoms(PAWS).Methods:A total of 62 participants who met the inclusion criteria were enrolled in a two-arm randomized,placebo controlled,patients-blind trial and allocated to an escitalopram with real-EA group(realEA group,patients=31)and an escitalopram with sham-EA group(sham-EA group,patients=31),respectively.In addition to the oral administration of escitalopram for total four weeks,patients in each group received corresponding EA treatment five days per week and two days off for consecutive four weeks.Both serum homocysteine(Hcy)test and electrophysiological tests,including event-related potentials(ERPs)and exploratory eye movement(EEM)were performed at pre-and post-treatment.Additionally,the global scores of Penn Alcohol Craving Scale(PACS),17-items Hamilton Depression Rating Scale(HAMD-17),and Hamilton Anxiety Scale(HAMA)were used for assessing the subjective emotion experience of patients,respectively.Meanwhile,adverse effects were monitored and recorded.Results:After four-week treatment,the global scores of PACS and HAMD-17 declined significantly in both groups(both P<0.05).Furthermore,the decline in the real-EA group was superior to that in the shamEA group(P<0.05).Meanwhile,the total scores of HAMA only decreased in the real-EA group(P<0.05)but not in the sham-EA group(P>0.05).According to the parameters of ERPs,significant declines for N2PL,P3PL,and P3amp were observed in both two groups(all P<0.05),and the decreases for P3PL and P3amp in the real-EA group was much superior to that in the sham-EA group(both P<0.05).According to the parameters of EEM,significant increase for NEF was observed only in the real-EA group(P<0.05).Besides,there was a dramatic decline for serum Hcy level only in the real-EA group(P<0.05).One case in the sham-EA group withdrew from the trial due to self-reported nausea and bitter taste,and outcomes of the remaining 61 patients were adopted for analysis.Conclusion:(1)Escitalopram with EA may be a potential alternative therapy for mitigating PAWS among male inpatients with alcohol dependence.(2)Escitalopram with EA might improve the alcoholdependence induced cognitive dysfunctions via upregulating the expression of Hcy.

Post-schizophrenia comorbid depressive disorder and insomnia treated by acupuncture combined with Chinese medicine:A retrospective case series based on JBI reporting checklist

Background:Acupuncture combined with Chinese herbal medicine was performed on 24 patients with post-schizophrenia comorbid depressive disorder and insomnia admitted to the Psychiatry Department,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine from 2016 to 2020,and provided satisfactory results.Considering post-schizophrenia comorbid depressive disorder and insomnia is not a common clinical disorder in hospital of traditional Chinese medicine,the treatment and follow-up cycle is long,and the dropout rate is high,a retrospective case series based on Joanna Briggs Institute(JBI) reporting checklist were conducted instead of a randomized controlled trial.Objective:To retrospectively summary the short-,mid-and long-term effects of acupuncture combined with Chinese herbal medicine for post-schizophrenia comorbid depressive disorder and insomnia,and analyze the principles of the prescriptions.Methods:A retrospective analysis based on case series JBI reporting checklist were performed to investigate effects of 24 patients with post-schizophrenia comorbid depressive disorder and insomnia undergoing 12-week combined acupuncture and Chinese herbal medicine treatment(patients did not receive full dosage treatments,or received western medicine or other physical and psychological therapies during the treatment period were excluded).The psychotic symptoms,depression,insomnia,and self-care ability for daily living were measured by the Positive and Negative Syndrome Scale(PANSS),Calgary Depression Scale for Schizophrenia(CDSS),Pittsburgh Sleep Quality Index(PSQI),and Activity of Daily Living Questionnaire(ADL-Q),respectively.Follow-ups were conducted at 8 and 16 weeks after treatment.Meanwhile,Acupuncture Beliefs Scale(ABS) was assessed at pre-and post-treatment as well as 16-week follow-up to investigate patients’ beliefs and expectations for acupuncture treatment.Results:(1) compared with pre-treatment,the PANSS global scores did not decrease significantly at posttreatment and follow-up periods(P> 0.05).(2) compared with pre-treatment,the global scores of CDSS and PSQI decreased significantly at post-treatment and follow-up periods(both P<0.05).The PSQI global scores at the 16-week follow-up were even significantly lower than at port-treatment(P<0.05).(3) after treatment,the ADL-Q.global scores decreased significantly(P<0.05),and continued to decrease during the follow-ups(P<0.05).(4) effective treatment improved patients’ beliefs and expectations of acupuncture therapy.Conclusions:Acupuncture combined with Chinese herbal medicine can significantly improve the insomnia and depressed mood following schizophrenia,with satisfactory short-,medium-and long-term effects;effective treatment experience can increase patients’ beliefs and expectations for acupuncture therapy.

Attention network function of insomniacs improved by manual acupuncture: Evidence from Attention Network Task

Objective:To investigate if manual acupuncture can improve the primary insomnia-induced impairments of attention network function and its safety.Methods:Totally 64 eligible participants were enrolled in a randomized controlled trial,with 32 cases allocated to the treatment group and 32 cases allocated to the control group,respectively.The participants in the treatment group received real-acupuncture therapy[acupuncture at 'Five Spirits Acupoints' including Shéntíng(神庭 GV 24),Běnshén(本神 GB 13),Sìshéncōng(四神聪 EX-HN 1),Shéndào(神道 GV11)and Shénmén(神门 HT 7)]whereas participants in control group received sham-acupuncture therapy with Streitberger placebo-needle and same acupoints.Interventions were offered every two days and three times a week for total 8 weeks.Both Pittsburgh sleep quality index(PSQI)and Attention Network Task(ANT)were employed to assess the changes of sleep quality and attention network function at pretreatment and post-treatment,respectively.Meanwhile,adverse effects were monitored and recorded.Results:(1)After 8-week treatment,the total score of PSQI in the treatment group decreased from14.22±3.46 to 8.19±3.34(P<0.001),and the total score of PSQI in the control group decreased from12.84±3.90 to 11.41±3.90(P<0.05).The decrease in the treatment group was more significant than that in the control group(P<0.001).(2)After treatment,the alerting efficiency of both groups increased,the treatment group increased from 40.44±5.62 to 56.44±5.37(P<0.001),and the control group increased from 39.50±6.39 to 40.06±6.14(P<0.05).The increase in the treatment group was more significant than that in the control group(P<0.001).The total reaction time of both groups decreased,the treatment group decreased from 574.94±10.1 to 548.34±15.05(P<0.001),and the control group decreased from578.25±13.26 to 576.78±12.15(P<0.05).The decrease in the treatment group was more significant than that in the control group(P<0.001).(3)No obvious change in orienting efficiency was observed in both groups after treatment(P>0.05).(4)No serious adverse events were reported in this trial,except 2 patients from treatment group had slight hematoma after receiving acupuncture therapy.Conclusion:Acupuncture represents a safe and useful non-pharmacologic intervention option for primary insomniacs with impairments of attention network function(alertness and conflict processing/executive control).

Palladium-catalyzed multi-acetoxylation of 1,3-disubstituted 1H-pyrazole-5-carboxylates via direct C(sp^2)-H or C(sp^3)-H bond activation

A palladium-catalyzed multi-acetoxylation of 1,3-disubstituted 1H-pyrazole-5-carboxylate derivatives containing multiple potential reactive sites is described. Therein, the sequence of this process has been appropriately investigated. The protocol mainly provides the di- and tri-acetoxylated products for 1,3- diarylpyrazoles. Besides, it is found that the acetoxylation of C（sp3）-H bond is prior to that of C（sp2）-H bond under structurally competitive conditions.

Does acupuncture response increase with the increasing dosage:A preclinical study investigating rats with sleep deprivation

Background:The effectiveness of acupuncture for insomnia and insomnia-related anxiety and depression has been widely investigated in clinical trials.However,whether higher dosage(more frequent)acupuncture can bring greater responses(a greater size of effect)is less understood.Objective:This study is designed to investigate whether a five-times weekly(5 Ts/w)electroacupuncture(EA)treatment is better than a three-times weekly(3 Ts/w)EA in alleviating sleep deprivation,and sleep disturbance-induced cognitive dysfunctions and negative emotions in rats through four various behavioral te sts.Methods:Forty-six male Sprague-Dawley rats were randomly divided into control group(n=10),model group(n=12),EA-3 Ts/w group(n=12),and EA-5 Ts/w group(n=12).Except for the control group,the other three groups were established as chronic sleep deprivation models via the modified multi-platform water environment methodology.Then,rats in both EA-3 Ts/w group and EA-5 Ts/w group received corresponding dosage of EA therapy,respectively.After modeling and interventions,all four groups received four behavioral tests as follows:(1)sleep behavioral monitoring and evaluation was achieved by Comprehensive Lab Animal Monitoring System(CLAMS).(2)Cognitive functions were assessed by Novel Object Recognition(NOR)test.(3)Depressive-like behaviors was evaluated by Open-Field(OF)test.(4)Anxietylike behaviors was appraised by Elevated Plus-Maze(EPM)test.After finishing the behavioral tests,the hippocampus of each rat was removed and its synaptic structure changes were observed under electron microscope.Results:(1)CLAMS:two EA groups derived more sleep time within 24 h than the model group(both P<0.05),and no statistical differences was found between these two EA groups(P>0.05).(2)NOR test:NOR ratio in the EA-3 Ts/w group was higher than that of the model group(P<0.05)but lower than that of either the control group(P<0.05)or the EA-5 Ts/w group(P<0.05).(3)OF test:the difference of horizontal movements between the EA-3 Ts/w group and the EA-5 Ts/w group was not significant(P>0.05),although both of them were lower than that of the control group(both P<0.05)but higher than that of the model group(P<0.05).(4)EPM test:no significant decline of open-arm total time(OT)was found in EA-3 Ts/w group(P>0.05)but was found in both the model group(P<0.05)and the EA-5 Ts/w group(P<0.05)compared to the control group.Conclusion:(1)Five-week EA treatment can partially mitigate cognitive dysfunctions,anxiety-like behaviors,and depressive behaviors in rats with sleep deprivation,and this effect might be associated with the repairs on mitochondrial damage in hippocampal neurons.(2)There is insufficient evidence supporting 3 Ts/w EA treatment is less effective than 5 Ts/w EA treatment in mitigating sleep deprivation symptoms and depressive behaviors induced by sleep deprivation among rats.(3)5 Ts/w EA treatment might be more effective than 3 Ts/w EA treatment in attenuating sleep deprivation-induced cognitive impairments while it might further increase rat’s anxiety-like behaviors at the same time.