Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence

Urinary incontinence (UI) is a common problem worldwide.It has a major impact on physical and social activities and interpersonal relationships.UI is common in women,but is under-reported and undertreated.It affects the quality of life of female patients severely.Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI.Hence,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI.This CPG was developed according to the Grading of Recommendations Assessment,Development,and Evaluation (GRADE) methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group (GDG) played an important role.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method.This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions,which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison.This CPG also provides one protocol for conventional filiform needle therapy,two therapy protocols for deep needling stimulation on lumbosacral acupoints,and four moxibustion therapy protocols,based on the protocols presented in randomized controlled trials reviewed by the GDG.

Clinical practice guideline for acupuncture and moxibustion:Allergic rhinitis

Acupuncture is one of the most effective complementary therapies for allergic rhinitis(AR)and has been recommended by several clinical practice guidelines(CPGs)for AR.However,these CPGs mentioned acupuncture without making recommendations for clinical implementation and therapeutic protocols,therefore limiting the applicability of acupuncture therapies for AR.Hence,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies have initiated a project to develop the CPG for the use of acupuncture and moxibustion to treat AR.This CPG was developed according to the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group(GDG)played an important role.The clinical questions,recommendations and therapeutic protocols were all formulated by the GDG using the modified Delphi method.The CPG contains recommendations for 15 clinical questions about the use of acupuncture and moxibustion interventions.These include one strong recommendation for the intervention based on high-quality evidence,three conditional recommendations for either the intervention or standard care,and 11 conditional recommendations for the intervention based on very low quality of evidence.The CPG also provides one filiform needle acupuncture protocol and five moxibustion protocols extracted based on the protocols presented in randomized controlled trials reviewed by the GDG.

Influence of sintering time on microstructure and properties of hot oscillatory pressing sintered W–Cu refractory alloys

W–Cu refractory alloys are widely used in aerospace,aviation,electronics,power,and other fi elds.However,because of its large melting point diff erence between alloy elements,the conventional powder metallurgy method required a long time of high temperature sintering is very likely to cause low density and abnormal grain size growth.Therefore,90W-10Cu refractory alloys were successfully prepared by hot oscillatory pressing(HOP)under diff erent sintering time in this work.Then the infl uence of sintering time on the microstructure,grain size,density,Vickers hardness,room-tensile property,and electrical conductivity of the W–Cu refractory alloy was systematically invested.The results showed that during the short sintering time(30–90 min),the density,Vickers hardness,tensile strength,and electrical conductivity of the W–Cu refractory alloy increased signifi cantly to 98.7%,163.29 HV 30,507.3 MPa,and 14.2%International Annealed Copper Standard with the sintering time increasing,respectively,while its grain size showed no obvious change.When the sintering time further increased to 120 min,the density was basically consistent with the sintering time of 90 min.Nevertheless,the prolonged high temperature sintering resulted in the grain growth of the samples,which caused the deterioration of the Vickers hardness,room-tensile strength,and conductivity properties of the W–Cu refractory alloy.At the same sintering time,the density,Vickers hardness,and electrical conductivity of the HOP sintered W–Cu refractory alloy were signifi cantly higher than those of the HP sintered sample.It was indicated that high density,fi ne-grain,and excellent properties W–Cu refractory alloys could be prepared by hot oscillatory pressing under appropriate sintering time.

艾灸治疗女性尿失禁的系统评价与meta分析

Background:Urinary incontinence(Ul)is a common condition that bothers women's lives,including stress urinary incontinence(SUI),urgency urinary incontinence(UUI)and mixed urinary incontinence(MuI).The current non-surgical treatment of Western medicine includes pelvic floor muscle training(PFMT),medication,electric stimulation,etc.,all of which have varied limitations.For instance,the patients are poor in compliance with PFMT and medication results in frequent adverse effects.Being one of the featured treatments of TCM,moxibustion has several merits including safety,low cost and simple operation.In recent years,the clinical evidences prove increasingly that moxibustion may be effective for women with Ul.However,there is no high-quality systematic review of moxibustion for this disease.Objective:To evaluate the effect and safety of moxibustion on UI(including SUI,UUI and MUI)among women.Methods:From the inception to October 13,2022,the data of the randomized controlled trials(RCTs)of moxibustion on UI among women were collected from CNKI,WanFang Data,VIP,SinoMed,Web of Science,Pubmed,EMBASE and Cochrane Library databases.Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance.Using the risk of bias assessment tool of Cochrane Handbook,the included RCTs were evaluated.With RevMan 5.3 software,meta-analysis was performed,and the GRADE tool was adopted to assess evidence certainty of different outcomes.Results:A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review.In experimental groups,moxibustion combined with PFMT was used,while in control groups PFMT was applied alone.And the subjects were all women with SUI.Meta-analysis showed that compared with PFMT alone,moxibustion combined with PFMT reduced the urine leakage volume(1-hour pad test)(MD=-1.95,95%CI[-2.32,-1.57],P<0.001),the frequency of Ul in 24-hour(MD=-0.64,95%CI[-0.88,-0.40],P<0.001)and the score of the short form of International Consultation on Incontinence Questionnaire(ICIQ-SF)of women with SUI(MD=-2.53,95%CI[-3.43,-1.63],P<0.001);and this combined intervention measure did not increase significantly the adverse events(RR=0.82,95%CI[0.15,4.6],P=0.82).GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality,the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality.Conclusion:Compared with PFMT alone,the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life(QoL)among women with SUI with favorable safety.Moxibustion could be effective supplementary therapy on sUI among women.However,due to the high risk of bias of the included trials and low certainty of evidence,more highquality clinical studies are needed to verify the above findings.

《过敏性鼻炎针灸临床实践指南》关键临床问题和结局指标的研究

Objective:Formulating critical clinical questions and outcomes is essential for developing clinical practice guidelines(CPGs).This study aims to formulate the key clinical questions and outcomes for the CPG on acupuncture and moxibustion for allergic rhinitis(AR).Methods:PICO(patient,intervention,comparator,and outcome)question survey,Delphi survey,and consensus conference of the guideline development group(GDG)were employed.PICO questionnaires were used to gather and analyze the target users’key demands and interests.The GDG then selected the critical clinical questions and outcomes via a mixed method of Delphi survey and consensus conference.Results:Fifteen potential clinical questions and ten types of outcomes were formulated based on the analysis of 123 responses from seventeen countries on five continents.After two rounds of the Delphi survey and complete discussions,a consensus was reached by the GDG that all potential questions were included.After three rounds of the Delphi survey and complete debate,the consensus was reached that nine outcomes were considered important.Conclusion:Fifteen key clinical questions and nine important outcomes were formulated for the CPG.These covered issues elicited the most attention from global users in acupuncture therapy and AR.The results will contribute to the CPGs development and future clinical studies.

《女性尿失禁针灸临床实践指南》临床问题征询调查

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating urinary incontinence in women.The survey is consisted of multiple-choice questions,ranking questions and open questions.We hope you can help us to complete the questions using PICO(Patients,Intervention,Comparator and Outcome)framework referring to the examples.The survey might take about 30 min,and the responses from you will greatly contribute to the formation of this guideline.

《过敏性鼻炎针灸临床实践指南》临床问题征询

The survey aims to collect clinical questions for the clinical practice guideline on acupuncture and moxibustion in treating allergic rhinitis.The survey is consisted of multiple-choice questions,ranking questions,and open questions.Readers are recommended to complete the open questions using PICO(Patients,Intervention,Comparator and Outcome)framework,referring to the examples.The survey might take about 30 min,and the responses from readers will greatly contribute to the formation of this guideline.

Filiform needle acupuncture for allergic rhinitis:A systematic review and meta-analysis

Background:Filiform needle acupuncture(FNA),the most classical and widely applied acupuncture method based on traditional Chinese medicine theory,has shown a promising effect in the treatment of allergic rhinitis(AR).Objective:To evaluate the efficacy,safety,cost-effectiveness,and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture,no treatment,and conventional medication.Search strategy:Eight electronic databases were systematically searched from inception to October 14,2021.Additional studies were acquired from clinical trial registration platforms and reference lists.Inclusion criteria:Randomized controlled trials were included if they compared FNA with either sham acupuncture,no treatment or conventional medication for AR.Data extraction and analysis:Two researchers extracted data independently of each other using a predesigned data acquisition form,and results were cross-checked after completion.The primary outcome was symptom score(Total Nasal Symptom Score or Visual Analogue Scale),and the secondary outcomes were the AR control questionnaire,quality of life(QoL)score(Different versions of Rhinoconjunctivitis Quality of Life Questionnaire),medication score(use of rescue medication),mental health score,total IgE,adverse event rate,clinical economic indicators,and patient satisfaction score.Standardized mean difference(SMD)or mean difference(MD)with 95% confidence interval was used to calculate the effect size for continuous data,while risk ratio with 95%CI was used for dichotomous data.Results:Thirty studies were included in this review.Compared with sham acupuncture,FNA significantly reduced the symptom score(SMD:-0.29[-0.43,-0.15]),AR’s impact on QoL(SMD:-0.23[-0.37,-0.08])and medication score(SMD:-0.3[-0.49,-0.11]).Compared with no treatment,FNA dramatically reduced the symptom score(SMD:-0.8[-1.2,-0.39])and AR’s impact on QoL(SMD:-0.82[-1.13,-0.52]).There were no increased rates of adverse events with FNA compared to sham acupuncture and no treatment.FNA increased patient satisfaction and may be cost-effective.Most pieces of evidence from the above two comparisons were of high confidence.Moreover,FNA significantly outperformed conventional medication in reducing the symptom score(SMD:-0.48[-0.85,-0.1])and displayed a lower rate of adverse events,but the quality of evidence was very low.Conclusion:FNA is an effective and safe intervention for AR and can help with symptom relief,QoL improvement,reducing medication usage,and increasing patient satisfaction.Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies.