Involvement of connexin 43 in acupuncture analgesia

Background Connexin 43 （Cx43） is one of the major components of human keratinocyte gap junctions. To study whether gap junctional intercellular communication participates in the transfer of acupoint signals and acupuncture analgesia, the expression of Cx43 was studied in Zusanli （ST36） acupoints compared with control non-acupoint regions in rats after acupuncture. In addition, Cx43 heterozygous gene knockout mice were used to further explore the relationship between Cx43 and acupuncture analgesia.Methods The expression of Cx43 was detected by immunohistochemistry, immunoblotting, and RT-PCR for the Cx43 protein and mRNA. The influence of the Cx43 gene knockout on acupuncture analgesia was measured by a hot plate and observing the writhing response on Cx43 heterozygous gene knockout mice. Results Immunohistochemistry showed abundant Cx43 expression in some cells in the skin and subcutaneous tissue of rat ST36 acupoints. The mRNA and protein levels of Cx43 in acupoints were significantly higher than those in the control points in the non-acupuncture group, and even more so after acupuncture. The hot plate and writhing response experiments showed that partial knockout of the Cx43 gene decreased acupuncture analgesia. Conclusion Cx43 expression and acupuncture analgesia showed a positive correlation.

Acupuncture Analgesia in Migraine

There is no curative treatment for migraine, although there does exist various options for pharmacological treatment.Drug treatment withβ-adrenoceptor blockers,calcium antagonists,or other agents has been shown to reduce the frequency of migraine attacks;however,the success of treatment is usually modest.Acupuncture has been increasingly used as adjunctive treatment in primary headache syndromes and there is growing evidences from clinical trials that it might be beneficial in the treatment of migraine,with an effect size comparable to pharmacologic treatment.Despite its popularity,there’s still some controversy as to the difference between the specific and the nonspecific effects of acupuncture.

Efficacy of acupuncture on acute tonsillitis:a systematic review and meta-analysis

OBJECTIVE To systematically assess the efficacy and safety of acupuncture in treating acute tonsillitis,providing a reference for clinical decision-making.METHODS We searched PubMed,CENTRAL,Embase,Web of Science,China National Knowledge Infrastruc⁃ture,China Biomedical,clinical research registra⁃tion platforms,grey literature,and the reference lists of the selected studies from inception to Oct.30,2022.The risk of bias assessment used Rev⁃Man.Meta-analysis was performed using STATA with Hedges′g value.In addition,we performed subgroup analysis,meta-regression,and publica⁃tion bias detection with Harbord′s and Egger′s tests.RESULTS We included 19 randomized controlled trials comprising 1701 patients,of which 1 study was assessed high risk of bias.The primary outcome,the response rate,revealed that acupuncture was more effective than antibi⁃otics.The secondary outcomes showed that the difference in the reduction of the VAS scores,sore throat time,and white blood cell counts was statistically significant with acupuncture compared to antibiotics.However,the difference in modulat⁃ing neutrophil percentage and C-reactive protein was not statistically significant.Besides,acupuncture treatments showed a lower incidence of adverse events than antibiotics.CONCLUSION Acupuncture therapy on acute tonsillitis is safe,and the response rate is superior to antibiotics.For alleviating sore throat symptoms,shortening sore throat time,and improving immune in fl am mation index,acupuncture has positive signi fi cance.Nevertheless,because of the limitations of this study,our conclusions should be inter⁃preted with caution.Future efforts still need more high-quality trials to improve the methodology and reporting quality.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND During anesthesia administration for cataract surgery,low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing,with the use of additional drops intraoperatively increasing the risk of complications.Accordingly,there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study.Patients were divided into the proparacaine surface anesthesia(SA)group(65 cases)and the compound acupuncture-medicine anesthesia group(CAMA group,65 cases).Patients in the CAMA group were provided acupuncture analgesia in addition to SA.Preoperative anxiety[Self-Rating Anxiety Scale(SAS)score and state anxiety inventory(SAI)score],intraoperative stress,vital signs,analgesia,and cooperation,as well as postoperative adverse events,were compared between groups.RESULTS More marked reductions in anxiety were observed among patients in the CAMA group,with corresponding reductions in SAS and SAI scores.During the operation,no change in the secretion of E,NE,or Cor group compared to the preoperative period was observed in the CAMA,which was markedly lower than that in the SA group.Heart rate,blood pressure,and respiratory rate were more stable intraoperatively in the CAMA group.In addition,the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group.Accordingly,patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery.Furthermore,marked reductions in intraoperative adverse effects were observed in the CAMA group,indicating greater overall safety.CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

WRIST-ANKLE ACUPUNCTURE FOR ANALGESIA IN TREATING SOME COMMON DISEASES IN ATHLETES

With gradual generalization of acupuncture-moxibustion therapy in developed countries, an increasing attention has been paid to its application in the athletic field. Wrist-ankle acupuncture is a kind of shallow acupuncture, by which 6 points in the wrist and ankle regions are selected and punctured for treating diseases related to individual parts of the body. It is a kind of information therapy concerning biological hologram regularities. The analgesic effects of the therapy in treating some common diseases in 64 athletes are reported as follows.

Correlation between the cumulative analgesic effect of electroacupuncture intervention and synaptic plasticity of hypothalamic paraventricular nucleus neurons in rats with sciatica

In the present study, a rat model of chronic neuropathic pain was established by ligation of the sciatic nerve and a model of learning and memory impairment was established by ovariectomy to investigate the analgesic effect of repeated electroacupuncture stimulation at bilateral Zusanfi （ST36） and Yanglingquan （GB34）. In addition, associated synaptic changes in neurons in the paraventricular nucleus of the hypothalamus were examined. Results indicate that the thermal pain threshold （paw withdrawal latency） was significantly increased in rats subjected to 2-week electroacupuncture intervention compared with 2-day electroacupuncture, but the analgesic effect was weakened remarkably in ovariectomized rats with chronic constrictive injury. 2-week electroacupuncture intervention substantially reversed the chronic constrictive injury-induced increase in the synaptic cleft width and thinning of the postsynaptic density. These findings indicate that repeated electroacupuncture at bilateral Zusanfi and Yanglingquan has a cumulative analgesic effect and can effectively relieve chronic neuropathic pain by remodeling the synaptic structure of the hypothalamic paraventricular nucleus.

The cumulative analgesic effect of repeated electroacupuncture involves synaptic remodeling in the hippocampal CA3 region

In the present study, we examined the analgesic effect of repeated electroacupuncture at bilateral Zusanfi （ST36） and Yanglingquan （GB34） once a day for 14 consecutive days in a rat model of chronic sciatic nerve constriction injury-induced neuropathic pain. In addition, concomitant changes in calcium/calmodulin-dependent protein kinase II expression and synaptic ultrastructure of neurons in the hippocampal CA3 region were examined. The thermal pain threshold （paw withdrawal latency） was increased significantly in both groups at 2 weeks after electroacupuncture intervention compared with 2 days of electroacupuncture. In ovariectomized rats with chronic constriction injury, the analgesic effect was significantly reduced. Electroacupuncture for 2 weeks significantly diminished the injury-induced increase in synaptJc cleft width and thinning of the postsynaptJc density, and it significantly suppressed the down-regulation of intracellular calcium/ calmodulin-dependent protein kinase II expression in the hippocampal CA3 region. Repeated electroacupuncture intervention had a cumulative analgesic effect on injury-induced neuropathic pain reactions, and it led to synaptic remodeling of hippocampal neurons and upregulated calcium/calmodulin-dependent protein kJnase II expression in the hippocampal CA3 region.

Clinical research progress of acupuncture therapy in the treatment of ankylosing spondylitis

Ankylosing spondylitis is a chronic inflammatory disease characterized by ankylosis of the spine and sacroiliac joints.The continuous development of this disease can cause damage to multiple organs.At present,modern medical treatment programs generally focus on symptomatic treatment such as analgesia and anti-inflammatory,which can relieve pain and inflammation to a certain extent,but there are many problems such as adverse drug reactions,and cannot be completely cured.Modern medical treatment of ankylosing spondylitis focuses on relieving symptoms,controlling disease activity,slowing disease progression,and reducing disability rates.As an important part of traditional Chinese medicine,acupuncture therapy,compared with modern medicine,has obvious advantages in the treatment of ankylosing spondylitis,such as good curative effect,quick effect,safety and low price,and no toxic and side effects.By reviewing the literature,it is found that there are a large number of clinical studies on the treatment of ankylosing spondylitis by acupuncture and moxibustion in recent years,and it is concluded that acupuncture and moxibustion has unique advantages in reducing local pain,alleviating inflammatory symptoms,improving joint function,preventing spinal deformity,and improving quality of life.Therefore,this study summarizes and reviews the relevant literature on different acupuncture and moxibustion therapy for ankylosing spondylitis,in order to provide ideas and solutions for the effective treatment of this disease.

Acupuncture Mechanisms: Anesthesia, Analgesia and Protection on Organ Functions

Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles,lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation

Objective: This study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.Methods: This retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group(n = 32), patient-controlled analgesia(PCA) group(n = 27), and oral analgesia group(n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale(VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale(C-MASS) was used in the acupuncture group.Results: Each of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain(P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the“dull pain” in the acupuncture sensation.Conclusion: The results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient’s acupuncture sensation and the improvement of pain VAS score.

Analysis on Interrelation between Electroacupuncture-lnduced Cumulative Analgesic Effect and Hypothalamic Cholinergic Activities in Chronic Neuropathic Pain Rats

Objective： To observe the effects of repeated electroacupuncture （EA） of Zusanli （ST36）Yanglingquan （GB34） on hypothalamic acetylcholinesterase （AchE） and vesicular acetylcholine （ACh） transporter （VAChT） activities and choline acetyltransferase （CHAT） mRNA and muscarinic M1 receptor （MIR） mRNA expression in chronic constrictive injury （CCI） and/or ovariectomy （OVX） rats so as to reveal its underlying mechanism in cumulative analgesia. Methods： A total of 103 female Wistar rats were randomly divided into normal control （n=15）, CCI （n=15）, CCI＋EA2d （n=15）, CCI＋EA2W （n=15）, OVX＋CCI （n=13）, OVX＋CCI＋EA2d （n=15）, and OVX＋CCI＋EA2W groups （n=15）. CCI model was established by ligature of the unilateral sciatic nerve with surgical suture. Memory impairment model was established by removal of the bilateral ovaries. Morris water test was conducted to evaluate the OVX rats＇ memorylearning ability, and the thermal pain threshold （PT） of the bilateral paws was detected the next morning after EA. EA （2/15 Hz, 1 mA） was applied to bilateral ST36-GB34 for 30 min, once daily for 2 days or 2 weeks, respectively. Hypothalamic AChE activity was detected by histochemistry, VAChT immunoactivity was determined by immunohistochemistry, and ChAT mRNA and MIR mRNA expressions were assayed by reverse transcription-polymerase chain reaction （RT-PCR）. Results： In comparison with the normal control group, the AChE activity in hypothalamic arcuate nucleus （ARC） and supraoptic nucleus （SON） regions of CCI group, AChE activity in paraventricular nucleus （PVN）, ARC, and SON regions of OVX＋CCI group, and hypothalamic muscarinic M1R mRNA expression levels in both CCI and OVX＋CCI groups were down-regulated significantly （P〈0.05）. Compared with the CCI group, the AChE activities in hypothalamic ARC and SON regions of CCI＋EA2d and CCI＋EA2W groups and PVN region of CCI＋EA2W group and hypothalamic ChAT mRNA and M1R mRNA expression levels in CCi＋EA2W group were up-regulated considerably （P〈0.05）. In comparison with the OVX＋CCI group, the AChE activities in PVN, ARC, and SON regions and the expressions of hypothalamic ChAT mRNA and VAChT in ARC region of OVX＋CCI＋EA2W group were up-regulated remarkably （P〈0.05）. The effects in rats of CCI＋EA2W group were evidently superior to those of OVX＋CCI＋EA2d group in up-regulating AChE activities in PVN, ARC, and SON regions, VAChT immunoactivity in ARC region, and expression levels of hypothalamic ChAT mRNA and MIR mRNA （P〈0.05）. Similar situations were found in OVX＋CCI rats after EA2W. It suggested a cumulative effect after repeated EA of ST36-GB34. Comparison between CCI＋EA2W and OVX＋CCI＋EA2W groups showed that the effects in rats of the former group were evidently better than those of the latter group in up-regulating AChE activity in ARC and SON regions and the expressions of hypothalamic ChAT mRNA and M1 mRNA （P〈0.05）, suggesting a reduction of EA2W effects after OVX. Conclusion： Repeated EA can significantlyup-regulate AChE and VAChT activities and ChAT mRNA and MIR mRNA expressions in the hypothalamus of CCI and OVX＋CCI rats, which may contribute to the cumulative analgesic effects of repeated EA and be closely related to the animals＇ neuromemory ability.

Rapid acupuncture for musculoskeletal pain in the emergency room of the Hospital Servidor Publico Estadual, Brazil: A quasi-experimental study

Objective:To compare differences in self-reported musculoskeletal pain before and after receiving rapid acupuncture for pain at an outpatient emergency department.Methods:Exactly 102 patients presenting to the emergency room of the Hospital Servidor Publico Estadual in Sao Paulo,Brazil,participated in this before-and-after study.All participants had musculoskeletal pain and were treated with the technique proposed by Marques Filho.This emergency acupuncture involved inserting a needle at a point defined by traditional Chinese medicine and applying intense stimulation for 10 s;no more than two points were used on any individual patient.Pain was measured using a numerical visual scale before and immediately after the procedure.Results:Participants in this study were mostly women(78%),had a college degree(47%)and were below the age of 60(56%).The most common region of pain was the lower back(31%),and the most common type of pain was acute and exacerbated chronic pain.The meridians most commonly involved were the eight extra meridians(40%),and the points most often used for treatment were Houxi(SI3),Shenmai(BL62)and Zulinqi(GB41).Almost all participants reported a decrease in pain intensity,independent of sex,education level,pain site and pain type(acute/chronic;P<0.05).At the end of the session,only4%of the participants reported a desire for allopathic medication.Conclusion:This emergency acupuncture technique for analgesia appears to reduce musculoskeletal pain.Trial registration:Brazilian Registry of Clinical Trials(http://www.ensaiosclinicos.gov.br/)with No.RBR-8 dmfjf.

经络系统与针刺效应机制的科学评价

Objective:To search all available sources to find incontrovertible scientific explanation of the meridian system and mechanism of acupuncture action.Methods:Extensive search of electronic databases was carried out to identify all published scientific articles,research papers and experimental findings regarding meridian system,acupuncture points and mechanisms of acupuncture action,from both English and Chinese language journals,from inception till date.Results:There are many hypotheses and studies about meridian system such as,primovascular system as meridian,nuclear tracers study to locate the track of meridian,infrared imaging studies to prove existence of meridians,investigations about anatomical structure of acupoints,etc.There are many researches and theories about mechanism of acupuncture action such as gate control theory of acupuncture analgesia,neurotransmitters,neuro-endocrine-immune network,fMRI evidences of brain’s processing of pain signal etc.Conclusion:Researchers over half a century discovered many factual information about meridian system,acupoints,neuro-transmitters and acupuncture analgesia,neuro-hormonal mechanism etc.All these important discoveries contributed to clarify the mysteries of meridian system and acupuncture action,but they still fell short of providing an incontrovertible scientific explanation.Further coordinated studies are warranted to explore more plausible and scientifically valid explanation of meridian system and acupuncture action.

Two Sets of Acupoint Combination of Similar Functions Engage Shared Neural Representation:A Functional Magnetic Resonance Imaging Study

Objective： To investigate whether the neural representations underlying alternating two acupoint combinations （ACs） are the same or not. Methods： In this functional magnetic resonance imaging study, two sets of analgesia ACs were utilized, including Waiguan （TE5） and Qiuxu （GB40） for Group A, and Neiguan （PC6） and Taichong （LR3） for Group B, which are the most commonly adopted in clinical treatment. Each group had 20 healthy subjects. An experinlental design was proposed, which consisted of a pre-needling resting phase, a needling phase and a post-needling resting phase. This paradigm optimally mimics the clinical protocol as well as focuses on both the stimulation and the resting periods. The results were subjected to general linear model analysis, conjunction analysis and the functional connectivity analysis. Results： The rostral anterior cingulated cortex was engaged in the initiative period of the acupuncture effect in both groups, and it was chosen as the seed region for the functional connectivity analysis for the following resting period. The results showed that several shared brain regions were involved in both groups, in particular the insula, amygdala and hypothalamus. Moreover, significant differences were located at the posterior cingulated cortex as revealed by a two sample t-test （P〈0.05, corrected）. Other regions showed no significant differences. This finding was further supported by the spatial correlation analysis that the two groups were significantly correlated （r=0.51, P〈0.01）. Conclusion： This preliminary research helps us understand the neurophysiological mechanisms of acupuncture when following clinical guidelines on ACs, as well as provides an important opportunity to develop better treatment strategies for reducing, or even preventing pain.