Study of wrist-ankle acupuncture therapy for optimizing anaesthesia scheme of painless gastroscopy and improving painless gastroscopy related complications

BACKGROUND Painless gastroscopy is a widely used diagnostic and therapeutic technology in clinical practice.Propofol combined with opioids is a common drug for painless endoscopic sedation and anaesthesia.In clinical work,adverse drug reactions of anaesthesia schemes are often one of the important areas of concern for doctors and patients.With the increase in propofol dosage,the risk of serious adverse drug reactions,such as respiratory depression and hypotension,increases significantly;the use of opioids often causes gastrointestinal reactions in patients after examination,such as nausea,vomiting,delayed recovery of gastrointestinal function and other complications,which seriously affect their quality of life.AIM To observe the effect of wrist-ankle acupuncture therapy on the anaesthesia regimen and anaesthesia-related complications during and after painless gastroscopy examination.METHODS Two hundred patients were selected and randomly divided into a treatment group(n=100)and a control group(n=100).Both groups were routinely anaesthetized with the nalbuphine and propofol regimen,gastroscopy began after the patient lost consciousness,and given supportive treatment and vital sign monitoring.If the patient interrupted the surgery due to intraoperative torsion,intravenous propofol was used to relieve his or her discomfort.The treatment group received wrist-ankle acupuncture on this basis.RESULTS The general data before treatment,American Society of Anesthesiologist(ASA)grade and operation time between the two groups was no significant difference.The Wakeup time,and the Selfambulation time in the treatment group was significantly faster than that in the control group(P<0.05).The total dose of propofol in the treatment group was 109±8.17 mg,significantly lower than that in the control group(P<0.05).The incidence of respiratory depression and hypotension was not significantly different,but the incidence of hiccups was significantly lower than that in the control group(P<0.05).After the examination,the incidence of nausea,vomiting,abdominal distension,and abdominal pain was 11%,8%,6%,and 5%,respectively,which was significantly lower than that in the control group(P<0.05).In addition,both the operators and the patients were more satisfied with this examination,with no significant difference between the groups(P>0.05).CONCLUSION Wrist-ankle acupuncture treatment can optimize the painless gastroscopy and anaesthesia scheme,reduces propofol total dose;shortens patient Wakeup time and Self-ambulation time,improves patient compliance and tolerance,is beneficial to clinical application.

Effect of wrist-ankle acupuncture on propofol dosage during painless colonoscopy:A randomized controlled prospective study

BACKGROUND The clinical advantages of painless colonoscopy can reduce the fear and discomfort of patients and increase the detection rate of diseases.Propofol has the characteristics of fast effect and short action time.It is a common choice for painless endoscopic sedation and anesthetics.However,propofol can cause severe respiratory and circulatory depression.Therefore,it is important to find a way to reduce the dose of propofol.AIM To explore the effect of wrist-ankle acupuncture on propofol dose during colonoscopy.METHODS Two hundred patients who were going to receive selective painless colonoscopy in Hebei Hospital of Traditional Chinese Medicine were selected and divided into wrist-ankle acupuncture group(WAA group,n=100)and control group(CON group,n=100).After entering the operation room,patients were given 0.025 mg/kg nabufine intravenously and propofol at the initial dose of 0.5 mg/kg.In patients who did not fall asleep,propofol(10 mg/time)was given until loss of consciousness.Prior to anesthesia,patients in WAA group were punctured by specialist in the inferior 1,2 and 3 regions according to the zoning principle of wrist-ankle acupuncture.The primary endpoint was required dose of propofol,and the secondary endpoints were the incidence of hypoxemia and hypotension.Furthermore,the following data were recorded:The operation time,wake-up time,incidence of nausea and vomiting,incidence of abdominal distention,post colonoscopy pain,examiners'satisfaction,patients'satisfaction and Borg fatigue index.This study has been registered in the Chinese Clinical Trial Registry(Registration Code:ChiCTR1900022177).RESULTS The induced dose of propofol and the total dose of propofol in WAA group were 80 mg and 110 mg,respectively,which were significantly lower than those in CON group(P<0.05).The incidences of hypoxemia and hypotension in the WAA group were 2.2%and 3.3%,respectively,significantly lower than those in the CON group(P<0.05).The incidence of abdominal distension in the WAA group was 8.8%,which was significantly lower than that in the CON group(P<0.05,28.9%).The waking time of WAA group was 3.26±0.87 min,which was significantly lower than that of CON group(6.06±0.88 min,P<0.05).CONCLUSION Wrist-ankle acupuncture can reduce the induction dose and total dose of propofol as well as the incidence of adverse reactions in painless colonoscopy without affecting the satisfaction of examiners and patients.This procedure is simple in operation and easy to promote in clinical practice.

Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain

BACKGROUND Urological calculi often cause renal colic,which is characterized by paroxysmal or persistent severe pain in the upper abdomen or lumbar region.Development of methods to quickly relieve these pain symptoms has garnered clinical attention.Wrist-ankle acupuncture is a type of floating acupuncture therapy administered at selected points in the carpal and ankle areas,and it has good pain-relieving effects.We used wrist-ankle acupuncture combined with pain nursing for pain intervention in patients with renal calculi to confirm its application and safety.AIM To study the effect of wrist-ankle acupuncture combined with pain nursing in the treatment of urinary calculi with acute pain.METHODS Eighty-two patients with urinary calculi with acute pain as the first symptom followed at our hospital from November 2019 to June 2021 were enrolled in the study and classified into two groups according to the odd and even numbers of the visit sequences,each with 41 cases.The control group received a routine nursing intervention and intramuscular injection of nonsteroidal anti-inflammatory drugs,whereas the observation group received pain management nursing and wrist-ankle acupuncture.Subsequently,the pain-relieving effect was compared between the two groups.RESULTS The score on the visual analog scale(VAS)at 24,48,and 72 h postintervention was decreased in both groups compared with the baseline data;moreover,the observation group scored significantly lower than the control group on the VAS at each time point after the intervention(P<0.05).The clinical efficacy at 24 h postintervention was not significantly different between the two groups(P>0.05).In turn,the pain recurrence rate at 72 h postintervention was lower in the observation group compared with the control group(P<0.05).Finally,the nursing satisfaction rate in the observation group was significantly higher than that observed in the control group(P<0.05).No serious adverse reactions occurred during the treatment and the safety of treatment was high in both groups.CONCLUSION Wrist-ankle acupuncture combined with pain nursing for treating urolithiasis with acute pain effectively alleviated the degree of pain and reduced the recurrence rate,which was worthy of clinical application.

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.

CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECTS OF WRIST-ANKLE ACUPUNCTURE IN TREATMENT OF PAIN OF VARIOUS ORIGINS

Wrist-ankle acupuncture is performed at the specific points of the wrist or ankle to treat diseases inyolving corresponding parts of the body. It is a new therapeutic method enlightened by the theory of channels and collaterals and the theory of nerves, and advanced through clinical trials. It, therefore, exhibits not only the advantages of traditional acupuncture, but also its unique characteristics, yielding satisfactory results especially in pain of various origins. A report is presented below.

Seventy-two cases of external humeral epicondylitis treated by wrist-ankle acupuncture

Objective To observe the clinical effects of wrist-ankle acupuncture on external humeral epicondylitis. Methods Seventy-two cases diagnosed as external humeral epicondylitis were brought into the study. Horizontal needling was used at upper area 3, upper area 4 and upper area 5 near wrists with long filiform needles. The frequency was once a day, and a course included 10 times. Results 27 cases got cured, 36 cases were marked effective, 5 cases were effective and 4 cases were failed after 1 course to 5 courses of treatment. The total effective rate was 94.5%. Conclusion Wrist-ankle acupuncture is a simple and effective therapy on external humeral epicondylitis.

Curative effect of wrist-ankle acupuncture on postpartum abdominal pain and its influence on serum β-EP level in puerpera

Objective To observe the clinical effect of wristankle acupuncture on postpartum abdominal pain and its influence on serum beta-endorphin (β-EP) level in puerpera.Methods Seventy patients with postpartum abdominal pain were randomly divided into an acupuncture+herbal medication group (35 cases,1 case dropped out) and a herbal medication group(35 cases,2cases dropped out).In the herbal medication group.

Effects of wrist-ankle acupuncture on associated factors in uterus tissue and serum in rats with primary dysmenorrhea

Objective：To observe effects of wrist-ankle acupuncture （WAA） onβ-endorphin （EP）, nitric oxide （NO） in uterus tissue and prostaglandin F2α （PGF2α）, substance P （SP） in serum of rats with primary dysmenorrhea. Methods：A total of 45 non-pregnant Wistar rats were randomly divided into a control group, a model group and a WAA group, 15 rats in each group. Rats in the model group and the WAA group received continuous abdominal subcutaneous injection of Diethylstilbestrol to establish dysmenorrhea rat models. On the first day after modeling, rats in the WAA group began to receive acupuncture on Point Lower 1 and Point Lower 2, once a day for 10 d. The control group and the model group didn’t receive any treatment. Writhing latencies and frequencies were recorded.β-EP and NO in uterus tissue homogenates and PGF2α, SP in serum were detected. Results：In the model group,β-EP and NO levels were the lowest among the groups, the serum PGF2α level was the highest, and serum SP level was the lowest. These measurements showed significantly difference between the model group and the control group （P〈0.05）. PGF2α in the WAA group was lower than that in the model group;β-EP, NO and SP levels were higher than those in the model group, with inter-group statistically significant differences （P〈0.05）. Conclusion： WAA may achieve analgesic effect through decreasing PGF2α, increasingβ-EP, NO and SP to relieve uterine cramps, increase blood flow and promote functional improvement.

Wrist-ankle acupuncture and Fluoxetine in the treatment of post-stroke depression: a randomized controlled clinical trial

OBJECTIVE: To investigate the effects of WAA combined with fluoxetine in the clinical treatment of post-stroke depression(PSD).METHODS: In this randomized, controlled and single-blind trial, 105 PSD patients who met the inclusion criteria were randomly divided into three equal groups: Thin wrist-ankle acupuncture(WAA)group(Thin WAA needle + Fluoxetine), Thick WAA group(Thick WAA needle + Fluoxetine), and Sham WAA group(sham WAA needle + Fluoxetine). In this trial, the primary outcome was Hamilton Depression Scale(HAMD), while the secondary outcomes included Zung self-rating depression scale(SDS) and World Health Organization Quality of Life BREF(QQL).RESULTS: Ninety nine PSD patients completed all the treatment. The HAMD scores and SDS scores of all the three groups decreased after treatment(P <0.05);thick WAA group and thin WAA group decreased more obviously than the sham WAA group(P < 0.05). There was no significant difference between the QQL scores of the three groups(P >0.05). There was no significant difference in the scores of the three scales between the thick wrist ankle needles and the thin wrist ankle needles(P >0.05).CONCLUSION: The present study showed that WAA combined with fluoxetine can relieve the symptoms of depression after stroke. WAA therapy could improve the antidepressant effect of fluoxetine.

Wrist-Ankle Acupuncture and Ginger Moxibustion for Preventing Gastrointestinal Reactions to Chemotherapy:A Randomized Controlled Trial

Objective： To evaluate the effects of wrist-ankle acupuncture combined with ginger moxibustion against gastrointestinal tract reactions （nausea, vomiting, and constipation） to chemotherapy in cancer patients. Methods： A total of 60 patients with gynecological tumors treated by chemotherapy were randomly divided into two groups. The treatment group （30 cases） underwent wrist-ankle acupuncture and ginger moxibustion, whereas tropisetron hydrochloride and dexamethasone were intravenously administered to the control group （30 cases） during chemotherapy. Results： The frequency of nausea in the treatment group was significantly less than that of the control group from the 2nd to the 5th day of chemotherapy （P〈0.01）. The anti-emetic effect in the treatment group was significantly better than that in the control group on the 3rd day of therapy （P〈0.05）. The incidence rate of constipation was significantly lower in the treatment group than that in the control group （P〈0.01）. Furthermore, the cost of therapy for the treatment group was significantly lower than that of the control group （P〈0.01）. Only 1 patient manifested a post-acupuncture side effect in the form of subcutaneous blood stasis. Conclusion： Wrist-ankle acupuncture combined with ginger moxibustion could prevent gastrointestinal tract reactions to chemotherapy in cancer patients. In addition, the proposed method had fewer side effects, lower cost, and less risk.

Treatment on 2 cases of pain in the heel based on syndrome differentiation by wrist-ankle acupuncture

Two patients with pain in the heel were treated by new methods based on symptom differentiation after regular wrist-ankle acupuncture were invalid. According to the manifestations in tongue diagnosis and symptoms,the 2 cases both belonged to bladder excess syndrome,the acupuncture was carried out on area 6 of low limb（external anterior border of achilles tendon at three finger wide above the lateral malleolus）,and acupuncture was also carried out on Zútōnggǔ（足通谷 BL 66）,Jīnmén（金门 BL 63） and Shēnmài（申脉 BL 62） at the le side. The results showed that the therapeu c effi cacy of treatments on the 2 pa ents was sa sfactory and thus the clinical values for new methods for using wrist-ankle acupuncture based on syndrome differentiation were verified.

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain:A randomized controlled trial

Background Treatment duration of wrist-ankle acupuncture(WAA)is uncertain for post-thyroidectomy pain relief.Objective This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.Design,setting,participants and intervention This randomized controlled trial was conducted at a single research site in Guangzhou,China.A total of 132 patients receiving thyroidectomy were randomly divided into the control group(sham WAA,30 min)and three intervention groups(group 1:WAA,30 min;group 2:WAA,45 min;group 3:WAA,60 min),with group allocation ratio of 1:1:1:1.Acupuncture was administered within 1 hour of leaving the operating room.Outcomes and measures Primary outcome was patients’pain at the surgical site assessed by visual analogue scale(VAS)at the moment after acupuncture treatment(post-intervention).Secondary outcomes included the patients’pain VAS scores at 6,12,24,48 and 72 h after the thyroidectomy,the 40-item Quality of Recovery(QoR-40)score,the grade of post-operative nausea and vomiting(PONV),and the use of additional analgesic therapy.Results The adjusted mean difference(AMD)in VAS scores from baseline to post-intervention in group 1 was-0.89(95%confidence interval[CI],-1.02 to-0.76).The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group(AMD,-0.43;95%CI,-0.58 to-0.28;P<0.001),and in groups 2 and 3 compared to group 1(group 2 vs group 1:AMD,-0.65;95%CI,-0.81 to-0.48;P<0.001;group 3 vs group 1:AMD,-0.66;95%CI,-0.86 to-0.47;P<0.001).The VAS scores in the four groups converged beyond 24 h after the operation.Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation.No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.Conclusion Compared with the 30 min intervention,WAA treatment with longer needle retention time(45 or 60 min)had an advantage in pain relief within 6 h after surgery.WAA’s analgesic effect lasted for 6-12 h post-operatively.

Effect of wrist-ankle acupuncture on propofol dosage in painless bronchoscopy of elderly patients:A randomized controlled trial

Objective:To observe whether wrist-ankle acupuncture can reduce propofol dosage in painless bronchoscopy of elderly patients or not and its potential effect mechanism.Methods:A total of 60 patients undergoing painless bronchoscopy were randomized into a wrist-ankle acupuncture group and a control group,30 cases in each one.In the wrist-ankle acupuncture group,wrist-ankle acupuncture was received and the needles were retained for 30 min before entering to the operating room.In the control group,no any intervention was provided.The patients in two groups all received venous administration of midazolam,nalorphine and lidocaine and target controlled infusion of propofol.When the patient’s consciousness was lost and the eyelash reflex disappeared,bronchoscopy was performed and the propofol dosage was increased accordingly during operation.Propofol dosage,vital signs and occurrence of adverse reactions,bronchoscopist satisfaction,operation time and recovering time were recorded in the patients of two groups.Results:Propofol dosage in induction period and the total dosage of propofol in the wrist-ankle acupuncture group were lower than those in the control group,indicating the statistical differences(both P<0.05).The vital signs were stable during bronchoscopy in patients of two groups.The occurrence rates of hypoxemia and choking in the wrist-ankle acupuncture groups were lower than those in the control group,indicating the statistical differences(both P <0.05).Bronchoscopist satisfaction in the wrist-ankle acupuncture group was higher than that of the control group,and the operation time and recovering time were lower than the control group,indicating the statistical differences(all P<0.05).Conclusion:In painless bronchoscopy,wrist-ankle acupuncture may effectively reduce propofol dosage,alleviate respiratory suppression,reduce adverse reaction and shorten the recovering time in elderly patients.

Effect of Wrist-Ankle Acupuncture on Postoperative Analgesia after Total Knee Arthroplasty

Objective:To evaluate the effect of wrist-ankle acupuncture(WAA)in pain and functional recovery after total knee arthroplasty(TKA).Methods:From June to September 2020,94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group(47 cases)and the sham WAA group(47 cases)by a random number table,receiving real or sham WAA treatment,respectively.The primary outcome measure involved the visual analogue scale(VAS)scores at rest and in motion.The secondary outcomes involved the range of motion(ROM)of the knee joints,straight-leg raising time,postoperative weight-bearing time,sufentanil consumption within 48 h of patient-controlled analgesia(PCA)pump,length of hospital stay,and postoperative complications.Results:The VAS scores on the 3rd,5th,and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group(P<0.01).The ROM on the 1st,2nd,and 3rd PODs was significantly higher in the WAA group than that of the sham WAA group(P<0.01).In comparison to the sham WAA group,the sufentanil consumption within 48 h of PCA pump was significantly less in the WAA group(156.3±12.2μg vs.128.8±9.8μg,P<0.01).There was no significant difference in active straight-leg raising time,postoperative weight-bearing time,length of hospital stay,and postoperative complications between the two groups(P>0.05).Conclusions:WAA could alleviate post-TKA pain,improve knee joint function,and reduce the sufentanil consumption within 48 h of PCA pump.WAA is a safe and effective treatment in the perioperative analgesic management for TKA.

Bo’s abdominal acupuncture treatment for adult-onset Still's disease:A case report

BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.

Observation of efficacy on prolapse of lumbar intervertebral disc treated with body acupuncture and wrist-ankle acupuncture

Objective To observe the clinical effects of body acupuncture and wrist-ankle acupuncture on prolapse of lumbar intervertebral disc, Methods One hundred and eighty cases of prolapse of lumbar intervertebral disc were randomly divided into body acupuncture and wrist-ankle acupuncture group （observation group） and simple body acupuncture group （control group）, 90 cases in each one. In observation group, body acupuncture was applied on Ahshi points of lumbar region, lumbar Jiájǐ （夹脊EX-B 2）, Dàchángshú（大肠俞 BL 25）, etc. and wrist-ankle acupuncture was applied on lower No. 4, 5 and 6 regions. In control group, simple body acupuncture was applied on the same points as observation group. Results The lumbar vertebral function and pain scale were improved in either group in comparison before and after treatment （P〈0.05）. Concerning pain improvement, the total effective rate was 95.6% in observation group, which was superior to that （86.7%） in control group （P〈0.05）. Concerning the improvement of lumbar vertebral function, the total effective rate was 90.0% in observation group and 93.3% in control group, without significant difference between two groups （P〉0.05）. Conclusion Combined therapy of body acupuncture and wrist-ankle acupuncture demonstrates apparent analgesia in prolapse of lumbar intervertebral disc.

Effect of wrist-ankle acupuncture on postoperative nausea and vomiting undergoing radiofrequency ablation in thyroid nodule:A randomized controlled trial

Objective:To observe the influence of wrist-ankle acupuncture(WAA)on postoperative nausea and vomiting(PONV)undergoing radiofrequency ablation(RFA)in thyroid nodule and its analgesic effect.Methods:A total of 66 patients with thyroid nodule and undergoing RFA were randomized into a WAA group and a sham-acupuncture(SA)group,33 cases in each one.Acupuncture was exerted after the patients entering operation room.In the WAA group,WAA was applied on the bilateral Upper 1,2 and 3 areas.In the SA group,the sham-acupuncture was given on the same areas.In 30 min after needle insertion,the routine RFA started in the patients of the two groups.All the needles were removed when the operation was finished.The proportion of intraoperative sufentanil supplementation,the incidence of24 h PONV and the proportion of intraoperative intravenous injection of urapidil were recorded in the patients of the two groups.Results:In the WAA group,sufentanil was supplemented by 12.90%,obviously less than 36.36%in the SA group.The incidence of 24 h PONV was 9.68%in the WAA group,remarkably lower than 27.27%in the SA group,indicating statistical significances(both P<0.05).The intravenous injection of urapidil was not applied during operation in the two groups,without statistical difference between the groups(P>0.05).Conclusion:Wrist-ankle acupuncture reduces the intraoperative demand of sufentanil in radiofrequency ablation of thyroid nodule and this therapy is preventive for PONV.

Research progress on insomnia treated by traditional Chinese medicine and acupuncture based on microbial-gut-brain axis theory

Insomnia,as one of the emotional diseases,has been increasing in recent years,which has a great impact on people's life and work.Therefore,researchers are eager to find a more perfect treatment.The microbiome-gut-brain axis is a new theory that has gradually become popular abroad in recent years and has a profound impact in the field of insomnia.In recent years,traditional Chinese medicine(TCM)has played an increasingly important role in the treatment of insomnia,especially acupuncture and Chinese herbal medicine.It is the main method of TCM in the treatment of insomnia.This paper mainly reviews the combination degree of"microorganism-gut-brain axis"theory with TCM and acupuncture under the system of TCM.To explore the mechanism of TCM and acupuncture in the treatment of insomnia under the guidance of"microorganismgut-brain axis"theory,in order to provide a new idea for the diagnosis and treatment of insomnia.

“Baihui”(DU20)-penetrating “Qubin”(GB7) acupuncture on blood–brain barrier integrity in rat intracerebral hemorrhage models via the RhoA/ROCK Ⅱ/MLC 2 signaling pathway

Background: Blocking the Rho A/ROCK Ⅱ/MLC 2(Ras homolog gene family member A/Rho kinase Ⅱ/myosin light chain 2) signaling pathway can initiate neuroprotective mechanisms against neurological diseases such as stroke, cerebral ischemia, and subarachnoid hemorrhage. Nevertheless, it is not clear whether and how disrupting the Rho A/ROCK Ⅱ/MLC 2 signaling pathway changes the pathogenic processes of the blood–brain barrier(BBB) after intracerebral hemorrhage(ICH). The present investigation included the injection of rat caudal vein blood into the basal ganglia area to replicate the pathophysiological conditions caused by ICH. Methods: Scalp acupuncture(SA) therapy was performed on rats with ICH at the acupuncture point “Baihui”-penetrating “Qubin,” and the ROCK selective inhibitor fasudil was used as a positive control to evaluate the inhibitory effect of acupuncture on the Rho A/ROCK Ⅱ/MLC 2 signaling pathway. Post-assessments included neurological deficits, brain edema, Evans blue extravasation, Western blot, quantitative polymerase chain reaction, and transmission electron microscope imaging. Results: We found that ROCK Ⅱ acts as a promoter of the Rho A/ROCK Ⅱ/MLC 2 signaling pathway, and its expression increased at 6 h after ICH, peaked at 3 days, and then decreased at 7 days after ICH, but was still higher than the preintervention level. According to some experimental results, although 3 days is the peak, 7 days is the best time point for acupuncture treatment. Starting from 6 h after ICH, the neurovascular structure and endothelial cell morphology around the hematoma began to change. Based on the changes in the promoter ROCK Ⅱ, a 7-day time point was selected as the breakthrough point for treating ICH model rats in the main experiment. The results of this experiment showed that both SA at “Baihui”-penetrating “Qubin” and treatment with fasudil could improve the expression of endothelial-related proteins by inhibiting the Rho A/ROCK Ⅱ/MLC 2 signaling pathway and reduce neurological dysfunction, brain edema, and BBB permeability in rats. Conclusion: This study found that these experimental data indicated that SA at “Baihui”-penetrating “Qubin” could preserve BBB integrity and neurological function recovery after ICH by inhibiting Rho A/ROCK Ⅱ/MLC 2 signaling pathway activation and by regulating endothelial cell–related proteins.

Treating acute low back pain with acupuncture:A randomized controlled study protocol to compare the effectiveness between distal and local acupoints

Objective:To compare the efficacy of using“distal acupoints only”vs.“local acupoints mainly combined with distal acupoints”in cases of acute low back pain(ALBP).Methods: A total of 102 eligible patients aged 18–65 years with ALBP lasting less than 6 weeks will be randomized in a 1:1 ratio to the distal acupoints only group(DPOG)and the local acupoints mainly combined with the distal acupoints group(LPMG).During a 4-week treatment period,patients in the DPOG will receive acupuncture at distal acupoints only(Houxi[SI 3]and Yaotongxue[EX-UE 7])twice a week,while those in the LPMG group will receive acupuncture at local acupoints(mainly Shenshu[BL 23]and Dachangshu[BL 25])combined with distal points(Weizhong[BL 40]).The patients in both groups will be evaluated at every session of treatment,and the follow-up will be performed for 3 months.The primary outcome measure will be the change in ALBP intensity,assessed using visual analogue scale scores before and after treatment.The secondary outcome measure will be the evaluation of functional disability using the Oswestry Disability Index.Discussion: This study compares the DPOG and LPMG to explore the feasibility of the DPOG in the treatment of ALBP.