Survey for late-onset hypogonadism among old anti middle-aged males in Shanghai communities

This study sought to investigate late-onset hypogonadism （LOH） in old and middle-aged males in Shanghai communities, using symptom score evaluation systems and measurements of sex hormone levels. One thousand cases of males aged 40-70 years were investigated. The aging male symptoms （AMS） scale and androgen deficiency in aging males （ADAM） questionnaire were used at the beginning of the investigation, followed by measurement of the sex hormone-related factors （total testosterone （TT）, free testosterone （fT）, sex hormone-binding globulin （SHBG） and bioavailability of testosterone （Bio-T））. There were 977 valid questionnaires. The LOH-positive rates shown by AMS and ADAM were 59.88% and 84.65%, respectively; values increased with the age of the patients. There were 946 results related to sex hormone measurements, which showed the following results： TT was not related to aging （P〉O.05）; levels of SHBG increased with age; and fT and Bio-T decreased with age. There was a significant difference in fT between LOH-positive and LOH-negative patients, as shown by the ADAM. In summary, TT levels were not related to aging, even though SHBG did increase while fT and Bio-T decreased with aging. Clinically, the diagnosis of LOH cannot be based on serum TT level.

Efficacy and safety of electroacupuncture for perimenopausal insomnia: a randomized controlled trial

Objective: To observe the effectiveness and safety of electroacupuncture (EA) plus Luohua Anshen oral liquid for patients with perimenopausal insomnia. Methods: A total of 66 participants who met the inclusion criteria were enrolled in the randomized controlled trial and allocated to a treatment group and a control group at a ratio of 1:1, with 33 cases in each group. Both groups were given Luohua Anshen oral liquid as a basic treatment. The treatment group was additionally given EA every other day, three times a week. Both groups were treated for four weeks and a four-week follow-up was conducted. The scores of Pittsburgh sleep quality index (PSQI), Kupperman index (KI) and traditional Chinese medicine sleep syndrome scale (TCMSSS) were recorded at pre- and post-treatment, and at the follow-up. Meanwhile, adverse effects were monitored and recorded. Results: After four-week treatment, the global scores of PSQI, KI and TCMSSS in both groups declined significantly (all P<0.05), and the decreases in the treatment group were more significant than those in the control group (allP<0.05). The global scores of PSQI, KI and TCMSSS in both groups at the follow-up visit were significantly different from the corresponding baseline (allP<0.05), while insignificantly different from those assessed at post-treatment (allP>0.05). The total effective rate was 93.9% in the treatment group, significantly higher than 72.2% in the control group (P<0.05). No significant adverse event was reported in this trial excepted one patient experienced slight dizziness in the first acupuncture treatment. Conclusion: EA plus Luohua Anshen oral liquid is safe for perimenopausal insomnia with satisfactory short- and long-term effectiveness, and it shows certain advantage compared with using Luohua Anshen oral liquid alone.

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.

Clinical Observations on the Treatment of 90 Chronic Gastritis Patients by Combination of Acupuncture and Herbal Medicine

Objective： To investigate the clinical efficacy of combined acupuncture and herbal medicine based on Prof. QIN Liang-fu＇s experience in treating chronic gastritis. Methods： Ninety chronic gastritis patients were randomly divided into acupuncture, herbal medicine and acupuncture plus herbal medicine groups. The clinical effects were evaluated after 6 months. Results： After 6 months, the clinical effect was better in the acupuncture plus herbal medicine group than in the acupuncture group and in the herbal medicine group（P〈 0.05）. Conclusion： The curative effect on chronic gastritis was better in the acupuncture plus herbal medicine group than in the acupuncture group and in the herbal medicine group.

Discussion of the promising effect of electroacupuncture on cognitive improvement in D-galactose-induced aging rats based on NLRP3-ASC-Caspase-1 signaling pathway

Objective:To investigate the effect of electroacupuncture(EA)on cognitive function in D-galactose(D-gal)-induced aging rats,and the correlation between the effect and nucleotide-binding oligomerization domain(NOD)-like receptor protein 3(NLRP3)-ASC-Caspase-1 signaling pathway.Methods:Forty-six male Sprague-Dawley(SD)rats were randomly divided into a control group(n=10),a model group(n=12),an EA-7 d group(n=12)and an EA-21 d group(n=12).Except the control group,the other three groups received 42 consecutive days of intraperitoneal injection of D-gal to establish aging rat models with cognitive dysfunction.The control group received the same amount of normal saline via intraperitoneal injection.Two EA groups were given EA therapy for 21 consecutive days(began from the 22nd day of modeling)or 7 consecutive days(began from the 36th day of modeling)accordingly at Dazhui(GV 14),Baihui(GV 20),Shenshu(BL 23)and Zusanli(ST 36).After modeling/intervention,all four groups received behavioral evaluations by Morris water maze(MWM)test,novel object recognition(NOR)test and step-down passive avoidance(SDPA)test followed by the Western blot(WB)detection of the expression levels of hippocampal NLRP3 inflammasome-associated proteins NLRP3,ASC and Caspase-1.Results:MWM(place navigation test,PNT)results showed that the escape latency in the model group was significantly longer than that in the other three groups(P<0.05),and there was no significant difference among the other three groups on the 1st day of the test(P>0.05).From the 2nd day to the 4th day of the test,there was no significant difference between the EA-21 d group and the control group(P>0.05)in the escape latency;the escape latency was significantly shorter in the EA-21 d group than in the model group and the EA-7 d group(P<0.05).MWM(spatial probe test,SPT)results showed that the time spent in the target quadrant was significantly shorter and platform crossover number was significantly lower in the model group than in the other three groups(P<0.05).The time spent in the target quadrant was longer in the EA-7 d group than in the model group(P<0.05),but was shorter than that in the control group and the EA-21 d group(P<0.05).There was no significant difference in the swimming speed among the four groups(P>0.05).NOR results showed that there was no significant difference in the recognition ratio between the EA-7 d group and the EA-21 d group(P>0.05),and the recognition ratio was significantly higher in the two EA groups than in the model group(P<0.05),but was lower than in the control group(P<0.05).SDPA results showed that the electric shock number was higher in the model group than in the other three groups(P<0.05),and the differences among the other three groups were statistically insignificant(P>0.05).The model group had the shortest step-down latency,followed by the EA-7 d group,the EA-21 d group and the control group in order(P<0.05).The WB results indicated that the expression level of NLRP3 was significantly lower in the control group and the EA-21 d group than in the model group and the EA-7 d group(P<0.05).The expression levels of ASC and Caspase-1 were significantly higher in the model group than in the other three groups(P<0.05),and there was no significant difference among these three groups(P>0.05).Conclusion:NLRP3 inflammasome may be involved in the development of cognitive decline in aging rats;7 consecutive days of EA intervention can partially improve the cognitive impairment in aging rats though the effect is rather limited;21 consecutive days of EA intervention may improve the learning and memory abilities in aging rats via downregulating the expression levels of NLRP3 inflammasome-associated proteins in hippocampus.

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).

Effects of electroacupuncture on the behaviors and expressions of hippocampal neurotransmitters and Bax/Bcl-2 proteins in rat models of anxiety disorder

Objective:To investigate the effects of electroacupuncture(EA)on the behaviors of rat with anxiety disorder,and the expressions of hippocampal neurotransmitters including 5-hydroxytryptamine(5-HT),norepinephrine(NE)and dopamine(DA),and the expressions of hippocampal B-cell lymphoma-2(Bcl-2)and Bcl-2 associated X(Bax).Methods:Forty-six male Wistar rats were randomly divided into a control group(n=10);a model group(n=12),an EA group(n=12),and a drug group(n=12).Except the control group,the other three groups were established into rat models of anxiety disorder using uncertain empty bottle stimulation.Rats in the EA group and the drug group received corresponding interventions for 15 consecutive days[EA group was given EA at Baihui(GV 20)and Sanyinjiao(SP 6);the drug group was given aqueous solution of alprazolam via intragastric administration].After intervention,all four groups received open-field test(OFT)and elevated plus-maze(EPM)for behavioral evaluations.The expressions of 5-HT,NE and DA in hippocampus were determined by fluorescence spectroscopy(FS)while the expressions of Bcl-2 and Bax proteins in hippocampus were determined by Western blot(WB).Results:The OFT horizontal scores in the control group,EA group and drug group were significantly higher than that in the model group(all P<0.05),and the difference between the EA group and the drug group was statistically insignificant(P>0.05);the OFT vertical scores in the model group,EA group and drug group were significantly lower than the score in the control group(all P<0.05).The EPM percent of open-arm entries(OE%)in the control group,EA group and drug group was higher than that in the model group(P<0.05),and the differences among these three groups were statistically insignificant(P>0.05);though the percent of open-arm total time(OT%)in the EA group was lower than that in the control group(P<0.05);the difference was statistically insignificant when compared with the drug group(P>0.05),and it was significantly higher than that in the model group(P<0.05).The expression of 5-HT in the EA group was higher than that in the control group(P<0.05);the expression of 5-HT in the EA group was significantly lower than that in the model group(P<0.05);the difference between the EA group and the drug group was statistically insignificantly(P>0.05).The expression of NE in the model group was significantly higher than that in the other three groups(P<0.0S),and there was no significant difference among these three groups(P>0.05).The expression of DA in the EA group was significantly higher than that in the control group and the drug group(both P<0.05),while the difference between the EA group and the model group was statistically insignificant(P>0.05).The expression of Bax in the model group was significantly higher than that in the other three groups(all P<0.05),whereas the expression of Bcl-2 in the model group was significantly lower than that in the other three groups(all P<0.05),and the differences in both Bax and Bcl-2 among the other three groups were statistically insignificant(all P>0.05).Bax/Bcl-2 in the EA group was significantly higher than that in the control group(P<0.05)and lower than that in the model group(P<0.05),and the difference was statistically insignificant when compared with the drug group(P>0.05).Conclusion:EA shows promising effects in attenuating rats'anxiety disorder,which may be achieved by the down-regulation of the expressions of 5-HT and NE in the hippocampus and/or inhibition of hippocampal neuronal apoptosis.The efficacy is comparable to that of intervention with alprazolam.

VEGF-B antibody and interleukin-22 fusion protein ameliorates diabetic nephropathy through inhibiting lipid accumulation and inflammatory responses

Diabetic nephropathy(DN)is considered the primary causes of end-stage renal disease(ESRD)and is related to abnormal glycolipid metabolism,hemodynamic abnormalities,oxidative stress and chronic inflammation.Antagonism of vascular endothelial growth factor B(VEGF-B)could effi-ciently ameliorate DN by reducing renal lipotoxicity.However,this pharmacological strategy is far from satisfactory,as it ignores numerous pathogenic factors,including anomalous reactive oxygen species(ROS)generation and inflammatory responses.We found that the upregulation of VEGF-B and downregulation of interleukin-22(IL-22)among DN patients were significantly associated with the progression of DN.Thus,we hypothesized that a combination of a VEGF-B antibody and IL-22 could protect against DN not only by regulating glycolipid metabolism but also by reducing the accumulation of inflammation and ROS.To meet these challenges,a novel anti-VEGFB/IL22 fusion protein was developed,and its therapeutic effects on DN were further studied.We found that the anti-VEGFB/IL22 fusion protein reduced renal lipid accumulation by inhibiting the expression of fatty acid transport proteins and ameliorated inflammatory responses via the inhibition of renal oxidative stress and mitochondrial dysfunction.Moreover,the fusion protein could also improve diabetic kidney disease by increasing insulin sensitivity.Collectively,our findings indicate that the bifunctional VEGF-B antibody and IL-22 fusion protein could improve the progression of DN,which highlighted a novel therapeutic approach to DN.

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.

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.

Memory response to manual acupuncture in chronic insomniacs: evidence from event-related potentials

Objective:To investigate the effectiveness and safety of manual acupuncture for memory loss and sleep quality in chronic insomniacs.Methods:A total of 60 eligible participants were enrolled and randomized into either a treatment group or a control group,with 30 cases in each group.The treatment group was intervened by manual acupuncture whereas the control group was given sham acupuncture.In the two groups,the interventions were offered once every other day and three times a week,for 8 weeks in total.Before and after the treatment,Pittsburgh sleep quality index (PSQI) and eventrelated potentials (ERPs) were used to assess the patients' sleep quality and memory,respectively.Meanwhile,adverse events were monitored and recorded.Results:After 8-week treatment,both the treatment group and the control group showed a significant decrease in the PSQI global score (P<0.001,P<0.01),and the decrease in the treatment group was more significant than that in the control group (P<0.001).The intra-group comparisons of ERPs indicated that,the latencies of N1 and P3 were shortened and the amplitudes of N1 and P3 were increased in the treatment group after the intervention,and the differences were statistically significant (P<0.05,P<0.001);in the control group,there were no significant changes in the latency and amplitude after the treatment (P>0.05).The between-group comparisons of ERPs showed that the treatment group was more effective than the control group in shortening the latency of P3 (P<0.01).Conclusion:Acupuncture can be a safe and effective treatment option for chronic insomnia coupled with memory impairment.