[Acupotomy combined with Xingnao Kaiqiao acupuncture therapy in treatment of sensory impairment in the recovery stage of cerebral infarction: a randomized controlled trial].

OBJECTIVE: To compare the therapeutic effect on sensory impairment in the recovery stage of cerebral infarction between the combined treatment of acupotomy and Xingnao Kaiqiao acupuncture therapy (for regaining consciousness and opening the orifices) and the simple application of Xingnao Kaiqiao acupuncture therapy. METHODS: A total of 80 patients with cerebral infarction in the recovery stage were randomized into an observation group (40 cases, 2 cases dropped off) and a control group (40 cases, 1 case dropped off). On the basis of the conventional treatment of internal medicine, in the control group, Xingnao Kaiqiao acupuncture therapy was adopted at Shuigou (GV 26), Neiguan (PC 6), Sanyinjiao (SP 6), etc., once daily, 6 times a week. In the observation group, on the base of the treatment as the control group, acupotomy was used at extraoccipital protuberance, posterior atlas nodules, cervical facet ligaments and posterior transverse nodules, once a week. The total treatment duration was 4 weeks. The scores of Fugl-Meyer assessment scale (FMA) and the visual analogue scale (VAS) were observed before and after treatment in the patients of the two groups. The clinical therapeutic effect was evaluated in the two groups. RESULTS: After treatment, FMA scores were increased and VAS scores were decreased in the patients of the two groups (P<0.05). The increase range of FMA score and the decrease range of VAS score in the observation group were larger than those in the control group (P<0.05). The total effective rate was 89.5% (34/38) in the observation group, higher than 76.9% (30/39) in the control group (P<0.05). CONCLUSION: The combined treatment of acupotomy and Xingnao Kaiqiao acupuncture therapy relieves sensory impairment and pain symptoms in the patients with cerebral infarction in the recovery stage and its therapeutic effect is better than the simple use of Xingnao Kaiqiao acupuncture therapy.

Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo.

Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3-4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.

Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke.

Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group (n = 22), a midbrain and pons infarction group (n = 16), and a multiple cerebral infarction group (n = 26) according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan (PC6), Renzhong (DU26), Sanyinjiao (SP6), Fengchi (GB20), Wangu (GB12), and Yifeng (SJ17). Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction (95.9%). These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient's swallowing ability and quality of life.

The quantity-effect relationship and physiological mechanisms of different acupuncture manipulations on posterior circulation ischemia with vertigo: study protocol for a randomized controlled trial.

BACKGROUND: Recent experiments have demonstrated that different needling manipulations may induce variable effects via diverse physiological mechanisms. A previous study indicated that needling at Fengchi (GB 20) improved cerebral blood flow in patients with vertigo induced by posterior circulation ischemia (PCI). In this study, we aim to explore the quantity-effect relationship and the physiological mechanisms underlying different acupuncture manipulations in PCI patients with vertigo. METHODS/DESIGN: We propose a pragmatic randomized and controlled trial. All participants, outcome assessors, and statisticians will be blinded. A total of 144 eligible participants will be randomized into one of four treatment groups receiving acupuncture at Fengchi (GB 20) with different one-minute manipulation parameters. Group 1 will receive twirling at a frequency of 60 times per minute toward the contralateral outer canthus at a depth of 0.5 to 0.8 cun. Group 2 will receive twirling at a frequency of 60 times per minute toward the Adam's apple at a depth of 0.5 to 0.8 cun. Group 3 will receive twirling at a frequency of 120 times per minute toward the contralateral outer canthus at a depth of 0.5 to 0.8 cun. Group 4 will receive twirling at a frequency of120 times per minute toward the Adam's apple at a depth of 0.5 to 0.8 cun. Additional points will be added based on individualized pattern diagnoses. The participants will receive 14 acupuncture sessions over 3 to 4 weeks. The subjects will be assessed at two time points: baseline and post-treatment. The primary outcome measurements will include subjective measurements (Vertebrobasilar System Ischemic Neurological Impairment Scale, UCLA Dizziness Questionnaire, Activities of Daily Living Scale, and Psychological and Social Adaptation Scale) and objective measurements (Transcranial Doppler, carotid ultrasonography and changes in cerebral oxygenation) to reduce bias arising from the placebo effect. We will use metabolomics to investigate the mechanisms underlying the different manipulation parameters. DISCUSSION: This trial aims to explore the quantity-effect relationship between different acupuncture manipulations and their clinical effects. The results from this study may help explain the contradictory results found in acupuncture studies that practice different manipulations. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-RTRCC-12002675 (registered on 14 November 2012).

Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion.

Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture manipulations and durations may result in different therapeutic effects. In the present study, the Neiguan (PC6) acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency (3 Hz) with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke.

[Different stimulation intensities of acupuncture at Hegu (LI 4) for central facial nerve paralysis after ischemic stroke: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of acupuncture at Hegu (LI 4) on central facial nerve paralysis after ischemic stroke, and explore dose-effect relationship among different stimulation intensities of acupuncture at Hegu (LI 4) as well as its optimal treatment plan. METHODS: According to different acupuncture stimulation intensities which were based on treatment time and needle insertion direction, fifty patients were randomly divided into a Hegu 1 group, a Hegu 2 group, a Hegu 3 group, a Hegu 4 group and a control group, ten cases in each one. Different stimulation intensities of acupuncture at Hegu (LI 4) combined with facial paralysis acupoints, including Yingxiang (LI 20), Dicang (ST 4), Jiache (ST 6) and Quanliao (SI 18), were applied in Hegu 1 to 4 groups; meanwhile acupuncture at stroke acupoints, including Neiguan (PC 6), Shuigou (GV 26) and Sanyinjiao (SP 6), and medication treatment were adopted. Except acupuncture at Hegu (LI 4), the treatment of the control group was identical as Hegu groups. The treatment duration lasted for 14 days. The House-Brackmann facial never grading systems (H-B), Toronto facial grading system (TFGS), degrees of facial never paralysis (DFNP), facial disability index (FDI) and clinical efficacy were compared among groups. RESULTS: (1) Compared before the treatment, H-B, TFGS, DFNP and physical function score in FDI were all improved significantly in the Hegu 1 to 4 groups (all P < 0.05), but social function score in FDI was not obviously improved (all P > 0.05); all the scores in the control group were not evidently changed (all P > 0.05). (2) Compared with the control group, differences of H-B before and after treatment in the Hegu 1 to 4 groups, differences of TFGS in the Hegu 2 group and differences of DFNP in the Hegu 1 and Hegu 2 group were significantly improved (all P < 0.05). The differences of any scale among Hegu 1 to 4 groups were not significant (all P > 0.05), in which the most evident change was found in Hegu 2 group. (3) The total effective rate was 90.0% (9/10), 100.0% (10/10), 90.0% (9/10) and 80.0% (8/10) in Hegu 1 to 4 groups, which were significantly higher than 60.0% (6/10) in the control group (all P < 0.05). CONCLUSION: Acupuncture at Hegu (LI 4) has affirmative clinical efficacy on central facial nerve paralysis after ischemic stroke, in which oblique insertion along the opposite direction of meridian for 5 s of twirling manipulation has the best clinical effect.

Study on acupuncture parameters impacting on the acupuncture effect using cluster analysis in a rat model with middle cerebral artery occlusion.

OBJECTIVE: To investigate the influence of acupuncture parameters on the acupuncture effect through the cluster analysis in Wistar rat model with middle cerebral artery occlusion (MCAO). METHODS: Duplicated MCAO models by Zea-longa's thread ligation and chose rats with 1-3 scores assessed by Zausinger's six-score method to be grouped. The rats were divided into 6 basic control groups [(including a normal group, a sham group, a model control group, a model group without intervention, a Nimodipine group, a lateral-to-Renzhong (DU6) group] and 6 acupuncture groups [a Neiguan (PC6) group, a Weizhong (BL40) group, a Sanyinjiao (SP6) group, a Chize (LU5) group, a Renzhong (DU6) group and a Feixue (non-acupoint) group]. In the acupuncture groups, for every acupoint or needling site, 9 different parameters [2 factors (frequency and time) and 3 levels (180, 120, and 60 cpm of the frequency and 5, 60, and 180 s of the time)] were set respectively by the orthogonal intersection method, in total 54 groups. The rats were treated by acupuncture with a lifting-thrusting manipulation once every 12 h, in total 6 times. Neurobehavioral scores, cerebral blood flow, infarction rate, microcirculation, light microscopy, etc. were measured. The factor analysis was first applied to get the comprehensive effect scores of the samples in the acupuncture groups and then by which the cluster analysis was made with the statistical software of SPSS17.0. RESULTS: For the Neiguan (PC6) group, the exceptional results of acupuncture comprehensive effect were parameters 7, 8, 9, 10; the valid results were parameters 2, 3, 4, and the invalid were parameters 5, 6. For the Weizhong (BL40) group, the exceptional results were parameters 2, 4; the valid results were parameters 3, 5, 6, 7, and the invalid were parameters 8, 9, 10. For the Chize (LU5) group, the exceptional results were parameters 7, 8; the valid results were parameters 3, 4, 5, 6, 9, 10; and the invalid was parameter 2. For the Sanyinjiao (SP6) group, the exceptional results were parameters 4, 6; the valid results were parameters 2, 3, 5; and the invalid were parameters 7, 8, 9,10. For the Renzhong (DU6) group, the exceptional results were parameters 3, 4, 6, 7, 9, 10; the valid results were parameters 2, 5; and the invalid was parameter 8. For the Non-acupoint group, the exceptional result was parameter 10; the valid results were parameters 2, 3, 4, 7, 9; and the invalid were parameters 5, 6, 8. CONCLUSIONS: For each meridian acupoint, different acupuncture parameters could consequently get a different acupuncture effect; each meridian acupoint had the most suitable or optimal acupuncture parameters; acupuncture parameters might be the main factors impacting on acupuncture effect.

Cluster analysis for acupoint specificity of acupuncture effect based on cerebral infarction rat model.

OBJECTIVES: To study the acupoint specificity through the comprehensive evaluation of the acupuncture effect on rat model with the middle cerebral artery occlusion (MCAO). METHODS: Duplicated MCAO model by Zea-longa's thread ligation was assessed by Zausinger's six-point method, and rats with 1-3 scores were chosen to be grouped. According to the randomized and controlled principle, rats were divided into 6 basic control groups (including normal group, sham group, model control group, model group without intervention, Nimodipine group, lateral-to-Renzhong group) and 6 acupuncture groups [including Neiguan (PC6) group, Weizhong (BL40) group, Chize (LU5) group, Sanyinjiao (SP6) group, Renzhong (DU6) group and non-acupoint group]; in each acupoint or non-acupoint 9 different parameter combinations were respectively set by orthogonal intersection method. There were in total 60 groups, and each group had 12 rats. The rats were treated by acupuncture with the lifting-thrusting manipulation every 12 h, in total 6 times. Indices of neurobehavioral scores, cerebral blood flow, infarction rate, microcirculation, and light microscope, etc. were measured. In order to comprehensively evaluate the acupuncture effect to research the specificity of acupoint, a cluster analysis was made with SPSS17.0 for the comprehensive effect scores of the samples computed according to the comprehensive evaluation models, and then sorting and classification were made for the comprehensive effect scores. RESULTS: In the acupuncture groups every acupoint had different therapeutic effect due to different acupuncture parameter combinations; among the acupuncture groups the orders of curative effect were as followings: Neiguan group was of exceptional result, Weizhong group and Sanyinjiao group were of valid results in upper level, Chize group and Renzhong group were of valid results in lower level, and non-acupoint group was of invalid result; the therapeutic result of acupoint group was superior to non-acupoint group; and the curative effect of acupuncture group was also superior to basic control group. CONCLUSION: The acupoint has the specificity of acupuncture effect, and the acupoint specificity is relative.

[Efficacy judgment for treating ischemic stroke by acupuncturing at Neiguan (PC6) and the screening for optimal parameters].

OBJECTIVE: To select optimal parameters and judge the comprehensive effect of acupuncture. METHODS: The middle cerebral artery occlusion (MCAO) rat model was duplicated. Nine acupuncture parameters groups were set up by the frequency of acupuncture (slow, medium, and fast: 60, 120, and 180 times/min) and the acupuncture duration (short, medium, and long: 5, 60, and 180 s). Twisting technique was used in needling at Neiguan (PC6). By taking neurological impairment scoring, leptomeningeal cerebral blood flow, microcirculation (input branch diameter, output branch diameter, input/output), and cerebral infarction rate as effect indicators, the comprehensive effects of different acupuncture parameters at Neiguan (PC6) on MCAO were determined by factor analysis, thus screening the optimal parameters. RESULTS: By factor analysis, the highest score for comprehensive effect could be achieved with the acupuncture parameters of 180 times/min and 60 s. That is to say, fast frequency and middle time duration could achieve the optimal acupuncture effects, suggesting that appropriate acupuncture time duration should be used under the condition of guaranteeing fast frequency when treating ischemic stroke by needling at Neiguan (PC6). CONCLUSION: The 180 times/min and 60 s were the optimal parameter group when needling at Neiguan (PC6) by twisting technique for treating ischemic stroke.

[Thinking on acupuncture finger force in the acupuncture quantity study].

As an important link during the whole operation process of acupuncture, it is very necessary to launch quantity study closely related to acupuncture finger force in the acupuncture quantity study. After retrieval of related literatures on finger force during acupuncture in recent 20 years, it was found out that although some exploration on acupuncture finger force had been made, it was scattered and had no deep research, which pointed out it was a weak link in the acupuncture quantity study. So study of finger force should be paid attention to in acupuncture-moxibustion field, the level of theoretical and experimental research and development of measuring instrument on acupuncture finger force should be strengthened, the application of instrument should be expanded in teaching and scientific research areas, which could promote the modernization and internationalization of acupuncture and moxibustion better and faster.

[Study progression on the specificity of meridian points effectiveness].

The present situation of the study on the specificity of meridian points effectiveness through checking up the relevant literatures on the study of this subject published in recent 10 years from the databases such as CNKI and SCI are summarized in the paper. It is indicated in the summarization that the effectiveness of meridian points is specific and the meridian points bring their role into play probably through the biological mechanism in the body. But, it is still limitative in systematic, complete and scientific study on such conclusion. In future, the relevant study is required by adopting adequately modern scientific technology and facility, strict and scientific experiment designs as well as assessment method and taking extensive diseases or disease models as the carriers.

Identification of novel inhibitors of the streptogramin group A acetyltransferase via virtual screening.

Virginiamycin acetyltransferase D (VatD) plays a vital rule in streptogramins resistance by chemically inactivating streptogramin A. Therefore, it is desirable to discover novel small molecular weight inhibitors of VatD via state-of-the-art virtual screening techniques. This "cocktail" strategy by combining VatD inhibitor with streptogramins may provide new therapeutic opportunity for resistant bacteria infections. Structure-based virtual screening method (molecular docking) was applied to rank and score a chemical database containing 300 000 commercially available compounds against the VatD substrate binding site. Twenty six out of the 200 top scored compounds from the docking calculation were selected and submitted to the VatD enzymatic inhibition assay. The plasmid pRSET B/vatD was constructed and transformed into E. coli (trxB) host cells for over-expression, and VatD enzyme was purified and validated by showing acetyltransferase activity to Virginiamycin M1. Three out of these 26 tested compounds showed enzymatic inhibition on VatD with IC50 168.6, 91.0 and 55.2 micromol x L(-1), separately. Other compounds could not be dissolved in the system and/or had little effect on the enzyme (IC50 > 200 micromol x L(-1)). To our knowledge, it is first time that small molecular weight organic compounds were identified as VatD inhibitors. It is expected that the VatD inhibitors identified at present study could serve as lead compounds for the further development of the novel therapeutic agents to overcome streptogramins resistance.

A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function.

BACKGROUND: Hypothermia is associated with an increased risk of bleeding and is a significant contributing factor to the morbidity and mortality of trauma and complicated surgical procedures. A core temperature of 33 degrees C is associated with a significantly increased risk of death after trauma compared with 37 degrees C. Hypothermia-associated bleeding has been hypothesized to result from dysregulation of enzymatic function, reduced platelet activity, and/or altered fibrinolysis. METHODS: We systematically evaluated the effects of temperature on isolated pro- and anticoagulant enzyme processes and platelet activation and adhesion. We also evaluated the effects of temperature on complete coagulation systems (activated partial thromboplastin time and an in vitro, cell-based model of coagulation). RESULTS: Enzyme activities were only slightly reduced at 33 degrees C versus 37 degrees C, and this reduction was not statistically significant (p > 0.05). Platelet activation was also not significantly reduced at 33 degrees C versus 37 degrees C. Conversely, platelet aggregation and adhesion were significantly reduced at 33 degrees C compared with 37 degrees C (p < 0.05). Below 33 degrees C, however, both enzyme activity and platelet function were significantly reduced. CONCLUSION: Our results suggest that bleeding observed at mildly reduced temperatures (33 degrees - 37 degrees C) results primarily from a platelet adhesion defect, and not reduced enzyme activity or platelet activation. However, at temperatures below 33 degrees C, both reduced platelet function and enzyme activity likely contribute to the coagulopathy.

The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients.

BACKGROUND: Recombinant coagulation factor VIIa (FVIIa) is approved for treating hemophiliacs with inhibitors. High-dose FVIIa has also been used off-label to manage hemorrhage in trauma and surgical patients, many of whom also develop hypothermia and acidosis. METHODS: We examined the activity of FVIIa on phospholipid vesicles in the presence and absence of tissue factor (TF) and on platelets as a function of temperature and pH. RESULTS: FVIIa activity on phospholipids and platelets was not reduced at 33 degrees C compared with 37 degrees C. The activity of FVIIa/TF was reduced by 20% at 33 degrees C compared with 37 degrees C. A pH decrease from 7.4 to 7.0 reduced the activity of FVIIa by over 90% and FVIIa/TF by over 60%. CONCLUSION: FVIIa should be effective in enhancing hemostasis in hypothermic patients. However, because the activity of FVIIa is so dramatically affected by pH, its efficacy may be reduced in acidotic patients.

The effect of recombinant factor VIIa on noncoagulopathic pigs with grade V liver injuries.

BACKGROUND: Recombinant Factor VIIa (rFVIIa) has been used to decrease bleeding in a number of settings, including hemophilia, liver transplantation, intractable bleeding, and cirrhosis. It has also been shown to reduce bleeding in coagulopathic pigs with Grade V liver injuries when used as an adjunct to packing. This study was performed to determine if rFVIIa would reduce blood loss after a Grade V liver injury in noncoagulopathic pigs when used as sole therapy. STUDY DESIGN: Thirty normothermic animals were randomized to receive either 150 microg/kg of rFVIIa or normal saline intravenously. After laparotomy and splenectomy, a standardized Grade V liver injury was made with a liver clamp. Thirty seconds after injury, blinded therapy was given. Blood loss was measured 15 minutes after injury and the abdomen was closed. Animals were resuscitated to their baseline blood pressure and the study was continued for 2 hours. Serial coagulation parameters were obtained. Following the study period, blood loss was measured and an autopsy was performed. Grossly normal areas of lung were examined for evidence of intravascular thrombosis. RESULTS: Mean Factor VII:C levels increased 155-fold in the treatment group after infusion of rFVIIa. The mean prothrombin time in the treatment group decreased from 9.8 +/- 0.4 seconds to 7.3 +/- 0.2 seconds and remained significantly different from the control group throughout the study (p < 0.01). There were no differences in other coagulation parameters. Mean initial blood loss was 822 +/- 266 mL in the treatment group and 768 +/- 215 mL in the control group (p = 0.6). Rebleeding blood volume was 397 +/- 191 mL in the treatment group and 437 +/- 274 mL (p = 0.6) in the control group. Lung histology revealed no evidence of abnormal microvascular thrombosis. CONCLUSIONS: rFVIIa does not reduce blood loss after Grade V liver injury when it is used as sole therapy in warm noncoagulopathic pigs.