Effectiveness of Mindfulness-Based Stress Reduction on Mental Health and Psychological Quality of Life among University Students: A GRADE-Assessed Systematic Review.

Background: Psychological distress is a progressive health problem that has been linked to decreased quality of life among university students. This meta-analysis reviews existing randomized controlled trials (RCTs) that have examined the effects of mindfulness-based stress reduction (MBSR) on the relief of psychosomatic stress-related outcomes and quality of life among university students. Methods: The PubMed, EMBASE, Web of Science, PsycINFO (formerly PsychLit), Ovid MEDLINE, ERIC, Scopus, Google Scholar, ProQuest, and Cochrane Library databases were searched in November 2023 to identify the RCTs for analysis. Data on pathology (anxiety, depression, and perceived stress), physical capacity (sleep quality and physical health), and well-being (mindfulness, self-kindness, social function, and subjective well-being) were analyzed. Results: Of the 276 articles retrieved, 29 met the inclusion criteria. Compared with control therapies, the pooled results suggested that MBSR had significant effects, reducing anxiety (SMD = -0.29; 95% CI: -0.49 to -0.09), depression (SMD = -0.32; 95% CI: -0.62 to -0.02), and perceived stress (SMD = -0.41; 95% CI: -0.60 to -0.29) and improving mindfulness (SMD = 0.34; 95% CI: 0.08 to 0.59), self-kindness (SMD = 0.57; 95% CI: 0.30 to 1.12), and physical health (SMD = -0.59; 95% CI: -1.14 to -0.04). No significant differences were observed in sleep quality (SMD = -0.20; 95% CI: -0.06 to 0.20), social function (SMD = -0.71; 95% CI: -2.40 to 0.97), or subjective well-being (SMD = 0.07; 95% CI: -0.18 to 0.32). The quality of the evidence regarding sleep quality and physical health outcomes was low. Conclusions: MBSR therapy appears to be potentially useful in relieving functional emotional disorders. However, additional evidence-based large-sample trials are required to definitively determine the forms of mindfulness-based therapy that may be effective in this context and ensure that the benefits obtained are ongoing. Future studies should investigate more personalized approaches involving interventions that are tailored to various barriers and students' clinical characteristics. To optimize the effects of such interventions, they should be developed and evaluated using various designs such as the multiphase optimization strategy, which allows for the identification and tailoring of the most valuable intervention components.

Transcriptomic profiling of Dip2a in the neural differentiation of mouse embryonic stem cells.

Introduction: The disconnected-interacting protein 2 homolog A (DIP2A), a member of disconnected-interacting 2 protein family, has been shown to be involved in human nervous system-related mental illness. This protein is highly expressed in the nervous system of mouse. Mutation of mouse DIP2A causes defects in spine morphology and synaptic transmission, autism-like behaviors, and defective social novelty [5], [27], indicating that DIP2A is critical to the maintenance of neural development. However, the role of DIP2A in neural differentiation has yet to be investigated. Objective: To determine the role of DIP2A in neural differentiation, a neural differentiation model was established using mouse embryonic stem cells (mESCs) and studied by using gene-knockout technology and RNA-sequencing-based transcriptome analysis. Results: We found that DIP2A is not required for mESCs pluripotency maintenance, but loss of DIP2A causes the neural differentiation abnormalities in both N2B27 and KSR medium. Functional knockout of Dip2a gene also decreased proliferation of mESCs by perturbation of the cell cycle and profoundly inhibited the expression of a large number of neural development-associated genes which mainly enriched in spinal cord development and postsynapse assembly. Conclusions: The results of this report demonstrate that DIP2A plays an essential role in regulating differentiation of mESCs towards the neural fate.

Loss of Dip2b leads to abnormal neural differentiation from mESCs.

BACKGROUND: Disco-interacting protein 2 homolog B is a member of the Dip2 family encoded by the Dip2b gene. Dip2b is widely expressed in neuro-related tissues and is essential in axonal outgrowth during embryogenesis. METHODS: Dip2b knockout mouse embryonic stem cell line was established by CRISPR/Cas9 gene-editing technology. The commercial kits were utilized to detect cell cycle and growth rate. Flow cytometry, qRT-PCR, immunofluorescence, and RNA-seq were employed for phenotype and molecular mechanism assessment. RESULTS: Our results suggested that Dip2b is dispensable for the pluripotency maintenance of mESCs. Dip2b knockout could not alter the cell cycle and proliferation of mECSs, or the ability to differentiate into three germ layers in vitro. Furthermore, genes associated with axon guidance, channel activity, and synaptic membrane were significantly downregulated during neural differentiation upon Dip2b knockout. CONCLUSIONS: Our results suggest that Dip2b plays an important role in neural differentiation, which will provide a valuable model for studying the exact mechanisms of Dip2b during neural differentiation.

A New Generation of Lineage Tracing Dynamically Records Cell Fate Choices.

Reconstructing the development of lineage relationships and cell fate mapping has been a fundamental problem in biology. Using advanced molecular biology and single-cell RNA sequencing, we have profiled transcriptomes at the single-cell level and mapped cell fates during development. Recently, CRISPR/Cas9 barcode editing for large-scale lineage tracing has been used to reconstruct the pseudotime trajectory of cells and improve lineage tracing accuracy. This review presents the progress of the latest CbLT (CRISPR-based Lineage Tracing) and discusses the current limitations and potential technical pitfalls in their application and other emerging concepts.

The Characteristics of Spike Glycoprotein Gene of Swine Acute Diarrhea Syndrome Coronavirus Strain CH/FJWT/2018 Isolated in China.

Swine acute diarrhea syndrome (SADS) is a highly contagious infectious disease characterized by acute vomiting and watery diarrhea in neonatal piglets. The causative agent for SADS is the swine acute diarrhea syndrome coronavirus (SADS-CoV), an alphacoronavirus in the family Coronaviridae. Currently, SADS-CoV was identified only in Guangdong and Fujian provinces of China, not in any other regions or countries in the world. To explore the genetic diversity of SADS-CoV isolates, herein we comparatively analyzed 44 full-length genomes of viruses isolated in Guangdong and Fujian provinces during 2017-2019. The spike glycoprotein gene of SADS-CoV strain CH/FJWT/2018 isolated in Fujian province is distinct from that of other viral isolates in either spike glycoprotein gene-based phylogenetic analysis or whole genome-based gene similarity analysis. Moreover, at least 7 predicted linear B cell epitopes in the spike glycoprotein of CH/FJWT/2018 would be affected by amino acid variations when compared with a representative virus isolated in Guangdong province. The spike glycoprotein of coronaviruses determines viral host range and tissue tropism during virus infection via specific interactions with the cellular receptor and also plays critical roles in eliciting the production of neutralizing antibodies. Since SADS-CoVs have a broad cell tropism, the results in this report further emphasize that the spike glycoprotein gene is a pivotal target in the surveillance of SADS-CoV.

The spike glycoprotein genes of porcine epidemic diarrhea viruses isolated in China.

The porcine epidemic diarrhea virus (PEDV) causes a highly contagious disease in pigs, which is one of the most devastating viral diseases of swine in the world. In China, PEDV was first confirmed in 1984 and PEDV infections occurred sporadically from 1984 to early 2010. From late 2010 until present, PEDV infections have swept every province or region in China. In this study, we analyzed a total of 186 full-length spike genes and deduced proteins of all available complete genomes of PEDVs isolated in China during 2007-2019. A total of 28 potential recombination events were identified in the spike genes of PEDVs in China. Spike gene recombination not only expanded the genetic diversity of PEDVs in the GII genogroup, but also resulted in the emergence of a new evolutional branch GI-c during 2016-2018. In addition, comparative analysis of spike proteins between GI-a prototype virulent CV777 and GII strain AJ1102 reveals that the amino acid variations could affect 20 potential linear B cell epitopes, demonstrating a dramatic antigen drift in the spike protein. These results provide a thorough view of the information about the genetic and antigenic diversity of PEDVs circulating in China and therefore could benefit the development of suitable strategies for disease control.

Genetic drift of MERS-CoV in Saudi Arabia during 2012-2019.

Middle East respiratory syndrome (MERS) is caused by MERS-CoV that infects both human and camel. Camel is supposed to be the natural reservoir for human infection while the sources for most of the primary human infection cases are still not known. We identified two conserved pyrimidine nucleotides that flank UAAU element in MERS-CoV 5'-UTR. These conserved pyrimidine nucleotides distinguish MERS-CoVs into 3 types, that is, UUAAUU, CUAAUU and CUAAUC (referred to as U----U, C----U, and C----C types, respectively). Human MERS-CoV displays a genetic drift from U----U, C----U, to C----C from 2012 to 2019. Camel virus displays a genetic drift from U----U to C----U with a time lag when compared with human virus. The discrepancy in genetic drift seems not to support the notion that camel serves as the only natural reservoir for human infection.

RNA Helicase A Regulates the Replication of RNA Viruses.

The RNA helicase A (RHA) is a member of DExH-box helicases and characterized by two double-stranded RNA binding domains at the N-terminus. RHA unwinds double-stranded RNA in vitro and is involved in RNA metabolisms in the cell. RHA is also hijacked by a variety of RNA viruses to facilitate virus replication. Herein, this review will provide an overview of the role of RHA in the replication of RNA viruses.

Value of Xpert MTB/RIF Using Bronchoalveolar Lavage Fluid for the Diagnosis of Pulmonary Tuberculosis: a Systematic Review and Meta-analysis.

The performance of Xpert MTB/RIF using bronchoalveolar lavage fluid (BAL) for the diagnosis of pulmonary tuberculosis (PTB) remains unclear. Therefore, a systematic review/meta-analysis was conducted. Studies published before 31 December 2019 were retrieved from the PubMed, Embase, and Web of Science databases using the keywords "pulmonary tuberculosis," "Xpert MTB/RIF," and "BAL." Two independent evaluators extracted the data and assessed the bias risk of the included studies. A random-effects model was used to calculate the overall sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR), and the area under the curve (AUC), as well as the respective 95% confidence intervals (CIs). Nineteen trials involving 3,019 participants met the inclusion criteria. Compared to the culture method, the pooled sensitivity, specificity, PLR, NLR, DOR, and the AUC with 95% CIs of Xpert MTB/RIF were 0.87 (0.84 to 0.90), 0.92 (0.91 to 0.93), 10.21 (5.78 to 18.02), 0.16 (0.12 to 0.22), 78.95 (38.59 to 161.53), and 0.9467 (0.9462 to 0.9472), respectively. Relative to the composite reference standard, the observed values were 0.69 (0.65 to 0.72), 0.98 (0.98 to 0.99), 37.50 (18.59 to 75.62), 0.30 (0.21 to 0.43), 171.98 (80.82 to 365.96), and 0.9691 (0.9683 to 0.9699), respectively. All subgroups, except children, showed high sensitivity and specificity. In conclusion, the use of Xpert MTB/RIF in the context of BAL samples has a high diagnostic performance for PTB (except for children) and may serve as an alternative rapid diagnostic tool.

The Current View on the Helicase Activity of RNA Helicase A and Its Role in Gene Expression.

RNA helicase A (RHA) is a DExH-box helicase that plays regulatory roles in a variety of cellular processes, including transcription, translation, RNA splicing, editing, transport, and processing, microRNA genesis and maintenance of genomic stability. It is involved in virus replication, oncogenesis, and innate immune response. RHA can unwind nucleic acid duplex by nucleoside triphosphate hydrolysis. The insight into the molecular mechanism of helicase activity is fundamental to understanding the role of RHA in the cell. Herein, we reviewed the current advances on the helicase activity of RHA and its relevance to gene expression, particularly, to the genesis of circular RNA.

Effects of inflammatory and anti-inflammatory environments on the macrophage mitochondrial function.

Mitochondrial response to inflammation is crucial in the metabolic adaptation to infection. This study aimed to explore the mitochondrial response under inflammatory and anti-inflammatory environments, with a focus on the tricarboxylic acid (TCA) cycle. Expression levels of key TCA cycle enzymes and the autophagy-related protein light chain 3b (LC3b) were determined in raw 264.7 cells treated with lipopolysaccharide (LPS) and metformin (Met). Additionally, reactive oxygen species (ROS) levels and mitochondrial membrane potential were assessed using flow cytometry. Moreover, 8-week-old C57BL/6J mice were intraperitoneally injected with LPS and Met to assess the mitochondrial response in vivo. Upon LPS stimulation, the expression of key TCA enzymes, including citrate synthase, α-ketoglutarate dehydrogenase, and isocitrate dehydrogenase 2, and the mitochondrial membrane potential decreased, whereas the levels of LC3b and ROS increased. However, treatment with Met inhibited the reduction of LPS-induced enzyme levels as well as the elevation of LC3b and ROS levels. In conclusion, the mitochondrial TCA cycle is affected by the inflammatory environment, and the LPS-induced effects can be reversed by Met treatment.

Correction to: EIF4A3-induced circular RNA MMP9 (circMMP9) acts as a sponge of miR-124 and promotes glioblastoma multiforme cell tumorigenesis.

An amendment to this paper has been published and can be accessed via the original article.

Study on the Expression Levels and Clinical Significance of PD-1 and PD-L1 in Plasma of NSCLC Patients.

As new members of the CD28/B7 costimulatory superfamily, PD-1 (programmed cell death 1) and its ligand PD-L1 (programmed cell death ligand 1) mediate a negative costimulatory signal, which inhibits functioning and proliferation of T and B cells, and reduce interleukin-2, interleukin-10, and interferon-γ secretion. This inhibitory pathway plays an important role in immune escape and the microenvironment of the tumor, and closely related to tumor progression. sPD-1 and sPD-L1 are the soluble form of PD-1 and PD-L1 in peripheral blood, which had not been well investigated. In this study, sPD-1 and sPD-L1 level in peripheral blood of non-small cell lung cancer (NSCLC) patients were determined, and their correlation to clinicopathologic features and long-term survival of these patients were analyzed, so as to provide references for further investigations. Plasma sPD-1 and sPD-L1 levels in 88 NSCLC patients and 40 healthy controls were determined by enzyme-linked immunosorbent assay, and their correlation to clinicopathologic features and long-term survival of these patients were analyzed. Our study showed that the plasma sPD-1 and sPD-L1 were higher in NSCLC patients than in healthy controls, and plasma sPD-L1 and sPD-L1/sPD-1 ratio independently and positively correlated with overall survival of NSCLC patients. This study provides a reference for the assessment of prognosis and risk stratification for NSCLC patients, as well as for immune treatment of cancer.

Effects of dietary sorghum dried distiller's grains with solubles on growth performance, diet nutrient digestibility, carcass characteristics and immunity in growing rabbits.

Sorghum dried distiller's grains with solubles (S-DDGS) are distillation extract residues from the ethanol fuel industry. In this experiment, two hundred 42-day-old rabbits were randomly allocated to five experimental diets containing 0 g/kg (control), 75, 150, 225 and 300 g/kg S-DDGS. The experiment lasted for 4 weeks. No difference was found in the average daily feed intake (ADFI; p > 0.05). With increasing sorghum inclusion, the average daily gain (ADG) was linearly (p < 0.001) and quadratically (p = 0.039) reduced, while, conversely, the feed conversion ratio (FCR) linearly (p < 0.001) increased. Increasing the amount of S-DDGS in the diet linearly decreased (p < 0.001) the apparent total tract digestibility (ATTD) of dry matter (DM), organic matter (OM), crude protein (CP) and ash. Carcass weight, carcass yield, heart and liver weights were linearly decreased by an increase in the amount of S-DDGS added to diets (p < 0.001), but no difference was observed between the 0, 75 and 150 g/kg S-DDGS groups (p > 0.05). Serum IL-6, IL-10 and SIgA linearly increased (p = 0.008) with increasing levels of S-DDGS in the diet. Rabbits fed 0, 75 and 150 g/kg of S-DDGS had similar IL-6 and IL-10 levels. Statistically significant differences in SIgA were observed between rabbits fed control diets and feed mixtures containing S-DDGS (p < 0.01). To conclude, S-DDGS can safely be added up to 75 g/kg, to the diet of rabbits. Increasing dietary S-DDGS inclusion may decrease the growth performance, nutrient digestibility and carcass traits, and activate immune responses.

EIF4A3-induced circular RNA MMP9 (circMMP9) acts as a sponge of miR-124 and promotes glioblastoma multiforme cell tumorigenesis.

BACKGROUND: Circular RNAs (circRNAs) have been found to play critical roles in the development and progression of various cancers. However, little is known about the effects of the circular RNA network on glioblastoma multiforme (GBM). METHODS: A microarray was used to screen circRNA expression in GBM. Quantitative real-time PCR was used to detect the expression of circMMP9. GBM cells were transfected with a circMMP9 overexpression vector or siRNA, and cell proliferation, migration and invasion, as well as tumorigenesis in nude mice, were assessed to examine the effect of circMMP9 in GBM. Biotin-coupled miRNA capture, fluorescence in situ hybridization and luciferase reporter assays were conducted to confirm the relationship between circMMP9 and miR-124. RESULTS: In this study, we screened differentially expressed circRNAs and identified circMMP9 in GBM. We found that circMMP9 acted as an oncogene, was upregulated in GBM and promoted the proliferation, migration and invasion abilities of GBM cells. Next, we verified that circMMP9 served as a sponge that directly targeted miR-124; circMMP9 accelerated GBM cell proliferation, migration and invasion by targeting miR-124. Furthermore, we found that cyclin-dependent kinase 4 (CDK4) and aurora kinase A (AURKA) were involved in circMMP9/miR-124 axis-induced GBM tumorigenesis. Finally, we found that eukaryotic initiation factor 4A3 (eIF4A3), which binds to the MMP9 mRNA transcript, induced circMMP9 cyclization and increased circMMP9 expression in GBM. CONCLUSIONS: Our findings indicate that eIF4A3-induced circMMP9 is an important underlying mechanism in GBM cell proliferation, invasion and metastasis through modulation of the miR-124 signaling pathway, which could provide pivotal potential therapeutic targets for the treatment of GBM.

Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy-Related Side Effects in Breast Cancer Patients: A Systematic Review.

IMPORTANCE: Acupuncture can help reduce unpleasant side effects associated with endocrine therapy for breast cancer. Nevertheless, comprehensive evaluation of current evidence from randomized controlled trials(RCTs) is lacking. OBJECTIVE: To estimate the efficacy of acupuncture for the reduction of hormone therapy-related side effects in breast cancer patients. EVIDENCE REVIEW: RCTs of acupuncture in breast cancer patients that examined reductions in hormone therapy-related side effects were retrieved from PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library databases through April 2016. The quality of the included studies was evaluated according to the 5.2 Cochrane Handbook standards, and CONSORT and STRICTA (Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture) statements. INTERVENTION: Interventions included conventional acupuncture treatment compared with no treatment, placebo, or conventional pharmaceutical medication. Major outcome measures were the alleviation of frequency and symptoms and the presence of hormone therapy-related side effects. Findings/Results. A total of 17 RCTs, including a total of 810 breast cancer patients were examined. The methodological quality of the trials was relatively rigorous in terms of randomization, blinding, and sources of bias. Compared with control therapies, the pooled results suggested that acupuncture had moderate effects in improving stiffness. No significant differences were observed in hot flashes, fatigue, pain, gastrointestinal symptoms, Kupperman index, general well-being, physical well-being, tumor necrosis factor (TNF), and interleukin (IL). CONCLUSIONS: Acupuncture therapy appears to be potentially useful in relieving functional stiffness. However, further large-sample trials with evidence-based design are still needed to confirm these findings.

CircNT5E Acts as a Sponge of miR-422a to Promote Glioblastoma Tumorigenesis.

Circular RNA and long noncoding RNA function as efficient miRNA sponges that regulate gene expression in eukaryotes. However, the sponges of functional miRNAs in glioblastoma remain largely unknown. Here, we identify a subset of circRNAs and lncRNAs that are specifically increased in miR-422a-downregulated glioblastoma tissues. We characterized a novel circRNA derived from NT5E, named circNT5E, that is regulated by ADARB2 binding to sites flanking circRNA-forming introns. We hypothesized that circNT5E may serve as a sponge against miR-422a in glioblastoma tumorigenesis. circNT5E controlled multiple pathologic processes, including cell proliferation, migration, and invasion. circNT5E directly bound miR-422a and inhibited miR-422a activity. Furthermore, circNT5E was observed to sponge other miRNAs, exhibiting tumor suppressor-like features in glioblastoma. Taken together, these findings highlight a novel oncogenic function of circRNA in glioblastoma tumorigenesis.Significance: Microarray profiling of circRNA/lncRNA/mRNA in glioblastoma identifies circNT5E as an oncogenic circular RNA and a sponge of miR-422a. Cancer Res; 78(17); 4812-25. ©2018 AACR.

Changes of free-form volatile compounds in pre-treated raisins with different packaging materials during storage.

The aroma profiles of volatile compounds (VOCs) were analyzed by GC/MS in pre-treated air-dried (PAD) and sun-dried (PSD) raisins during storage. Total 98, 94 and 81 VOCs were identified in Zixiang Seedless raisins (ZSRs), Centennial Seedless raisins (CSRs) and Thompson Seedless raisins (TSRs), respectively. During storage, the overall concentrations of VOCs of PSD raisins were higher in plastic bag (PB) compared to those in woven bag (WB). Regarding fruity and floral aromas, the effect of PAD and PB was significant throughout the storage periods (3, 6 and 9 months), however, fatty aroma was higher in PSD raisins due to the major contribution of 2,3-butanedione. The main fruity and floral aroma contributors were ß-damascenone, limonene, rose oxide, geraniol and ethyl hexanoate. This study showed that compounds came from unsaturated fatty acid oxidation, glycosidically-derived and grape-derived source were contributed to fruity, floral or herbaceous aromas, but Maillard reaction-derived VOCs imparted fatty and roasted aromas.

Reporting Characteristics and Quality of Systematic Reviews of Acupuncture Analgesia.

BACKGROUND: Evaluating the clinical efficacy of acupuncture analgesia with systematic reviews (SRs) has attracted wide interest. OBJECTIVE: To collect a sample of published SRs on acupuncture analgesia in PubMed and examine them in terms of reporting characteristics and quality. METHODS: A search in PubMed was performed in January 2016. All SRs on acupuncture analgesia were included. To assess the quality of the SRs, AMSTAR tool and PRISMA Statements were used. RESULTS: One hundred and nine SRs were included in our analysis, the yearly number of publications ranging from 1 in 1997 to 15 in 2015. Only 17% of these publications were Cochrane Systematic Reviews, and 94% were published in Science Citation Index journals. The United Kingdom was the country with the higher number of publications. Low back pain, headache, cancer pain, and labor pain were the most reported diseases or phenotypes. Nearly 73% of these SRs conducted a meta-analysis, 58% revealed positive results, 53% used RevMan software to analyze data, and 44% used the Cochrane Risk of Bias Tool for quality assessment. Only a few SRs assessed the likelihood of publication bias, reported details about the protocol and the registration information, and performed additional analyses. CONCLUSIONS: The quantity and the quality of SRs regarding acupuncture analgesia have been promoted in recent years. More effort should be expended on the assessment of publication bias, the provision of detailed information about the protocol and the registration process, and the implementation of additional analyses to improve the validity of the SRs.

Reporting characteristics and risk of bias in randomised controlled trials of acupuncture analgesia published in PubMed-listed journals.

BACKGROUND: Acupuncture analgesia has been evaluated by a number of randomised controlled trials (RCTs); however, a systematic summary of reporting quality of RCTs in this specific field is lacking. OBJECTIVE: To examine the reporting characteristics and risk of bias of RCTs of acupuncture analgesia indexed in the PubMed database. METHODS: A PubMed search of RCTs of acupuncture analgesia was conducted through November 2015. The Cochrane Collaboration Risk of Bias Tool was used to assess the risk of bias of each trial. RESULTS: 206 articles were identified across 59 journals (impact factor 0.4-20), of which 56% of articles and 86% of journals were Science Citation Index (SCI)-indexed. Nearly half of the articles were published in China. The next most represented countries of origin were the UK (22%) and USA (21%). Of the included trials, postoperative pain was the most prevalent phenotype, and manual acupuncture was the most frequently applied type of stimulation (46%). A total of 12% of articles reported on analgesic mechanisms. The most frequently used acupuncture points were LI4, ST36, PC6, SP6 and Shenmen. The overwhelming majority of trials were considered to be at high risk of bias (84%). Furthermore, 79% of trials enrolled <50 participants per treatment arm. CONCLUSIONS: RCTs of acupuncture analgesia indexed in PubMed journals generally exhibited poor reporting of methodological and treatment details. Future studies should provide more information regarding clinical trial registration, blinding of participants (including sham procedures where applicable) and outcome assessors, as well as the training and qualification of acupuncturists.