Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis.

BACKGROUND: Electroacupuncture is often used to treat insomnia. OBJECTIVE: To evaluate the efficacy and safety of electroacupuncture for insomnia. SEARCH STRATEGY: Databases including PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data and VIP Full-text e-Journals Database were searched up to January 15, 2023. INCLUSION CRITERIA: Randomized clinical trials were included if they compared the clinical efficacy and safety of electroacupuncture with sham acupuncture, no treatment or usual care (UC) and general acupuncture. DATA EXTRACTION AND ANALYSIS: The full texts of the studies were reviewed to remove ineligible literature. The extracted data included authors, publication year, diagnostic criteria, sample size, population characteristics, interventions and outcomes. The above steps were performed independently by two reviewers and the data were cross-checked. Stata15.0 software was used to analyze the extracted outcome data. For continuous data (Pittsburgh Sleep Quality Index [PSQI] score and Insomnia Severity Index score), weighted mean difference (WMD) was calculated and 95% confidence interval (CI) was reported when the same scale was applied. For dichotomous variables (clinical response rate and adverse events), a meta-analysis was performed using risk ratio (RR) as the effect indicator. RESULTS: Thirty-one trials with 2226 subjects were included. The meta-analysis suggested that electroacupuncture was more effective in improving insomnia compared with the control group (sham acupuncture, no treatment, UC and general acupuncture) (RR = 1.21; 95% CI: [1.16, 1.27]), significantly reducing the PSQI score in insomnia patients after treatment and at follow-up (WMD = -3.23; 95% CI: [-4.29, -2.17]; P < 0.001). There was no significant difference in the incidence of adverse events between the EA and control groups (sham acupuncture and no treatment or UC. RR = 1.48; 95% CI: [0.91, 2.40]; P = 0.117). In addition, the regression results revealed that receiving electroacupuncture for seven to nine weeks provided the best efficacy (P < 0.05). CONCLUSION: Electroacupuncture can significantly promote better sleep quality in insomnia patients and is suitable for the treatment of various types of insomnia. However, the articles included were single-center trials with small sample sizes, and some articles were of poor quality. Therefore, further research is still needed to confirm these findings. Please cite this article as: Xu HY, Wu LN, Zhang Y, Ba T, Zhao XF. Efficacy and safety of electroacupuncture for insomnia: A systematic review and meta-analysis. J Integr Med. 2024; Epub ahead of print.

[Acupoint selection rules of acupuncture and moxibustion for post-stroke epilepsy based on data mining technology].

OBJECTIVE: To analyze the acupoint selection rules of acupuncture and moxibustion for post-stroke epilepsy by data mining technology. METHODS: The literature regarding acupuncture and moxibustion for post-stroke epilepsy included in CNKI, VIP, Wanfang, SinoMed and PubMed databases from the establishment of the database to August 1st 2022 was retrieved. Microsoft Excel 2019 software was used to establish a database to conduct the descriptive analysis of acupoints; SPSS Modeler 18.0 Apriori algorithm was used to conduct association rule analysis; high-frequency acupoint co-occurrence network diagrams were drawn by Cytoscape3.9.0 software; SPSS Statistics 25.0 software was used to perform hierarchical cluster analysis on high-frequency acupoints and a tree diagram was drawn. RESULTS: Totally 39 articles were included, and 63 prescriptions of acupuncture and moxibustion were extracted, involving 56 acupoints, with a total frequency of 516 times; the top three acupoints with the highest frequency of use were Baihui (GV 20), Fenglong (ST 40) and Neiguan (PC 6); the selected meridians were mainly the governor vessel, the hand and foot yangming meridians; the selection of acupoints were mostly in the head, neck and lower limbs; in terms of acupoint compatibility, Hegu (LI 4)-Shuigou (GV 26) and Neiguan (PC 6) had the highest confidence degree; The top 20 high-frequency acupoints could be divided into 4 effective clusters. CONCLUSION: Modern acupuncture and moxibustion treatment for post-stroke epilepsy attaches great importance to the use of yang meridians and meridians with enrich qi and blood; the core prescription is Shuigou (GV 26)-Neiguan (PC 6)-Hegu (LI 4)-Baihui (GV 20). In addition, the combination of distant and near acupoints is highly valued to improve clinical efficacy.

[Home-based Rehabilitation of Stroke Patients].

OBJECTIVE: To assess the physical,psychological and social functioning of stroke patients with home-based rehabilitation. METHODS: Convenient sampling strategy was adopted to select 234 stroke patients discharged from a tertiary hospital rehabilitation center. The patients were assessed using Barthel index (BI),instrumental activities of daily living (IADL) scale,modified rivermead mobility index (mRMI),self-perceived burden scale (SPBS),self-rating depression scale,and Zarit caregiver burden interview (ZBI) during their outpatient visits,household visits,or telephone interviews. RESULTS: The patients had an average BI score of 61.77±22.83,61.11% had mild dependence on daily life. Their IADL score was low at an average of 7.25±6.26. They had 28.90±10.22 in MRMI score and 29.26±7.07 in SPB score. More than 90% had a feeling of self-burden. The caregiver burden score reached 43.97±12.28. Male patients and those with cerebral infarction had better functioning than female patients and those with cerebral hemorrhage. Better physical functioning was demonstrated in those who were younger than 60 yr.,experienced more than one year home-based rehabilitation,were cared by relatives,and had a female caregiver. But such differences were not significant in SPBS and ZBI scores. CONCLUSION: Home-based rehabilitation of stroke has failed to achieve anticipated results. The outcomes vary across those with different age,gender,and type of stroke.

[Component Changes of Metabolic Syndrome in Pre-elderly People with Healthy Obese Phenotype].

OBJECTIVE: To determine component changes of metabolic syndrome in pre-elderly people with healthy obese phenotype. METHODS: A total of 1 686 adults aged between 45-59 yr. who underwent health examinations from 2010 to 2016 in West China Hospital of Sichuan University participated in this study. The participants had healthy obese phenotype at the baseline but no history of diabetes,high blood pressure,high cholesterol and cardiovascular disease. Component changes of metabolic syndrome (MS) and associated factors over the seven-year period were analysed using logistic regression modeling. RESULTS: The number of MS components increased over the years in centrally obese individuals,and 11.0% developed MS,including 118 men [(53.29±4.00) years old,66.95% current smokers,5.93% past smokers,24.58% alcohol drinkers] and 67 women [(52.01±4.06) years old,26.87% current smokers,1.49% past smokers,11.94% alcohol drinkers]. The most frequently presented MS components included higher fasting glucose,higher blood pressure and higher triglyceride. Healthy status (0 MS component) resumed in 44 participants who had abdominal obesity (1 MS component) at the baseline: 27 women and 17 men. Age (OR=1.732, 95%CI：1.594-1.882, P<0.000 1),smoking (OR=7.188, 95%CI：4.311-11.986, P<0.000 1) and drinking (OR=3.986, 95%CI：2.283-6.959, P<0.000 1) were identified as risk factors of MS. CONCLUSION: MS components increase over years in both men and women. Smoking and drinking are the main risk factors of MS progression. Regular MS surveillance and behavioral interventions are recommended for pre-elderly people with healthy obese phenotype.

[Preparation and release behaviour of mesoporous silica/ethylcellulose sustained-release mini-matrix].

Hot-melt extrusion was applied to prepare mesoporous silica/ethylcellulose mini-matrix for sustained release, and fenofibrate was used as a model drug, ethylcellulose and xanthan gum were chosen as sustained-release agent and releasing moderator, respectively. This novel matrix obtained the controlled release ability by combining mesoporous silica drug delivery system and hot-melt extrusion technology. And mesoporous silica particle (SBA-15) was chosen as drug carrier to increase the dissolution rate of fenofibrate in this martix. Scanning electron microscope, transmission electron microscope, small angle X-ray powder diffraction and N2 adsorption-desorption were introduced to determine the particle morphology, particle size and pore structure of the synthesized SBA-15. The results showed that SBA-15 had a very high Brunauer-Emmett-Teller specific surface area, a narrow pore size distribution, large pore volume and a ordered two-dimensional hexagonal structure of p6mm symmetry. Differential scanning calorimetry and X-ray powder diffraction results demonstrated that fenofibrate dispersed in an amorphous state inside the pores of the mesoporous silica which contributed to the improvement in the dissolution rate. The drug release of mini-matrices was influenced by ethylcellulose viscosity grades and xanthan gum concentration, which increased with the increasing of xanthan gum concentration and decreasing of ethylcellulose viscosity. Mini-matrix containing 22% xanthan gum exhibited a good sustained release performance, and the drug release behavior followed the first-order kinetics.

[Preparation and in vitro embolic efficiency evaluation of hydroxycamptothecine-loaded liquid embolic agent].

The purpose of this study is to investigate the preparation of hydroxycamptothecine (HCPT)-loaded cubic crystal liquid embolic precursor solution, and evaluate its in vitro embolic efficiency. Phytantriol was used as cubic crystal liquid embolic material, and the optimal formulation was selected according to ternary phase diagram. Polarized light microscopy, differential scanning calorimetry, and small angle X-ray scattering (SAXS) were used to characterize the cubic crystal structure. High performance liquid chromatography and X-ray diffraction analysis were used to investigate the lactone ring of HCPT. In vitro dissolution was preliminary evaluated, and the simulation embolic model was constructed to evaluate the embolic efficiency of precursor solution. Meanwhile, the gelation time and adhesion force were investigated. The results showed that HCPT-loaded precursor solution for embolization had been successfully prepared with low viscosity which was injectable. The precursor solution could transform into Pn3m structure liquid crystal phase gel rapidly when contracting with excess water. The formed HPCT gel remained its lactone form as the same in precursor solution, and expressed the good ability to block the saline flow, and HCPT could keep sustained releasing drug over 30 days. The prepared drug-loaded embolic precursor solution showed a promising potential for vascular embolization and application in clinical treatment of tumor.

[Development of the comprehensive geriatric assessment scale for Chinese elderly].

OBJECTIVE: To establish a comprehensive geriatric assessment scale which fit the situations of Chinese old people most, and to provide an evaluation tool for the proposal and intervention of functional health problems for the elderly. METHODS: The comprehensive geriatric assessment scale was produced by Delphi method combing with Chinese cultural background, some methods such as literature review and experts evaluation were conducted. The manuscript of this questionnaire was developed through Delphi and pre-experiment. Then the manuscript questionnaires were used among 300 old people, to analyze and assess the reliability, validity and reactivity. RESULTS: The experiment analysis demonstrated that the total Cronbach alpha coefficient was 0. 909 and that of each index ranged from 0.718-0.960, most of the dimension-related coefficients were over 0.5. The construct validity was validated by factor analysis and the cumulative contribution rate was up to 76.88%. Results of non-parametric test on reactivity showed that the differences of total scores and each dimension' scores and substitute scores between the elderly from different institutions were statistically significant (P < 0.01). CONCLUSION: The comprehensive geriatric assessment scale owns a reasonable reliability, validity and reactivity, and this scale can be used as an evaluation instrument for the finding and intervention of the elder's health problems.

[Relationship between social-psycological factors and quality of life in old women with coronary heart disease].

OBJECTIVE: To investigate the influence of depression, social supports and quality of sleep and quality of life on old women who were 60 years or older and postmenopause with coronary heart disease. METHODS: 125 old women with coronary heart disease completed questionnaires of Seattle Angina Questionnaire (SAQ), Social Support Scale (SSRS) and Self-rating Depression Scale (SDS). Logistic regression analysis and Spearman correlation analysis were performed to evaluate the relationship between social-psycological factors and quality of life. RESULTS: 120 of questionnaires wereeffective (representing 96% of all collected questionnaires). Regression analysis showed that marital status (OR = 2.450), education (OR = 0.520), income (OR = 19.541) and course of disease (OR = 0.309) were associated with QOL in CHD (P < 0.05). Spearman analysis demonstrated that there were negative correlations between SQA score and PSQI and depression scores (r = -0.771, P < 0.01; r = -0.703, P < 0.05); and positive correlation between SQA score and Social support score (r = 0.565, P < 0.05). CONCLUSION: Social-psychological factors might influence the quality of life in old women with coronary heart disease, it is important that physicians pay attention to these factors when they treat old women with coronary heart disease.

[Prevention of falls of hospitalized elderly patients using clinical pathway].

OBJECTIVE: To explore effective strategies for preventing falls of hospitalized elderly patients using clinical pathway. METHODS: A total of 2442 patients aged > or = 70 years who were hospitalized during December 2009 and December 2010 were recruited for the study. The patients were assessed with "Falls Risk Assessment and Nursing Care Inventory" and 1796 were identified as with high risk of falls. The clinical pathway for preventing falls was applied to those patients with high risk of falls. The interventions included timely assessments, safe environment and facilities, targeted health education, extended nursing care on patients with high risk, improved hand-off, rational use of medicine, and so on. RESULTS: Only 4 patients fell, with an incidence of 0.22%. Sex, age, disease, psychological factors, clothing, hospital environment, drug effects, and history of falls were associated with the occurrence of falls. CONCLUSION: Risk assessment and targeted intervention through clinical pathway are effective strategies for preventing falls of hospitalized elderly patients.

[Activities of daily living and demand for care of the elderly with chronic conditions in Chengdu].

OBJECTIVE: To evaluate the activities of daily living and demand for care of the elderly with chronic conditions in Chengdu in order to develop appropriate care models. METHODS: Convenient sampling strategy was adopted to recruit participants in four communities in Chengdu. A total of 180 elderly respondents with chronic conditions completed a questionnaire survey, which evaluated the activities of daily living and demand for care of the respondents. RESULTS: More than 77% respondents suffered from two or more chronic conditions. Over 97% respondents followed medical advices of doctors in drug therapy, with 70% monitoring the effectiveness of the drug therapy by themselves. The chronic conditions of 61% of respondents were well controlled. More than 54% were able to perform activities of daily living; 38% needed assistance; and 8% were completely dependent on others. Age and numbers of conditions influenced the activities of daily living (P < 0.005). Over 98% respondents were aware of their care needs and 1% identified unmet needs. Care for elderly came mainly from families, followed by relatives, friends, neighbors and workmates. Demands for care depended on financial capacity, degree of independence and numbers of conditions. Demands for nursing care increased with numbers of conditions (P < 0.05). CONCLUSION: The ability of elderly performing activities of daily living decreases with age and chronic conditions. A multidimensional care model involving professional carers needs to be developed in responding to the increasing needs of aged care.

[Improving the dissolution rate of poorly water-soluble resveratrol by the ordered mesoporous silica].

The aim of this study is to synthesize the ordered mesoporous silica (OMS) as drug carrier to improve release property of insoluble drug and investigate the dissolution profile of insoluble drug from the porous carrier. The OMS was obtained by using cetyltrimethyl ammonium bromide as the template and resveratrol was selected as the model drug. The resveratrol-loaded OMS (Res-OMS) were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), N2 adsorption-desorption, X-ray diffraction (XRD) and FT-IR spectroscopy. In vitro drug release behavior was also investigated. It was found that the synthesized OMS showed a large surface area, a narrow pore size distribution and an important mesoporosity associated to hexagonally organized channels. Compared with physical mixture and crystalline powder, resveratrol was in amorphous or molecular form after loading into OMS. The release rate ofresveratrol from drug-loaded OMS was significantly increased suggesting the great potential application of OMS for the formulation of poorly soluble drugs.

[Degradation of 2, 4-dichlorophenol in aqueous solution by ZVI/EDDS/air system].

A new oxidation system of Fenton-like system (ZVI/EDDS/Air) has been developed to degrade 2,4-chlorophenols (2,4-DCP) in aqueous solution. The influences of initial conditions, i. e., EDDS concentration, iron dosage, aeration rate, 2,4-DCP concentration and pH as well as reaction temperature on the degradation of 2,4-DCP were studied. The results demonstrated that this ZVI/EDDS/Air system was able to effectively degrade 2,4-DCP in aqueous solution, and the degradation of 2,4-DCP conforms to the pseudo-first-order reaction kinetics equation. Removal of above 99% 2,4-DCP was achieved in ZVI/EDDS/Air system at room temperature and pressure after 1 h reaction when the initial conditions were 2,4-DCP 100 mg x L(-1), EDDS 0.80 mmo x L(-1), ZVI 20 g x L(-1), aeration rate 2 L x (min x L)(-1). Compared with ZVI/EDTA/Air system, ZVI/EDDS/Air system showed higher efficiency in the degradation of 2,4-DCP at ambient circumstance and was more environmentally benign.