Letter regarding article named 'Is acupuncture effective in the treatment of COVID-19 related symptoms? Based on bioinformatics/network topology strategy'.

I noticed a recently published paper named 'Is acupuncture effective in the treatment of COVID-19 related symptoms? Based on bioinformatics/network topology strategy' with great interest. I am inspired and also have some doubts, which are mainly about the active compounds of acupuncture treating COVID-19. The authors choose only two active compounds, which remains to be elucidated clearly with some criteria description. The 11 300 disease targets of COVID-19 were screened using the terms like the related symptoms, which might be other diseases' manifestations. So the better legends of Figures and Tables should be the terms like COVID-19-related symptoms, instead of COVID-19.

Successful management of diaphragmatic ectopic pregnancy using ultrasound-guided percutaneous microwave ablation.

Diaphragmatic ectopic pregnancy is a rare status during the perinatal period. We reported that a 24-year-old woman with diaphragmatic ectopic pregnancy successfully received ultrasound-guided percutaneous microwave ablation. It found that beta-human chorionic gonadotropin level decreased showing 1067, 311.3 and 118.4 mIU/mL within five postoperative days, and P level reduced from 3.64 to 1.59 nmol/L. Contrast-enhanced ultrasonography image on the third day after ablation indicated that there was no enhancement in the lesion. This case indicated that ultrasound-guided percutaneous microwave ablation could be critical for a good outcome in diaphragmatic ectopic pregnancy.

Comparison between the Effects of Acupuncture Relative to Other Controls on Irritable Bowel Syndrome: A Meta-Analysis.

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with recurrent abdominal pain and altered defecation habits. We here attempted to determine the effect of acupuncture on IBS. Methods: Randomized controlled trials (RCTs) published in CNKI, VIP, Wanfang, PubMed, Cochrane Library, EMBASE, Web of science, and ClinicalTrials.gov till July 17, 2019 were searched. Outcomes were total efficacy rates, overall IBS symptom scores, or global quality of life scores. Standardized mean difference (SMD) with 95% confidence intervals (CI) and risk ratio (RR) with 95% CI were calculated for meta-analysis. Results: We included 41 RCTs involving 3440 participants for analysis. 8 RCTs compared acupuncture with sham acupuncture, among which 3 trials confirmed the biological effects of acupuncture, especially in treating abdominal pain, discomfort, and stool frequency. No significant difference was found when acupuncture was compared with sham acupuncture, in terms of effects on IBS symptoms and quality of life (SMD = 0.18, 95% CI -0.26∼0.63, P=0.42; SMD = -0.10, 95% CI -0.31∼0.11, P=0.35), but the pooled efficacy rate data showed a better outcome for true acupuncture (RR = 1.22, 95% CI 1.01∼1.47, P=0.04), which was not supported by sensitivity analysis. Acupuncture was more effective relative to western medicine in alleviating IBS symptoms (RR = 1.17, 95% CI 1.12∼1.23, I 2 = 0%, P < 0.00001), whose effect might last 3 months. Besides, acupuncture as an adjunct to western medicine, Chinese medications, or tuina was superior over the single latter treatment (RR = 1.68, 95% CI 1.18 to 2.40, P=0.004; 1.19, 1.03 to 1.36, P=0.02; 1.36, 1.08 to 1.72, P=0.009, respectively), with high heterogeneities. Conclusions: Relative to sham controls, acupuncture showed no superiority for treating IBS, while the advantage over western medicine was significant. Acupuncture could be used as an adjunct in clinical settings to improve efficacy. Future high-quality and large-sample-size studies with adequate quantity-effect design need to be conducted.

Regulation of Hypertension for Secondary Prevention of Stroke: The Possible 'Bridging Function' of Acupuncture.

Worldwide, stroke is the leading cause of mortality and disability, with hypertension being an independent risk factor for a secondary stroke. Acupuncture for the treatment of hypertension gains more attention in alternative and complementary medicine, but the results are inconsistent. Few studies regarding the secondary prevention of stroke by managing hypertension with acupuncture have been carried out as there are some problems regarding the antihypertensive drug status in the secondary prevention of stroke. Still, the potential of acupuncture in regulating the blood pressure for secondary stroke prevention deserves our focus. This review is based on papers recorded in the PubMed, Embase, and Web of Science databases, from their inception until March 28, 2017, and retrieved with the following search terms: hypertension and acupuncture, limited in spontaneously hypertensive rats (SHRs), stress-induced (or cold-induced) hypertensive or pre-hypertensive models. We find that, in these hypertensive animals, acupuncture could mainly influence factors related to the nervous system, oxidative stress, the endocrine system, cardiovascular function, and hemorheology, which are closely associated with the stroke outcome. This trend may give us a hint that acupuncture might well participate in the secondary prevention of stroke through these pathways when used in the management of hypertension.

Acupuncture lowering blood pressure for secondary prevention of stroke: a study protocol for a multicenter randomized controlled trial.

BACKGROUND: Stroke is the prime cause of morbidity and mortality in the general population, and hypertension will increase the recurrence and mortality of stroke. We report a protocol of a pragmatic randomized controlled trial (RCT) using blood pressure (BP)-lowering acupuncture add-on treatment to treat patients with hypertension and stroke. METHODS: This is a large-scale, multicenter, subject-, assessor- and analyst-blinded, pragmatic RCT. A total of 480 patients with hypertension and ischemic stroke will be randomly assigned to two groups: an experimental group and a control group. The experimental group will receive "HuoXueSanFeng" acupuncture combined with one antihypertensive medication in addition to routine ischemic stroke treatment. The control group will only receive one antihypertensive medication and basic treatments for ischemic stroke. HuoXueSanFeng acupuncture will be given for six sessions weekly for the first 6 weeks and three times weekly for the next 6 weeks. A 9-month follow-up will, thereafter, be conducted. Antihypertensive medication will be adjusted based on BP levels. The primary outcome will be the recurrence of stroke. The secondary outcomes including 24-h ambulatory BP, the TCM syndrome score, the Short Form 36-item Health Survey (SF-36), the National Institute of Health Stroke Scale (NIHSS), as well as the Barthel Index (BI) scale will be assessed at baseline, 6 weeks and 12 weeks post initiating treatments; cardiac ultrasound, carotid artery ultrasound, transcranial Doppler, and lower extremity ultrasound will be evaluated at baseline and 12 weeks after treatment. The safety of acupuncture will also be assessed. DISCUSSION: We aim to determine the clinical effects of controlling BP for secondary prevention of stroke with acupuncture add-on treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02967484 . Registered on 13 February 2017; last updated on 27 June 2017.

Acupuncture for Blood Pressure Control in Stroke Patients: Case Reports.

BACKGROUND: Effective control of hypertension is deeply associated with the secondary prevention of stroke. The blood pressure-lowering effect of acupuncture alone is controversial but worthy of exploration, considering the side effects of and the problems of low adherence to drugs. CASE REPORTS: One male patient experienced severe dizziness after overuse of valsartan, which decreased his blood pressure to 110/70 mm Hg. Our acupuncture treatment of 40 sessions alone regulated his blood pressure to about 110/70-130/80 mm Hg, with disappearance of the dizziness after 3 sessions. The second male patient with a suboptimal blood pressure during treatment with 50 mg/day of irbesartan received sole acupuncture treatment of 41 sessions, which decreased his blood pressure to about 120/70-130/80 mm Hg after 6 sessions. The third patient, who refused to take antihypertensive drugs because of their side effects, received acupuncture treatment of 46 sessions over 2 months, which reduced his blood pressure from 150/90 to 120/80 mm Hg. The efficacy continued for 3 months (cases 1 and 3) or 2 months (case 2) post treatment end. CONCLUSION: Our cases suggest the potential of acupuncture alone to favorably control high blood pressure or regulate low blood pressure in stroke individuals, as a means of secondary prevention of stroke.

Electroacupuncture induces acute changes in cerebral cortical miRNA profile, improves cerebral blood flow and alleviates neurological deficits in a rat model of stroke.

Electroacupuncture has been shown to improve cerebral blood flow in animal models of stroke. However, it is unclear whether electroacupuncture alters miRNA expression in the cortex. In this study, we examined changes in the cerebral cortical miRNA profile, cerebral blood flow and neurological function induced by electroacupuncture in a rat model of stroke. Electroacupuncture was performed at Renzhong (GV26) and Neiguan (PC6), with a frequency of 2 Hz, continuous wave, current intensity of 3.0 mA, and stimulation time of 1 minute. Electroacupuncture increased cerebral blood flow and alleviated neurological impairment in the rats. miRNA microarray profiling revealed that the vascular endothelial growth factor signaling pathway, which links cell proliferation with stroke, was most significantly affected by electroacupuncture. Electroacupuncture induced changes in expression of rno-miR-206-3p, rno-miR-3473, rno-miR-6216 and rno-miR-494-3p, and these changes were confirmed by quantitative real-time polymerase chain reaction. Our findings suggest that changes in cell proliferation-associated miRNA expression induced by electroacupuncture might be associated with the improved cerebral blood supply and functional recovery following stroke.

Is Acupuncture Effective for Hypertension? A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the efficacy of acupuncture for hypertension. METHOD: Seven electronic databases were searched on April 13, 2014 to include eligible randomized controlled trials (RCTs). Data were extracted and risk of bias was assessed. Subgroup analyses and meta- analysis were performed. RESULTS: 23 RCTs involving 1788 patients were included. Most trials had an unclear risk of bias regarding allocation concealment, blinding, incomplete outcome data and selective reporting. Compared with sham acupuncture plus medication, a meta-analysis of 2 trials revealed that acupuncture as an adjunct to medication was more effective on systolic (SBP) and diastolic (DBP) blood pressure change magnitude (n=170, SBP: mean difference (MD)= -7.47,95% confidence intervals (CI):-10.43 to -4.51,I2 =0%; DBP: -4.22,-6.26 to -2.18, 0%).A subgroup analysis of 4 trials also showed acupuncture combined with medication was superior to medication on efficacy rate (n=230, odds ratio (OR)=4.19, 95%CI: 1.65 to 10.67, I2 =0%). By contrast, compared with medication, acupuncture alone showed no significant effect on SBP /DBP after intervention and efficacy rate in the subgroup analysis. (7 trials with 510 patients, SBP: MD=-0.56, 95%CI:-3.02 to 1.89,I2 =60%; DBP: -1.01,-2.26 to 0.24, 23%; efficacy rate: 10 trials with 963 patients, OR=1.14, 95% CI: 0.70 to 1.85, I2 =54%).Adverse events were inadequately reported in most RCTs. CONCLUSION: Our review provided evidence of acupuncture as an adjunctive therapy to medication for treating hypertension, while the evidence for acupuncture alone lowing BP is insufficient. The safety of acupuncture is uncertain due to the inadequate reporting of it. However, the current evidence might not be sufficiently robust against methodological flaws and significant heterogeneity of the included RCTs. Larger high-quality trials are required.

Safety and efficacy of Danqipiantan capsule for treatment of stroke: a systematic review.

OBJECTIVE: To evaluate the efficacy and safety of Danqipiantan capsule (DPC) for the treatment of stroke. METHODS: PubMed, China Science And Technology Journal Database, Wanfang Database, Chinese periodicals in the China National Knowledge Infrastructure, and the General Hospital of Tianjin Medical University's Library were searched until July 2012. Randomized controlled trials (RCTs) and observational studies that reported the use of DPC for treatment of stroke were selected. RESULTS: Eleven articles that included 12 RCTs, and 2 articles that included 3 observational studies were identified. A total of 2590 patients participated inthe studies. We found that there was a signficant statistical difference between DPC treatment groups and the control groups in terms of the effective rate [risk ratio (RR), 1.14; 95% confidence intervals (CI), 1.04, 1.25; P = 0.01], Fugl-Meyer Assessment Scale [weighted mean difference (WMD), 9.77; 95% C (4.84, 14.70); P = 0.00], Barthel Index [WMD = 6.40; 95% Cl (3.15, 9.65)], and mean flow velocity [WMD = 5,79; 95% CI (1.64, 9.94)]. There were no significant differences for The National Institutes of Health Stroke Scale [WMD = 0.60; 95% CI (-1.09, 2.29)], visual field defects [left visual field: WMD = -203.10; 95% CI (-424.41, 18.21); right visual field: WMD = -172.60; 95% CI (-409.29, 64.09)] or the functional independence measure [WMD = -7.90; 95% Cl (-16.64, 0.84)]. Seven articles that included eight RCTs reported the safety of DPC treatment. Two articles that included three observational studies also reported beneficial effects for DPC. Because the Chinese studies were of poor methodological quality, and most of the sample sizes were small, our analysis was likely affected by bias. CONCLUSION: DPC has a beneficial effect and is relatively safe when used for the treatment of stroke.