Efficacy and safety of moxibustion on cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. METHODS: Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). RESULTS: In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I2 = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. CONCLUSION: Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality.

Predictors of post-stroke depression: the perspective from the social convoy model.

BACKGROUND: Post-stroke depression (PSD) as one of the most common neuropsychiatric disorders after a stroke and is caused by many factors. However, the relationships among different factors and their potential contributions to PSD remain unclear. METHODS: Two hundred and seventy-six patients were recruited into this study. The general information questionnaire, the Patient Health Questionnaire-9, the Perceived Social Support Scale, the Family Assessment Device, the General Well-Being Scale, the Barthel Index, and the modified Rankin Scale were used to assess the condition of patients. Subsequently, we identify the main causes associated with the PSD and then performed a path analysis to clarify the direct, indirect and total effects among the variables. RESULTS: We found that age, stroke with coronary heart disease, neurological function, family function, social support, and general well-being had a significant impact on PSD (P < 0.05). Of these, neurological function had the largest total effect on PSD (ß = 0.451), social support contributed the most as a direct effect (ß = -0.306), and family function showed the largest indirect effect (ß = -0.264). CONCLUSION: Individual, disease, and social-psychological factors all contributed to the development of PSD. We should pay more attention to comprehensive assessment, especially for those with poor neurological function, and lacking family or social support. In addition, it would be preferable to provide them with necessary support and care strategies to reduce the incidence of PSD.

The feasibility and efficacy of perioperative auricular acupuncture technique via intradermal needle buried for postoperative movement-evoked pain after open radical gastrectomy: A randomized controlled pilot trial.

INTRODUCTION: Auricular acupuncture is widely used in the treatment of pain. Recently, the most commonly used method of auricular acupuncture is to embed an intradermal needle into the skin to enhance analgesia through continuous stimulation. We aimed to explore the efficacy and feasibility of this form of auricular acupuncture in the treatment of postoperative movement-evoked pain. METHODS: This single-blind randomized controlled pilot trial was conducted between 23/8/2019 and 10/1/2020. Forty patients were recruited and randomised to either the control group (n = 20) or the experimental group (n = 20). Patients in the control group received sham auricular acupuncture, while patients in the experimental group received auricular acupuncture. A standard routine analgesia was performed in both groups. The patients with NRS score≥4 were given rescue analgesia. Postoperative pain, use of opioids and other analgesics, postoperative recovery and patient's satisfaction were recorded. RESULTS: The credibility and feasibility of auricular acupuncture for postoperative pain were high in both groups. After auricular acupuncture, the scores of the postoperative movement-evoked pain had a tendency to decrease, but no significant difference was observed between two groups at any time point (P = 0.234∼0.888). The data on postoperative pain at rest confirmed that no significant difference was observed between two groups within 48 h of surgery (P = 0.134∼0.520), and the postoperative pain at rest scores decreased over time; however, from the third day, the pain at rest scores of the experimental group were decreased, and significant differences were observed between the two groups (P = 0.039∼0.047). As for use of rescue analgesic, total opioid consumption and the incidence of postoperative nausea and vomiting, there were no significant differences between the two groups (P = 0.311, P = 0.101, P = 0.661) . In terms of patients' satisfaction, the score of the experimental group was higher than that of the control group, and a significant difference was observed between the two groups (P = 0.000). As for adverse events, two participants reported pain and one patient reported discomfort at the insertion sites during the process of auricular acupuncture intervention, but they both were minor and tolerable. CONCLUSION: Auricular acupuncture may have a relief effect on mild postoperative pain at rest with pain score below 3, suggesting that it may be a feasible adjuvant method to relieve mild pain at rest. However, more multi-centre and large-sample studies are needed to verify this result.

Qigong Exercise for Patients with Gastrointestinal Cancer Undergoing Chemotherapy and at High Risk for Depression: A Randomized Clinical Trial.

Aims and objectives: This study evaluated the effects of a Chinese traditional qigong exercise-monkey frolic in Wuqinxi on depression and quality of life in patients with gastrointestinal cancer undergoing chemotherapy and at high risk for depression. Methods: In this prospective, randomized-controlled clinical trial, 80 patients with gastrointestinal cancer undergoing chemotherapy and at high risk for depression were randomized to an intervention group or a control group. Participants in the intervention group participated in qigong exercise five sessions each week and also received conventional treatment for 4 weeks; whereas participants in the control group received conventional treatment only. The primary outcome was the change in depressive symptoms as obtained through the Self-Rating Depression Scale. Automatic negative thoughts and quality of life were measured by the Automatic Thoughts Questionnaire and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-core30, respectively. Analyses were based on analysis of covariance (ANCOVA) with the "intention-to-treat" population, defined as all randomized patients by imputing mean of the column in place of missing data. Results: Seventy-nine participants (98.8%) completed the study, 40 in the intervention group and 39 in the control group. Results of ANCOVA revealed that, compared with the control group, the intervention group reported significantly lower depression scores, fewer negative thoughts, and showed significant improvement in global health status and physical, role, emotional, cognitive, and social functions (p < 0.05) following the intervention. Post-treatment scores for all symptoms in the intervention group were significantly lower than those in the control group (p < 0.05), except for financial difficulties. No significant differences between the two groups were present in the adverse events (all p > 0.05). Conclusions: Qigong exercise may be useful for relieving depression, reducing negative thoughts, and improving the quality of life in patients with gastrointestinal cancer undergoing chemotherapy. Clinical Trial Registry (#ChiCTR2100043417).

Effect of Scraping Therapy on Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: The purpose of this study was to review the literature on the effect of scraping therapy on chronic low back pain (LBP) from randomized controlled trials (RCTs). METHODS: Three English medical electronic databases (PubMed, Embase, and the Cochrane Library) and 2 Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials related to the effects of scraping therapy on chronic LBP were included in this systematic review. Study selection, data extraction, and validation were conducted independently by 2 reviewers. The methodological quality of the studies was evaluated by the Cochrane risk-of-bias tool. RevMan 5.3 software was applied to perform meta-analysis of the data. RESULTS: Ten studies comprising 627 participants were included. Overall, the quality of evidence was moderate owing to a lack of blinding and allocation concealment in some studies and unclear risk of selective reporting. Meta-analysis of 9 RCTs indicated that scraping therapy had a statistically significant effect on pain reduction (standard mean difference = -0.66, 95% confidence interval [CI], -0.83 to -0.49, P < .001). However, if only a single scrape treatment was carried out, the results did not show that scraping was superior to the control group regarding pain relief (mean difference = -0.35, 95% CI, -1.23 to 0.53, P = .44). Moreover, the results of 6 RCTs involving 468 participants showed significantly greater improvement in lumbar dysfunction (mean difference = -10.05, 95% CI, -13.52 to -2.32, P < .001). In addition, the results of 5 RCTs involving 393 participants showed a favorably significant effect on the overall efficacy (odds ratio = 4.74, 95% CI, 2.34-9.62, P < .001). As for follow-up effects, meta-analysis of 3 RCTs involving 241 participants showed a promising effect on pain reduction and lumbar function improvement at 1 month and 3 months after the end of treatment, respectively. Only 1 study reported adverse effects, and none were serious. CONCLUSION: Scraping therapy may have a therapeutic effect for some individuals with chronic LBP. However, due to the limited amount of research and the low methodological quality of the included studies, additional large-scale, multicenter, high-quality RCTs on relieving pain intensity and improving lumbar dysfunction are still necessary.

[Efficacy of assisted treatment of thumb-tack acupuncture with surrounding needling method for herpes zoster of stagnated heat in liver meridian].

OBJECTIVE: To compare the efficacy difference between thumb-tack acupuncture with surrounding needling method plus medication and medication alone for herpes zoster (HZ) of stagnated heat in liver meridian type. METHODS: According to random number table method, 60 patients with HZ of stagnated heat in liver meridian type were randomly divided into an observation group and a control group, 30 cases in each one. All the patients were treated with oral valaciclovir hydrochloride dispersible tablets (0.3 g per time, twice per day), mecobalamin tablets (0.5 mg per time, three times a day) and vitamin B1 (10 mg per time, three times a day) for 15 days. In addition, the patients in the observation group were treated with thumb-tack acupuncture at area 1 cm outside the herpes, with an interval of 3 cm between thumb-tack needles. The thumb-tack acupuncture was given once every 3 days, retained for 48 h, with an interval of 1 day between treatments, and totally 5 treatments were given. The index of herpetic evaluation (stopping time of herpes, scarring time, decrustation time), visual analogue scale (VAS), serum immune-related factors (IgG, IgM, IgA) and serum inflammatory factors (IL-4, IL-17, TNF-α, TGF-ß1) were observed before and after treatment in the two groups. RESULTS: After treatment, the stopping time of herpes, scarring time, decrustation time in the observation group were shorter than those in the control group (all P<0.05). Compared before treatment, the VAS score in the two groups were reduced after treatment (both P<0.05), and no significant difference was observed between the two groups (P>0.05), but the difference before and after treatment in the observation group was superior to that in the control group (P<0.05). Compared before treatment, the levels of serum immune-related factors IgG, IgM, IgA were increased in the two groups after treatment (all P<0.05), and the levels in the observation group after treatment were higher than those in the control group (all P<0.05). Compared before treatment, the levels of serum inflammatory factors IL-4, IL-17, TNF-α, TGF-ß1 were reduced in the two groups after treatment (all P<0.05), and the levels in the observation group after treatment were lower than those in the control group (all P<0.05). CONCLUSION: The thumb-tack acupuncture with surrounding needling method plus medication have the advantages of rapid onset and analgesic effect for HZ of stagnated heat in liver meridian type, which could also improve serum immune-related factors and reduce inflammatory reaction.

Efficacy of Auricular Acupressure for Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: To identify the efficacy of auricular acupressure on pain and disability for chronic LBP by systematic review. METHODS: A search of randomized controlled trials was conducted in four English medical electronic databases and three Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. RESULTS: A total of 7 trials met the inclusion criteria, of which 4 had the low risk of bias. The findings of this study showed that, for the immediate effect, auricular acupressure had large, significant effects in improving pain within 12 weeks. As for the follow-up effect, the pooled estimates also showed promising effect at 4-week follow-up after 4-week intervention (standardized mean difference = -1.13, 95% CI (-1.70, -0.56), P < 0.001). But, for the disability level, the therapeutic effect was not significant (mean difference = -1.99, 95% CI (-4.93, 0.95), P = 0.18). No serious adverse effects were recorded. CONCLUSIONS: The encouraging evidence of this study indicates that it is recommended to provide auricular acupressure to patients with chronic low back pain. However, a more accurate estimate of the effect will require further rigorously designed large-scale RCTs on chronic LBP for improving pain and disability.

Effect of Gua sha therapy on perimenopausal syndrome: a randomized controlled trial.

OBJECTIVE: This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms, quality of life, and serum female hormones in participants with perimenopausal syndrome. METHODS: A prospective, randomized, controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China. Eighty women with perimenopausal syndrome were recruited and randomized into an intervention group or a control group. Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks, whereas participants in the control group received conventional treatment alone. The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index (KI) and the Menopause-Specific Quality of Life. The secondary outcome was the change of serum female hormones including estrogen, follicle-stimulating hormone, and luteinizing hormone. RESULTS: Seventy-five out of 80 participants (93.8%) completed the study-38 in the intervention group and 37 in the control group. The baseline levels of demographic and outcome measurements were comparable between the two groups. After eight sessions of intervention, the reduction in the total modified KI score was, however, 16.32 ±â€Š4.38 in the intervention group and 11.46 ±â€Š5.96 in the control group, with a difference of 4.86 ±â€Š6.15 (P < 0.01) between the two groups. Also the reductions of hot flash/sweating, paresthesia, insomnia, nervousness, melancholia, fatigue, and headache were greater in the intervention group than in the control group (P < 0.05). The reduction in the total Menopause-Specific Quality of Life score was 17.87 ±â€Š3.84 in the intervention group and 13.62 ±â€Š7.40 in the control group, with a difference of 4.46 ±â€Š7.52 (P < 0.01) between the two groups. And the scores for vasomotor, psychosocial, and physical domains in the intervention group were significantly lower than those in the control group (P < 0.05). There were no significant differences in serum estrogen, follicle-stimulating hormone, and luteinizing hormone between the two groups. CONCLUSIONS: The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome. The therapy may serve as a promising, effective, nondrug treatment for perimenopausal syndrome in clinical work. Additional research is needed to better understand its effectiveness and examine its mechanism for treating perimenopausal syndrome.

Efficacy of auriculotherapy for constipation in adults: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To assess the clinical evidence of auriculotherapy for constipation treatment and to identify the efficacy of groups using Semen vaccariae or magnetic pellets as taped objects in managing constipation. METHODS: Databases were searched, including five English-language databases (the Cochrane Library, PubMed, Embase, CINAHL, and AMED) and four Chinese medical databases. Only randomized controlled trials were included in the review process. Critical appraisal was conducted using the Cochrane risk of bias tool. RESULTS: Seventeen randomized, controlled trials (RCTs) met the inclusion criteria, of which 2 had low risk of bias. The primary outcome measures were the improvement rate and total effective rate. A meta-analysis of 15 RCTs showed a moderate, significant effect of auriculotherapy in managing constipation compared with controls (relative risk [RR], 2.06; 95% confidence interval [CI], 1.52- 2.79; p<0.00001). The 15 RCTs also showed a moderate, significant effect of auriculotherapy in relieving constipation (RR, 1.28; 95% CI, 1.13-1.44; p<0.0001). For other symptoms associated with constipation, such as abdominal distension or anorexia, results of the meta-analyses showed no statistical significance. Subgroup analysis revealed that use of S. vaccariae and use of magnetic pellets were both statistically favored over the control in relieving constipation. CONCLUSIONS: Current evidence illustrated that auriculotherapy, a relatively safe strategy, is probably beneficial in managing constipation. However, most of the eligible RCTs had a high risk of bias, and all were conducted in China. No definitive conclusion can be made because of cultural and geographic differences. Further rigorous RCTs from around the world are warranted to confirm the effect and safety of auriculotherapy for constipation.