Effect of acupuncture for disorders of consciousness in patients with stroke: A systematic review and meta-analysis.

Background: Disorder of consciousness (DOC) is frequent in patients with stroke, which is the second most common cause of death and a leading cause of disability. Acupuncture has been used as a curative method for DOC treatment in China. Nevertheless, no critical systematic review of acupuncture's effect on DOC has been published. This review aims to evaluate the present evidence regarding the efficacy of acupuncture for DOC after stroke. Methods: Seven databases were searched from their inception to November 1, 2021, containing three English databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and four Chinese databases (CNKI, CBM, VIP, and Wanfang Database). The primary outcomes comprise the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) before and after treatment. Secondary outcomes involve resuscitation rate, resuscitation time, and adverse events. Data synthesis was calculated by RevMan (V.5.4.1) software. According to the Cochrane Handbook, methodological quality was assessed with the risk of bias tool 2.0 (RoB2). Results: Seventeen studies containing 1,208 patients were eventually included in our review. Overall, most trials were rated as high or had some concerns regarding the risk of bias. GCS was reported in 16 trials, and a meta-analysis showed that GCS improvement in the acupuncture group was greater than in the non-acupuncture group (MD 1.45, 95% CI 0.94-1.97, P < 0.0001). One trial reported that GOS improvement in the acupuncture plus medication group was greater than in the medication group (MD 0.58, 95% CI 0.11-1.05, P = 0.01). Another study reported that acupuncture plus medication was statistically more effective in shortening resuscitation time than medication alone (MD-0.89, 95% CI -1.53 to -0.25, P = 0.006). Four trials reported that the resuscitation rate in the acupuncture group was higher than without acupuncture intervention (RR 1.68, 95% CI 1.30-2.18, I 2 0%, P = 0.39). Adverse events were reported in two studies, with one case in the acupuncture group suffering from subcutaneous hematoma. Conclusion: Acupuncture may improve consciousness level, increase the resuscitation rate, and shorten resuscitation time for post-stroke patients with DOC. Adverse events from acupuncture were rare, tolerable, and recoverable. However, the results should be interpreted cautiously, and more rigorous RCTs with better methodology are warranted. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=289802, identifier 289802.

[Effect of electroacupuncture serum on expression of myogenic differentiation antigen and autophagy-related protein Beclin 1 in cultured muscle satellite cells under starvation].

OBJECTIVE: To explore the effect of electroacupuncture (EA) serum on expression of myogenic differentiation antigen (Myod) and autophagy-related protein Beclin 1 in cultured muscle satellite cells of rats under starvation conditions. METHODS: The primary multifidus muscle satellite cells of one male SD rat were isolated and cultured to obtain the 3rd generation of cells. The EA serum was got from the rat received EA stimulation of bilateral "Weizhong" (BL40, 2 Hz/10 Hz, 1 mA, duration of 20 min, once daily for 7 days). The cell suspension (2×104/well) of the 3rd generation of cultured cells was transferred to each well of a 96-well plate in medium containing 10% fetal bovine serum (FBS). Twelve duplicate wells were set up for the blank control serum (without FBS), 10% FBS, 10% EA serum, 20% EA serum and 30% EA serum groups and incubated for 12 h and 24 h, respectively. Each well was supplemented with 10 µL CCK-8 reagent to be incubated for 1 h again for observing the state of cell proliferation. After culturing the primary muscle satellite cells in serum-free medium for 12 h, the cells were randomly divided into serum-free group, 10% fetal bovine serum group and optimal concentration electroacupuncture serum group, and serum of corresponding concentration was added respectively. The expression levels of Beclin 1 and cell-proliferation-related protein Myod were detected by Western blot. RESULTS: CCK-8 assay displayed that the proliferation levels were significantly higher at 12 h and 24 h after serum intervention in the 10% FBS, 10% EA serum, 20% EA serum and 30% EA serum groups than that in the blank control serum group (P<0.01), and at 24 h in the 3 EA serum groups than in the 10% FBS group (P<0.01), but without significant difference among the three EA serum groups (P>0.05). As a result, 10% EA serum was selected as the optimal concentration for Western blot tests. No significant difference was found in the expression levels of Myod and Beclin 1 proteins among the serum-free, 10% FBS and 10% EA serum groups before intervention (P>0.05), and there was a marked up-regulation of Myod expression and an obvious down-regulation of Beclin 1 expression at 12 h in both the 10% EA serum and 10% FBS groups in comparison with their own pre-intervention (P<0.05). There were a marked up-re-gulation of Myod expression at both 12 h and 24 h and Beclin 1 expression at 24 h in both the 10% EA serum group and 10% FBS group than that in the serum-free group (P<0.05), and an obvious down-regulation of Beclin 1 expression at 12 h in both 10% FBS and 10% EA serum groups than that in the serum-free group (P<0.05, P<0.01). After 24 h's serum intervention, there was an increase of Myod expression and a reduction of Beclin 1 expression in both 10% FBS and 10% EA serum groups compared with those after the 12 h intervention (P<0.05). No significant differences were found between the 10% FBS and 10% EA serum groups in the expression levels of Myod and Beclin 1 proteins (P>0.05). CONCLUSION: EA serum can promote proliferation of cultured muscle satellite cells under starvation conditions, which is related to its functions in regulating expression of Beclin 1 and cell-proliferation-related protein Myod.

Effect of auricular electroacupuncture combined with body acupuncture in improving the consciousness of patients after traumatic brain injury: Study protocol for a randomized controlled trial.

BACKGROUND: Traumatic brain injury (TBI) has become a major cause of morbidity and mortality both in China and abroad. Disorders of consciousness following severe TBI is a common refractory complication, resulting in difficult rehabilitation and poor life quality. However, effective therapeutic approaches remain limited. Although acupuncture has been widely applied in the treatment of neurological disorders in China, its efficacy and safety for consciousness recovery remain to be elucidated. METHODS: Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electroacupuncture at auricular acupoints "heart" and "brainstem" combined with body acupuncture in the consciousness recovery of patients with TBI. A total of 80 patients with initial Glasgow coma scale score between 3 and 8 points will be recruited in the trial and randomized into intervention (combined application of auricular electroacupuncture and body acupuncture) group or control (conventional treatment) group. Patients in the intervention group will receive electroacupuncture at bilateral auricular acupoints "heart" and "brainstem" (4 points in total) combined with body acupuncture in addition to conventional treatment while patients in the control group will receive conventional treatment alone for 8 weeks. The primary outcomes are changes of Glasgow coma scale score and mismatch negativity of event-related brain potentials at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The secondary outcome measures will be changes of Barthel and FuglMeyer scores at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION: Results from this trial will significantly support the application of auricular acupuncture and body acupuncture in the consciousness recovery of patients with severe TBI. If found to be effective and safe, auricular acupuncture combined with body acupuncture will be a valuable complementary option for comatose patients with TBI. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800020245. Registered on 21 December 2018.

[Clinical trials of treatment of post-stroke foot drop by fire-needling plus stuck-needle-stretching].

OBJECTIVE: To compare the therapeutic effect of fire-needling plus stuck-needle-stretching and conventional acupuncture for post-stroke foot drop, so as to provide a reference foundation for optimizing clinical treatment regimen. METHODS: A total of 60 patients with post-stroke foot drop were equally randomized into a treatment group and a control group. In the treatment group, fire-needling plus stuck-needle-stretching was applied to acupoint pairs Jiexi (ST41)-Taichong (LR3), Xiajuxu (ST39)-ST41, Fenglong (ST40)-ST39, shangjuxu (ST37)-ST40, Zusanli (ST36)-ST37, Dubi (ST35)-ST36, Xuanzhong (GB39)-Qiuxu (GB40) on the affected side, and Chengshan (BL57) and Ashi points were swiftly pricked with red-hot filiform needle without needle retaining. In the conventional acupuncture group, the same acupoints were needled with filiform needles, and the treatment for both groups was given once a day, 6 times a week, for consecutive 4 weeks. The spasm severity of posterior triceps of the lower leg was evaluated using modified Ashworth scale, the tibial anterior muscle strength was measured using Lovett' and Martin's methods, the activities of daily living were assessed using modified Barthel's index, the walking ability was evaluated using Holden walking rating scale and the lower limb motor function assessed using Fugl-Meyer assessment scale, and the severity of foot drop was assessed in reference to Garceau criteria. RESULTS: After the treatment, the score of the modified Ashworth scale was significantly reduced (P<0.01), and those of Lovett muscle strength scale, Barthel index, Holden walking rating scale and Fugl-Meyer lower limb motor function scale were considerably increased in both groups versus their own pre-treatment (P<0.01). The therapeutic effect of the treatment group was significantly superior to that of the control group in reducing Ashworth scale score and in increasing the scores of Lovett muscle strength test, Barthel index, Holden walking function scale and Fugl-Meyer lower limb motor function scale (P<0.01). Of the two 30 cases in the control and treatment groups, 10(33.33%)and 14(46.67%) experienced a remarkable improvement, 10(33.33%)and 12(40.00%)were improved, 7(23.33%)and 3(10.00%)had a mild progress, 3(10.00%) and 1(3.33%) failed, with the excellent plus good effective rates being 66.67% and 86.67%, respectively, but without significant difference between the two groups (P>0.05). CONCLUSION: Both fire-needling plus stuck-needle-stretching and conventional acupuncture are effective in the treatment of post-stroke foot drop, but the former is relatively better.

Therapeutic effect of Fu's subcutaneous needling for hemiplegic shoulder pain among stroke survivors: Study protocol for a randomized controlled trial.

BACKGROUND: Hemiplegic shoulder pain (HSP) is a frequent complication after stroke and limits patients' physical functioning of the affected arm, thus compromising their quality of life. Fu's subcutaneous needling (FSN) has been widely applied in the treatment of pain diseases in China; however, its efficacy and safety for HSP remain to be elucidated. We therefore conducted a randomized, controlled trial to summarize the current evidence on the effects of FSN on the recovery outcomes of stroke survivors with HSP. METHODS: Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of FSN in patients with HSP. A total of 60 patients with numerical rating scale (NRS) score above 1 will be recruited in the trial and randomized into FSN group or usual care (UC) group. Patients in the FSN group will receive FSN treatment combined with UC treatment while patients in the UC group will receive UC treatment alone for 4 weeks. The primary outcomes are changes of NRS at baseline, after the 1st treatment, after the final treatment and 4 weeks after the final treatment. Secondary measurements will be changes of Fugl-Meyer score, constant score, MPQ-SF score, quality of life score, and range of motion at baseline, after the final treatment, and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION: Results from this trial will significantly support the application of FSN in the recovery of patients with HSP. If found to be effective and safe, FSN will be a valuable complementary option for patients with HSP. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1900021644 (registered on March 2, 2019).

Acupuncture for uterine fibroids: Protocol for a systematic review of randomized controlled trials.

BACKGROUND: Uterine fibroids represent the most common gynecological benign tumors in reproductive females. Acupuncture has been applied as a therapeutic modality in China to treat uterine fibroids. However, currently, few critical systematic reviews regarding the effect of acupuncture on uterine fibroids have been published. Our proposed review aims to evaluate the current evidence on the efficacy of acupuncture for uterine fibroids. METHODS: A total of 7 databases were searched from their inception to December 2018, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. The primary outcomes will be reduction in uterine volume and number of fibroids. Secondary outcomes are pelvic or low-back pain, assessed by Visual Analog Scale (VAS); Irregular menstrual periods; Low-abdominal pressure symptoms such as frequent or urgent urination, or constipation and adverse events. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook. RESULTS: This study will provide high-quality evidence of acupuncture for uterine fibroids. CONCLUSION: The conclusion of this systematic review will provide evidence to judge whether acupuncture is an effective therapeutic intervention for patients with uterine fibroids. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019120484.