Acupuncture in Medicine最新文献

Objective: Cognitive impairment (CI) is highly prevalent in subarachnoid hemorrhage (SAH) patients. The phosphatidylinositol 3-kinase (PI3K)/AKT pathway plays a critical role in neuronal survival in a variety of central nervous system injuries. This study aimed to determine whether electroacupuncture (EA) at Yintang and LI20 ameliorates SAH-CI in a rat model and to examine whether it modulates the PI3K/AKT pathway by administering a PI3K inhibitor (LY294002) versus dimethyl sulfoxide (DMSO) vehicle.

Methods: Notably, 129 male Sprague-Dawley rats were divided into Blank, Sham, SAH and SAH + EA groups (Experiment 1, n = 54) and SAH, SAH + EA, SAH + LY294002, SAH + EA + LY294002 and SAH + EA + DMSO groups (Experiment 2, n = 75). Garcia scoring was used to evaluate neurological function. The moisture content of the rat brain was determined by dry‒wet method. The Morris water maze was used to assess learning and memory function. Pathological changes in neurons in the hippocampus were observed via hematoxylin-eosin (H&E) staining. The number of surviving neurons and the percentage of apoptotic cells in the hippocampus were detected via Nissl and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. The expression of PI3K/AKT pathway-related proteins was detected via Western blotting.

Results: The results indicated that EA intervention after SAH reduced brain water content, enhanced Garcia scores, improved neurological function and behavioral markers of CI, and increased the number of surviving neurons in the hippocampus. Moreover, EA significantly increased the expression of AKT, phosphorylated (p)-AKT, PI3K, p-PI3K, glycogen synthase kinase (GSK)-3β, p-GSK-3β and B cell lymphoma (Bcl)-2 proteins, and decreased the expression of Bcl-2-associated X (Bax) and caspase-3. In addition, the effects of EA were abolished by LY294002.

Conclusion: EA appeared to improve CI in a rat model of SAH through the activation of the PI3K/AKT pathway.

Background: Although growing numbers of patients seek acupuncture for pain management, few acupuncturists with insurance credentialing work in the conventional medical settings. This has resulted in increasing frustration among patients wishing to receive acupuncture in primary care settings as part of their insurance benefits.

Methods: A course of eight weekly sessions of group auricular acupuncture (AA) for chronic musculoskeletal pain was implemented in a US primary care clinic and billed to insurance. The process of implementing group AA is described, including patients and researchers' perceptions of their experience. We also examined various hypothetical scenarios for reimbursement based on relative value units (RVUs) based on Centers for Medicare and Medicaid (CMS) billing/coding.

Results: Recruitment was greatly limited by COVID-19 requirements for social distancing and administrative hurdles, such that only four patients participated, three of whom attended all eight sessions. Seven additional Medicare patients were excluded due to concerns that acupuncture would not be covered. Participants reported mostly positive experiences with both AA and the group model of care. Based on our hypothetical reimbursement scenarios, in the fee-for-service model, group sessions appear to be economically more viable when staffed by non-physician acupuncturists credentialed for insurance reimbursement. For example, for a group of six patients each receiving acupuncture would be anticipated to generate 3.60 RVUs, whereas a physician seeing three individual patients consecutively for return office visits at CMS Evaluation and Management (E/M) level 3 could generate at least 4.11 RVUs.

Conclusions: Offering group AA services in primary care clinics might increase access to acupuncture for patients with chronic pain. Although patients appreciated quicker access to acupuncture through group visits, and the group visit experience itself, logistical and economic barriers remain a challenge for sustainable group-based acupuncture visits.

Objective: The aim of this study was to investigate the role of ferroptosis in the occurrence of postoperative cognitive dysfunction (POCD) using a mouse model and to elucidate whether electroacupuncture (EA) can improve POCD by suppressing ferroptosis via the transferrin receptor 1 (TFR1)-divalent metal transporter 1 (DMT1)-ferroportin (FPN) pathway.

Methods: The experiment involved three groups: the control group, the POCD group and the POCD + EA group. The POCD animal model was established using sevoflurane anesthesia and tibial fracture. Cognitive and behavioral changes in mice were assessed using the novel object recognition test (NORT) and the Morris water maze (MWM) test, 1 and 3 days after surgery. Transmission electron microscopy was performed to observe changes in the mitochondrial structure of hippocampal tissue. Enzyme-linked immunosorbent assay was conducted to determine the levels of glutathione (GSH) and iron ion (Fe) concentrations. Western blot analysis was used to measure the expression of TFR1, DMT1 and iron pump protein. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was employed to detect the mRNA levels of DMT1 and FPN.

Results: Based on the experimental results of the MWM test and the NORT, we found that EA can improve POCD in mice. Observation by projection electron microscopy showed that EA improved the mitochondrial structure in the hippocampus. The enzyme-linked immunosorbent assay (ELISA) results showed that EA suppressed ferroptosis in the hippocampal area. The qRT-PCR and Western blot results suggested that EA suppresses ferroptosis by regulating the TFR1-DMT1-FPN pathway.

Conclusion: This study reveals that sevoflurane and tibial fractures cause cognitive damage through the mechanism of ferroptosis, while EA may inhibit ferroptosis through the TFR1-DMT1-FPN pathway and improve POCD when induced in this way.

Background: Electroacupuncture (EA) has been demonstrated to be efficacious and safe in patients with knee osteoarthritis (KOA), yet the optimal current intensity for pain control in KOA remains unspecified. The present meta-analysis aimed to compare the effects of high-intensity and low-intensity EA in terms of pain relief and functional improvement in KOA.

Methods: A thorough and comprehensive literature search for randomized controlled trials (RCTs), all looking at the intensity of EA for KOA, was carried out in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science Journal Citation Report (VIP) and Wanfang database, as well as ClinicalTrials.gov. All databases were searched from their inception until April 2022. Study quality was assessed using the Cochrane risk of bias (RoB)2 tool. Finally, a meta-analysis of all eligible RCTs was performed using Review Manager 5.3.

Results: Three studies with 472 individuals were included in the meta-analysis. The pain intensity reductions were significantly different between the high-intensity EA group and low-intensity EA group (mean difference (MD) = -0.22, 95% confidence interval (CI) = -0.26 to -0.18, p < 0.00001). There was no significant difference between the two groups in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (MD = -3.62, 95% CI = -12.22 to 4.98, p = 0.41). High-intensity EA significantly improved emotional scale (ES) scores compared to low-intensity EA (MD = -0.72, 95% CI = -0.76 to -0.67, p < 0.00001).

Conclusion: The findings of this systematic review and meta-analysis indicated that high-intensity EA provides superior pain relief and has a bigger impact on emotional scale scores in patients with KOA.

Objective: Our aim was to examine the effectiveness of acupuncture in post-stroke depression/anxiety disorders and to determine whether it reduces the need for anxiolytic and sedative drug use.

Methods: This study included 54 stroke patients with depression and/or anxiety disorder. Patients were randomly assigned to the acupuncture treatment group (n = 27) or the control group (n = 27). A conventional rehabilitation program was applied to all patients and acupuncture was performed twice a week for 4 weeks. Patients were evaluated blindly by a psychiatrist at baseline (week 0), week 4 and week 8, using the Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A), and drug doses were adjusted when necessary. The HAM-D and HAM-A scores at week 4 were pre-specified as the two primary outcome measures.

Results: Within each group, there was a significant decrease in the mean scores of HAM-D and HAM-A at weeks 4 and 8. No between-group differences in HAM-A or HAM-D scores were seen at 4 weeks but there was a significant decrease in HAM-D scores in favor of the acupuncture group at week 8 (p < 0.025). At week 4, the number of cases whose selective serotonin reuptake inhibitor (SSRI) dose was increased was found to be significantly higher in the control group.

Conclusion: While the study was negative with respect to its primary outcomes, the findings with respect to certain secondary outcomes suggests further research is warranted to determine if acupuncture treatment is an effective/safe treatment to alleviate post-stroke depression/anxiety.

Trial registration number: NCT04283591 (ClinicalTrials.gov).

Background: Nosocomephobia, a type of posttraumatic stress disorder (PTSD), is a diagnosis of an extreme fear of hospitals that can hinder current/future medical care. There is little research on how nosocomephobia affects elective surgery or how acupuncture can help patients cope.

Methods: Using the transactional model of stress/coping, this qualitative case study examined the role of acupuncture in nosocomephobia patients' elective surgery appraisal processes. Two patients were interviewed about their nosocomephobia and prior hospital experiences. Six reviewers coded interview transcripts line-by-line using Dedoose software. Reviewers labeled meaningful words, phrases and sentences and produced over 600 codes. Reviewers discussed/identified themes by grouping similar codes and resolving discrepancies. A thematic analysis was then used to develop final themes. Pseudonyms were assigned to protect patient privacy. Sophie had avascular necrosis in both hips and suffered PTSD from a previous traumatic event. Intraoperative acupuncture calmed her hospital anxiety, allowing her to have both hips replaced. Olivia had experienced PTSD and hospital phobia since she was 12 years old. Acupuncture reduced her anxiety surrounding a necessary knee arthrotomy and osteochondral allograft.

Results: Thematic analysis showed how nosocomephobia impacted patients' views of surgery and distinguished between their unique fear rationale. The transactional model of stress/coping illustrated patients' appraisal process from surgery (stressor) to coping (acupuncture) to reappraisal (mental state).

Conclusion: Procedural visits can be stressful due to already heightened anxiety. Although no definitive conclusions can be drawn from this small, uncontrolled case series, acupuncture may represent a safe, noninvasive way for nosocomephobia patients to manage preoperative anxiety.

Objective: To determine the effect of electroacupuncture (EA) on β₁-adrenergic receptor (β₁-AR) and post-receptor protein kinase A (PKA) signaling pathway after acute myocardial ischemia (MI).

Methods: An MI model was established by ligating the left anterior descending coronary artery of wild-type (WT) C57/BL and β₁-AR^+/- mice (heterozygous for β₁-AR gene deletion). EA treatment was administered at HT5-HT7 or LU9-LU8. We evaluated cardiac function by measuring ST segment displacement, ischemic area and serum levels of creatine kinase (CK)-MB and lactate dehydrogenase (LDH). Pathological morphology/apoptosis of myocardial tissue were examined using hematoxylin-eosin and terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Norepinephrine (NE) levels in myocardial tissue were detected by ELISA. Levels of β₁ and post-receptor PKA signaling components were evaluated by quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting.

Results: EA stimulation at HT7-HT5 could better regulate the level of β₁-AR in myocardial tissue than that at LU9-LU8. Following EA, the ST segment, serum CK-MB/ LDH and area of myocardial infarction were decreased in WT mice, and the degree of myocardial pathology/apoptosis and expression of cleaved caspase-3 were decreased. Myocardial levels of Gs protein (Gs), adenylate cyclase (AC), cyclic adenosine monophosphate (cAMP), phosphorylated protein kinase A (p-PKA), L-type voltage-gated calcium channel α1C (Cav1.2), serine phosphate 16-phospholamban (p-PLB^s16) and sarcoplasmic reticulum Ca²⁺-adenosine triphosphate (ATP)ase 2a (SERCA2a) increased after EA. However, these effects of EA were not replicated in β₁-AR^+/- mice. Interestingly, myocardial NE content decreased after EA in WT and β₁-AR^+/- mice.

Conclusion: EA may enhance cardiac function and reduced MI area/apoptosis by restoring the activity of β₁-AR and post-receptor PKA signaling.

Cocaine is a frequently abused and highly addictive drug that damages brain health and imposes substantial social and economic costs. Acupuncture has been used in the treatment of cocaine addiction and has been shown to improve abnormal mental and motor states. This article mainly focuses on the neurobiological mechanisms involving the central nervous system (CNS) and peripheral nervous system (PNS) that underlie the effects of acupuncture in the treatment of cocaine addiction. The central dopamine system is a key player in acupuncture treatment of cocaine addiction; the ventral tegmental area (VTA)-nucleus accumbens (NAc) signaling pathway, which has a modulatory influence on behavior and psychology after chronic use of cocaine, is a significant target of acupuncture action. Moreover, acupuncture alleviates cocaine-induced seizures or acute psychomotor responses through the paraventricular thalamus and the lateral habenula (LHb)-rostromedial tegmental (RMTg) nucleus circuits. The data suggest that acupuncture can impact various cocaine-induced issues via stimulation of diverse brain areas; nevertheless, the interconnection of these brain regions and the PNS mechanisms involved remain unknown. In this review, we also discuss the effects of specific acupuncture protocols on cocaine addiction and note that variations in needling modalities, current intensities and traditional acupuncture point locations have led to different experimental results. Therefore, standardized acupuncture protocols (with respect to stimulation methods, point locations and number of sessions) may become particularly important in future studies.