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In recent years, the number of functional magnetic resonance imaging (fMRI) research in acupuncture grows increasingly. However, due to the differences in acupoint selection, acupuncture technique and sample size, the problems get more prominent in terms of the diverse results and the lack of common rules of acupuncture among researches. By taking the fMRI research for post-stroke motor dysfunction (PSMD) treated with acupuncture as the example, this paper introduces the fMRI Meta-analysis technology for integrating the relevant research results and extracting the common rules, namely image-based Meta-analysis (IBMA) and coordinate-based Meta-analysis (CBMA). Considering the higher feasibility of CBMA, three available CBMA methods are explained specially, including activation likelihood estimation (ALE), kernel density analysis (KDA), and seed-based d mapping (SDM). Focusing on the precautions and operation procedure of CBMA, the review is conducted systematically on the type of fMRI research, task design, analytical method, and the thinking integrity of fMRI Meta-analysis, and the review findings are collated in charts. It aims to assist readers to understand the abstract and complex theories and practical information of this technology efficiently, conveniently and systematically, and hopes to provide the references for the future learning and the application.

Stroke Phase Is Essential for Pneumonia in Dysphagia Patients After Cerebral Infarction.

BACKGROUND: The risk of pneumonia increases after stroke, especially in poststroke dysphagia patients. Propensity score matching (PSM) is a statistical method in SPSS, which can be used to balance the difference between the 2 groups of known factors. Nasogastric tube feeding is an important factor of stroke-associated pneumonia. However, few studies have used PSM to eliminate the effect of confounding factor. METHODS: Our research was a retrospective case-control study. Retrospective review of the patient database between December 1, 2019, and June 30, 2022, to identify consecutive dysphagia patients after cerebral infarction during hospitalization. An 1:1 PSM in SPSS 25.0 was used to balance nasogastric tube feeding between patients with and without pneumonia. The characteristics of these 2 groups were analyzed. Univariate and binary logistic regression analyses were used to screen the risk factors of dysphagia after cerebral infarction. RESULTS: After 1:1 PSM, 198 subjects met our criteria and were included in the analysis. Age [odds ratio (OR)=1.047, 95% CI: 1.013-1.081, P =0.006], stroke phase (acute stroke) (OR=5.931, 95% CI: 1.133-31.054, P =0.035), admission National Institutes of Health Stroke Scale score (OR=1.058, 95% CI: 1.004-1.115, P =0.034), and length of hospital stay (OR=1.025, 95% CI: 1.001-1.049, P =0.042) had statistically significant correlation with pneumonia in patients with dysphagia after cerebral infarction. CONCLUSION: In clinical practice, for the prevention of pneumonia in patients with dysphagia after cerebral infarction, we should pay more attention to admission National Institutes of Health Stroke Scale score, age, and stroke phase, especially in acute cerebral infarction patients.

The neural plasticity and efficacy of acupuncture for post-stroke dysphagia: protocol for a randomized controlled trial with fMRI and DTI.

BACKGROUND: Dysphagia, a common complication of acute stroke, is associated with increased mortality and morbidity. Acupuncture, a widely used swallowing therapy in China, has been suggested as an effective therapy for treating Post-Stroke Dysphagia (PSD) by recent meta-analyses and guidelines. The use of resting-state functional Magnetic Resonance Imaging (rs-fMRI) and Diffusion Tensor Imaging (DTI) could explore the change of regional spontaneous neural activity, functional relationships between brain regions, and white matter connectivity patterns after acupuncture intervention for PSD. This trial aims to evaluate the efficacy of acupuncture treatment for PSD and explore its central mechanism by neuroimaging. METHODS/DESIGN: This randomized controlled trial will recruit 40 PSD patients. All patients will be randomized to either the Real Acupuncture (RA) or Sham Acupuncture (SA) group by a ratio of 1:1. All patients will receive immediate acupuncture treatment in the MRI scanning room, followed by four weeks of long-term acupuncture treatment. The primary outcomes are the rs-fMRI and DTI indicators, which will be evaluated after the immediate and long-term acupuncture treatment. The secondary outcomes are the scales that assess the efficacy, including the Functional Oral Intake Scale (FOIS), Water Swallowing Test (WST), Swallowing Quality Of Life Questionnaire (SWAL-QOL), and National Institute of Health Stroke Scale (NIHSS). The modified version of the Massachusetts General Hospital Acupuncture Sensation Scale (M-MASS) and fMRI sensation record table will also be evaluated. DISCUSSION: This protocol presents the design of a randomized, single-blind trial that will evaluate the efficacy and explore the neural plasticity of acupuncture treatment for PSD. This trial will deepen our insight into the clinical value of acupuncture for PSD and initially probe into the time-dosage-effect mechanism of acupuncture. TRIAL REGISTRATION NUMBERS: Chinese Clinical Trial Registry ( www.chictr.org.cn ) ChiCTR2300067480. This study was registered on 9th January 2023.

Electroacupuncture pretreatment enhances the calcium efflux activity of Na+/Ca2+ exchanger to attenuate cerebral injury by PI3K/Akt-mediated NCX1 upregulation after focal cerebral ischaemia.

Electroacupuncture pretreatment is considered as an optimal strategy for inducing cerebral ischaemic tolerance. However, the underlying neuroprotective mechanism of this approach has never been explored from the perspective of calcium homeostasis. Intracellular calcium overload is a key inducer of cascade neuronal injury in the early stage after cerebral ischaemia attack and the Na+/Ca2+ exchanger (NCX) is the main plasma membrane calcium extrusion pathway maintaining post-ischaemic calcium homeostasis. This study aims to investigate whether the regulation of NCX-mediated calcium transport contributes to the cerebroprotective effect of electroacupuncture pretreatment against ischaemic injury and to elucidate the underlying mechanisms involved in this process. Following five days of repeated electroacupuncture stimulation on Baihui (GV20), Neiguan (PC6), and Sanyinjiao (SP6) acupoints in rats, in vivo and in vitro models of cerebral ischaemia were induced through middle cerebral artery occlusion and oxygen/glucose deprivation (OGD), respectively. Firstly, we verified the neuroprotective effect of electroacupuncture pretreatment from the perspective of neurological score, infarct volume and neuronal apoptosis. Our findings from brain slice patch-clamp indicated that electroacupuncture pretreatment enhanced the Ca2+ efflux capacity of NCX after OGD. NCX1 expression in the ischaemic penumbra exhibited a consistent decline from 1 to 24 h in MCAO rats. Electroacupuncture pretreatment upregulated the expression of NCX1, especially at 24 h, and silencing NCX1 by short hairpin RNA (shRNA) administration reversed the protective effect of electroacupuncture pretreatment against cerebral ischaemic injury. Furthermore, we administered LY294002, a phosphatidylinositol 3 kinase (PI3K) inhibitor, prior to inducing ischaemia to investigate the upstream regulatory mechanism of electroacupuncture pretreatment on NCX1 expression. Electroacupuncture pretreatment activates PI3K/Akt pathway, leading to an increase in the expression of NCX1, which facilitates calcium extrusion and exerts a neuroprotective effect against cerebral ischaemia. These findings provided a novel insight into the prevention of ischemic stroke and other similar conditions characterized by brain ischaemia or hypoperfusion.

[Efficacy judgment for treating ischemic stroke by acupuncturing at Neiguan (PC6) and the screening for optimal parameters].

OBJECTIVE: To select optimal parameters and judge the comprehensive effect of acupuncture. METHODS: The middle cerebral artery occlusion (MCAO) rat model was duplicated. Nine acupuncture parameters groups were set up by the frequency of acupuncture (slow, medium, and fast: 60, 120, and 180 times/min) and the acupuncture duration (short, medium, and long: 5, 60, and 180 s). Twisting technique was used in needling at Neiguan (PC6). By taking neurological impairment scoring, leptomeningeal cerebral blood flow, microcirculation (input branch diameter, output branch diameter, input/output), and cerebral infarction rate as effect indicators, the comprehensive effects of different acupuncture parameters at Neiguan (PC6) on MCAO were determined by factor analysis, thus screening the optimal parameters. RESULTS: By factor analysis, the highest score for comprehensive effect could be achieved with the acupuncture parameters of 180 times/min and 60 s. That is to say, fast frequency and middle time duration could achieve the optimal acupuncture effects, suggesting that appropriate acupuncture time duration should be used under the condition of guaranteeing fast frequency when treating ischemic stroke by needling at Neiguan (PC6). CONCLUSION: The 180 times/min and 60 s were the optimal parameter group when needling at Neiguan (PC6) by twisting technique for treating ischemic stroke.

To explore the pathogenesis of Bell's palsy using diffusion tensor image.

To explore the pathogenesis of Bell's palsy using the diffusion tensor image on 3.0 T MR. The healthy people and the patients with Bell's palsy underwent intraparotid facial nerve scanning by using the DTI and T1 structural sequence at 3.0 T MR. The raw DTI data were performed affine transformation and nonlinear registration in the common MNI152_T1 space and resampled to the 0.4 mm3 voxel size. A group of 4 spherical seed regions were placed on the intratemporal facial nerves in the common space, bilaterally and symmetrically. The DTI data in the common space were used to track the intratemporal facial nerve fibers by using TrackVis and its Diffusion Toolkit. Each tractography was used to construct the maximum probability map (MPM) according to the majority rule. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated and extracted on the basis of MPM. For healthy people, there was no significant difference in FA, MD, RD and AD of bilateral facial nerves. For patients with Bell's palsy, there was no significant difference in AD, there was significant difference in FA, MD and RD between the affected nerve and the healthy nerve (P < 0.02). This study showed that the myelin sheath injury of the intratemporal facial nerve is the main cause of Bell's palsy. Most neural axons are not damaged. The results may explain the pathogenesis of the Bell's palsy, which is self-limited for most cases.

Influence of acupuncture on neural movement function in rats with middle cerebral artery occlusion--a randomized controlled trial.

OBJECTIVES: To observe recovery in movement function in rats with middle cerebral artery occlusion (MCAO) after acupuncture treatment. METHODS: According to the randomized and controlled principle 1384 rats were divided into the basic control group (including the normal, sham, model control, model without intervention, Nimodipine, and para-Renzhong groups) and the acupuncture group (including the Neiguan (PC 6), Weizhong (BL 40), Sanyinjiao (SP 6), Chize (LU 5), Renzhong (GV 6) and non-acupoint groups). MCAO was modeled by Zea-longa's thread ligation and rats with scores of 1-3, as assessed by Zausinger's six-point method, were used in this study. Moreover, in the acupuncture group each acupoint was set with 12 different parameters by the orthogonal intersection method, resulting in 78 groups with 18 rats per group. The rats were treated by acupuncture once every 12 h for a total of six sessions and neurobehavioral scores were measured after each session. The neurobehavioral scores were compared by one-way ANOVA using the statistical software SPSS 17.0. RESULTS: After acupuncture therapy the mean neurobehavioral scores in MCAO rats increased gradually at each time point with a significant difference among the six scores, but with no significant differences between the fourth (48 h) and the fifth score (60 h), and between the fifth (60 h) and the sixth (72 h) score (P > 0.05). CONCLUSIONS: MCAO rats gradually recovered movement function over multiple acupuncture sessions. After the fouth acupuncture session (48 h), the neurobehavioral scores of rats with cerebral infarction remained stable. Acupuncture treatment had a reliable curative effect on movement function in cerebral infarction rats.

[Preliminary study on the existing problems in health economic evaluation study of acupuncture in China].

The literature of health economic evaluation study in the field of acupuncture in China was systematically summarized and analyzed, and the existing problems in the current research were discussed from the aspects of research perspective, cost calculation scope, data analysis method selection. Moreover, the key points of the health economic evaluation research were summarized, and the research objectives, the relationship between the expected research results and data analysis methods and the process of thinking were sorted out, and several suggestions for research report writing were proposed, aiming to provide a reference for the quality improvement of the acupuncture health economic evaluation research in China.

[Quality control in the implementation of multi-center acupuncture clinical trial].

The paper introduced the experiences of quality management in the implementation of multi-center acupuncture clinical trials and the keys in training acupuncture operators. The process management was explained in view of the division of labor for researchers, protocol learning and the communication among sub-centers. Besides, specificity links of acupuncture research were summarized, i.e. meaning implementation brief of acupuncture operation training, control for quantity of stimulus in acupuncture and doctor-patient communication. It is anticipated to provide a valuable reference for the quality control and improvement of multi-center acupuncture clinical trial in future.

Manual Acupuncture or Combination of Rehabilitation Therapy to Treat Poststroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Backgroundand Objective. Poststroke dysphagia is one of the most common stroke complications with high morbidity and long course, while acupuncture treatment is easily accepted by patients due to its reliability, feasibility, simple operation, low price, and quick effect. Our objective was to evaluate the efficacy of manual acupuncture in poststroke dysphagia patients. Methods. Databases including Medline, Web of Science, PubMed, Cochrane Library databases, EMBASE, CNKI (China National Knowledge Infrastructure), WanFang (WanFang Database), and VIP (Chongqing VIP) were searched from inception until Aug 19, 2022. Data were analyzed using Revman 5.3, Stata 14.0, and TSA 0.9.5.10 Beta software. Evidence quality evaluation was performed by using GRADE profiler 3.6. Results. A total of 33 randomized control trials (RCTs) enrolled 2680 patients. Meta-analysis results revealed that compared to rehabilitation, acupuncture decreased water swallow test (WST) and standard swallowing assessment (SSA) scores. Meanwhile, in contrast to rehabilitation alone, integration of acupuncture with rehabilitation effectively decreased WST and SSA scores; improved swallowing scores of videofluoroscopic swallowing study (VFSS), swallowing scores of Fujishima Ichiro, Barthel index (BI), and swallowing quality of life questionnaire (SWAL-QOL); reduced the aspiration rates as well as aspiration pneumonia; and shortened the duration of empty swallowing and the duration of 5 mL water swallowing. Pooled analysis did not reveal any significant differences in dysphagia outcome severity scores (DOSS) (p=0.15 > 0.05p) between the acupuncture group combined with rehabilitation group and the rehabilitation group alone. After the risk-of-bias assessment, these studies were not of low quality, except in terms of allocation concealment and blindness. Evidence quality evaluation showed that allocation concealment and blindness led to a downgrade and primary outcomes' evaluation of acupuncture combined with rehabilitation were ranked as moderate-quality evidence while acupuncture alone was ranked as low-quality. Conclusion. This meta-analysis provided positive pieces of evidences that acupuncture and acupuncture combined with rehabilitation were better than using rehabilitation alone in the treatment of poststroke dysphagia.

[Dynamic observation on therapeutic features of thalamic pain by mind calming, blood activating and pain relief acupuncture and carbamazepine].

OBJECTIVE: To observe therapeutic features of thalamic pain by mind Calming, blood activating and pain relief acupuncture and Carbamazepine. METHODS: Crossover trial design was adopted. Eleven patients with confirmed diagnosis of thalamic pain were randomly assigned to two groups according to the minimal unbalance index method, i.e., Group I (Six patients received acupuncture first and then Western medicine.) and Group II (Five patients received Western medicine first and then acupuncture). The therapeutic course for each group was ten days. There was a ten-day elution phase between the two therapeutic methods. The total therapeutic course was thirty days. Eleven patients were enrolled in the two groups for statistical analysis. The therapeutic efficacy was assessed with visual analogue scale (VAS) and the pain assessment scale of Anderson Cancer Center in the USA (MD Pain Evaluation value) respectively. The VAS and MD values of the two groups were recorded every day to get the dynamic curve. RESULTS: The VAS and MD values obviously decreased in the two groups after treatment (P<0.05). The pain curves of the two groups showed a declining trend during the treatment. A gradual and stable descending process was shown in the acupuncture group. But a greater decrease first appeared in the Western medicine group, then a comparatively greater decrease occurred after one platform stage, showing ladder-shaped curve. CONCLUSIONS: Cumulative potency may be the main analgesic effects of acupuncture. Western medicine may possibly play a role by rapid initiate effect.

[Pivotal issue of acupuncture-moxibustion academical inheritance based on the present situation of the clinical application of Tongguan Liqiao needling method by the academician SHI Xue-min].

The present situation of clinical application of Tongguan Liqiao needling method of acupuncture innovated by academician SHI Xue-min, and the situation for the inheritance of academic thought were analyzed. It was found that during the application of Tongguan Liqiao needling method, some questions were presented, i.e. absence of main acupoints in acupuncture regimen, lack of rules for the selection of combined acupoints and lack of specification on manipulation. The reasons of the above questions were analyzed from three aspects of inheritance, i.e. integrity, systematicness and normativity. It is anticipated that the summary of this analysis may provide the references to the efficient development of normative clinical manipulation and academic inheritance.

[Criteria of "arrival of qi" of acupuncture from "reaction of spirit produces curative effect": inheriting SHI Xue-min's thoughts of treating spirit].

From "arrival of qi produces curative effect", it is considered that arrival of qi, qi reaching and acupuncture sensation cannot contain the effect attribute, location attribute and performance attribute of acupuncture at the same time, so it is necessary to find a more suitable standard to measure the arrival of qi and clinical curative effect. Inspired by "the arrival of qi should be reaction of spirit, and reaction of spirit produces curative effect", the authors propose to use the term "reaction of spirit" to summarize the numerous external manifestations of arrival of qi, and to coordinate the attributes of arrival of qi, qi reaching and acupuncture sensation. Academician SHI Xue-min guides the clinical treatment with "reaction of spirit produces curative effect", attaches importance to the spirit treatment to improve the clinical curative effect, and evaluates whether acupuncture is successful or not with "reaction of spirit".

[Application and thinking of cohort study in clinical research of acupuncture and moxibustion].

Cohort study has been greatly considered and widely used in clinical research of traditional Chinese medicine in China, but it is seldom applied in the field of acupuncture and moxibustion. This paper introduces the development background, basic concepts, advantages and limitations of cohort study, analyzes the existing problems in the evaluation of acupuncture and moxibustion curative effect and development status of cohort study in the cycle of acupuncture and moxibustion, explores the feasibility and value of such method in clinical research of acupuncture and moxibustion and proposes the methodological suggestions on rigorous design, control of selective bias, control of cohort migration and reduction of loss to follow-up, aiming at broadening the new ideas andmethods for clinical research of acupuncture and moxibustion.

[Dynamic physiologic and pathologic changes in brain of rat with middle cerebral artery obstruction and effects of acupuncture in different frequencies on them].

OBJECTIVE: To study the dynamic changes of capillaries and inflammatory cells in different regions of brain in rat with middle cerebral artery obstruction (MCAO), and the effects of acupuncture in different frequencies on them. METHODS: In reference to Zea-Longa's method, rat model of MCAO was established by thread-ligation. Shuigou point (DU26), the main acupoint for "awakening brain and opening apertures", was stimulated by high (180 times/s) or low (60 times/s) frequency puncturing 5 s every 12 h for 6 times totally. The amount of capillaries (AC) and inflammatory cells (AIC) in brain cortex (BC), hippocampus (Hp) and corpus striatum (CS) was counted. RESULTS: Changes in AC and AIC of all brain regions (except for CS) in rats immediately after modeling were statistically insignificant (P > 0.05). But 72 h later, AC in CS decreased, AC in Hp, AIC in BC and AIC in Hp increased significantly in the modeled rats, showing significant difference to the normal level, but AIC reduced to approach the normal. As compared with the rats un-intervened, AIC in BC and Hp was decreased in rats intervened with high frequency puncturing, AC and AIC in CS were increased in rats intervened by slow frequency puncturing (both P < 0.05). CONCLUSION: Amount of capillaries and inflammation cells are changed dynamically in MCAO rats after brain ischemia, showing evident brain regional specificity; the ischemic improving effects of acupuncture in different frequencies are various in their action rings, also showing brain regional specificity.

Microvascular pericytes in brain-associated vascular disease.

Pericytes, as mural cells of microvessels, are important regulators of vascular structure formation and function maintenance in the process of cerebrovascular maturation, cerebrovascular homeostasis and disease. In the recent years, they have gradually become the hot spot of the research. In fact, pericytes are not isolated cells. Their functions can't be played without the cooperation with surrounding cells. In the neurovascular unit (NVU), they communicate with other cells by direct contact or through signaling pathways to regulate cerebral vascular function and the state of blood vessels in response to changes in neural activity. Pericytes are closely related to the cerebrovascular and central nervous system disease. Currently, a large number of clinical and animal studies have confirmed that pericytes biological function is related to cerebral blood flow, blood-brain barrier permeability, cerebral vascular formation maintenance, and neuroinflammation. The objective of this review is to highlight the role of pericytes in cerebral microvessels as well as their relationships with stroke, dementia, and brain tumor disease. The possible pathogenic mechanisms between pericytes and these diseases will also be described. As a matter of fact, the role of pericytes in the brain-associated vascular disease may provide new ideas for clinical treatment.

The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Acupressure, as part of Traditional Chinese Medicine, has shown promise as an effective method of pain relief in labour and birth. This systematic review and meta-analysis aims to critically assess the effect of acupressure on pain reduction during first stage of labour. METHODS: Five major electronic databases were searched in November 2018 to screen English articles. Only randomized controlled trials (RCTs) comparing acupressure with placebo and/or no intervention were selected. Intensity of labour pain was considered for primary outcome and pooled analysis. RESULTS: Ten RCTs were included in this review. LI4 and SP6 were the most commonly used acupoints. At the active and transitional phase, acupressure significantly reduced labour pain when compared to placebo (pooled MD -1.91; 95% CI -2.73,-1.08; pooled MD -3.03; 95% CI -5.03,-1.02, respectively). Acupressure was also superior to no intervention group at the active (pooled MD -3.00; 95% CI -3.88,-2.13) and transitional phase (pooled MD -2.03; 95% CI -3.72,-0.35). CONCLUSION: Acupressure can provide significant pain relief during first stage of labour. However, further clinical trials with standardized intervention procedures are required for the creation of evidence-based guidelines.

[On the quantitative analysis of focal ischemic cerebral infarction by TTC staining].

It is known that ischemic cerebrovascular disease is causing enormous harm to human health on account of the resultant high morbidity and disability rate. In this connexion, the anticipated target is to control the size of focal ischemic cerebral infarction, which is also an important method for judgment of therapeutic efficacy. The key question is to survey the size accurately and objectively; at the same time, the quantitative analysis of focal ischemic cerebral infarction is the pivotal question affecting the experiment conclusion and the reliability level. In this paper are introduced and summarized the methods being recently and commonly used in survey and computation, and the studies made on quantitative analysis of focal ischemic cerebral infarction by 2, 3, 5-triphenyltetrazolium chloride (TTC) staining method. Also are summarized the principles of dyeing in TTC method, the preparatory work, and the commonly used method of surveying and computation. It is the intent of this review to provide relevant data and suggestion for research workers.

[Idea of shen-brain-orifice in the acupuncture system of Xingnao Kaiqiao].

Academician SHI Xue-min innovatively proposed that "closed minds and shen don't guide the qi " is the general pathogenesis of stroke, and created the Xingnao Kaiqiao acupuncture therapy, which is based on the theory of "brain" and the idea of "treating shen" is the core connotation. It is based on "Xing Nao" "Xing Shen" and "adjust shen". The clinical application has also extended to different types of diseases. Despite the differences in the allocation of acupoints, the therapeutic principles are always related to the shen, brain and orifice. In this paper, the author explains the meaning and interrelationship of shen, brain, and orifice by quoting ancient literature and the views of modern scholars, which is helpful to understand and inherit the academic thought of academician SHI Xue-min.