The efficacy and safety of warming acupuncture and moxibustion on rheumatoid arthritis: A protocol for a systematic review and meta-analysis.

BACKGROUND: Rheumatoid arthritis (RA), as an autoimmune disease, can eventually lead to joint deformity and loss of function, seriously reduce the quality of life of patients and increase economic burden. As a traditional Chinese therapy, warming acupuncture and moxibustion is safe, economical, and has few side effects. At present, some studies have shown that warming acupuncture and moxibustion has a certain effect on RA, but there is no evidence of evidence-based medicine. The purpose of this study was to evaluate the efficacy and safety of warming acupuncture and moxibustion in the treatment of rheumatoid arthritis. METHOD: Randomized controlled trials of warming acupuncture and moxibustion treating RA will be searched in the databases including PubMed, EMBASE, the Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI), WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database (VIP), and China biomedical literature database (CBM) from inception to July, 2020. In addition, Baidu, Google Scholar, International Clinical Trials Registry Platform, and Chinese Clinical Trials Registry will be searched to obtain the gray literature and relevant data that have not yet been published. Two qualified researchers will extract data and assess the risk of bias from included studies independently. Statistical analysis is performed in RevMan 5.3 software. RESULTS: The primary outcome is symptom evaluation including morning stiffness, pain, and joint swelling. The number of joints affected by RA, Rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), anti-cyclic peptide containing citrulline (A-CCP), and adverse effects, will be evaluated as secondary outcomes. CONCLUSIONS: This study will compare the efficacy and safety of warming acupuncture and moxibustion with common acupuncture in the treatment of RA, providing reliable evidence for clinical application. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/C8RY9.

Updates on the epidemiology, pathogenesis, diagnosis, and management of postinfectious irritable bowel syndrome.

PURPOSE OF REVIEW: With its impact on quality of life and increasing awareness, postinfectious irritable bowel syndrome (PI-IBS) is now gaining attention as one of the major health problems commonly encountered in gastrointestinal practice. Literature investigating the various pathogenic mechanisms involved is rapidly emerging. The objective of the current review is to provide an update on recent evidence published in the past 2 years describing advances in our understanding of the epidemiology, pathogenesis, diagnosis, and treatment of PI-IBS. RECENT FINDINGS: Significant proportion of research in the recent past was preclinical in nature. Epidemiological studies continue to highlight the risk of IBS after infection, with recent studies documenting postprotozoal effects. Advances in pathogenic mechanisms included clinical studies, which documented micro-RNA down-regulation and Peroxiredoxin-1 up-regulation in colonic mucosa of PI-IBS patients. Protease-activated receptor-2 (PAR-2) activation in PI-IBS mice models resulted in increase in epithelial permeability, mucosal inflammation, visceral hypersensitivity. Moxibustion and rifamycin reduced intestinal inflammation by inhibiting cytokine and chemokine release via different mechanisms. Miltefosine reduced mast cell degranulation and TRPV1 activation, thereby reducing visceral hypersensitivity. SUMMARY: At present, generalization of limited diagnostic and therapeutic strategies across a heterogeneous prevalent patient population impedes the ability to provide effective personalized care in PI-IBS. Further development in pathogenesis discovery, diagnostic tool development are needed in order to design well tolerated and effective therapies that guide treatments based on distinct pathways of disease.

A randomized controlled trial for acupuncture combined with conventional therapy in the treatment of pain caused by prostate cancer: Study protocol clinical trial (SPIRIT compliant).

INTRODUCTION: Prostate cancer refers to an epithelial malignant tumor that occurs in the prostate area. In recent years, with the improvement of people's living standards, the incidence of prostate cancer has gradually increased, which has greatly affected people's life and health and quality of life. Acupuncture has its unique advantages in treating cancer pain. We will evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of pain caused by prostate cancer using a clinical randomized parallel control method. METHODS/DESIGN: This pragmatic randomized controlled trial will recruit 120 patients who are diagnosed with prostate cancer. Simple randomization to conventional drug treatment with a 1:1 allocation ratio will be used. Based on the patient's pain location and the primary lesion, the acupuncture needle insertion position was determined according to the principle of local selection of acupoints. All participants will continue to receive conventional drug treatment. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of acupuncture for pain caused by prostate cancer. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2000029801, Registered on 14 February 2020.

Application of Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to the guideline development for clinical practice with acupuncture and moxibustion.

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) offers a worldwide approach to guideline development for clinical practice. For the clinical practice of acupuncture therapy, 18 evidence-based guidelines have been developed in China using GRADE. In this study, we review the advantages and limitations of the GRADE approach in the guideline development for acupuncture and moxibustion and propose some solutions to these limitations. Scientific advantages of rating the quality of evidence, outcome-centric direction, overall progression to develop recommendations, and strength of recommendations providing specific clinical guidance are the advantages of GRADE. The limitations of GRADE in the development of guidelines for acupuncture and moxibustion include rating the quality of evidence for ancient literature and literature on famous traditional Chinese medicine experts' experiences and specific guidelines for formulating recommendations from evidence. In the guideline development for clinical practice with acupuncture and moxibustion, we suggest that a specific method should be explored based on the GRADE approach and the characteristics of acupuncture therapy.

Safety recommendations for moxa use based on the concentration of noxious substances produced during commercial indirect moxibustion.

BACKGROUND: Moxibustion therapy has been used historically for thousands of years and there are many clinical trials supporting its efficacy and effectiveness for various conditions. Moxa smoke has been a major reason for avoiding moxibustion due to its smell and potential risks to the human body. METHODS: 10 units of commercial indirect moxa (CIM) from six manufacturers (A-F) were burnt in a 2.5×2.5×2.5 m chamber without ventilation, and concentrations of carbon oxides (CO and CO2), nitrogen oxides (NOx), and volatile organic compounds (VOCs) from the indoor air samples were measured. RESULTS: For brands A, B, C, D, E, and F, respectively, relative to baseline values, we observed an increase in CO (from 0.002 to 0.007, 0.006, 0.005, 0.006, 0.005, and 0.006 parts per billion (ppb)), NOx (from 0.009 to 0.051, 0.025, 0.015, 0.050, 0.019, and 0.020 ppb), and total VOCs (TVOC; from 48.06 to 288.83, 227.93, 140.82, 223.22, 260.15, and 161.35 µg/m3), while the concentration of CO2 was not elevated. Each CIM brand demonstrated different VOC emission characteristics, which could be divided into three groups. On average, we estimated that 20 units of CIM or 2.41 g moxa floss would need to be combusted in order to exceed the safe levels set by Korean environmental law. This limit is likely to be greater in the case of a larger room or use of ventilation. CONCLUSIONS: Despite increased CO/NOx/VOC concentrations, overall levels remained within safe limits. These findings may help clinicians to maintain safe moxibustion treatment conditions to help keep both patients and clinicians safe from the pollutants generated by moxa combustion.

Quality assessment of randomized controlled trials reporting on knee osteoarthritis treated with warming needle moxibustion.

OBJECTIVE: To evaluate the quality of randomized controlled trials (RCTs) testing the efficacy of warming needle moxibustion on knee osteoarthritis (KOA). METHODS: Nine databases were searched systematically including: the Cochrane Library (1/1993-10/2012), PubMed (1/1980-10/2012), EMBASE (1/1990-10/12012), SCI Expanded (1/1986-10/2012), Science Direct (1/1979-10/2012), Chinese Biomedical Literature Database disc (1/1978-10/2012), China National Knowledge Infrastructure Database (1/1979-10/2012), China Science and Technology Journal Database (a full text issue database of China, 1/1989-10/2012), and Wanfang Database (a full text issue database of China, 1/1990-10/12012). Traditional reference retrieval was also conducted. Language was limited to Chinese and English. We identified 37 RCTs that used warming needle moxibustion as an intervention and they were assessed with the Consolidated Standards for Reporting of Trials Statement 2010 (CONSORT 2010) and Standards for Reporting Interventions Controlled Trials of Acupuncture 2010 (STRICT A 2010). RESULTS: Of the 37 reports, only seventeen (45.95%) mentioned the random allocation of sequence methods, nine used unacceptable methods, and only one (2.70%) gave the description of the mechanism of allocation concealment. One study (2.70%) mentioned blinding, one (2.70%) had a sample size calculation, and twenty-three (62.16%) used reasonable statistical methods. Thirteen (35.14%) described the background and reason for the RCTs, three (8.11%) gave a description of lost or eliminated patients, and two (5.41%) reported accidental situations. Only three (8.11%) gave analysis of the RCT limitations. No report mentioned intentional analysis. CONCLUSION: The quality of the RCTs assessed in this study was from moderate to low. The design of RCTs, the methods of statistical analysis, and the description of reports information needs to be improved. CONSORT 2010 and STRICT A 2010 should be used to standardize the reporting of acupuncture RCTs in the future.

Economic evaluation of treating herpes zoster with various methods of acupuncture and moxibustion.

OBJECTIVE: To analyze the cost effect of surrounding acupuncture plus electric acupuncture, cotton-sheet moxibustion, puncturing with red-hot needles, tapping plus cupping on herpes zoster. METHODS: Five hundred patients with herpes zoster were randomly divided into group A (surrounding acupuncture plus electric acupuncture), group B (cotton-sheet moxibustion), group C (puncturing with red-hot needles), group D (tapping plus cupping), and group E (Western medicine). The treatment was carried out twice a day in group E and once a day in the other four groups. The curative effect was observed on the 10th day of treatment; the cost was calculated for the five therapies, and the cost-effect ratio (C/E) and increment ratio (delta C/delta E) were analyzed. RESULTS: After the 10-day treatment, there was no statistical difference (P > 0.05) in the curative effect among the five groups. Pain being alleviated one day faster than in group E amounted to a saving of RMB 21.90 yuan in group A, a saving of RMB 21.87 yuan in group B, a saving of RMB 26.00 yuan in group C, and a saving of RMB 20.23 yuan in group D. Compared with group C, the values of delta C/delta E were RMB 1.55, 2.81, and 0.21 yuan in groups A, B, and D, respectively. CONCLUSIONS: The curative effect in groups A, B, C, and D was similar to that in group E, but the C/E was better than in group E.

[Problems and countermeasures of assessment standard on manipulative skill in Acupuncture and Moxibustion Manipulations].

In order to construct a scientific, objective and quantitative assessment standard of operating skills, characteristics of operation test in Acupuncture and Moxibustion Manipulations are analyzed and problems of assessment standard in appendix of the textbooks of various types and levels are discussed. It is concluded that improvement should be made through compiling an operation manual, drawing up a specification operation steps and quantitative indices. At the same time, a problem-oriented test on people-oriented service should be added as well. And it is held that only through the innovation of assessment standard of skills operation in Acupuncture and Moxibustion Manipulations, the comprehensive quality and application ability of students can be promoted.

Bioengineering assessment of acupuncture, part 8: innovative moxibustion.

The actual Chinese character for acupuncture, translated literally, means "acupuncture-moxibustion." This shows the enormous importance of moxibustion in Asia for thousands of years. In this review article, the history of the burning of mugwort (moxatherapy) is briefly described. In addition, new technical methods such as new infrared-moxa or laser-moxa devices, electrobian stone moxibustion, and the investigations of a new needle-moxa system using high-tech methods such as thermography, laser Doppler flowmetry, and laser Doppler imaging are presented.

Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach.

OBJECTIVES: To assess, using a modelling approach, the effectiveness and costs of breech version with acupuncture-type interventions on BL67 (BVA-T), including moxibustion, compared to expectant management for women with a foetal breech presentation at 33 weeks gestation. DESIGN: A decision tree was developed to predict the number of caesarean sections prevented by BVA-T compared to expectant management to rectify breech presentation. The model accounted for external cephalic versions (ECV), treatment compliance, and costs for 10,000 simulated breech presentations at 33 weeks gestational age. Event rates were taken from Dutch population data and the international literature, and the relative effectiveness of BVA-T was based on a specific meta-analysis. Sensitivity analyses were conducted to evaluate the robustness of the results. MAIN OUTCOME MEASURES: We calculated percentages of breech presentations at term, caesarean sections, and costs from the third-party payer perspective. Odds ratios (OR) and cost differences of BVA-T versus expectant management were calculated. (Probabilistic) sensitivity analysis and expected value of perfect information analysis were performed. RESULTS: The simulated outcomes demonstrated 32% breech presentations after BVA-T versus 53% with expectant management (OR 0.61, 95% CI 0.43, 0.83). The percentage caesarean section was 37% after BVA-T versus 50% with expectant management (OR 0.73, 95% CI 0.59, 0.88). The mean cost-savings per woman was euro 451 (95% CI euro 109, euro 775; p=0.005) using moxibustion. Sensitivity analysis showed that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management. To prevent one caesarean section, 7 women had to use BVA-T. The expected value of perfect information from further research was euro0.32 per woman. CONCLUSIONS: The results suggest that offering BVA-T to women with a breech foetus at 33 weeks gestation reduces the number of breech presentations at term, thus reducing the number of caesarean sections, and is cost-effective compared to expectant management, including external cephalic version.

[Assessment of methodology and report quality of systematic evaluation and meta-analysis of acupuncture-moxibustion in China].

OBJECTIVE: To assess the methodology and report quality of systematic evaluation and Meta-analysis of acupuncture and moxibustion in China. METHODS: Retrieve CBM, CNKI, WF and VIP database, collect data from the information system established by Epidata 2.1, assess the methodology and report quality by using the QQAQ and QUOROM, calculate the percentage of adequate rate. RESULTS: Thirty-eight reviews, including twenty six systematic evaluation and twelve Meta-analyses, met the enrolled criteria. Twenty-two kinds of diseases and six diseases systems were included. The methodology quality scores were generally low (3.34 +/- 1.44). The causes of the problems were insufficient literature resource, bias in data collections and inaccurate merging methods. The report quality was relatively low in abstracts, methods, trial flow, introduction and data merging. CONCLUSION: The amount of literatures on systematic evaluation and Meta-analysis of acupuncture is gradually increasing from 2002. However, the quality control is not ideal. It is important to improve the methodology and report quality.

Efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement.

This study was performed to assess the efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement (AD). The experimental group comprised 86 Holstein cows with left displacement of the abomasum (LDA) and right displacement of the abomasum (RDA), with a mean age of 3.8 with AD during a 2-year period. The cows were rolled for correction of AD. After the rolling procedure, moxibustion was conducted on six acupoints once a day during the course of treatment. After repositioning the abomasums, the bilateral points of BL-20, BL-21 and BL-26 were then stimulated. During the follow-up of 1 week, 67 (93.1%) of 72 LDA and 12 (85.7%) of 14 RDA cows were released as cured after moxibustion. In conclusion, moxibustion effectively treats AD following rolling correction in dairy cows.