[Effect and mechanism of Zexie Decoction in promoting white adipose tissue browning/brown adipose tissue activation based on GLP-1R/cAMP/PKA/CREB pathway].

This study investigated the mechanism of Zexie Decoction(ZXD) in promoting white adipose tissue browning/brown adipose tissue activation based on the GLP-1R/cAMP/PKA/CREB pathway. A hyperlipidemia model was induced by a western diet(WD) in mice, and the mice were divided into a control group, a model group(WD), and low-, medium-, and high-dose ZXD groups. An adipogenesis model was induced in 3T3-L1 cells in vitro, and with forskolin(FSK) used as a positive control, low-, medium-, and high-dose ZXD groups were set up. Immunohistochemistry and immunofluorescence results showed that compared with the WD group, ZXD promoted the expression of UCP1 in white and brown adipose tissues, and also upregulated UCP1, CPT1ß, PPARα, and other genes in the cells. Western blot analysis showed a dose-dependent increase in the protein expression of PGC-1α, UCP1, and PPARα with ZXD treatment, indicating that ZXD could promote the white adipose tissue browning/brown adipose tissue activation. Hematoxylin-eosin(HE) staining results showed that after ZXD treatment, white and brown adipocytes were significantly reduced in size, and the mRNA expression of ATGL, HSL, MGL, and PLIN1 was significantly upregulated as compared with the results in the WD group. Oil red O staining and biochemical assays indicated that ZXD improved lipid accumulation and promoted lipolysis. Immunohistochemistry and immunofluorescence staining for p-CREB revealed that ZXD reversed the decreased expression of p-CREB caused by WD. In vitro intervention with ZXD increased the protein expression of CREB, p-CREB, and p-PKA substrate, and increased the mRNA level of CREB. ELISA detected an increase in intracellular cAMP concentration with ZXD treatment. Molecular docking analysis showed that multiple active components in Alismatis Rhizoma and Atractylodis Macrocephalae Rhizoma could form stable hydrogen bond interactions with GLP-1R. In conclusion, ZXD promotes white adipose tissue browning/brown adipose tissue activation both in vivo and in vitro, and its mechanism of action may be related to the GLP-1R/cAMP/PKA/CREB pathway.

Efficacy and safety of acupoint application in the treatment of ulcerative colitis: A systematic review and meta-analysis.

BACKGROUND: The efficacy of acupoint application in the treatment of ulcerative colitis (UC) is still controversial. The purpose of this study is to systematically evaluate the clinical efficacy and safety of acupoint application in the treatment of ulcerative colitis. METHODS: The databases of China National Knowledge Infrastructure (CNKI), Chinese Biology Medicine (CBM), VIP, Wanfang, Embase, PubMed, the Cochrane Library and Web of Science were searched. The time limit was from the establishment of the database to July 2022. The published randomized controlled trials of acupoint application in the treatment of UC were analyzed by meta-analysis and trial sequential analysis. RESULTS: A total of 13 studies were included, with a total sample size of 878 cases. Compared with conventional western medicine, acupoint application can effectively improve the effective rates of clinical comprehensive (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.06-1.20, P = .0003), syndrome (RR 1.13, 95% CI 1.03-1.24, P = .009), and interleukin-4 (IL-4) (mean differences 2.62, 95% CI 1.96-3.28, P < .00001) in the treatment of UC, and reduce interferon-γ (mean differences -5.38, 95% CI -6.81 to -3.94, P < .00001). The effective rates of colonoscopy (RR 0.94, 95% CI 0.84-1.05, P = .25), pathological examination (RR 1.04, 95% CI 0.90-1.20, P = .60) and rate of adverse reaction (RR 0.55, 95% CI 0.25-1.21, P = .14) were the same. Trial sequential analysis indicated that the benefits of effective rates of clinical comprehensive and syndrome, IL-4, and interferon-γ were conclusive. Harbord regression showed no publication bias (P = .98). The evaluation of evidence quality suggested that the evidence quality of effective rates of clinical comprehensive and syndrome was moderate and the evidence quality of other indicators was low or very low. CONCLUSION: Acupoint application is a safe and effective method for the treatment of UC, and has the prospect of clinical application.

Effect and mechanisms of exercise for complex regional pain syndrome.

Complex regional pain syndrome characterized by severe pain and dysfunction seriously affects patients' quality of life. Exercise therapy is gaining attention because it can effectively relieve pain and improve physical function. Based on the previous studies, this article summarized the effectiveness and underlying mechanisms of exercise interventions for complex regional pain syndrome, and described the gradual multistage exercise program. Exercises suitable for patients with complex regional pain syndrome mainly include graded motor imagery, mirror therapy, progressive stress loading training, and progressive aerobic training. In general, exercise training for patients with complex regional pain syndrome not only alleviates pain but also improves physical function and positive mental status. The underlying mechanisms of exercise interventions for complex regional pain syndrome include the remodeling of abnormal central and peripheral nervous system, the regulation of vasodilation and adrenaline levels, the release of endogenous opioids, and the increased anti-inflammatory cytokines. This article provided a clear explanation and summary of the research on exercise for complex regional pain syndrome. In the future, more high-quality studies with sufficient sample sizes may provide more exercise regimens and better evidence of efficacy.

Acupuncture alleviates acute peritonitis: A case report.

Many inflammatory and infectious entities can affect the peritoneum acutely, and patients with peritonitis often have painful expressions. Abdominal pain can be aggravated by coughing, breathing, and turning the body. Here we report the case of an 88-year-old patient with acute gastrointestinal perforation. The patient has been experiencing pain in the right lower abdomen, presenting persistent colic. The X-ray of abdomen and abdominal computed tomography showed perforation of digestive tract. In addition to the use of anti-infection and stomach protection agents, we use different analgesic injections, but the effect on reducing the pain was not obvious. After acupuncture treatment, the patient quickly relieved the pain of acute peritonitis in 1 minute. However, to our knowledge, there is few literature showing that acupuncture relieves preoperative opioid-induced hyperalgesia in patients with acute peritonitis. Based on this case, we suggest acupuncture as an option in the management of relieving the pain of acute peritonitis when opioid therapy is ineffective.

Acupuncture for acute low back pain: a systematic review and meta-analysis.

BACKGROUND: Acupuncture has been widely used for acute low back pain (LBP), yet there remains continued controversy regarding its efficacy. Therefore, we aimed to critically evaluate the evidence for acupuncture as an effective treatment for acute LBP. METHODS: English and Chinese databases were searched for randomized controlled trials (RCTs) that involved acupuncture for acute LBP published up to May 2020. Data on the outcomes of pain intensity, functional status, and analgesic use were extracted. The meta-analysis was performed using the Cochrane Collaboration's RevMan 5.3, and pooled data were expressed as mean differences (MD) with 95% confidence intervals (CIs). RESULTS: Of the 13 eligible RCTs identified, 11 RCTs (involving 707 patients) provided moderate-quality evidence that acupuncture has a statistically significant association with improvements in VAS (visual analog scale) score [MD: -1.75 (95% CI: -2.39, -1.12)]. Two studies indicated that acupuncture did not influence the RMDQ (Roland-Morris Disability Questionnaire) scores more than the control treatment [MD: -2.34 (95% CI: -5.34, 0.67)]. Three studies suggested that acupuncture influenced the ODI (Oswestry Disability Index) scores more than the control treatment [MD: -12.84 (95% CI: -23.94, -1.74)]. Two studies suggested that acupuncture influenced the number of pills more than the control treatment [MD: -3.19 (95% CI: -3.45, -2.92)]. CONCLUSIONS: Acupuncture treatment of acute LBP was associated with modest improvements in the VAS score, ODI score, and the number of pills, but not the RMDQ score. Our findings should be considered with caution due to the low power original studies. High-quality trials are needed to assess further the role of acupuncture in the treatment of acute LBP.

'Governor vessel-unblocking and mind-regulating' acupuncture therapy ameliorates cognitive dysfunction in a rat model of middle cerebral artery occlusion.

Acupuncture is a traditional Chinese medicinal therapy, which is used for the amelioration of cognitive dysfunction. The aim of this study was to investigate the effectiveness and relevancy mechanisms of 'governor vessel­unblocking and mind­regulating' acupuncture therapy for cognitive dysfunction in rats with ischemia. For this purpose, we used the middle cerebral artery occlusion (MCAO) method to induce cognitive dysfunction in rats. The behavioral changes in the rats were examined using the Morris water maze (MWM) test. The effects of the treatment on oxidative stress response and the function of the mitochondria in brain tissues were also assessed. The results revealed that 'governor vessel­unblocking and mind­regulating' acupuncture therapy markedly improved the cognitive ability of the rats with cognitive dysfunction. The production of pro­oxidative stress factors, including nitric oxide (NO) and inducible nitric oxide synthase (iNOS), was also blocked along with the amelioration of cognitive function, while the production of adenosine triphosphate (ATP), superoxide dismutase (SOD) and cyclooxygenase (COX) was restored. At the molecular level, the accumulation of amyloid ß (Aß) in the mitochondria was suppressed by 'governor vessel­unblocking and mind­regulating' acupuncture therapy, which may be attributed to the inhibition of the function of translocase of outer mitochondrial membrane 40 (TOMM40) and translocase of inner mitochondrial membrane 17A (TIMM17A). On the whole, the findings of the present study confirm the effects of 'governor vessel­unblocking and mind­regulating' acupuncture therapy on cognitive dysfunction induced by brain ischemia in rats, and that the mechanisms underlying the effects of this treatment might be mediated through the inhibition of TOMM40 and TIMM17A synthesis, which can relieve mitochondrial dysfunction from the accumulation of Aß.

[Acuuncture combined with swallowing training for post-stroke dysphagia: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training for post-stroke dysphagia. METHODS: Sixty cases of post-stroke dys phagia were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the observation group, based on the regular acupuncture treatment, were treated with deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17), once a day, 30 min per treatment; also swallowing training was combined, twice a day, 20 min per treatment. Patients in the control group were treated with swallowing training. All the patients were treated with regular treatment of stroke. Six days of treatment were taken as one session, and totally 3 sessions were given with an interval of one day between sessions. The video fluoroscopic swallowing study (VFSS) dysphagia evaluation scale and Watian water swallow test (WWST) were evaluated before and after treatment also the clinical efficacy and the recovery time of two groups were compared. RESULTS: After treatment, the VFSS score in the observation group was significantly superior to that in the control group (P < 0.01); the WWST in the observation group was significantly superior to that in the control group (P < 0.01). The cured rate was 70.0% (21/30) in the observation group, which was significantly superior to 43.3% (13/30) in the control group (P < 0.01); the total effective rate was 86.7% (26/30) in the observation group, which was significantly superior to 66.7% (20/30) in the control group (both P < 0.01). The clinical recovery time in the observation group was significantly shorter than that in the control group (P < 0.01). CONCLUSION: Deep acupuncture at Lianquan (CV 23) and Yifeng (TE 17) combined with swallowing training could effectively improve post-stroke swallow function.

Immediate- and medium-term effects of simultaneous percutaneous corrections of secundum type atrial septal defect combined with pulmonary valve stenosis in local anesthesia and without transesophageal echocardiography guidance.

BACKGROUND: The feasibility and efficacy of simultaneous percutaneous treatment of secundum type atrial septal defect (ASD) combined with pulmonary valve stenosis (PS) have not been proved. OBJECTIVE: To evaluate the safety and efficacy on the clinical benefit of simultaneous percutaneous correction of these two pathologies under local anesthesia and without transesophageal echocardiography guidance. METHODS: Transpulmonary gradient, functional status, pulmonary regurgitation (PR), and tricuspid regurgitation (TR) were studied in 35 patients undergoing percutaneous balloon pulmonary valvuloplasty and ASD closure from March 2004 to July 2012. All patients were followed up until January 2013, an average of 39 months. RESULTS: According to color Doppler transthoracic echocardiography (TTE) before the intervention, the ASD defect size and transpulmonary gradient were 17±8.4 mm and 88±37.8 mmHg, respectively. Post-interventionally, the peak-to-peak transpulmonary gradient decreased from 77±37.6 mmHg to 20±16.2 mmHg (p<0.001) and the ASD occluder size was 23±10.5 mm. In all those patients, there was no residual shunt detected, and moderate and severe TR decreased from 45.7% (16/35) and 20% (7/35) to 8.6% (3/35) and 5.7% (2/35) before and after intervention detected by TTE, respectively. Eight patients had mild PR after procedure and two of them recovered at 6 months and no patient encountered severe adverse events at the latest follow-up. CONCLUSION: Simultaneous percutaneous corrections of ASD combined with PS are feasible, safe, and effective with satisfactory results.

Proteomic analysis of serum proteins in acute ischemic stroke patients treated with acupuncture.

In the present study, we have investigated the effects of acupuncture on (1) serum protein expression that might have a beneficial effect on stroke patients and (2) the strength of limb muscles in stroke patients. A total of 35 acute ischemic stroke (IS) patients were divided into two groups, one receiving drug treatment alone and the other receiving electroacupuncture (EA) and drug treatment. EA treatment was performed on eight acupuncture points once a day for 10 consecutive days. Serum proteins were detected using a proteomics method based on two-dimensional gel electrophoresis, and the specificity of proteins was confirmed by Western blotting. Changes of limb muscle strength were measured using a modified Medical Research Council grading scale. After EA, SerpinG1 protein expression in serum was down-regulated while the expressions of gelsolin, complement component I, C3, C4B and beta-2-glycoprotein I proteins were up-regulated in patients. The changes of serum protein expression were further confirmed by Western blotting in a majority of the cases. The muscle strength of limbs was increased after EA in 18 patients. EA appears to be effective in regulating differential expression of multiple serum proteins involved in stroke, and also in enhancement of muscle strength recovery in acute IS patients despite an individual variation.

[Effects of electroacupuncture of different frequencies for treatment of patients with refractory tennis elbow syndrome].

OBJECTIVE: To observe the different effects of electroacupuncture of different frequencies for treatment of patients with refractory tennis elbow syndrome. METHODS: Eighty five patients with refractory tennis elbow syndrome were randomly devided into continuous wave group (n=41) and rarefaction wave group (n= 44). The same acupoints were selected in both groups, and the major acupoints were the tenderness point around affected area in both groups. The Visual Analogue Scale (VAS) was used to evaluate the tenderness score of each patient in both groups. The effectiveness was evaluated by the tenderness score. RESULTS: The effective rate was 82. 9% in continuous wave group, and 84. 1% in rarefaction wave group, with no significant difference in statistical analysis (P>0.05). The healing rate was 56. 8% in rarefaction wave group, better than 31. 7% in continuous wave group (P<0.05). The VAS scores were significantly reduced after electroacupuncture treatment in both groups (both P<0.001). There was significant difference in decreasing the VAS score between two groups after treatment (P<0.05), and the rarefaction wave group was better than the continuous wave group. CONCLUSION: The electroacupuncture of rarefaction wave is better than the electroacupuncture of continuous wave, therefore, it is a better treatment for refractory tennis elbow syndrome.