[Bushen Anshen acupuncture for perimenopausal insomnia of kidney-yin deficiency: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of Bushen Anshen acupuncture (acupuncture for tonifying kidney and calming spirit ) in treating perimenopausal insomnia (PMI) of kidney-yin deficiency. METHODS: A total of 72 patients with PMI of kidney-yin deficiency were randomized into an observation group (36 cases, 1 case dropped off) and a control group (36 cases, 1 case dropped off). Acupuncture was applied at Baihui (GV 20) and bilateral Shenshu (BL 23), Taixi (KI 3), Anmian (Extra) in the observation group, while sham acupuncture of shallow needling at non-acupoints was applied in the control group. The treatment was required once every other day, 3 times a week for 10 times in the two groups. Before and after treatment, Pittsburgh sleep quality index (PSQI) was used to evaluate the subjective sleep quality, and polysomnography (PSG) was used to monitor the objective sleep quality in the two groups. RESULTS: After treatment, the scores of sleep quality, sleep latency, sleep duration, sleep efficiency, hypnotic, daytime dysfunction and total score of PSQI were decreased compared with those before treatment in the observation group (P<0.01), the scores of sleep duration, sleep efficiency and total score of PSQI were decreased compared with those before treatment in the control group (P<0.05); the scores of sleep quality, sleep latency, sleep efficiency, hypnotic and total score of PSQI in the observation group were lower than those in the control group (P<0.05). After treatment, the sleep time was prolonged, the sleep efficiency was improved, the sleep latency and the awake time after falling asleep were shortened, the arousal awake index was reduced (P<0.01) when PSG indexes were monitored, and the percentage of non-rapid eye movement sleep period 1 (N1%) was decreased while the percentage of non-rapid eye movement sleep period 3 (N3%) was increased (P<0.05) compared with those before treatment in the observation group; there was no statistical difference in the PSG indexes compared with those before treatment in the control group (P>0.05). After treatment, compared with the control group, the sleep time was prolonged, the sleep efficiency was improved, the sleep latency and the awake time after falling asleep were shortened, the arousal awake index and N1% were decreased in the observation group (P<0.01). CONCLUSION: Bushen Anshen acupuncture can effectively improve the subjective and objective sleep quality in PMI patients of kidney-yin deficiency.

Impact of Acupuncture on Sleep and Comorbid Symptoms for Chronic Insomnia: A Randomized Clinical Trial.

STUDY OBJECTIVES: To evaluate the efficacy and safety of acupuncture at HT 7 (Shenmen) and KI 7 (Fuliu) on sleep and comorbid symptoms for chronic insomnia. METHODS AND DESIGN: A randomized, single-blind, parallel and sham-controlled trial consisted of an acupuncture group (n = 41) and a sham acupuncture group (n = 41). Setting: a tertiary hospital of integrated Chinese and Western medicine. Participants: 82 subjects with chronic insomnia based on the International Classification of Sleep Disorders, Third Edition (ICSD-3). Interventions: a 10-session acupuncture treatment at bilateral HT 7 and KI 7 or sham acupoints with shallow needling was performed over 3 weeks. Measurements: the Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI) were evaluated at baseline, posttreatment, and at two follow-ups as the primary outcome measures. Polysomnography (PSG) on two consecutive nights, the Beck anxiety inventory (BAI), the Beck depression inventory (BDI) fatigue severity scale (FSS) and the Epworth sleepiness scale (ESS) were evaluated at baseline and posttreatment as the secondary outcome measures. RESULTS: After the treatments, PSQI scores decreased by 5.04 in the acupuncture group and 2.92 in the sham acupuncture group. ISI scores decreased by 7.65 in the acupuncture group and 5.05 in the sham acupuncture group. The between-group differences in the primary outcome measures posttreatment were statistically significant. However, no differences were found between the two groups during the two follow-ups. Regarding the PSG data, there were significantly lower levels of sleep onset latency (SOL), a lower percentage of sleep stage N1 and a higher percentage of sleep stage N3 in the acupuncture group than in the sham acupuncture group. After treatment, there were lower levels of comorbid symptoms (BAI, BDI, FSS and ESS) in both groups. However, no significant differences were observed between the groups. CONCLUSION: Acupuncture at HT 7 and KI 7 is an effective and safe nonpharmacologic intervention option for chronic insomnia. CLINICAL TRIAL REGISTRATION: The study was registered at the Chinese Clinical Trial Registry, registration ID: ChiCTR1900023787, China.

Acupuncture for insomnia with short sleep duration: protocol for a randomised controlled trial.

INTRODUCTION: Insomnia with short sleep duration has a more serious negative impact on patient health. The existing literature suggests that medication therapy is more effective for this phenotype of insomnia compared with cognitive-behavioural therapy. However, the potential side effects of hypnotic medications hinder their clinical application. Acupuncture has been widely used in the treatment of insomnia, but it remains unclear whether it has therapeutic efficacy for insomnia with short sleep duration. The purpose of this trial is to evaluate the efficacy and safety of acupuncture for insomnia with short sleep duration. METHODS AND ANALYSIS: This study is designed as a randomised, single-centre, single-blinded, placebo acupuncture controlled trial involving 152 participants. Eligible patients will be divided into two groups according to the objective total sleep time: insomnia with normal sleep duration group and insomnia with short sleep duration group. Then, patients in each group will be randomly assigned to two subgroups, the treatment group (acupuncture) and the control group (placebo acupuncture), in a 1:1 ratio with 38 subjects in each subgroup. The primary outcome is the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Secondary outcomes are actigraphy, the Beck Anxiety Inventory, the Beck Depression Inventory and the Fatigue Severity Scale. All adverse effects will be assessed by the Treatment Emergent Symptom Scale. Outcomes will be evaluated at baseline, post treatment, as well as at 1-week and 1-month follow-up. ETHICS AND DISSEMINATION: This protocol has been approved by the ethics committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (no. 2019-17). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals for publications. TRIAL REGISTRATION NUMBER: ChiCTR1900023473; Pre-results.

[Electroacupuncture at "Zusanli"(ST36) and "Xuanzhong"(GB39) improves inflammatory reactions and reduces levels of serum MMP-3 and MMP-9 in adjuvant arthritis rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Zusanli" (ST36) and "Xuanzhong" (GB39) on joint inflammatory reactions and serum matrix metalloproteinase-3 (MMP-3) and MMP-9 contents in rats with adjuvant arthritis (AA), so as to explore its mechanism underlying improvement of AA. METHODS: Forty male SD rats were randomly divided into control, model, acupoint and non-acupoint groups (n=10 in each group). The arthritis model was established by hypodermic injection of complete Freund's adjuvant (0.1 mL) into the bilateral footpads. EA (2 Hz, 3 V) was applied to bilateral ST36 and GB39 or two non-acupoints (5 mm left to ST36 and GB39) for 15 min, once every other day for a total of 8 times. The arthritis index score was evaluated according to the severity of local erythema and swelling of the ankle joint, plantar joint, toe joint and foot metacarpal joint (0-4 points). The inflammatory conditions of the ankle joint were observed by H.E. staining, and the contents of serum MMP-3 and MMP-9 were assayed by ELISA. RESULTS: The arthritis index score and serum concentrations of MMP-3 and MMP-9 were significantly increased in the model group relevant to the control group (P<0.01), and obviously decreased after EA intervention on the 18th day (P<0.01). The therapeutic effect of acupoint EA was notably superior to non-acupoint EA in down-regulating the arthritis index score and serum MMP-3 and MMP-9 concentrations (P<0.01). Under light microscope, marked proliferation of the synovial cells, inflammatory cell infiltration and increase of newly blood vessels were observed in the ankle joint of the model group, which was relatively milder in the acupoint group. CONCLUSION: acupoint EA intervention can significantly alleviate the inflammatory reaction of AA rats, which may be related to its effects in reducing the levels of serum MMP-3 and MMP-9.

[Regularity of Acupoint Selection in Treatment of Insomnia by Catgut Embedding Therapy].

OBJECTIVE: To analyze the regularity of acupoint selection in the treatment of insomnia by using catgut embedding so as to provide reference and evidence for clinical application. METHODS: Sixty-six studies about acupoint catgut embedding treatment of insomnia published from 1996 to 2017 were finally selected from the databases of China National Knowledge Infrastructure (CNKI), Chinese Journal of Science and Technology of VIP (VIP), and WanFang Database. The Excel 2016 software was used for data processing and analysis, SPSS 21.0 was employed for descriptive and cluster analyses, and the Clementine 12.0 software was employed to analyze the association regularities of the most frequently used acupoints or acupoint recipes. RESULTS: The most frequently selected main acupoints for insomnia by using catgut embedment are Xinshu (BL 15), Shenshu (BL 23), Sanyinjiao (SP 6), Pishu (BL 20), Ganshu (BL 18), combined with adjuvant acupoints Danshu (BL 19) and Fenglong (ST 40). The most frequently selected channels are the Bladder and Stomach Meridians, and the most frequently involved body positions are the back and lower limbs. Effective clusterings are BL 20-SP 6, Shenmen (HT 7)-Anmian, ST 40-Shenting (GV 24), Qihai (CV 6)-Jueyinshu (BL 14). Descriptive analysis indicated: ①The stronger correlation acupoint groups between back-shu points are BL 18-BL 23; BL 18，BL 15-BL 23; BL 18，BL 20，BL 15-BL 23. ②The stronger correlation acupoint groups between common acupoints are Neiguan (PC 6)，Zusanli (ST 36) -SP 6; PC 6, HT 7 - SP 6.③The stronger correlation acupoint groups between common acupoints and back-shu points are BL 18, SP 6-BL 23; PC 6, BL 23 - SP 6; ST 36, PC 6, BL 15 - SP 6; BL 18，BL 15，SP 6 - BL 23. CONCLUSION: Acupoint catgut embedding therapy is effective in the treatment of insomnia, being worthy of further popularization in clinical practice.

Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial.

Study Objectives: To evaluate the short-term efficacy of acupuncture for the treatment of peri-menopausal insomnia (PMI). Methods: Design: A randomized, participant-blind, placebo-controlled trial consisted of the acupuncture group (n = 38) and placebo-acupuncture group (n = 38). Setting: A tertiary teaching and general hospital. Participants: 76 peri-menopausal women with insomnia disorder based on the International Classification of Sleep Disorders, Third Edition. Interventions: A 10-session of acupuncture at bilateral Shenshu (BL 23) and Ganshu (BL 18) with unilateral Qimen (LR 14) and Jingmen (GB 25) or Streitberger needles at the same acupoints was performed for over 3 weeks. Measurements: Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with over-night polysomnography (PSG) exam were completed at baseline and post-treatment. Results: After the treatments, the decrease from baseline in PSQI score was 8.03 points in acupuncture group and 1.29 points in placebo-acupuncture group. The change from baseline in ISI score was 11.35 points in acupuncture group and 2.87 points in placebo-acupuncture group. In PSG data, acupuncture significantly improved the sleep efficiency and total sleep time, associated with less wake after sleep onset and lower percent stage 1 after the treatment. No significant differences from baseline to post-treatment were found in placebo-acupuncture group. Conclusions: Acupuncture can contribute to a clinically relevant improvement in the short-term treatment of PMI, both subjectively and objectively. Clinical Trial Registration: Acupuncture for peri-menopause insomnia: a randomized controlled trial, http://www.chictr.org.cn/showproj.aspx?proj=12118 ChiCTR-IPR-15007199, China.

[Effects of Electroacupuncture on Joint Function in Rheumatoid Arthritis Patients of Liver- and Kidney-Yin Deficiency Type].

OBJECTIVE: To compare the effects between electroacupuncture (EA) plus western medicine and simple western medicine in improving clinical symptoms and local joint function of rheumatoid arthritis (RA) patients with yin deficiency of Liver and Kidney. METHODS: A total of 68 RA patients of yin deficiency of Liver and Kidney were equally randomized into EA+medication group and medication group (n=34 in each group). Both groups were given once-a-week methotrexate (7.5 mg/time) and once-a-day leflunomide (10 mg/time), while EA+medication group was additionally treated by EA at bilateral Ganshu (BL 18), Shenshu (BL 23), Xuanzhong (GB 39), Zusanli (ST 36), Taichong (LR 3), Hegu (LI 4) 3 times/week. The treatment lasted for 12 weeks. The visual analogue scale (VAS, for assessing rest pain), swollen joint count (SJC), tender joint count (TJC), patient's global assessment (PGA), physician's global assessment (PhGA), traditional Chinese medicine (TCM) symptom scoring, 28 joints activity index (disease activity score, DAS 28), American College of Rheumatology 20 (ACR 20, i.e. 20% of clinical improving rate), and health assessment questionnaire (HAQ) were assessed and erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) levels were examined for comparison. RESULTS: Statistical differences were observed in before-after-treatment comparisons in both groups in reducing rest pain, SJC, TJC, serum CRP content, PGA and PhGA, HAQ scoring and DAS 28 (P<0.05, P<0.01). The ESR in the medication group and TCM symptom scoring of the EA+medication group were also significantly decreased after the treatment (P<0.05).The effects of the EA+medication group were superior to those of the medication group in reducing rest pain, SJC, TJC, TCM symptom and HAQ score, and the total effetive rate (P<0.05,90.9% vs 66.67%). Adverse reactions as pharyngeal obstruction sensation, anorexia, abdominal distension, etc. can be reduced by EA therapy coordinated with western medicine. CONCLUSIONS: EA is effective in relieving symptom and joint function in RA patients with yin deficiency of Liver and Kidney.

Electroacupuncture attenuates collagen-induced arthritis in rats through vasoactive intestinal peptide signalling-dependent re-establishment of the regulatory T cell/T-helper 17 cell balance.

OBJECTIVE: Imbalance between T-helper 17 (Th17) cells and regulatory T (Treg) cells is causally linked to the development of rheumatoid arthritis (RA). In this study, we tested the hypothesis that electroacupuncture (EA) confers therapeutic benefits in RA through activation of vasoactive intestinal peptide (VIP)-dependent signalling and restoration of the Th17/Treg cell balance. MATERIALS AND METHODS: A collagen-induced arthritis (CIA) model was induced in Sprague-Dawley rats by injection of bovine type II collagen in incomplete Freund's adjuvant on day 0 and day 7. Three days after the second injection, EA was given at acupuncture points GB39 and ST36 three times per week for 4 weeks. To block VIP signalling, [D-P-Cl-Phe(6)-Leu(17)]-VIP, a VIP receptor antagonist, was administered intraperitoneally 30 min before EA. Inflammatory and pathological responses in the joint were assessed. Synovial VIP receptor mRNA levels and Treg and Th17 cell frequencies in the spleen were determined. RESULTS: EA significantly reduced the severity of CIA, as evidenced by reduced paw volumes, arthritis scores and inflammation scores. EA significantly increased mRNA expression of the VIP receptor VPAC1 and led to an elevation in CD4(+)FOXP3(+) Treg cell frequency and a reduction in CD4(+)IL17(+) Th17 cell frequency. Pre-injection of a VIP receptor antagonist significantly reversed EA-induced expansion of Treg cells, but did not alter the frequencies of Th17 cells. CONCLUSIONS: EA exerts anti-inflammatory effects in a collagen-induced rat model of arthritis. These effects appear to be mediated through activation of VIP signalling and re-establishment of the Th17/Treg cell balance.

Preparation and application of attapulgite/iron oxide magnetic composites for the removal of U(VI) from aqueous solution.

Recently, magnetic sorbents have received considerable attention because of their excellent segregative features and sorption capacities. Herein, attapulgite/iron oxide magnetic (ATP/IOM) composites were prepared and characterized. The sorption results indicated that ATP/IOM composites were superior to ATP and iron oxides individually for the removal of U(VI) from aqueous solution. Based on X-ray photoelectron spectroscopy (XPS) analysis and surface complexation model, the main sorption species of U(VI) on ATP were==X(2)UO(2)(0) below pH 4.0 and==S(s)OUO(2)(+), ==S(w)OUO(2)CO(3)(-), and==S(w)OUO(2)(CO(3))(2)(3-) above pH 5.0. However the prevalent species on ATP/IOM composites were==S(s)OUO(2)(+) and==S(w)OUO(2)(CO(3))(2)(3-) over the observed pH range. ATP/IOM composites are a promising candidate for pre-concentration and immobilization of radionuclides from large volumes of aqueous solutions, as required for remediation purposes.

Electroacupuncture inhibits inflammation reaction by upregulating vasoactive intestinal Peptide in rats with adjuvant-induced arthritis.

Acupuncture is emerging as an alternative therapy for rheumatoid arthritis (RA). However, the molecular mechanism underlying this beneficial effect of acupuncture has not been fully understood. Here, we demonstrated that electroacupuncture at acupoints Zusanli (ST36), Xuanzhong (GB39); and Shenshu (BL23) markedly decreased the paw swelling and the histologic scores of inflammation in the synovial tissue, and reduced the body weight loss in an adjuvant-induced arthritis rat model. However, the electrical stimulation at nonacupoint did not produce any beneficial effects against the experimental arthritis. Most interestingly, the electroacupuncture treatment resulted in an enhanced immunostaining for vasoactive intestinal peptide (VIP), a potent anti-inflammatory neuropeptide, in the synovial tissue. Moreover, the VIP-immunostaining intensity was significantly negatively correlated with the scores of inflammation in the synovial tissue (r = -0.483, P = .0026). In conclusion, these findings suggest that electroacupuncture may offer therapeutic benefits for the treatment of RA, at least partially through the induction of VIP expression.

[Progress of studies on regulative effect of acupuncture on activities of vasoactive intestinal peptide].

Vasoactive intestinal peptide (VIP) is a widely studied peptide hormone, distributes in multiple systems of the human body and plays a variety of biological effects in many diseases. In recent years, there have been abundant researches about the regulative effect of acupuncture on changes of VIP activities. The authors of the present paper make a review about its research progress in recent ten years from (1) effect of acupuncture on VIP functional activities of the gastrointestinal tract; (2) involvement of VIP in electroacupuncture (EA) induced improvement of gastric mucosal and cerebral blood flow (3) effect of EA on functions of VIP being as a neurotransmitter; (4) effect of EA on VIP-involved immune regulation function. Moreover, the authors also make a prospect on the correlation between the effect of acupuncture and VIP. Currently, the mechanism of VIP underlying the efficacy of acupuncture still remains unknown, and needs further investigation.

[Effects of acupuncture on the number and degranulation ratio of mast cells and expression of tryptase in synovium of rats with adjuvant arthritis].

OBJECTIVE: To observe the effects of acupuncture on synovial pathology, synovial mast cell degranulation and tryptase expression and to investigate the relationship between the functions of mast cells and effects of acupuncture on early adjuvant arthritis in rats. METHODS: Forty-six male Wistar rats were randomly divided into normal control group (n=16), untreated group (n=15) and acupuncture group (n=15). Adjuvant arthritis was induced by injection of 0.1 mL Freund's complete adjuvant in right hind limb footpad. Normal control group and untreated group received no acupuncture treatment, while rats in the acupuncture group were treated with sterilized disposable stainless steel needles inserted perpendicularly as deep as 2 to 3 mm at Xuanzhong (GB39), 6 mm at Shenshu (BL23) and 7 mm at Zusanli (ST36) for eight times (15 min each time) every two days. Setting the modeling day as the 0 day of the experiment, the body weight and paw volume of the rats were measured every three days from the 0 day. In the end, synovial tissues of the right hind ankles were sampled and made into paraffin sections. Then they were firstly stained with hematoxylin-eosin for observing synovial pathology to evaluate the effects of acupuncture on adjuvant arthritis, then stained with toluidine blue for observing the number and degranulation ratio of synovial mast cells and finally detected by immunohistochemical staining method to investigate the expression of tryptase in synovium. RESULTS: Compared with the untreated group, the body weight of rats in the acupuncture group was increased significantly (P<0.05), while the paw volume decreased obviously (P<0.01). Hematoxylin-eosin staining showed that acupuncture significantly inhibited inflammatory cell infiltration, synovial cell hyperplasia, and synovial fibroplasia in synovium of rats with adjuvant arthritis as compared with the untreated group (P<0.05). Toluidine blue staining showed that acupuncture could significantly diminish the numbers of total and degranulated mast cells in rats with adjuvant arthritis (P<0.01), which were significantly higher in the untreated group than in the normal control group (P<0.01). Showing by immunohistochemical staining, the expression of tryptase in synovium in the acupuncture group was decreased as compared with the untreated group (P<0.01). Analyzed by Spearman's bivariate correlation, the number of mast cells and degranulation ratio of mast cells were positively correlated with the pathological scores (r=0.837, P<0.01; r=0.634, P<0.01). CONCLUSION: Acupuncture can improve pathological condition of inflammatory synovium in rats with early adjuvant arthritis by inhibiting the function of synovial mast cells, which may play an important underlying role in the immunoregulation of acupuncture on adjuvant arthritis.

[Advances in studies on the correlation between acupuncture-moxibustion treatment and mast cells].

The present paper reviewed the literatures at home and abroad in the recent ten years; it stated the effects of acupuncture on local mast cells around meridian acupoints and affected area; it stated the advanced development in the possible mechanism of the efficacy of acupuncture treatment for diseases related to mast cells in recent ten years. Currently, the underlying mechanism of the efficacy of acupuncture on mast cells still remains mysterious. It needs further investigations to study the effect of mast cells in acupuncture treatment and the mechanism of the effects of moxibustion on mast cells.

[Effects of acupuncture combined with medicine on expression of matrix metalloproteinase-2 in the rat of endometriosis].

OBJECTIVE: To probe into an effective method for treatment of endometriosis (EMs) and the mechanism. METHODS: Rat EMs model was established and they were randomly divided into a model group, an acup-moxibustion group, a TCM group, an acupuncture and medicine group, with a control group set. The acup-moxibustion group were treated with electroacupuncture at "Xuehai (SP 10)", "Sanyinjiao (SP 6)" and moxibustion at "Guanyuan (CV 4)"; the TCM group were treated with stomach perfusion of modified Mojie Tablet in normal saline; the acupuncture and medicine group were treated with the above two methods; both the control group and the model group were bound and treated with stomach perfusion of saline. After treatment of 35 days, the greatest diameter of the ectopic tissue was measured in the rats, pathological observation of the ectopic tissue was made and matrix metalloproteinase-2 (MMP-2) expression in the ectopic tissue was determined. RESULTS: The greatest diameter of ectopic tissue and MMP-2 expression in the ectopic tissue in the acupuncture and medicine group were significantly lower than those in the model group, the acup-moxibustion group and the TCM group (P < 0.05); and the ectopic endometrium trended to atrophy, and with necrosis of some epithelial cells. CONCLUSION: Combination of acupuncture with medicine has a better therapeutic effect on endometriosis and down-regulates the abnormal increase of MMP-2 level to inhibit the invasion of ectopic tissue to extracellular matrix, so as to reduce the ectopic tissue, hence cure of endometriosis.