Efficacy and safety of moxibustion on cancer-related fatigue: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The goal of this research was to review the literature from randomized controlled trials (RCTs) on the impacts of moxibustion on cancer-related fatigue (CRF) as well as provide credible evidence to guide clinical practice. METHODS: Three English electronic medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang) were searched. Only randomized controlled trials on the effect of moxibustion on CRF were included in this systematic review. Study selection, data extraction, and validation were all carried out independently by two reviewers. The revised Cochrane Risk of Bias tool was used to assess the quality of the RCTs (RoB 2.0). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to assess effect sizes in individual RCTs and pooled effect sizes in meta-analyses. Data were meta-analyzed using Stata (version 14.0). RESULTS: In a random-effects meta-analysis of 24 RCTs with 1894 participants, the aggregated standardized mean difference (SMD) revealed a statistically significant association between moxibustion and alleviation from cancer-related fatigue (SMD = - 1.66, 95% CI = - 2.05, - 1.28, p = 0.000). Pooled results, however, show significant heterogeneity (I2 = 92.5%), and the evidence is insufficient to determine whether this association varies systematically by measuring tools and moxibustion modalities. Furthermore, evidence ranging from very low to low showed that moxibustion had an immediate positive effect on patients with CRF. CONCLUSION: Moxibustion may have a therapeutic effect on cancer-related fatigue. However, further large-scale, multicenter, high-quality RCTs on moxibustion for fatigue relief and safety are still needed because of the handful of studies included and the low methodological quality.

Auricular Point-Pressing With Bean Plus Esomeprazole Magnesium in Relieving Gastrointestinal Dysfunction.

Context: The frequency of gastric-cancer (GC) diagnosis has been increasing in recent years and often has no obvious symptoms at an early stage. Upon clinical diagnosis of early GC (EGC), surgical treatment is generally recommended but as an invasive operation, surgical resection can't avoid postoperative gastrointestinal dysfunction (GID) and other problems. Objective: The study intended to evaluate the clinical benefits for EGC patients of auricular point-pressing with beans, combined with esomeprazole magnesium (EM), for relieving gastrointestinal dysfunction (GID) after endoscopic submucosal dissection (ESD), aiming to provide accurate and effective reference opinions for future clinical treatment. Design: The research team designed a retrospective analysis. Setting: The study took place at the Jiangsu Province Hospital of Chinese Medicine in Nanjing, Jiangsu, China. Participants: Participants were 78 EGC patients who underwent ESD at the hospital between January 2019 and January 2021 and who had developed postoperative GID. Intervention: Thirty-seven patients chose to receive routine EM treatment, and they served as a control group. 41 patients chose to receive auricular point-pressing with bean plus EM intervention, and they served as a intervention group. Outcome Measures: At baseline and postintervention, the research team measured the levels of serum motilin (MOT), substance P (SP), prealbumin (PAB), transferrin (TF), and albumin (ALB). They also recorded the time of intestinal peristalsis recovery, first exhaust, first defecation, normal food intake, and resolution of abdominal distension symptoms. Finally, they counted the incidence of adverse events during treatment. Results: The levels of MOT, SP, PAB, TF, and ALB significantly changed between baseline and postintervention in both groups (P < .05). In the intervention group as compared to the control group postintervention, the decreases in the levels of MOT PAB, TF, and ALB and the increase in the SP level were significantly greater in the control group than those of the intervention group (all P < .05). In addition, the intervention group showed a shorter recovery time related to postoperative intestinal function and normal food intake and resolution of abdominal distension symptoms than did the control group (all P < .05), with a lower incidence of adverse events. Conclusions: Auricular point-pressing with beans plus EM can effectively alleviate the GID of EGC patients after ESD and help them to maintain normal gastrointestinal function, and its use is worth popularizing in clinical settings.

Effect of intracutaneous pyonex on analgesia and sedation in critically ill patients with mechanical ventilation.

The purpose of this study was to evaluate the effect of intracutaneous pyonex on analgesia and sedation in critically ill patients who underwent mechanical ventilation. A total of 88 critically ill patients were divided into a control group and an intervention group. Critical Care Pain Observation Tool (CPOT) and Richmond Agitation and Sedation Scale (RASS) were used to evaluate pain and agitation. The dosage and treatment period of sedative and analgesic drugs in the intervention group were notably lower than the control group (p < 0.05). Analgesia compliance time in the intervention group was superior to control group (p < 0.05). The shallow sedation compliance rate in the intervention group was significantly higher than the control group (p < 0.01). There was significant difference in blood gas analysis before and after treatment between the two groups (p < 0.05). After 2 h of sedation and analgesia, heart rate in the intervention group was lower than control group, but respiratory rate was higher than the control group (p < 0.05). The traditional analgesia and sedation combined with intracutaneous pyonex reduced the total amount and treatment period of sedative and analgesic drugs in critically ill patients throughout the treatment process, and it also decreased the adverse reactions such as blood pressure drops and respiratory depression.

The feasibility and efficacy of perioperative auricular acupuncture technique via intradermal needle buried for postoperative movement-evoked pain after open radical gastrectomy: A randomized controlled pilot trial.

INTRODUCTION: Auricular acupuncture is widely used in the treatment of pain. Recently, the most commonly used method of auricular acupuncture is to embed an intradermal needle into the skin to enhance analgesia through continuous stimulation. We aimed to explore the efficacy and feasibility of this form of auricular acupuncture in the treatment of postoperative movement-evoked pain. METHODS: This single-blind randomized controlled pilot trial was conducted between 23/8/2019 and 10/1/2020. Forty patients were recruited and randomised to either the control group (n = 20) or the experimental group (n = 20). Patients in the control group received sham auricular acupuncture, while patients in the experimental group received auricular acupuncture. A standard routine analgesia was performed in both groups. The patients with NRS score≥4 were given rescue analgesia. Postoperative pain, use of opioids and other analgesics, postoperative recovery and patient's satisfaction were recorded. RESULTS: The credibility and feasibility of auricular acupuncture for postoperative pain were high in both groups. After auricular acupuncture, the scores of the postoperative movement-evoked pain had a tendency to decrease, but no significant difference was observed between two groups at any time point (P = 0.234∼0.888). The data on postoperative pain at rest confirmed that no significant difference was observed between two groups within 48 h of surgery (P = 0.134∼0.520), and the postoperative pain at rest scores decreased over time; however, from the third day, the pain at rest scores of the experimental group were decreased, and significant differences were observed between the two groups (P = 0.039∼0.047). As for use of rescue analgesic, total opioid consumption and the incidence of postoperative nausea and vomiting, there were no significant differences between the two groups (P = 0.311, P = 0.101, P = 0.661) . In terms of patients' satisfaction, the score of the experimental group was higher than that of the control group, and a significant difference was observed between the two groups (P = 0.000). As for adverse events, two participants reported pain and one patient reported discomfort at the insertion sites during the process of auricular acupuncture intervention, but they both were minor and tolerable. CONCLUSION: Auricular acupuncture may have a relief effect on mild postoperative pain at rest with pain score below 3, suggesting that it may be a feasible adjuvant method to relieve mild pain at rest. However, more multi-centre and large-sample studies are needed to verify this result.

Qigong Exercise for Patients with Gastrointestinal Cancer Undergoing Chemotherapy and at High Risk for Depression: A Randomized Clinical Trial.

Aims and objectives: This study evaluated the effects of a Chinese traditional qigong exercise-monkey frolic in Wuqinxi on depression and quality of life in patients with gastrointestinal cancer undergoing chemotherapy and at high risk for depression. Methods: In this prospective, randomized-controlled clinical trial, 80 patients with gastrointestinal cancer undergoing chemotherapy and at high risk for depression were randomized to an intervention group or a control group. Participants in the intervention group participated in qigong exercise five sessions each week and also received conventional treatment for 4 weeks; whereas participants in the control group received conventional treatment only. The primary outcome was the change in depressive symptoms as obtained through the Self-Rating Depression Scale. Automatic negative thoughts and quality of life were measured by the Automatic Thoughts Questionnaire and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-core30, respectively. Analyses were based on analysis of covariance (ANCOVA) with the "intention-to-treat" population, defined as all randomized patients by imputing mean of the column in place of missing data. Results: Seventy-nine participants (98.8%) completed the study, 40 in the intervention group and 39 in the control group. Results of ANCOVA revealed that, compared with the control group, the intervention group reported significantly lower depression scores, fewer negative thoughts, and showed significant improvement in global health status and physical, role, emotional, cognitive, and social functions (p < 0.05) following the intervention. Post-treatment scores for all symptoms in the intervention group were significantly lower than those in the control group (p < 0.05), except for financial difficulties. No significant differences between the two groups were present in the adverse events (all p > 0.05). Conclusions: Qigong exercise may be useful for relieving depression, reducing negative thoughts, and improving the quality of life in patients with gastrointestinal cancer undergoing chemotherapy. Clinical Trial Registry (#ChiCTR2100043417).

[Efficacy of assisted treatment of thumb-tack acupuncture with surrounding needling method for herpes zoster of stagnated heat in liver meridian].

OBJECTIVE: To compare the efficacy difference between thumb-tack acupuncture with surrounding needling method plus medication and medication alone for herpes zoster (HZ) of stagnated heat in liver meridian type. METHODS: According to random number table method, 60 patients with HZ of stagnated heat in liver meridian type were randomly divided into an observation group and a control group, 30 cases in each one. All the patients were treated with oral valaciclovir hydrochloride dispersible tablets (0.3 g per time, twice per day), mecobalamin tablets (0.5 mg per time, three times a day) and vitamin B1 (10 mg per time, three times a day) for 15 days. In addition, the patients in the observation group were treated with thumb-tack acupuncture at area 1 cm outside the herpes, with an interval of 3 cm between thumb-tack needles. The thumb-tack acupuncture was given once every 3 days, retained for 48 h, with an interval of 1 day between treatments, and totally 5 treatments were given. The index of herpetic evaluation (stopping time of herpes, scarring time, decrustation time), visual analogue scale (VAS), serum immune-related factors (IgG, IgM, IgA) and serum inflammatory factors (IL-4, IL-17, TNF-α, TGF-ß1) were observed before and after treatment in the two groups. RESULTS: After treatment, the stopping time of herpes, scarring time, decrustation time in the observation group were shorter than those in the control group (all P<0.05). Compared before treatment, the VAS score in the two groups were reduced after treatment (both P<0.05), and no significant difference was observed between the two groups (P>0.05), but the difference before and after treatment in the observation group was superior to that in the control group (P<0.05). Compared before treatment, the levels of serum immune-related factors IgG, IgM, IgA were increased in the two groups after treatment (all P<0.05), and the levels in the observation group after treatment were higher than those in the control group (all P<0.05). Compared before treatment, the levels of serum inflammatory factors IL-4, IL-17, TNF-α, TGF-ß1 were reduced in the two groups after treatment (all P<0.05), and the levels in the observation group after treatment were lower than those in the control group (all P<0.05). CONCLUSION: The thumb-tack acupuncture with surrounding needling method plus medication have the advantages of rapid onset and analgesic effect for HZ of stagnated heat in liver meridian type, which could also improve serum immune-related factors and reduce inflammatory reaction.

Curcumin as a therapeutic agent for blocking NF-κB activation in ulcerative colitis.

Ulcerative colitis (UC) is a chronic, relapsing, remitting, and inflammatory disorder that afflicts millions of people around the world. It carries a substantial economic burden, reducing the quality of life, ability to work, and increasing disability. Conventional medical treatment of UC includes the use of aminosalicylates, corticosteroids, and immunosuppressive drugs. However, these medicines are not always effective due to some serious side effects. Nuclear factor-kappa B (NF-κB) is a key factor in the inflammatory setting and strongly affects the course of mucosal inflammation in UC. This review aims to describe the complex role of NF-κB in UC and discuss existing pharmacological attempts by curcumin for blocking NF-κB activation to develop new therapeutic strategies in UC. Several studies have shown intriguing pharmacologic effects associated with curcumin, which inhibits NF-κB expression by regulating NF-κB/IkB pathway and down-regulation expression of pro-inflammatory cytokines, such as Interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF)-α. The efficacy of curcumin has been confirmed in several experimental models of UC. Furthermore, curcumin significantly induced clinical remission in active mild-to-moderate UC patients and reduced clinical relapse in quiescent UC patients. The inhibitory effects of curcumin on NF-κB and its unrivaled safety profile indicate that it remains effective for the treatment of UC. In addition, curcumin is a nontoxic, inexpensive, and easily available natural polyphenol. In conclusion, curcumin can be used as a potential and safe drug in the management of patients with remission and mild-to-moderate UC.

Efficacy of Auricular Acupressure for Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: To identify the efficacy of auricular acupressure on pain and disability for chronic LBP by systematic review. METHODS: A search of randomized controlled trials was conducted in four English medical electronic databases and three Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed using all time-points meta-analysis. RESULTS: A total of 7 trials met the inclusion criteria, of which 4 had the low risk of bias. The findings of this study showed that, for the immediate effect, auricular acupressure had large, significant effects in improving pain within 12 weeks. As for the follow-up effect, the pooled estimates also showed promising effect at 4-week follow-up after 4-week intervention (standardized mean difference = -1.13, 95% CI (-1.70, -0.56), P < 0.001). But, for the disability level, the therapeutic effect was not significant (mean difference = -1.99, 95% CI (-4.93, 0.95), P = 0.18). No serious adverse effects were recorded. CONCLUSIONS: The encouraging evidence of this study indicates that it is recommended to provide auricular acupressure to patients with chronic low back pain. However, a more accurate estimate of the effect will require further rigorously designed large-scale RCTs on chronic LBP for improving pain and disability.

Effect of Gua sha therapy on perimenopausal syndrome: a randomized controlled trial.

OBJECTIVE: This study aims to evaluate the effectiveness and safety of Gua sha therapy on perimenopausal symptoms, quality of life, and serum female hormones in participants with perimenopausal syndrome. METHODS: A prospective, randomized, controlled clinical trial was conducted at the First Affiliated Hospital of Nanjing University of Chinese Medicine in China. Eighty women with perimenopausal syndrome were recruited and randomized into an intervention group or a control group. Participants in the intervention group received 15-minute Gua sha treatment sessions once a week plus conventional treatment for 8 weeks, whereas participants in the control group received conventional treatment alone. The primary outcome was the change in perimenopausal symptoms and quality of life as obtained through the modified Kupperman Index (KI) and the Menopause-Specific Quality of Life. The secondary outcome was the change of serum female hormones including estrogen, follicle-stimulating hormone, and luteinizing hormone. RESULTS: Seventy-five out of 80 participants (93.8%) completed the study-38 in the intervention group and 37 in the control group. The baseline levels of demographic and outcome measurements were comparable between the two groups. After eight sessions of intervention, the reduction in the total modified KI score was, however, 16.32 ±â€Š4.38 in the intervention group and 11.46 ±â€Š5.96 in the control group, with a difference of 4.86 ±â€Š6.15 (P < 0.01) between the two groups. Also the reductions of hot flash/sweating, paresthesia, insomnia, nervousness, melancholia, fatigue, and headache were greater in the intervention group than in the control group (P < 0.05). The reduction in the total Menopause-Specific Quality of Life score was 17.87 ±â€Š3.84 in the intervention group and 13.62 ±â€Š7.40 in the control group, with a difference of 4.46 ±â€Š7.52 (P < 0.01) between the two groups. And the scores for vasomotor, psychosocial, and physical domains in the intervention group were significantly lower than those in the control group (P < 0.05). There were no significant differences in serum estrogen, follicle-stimulating hormone, and luteinizing hormone between the two groups. CONCLUSIONS: The results of this study suggest that Gua sha therapy was effective and safe in relieving perimenopausal symptoms and improving the quality of life in participants with perimenopausal syndrome. The therapy may serve as a promising, effective, nondrug treatment for perimenopausal syndrome in clinical work. Additional research is needed to better understand its effectiveness and examine its mechanism for treating perimenopausal syndrome.

[Clinical observation of post-infectious cough differentiated as wind-cold retention in the lung treated with scraping therapy and xuanfei zhisou decoction].

OBJECTIVE: To compare the difference in the therapeutic effect on post-infectious cough differentiated as wind-cold retention in the lung between the combined therapy of scraping and xuanfei zhisou decoction and the simple application of xuanfei zhisou decoction. METHODS: Eighty patients were randomized into a combined therapy group and a Chinese herbal medicine group, 40 cases in each one. In the Chinese herbal medicine group, the oral administration of xuanfei zhisou decoction was used. The main ingredients included roasted herba ephedrae, amygdalus communis vas, rhizoma zingiberis recens, platycodon grandiflorum, flos farfarae, pinellia temata, radix stemonae, herba periliae, etc., one dose a day, twice a day. In the combined therapy group, on the basis of the treatment as the Chinese herbal medicine group, scraping therapy was added and applied to the bladder meridian of foot-taiyang, the lung meridian of hand-taiyin, the conception vessel and the governor vessel, focusing on Tiantu (CV 22), Baihui (GV 20), Dazhui (GV 14), Feishu (BL 13), Fengmen (BL 12), Taiyuan (LU 9), Lieque (LU 7) and Fengchi (GB 20), once a week and one-week treatment as one session. Totally, the continuous two sessions were required in the two groups. The cough symptom score, cough remission time, relapse, TCM syndrome score, the score of Leicester cough questionnaire (LCQ), SP concentration in the supernatant of the induced sputum before and after treatment as well as clinical efficacy were observed in the two groups. RESULTS: The cough symptom score, TCM symptom score and SP concentration in the supernatant of the induced sputum were all apparently reduced after treatment in the patients of the two groups (all P<0.01). The scores in the combined therapy group were reduced in the higher amplitude as compared with those in the Chinese herbal medicine group (all P<0.01). The total effective rate was 95.0% (38/40) in the combined therapy group, better than 87.5% (35/40) in the Chinese herbal medicine group (P<0.05). Regarding the cough remission time and relapse rate, the results in the combined therapy group were better than those in the Chinese herbal medicine group[(5.3±1.2) d vs (7.4±1.5) d, P<0.01; 0% (0/19) vs 62.5% (5/8), P<0.01]. The scoreo of LCQ was all apparently improved in the patients of the two groups (both P<0.01), and the score in the combined therapy group was higher than that in the Chinese herbal medicine group (P<0.01). CONCLUSIONS: Scraping therapy combined with xuanfei zhisou decoction and the simple application of xuanfei zhisou decoction all relieve the symptoms of post-infectious cough and improves the living quality. The therapeutic effects of the combined therapy are superior to the oral administration of xuanfei zhisou decoction.

[Scrapping therapy combined with Qingxin Zishen Decoction for perimenopausal syndrome with pattern of fire excess from yin deficiency].

OBJECTIVE: To observe the efficacy difference between scrapping therapy combined with Qingxin Zishen Decoction and the single application of Qingxin Zishen Decoction for perimenopausal syndrome (PMS) with pattern of fire excess from yin deficiency. METHODS: Eighty patients were assinged into an observation group and a control group, 40 cases in each one. Patients in the control group were treated with oral administration of Qingxin Zishen Decoction to clear heart heat and nourish kidney. One dose of the decoction was taken by two times within one day. Based on the treatment of the control group, patients in the observation group were additionally treated with scrapping therapy along the urinary bladder meridian of foot-taiyang, heart meridian of hand-shaoyin and kidney meridian of foot-shaoyin; the scrapping therapy was performed at Back-shu points, Shenmen (HT 7), Yongquan (KI 1), Taixi (KI 3), Zhaohai (KI 6), Sanyinjiao (SP 6), Zusanli (ST 36), etc.; the treatment was given once every week. Four weeks of treatment were taken as one course in two groups, and totally 2 courses were given. The modified Kupperman score, menopausal quality of life (MENQOL), level of serum estrogen (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) before and after treatment as well as the clinical efficacy were valuated between the two groups. RESULTS: After treatment, each item score and total score of modified Kupperman were reduced apparently in the two groups (P<0.01,P<0.05) except dyspareunia score in the control group. The score of hot flash and sweating, paresthesia, depression, fatigue, arthralgia, palpitation, formication, urinary symptoms and total score in the observation group were superior to those in the control group (P<0.01, P<0.05). After treatment, the total score and each dimension score of MENQOL were obviously decreased in the two groups (all P<0.01), and the scores of vasomotor symptoms, psychosocial condition and physical condition in the observation group were significantly lower than those in the control group (P<0.01, P<0.05). There were no significant differences of serum hormone levels before and after treatment between the two groups (all P>0.05), however, after treatment, the serum E2 level had the tendency to raise and serum LH, FSH levels had the tendency to decrease in the observation group. The total effective rate was 97.4% (37/38) in the observation group, which was higher apparently than 81.1% (30/37) in the control group (P<0.01). CONCLUSIONS: The scrapping therapy combined with Qingxin Zishen Decoction or the simple application of Qingxin Zishen Decoction can both improve PMS symptoms and the quality of life, delay the ovary recession; the combination of scrapping therapy and Qingxin Zishen Decoction achieve superior efficacy on PMS syndrome to the simple application of Qingxin Zishen Decoction.

Efficacy of auriculotherapy for constipation in adults: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To assess the clinical evidence of auriculotherapy for constipation treatment and to identify the efficacy of groups using Semen vaccariae or magnetic pellets as taped objects in managing constipation. METHODS: Databases were searched, including five English-language databases (the Cochrane Library, PubMed, Embase, CINAHL, and AMED) and four Chinese medical databases. Only randomized controlled trials were included in the review process. Critical appraisal was conducted using the Cochrane risk of bias tool. RESULTS: Seventeen randomized, controlled trials (RCTs) met the inclusion criteria, of which 2 had low risk of bias. The primary outcome measures were the improvement rate and total effective rate. A meta-analysis of 15 RCTs showed a moderate, significant effect of auriculotherapy in managing constipation compared with controls (relative risk [RR], 2.06; 95% confidence interval [CI], 1.52- 2.79; p<0.00001). The 15 RCTs also showed a moderate, significant effect of auriculotherapy in relieving constipation (RR, 1.28; 95% CI, 1.13-1.44; p<0.0001). For other symptoms associated with constipation, such as abdominal distension or anorexia, results of the meta-analyses showed no statistical significance. Subgroup analysis revealed that use of S. vaccariae and use of magnetic pellets were both statistically favored over the control in relieving constipation. CONCLUSIONS: Current evidence illustrated that auriculotherapy, a relatively safe strategy, is probably beneficial in managing constipation. However, most of the eligible RCTs had a high risk of bias, and all were conducted in China. No definitive conclusion can be made because of cultural and geographic differences. Further rigorous RCTs from around the world are warranted to confirm the effect and safety of auriculotherapy for constipation.