Effect of electroacupuncture at "Jiaji" (EX-B2) on senescence of nucleus pulposus cells of degenerated lumbar intervertebral disc in rabbits. / 电针"夹脊"å¯¹è °æ¤Žé—´ç›˜é€€å˜å ”é€€å˜æ¤Žé—´ç›˜é«“æ ¸ç»†èƒžè¡°è€çš„å½±å“.

OBJECTIVES: To observe the effect of electroacupuncture (EA) at "Jiaji"(EX-B2) on body mass, motor function, expression of caveolin-1 (Cav-1) in nucleus pulposus cells and annulus fibrosus tissue, telomerase activi-ty, relative telomere length and different cell cycle ratio of nucleus pulposus cells in rabbits with intervertebral disc degeneration(IVDD), so as to investigate its mechanism underlying delaying senescence of the degenerated lumbar intervertebral disc nucleus pulposus cells. METHODS: Twenty-five male New Zealand rabbits with mature bones were divided into control, sham operation, model, EA, and acupuncture groups, with 5 rabbits in each group. The IVDD model was established by inserting kirschner wires to the vertebral bone surface between the lumbar (L)4 and L5 vertebrae, followed by applying continuous axial pressure for 28 d. EA (2 Hz/15 Hz, 1-2 mA) or acupuncture (only insertion of acupuncture needles into bilateral EX-B2, but without electrical stimulation) was applied to bilateral EX-B2 for 20 min, once daily, 6 times a week for 4 weeks. The hindlimb locomotor function (locomotor score) was assessed by using Faden's and colleagues' methods. The general conditions of rabbits in each group were observed, and their body weight changes were measured every week. Nucleus pulposus cells were isolated using enzyme digestion method. After the treatment, the Cav-1 positive cell counts in nucleus pulposus cells and annulus fibrosus tissues were detected by immunohistochemistry, and the telomerase activity of nucleus pulposus cells was detected by PCR-ELISA. The relative telomere length of nucleus pulposus cells was measured by real-time quantitative polymerase chain reaction (real-time qPCR), and the cell cycle of nucleus pulposus was detected by flow cytometry. RESULTS: Compared with the sham operation group, the body mass from 4 to 11 week, locomotor score at 4, 7 and 11 week, telomerase activity, relative telomere length and the proportion of cells in G2/M phase of nucleus pulposus cells were significantly decreased (P<0.01), while Cav-1 positive cell counts of nucleus pulposus and annulus fibrosus tissue, and the proportion of nucleus pulposus cells in the G0/G1 phase considerably increased (P<0.01) in the model group. Relevant to the model group, the EA group rather than the acupuncture group had an increase in the body mass from 8 to 11 week, locomotor score at 11 week, telomerase activity, relative telomere length of nucleus pulposus cells, and the proportion of nucleus pulposus cells in G2/M phase (P<0.01), and a decrease in the Cav-1 positive cell counts of nucleus pulposus and annulus fibrosus tissue and the proportion of cells in G0/G1 phase (P<0.01). No significant differences were found between the model and acupuncture groups in all the indexes mentioned above. CONCLUSIONS: EA at EX-B2 has a bene-ficial effect in improving motor function in rabbits with IVDD, which may be related to its functions in reducing the expression of Cav-1 in nucleus pulposus cells and annulus fibrosus, improving cycle arrest, enhancing the telomerase activity and the relative telomere length of nucleus pulposus cells, delaying the senescence of nucleus pulposus cells of the degenerated lumbar intervertebral discs.

Electroacupuncture promotes microglial M2 polarization in ischemic stroke via annexin A1.

BACKGROUND: Neuroinflammation is the leading cause of neurological sequelae in ischemic stroke. Recently, we reported that the anti-inflammatory mediator annexin A1 (ANXA1) favored microglial M2 polarization in brain injury. The purpose of this study was to investigate electroacupuncture (EA) treatment and its potentially ANXA1-mediated anti-inflammatory effects in the middle cerebral artery occlusion/reperfusion (MCAO/R) mouse model of stroke. METHODS: Treatment with EA consisted of dense-sparse frequencies (alternating 4 Hz sparse waves for 1.5 s and 16 Hz dense waves for 1.5 s) at CV24 and GV26. Intracerebroventricular (ICV) injection of Boc-2 (5 µM) or short hairpin RNA (sh)ANXA1 (2 µL) 3 days before EA was performed to block the effects of ANXA1. RESULTS: EA pretreatment enhanced expression of ANXA1 and its receptor, formyl peptide receptor (FPR), when compared to MCAO/R alone. EA treatment also rescued MCAO/R-induced deficits in neurological performance, and learning and memory, and reduced infarct volume. Double immunofluorescent labeling showed that EA prevented MCAO/R-induced changes in microglial activation and morphology. EA also reduced the release of pro-inflammatory cytokines, such as interleukin (IL)-1ß, inducible nitric oxide synthase (iNOS) and tumor necrosis factor (TNF)-α, while increasing the release of anti-inflammatory cytokines, such as arginase-1 (Arg-1) and brain-derived neurotrophic factor (BDNF). All EA-induced effects were either partially or completely prevented by prior administration of FPR antagonist Boc-2 or shANXA1. CONCLUSION: The current study provides strong evidence that EA treatment has protective effects against ischemic stroke in the MCAO/R mouse model and that the mechanism likely involves the promotion of M2 polarization in microglia via ANXA1.

Effects of intensity of electroacupuncture on chronic pain in patients with knee osteoarthritis: a randomized controlled trial.

BACKGROUND: Conditioned pain modulation (CPM) is impaired in people with chronic pain such as knee osteoarthritis (KOA). The purpose of this randomized, controlled clinical trial was to investigate whether strong electroacupuncture (EA) was more effective on chronic pain by strengthening the CPM function than weak EA or sham EA in patients with KOA. METHODS: In this multicenter, three-arm parallel, single-blind randomized controlled trial, 301 patients with KOA were randomly assigned. Patients were randomized into three groups based on EA current intensity: strong EA (> 2 mA), weak EA (< 0.5 mA), and sham EA (non-acupoint). Treatments consisted of five sessions per week, for 2 weeks. Primary outcome measures were visual analog scale (VAS), CPM function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Three hundred one patients with KOA were randomly assigned, among which 271 (90.0%) completed the study (mean age 63.93 years old). One week of EA had a clinically important improvement in VAS and WOMAC but not in CPM function. After 2 weeks treatment, EA improved VAS, CPM, and WOMAC compared with baseline. Compared with sham EA, weak EA (3.8; 95% CI 3.45, 4.15; P < .01) and strong EA (13.54; 95% CI 13.23, 13.85; P < .01) were better in improving CPM function. Compared with weak EA, strong EA was better in enhancing CPM function (9.73; 95% CI 9.44, 10.02; P < .01), as well as in reducing VAS and total WOMAC score. CONCLUSION: EA should be administered for at least 2 weeks to exert a clinically important effect on improving CPM function of KOA patients. Strong EA is better than weak or sham EA in alleviating pain intensity and inhibiting chronic pain. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry ( ChiCTR-ICR-14005411 ), registered on 31 October 2014.

Electroacupuncture inhibits chronification of the acute pain of knee osteoarthritis: study protocol for a randomized controlled trial.

BACKGROUND: Previous studies have shown that electroacupuncture (EA) has a significant effect on acute pain, but it has not solved the clinical problem of the chronification of acute pain. Diffuse noxious inhibitory controls (DNIC) function as a reliable indicator to predict the risk of chronic pain events. DNIC function in knee osteoarthritis (KOA) patients has been demonstrated to gradually decrease during the development of chronic pain. The purpose of this study is to conduct a randomized, controlled clinical trial to determine if EA can repair impaired DNIC function and thus prevent chronification of the acute pain of KOA. METHODS/DESIGN: This is a multicenter, single blind, randomized, controlled, three-arm, large-scale clinical trial. A total of 450 KOA patients will be randomly assigned to three groups. The strong EA group will receive EA with high-intensity current (2 mA < current < 5 mA) at the ipsilateral 'Neixiyan' (EX-LE5), 'Dubi'(ST35), 'Liangqiu'(ST34) and 'Xuehai' (SP10). The weak EA group will receive EA with low-intensity current (0 mA < current < 0.5 mA) on the same acupoints. The sham EA group will receive EA with low-intensity current (0 mA < current < 0.5 mA) with fine needles inserted superficially into the sites 2 cm lateral to the above acupoints. The patients will be treated with EA once a day, 30 minutes per session, in 5 sessions per week, for 2 weeks. In order to determine the best stage of KOA for effective EA intervention, patients within the treatment groups also will be divided into four stages. The primary outcomes are Visual Analog Scale (VAS), DNIC function and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Clinical assessments will be evaluated at baseline (before treatment) and after 5 to 10 sessions of treatment. DISCUSSION: This trial will be helpful in identifying whether strong EA is more effective than weak EA in reversing chronification of acute pain through repairing the impaired DNIC function and in screening for the best stage of KOA for effective EA intervention. TRIAL REGISTRATION: Chinese Clinical Trial Registry Number: ChiCTR-ICR-14005411. The date of registration is 31 October 2014.

Electroacupuncture stimulates remodeling of extracellular matrix by inhibiting apoptosis in a rabbit model of disc degeneration.

The present study was designed to determine whether EA stimulates remodeling of extracellular matrix by inhibiting apoptosis in degenerated disc. 40 rabbits were randomly assigned to one of the four groups. Animal model was established by a loading device. Magnetic resonance imaging and Pfirrmann's classification were obtained to evaluate both the model and the EA treatment on disc degeneration. The ultrastructure of discs was observed by TEM. Apoptosis involvement was determined with TUNEL staining and western blot for the protein expression of Bax and Bcl-2. The results indicated that EA intervention decreased the MRI grades. TEM analysis showed an apparent remodeling and rearrangement of disc ECM after EA intervention for 28 days. The number of TUNEL-positive cells in the EA group was significantly lower than that in the compression group. The protein expression demonstrated an antiapoptosis effect mediated by EA. Increased expression of Bcl-2 proteins and reduced Bax protein expression were detected after 28 days treatment. It was concluded that antiapoptosis pathway probably participates in the mechanism of EA stimulating the remodeling of ECM in disc degeneration.

Changes in responses of neurons in spinal and medullary subnucleus reticularis dorsalis to acupoint stimulation in rats with visceral hyperalgesia.

The purpose of this study was to explore the mechanism of acupoints sensitization phenomenon at the spinal and medulla levels. Experiments were performed on adult male Sprague-Dawley rats and visceral noxious stimuli was generated by colorectal distension (CRD). The activities of wide dynamic range (WDR) and subnucleus reticularis dorsalis (SRD) neurons were recorded. The changes of the reactions of WDR and SRD neurons to electroacupuncture (EA) on acupoints of "Zusanli-Shangjuxu" before and after CRD stimulation were observed. The results showed that visceral nociception could facilitate the response of neurons to acupoints stimulation. In spinal dorsal horn, EA-induced activation of WDR neurons further increased to 106.84 ± 17.33% (1.5 mA) (P < 0.001) and 42.27 ± 13.10% (6 mA) (P < 0.01) compared to the neuronal responses before CRD. In medulla oblongata, EA-induced activation of SRD neurons further increased to 63.28 ± 15.96% (1.5 mA) (P < 0.001) and 25.02 ± 7.47% (6 mA) (P < 0.01) compared to that before CRD. Taken together, these data suggest that the viscerosomatic convergence-facilitation effect of WDR and SRD neurons may underlie the mechanism of acupoints sensitization. But the sensitizing effect of visceral nociception on WDR neurons is stronger than that on SRD neurons.

[Effects of electroacupuncture stimulation of "Jiaji" (EX-B 2) on expression of matrix metalloproteinase-13 and tissue inhibitor of metalloproteinase-1 in intervertebral disc tissue in rabbits with lumbar intervertebral disc degeneration].

OBJECTIVE: To observe the effect of electroacupuncture(EA) stimulation of "Jiaji" (EX-B 2) on the expression of matrix metalloproteinase-13 (MMP-13) and tissue inhibitor of metalloproteinase-1 (TIMP-1) proteins in the lumbar disc in rabbits with lumbar intervertebral disc degeneration so as to explore its mechanism in relieving intervertebral disc degeneration. METHODS: A total of 36 New Zealand rabbits were randomly divided into normal, sham operation (sham), model, and EA groups, with 9 rabbits in each group. The lumbar intervertebral disc degeneration model was established by using a custom-made external loading device to axially compress the lumbar discs (L4, L5) for 28 days in reference to Kroeber and colleagues' methods. After modeling, EA stimulation (2 Hz/15 Hz, 1-2 mA) was applied to bilateral "Jiaji" (EX-B 2) areas for 20 min, once daily for 28 days. The expression levels of MMP-13 and TIMP-1 proteins of the lumbar intervertebral disc (L4-L5) tissues were assayed by Western blot and immunoflorescence methods, separately. RESULTS: Compared to the normal and sham groups, MMP-13 expression levels at the time-points of day 28 in the model group, on day 28 (pre-EA) in the EA group were significantly up-regulated (P < 0.01); and TIMP-1 expression levels on day 28 in both model and EA groups were significantly decreased (P < 0.01). Following EA treatment, the expression level of MMP-13 was notably lower in the EA group than in the model group, and that of TIMP-1 was remarkably higher in the EA group than in the model group (P < 0.01). No significant differences were found in the expression levels of MMP-13 and TIMP-1 from day 1 to day 56 in the same one group of both normal and sham groups, and between these two groups (P > 0.05). CONCLUSION: Electroacupuncture at "Jiaji" (EX-B 2) can effectively suppress intervertebral disc degeneration induced up-regulation of MMP-13 protein and down-regulation of TIMP-1 protein in the disc tissue in rabbits, which may contribute to its effect in bettering lumbago in clinic.

The effect of electroacupuncture on the extracellular matrix synthesis and degradation in a rabbit model of disc degeneration.

The present study was aimed at determining if the electroacupuncture (EA) is able to protect degenerated disc in vivo. New Zealand white rabbits (n = 40) were used for the study. The rabbits were randomly assigned to four groups. EA intervention was applied to one of the four groups. Magnetic resonance imaging and Pfirrmann's classification were obtained for each group to evaluate EA treatment on the intervertebral disc degeneration. Discs were analyzed using immunofluorescence for the labeling of collagens 1 and 2, bone morphogenetic protein-2 (BMP-2), matrix metalloproteinase-13 (MMP-13), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1). For protein expression analysis, western blot was used for biglycan and decorin. Outcomes indicated that EA intervention decreased the grades compared with the compressed disc. Immunofluorescence analysis showed a significant increase of collagens 1 and 2, TIMP-1, and BMP-2 positive cells, in contrast to MMP-13 after EA treatment for 28 days. The protein expression showed a sign of regeneration that decorin and biglycan were upregulated. It was concluded that EA contributed to the extracellular matrix (ECM) anabolic processes and increased the ECM components. MMPs and their inhibitors involved in the mechanism of EA intervention on ECM decreased disc. It kept a dynamic balance between ECM synthesis and degradation.

[Comparison of therapeutic effects of different types of acupuncture interventions on herpes zoster in acute stage].

OBJECTIVE: To compare the therapeutic effects of different types of acupuncture therapy on herpes zoster (acute stage). METHODS: A total of 189 cases of acute herpes zoster outpatients and inpatients were recruited in the present multicenters (3 hospitals) randomized controlled clinical trials. They were divided into (computer-aided random allocation): basic acupuncture (n = 36), cotton moxibustion (n = 35), fire needle (n = 43), tapping-cupping (n = 39) and medication (n = 36) groups. Ashi-points (around the locus), Jiaji (EX-B 2), Zhigou (SJ 6) and Houxi (SI 3) were used in this study. For patients of the acupuncture group, the abovementioned acupoints were punctured with filiform needles (encircled needling around the affected loci) and also stimulated with electroacupuncture (EA). For patients of the cotton moxibustion group, thin defated dry cotton pieces put over the Ashi-point were ignited, 3 times altogether, followed by EA and encircled needling stimulation which were the same to those in the basic acupuncture group. Patients of the fire needle group were treated by pricking the herpes (3-5 in number) with a hot-red needle, followed by EA and encircled needling treatment. Patients of the tapping-cupping group were treated by tapping Ashi-points repeatedly with a percussopunctator and cupping over the pricked region, followed by EA and encircled needling treatment. Patients of the medication group were treated by oral administration of Valaciclovir Hydrochlordide (300 mg/time, twice a day) and vitamin B1 (10 mg/time, t. i.d.) for 10 days. The acupuncture-moxibustion treatment was given once daily for 10 days. The time of blister-occurrence cease, scab formation and decrustation was recorded, and pain degree was evaluated using visual analog scale (VAS). The therapeutic effect was assessed according to the related standards. RESULTS: There were no significant differences among the 5 groups in the time of blister-occurrence cease, scab formation and decrustation, and in the therapeutic effect (P > 0.05). The VAS scores of the 5 groups were decreased gradually and apparently along with the treatment (P < 0.05), suggesting a pain relief after the treatment. In comparison with the medication group, the VAS scores of the basic acupuncture group, cotton moxibustion group, fire needle group and tapping-cupping group were significantly lower from the 7th day on following the treatment (P < 0.05). CONCLUSION: Acupuncture plus encircled needling and acupuncture plus encircled needling combined with cotton-moxibustion, or with fire needle stimulation, or with tapping and cupping are effective in the treatment of herpes zoster at the acute stage, being comparable to the medication in the clinical curative effect and improvement of blisters, and better than medication in pain relief.

[Analysis of the distribution of diseases in 6435 inpatients from the department of acupuncture and moxibustion].

OBJECTIVE: To understand the distribution of diseases in inpatients from the department of acupuncture and moxibustion and to provide the references for the scientific research direction of acupuncture and moxibustion. METHODS: By use of information management system of the medical records, the first page of the medical record of 6435 cases from January 1, 2003 to December 31, 2010 was extracted. RESULTS: It shows a clear upward trend in the department of acupuncture and moxibustion in 8 years. The vast majority are elderly patients in 6435 cases, involving in 309 kinds of diseases, the major cases focus on the diseases of motor system and cerebrovascular system. The top 10 ranking of diseases and the rates are lumbar spondylosis (17.73%), cerebral infarction (13.77%), cervical spondylosis (13.66%), sequelae of cerebral infarction (7.47%), lumbar disc herniaion (4. 41%), osteoarthropathia (3.40%), cerebral hemorrhage (2.91%), herpes zoster (2.33%), postherpetic neuralgia (2.33%), sequelae of cerebral hemorrhage (2.32%). CONCLUSION: The people's acceptance of acupuncture and moxibustion is increasing and the sufferers treated by acupuncture and moxibustion are mostly elderly patients. The research on the motor system diseases and cerebrovascular diseases should be strengthened.

[Observation on therapeutic effect of electroacupuncture at Jiaji (EX-B 2) combined with blood-letting and cupping on herpes zoster].

OBJECTIVE: To compare the therapeutic effect differences between electroacupuncture at Jiaji (EX-B 2) combined with blood-letting plus cupping and western medicine therapy. METHODS: Fifty-three cases were randomly divided into an observation group (n=31) and a control group (n=22). The observation group was treated by electroacupuncture at Jiaji (EX-B 2) combined with blood-letting with a plum-blossom needle at the affected parts plus cupping, once each day. The control group was treated by oral administration of Valaciclovir Hydrochlordide, Indomethacin, Vitamin B1 and Vitamin B12. RESULTS: The cured and markedly effective rate of 96.8% in the observation group was better than that of 81.8% in the control group (P < 0.05), and improvements of pain, pruritus, burning sensation and sleep in the observation group were superior to those of the control group (all P < 0.01). CONCLUSION: Electroacupuncture at Jiaji (EX-B 2) combined with blood-letting and cupping is a better therapy for herpes zoster and its therapeutic effect is better than that of routine western medicine therapy.

[Observation on the therapeutic effect of electroacupuncture of Jiaji (EX-B 2) plus regional encircled needling for herpes zoster].

OBJECTIVE: To observe the clinical therapeutic effect of electroacupuncture (EA) of Jiaji (EX-B 2) plus focus-encircled needling for promoting the crust formation of herpes zoster and analgesia. METHODS: Eighty cases of herpes zoster patients were equally randomized into EA group [treated with EA of Ashi-point, Jiaji (EX-B 2), Zhigou (SJ 6) and Houxi (SI 3), once daily for 10 times] and medication group (treated with valaciclovir hydrochloride 300 mg/time, b. i. d. and vitamin B1 10 mg/time, t.i.d., 10 days). The pain severity was evaluated by using visual analogous scale (VAS) method. The time when the cutaneous scabbing area was equal or over 50% was recorded. RESULTS: After the treatment, of the two 40 cases in EA and medication groups, 30 (75.0%) and 15 (37.5%) were cured, 7 (17.5%) and 12 (30.0%) improved, 3 (7.5%) and 13 (32.5%) failed, with the total effective rates being 92.5% and 67.5%, respectively. The therapeutic effect of EA was significantly superior to that of medication (P < 0.01). VAS scores of both groups reduced significantly (P < 0.01). Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group (P < 0.01). CONCLUSION: EA of Jiaji (EX-B 2) in combination with focus-encircled needling is effective in facilitating the crust formation and pain relief in the treatment of herpes zoster, and the effect of acupuncture is superior to that of medication.

[Effects of scalp acupuncture combined with rehabilitation therapy on motor function in the hemiplegic patient of cerebral thrombosis at convalescent period].

OBJECTIVE: To search for the best way to elevate the clinical therapeutic effect in the hemiplegic patient of cerebral thrombosis at convalescent period. METHODS: Adopting single-blind, randomized controlled method, 90 cases of cerebral thrombosis at convalescent period were assigned to 3 groups: a scalp acupuncture group (group A), a rehabilitation therapy group (group B) and a scalp acupuncture combined with rehabilitation therapy group (group C). Group A were treated with scalp acupuncture at the anterior oblique line of vertex-temporal and the posterior oblique line of vertex-temporal on the healthy side; group B were treated with modern rehabilitation medical therapy, making limb function treatment; group C were treated with the scalp acupuncture in the group A combined with the rehabilitation therapy in the group B. Improvement of neural function defect and activity of daily life (ADL), and clinical therapeutic effect were observed. RESULTS: After treatment, the scores of neural function defect of 6.14 +/- 0.36 in the group C was significantly lower than 8.94 +/- 0.56 in the group A and 8.64 +/- 0.49 in the group B (P<0.05); the score of ADL of 88.39 +/- 10.02 and clinical therapeutic effect of 90.0% in the group C were significantly higher than 74.19 +/- 12.12 and 76.7% in the group A and 72.29 +/- 11.52 and 73.3% in the group B (P<0.05). CONCLUSION: The scalp acupuncture and rehabilitation therapy have synergistic action in improving motor function for the hemiplegic patient of cerebral thrombosis at convalescent period, and it is a better method for cerebral thrombosis at the convalescent stage.

[Therapeutic effects of acupoint injection at cervical Jiaji points and effects on ET and CGRP in the patient of ischemic stroke].

OBJECTIVE: To observe effects of point injection at cervical Jiaji points on endothelin (ET) and calcitonin gene related peptide (CGRP) in the patient of ischemic stroke (IS). METHODS: Seventy cases of IS were randomly divided into a treatment group of 35 cases and a control group of 35 cases. The treatment group were treated with acupoint injection at cervical Jiaji points and routine acupuncture, and the control group only with routine acupuncture. Two weeks constituted one course with an interval of one day between courses. After two courses and 4 courses, changes of ET and CGRP were detected, and after 4 courses, their clinical therapeutic effects were evaluated. RESULTS: Acupoint injection at cervical Jiaji points could significantly decrease ET and increase CGRP level; the cured and markedly effective rate was 88.6% in the treatment group and 68.6% in the control group with a significant difference between the two groups (P < 0.05). CONCLUSION: Acupoint injection at cervical Jiaji points has a very good clinical therapeutic effect and can improve ET and CGRP levels in the patient of IS.