Hui Medicine Moxibustion Promotes the Absorption of Lumbar Disc Herniation and the Recovery of Motor Function in Rats through Fas/FasL Signaling Pathway.

Objectives: To study the resorption of the herniated lumbar disc (RHLD) and its mechanism in the SD rats of lumbar intervertebral disc herniation treated with Hui medicine moxibustion (HMM). Methods: Forty SD rats were randomly divided into four groups, normal group, lumbar disc herniation (LDH) group, HMM group, and antagonist (HMM+Met12) group, with 10 rats in each group. The rat model of LDH was prepared with the method of lumbar epidural emplacement of the caudal intervertebral disc. In the HMM group and HMM+Met12 groups, 4 weeks after modeling, HMM therapy was performed in the lumbar spine for 3 months with 1 time per day and 20 min each time, the samples were collected 8 weeks after the treatment. The histological degeneration was observed through HE staining, and the neovascularization of intervertebral disc tissues was detected by the expression of CD34 and vascular endothelial growth factor (VEGF). The apoptosis of nucleus pulpous cells was detected by TUNEL assay, and the activity of caspase-3, -8, and -9 and extracellular matrix enzymes was detected by western blotting. Results: HMM treatment significantly improved the behavioral ability of rats with LDH surgery. The morphological structure was obviously destroyed in the LDH group, but disc structure was significantly repaired in the HMM group, and mild structure alterations were observed in the HMM+Met12 group. Higher levels of CD34 and VEGF were detected in the HMM group indicating that neovascularization is formed. The expression level of FasL was significantly increased in the HMM group. The protein expression levels of cleaved-caspase-3, cleaved-caspase-8, and cleaved-caspase-9 in nucleus pulposus (NP) tissues were also elevated when treated with HMM, and the TUNEL staining showed the same results. The protein expression levels of matrix metalloproteinases- (MMP-) 1, MMP-2, MMP-3, MMP-13, and ADAMTS-4 were markedly promoted in the HMM group. Met12, a small peptide antagonist of FasL, significantly reduced the effects of HMM. Conclusion: HMM can promote the formation of neovascularization of lumbar intervertebral disc, support the apoptosis of NP cells through Fas/FasL signaling, and regulate the degradation of extracellular matrix enzyme, which then accelerates the absorption of lumbar intervertebral disc herniation and the recovery of motor function in rats.

The Clinical Efficacy of Platelet-Rich Plasma versus Conventional Drug Injection in the Treatment of Knee Osteoarthritis: A Study Protocol for a Randomized Controlled Trial.

Knee osteoarthritis is a common chronic degenerative joint disease in middle-aged and elderly people. Intra-articular injection for the treatment of knee osteoarthritis is a regularly utilized nonsurgical treatment in modern medicine. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two frequently employed intra-articular devices. Hyaluronic acid (HA) is an accepted nonsurgical treatment for symptomatic KOA, and platelet-rich plasma is a popular option in the treatment of KOA in recent years. The purpose of this research is to compare the efficacy and safety of intra-articular injection of platelet-rich plasma (PRP) versus hyaluronic acid (HA) on the pain score scale, knee function, and related inflammatory biomarkers in KOA patients using a clinical randomized controlled trial. Participants are being randomized into either the hyaluronic acid (HA) or into the platelet-rich plasma (PRP) group. All patients receive 4 weeks of treatment (once a week), and well-being support and quadriceps training (3 times a week). The primary outcomes are measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analog scale (VAS). The secondary outcomes include the activities of daily living score, erythrocyte sedimentation rate, C-reactive protein testing, interleukin-6 levels, and X-ray examination. In order to monitor the occurrence of irregularities and abnormalities, patients are assessed at each visit, and restorative treatment is given if necessary. The results of this clinical trial will verify the efficacy of PRP and HA in the treatment of KOA and provide important evidence for the clinical treatment of KOA. The trial was enlisted at the Chinese Clinical Trial Registry on 26 September 2020 (ChiCTR2000038635).

[Effect of internal heat-type acupuncture needle on the expression of osteoprotegerin, receptor activator of NF-κB ligand and receptor activator of NF-κB of subchondral bone in knee osteoarthritis rabbits].

OBJECTIVE: To investigate the effect of internal heat-type acupuncture needle on the expression of osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), and receptor activator of NF-κB (RANK) in knee osteoarthritis (KOA) rabbits, so as to explore its mechanisms in relieving KOA. METHODS: Thirty New Zealand rabbits were randomly divided into control, model and treatment groups, with 10 rabbits in each group. The KOA model was established by using Hulth method. The rabbits of the treatment group received internal heat-type acupuncture needles (42 ℃) on the left hind limb 20 min, once a week for 4 weeks. The behavioral scores were assessed according to the pain severity, gait, joint motion range and articular swelling severity in reference to the modified Lequesne's methods. Toluidine Blue staining was performed to observe the structure of the subchondral bone and to analyze the difference of morphometric parameters. The protein and mRNA expressions of OPG, RANKL and RANK were detected by Western blot and real-time PCR, respectively. RESULTS: Compared with the control group, the Lequesne total score, the separation degree of trabecular bone, the protein and mRNA expressions of RANKL and RANK in subchondral bone tissues were significantly increased in the model group, while the percentage of trabecular bone area, number of trabecular bone, the expression of OPG protein and mRNA were decreased (P<0.05, P<0.01). The above indexes were all reversed in the treatment group relevant to those of the model group (P<0.05). CONCLUSION: The internal heat-type acupuncture needle therapy can improve the motor function of rabbits with KOA, which may be related to its effects in up-regulating the expression of OPG and down-regulating the RANKL and RANK in subchondral bone tissue.

Effect and Neuroimaging Mechanism of Electroacupuncture for Vascular Cognitive Impairment No Dementia: Study Protocol for a Randomized, Assessor-Blind, Controlled Clinical Trial.

Vascular cognitive impairment no dementia (VCIND) is likely to develop into vascular dementia (VD) without intervention. The clinical efficacy of electroacupuncture (EA) for VCIND has been previously demonstrated. However, the neuroimaging mechanism of EA for VCIND has not been elucidated clearly. This trial is designed to provide solid evidence for the efficacy and neuroimaging mechanism of EA treatment for patients with VCIND. This ongoing study is an assessor-blind, parallel-group, randomized controlled trial. 140 eligible subjects will be recruited from the General Hospital of Ningxia Medical University and randomized into either the electroacupuncture (EA) group or the control group (CG). All subjects will receive basic treatment, and participants in the CG will receive health education performed weekly. Except for basic treatment and health education, participants in the EA group will receive treatment 5 times per week for a total of 40 sessions over 8 weeks. The primary outcome in this study is Montreal Cognitive Assessment (MoCA), and the secondary outcomes are Auditory Verbal Learning Test (AVLT), Stroop color-naming condition (STROOP), Rey-Osterrieth Complex Graphics Testing, and resting-state functional magnetic resonance imaging (rs-fMRI). All of the outcome measures will be assessed at baseline and 8 weeks of intervention. The medical abstraction of adverse events will be done at each visit. The results of this trial will demonstrate the efficacy and neuroimaging mechanism of EA treatment for VCIND, thus supporting EA treatment as an ideal choice for VCIND treatment. The trial was registered at the Chinese Clinical Trial Registry on 28 July 2018 (ChiCTR1800017398).

Acupuncture-movement therapy for acute lumbar sprain: a randomized controlled clinical trial.

OBJECTIVE: Several studies have reported that acupuncture is effective for treatment of acute lumbar sprain, but they neglected to consider that acupuncture cannot remarkably improve lumbar activity. We performed a randomized controlled trial to evaluate the effect of acupuncture-movement therapy versus conventional acupuncture in the treatment of acute lumbar sprain. METHODS: Sixty patients were randomized into four groups: the acupuncture-movement (AM) group, sham acupuncture-movement (SAM) group, conventional acupuncture (CA) group, and physical therapy (PT) group. Patients in the AM group were treated with acupuncture at Yintang (EX-HN 3) and exercise of the lumbar region during acupuncture. Patients in the SAM group were treated with sham acupuncture at Yintang (EX-HN 3) and exercise of the lumbar region during sham acupuncture. Conventional acupuncture was performed in the CA group, and physical therapy was applied in the PT group. Each treatment lasted for 20 min. Patients were assessed before and after treatment using a visual analogue scale (VAS) and the Roland Morris Questionnaire (RMQ). RESULTS: The VAS and RMQ scores in the AM group were significantly lower after than before treatment (P < 0.01). The AM group reported lower RMQ scores in after-treatment and 24 h after treatment and lower VAS score in 24 h after treatment in comparison with those of the CA, SAM, and PT groups (P < 0.05). CONCULSION: Acupuncture-movement therapy is effective for treating acute lumbar sprain with a persistent pain-relief and remarkable improvement of lumbar activity. Movement, that is, lumbar exercise during acupuncture, enhances the effect of acupuncture.

[Electrophysiological Characteristics of Sensitized Acupoints after Acute Intestinal Mucosal Injury in Rats].

OBJECTIVE: To observe the dynamic distribution of the extravasated Evans Blue (EB) dye points at the skin after acute colorectal mucosal injury (AIMI) so as to reveal characteristics of acupoint sensitization. METHODS: Forty adult male SD rats were randomly divided into control (n= 10), AIMI (n=20) and AIMI-recovery (n= 10) groups. According to the reaction state (EB-dye extravasation), each group was further divided into resting state (control), sensitized state (appearance of extravasated EB points), recovery state (disappearance of the extravasated EB points), non-sensitization (NS, no extravasated EB points) state and NS recovery state. The AIMI model was induced by perfusion of 2. 5% mustard oil into the colorectum via a thin tube. Evans blue dye was injected into the caudal vein 4 h after AIMI modeling. The distribution of plasma extravasated EB dye points at the skin of the lower limbs was observed. The C-fiber discharge of the separated ipsilateral sciatic nerve was induced by electrical stimulation of the EB-extravasated acupoints and non-acupoint at the threshold and double-fold threshold using an electric stimulator and recorded using a bicelectric amplifier-computer system. RESULTS: In AIMI rats, the extravasated EB-dye points were found to overlap the "Xiqian" and "Zusanli" (ST 36)-"Shangjuxu"(ST 37) regions. Moreover, the thresholds of C-fiber discharges induced by electrical stimulation of "Xiqian" and "Zusanli" (ST 36)-"Shangluxu"(ST 37) regions were significantly lower than those of the regions without extravasated EB dye acupoint and non-acupoint(P<0. 01, P<0. 05). The numbers of C-fiber discharges evoked by 2-fold threshold electro-stimulation at the "Xiqian" and "Zusanli" (ST 36)-"Shangjuxu" (ST 37) regions were obviously more than those of stimulation of non-acupoint which were experiencing sensitized state(P<0. 01, P<0. 05). CONCLUSION: In rats with acute colorectal mucosal injury, electrical stimulation of the acupoints where the extravasated EB-dye points appear may produce an obvious increase of C-fiber discharges under lower electro-stimulation threshold, suggesting a larger action of the sensitized acupoint.

Effect of stimulating acupoint Guanyuan (CV 4) on lower back pain by burning moxa heat for different time lengths: a randomized controlled clinical trial.

OBJECTIVE: To investigate the effect of different heat-stimulating time lengths on lower back pain. METHODS: Forty participants were randomly assigned to four groups of various heating time lengths. The short heating time length group (SL), moderate heating time length group (ML), and long heating time length group (LL) respectively received 15, 30, and 60 min of moxibustion therapy stimulating the acupoint Guanyuan (CV 4). The conventional acupuncture group (CA) received needle acupuncture treatment as a control group. The participants were treated continuously over a 2-week treatment period for a total of 10 sessions, with five sessions given per week. Participants were assessed weekly by blinded assessors,using the visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ). RESULTS: The VAS and RMQ scores reduced in all four groups during treatment. There were significant differences in VAS scores (P < 0.01) and RMQ scores (P < 0.01) between before treatment and after 2 weeks of treatment in the LL group. After treatment, the LL group reported significantly lower VAS scores compared with the CA group, ML group, and SL group (P < 0.05). CONCLUSION: The long and moderate lengths of heat-stimulating time of 30 and 60 min may be more effective for relieving lower back pain than that of short stimulating time lengths.

Effect of acupuncture anesthesia on acne vulgaris of pricking-bloodletting cupping: a single-blind randomized clinical trail.

OBJECTIVE: To evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu (LI 4) and Quchi (LI 11) might have an additional therapeutic benefit. METHODS: Thirty-eight patients were recruited and randomized into a control group and an intervention group with a single-blind (observer-blind) method. The control group was treated by pricking-bloodletting cupping at Dazhui (GV 14)-and the studied group by pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11). Both groups were treated twice weekly for 6 weeks. The analgesic and therapeutic effects of acupuncture were evaluated on a visual analog scale (VAS) and global acne grading system (GAGS), respectively. RESULTS: There were differences in the VAS scores of pain on pricking and in the pricked area, and the duration of pain between the groups. After 12 treatments, there was a significant reduction in GAGS scores from baseline in both groups, but there was no significant difference between the groups. CONCLUSION: Acupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11) is an effective means of alleviating the pain of pricking-bloodletting cupping and reducing the duration of pain in the treatment area. Pricking-bloodletting cupping at Dazhui (GV 14) improves the skin lesions of patients with moderate acne vulgaris, but acupuncture anesthesia does not appear to have an additional therapeutic effect.