Acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) in patients with insomnia: study protocol for a randomised controlled trial.

INTRODUCTION: Insomnia affects physical and mental health due to the lack of continuous and complete sleep architecture. Polysomnograms (PSGs) are used to record electrical information to perform sleep architecture using deep learning. Although acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) could not only improve sleep quality, solve anxiety, depression but also ameliorate poor sleep habits and detrimental cognition. Therefore, this study will focus on the effects of electroacupuncture combined with CBT-I on sleep architecture with deep learning. METHODS AND ANALYSIS: This randomised controlled trial will evaluate the efficacy and effectiveness of electroacupuncture combined with CBT-I in patients with insomnia. Participants will be randomised to receive either electroacupuncture combined with CBT-I or sham acupuncture combined with CBT-I and followed up for 4 weeks. The primary outcome is sleep quality, which is evaluated by the Pittsburgh Sleep Quality Index. The secondary outcome measures include a measurement of depression severity, anxiety, maladaptive cognitions associated with sleep and adverse events. Sleep architecture will be assessed using deep learning on PSGs. ETHICS AND DISSEMINATION: This trial has been approved by the institutional review boards and ethics committees of the First Affiliated Hospital of Sun Yat-sun University (2021763). The results will be disseminated through peer-reviewed journals. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters. TRIAL REGISTRATION NUMBER: CTR2100052502.

Electroacupuncture for Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Background: Previous studies have shown that electroacupuncture (EA) has a positive effect on motor and sensory function in patients with spinal cord injury (SCI). This review evaluated the effectiveness of EA for improvement in activities of daily living in patients with SCI. Methods: We searched the Cochrane Library, PubMed, Web of Science, CNKI, WanFang Data, and VIP databases using a search strategy according to the guidelines of the Cochrane Handbook for Systematic Review of Interventions up to 30th September 2020. Only randomized controlled trials (RCTs) of EA in patients with SCI were included. We analyzed the data using RevMan (version 5.3) and graded the quality of evidence using GRADE profiler 3.6.1. Results: This meta-analysis included 10 RCTs with 712 patients. Three studies revealed that the functional independence measure score for SCI patients in the EA group was higher than that in the control group (mean difference [MD] = 13.46, 95% CI: 8.00 to 18.92, P < 0.00001). Five studies showed that the modified Barthel index in the EA group was higher than that in the control group (MD = 6.92, 95% CI: 4.96 to 8.89, P < 0.00001). Five studies showed that the American Spinal Injury Association-motor score (ASIA-motor score) in the EA group was higher than that in the control group (standard MD = 0.96, 95% CI: 0.75 to 1.18, P < 0.00001). Three studies reported the ASIA-tactile and pain scores and also reported that the scores in the EA group were higher than those in the control group, with high homogeneity (tactile I2 = 86%, P = 0.0008; pain I2 = 54%, P = 0.11). The quality of evidence for the use of EA for improvement in motor and sensory function in SCIs was moderate according to the GRADE system. Conclusion: This review suggested that EA improves activities of daily living and motor function in patients with SCI, with a moderate level of evidence.

Electroacupuncture promotes the survival and synaptic plasticity of hippocampal neurons and improvement of sleep deprivation-induced spatial memory impairment.

AIMS: This study aimed to investigate whether electroacupuncture (EA) promotes the survival and synaptic plasticity of hippocampal neurons by activating brain-derived neurotrophic factor (BDNF)/tyrosine receptor kinase (TrkB)/extracellular signal-regulated kinase (Erk) signaling, thereby improving spatial memory deficits in rats under SD. METHODS: In vivo, Morris water maze (MWM) was used to detect the effect of EA on learning and memory, at the same time Western blotting (WB), immunofluorescence (IF), and transmission electron microscopy (TEM) were used to explore the plasticity of hippocampal neurons and synapses, and the expression of BDNF/TrkB/Erk signaling. In vitro, cultured hippocampal neurons were treated with exogenous BDNF and the TrkB inhibitor K252a to confirm the relationship between BDNF/TrkB/Erk signaling and synaptic plasticity. RESULTS: Our results showed that EA mitigated the loss of hippocampal neurons and synapses, stimulated hippocampal neurogenesis, and improved learning and memory of rats under SD accompanied by upregulation of BDNF and increased phosphorylation of TrkB and Erk. In cultured hippocampal neurons, exogenous BDNF enhanced the expression of synaptic proteins, the frequency of the postsynaptic currents, and the phosphorylation of TrkB and Erk; these effects were reversed by treatment with K252a. CONCLUSIONS: Electroacupuncture alleviates SD-induced spatial memory impairment by promoting hippocampal neurogenesis and synaptic plasticity via activation of BDNF/TrkB/Erk signaling, which provided evidence for EA as a therapeutic strategy for countering the adverse effects of SD on cognition.

Efficacy of thermotherapy for herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis.

BACKGROUND: Herpes zoster (HZ), is a painful skin rash disease with cutaneous symptoms and acute zoster-associated pain (ZAP). Postherpetic neuralgia (PHN), as the most frequent sequela of HZ, can persist a long time. Both HZ and PHN may significantly impact the quality of life and made great economical afford to affected patients. Its optimal treatment on HZ and PHN is still an urgent problem. In China, thermotherapy, including moxibustion and fire needle, is widely used because they can quickly promote the recovery of shingles and reduce the occurrence of PHN. Thermotherapy can also reduce pain intensity, relieve anxiety, and improve quality of life of PHN. Based on the current literatures, the effect and safety of thermotherapy will be systematically evaluated to provide appropriate complementary therapies for HZ and PHN. METHODS: Studies search for eligible randomized controlled trials (RCTs) that use thermotherapy including fire needle and moxibustion for HZ or PHN from the following databases: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), Technology Periodical database (VIP), and Wanfang database. Language restrictions for retrieving literature are English and Chinese. Their data extraction will be done by 2 researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I2 > 50%). RESULTS: This meta-analysis will provide an authentic synthesis of the thermotherapy's effect on HZ and PHN, including incidence of postherpetic neuralgia and adverse events. DISCUSSION: The findings of the review offer updated evidence and identify whether thermotherapy can be an effective treatment for HZ and PHN for clinicians. REGISTRATION NUMBER: INPLASY2020110009.

Evaluation of Reporting Quality in Randomised Controlled Trials of Acupuncture for Acute Herpes Zoster by the CONSORT Statement and STRICTA Guidelines.

OBJECTIVE: To explore the methods for improving the reporting quality of randomised controlled trials (RCTs) on acupuncture through evaluating the reporting quality in RCTs of acupuncture for acute herpes zoster by the CONSORT statement and STRICTA guidelines. METHODS: English and Chinese databases were searched from database creation until October 2018 and updated to July 2019. The basic characteristics and methodological quality of the literatures included were evaluated based on the CONSORT statement and the STRICTA guidelines. Descriptive statistical analysis was used in this study. The agreement between the two researchers of all items was calculated by Cohen's kappa statistics. RESULTS: A total of 40 RCTs were included. Based on the CONSORT statement, items "Background," "Randomised" in the title or abstract," "Statistical methods," and "Outcomes and estimation" were good reporting, with positive rates >80%. However, the quality of reporting in items "Sample size," "Allocation concealment," "Implementation," "Blinding," "Flow chart," "Intent-to-treat analysis," "Ancillary analyses," and "Clinical Trials Register" was very poor, with positive rates <10%. Based on the STRICTA guidelines, good reporting existed in items "Acupuncture rational," "Points used," "Needle stimulation," "Needle retention time," "Course of treatment," "Control intervention," and "Treatment frequency," with positive ratings >80%. The reporting quality of items "Numbers of needles inserted," "Depth of insertion," "Responses elicited," and "Practitioner background" was lower, with positive rates <50%. The agreement of most items was judged as moderate, substantial, or good. CONCLUSION: The reporting quality of RCTs in acupuncture for acute HZ is generally inadequate. It is necessary that researchers and journal editors learn and raise the adoption of the CONSORT statement and STRICTA guidelines to enhance the reporting quality of the RCTs in acupuncture.

Assessing the reporting quality in randomized controlled trials of acupuncture for postherpetic neuralgia using the CONSORT statement and STRICTA guidelines.

BACKGROUND: This study evaluates the reporting quality of randomized controlled trials (RCTs) on acupuncture use for the treatment of postherpetic neuralgia and explores related factors. METHODS: The following six databases PubMed, Embase, Cochrane Library, VIP, CNKI, and SinoMed, were systematically searched from their inception to December 2018. RCTs using acupuncture as an intervention for postherpetic neuralgia were selected and incorporated in this study. The reporting quality was assessed based on the CONSORT statement and the STRICTA guidelines. Regression analyses were also conducted on pre-specified study characteristics searching for factors associated with reporting quality. RESULTS: A total of 137 RCTs were included in this study. The CONSORT based median OQS was 12 (minimum 3, maximum 29). Of the items comprised in the statement, ten were sufficiently reported (reported in over 70% of trials). The remaining fifty-five items were poorly reported (reported by fewer than 5% of trials). The STRICTA based median OQS was 9 (minimum 2, maximum 15). The results showed that eight of the comprised items were well reported (reported in over 70% of trials), and only three were incompletely reported (reported in fewer than 20% of trials). Based on the CONSORT statement related analysis, a post-2010 publication (ß coefficient 2.394, 95% confidence interval [CI] 1.168-3.620) and funding (ß coefficient 4.456, 95% CI: 3.009-5.903) represented independent and significant predictors of a high overall reporting quality. However, only a funding source (ß coefficient 1.305, 95% CI 0.219-2.391) was associated with an increased OQS based on STRICTA analysis. CONCLUSION: The findings indicated that RCTs on acupuncture for PHN generally had a sub-optimal reporting quality, a situation that improved for those published after 2010 or with funding sources. Therefore, rigorous adherence to the CONSORT statement and the STRICTA guidelines should be emphasized in future studies.

Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis.

BACKGROUND: Postherpetic neuralgia (PHN) refers to pain which remains after the healing of rashes from herpes zoster. Previous literatures have shown that acupuncture has potential benefits for PHN, but evidence remains lacking. Thus, we have performed a systematic review and meta-analysis to identify the effectiveness of acupuncture in the treatment of PHN. METHODS: Six databases were searched for randomized controlled trials (RCTs) to assess the effects of acupuncture on PHN. After selecting the studies, extracting the data, and assessing study quality, meta-analysis was performed on several of the studies with RevMan 5.3. The GRADE (Grading of Recommendations Assessment Development and Evaluation) system was used to assess the overall quality of the evidence. RESULTS: Acupuncture helps relieve pain intensity (standardized mean difference [SMD]: -1.78, 95% confidence interval [CI]: -2.36 to -1.21). For other intervention types, electroacupuncture (SMD: -1.28, 95% CI: -2.51 to -0.05), fire needle (SMD: -2.23, 95% CI: -2.62 to -1.84), bloodletting and cupping (SMD: -2.46, 95% CI: -2.95 to -1.97) have better effects on pain intensity relief. To date, no study has reported on the onset of pain relief time. The Hamilton Anxiety Scale score (SMD: -18.94, 95% CI: -37.37 to -0.52) was lower for the acupuncture group than for the control group. It was also found that acupuncture can improve quality of life (QOL) (SMD: 3.78, 95% CI: 2.50 to 5.06). The quality of evidence for acupuncture for PHN pain intensity was moderate according to the GRADE system. CONCLUSION: Acupuncture may reduce pain intensity, relieve anxiety and improve quality of life in patients with PHN. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results.

Research trends of acupuncture therapy on insomnia in two decades (from 1999 to 2018):a bibliometric analysis.

OBJECTIVES: We aimed to evaluate the global scientific output of research of acupuncture on insomnia and explore the hotspots and frontiers from 1999 to 2018, by using bibliometric methods. METHODS: Articles about acupuncture therapy on insomnia were retrieved from the Web of Science Core Collection (WoSCC). We used Citespace V to analyze publication years, journals, countries, institutions, authors and cited authors. We plotted the reference co-citation network and key words to analyze the research hotspots and trends. RESULTS: Until August 31, 2018 31, 2018, a total of 292 records in acupuncture therapy on insomnia research were identified from 1999 to 2018. The number and rate of the annual publication gradually increased. Respectively, SLEEP and J NEUROPSYCH CLIN N (journal of neuropsychiatry and clinical neurosciences) ranked the first in the frequency and centality of cited joural. Among countries, China ranked highest in the number of publications and the top 3 institutes were in Hong Kong. Chung KF and Yeung WF were the most productive authors and YEUNG WF ranked the first in the cited authors. In the ranking of frequency and in cited reference, the first was the article published in by CAO HJ and KALAVAPALLI R. 'Randomized controlled trial' had a high frequncy and centrality in keyword. CONCLUSIONS: A higher degree of acceptance acupuncture was obtained in the Asian. Recently, systematic reviews and clinic trials most focused on electrocacupuncture and acupressure among the acupuncture therapy.

[Influence of fire needle stimulation at Sihua acupoints on performance status and Th1/Th2 ba-lance in the patients with advanced non-small cell lung cancer after chemotherapy].

OBJECTIVE: To observe the influence of fire needle stimulation at Sihua acupoints combined with chemotherapy on Th1/Th2 imbalance and performance status in the patients with advanced non-small cell lung cancer (NSCLC) so as to investigate its immunological mechanism underlying the improvement of lung cancer. METHODS: Sixty eligible NSCLC inpatients were randomly assigned to a control group and a treatment group (n＝30 cases in each one). The control group was treated with paclitaxel combined with cisplatin (TP) or gemcitabine plus cisplatin (GP) of chemotherapy, and the treatment group was treated with fire needle stimulation at Sihua acupoints (i.e. bilateral Geshu [BL17] and Danshu [BL19]) and with chemotherapy simultaneously. The fire needle stimulation was given once daily for successive 7 days. One day before and 14 days after chemotherapy, the patients' blood samples were collected for assaying the concentrations of Th1 related cytokines (IL-2, IFN-γ) and Th2 related cytokines (IL-4, IL-10) with ELISA. The Karnofsky performance status (KPS) score was used to assess the patient's physical conditions before and 14 days after chemotherapy. RESULTS: Compared with the results before treatment, the levels of IL-2 and IFN-γ concentration increased obviously and the levels of IL-4 and IL-10 concentration as well as KPS score decreased significantly in the treatment group and the control group after treatment (all P<0.01). After treatment, compared with the control group, the levels of IL-2 and IFN-γ concentration in the treatment group increased and the levels of IL-4 and IL-10 concentration decreased (P<0.01); and the decrease amplitude of KPS score in the treatment group was less than that in the control group (P<0.01). CONCLUSION: Fire needle stimulation at Sihua acupoints improves the function of Th1 cells, and reduces the function of Th2 cells. As a result, the balance between Th1 and Th2 has been modified and the deterioration degree of the performance status been alleviated in the patients after chemotherapy.

[Shallow Fire-needle Acupuncture Stimulation Plus Cupping Relieves Neuralgia and Down-regulates Serum Substance P Level in Patients with Acute Herpes Zoster].

OBJECTIVE: To observe the influence of repeated shallow fire-needle acupuncture stimulation plus cupping on local neuralgia and serum substance P(SP)content in patients with acute herpes zoster (AHZ). METHODS: A total of 60 cases of AHZ patients were randomly divided into control (medication) group and treatment (medication plus fire-needle) group (n＝30 in each). Patients of both groups were ordered to take Famciclovir (0.25 g/time, three times a day) and Mecobalamin (0.5 g/time, three times a day) orally for 7 days. In addition, patients of the treatment group were also treated by repeated shallow fire-needle stimulation and cupping, once a day for 7 days. Before and after the treatment, the patient's pain severity was assessed using visual analogue scale (VAS) and serum SP concentration was measured using ELISA. RESULTS: After the treatment, the VAS scores and serum SP concentrations in both groups were significantly decreased in comparison with those of their own pre-treatment (P<0.01), and were significantly lower in the treatment group than in the control group(P<0.01). There was a highly positive correlation between the decreased VAS score and serum SP content in the treatment group(P<0.01). CONCLUSION: Repeated shallow fire-needle stimulation plus cupping can accelerate the relief of local neuralgia in AHZ patients, which may be associated with its effect in down-regulating serum SP level.

[Effects of fire needle on quality of life in patients with chemotherapy of non-small cell lung cancer].

OBJECTIVE: To observe the effect difference between fire needle combined with chemotherapy and fire needle on quality of life in patients with chemotherapy of non-small cell lung cancer (NSCLC). METHODS: With randomized controlled method, a total of 60 patients with chemotherapy of NSCLC were divided into an observation group (fire-needle plus chemotherapy group) and a control group (chemotherapy group), 30 cases in each one. The observation group was treated with fire needle at Sihua points which consisted of Geshu (BL 17) and Danshu (BL 19), combined with chemotherapy selected from TP (paclitaxel+cisplatin)/GP (gemcitabine+cisplatin)/DP (docetaxel+cisplatin)/NP (vinorelbine+cisplatin) by the oncologist according to patients' condition. The fire needle was given once a day for 7 days, and chemotherapy was given for 21 days. The control group was treated with chemotherapy alone for 21 days. Before and after treatment, response evaluation criteria in solid tumors (RECIST) was applied for evaluation, and Karnofsky performance status (KPS) and functional assessment of cancer therapy-lung (FACT-L) were applied for evaluation of quality of life in patients with chemotherapy of NSCLC. RESULTS: The effective rate was 20.0% (6/30) and the stability rate was 73.3% (22/30) in the observation group, which were insignificantly higher than 16.7% (5/30) and 63.3% (19/30) in the control group, respectively (both P>0.05). The KPS after treatment was lower than that before treatment in the control group (P<0.05); the KPS after treatment was similar to that before treatment in the observation group (P>0.05); the KPS in the observation group after treatment was higher than that in the control group (P<0.05). The total score and each item score of FACT-L after treatment were higher than those before treatment in the observation group (all P<0.05); the physical score and emotional score of FACT-L after treatment were higher than those before treatment in the control group (both P<0.05); the total score, physical score, functional score and subscale score in the observation group were significantly higher than those in the control group after treatment (all P<0.05), while the social/family score and emotional score in the observation group were insignificantly higher than those in the control group (both P>0.05). The differences of KPS total score before and after treatment in the two groups had moderate positive correlation with differences of FACT-L total score (P<0.01). CONCLUSION: Fire needle can improve quality of life in patients of NSCLC chemotherapy.

[Professor LIN Guohua's experience of gold implantation at acupoint for rheumatoid arthritis].

Based on the pathogenesis and symptom of rheumatoid arthritis (RA), professor LIN Guohua's unique opinion and method for RA in clinical treatment are summarized and analyzed. In the opinion of Professor Lin, RA is considered as "Jinbi" and "Gubi" in TCM, which is caused by deficient root with superficial excess. Based on the symptoms of RA, attention should be focused on lung-kidney diagnosis and treatment, and gold and catgut implantation at acupoint can be mutually combined, which is aimed to provide a special and effective method for clinical treatment of RA.