[Study on mechanisms of acupuncture underlying improvement of CUMS-induced depression in rats based on tandem mass spectrometry proteomics technique].

OBJECTIVE: To investigate the possible mechanism of "regulating qi and relieving depression" acupuncture underlying improvement of chronic unpredictable mild stress (CUMS)-induced depression in rats by using Tandem Mass Tags(TMT) quantitative proteomics technique. METHODS: Thirty-six male SD rats were randomly divided into control, model and acupuncture groups, with 12 rats in each group. The depression model was induced by CUMS stress for 21 days. After the depression model was successfully established, the rats in the acupuncture group received manual acupuncture stimulation at "Baihui" (GV20) and "Yintang" (GV24+) for 20 min, once daily for 21 days. Open field test, sugar water preference test and forced swimming test (FST) were used to evaluate the behavioral changes. TMT quantitative proteomics was used to obtain differential proteins in the hippocampus tissue and related signaling pathways enrichment was analyzed, followed by verifying differential protein pathways by using Western blot and immunofluorescence methods. RESULTS: Behavior tests showed that on the 21st and 42nd days, the horizontal crossing times, walking distance and percentage of sugar water consumption were significantly decreased (P<0.05), while the immobility time of FST was obviously increased (P<0.05) in the model group relevant to the control group. After acupuncture intervention, the horizontal crossing times, walking distance and percentage of sugar water consumption were significantly increased (P<0.05), and the immobility time was apparently decreased (P<0.05) in the acupuncture group relevant to the model group. The TMT quantitative proteomics of hippocampus tissue displayed that of the 71 differential proteins (model group vs control group), 32 was down-regulated and 39 up-regulated in the model group; and among the above 71 differential proteins, there were 20 differential proteins between acupuncture group and model group, 15 down-regulated and 5 up-regulated in the acupuncture group (vs the model group). The expression of Mapk8ipl was up-regulated in the model group (vs the control group) and down-regulated in the acupuncture group (vs the model group). GO and KEGG enrichment analysis showed that these acupuncture-related differential proteins mainly involve the regulation of blood coagulation system, MAPK signaling pathway, etc. We selected the MAPK/JNK signaling pathway related to depression for verification. Western blot showed that the expression levels of c-JUN and phosphorylated c-JUN terminal kinase (p-JNK) proteins in the hippocampus were up-regulated in the model group relevant to the control group (P<0.05); while the expression levels of c-JUN and p-JNK proteins in the hippocampus were down-regulated in the acupuncture group relevant to the model group (P<0.05). The results of immunofluorescence showed that the mean fluorescence intensity of c-JUN and p-JNK in hippocampal CA1, CA3 and DG regions was increased in the model group relevant to the control group (P<0.05), while the mean fluorescence intensity of c-JUN and p-JNK in hippocampal CA1, CA3 and DG regions was obviously lower in the acupuncture group than in the model group (P<0.05). CONCLUSION: Acupuncture for "regulating qi and relieving depression" can significantly improve depression-like behavior in CUMS-induced depression model rats, which involves multiple targets and multiple pathways, including MAPK/JNK signaling.

[Tiaoqi Jieyu acupuncture for treatment-resistant depression: a randomized controlled trial].

OBJECTIVE: To observe the effect of Tiaoqi Jieyu (regulating qi and relieving depression) acupuncture on the clinical symptoms of treatment-resistant depression (TRD), and to explore the relationship between the acupuncture pain sensitivity and symptom's improvement. METHODS: A total of 78 patients with TRD were randomly divided into an observation group (39 cases, 3 cases dropped off) and a control group (39 cases, 4 cases dropped off). The patients in the control group were treated with medications according to the treatment plan of psychiatrists (at least one medication was 5-hydroxytryptamine reuptake inhibitor). On the basis of the control group, the patients in the observation group were treated with Tiaoqi Jieyu acupuncture, and Baihui (GV 20), Yintang (GV 24+), Yanglingquan (GB 34), Taichong (LR 3), Hegu (LI 4), Neiguan (PC 6), Yinlingquan (SP 9) and Zusanli (ST 36), etc. were selected. The acupuncture was given three times a week. Both groups were treated for 8 weeks. After 8-week treatment, the response rate of Hamilton depression scale-24 (HAMD-24) score after was evaluated in the two groups. The scores of HAMD-24 and Hamilton anxiety scale (HAMA) were compared between the two groups before treatment, after 4, 8-week treatment and 12 weeks after treatment (follow-up). After the first treatment and 8-week treatment, the visual analogue scale (VAS) score in the observation group was evaluated, and the correlation between VAS score after the first treatment and HAMD-24 score before treatment, between VAS score after the first treatment and the course of disease in the observation group was analyzed, and the correlation between difference of VAS after 8-week treatment and after the first treatment and difference of HAMD-24 score before treatment and after 8-week treatment was analyzed. RESULTS: After 8-week treatment, the response rate of HAMD-24 score in the observation group was 52.8% (19/36), higher than 17.1% (6/35) in the control group (P<0.001). Compared before treatment, the scores of HAMD-24 and HAMA in the two groups were decreased after 4-week treatment, 8-week treatment and in follow-up (P<0.05), and those in the observation group were superior to the control group (P<0.05). After 8-week treatment, the acupuncture pain VAS score in the observation group was (5.28±2.13) points, which was higher than (3.33±1.62) points after the first treatment (P<0.001). There was a negative correlation between VAS score after the first treatment and HAMD-24 score before treatment in the observation group (r =-0.486, P=0.003); there was no correlation between acupuncture pain VAS score after the first treatment and the course of disease in the observation group (P>0.05). After 8-week treatment, there was a positive correlation between the difference of VAS score and the difference of HAMD-24 score in the observation group (r =0.514, P=0.001). CONCLUSION: Tiaoqi Jieyu acupuncture could improve the depression and anxiety in patients with TRD, and the symptom's improvement is related to the recovery of acupuncture pain sensitivity.

Effect of Electroacupuncture Based on ERAS for Preoperative Anxiety in Breast Cancer Surgery: A Single-Center, Randomized, Controlled Trial.

BACKGROUND: To evaluate the effect of electroacupuncture (EA) based on enhanced recovery after surgery on preoperative anxiety in patients undergoing breast cancer surgery. PATIENTS AND METHODS: This was a single-center, randomized, controlled, single-blind clinical trial. Between December 2018 and 2019, 144 female undergoing breast conserving surgery were assigned to conventional (A), preoperative EA (B), intraoperative EA (C), and combination of preoperative and intraoperative EA (D) groups. Primary outcome was the self-rating anxiety scale. Secondary outcomes included visual analogue scale, quality of recovery 40, postoperative complications, and acupuncture-related adverse reactions. RESULTS: 141 patients completed the trial. Groups B and D self-rating anxiety scale were significantly lower than A and C (P < .01); the sleep quality was significantly better (P < .01). The incidence of nausea at 6 hours postoperatively was significantly lower in group D than other groups (P < .007); the incidence of vomiting at 6 hours postoperatively was better than group A (P < .007). visual analogue scale at 24 hours postoperatively was significantly different between groups A, B, and D (P < .01). Quality of recovery 40 total score at 24 hours postoperatively in group D was significantly higher than A and B (P < .05). The 72-hour postoperative emotional state was most significantly improved in group D (P < .05), while groups B and C showed interactive effect (P < .05). CONCLUSION: Preoperative EA alleviated anxiety in the preoperative waiting area, and improved sleep quality. Combination of preoperative and intraoperative EA may be more effective in improving postoperative quality of life. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800019979. Registered on December 10, 2018. (http://www.chictr.org.cn/edit.aspx?pid=27653&htm=4).

Electroacupuncture treatment ameliorated the long-term cognitive impairment via activating eNOS/NO pathway and related Aß downregulation in sepsis-survivor mice.

OBJECTIVE: Sepsis is a major challenge in intensive care unit worldwide and the septic survivors are left with long-term cognitive deficits. This work aims to explore the effects of electroacupuncture (EA) on long-term cognitive function and its underlying mechanism in sepsis-survivor mice. METHODS: Sepsis was induced by cecal ligation and puncture in C57BL/6 male mice. Seven days post-surgery, sepsis-survivor mice were treated with EA or nonacupoint EA for 17 days twice daily. Then, cognitive function was evaluated by Morris water maze task. The hippocampus tissue were collected from the mice at 30 days post-surgery. The level of nitric oxide and the expression of endothelial nitric oxide (eNOS), phospho-eNOS (p-eNOS), and amyloid ß-peptide (Aß) were measured. RESULTS: Compared with the sham-operated control, sepsis-survivors had significant cognitive deficits evidenced by the increased time of escape latency and reduced crossing number in Morris water maze task, as well as lower NO and p-eNOS level and higher Aß level. EA treatment at GV20 and ST36 acupoints but not at a nonacupoint improved the cognitive function, increased the NO and p-eNOS level, and decreased Aß generation; while eNOS inhibitor (l-NAME) undermined the efficacy of EA treatment. CONCLUSION: In conclusion, repeated EA treatment could ameliorate the long-term cognitive impairment via manipulating the expression of p-eNOS and related Aß in sepsis-survivor mice.

Acupuncture for post-stroke depression: a systematic review and meta-analysis.

BACKGROUND: Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. METHODS: An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. RESULTS: A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, - 5.08 [95% CI, - 6.48 to - 3.67], I2 = 0%), (MD, - 9.72 [95% CI, - 14.54 to - 4.91], I2 = 65%) and (MD, - 2.72 [95% CI, - 3.61 to - 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, - 0.43 [95% CI, - 1.61 to 0.75], I2 = 51%), (MD, - 3.09 [95% CI, - 10.81 to 4.63], I2 = 90%) and (MD, - 1.55 [95% CI, - 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. CONCLUSIONS: The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

Can acupuncture therapy reduce preoperative anxiety? A systematic review and meta-analysis.

BACKGROUND: Acupuncture therapy has shown promise for effectively relieving preoperative anxiety. Nevertheless, previous findings from randomized controlled trials (RCTs) are inconsistent and must be examined in detail. OBJECTIVE: This study systematically evaluates the efficacy and safety of acupuncture therapy for preoperative anxiety as well as the quality of evidence supporting this application. SEARCH STRATEGY: The China National Knowledge Infrastructure Database, Wanfang Data Journal Database, Chinese Biomedical Literature Database, Chongqing VIP, Embase, PubMed and Cochrane Library Databases were queried from their inception to 19, February 2020, using keywords such as "acupuncture therapy," "preoperative" and "anxioty." Manual searches expanded the search breadth and included conference abstracts and other reference lists. INCLUSION CRITERIA: RCTs were included in the current study if they contained a comparison between a group of anxiety patients that received acupuncture therapy and a control group that received sham acupuncture. DATA EXTRACTION AND ANALYSIS: Literature was reviewed, and various articles were selected using the NoteExpress 3.2.0 software. Two researchers independently screened and extracted data and evaluated the risk of bias in the included studies. The RevMan 5.3 software was used for data aggregation and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) assessment was used to evaluate the quality of the study outcomes. RESULTS: Twelve studies were included in the review, containing a total of 916 patients. Meta-analysis showed that, compared with the control group, patients who received acupuncture therapy had reduced State-Trait Anxiety Inventory Scale (STAI-S) score (mean difference [MD] = -9.07, 95% confidence interval [CI] [-13.19 to -4.96], P < 0.0001) and Visual Analogue Scale (VAS) score (MD = -1.37, 95% CI [-2.29 to -0.45], P = 0.003). However, for the Hamilton Anxiety Scale (HAMA) score, there was no difference between the two groups (MD = -3.98, 95% CI [-12.89 to 4.92], P = 0.38). Further, the GRADE assessment demonstrated that the STAI-S was of moderate quality, the VAS of low quality and the HAMA of very low quality. CONCLUSION: Acupuncture therapy may be able to decrease anxiety in preoperative patients, but the results need to be further verified due to the small sample sizes and the low quality of evidence to date.

A Case Study on Preoperative Acupuncture in Reducing the Risk of Operation.

The present study investigated the role of acupuncture as a pretreatment prior to surgery. The 72-y-old female was diagnosed with bilateral breast cancer and suffered from severe anxiety before the operation. The blood pressure of the patient was elevated due to anxiety. With concern regarding the potential risk of planned surgery, the operation was cancelled. Alternatively, acupuncture was used to reduce her blood pressure and relieve the anxiety. Later on, the patient was examined by an anesthetist, who confirmed that the operation could be carried out as planned. Thus, acupuncture is a promising add-on treatment that may stabilize the condition of patients during surgery.

[Mechanism of acupoint transcutaneous electric stimulation on analgesic anesthesia in the patients undergoing general anesthesia anorectal operation].

OBJECTIVE: To observe the regulatory effects of acupoint electric stimulation on the analgesic substances and the relevant indices of nerve-immunity-endocrine system in the patients undergoing general anesthesia anorectal operation. METHODS: One hundred and fifty-six patients undergoing hemorrhoids and anal fistula operation were randomized into three groups, 146 cases were included in the analysis. In the No.1 group (48 cases), the conventional intravenous general anesthesia was applied. In the No.2 group (50 cases), besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Neiguan (PC 6), Shenmen (HT 7), Shangliao (BL 31) and Ciliao (BL 32). operation in the No.2 and No.3 groups were lower apparently than that in the No.1 group (P<0.05, P<0.01). CONCLUSIONS: During the general anesthesia anorectal operation, the acupoint transcutaneous electric stimulation achieves analgesic anesthesia through effectively promoting the release of body analgesic substance and reducing the stress level in the operation. With the comprehensive acupoint selection as Neiguan (PC 6) and Shenmen (HT 7) and the local acupoints, the therapeutic effects are better in comparison with the simple selection of local acupoints. In the No.3 group (48 cases), besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Shangliao (BL 31) and Ciliao (BL 32). The electric stimulation was maintained till the end of operation. The patients' saliva was collected 0.5 h before operation and 1 h after operation separately. The indices that reflect the body pain regulation and nerve-immune-endocrine secretion were detected, such as opiophin protein (OPI), secretory immunoglobulin A (SIgA), saliva amylase (sAA), cortisol (Cor) and tumor necrosis factor α (TNF-α). The pain degree was observed 1 h after operation. RESULTS: In the No.2 group, OPI after operation was higher than that before operation (P<0.05). The difference value of OPI in the No.2 group was higher apparently than that in the No.1 group and the No.3 group (both P<0.05). SIgA after operation was higher than that before operation in the No.1 group (P<0.05). The difference values of SIgA, sAA, Cor in the No.2 group were lower apparently than those in the No.1 group (P<0.05, P<0.01). TNF-αbefore and after operation and its difference value among the groups were not significant statistically (all P>0.05). The pain degrees in 1 h after.

[Analgesic effect of acupuncture compound anesthesia in functionality nasal endoscopic sinus surgery].

OBJECTIVE: To verify the analgesic effect of acupuncture compound anesthesia in functionality nasal endoscopic sinus surgery (FNES). METHODS: Ninety patients undergoing FNES were randomly divided into three groups. Group A was treated with routine local anesthesia, and group B and C were treated with electroacupuncture at Yintang (EX-HN 3) and Yingxiang (LI 20) for 30 min before local anesthesia. Group B received routine local anesthesia, and group C received decrement local anesthesia. The dosage of narcotic, modified fingers pain scores and postoperative satisfaction scores were observed in three groups. RESULTS: The operative dosage of decicaine was (118.33 +/- 26.21) mg in group A, (100.83 +/- 4.56) mg in group B, and (71.33 +/- 8.90) mg in group C, with significant differences among the three groups (all P < 0.01), the lowest dosage was used in group C and the highest dosage in group A. The fingers pain scores of group B and C were both lower than that of group A (both P < 0.01), and the postoperative satisfaction scores of group B and C were both higher than that of group A (both P < 0.01). CONCLUSION: Acupuncture compound anesthesia can effectively alleviate the pain, decrease the dosage of local anesthetic, lower the discomfortableness and be helpful for safety of the patients during sinus surgery.

[Influence of acupuncture-drug compound anesthesia with different frequency electroacupuncture on immune function in patients undergoing pneumonectomy].

OBJECTIVE: To explore different frequency electroacupuncture in acupuncture-drug compound anesthesia on analgesic effect and immune function in the pulmonary resection patients in order to recommend the best electroacupuncture frequency in acupuncture-drug compound anesthesia. METHODS: One hundred and sixty-three patients scheduled for pneumonectomy were randomly divided into group A (n = 31), B (n = 34), C (n = 32), D (n = 34) and E (n = 32). Houxi (SI 3), Zhigou (TE 6), Neiguan (PC 6) and Hegu (LI 4) were selected in the five groups. Group A was treated with sham acupuncture by pasting needles without needle bodies at acupoints and electroacupuncture at the needle handle, and group B with 2 Hz electroacupuncture, and group C with 2 Hz/ 100 Hz electroacupuncture, and group D with 100 Hz electroacupuncture, and group E with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation, and general anesthesia was produced in all the groups followed by 30 min electrical stimulation and the stimulation was lasted till the end of operation. The dosages of the anesthetics and the changes of surface antigen of leukomonocyte (CD3+ , CD4+ , CD8+ and CD4+/CD8+) and natural killer (NK) cell were observed at 1 day before surgery, intraoperative and 1 day after surgery. RESULTS: In comparison with group A, the dosages of Propofol in group B and D were decreased, Fentanyl in group B, D and E were decreased. CD3+ and CD4+ in 5 groups increased at first and then decreased over time (all P < 0.01), and group E and C could inhibit the decrease of CD3+ and CD4+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and D could inhibit the decrease of CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). CD4+/CD8+ in 5 groups has no change in different times (all P > 0.05), and group E and C could inhibit the decrease of CD4+/CD8+ in postoperation in comparison with that in the other three groups (all P < 0.05). NK cells of 5 groups were increased gradually in different times (all P < 0.01), with the similar regulation of NK cells (all P > 0.05). CONCLUSION: Acupuncture-drug compound anesthesia with 2 Hz and 100 Hz electroacupuncture together with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation have the best analgesic effect, and 2 Hz/100 Hz transcetaneous acupoints electrical stimulation and 2 Hz/100 Hz electroacupuncture have the best regulation of immune function. Acupuncture-drug compound anesthesia with 2 Hz/100 Hz transcetaneous acupoints electrical stimulation is recommended for that it can not only decrease the dosages of the anesthetics, but also significantly improve the immunosuppression in patients undergoing pneumonectomy.

[Discussion about acupuncture anesthesia applied to nasal operation].

In view of the characteristics of different analgesic methods applied to nasal operation, the principle of point selection in acupuncture anesthesia, the frequency of electroacupuncture and the assessment of operation, it was stated that the compound acupuncture anesthesia not only prevented from incomplete analgesia of local anesthesia, but also avoided the adverse reactions of general anesthesia in this paper. Moreover, by reducing the dose of narcotics, the unique advantage of acupuncture anesthesia could be displayed. At present, it was initially believed that a satisfactory analgesia could be achieved by acupuncture at Yingxiang (LI 2) and Yintang (EX-HN 3), with 30 Hz, continuous wave. But there were not many clinical reports on the application of acupuncture anesthesia in nasal endoscopic operation and the operation was not normalized enough. It was expected to optimize the operation procedure of nasal operation under acupuncture anesthesia and promote the clinical practice of it.

[Observation on the anti-stress effect of acupuncture-assisted anesthesia for puhnlmonary lobectomy patients].

OBJECTIVE: To observe the anti-stress effect of acupuncture-assisted anesthesia in patients undergoing pulmonary lobectomy. METHODS: A randomized, controlled, single-blind clinical trial was conducted in the present study. A total of 48 patients undergoing pulmonary lobectomy were randomized into regular general anesthesia (RGA), general anesthesia combined with 2 Hz electroacupuncture (EA) (GA+2 Hz-EA), general anesthesia combined with 2 Hz/100 Hz EA (GA+2 Hz/100 Hz-EA), and GA + 100 Hz-EA groups (n=12). EA (1-3 mA) was applied to bilateral Houxi (SI 3), Zhigou (SJ 6), Neiguan (PC 6) and Hegu (LI 4) for 30 min, followed by general anesthesia with midazolam (0.05 mg/kg), fentanyl (5 microg/kg), propofol (2 mg/kg), and vecuronium (0.1 mg/kg). The dosages of the anesthetics, heart rate (HR), systolic blood pressure (SBP), and bispectral index (BIS) of electroencephalogam during general anesthesia were recorded. Plasma adrenaline and cortisol concentrations were assayed by radioimmunoassay. RESULTS: In comparison with the RGA group, the dosages of supplementary propofol and fentanyl in both GA + 2 Hz-EA and GA + 100 Hz-EA groups,and that of propofol in the GA+2 Hz/100 Hz-EA group were decreased significantly (P < 0.05, P < 0.01). Compared to the RGA group, both HR and SBP values during trachea extubation in the GA+ 2 Hz/100 Hz-EA and GA + 100 Hz-EA groups were significantly lower (P < 0.01, P < 0.05). No significant differences were found between the GA+2 Hz/100 Hz-EA and RGA groups in the supplementary dose of fentanyl, between the GA+2 Hz-EA and RGA groups in HR and SBP values during trachea extubation, among the 4 groups in HR and SBP values before trachea extubation and in plasma adrenaline and cortisol levels (P > 0.05). CONCLUSION: Acupuncture-assisted anesthesia can decrease the dosage of general anesthetics, and effectively restrain cardiovascular stress reaction during trachea extubation in pulmonery lobectomy patients.