[Observation of the therapeutic effect on acute ankle sprain treated with surrounding needling and cold compression].

OBJECTIVE: To observe the difference in the therapeutic effect on acute ankle sprain treated with the combination of surrounding needling and cold compression in comparison of the conventional cold compression. METHODS: The patients with acute ankle sprain were randomly divided into control group (33 cases) and observation group (35 cases). In the first 3 days of treatment, the conventional cold compression was used in the control group, while the surrounding needling technique of acupuncture was combined with cold compression in the observation group. Separately, along the distal-lateral side of the leg, and the lateral sides of the heel and the dorsal part of the foot, 3 or 4 needles were inserted in each part，total 9 to 12 needles, toward the center of swelling and pain site, and distributed in a fan shape. The needles were retained for 30 min and the acupuncture therapy was delivered once daily. Since the 4th day of treatment, the hot compress and the static stretching exercise of the ankle joint were adopted in the two groups, once daily for 1 week. The visual analogue scale (VAS) score for ankle pain and ankle swelling degree were compared between the two groups before and after 3-day treatment, as well as the score of American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale was evaluated. RESULTS: After 3-day treatment, VAS score was decreased in both groups (P<0.01), and the score in the observation group was lower than that of the control group (P<0.01). Ankle swelling degree was relieved in both groups (P<0.01), and there was no significant difference between the two groups. After 1 week of treatment, the scores of AOFAS ankle-hindfoot scale were improved in both groups (P<0.01), and the score in the observation group was higher than the control group (P<0.05). CONCLUSION: Either the combined therapy of surrounding needling and cold compression or the conventional cold compression can effectively relieve pain and swelling induced by acute ankle sprain. The therapeutic effect of the combined therapy is superior to the conventional cold compression for the motor function improvement of ankle joint.

[Effects of electroacupuncture on neurological function and expressions of p-JNK and Beclin-1 in traumatic brain injury rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on neurological function, the expressions of phosphorylated c-Jun amino terminal kinase (p-JNK) and Beclin-1 in rats with traumatic brain injury (TBI), so as to explore the underlying mechanism of EA in the treatment of TBI. METHODS: A total of 64 SD rats were randomly divided into blank, sham, modeling groups, with 8 rats in the blank group and the sham group and 48 rats in the modeling group. The modified Feeney free-fall impact method was used to establish the TBI rat model. After modeling, rats of the modeling group were randomly divided into model and EA groups, which were further divided into 3 d, 7 d and 14 d subgroups with 8 rats in each group. Rats in the EA group were treated with acupuncture at "Baihui" (GV20, retained for 15 min), "Shuigou" (GV26, stabbed for 20 s), "Neiguan" (PC6) and "Zusanli" (ST36) of the right side. EA (2 Hz, 1 mA) was applied to PC6 and ST36 for 15 min. The above treatments were performed once a day, and different subgroups were continuously stimulated for 3, 7 and 14 days, respectively. The neurological impairment was evaluated by modified neurological severity score(mNSS). The pathological morphological changes and the protein expressions of p-JNK and Beclin-1 in the injured area of the brain were detected by Nissl staining and immunohistochemistry, separately. RESULTS: After modeling, the mNSS and the protein expressions of p-JNK and Beclin-1 were increased (P< 0.05) on day 3, 7 and 14 in the model group relative to the sham group. The Nissl bodies were reduced or even dissolved and neurons were seriously damaged in the model group on the 3rd day, which were mildly repaired on day 7 and 14. Following acupuncture interventions, compared with the model group, the mNSS on day 7 and 14 and the protein expressions of p-JNK and Beclin-1 on day 3, 7 and 14 were decreased (P< 0.05)in the EA group. The status of Nissl bodies and neurons in the EA group was better at all time points than that in the model group. There were no significant differences in the above indicators between the blank group and the sham group. CONCLUSION: EA can significantly improve the neurological function of TBI model rats, which may be related to its effects in down-regulating the protein expressions of p-JNK and Beclin-1 in the injured area of the brain.

[Effect of electroacupuncture on behavior and cell apoptosis of brain tissue in traumatic brain injury rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on behavior, pathomorphology and brain cell apoptosis in traumatic brain injury (TBI) rats, so as to explore its mechanisms underlying treatment of TBI. METHODS: Male SD rats were randomly divided into control (n=10), sham (n=30), model (n=30) and EA (n=30) groups, the latter three groups were further divided into 3, 7, 14 d subgroups （n=10）. TBI model was established by using a free fall brain injury striking device after exposing the local cranial bone (to induce the left parietal cerebral contusion). Twenty-four hours after modeling, EA (2 Hz, 1 mA) was applied at "Quchi"(LI11), "Neiguan"(PC6), "Zusanli"(ST36) and "Yongquan" (KI1) combined with acupuncture at "Shuigou"(GV26) and "Baihui"(GV20) for 15 min, once a day for 14 consecutive days. After 3, 7, and 14 days treatment, the behavioral function (balance, walking, nerve, and limb retraction) of the rats was evaluated. The histopathological changes of the injured brain tissue were observed by HE staining. TUNEL method was used to detect the apoptosis of cells in the brain injury area. RESULTS: After modeling, the scores of balance and walking in the model group were higher than those in the sham group (P<0.01, P<0.05), the neurological function score and the right limb retraction force were lower than those in the sham group(P<0.01). After 3 days treatment, the neurological function score and the right limb retraction force in the EA group were higher than those in the model group (P<0.05). After 7 and 14 days treatment, the scores of balance and walking function in the EA group were lower than those in the model group (P<0.05, P<0.01), while the scores of nerve function and right limb retraction force were higher (P<0.05, P<0.01). HE staining showed that modeling induced pathological changes such as the inflammatory cell infiltration, interstitial edema, necrosis, nuclear pyknosis and nuclear lysis were relatively milder in the EA group on the 7th and 14th day. Compared with the sham group, the cell apoptosis of brain injury area was higher in the model group (P<0.01); while it was lower on day 7 and 14 in the EA group in comparison with the model group (P<0.01, P<0.05). CONCLUSION: EA can improve the behavioral function, reduce the apoptosis of brain cells in the injured area, and promote the rehabilitation of craniocerebral injury.

[Current status of body position selection in acupuncture treatment].

In addition to the prone position or the supine position, some scholars have observed and discussed the therapeutic effect of acupuncture in other body positions, but their criteria are different and individual differences in body position have not been analyzed. According to the relevant discussions in The Inner Canon of Yellow Emperor and with reference to the clinical practice of acupuncture treatment, this article explores the criteria for body position selection, in order to provide guidance for clinical acupuncture treatment.

[Effect of electroacupuncture on neuronal apoptosis in rats with traumatic brain injury based on PI3K/Akt signaling pathway].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on neuronal apoptosis in rats with traumatic brain injury (TBI), and to explore the action mechanism of EA on improving the brain nerve function of TBI. METHODS: A total of 88 6-week-old SD rats were randomly divided into a sham operation group, a model group, an EA group and a LY294002+EA group, 22 rats in each group. The TBI model on the left side was established by the improved Feeney's free fall method. After modeling for 24 h, the rats in the EA group and LY294002+EA group were treated with acupuncture at "Baihui" (GV 20) for 10 min and pricking acupuncture at "Shuigou" (GV 26) for 20 s; EA was applied at "Neiguan" (PC 6) and "Zusanli" (ST 36) on the right side (discontinuous wave, 2 Hz of frequency, 1 mA of intensity) for 10 min, once a day for 3 days. After 3 days of intervention, the TUNEL method was used to detect the level of neuron apoptosis in left cerebral cortex; the Western blot method was used to detect the expression of Akt, p-Akt, Bcl-2, Bax, Cyt-C and Caspase-9 in the left cerebral cortex. RESULTS: After 3-day treatment, compared with the sham group, the number of neuronal apoptosis in the left cortex was increased in the model group (P<0.01), and the expression of Bax, Cyt-C and Caspase-9 protein was increased (P<0.01), and the expression of p-Akt/Akt, Bcl-2 was decreased (P<0.01). Compared with the model group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (P<0.01), and the expression of Bax, Cyt-C and Caspase-9 was decreased (P<0.01), and the expression of p-Akt/Akt and Bcl-2 was increased (P<0.01). Compared with the LY294002+EA group, the number of neuronal apoptosis in the left cortex was decreased in the EA group (P<0.01), and the expression of Bax, Caspase-9 and Cyt-C was decreased (P<0.01, P<0.05), and the expression of p-Akt/Akt and Bcl-2 was increased (P<0.01). CONCLUSION: EA could significantly reduce the neuronal apoptosis in rats with TBI, and its mechanism may be related to the activation of PI3K/Akt signaling pathway.

[Effect of electroacupuncture at different stages on the expression of Fas and FasL in brain tissue of rats with traumatic brain injury].

OBJECTIVE: To investigate the expression of apoptosis-related proteins Fas and FasL in the brain tissue of rats with traumatic brain injury and the effect of electroacupuncture on the expression of Fas and FasL, so as to explore the effective time window of electroacupuncture in the treatment of traumatic brain injury. METHODS: Sprague-Dawley rats were randomly divided into blank group, sham-operation group, model group, and electroacupuncture treatment groups 1, 2, and 3. Traumatic brain injury was induced by the modified Feeney free-fall impact device, and for the rats in the electroacupuncture treatment groups 1, 2, and 3, electroacupuncture started at 4 hours and on days 3 and 7, respectively, after modeling and lasted to day 14. The Morris water maze test was used to evaluate learning and memory ability, and immunofluorescence assay and Western blot were used to observe the changes in the expression of Fas and FasL in traumatic brain tissue. RESULTS: Compared with the blank group and the sham-operation group, the model group had a lower percentage of time spent in the target quadrant from the 3rd day folowing modeling; after electroacupuncture intervention, the electroacupuncture treatment groups showed a gradual increase in the time spent in the target quadrant, and on day 7,10 and 14, electroacupuncture treatment group 1 had a significantly higher percentage than the model group (P<0.05). On day 14, electroacupuncture treatment group 2 had a significantly higher percentage than the model group (P<0.05). After electroacupuncture intervention, all groups except the blank group and the sham-operation group had increases in the expression of Fas and FasL in brain tissue, which reached the highest level on day 7 after modeling and then tended to decrease; compared with electroacupuncture treatment groups 2 and 3 and the model group, electroacupuncture treatment group 1 had significant reductions in the expression of Fas and FasL (P<0.05, P<0.01); compared with electroacupuncture treatment group 3 and the model group, electroacupuncture treatment group 2 had significant decreases in the expression of Fas and FasL (P<0.05) on day 14 after modeling; compared with the model group, electroacupuncture treatment group 3 had significant reductions in the expression of Fas and FasL in brain tissue on day 14 after modeling (P<0.05). CONCLUSION: Early electroacupuncture intervention can regulate the apoptosis receptor pathway by down-regulating Fas and FasL to exert a therapeutic effect on traumatic brain injury and help with the recovery of cognition and memory ability after traumatic brain injury.

[Effect of electroacupuncture on expression of corticocerebral autophagy-related proteins in rats with traumatic brain injury].

OBJECTIVE: To observe the effect of electroacupuncture on the expression of phosphorylated adenosine 5'-monophosphate-activated protein kinase(p-AMPK), phosphorylated mammalian target of rapamycin(p-mTOR) and phosphorylated Ulk1(p-Ulk1) proteins in the cortex of traumatic brain injury (TBI) rats, so as to explore its mechanisms underlying treatment of TBI. METHODS: Male SD rats were randomly divided into sham operation (sham), model, electroacupuncture Ⅰ (EA Ⅰ), electroacupuncture Ⅱ (EA Ⅱ) groups (n＝10 in each group). TBI model was established by using a free fall brain injury striking device after exposing the local cranial bone (to induce the left parietal cerebral contusion). Rats in EA Ⅰ group were treated by electroacupuncture at "Neiguan" (SP6) and "Zusanli" (ST36) combined with acupuncture at "Shuigou" (GV26) and "Baihui"(GV20) on the 7thday after modeling, once a day for 7 consecutive days. Rats in EA Ⅱ group received the treatments as those in EA Ⅰ group on 24 h after modeling, once a day for 14 d. After the treatment, histopathological changes of the injured cerebral cortex were observed by HE staining and Nissl staining. Western blot was used to detect the expression of AMPK, p-AMPK, mTOR, p-mTOR, Ulk1, p-Ulk1 proteins in the injured cerebral cortex tissue. RESULTS: After modeling and compared with the sham group, a large number of tissue necrosis, scattered arrangement of nerve fibers, vacuolar changes of cells, nuclear fragmentation, consolidation and hyperplastic scar tissue were found in the brain trauma area of rats in the model group. Nissl corpuscles were obviously absent. The ratio of p-AMPK/AMPK was up-regulated in the cortex of the wound region (P<0.01), and the ratio of p-mTOR/mTOR, p-Ulk1/Ulk1 were down-regulated (P<0.01). Compared with the model group, the pathological changes in brain injury area of rats in both EA groups were alleviated, the number of Nissl corpuscles increased, the ratio of p-AMPK/ AMPK was down-regulated in cortex of the injury area (P<0.01), and the ratios of p-mTOR/mTOR and p-Ulk1/Ulk1 were up-regulated (P<0.01). Compared with EA Ⅰ group, the pathological changes in the brain injury area in EA Ⅱ group showed obvious improvement, with down-regulation of p-AMPK/AMPK (P<0.05), and up-regulation of p-mTOR/mTOR and p-Ulk1/Ulk1 (P<0.05). CONCLUSION: Electroacupuncture may inhibit the over-activation of autophagy of cranial neurons by regulating the activation of AMPK, mTOR and Ulk1, thus exerting brain protection effect on TBI rats, and early electroacupuncture intervention is more effective in acute phase of TBI.

[Impacts of electroacupuncture on neurological function and protein expressions of apoptosis-related Cyt-C and Caspase-9 in rats with traumatic brain injury].

OBJECTIVE: To observe the impacts of electroacupuncture (EA) on neurological function, the pathological morphology in brain tissue, apoptosis level and the protein expressions of apoptosis-related cytochrome C (Cyt-C) and cysteine aspartic acid protease-9 (Caspase-9) in the rats with traumatic brain injury (TBI) and explore the potential mechanism of EA in treatment of TBI. METHODS: A total of 70 clean-grade SD mice were randomized into a blank group (8 rats), a sham-operation group (8 rats), a model group (27 rats) and an EA group (27 rats). In terms of interventions of 3, 7 and 14 days, 3 subgroups were divided in the model group and the EA group successively, 9 rats in each subgroup. The modified Feeney free-fall percussion method was adopted to establish TBI models of rats. In the sham-operation group, only the skull was exposed and drilled and no free-fall percussion was exerted. One day after modeling, EA was given in the rats of EA group at "Shuigou" (GV 26), "Baihui" (GV 20) and "Neiguan" (PC 6) and "Zusanli" (ST 36) on the affected side, with intermittent wave, 2 Hz in frequency, once daily, 10 min each time, for 3, 7 and 14 days successively. Separately, on the day 3, 7 and 14 of intervention, the modified neurological severity scale (mNSS) was used to evaluate the degree of neurological function injury in the rats, HE staining and Nissl staining were to observe the pathological and morphological changes in brain tissue, TUNEL method was to observe the level of apoptosis in brain tissue and immunohistochemistry (IHC) method and Western blot were to determine the protein expressions of Cyt-C and Caspase-9 in brain tissue. RESULTS: Compared with the sham-operation group, on the day 3, 7 and 14 of intervention, mNSS scores were increased obviously in the rats of the model group respectively (P<0.01). Compared with the model group, on the day 3, 7 and 14 of intervention, mNSS scores were reduced in the rats of the EA group respectively (P<0.05). On day 3 of intervention, in brain injury region of the rats in the model group and the EA group, gross tissue necrosis, nuclear fragmentation, consolidation and obvious vacuolar changes, reduced Nissl bodies and scattered arrangement were found. On day 7 and 14 of intervention, in the model group and the EA group, the new connective tissue filling and normal cells were visible and Nissl bodies increased. The overall repair and Nissl body quantity in the EA group were better than the model group. Compared with the sham-operation group, on day 3, 7 and 14 of intervention, the numbers of apoptotic cells were increased obviously in the model group (P<0.01) and they were reduced in the EA group as compared with the model group (P<0.05). Compared with the sham-operation group, on day 3, 7 and 14 of intervention, the protein expressions of Cyt-C and Caspase-9 in damaged brain tissue were all increased obviously in the model group (P<0.01) and they were all reduced in the EA group as compared with the model group successively (P<0.05). CONCLUSION: Electroacupuncture remarkably improves the condition in the neurological function injury and reduces apoptosis degree in TBI model rats, which is likely related to the down-regulation of the protein expressions of Cyt-C and Caspase-9 in damaged brain tissue and further to bring the impacts on mitochondria mediated apoptosis process.

[Therapeutic effect on mild perimenopausal depression treated with acupuncture at the "thirteen ghost points" and kaixin powder].

OBJECTIVE: To compare the clinical therapeutic effect on perimenopausal depression between the combined treatment with acupuncture at the "thirteen ghost points" and kaixin powder and the single application of kaixin powder. METHODS: A total of 60 patients with mild perimenopausal depression were randomized into a Chinese medication group (30 cases, 2 cases dropped off) and a combined treatment group (acupuncture and Chinese medication, 30 cases). In the Chinese medication group, the modified kaixin powder was administered, one dose a day, taking in the morning and the evening separately. In the combined treatment group, on the base of the treatment as the Chinese medication group, acupuncture was applied to the "thirteen ghost points" invented by SUN Si-miao, e.g. Shuigou (GV 26), Shaoshang (LU 11), Yinbai (SP 1), Daling (PC 7), Shenmai (BL 62), Jiache (ST 6), Chengjiang (CV 24), Laogong (PC 8), Shangxing (GV 23), etc. The needles were withdrawed after the qi was acquired, and acupuncture was given once every two days, 3 times a week. In both of the groups, the consecutive treatment for 12 weeks was required. Separately, before treatment, after treatment and in 1-month follow-up visit, the score of the Hamilton depression scale (HAMD), the score of the self-rating depression scale (SDS) and the score of the perimenopausal Kupperman were observed in the two groups. In 12 weeks of treatment, the clinical therapeutic effect was compared between the two groups. RESULTS: After treatment and during the follow-up, HAMD, SDS and Kupperman scores were all reduced obviously as compared with those before treatment in the two groups (P<0.05). These scores in the combined treatment group were all lower than those in the Chinese medication group (P<0.05). The total effective rate was 90.0% (27/30) in the combined treatment group, better than 78.6% (22/28) in the Chinese medication group (P<0.05). CONCLUSION: Either the combined treatment with acupuncture at the "thirteen ghost points" and kaixin powder or the single application of kaixin powder is effective on perimenopausal depression. The therapeutic effect of the combined treatment of acupuncture and Chinese medication is superior to the simple application of kaixin powder.

Acupuncture for patients with mild hypertension: A randomized controlled trial.

Acupuncture may be beneficial for patients with mild hypertension, but the evidence is not convincing. We aimed to examine the effect of acupuncture on blood pressure (BP) reduction in patients with mild hypertension. We conducted a multicenter, single-blind, sham-controlled, randomized trial in eleven hospitals in China. The trial included 428 patients with systolic blood pressure (SBP) from 140 to 159 mm Hg and/or with diastolic blood pressure (DBP) from 90 to 99 mm Hg. The patients were randomly assigned to receive 18 sessions of affected meridian acupuncture (n = 107) or non-affected meridian acupuncture (n = 107) or sham acupuncture (n = 107) during 6 weeks, or to stay in a waiting-list control (n = 107). All patients received 24-hour ambulatory blood pressure monitoring at weeks 6, 9, and 12. We included 415 participants in the intention-to-treat analysis. The two acupuncture groups were pooled in the analysis, since they had no difference in all outcomes. SBP decreased at week 6 in acupuncture group vs sham acupuncture vs waiting-list group (7.2 ± 11.0 mm Hg vs 4.1 ± 11.5 mm Hg vs 4.1 ± 13.2 mm Hg); acupuncture was not superior to sham acupuncture (mean difference 2.7 mm Hg, 95% CI 0.4 to 5.9, adjusted P = 0.103) or waiting-list control (2.9 mm Hg, 95% CI -0.2 to 6.0, adjusted P = 0.078). However, acupuncture was superior to sham acupuncture (3.3 mm Hg, 95% CI 0.2 to 6.3, adjusted P = 0.035) and waiting-list control (4.8 mm Hg, 95% CI 1.8 to 7.8, P < 0.001) at week 9. Acupuncture had a small effect size on the reduction of BP in patients with mild hypertension.

[Effects of scalp-acupuncture on astrocyte apoptosis in hippocampal CA 1 region in rats with vascular dementia].

OBJECTIVE: To observe the effect of scalp-acupuncture intervention on the expression of Bcl-2 of astrocytes in the hippocampus in vascular dementia (VD) rats, so as to reveal its underlying mechanism in improving VD. METHODS: A total of 40 male SD rats were randomly divided into normal control, sham-operation, VD model, and scalp-acupuncture groups (n=10 in each group). The VD model was established by using modified Pulsinelli 4-vessel-occlusion method. Scalp-acupuncture was applied to bilateral "Daozang Shangjiao" and bilateral "Jiyi", and "Siwei" acupoints according to FANG's scalp-acupuncture therapy for 30 min, once daily for 10 days. The rat's learning-memory ability was detected by Morris water maze tests, and the expression of apoptosis related proteins Bcl-2 of astrocytes in the hippocampus was detected by immunofluorescence double labeling technique and Western blot, respectively. RESULTS: Morris water maze tests showed that the average escape latency of place navigation test and the duration of the first platform-site crossover (space probing test) were significantly increased in the model group compared with the normal control group (P<0.01), and the number of platform-site crossovers in 2 min was markedly decreased in the model group (P<0.01). The increased average escape latency and the increased duration of first platform-site crossover were markedly shortened in the scalp-acupuncture group in comparison with the model group (P<0.01), and the number of the platform crossovers in 2 min was significantly increased in the scalp-acupuncture group (P<0.01). The expression of Bcl-2 protein and the number of GFAP/Bcl-2-labeled cells of hippocampal CA 1 region in the model group were remarkably decreased compared with the normal control group (P<0.01). After scalp-acupuncture intervention, the decreased Bcl-2 protein expression level and the number of double-labeled GFAP/Bcl-2 cells were significantly up-regulated in the scalp-acupuncture group compared with the model group (P<0.01). No significant differences were found between the normal control and sham-operation groups in the escape latency, duration of the first platform-site crossover, number of platform crossovers in 2 min, number of GFAP/Bcl-2 double labeled cells and the expression level of hippocampal Bcl-2 protein (P>0.05). CONCLUSION: Scalp-acupuncture can effectively regulate the expression of apoptosis related proteins Bcl-2 of astrocytes in the CA 1 region of hippocampus in rats with VD, which may contribute to its effect in the improvement of VD.

Acupuncture for patients with mild hypertension: study protocol of an open-label multicenter randomized controlled trial.

BACKGROUND: Several studies using acupuncture to treat essential hypertension have been carried out. However, whether acupuncture is efficacious for hypertension is still controversial. Therefore, this trial aims to evaluate the efficacy and safety of acupuncture for patients with mild hypertension. METHODS/DESIGN: This is a large scale, open-label, multicenter, randomized controlled clinical trial with four parallel arms. We will recruit 428 hypertensive patients with systolic blood pressure (SBP) between 140 and 159 mmHg, diastolic blood pressure (DBP) between 90 and 99 mmHg. The participants will be randomly assigned to four different groups (three acupuncture groups and one waiting list group) (1).The affected meridian acupuncture group (n = 107) is treated with acupoints on the affected meridians (2).The non-affected meridian acupuncture group (n = 107) is treated with acupoints on the non-affected meridians (3).The invasive sham acupuncture group (n = 107) is provided with sham acupoints treatment (4).The waiting-list group (n = 107) is not offered any intervention until they complete the trial. Each patient allocated to acupuncture groups will receive 18 sessions of acupuncture treatment over 6 weeks. This trial will be conducted in 11 hospitals in China. The primary endpoint is the change in average 24-hSBP before and 6 weeks after randomization. The secondary endpoints are average SBP and average DBP during the daytime and night-time, and 36-Item Short Form Survey (SF-36), and so on. DISCUSSION: This is the first large scale, multicenter, randomized, sham controlled trial of acupuncture for essential hypertension in China. It may clarify the efficacy of acupuncture as a treatment for mild hypertension. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01701726.