Using telehealth to deliver Qi Gong and Tai Chi programs: A mixed-methods systematic review on feasibility, acceptability and participant engagement factors.

INTRODUCTION: Due to the COVID-19 pandemic, the use of digitally delivered exercise classes to promote physical activity has become widespread amongst various populations as an alternative to in-person activities. OBJECTIVES: To examine the feasibility, acceptability, and participant engagement variables to delivering Qi Gong and Tai Chi programs through telehealth interventions. METHODS: Ten databases (Seven English databases; three Chinese databases) were searched between October and November 2021. Studies published in English or Chinese, or having translations in English or Chinese, were included. Titles and abstracts of identified articles were screened, relevant studies were then retrieved for full-text screening. Study selection, assessment of methodological quality, data extraction, data transformation, and data synthesis were completed following a convergent integrated approach to mixed method systematic reviews. RESULTS: Seven articles were included in review. Digital literacy of both participants and providers was found to be a significant hurdle towards digital program implementation. There were no notable issues pertaining to access to an internet connection, participant safety, program costs, or connectivity. A major theme for sustaining program engagement was found to be individual perceived relevance for intervention involvement. Online social involvement was noted to be both a facilitator for participant acceptability and engagement. Overall, participants expressed satisfaction with the use of telehealth, while providers expressed acceptability concerns regarding quality of care. CONCLUSION: It is recommended that planned measures be taken prior to program commencement to decrease digital literacy requirements while also including a participatory approach to encourage uptake. During the program, provision of technical support alongside appropriate social-environmental engagement facilitators would promote sustained adherence.

Effects of electroacupuncture on the ventral tegmental area- nucleus accumbens dopamine pathway in rats with chronic sleep deprivation.

BACKGROUND: Insomnia is a well-recognized clinical sleep disorder in the adult population. It has been established that acupuncture has a clinical effects in the treatment of insomnia; however, research on the underlying neural circuits involved in these effects is limited. METHODS: The modified multiple platform method (MMPM) was used to establish a rat model of chronic sleep deprivation (CSD). Forty rats were randomly divided into a control (Con) group, (untreated) CSD group, electroacupuncture-treated CSD group (CSD + EA) and estazolam-treated CSD group (CSD + Estazolam group) with n = 10 per group. In the CSD + EA group, EA was delivered at Yintang and unilateral HT7 (left and right treated every other day) with continuous waves (2 Hz frequency) for 30 min/day over 7 consecutive days. In the CSD + Estazolam groups, estazolam was administered by oral gavage (0.1 mg/kg) for 7 consecutive days. The open field test (OFT) was used to observe behavioral changes. Immunofluorescence assays and enzyme-linked immunosorbent assay (ELISA) were used to observe the effects of EA on the ventral tegmental area (VTA)-nucleus accumbens (NAc) dopamine (DA) pathway. We also assessed the effects of EA on the expression of dopamine D1 receptor (D1R) and dopamine D2 receptor (D2R) in the NAc, which are the downstream targets of the VTA-NAc DA pathway. RESULTS: After CSD was established by MMPM, rats exhibited increased autonomous activity and increased excitability of the VTA-NAc DA pathway, with increased VTA and NAc DA content, increased D1R expression and decreased D2R expression in the NAc. EA appeared to reduce the autonomous ability of CSD rats, leading to lower DA content in the VTA and NAc, reduced expression of D1R in the NAc and increased expression of D2R. Most importantly, EA produced effects similar to estazolam with respect to the general condition of rats with CSD and regulation of the VTA-NAc DA pathway. CONCLUSIONS: The therapeutic effect of EA in chronic insomnia may be mediated by reduced excitability of the VTA-NAc DA pathway, with lower DA content in the VTA and NAc, downregulated expression of D1R in the NAc and increased expression of D2R.

Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis.

Background: Studies on the efficacy of acupuncture and auricular acupressure on sleep disturbances in cancer patients have been growing, but there is no specific and comprehensive systematic review and meta-analysis. This review aims to evaluate the efficacy and safety of acupuncture and auricular acupressure on sleep disturbances in cancer survivors based on existing randomized clinical trials (RCTs). Methods: Four English-language and four Chinese-language biomedical databases were searched for RCTs published from database inception to July 30, 2021. RCTs comparing acupuncture and auricular acupressure with sham control, drug therapy, behavior therapy, or usual care for managing cancer were included. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias (ROB) tool. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the effect sizes. Results: Thirteen RCTs with 961 patients were included. The risk of performance bias or reporting bias for most of the included trials was high or unclear. Evidence was not found for short-term effects on sleep scales compared to sham control (MD, 1.98; 95% CI, 0.33-3.64; p = 0.02; I2 = 36%), wait list control (MD, 0.40; 95% CI, -0.87-1.68; p = 0.54; I2 = 49%), drug therapy (MD, 1.18; 95% CI, -3.09-5.46; p = 0.59; I2 = 98%). For long-term effect, two sham-controlled RCTs showed no significance of acupuncture on insomnia scale scores (MD, 1.71; 95% CI, -2.38-5.81; p = 0.41; I2 = 89%). Subgroup analyses suggested no evidence that auricular acupressure (MD, 3.14; 95% CI=1.52, 4.76; p = 0.0001; I2 = 0%) or acupuncture (MD, 0.54; 95% CI=-1.27, 2.34; p = 0.56; I2 = 0%) was associated with the reduction in insomnia scale scores. Conclusions: This systematic review and meta-analysis found no evidence about acupuncture or auricular acupressure in the improvement of sleep disturbances in cancer survivors in terms of short- or long-term effect. Adverse events were minor. The finding was inconsistent with previous research and suggested that more well-designed and large-scale randomized controlled trials are needed to identify the efficacy of acupuncture and auricular acupressure for sleep disturbances in cancer survivors. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42020171612.

Preoperative electroacupuncture for postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial.

OBJECTIVE: We aimed to evaluate the effectiveness and safety of preoperative electroacupuncture (EA) on the incidence of postoperative nausea and vomiting (PONV), and severity of postoperative pain, in gynecological patients undergoing laparoscopic surgery. The effects of EA administered at different preoperative time points were compared. METHODS: A total of 413 patients undergoing elective laparoscopic gynecological surgery were randomly allocated into 4 groups receiving EA the day before surgery (Group Pre, n = 103), 30 min before (Group 30, n = 104) or both (Group Comb, n = 103), or usual care alone (Group Usual, n = 103). All acupuncture groups had usual care. The incidence of PONV and pain at 24 h were primary outcomes. Secondary outcomes included the severity of postoperative nausea, vomiting and pain, requirement for antiemetic medication and quality of recovery (QoR)-15 scores after surgery. RESULTS: There were significant differences between the four groups in nausea and vomiting incidence (0-24 h), postoperative antiemetic use (0-48 h), and postoperative pain (0-6 h), with the EA groups recording the lowest levels. Regarding primary outcomes, incidence of nausea and vomiting at 6-24 h was 28/11/18/11% (p = 0.003) 23/5/8/9% (p < 0.001), respectively, for Groups Usual/Pre/30/Comb. Accordingly, EA reduced the incidence of nausea and vomiting at 6-24 h by 61/34/60% and 79/65/61% for Groups Pre/30/Comb, respectively. Regarding secondary outcomes, incidence of nausea and vomiting at 0-6 h was 20/9/11/7% (p = 0.013) and 17/7/9/6% (p = 0.021), respectively, for Groups Usual/Pre/30/Comb. Rescue antiemetics at 0-6 h were required by 18/4/11/4% (p = 0.001) in Groups Usual/Pre/30/Comb. The mean numerical rating scale (NRS) pain score (0-10) at 0-6 h was significantly different between groups (2.45/1.89/2.01/1.97 for Groups Usual/Pre/30/Comb, p = 0.024). There were no significant differences between the three EA-treated groups. CONCLUSION: In gynecological patients undergoing laparoscopic surgery and treated with multimodal antiemetic methods, one session of preoperative EA may be a safe adjunctive treatment for PONV prophylaxis. Optimal timing of EA requires further verification. TRIAL REGISTRATION NUMBER: ChiCTR-INR-16010035 (Chinese Clinical Trial Registry).

Effectiveness of different acupuncture therapies for chronic cancer pain: A protocol for systematic review and Bayesian network meta-analysis.

BACKGROUND: Pain is a common and distressing symptom experienced by cancer patients. Previous research found acupuncture was associated with significant reductions in pain intensity and opioid use. Acupuncture therapies are various, and the difference in efficacy and safety has never been assessed. This paper aims to assess and rank the effectiveness of the different acupuncture methods and provide an acupuncture treatment guideline for relieving chronic pain in cancer survivors. METHODS: Four English databases (PubMed, Embase, Cochrane library, and Web of Science) and 4 Chinese databases (China National Knowledge Infrastructure, Wanfang Data, and Chinese Biomedical Literature Database) will be searched for randomized controlled trials (RCTs) published from the database inception to November 30, 2021. The primary outcomes will be patient-reported pain intensity measured by the Brief Pain Inventory, Visual Analog Scale, Verbal Rating Scale, Numerical Rating Scale, and other valid outcome measures. The Grading of Recommendations Assessment, and Development and Evaluation System will evaluate the quality of evidence. Bayesian network meta-analysis will be performed in WinBUGS V.1.4.3 to determine the comparative effectiveness of the acupuncture therapies. RESULTS: This study will quantify the effectiveness of each acupuncture intervention for chronic cancer pain with pain scores and the use of analgesics. The adverse events of acupuncture treatment for cancer pain will also be reported. CONCLUSION: The conclusion of our study will help physicians and patients choose suitable acupuncture methods to manage cancer pain.

Acupuncture combined with traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for chronic insomnia: study protocol for a randomized controlled trial.

INTRODUCTION: The incidence of insomnia is getting higher and higher. Long-term insomnia seriously affects people's health. Drug use is usually accompanied with adverse events. Both acupuncture and cognitive behavioral therapy for insomnia (CBT-I) have been proven to be safe and effective non-pharmacological treatments for insomnia. As the insomniacs' bad sleep behavior and wrong cognition have not been effectively corrected, acupuncture has a quick effect, high patient compliance but unstable long-term efficacy, while CBT-I is complex, time-consuming, and expensive; additionally, patient compliance is low, and the number of trained therapists is limited, making it difficult to carry out. Therefore, this study aims to use the insomnia TCM system to construct a convenient and feasible traditional Chinese medicine e-aid cognitive behavioral therapy for insomnia (TCM-eCBT-I) for Chinese people, and combine the advantages of acupuncture and TCM-eCBT-I for maintaining long-term efficacy, and three treatments will be evaluated to provide clinicians with a more effective clinical protocol METHODS AND ANALYSIS: This study is a single-center, open-label, randomized controlled trial. Ninety subjects will be recruited and randomly assigned to three groups: the acupuncture group, the TCM-eCBT-I group, and the acupuncture combined with TCM-eCBT-I group, in a ratio of 1:1:1. We will evaluate the Pittsburgh Sleep Quality Index (PSQI) and Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Insomnia Severity Index (ISI), sleep diary, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Fatigue Scale-14 Scale (FS-14) scales. All adverse reactions will be assessed through the ADVERSE event table. All outcomes will be evaluated online at 0 weeks, 4 weeks, 8 weeks, 16 weeks, and 28weeks. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Review Board of the Affiliated Hospital of Nanjing University of Chinese Medicine (2020 NL-018-02). Informed consent will be obtained from all the subjects. The results will be shared with sleep researchers, public, and relevant academic institutions through high-impact peer-reviewed publications. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000032960. Registered on 17 May 2020.

Acupuncture for hypertension with insomnia: Study protocol for a randomized, sham-controlled, subject-and-assessor-blinded trial.

Background: Previous studies show that insomnia and hypertension are closely related. Currently, intervention for hypertension with insomnia has become a research hotspot. Acupuncture, as a representative non-pharmaceutical therapy of traditional Chinese medicine (TCM), has been widely used in improving insomnia and hypertension. However, there are few clinical studies on acupuncture for hypertension with insomnia. Methods: A single-center, subject-and-assessor-blind, randomized, sham-controlled trial has been designed for a study to be conducted in Jiangsu Province Hospital of Chinese Medicine. Sixty eligible patients will be randomly assigned to the treatment group and the control group in a 1:1 ratio. The treatment group will receive acupuncture treatment, while the control group will receive sham acupuncture treatment. Both groups will be treated three times per week for 4 weeks. Data will be collected at baseline and after 4 weeks of treatment and analyzed by using SPSS 25.0. The primary outcome measures are sleep parameters of portable polysomnography before and after treatment. Secondary outcomes are Pittsburgh Sleep Quality Index, Insomnia Severity Index, home blood pressure, and heart rate variability. Discussion: This study aims to evaluate the efficacy of acupuncture using the portable polysomnography combined with sleep scales, and analyze heart rate variability to preliminarily explore the underlying mechanism of acupuncture on hypertension with insomnia. The trail, if proven to be effective, will provide strong scientific evidence to support acupuncture is effective to manage patients for hypertension with insomnia. Clinical trial registration: ChiCTR2200059161.

Randomized controlled trial of acupuncture for anxiety and depression in patients with chronic insomnia.

BACKGROUND: Acupuncture treatment of chronic insomnia (CI) was effective. Anxiety and depression symptoms of the CI patients were improved to varying degrees after acupuncture treatment. Corticosterone (CORT) and 5-hydroxytryptamine (5-HT) are involved in the occurrence and development of comorbidity of insomnia, anxiety, and depression. Whether acupuncture can treat insomnia and accompany anxiety and depression symptoms by regulating CORT and 5-HT is still unclear. METHODS: This was a randomized, single-blind (participant), parallel, placebo-controlled trial. Sixty CI patients were randomly divided into acupuncture and sham acupuncture groups, with 30 patients in each group. In the acupuncture group, acupuncture was applied at Baihui (GV20), Yintang (GV29), Shenmen (HT7, bilateral), and Sanyinjiao (SP6, bilateral), while in the sham acupuncture group, superficial needles were used on non-disorder-related acupoints. Both groups were treated 3 times a week (once every other day) for 4 weeks and at the 3-month follow-up. The patients were assessed using the Pittsburgh Sleep Quality Index (PQSI), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD). The serum concentrations of CORT and 5-HT were also measured before and after treatment. RESULTS: After treatment, the decrease in serum CORT and the increase in serum 5-HT were significantly greater in the acupuncture group than in the sham acupuncture group. At follow-up, the PSQI, HAMA, and HAMD scores in the acupuncture group were significantly lower than those in the sham acupuncture group. CONCLUSIONS: Elevated serum CORT and decreased serum 5-HT levels may be associated with mood regulation disorders in CI patients. Acupuncture can significantly improve the sleep quality, efficiency, and latency of CI patients, and it can alleviate anxiety and depression in such patients. Compared with the sham acupuncture group, the acupuncture group showed a stable long-term efficacy. TRIAL REGISTRATION: Chinese Clinical Trials Register ChiCTR1800020298.

Effect of Acupuncture on Cognitive Function of Insomnia Patients Compared with Drugs: A Protocol for Meta-analysis and Systematic Review.

Insomnia, one of the most common sleep disorders, is thought to have an adverse effect on cognitive function. At the same time, people with cognitive dysfunction are more prone to insomnia. At present, pharmacotherapy is the main treatment for insomnia, but there are some shortcomings such as poor long-term efficacy and potential dependence. There is some evidence that acupuncture has some advantages in alleviating insomnia and improving cognitive function. This study is aimed at investigating the effects of acupuncture and drugs on cognitive function in patients with insomnia and evaluating the efficacy and safety of these two interventions, providing strong evidence for clinical decision-making. The study will retrieve eight major databases: China National Knowledge Infrastructure, Wanfang Database, VIP Database for Chinese Technical Periodicals, SinoMed, PubMed, Web of Science, Embase, and Cochrane Library. Dissertations, conference papers, and ongoing experiments will also be retrieved for supplement. Literature screening and data extraction will be completed by two authors independently (JJ and X-QW). If there were any disagreements, they would be discussed or referred to a third person for adjudication (W-ZW). Authors will use Cochrane risk of bias tool to assess the included studies. The Review Manager Statistical (RevMan) software is used to conduct the statistical process of meta-analysis, and funnel plot is used to evaluate reporting biases. The Grading of Recommendations Assessment Development and Evaluation (GRADE) Profiler can be used to be aware of the quality of evidence.

[Effect of Tiaoshen needling on plasma melatonin and cortisol in patients with chronic insomnia].

OBJECTIVE: To observe the clinical efficacy of Tiaoshen needling (dredging Governor Vessel and regulating mind)in the treatment of chronic insomnia (CI) and its effect on plasma melatonin (MT) and cortisol (CORT) levels, so as to explore its underlying mechanism. METHODS: Sixty patients with CI were randomly divided into the treatment group and the control group, with 30 cases in each group. Both groups were given sleep hygiene education before treatment. Patients in the treatment group received acupuncture or electroacupuncture at Baihui (GV20), Shenting (GV24), Yintang (GV29), bilateral Shenmen (HT7) and Sanyinjiao (SP6). Patients in the control group received acupuncture or electroacupuncture at bilateral Shousanli (LI10), Futu (ST32) and Feiyang(BL58). Both groups were treated every other day, 3 times a week, for a total of 4 weeks. Before and after treatment, Pittsburgh sleep quality index (PSQI) and fatigue severity scale (FSS) were used to evaluate sleep qua-lity and daytime fatigue, the plasma MT and CORT levels were measured by enzyme-linked immunosorbent assay. RESULTS: Compared with before treatment, the PSQI scores and total FSS score of the treatment group decreased significantly (P<0.01，P<0.05), and the plasma MT content increased and CORT decreased significantly in the treatment group (P<0.01)，while the sleep-onset time score, sleep disturbance score and the PSQI total score of the control group decreased significantly (P<0.05). Compared with the control group, the PSQI sleep disorder score and total score, and the total FSS score as well as plasma CORT level were significantly down-regulated (P<0.01，P<0.05), while the plasma MT content was up-regulated (P<0.05) in the treatment group. CONCLUSION: Tiaoshen acupuncture can significantly improve the sleep quality of patients with CI and relieve daytime fatigue, which may be related to the increase of plasma MT content in patients with CI, thereby inhibiting the excessive activation of the hypothalamic-pituitary-adrenal axis.

The efficacy of acupuncture on the sleep structure of patients with insomnia: A systematic review and meta-analysis.

This study aims to evaluate the efficacy of acupuncture on the sleep structure of patients with insomnia, so as to provide a valuable basis for the effectiveness of acupuncture in the treatment of insomnia. We conducted searches based on MeSH terms and free words in Cochrane Library, PubMed, Web of science, CKNI (China Knowledge Resource Integrated Database), WanFang Database, and Chongqing VIP Information from the inception of these database until 10 July 2020 for randomized controlled trials (RCTs) that investigated acupuncture treatment in patients with insomnia, and pertinent details of the results were saved. Comprehensive analysis showed that: (1) compared with the Western medicine groups, the acupuncture groups showed significant advantages in reducing the percentage of N1 sleep stage and N2 sleep stage, as well as increasing that of N3 sleep stage and REM sleep stage. However, no significant difference was found in increasing the effective rate, reducing total PSQI score, improving the total sleep time, reducing sleep latency, and improving sleep efficiency between the Western medicine groups and the acupuncture groups. (2) Compared with the sham acupuncture groups, the acupuncture treatment showed advantages in increasing the effective rate, reducing Pittsburgh Sleep Quality Index (PSQI) score, increasing the total sleep time, and improving sleep efficiency. However, no significant difference was observed between the sham acupuncture groups and the acupuncture groups with regard to reducing sleep latency, the percentage of N1 sleep stage and N2 sleep stage, as well as increasing that of N3 sleep stage and REM sleep stage.

[Effect of Tongdu Tiaoshen acupuncture on serum GABA and CORT levels in patients with chronic insomnia].

OBJECTIVE: To observe the clinical effect of Tongdu Tiaoshen acupuncture on chronic insomnia, and explore its possible mechanism. METHODS: A total of 60 patients with chronic insomnia were randomly divided into an observation group (30 cases) and a control group (30 cases, 1 case dropped off ). The observation group was treated with Tongdu Tiaoshen acupuncture at Baihui (GV 20), Yintang (GV 29), Shenting (GV 24), etc. once every other day, 3 times a week. The control group was treated with estazolam tablets (1 mg) orally before going to bed every night. The treatments of both groups were required 4 weeks. The Pittsburgh sleep quality index (PSQI) scores, serum gamma-aminobutyric acid (GABA) and cortisol (CORT) levels were observed before and after treatment in the two groups, and the clinical effect was compared. RESULTS: After treatment, the sleep quality, day dysfunction scores of PSQI in the observation group and the falling asleep time, sleep time, sleep efficiency, sleep disturbance scores and total scores of PSQI in the two groups were lower than before treatment (P<0.01, P<0.05). After treatment, the daytime dysfunction score of PSQI in the observation group was lower than that in the control group (P<0.05). After treatment, the serum GABA levels in the two groups were higher than before treatment (P<0.05), and the serum CORT levels were lower than before treatment (P<0.01). The total effective rate was 90% (27/30) in the observation group and 93.1% (27/29) in the control group, the difference was not statistically significant (P>0.05). CONCLUSION: Tongdu Tiaoshen acupuncture has the same effect as western medication estazolam tablets in the treatment of patients with chronic insomnia, and has little effect on daytime dysfunction. The mechanism may be related to the increase of serum GABA level and the inhibition of the hyperactivation of hypothalamus-pituitary-adrenal (HPA) axis.

[Effect of electroacupuncture on serum melatonin and dopamine in aged insomnia].

OBJECTIVE: To observe the clinical effect of electroacupuncture (EA) on aged insomnia, and explore its possible mechanism. METHODS: A total of 60 patients with aged insomnia were randomly divided into an EA group (30 cases) and a sham EA group (30 cases, 1 case dropped off). The patients in the EA group were treated with acupuncture at Baihui (GV 20), Yintang (GV 29), Shenmen (HT 7), Sanyinjiao (SP 6), Xinshu (BL 15) and Shenshu (BL 23), and EA was used at Baihui (GV 20) and Yintang (GV 29), with intermittent wave, 2 Hz in frequency. In the sham EA group, the acupoints and the EA connection acupoints were the same as those in the EA group, 2-3 mm in depth, but no current was connected. The intervention was given 30 min each time, once every other day, 3 times a week for 4 weeks in the both groups. Before and after treatment, the Pittsburgh sleep quality index (PSQI) and Montreal cognitive assessment (MoCA) scale were used to assess sleep quality and cognitive function, and serum melatonin (MT) and dopamine (DA) levels were detected. RESULTS: After treatment, the total score and sub-item scores of PSQI in the EA group were lower than those before treatment (P<0.01, P<0.05), among them, the sub-item scores of sleep quality, time to fall asleep, sleep time and sleep efficiency, daytime dysfunction and total score were all lower than those in the sham EA group (P<0.01, P<0.05). After treatment, the MoCA score and serum MT and DA levels in the EA group were higher than those before treatment (P<0.01), and the MoCA score and serum MT level in the EA group were higher than the sham EA group (P<0.01, P<0.05). CONCLUSION: Electroacupuncture can improve sleep quality and cognitive function in aged insomnia patients, and its mechanism may be related to regulating serum MT and DA levels.

[Effect of acupuncture at Tiaoshen acupoints on hyperarousal state in chronic insomnia].

OBJECTIVE: To observe the clinical effect of acupuncture at Tiaoshen (regulating the spirit) acupoints on chronic insomnia and hyperarousal state, and explore its possible mechanism. METHODS: A total of 60 patients with chronic insomnia were randomly divided into an acupuncture group (30 cases, 1 case dropped off) and a sham acupuncture group (30 cases, 1 cases dropped off). Both groups were given basic sleep health education. The acupuncture group was treated with acupuncture at Tiaoshen acupoints including Baihui (GV 20), Shenting (GV 24), Yintang (GV 29), Shenmen (HT 7) and Sanyinjiao (SP 6). The sham acupuncture group was treated with non-effective point shallow acupuncture. Both groups were treated once every other day, 3 times a week for 4 weeks. The Pittsburgh sleep quality index (PSQI) score, pre-sleep arousal scale (PSAS) score, hyperarousal scale (HAS) score, and serum gamma-aminobutyric acid (GABA) level before and after treatment were compared between the two groups. RESULTS: Compared before treatment, the sleep quality, time to fall asleep, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI, various scores and total score of PSAS, and HAS score in the acupuncture group after treatment were decreased (P<0.05, P<0.01); in the sham acupuncture group, the time to fall asleep, daytime dysfunction scores and total score of PSQI, and cognitive arousal score of PSAS after treatment were decreased (P<0.05). After treatment, the sleep quality, time to fall asleep, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI, various scores and total score of PSAS, and HAS score in the acupuncture group were lower than those in the sham acupuncture group (P<0.05, P<0.01). Compared before treatment, the serum GABA level in the acupuncture group were increased (P<0.05), and the serum GABA level in the acupuncture group was higher than that in the sham acupuncture group after treatment (P<0.05). CONCLUSION: Acupuncture at Tiaoshen acupoints can obviously improve the sleep and hyperarousal state of patients with chronic insomnia, and up-regulating serum GABA content is one of its possible mechanisms.

[Effect of Tongdu Tiaoshen needling in treatment of chronic insomnia by regulating the hypothalamic-pituitary-adrenal axis].

OBJECTIVE: To investigate the clinical effect of Tongdu Tiaoshen needling in the treatment of chronic insomnia and its mechanism based on the hypothalamic-pituitary-adrenal (HPA) axis. METHODS: A total of 60 patients with chronic insomnia were randomly divided into treatment group and control group, with 30 patients in each group. In addition to the health education on sleep, the patients in the treatment group were given Tongdu Tiaoshen needling, i．e., electroacupuncture at Baihui (GV20), Shenting (GV24), Yintang (EX-HN3), bilateral Shenmen (HT7), and bilateral Sanyinjiao (SP6), and those in the control group were given superficial acupuncture at Shousanli (LI10), Futu (ST32), and Feiyang (BL58) at both sides, once every other day and three times a week for 4 consecutive weeks. Before and after treatment, the Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality and efficiency of sleep, and ELISA was used to measure the serum levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and corticosterone (CORT). RESULTS: After treatment, the treatment group had significant reductions in the total PSQI score and the score of each component of PSQI (P<0.01), and the control group had significant reductions in the total PSQI score (P<0.01) and the scores of all components except sleep duration (P<0.05); compared with the control group, the treatment group had significantly lower total PSQI score and the score of each component (P<0.01). After treatment, the treatment group had significant reductions in the serum levels of CRH, ACTH and CORT (P<0.05，P <0.01), and compared with the control group, the treatment group had significant reductions in the serum levels of CRH, ACTH and CORT (P<0.01，P<0.05). CONCLUSION: Tongdu Tiaoshen needling has a good clinical effect in the treatment of chronic insomnia and can significantly improve the sleep condition of patients with chronic insomnia, possibly by reducing the hormones associated with the HPA axis.

Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis.

BACKGROUND: Acupuncture is a common alternative therapy for clinical treatment of insomnia. As the underlying mechanism is yet unclear, its efficacy is often considered as placebo effect. To clarify whether acupuncture treatment of insomnia is only due to its placebo effect, a systematic review and a meta-analysis were designed based on the comparison between acupuncture and sham acupuncture. METHODS: Four English (PubMed, Embase, Web of Science, and The Cochrane Library) and three Chinese (CNKI, VIP, and Wanfang) databases were searched, and the validity of the eligible studies was critically appraised. Thirteen eligible randomized controlled trials of moderate-to-high quality that employed polysomnography (PSG), actigraphy, or self-assessment sleep quality tools were included in the present study. A meta-analysis was conducted using a random-effects model with the Pittsburgh Sleep Quality Index (PSQI) as the primary outcome measure (911 adult patients, 13 trials) for trials investigating the effects of acupuncture as compared to the sham acupuncture. Then, a subgroup analysis was performed to detect the sources of heterogeneity, identify the selection of sham acupuncture methods and different crowd characteristics, and explore its contributions to the total score change of PSQI. RESULTS: Compared to the sham groups, acupuncture significantly decreased the PSQI score (P<0.0001). A subgroup analysis showed that the selection of sham acupuncture methods did not affect the results of PSQI. A subgroup of two trials with a total of 141 participants with major depressive disorder did not show any significant reductions in total PSQI scores (P=0.11). In addition, a significant difference was detected in the change of Insomnia Severity Index (ISI) scores (362 adult patients, 4 trials) between acupuncture and sham acupuncture (P<0.0001). The PSG and actigraphy data from acupuncture and the sham did not reveal any significant differences in the sleep structure changes. CONCLUSIONS: Acupuncture treatment of insomnia is efficacious, not because of its placebo effect. For the selection of sham acupuncture, both methods performed similarly in a clinical setting. Moreover, insomnia patients with major depression disorder were not recommended to use only acupuncture treatment.

[Insomnia treated with three acupuncture combinations guided by theory of Tongdu Tiaoshen: a randomized controlled trial].

OBJECTIVE: To compare the clinical therapeutic effect and safety on insomnia among three acupuncture combinations, named Tongdu Tiaowei (promoting the circulation of the governor vessel and regulating the defensive system), Tongdu Yangxin (promoting the circulation of the governor vessel and nourishing the heart) and Tongdu Tiaozang (promoting the circulation of the governor vessel and regulating zang functions). METHODS: A total of 90 patients with insomnia were randomized into a Tongdu Tiaowei group (30 cases, 1 case dropped off ), a Tongdu Yangxin group (30 cases, 2 cases dropped off ) and a Tongdu Tiaozang group (30 cases, 1 case dropped off ). Besides electroacupuncture (EA) applied to Baihui (GV 20) and Yintang (GV 29) in all of the three groups, acupuncture was added at Shenmai (BL 62) and Zhaohai (KI 6), Shenmen (HT 7) and Sanyinjiao (SP 6) as well as back-shu points of five zang organs [Feishu (BL 13), Xinshu (BL 15), Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23)] in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively. The treatment was given once every two days, 3 times weekly, consecutively for 4 weeks. The score of Pittsburgh sleep quality index (PSQI) before and after treatment was observed, the therapeutic effect was evaluated and the adverse reactions were recorded in the patients of each group. RESULTS: After treatment, the score of each of 6 factors, named sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbance and daytime dysfunction, as well as the total score of PSQI scale were all reduced as compared with the scores before treatment in the patients of each group (P<0.05). After treatment, the scores of sleep latency and daytime dysfunction in the Tongdu Tiaowei group were lower than the other two groups (P<0.05). The score of sleep time in the Tongdu Yangxin group was lower than the other two groups (P<0.05) and the score of sleep quality in the Tongdu Tiaozang group was lower than the other two groups (P<0.05). After treatment, the total effective rates were 96.6% (28/29), 96.4% (27/28) and 96.6% (28/29) in the Tongdu Tiaowei group, the Tongdu Yangxin group and the Tongdu Tiaozang group successively, without significant difference in comparison among the three groups (P>0.05). During treatment, 1 case of mild adverse reaction occurred in each group. CONCLUSION: All of the three acupuncture combinations, named Tongdu Tiaowei, Tongdu Yangxin and Tongdu Tiaozang can effectively improve the sleep conditions in the patients with insomnia and are satisfactory in safety. The acupuncture combinations of Tongdu Tiaowei has the potential advantage in shortening sleep latency and relieving daytime dysfunction, the combinations of Tongdu Yangxin has the potential advantage in increasing sleep time and the combinations of Tongdu Tiaozang has the potential advantage in improving sleep quality.

Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice.

BACKGROUND: Acute postoperative pain remains a major clinical problem that affects patient recovery. Distal acupoint and peri-incisional stimulation are both used for relieving acute postoperative pain in hospital. Our objective was to assess and compare the effects of distal and peri-incisional stimulation on postoperative pain in open abdominal surgery. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Chinese databases CNKI and Wanfangdata were searched to identify eligible randomized controlled trials. Intensity of postoperative pain, opioid consumption and related data were extracted and analyzed using a random effects model. Risk of bias was assessed. Subgroup analyses were conducted when data were enough. RESULTS: Thirty-five trials were included, in which 17 trials studied distal stimulation, another 17 trials studied peri-incisional stimulation and one studied the combination of the two approaches. No studies that directly compared the two approaches were identified. Subgroup analysis showed that both distal and peri-incisional stimulation significantly alleviated postoperative resting and movement pain from 4 h to 48 h after surgery by 6 to 25 mm on a 100 mm visual analogue scale. Peri-incisional stimulation showed a better reduction in postoperative opioid consumption. No studies compared the effects of the combined peri-incisional and distal stimulation with either mode alone. Overall the quality of evidence was moderate due to a lack of blinding in some studies, and unclear risk of allocation concealment. CONCLUSION: Both distal and peri-incisional modes of stimulation were effective in reducing postoperative pain. Whether a combined peri-incisional stimulation and distal acupuncture has superior results requires further studies.

Effects of acupuncture on the hypothalamus-pituitary-adrenal axis in chronic insomnia patients: a study protocol for a randomized controlled trial.

BACKGROUND: Acupuncture, as an important component of traditional Chinese medicine (TCM), has been widely applied in the treatment of chronic insomnia in China, while there is no clinical study related to its therapeutic mechanism. METHODS/DESIGN: A single-center, single-blind, randomized, placebo-controlled trial will be conducted at Jiangsu Hospital of Traditional Chinese Medicine. A total of 60 patients will be registered. Eligible participants will be randomly divided into acupuncture group and sham acupuncture group (n = 30 cases in each group). Patients in both groups will be treated once every other day, three times per week for 4 weeks. The primary outcome measures are Pittsburgh Sleep Quality Index (PSQI) and concentrations of adrenocorticotropic hormone (ATCH), corticotrophin-releasing hormone (CRH), and cortisol (CORT). Secondary outcome measures are Insomnia Severity Index (ISI) and Fatigue Severity Scale (FSS). DISCUSSION: This study aims to evaluate the therapeutic effects of acupuncture on chronic insomnia by using PSQI, ISI, and FSS. The mechanism of acupuncture on CIPs will be preliminarily discussed by analyzing the changes in concentrations of CRH, ACTH, and CORT before and after treatment. TRIAL REGISTRATION: Chinese Clinical Trials Register, ChiCTR1800020298.

Innate differences and colostrum-induced alterations of jejunal mucosal proteins in piglets with intra-uterine growth restriction.

Mammalian neonates undergo rapid transitions from a sterile uterine environment with a continuous intravenous supply of nutrients to a microbe-rich environment with intermittent ingesting of colostrum/milk via the gut. Currently, little is known about the colostrum-induced alterations of intestinal mucosal proteins in piglets with intra-uterine growth restriction (IUGR). In this study, we sought to investigate the innate differences and effects of colostrum on alterations in small-intestinal proteomes of IUGR piglets. Two IUGR (approximately 0·9 kg) and two normal-birth weight (NBW; approximately 1·3 kg) piglets were obtained from each of six sows at birth. One half (n 12; 6 IUGR v. 6 NBW) of the selected newborn piglets were killed to obtain jejunum samples, and the other half (n 12; 6 IUGR v. 6 NBW) of the newborn piglets were allowed to suckle colostrum from their own mothers for 24 h before jejunum sample collection. On the basis of proteomic analysis, we identified thirty-one differentially expressed proteins in the jejunal mucosa between IUGR and normal neonates before or after colostrum consumption. The intestinal proteins altered by colostrum feeding play important roles in the following: (1) increasing intestinal integrity, transport of nutrients, energy metabolism, protein synthesis, immune response and, therefore, cell proliferation; and (2) decreasing oxidative stress, and therefore cell apoptosis, in IUGR neonates. However, colostrum only partially ameliorated the inferior status of the jejunal mucosa in IUGR neonates. These findings provide the first evidence in intestinal protein alterations of IUGR neonates in response to colostrum ingestion, and thus render new insights into the mechanisms responsible for impaired growth in IUGR neonates and into new nutritional intervention strategies.