Electroacupuncture with or without combined warm needling for tinnitus: Study protocol for a randomized, waitlist-controlled trial.

BACKGROUND: Tinnitus is a common auditory condition that can lead to serious problems. Clinically, acupuncture and moxibustion have been commonly applied to treat tinnitus in China, with potential therapeutic effects but with limitations in study methodology and high-quality evidence. Therefore, we designed a randomized controlled trial to evaluate the efficacy and safety of either electroacupuncture alone or combined with warm needling for reducing tinnitus loudness and improving quality of life. METHODS: This study is a prospective, multicenter, assessor-blind, 3-arm, parallel-group, randomized, waitlist-controlled trial. In total, 90 patients will be randomly assigned to the electroacupuncture, electroacupuncture and warm needing, or waitlist control group in a 1:1:1 ratio. Patients in the 2 treatment groups will be treated twice a week for a total of 5 weeks. Patients in the control group will not receive treatment during the study period and will be informed that they can receive it for free after a 10-week waiting period. The duration of intervention for this study will be 5 weeks, followed by another 5 weeks for the posttreatment assessment. The primary outcome is the change in the visual analog scale score for tinnitus loudness from baseline until the end of treatment. The secondary outcome is the tinnitus discomfort assessment measured using the Tinnitus Handicap Inventory. Outcome parameters will be assessed at baseline and at weeks 5 and 10. Any adverse events will be observed and recorded for safety assessment. Linear mixed models for repeated measures will be applied in the analysis. DISCUSSION: Acupuncture and moxibustion could be potentially effective treatment alternatives for tinnitus. The study results will provide evidence to determine the efficacy and safety of electroacupuncture with or without warm needling for tinnitus.

Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial.

OBJECTIVE: To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP). METHODS: This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention-to-treat analysis. RESULTS: Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients (P < 0.001). There were no study-related adverse events. CONCLUSION: EAWN therapy could be an effective treatment for PHP in middle-aged and older adults. TRIAL REGISTRATION NUMBER: ChiCTR1800014906 (Chinese Clinical Trials Registry).

A randomized controlled trial to assess the effectiveness and safety of acupuncture for overactive bladder: a study in Hong Kong population.

BACKGROUND: Around 15% of the Hong Kong population was found to suffer from overactive bladder (OAB), but the current available treatments, such as medication, behavioral therapy and physical therapy are unsatisfactory. Previous studies have suggested that acupuncture may have promising effect for OAB, but some limitations on the study design render the evidence questionable. This study aimed to evaluate the effectiveness and safety of acupuncture treatment for patients with OAB in Hong Kong. METHODS: One hundred patients with OAB were enrolled. The patients were randomized to receive either active acupuncture or sham needle intervention twice a week for 8 consecutive weeks, and had a follow-up consultation 12 weeks after the completion of acupuncture intervention. The primary outcome assessment was the 3-Day Voiding Diary, which records daytime and night-time urinary frequency and symptoms, at the baseline, the end of the 8-week intervention and 12 weeks after acupuncture intervention. Secondary outcomes included Urine NGF level, Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6), as well as Overactive Bladder Symptom Score (OABSS). RESULTS: After 16 sessions of treatment, when compared with the baseline, both active and sham acupuncture significantly reduced the frequency of urgency urinary incontinence (UUI), daytime and night-time urinary frequency as well as the scores of IIQ-7, UDI-6 and OABSS. Moreover, the treatment effects could last for at least 3 months. However, no significant difference in frequency of UUI and daytime urinary frequency was found between the active and sham acupuncture groups. On the other hand, the night-time urinary frequency decreased more significantly during the treatment and follow-up in the active acupuncture group than in the sham control group after controlling baseline night-time urinary frequency. Urine NGF level could not be detected by ELISA method in our experiments. CONCLUSION: This study suggests a beneficial effect of acupuncture on improving OAB symptoms. Both active and sham acupuncture treatment were able to improve the symptoms of frequency of urgency urinary incontinence, and the daytime and night-time urinary frequency, while only mild adverse effects were found. This project was unable to establish the specific effect of acupuncture for OAB.Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010048. Registered on 29 Nov 2016.

Acupuncture for Poststroke Dysphagia: A Pilot, Nonrandomized, Self-Controlled Trial.

OBJECTIVE: To evaluate the effectiveness and safety of acupuncture treatment for dysphagia as a complication of stroke. Methods and Design. This is a multicenter, pragmatic, nonrandomized, self-controlled clinical trial. A total of 39 patients were recruited from several Chinese medicine outpatient clinics and hospital-affiliated speech therapy outpatient clinics in Hong Kong. 26 patients completed all the 24 sessions of acupuncture treatment within two months, and only 12 of them were used as self-control. For the self-control group, the retrospective clinical data was taken from the electronic patient records with patient consent. The descriptive swallowing function data were converted into the quantitative Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS) scores by two registered speech therapists through a validation process. And the data were validated by reaching consensus between the two speech therapists. All subjects underwent a baseline assessment before commencement of treatment, and outcome assessments were conducted upon the completion of treatment. The primary outcome measure is the RBHOMS score, which is a swallowing disability rating scale for monitoring difficulties in daily swallowing function. Secondary outcome measures include the Chinese version of the Swallow Quality-of-Life Questionnaire and adverse events. All the primary and secondary outcomes were assessed at baseline as well as at the end of acupuncture treatment (month 2). RESULTS: A total of 39 participants aged 46 to 89 years were enrolled in the study, and the male-to-female ratio was 15 : 11. The mean baseline RBHOMS score of all 39 participants was 5.92 ± 2.23. The mean retrospective RBHOMS score of the 12 subjects who were used as self-control was 5.67 ± 1.72 before enrollment, while the mean RBHOMS score of the 26 participants who completed all the 24 sessions of treatment was 6.92 ± 2.07. There were statistically significant differences between the RBHOMS score at the completion of treatment and baseline (p=0.006), and retrospective data (p=0.042). Moreover, a significant difference was also found in terms of swallow quality-of-life score before and after acupuncture treatment (p < 0.01). CONCLUSIONS: This pilot study provides preliminary evidence for the effectiveness of acupuncture for poststroke dysphagia. The findings from this trial can be used as a foundation for future full-scale randomized controlled clinical trials to assess the efficacy and safety of acupuncture for poststroke dysphagia. Ethics and Dissemination. The ethical approval of the clinical research study was granted by the Research Ethics Committee of both New Territories East and West Cluster of Hong Kong. Written informed consent was obtained from all participants, and the study was undertaken according to the ICH-GCP Guidelines. Trial Registration. This trial is registered with ChiCTR-TRC-12002621 and the registration date is 2012-10-26.

A generalized solid strengthening rule for biocompatible Zn-based alloys, a comparison with Mg-based alloys.

Solid solution strengthening has been widely used in designing various high-performance biocompatible Mg-based alloys, but its transferability to other biocompatible metals such as Zn-based alloys is questionable or nearly absent. In the present study, an ab initio informed Peierls-Nabarro model and Leyson et al.'s strengthening model are used for a systematic investigation on solute strengthening in Zn-based alloys, which is compared with the widely studied Mg-based alloys. Although an inverse relationship was revealed between volume misfit εb and chemical misfit εSFE for both Zn-based and Mg-based alloys, most solutes would however result in positive εb and negative εSFE for Zn-based alloys, differing from Mg-based alloys. With εb and εSFE as two key descriptors, a generalized scaling diagram is finally drawn for a fast evaluation of solid solution strengthening in Zn-based alloys, indicating that the alkaline-earth and rare earth elements are better strengtheners for Zn-based alloys, which provides a general rule in designing novel biocompatible materials.

Efficacy and safety of electroacupuncture plus warm needling therapy for heel pain: study protocol for a randomized controlled trial.

BACKGROUND: Heel pain is a common foot disorder that causes pain and functional limitations. The prevalence of disabling foot pain will increase as the population ages. Previous studies have reported the positive therapeutic effects of electroacupuncture, warm needling, or the combination of both for heel pain but with limitations in the study methodologies. The current study is a rigorously designed randomized controlled trial that aims to evaluate the clinical efficacy and safety of electroacupuncture plus warm needling therapy in patients with heel pain. METHODS/DESIGN: The study protocol describes a prospective, open-label, parallel-group, randomized controlled trial to be conducted in Hong Kong. Eighty patients aged 50-80 years who have reported heel pain and first-step pain equal to or exceeding 50 mm on the 100-mm visual analog scale (VAS) will be recruited. They will be randomly assigned (1:1 ratio) to the electroacupuncture plus warm needling therapy (i.e., treatment) group or the waitlist (i.e., control) group. The treatment group will undergo six treatment sessions in 4 weeks. The control group will receive no treatment during the study period. The primary outcome measure is a mean change in the first-step pain VAS score from the baseline to week 4. Secondary outcome measures include a mean change in first-step pain VAS score from the baseline to week 2, a mean change in Foot Function Index (FFI) subscale scores and the total score from the baseline to week 2 and week 4, and patients' self-reported level of improvement at week 4. Additional week 8 follow-up assessments with first-step pain VAS and FFI measurements will be arranged for the treatment group. Any adverse events will be recorded throughout the study to evaluate safety. An intention-to-treat approach will be used to analyze the study results. DISCUSSION: This study will provide evidence on the efficacy and safety of electroacupuncture plus warm needling therapy as an alternative treatment method for heel pain. The findings will determine whether the treatment protocol is efficacious in relieving pain and improving foot function among older adults with heel pain. The study will also provide information for subsequent large-scale randomized controlled trials in the future. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800014906 . Registered on 12 February 2018.

Acutherapy for Knee Osteoarthritis Relief in the Elderly: A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review and meta-analysis was conducted to investigate the effects of various acutherapies on knee osteoarthritis (KOA) relief in the elderly. METHODS: Five databases were accessed from inception to July 2017 for searching randomized controlled trials (RCTs) on acutherapy for KOA relief in the elderly. Data were pooled after trial quality assessment for meta-analysis. Outcomes were the scores of knee pain, knee stiffness, and physical function accessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. RESULTS: 17 RCTs including 4774 subjects were included. The results indicated that acutherapy significantly affected knee pain (standardized mean difference, i.e., SMD = - 0.73, [95% CI, -0.98 to -0.47], P <0.001), knee stiffness (SMD = -0.66, [95%CI, -0.85 to -0.47], P <0.001), and physical function (SMD = -1.56, [95%CI, -2.17 to -0.95], P<0.001) when compared with control condition without intervention of any acutherapy. Moreover, acutherapy was more effective than corresponding sham (placebo) intervention applied on nonacupoints (SMD = -0.16, [95% CI, -0.32 to -0.01], P = 0.04). However, no significant differences were found on treatment effects between acutherapy and sham acutherapy at the same acupoints (SMD= - 0.09, [95%CI, -0.40 to 0.21], P = 0.55). CONCLUSIONS: Acutherapy was an effective approach for KOA relief in the elderly. The selection of acupoints position could be a crucial factor that influences the treatment efficacy of acutherapy.

Designing flexible 2D transition metal carbides with strain-controllable lithium storage.

Efficient flexible energy storage systems have received tremendous attention due to their enormous potential applications in self-powering portable electronic devices, including roll-up displays, electronic paper, and "smart" garments outfitted with piezoelectric patches to harvest energy from body movement. Unfortunately, the further development of these technologies faces great challenges due to a lack of ideal electrode materials with the right electrochemical behavior and mechanical properties. MXenes, which exhibit outstanding mechanical properties, hydrophilic surfaces, and high conductivities, have been identified as promising electrode material candidates. In this work, taking 2D transition metal carbides (TMCs) as representatives, we systematically explored several influencing factors, including transition metal species, layer thickness, functional group, and strain on their mechanical properties (e.g., stiffness, flexibility, and strength) and their electrochemical properties (e.g., ionic mobility, equilibrium voltage, and theoretical capacity). Considering potential charge-transfer polarization, we employed a charged electrode model to simulate ionic mobility and found that ionic mobility has a unique dependence on the surface atomic configuration influenced by bond length, valence electron number, functional groups, and strain. Under multiaxial loadings, electrical conductivity, high ionic mobility, low equilibrium voltage with good stability, excellent flexibility, and high theoretical capacity indicate that the bare 2D TMCs have potential to be ideal flexible anode materials, whereas the surface functionalization degrades the transport mobility and increases the equilibrium voltage due to bonding between the nonmetals and Li. These results provide valuable insights for experimental explorations of flexible anode candidates based on 2D TMCs.

Efficacy of abdominal acupuncture for neck pain: A randomized controlled trial.

OBJECTIVE: This study aims to provide evidence regarding the clinical efficacy of abdominal acupuncture for neck pain. METHODS: This randomized, patient and assessor-blind, sham-controlled trial was conducted at a Chinese medicine center in Hong Kong between November 2014 and March 2016. A total of 154 eligible participants (age range, 18-65 years) with neck pain were randomly assigned to receive abdominal (n = 77) or non-penetrating sham abdominal (sham group; n = 77) acupuncture. Each participant was administered treatment over six sessions by Registered Chinese Medicine Practitioners, in accordance with a standardized protocol. The primary outcome was mean improvement in neck pain disability scores evaluated by the Northwick Park Neck Pain Questionnaire (NPQ). Secondary outcomes included intensity of neck pain and health-related quality-of-life measures. The outcomes were assessed at baseline and at 2 and 6 weeks from baseline. Patients in the abdominal acupuncture group received additional follow-up evaluation at 14 weeks from baseline. Outcomes were evaluated by intention-to-treat analysis. RESULTS: All participants provided informed consent for treatment and follow-up evaluation. Patients who received abdominal acupuncture exhibited greater improvement in NPQ scores than those who received sham treatment at both 2 and 6 weeks from baseline (intergroup mean differences, -5.75; 95% confidence interval [CI], -9.48 to -2.03; P = 0.008 and -8.65; 95% CI, -12.13 to -5.16; P < 0.001, respectively). The improvement in NPQ scores in the abdominal acupuncture group was even more significant at 14 weeks from baseline. Patients in the abdominal acupuncture group also exhibited significantly greater improvements in intensity of neck pain and a few quality-of-life measures than those in the sham abdominal acupuncture group, without any serious adverse events. CONCLUSION: These findings suggest that abdominal acupuncture is an effective alternative treatment for neck pain. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC-14004932.

[Randomized controlled clinical trails on treatment of knee osteoarthritis with acupuncture combined with blood-letting therapy].

OBJECTIVE: To observe the therapeutic effect of acupuncture combined with blood-letting therapy for knee osteoarthritis (KOA) and to analyze the synergism of the blood-letting therapy. METHODS: Sixty-three cases of KOA patients were randomized into a treatment group (n=31) and a control group (n=32). Patients of treatment group were treated with routine acupuncture at Ashi-points, Dubi (ST 35) and Neixiyan (EX-LE 4), Zusanli (ST 36), Yanglingquan (GB 34), etc. on the affected side, 3 times a week for 4 weeks, in combination with blood-letting (at the superficial veins around popliteal fossa) once a week for 4 weeks. Patients of control group were treated with routine acupuncture only. Western Ontario and McMaster Universities osteoarthritis index scores (WOMAC) and clinical therapeutic effects served as the objective indexes for evaluating the efficacy of blood-letting therapy. RESULTS: After the treatment, of the 32 and 31 KOA patients in control and treatment groups, 4 (12.50%) and 5 (16. 13) were under control in their symptoms, 14 (43.75%) and 17(54.84%) experienced marked improvement, 10 (31.25%) and 6 (19.35%) had an improvement, and 4 (12.50%) and 3 (9.68%) were failed, with the total effective rates being 87.50% and 90.32% respectively. No significant difference was found between the two groups in the therapeutic effect (P > 0.05). In comparison with pre-treatment, WOMAC scores, pain index, and physiological integral scores in treatment and control groups after the first and the last treatment decreased significantly (P < 0.001), and their joint stiffness index of the last treatment also lowered considerably (P < 0.001). The difference values of the integral scores between post- and pre-treatment in WOMAC, pain index, and physiological function of treatment group were remarkably higher than those of control group (P < 0.05). CONCLUSION: Acupuncture combined with blood-letting therapy can effectively improve KOA patients' physiological function and reduce joint pain especially in the early stage.

[Clinically randomized controlled study on abdominal acupuncture for treatment of cervical spondylosis].

OBJECTIVE: To compare clinical therapeutic effects of abdominal acupuncture and traditional acupuncture on cervical spondylosis (CS). METHODS: Sixty-two cases of neck or nerve-root type CS were randomly divided into an observation group (n=32) treated by abdominal acupuncture at Zhongwan (CV 12), Guanyuan (CV 4) and others, and a control group (n=30) treated by traditional acupuncture at Fengchi (GB 20) and cervical Jiaji (EX-B 2), etc.. Simplified McGill Pain Questionnaire (MPQ) and clinical therapeutic effects were served as the objective indexes. Their clinical therapeutic effects were compared after the first session of treatment, at the end of therapeutic course and 3 months after the end of treatment. RESULTS: The two groups had a same effective rate of 100.0%. All items of MPQ in these two groups after treatment and 3 months after the end of treatment significantly improved, and in the observation group the differences in the PRI feeling score before and after the first treatment, and the difference of the total PRI scores after the first treatment, at the end of therapeutic course and 3 months after the end of treatment significantly improved as compared with the control group (P < 0.05). CONCLUSION: Abdominal acupuncture can better reduce the pain of the patient caused by CS, with transient pain-alleviating effect, but whether or not the clinical therapeutic effect of abdominal acupuncture is better than the traditional acupuncture still can not be proved.

Effect of "phased whole acupuncture therapy" on ability of daily life in 63 cases of cerebral infarction-induced hemiplegia.

OBJECTIVE: To observe the effect of "phased whole acupuncture therapy" on the ability of daily life (ADL) of the patients with cerebral infarction-induced hemiplegia. METHODS: 113 patients were randomly divided into a treatment group (n=63) treated with phased whole acupuncture and a control group (n=50) treated with traditional acupuncture. After the treatment, the improvement of ADL was compared between the two groups. RESULTS: Patients in the treatment group obtained satisfactory therapeutic effects in ADL improvement and in lowering of deformed rate, which were superior to those in the control group. CONCLUSION: The phased whole acupuncture is an effective therapy in treating cerebral infarction-induced hemiplegia, which can better improve the life quality of the patients.

[Observation on short-term therapeutic effect of Bo's abdominal acupuncture on chronic urticaria].

OBJECTIVE: To observe short-term therapeutic effect and safety of Bo's abdominal acupuncture for treatment of chronic urticaria. METHODS: Sixty-one cases of chronic urticaria were randomly divided into an observation group (n = 31) and a control group (n = 30). They were treated respectively with Bo's abdominal acupuncture and cetirizine. Their therapeutic effects were compared. RESULTS: The effective rate was 80.7% in the observation group and 76.7% in the control group with no significant difference, but no adverse effect was found in the observation group, and the adverse effects such as sleepiness, headache, thirsty and so on were found in the control group. CONCLUSION: Bo's abdominal acupuncture has a short-term therapeutic effect similar to cetirizine on chronic urticaria, and has no adverse effect of anti-histamine agents, being more safe.

[Randomized controlled study on picking therapy for treatment of cervical spondylosis].

OBJECTIVE: To use randomized controlled clinical research method to assess therapeutic effect of picking therapy on cervical spondylosis. METHODS: One hundred and fifty-eight cases were randomly divided into a picking therapy group (n=56), a routine acupuncture group (n=55) and a local anesthesia group (n=47). They were treated respectively with picking therapy, routine acupuncture and local anesthesia at Jing bailao (EX HN 15), Dazhui (GV 14), Jianjing (GB 21), etc. Brief McGill Pain Questionaire was used for score, which was combined with clinical symptoms and signs to analyze the therapeutic effect. RESULTS: The cured rate was 57.1% in the picking therapy group, better than 23.6% in the acupuncture group and 14.9% in the local anesthesia group (P < 0.01), and adverse reaction was basically not found in the picking therapy group. CONCLUSION: Picking therapy is a highly effective and safe therapy for cervical spondylosis.

[Clinically controlled study on phased integral needling method for treatment of cerebral infarction].

OBJECTIVE: To compare clinical therapeutic effects of phased integral acupuncture and routine acupuncture on patients with cerebral infarction. METHODS: One hundred and thirteen cases were randomly divided into a treatment group (n = 63) treated by phased integral acupuncture and a control group (n = 50) treated by routine acupuncture. Their clinical therapeutic effects were compared after treatment. RESULTS: The treatment group in the decreases of both the diagnostic score for TCM diseases of stroke and the score for neurological function defect, and the therapeutic effect was superior to the control group with significant differences (all P < 0.05). CONCLUSION: The phased integral acupuncture is an effective therapy with a therapeutic effect better than that of the routine acupuncture for treatment of hemiplegia due to cerebral infarction.