Acupuncture treatment for Hashimoto's thyroiditis: An exploratory randomized controlled trial.

Background: Hashimoto's thyroiditis (HT) has a high incidence rate and unresolved clinical symptoms. Although Hand Yangming Meridian Penetrating Acupuncture has been used to treat thyroid diseases in China, there is no randomized controlled trial (RCT) on HT. Methods: This exploratory RCT aims to preliminarily evaluate the efficacy, safety, and feasibility of Hand Yangming Meridian Penetrating Acupuncture in the treatment of HT. Included subjects were randomly assigned to the acupuncture group and the waiting treatment group at a ratio of 1:1. Subjects in the acupuncture group received 16 weeks of acupuncture treatment, followed by a 16-week follow-up observation phase. Subjects in the waiting group received thyroxine supplementation for 16 weeks, followed by 16 weeks of compensation treatment. Serum thyroid peroxidase antibody (TPOab) and thyroglobulin antibody (TGab) levels were the main indicators, and Thyroid-Related Patient-Reported Outcome short form (ThyPRO-39), MOS Item Short Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS) scores were also recorded. Results: In total, 58 subjects were included. After 16 weeks of treatment, there was no statistical difference in the changes in TPOab levels between the two groups, but the TGab level in the acupuncture group was significantly lower than in the waiting group (difference: -141.97 [95 % CI: -222.4 to -61.5], P = 0.011). Moreover, the total ThyPRO-39 and SF-36 scores were statistically different between the two groups (PThyPRO-39 < 0.001, PSF-36 = 0.005). There was no statistical difference in HADS between the two groups. Conclusions: Hand Yangming Meridian Penetrating Acupuncture may be safe and feasible for HT hypothyroidism to improve symptoms and reduce TGab levels. Trial registration number: This trial was registered at Acupuncture-Moxibustion Clinical Trial Registry: AMCTR-IOR-19000308 (ChiCTR1900026830, https://www.chictr.org.cn/searchprojEN.html).

[From the body-mind holism to psychosomatic medicine: theory and practice of acupuncture and moxibustion].

The traditional life concept of "body-mind holism" in Chinese medicine has drawn a special attention with the development of modern psychosomatic medicine. The "body-mind holism" is valuable in the guidance for clinical acupuncture practice, but, it is only remained on the theoretical significance by the medical masters in the past dynasties. In the paper, based on the understanding of Huangdi Neijing (Yellow Emperor's Internal Classic), the similarities and differences are compared between the body-mind theory and psychosomatic medicine. In association with clinical observation, from three aspects, i.e. body-mind pathogenesis, acupoint detection and observing the mind, and body-mind treatment, the guidance of "body-mind holism" is explored for the clinical diagnosis and treatment of acupuncture and moxibustion; the referents of "body" and "mind" are clarified in views of disease, diagnosis and treatment; and the treatment strategies of acupuncture and moxibustion are discussed in the perspective of "body-mind holism".

[Constructing of clinical thinking of acupuncture and moxibustion, improving the medical record writing ability of standardized training physicians: teaching experience of the standardized training textbook Acupuncture and Moxibustion for national TCM resident physicians].

To explore the methods of cultivating the clinical thinking ability of acupuncture and moxibustion in the standardized training of resident physicians, so as to improve the medical record writing ability of the regular training physicians. The clinical diagnosis and treatment of acupuncture and moxibustion has its own characteristics and can't copy the syndrome differentiation and treatment mode of TCM internal medicine. In the treatment section, Acupuncture and Moxibustion, a standardized training textbook for national TCM resident physicians, takes clinical cases as the breakthrough point and uses the problem as the guide, guides the training physicians to cultivate acupuncture and moxibustion clinical diagnosis and treatment from three aspects: disease diagnosis, syndrome diagnosis, and treatment ideas, forms a complete understanding of the disease, and improves the standardization, logicality and systematicness of medical record writing through repeated practical training.

[Consideration on the construction of acupuncture and moxibustion clinical diagnosis and treatment system with the core of "differentiation of disease location": taking "treatment" of Science of Acupuncture and Moxibustion as an example].

Based on the difference between disease and syndrome differentiation of acupuncture and moxibustion and each department of TCM, i.e. internal medicine, external medicine, gynecology and pediatrics, it is believed that "differentiation of disease location" is the key of disease and syndrome differentiation of acupuncture and moxibustion. According to the disease location, in the section "treatment" of Science of Acupuncture and Moxibustion, the disorders/illness are classified as zangfu disorder, disorders of limbs and meridians, dermatological disorder, ophthalmological and otorhinolaryngological disorder, gynecological disorder, as well as qi, blood and body fluid disorder. Besides, the rules of disease and syndrome differentiation, as well as treatment characteristics of each category are explained separately. It is considered that the clinical diagnosis and treatment system of acupuncture and moxibustion should be constructed by focusing on "differentiation of disease location".

Contralateral Acupuncture for the Treatment of Phantom Limb Pain and Phantom Limb Sensation in Oncologic Lower Limb Amputee: A Case Report.

Phantom limb pain (PLP) and phantom limb sensation (PLS) are common and distressing sequelae of amputation. Current pain management following amputation is challenging and unsatisfying. In this case study, a 74-year-old woman underwent above-knee amputation because of the rhabdomyosarcoma in the right leg. Despite several analgesics, pain was poorly controlled. The phantom limb pain and sensation were immediately reduced by the contralateral acupuncture, and abolished after the third session with no side-effects, no relapse during the next 9 months. Contralateral acupuncture showed positive effect on PLP and PLS in this case, but more robust evidence would be needed to support the efficacy of this treatment technique for indication.

Efficacy of Electroacupuncture Therapy in Patients With Postherpetic Neuralgia: Study Protocol for a Multicentre, Randomized, Controlled, Assessor-Blinded Trial.

Introduction: The efficacy of conventional treatments for treating postherpetic neuralgia (PHN) remains unsatisfactory. Thus, this multicentre, randomized controlled, assessor-blinded trial aims to investigate the efficacy and safety of electroacupuncture (EA) therapy in patients with PHN. Methods and Analysis: This multicentre randomized controlled trial will enroll 132 patients with PHN from 3 hospitals. All patients will be randomly assigned to either the EA combined with medication group or medication group through a computerized central randomization system in a 1:1 ratio. Outcome measures will be assessed before intervention, at 2, 4, 6 weeks after intervention and at the end of 8-week follow-up. Primary outcomes will be sensory thresholds and pain intensity. Secondary outcomes will include dosage of analgetic, quality of life, anxiety, and depression severity and sleep quality. All adverse effects will be assessed during the trial. Conclusions: This study will provide evidence to ascertain whether EA is effective and safe for treating PHN. Ethics and Dissemination: Ethics approval (No.ZSLL-KY-2017-025) has been obtained from the Ethics Committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University. Informed consent will be signed prior to subject enrolment. The results will be submitted to international peer-reviewed journals and presented at international conferences. Trial Registration Number: The study protocol has been registered in the clinicaltrials registry with the identification code NCT04594226.

Auricular Therapy for Treating Phantom Limb Pain Accompanied by Jumping Residual Limb: A Short Review and Case Study.

Phantom limb pain (PLP) is a common complaint among patients after amputation, while jumping residual limb is a rare post-amputation complication, they rarely happen at the same time and both remain difficult to manage. At present, there is a paucity of literature on this topic, and no treatment has been proven effective for treating both of them. In the present brief report, we described a patient who developed severe PLP accompanied by jumping residual limb after below-the-knee amputation and she was treated by auricular therapy (AT) with satisfactory effect.

[Acupuncture Treatment of Primary Dysmenorrhea by Needling Acupoints of the Spleen Meridian with Positive Reactions：A Randomized Controlled Clinical Trial].

OBJECTIVE: To observe whether acupuncture of the tender-points of the Spleen Meridian can achieve a better therapeutic effect for primary dysmenorrhea (PD) patients, so as to verify the importance of examining meridian-acupoint reactions in clinical practice. METHODS: A total of 72 PD patients were randomly assigned to tender-point group (observation group) and regular acupoint group (control group, n＝36 in each). For patients of the observation group, the tender-points around San-yinjiao (SP 6), Diji (SP 8) and Yinlingquan (SP 9) were needled, and for those of the control group, the regular SP 6, SP 8 and SP 9 were needled. After "Deqi", the filiform needles were manipulated with lifting-thrusting reducing technique for about 30 s, repeated once again every 10 min during 30 min's needle retention, and the treatment was conducted once daily for 3 days during every menstrual cycle, continuously for 3 months. The visual analogue scale (VAS) was rated for assessing the pain severity, and the COX menstrual symptom scale (CMSS) consists of 17 items and 5 grades/item (0－4 points) according to the severity of discomfort was rated before and after the treatment. RESULTS: After the treatment, the VAS and CMSS scores on the 1st days of the 1st, 2nd and 3rd menstrual cycles were significantly decreased in both control and observation groups in comparison with their own individual pre-acupuncture (P<0.05), suggesting a marked relief of both pain and discomforts after the treatment, and the therapeutic effect of the tender-point needling was significantly superior to that of the regular acupoint needling in relieving pain in the 2nd and 3rd menstrual cycles. No significant difference was found between the two groups in the discomfort severity (P>0.05). CONCLUSION: Acupuncture stimulation of the tender points around the SP 6, SP 8 and SP 9 has a stronger analgesic effect relevant to needling the regular acupoints in PD patients.

Is dry needling effective for low back pain?: A systematic review and PRISMA-compliant meta-analysis.

BACKGROUND: To evaluate the efficacy and safety of dry needling (DN) for treating low back pain (LBP). METHODS: Nine databases were searched from inception to October 2017. Eligible randomized controlled trials (RCTs) involving DN for treating LBP were retrieved. Two reviewers independently screened the articles, extracted data, and evaluated the risk of bias among the included studies using the risk of bias assessment tool by Cochrane Collaboration. RESULTS: Sixteen RCTs were included and the risk of bias assessment of them was "high" or "unclear" for most domains. Meta-analysis results suggested that DN was more effective than acupuncture in alleviating pain intensity and functional disability at postintervention, while its efficacy on pain and disability at follow-up was only equal to acupuncture. Besides, DN was superior to sham needling for alleviating pain intensity at postintervention/follow-up and functional disability at postintervention. Additionally, qualitative review revealed that DN combined with acupuncture had more significant effect on alleviating pain intensity at postintervention and achieved higher response rate than DN alone. However, compared with other treatments (laser, physical therapy, other combined treatments, etc.), it remained uncertain whether the efficacy of DN was superior or equal because the results of included studies were mixed. CONCLUSIONS: Compared with acupuncture and sham needling, DN is more effective for alleviating pain and disability at postintervention in LBP, while its effectiveness on pain and disability at follow-up was equal to acupuncture. Besides, it remains uncertain whether the efficacy of DN is superior to other treatments. Nevertheless, considering the overall "high" or "unclear" risk of bias of studies, all current evidence is not robust to draw a firm conclusion regarding the efficacy and safety of DN for LBP. Future RCTs with rigorous methodologies are required to confirm our findings. DETAILS OF ETHICS APPROVAL: No ethical approval was required for this systematic review and meta-analysis.

[Analysis on the laws of acupoint selection and therapeutic operations with acupuncture based on the characteristics of postherpetic neuralgia].

Postherpetic neuralgia is manifested as drastic lingering pain, which seriously impacts the survival quality of patient. In the paper, focusing on the time of postherpetic neuralgia and in association with the characteristics of symptoms such as the location and nature of pain and skin lesion, the etiology, location of sickness, nature of sickness and pathogenesis were differentiated, and the laws of acupoint selection and therapeutic operations were explored in the treatment with acupuncture. Regarding the apparent pain at night, especially during 23:00 to 3:00, Ashi points (Extra) and Jiaji (EX-B 2) were selected in terms of location differentiation. The acupoints on the liver and gallbladder meridians were specially selected and the supplementary acupoints were used according to general symptoms based on syndrome and symptom differentiation to improve the therapeutic effects. Regarding the therapeutic operation, the bloodletting puncture was used in terms of blood stagnation in collaterals. Additionally, the other operations were selected individually, such as filiform needle therapy, fire needling therapy, plum-blossom needle therapy and bleeding and cupping therapy.

ZNF23 Suppresses Cutaneous Melanoma Cell Malignancy via Mitochondria-Dependent Pathway.

BACKGROUND/AIMS: Cutaneous melanoma is one of the leading causes of cancer deaths with an increasing incidence worldwide. A KRAB-containing zinc finger protein member, zinc finger 23 (ZNF23), was reduced in some types of tumors and inhibited cell growth by inducing cell cycle arrest. However, the role of ZNF23 expression is still poorly understood in melanoma. METHODS: The level of ZNF23 expression was detected in cutaneous melanoma, adjacent normal skin tissues and cutaneous melanoma cell lines using immunohistochemistry and western blotting. The correlations between ZNF23 expression and other clinicopathologic parameters were analyzed in melanoma patients. Ectopic expression of ZNF23 plasmid was transfected into melanoma cells, SK-MEL-1 and SK-MEL-28. MTT, flow cytometry and transwell assay were used to measure cell proliferation, apoptosis, invasion and migration abilities, respectively. Mitochondrial functions and structures were detected by mitochondrial membrane potential assay and Transmission electron microscopy (TEM) method in melanoma cells transfected with overexpressing ZNF23 plasmid or empty vector. Western blotting was performed to detect the levels of ZNF23, p53, p27, Bcl-2 and cleaved caspase-3 after overexpressing of ZNF23 in melanoma cells. RESULTS: ZNF23 was elevated in adjacent normal skin tissues compared with melanoma tissues. Patients with low level of ZNF23 expression exhibited higher incidence of lymphoid metastasis, thicker size of tumors and worse outcome. By using Cox's regression analysis, ZNF23 expression, tumor thickness and lymph node metastasis were the independent prognostic factors for overall survival (p < 0.05). Results from cellular experiments indicated that ectopic expression of ZNF23 induced cell apoptosis by activation of caspase-3, p27, p53 expression and down-regulation of Bcl-2 through mitochondria-dependent pathway. CONCLUSIONS: Decreased ZNF23 was contributed to melanoma progression and poor survival with mitochondria-dependent pathway. It indicated that ZNF23 could be a promising therapeutic biomarker candidate for cutaneous melanoma.

[Impact of electroacupuncture on the life quality in patients of female mixed urinary incontinence].

OBJECTIVE: To observe the impact of electroacupuncture (EA) on the quality of life in the patients of female mixed urinary incontinence (MUI) and evaluate its clinical efficacy. METHODS: EA was adopted in 25 cases of MUI at Zhongliao (BL 33) and Huiyang (BL 35), needle retaining for 30 min each time. The treatment was given once every two days, three treatments a week, totally for 12 weeks of treatment. The incontinence quality of life questionnaire (I-QOL), the incontinence impact questionnaire-7 (IIQ-7), the urogenital distress inventory short form (UDI-SF) and the visual analogue scale (VAS) were adopted in the comparison before and after treatment. The efficacy was evaluated. RESULTS: The curative rate was 52.0% (13/25) and the total effective rate was 96.0% (24/25) in 25 cases. In comparison before and after treatment, in I-QOL, the score of limiting behaviors was increased up to (30.32 ± 3.39) from (11.52 ± 2.45), the score of psychosocial impacts was up to (36.48 ± 2.90) from (13.52 ± 2.25) and the score of social isolation was up to (21.52 ± 1.61) from (9.84 ± 2.23). The score of IIQ-7 was decreased, down to (2.48 ± 1.36) from (11.96 ± 3.45), the score of UDI-SF was down to (2.92 ± 0.95) from (8.84 ± 2.58) and VAS score was down to (1.40 ± 0.91) from (6.96 ± 1.65). The differences were all significant statistically in comparison (all P < 0.05). CONCLUSION: EA improves effectively the quality of life in MUI patients and the clinical efficacy is apparent.

[Effective observation of electroacupuncture with different courses for female stress urinary incontinence].

OBJECTIVE: To verify the effect of electroacupuncture (EA) for female stress urinary incontinence (SU). METHODS: Forty-two patients were randomly divided into an observation group(20 cases) and a control group (22 cases). EA at Zhongliao (BL 33) and Huiyang (BL 35) was used in the observation group. Sham acupuncture at non meridian points, one can beside Zhongliao (BL 33) and Huiyang (BL 35), was applied, and placebo EA was adopted in the control group. Treatment with needle retained for 30 min a time was given once every other day and three times a week for continuous six weeks in the two groups. Urinary and reproductive simple score (UDI),visual analogue scale (VAS) and the frequency of nocturnal enuresis were observed before treatment, at the second, forth and sixth week of treatment in the two groups, and the efficacy was compared. RESULTS: The effective rates of the observation group were 80.0% (16/20), 95.0% (19/20) and 95.0% (19/20), which were better than 40.9% (9/22), 31.8% (7/22) and 27.3% (6/22) of the control group at the second, forth and sixth week of treatment. The differences were statistically significant between the two groups (all P < 0.05). After treatment in the observation group, the results of UDI, VAS and frequency of nocturnal enuresis were improved compared with those before treatment (all P < 0.05). Along with treatment, all indices were gradually improved, and the change at the sixth week was the most obvious in observation group. The results of the observation group were better than those of the control group at all times (all P < 0.05). CONCLUSION: EA achieves obvious effect for female SUI, and effectively improves the lower urinary trace symptoms, the degree of urinary incontinence and the frequency of nocturnal enuresis. The effect becomes increasingly better along with treatment within six weeks.

[Standardizing the manipulation procedure of acupuncture-moxibustion, reinforcing the training of' clinical skill: learning experience of Acupuncture-moxibustion Clinical Skills Training: Chapter of Commonly Used Needling and Moxibustion Techniques].

The book Acupuncture-moxibustion Clinical Skills Training is one of "Twelfth Five-Year Plan" in novative teaching materials, which is published by People's Medical Publishing House. Through learning the first half of the book commonly used needling and moxibustion techniques, it is realized that the selection of book content is reasonable and much attention is paid to needling and moxibustion techniques; the chapter arrangement is well-organized, and the form is novel, which is concise and intuitive; for every technique, great attention is paid to standardize the manipulation procedure and clarify the technique key, simultaneously the safety of acupuncture and moxibustion is also emphasized. The characteristics of the book, including innovativeness, practicability, are highlighted, and it greatly helps to improve students' clinical skills and examination ability.

RIN1 exhibits oncogenic property to suppress apoptosis and its aberrant accumulation associates with poor prognosis in melanoma.

Malignant melanoma is an increasing disease in China, and its molecular mechanisms of development and progression are limited. The objective of this study was to investigate the expression of Ras interaction/interference 1 (RIN1) protein and its clinical significance in human melanoma. Immunohistochemistry was performed to detect the expression of RIN1 in 81 melanoma patients with a 5-year follow-up. The prognosis of the patients, classified by the clinicopathologic features and RIN1 expression, was assessed by multivariate analysis. RIN1 levels were then analyzed with overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS) in the cohort. The biological function was determined by proliferation assay, flow cytometry analysis through knocking down of RIN1 in melanoma cells A375, as well as caspase-3 activation and PARP cleavage were detected by western blot or fluorometric assay. Data showed that RIN1 was overexpressed in melanoma samples. High-level RIN1 expression was observed in 49.4 % (40 of 81 cases), associated with thickness grade (P = 0.008) and lymph node metastasis (P < 0.001). Two distinguished subgroups were segregated by RIN1 levels within this set comparing prognostication of OS, PFS, and RFS. Importantly, RIN1 level was revealed as the significant independent prognostic factor for death and progression but a weak contribution for recurrence. Moreover, knock down of RIN1 expression in A375 cells, suppressed cell proliferation and induced apoptosis through caspase-3 activation and PARP cleavage. RIN1 expression could be a potential prognostic predictor for the melanoma patients and provide a potential target therapy for melanoma treatment.