Clinical efficacy of acupuncture therapy combined with core muscle exercises in treating patients with chronic nonspecific low back pain: a systematic review and meta-analysis of randomized controlled trials.

Introduction: This meta-analysis aimed to determine the clinical efficacy of acupuncture combined with core muscle exercises on pain and functional status in patients with chronic nonspecific low back pain. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and meta-analysis criteria for systematic reviews and meta-analyses. Randomized controlled trials published till November 2023 were searched in PubMed, Web of Science, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang databases. The search strategy was related to disease type, intervention, and control measures and was structured around the search terms "low back pain," "acupuncture therapy," and "exercise." Two reviewers applied inclusion and exclusion criteria. Sensitivity and fixed effects analyses were performed to determine the primary outcomes. Results: We included 11 randomized controlled trials (n = 727) on acupuncture combined with core muscle exercises in patients with chronic nonspecific low back pain. Compared with controls, clinical efficacy was significant, with improvements in pain scores (visual analog pain scale and numerical rating scale) and Oswestry Disability Index in the intervention group. Discussion: Acupuncture therapy combined with core muscle exercises improved pain and functional status in patients with chronic nonspecific low back pain, with favorable clinical outcomes compared with single-core muscle training. Multicenter large-sample trials are required to obtain more reliable conclusions.

Early risk assessment and prediction model for osteoporosis based on traditional Chinese medicine syndromes.

Objective: To evaluate the risk factors of osteoporosis and establish a risk prediction model based on routine clinical information and traditional Chinese medicine (TCM) syndromes. Methods: Adults aged 30-82 who lived in 12 grass-roots communities or rural towns in Shanghai, Jilin Province, and Jiangsu Province from December 2019 to January 2022 through a multi-stage sampling method were included in this study. The risk factors and risk prediction of osteoporosis in women and men were explored and established by univariate analysis and multivariate logistic regression model. ROC curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the prediction model. Results: A total of 3000 subjects including 2243 females (75 %) and 757 males (25 %) were included in this study. The logistic prediction model of osteoporosis in women was Logit (P) = -2.946 + 0.960 (age ≥50 years old) + 0.633 (BMI ≥24 kg/m2) - 0.545 (daily exposure to sunlight >30 min) + 0.519 (no intake of dairy products) + 0.827 (coronary heart disease) + 0.383 (lumbar disc herniation) + 0.654 (no intake of calcium tablets and vitamin D) - 0.509 (insomnia) + 0.580 (flushed face and congested eyes) + 1.194 (thready and rapid pulse) + 1.309 (sunken and slow pulse). The logistic prediction model of osteoporosis in men was Logit (P) = -1.152-0.644 (daily exposure to sunlight >30 min) + 0.975 (no intake of calcium tablets and vitamin D) - 0.488 (insomnia). The area under the ROC curve (AUC) of female and male osteoporosis prediction models was 0.743 and 0.679, respectively. The Hosmer-Lemeshow goodness-of-fit test was >0.5. Conclusions: There are some significant differences in risk factors between female and male patients with osteoporosis. The risk of osteoporosis are found to be associated with TCM syndromes, and osteoporosis risk prediction models based on routine clinical information and TCM syndrome is effective.

Identification of biomarkers associated with oxidative stress-related genes in postmenopausal osteoporosis.

Osteoporosis (OP) is a prevalent metabolic disease, with aging and menopause being the major risk factors. Studies have shown that nearly one-third of postmenopausal women suffer from osteoporosis. However, there is a scarcity of research on antioxidant systems for the prevention and treatment of postmenopausal osteoporosis (PM-OP). To address this gap, we performed differential analysis using Limma to identify differentially expressed genes (DEGs) in PM-OP samples. We employed weighted correlation network analysis (WGCNA) to identify oxidative stress (OS)-related genes (OSRGs) highly correlated with PM-OP. The intersection of key modular genes and DEGs yielded differentially expressed OSRGs (DE-OSRGs) specific to PM-OP. We conducted GO and KEGG functional enrichment analyses on these genes. Additionally, we constructed a protein-protein interaction (PPI) network and utilized support vector machine recursive feature elimination (SVM-RFE) and random forest (RF) algorithms to identify signature genes. The diagnostic value of the signature genes was evaluated and validated using ROC curves. GSEA enrichment analysis was employed to explore the potential mechanisms associated with the signature genes. Finally, we constructed a regulatory network involving TF-miRNA-mRNA interactions for the signature genes and verified the biological roles of FOXO3 and DDIT3 in PM-OP and healthy groups using quantitative real-time PCR (qRT-PCR). Our analysis revealed 20 DE-OSRGs specific to PM-OP, obtained by intersecting modular and differential genes. The PPI network identified central genes (DDIT3, MAPK8, CDK2, SIRT1, and FOXO3) with more than 3 nodes. Through integration with machine learning algorithms, we identified DDIT3 and FOXO3 as signature genes. The ROC curve analysis indicated that the AUC value was greater than 0.7, suggesting the potential diagnostic value of these signature genes. Furthermore, GSEA results revealed their involvement in pathways related to the regulation of neutrophil activation, oxidative phosphorylation, MAPK signaling, mitochondrial matrix, and phagocytosis. Lastly, we constructed a regulatory network comprising 27 nodes (22 TFs, 3 miRNAs, and 2 mRNAs) and 28 edges. Additionally, qRT-PCR confirmed the significant up-regulation of FOXO3 and DDIT3 expressions in the PM-OP group compared to the healthy control group. In summary, this study employed bioinformatics analysis to identify OS-related biomarkers (DDIT3 and FOXO3) in PM-OP, providing new biological targets for clinical treatment.

Shi-Style Cervical Mobilizations Versus Massage for Cervical Vertigo: A Multicenter, Randomized, Controlled Clinical Trial.

Objectives: Large sample and high-quality evidence to evaluate the preliminary safety of the mobilizations and massage for cervical vertigo are not yet available. Thus, the present study aimed to investigate the comparative effectiveness and preliminary safety of Shi-style cervical mobilizations (SCM) compared with traditional massage (TM) in cervical vertigo patients. Design: A prospective, multicenter, open-label, randomized, controlled clinical trial with a 1:1 allocation ratio. Settings: Five academic medical centers. Subjects: A total of 360 adult patients with a diagnosis of cervical vertigo. Interventions: The patients were randomly allocated to either an SCM (n = 180) or TM (n = 180) group. The patients were treated during six sessions over 2 weeks. The primary outcome was the Dizziness Handicap Inventory (DHI) total scale score, and secondary outcomes included the DHI subscales, Chinese version of the Short-Form 36 Health Survey (CSF-36), and adverse events (AEs). Outcomes were assessed in the short term at 2 weeks, 1 month, and 3 months, and in the intermediate term at 6 months after randomization. Results: Significant changes were observed from the baseline in the DHI total scale and subscales at 2 weeks and 1, 3, and 6 months in both groups (all p < 0.05). However, the differences between the two groups were not significant (all p > 0.05). Furthermore, we noted significant changes from the baseline in SF-36 scores at 2 weeks in both groups (all p < 0.05), whereas CSF-36 scores were not significantly higher in the SCM group (all p > 0.05) compared with the TM group. No serious AEs were reported in either of the two groups. Conclusions: No differences in outcomes were detected between the SCM and TM groups in terms of treatment of cervicogenic dizziness. Efficacy trials are required to determine whether the improvement observed for each treatment was causally related to the interventions.

Shi-style cervical manipulations for cervical radiculopathy: A multicenter randomized-controlled clinical trial.

BACKGROUND: There is a lack of high-quality evidence supporting the use of manipulation therapy for patients with cervical radiculopathy (CR). This study aimed to evaluate the effectiveness of Shi-style cervical manipulations (SCMs) versus mechanical cervical traction (MCT) for CR. METHODS: This was a randomized, open-label, controlled trial carried out at 5 hospitals in patients with CR for at least 2 weeks and neck pain. The patients received 6 treatments of SCM (n = 179) or MCT (n = 180) over 2 weeks. The primary outcome was participant-rated disability (neck disability index), measured 2 weeks after randomization. The secondary outcomes were participant-rated pain (visual analog scale) and health-related quality of life (36-Item Short Form Health Survey [SF-36]). Assessments were performed before, during, and after (2, 4, 12, and 24 weeks) intervention. RESULTS: After 2 weeks of treatment, the SCM group showed a greater improvement in participant-rated disability compared with the control group (P = .018). The SCM group reported less disability compared with the control group (P < .001) during the 26-week follow-up. The difference was particularly important at 6 months (mean -28.91 ±â€Š16.43, P < .001). Significant improvements in SF-36 were noted in both groups after 2 weeks of treatment, but there were no differences between the 2 groups. CONCLUSION: SCM could be a better option than MCT for the treatment of CR-related pain and disability.

Yiqi Huayu recipe relieves nerve root constriction induced radicular neuralgia by down-regulating TRPV4 expression in dorsal root ganglion.

The aim of this study was to observe the effects of Yiqi Huayu recipe on TRPV4 expression in radicular neuralgia model induced by chronic constriction to the rat lumber nerve root. Healthy male SD rats were divided into 3 groups for radicular neuralgia (RN) model construction: the sham operation group, model groups (day 3, 7, 14 and 28), and medication groups (day 3, 7, 14 and 28). Von-Frey hairs test was performed to detect the 50% with drawal threshold (50% TPW) for rats of each group. The expression of TRPV4 in dorsal root ganglion was detected at both mRNA and protein level. Rats from all model groups displayed hyperalgesia with significantly reduced 50% TPW values compared with sham-operation group (P<0.01); Yiqi Huayu recipe medication groups showed higher 50% TPW than model group since 7 days post medication (P<0.01); the medication groups showed decreased TRPV4 expression than that of model groups (P<0.01). In conclusion, Yiqi Huayu recipe alleviates nerve root constriction induced radicular neuralgia by repressing TRPV4 expression in dorsal root ganglion.

A 12-Words-for-Life-Nurturing Exercise Program as an Alternative Therapy for Cervical Spondylosis: A Randomized Controlled Trial.

In this paper, we carried out a randomized controlled clinical trial to explore the effect of 12-words-for-life-nurturing exercise on patients presenting with cervical spondylosis. After exercise intervention, the mean VAS and NDI scores of the patients decreased significantly and the scores of BP, VT, and MH in SF-36 Health Questionnaire were significantly higher. Exercise therapy showed significant effect on relieving pain and improving vitality and mental health. The 12-words-for-life-nurturing exercise may be a potential effective therapy for patients with cervical spondylosis.

Effects of electroacupuncture on muscle state and electrophysiological changes in rabbits with lumbar nerve root compression.

OBJECTIVE: To observe the effects of electroacupuncture on force-displacement value (FDV) of muscle state and electrophysiology of the muscle in rabbits with lumbar nerve root compression. METHODS: Thirty New Zealand white rabbits were randomly divided into a control, a model, an electro-acupuncture acupoints (EAA), a medication, and an electro-acupuncture un-acupoints (EAU) group. All rabbits except those in the control group were subject to modeling (surgical lumbar nerve root compression). The control group was sham-operated without nerve root compression. The EAA group received electro-acupuncture at bilateral Shenshu (BL23) and Dachangshu (BL25) that were located 1.5 cun lateral to the posterior midline on the lower border of the spinous process of the 2nd and 4th lumbar vertebra, respectively. The EA was 15 mm deep and the frequency was 2 Hz. Each session lasted for 20 min per day for a total of 14 times. The medication group was treated with Loxoprofen sodium by gastrogavage at 4 mg/kg per day for 14 days. The EAU group received electro-acupuncture identical to the EAA group with regard to the treatment frequency and duration except a different acupoint at the tip of rabbit tail. Muscle states were determined by measuring FDVs of the bilateral biceps femoris using the Myotonometer® fast muscle state detector. Meanwhile, the prolonged and non-prolonged insertion potentials were measured by electromyography before and after modeling and after treatment. Latency, amplitude (Amp) of evoked potential, motor nerve conduction velocity (MNCV) were also determined after treatment. RESULTS: (1) After modeling, FDVs of right side activation (RSA, P=0.003) and right side relaxation (RSR) in the model group (P=0.000) were significantly decreased in comparison to the control group. The number of rabbits with non-prolonged insertion potentials in the model group was also significantly decreased (P=0.015) in comparison to the control group. (2) After treatment, FDVs of RSR were significantly increased in the EAA (P=0.000) and medication groups (P=0.018) in comparison to the model group. The increase in FDVs of RSR in the EAA group was significantly higher than that in EAU (P=0.000) and medication groups (P=0.002). MNCV in the model group was reduced compared with the control group (P=0.000). The reduction in MNCV after modeling was reversed in the EAA group (P=0.000) and medication group (P=0.008) after treatment and the increases were significant in both treatment groups in comparison to the model group. The EAA group had a greater MNCV recovery than the medication group (P=0.022). CONCLUSION: Electro-acupuncture could improve the rehabilitation and regeneration of FDVs and the electrophysiology index of the muscle with nerve control impairment.

Changes of cervical dorsal root ganglia induced by compression injury and decompression procedure: a novel rat model of cervical radiculoneuropathy.

Our study aimed to establish a model of compression injury of cervical dorsal root ganglia (DRG) in the rat and to investigate the pathological changes following compression injury and decompression procedures. Thirty rats were divided into three groups: control group receiving sham surgery, compression group undergoing surgery to place a micro-silica gel on C6 DRG, and decompression group with subsequent decompression procedure. The samples harvested from the different groups were examined with light microscopy, ultrastructural analysis, and horseradish peroxidase (HRP) retrograde tracing techniques. Apoptosis of DRG neurons was demonstrated with TUNEL staining. Changes in PGE2 and PLA2 in DRG neurons were detected with enzyme-linked immunosorbent assay (ELISA). Local expression of vascular endothelial growth factor (VEGF) was monitored with immunohistochemistry. DRG neurons in the compression group became swollen with vacuolar changes in cytoplasm. Decompression procedure partially ameliorated the resultant compression pathology. Ultrastructural examination showed a large number of swollen vacuoles, demyelinated nerve root fibers, absence of Schwann cells, and proliferation in the surrounding connective tissues in the compression group. Compared to the control group, the compression group showed a significant decrease in the number of the HRP-labeled cells and a significant increase in levels of PGE2 and PLA2, in the expression of VEGF protein, and in the number of apoptotic DRG neurons. These findings demonstrate that compression results in local inflammation, followed by increased apoptosis and upregulation of VEGF. We conclude that such a model provides a tool to study the pathogenesis and treatment of cervical radiculoneuropathy.