Electroacupuncture pretreatment enhances the calcium efflux activity of Na+/Ca2+ exchanger to attenuate cerebral injury by PI3K/Akt-mediated NCX1 upregulation after focal cerebral ischaemia.

Electroacupuncture pretreatment is considered as an optimal strategy for inducing cerebral ischaemic tolerance. However, the underlying neuroprotective mechanism of this approach has never been explored from the perspective of calcium homeostasis. Intracellular calcium overload is a key inducer of cascade neuronal injury in the early stage after cerebral ischaemia attack and the Na+/Ca2+ exchanger (NCX) is the main plasma membrane calcium extrusion pathway maintaining post-ischaemic calcium homeostasis. This study aims to investigate whether the regulation of NCX-mediated calcium transport contributes to the cerebroprotective effect of electroacupuncture pretreatment against ischaemic injury and to elucidate the underlying mechanisms involved in this process. Following five days of repeated electroacupuncture stimulation on Baihui (GV20), Neiguan (PC6), and Sanyinjiao (SP6) acupoints in rats, in vivo and in vitro models of cerebral ischaemia were induced through middle cerebral artery occlusion and oxygen/glucose deprivation (OGD), respectively. Firstly, we verified the neuroprotective effect of electroacupuncture pretreatment from the perspective of neurological score, infarct volume and neuronal apoptosis. Our findings from brain slice patch-clamp indicated that electroacupuncture pretreatment enhanced the Ca2+ efflux capacity of NCX after OGD. NCX1 expression in the ischaemic penumbra exhibited a consistent decline from 1 to 24 h in MCAO rats. Electroacupuncture pretreatment upregulated the expression of NCX1, especially at 24 h, and silencing NCX1 by short hairpin RNA (shRNA) administration reversed the protective effect of electroacupuncture pretreatment against cerebral ischaemic injury. Furthermore, we administered LY294002, a phosphatidylinositol 3 kinase (PI3K) inhibitor, prior to inducing ischaemia to investigate the upstream regulatory mechanism of electroacupuncture pretreatment on NCX1 expression. Electroacupuncture pretreatment activates PI3K/Akt pathway, leading to an increase in the expression of NCX1, which facilitates calcium extrusion and exerts a neuroprotective effect against cerebral ischaemia. These findings provided a novel insight into the prevention of ischemic stroke and other similar conditions characterized by brain ischaemia or hypoperfusion.

Introduction to the Meta-analysis method of functional magnetic resonance imaging research and the exploration of its application in the field of acupuncture. / åŠŸèƒ½ç£å ±æŒ¯ç ”ç©¶å ƒåˆ†æžæ–¹æ³•ä»‹ç»åŠå ¶åœ¨é’ˆåˆºé¢†åŸŸçš„åº”ç”¨æŽ¢æž.

In recent years, the number of functional magnetic resonance imaging (fMRI) research in acupuncture grows increasingly. However, due to the differences in acupoint selection, acupuncture technique and sample size, the problems get more prominent in terms of the diverse results and the lack of common rules of acupuncture among researches. By taking the fMRI research for post-stroke motor dysfunction (PSMD) treated with acupuncture as the example, this paper introduces the fMRI Meta-analysis technology for integrating the relevant research results and extracting the common rules, namely image-based Meta-analysis (IBMA) and coordinate-based Meta-analysis (CBMA). Considering the higher feasibility of CBMA, three available CBMA methods are explained specially, including activation likelihood estimation (ALE), kernel density analysis (KDA), and seed-based d mapping (SDM). Focusing on the precautions and operation procedure of CBMA, the review is conducted systematically on the type of fMRI research, task design, analytical method, and the thinking integrity of fMRI Meta-analysis, and the review findings are collated in charts. It aims to assist readers to understand the abstract and complex theories and practical information of this technology efficiently, conveniently and systematically, and hopes to provide the references for the future learning and the application.

Stroke Phase Is Essential for Pneumonia in Dysphagia Patients After Cerebral Infarction.

BACKGROUND: The risk of pneumonia increases after stroke, especially in poststroke dysphagia patients. Propensity score matching (PSM) is a statistical method in SPSS, which can be used to balance the difference between the 2 groups of known factors. Nasogastric tube feeding is an important factor of stroke-associated pneumonia. However, few studies have used PSM to eliminate the effect of confounding factor. METHODS: Our research was a retrospective case-control study. Retrospective review of the patient database between December 1, 2019, and June 30, 2022, to identify consecutive dysphagia patients after cerebral infarction during hospitalization. An 1:1 PSM in SPSS 25.0 was used to balance nasogastric tube feeding between patients with and without pneumonia. The characteristics of these 2 groups were analyzed. Univariate and binary logistic regression analyses were used to screen the risk factors of dysphagia after cerebral infarction. RESULTS: After 1:1 PSM, 198 subjects met our criteria and were included in the analysis. Age [odds ratio (OR)=1.047, 95% CI: 1.013-1.081, P =0.006], stroke phase (acute stroke) (OR=5.931, 95% CI: 1.133-31.054, P =0.035), admission National Institutes of Health Stroke Scale score (OR=1.058, 95% CI: 1.004-1.115, P =0.034), and length of hospital stay (OR=1.025, 95% CI: 1.001-1.049, P =0.042) had statistically significant correlation with pneumonia in patients with dysphagia after cerebral infarction. CONCLUSION: In clinical practice, for the prevention of pneumonia in patients with dysphagia after cerebral infarction, we should pay more attention to admission National Institutes of Health Stroke Scale score, age, and stroke phase, especially in acute cerebral infarction patients.

To explore the pathogenesis of Bell's palsy using diffusion tensor image.

To explore the pathogenesis of Bell's palsy using the diffusion tensor image on 3.0 T MR. The healthy people and the patients with Bell's palsy underwent intraparotid facial nerve scanning by using the DTI and T1 structural sequence at 3.0 T MR. The raw DTI data were performed affine transformation and nonlinear registration in the common MNI152_T1 space and resampled to the 0.4 mm3 voxel size. A group of 4 spherical seed regions were placed on the intratemporal facial nerves in the common space, bilaterally and symmetrically. The DTI data in the common space were used to track the intratemporal facial nerve fibers by using TrackVis and its Diffusion Toolkit. Each tractography was used to construct the maximum probability map (MPM) according to the majority rule. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated and extracted on the basis of MPM. For healthy people, there was no significant difference in FA, MD, RD and AD of bilateral facial nerves. For patients with Bell's palsy, there was no significant difference in AD, there was significant difference in FA, MD and RD between the affected nerve and the healthy nerve (P < 0.02). This study showed that the myelin sheath injury of the intratemporal facial nerve is the main cause of Bell's palsy. Most neural axons are not damaged. The results may explain the pathogenesis of the Bell's palsy, which is self-limited for most cases.

Manual Acupuncture or Combination of Rehabilitation Therapy to Treat Poststroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Backgroundand Objective. Poststroke dysphagia is one of the most common stroke complications with high morbidity and long course, while acupuncture treatment is easily accepted by patients due to its reliability, feasibility, simple operation, low price, and quick effect. Our objective was to evaluate the efficacy of manual acupuncture in poststroke dysphagia patients. Methods. Databases including Medline, Web of Science, PubMed, Cochrane Library databases, EMBASE, CNKI (China National Knowledge Infrastructure), WanFang (WanFang Database), and VIP (Chongqing VIP) were searched from inception until Aug 19, 2022. Data were analyzed using Revman 5.3, Stata 14.0, and TSA 0.9.5.10 Beta software. Evidence quality evaluation was performed by using GRADE profiler 3.6. Results. A total of 33 randomized control trials (RCTs) enrolled 2680 patients. Meta-analysis results revealed that compared to rehabilitation, acupuncture decreased water swallow test (WST) and standard swallowing assessment (SSA) scores. Meanwhile, in contrast to rehabilitation alone, integration of acupuncture with rehabilitation effectively decreased WST and SSA scores; improved swallowing scores of videofluoroscopic swallowing study (VFSS), swallowing scores of Fujishima Ichiro, Barthel index (BI), and swallowing quality of life questionnaire (SWAL-QOL); reduced the aspiration rates as well as aspiration pneumonia; and shortened the duration of empty swallowing and the duration of 5 mL water swallowing. Pooled analysis did not reveal any significant differences in dysphagia outcome severity scores (DOSS) (p=0.15 > 0.05p) between the acupuncture group combined with rehabilitation group and the rehabilitation group alone. After the risk-of-bias assessment, these studies were not of low quality, except in terms of allocation concealment and blindness. Evidence quality evaluation showed that allocation concealment and blindness led to a downgrade and primary outcomes' evaluation of acupuncture combined with rehabilitation were ranked as moderate-quality evidence while acupuncture alone was ranked as low-quality. Conclusion. This meta-analysis provided positive pieces of evidences that acupuncture and acupuncture combined with rehabilitation were better than using rehabilitation alone in the treatment of poststroke dysphagia.

[Preliminary study on the existing problems in health economic evaluation study of acupuncture in China].

The literature of health economic evaluation study in the field of acupuncture in China was systematically summarized and analyzed, and the existing problems in the current research were discussed from the aspects of research perspective, cost calculation scope, data analysis method selection. Moreover, the key points of the health economic evaluation research were summarized, and the research objectives, the relationship between the expected research results and data analysis methods and the process of thinking were sorted out, and several suggestions for research report writing were proposed, aiming to provide a reference for the quality improvement of the acupuncture health economic evaluation research in China.

[Quality control in the implementation of multi-center acupuncture clinical trial].

The paper introduced the experiences of quality management in the implementation of multi-center acupuncture clinical trials and the keys in training acupuncture operators. The process management was explained in view of the division of labor for researchers, protocol learning and the communication among sub-centers. Besides, specificity links of acupuncture research were summarized, i.e. meaning implementation brief of acupuncture operation training, control for quantity of stimulus in acupuncture and doctor-patient communication. It is anticipated to provide a valuable reference for the quality control and improvement of multi-center acupuncture clinical trial in future.

[Criteria of "arrival of qi" of acupuncture from "reaction of spirit produces curative effect": inheriting SHI Xue-min's thoughts of treating spirit].

From "arrival of qi produces curative effect", it is considered that arrival of qi, qi reaching and acupuncture sensation cannot contain the effect attribute, location attribute and performance attribute of acupuncture at the same time, so it is necessary to find a more suitable standard to measure the arrival of qi and clinical curative effect. Inspired by "the arrival of qi should be reaction of spirit, and reaction of spirit produces curative effect", the authors propose to use the term "reaction of spirit" to summarize the numerous external manifestations of arrival of qi, and to coordinate the attributes of arrival of qi, qi reaching and acupuncture sensation. Academician SHI Xue-min guides the clinical treatment with "reaction of spirit produces curative effect", attaches importance to the spirit treatment to improve the clinical curative effect, and evaluates whether acupuncture is successful or not with "reaction of spirit".

[Application and thinking of cohort study in clinical research of acupuncture and moxibustion].

Cohort study has been greatly considered and widely used in clinical research of traditional Chinese medicine in China, but it is seldom applied in the field of acupuncture and moxibustion. This paper introduces the development background, basic concepts, advantages and limitations of cohort study, analyzes the existing problems in the evaluation of acupuncture and moxibustion curative effect and development status of cohort study in the cycle of acupuncture and moxibustion, explores the feasibility and value of such method in clinical research of acupuncture and moxibustion and proposes the methodological suggestions on rigorous design, control of selective bias, control of cohort migration and reduction of loss to follow-up, aiming at broadening the new ideas andmethods for clinical research of acupuncture and moxibustion.

[Pivotal issue of acupuncture-moxibustion academical inheritance based on the present situation of the clinical application of Tongguan Liqiao needling method by the academician SHI Xue-min].

The present situation of clinical application of Tongguan Liqiao needling method of acupuncture innovated by academician SHI Xue-min, and the situation for the inheritance of academic thought were analyzed. It was found that during the application of Tongguan Liqiao needling method, some questions were presented, i.e. absence of main acupoints in acupuncture regimen, lack of rules for the selection of combined acupoints and lack of specification on manipulation. The reasons of the above questions were analyzed from three aspects of inheritance, i.e. integrity, systematicness and normativity. It is anticipated that the summary of this analysis may provide the references to the efficient development of normative clinical manipulation and academic inheritance.

The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Acupressure, as part of Traditional Chinese Medicine, has shown promise as an effective method of pain relief in labour and birth. This systematic review and meta-analysis aims to critically assess the effect of acupressure on pain reduction during first stage of labour. METHODS: Five major electronic databases were searched in November 2018 to screen English articles. Only randomized controlled trials (RCTs) comparing acupressure with placebo and/or no intervention were selected. Intensity of labour pain was considered for primary outcome and pooled analysis. RESULTS: Ten RCTs were included in this review. LI4 and SP6 were the most commonly used acupoints. At the active and transitional phase, acupressure significantly reduced labour pain when compared to placebo (pooled MD -1.91; 95% CI -2.73,-1.08; pooled MD -3.03; 95% CI -5.03,-1.02, respectively). Acupressure was also superior to no intervention group at the active (pooled MD -3.00; 95% CI -3.88,-2.13) and transitional phase (pooled MD -2.03; 95% CI -3.72,-0.35). CONCLUSION: Acupressure can provide significant pain relief during first stage of labour. However, further clinical trials with standardized intervention procedures are required for the creation of evidence-based guidelines.

Microvascular pericytes in brain-associated vascular disease.

Pericytes, as mural cells of microvessels, are important regulators of vascular structure formation and function maintenance in the process of cerebrovascular maturation, cerebrovascular homeostasis and disease. In the recent years, they have gradually become the hot spot of the research. In fact, pericytes are not isolated cells. Their functions can't be played without the cooperation with surrounding cells. In the neurovascular unit (NVU), they communicate with other cells by direct contact or through signaling pathways to regulate cerebral vascular function and the state of blood vessels in response to changes in neural activity. Pericytes are closely related to the cerebrovascular and central nervous system disease. Currently, a large number of clinical and animal studies have confirmed that pericytes biological function is related to cerebral blood flow, blood-brain barrier permeability, cerebral vascular formation maintenance, and neuroinflammation. The objective of this review is to highlight the role of pericytes in cerebral microvessels as well as their relationships with stroke, dementia, and brain tumor disease. The possible pathogenic mechanisms between pericytes and these diseases will also be described. As a matter of fact, the role of pericytes in the brain-associated vascular disease may provide new ideas for clinical treatment.

[Effect of acupuncture on left ventricular configuration and cardiac function in patients with hypertension].

OBJECTIVE: To observe the related factors of left ventricular configuration in patients with mild to moderate hypertension, and to evaluate the influence of acupuncture on left ventricular configuration and cardiac function. METHODS: Huoxue Sanfeng acupuncture regime formulated by academician SHI Xue-min was applied to 200 patients with mild to moderate hypertension. The treatment was given once a day, 5 times a week for 3 months. Blood pressure and blood lipid levels were measured before treatment. Before treatment and 3 months after treatment, the echocardiography was used to measured end-diastolic left ventricular diameter (LVIDd), end-diastolic left ventricular posterior wall thickness (LVPWTd), and end-diastolic interventricular septum thickness (IVSTd), ejection fraction (EF), left ventricular mass index (LVMI), etc.; the relevant influencing factors of different left ventricular configurations were analyzed. RESULTS: The patients with mild to moderate hypertension had left ventricular dysplasia (left ventricular remodeling, concentric hypertrophy, eccentric hypertrophy) reached 60%, and compared with the normal configuration group and the left ventricular remodeling group, there were significant differences in nighttime mean pulse pressure, total cholesterol, BMI and waist circumference in the eccentric hypertrophy group (P<0.05). LVMI was associated with nighttime pulse pressure, waist circumference, total cholesterol and BMI (P<0.05). Left ventricular relative wall thickness was associated with total cholesterol, BMI and waist circumference (P<0.05). The diastolic function from normal configuration to left ventricular remodeling, concentric hypertrophy and eccentric hypertrophy gradually decreased, but there were no significant difference (P>0.05). The systolic function in the concentric hypertrophy group and the eccentric hypertrophy group was significantly lower than that in the normal configuration group and the left ventricular remodeling group (P<0.05). There was no significant difference in left ventricular systolic function and diastolic function before and after acupuncture (P>0.05). CONCLUSION: Sixty percents of patients with mild to moderate hypertension have abnormal left ventricular configuration and are associated with total cholesterol, BMI, waist circumference and nighttime mean pulse pressure. Studies have not found that acupuncture can significantly improve the left ventricular configuration and left cardiac function.

[Idea of shen-brain-orifice in the acupuncture system of Xingnao Kaiqiao].

Academician SHI Xue-min innovatively proposed that "closed minds and shen don't guide the qi " is the general pathogenesis of stroke, and created the Xingnao Kaiqiao acupuncture therapy, which is based on the theory of "brain" and the idea of "treating shen" is the core connotation. It is based on "Xing Nao" "Xing Shen" and "adjust shen". The clinical application has also extended to different types of diseases. Despite the differences in the allocation of acupoints, the therapeutic principles are always related to the shen, brain and orifice. In this paper, the author explains the meaning and interrelationship of shen, brain, and orifice by quoting ancient literature and the views of modern scholars, which is helpful to understand and inherit the academic thought of academician SHI Xue-min.

[Effects of acupuncture on carotid intima-media thickness and cerebral blood flow velocity in patients with mild-to-moderate hypertension].

OBJECTIVE: To observe the characteristics of carotid intima-media thickness (IMT) and cerebral blood flow velocity in patients with mild-to-moderate hypertension, and to evaluate the effects of acupuncture on carotid IMT and blood flow velocity of middle cerebral artery and vertebral-basilar artery. METHODS: A total of 240 patients with mild-to-moderate hypertension who met the inclusion criteria were treated with Huoxue Sanfeng acupuncture method proposed by academician SHI Xue-min. The acupoints of Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3) were selected. The treatment was given once a day, five times a week for 3 months. The carotid ultrasonography and transcranial color Doppler were performed before treatment and 3 months after treatment to evaluate the improvements of carotid IMT and brain blood flow velocity. RESULTS: Among 175 patients, 94.3% suffered from impaired carotid IMT. After acupuncture intervention, 7.7%-10.9% patients had improved IMT but 4.6%-6.3% had aggravated carotid IMT. There was no significant difference of carotid IMT before and after treatment (P>0.05). About 50% patients had abnormal intracranial blood flow velocity; after acupuncture intervention, 27.4%-33.3% patients who had the abnormal blood flow velocity had normal one, but 27.0%-52.5% patients who had normal blood flow velocity had abnormal one. After acupuncture intervention, the low-speed blood flow of MCA, VA and BA in female patients aged 41-60 years and the low-speed blood flow of MCA and VA in female patients aged 61-70 years were significantly improved (all P<0.05); the high-speed blood flow of MCA and VA in male patients aged 61-70 years and the high-speed blood flow of VA and BA in female patients aged 41-60 years were significantly decreased (all P<0.05). CONCLUSION: Nearly 95% of patients with mild-to-moderate hypertension had carotid IMT, and about 50% had abnormal blood flow velocity of intracranial artery. The present study failed to found significant effects of acupuncture on carotid IMT, but it shows acupuncture can generally improve the low blood flow velocity in women with mild-to-moderate hypertension.

Effects of acupuncture with needle manipulation at different frequencies for patients with hypertension: Result of a 24- week clinical observation.

OBJECTIVES: To investigate whether the manipulation parameter of the twirling frequency in acupuncture affects the blood pressure when acupuncture is applied on the acupoints ST9 and LR3 in a human body. DESIGN: A randomized, controlled trial. INTERVENTIONS: A hundred and twenty patients with hypertension were randomized into four treatment groups. A twirling frequency of 120 twirls per minute or 60 twirls per minute were respectively applied on the acupoints ST9 or LR3. Each patient received five acupuncture sessions a week over a period of 12 weeks, with a follow-up period of a further12 weeks. The outcome was assessed by using an ambulatory blood pressure monitor. RESULTS: A hundred and twenty twirls per minute on ST9 could overall improve the BP (24hDBP, mSBP, mDBP, dDBP, nSBP and nDBP). Sixty twirls per minute on ST9 improved the 24hDBP, dSBP, dDBP and mDBP; 120 twirls per minute on LR3 did not show any anti-hypertensive effect, while 60 twirls per minute on LR3 improved the dSBP and dDBP. The results indicated that the acupuncture effect on BP, the onset of anti-hypertensive effect, the occurrence of the effect, and the duration of the effect depended on the frequency of needle manipulation on the same acupuncture point. CONCLUSIONS: As one of the important factors of the effects of acupuncture, the manipulation parameter's impact has its specificity for different acupoints. Thus, in the future, close attention needs to be paid to this clinically. TRIAL REGISTRATION: Chinese Clinical Trial Registry: Chi CTR-TRC-12002582.

[Brief discussion on acupuncture technique "controlling Qihai to regulate blood pressure" proposed by academician SHI Xuemin].

According to Qihai theory, academician SHI Xuemin established the acupuncture technique "controlling Qihai to regulate blood pressure" which focused on Renying (ST 9), and achieved favorable effects in clinical application. In this paper, based on the Qihai theory, from aspects of Yuanqi, Zongqi, Yingqi and Weiqi and relations among qi, blood and veins in TCM, and cardiac output, sympathetic nerve activity and blood vessels in modern medicine, the understanding on hypertension was explained. As a result, both TCM and modern medicine had consistency in the understanding of hypertension, reflecting the scientificity and practicability of this acupuncture technique. Besides, according to Qihai theory and "wind leading to vertigo" theory, academician SHI Xuemin brought forward the key pathogenesis of hypertension was "dysfunction of Qihai", and the acupoint selected Renying (ST 9), Quchi (LI 11), Hegu (LI 4), Zusanli (ST 36) and Taichong (LR 3). At the same time, the operation specification of each acupoint was mainly discussed, and the references of acupoint selection was explained based on TCM theory and modern clinical research.