Nonpharmaceutical therapy for autism spectrum disorder: A protocol for systematic review and network meta-analysis.

BACKGROUND: Autism spectrum disorder (ASD) is a widespread developmental disorder of the nervous system with an unclear etiology and pathogenesis. Its global incidence is currently increasing, and no effective drugs are available to improve its core symptoms. Nonpharmaceutical therapy can effectively relieve the core symptoms of autism, has fewer side effects than drugs, and is easily accepted by patients. This systematic and network meta-analysis aimed to evaluate the impact of non-pharmaceutical therapy on autism to explore preferable therapeutic options for autism. METHODS: Online databases, including the China National Knowledge Infrastructure [CNKI], SinoMed, Wanfang Database [WF], China Science and Technology Journal Database [VIP], MEDLINE, Web of Science, EMBASE, and the Cochrane Library will be searched for randomized controlled trials of nonpharmacological interventions for autism published before October 2021. Two researchers will be independently responsible for the literature screening, data extraction, and quality assessment. Standard paired and Bayesian network meta-analyses will be performed using RevMan 5.3 Software and GEMTC 0.14.3, to compare the efficacy and safety of different nonpharmacological regimens. RESULTS: The results of this systematic and network meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study provides a comprehensive and reliable evidence-based reference for the efficacy and safety of different non-pharmacological interventions for autism. PROSPERO REGISTRATION NUMBER: CRD 42021275571.

[YUAN Qing's experience of Tiaoshen acupuncture in treating autism spectrum disorder].

YUAN Qing's clinical experience in treating autism spectrum disorder using Tiaoshen (regulating the spirit) acupuncture is summarized. YUAN Qing believes that the basic pathogenesis of children with autism spectrum disorder is due to the impairment of brain essence and heart mind. Thus regulating the spirit, especially adjusting brain essence and heart mind is essential during clinical treatment. The main acupoints on the head (brain tri-points, four-spirit points, spirit setting points, mental tri-points, spirit waking-up points and foot mental points) are used to adjust brain essence, and hand mental tri-points (Shenmen[HT 7], Neiguan[PC 6] and Laogong[PC 8]) are used for adjusting heart mind, and emphasizing the importance of the spirit of the doctor and the children's parents.

Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups. METHODS AND ANALYSIS: Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the "risk of bias" assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups. CONCLUSIONS: This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER: CRD42020114900.

[Acupuncture improves locomotor activity and learning-memory ability by improving hippocampal cellular autophagy in rats with fetal intrauterine distress].

OBJECTIVE: To investigate the effect of acupuncture stimulation of head acupoints "Jin San Zhen" (JIN's Three Acupuncture Needles Therapy) on behavior reactions, hippocampal neuronal autophagy and expression of autophagy associated proteins (Beclin-1 and light chain 3 Ⅱ/Ⅰ [LC 3 Ⅱ/Ⅰ]) in rats with hypoxic-ischemic brain damage (HIBD) due to fetal intrauterine distress, so as to reveal its underlying mechanisms in improving neonatal HIBD. METHODS: Pregnant SD rats were used in the present study. The HIBD model was established by delayed caesarean delivery and bilateral uterine arteries clipping for 10 minutes. The HIBD rats were randomly divided into model group and acupuncture groups (n＝9 rats in each group). The other 9 rats delivered naturally were used as the normal control group. On day 14 after delivery, the neonatal rats in the acupuncture group received acupuncture stimulation of head acupoints ("Nao San Zhen""Nie San Zhen" and "Zhi San Zhen") by twirling each needle leftward and rightward for 10 times, once a day for 14 d. The open field test and Morris water maze test were used to determine the locomotive activity and spatial learning-memory ability, respectively. The ultrastructure and autophagosomes in the hippocampal neurons were observed by transmission electron microscope. The contents and expression levels of Beclin-1 and LC3 Ⅱ/Ⅰ in the hippocampus tissues were detected by flow cytometry and Western blot, separately. RESULTS: Compared with the normal control group, the time to go out of the central region of open field test, and the escape latency and duration of first platform-quadrant-crossing of spatial exploration of Morris water maze tests were significantly increased (P<0.01，P<0.05，P<0.001), and the total distance and number of activities in the central region, and the target quadrant resistance time and number of platform-cros-sing remarkably decreased in the model group (P<0.01, P<0.05), suggesting a decline of both locomotor activity and learning-memory ability after modeling. The expression level (%) of Beclin-1 protein and ratio of LC3 Ⅱ/Ⅰ proteins were considerably increased in the model group (P<0.01). Following acupuncture interventions, the locomotor activity and spatial learning-memory ability were obviously increased (P<0.05，P<0.01，P<0.001), and the expression of Beclin-1 protein and ratio of LC3 Ⅱ/Ⅰ were further up-regulated relevant to the model group (P<0.001). Moreover, ultrastructural observation showed serrated change of nuclear membrane and widened perinuclear space, vacuolization in the mitochondria, dilation of endoplasmic reticulum and increase of autophagosomes in the hippocampal neurons in the model group. These situations were relatively milder in the acupuncture group. CONCLUSION: Acupuncture of head acupoints of "JIN San Zhen" may increase locomotor activity and learning-memory abi-lity in rats with HIBD due to fetal intrauterine anoxia, which is closely with its effect in promoting hippocampal neuronal autophagy via up-regulating the expression of Beclin-1 and LC3 Ⅱ/Ⅰ.

Comparative efficacy of nonpharmaceutical therapy in the treatment of dysphagia after stroke: A protocol for systematic review.

BACKGROUND: Dysphagia is one of the major post-stroke complications that can severely damage a patient's quality of life. An increasing number of studies have demonstrated that many kinds of nonpharmacological treatments can be used for post-stroke dysphagia. However, there is not enough evidence evaluating the effectiveness and safety of these interventions. This study will conduct a systematic review, and Bayesian network meta-analysis, of nonpharmacological treatments in order to provide evidence for a future study investigating more options for post-stroke dysphagia. METHODS: Randomized controlled trials (RCTs) of adult patients aged >18 years old who meet the criteria for a diagnosis of post-stroke dysphagia will be included, regardless of gender, nationality, or education level. Four Chinese databases (CNKI, SinoMed, Wanfang Database, and the Chinese Scientific Journal Database) and four English databases (Web of Science, MEDLINE, Embase, and the Cochrane Library) will be searched. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the RevMan 5.3 software, and the risk of bias assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The Bayesian network meta-analysis will be performed using R-3.3.2 software. The quality evaluation of this study will be completed using the World Health Organization's Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying nonpharmacological treatments to post-stroke dysphagia. CONCLUSION: This systematic review will provide evidence to assess the validity and safety of applying different types of nonpharmacological treatments for post-stroke dysphagia, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER: CRD42019119368.