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Sun R, Jiang Z, Sun Y. A prospective study of Acupuncture Combined With Modified Blood and Vessel Expelling Blood Stasis Tang in Treating Poststroke Facial Paralysis With Insomnia. J Craniofac Surg 2024:00001665-990000000-01911. [PMID: 39264173 DOI: 10.1097/scs.0000000000010623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVE This study aimed to assess the clinical efficacy of acupuncture combined with modified Blood and Vessel Expelling Blood Stasis Tang in the treatment of poststroke patients experiencing facial paralysis and insomnia. METHODS A total of 120 patients with poststroke facial paralysis and insomnia were selected from the Department of Acupuncture and Moxibustion at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine between January 2021 and January 2023. They were randomly assigned to either a control group or a study group, with 60 patients in each group. The control group received conventional treatment, while the study group received acupuncture combined with modified Blood and Vessel Expelling Blood Stasis Tang. The neurological function, facial paralysis, and sleep quality of the patients in both groups were compared. RESULTS The study group exhibited a significantly higher total effective rate compared with the control group (86.67% versus 66.67%). After treatment, both groups showed a significant reduction in National Institutes of Health Stroke Scale scores, with the study group demonstrating significantly lower scores than the control group. The Functional Disability Index scores for somatic functioning and social life functioning significantly improved in both groups after treatment, with the study group achieving significantly lower scores compared with the control group. The Sleep-Related Symptom Scale and Pittsburgh Sleep Quality Index scores significantly decreased in both groups after treatment, with the study group achieving significantly lower scores than the control group. CONCLUSIONS Acupuncture combined with modified Blood and Vessel Expelling Blood Stasis Tang effectively promotes recovery of neurological function and significantly improves facial paralysis and insomnia in patients with poststroke facial paralysis and insomnia. However, further research is warranted to validate these findings.
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Affiliation(s)
- Ran Sun
- Chengdu University of Traditional Chinese Medicine
| | - Zefei Jiang
- Chengdu University of Traditional Chinese Medicine
| | - Yiming Sun
- TCM Department, Chengdu Eighth People's Hospital
- Geriatric Hospital, Chengdu Medical College, Chengdu, Sichuan
- The First Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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2
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Yang Y, Zhang R, Zhong Z, Li J, Feng Y. Efficacy of transauricular vagus nerve stimulation for the treatment of chemotherapy-induced painful peripheral neuropathy: a randomized controlled exploratory study. Neurol Sci 2024; 45:2289-2300. [PMID: 38063922 DOI: 10.1007/s10072-023-07229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/26/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND Chemotherapy-induced painful peripheral neuropathy (CIPN) is a common adverse event in cancer patients, and there is still a lack of effective treatment. Transauricular vagal nerve stimulation (taVNS) is a minimally invasive treatment, but there are few reports regarding its efficacy for CIPN. OBJECTIVE To investigate the efficacy and possible mechanism of taVNS in patients with CIPN. METHODS Twenty-seven patients with CIPN were randomly divided into a taVNS group (n = 14) and a sham stimulation (SS) group (n = 13). A numerical rating scale (NRS) for pain, NCICTCAE 4.0 (neurotoxicity classification), quantitative sensory test (QST), Short-Form-Health Survey-12 (SF-12), and Athens Insomnia Scale (AIS) were administered before the intervention (D-10) and on the day after the intervention (D0), and the inflammatory cytokines in plasma were also measured. The NRS, NCI-CTCAE 4.0, SF-12, and AIS were administered again at D30 and D90. RESULTS Compared with the SS group, the NRS and AIS in the taVNS group were significantly lower at D0. The impact lasted until D30. There were no statistically significant differences in the NRS and AIS between the 2 groups at D90. On D30, the mental component score of the SF-12 was significantly higher in the taVNS group than in the SS group. No adverse events were found. There was no significant difference in QST and plasma inflammatory cytokines between the 2 groups. CONCLUSION taVNS can relieve chemotherapy-induced neuropathic pain in the short term, can improve sleep status and quality of life, and is expected to become a novel clinical treatment method for CIPN.
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Affiliation(s)
- Yifan Yang
- Department of Pain Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ran Zhang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhifang Zhong
- Department of Pain Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jun Li
- Department of Pain Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
| | - Yi Feng
- Department of Pain Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
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Yue M, Peng X, Chunlei G, Yi L, Shanshan G, Jifei S, Qingyan C, Bai Z, Yong L, Zhangjin Z, Peijing R, Jiliang F. Modulating the default mode network: Antidepressant efficacy of transcutaneous electrical cranial-auricular acupoints stimulation targeting the insula. Psychiatry Res Neuroimaging 2024; 339:111787. [PMID: 38295529 DOI: 10.1016/j.pscychresns.2024.111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/22/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is a novel non-invasive therapy for major depressive disorder (MDD) that stimulates acupoints innervated by the trigeminal and auricular vagus nerves. However, there are few neuroimaging studies involving the TECAS for the treatment of MDD. Therefore, this study aimed to investigate the treatment response and neurological effects of TECAS using resting-state functional magnetic resonance imaging (rs-fMRI). METHOD A total of 34 patients with mild-to-moderate MDD and 34 demographically matched healthy controls (HCs) were recruited. After an eight-week treatment the primary outcome was clinical response, defined as a baseline-to-endpoint ≥ 50 % reduction in the 17-item Hamilton Depression Rating Scale (HAMD-17). The low-frequency fluctuations (ALFF) method were used to investigate the brain abnormalities of MDD patients and HCs, and altered brain networks were analyzed between pre- and post-treatment using seed-based functional connectivity (FC) analysis. RESULTS We found no significant differences in terms of gender, age, and years of education between the two groups. After treatment, the response rate was 58.82 %. Compared to HCs, MDD patients showed lower ALFF values in the left insula(t = -4.298,P < 0.005), the insula-based FC revealed in the right middle frontal gyrus (MFG)/ right superior frontal gyrus, orbital part (ORBsupmed) (t = -5.29,P < 0.005) and the right anterior cingulate gyrus (ACC)were decreased (t = -6.08,P < 0.005). Furthermore, Compared to pre-treatment, abnormal FC values in the ACC /orbital superior frontal gyrus (SFG) (t = 3.42,P < 0.005) and left superior frontal gyrus (SFG)/ supplement motor area (SMA) were enhanced (t = 3.34,P < 0.005). CONCLUSION TECAS exhibits antidepressant efficacy, particularly influencing the insula-based functional connections within the Default Mode Network (DMN) related to emotion processing in individuals with MDD.
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Affiliation(s)
- Ma Yue
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xu Peng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China
| | - Guo Chunlei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Luo Yi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Gao Shanshan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Sun Jifei
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Chen Qingyan
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Zhenjun Bai
- College of Traditional Chinese Medicine Health Service, Shanxi Datong University, Datong, 037009, Shanxi Province, China
| | - Liu Yong
- Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, 646000, Luzhou, China
| | - Zhang Zhangjin
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Rong Peijing
- Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Fang Jiliang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053, Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700, Beijing, China.
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4
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Lee YJ, Chen MQ, Dong J. Effect of foot reflexology on an infant with sensorineural hearing loss: A case report. World J Clin Cases 2024; 12:1437-1441. [PMID: 38576800 PMCID: PMC10989455 DOI: 10.12998/wjcc.v12.i8.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/15/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Our study contributes to the further understanding of the mechanism of foot reflexology. Foot reflexology has been reported to affect hearing recovery, but no physiological evidence has been provided. This lack of evidence hampers the acceptance of the technique in clinical practice. CASE SUMMARY A girl was taken to North Sichuan Medical University Affiliated Hospital for a hearing screen by her parents. Her parents reported that her hearing level was the same as when she was born. The girl was diagnosed with sensorineural hearing loss (SNHL) by a doctor in the otolaryngology department. After we introduced the foot reflexology project, the parents agreed to participate in the experiment. After 6 months of foot reflexology treatment, the hearing threshold of the girl recovered to a normal level, below 30 dB. CONCLUSION Foot reflexology should be encouraged in clinical practice and for families of infants with SNHL.
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Affiliation(s)
- Yu-Jun Lee
- Graduate School, Xi'an International Studies University; North Sichuan Medical University, Xi'an 710061, Shaanxi Province, China
- Department of Neural Disease, North Sichuan Medical University, Nanchong 635200, Sichuan Province, China
| | - Mao-Qing Chen
- Department of Nursing, North Sichuan Medical University, Nachong 635200, Sichuan Province, China
| | - Jie Dong
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi’an International Studies University, Xi’an 710128, Shaanxi Province, China
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Gerges ANH, Williams EER, Hillier S, Uy J, Hamilton T, Chamberlain S, Hordacre B. Clinical application of transcutaneous auricular vagus nerve stimulation: a scoping review. Disabil Rehabil 2024:1-31. [PMID: 38362860 DOI: 10.1080/09638288.2024.2313123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Transcutaneous auricular vagus nerve stimulation (taVNS) is an emerging non-invasive neuromodulation therapy. This study aimed to explore the therapeutic use of taVNS, optimal stimulation parameters, effective sham protocols, and safety. METHODS A scoping review was conducted. Five databases and grey literature were searched. The data extracted included stimulation parameters, adverse events (AEs), and therapeutic effects on clinical outcomes. RESULTS 109 studies were included. taVNS was used across 21 different clinical populations, most commonly in psychiatric, cardiac, and neurological disorders. Overall, 2,214 adults received active taVNS and 1,017 received sham taVNS. Reporting of stimulation parameters was limited and inconsistent. taVNS appeared to have a favourable therapeutic effect across a wide range of clinical populations with varied parameters. Three sham protocols were reported but their effectiveness was documented in only two of the 54 sham-controlled studies. Most reported adverse events were localised to stimulation site. CONCLUSION There is growing evidence for taVNS therapeutic effect. taVNS appears safe and tolerable. Sham protocols need evaluation. Standardised and comprehensive reporting of both stimulation parameters and adverse events is required. Two different questionnaires have been proposed to evaluate adverse events and the effectiveness of sham methods in blinding participants.
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Affiliation(s)
- Ashraf N H Gerges
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ellen E R Williams
- School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Susan Hillier
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jeric Uy
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Taya Hamilton
- Perron Institute for Neurological and Translational Science, Perth, Australia
- Fourier Intelligence International Pte Ltd., Global Headquarters, Singapore, Singapore
| | - Saran Chamberlain
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Kang K, Shi K, Liu J, Li N, Wu J, Zhao X. Autonomic dysfunction and treatment strategies in intracerebral hemorrhage. CNS Neurosci Ther 2024; 30:e14544. [PMID: 38372446 PMCID: PMC10875714 DOI: 10.1111/cns.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/15/2023] [Accepted: 11/17/2023] [Indexed: 02/20/2024] Open
Abstract
AIMS Autonomic dysfunction with central autonomic network (CAN) damage occurs frequently after intracerebral hemorrhage (ICH) and contributes to a series of adverse outcomes. This review aims to provide insight and convenience for future clinical practice and research on autonomic dysfunction in ICH patients. DISCUSSION We summarize the autonomic dysfunction in ICH from the aspects of potential mechanisms, clinical significance, assessment, and treatment strategies. The CAN structures mainly include insular cortex, anterior cingulate cortex, amygdala, hypothalamus, nucleus of the solitary tract, ventrolateral medulla, dorsal motor nucleus of the vagus, nucleus ambiguus, parabrachial nucleus, and periaqueductal gray. Autonomic dysfunction after ICH is closely associated with neurological functional outcomes, cardiac complications, blood pressure fluctuation, immunosuppression and infection, thermoregulatory dysfunction, hyperglycemia, digestive dysfunction, and urogenital disturbances. Heart rate variability, baroreflex sensitivity, skin sympathetic nerve activity, sympathetic skin response, and plasma catecholamine concentration can be used to assess the autonomic functional activities after ICH. Risk stratification of patients according to autonomic functional activities, and development of intervention approaches based on the restoration of sympathetic-parasympathetic balance, would potentially improve clinical outcomes in ICH patients. CONCLUSION The review systematically summarizes the evidence of autonomic dysfunction and its association with clinical outcomes in ICH patients, proposing that targeting autonomic dysfunction could be potentially investigated to improve the clinical outcomes.
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Affiliation(s)
- Kaijiang Kang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Kaibin Shi
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Jiexin Liu
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Na Li
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Jianwei Wu
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
| | - Xingquan Zhao
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
- Research Unit of Artificial Intelligence in Cerebrovascular DiseaseChinese Academy of Medical SciencesBeijingChina
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7
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Tian QQ, Cheng C, Yin ZX, Yuan YY, Wang C, Zeng X, Sun JB, Yang Q, Yang XJ, Qin W. Combined transcutaneous auricular vagus stimulation (taVNS) with 0.1Hz slow breathing enhances insomnia treatment efficacy: A pilot study. Brain Stimul 2024; 17:4-6. [PMID: 38042286 DOI: 10.1016/j.brs.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Qian-Qian Tian
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Chen Cheng
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Zi-Xin Yin
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Yang-Yang Yuan
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Cong Wang
- Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Xiao Zeng
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China
| | - Qun Yang
- Department of Medical Psychology, Air Force Medical University, Xi'an, Shaanxi, 710032, China
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China.
| | - Wei Qin
- Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaan xi, 710126, China; Intelligent Non-invasive Neuromodulation Technology and Transformation Joint Laboratory, Xidian University, Xi'an, Shaan xi, 710126, China; Guangzhou Institute of Technology, Xidian University, Xi'an, Shaanxi, China.
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8
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Wu D, Liu B, Wu Y, Wang Y, Sun J, Yang J, Duan J, Liu G, Cao K, Zhang Y, Rong P. Meniere Disease treated with transcutaneous auricular vagus nerve stimulation combined with betahistine Mesylate: A randomized controlled trial. Brain Stimul 2023; 16:1576-1584. [PMID: 37838094 DOI: 10.1016/j.brs.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Meniere Disease is a clinical condition defined by hearing loss, tinnitus, and aural fullness symptoms, there are currently no any medications approved for its treatment. OBJECTIVE To determine whether taVNS as an adjunctive therapy could relieve symptoms and improve the quality of life in patients with Meniere disease. METHODS In this Single-center, single blind, randomized trial, participants were assigned to transcutaneous auricular vagus nerve stimulation (taVNS) group and sham taVNS group. The primary outcome measures comprised Tinnitus Handicap Inventory, Dizziness Handicap Inventory, Pure Tone Auditory, Visual analogue scale of aural fullness. Secondary outcome measures comprised the 36-Item Short Form Health Survey, video head impulse test, and the caloric test. RESULTS After 12 weeks, the THI (-11.00, 95%CI, -14.87 to -7.13; P < 0.001), DHI (-47.26, 95%CI, -50.23 to -44.29; P < 0.001), VAS of aural fullness (-2.22, 95%CI, -2.95 to -1.49; P<0.01), and Pure Tone Thresholds (-7.07, 95%CI, -9.07 to -5.06; P<0.001) were significantly differed between the two groups. In addition, SF36(14.72, 95%CI, 11.06 to 18.39; P < 0.001), vHIT (RD, 0.26, 95 % CI, -0.44 to -0.08, RR, 0.43, 95 % CI, 0.22 to 0.83, P < 0.01), and the caloric test (RD, -0.24, 95 % CI, -0.43 to -0.04, RR, 0.66, 95 % CI, 0.44 to 0.95, P = 0.02) have significant difference between two group, respectively. CONCLUSIONS These findings suggest that taVNS combined with Betahistine Mesylate relieve symptoms and improve the quality of life for patients with Meniere Disease. taVNS can be considered an adjunctive therapy in treatment of Meniere Disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05328895.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Yunqing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingyi Sun
- Department of Oncology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jun Yang
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Jinping Duan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
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9
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Ma Y, He J, Lu X, Sun J, Guo C, Luo Y, Gao S, Liu Y, Zhang Z, Rong P, Fang J. Transcutaneous electrical cranial-auricular acupoint stimulation versus escitalopram for modulating the brain activity in mild to moderate major depressive disorder: An fMRI study. Neurosci Lett 2023; 814:137414. [PMID: 37544579 DOI: 10.1016/j.neulet.2023.137414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is an innovative, non-invasive therapy for major depressive disorder (MDD). However, its effectiveness and underlying neural mechanisms remain not fully understood. This study aimed to investigate the treatment response and neurological effects of TECAS compared to escitalopram, a commonly used depression medication, using resting-state functional magnetic resonance imaging (rs-fMRI). Fifty-one patients with mild-to-moderate MDD (34 in the TECAS group and 17 in the Escitalopram group) and 51 healthy controls (HCs) participated in the study. We employed the low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) methods to explore brain abnormalities in MDD patients and HCs. Additionally, seed-based functional connectivity (FC) analysis was conducted to examine altered brain networks before and after treatment.Compared to the HCs group, the MDD group exhibited lower ReHo and ALFF values in the right medial superior frontal gyrus (mSFG_R), indicating altered neural activity in this region. Furthermore, mSFG-based FC analysis revealed abnormal FC values in the right inferior occipital gyrus (IOG_R) and middle temporal gyrus (MTG) between after and before treatment in MDD patients. Interestingly, TECAS treatment was found to normalize these abnormal FC brain regions, suggesting its potential role in restoring neural connectivity in MDD patients. Notably, both TECAS and escitalopram demonstrated equivalent antidepressant efficacy, with both treatments showing modulatory effects on connectivity within the default mode network (DMN). The observed normalization of abnormal FC regions, including mSFG_R, IOG_R, and MTG, all belong to the DMN. In conclusion, this study sheds light on the neurological effects and treatment response of TECAS in MDD, highlighting its potential as a non-invasive therapeutic option for depressed patients.
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Affiliation(s)
- Yue Ma
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Jiakai He
- Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Xinyu Lu
- Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical, China
| | - Jifei Sun
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Chunlei Guo
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Yi Luo
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Shanshan Gao
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Yong Liu
- Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical, China
| | - Zhangjin Zhang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital, (HKU-SZH), Shenzhen, China
| | - Peijing Rong
- Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China; Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 100700 Beijing, China
| | - Jiliang Fang
- Guang anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China; Graduate School of China Academy of Chinese Medical Sciences, 100700 Beijing, China.
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10
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Seon C, Lee DH, Kwon BI, Yu JS, Park SK, Woo Y, Kim JH. Neural mechanisms of acupuncture for peripheral facial nerve palsy: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e33642. [PMID: 37145006 PMCID: PMC10158860 DOI: 10.1097/md.0000000000033642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Peripheral facial nerve palsy (PFNP) is a cranial neuropathy that occurs when the seventh facial nerve is damaged. PFNP seriously affects patients' quality of life, and approximately 30% of patients suffer from sequelae, such as unrecovered palsy, synkinesis, facial muscle contracture, and facial spasm. Many studies have confirmed the effectiveness of acupuncture for the treatment of PFNP. However, the specific mechanism remains unclear and needs to be further explored. Therefore, the purpose of this systematic review is to investigate the neural mechanisms underlying acupuncture treatment for PFNP using neuroimaging methods. METHODS We will search all published studies from inception to March 2023 using the following databases: MEDLINE, Cochrane Library, EMBASE, CNKI, KMBASE, KISS, ScienceON, and OASIS. All clinical studies evaluating the effectiveness of acupuncture for treating PFNP using functional neuroimaging will be selected without language restrictions. Two reviewers will independently conduct the study selection, data extraction, and risk of bias assessment, according to a predetermined protocol. The outcomes, including the types of functional neuroimaging techniques, brain function alterations, and clinical outcomes, such as the House-Brackmann scale and Sunnybrook Facial Grading System, will also be analyzed. Coordinate-based meta-analysis and subgroup analyses will be performed if possible. RESULTS This study will analyze the effect of acupuncture on brain activity alterations and clinical improvement in patients with PFNP using functional neuroimaging. CONCLUSION This study will provide a comprehensive summary and help elucidate the neural mechanisms of acupuncture treatment for PFNP. PROSPERO REGISTRATION NUMBER CRD42022321827.
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Affiliation(s)
- Changwoo Seon
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Dong Hyuk Lee
- Department of Anatomy, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Bo-In Kwon
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Pathology, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Jun-Sang Yu
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Sang Kyun Park
- Department of Meridian and Acupoints, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Yeonju Woo
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Physiology, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
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11
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Zhang ZJ, Zhang SY, Yang XJ, Qin ZS, Xu FQ, Jin GX, Hou XB, Liu Y, Cai JF, Xiao HB, Wong YK, Zheng Y, Shi L, Zhang JN, Zhao YY, Xiao X, Zhang LL, Jiao Y, Wang Y, He JK, Chen GB, Rong PJ. Transcutaneous electrical cranial-auricular acupoint stimulation versus escitalopram for mild-to-moderate depression: An assessor-blinded, randomized, non-inferiority trial. Psychiatry Clin Neurosci 2023; 77:168-177. [PMID: 36445151 DOI: 10.1111/pcn.13512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AIM Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is a novel non-invasive therapy that stimulates acupoints innervated by the trigeminal and auricular vagus nerves. An assessor-blinded, randomized, non-inferiority trial was designed to compare the efficacy of TECAS and escitalopram in mild-to-moderate major depressive disorder. METHODS 468 participants received two TECAS sessions per day at home (n = 233) or approximately 10-13 mg/day escitalopram (n = 235) for 8 weeks plus 4-week follow-up. The primary outcome was clinical response, defined as a baseline-to-endpoint ≥50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score. Secondary outcomes included remission rate, changes in the severity of depression, anxiety, sleep and life quality. RESULTS The response rate was 66.4% on TECAS and 63.2% on escitalopram with a 3.2% difference (95% confidence interval [CI], -5.9% to 12.9%) in intention-to-treat analysis, and 68.5% versus 66.2% with a 2.3% difference (95% CI, -6.9% to 11.4%) in per-protocol analysis. The lower limit of 95% CI of the differences fell within the prespecified non-inferiority margin of -10% (P ≤ 0.004 for non-inferiority). Most secondary outcomes did not differ between the two groups. TECAS-treated participants who experienced psychological trauma displayed a markedly greater response than those without traumatic experience (81.3% vs 62.1%, P = 0.013). TECAS caused much fewer adverse events than escitalopram. CONCLUSIONS TECAS was comparable to escitalopram in improving depression and related symptoms, with high acceptability, better safety profile, and particular efficacy in reducing trauma-associated depression. It could serve an effective portable therapy for mild-to-moderate depression.
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Affiliation(s)
- Zhang-Jin Zhang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Shui-Yan Zhang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Xin-Jing Yang
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Zong-Shi Qin
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Feng-Quan Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Gui-Xing Jin
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Bing Hou
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Yong Liu
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ji-Fu Cai
- Department of Neurology, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Hai-Bing Xiao
- Department of Neurology, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China
| | - Yat Kwan Wong
- Department of Chinese Medicine, the University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, China.,School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Yu Zheng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Lei Shi
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Jin-Niu Zhang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan-Yuan Zhao
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Liu-Lu Zhang
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Jiao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China.,Department of TCM, Tsinghua University Hospital Beijing, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Jia-Kai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
| | - Guo-Bing Chen
- Department of Microbiology and Immunology, School of Medicine; Institute of Geriatric Immunology, School of Medicine, Jinan University, Guangzhou, China
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences (CACMS), Beijing, China
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12
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Wang Y, Li L, Li S, Fang J, Zhang J, Wang J, Zhang Z, Wang Y, He J, Zhang Y, Rong P. Toward Diverse or Standardized: A Systematic Review Identifying Transcutaneous Stimulation of Auricular Branch of the Vagus Nerve in Nomenclature. Neuromodulation 2022; 25:366-379. [PMID: 35396069 DOI: 10.1111/ner.13346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 11/23/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES After 20 years of development, there is confusion in the nomenclature of transcutaneous stimulation of the auricular branch of the vagus nerve (ABVN). We performed a systematic review of transcutaneous stimulation of ABVN in nomenclature. MATERIALS AND METHODS A systematic search of the literature was carried out, using the bibliographic search engine PubMed. The search covered articles published up until June 11, 2020. We recorded the full nomenclature and abbreviated nomenclature same or similar to transcutaneous stimulation of ABVN in the selected eligible studies, as well as the time and author information of this nomenclature. RESULTS From 261 studies, 67 full nomenclatures and 27 abbreviated nomenclatures were finally screened out, transcutaneous vagus nerve stimulation and tVNS are the most common nomenclature, accounting for 38.38% and 42.06%, respectively. In a total of 97 combinations of full nomenclatures and abbreviations, the most commonly used nomenclature for the combination of transcutaneous vagus nerve stimulation and tVNS, accounting for 30.28%. Interestingly, the combination of full nomenclatures and abbreviations is not always a one-to-one relationship, there are ten abbreviated nomenclatures corresponding to transcutaneous vagus nerve stimulation, and five full nomenclatures corresponding to tVNS. In addition, based on the analysis of the usage habits of nomenclature in 21 teams, it is found that only three teams have fixed habits, while other different teams or the same team do not always use the same nomenclature in their paper. CONCLUSIONS The phenomenon of confusion in the nomenclature of transcutaneous stimulation of ABVN is obvious and shows a trend of diversity. The nomenclature of transcutaneous stimulation of ABVN needs to become more standardized in the future.
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Affiliation(s)
- Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shaoyuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zixuan Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yifei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.
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13
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Wang J, Chen Y, Zhai X, Chu Y, Liu X, Ma X. Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection. Front Neurol 2022; 13:816031. [PMID: 35432182 PMCID: PMC9009417 DOI: 10.3389/fneur.2022.816031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Objective To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia. Background Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia. Method Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba. Result As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design. Conclusion We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.
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Affiliation(s)
- Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yufeng Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Zhai
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yupeng Chu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Xiangdi Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xiangdi Liu
| | - Xueling Ma
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Xueling Ma
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14
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Li L, Wang D, Pan H, Huang L, Sun X, He C, Wei Q. Non-invasive Vagus Nerve Stimulation in Cerebral Stroke: Current Status and Future Perspectives. Front Neurosci 2022; 16:820665. [PMID: 35250458 PMCID: PMC8888683 DOI: 10.3389/fnins.2022.820665] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/25/2022] [Indexed: 12/26/2022] Open
Abstract
Stroke poses a serious threat to human health and burdens both society and the healthcare system. Standard rehabilitative therapies may not be effective in improving functions after stroke, so alternative strategies are needed. The FDA has approved vagus nerve stimulation (VNS) for the treatment of epilepsy, migraines, and depression. Recent studies have demonstrated that VNS can facilitate the benefits of rehabilitation interventions. VNS coupled with upper limb rehabilitation enhances the recovery of upper limb function in patients with chronic stroke. However, its invasive nature limits its clinical application. Researchers have developed a non-invasive method to stimulate the vagus nerve (non-invasive vagus nerve stimulation, nVNS). It has been suggested that nVNS coupled with rehabilitation could be a promising alternative for improving muscle function in chronic stroke patients. In this article, we review the current researches in preclinical and clinical studies as well as the potential applications of nVNS in stroke. We summarize the parameters, advantages, potential mechanisms, and adverse effects of current nVNS applications, as well as the future challenges and directions for nVNS in cerebral stroke treatment. These studies indicate that nVNS has promising efficacy in reducing stroke volume and attenuating neurological deficits in ischemic stroke models. While more basic and clinical research is required to fully understand its mechanisms of efficacy, especially Phase III trials with a large number of patients, these data suggest that nVNS can be applied easily not only as a possible secondary prophylactic treatment in chronic cerebral stroke, but also as a promising adjunctive treatment in acute cerebral stroke in the near future.
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Affiliation(s)
- Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Dong Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
- *Correspondence: Quan Wei,
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15
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Sun J, Ma Y, Du Z, Wang Z, Guo C, Luo Y, Chen L, Gao D, Li X, Xu K, Hong Y, Xu F, Yu X, Xiao X, Fang J, Hou X. Immediate Modulation of Transcutaneous Auricular Vagus Nerve Stimulation in Patients With Treatment-Resistant Depression: A Resting-State Functional Magnetic Resonance Imaging Study. Front Psychiatry 2022; 13:923783. [PMID: 35845466 PMCID: PMC9284008 DOI: 10.3389/fpsyt.2022.923783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies found that transcutaneous auricular vagus nerve stimulation (taVNS) was clinically effective in treating a case of treatment-resistant depression (TRD). However, the brain neural mechanisms underlying the immediate effects of taVNS treatment for TRD have not been elucidated. MATERIALS AND METHODS Differences in the amplitude of low-frequency fluctuations (ALFF) between TRD and healthy control (HC) groups were observed. The TRD group was treated with taVNS for 30 min, and changes in ALFF in the TRD group before and after immediate treatment were observed. The ALFF brain regions altered by taVNS induction were used as regions of interest to analyze whole-brain functional connectivity (FC) changes in the TRD group. RESULTS A total of 44 TRD patients and 44 HCs completed the study and were included in the data analysis. Compared with the HC group, the TRD group had increased ALFF in the left orbital area of the middle frontal gyrus. After taVNS treatment, ALFF in the left orbital area of the middle frontal gyrus and right middle frontal gyrus decreased in the TRD group, while ALFF in the right orbital area of the superior frontal gyrus increased. The FC in the left orbital area of the middle frontal gyrus with left middle frontal gyrus and the right inferior occipital gyrus was significantly increased. CONCLUSION Transcutaneous auricular vagus nerve stimulation demonstrates immediate modulation of functional activity in the emotional network, cognitive control network, and visual processing cortex, and may be a potential brain imaging biomarker for the treatment of TRD.
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Affiliation(s)
- Jifei Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhongming Du
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Chunlei Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Luo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Limei Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School of China Academy of Chinese Medical Sciences, Beijing, China
| | - Deqiang Gao
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaojiao Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ke Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Hong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengquan Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue Yu
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Jiliang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaobing Hou
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
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16
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Wang L, Wang Y, Wang Y, Wang F, Zhang J, Li S, Wu M, Li L, Rong P. Transcutaneous auricular vagus nerve stimulators: a review of past, present and future devices. Expert Rev Med Devices 2021; 19:43-61. [PMID: 34937487 DOI: 10.1080/17434440.2022.2020095] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION As an emerging neuromodulation therapy, transcutaneous auricular vagus nerve stimulation (taVNS) has been proven to be safe and effective for epilepsy, major depressive disorders, insomnia, glucose metabolic disorders, pain, stroke, post stroke rehabilitation, anxiety, fear, cognitive impairment, cardiovascular disorders, tinnitus, Prader-Willi Syndrome and COVID-19. AREAS COVERED Although the history of taVNS is only two decades, the devices carrying taVNS technique have been constantly updated. Especially in recent years, the development of taVNS devices has presented a new trend. To conclude, the development of taVNS devices has entered a new era, thus the update speed and quality of taVNS devices will be considerably improved in the future. This article reviewed the history and classification of taVNS devices. EXPERT OPINION The correlation between the effectiveness and stimulation parameters from taVNS devices still remains unclear. There is a lack of standard or harmonization among different taVNS devices. Strategies, including further comparative research and establishment of standard, have been recommended in this article to promote the future development of taVNS devices.
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Affiliation(s)
- Lei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yifei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Fang Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Shaoyuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mozheng Wu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
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17
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Wang X, Ji X. Interactions between remote ischemic conditioning and post-stroke sleep regulation. Front Med 2021; 15:867-876. [PMID: 34811643 DOI: 10.1007/s11684-021-0887-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/31/2021] [Indexed: 12/31/2022]
Abstract
Sleep disturbances are common in patients with stroke, and sleep quality has a critical role in the onset and outcome of stroke. Poor sleep exacerbates neurological injury, impedes nerve regeneration, and elicits serious complications. Thus, exploring a therapy suitable for patients with stroke and sleep disturbances is imperative. As a multi-targeted nonpharmacological intervention, remote ischemic conditioning can reduce the ischemic size of the brain, improve the functional outcome of stroke, and increase sleep duration. Preclinical/clinical evidence showed that this method can inhibit the inflammatory response, mediate the signal transductions of adenosine, activate the efferents of the vagal nerve, and reset the circadian clocks, all of which are involved in sleep regulation. In particular, cytokines tumor necrosis factor α (TNFα) and adenosine are sleep factors, and electrical vagal nerve stimulation can improve insomnia. On the basis of the common mechanisms of remote ischemic conditioning and sleep regulation, a causal relationship was proposed between remote ischemic conditioning and post-stroke sleep quality.
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Affiliation(s)
- Xian Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, 100069, China. .,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, 100069, China.
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18
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Zhang S, He JK, Meng H, Zhao B, Zhao YN, Wang Y, Li SY, Wang L, Wu MZ, Chen Y, Xiao X, Hou LW, Fang JL, Rong PJ. Effects of transcutaneous auricular vagus nerve stimulation on brain functional connectivity of medial prefrontal cortex in patients with primary insomnia. Anat Rec (Hoboken) 2021; 304:2426-2435. [PMID: 34623769 DOI: 10.1002/ar.24785] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 01/26/2023]
Abstract
As a representative of acupuncture and nonpharmaceutical therapy, auricular acupuncture has been widely for the treatment of insomnia. Transcutaneous auricular vagus nerve stimulation (taVNS) is a combination of auricular point stimulation and vagus nerve stimulation. It can not only treat primary insomnia effectively, but also is noninvasive, painless, portable and economical. The medial prefrontal cortex (mPFC) is a core region of default mode network (DMN), which is important for maintenance of sleep. However, the mechanism of taVNS in alleviating primary insomnia (PI) remains to be clarified. In this study, we found that taVNS could not only effectively reduce the score of Pittsburgh Sleep Quality Index, but also decreased functional connection (FC) between the left mPFC and bilateral dorsal anterior cingulate gyrus as well as FC between the right mPFC and the occipital cortex in patients with PI. Furthermore, the decrease in FC was positively correlated with the decline of sleep index score. Therefore, we proposed that treatment with taVNS can improve sleep quality and prolong sleep duration in patients with PI by reducing FC within DMN, FC between DMN and salience network, as well as FC between DMN and the occipital cortex. This may be one of mechanisms of taVNS in treating PI.
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Affiliation(s)
- Shuai Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jia-Kai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hong Meng
- Beijing Key Lab of Plant Resource Research and Development, Beijing Technology and Business University, Beijing, China
| | - Bin Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.,School of Traditional Chinese Medicine, Southern Medical University, Guangdong, China
| | - Ya-Nan Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shao-Yuan Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mo-Zheng Wu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Chen
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xue Xiao
- Department of Psychiatry, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Li-Wei Hou
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ji-Liang Fang
- Guang 'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Pei-Jing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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19
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Szulczewski MT. Transcutaneous Auricular Vagus Nerve Stimulation Combined With Slow Breathing: Speculations on Potential Applications and Technical Considerations. Neuromodulation 2021; 25:380-394. [PMID: 35396070 DOI: 10.1111/ner.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing. MATERIALS AND METHODS A nonsystematic review. RESULTS Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises. CONCLUSIONS Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.
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20
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Yao L, Li M, Cao J, Liu Y, Zheng H, Huang H, Wang H. Study on acupuncture improving insomnia comorbid with depression and anxiety based on rs-fMRI: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25988. [PMID: 34011090 PMCID: PMC8136997 DOI: 10.1097/md.0000000000025988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Long term insomnia and low sleep quality often lead to depression, anxiety and other negative emotions, and often interact with each other. Many studies have confirmed the effectiveness of acupuncture in the treatment of insomnia comorbid with emotional disorders, but its specific mechanism needs to be further explored. Resting-state functional magnetic resonance (rsfMRI) is an important means to study the changes of brain activity. However, the results are inconsistent and lack of systematic evaluation and analysis. METHODS Nine databases will be searched, including PubMed, EMBASE, EBSCOhost-medline, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP Database and Wan-Fang Database, Chinese Biomedical Literature Database from inception to January 2021. And screening clinical registration platform related research, in order to obtain more relevant studies. The outcomes include the change of rs-fMRI, sleep quality, depression, and anxiety. Quality assessment of the included studies will be performed according to the Cochrane Risk of Bias tool. Evidence quality will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RevMan software (Version 5.3) and stata13.1will be used for statistical analyses. Subgroup analysis will be performed if necessary. If the data is insufficient, qualitative synthesis will be conducted instead of quantitative synthesis. RESULTS This study will analyze the effect of acupuncture on the brain activity changes, improvement of sleep quality and clinical symptoms of anxiety and depression with insomnia comorbid with emotional disorders. CONCLUSION This study used meta-analysis method to explore the characteristics of acupuncture on brain activity changes in insomnia comorbid with emotional disorders, so as to provide effective evidence for clarifying its pathogenesis.
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21
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Transcutaneous Auricular Vagus Nerve Stimulation: From Concept to Application. Neurosci Bull 2020; 37:853-862. [PMID: 33355897 DOI: 10.1007/s12264-020-00619-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
Whether in the West or the East, the connection between the ear and the rest of the body has been explored for a long time. Especially in the past century or more, the relevant theoretical and applied research on the ear has greatly promoted the development of ear therapy, and finally the concept of transcutaneous auricular vagus nerve stimulation (taVNS) has been proposed. The purpose of taVNS is to treat a disease non-invasively by applying electrical current to the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear. In the past two decades, taVNS has been a topic of basic, clinical, and transformation research. It has been applied as an alternative to drug treatment for a variety of diseases. Based on the rapid understanding of the application of taVNS to human health and disease, some limitations in the development of this field have also been gradually exposed. Here, we comprehensively review the origin and research status of the field.
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22
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Yap JYY, Keatch C, Lambert E, Woods W, Stoddart PR, Kameneva T. Critical Review of Transcutaneous Vagus Nerve Stimulation: Challenges for Translation to Clinical Practice. Front Neurosci 2020; 14:284. [PMID: 32410932 PMCID: PMC7199464 DOI: 10.3389/fnins.2020.00284] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
Several studies have illustrated that transcutaneous vagus nerve stimulation (tVNS) can elicit therapeutic effects that are similar to those produced by its invasive counterpart, vagus nerve stimulation (VNS). VNS is an FDA-approved therapy for the treatment of both depression and epilepsy, but it is limited to the management of more severe, intervention-resistant cases as a second or third-line treatment option due to perioperative risks involved with device implantation. In contrast, tVNS is a non-invasive technique that involves the application of electrical currents through surface electrodes at select locations, most commonly targeting the auricular branch of the vagus nerve (ABVN) and the cervical branch of the vagus nerve in the neck. Although it has been shown that tVNS elicits hypo- and hyperactivation in various regions of the brain associated with anxiety and mood regulation, the mechanism of action and influence of stimulation parameters on clinical outcomes remains predominantly hypothetical. Suppositions are largely based on correlations between the neurobiology of the vagus nerve and its effects on neural activity. However, tVNS has also been investigated for several other disorders, including tinnitus, migraine and pain, by targeting the vagus nerve at sites in both the ear and the neck. As most of the described methods differ in the parameters and protocols applied, there is currently no firm evidence on the optimal location for tVNS or the stimulation parameters that provide the greatest therapeutic effects for a specific condition. This review presents the current status of tVNS with a focus on stimulation parameters, stimulation sites, and available devices. For tVNS to reach its full potential as a non-invasive and clinically relevant therapy, it is imperative that systematic studies be undertaken to reveal the mechanism of action and optimal stimulation modalities.
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Affiliation(s)
- Jonathan Y. Y. Yap
- ARC Training Centre in Biodevices, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Charlotte Keatch
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Elisabeth Lambert
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Will Woods
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Paul R. Stoddart
- ARC Training Centre in Biodevices, Swinburne University of Technology, Hawthorn, VIC, Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Tatiana Kameneva
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
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23
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Sclocco R, Garcia RG, Kettner NW, Fisher HP, Isenburg K, Makarovsky M, Stowell JA, Goldstein J, Barbieri R, Napadow V. Stimulus frequency modulates brainstem response to respiratory-gated transcutaneous auricular vagus nerve stimulation. Brain Stimul 2020; 13:970-978. [PMID: 32380448 DOI: 10.1016/j.brs.2020.03.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/22/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The therapeutic potential of transcutaneous auricular VNS (taVNS) is currently being explored for numerous clinical applications. However, optimized response for different clinical indications may depend on specific neuromodulation parameters, and systematic assessments of their influence are still needed to optimize this promising approach. HYPOTHESIS We proposed that stimulation frequency would have a significant effect on nucleus tractus solitarii (NTS) functional MRI (fMRI) response to respiratory-gated taVNS (RAVANS). METHODS Brainstem fMRI response to auricular RAVANS (cymba conchae) was assessed for four different stimulation frequencies (2, 10, 25, 100 Hz). Sham (no current) stimulation was used to control for respiration effects on fMRI signal. RESULTS Our findings demonstrated that RAVANS delivered at 100 Hz evoked the strongest brainstem response, localized to a cluster in the left (ipsilateral) medulla and consistent with purported NTS. A co-localized, although weaker, response was found for 2 Hz RAVANS. Furthermore, RAVANS delivered at 100 Hz also evoked stronger fMRI responses for important monoamine neurotransmitter source nuclei (LC, noradrenergic; MR, DR, serotonergic) and pain/homeostatic regulation nuclei (i.e. PAG). CONCLUSION Our fMRI results support previous localization of taVNS afference to pontomedullary aspect of NTS in the human brainstem, and demonstrate the significant influence of the stimulation frequency on brainstem fMRI response.
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Affiliation(s)
- Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Radiology, Logan University, Chesterfield, MO, USA.
| | - Ronald G Garcia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; School of Medicine, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Norman W Kettner
- Department of Radiology, Logan University, Chesterfield, MO, USA
| | - Harrison P Fisher
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Kylie Isenburg
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Maya Makarovsky
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jessica A Stowell
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jill Goldstein
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riccardo Barbieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; Department of Radiology, Logan University, Chesterfield, MO, USA
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24
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Zhao B, Bi Y, Li L, Zhang J, Hong Y, Zhang L, He J, Fang J, Rong P. The Instant Spontaneous Neuronal Activity Modulation of Transcutaneous Auricular Vagus Nerve Stimulation on Patients With Primary Insomnia. Front Neurosci 2020; 14:205. [PMID: 32231517 PMCID: PMC7082749 DOI: 10.3389/fnins.2020.00205] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Primary insomnia (PI) is associated with increased spontaneous neuronal activity. Transcutaneous auricular vagus nerve stimulation (taVNS) modulates brain function, and it is an effective treatment for primary insomnia. However, whether taVNS alleviates insomnia through modulating spontaneous neuronal activity is not fully clarified. This study aims to investigate the instant effect of taVNS in modulating spontaneous neuronal activity in PI patients using resting-state functional magnetic resonance imaging (rs-fMRI). Twenty-two PI subjects underwent rs-fMRI scanning prior and immediately after 30 min treatment of taVNS controlled by twenty healthy adults. Amplitude of low frequency fluctuations (ALFF) analysis was employed to assess the difference in spontaneous neuronal activity between PI patients and healthy adults, as well as between pre-treatment and post-treatment of taVNS. The taVNS-induced altered ALFF brain areas were then selected as regions of interest to perform the resting state functional connectivity (RSFC) analysis in PI patients. The right precuneus showed significantly increased ALFF in PI patients. After immediate taVNS treatment, the ALFF was significantly decreased in the right precuneus and increased in the left middle occipital gyrus. The RSFC in right precuneus with right angular, right superior frontal gyrus, and right middle frontal gyrus was significantly decreased. This study provides insights into the instant brain effects of taVNS on PI patients.
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Affiliation(s)
- Bin Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Hong
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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25
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Cakmak YO. Concerning Auricular Vagal Nerve Stimulation: Occult Neural Networks. Front Hum Neurosci 2019; 13:421. [PMID: 31920585 PMCID: PMC6920183 DOI: 10.3389/fnhum.2019.00421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022] Open
Abstract
Auricular vagal nerve stimulation (AVNS) is an evolving neuromodulation technology that has a wide range of therapeutic applications across multiple disciplines of medical science. To date, AVNS results had been interpreted in the context of a monolog concept of the auricular branch of the vagus nerve (ABVN): that this is the sole network of the mechanism of action and/or structure in the auricular area of the stimulation in the context of activations in the brainstem nuclei, including the nucleus tractus solitarius (NTS), locus coeruleus (LC), trigeminal brainstem nuclei, and the nucleus cuneatus. This review considers the overlooked aspects of neural networks, connections, hijacking axons from cranial nerves and cervical sympathetic ganglions, the inhomogeneous distribution of perivascular sympathetic nerves, and intrinsic/extrinsic auricular muscles in the auricular zone that can explain the vagal and non-vagal nucleus activations in AVNS. In addition, the unique cortical representation of the human ear and interspecies differences in the auricula are discussed. The detailed auricular anatomy of the AVNS zone explored in the present study references structural and functional neural network information to overcome default designs and misinterpretations of existing research on AVNS to provide a better foundation for future investigations that use this modality.
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Affiliation(s)
- Yusuf Ozgur Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,Brain Health Research Centre, University of Otago, Dunedin, New Zealand.,Centre for Health Systems and Technologies, University of Otago, Dunedin, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
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26
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Yoon HK. Therapeutic Application of Transcutaneous Auricular Vagus Nerve Stimulation in Primary Insomnia. ACTA ACUST UNITED AC 2019. [DOI: 10.33069/cim.2019.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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27
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Rong P, Luo M, Li L, Zhang J, Guo X, Zhao B, Li S, Yang Y, Liu S, Wang Y, Li S, Jiao Y, Zhao Y. Sleep electroencephalography power spectral response to transcutaneous auricular vagus nerve stimulation on insomnia rats. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_51_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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