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Lu PH, Chuo HE, Chiu LY, Lai CC, Wang JY, Lu PH. Comparative efficacy of acupuncture point stimulation treatments for dialysis patients with uremic pruritus: a systematic review and network meta-analysis. Front Neurol 2024; 15:1342788. [PMID: 38595850 PMCID: PMC11003387 DOI: 10.3389/fneur.2024.1342788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Background Uremic pruritus (UP) is a common complication of chronic kidney disease that causes sleep disturbances and increases all-cause mortality. Currently, the first-line medications for UP exhibit inadequate pruritus control with adverse effects. Various acupuncture point stimulation treatments (APSTs) have been shown to be effective as adjuvant therapies in UP, and a network meta-analysis can offer relative efficacy estimates for treatments for which head-to-head studies have not been performed. Methods We conducted a random-effects network meta-analysis on a consistency model to compare the different APSTs for UP. The primary outcomes were the mean visual analog scale (VAS) score and effectiveness rate (ER). Results The network meta-analysis retrieved 27 randomized controlled trials involving 1969 patients. Compared with conventional treatment alone, combination treatment with acupuncture (mean difference, -2.63; 95% confidence interval, -3.71 to -1.55) was the most effective intervention in decreasing VAS scores, followed by acupoint injection and massage (mean difference, -2.04; 95% confidence interval, -3.96 to -0.12). In terms of the ER, conventional treatment with acupuncture and hemoperfusion (risk ratio, 14.87; 95% confidence interval, 2.18 to 101.53) was superior to other therapeutic combinations. Considering the VAS score and ER, combination treatment with acupoint injection and massage showed benefits in treating UP. Conclusion Our network meta-analysis provided relative efficacy data for choosing the optimal adjuvant treatment for UP. Combined treatment with acupuncture was more effective than conventional treatment only and was the most promising intervention for treating UP.Systematic review registration: PROSPERO (CRD42023425739: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023425739).
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Affiliation(s)
- Po-Hsuan Lu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hui-En Chuo
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ling-Ya Chiu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chien-Cheng Lai
- Department of Medical Education, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jen-Yu Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ping-Hsun Lu
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Zhong Y, Du Q, Wang Z, Zheng Q, Yang M, Hu P, Yang Q, Xu H, Wu Z, Huang X, Li H, Tang M, Zeng H, Zhu L, Ren G, Cao M, Liu Y, Wang H. Antidepressant effect of Perilla frutescens essential oil through monoamine neurotransmitters and BDNF/TrkB signal pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116840. [PMID: 37355083 DOI: 10.1016/j.jep.2023.116840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional Chinese medicine posits that affect-mind ill-being is the primary cause of depression, with Qi movement stagnation as its pathogenesis. As such, clinical treatment for depression should prioritize regulating Qi and relieving depressive symptoms. The pharmacological properties of traditional Chinese medicine indicate that Perilla frutescens may have potential therapeutic effects on depression and other neuropsychiatric diseases due to its ability to regulate Qi and alleviate depressive symptoms. Although previous studies have reported the antidepressant effects of Perilla frutescens, the mechanism underlying PFEO inhalation-mediated antidepressant effect remains unclear. AIM OF THE STUDY The aim of this investigation is to elucidate the antidepressant mechanisms of PFEO by examining its effects on monoamine neurotransmitters and the BDNF/TrkB signaling pathway. MATERIALS AND METHODS The CUMS rat model of depression was established, and the depressive state of the animals was assessed through sucrose preference and forced swim tests. ELISA assays were conducted to determine monoamine neurotransmitter levels in the hippocampus and cerebral cortex of rats. Immunohistochemistry, western blotting, and RT-PCR experiments were employed to investigate the BDNF/TrkB signaling pathway's regulation of depression via PFEO inhalation. RESULTS It has been observed that inhalation administration of PFEO can significantly enhance the preference for sugar water in CUMS rats and reduce their immobility time during forced swimming. Additionally, there was an increase in the levels of monoamine transmitters in both the hippocampus and cerebral cortex of these rats. Furthermore, there was an upregulation in the expression levels of BDNF and TrkB positive cells as well as BDNF and TrkB proteins within both regions, along with increased BDNF mRNA and TrkB mRNA expression levels. CONCLUSION The antidepressant effect of PFEO via inhalation administration is speculated to be mediated through the monoamine neurotransmitters and BDNF/TrkB signaling pathway.
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Affiliation(s)
- Yu Zhong
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Qing Du
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Ziqian Wang
- Jiangxi Drug Inspection Center, Nanchang, 330000, China
| | - Qin Zheng
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China.
| | - Ming Yang
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China.
| | - Pengyi Hu
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China.
| | - Qiyue Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Huanhua Xu
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Zhenfeng Wu
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Xiaoying Huang
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Huiting Li
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Mingxia Tang
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Huiming Zeng
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Liyun Zhu
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Guilin Ren
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Ming Cao
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Yu Liu
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
| | - Hongbo Wang
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, State Key Lab.of Innovation Drug and Effcient Energy-Saving Pharmaceutical Equipment, Jiangxi University of Chinese Medicine, Nanchang, 330004, China
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Lu PH, Chung CH, Chuo HE, Lin IH, Lu PH. Efficacy of acupoint stimulation as a treatment for uremic pruritus: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1036072. [PMID: 36530891 PMCID: PMC9751623 DOI: 10.3389/fmed.2022.1036072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Uremic pruritus causes sleep disturbances, poor quality of life, and increased morbidity in patients with chronic kidney disease. Acupuncture has been shown to improve uremic pruritus. There is limited evidence of the efficacy of traditional Chinese therapies. We conducted a systematic review and meta-analysis to evaluate the efficacy of acupoint stimulation therapy in patients with uremic pruritus. METHODS A systematic search of seven databases (up to Sep 2022) was conducted for randomized controlled trials that evaluated the clinical efficacy of acupuncture, acupressure, auricular acupressure, acupoint injection, acupoint thermal therapy, acupoint sticking therapy, or transcutaneous electrical acupoint stimulation in the treatment of patients with uremic pruritus. Two reviewers selected eligible articles for inclusion in the meta-analysis and evaluated the risk of bias via Cochrane Collaboration. The results of pruritus assessments and uremic pruritus-related laboratory parameters were analyzed. RESULTS Forty trials published between 2002 and 2022, including a total of 2,735 participants, were identified for inclusion in the meta-analysis. The effective rates for acupuncture, auricular acupressure, and the combination of acupoint injection and acupoint massage were significantly greater in patients with uremic pruritus compared to the control group. The levels of serum BUN, PTH, and histamine levels were significantly lower vs. control group. CONCLUSIONS Acupuncture, auricular acupressure, and the combination of acupoint injection and acupoint massage seem to be effective in improving uremic pruritus in patients with chronic kidney disease. However, further investigation of these potential treatments is now warranted in larger patient populations and over a longer time frame. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022354585, identifier: PROSPERO CRD42022354585.
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Affiliation(s)
- Ping-Hsun Lu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | | | - Hui-En Chuo
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
| | - I-Hsin Lin
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Po-Hsuan Lu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Abstract
This overview reports the global research advances in acupuncture point injection in the last 5 years. Acupuncture point injection can be applied to a wide range of curable diseases, predominantly those involving pain, but it has poor clinical evidence. Progress has been attained in the mechanism research on acupuncture point injection, but further studies remain necessary. With the reported adverse effects of acupuncture point injection, the need to standardize its clinical procedure has become urgent.
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Affiliation(s)
- T Sha
- From the Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - L L Gao
- College of Acupuncture and Massage, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - C H Zhang
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - J G Zheng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Z H Meng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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