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Wu Y, Zhao K, Wen W, Zhu K, Lu F, Kong Y, Ye X, Wang H. Acupuncture for poststroke coma: A systematic review and meta-analysis. Complement Ther Med 2024; 82:103046. [PMID: 38704101 DOI: 10.1016/j.ctim.2024.103046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Despite being widely applied in clinical practice, the wake-promoting effect of acupuncture in poststroke coma patients remains controversial. OBJECTIVE This study aimed to evaluate the efficacy of acupuncture for the treatment of poststroke coma. METHODS Randomized controlled trials (RCTs) of acupuncture for treating poststroke coma were identified in PubMed, Cochrane Library, EMBASE, CNKI, WanFang and VIP up to 25 November 2023. The main outcomes were Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score, awakening ratio and clinically effective ratio. Stata 17 and Review Manager 5.4 software were used for mate analysis. RESULTS A total of 34 RCTs involving 2757 patients were included. GCS (WMD = 1.78; 95% CI: 1.35 to 2.21) and NIHSS score (WMD = -2.84; 95% CI: -3.84 to -1.84) were significantly increased in acupuncture group compared with control group. Acupuncture combined with routine treatment may be better than routine treatment in improving the awakening ratio (RR= 1.65; 95% CI: 1.24 to 2.91) and the clinically effective ratio (RR= 1.20; 95% CI: 1.13 to 1.27). Some methodological flaws were identified in the included studies, including non-implementation of blinding, inappropriate disease assessment and heterogeneous interventions. CONCLUSIONS The existing evidence suggests that acupuncture combined with conventional treatment may be an effective treatment for poststroke coma patients. In the meantime, more high-quality RCTs are needed to demonstrate these findings due to methodological weaknesses like randomization, blinding, heterogeneous interventions and long-term follow-up.
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Affiliation(s)
- Yulun Wu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wanshun Wen
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Keying Zhu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Fei'ao Lu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Hui Wang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Wake-Promoting Effect of Bloodletting Puncture at Hand Twelve Jing-Well Points in Acute Stroke Patients: A Multi-center Randomized Controlled Trial. Chin J Integr Med 2020; 27:570-577. [PMID: 32946039 DOI: 10.1007/s11655-020-3093-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the effect and safety of bloodletting puncture at hand twelve Jing-Well points (HTWPs) in acute stroke patients with conscious disturbance. METHODS In this multi-center and randomized controlled trial, 360 patients suffered from ischemic or hemorrhagic stroke with conscious disturbance within 48 h from the onset of symptom were divided into bloodletting (180 cases) and control (180 cases) groups using a block randomization. Patients in both groups received routine Western medicine, and patients in the bloodletting group received additional bloodletting puncture at HTWPs on admission immediately before conventional treatment. The primary outcome measure was Glasgow Coma Scale (GCS) score and the secondary outcomes included blood pressure, respiratory rate and pulse rate. All variables were evaluated at baseline (before bloodletting), 0 (after bloodletting immediately), 15, 30, 50 and 80 min post bloodletting. RESULTS At 80 min post bloodletting, the proportion of patients with improved consciousness in the bloodletting group was greater than the control group (P<0.05). In the separate analysis of moderate consciousness disturbance subgroup, bloodletting therapy benefited ischemic patients, and improved the eye and language response of GCS score at 15, 30, 50, 80 min post bloodletting (P<0.05 or P<0.01). No significant differences were observed regarding the secondary outcomes between two groups (P>0.05). CONCLUSION The bloodletting puncture at HTWPs was safe and could improve conscious levels of ischemic stroke patients, highlighting a first-aid intervention for acute stroke. (Registration No. ChiCTR-INR-16009530).
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Abstract
Acupuncture is potentially beneficial for post-stroke rehabilitation and is considered a promising preventive strategy for stroke. Electroacupuncture pretreatment or treatment after ischemic stroke by using appropriate electroacupuncture parameters generates neuroprotective and neuroregenerative effects that increase cerebral blood flow, regulate oxidative stress, attenuate glutamate excitotoxicity, maintain blood-brain barrier integrity, inhibit apoptosis, increase growth factor production, and induce cerebral ischemic tolerance.
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Affiliation(s)
- Qwang-Yuen Chang
- Department of Family Medicine, Lin Shin Hospital, Taichung, Taiwan, China
| | - Yi-Wen Lin
- Research Center for Chinese Medicine and Acupuncture; Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan, China
| | - Ching-Liang Hsieh
- Research Center for Chinese Medicine and Acupuncture; Graduate Institute of Acupuncture Science, College of Chinese Medicine; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University; Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, China
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Yu N, Wang Z, Chen Y, Yang J, Lu X, Guo Y, Chen Z, Xu Z. The ameliorative effect of bloodletting puncture at hand twelve Jing-well points on cerebral edema induced by permanent middle cerebral ischemia via protecting the tight junctions of the blood-brain barrier. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:470. [PMID: 28950851 PMCID: PMC5615481 DOI: 10.1186/s12906-017-1979-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/19/2017] [Indexed: 01/17/2023]
Abstract
Background Cerebral edema, erupting simultaneously with severe ischemic stroke, might lead to increased intracranial pressure, cerebral herniation, and ultimately death. Studies conducted previously by our team have demonstrated the fact that bloodletting puncture at hand twelve Jing-well points (HTWP) could alleviate cerebral edema, which mainly results from the disruption of blood-brain barrier (BBB). The study, therefore, was first designed to demonstrate whether BBB-protection serves an important role in the edema-relief effect of HTWP bloodletting, based on which to research the molecular mechanism underlying. Methods The rats were made into model suffering from permanent middle cerebral artery occlusion (pMCAO) and then bloodletting puncture were treated at HTWP once a day. Wet and dry weight method was adopted to evaluate the degree of brain edema, evans blue extravasation and electron microscopy were used to evaluate the integrity of the BBB, and RT-qPCR was carried out to analyze the expression level of occludin, claudin-5, ICAM-1, and VEGF. Results Results revealed that bloodletting puncture treatment could reduce water content of brain and the permeability of BBB caused by ischemic stroke. In bloodletting puncture group, ameliorated tight junctions could be observed under electron microscopy. It was demonstrated in further study that, in bloodletting group, compared with pMCAO one, the expression levels of occludin and claudin-5 were up-regulated, while ICAM-1 and VEGF were down-regulated. Conclusions In conclusion, bloodletting puncture at HTWP might play a significant role in protecting the tight junctions of BBB, thus alleviating cerebral edema induced by ischemic stroke. Therefore, the therapy of bloodletting puncture at HTWP may be a promising strategy for acute ischemic stroke in the future.
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Tu Y, Miao XM, Yi TL, Chen XY, Sun HT, Cheng SX, Zhang S. Neuroprotective effects of bloodletting at Jing points combined with mild induced hypothermia in acute severe traumatic brain injury. Neural Regen Res 2016; 11:931-6. [PMID: 27482221 PMCID: PMC4962590 DOI: 10.4103/1673-5374.184491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Bloodletting at Jing points has been used to treat coma in traditional Chinese medicine. Mild induced hypothermia has also been shown to have neuroprotective effects. However, the therapeutic effects of bloodletting at Jing points and mild induced hypothermia alone are limited. Therefore, we investigated whether combined treatment might have clinical effectiveness for the treatment of acute severe traumatic brain injury. Using a rat model of traumatic brain injury, combined treatment substantially alleviated cerebral edema and blood-brain barrier dysfunction. Furthermore, neurological function was ameliorated, and cellular necrosis and the inflammatory response were lessened. These findings suggest that the combined effects of bloodletting at Jing points (20 μL, twice a day, for 2 days) and mild induced hypothermia (6 hours) are better than their individual effects alone. Their combined application may have marked neuroprotective effects in the clinical treatment of acute severe traumatic brain injury.
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Affiliation(s)
- Yue Tu
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Mei Miao
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tai-Long Yi
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Xu-Yi Chen
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Hong-Tao Sun
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China
| | - Shi-Xiang Cheng
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Sai Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury & Neuroscience of Chinese People's Armed Police Forces, Neurosurgery & Neurology Hospital, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, China; Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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The immunomodulatory effect of acupoint application for childhood asthma: a systematic review and meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:896247. [PMID: 26000027 PMCID: PMC4426892 DOI: 10.1155/2015/896247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/18/2022]
Abstract
Objective. To evaluate the evidence on the immunomodulatory effect of acupoint application for childhood asthma. Methods. Five electronic databases through October 2014 were searched. The risk of bias in eligible studies was assessed using the Cochrane Collaboration tool. Standardised mean difference (SMD) and 95% confidence intervals (CI) of random-effects model were calculated. And heterogeneity was assessed using the Cochran Q statistic and quantified with the I (2) index. Results. Six studies were included in our review. The aggregated results suggested that acupoint application showed the beneficial effect for childhood asthma in improving IgA (SMD, -0.83; 95% CI -1.14 to -0.52; P < 0.00001), IgE (SMD, -0.52; 95% CI -0.76 to -0.29; P < 0.001), IgG (SMD, -1.17; 95% CI -1.61 to -0.74; P < 0.0001), IL-4 (SMD, -0.57; 95% CI -0.91 to -0.23; P = 0.0009), and IFN-γ (SMD, -0.38; 95% CI -0.71 to -0.04; P = 0.03) but not IgM (SMD, -0.40; 95% CI -0.98 to 0.18; P = 0.18). And the effective dose of acupoint application may be 2-6 hours/time and a total of 3 times within 4 weeks. Conclusions. This review showed the positive evidence that acupoint application had the favorable immunomodulatory effect for childhood asthma. However, more studies with long follow-up are warrant to confirm the current findings.
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Lu X, Chen Z, Guo Y, Gao L, Jiang L, Li Z, Fang J. Blood-letting punctures at twelve Jing-Well points of the hand can treat cerebral ischemia in a similar manner to mannitol. Neural Regen Res 2014; 8:532-9. [PMID: 25206696 PMCID: PMC4146051 DOI: 10.3969/j.issn.1673-5374.2013.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/10/2013] [Indexed: 12/25/2022] Open
Abstract
A rat model of middle cerebral artery permanent occlusion was established using the modified Longa method. Successfully established model animals were treated by blood-letting puncture at twelve Jing-Well points of the hand, and/or by injecting mannitol into the caudal vein twice daily. Brain tissue was collected at 24, 48 and 72 hours after modeling, and blood was collected through the retinal vein before Evans blue was injected, approximately 1 hour prior to harvesting of brain tissue. Results showed that Evans blue leakage into brain tissue and serum nitric oxide synthase activity were significantly increased in model rats. Treatment with blood-letting punctures at twelve Jing-Well points of the hand and/or injection of mannitol into the caudal vein reduced the amount of Evans blue leakage into the brain tissue and serum nitric oxide synthase activity to varying degrees. There was no significant difference between single treatment and combined treatment. Experimental findings indicate that blood-letting punctures at twelve Jing-Well points of the hand can decrease blood-brain barrier permeability and serum nitric oxide synthase activity in rats following middle cerebral artery occlusion, and its effect is similar to that of mannitol injection alone and Jing-Well points plus mannitol injection.
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Affiliation(s)
- Xuan Lu
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Zelin Chen
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Yi Guo
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Liang Gao
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Liyuan Jiang
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Zhongzheng Li
- Experimental Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Jianqiao Fang
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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