Effect of Auricular Pellet Acupressure on Antioxidative Systems in High-Risk Diabetes Mellitus

Acupuncture and moxibustion therapy for cognitive impairment: the microbiome-gut-brain axis and its role

Cognitive impairment poses a significant burden on individuals, families, and society worldwide. Despite the lack of effective treatment strategies, emerging evidence suggests that the microbiome-gut-brain (MGB) axis may play a critical role in the pathogenesis of cognitive impairment. While targeted treatment is not yet comprehensive, recently, acupuncture and moxibustion therapy has participated increasingly in the treatment of degenerative diseases and has achieved a certain therapeutic effect. In this review, the possible mechanisms by which acupuncture and moxibustion therapy may improve cognitive impairment through the MGB axis are reviewed, including regulating gut microbial homeostasis, improving intestinal inflammation mediated by the neuroendocrine-immune system, and enhancing intestinal barrier function. We also discuss common acupoints and corresponding mechanism analysis to provide insights into further exploration of mechanisms that target the MGB axis and thereby intervene in cognitive impairment.

Auricular Acupuncture for Lowering Blood Glucose in Type 2 Diabetes: A Pilot Study

Objective

Although type 2 diabetes mellitus (T2DM) is a major health epidemic, little research on auricular acupuncture for reducing blood glucose levels has been published. In Guatemala, where this study was conducted, the prevalence of T2DM is high and access to care is limited. The purpose of this pilot study was to determine if an auricular acupuncture protocol could be a feasible, effective treatment for reducing blood glucose, thus offering another potential accessible treatment.

Materials and Methods

Utilizing a self-controlled design approach, 28 participants diagnosed with T2DM were recruited and received 2 weeks of treatment consisting of a set protocol of 5 points in each ear. Pre- and post-treatment surveys were used to assess patients' health status, treatment expectations, and quality of life. Paired t-tests were used to measure pre- to post-treatment glucose levels.

Results

Treatment produced significant reduction in the patients' fasting and postprandial blood glucose levels, averaging 45.35 (n = 19; P = 0.014) and 109.45 points (n = 10; P = 0.008), respectively. Surveys indicated that all participants would be interested in using the treatment again to help manage their blood glucose.

Conclusions

An auricular protocol may provide a low-cost, effective treatment for lowering blood glucose in patients with T2DM. The results of this study are promising, suggesting that further investigation is warranted.

Retinal Changes in Panic Disorder Patients

AIM

Optical coherence tomography (OCT) is a novel method that allows high resolution cross-sectional imaging of biological tissues. It was suggested that changes in the cranial structure or functions would be reflected in the retina. OCT has been an important method in the diagnosis and follow-up of diseases via morphometric or quantitative retinal measurements. Panic disorder (PD) is an anxiety disorder, where free radicals, inflammatory processes and neurotransmitter transmission disorders play a role in the etiology. The present study aimed to demonstrate neurodegeneration in PD by the comparison of PD patient and control OCT data.

MATERIAL AND METHOD

The study group included 21 PD patients who met the study criteria. The control group included 21 healthy individuals without any known psychiatric or organic disease, including eye disease, and gender-matched to the patient group. All participants underwent detailed psychiatric and eye examinations. Central macular thickness (CMT), macular volume (MV), mean and retinal nerve fiber layer thickness (RNFL), ganglion cell layer thickness (GCLT), and central choroidal thickness (CCT) were measured in both eyes of all participants with OCT. A sociodemographic data form, Clinical Global Impression Scale (CGIS), and Panic Disorder Severity Scale (PDSS) were administered to the participants.

RESULTS

In the study, it was determined that the CMT values of the PD patients were lower when compared to the controls in the OCT examination. There was a statistically significant difference between the CMT of the PD patient group and the control group; the CMT was lower in the patient group. There were no significant differences between the groups based on GCLT, RNFL superior, RNFL inferior, RNFL nasal, RNFL temporal, and CCT. There was no significant correlation between CGIS, PDSS scores and OCT measurements.

CONCLUSION

This is the first study in the literature where patients with a PD diagnosis were analyzed based on the OCT method. OCT, which is a simple, noninvasive and relatively inexpensive method that the patient could easily adapt to during imaging, could be employed as a supplementary method in the diagnosis and follow-up of PD patients.

The effects of auricular acupuncture on vascular parameters on the risk factors for diabetic foot: A randomized clinical trial

AIMS AND OBJECTIVES

To evaluate the effects of auricular acupuncture on vascular parameters on the risk factors for Diabetic Foot.

METHODS

Randomized and masked clinical trial. The sample was composed of 44 individuals with type 2 Diabetes Mellitus and they were randomly assigned to two groups: intervention (n = 22), which received five sessions of auricular acupuncture, and control (n = 22), which did not receive the therapy. Three evaluations were performed: before the intervention; one day after the last acupuncture session and 15 days after the second evaluation. For this, the subject's characterization instrument, the Ankle-Brachial Index measurement, and thermography were used. For data analysis, Mann-Whitney, Wilcoxon, Wilcoxon signed-rank, Fisher's Exact and Chi-Square tests were used.

RESULTS

Auriculotherapy provided results in the Ankle-Brachial Index Test, as well as in thermography, which showed significant temperature improvement.

CONCLUSIONS

The technique proved to be efficient in improving circulatory conditions and plantar temperature.

Auricular points acupressure for insulin resistance in overweight/obese women with polycystic ovary syndrome: protocol for a randomised controlled pilot trial

INTRODUCTION

Approximately 5%-20% of reproductive women suffer from polycystic ovary syndrome (PCOS). Auricular points acupressure (AA) may serve as alternative management for PCOS for its benefits in both physical and psychological well-being. However, the effects of AA for insulin resistance (IR) in overweight/obese PCOS women have not been confirmed.

METHODS AND ANALYSIS

The present study is designed as a randomised, placebo-controlled pilot trial to evaluate the effectiveness and safety of AA in treating IR in women with PCOS. A total of 60 eligible PCOS subjects will be randomised into an intervention group (AA group) and a control group (sham AA group) in a ratio of 1:1. Magnetic beads will be taped to the auricular points by the same senior acupuncture specialist from the First Affiliated Hospital, Heilongjiang University of Chinese Medicine. The treatment will last for 12 weeks. Primary outcome measure will be changes in homeostasis model assessment of IR between baseline and after 3 months of AA/sham AA treatment. Secondary outcomes include hormonal profile, weight, waist/hip circumference, body mass index, blood pressure, Ferriman-Gallwey score, acne and the assessment of health-related quality of life. Outcome measures are collected at baseline and the end of treatment visit.

ETHICS AND DISSEMINATION

The protocol has been approved by the ethics committee of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine (HZYLLKY201800301). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals for publications.

TRIAL REGISTRATION NUMBER

NCT03546595; Pre-results.

Effect of self-acupressure on fasting blood sugar (FBS) and insulin level in type 2 diabetes patients: a randomized clinical trial

Background

Uncontrolled symptoms of diabetes can lead to irreparable damage to vital organs. Despite the global trend towards the use of complementary alternative therapies, few studies have evaluated the effectiveness of self-acupressure in diabetes patients.

Objective

The aim of this study was to determine the effect of self-acupressure on FBS and insulin level in type 2 diabetes patients.

Methods

This randomized clinical trial was performed from September 2016 to February 2017. A total of 60 diabetic patients were selected from diabetes clinic in Rafsanjan in Iran, according to inclusion and exclusion criteria and then assigned to 2 groups (30 in acupressure and 30 in control) randomly by the minimization method. The intervention group received acupressure at ST-36, LIV-3, KD-3 and SP-6 points bilaterally for five minutes for each point in 10 seconds pressure and 2 seconds rest periods. Subjects in the control group received no intervention. The FBS and insulin levels were measured before and after the intervention for both groups. The data were analyzed by SPSS version 16 by the Chi-square test, independent-samples t-test, and paired-samples t-test. A level of 0.05 was considered significant for examining the hypotheses.

Results

There were no significant differences between the acupressure and control group regarding age, sex and level of education. The insulin level significantly increased after treatment in the acupressure group (p=0.001). There were no significant differences between the levels of insulin in study or control groups. Serum FBS level decreased significantly after intervention in the acupressure group compared to the control group (p=0.02).

Conclusion

Self-acupressure as a complementary alternative medicine can be a helpful complementary method in reducing FBS and increasing insulin levels in type 2 diabetic patients.

Trial registration

This trial was registered at the Iranian Registry of Clinical Trials with clinical trial registration number: IRCT2016122131459N1.

Funding

This study was financially sported by Deputy of Research and Technology of Rafsanjan University of Medical Sciences (Ref: 20.519).

Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review

OBJECTIVES

To analyze the efficacy and safety of auricular acupuncture (AA) in patients with cognitive impairment and dementia.

METHODS

Twelve electronic databases were searched for randomized controlled trials evaluating effects of AA in patients with cognitive impairment and/or dementia, from their inception to August 2017. The primary outcome was cognitive function, and secondary outcomes were self-care ability, quality of life, clinical efficacy rate, and incidences of adverse events.

RESULTS

Nine studies were included, and five involving 677 participants were analyzed quantitatively. Compared with Western medications (WM), AA had mixed effects on cognitive functions (Mini-Mental State Examination [MMSE], mean difference [MD] 0.73, 95% confidence interval [CI] -0.02 to 1.48; Hierarchic Dementia Scale [HDS], MD 2.21, 95% CI 1.09 to 3.33); there was no significant improvement in the activities of daily living (ADL) score (MD 0.20, 95% CI -3.51 to 3.91) in patients with vascular dementia (VD). Compared to WM, AA combined with WM showed better clinical efficacy rate (risk ratio [RR] 1.42, 95% CI 1.06 to 1.91) in patients with VD; there was no significant improvement in cognitive functions (MMSE, MD 0.97, 95% CI -0.44 to 2.38; Montreal Cognitive Assessment [MoCA], MD 0.22, 95% CI -1.83 to 2.27) in patients with mild cognitive impairment (MCI). Compared to herbal medicine (HM), AA plus HM showed significant improvements in cognitive function (MMSE, MD 1.31, 95% CI 0.13 to 2.49) in patients with MCI and patients with vascular cognitive impairment, no dementia (VCIND) and in ADL score (MD -6.70, 95% CI -8.78 to -4.62) in patients with MCI. No adverse event associated with AA was reported.

CONCLUSION

The evidence reveals mixed efficacy of AA in patients with cognitive impairment and/or dementia. However, the results were inconclusive because of the small number and poor methodological quality of the included studies.

The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine

Auricular therapy includes acupuncture, electroacupuncture, acupressure, lasering, cauterization, moxibustion, and bloodletting in the auricle. For 2500 years, people have employed auricular therapy for treating diseases, but the methods have been limited to bloodletting and cauterization. Only after 1957, the international scientific community became aware that the map of the ear resembles an inverted fetus, its introduction has led to auricular acupuncture (AA) becoming a more systemic approach, and, following the identification and standardization of more precise points, AA has been employed in clinical applications. The mechanisms of AA are considered to have a close relationship with the autonomic nervous system, the neuroendocrine system, neuroimmunological factors, neuroinflammation, and neural reflex, as well as antioxidation. Auricular therapy has been applied, for example, for pain relief, for the treatment of epilepsy, anxiety, and obesity, and for improving sleep quality. However, the mechanisms and evidence for auricular therapy warrant further study.

Use of auricular acupressure to improve the quality of life in diabetic patients with chronic kidney diseases: a prospective randomized controlled trial

Background. Diabetic patients with chronic kidney disease (CKD) suffer from low quality of life (QOL). We aim to assess the effectiveness of auricular acupressure for QOL improvement in these patients. Materials and Methods. Sixty-two participants were randomly assigned to an auricular or a control arm in a randomized controlled trial. Participants in the auricular arm were instructed to perform auricular acupressure 3–5 times per day for 3 months, when they were receiving conventional treatments. Participants in the control arm received conventional treatments only. The primary outcome was the summarized score of Kidney Disease and Quality of Life Short-Form (KDQOL-SF) at 3 months after randomization. The secondary outcomes included the 36-Item Short Form Health Survey (SF-36), glycosylated hemoglobin (HbA1c), and estimated glomerular filtration rate (eGFR). Results. The summarized KDQOL differed significantly between the acupressure (76.6, 95% CI, 72.2 to 81.0) and the control group (61.8, 95% CI, 57.7 to 65.9). Similar results were found in the SF-36 scores. HbA1c and eGFR were not found to be significantly different between the arms and neither were the adverse events. Conclusion. Auricular acupressure was well tolerated in diabetic patients with chronic kidney diseases receiving hemodialysis. Future research is needed to confirm these results.

Effects of auricular stimulation in the cavum conchae on glucometabolism in patients with type 2 diabetes mellitus

OBJECTIVE

To investigate the effect of auricular stimulation in cavum conchae on the glycemic control for patients with type 2 diabetes mellitus.

METHODS

Seventy-one cases were treated with auricular electrical stimulator in the cavum choncha for 30 min, once daily for consecutive 3 months. The changes on the fasting plasma glucose (FBG), 2-h postprandial blood glucose after a 75 g oral glucose load (P2BG), glycated hemoglobin (HbA1c), blood urea nitrogen (BUN), serum creatinine (SCr), total cholesterol (TC) and aspartate transaminase (AST) were compared before and after the treatment.

RESULTS

The level of the HbA1c was significantly decreased (P<0.05), and there were also statistically significant decreases in BUN, SCr, TC and AST after the treatment (P<0.05). A few patients (n=7) reduced the dose of the hypoglycemic agents in response to repeated hypoglycemia during the treatment.

CONCLUSION

The stimulation in the cavum conchae of patients with types 2 diabetes mellitus may help decrease HbA1c, BUN, SCr, TC and AST, and may be an effective treatment for type 2 diabetes mellitus.

Auricular acupressure reduces anxiety levels and improves outcomes of in vitro fertilization: a prospective, randomized and controlled study

The study was to explore whether auricular acupressure (AA) can relieve anxiety during the period from trans-vaginal oocyte retrieval to the embryo transfer in IVF treatment and whether AA can improve the outcomes of IVF. 305 infertile patients with tubal blockage who were referred for IVF were included. The women were randomized into a control group with 102 cases, a Sham-AA group with 102 cases and an AA group with 101 cases. The anxiety levels were rated with Spielberger's State Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. Data of clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) were obtained. The levels of neuropeptide Y (NPY) and transforming growth factor alpha (TGF-alpha) in the follicular fluids were detected with ELISA. After treatment, in AA group, the levels of state anxiety, preoperative anxiety and need-for-information were significantly lower, whereas CPR, IR, LBR and NPY levels in the follicular fluids were markedly higher than Sham-AA group and control group. We concluded that AA could help to reduce anxiety levels associated with IVF and improves the outcomes of IVF partly through increasing the levels of NPY in the follicular fluids.

Association of oxidative stress to the genesis of anxiety: implications for possible therapeutic interventions

Oxidative stress caused by reactive species, including reactive oxygen species, reactive nitrogen species, and unbound, adventitious metal ions (e.g., iron [Fe] and copper [Cu]), is an underlying cause of various neurodegenerative diseases. These reactive species are an inevitable by-product of cellular respiration or other metabolic processes that may cause the oxidation of lipids, nucleic acids, and proteins. Oxidative stress has recently been implicated in depression and anxiety-related disorders. Furthermore, the manifestation of anxiety in numerous psychiatric disorders, such as generalized anxiety disorder, depressive disorder, panic disorder, phobia, obsessive-compulsive disorder, and posttraumatic stress disorder, highlights the importance of studying the underlying biology of these disorders to gain a better understanding of the disease and to identify common biomarkers for these disorders. Most recently, the expression of glutathione reductase 1 and glyoxalase 1, which are genes involved in antioxidative metabolism, were reported to be correlated with anxiety-related phenotypes. This review focuses on direct and indirect evidence of the potential involvement of oxidative stress in the genesis of anxiety and discusses different opinions that exist in this field. Antioxidant therapeutic strategies are also discussed, highlighting the importance of oxidative stress in the etiology, incidence, progression, and prevention of psychiatric disorders.

Association between oxidative stress and contextual fear conditioning in Carioca high- and low-conditioned freezing rats

We recently reported two novel breeding lines of rats known as Carioca high-and low-conditioned freezing (CHF and CLF), based on defensive freezing responses to contextual cues previously associated with electric footshock. The anxiety-like profile of these animals from the 7th generation was tested in the elevated plus maze. The results indicated that CHF animals presented a significantly more "anxious" phenotype compared with CLF animals. Animals from the 12th generation were used to evaluate the oxidative stress status of the cortex, hippocampus, and cerebellum. Reactive oxidative species (ROS) were evaluated using 2,7-dichlorofluorescin diacetate (DCFH-DA; a sensor of reactive oxygen species [ROS]), and the levels of malondialdehyde (MDA), an early marker of lipid peroxidation, were assessed. The results indicated that free radical concentrations and MDA levels were significantly higher in all three brain structures in CHF rats compared with CLF rats. Our data also showed that the hippocampus had the highest reactive species and MDA concentrations compared with the cortex and cerebellum in CHF rats. Animals from the 16th generation were used to evaluate the antioxidant enzyme activity of catalase (CAT) and glutathione peroxidase (GPx) within these three brain structures. The results indicated that CAT activity was lower in the cortex and hippocampus in CHF rats compared with CLF rats. No significant difference was observed in the cerebellum. The enzymatic activity of GPx was significantly decreased in all three structures in CHF rats compared with CLF rats. The hippocampus exhibited the highest GPx activity compared with the other two brain structures. These findings suggest the involvement of a redox system in these two bidirectional lines, and the hippocampus might be one of the prime brain structures involved in this state of oxidative stress imbalance.

Oxidative stress: a potential recipe for anxiety, hypertension and insulin resistance

We recently reported involvement of oxidative stress in anxiety-like behavior of rats. Others in separate studies have demonstrated a link between oxidative stress and hypertension as well as with type 2 diabetes/insulin resistance. In the present study, we have tested a putative role of oxidative stress in anxiety-like behavior, hypertension and insulin resistance using a rat model of oxidative stress. Oxidative stress in rats was produced by xanthine (0.1%; drinking water) and xanthine oxidase (5 U/kg; i.p.). X+XO-treated rats had increased plasma and urinary 8-isoprostane levels (a marker of oxidative stress) and increased malondialdehyde (MDA) levels in the hippocampus and amygdala as compared to control rats. Serum corticosterone (a systemic marker of stress and anxiety) levels also increased with X+XO treatment. Moreover, anxiety-like behavior measured via open-field and light-dark exploration behavior tests significantly increased in X+XO-treated rats. Mean arterial blood pressure measured in anesthetized rats increased in X+XO-treated compared to control rats. Furthermore, plasma insulin but not glucose levels together with homeostasis model assessment (HOMA), an index of insulin resistance, were higher in X+XO-treated rats. Our studies suggest that oxidative stress is a common factor that link anxiety-like behavior, hypertension and insulin resistance in rats.