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Fu YM, Yang YC, Zhang J, Zhao J, Liu GY, Ling S, Wang C, Wang LW, Yang YT, Wang Y, Yang NN, Liu CZ, Pei W. Preoperative electroacupuncture versus sham electroacupuncture for the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer in China: a study protocol for a multicentre, randomised, sham-controlled trial. BMJ Open 2024; 14:e083460. [PMID: 38969370 PMCID: PMC11227784 DOI: 10.1136/bmjopen-2023-083460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/17/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Postoperative ileus (POI) is a postoperative complication that can cause lingering recovery after colorectal resection and a heavy healthcare system burden. Acupuncture aims to prevent postoperative complications, reduce the duration of POI, help recovery and shorten hospital stays. We hypothesise that preoperative electroacupuncture (EA) can promote POI recovery under the enhanced recovery after surgery protocol after laparoscopic surgery in patients with POI. METHODS AND ANALYSIS This is a multicentre, randomised, sham-controlled trial. A total of 80 patients will be enrolled and randomly assigned to the EA or sham electroacupuncture (SA) group. The eligible patients will receive EA or SA for one session per day with treatment frequency starting on preoperative day 1 for four consecutive days. The primary outcome is the time to first defecation. The secondary outcomes include the time to first flatus, length of postoperative hospital stay, time to tolerability of semiliquid and solid food, postoperative nausea, vomiting, pain and extent of abdominal distention, time to first ambulation, preoperative anxiety, 30-day readmission rate, the usage of anaesthetics and analgesics during operation, length of postanaesthesia care unit stay. A mechanistic study by single-cell RNA sequencing in which postintervention normal intestinal tissue samples will be collected. The results of this study will provide evidence of the effects of acupuncture on POI and promote good clinical decision to millions of patients globally every year. ETHICS AND DISSEMINATION This study has been approved by the ethical application of Beijing University of Chinese Medicine (2022BZYLL0401), Beijing Friendship Hospital Affiliated to Capital Medical University(2022-P2-368-02), Cancer Hospital Chinese Academy of Medical Science (23/175-3917), Huanxing Cancer Hospital (2023-002-02). The results will be published in a medical journal. In addition, we plan to present them at scientific conferences. TRIAL REGISTRATION NUMBER ChiCTR2300077633.
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Affiliation(s)
- Yi-Ming Fu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ying-Chi Yang
- Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Surgery, Huanxing Cancer Hospital, Beijing, China
| | - Jingjie Zhao
- Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Gong-Yong Liu
- Department of Surgery, Huanxing Cancer Hospital, Beijing, China
| | - Shen Ling
- Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Surgery, Huanxing Cancer Hospital, Beijing, China
| | - Li-Wei Wang
- Department of Surgery, Huanxing Cancer Hospital, Beijing, China
| | - Yu-Tong Yang
- Department of Surgery, Huanxing Cancer Hospital, Beijing, China
| | - Yu Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Na-Na Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yuan L, Quan SJ, Li XY, Huang YB, Li YQ, Zheng H. Effectiveness of electroacupuncture on postoperative ileus prevention after abdominal surgery: A systematic review and trial sequential analysis of randomized controlled trials. J Gastroenterol Hepatol 2024. [PMID: 38943533 DOI: 10.1111/jgh.16670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND We aimed to verify the effectiveness of electroacupuncture on postoperative ileus prevention after abdominal surgery by meta-analysis and trial sequential analysis (TSA). METHODS From inception to May 14, 2024, PubMed, the Cochrane Library, Web of Science, and Embase databases were searched. TSA was used to determine an optimal sample size and control false-positive findings. The primary outcome was the time to first defecation (hours). RESULTS Fourteen studies were included, with 1105 participants. Meta-analysis and TSA revealed firm evidence for benefits that electroacupuncture shorted the time to first defecation (mean difference [MD] -12.73 h, I2 = 22%, P < 0.01), the time to first flatus (MD -7.03 h, I2 = 25%, P < 0.01), the time to start of sips of water (MD -12.02 h, I2 = 0%, P < 0.01), and the time to start of liquid diet (MD -12.97 h, I2 = 0%, P < 0.01) compared with usual care. While compared with sham electroacupuncture, meta-analysis and TSA also confirmed that electroacupuncture shortened the time to first defecation (MD -10.81 h, I2 = 31%, P = 0.02) and the time to first flatus (MD -10.81 h, I2 = 0%, P < 0.01). However, TSA revealed that firm evidence for benefit or futility was not reached for the length of hospital stay and the rates of postoperative prolonged ileus. CONCLUSIONS Electroacupuncture shortened the duration of postoperative ileus in patients undergoing abdominal surgery, and the adverse events related to electroacupuncture were minor. Further investigation of the effect of electroacupuncture on the risk of prolonged postoperative ileus is warranted in the future.
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Affiliation(s)
- Lu Yuan
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-Jie Quan
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-Yu Li
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan-Bing Huang
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yan-Qiu Li
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui Zheng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Gao H, Lu L, Li L, Yin Z, Ruan W, Zou Y, Li H, Zhou Y, Li X, Wang Y, Song J, Chen W, Wang J. Electroacupuncture treatment improves postoperative ileus by inhibiting the Th1 cell-mediated inflammatory response through the vagus nerve. Acupunct Med 2024:9645284241248466. [PMID: 38813841 DOI: 10.1177/09645284241248466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Electroacupuncture (EA) has been reported to improve intestinal motility in mice with postoperative ileus (POI). Previous studies, however, have yielded heterogeneous results regarding the effect of EA on POI. METHODS Herein, a POI mouse model was constructed by intestinal manipulation. To evaluate the effect of EA treatment on colonic transit, the levels of inflammatory markers (macrophage inflammatory protein (MIP)-1α, interleukin (IL)-1β, IL-6, monocyte chemotactic protein (MCP)-1 and intercellular adhesion molecule (ICAM)-1) were detected by enzyme-linked immunosorbent assay (ELISA); immune cell infiltration was detected by immunohistochemical staining of myeloperoxidase (MPO), ectodysplasin (ED)-1 and ED-2, and the percentage of CD4+ interferon (IFN)-γ+ Th1 cells and IFN-γ secretion levels were determined. Activated Th1 cells and pentoxifylline, a cell differentiation inhibitor, were used to assess the role of Th1 cells in EA treatment of POI. Neostigmine administration and unilateral vagotomy were performed to confirm whether the effects of EA treatment on Th1 cells were mediated by the vagus nerve (VN). RESULTS The results revealed that EA treatment at ST36 improved POI, as indicated by a decreased level of inflammatory-related markers and immune cell infiltration and shortened colonic transit time. The activated Th1 cells abolished the effects of EA treatment on POI. The effects of EA treatment on POI were enhanced by stimulation of the VN along with a decreased level of Th1 cells, but these effects were abolished by vagotomy along with an increased percentage of Th1 cells; this result indicates that the VN mediates the role of Th1 cells in the effects of EA treatment of POI. CONCLUSION Our findings showed that the effects of EA treatment of POI were mainly mediated by Th1 cells through the stimulation of the VN and inhibition of the inflammatory response.
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Affiliation(s)
- Hao Gao
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liyue Lu
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lili Li
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiyu Yin
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenqing Ruan
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yinghua Zou
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - He Li
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yalan Zhou
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Li
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongqiang Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiangang Song
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Yang J, Huang L, Zhu J, Liu S, Ji F, Tian W, Zheng Z, Zheng M. Effects of perioperative electroacupuncture on postoperative gastrointestinal recovery after thoracoscopic lung surgery. Explore (NY) 2024; 20:450-455. [PMID: 38007308 DOI: 10.1016/j.explore.2023.11.004] [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: 01/10/2023] [Revised: 07/05/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To study whether perioperative electroacupuncture (EA) can improve postoperative gastrointestinal recovery in patients receiving thoracoscopic lung surgery. METHODS This study was a single-center, prospective, randomized open-label trial. 180 patients who underwent video-assisted thoracoscopic segmentectomy or lobectomy were randomized to EA group (three sessions, 24 h prior to surgery, postoperative 4 h and 24 h) or usual care group (UC group). The primary outcomes were time to first flatus and defecation. Secondary outcomes included incidence and degree of abdominal distention, postoperative nausea and vomiting (PONV) and pain scores within 72 h after surgery, postoperative morphine use, time to ambulation, and length of hospital stay. RESULTS Time to first flatus (15.4 ± 3.2 h vs. 17.0 ± 3.7 h, P = 0.004) and time to first defecation (75.9 ± 7.9 vs. 79.7 ± 8.1 h, P = 0.002) in the EA group were significantly shorter than the UC group. The incidences of abdominal distension and PONV postoperative 24 h were significantly reduced in the EA group (P < 0.05). There was no difference in postoperative pain intensity, morphine use, time to ambulation, and length of hospital stay between the two groups (P>0.05). CONCLUSION Electroacupuncture is a simple intervention for accelerating postoperative gastrointestinal recovery and may be considered as an adjunct strategy in enhanced recovery protocols in thoracoscopic lung surgery.
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Affiliation(s)
- Jie Yang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China
| | - Libing Huang
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China.
| | - Juan Zhu
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China
| | - Siying Liu
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China
| | - Fangbing Ji
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China
| | - Weiqian Tian
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China
| | - Zhen Zheng
- Discipline of Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, PO BOX 71, Bundoora, VIC 3083, Australia
| | - Man Zheng
- Department of Anesthesiology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Hanzhong Road 155, Nanjing 210029, China.
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Liu S, Fu W, Fu J, Chen G, He Y, Zheng T, Ma T. Electroacupuncture alleviates intestinal inflammation via a distinct neuro-immune signal pathway in the treatment of postoperative ileus. Biomed Pharmacother 2024; 173:116387. [PMID: 38471276 DOI: 10.1016/j.biopha.2024.116387] [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: 12/16/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The induction of intestinal inflammation as a result of abdominal surgery is an essential factor in postoperative ileus (POI) development. Electroacupuncture (EA) at ST36 has been demonstrated to relieve intestinal inflammation and restore gastrointestinal dysmotility in POI. This study aims to elucidate the neuroimmune pathway involved in the anti-inflammatory properties of EA in POI. METHODS After intestinal manipulation (IM) was performed to induce POI, intestinal inflammation and motility were assessed 24 h post-IM, by evaluating gastrointestinal transit (GIT), cytokines expression, and leukocyte infiltration. Experimental surgery, pharmacological intervention, and genetic knockout mice were used to elucidate the neuroimmune mechanisms of EA. RESULTS EA at ST36 significantly improved GIT and reduced the expression of pro-inflammatory cytokines and leukocyte infiltration in the intestinal muscularis following IM in mice. The anti-inflammatory effectiveness of EA treatment was abolished by sub-diaphragmatic vagotomy, whereas splenectomy did not hinder the anti-inflammatory benefits of EA treatment. The hexamethonium chloride (HEX) administration contributes to a notable reduction in the EA capacity to suppress inflammation and enhance motility dysfunction, and EA is ineffective in α7 nicotinic acetylcholine receptor (α7nAChR) knockout mice. CONCLUSIONS EA at ST36 prevents intestinal inflammation and dysmotility through a neural circuit that requires vagal innervation but is independent of the spleen. Further findings revealed that the process involves enteric neurons mediating the vagal signal and requires the presence of α7nAChR. These findings suggest that utilizing EA at ST36 may represent a possible therapeutic approach for POI and other immune-related gastrointestinal diseases.
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Affiliation(s)
- Shuchang Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Wei Fu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Jingnan Fu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China; Department of Minimally Invasive Surgery, Characteristics Medical Center of Chinese People Armed Police Force, Tianjin 300162, China
| | - Guibing Chen
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China; Department of Gastrointestinal Surgery, Clinical Medical College and The First Affilliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
| | - Yuxin He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Ting Zheng
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China.
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Lv H, Chen P, Wang Y, Xu L, Zhang K, Zhao J, Liu H. Chlorogenic acid protects against intestinal inflammation and injury by inactivating the mtDNA-cGAS-STING signaling pathway in broilers under necrotic enteritis challenge. Poult Sci 2024; 103:103274. [PMID: 38043405 PMCID: PMC10711517 DOI: 10.1016/j.psj.2023.103274] [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: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
This study aimed to determine the effects of chlorogenic acid (CGA) on the growth performance, intestinal health, immune response, and mitochondrial DNA (mtDNA)-cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling pathway in broilers under necrotic enteritis (NE) challenge. The 180 one-day-old male Cobb 500 broilers with similar body weight of 44.59 ± 1.39 g were randomly allocated into 3 groups. The groups were control diet (Control group), control diet + NE challenge (NE group), and control diet + 500 mg/kg CGA + NE challenge (NE + CGA group), with 6 replicates per treatment. All broilers except the Control group were given sporulated coccidian oocysts (d 14) and Clostridium perfringens (d 19-21) by oral gavage. Our findings showed that CGA improved the growth performance and intestinal morphology in broilers under NE challenge. CGA supplementation elevated the barrier function in broilers under NE challenge, which reflected in the decreased serum concentrations of D-lactate and diamine oxidase, and upregulated jejunal protein expression of occludin. CGA supplementation also improved the immune function, which reflected in the increased concentrations and gene expressions of anti-inflammatory factors, and decreased concentrations and gene expressions of proinflammatory factors. CGA supplementation further enhanced intestinal cell proliferation and differentiation, which manifested in the increased number of goblet cells and positive cells of proliferating cell nuclear antigen on d 28 and 42. Furthermore, CGA supplementation decreased the mtDNA (d 42) and mitochondrial reactive oxygen species levels (d 28 and 42), and increased the mitochondrial membrane potential (d 42) and mitochondrial complex I (d 28 and 42) or III (d 28) activity. Broilers challenged with NE had upregulated jejunal protein expressions of cGAS, phospho-TANK-binding kinase 1, and phospho-interferon regulatory factor 7 compared with the Control group, which were downregulated after CGA supplementation. In conclusion, dietary supplementation CGA could protect against intestinal inflammation and injury by reducing the leakage of mtDNA and inactivating the cGAS-STING signaling pathway in broilers under NE challenge.
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Affiliation(s)
- Huimin Lv
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Peng Chen
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Yang Wang
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Lianbin Xu
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Kai Zhang
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Jinshan Zhao
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China
| | - Huawei Liu
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109, China.
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Shi J, Zhang X, Chen J, Shen R, Cui H, Wu H. Acupuncture and moxibustion therapy for cognitive impairment: the microbiome-gut-brain axis and its role. Front Neurosci 2024; 17:1275860. [PMID: 38274501 PMCID: PMC10808604 DOI: 10.3389/fnins.2023.1275860] [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: 08/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
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.
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Affiliation(s)
- Jiatian Shi
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinyue Zhang
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianhua Chen
- Department of Mental Health, Shanghai Mental Health Center, Shanghai, China
| | - Ruishi Shen
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huashun Cui
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huangan Wu
- Department of Acupuncture and Moxibustion, Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Qi L, Shi H, Zhang Y, Zhang X, Jia H, Tian H. The effect of acupuncture on recovery after colorectal cancer resection: A systematic review meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34678. [PMID: 37657054 PMCID: PMC10476740 DOI: 10.1097/md.0000000000034678] [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: 03/14/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of acupuncture by systematically reviewing the literature on colorectal cancer resection. METHODS Seven electronic databases were searched from inception to February 28, 2023. Randomized controlled trials on acupuncture in patients after CRC resection were included. Two reviewers independently selected relevant trials, extracted data, and assessed the risk of bias. A random-effects meta-analysis model was used to obtain summary effect estimates. The data were pooled and analyzed using RevMan 5.3. The heterogeneity of selected studies was evaluated by evaluating the I-squared (I2) statistics. RESULTS Twenty-two studies with 1878 patients were included. Results of the meta-analysis showed there was a low level evidence that acupuncture may improve early postoperative symptoms, such as time to first flatus (n = 876, MD -0.77h, 95% CI -1.22 to -0.33 h, I2 = 89%), time to first bowel movement (n = 671, MD -1.41h, 95% CI -2.20 to -0.63 h, I2 = 95%), time to first defecation (n = 556, MD -1.03h, 95% CI -1.88 to -0.18 h, I2 = 95%), and nausea/vomiting (n = 1488, RR 0.72, 95% CI 0.59-0.89, I2 = 49%) compared with usual care and sham acupuncture. However, there were no statistically significant differences in postoperative pain (n = 1188, MD-0.21, 95% CI -0.59 to 0.17, I2 = 74%). And there was no sufficient evidence of improving long-term functional outcomes. There was substantial heterogeneity across trials. The adverse events associated with acupuncture stimulation were minor in include studies. CONCLUSION SUBSECTIONS There is currently low-level evidence supporting the use of acupuncture on postoperative symptoms for patients after colorectal cancer resection. More investigations should be established based on the STRICTA statement strictly.
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Affiliation(s)
- Lin Qi
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongshuo Shi
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yunsong Zhang
- The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Hongling Jia
- The Second Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, China
| | - Hu Tian
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Zhao X, Si S, Liu X, Liu J, Zhang D, Mu Y, Hou A. Does invasive acupuncture improve postoperative ileus after colorectal cancer surgery? A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1201769. [PMID: 37692781 PMCID: PMC10485617 DOI: 10.3389/fmed.2023.1201769] [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: 04/07/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background Postoperative ileus (POI) is one of the main complications after colorectal cancer (CRC) surgery, and there is still a lack of effective treatment. At present, the evidence for improvement of POI by invasive acupuncture (manual acupuncture and electroacupuncture, IA) is limited. This meta-analysis of randomized controlled trials (RCTs) aims to systematically review and evaluate the effect of IA in improving POI after CRC surgery. Methods This meta-analysis was reported according to PRISMA statement and AMSTAR guidelines. The retrieval time was from the inception to February 2023. The RCTs were screened by searching the databases (PubMed, Ovid, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Database, Sinomed Database, and WANFANG). Two independent investigators screened and extracted the data, assessed the risk of bias, and performed statistical analysis. The statistical analysis was carried out by RevMan5.3. The PROSPERO International Prospective Register of Systematic Reviews received this research for registration (CRD42023387700). Results Thirteen studies with 795 patients were included. In the primary outcome indicators: the IA group had shorter time to the first flauts [stand mean difference (SMD), -0.57; 95% CI, -0.73 to -0.41, p < 0.00001], shorter time to the first defecation [mean difference (MD), -4.92 h, 95% CI -8.10 to -1.74 h, p = 0.002] than the blank/sham stimulation (B/S) group. In the secondary outcome indicators: the IA group had shorter time to the first bowel motion (MD, -6.62 h, 95% CI -8.73 to -4.50 h, p < 0.00001), shorter length of hospital (SMD, -0.40, 95% CI -0.60 to -0.21, p < 0.0001) than the B/S group. In terms of the subgroup analysis: IA associated with enhanced recovery after surgery (ERAS) group had shorter time to the first flauts (MD, -6.41 h, 95% CI -9.34 to -3.49 h, p < 0.0001), shorter time to the first defacation (MD, -6.02 h, 95% CI -9.28 to -2.77 h, p = 0.0003) than ERAS group. Conclusion Invasive acupuncture (IA) after CRC surgery, acupuncture or electricacupuncture with a fixed number of times and duration at therapeutic acupoints, can promote the recovery of POI. IA combined with ERAS is better than simple ERAS in improving POI. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=387700, identifier CRD42023387700.
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Affiliation(s)
- Xiaohu Zhao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shangkun Si
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xin Liu
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jingxuan Liu
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongbin Zhang
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuejun Mu
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Aihua Hou
- Department of Oncology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
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Zhang X, Yang W, Shang J, Dan W, Shi L, Tong L, Yang G. The lower He-sea points playing a significant role in postoperative ileus in colorectal cancer treated with acupuncture: based on machine-learning. Front Oncol 2023; 13:1206196. [PMID: 37564931 PMCID: PMC10411531 DOI: 10.3389/fonc.2023.1206196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023] Open
Abstract
Background Postoperative ileus (POI) is a common complication following abdominal surgery, which can lead to significant negative impacts on patients' well-being and healthcare costs. However, the efficacy of current treatments is not satisfactory. The purpose of this study was to evaluate the therapeutic effects of acupuncture intervention and explore the regulation of acupoint selection for treating POI in colorectal cancer (CRC) patients. Methods We searched eight electronic databases to identify randomized controlled trials (RCTs) on acupuncture for POI in CRC and conducted a meta-analysis. Subsequently, we utilized the Apriori algorithm and the Frequent pattern growth algorithm, in conjunction with complex network and cluster analysis, to identify association rules of acupoints. Results The meta-analysis showed that acupuncture led to significant reductions in time to first defecation (MD=-20.93, 95%CI: -25.35, -16.51; I2 = 93.0%; p < 0.01; n=2805), first flatus (MD=-15.08, 95%CI: -18.39, -11.76; I2 = 96%; p < 0.01; n=3284), and bowel sounds recovery (MD=-10.96, 95%CI: -14.20, -7.72; I2 = 94%; p < 0.01; n=2043). A subgroup analysis revealed that acupuncture not only reduced the duration of POI when administered alongside conventional care but also further expedited the recovery of gut function after colorectal surgery when integrated into the enhanced recovery after surgery (ERAS) pathway. The studies included in the analysis reported no instances of serious adverse events associated with acupuncture. We identified Zusanli (ST36), Shangjuxu (ST37), Neiguan (PC6), Sanyinjiao (SP6), Xiajuxu (ST39), Hegu (LI4), Tianshu (ST25), and Zhongwan (RN12) as primary acupoints for treating POI. Association rule mining suggested potential acupoint combinations including {ST37, ST39}≥{ST36}, {PC6, ST37}≥{ST36}, {SP6, ST37}≥{ST36}, and {ST25, ST37}≥{ST36}. Conclusion Meta-analysis indicates acupuncture's safety and superior effectiveness over postoperative care alone in facilitating gastrointestinal recovery. Machine-learning approaches highlight the importance of the lower He-sea points, including Zusanli (ST36) and Shangjuxu (ST37), in treating POI in CRC patients. Incorporating additional acupoints such as Neiguan (PC6) (for pain and vomiting) and Sanyinjiao (SP6) (for abdominal distension and poor appetite) can optimize treatment outcomes. These findings offer valuable insights for refining treatment protocols in both clinical and experimental settings, ultimately enhancing patient care.
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Affiliation(s)
- Xu Zhang
- Department of Nutrition, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wenjing Yang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Junliang Shang
- Department of Surgery, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wenchao Dan
- School of Graduates, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Li Tong
- Department of Nutrition, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Guowang Yang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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11
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Lin D, Ou Y, Li L, Wu K, Zhang Q, Yan J, Kuang K, Peng D. Acupuncture for postoperative gastrointestinal dysfunction in cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1184228. [PMID: 37361600 PMCID: PMC10289226 DOI: 10.3389/fonc.2023.1184228] [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: 03/16/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Background Postoperative gastrointestinal dysfunction (PGD) in cancer is the commonest and most severe postoperative complication in patients with cancer. Acupuncture has been widely used for PGD in cancer. This study aimed to evaluate the efficacy and safety of acupuncture for PGD in cancer. Methods We comprehensively searched eight randomised controlled trials (RCTs) of acupuncture for PGD in cancer published until November 2022. Time to first flatus (TFF) and time to first defecation (TFD) were the primary outcomes, and time to bowel sound recovery (TBSR) and the length of hospital stay (LOS) were the secondary outcomes. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the RCTs, and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) system was used to evaluate the certainty of the evidence. The meta-analysis was performed using RevMan 5.4, and a publication bias test was performed using Stata 15.1. Results Sixteen RCTs involving 877 participants were included in this study. The meta-analysis indicated that acupuncture could effectively reduce the TFF, TFD, and TBSR compared with routine treatment (RT), sham acupuncture, and enhanced recovery after surgery (ERAS). However, acupuncture did not shorten the LOS compared with RT and ERAS. The subgroup analysis revealed that acupuncture could significantly reduce the TFF and TFD. Acupuncture effectively reduced the TFF and TFD in all cancer types included in this review. Besides, local acupoints in combination with distal acupoints could reduce the TFF and TFD, and distal-proximal acupoints could significantly reduce the TFD. No trial reported adverse events of acupuncture. Conclusions Acupuncture is an effective and relatively safe modality for treating PGD in cancer. We anticipate that there will be more high-quality RCTs involving more acupuncture techniques and cancer types, focusing on combining acupoints for PGD in cancer, further determining the effectiveness and safety of acupuncture for PGD in patients with cancer outside China. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42022371219.
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12
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Wang BG, Xu LL, Yang HY, Xie J, Xu G, Tang WC. Manual acupuncture for neuromusculoskeletal disorders: The selection of stimulation parameters and corresponding effects. Front Neurosci 2023; 17:1096339. [PMID: 36793537 PMCID: PMC9922711 DOI: 10.3389/fnins.2023.1096339] [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: 11/12/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
As a minimally invasive method of physical stimulation, manual acupuncture (MA) is used globally as a sort of therapy for neuromusculoskeletal disorders. In addition to selecting appropriate acupoints, acupuncturists should also determine the stimulation parameters of needling, such as the manipulation (lifting-thrusting or twirling), needling amplitude, velocity, and stimulation time. At present, most studies focus on acupoint combination and mechanism of MA, the relationship between stimulation parameters and their therapeutic effects, as well as the influence on mechanism of action are relatively scattered, and lack of systematic summary and analysis. This paper reviewed the three types of stimulation parameters of MA, their common options and values, corresponding effects and potential mechanisms of action. The purpose of such efforts is to provide a useful reference for the dose-effect relationship of MA and the quantification and standardization of its clinical treatment of neuromusculoskeletal disorders to further promote the application of acupuncture in the world.
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Affiliation(s)
- Bing-Gan Wang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu-Liu Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua-Yuan Yang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Xie
- Department of Acupuncture and Moxibustion, Yuhuan Hospital of Traditional Chinese Medicine, Taizhou, Zhejiang, China
| | - Gang Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Chao Tang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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13
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Nan S, Wan J, Lei Q, Wang X, Ma N, Yin R, Zhu J, Ding M, Ding Y. The involvement of the primo vascular system in local enteritis and its modification by electroacupuncture. Front Immunol 2023; 13:1072996. [PMID: 36713388 PMCID: PMC9874324 DOI: 10.3389/fimmu.2022.1072996] [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: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The primo vascular system (PVS), an intensive network structure, has been claimed to be representative of the acupuncture meridian. Here, we explored the role of the PVS in local enteritis and its modification by acupuncture. Methods Chronic cecitis in rabbits was induced by 2,4,6-trinitro-benzene-sulfonic acid (TNBS). The PVS on the cecum was visualized with trypan blue staining, and collected with the help of microsurgical forceps under an optical stereomicroscope. Results The increased primo vessels (PVs) and primo nodes (PNs) of the PVS on the surface of the cecum were induced by local inflammation, which was positively correlated with the inflammatory cells in the cecal mucosa. Tandem mass tag (TMT) based proteomic analysis revealed that 110 differentiated proteins of the PVS existed between TNBS-treated and control rabbits; 65 proteins were upregulated, while 45 proteins were downregulated. These proteins were mainly enriched in inflammation- and immunity-related processes, such as inflammatory cell proliferation, antigen presentation, and cell adhesion in the proliferated PVS (data are available via ProteomeXchange with the identifiers PXD034280). Importantly, TNBS-induced cecitis, the proliferated PVS and inflammation response-related proteins (CD40, CD45, HLA-DRA1, LAMP1, JAGN1 and FGL1) in the PVS were alleviated or reversed by repetitive electroacupuncture (EA) stimulations. Conclusion These results suggest that the proliferated PVS and its active inclusions were related to the inflammatory process, which was modified by EA. Our study provides a new avenue for further exploration of the mechanism by which EA exerts anti-inflammatory effects.
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Affiliation(s)
- Sha Nan
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Juan Wan
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China,Gannan Innovation and Transformation Medical Research Institute, First Affiliated Hospital, Gannan Medical University, Ganzhou, China
| | - Qianghui Lei
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xinya Wang
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ning Ma
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Ruiling Yin
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Jiandi Zhu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Mingxing Ding
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yi Ding
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China,*Correspondence: Yi Ding,
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14
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Lu Z, Luo A, Min S, Dong H, Xiong Q, Li X, Deng Q, Liu T, Yang X, Li C, Zhao Q, Xiong L. Acupoint Stimulation for Enhanced Recovery After Colon Surgery: A Prospective Multicenter Randomized Controlled Trial. J Multidiscip Healthc 2022; 15:2871-2879. [PMID: 36570812 PMCID: PMC9785190 DOI: 10.2147/jmdh.s391852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in improving bowel function and thus shortening hospital stay after laparoscopic colon surgery within the ERAS pathway. Patients and Methods From November 2016 to March 2018, 100 patients who underwent elective colon surgery were enrolled and 94 finished study (n = 47 for each) in three university hospitals. Patients in the TEAS group received TEAS 30 min before surgery and once a day for 3 days after surgery, while those in the Control Group received no stimulation. Primary outcome was the time to discharge. Results Compared with standardized postoperative care, TEAS resulted in a shorter time to first flatus (P=0.03) and time to first defecation (P=0.03), as well as a reduction in the length of hospital stay (P=0.02). Median patient-controlled analgesia (PCA) deliveries and PCA attempts at 24h, 48h and 72h after surgery were less in the TEAS group (P<0.01). No evidence of significant advantages in postoperative pain intensity, nausea, vomiting, sleeping quality and expenses was found in the TEAS group. Conclusion Perioperative TEAS further shortens the time to meet discharge criteria after laparoscopic colon surgery in patients under ERAS strategy.
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Affiliation(s)
- Zhihong Lu
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China,Correspondence: Zhihong Lu; Lize Xiong, Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Changle West Road127, Xi’an, Shaanxi, 710032, People’s Republic of China, Tel +86-29-84775337; Tel +86-29-84772126, Email ;
| | - Ailin Luo
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Su Min
- Department of Anaesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hailong Dong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Qiuju Xiong
- Department of Anaesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xinhua Li
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Qingzhu Deng
- Department of Anaesthesiology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Tingting Liu
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Xue Yang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Chen Li
- Department of Medical Statistics, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Qingchuan Zhao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, People’s Republic of China
| | - Lize Xiong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China,Translational Research Institute of Brain and Brain-Like Intelligence and Department of Anesthesiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, People’s Republic of China
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15
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Li H, Du C, Lu L, Hu X, Xu H, Li N, Liu H, Wen Q. Transcutaneous electrical acupoint stimulation combined with electroacupuncture promotes rapid recovery after abdominal surgery: Study protocol for a randomized controlled trial. Front Public Health 2022; 10:1017375. [PMID: 36452957 PMCID: PMC9703060 DOI: 10.3389/fpubh.2022.1017375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The most frequent complications after abdominal surgery include a decrease or loss of appetite, abdominal distension, abdominal pain caused by reduced gastrointestinal motility, anal arrest with intestinal distension and defecation, and nausea and vomiting due to anesthetic and opioid analgesic administration. These complications severely affect postoperative recovery, prolong hospital stay, and increase the financial burden. The objective of this study is to investigate the efficacy and safety of three acupoint stimulation modalities (electroacupuncture [EA], transcutaneous electrical acupoint stimulation [TEAS], and transcutaneous acupoint electrical stimulation combined with EA [TEAS+EA]), and two EA instrument waveforms (continuous wave and dilatational wave) for rapid recovery after abdominal surgery. Methods and analysis A total of 560 patients will be recruited and randomly allocated to receive one of the following seven interventions: continuous wave EA, continuous wave TEAS, continuous wave TEAS + EA, dilatational wave EA, dilatational wave TEAS, dilatational wave TEAS + EA, and a control. For this study, continuous waves at 2 Hz, and dilatational waves at 2/50 Hz would be selected. The points to be stimulated by EA are the bilateral Neiguan (PC6), Hegu (LI6), Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39), and TEAS would stimulate the bilateral Liangmen (ST21) and Daheng (SP15). The control group will neither receive EA nor TEAS. All patients will undergo an enhanced recovery plan after surgery and be provided with standardized perioperative management. Treatment will start on the first postoperative day and be administered once daily in the morning until the patient regains spontaneous bowel movements and can tolerate oral intake of solid food. The primary outcome is a composite of time to first defecation and time to tolerance of a solid diet. Secondary outcomes include time to first exhaustion; time of first defecation; time of tolerance of a solid diet; time to the first ambulation; length of hospital stay from surgery to discharge; visual analog scale score for postoperative daily pain, nausea, and vomiting; incidence of postoperative complications; and treatment acceptability. Discussion This study will compare the efficacy and safety of three acupoint stimulation methods and two EA instrument waveforms for rapid recovery after abdominal surgery. Trial Registration Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2100043883.
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Affiliation(s)
- Hao Li
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China
| | - Chen Du
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China,Party Committee Office, Sichuan University West China Hospital, Chengdu, China
| | - Lingyun Lu
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China
| | - Xiangyun Hu
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China
| | - Huiming Xu
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China
| | - Ning Li
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China
| | - Hong Liu
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China,*Correspondence: Hong Liu
| | - Qian Wen
- Center for Integrative Medicine, Sichuan University West China Hospital, Chengdu, China,Qian Wen
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16
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Electroacupuncture at Acupoint ST36 (Zusanli) Improves Intestinal Motility Dysfunction Via Increasing the Proportion of Cholinergic Neurons in Rat Ileal Myenteric Ganglia after Severe Acute Pancreatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:7837711. [PMID: 36317104 PMCID: PMC9617694 DOI: 10.1155/2022/7837711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023]
Abstract
Using a severe acute pancreatitis (SAP) rat model, the mechanism of electroacupuncture (EA) were studied on the intestinal function of pancreatitis. The SAP models were established by injecting 30% L-ornithine at hourly intervals, and were divided into two groups (14 in each): SAP model group, which was not treated, and EA group, which received EA at ST36 at a frequency of 1-2 Hz and amplitude of 1 mA for 30 min twice a day. Fourteen rats were also included as the control group. After EA, the intestinal propulsion was measured. In the distal ileum myenteric plexus, the density of HuC/D and the proportion of cholinergic neurons were measured using immunohistochemistry. Compared to the SAP model group, the EA group demonstrated significant improvements in intestinal propulsion rates. Furthermore, after EA, the density of myenteric neurons in the ileum returned to normal levels and the proportion of cholinergic neurons was increased compared to the SAP model group. And finally, EA alleviated the damage to the pancreas. Thus, our results suggest that EA stimulation at ST36 can partly restore the enteric neuron function and improve intestinal motility dysfunction, therefore could ameliorate SAP. The enteric nervous system can participate in changes in intestinal motility by affecting cholinergic neurons.
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17
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Xie Y, Zheng C, Tan X, Li Z, Zhang Y, Liu Y. Clinical efficacy of acupuncture in patients with adhesive intestinal obstruction: A meta-analysis. Medicine (Baltimore) 2022; 101:e30257. [PMID: 36221368 PMCID: PMC9542758 DOI: 10.1097/md.0000000000030257] [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] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adhesive intestinal obstruction (AIO) is a common surgical emergency. Surgical exploration has a considerable risk of intestinal injury, and surgical treatment may greatly reduce the quality of life after surgery and cause AIO after re-operation. The nonsurgical treatment is effective for approximately 70% to 90% of patients with adhesive small bowel obstruction (ASBO). However, the high recurrence (30%) and mortality (2%) rates of ASBO are concerning. Moreover, the ideal management method of ASBO remains debatable. Studies have shown that acupuncture can also promote postoperative gastrointestinal function recovery and prevent postoperative complications such as nausea, vomiting, and visceral pain. AIM We aimed to evaluate the effectiveness of acupuncture in the treatment of AIO. METHODS Randomized controlled trials investigating the effectiveness of acupuncture for adhesive bowel obstruction published until November 2021 were identified by searching 8 comprehensive databases. Data analysis was performed using RevMan v. 5.4 and Stata software v. 16.0. The random-effects model and the fixed-effects model were used to perform the meta-analysis on the experimental group and control group. RESULTS Twelve studies with a total of 892 participants were included. The results showed that the experimental group had a significantly higher effective rate (relative risk: 1.20; 95% confidence interval (CI): 1.11-1.28; P < .00001) and a markedly shorter time of the first defecation (mean difference: -11.49, 95% CI: -19.31 to -3.66; P = .004) than the control group. The experimental group also showed a reduction in the duration of abdominal pain, and the reduced length of hospital stay. However, no statistical differences were observed between the 2 groups in terms of the surgery conversion rate. CONCLUSION Acupuncture is effective in the treatment of AIO. It can remarkably alleviate some clinical symptoms in patients with AIO.
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Affiliation(s)
- Yujia Xie
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chengwen Zheng
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyue Tan
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zongyu Li
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yiyi Zhang
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan Liu
- Basic Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Yuan Liu, Basic Medical School, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China (e-mail: )
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18
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Zou X, Yang YC, Wang Y, Pei W, Han JG, Lu Y, Zhang MS, Tu JF, Lin LL, Wang LQ, Shi G, Yan SY, Yang JW, Liu CZ. Electroacupuncture versus sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: study protocol for a multicentre, randomised, sham-controlled trial. BMJ Open 2022; 12:e050000. [PMID: 35428615 PMCID: PMC9014026 DOI: 10.1136/bmjopen-2021-050000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Postoperative ileus (POI) is an inevitable complication of almost all abdominal surgeries, which results in prolonged hospitalisation and increased healthcare costs. Various treatment strategies have been developed for POI but with limited success. Electroacupuncture (EA) might be a potential therapy for POI. However, evidence from rigorous trials that evaluated the effectiveness of EA for POI is limited. Thus, the aim of this study was to examine whether EA can safely reduce the time to the first defecation after laparoscopic surgery in patients with POI. METHODS AND ANALYSIS This multicentre randomised sham-controlled trial will be conducted in four hospitals in China. A total of 248 eligible participants with colorectal cancer who will undergo laparoscopic surgery will be randomly allocated to an EA group and a sham EA group in a 1:1 ratio. Treatment will be performed starting on postoperative day 1 and continued for four consecutive days, once per day. If the participant is discharged within 4 days after surgery, the treatment will cease on the day of discharge. The primary outcome will be the time to first defecation. The secondary outcome measures will include time to first flatus, tolerability of semiliquid and solid food, length of postoperative hospital stay, postoperative nausea and vomiting, abdominal distension, postoperative pain, postoperative analgesic, time to first ambulation, blinding assessment, credibility and expectancy and readmission rate. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of Beijing University of Chinese Medicine (number 2020BZHYLL0116) and the institutional review board of each hospital. The results will be disseminated through peer-reviewed publications. This study protocol (V.3.0, 6 March 2020) involves human participants and was approved by the ethics committees of Beijing University of Chinese Medicine (number 2020BZHYLL0116), Beijing Friendship Hospital Affiliated to Capital Medical University (number 2020-P2-069-01), Beijing Chao-Yang Hospital Affiliated to Capital Medical University (number 2020-3-11-2), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (number 20/163-2359), and the Affiliated Hospital of Qingdao University (number QYFYKYLL711311920). The participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER ChiCTR2000038444.
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Affiliation(s)
- Xuan Zou
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ying-Chi Yang
- Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yu Wang
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Pei
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Gang Han
- Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yun Lu
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mao-Shen Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jian Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lu Lu Lin
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guangxia Shi
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Jiang T, Xia G, Yang B, Zhang HW, Yin YS, Tang CW, Yang JH. Application of Bone Marrow Mesenchymal Stem Cells Effectively Eliminates Endotoxemia to Protect Rat from Acute Liver Failure Induced by Thioacetamide. Tissue Eng Regen Med 2022; 19:403-415. [PMID: 35122584 PMCID: PMC8971247 DOI: 10.1007/s13770-021-00421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Endotoxemia is related to worse clinical outcomes in acute liver failure (ALF), but its management remains unsatisfactory. In this study, we aimed to assess whether the application of bone marrow mesenchymal stem cells (BMSCs) could eliminate endotoxemia and protect rats against ALF induced by thioacetamide (TAA). METHODS BMSCs were isolated from rats and identified by the specific morphology, differentiation potential, and surface markers. The optimal dose of TAA for this study was explored and TAA-induced ALF rats were randomized to three groups: the normal control group (Saline), ALF group (TAA + Saline), and BMSCs-treated group (TAA + BMSCs). The intestinal migration and differentiation of BMSCs was tracked in vivo, and intestinal permeability, endotoxin and inflammatory cytokines, histology, and mortality were analyzed. Moreover, we added the inhibitor of the PI3K/AKT/mTOR signaling pathway into the co-culture system of BMSCs with enterocytes and then performed CK and Villin expression experiments to assess the role of PI3K/AKT/mTOR signal pathway in the intestinal differentiation of BMSCs. RESULTS BMSCs migrated to the intestinal injury sites and differentiated into enterocytes, intestinal permeability was decreased compared with the ALF group. The higher expression of endotoxin and inflammatory cytokines were reversed after BMSCs transplantation in rats with ALF. Mortality and intestinal lesion were significantly decreased. Blocking the PI3K/AKT/mTOR signal pathway inhibited BMSCs' intestinal differentiation in vitro. CONCLUSION BMSCs can eliminate endotoxemia and reduce mortality in rats with ALF, and the PI3K/AKT/mTOR signal pathway is involved in intestinal differentiation. BMSCs transplantation could be a potential candidate for the treatment of endotoxemia in ALF.
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Affiliation(s)
- Ting Jiang
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650106, Yunnan, China
| | - Geng Xia
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650106, Yunnan, China
| | - Bo Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650106, Yunnan, China
| | - Hong-Wei Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, 935 Jiaoling Road, Kunming, 650031, Yunnan, China
| | - Yue-Shan Yin
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650106, Yunnan, China
| | - Cheng-Wei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610044, Sichuan, China
| | - Jin-Hui Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Kunming, 650106, Yunnan, China.
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20
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Oh JE, Kim SN. Anti-Inflammatory Effects of Acupuncture at ST36 Point: A Literature Review in Animal Studies. Front Immunol 2022; 12:813748. [PMID: 35095910 PMCID: PMC8790576 DOI: 10.3389/fimmu.2021.813748] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
So far, a number of acupuncture studies have shown anti-inflammatory effects of acupuncture treatment, mostly known at specific point ST36. However, there is no literature that oversaw the inflammation-regulatory effects of acupuncture in each tissue. Therefore, we investigated how acupuncture at specific acupoint ST36 regulates inflammation and its underlying mechanisms. We searched literatures on PubMed until July 2021 using the keywords “animal, acupuncture, ST36, inflammation, immune,” and 292 literatures were searched. We ultimately selected 69 studies to determine the anti-inflammatory actions of acupuncture at ST36 and classified the changes of inflammatory mediators according to target regions. Forty-three studies were included in body fluids, 27 studies in the digestive system, 17 studies in the nervous system, and 30 studies in other tissues or organs. In this review, we found that acupuncture at ST36 has clinical benefits in relieving inflammation through several mechanisms such as vagus nerve activation, toll-like receptor 4 (TLR4)/NF-κB signaling, macrophage polarization, mitogen-activated protein kinase (MAPK) signaling pathway, and cholinergic anti-inflammatory pathway. We expect that these data will inform further studies related to ST36 acupuncture on inflammation.
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Affiliation(s)
- Ji-Eun Oh
- College of Korean Medicine, Dongguk University, Goyang, South Korea
| | - Seung-Nam Kim
- College of Korean Medicine, Dongguk University, Goyang, South Korea
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21
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Effects of Electroacupuncture at Different Acupoints on Functional Dyspepsia Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6548623. [PMID: 35154349 PMCID: PMC8824746 DOI: 10.1155/2022/6548623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/28/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
Abstract
Although, acupoint specificity is regarded as the core of scientific issues in electroacupuncture (EA), the difference of EA on treating functional dyspepsia (FD) at different acupoints is unclear. Therefore, this study aims to investigate the different therapeutic effects of EA at lower extremity or abdominal acupoints on the mucosal integrity and lower-inflammatory response in FD. The intragastric administration of iodoacetamide (IA) was performed in 48 rats to establish the FD model. These rats were randomly divided into the control group, the model group and the six EA groups receiving stimulation at the lower extremity (ST36, ST37, and ST39) or abdominal acupoints (ST25, CV4, and CV12) separately. The open-field test (OFT) was measured after 8 weeks of IA, and gastric emptying was evaluated after 10 days of the EA treatment. The local inflammation markers of CD45, eosinophil major basic protein (EMBP), and the tight junction proteins ZO1 and Claudin3 were assessed by immunofluorescence in all groups. Western blot analysis showed that the EMBP and Occludin1 levels in the duodenal. EA at lower extremity acupoint ST36 could improve the gastric emptying. EA at lower extremity acupoints reduced the immunoreactivity of EMBP, but the CD45 was reregulated by the ST37 and ST39 acupoints. The lower extremity acupoints also ameliorated FD-tight junction protein in the expression of Claudin3 and ZO1. However, only the ST36 suppressed the expression of EMBP and recovered the expression of Occludin1. Similarly, the effect of EA at abdominal acupoints was not obvious either in facilitating gastric motility or in improving inflammatory and mucosal injury. EA at lower extremity and abdominal acupoints with the same stimulation parameters had different therapeutic effects in gastric emptying, intestinal mucosal integrity, and inflammation response, thus proving the specificity of acupoints.
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22
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Yang NN, Tan CX, Lin LL, Su XT, Li YJ, Qi LY, Wang Y, Yang JW, Liu CZ. Potential Mechanisms of Acupuncture for Functional Dyspepsia Based on Pathophysiology. Front Neurosci 2022; 15:781215. [PMID: 35145373 PMCID: PMC8822151 DOI: 10.3389/fnins.2021.781215] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Functional dyspepsia (FD), a common disorder of gastrointestinal function, originated from the gastroduodenum. Although the therapeutic effect of acupuncture has been investigated by various high-quality randomized controlled trials, the potential mechanisms showed obvious heterogeneity. This review summarized the potential mechanisms of acupuncture on FD in order to guide for future laboratory and clinical studies. Here, we argued that the primary cause of FD was gastroduodenal low-grade inflammation and acid exposure, which impaired mucosal integrity, caused brain-gut axis dysfunction, and impaired brain network connectivity, all of which generated various symptom patterns. Overall the clinical studies indicated that acupuncture was a promising treatment to alleviate symptoms in FD patients, whose efficacy was influenced by acupoints and individual variance. Mechanistically, studies with animal models of FD and patients have shown that acupuncture, a non-invasive strategy for nerve stimulation, may have the potential to control intestinal inflammation and suppress acid-secretion via different somatic autonomic reflex pathways, regulate the brain-gut axis through intestinal microbiota, and has the potential to ameliorate FD-symptoms. The cumulative evidence demonstrated that acupuncture is a promising treatment to alleviate symptoms of FD patients.
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23
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Li N, Guo Y, Gong Y, Zhang Y, Fan W, Yao K, Chen Z, Dou B, Lin X, Chen B, Chen Z, Xu Z, Lyu Z. The Anti-Inflammatory Actions and Mechanisms of Acupuncture from Acupoint to Target Organs via Neuro-Immune Regulation. J Inflamm Res 2022; 14:7191-7224. [PMID: 34992414 PMCID: PMC8710088 DOI: 10.2147/jir.s341581] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/01/2021] [Indexed: 12/17/2022] Open
Abstract
Inflammation plays a significant role in the occurrence and development of multiple diseases. This study comprehensively reviews and presents literature from the last five years, showing that acupuncture indeed exerts strong anti-inflammatory effects in multiple biological systems, namely, the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. It is well known that localized acupuncture-mediated anti-inflammatory effects involve the regulation of multiple populations and functions of immune cells, including macrophages, granulocytes, mast cells, and T cells. In acupuncture stimulation, macrophages transform from the M1 to the M2 phenotype and the negative TLR4 regulator PPARγ is activated to inhibit the intracellular TLR/MyD88 and NOD signaling pathways. The downstream IκBα/NF-κB and P38 MAPK pathways are subsequently inhibited by acupuncture, followed by suppressed production of inflammasome and proinflammatory mediators. Acupuncture also modulates the balance of helper T cell populations. Furthermore, it inhibits oxidative stress by enhancing SOD activity via the Nrf2/HO-1 pathway and eliminates the generation of oxygen free radicals, thereby preventing inflammatory cell infiltration. The anti-inflammatory effects of acupuncture on different biological systems are also specific to individual organ microenvironments. As part of its anti-inflammatory action, acupuncture deforms connective tissue and upregulates the secretion of various molecules in acupoints, further activating the NF-κB, MAPK, and ERK pathways in mast cells, fibroblasts, keratinocytes, and monocytes/macrophages. The somatic afferents present in acupuncture-activated acupoints also convey sensory signals to the spinal cord, brainstem, and hypothalamic neurons. Upon information integration in the brain, acupuncture further stimulates multiple neuro-immune pathways, including the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis, ultimately acting immune cells via the release of crucial neurotransmitters and hormones. This review provides a scientific and reliable basis and viewpoints for the clinical application of acupuncture in various inflammatory conditions.
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Affiliation(s)
- Ningcen Li
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China.,School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Yinan Gong
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China
| | - Yue Zhang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Wen Fan
- Suzuka University of Medical Science, Suzuka City, Japan
| | - Kaifang Yao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Zhihan Chen
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Baomin Dou
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Xiaowei Lin
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China.,School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China
| | - Bo Chen
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China
| | - Zelin Chen
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China
| | - Zhifang Xu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China
| | - Zhongxi Lyu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People's Republic of China
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24
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Electroacupuncture for Gastrointestinal Function Recovery after Gynecological Surgery: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2021:8329366. [PMID: 34970326 PMCID: PMC8714373 DOI: 10.1155/2021/8329366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 11/06/2021] [Indexed: 01/12/2023]
Abstract
Background Evidence for the efficacy and safety of electroacupuncture (EA) on gastrointestinal function recovery after gynecological surgery is unclear. Objective This meta-analysis aimed to evaluate the effects of EA on recovery of postoperative gastrointestinal function for patients receiving gynecological surgery. Data sources: PubMed, Cochrane Central Register of Controlled Trials (CINAHL), Embase, China National Knowledge Infrastructure (CNKI), Weipu (CQVIP), and Wanfang databases were systematically searched from the inception dates to May 30, 2020, for relevant randomized controlled trials (RCTs). Study selection: RCTs that evaluated EA for postoperative gastrointestinal function directly related to gynecological surgery in adults aged 18 years or over. Data extraction and synthesis: paired reviewer independently extracted the data and assessed study quality. Standardized mean differences (SMD) were calculated as the effect measure from a random effects model. Main outcomes and measures: time to first flatus (TFF), time to bowel sounds recovery (TBS), and time to first defecation (TFD) were recorded as primary outcomes; postoperative nausea and vomiting (PONV), motilin (MTL), gastrin (GAS), pH value of gastric mucosa (pHi), gastric mucosal partial pressure of carbon dioxide (PgCO2), vasoactive intestinal peptide (VIP), and adverse event were reported as secondary outcomes. Results We included eighteen RCTs (1117 participants). Our findings suggested that compared to the control group (CG), electroacupuncture group (EG) showed significant effects on TFF (SMD = −0.98, 95% CI: [−1.28, −0.68], P < 0.00001, I2 = 69%), TBS (SMD = −0.98, 95% CI: [−1.84, −0.12], P=0.03, I2 = 92%), and TFD (SMD = −1.23, 95% CI: [−1.59, −0.88], P < 0.0001, I2 = 0%). Moreover, the incidence of PONV at postoperative 6 h (OR = 0.42, 95% CI: [0.27, 0.64], P < 0.0001, I2 = 0%) and 24 h (OR = 0.46, 95% CI: [0.32, 0.68], P < 0.0001, I2 = 0%) was lower in the EG than that in the CG, whereas no significant difference in ratio of PONV at postoperative 48 h (OR = 0.55, 95% CI: [0.20, 1.51], P=0.25, I2 = 0%) was detected between the two groups. Meanwhile, there was a significant effect in favor of EA on the level of MTL at postoperative 6 h (SMD = −0.93, 95% CI: [−1.36, −0.61], P < 0.0001, I2 = 21%), while no significant effect was observed at postoperative 24 h (SMD = −0.43, 95% CI: [−0.89, 0.02], P=0.06, I2 = 69%) in the EG when compared to the CG. Additionally, a large significant effect on decreasing PgCO2 was found in the EG in comparison to the CG, but no significant effect in favor of EA on GAS, VIP, or pHi was observed. It was reported that there was one participant with pain at the needling sites and bruising, and three participants withdrew because they were not intolerant to EA. Conclusions EA could be a promising strategy for the prevention and treatment of gastrointestinal dysfunction after gynecological surgery, including shortening TFF and TFD, TBS, regulating MTL, and decreasing the ratio of PONV within postoperative 24h. The effects on MTL and PONV varied with different intervention points, and EA used at 30 min prior to surgery might be recommended. However, the evidence quality ranged from low to very low, and large-scale and high-quality RCTs were warranted.
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25
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Li H, Wen Q, Lu L, Hu H, He Y, Zhou Y, Wu X, Li N. Transcutaneous electrical acupoint stimulation combined with electroacupuncture for rapid recovery of patients after laparotomy for gastrointestinal surgery: a study protocol for a randomised controlled trial. BMJ Open 2021; 11:e053309. [PMID: 34728456 PMCID: PMC8565572 DOI: 10.1136/bmjopen-2021-053309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Abdominal surgery is associated with common complications, including decreased or poor appetite, abdominal distension, abdominal pain caused by decreased or absent gastrointestinal motility, anal arrest with flatus and defecation, and nausea and vomiting resulting from the use of anaesthetics and opioid analgesics. These complications seriously affect postoperative recovery, prolong hospital stay and aggravate patient burden. This study aims to investigate for the first time the efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) therapy for rapid recovery after laparotomy for gastrointestinal surgery. There have been no clinical studies of this combination therapy. METHODS AND ANALYSIS This will be a prospective, single-centre, three-arm, randomised controlled trial. A total of 480 patients undergoing abdominal surgery will be stratified according to surgery type (ie, gastric or colorectal procedure) and randomised into three groups; namely, the EA, TEAS +EA and control groups. The control group will receive enhanced recovery after surgery (ERAS)-standardised perioperative management, including preoperative education, optimising the anaesthesia scheme, avoiding intraoperative hypothermia, restrictive fluid infusion and reducing surgical trauma. The EA group will receive EA stimulation at LI4, PC6, ST36, ST37 and ST39 based on the ERAS-standardised perioperative management. Moreover, the TEAS +EA group will receive ERAS-standardised perioperative management; EA stimulation at the LI4, PC6, ST36, ST37 and ST39; and TEAS stimulation at ST21 and SP15. The primary outcome will be the GI-2 (composite outcome of time to first defaecation and time to tolerance of a solid diet). Secondary outcomes will include the time of first passage of flatus, time to first defaecation, time to tolerance of a solid diet, time to first ambulation, hospital duration from operation to discharge, pain and nausea vomiting scores on the Visual Analogue Scale, medication use, incidence of postoperative complications and evaluation of treatment modality acceptability. All statistical analyses will be performed based on the intention-to-treat principle. ETHICS AND DISSEMINATION Ethics approval has been granted by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University (approval number: 2021; number 52). The results are expected to be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2100045646.
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Affiliation(s)
- Hao Li
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Qian Wen
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Lingyun Lu
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Hangqi Hu
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ying He
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yaming Zhou
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Ning Li
- Department of Integrated Traditional Chinese and Western Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
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26
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Wang J, Lu S, Yang F, Guo Y, Chen Z, Yu N, Yao L, Huang J, Fan W, Xu Z, Gong Y. The role of macrophage polarization and associated mechanisms in regulating the anti-inflammatory action of acupuncture: a literature review and perspectives. Chin Med 2021; 16:56. [PMID: 34281592 PMCID: PMC8287695 DOI: 10.1186/s13020-021-00466-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022] Open
Abstract
Acupuncture is used in the treatment of a variety of inflammatory conditions and diseases. However, the mechanisms of its anti-inflammatory action are complex and have not been systematically investigated. Macrophages are key components of the innate immune system, thus, balancing the M1/M2 macrophage ratio and modulating cytokine levels in the inflammatory environment may be desirable therapeutic goals. Evidence has shown that acupuncture has anti-inflammatory actions that affect multiple body systems, including the immune, locomotory, endocrine, nervous, digestive, and respiratory systems, by downregulating pro-inflammatory M1 and upregulating anti-inflammatory M2 macrophages, as well as by modulating associated cytokine secretion. Macrophage polarization is controlled by the interlocking pathways of extrinsic factors, the local tissue microenvironment, and the neural-endocrine-immune systems. It has been suggested that polarization of T lymphocytes and cytokine secretions resulting in modulation of the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, may be upstream mechanisms of acupuncture-induced macrophage polarization. We further propose that macrophage polarization could be the principal pathway involved in acupuncture immune regulation and provide the scientific basis for the clinical application of acupuncture in inflammatory conditions.
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Affiliation(s)
- Jiaqi Wang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Shanshan Lu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Fuming Yang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Yi Guo
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China.,School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Zelin Chen
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China.,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Nannan Yu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Lin Yao
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Jin Huang
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Wen Fan
- Suzuka University of Medical Science, Suzuka, 5100293, Japan
| | - Zhifang Xu
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China. .,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China. .,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China.
| | - Yinan Gong
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China. .,School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, No.10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People's Republic of China.
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27
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Xue X, Wang D, Ji Z, Xie Y. Risk factors of postoperative ileus following laparoscopic radical cystectomy and developing a points-based risk assessment scale. Transl Androl Urol 2021; 10:2397-2409. [PMID: 34295726 PMCID: PMC8261424 DOI: 10.21037/tau-21-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
Background Postoperative ileus (POI) is one of the most common complications after laparoscopic radical cystectomy (LRC). Albeit its high incidence, its risk factors are obscure, and few studies have attempted to explore them. Meanwhile, risk-assessing tools for predicting its happening are lacking. Methods Clinical data of 197 patients who underwent LRC between March 2014 and October 2019 were retrospectively collected. All cases of POI were identified and double-checked. Data pertaining to the following categories were extracted as well: patients' general characteristics, preoperative laboratory tests results and preparations, intraoperative and postoperative general items, pathological results. The correlation between candidate risk factors and ileus was analyzed by multivariable binary logistic regression. Clinical and pathophysiological explanations for those results were explored. Finally, a points-based prediction model was developed and validated for predicting the happening of POI. Results A total of 63 out of 197 patients (31.98%) suffered from POI. Multivariate logistic regression analysis showed chronic constipation, increased dosage of laxative, elevated preoperative serum creatinine level, delayed postoperative ambulation, intestine-related urine derivations were statistically significant for developing POI (P<0.05). No significant differences were found between POI and age, gender, body mass index (BMI), antibiotics, hypertension, diabetes, smoking, hard-drinking, preoperative hemoglobin level, preoperative albumin level, history of previous abdominal surgery, surgery time, intraoperative blood loss, blood transfusion, tumor size, lymph nodes yields, TNM staging and intensive care unit hospitalization. An external cohort had been used for testing the validation of the assessment scale, and the results were promising. Conclusions Early recognition is of great importance in protecting vulnerable patients from developing POI, knowing the above-mentioned risk factors and using the assessment scale should help to screen them better. Cases from diverse backgrounds might contribute to a more accurate and complete scale.
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Affiliation(s)
- Xiaoqiang Xue
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Dong Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
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Wang H, Zhao K, Shi N, Niu Q, Liu C, Chen Y. Electroacupuncture Regularizes Gastric Contraction and Reduces Apoptosis of Interstitial Cells of Cajal in Diabetic Rats. Front Physiol 2021; 12:560738. [PMID: 33867995 PMCID: PMC8047410 DOI: 10.3389/fphys.2021.560738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Gastric dysmotility is a frequent complication among patients with diabetes mellitus. Electroacupuncture (EA) has been empirically used to relieve gastrointestinal symptoms. The aims of this study were to investigate the effects of EA on gastric contraction and the mechanisms of interstitial cells of Cajal (ICC) involved. Materials and Methods Male Sprague–Dawley rats were randomized into the normal control, diabetes (DM), diabetic and sham EA (DM + SEA), diabetic and low-frequency EA (DM + LEA), and diabetic and high-frequency EA (DM + HEA) groups. Diabetic models were established and then treated with EA for 8 weeks. Body weight and blood glucose were recorded every 2 weeks. The spontaneous contractions of distal gastric strips were analyzed. Immunostaining and RT-PCR were used to test the apoptotic ICC, IGF-1/IGF-1R, and Nrf2/HO-1 pathways. Results The body weight in the DM + LEA and DM + HEA groups were increased compared with that of the DM group, though there was no effect on the blood glucose. The gastric contractions were obviously disordered in the DM group, but EA could regularize the contractions. The number of apoptotic ICC was dramatically increased in the DM group, but reduced with EA treatment. Meanwhile, the IGF-1/IGF-1R pathway was verified to be significantly altered in diabetic rats. The Nrf2/HO-1 pathway was not significantly increased in the DM group. EA with different frequencies efficiently improved the expression of IGF-1/IGF-1R signaling and activated the Nrf2/HO-1 pathway. Conclusion EA could improve gastric motility dysfunction and attenuate ICC apoptosis possibly through the regulation of IGF-1/IGF-1R and Nrf2/HO-1 pathways. EA may be a potential therapeutic method for diabetic gastric motility dysfunction.
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Affiliation(s)
- Hongcai Wang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Kaile Zhao
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Ning Shi
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Chengxia Liu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Yan Chen
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
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Acupuncture at Back-Shu and Front-Mu Acupoints Prevents Gastric Ulcer by Regulating the TLR4/MyD88/NF- κB Signaling Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8214052. [PMID: 33628315 PMCID: PMC7886517 DOI: 10.1155/2021/8214052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/22/2022]
Abstract
Purpose To assess the preventive effects of acupuncture at back-shu and front-mu acupoints on rats with restraint water-immersion stress (RWIS)-induced gastric ulcer. Methods Thirty-six rats were randomly divided into four groups for 10 days of treatment as follows: the normal group received no treatment; the model group received RWIS-induced gastric ulcer; the omeprazole group was administered omeprazole orally every 2 days; and the electroacupuncture group received electroacupuncture at the RN12 and BL21 acupoints every 2 days. After 10 days of treatment, except for the normal group, all rats were induced with gastric ulcer by RWIS for 3 h. The ulcer index (UI), ulcer inhibition rate, and histopathological score were calculated. We determined the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in serum, and the activities of myeloperoxidase (MPO), malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), and glutathione peroxidase (GSH-Px) in serum and gastric tissues. Protein expression of MyD88, nuclear factor (NF)-κB (p65), and toll-like receptor (TLR) 4 was quantified in gastric tissues. Results The electroacupuncture and omeprazole groups were equivalent in terms of UI, ulcer inhibition rate, and histopathological score. The serum levels of TNF-α and IL-6 were significantly lower in the electroacupuncture group compared with the omeprazole group (P < 0.05). Compared with the model group, there were significant changes in the levels of NO, MPO, GSH-Px, and MDA in all other groups, while the expression of TLR4, MyD88, and NF-κB p65 in gastric tissue decreased significantly in the electroacupuncture group. The expression of TLR4 was substantially lower in the electroacupuncture group compared with the omeprazole group. Conclusion Acupuncture at back-shu and front-mu acupoints played a role in preventing gastric ulcer by inhibiting extracellular signals, stimulating kinases in serum and gastric tissues, and activating the inhibition of the TLR4 signaling pathway.
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30
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Yang NN, Yang JW, Ye Y, Huang J, Wang L, Wang Y, Su XT, Lin Y, Yu FT, Ma SM, Qi LY, Lin LL, Wang LQ, Shi GX, Li HP, Liu CZ. Electroacupuncture ameliorates intestinal inflammation by activating α7nAChR-mediated JAK2/STAT3 signaling pathway in postoperative ileus. Am J Cancer Res 2021; 11:4078-4089. [PMID: 33754049 PMCID: PMC7977469 DOI: 10.7150/thno.52574] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022] Open
Abstract
Inflammatory cytokines produced by muscularis macrophages largely contribute to the pathological signs of postoperative ileus (POI). Electroacupuncture (EA) can suppress inflammation, mainly or partly via activation of vagal efferent. The goal of this study was to investigate the mechanisms by which EA stimulation at an hindlimb region ameliorates inflammation in POI. Methods: Intestinal motility and inflammation were examined after 24 h after intestinal manipulation (IM)-induced POI in mice. Local immune response in the intestinal muscularis, expression of macrophages, α7 nicotinic acetylcholine receptor (α7nAChR), Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) were determined by flow cytometry, Western Blot, qPCR and immunofluorescence. The effects of α7nAChR antagonists (methyllycaconitine and α-bungarotoxin) and JAK2/STAT3 inhibitors (AG490 and WP1066) were also administered in a subset of mice prior to EA. In the parasympathetic pathways, intestinal motility and inflammation were determined after cervical vagotomy and sub-diaphragmatic vagotomy. The expression of gamma absorptiometry aminobutyric acid (GABAA) receptor in dorsal motor nucleus of vagal (DMV) cholinergic neurons was assessed by immunofluorescence and the response to DMV microinjection of bicuculine (antagonist of GABAA receptor) or muscimol (agonist of GABAA receptor) were assessed. Results: EA suppressed intestinal inflammation and promoted gastrointestinal motility. Mechanistically, EA activated the α7nAChR-mediated JAK2/STAT3 signaling pathway in macrophages which reduced the production of inflammatory cytokines. Furthermore, we also demonstrated that hindlimb region stimulation drove vagal efferent output by inhibiting the expression of GABAA receptor in DMV to ameliorate inflammation. Conclusions: The present study revealed that EA of hindlimb regions inhibited the expression of GABAA receptor in DMV neurons, whose excited vagal nerve, in turn suppressed IM-induced inflammation via activation of α7nAChR-mediated JAK2/STAT3 signaling pathway.
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Seifarth C, Hering NA, Arndt M, Lehmann KS, Stroux A, Weixler B, Kreis ME. Increased proinflammatory cytokines in mesenteric fat in major surgery and Crohn's disease. Surgery 2021; 169:1328-1332. [PMID: 33431185 DOI: 10.1016/j.surg.2020.11.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/22/2020] [Accepted: 11/28/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Proinflammatory cytokines play an important role in abdominal surgery and are often associated with the development of postoperative ileus, especially in Crohn's disease. The aim of this study was to investigate proinflammatory cytokine levels in mesenteric fat in Crohn's disease and patients without Crohn's disease. METHODS Human mesenteric tissue specimen were divided into 3 patient groups (n = 10 each): minor surgery (laparoscopic cholecystectomy), major surgery (colectomy) in patients without Crohn's disease, and major surgery (colectomy) in patients with Crohn's disease. Levels of interleukin 6, interleukin 1-β, and tumor necrosis factor α were determined by cytometric bead array, enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction. The Kruskal-Wallis and the Mann-Whitney U test were used to compare continuous variables. For categorical variables, the χ2 test or Fisher exact test was used. RESULTS In minor surgery, cytokines levels of interleukin 6, interleukin 1-β and Tumor necrosis factor α were low (ie, interleukin 6: 1 pg/mL [0-36], interleukin 1-β: 0 fg/mL [0-18], tumor necrosis factor α: 157 fg/mL [91-237]) compared with major surgery in patients with and without Crohn's disease. Cytokines were significantly higher in major surgery (ie, interleukin 6: 147 pg/mL [29-347], interleukin 1-β: 660 fg/mL [0-2580], tumor necrosis factor α: 532 fg/mL [289-1647]; P = .02 and major surgery with CD (cytometric bead array: interleukin 6: 94 pg/mL [24-627], interleukin 1-β: 708 fg/mL [0-1664], tumor necrosis factor α: 733 fg/mL [209-1,354]; P < .05). Cytokine levels in major surgery with Crohn's disease showed a further increase of interleukin 6 in polymerase chain reaction in comparison to major surgery in patients without Crohn's disease (1.2 vs 4, P = .04). CONCLUSION Proinflammatory cytokines are increased in the mesenteric fat in major operations compared to minor operations, which indicates local mesenteric inflammation. In Crohn's disease, levels of proinflammatory cytokines are even higher, which may put the patients at risk for postoperative ileus.
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Affiliation(s)
- Claudia Seifarth
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Nina A Hering
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Arndt
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai S Lehmann
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Stroux
- Corporate Member of Freie Universität Berlin, Institute for Biometry and Clinical Epidemiology, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Weixler
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin E Kreis
- Corporate Member of Freie Universität Berlin, Department of General, Visceral, and Vascular Surgery, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Crosstalk between Acupuncture and NF- κB in Inflammatory Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7924985. [PMID: 32595736 PMCID: PMC7301242 DOI: 10.1155/2020/7924985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
Acupuncture has been used in China for thousands of years and concerned as a typical alternative medicine in inflammatory diseases nowadays. The nuclear factor-κB (NF-κB) transcription factor is an important regulator of inflammation. In this article, we discuss the role of acupuncture in NF-κB pathways and also present the acupoints selection, acupuncture administration, and related inflammation diseases and models from previous studies to bring readers close to a more complete understanding of the mechanisms between acupuncture and NF-κB in inflammatory diseases.
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